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• Incompetent lower esophageal sphincter, pyloric stenosis, or motility disorders can lead to gastroesophageal reflux disease.
• Gastroesophageal reflux disease incidence increases with aging

Clinical Manifestations of Gastroesophageal Reflux Disease

• Pyrosis (heartburn)
• Dyspepsia (indigestion)
• Regurgitation
• Dysphagia
• Odynophagia
• Hypersalivation
• Esophagitis

Assessment and Diagnostic Findings for Gastroesophageal Reflux Disease

• Endoscopy
• Barium swallow
• Ambulatory 12 to 36-hour esophageal pH monitoring
• Bilirubin monitoring

Management of Gastroesophageal Reflux Disease

• Avoid situations that decrease LES pressure or cause esophageal irritation
• Diet: Modify eating habits in relation to bedtime and maintain a normal body weight
• The HOB (Head of Bed) should be elevated for non-ambulatory patients

Medications for Gastroesophageal Reflux Disease

• Antacids
• Histamine receptor blockers (H2); RANITIDINE
• PPI's (proton pump inhibitors)
• Prokinetic agents; BETHANECHOL, METOCLOPRAMIDE

Surgical management of Gastroesophageal Reflux Disease

• A Nissen fundoplication involves wrapping a portion of the gastric fundus around the sphincter area of the esophagus.
• In Barrett's esophagus, the flat pink lining of the esophagus becomes damaged by acid reflux, thickening and turning red
• Intestinal metaplasia is a precancerous condition of the esophagus linked to long-standing GERD, where esophageal tissue resembles intestinal lining

Clinical Manifestations and Management of Barrett's Esophagus

• Symptoms resemble GERD
• Diagnosed with similar assessment and diagnostic findings
• Gastritis involves stomach lining inflammation and is a prevalent Gl issue that can be either chronic or acute

Acute Gastritis Causes

• Dietary indiscretion
• Overuse of medications
• Excessive alcohol intake
• Bile reflux
• Radiation therapy
• Ingestion of strong acid or alkali
• Sign of systemic infection

Chronic Gastritis Causes

• Benign or malignant ulcers
• Helicobacter pylori
• Autoimmune diseases
• Dietary factors

Pathophysiology of Gastritis

• Edema and hyperemia of the gastric mucosa
• Decreased secretion of hydrochloric acid
• Increased presence of H. Pylori
• Causes superficial erosion
• Hemorrhage

Clinical Manifestations of Acute Gastritis

• Abdominal discomfort
• Headache
• Lassitude (lack of energy/body weakness)
• Nausea and vomiting
• Anorexia
• Hiccupping

Clinical Manifestations of Chronic Gastritis

• Anorexia
• Heartburn
• Belching, nausea and vomiting with sour taste
• Hyperemia is defined as an increased amount of blood in the vessels of an organ or tissue in the body.

Medical Management of Gastritis

• Involves Vitamin B12 deficiency

Assessment and Diagnostic Findings for Gastritis

• Achlorhydria/Hypochlorhydria to hyperchlorhydria can be a sign of gastritis
• H-pylori is detected through diagnostic measures, endoscopy, upper Gl radiographic studies, histologic exam

Medical Management of Gastritis

• Refrain from alcohol or food until symptoms subsides
• Control of bleeding with tranexamic acid
• Ingestion of acid and alkalis may be resolved with the assistance of diluting or neutralizing agents
• Induce emetics and lavage with NGT
• Gastric reaction

Diet Management of Gastritis

• Diet modification
• promoting rest
• reducing stress
• pharmacologic therapy

Nursing Process of Patient with Gastritis

• Involves assessment, nursing diagnosis, planning and goals, nursing interventions (reduce anxiety, ensure nutrition, promote fluids, relieve pain) and evaluation

Nursing Assessment for Gastritis

• Ask about the presenting signs and symptoms
• 72-hr dietary recall
• Treatment methods

Nursing Diagnosis for Gastritis

• Anxiety related to treatment
• Imbalanced nutrition, less than body requirements related to inadequate intake
• Risk for imbalanced fluid volume related to insufficient fluid • loss subsequent to vomiting
• Deficient knowledge
• Acute pain

Planning and goals for Gastritis

• Reduced anxiety
• Avoidance of irritating foods
• Fluid balance
• Relief of pain
• Dietary management

Nursing Interventions for Gastritis

• reduce anxiety
• optimal nutrition
• promote fluid balance
• relieve pain

Evaluation of Treatments for Gastritis

• Exhibits less anxiety
• Avoids eating irritating foods or drinking carbonated beverages
• Maintains fluid balance
• Adheres to medical regimen
• Maintains appropriate weight
• Reports less pain

Gastric and Duodenal Ulcers

• excavation forming in the mucosal wall of the stomach, pylorus, duodenum, or esophagus.
• Erosion depth varies in severity and occurs mostly between 40 and 60 y/o resulting from H. Pylori infection.
• HCL is the main problem

Risk factors of Gastric and Duodenal Ulcers

• Familial tendency and use of NSAIDS
• COX-1 prostaglandins protects gastrointestinal mucosa, while COX-2 prostaglandins mediate throughout the body.
• Excessive Smoking and Alcohol ingestion
• Zollinger-Ellison syndrome

Etiology of Gastric and Duodenal Ulcers

• Erosion comes from increased pepsin/HCL activity or decreased mucosal resistance
• ZES is suspected in unresponsive peptic ulcers
• Ischemia, increased acid/pepsin production, and reflux can cause stress
• Cushing/Curling Types

Clinical Manifestations of Gastric and Duodenal Ulcers

• Asymptomatic presentation
• Dull, gnawing, burning sensation in the midepigastric or back area

Treatments that relieve Gastric and Duodenal Ulcers

• Eating
• Pyrosis
• Vomiting
• Constipation
• Diarrhea
• bleeding
• Black Melana with upper presentation and bright red hematochezia with lower

Assessment and Diagnostic for Gastric and Duodenal Ulcers

• Physical Findings
• Upper GI Barium Study
• Endoscopy
• Stool Analysis
• Culture and Biopsy
• Urea breath test

Management of Gastric and Duodenal Ulcers

• Antibiotics and Proton-pump inhibitors
• H-2 receptors and Bismuth salts
• Cytoprotective agents
• Diet and stress reduction plus rest

Surgical Management of Gastric and Duodenal Ulcers

• Vagotomy (cutting of Vagus nerve)
• Biliroth I and II
• Assessment of Chief Complaint
• Ask value of pain Scale
• Analyze diet, life, and physical signs

Nursing Diagnosis for Gastric and Duodenal Ulcers

• Pain r/t effects of gastric acid secretion
• Imbalanced nutrition r/t changes in the diet
• Potential hemorrhage; perforation; penetration; and pyloric obstruction

Goals for managing Gastric and Duodenal Ulcers

• Pain and anxiety relief
• Nutrition, Fluid and Balance

Nursing Interventions management of Gastric and Duodenal Ulcers

• Relieving pain by avoiding caffeine and aspirin, or using techniques to relax

Potential Complications and Interventions for Gastric and Duodenal Ulcers

• Monitor Hemoglobin levels
• Lavage and IFC
• Positioning or Transendoscopy

Signs and Symptoms of Gastric and Duodenal Ulcer and interventions

• Perforations in R shoulder causes rigid abdomen, vomiting and fainting
• Penetration in back and epigastric area means monitoring required
• Pyloric Obstruction with upper GI and endoscopy
• Morbid Obesity is defined as being 100 pounds greater than the ideal weight, which could lead to risk of health complications.

Management of people with Morbid Obesity

• Pharmacologic- using Sibutramine HCL or Orlistat
• Diet and exercise
• Surgery- jejunoileal to gastrics
• Gastric Cancer: common in men than women in Japan resulting from Diet and chronic inflammation, H. Pylori, Gastric Ulcers, Genetics

Clinical and Medical Management of Gastric Cancer

• Early asymptomatic stages require removal of the tumor, Gastrectomy, then chemo and radiation

Nursing Diagnosis during Gastric Cancer treatment

• Relieve Anxiety
• reduce Complications-
• Restore nutrition
• Manage Constipation
• Constipation as abnormal function and regulation for defection with hard and reduced volume in stool with increased retaining in period

Etiology of abnormal Constipation

Tranquilizers, Anticholinergics or Antidepressants, rectal disorders with metabolic and neuro conditions or diet habits with reduced water intake leads distention, pain, hardness and dry stool

Abnormal Diarrhea: Frequent altered consistency due to IBS or IBD, or medication imbalances can be chronic leading to cramps or distention

Clinical Manifestations of Abnormal Malabsorption

• Weight decrease, foul stools and abdominal pains, indicating to electrolyte imbalances.

Medical Management for Maldigestion

• Monitor the patients
• Educate the dietary regulations for deficiencies
• acute abdomen: Appendicitis,

Appendicitis

• Acute abdomen: Appendicitis can obstruct the lymph nodes in the appendix located below the ilocecal
• Appendicitis can lead to nausea and vomiting, Rebound tenderness where intense pain during release- can indicate Peritonitis can be detected with elevated Leukocyte count, WBC and ultrasound

Appendicitis Complication and Management

• perforation if continues can be treated with surgery and corrected with fluids or antibiotics with antiemetric's
• Diverticular : Saclike that can be inflamed retaining bateria that causes bleeding while narrowing colon

Diverticular diagnosis and treatment

• CT is procedure for abscess tests with high fiber diet with antibiotics

Peritonitis

• Peritonitis happens due to an abundance in fluid caused by infection and bateria with low HCT levels indicated by fever and inflammation requiring medical treatment, intubation and a large variety of antibiotics

IBD (Inflammatory bowel disease)

• Crohns: abdominal pains in the ileum and colon areas for women who smoke where inflammation through the wall where the intestinal lumen narrows leading to intestinal strictures and deficiencies requiring biopsies and or CBC tests

Ulcerative Colitis -

• IBD (Inflammatory bowel disease): bleeding with severe diarrhea resulting from a low albumin and low iron diet, which are treated with antibiotics with sigmoidoscopy tests to determine symptoms and what the colon might be showing

Maldigestion -

• Malabsorptions result in patients on various prescriptions being overated, may need more medication or an enema to treat adverse sequelae.