Upper GI PPT for Class.ppt

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Chapter 17

Digestive System Disorders



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Digestive System

%ro#esses ingested food and f!uids &rea's them do(n into their units Contro!!ed by en)ymes

*bsorbs ne#essary #omponents +embrane transport me#hanisms +ost!y in sma!! intestine



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Stru#tures and -un#tions of the

.astrointestina! System /Cont$

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*natomy of the Digestive System




*ppetite #ontro!!ed by hypotha!amus Stimu!ated by hypog!y#emia, empty stoma#h,

de#reased body temperature, brain input

Deg!utition s(a!!o(ing "n#!udes mouth, pharyn5, and esophagus

"ngestion and %ropu!sion of -ood

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Digestion %hysi#a! and #hemi#a! brea'do(nof food into absorbab!e substan#es &egins in mouth Stoma#h fun#tions are to store food, se#rete

digestive ui#es, mi5 the food (ith gastri#se#retions, and empty the resu!ting #ontent

/#hyme into the sma!! intestine

Digestion and *bsorption





*bsorption o##urs in the sma!! intestine /vi!!i

nd produ#ts of digestion8 transfer a#ross the

intestina! (a!! to #ir#u!ation$

9o digestion or absorption o##urs in theesophagus$

Digestion is #omp!eted in the sma!! intestine$





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Carbohydrates Digestion starts in mouth -o!!o(ed by digestion in the sma!! intestine

%roteins Digestion starts in stoma#h, #ontinues in sma!!

intestine ipids

mu!sified by bi!e prior to #hemi#a! brea'do(n *#tion of en)ymes form monog!y#erides and free

fatty a#ids -ormation of #hy!omi#rons



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-at<so!ub!e vitamins =itamins *, D, , >

• *bsorbed (ith fats

?ater<so!ub!e vitamins =itamins & and C@diffuse into b!ood !e#tro!ytes

*bsorbed by a#tive transport or diffusion

Drugs are primari!y absorbed in the intestine$ =arious transport me#hanisms Some /e$g$, aspirin absorbed in the stoma#h





?ater *bsorbed primari!y by osmosis *bout 700 m of (ater is se#reted into the

digestive tra#t ea#h day$ *bout 200 m is ingested in food and f!uids An!y 30 to 200 m !eaves the body in fe#es$ Severe vomiting or diarrhea (i!! interrupt this

re#y#!ing me#hanism$

• *ffe#ts f!uid and e!e#tro!yte ba!an#e of body




Cepha!i# /nervous Se#retion of hydrogen #h!oride /BC,

pepsinogen, mu#us .astri# /hormona! and nervous

Se#retion of gastri# hormone from antrum to

stimu!ate gastri# se#retions "ntestina! /hormona!

*#idi# #hyme /pB 2 re!ease of se#retin, gastri#

inhibitory po!ypeptide, #ho!e#ysto'inin Chyme /pB re!ease of duodena! gastrin

.astri# Se#retion %hases





9eura! and Bormona! Contro!s

%arasympatheti# nervous system /%9S %rimari!y through vagus nerve /#rania! nerve

EC9F G• "n#reased moti!ity

• "n#reased se#retions

Sympatheti# nervous system /S9S Stimu!ated by fa#tors su#h as fear, anger "nhibits gastrointestina! a#tivity

Causes vaso#onstri#tion edu#ed se#retions and regeneration of epithe!ia!

#e!!s




+aor Contro!s in the Digestive

Hra#t and Hheir ffe#ts




9eura! and Bormona! Contro!s

-a#ia! /C9 ="" and g!ossopharyngea! /C9 "G

nerves +aintain #ontinuous f!o( of sa!iva in mouth

Distention and stret#hing of stoma#h %9S a#tivation I %erista!sis and gastri# se#retions

Stoma#h empties (ithin 2 to 6 hours after

mea!$ -ood in intestine Stimu!ation of intestina! a#tivity

• nterogastri# ref!e5

"nhibition of gastri# emptying




Bormona! Contro!s

.astrin Se#reted by mu#osa! #e!!s /stoma#h in response to

distention of stoma#h or partia!!y digested substan#es• "n#reases gastri# moti!ity, re!a5es py!ori# and i!eo#e#a!

sphin#ters@promotes stoma#h emptying Bistamine

"n#reased se#retion of hydro#h!ori# a#id Se#retin

De#reases gastri# se#retions

Cho!e#ysto'inin "nhibits gastri# emptyingJ stimu!ates #ontra#tion of

ga!!b!adder




"nvo!ves the !arge intestine +ost important fun#tion is absorption of (ater

and e!e#tro!ytes Haustral churning Defe#ation is vo!untary and invo!untary -a#i!itated by appropriate positioning

=a!sa!va manoeuvre

!imination





!imination /Cont$




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Kpper .astrointestina! Hra#t

Ara! #avity "nitia! phase of me#hani#a! brea'do(n of food

• +asti#ation by teeth

"nitia! #hemi#a! digestion• Sa!ivary amy!ase@starts #hemi#a! brea'do(n of

#arbohydrates

-ormation of bo!us %haryn5

S(a!!o(ing /deg!utition sophagus

C!osed e5#ept during s(a!!o(ing, s'e!eta! mus#!e

at superior end@fo!!o(ed by smooth mus#!e



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Hhe Ara! Cavity




Bea!thy %eriodontium




%eriodonta! Disease




Disorders of the Ara! Cavity

Carries &a#teria brea' do(n sugars and produ#e !arge Luantities of !a#ti# a#id$ a#ti# a#id disso!ves minera! in tooth ename! Hooth erosion and #aries formation Caries is promoted by freLuent inta'e of sugars and a#ids$ -!uoride@anti#aries treatment

.ingivitis "nf!ammation of the gingiva

• Hissue be#omes red, soft, s(o!!en, b!eeds easi!y

• +ay be a resu!t of a##umu!ated p!aLue "nadeLuate ora! hygiene Hoothbrush trauma

• esu!ts from improper or e5#essive brushing

• Creates e5tensive grooving on tooth surfa#e

• "n#rease p!aLue retention and damage to gingivae

%eriodonta! Disease "nfe#tion and damage to the periodonta! !igament and bone




Stoma#h

5pansib!e mus#u!ar sa# < reservoir for food and f!uid Hhree smooth mus#!e !ayers Constant mi5ing and #hurning of food "nitia! digestion of proteins

&y pepsin• -ormed by #ombination of pepsinogen and BC!

%rodu#tion of intrinsi# fa#tor ssentia! for absorption of vitamin &12 in the i!eum

-ormation of #hyme *bsorption of sma!! and !ipid<so!ub!e mo!e#u!es




o(er .astrointestina! Hra#t

Sma!! intestine Duodenum, eunum, i!eum =i!!i /fo!ds of the mu#osa M mi#rovi!!i /fo!ds of #e!!

membranes• "n#rease surfa#e area for absorption

+aor site for absorption of nutrients a#tea!@!ymphati# vesse! Site of produ#tion of

• +u#us• ntero'inase, peptidases, nu#!eosidases, !ipase,

su#rase, ma!tase, !a#tase, #ho!e#ysto'inin /hormone




+aor Digestive n)ymes and

Hheir *#tions




o(er .astrointestina! Hra#t /Cont$

arge intestine %eyer pat#hes /!ymphati# tissue esident norma! f!ora

• &rea'do(n of #ertain food materia!s

• =itamin > synthesis by ba#teria

-!uid and e!e#tro!yte reabsorption -ormation of so!id fe#es

• +ass movements




+outh %eriodonta! disease, taste buds de#rease sophagus De#reased tone and moti!ity *bdomina! (a!! Hhinner, de#reased re#eptors Stoma#h, sma!! intestine, !iver, ga!!b!adder, and

pan#reas De#reased synthesis and se#retions arge intestine, anus, and re#tum De#reased tone,

moti!ity and transit time

Consider impa#t of e#onomi# #onstraints

*ge<e!ated Considerations ffe#ts of

*ging on the .astrointestina! System


f .




*ssessment of ."

Sube#tive data

• Sores or !esions• Sore throat• &!eeding gums• Hooth a#he• Boarseness• *!tered taste• Smo'ing, a!#oho!

#onsumption• Se!f #are behaviors /denta! #are

pattern, dentures, app!ian#es, diet of high

fibre foods, most re#ent e5aminations

D, o##u!t stoo! test, #o!onos#opy, %S*

• Change in appetite• Dysphagia /s(a!!o(ing

• -ood into!eran#e

• *%• 9N=• &o(e! Babits, freLuen#y,

#o!our • Change in &o(e! Babit

/diarrhea, #onstipation, !a5ative and

enema use

• e#ta! &!eeding• %ast *bd B5 /u!#er, ga!!b!adder,

hepatitis, appendi#itis, "&D, hernia

• +eds /pres#ription, AHC, anta#ids,

!a5atives, stoo! softeners, iron

• *!#oho! M Hoba##o• 9utritiona! *ssessment

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%hysi#a! e5amination• +outh /ips, gums, teeth, tongue, bu##a! mu#oa, pa!ate,

tonsi!s

• *bdomen

"nspe#t Contour, symmetry, umbi!i#us, s'in, pu!sations ormovements, #!ient demeanor • *us#u!tate &o(e!s M vas#u!ar sounds• %a!pate !ight and deep pa!pation in a!! 4 Luadrants, =o!untary

guarding, rebound tenderness,• mass /!o#ation, si)e, shape, #onsisten#y Ehard, firm, softF,

Surfa#e Esmooth, nodu!arF, mobi!ity, pu!sati!ity M

tenderness• %er#uss Costovertebra! *ng!e Henderness

• e#tum M anus

*ssessment of ."

Abe#tive data

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*ssessment of the

.astrointestina! System /Cont$





*bdomina!%a!pation





iver %a!pation




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Common +anifestations of

Digestive System Disorders1$ 9ausea and =omiting

2$ *nore5ia

$ Diarrhea

4$ .as3$ &!ood in Stoo!

6$ Constipation

7$ -!uid M !e#tro!yte "mba!an#e

:$ %ain




9ausea and =omiting

+ay be signs ofdigestive disorder or

other #ondition

e!se(here in the body

Systemi# infe#tion Kremia motiona! responses +otion si#'ness

%ressure in the brain Averindu!gen#e of

food, drugs %ain




9ausea * fee!ing of dis#omfort in the epigastrium (ith a

#ons#ious desire to vomit Knp!easant sube#tive fee!ing Simu!ated by distention, irritation, inf!ammation of

digestive tra#t *!so stimu!ated by sme!!s, visua! images, pain, and

#hemi#a! to5ins andNor drugs

*nore5ia Aften pre#edes nausea and vomiting

9ausea and =omiting

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9ausea and =omiting

=omiting /emesis Hhe for#efu! ee#tion of partia!!y digested food and

se#retions from the K."H

=omiting #enter !o#ated in the medu!!a• Coordinates a#tivities invo!ved in vomiting

• %rote#ts air(ay during vomiting -or#efu! e5pu!sion of #hyme from stoma#h

•Sometimes in#!udes bi!e from intestine

*nore5ia and vomiting Can #ause serious #omp!i#ations

• Dehydration, a#idosis, ma!nutrition




9ausea and =omiting

&u!imia@eating disorder Damage to stru#tures of the ." tra#t #aused by

re#urrent vomiting• Ara! mu#osa

• Heeth• sophagus




=omiting Center *#tivation

Distention or irritation in digestive tra#t Stimu!i from various parts of the brain

esponse to unp!easant sights or sme!!s, is#hemia %ain or stress =estibu!ar apparatus of inner ear /motion "n#reased intra#rania! pressure

Sudden proe#ti!e vomiting (ithout previous nausea Stimu!ation of #hemore#eptor trigger )one

&y drugs, to5ins, #hemi#a!s



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=omiting ef!e5




Chara#teristi#s of =omitus

%resen#e of b!ood@hematemesis Coffee ground vomitus@bro(n granu!ar materia! indi#ates

a#tion of BC! on hemog!obin Bemorrhage@red b!ood may be in vomitus

Oe!!o(< or green<stained vomitus &i!e from the duodenum

Deeper bro(n #o!or +ay indi#ate #ontent from !o(er intestine

e#urrent vomiting of undigested food %rob!em (ith gastri# emptying or infe#tion




Carefu! *ssessment M +onitoring < parti#u!ar!y during

periods of f!uid !oss and subseLuent rehydration therapy$

+ore !i'e!y to have #ardia# or rena! insuffi#ien#y

< p!a#es them at greater ris' for !ife<threatening f!uid and e!e#tro!yteimba!an#es

Beart fai!ure or ena! Disease < 5#essive rep!a#ement

of f!uid and e!e#tro!ytes may resu!t in adverse #onseLuen#es

9ausea and =omiting A!der *du!t





Diarrhea

5#essive freLuen#y of stoo!s oose or (atery #onsisten#y *#ute or #hroni#

-reLuent!y (ith nausea M vomiting (ith infe#tionor inf!ammation

+ay be a##ompanied by #ramping pain %ro!onged may !ead to dehydration,

e!e#tro!yte imba!an#e, a#idosis, ma!nutrition




Common Hypes of Diarrhea

arge<vo!ume diarrhea /se#retory or osmoti# ?atery stoo! resu!ting from in#reased se#retions into

intestine from the p!asma Aften re!ated to infe#tion

imited reabsorption be#ause of reversa! of norma! #arriersfor sodium andNor g!u#ose

Sma!!<vo!ume diarrhea Aften #aused by inf!ammatory bo(e! disease Stoo! may #ontain b!ood, mu#us, pus

+ay be a##ompanied by abdomina! #ramps and tenesmus




Common Hypes of Diarrhea

Steatorrhea@fatty diarrhea8 -reLuent bu!'y, greasy, !oose stoo!s -ou! odor Chara#teristi# of ma!absorption syndromes

• Ce!ia# disease, #ysti# fibrosis -at usua!!y the first dietary #omponent affe#ted

• %resen#e interferes (ith digestion of other nutrients$ *bdomen often distended




&!ood in Stoo!

&!ood may o##ur in norma! stoo!s (ith

diarrhea, #onstipation, tumors, or an

inf!ammatory #ondition$

Frank blood• ed b!ood@usua!!y from !esions in re#tum or ana! #ana!

Occult blood• Sma!! hidden amounts, dete#tab!e (ith stoo! test

• +ay be #aused by sma!! b!eeding u!#ers

Melena• Dar'<#o!ored, tarry stoo!

• +ay resu!t from signifi#ant b!eeding in upper digestive

tra#t




.as

-rom s(a!!o(ed air < drin'ing from a stra(

&a#teria! a#tion on food -oods or a!terations in moti!ity

5#essive gas #auses ru#tation < be!#hing

&orborygmus P rumb!ing or gurg!ing noise made by movement

of f!dNgass

*bdomina! distention and pain -!atus




Constipation

ess freLuent bo(e! movements Sma!! hard stoo!s *#ute or #hroni# prob!em

+ay be #aused by de#reased perista!sis "n#reased time for reabsorption of f!uid

%eriods of #onstipation may a!ter (ith periods

of diarrhea$

Chroni# #onstipation may #ause hemorrhoids,ana! fissures, or diverti#u!itis$




Causes of Constipation

?ea'ness of smooth mus#!e < age or i!!ness

"nadeLuate dietary fiber "nadeLuate f!uid inta'e

-ai!ure to respond to defe#ation ref!e5 "mmobi!ity 9euro!ogi#a! disorders Drugs /i$e$, opiates

Some anta#ids, iron medi#ations Abstru#tions #aused by tumors or stri#tures




-!uid and !e#tro!yte "mba!an#es

Dehydration and hypovo!emia are #ommon

#omp!i#ations of digestive tra#t disorders$ !e#tro!ytes

ost in vomiting and diarrhea *#id<base imba!an#es

+etabo!i# a!'a!osis• esu!ts from !oss of hydro#h!ori# a#id (ith vomiting

+etabo!i# a#idosis• Severe vomiting #auses a #hange to metabo!i# a#idosis

be#ause of the !oss of bi#arbonate of duodena!

se#retions$

• Diarrhea #auses !oss of bi#arbonate$




%ain

Bigh!y #omp!e5 and sube#tive e5perien#e$ Knp!easant sensory and emotiona!

e5perien#ed asso#iated (ith a#tua! or

potentia! tissue damage$ %ain is a!(ayssube#tive8 /*%S$

Sube#tive report is most re!iab!e indi#ator$




%QSH

% R %rovo#ation N %a!!iation Q R Qua!ity N Quantity R egion N adiation S R Severity S#a!e

H R Himing Do#umentation R

%atients understanding of the pain s#a!e %atients satisfa#tion (ith pain !eve! (ith #urrent treatment

moda!ity

Hime!y reassessment fo!!o(ing any intervention and responseto t5

Communi#ation (ith +D %atient edu#ation provided and pts response to !earning$




%ain eferred %ain /Cont$

Common phenomenon %ain is per#eived at a

site different from origin$ esu!ts (hen vis#era!

and somati# nerves#onverge at one spina!

#ord !eve! Sour#e of vis#era! pain

is per#eived as thesame as that of the

somati# nerve$




*#ute *bdomina! %ain tio!ogy M %athophysio!ogy





%!ease fo!!o( the !in's be!o(

evie( of Septi# Sho#' evie( of Bypovo!emi# Sho#'




+a!nutrition

+ay be !imited to a spe#ifi# nutrient or genera! Causes of !imited ma!nutrition@spe#ifi#

prob!em =itamin &12 defi#ien#y

"ron defi#ien#y Causes of genera!i)ed ma!nutrition

Chroni# anore5ia, vomiting, diarrhea Ather systemi# #auses

• Chroni# inf!ammatory bo(e! disorders

• Can#er treatments

• ?asting syndrome

• a#' of avai!ab!e nutrients




&asi# Diagnosti# Hests

adio!ogi#a! studies /Contrast medium may be used Kpper gastrointestina! series /barium s(a!!o( o(er gastrointestina! series /barium enema *bdomina! u!trasonography /+ay sho( unusua! masses Computed tomography /CH +agneti# resonan#e imaging /+"

ndos#opy /&iopsy may be done during pro#edures ndos#opi# u!trasonography Capsu!e endos#opy Sigmoidos#opy and #o!onos#opy

iver biopsy /Apen and #!osed

iver fun#tion serum studies iver fun#tion, pan#reati# fun#tion, #an#er mar'ers

aboratory ana!ysis of stoo! spe#imens Che#' for infe#tion, parasites and ova, b!eeding, tumors, ma!absorption

. !!b! dd K!t d




.a!!b!adder K!trasound

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i d




iver ndos#opy

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Common Hherapies and

%revention Dietary modifi#ations

5amp!e@g!uten<free diet /#e!ia# disease edu#ed inta'e of a!#oho! and #offee "n#reased fiber and f!uid inta'e

Stress redu#tion te#hniLues Stress impairs immune fun#tion and tissue

hea!ing$ Drugs

=ariety of medi#ations are avai!ab!e$




Drugs Ksed in Digestive System

Disorders /Cont$




Kpper .astrointestina! Hra#t

Disorders




Dysphagia

Diffi#u!ty s(a!!o(ing Causes

9euro!ogi#a! defi#it +us#u!ar disorder +e#hani#a! obstru#tion

esu!ts and presentation %ain (ith s(a!!o(ing "nabi!ity to s(a!!o( !arger pie#es of so!id materia! Diffi#u!ty s(a!!o(ing !iLuids




Causes of Dysphagia




Dysphagia /Cont$

9euro!ogi#a! defi#it "nfe#tion Stro'e &rain damage *#ha!asia

• -ai!ure of the !o(er esophagea! sphin#ter to re!a5

be#ause of !a#' of innervation

+us#u!ar disorder

"mpairment from mus#u!ar dystrophy




Causes of Dysphagia /Cont$




Dysphagia /Cont$

+e#hani#a! obstru#tion Congenita! atresia /abnorma! narro(ing

• Deve!opmenta! anoma!y

• Kpper and !o(er esophagea! segments are separated$

Stenosis• 9arro(ing of the esophagus

• +ay be deve!opmenta! or a#Luired

• +ay be se#ondary to fibrosis, #hroni# inf!ammation,

u!#eration, radiation therapy

• Stenosis or stri#ture may a!so resu!t from s#ar tissue• +ay reLuire treatment (ith repeated me#hani#a! di!ation




Dysphagia /Cont$

+e#hani#a! obstru#tion /Cont$ sophagea! diverti#u!a

• Autpou#hings of the esophagea! (a!!

• Congenita! or a#Luired fo!!o(ing inf!ammation

• Causes irritation, inf!ammation, s#ar tissue• Signs in#!ude dysphagia, fou! breath, #hroni# #ough,

hoarseness

Humors• +ay be interna! or e5terna!




Biata! Bernia

*'a < Diaphramati# Bernia %rotrusion of the stoma#h through the

esophagea! hiaus of the diaprhragm into the

thro5$ S!iding hernia

+ore #ommon type %ortions of the stoma#h and gastroesophagea!

un#tion s!ide up above the diaphragm$

o!!ing or paraesophagea! hernia %art of the fundus of the stoma#h moves up through

an en!arged or (ea' hiatus in the diaphragm and

may be#ome trapped$




Hypes of Biata! Bernia




Biata! Bernia *ssessment

-ood may !odge in pou#h of the hernia Causes inf!ammation of the mu#osa ef!u5 of food up the esophagus /#hroni# esophagitis

Signs

%yrosis /Beartburn -reLuent be!#hing "n#reased dis#omfort (hen !aying do(n Substerna! pain that may radiate to shou!der and

a( -ee!ing fu!!ness after eating or a fee!ing of

breath!essness or suffo#ation Symptoms (orse (hen !ying do(n

. t h ! f!




.astroesophagea! ef!u5

Disease /.D %eriodi# ref!u5 of gastri#

#ontents into dista!

esophagus #auses erosion

and inf!ammation$

Aften seen in #onun#tion(ith hiata! hernia

Severity depends on

#ompeten#e of the !o(er

esophagea! sphin#ter$

De!ayed gastri# emptying

may be a fa#tor$




.D *ssessment

Consumption of fatty foods, #affeinated beverages, #ho#o!ate,

ni#otine, a!#oho!, peppermint

Drug history beta<b!o#'ers, #a!#ium #hanne! b!o#'ers, nitrates,

anti#o!inergi# drugs, estrogen M progesterone

"nf!ammation, dis#omfort up to 2 h after ea#hmea!

egurgitation (ith a sensation of (arm f!uid

trave!ing up(ard to the throat, !eaving a bitter,

sour taste in the mouth Dysphagia -!atu!en#e andNor b!oating after eating

. t h ! f!




Co!!aborative #are ifesty!e modifi#ations

• ?eight !oss and smo'ing #essation

9utritiona! therapy• edu#ing fatty foods, #affeinated beverages, #ho#o!ate, ni#otine,

a!#oho!, peppermint, inta'e of spi#y and a#idi# foods$• at 3 P 6 sma!! mea!s during the day /de#reases pressure

Drug therapy• *nta#ids < neutra!i)es gastri# a#id

• %roton pump inhibitor /%%" P most po(erfu!TT &!o#'s fina! step in

the BUion se#retion by the parieta! #e!!• Cispride and +etro#!opramide P ." stimu!ants P improves gastri#

emptying

Surgi#a! therapy


Disease /Cont$




9ursing +anagement




Hea#h patients to avoid fa#tors that #ause

ref!u5 Smo'ing #essation !evating BA& to 0 degrees /68 b!o#s under BA&

*void !ying do(n 2< hours after eating *void !ate<night eating / h before s!eep *void restri#tive #!othing, !ifting heavy obe#ts,

straining, (or'ing bend over$ va!uate effe#tiveness and adverse effe#ts of

medi#ations ta'en for heartburn

g g


Disease

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.D d Bi t ! B i



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"n#iden#e in#reases (ith age$ &oth are asso#iated (ith (ea'ening of the

diaphragm, obesity, 'yphosis, and use of #orsets or

other fa#tors that in#rease intra<abdomina! pressure$ -irst indi#ations may in#!ude esophagea! b!eeding

se#ondary to esophagitis or respiratory

#omp!i#ations /e$g$, aspiration pneumonia re!ated to

aspiration of gastri# #ontents$

.D and Biata! Bernia *ge<e!ated Considerations

Copyright © 2014 !sevier Canada, a division of eed !sevier Canada, td$ :0




.astritis *#ute .astritis

"nf!ammatory pro#ess of the mu#osa! !ining of thestoma#h$

+ay be u!#erated, edematous, and b!eeding *#ute

*!#oho! or ingestion of aspirin or 9S*"Ds VV

"nfe#tion by mi#roorganisms "ngestion of e5#essive amounts of tea, #offee, mustard, #!oves,

papri'a or pepper "ngestion of #orrosive or to5i# substan#es adiation or #hemotherapy Severe stress -ood poisoning /staph and infe#tions /#andida, herpesvirus

Chroni# Hype * P autoimmune Hype & P Be!i#oba#ter py!ori




.astritis +anifestations

Dis#omfort (ith fa#ia! grima#es and

rest!essness *nore5ia, nausea, vomiting may deve!op

Bematemesis #aused by b!eeding pigastri# pain, #ramps or genera! dis#omfort ?ith infe#tion, diarrhea may deve!op$

i




.astritis Hreatment

Acute gastritis Ksua!!y se!f<!imiting$ Comp!ete regeneration of

gastri# mu#osa

Supportive treatment (ithpro!onged vomiting

+ay reLuire treatment

(ith antimi#robia! drugs +ay reso!ve in 4:h /rapid

#e!! pro!iferation and

restoration of gastri# mu#osa

Chronic Gastritis ong<term -NK gastri# C* %erni#ious anemia

/destru#tion of parieta! #e!!s in

fundus and body !eads to

inadeLuate vitamin &12 absorption B2 e#eptor antagonist P

bo#'s gastri# se#retion and

maintains pB of gastri# #ontents

above 4$0 thus de#reasing

inf!ammation

*ntibioti#s P treat B$ py!ori

% ti K!




%epti# K!#er.astri# M Duodena! K!#ers

+ost #aused by H. Pylori infe#tion

Ksua!!y o##ur pro5ima! duodenum /duodena! u!#ers

*ntrum of the stoma#h /gastri# u!#ers

K!#er may e5tend through the tissue !ayers of

the mus#!e and serosa into the abd #avity

Deve!opment begins (ith inabi!ity of the

mu#osa to prote#t itse!f from damage by a#id

pepsin in the !umen

%epti# K!#er




%epti# K!#er+anifestations M Diagnosti# Hests

Signs and symptoms pigastri# sharp, gna(ing or burning !o#a!i)ed

pain,

Duodena! u!#er o##urs ;0m to h after eating,re!ieved (ith food or anta#ids

.astri# u!#er pain is pre#ipitated by foo and not

re!ieved by anta#id

Diagnosti# tests sophagogastroduodenos#opy

&arium 5<ray

%epti# K!#er




%epti# K!#erHreatment

Hreatment Combination of

• antimicrobial P to eradi#ate B$ %y!ori

• proton pump inhibitor P optimi)es u!#er

hea!tin by binding to the proton pump of parieta!#e!! and inhibiting se#retion of BU ions into

gastri# !umen

• H2 antagonist – reduces acid secretion to

optimize ulcer healing edu#tion of e5a#erbating fa#tors

%epti# K!#er



•;;•Copyright © 2014, 2011, 2006 by Saunders, an imprint of !sevier, "n#$

%epti# K!#er

Comp!i#ations Comp!i#ations of pepti# u!#er

Bemorrhage• Caused by erosion of b!ood vesse!s

• Common #omp!i#ation

• +ay be the first sign of a pepti# u!#er %erforation

• K!#er erodes #omp!ete!y through the (a!!$

• Chyme #an enter the peritonea! #avity$

• esu!ts in #hemi#a! peritonitis

Abstru#tion• +ay resu!t !ater be#ause of the formation of s#ar tissue$




%epti# K!#er Disease /Cont$


Upper GI PPT for Class.ppt

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