UPPER GASTROINTESTINAL DISORDER

Created by : Jessica Faye G. Manansala

GASTROESOPHAGEAL RELUX DISEASE (GERD)

• It is a syndrome resulting from esophageal reflux

Clinical Manifestation

• Heart burn• Odynophagia• Dysphagia• Acid regurgitation• Water brash• Eructation• Pain (back, neck or jaw)

Risk Factors

• Obesity & weight gain• Pregnancy• Chewing tobacco• Smoking• High fats foods• Theophylline• Caffeine• Chocolate

Diagnosis

• Barium swallow • Esophageal manometry• Esophagoscopy• Esophageal biopsy• Cytologic examination

• Acid perfusion test

Esophageal Manometry

esophagoscopy

Acid Perfusion Test

Treatment

• 1. Restrict diet into small frequent feedings.

• 2. Drink adequate fluid at meals to assist food passage.

• 3. Eat slowly and chew thoroughly to add saliva to the food

• 4. Avoid extremely hot or cold food, spices, fats, alcohol, coffee, chocolate & citrus juices.

Medications

• Cytotec- preventing gastric ulcer formation & GERD manifestation

• Antacids (30 ml 1hr before and 2 to 3hrs after meal) it helps to neutralize gastric acid secretions.

• Histamine receptors antagonist• (zantac, pepcid) – It decreases gastric secretions.• Cholinergic ( bethanechol or urecholine) – for clients

with severe manifestation it increase LES pressure and prevent reflux

• Metoclopramide (raglan)- increase LES pressure by stimulating the smooth muscle of GIT and increase the rate of gastric emptying. This medication is taken before meal.

• Cisapride (propulsid) 15min before meal and at bed time.• Proton pump inhibitor (prevacid) – suppresses secretion

of gastric acid,

Nursing management

• Identify specific manifestation• Document when sign and symptoms started

( frequency & severity)• Help client to identify risk factors for GERD• Instruct clients about lifestyle change• Explain the relationship of manifestation to

food and various product.

PEPTIC ULCER DISEASE (PUD)

- PUD involves break in continuity of the esophageal, gastric or duodenal mucosa

DUODENAL ULCER

• Duodenal ulcer has an increase incidence than gastric ulcers.

Stimuli Acid Secretion

• Protein rich meals• Alcohol consumption• Calcium• Vagal stimulation

GASTRIC ULCER

• Cause is the break in of the mucosal barrier.• Incompetent pylorus into stomach may break

mucosa barrier.

Risk Factor

• smoking (nicotine)• steroids• aspirin• NSAID’s • Caffeine• Alcohol• Stress

Clinical Manifestation

• Pain- aching, burning, cramp, gnawing pain• Gastric ulcer - food may cause pain and

vomiting may relieve it.• Duodenal ulcer- empty stomach and ingestion

of food or antacid may relieve pain.• Nausea and Vomiting – vomiting is more often

in gastric ulcer• Gastric ulcer – anorexia, weight loss and

dysphagia• Bleeding

Diagnosis

• X-ray and Endoscopy• CBC• Stool testing• Urea Breath Test

Treatment

• Anatacid• Cimetidine• Rahitidine• Pamotiidne• Clarithromycin• Cytotec

Nursing Management

• Modify diet• Assess bleeding• Prevent shock• Replace fluids• Maintain rest

GASTRIC CANCER

• Gastric cancer refers to the malignant neoplasms found in the stomach, usually adenocarcinoma. Most stomach cancers occur in the pylorus or antrum of the stomach and are adenocarcinomas

Clinical Manifestation

• Early stage – symptoms may be absent• indigestion• anorexia• dyspepsia• weight loss• abdominal pain• constipation• anemia• nausea & vomiting

Risk Factors

• chronic atrophic gastritis• history of exposure to background radiation or

trace metal soil• people usually eat pickled food, salted fish &

nitrates• metal craft workers, miners, bakers• those working in dusty, smoky & sulfur dioxide

containing environment

Diagnosis

• X-ray the upper GIT• Double contrast barium swallow• followed by endoscopy for biopsy• cytologic test• CT scan• Gastroscopy

Treatment

• chemotheraphy• radiation theraphy• surgical resection

Nursing Management

• assess the client history of diet (smoked fish, salty food,smoking)

• family history• asked the patient if she/he has a previous

gastric surgery• history of risk factors to the development of

cancer.• chronic gastritis• pernicious anemia• presence of H.Pylori

THE END

THANKS FOR LISTENING (^.^)!!