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Gastrointestinal Diseases

Gastrointestinal Diseases

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Published by FreeNursingNotes
Gastro Nursing notes
f you have questions please email me> freenursingnotes@yahoo.com
Gastro Nursing notes
f you have questions please email me> freenursingnotes@yahoo.com

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Published by: FreeNursingNotes on Nov 26, 2009
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11/04/2012

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GASTROINTESTINAL DISEASES
MOUTH: SIGNS AND SYMPTOMS
1.Bleeding gums – Vit. C deficiency2.Glossitis, cheilosis – Vit. B2 deficiency3.Smooth beefy red tongue – Vit. B12 deficiency4.Strawberry tongue – scarlet fever5.Koplik’s spots – measles6.Thrush (white, removable plaques) – Candida albicans
GI BLEEDINGHematemesis
Vomiting bright red blood (rapid bleed)
Vomiting “coffee-ground” (slow bleed)
Melena
Black, tarry stool
Source: upper GI, or small bowels
Hematochezia
Bright red blood in stool
Source: lower GI (or upper GI if massive)
MEDICAL CAUSES:1.Upper GI
Esophageal varices
Gastritis
Gastric ulcer
Duodenal ulcer
2.Lower GI
Hemorrohoids
Anal fissure
Diverticulosis
Inflammatory bowel disease
intussusception
UPPER ABDOMINAL PAINREFLUX ESOPHAGITIS
Burning substernal pain
After meals, at night
May radiate to left arm
GASTRIC ULCER
Steady, gnawing epigastric pain
Worsened by foodDUODENAL ULCER
Steady, gnawing epigastric pain
Typically awakens patient around 1:00 am
Relieved by food
 ______________________________________________________________ 
 
PERFORATED PEPTIC ULCER
Severe epigastric pain
May radiate to back or shoulders
Peritoneal signsCHOLECYSTITIS
Cramp-like epigastric pain
May radiate to tip of right scapula
Murphy’s sign-painful splinting of respiration during deepinspiration and right upper quadrant palpation.
ACUTE PANCREATITIS
Severe, boring abdominal pain
Often radiates to back 
Peritoneal signs (rebound tenderness, abdominalrigidity)HIATAL HERNIA
1.
SLIDING HERNIA
: gastroesophageal junction and part of stomachslide upwards
2.
PARAESOPHAGEAL
: part of stomach turns adjacent to esophagus
Assessment
1.Often asyptomatic2.Heartburn3.Regurgitation of food4.Diagnosis: chest X-ray or barium swallow
Implementation
1.If asymptomatic: no treatment necessary2.Small frequent meals3.Elevate head of bed to reduce acid reflux4.Avoid activities that increase abdominal pressure:(lifting heavy objects, bending over etc.)
ESOPHAGEAL VARICESLiver cirrhosis: elevated portal vein pressure> esophagealvaricesAssessment
1.History of alcohol (liver cirrhosis)2.Hematemesis = vomiting blood3.Melena = black, tarry stools4.Signs of shock if bleeding is severe
Implementation
1.Watch for hemorrhage, hypotension, signs of shock2.Monitor vital signs if acute bleeding3.Watch for signs of hepatic encephalopathy4.Assist with Sengstaken tube
Sengstaken tube (to compress varices)
Monitor bleeding in gastric drainage
Watch for signs of asphyxiation
Watch for tube displacement
GASTRITISInflammation of gastric mucosaACUTE GASTRITIS (Erosive)
Acute hemorrhagic lesions
 ______________________________________________________________ 
 
Stress ulcers
Aspirin, NSAIDs
Alcohol
CHRONIC GASTRITIS TYPE A (Non-erosive)
Autoimmune gastritis
Involves body and fundus
Pernicious anemia
CHRONIC GASTRITIS TYPE B (Non-erosive)
Involves body and fundus
H. pylori
Assessment
1.Nausea, anorexia2.Sour taste in mouth3.Belching4.Cramping, pain
Implementation
1.Watch for signs of GI bleeding (“coffee-ground” vomit)2.CBC if suspected pernicious anemia
Medications
1.Antacids2.Antihistamine (to reduce acid secretion)3.Antibiotics (to eradicate H. pylori)
PEPTIC ULCER DISEASEGASTRIC ULCER
Normal or decreased acid production
Decreased mucosal resistance
Chronic NSAID use
Pain gets worse after meals
DUODENAL ULCER
Increased acid production
Pain typically relieved by mealsAssessment
1.Gnawing, burning epigastric pain2.Vomiting3.GI bleeding>anemia
Diagnosis
1.upper GI series or endoscopy2.test for presence of Helicobacter pylori
Implementation
1.Watch for signs of bleeding- “coffee-groundvomit, tarrystools2.Avoid irritating food3.Avoid cigarette smoking4.Avoid aspirin, NSAIDs and steroids
Medications
1.Antihistamine2.Antibiotics to eradicate H. pylori
 ______________________________________________________________ 

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