Body mass index = weight / height2 (Osler’s disease)-inborn progressivetendency

(normal is 20-25 kg/m2) to form dilated endothelial spaces

MARASMUS UPPER ABDOMINAL PAIN
SEVERE MALNUTRITION REFLUX ESOPHAGITIS
• Watch for electrolyte imbalances • Burning substernal pain
• Do not refeed too rapidly! • After meals, at night
OBESITY • May radiate to left arm!
• Behavior modification GASTRIC ULCER
• Exercise • Steady, gnawing epigastric pain
• “Yo-yo dieting” may be a/w increased risk • Worsened by food
for coronary artery disease DUODENAL ULCER
• Surgery (gastroplasty, gastric bypass) only • Steady, gnawing epigastric pain
for severe obesity (BMI>40) • Typically awakens patient around 1:00 am
ANOREXIA NERVOSA • Relieved by food
• Psychiatric disease PERFORATED PEPTIC ULCER
• Psychotherapy • Severe epigastric pain
• Restore normal eating pattern/calorie • May radiate to back or shoulders
intake • Peritoneal signs
• Force feed only in life-threatening situation CHOLECYSTITIS
MOUTH: SIGNS AND SYMPTOMS • Cramp-like epigastric pain
• Bleeding gums – Vit. C deficiency • May radiate to tip of right scapula
• Glossitis, cheilosis – Vit. B2 deficiency Murphy’s sign-painful splinting of respiration
• Smooth beefy red tongue – Vit. B12 during deep inspiration and right upper
deficiency quadrant palpation.
• Strawberry tongue – scarlet fever ACUTE PANCREATITIS
• Koplik’s spots – measles • Severe, boring abdominal pain
• Thrush (white, removable plaques) – • Often radiates to back
Candida albicans • Peritoneal signs (rebound tenderness,
GI BLEEDING abdominal rigidity)
SIGNS AND SYMPTOMS: ESOPHAGITIS
Hematemesis ASSESSMENT
• Vomiting bright red blood (rapid bleed) • “Heartburn” 30-60 min. after meal
• Vomiting “coffee-ground” (slow bleed) • Pain worsens when lying down
Melena IMPLEMENTATION
• Black, tarry stool • Frequent, small meals
• Source: upper GI, or small bowels • Elevate head of bed 5-10 inches
HEMATOCHEZIA • No meals 3 hours prior to bedtime
• Bright red blood in stool • Avoid irritant food (coffee, alcohol, fried or
• Source: lower GI (or upper GI if massive) fatty food)
MEDICAL CAUSES: MEDICATIONS:
UPPER GI • Antacids for occasional “heartburn”
• Esophageal varices • Cimetidine to reduce gastric acid secretion
• Gastritis Note: Chronic inflammation of esophagus >>
• Gastric ulcer increased risk of cancer
• Duodenal ulcer HIATAL HERNIA
LOWER GI • SLIDING HERNIA: gastroesophageal junction
• Hemorrohoids and part of stomach slide upwards
• Anal fissure • PARAESOPHAGEAL: part of stomach turns
• Diverticulosis adjacent to esophagus
• Inflammatory bowel disease ASSESSMENT
• intussusception • Often asyptomatic
UPPER & LOWER GI • Heartburn
• Neoplasm • Regurgitation of food
• Angiodysplasias • Diagnosis: chest X-ray or barium swallow
IMPLEMENTATION
• If asymptomatic: no treatment necessary
• Small frequent meals
• Elevate head of bed to reduce acid reflux
• Avoid activities that increase abdominal
pressure:
(lifting heavy objects, bending over etc.)
ESOPHAGEAL VARICES
Liver cirrhosis: elevated portal vein pressure>
esophageal varices
ASSESSMENT
• History of alcohol (liver cirrhosis)
• Hematemesis = vomiting blood
• Melena = black, tarry stools
• Signs of shock if bleeding is severe
IMPLEMENTATION
• Watch for hemorrhage, hypotension, signs of
shock
• Monitor vital signs if acute bleeding
• Watch for signs of hepatic encephalopathy
• Assist with Sengstaken tube
Sengstaken tube (to compress varices)
• Monitor bleeding in gastric drainage
• Watch for signs of asphyxiation
• Watch for tube displacement
GASTRITIS
Inflammation of gastric mucosa
ACUTE 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