Obesity:

 A caloric intake that exceeds energy expenditure

o Referred to as visceral fat
 Morbid obesity – interferes with ADL, BMI is over 40.
o Diseases associated with being obese – atherosclerosis, gallbladder
disease, heart disease, hypertension, osteoarthritis, sleep apnea,
depression
 Comorbidities – diseases associated with being obese
Surgeries to correct Obesity:
 Bariatric surgery – weight loss surgery or metabolic surgery
o Complications – nausea, vomiting, bloating, heartburn, gallstones,
kidney stones, osteoporosis.
o Postoperative care – 30mL of fluid at a time, 6 weeks after surgery
normal food is continued. Significant weight loss is seen within 6-8
months. Wait 1 full year before reconstructive surgery

 Laparoscopic adjustable gastric banding- inflatable silicone band placed

around the upper portion of the stomach. A small pouch is created to limit
patient eating. Procedure is reversible.
 Gastric bypass – (Roux-en-Y) reduces stomach size and bypasses some of
the small intestine, which reduces calorie absorption.
 Gastric plication – folding the stomach inwardly, and then suturing it in
place. Reduces the stomach volume.
 Sleeve gastrectomy – removes about 75% of the stomach, leaving a slim
narrow tube. Reduces stomach volume and food intake. Decreases
hormone Ghrelin that causes hunger

Aphthous Stomatitis (Canker sore):

 Small, painful ulcers in the inner cheeks, lips, tongue, gums, palate, or
pharynx
o Lasts for several days to 2 weeks
 Triggers – dental work, vitamin b12 deficiency, zinc, folate, or iron
deficiency stress, menstruation
 Treatment – topical anesthetic benzocaine or lidocaine
Herpes simplex virus type 1 infection:
 Painful cold sores or fever blisters on the face, lips, perioral area, cheeks,
nose, or conjunctivae.
 Lasts for a few days each flare up
 Provoked by fever or stress
 Treatment – Acyclovir ointment

Oral Cancer:
 Found commonly in alcoholism or tobacco use
 Highest incidence is found in pharynx
 Signs/symptoms – sore that lasts more than 2 weeks, difficulty chewing,
swallowing, or speaking
 Biopsy is taken
 Treatment – radiation, chemotherapy, surgery. Radical neck dissection and
possible tracheostomy

Esophageal cancer:
 Risk factors – tobacco use, alcoholism, obesity, Barrett’s esophagus
 Signs/symptoms – progressive dysphagia, feeling of fullness, pain in chest,
foul breath, regurgitation
 Diagnosed with – barium swallow, biopsy, EGD, mediastinoscopy

Hiatal Hernia:
 Stomach slides up through the hiatus of the diaphragm into the thorax.
o Sliding hiatal hernia – junction of the stomach and esophagus slides
up into the thoracic cavity when a patient is supine and back to
normal when standing upright.
 Most common in – smokers, older than 50, pregnancy, GERD
 Signs/symptoms – pain, heartburn, feeling of fullness, and reflux
 Diagnosed with fluoroscopy or xray
 Surgical management – fundoplication where the stomach is wrapped
around the lower esophagus
GERD:
 Gastric secretions reflux into the esophagus.
 Signs/symptoms – heartburn 2-3x a week, regurgitation, sour taste,
dysphagia
 Tests – barium swallow, esophagoscopy, pH monitoring
 Complications – asthma, aspiration pneumonia, bronchospasm,
laryngospasm, chronic bronchitis
 Can lead to precancerous Barret’s esophagus

Mallory Weiss tear:

 Longitudinal tear in the mucous membrane of the esophagus at the
stomach junction.
 Occurs suddenly from prolonged coughing, vomiting, seizures, prolapse of
the stomach, or CPR
 Symptoms – bright red bloody emesis
 Diagnosed – EGD, hemoglobin and hematocrit are monitored
 Treatment – proton pump inhibitor and bleeding is controlled with
epinephrine injection

Esophageal Varices:
Dilated blood vessels in the esophagus.

Acute Gastritis:
 Protective mucosal barrier is broken down and allows autodigestion from
hydrochloric acid and pepsin to occur.
 Signs – abdominal pain, nausea, anorexia, feeling of fullness, reflux,
belching, and hematemesis
 Treatment – avoid alcohol, eat small frequent meals, antacids or H2
antagonists are used for pain
Chronic gastritis:
Type A:
 Autoimmune gastritis
 Occurs in the fundus with no symptoms
 Diagnosed by endoscopy, upper GI xray, gastric aspirate analysis
 Results in pernicious anemia related to malabsorption of B12

Type B:
 Affects the antrum and pylorus
 Associated with H Pylori
 Signs – poor appetite, heartburn, belching, sour taste, nausea, vomiting.
 Diagnosed by endoscopy, upper GI xray, gastric aspirate analysis

Causes of gastritis:
Alcoholism, endoscopic procedures, H. Pylori, Salmonella, medications,
nasogastric suctioning, radiation, trauma

Peptic Ulcer Disease:

 lining of the stomach, pylorus, duodenum, or esophagus is eroded.
o Usually caused by H. Pylori
 Peptic ulcers occur in the portions of the GI tract that are exposed to
hydrochloric acid and pepsin
 Peptic ulcer signs – burning and gnawing pain in the high left epigastric
region. Antacids ineffective. Hematemesis.
 Duodenal ulcer signs – cramping or burning pain in the mid-epigastric or
upper abdominal area. Relieved by food or antacids. Melena is common.
Nausea and vomiting.
 Patients will usually have low hematocrit and hemoglobin levels
 Complications – bleeding, perforation, obstruction
 Diagnosis – test for H. Pylori by doing a Urea breath test, Immunoglobin G
antibody test, Biopsy, or culture
 Test for peptic ulcer – upper GI series (barium swallow), EGD.

Gastric bleeding:
  caused by ulcer perforation, tumor gastric surgery, or other conditions.
 Signs and symptoms – slight weakness or diaphoresis
o Treatment for massive GI bleed:
 Patient is NPO
 IV line is started
 CBC is monitored
 Urinary catheter inserted
 NG tube is inserted
 Patient is turned to left side
Gastric cancer:
 Malignant lesions found in the stomach.
 Factors associated with gastric cancer development:
o Pernicious anemia, exposure to occupational substances, diet high in
smoked fish or meat, H. Pylori.
 Signs – indigestion, anorexia, pain relieved by antacids, weight loss, nausea,
vomiting.
 Diagnostic tests – upper GI x-ray, gastroscopy, gastric fluid analysis, serum
gastric levels
 Surgery:
o Gastroduodenostomy: distal portion of the stomach is removed, and
the remainder of the stomach is anastomosed to the duodenum.
o Gastrojejunostomy: removal of a larger amount of the distal
stomach to the proximal remnant of the stomach to the proximal
jejunum.
 Complications of gastric surgery:
 Hemorrhage – restlessness, cold skin, increased pulse and respiration,
decreased temperature and BP.
 Gastric distention – enlarged abdomen, epigastric pain, tachycardia,
hypotension
 Dumping syndrome – rapid entry of food into the jejunum without proper
mixing of the food with digestive juices. Symptoms occur 5 to 30 minutes
after eating. (dizziness, tachycardia, fainting, sweating, nausea, diarrhea,
abdominal cramping, rise in blood sugar).
 Nutritional issues after surgery:
B12 and folic acid deficiency and reduced absorption of calcium and vitamin D.