GASTROINTESTINAL FINALS REVIEWER
1. HIATAL HERNIA
- An opening in the diaphragm which esophagus
passes become enlarged and part of stomach
moves up into the lower portion of the thorax
- Etiology:
 Weakened diaphragmatic muscles
- Types of hiatal hernia:
o Sliding type
 Upper stomach and gastroesophageal
junction are displaced upward and slide
in and out the thorax
o Paraesophageal type
 All or part of the stomach pushes
through the diaphragm
esophagus.
- Clinical Manifestation
o Pyrosis, regurgitation, dysphagia
 Common in sliding hernia
o Epigastric pain or fullness after eating
o Nausea and vomiting, intolerance to food
 Common in large hiatal hernia or
paraesophageal hernia
o Reflux
o Hemorrhage
o Obstruction
o Strangulation
 Compression of trachea
- Diagnostic test
o X-ray studies
o Barium Swallow
o EGD (Esophagealgastroduodenoscopy)
o Esophageal Manometry
o Chest CT scan
- Medical and Nursing Management
o Frequent small feeding
o Stay upright position 1 hour after eating
o Elevate head of bed 4 to 8 inches
o Include management of patients with
GERD
- Surgical Management
o Surgical hernia repair
 Open/Laparoscopic
 Open (Transabdominal/Transthoracic)
for patients with complications such as
bleeding, dense adhesions, or injury to
the spleen
 Post-op dysphagia:
o Advances the diet slowly from
liquid to solids while managing
nausea and vomiting
o Tracking nutritional intake and
monitoring weight
o WOF: Monitor for post-operative
bleeding, vomiting, gagging,
abdominal distention
epigastric chest pain
 Indicated for surgical revision
2. GASTRITIS
- Inflammation of the gastric mucosa
- Classifications of Gastritis:
o Erosive Gastritis
 Due to local irritants
 NSAID/aspirin
 Alcohol consumption/smoking
 Gastric radiation therapy
o Non-erosive Gastritis
 Due to infection
 Helicobacter Pylori
- Types of Gastritis:
beside o Acute Gastritis
 Last for several hours
 Severe are forms commonly due to
strong alkaline ingestion
 Example: shampoo, Bleach
o Chronic Gastritis
 Commonly due to:
 H. Pylori infection
 Duodenal reflux
 Complications:
 Peptic ulcer
 Gastric adenocarcinoma
 Gastric mucosal lymphoma
- Clinical Manifestation
o Acute Gastritis
 Epigastric Pain
 Dyspepsia
 Anorexia
 Hiccups or nausea/vomiting
 Melena/Hematochezia
o Chronic Gastritis
 Chronic fatigue
 Pyrosis after eating
 Belching
 Sour taste in the mouth
 Ealy satiety
 Anorexia
 Nausea and vomiting
 Epigastric pain
 Spicy or fatty food intolerance
- Diagnostic Findings
 Upper GI series with biopsy
 Always obtain informed consent
 CBC
 For anemia
- Medical Management
o H2 blockers
o Antibiotics
 Amoxicillin, Clarithromycin
- Surgical Management
o Gastrojejunostomy
and
 Anastomosis of jejunum to stomach
to detour around the pylorus
  Billroth 2  CBC
- Nursing Management o For anemia
o Reduce Anxiety  Tumor makers
o Promoting optimum nutrition o Carcinoembryonic Antigen Test
o Avoid smoking and alcohol drinking (CEA)
o Promoting fluid balance o Carbohydrate Antigen (CA 19-9)
o Monitoring signs of hemorrhagic gastritis o CA 50 is all elevated indicating
o Pain management gastric cancer
o Educate patient and family about home care o Medical Management
and manifestation of possible complications  Multimodal management
- Possible Complications: o Surgery, Chemotherapy, targeted
o Vitamin B12 malabsorption therapy, radiation therapy
- Possible Nursing Diagnosis  Radiotherapy
o Acute pain  The use of radiation in
o Fluid Volume Deficit treating cancer
o Fluid imbalance  Teletherapy (External
o Imbalance nutrition: less than body Radiation)
requirements o Most common
o Anxiety method
o Knowledge deficit o Fast 2-5 minutes
3. GASTRIC CANCER o No radiation after
- A disease in which malignant (cancer) cells o Adverse effects:
form in the lining of the stomach o Diarrhea
- Etiology o Cystitis
o Unknown o Erectile dysfunction
- Precipitating factors o Vaginal stenosis (use
o Age: Older adults vaginal dilator 3
o Sex: Men times a week)
o Race: Hispanic and African American, o Sterility
Asia/Pacific Islander  Brachytherapy (Internal
o Diet: Smoked, Salted, and Pickled foods, Radiation)
Low fiber intake o Sealed
o Vices: Smoking and alcohol consumption o Unsealed
o H. pylori infection
 Most common: 60%
o Chronic inflammation, pernicious anemia,
obesity, gastric ulcer, previous partial
gastrectomy, genetics
- Clinical Manifestation
o Early Stage
 Pain relieved by antacids
o Benign ulcer like
o Late Stage
 Peptic ulcer like: dyspepsia, early
satiety, weight loss, abdominal pain
above umbilicus, loss or decrease of
appetite, bloating after meals, n/v,
hematemesis, melena, hematochezia
- Assessment and Diagnostic Test - Surgical Management
 Physical Exam o Total Gastrectomy
o Palpation on late stage  Resection of the midportion or body of
 Esophagogastroduodenoscopy (Upper the stomach
Gi Series) with biopsy o Billroth I
 Barium swallow  Anastomosis to duodenum
 Endoscopic ultrasound o Billroth II
 Chest, abdominal and pelvis CT scan  Anastomosis to duodenum
o To check for malignancy - COMPLICATIONS OF GASTRIC SURGERY
 o Hemorrhage
o Dumping Syndrome
o Bile reflux
o Gastric outlet obstruction
- DUMPING SYNDROME
o Rapid gastric emptying

- Clinical manifestation:
o Symptoms occurring 30 minutes after eating
o Nausea and vomiting
o Feelings of abdominal fullness and
abdominal
o Cramping
o Diarrhea
o Palpitations and tachycardia
o Perspiration
o Weakness and dizziness
o Borborygmi sounds
 Normal: 6-32 movements
o Steatorrhea
- Dumping syndrome management:
o Lie down after meals
o Avoid sugar, salt, and milk
 High gastric motility
o Take anti-spasmodic medications as
prescribed to delay gastric emptying
 Example: HNBB, anticholinergics
(atropine, Cogentin, Artane, Benadryl)
- Nursing intervention for gastric cancer
o Reducing Anxiety
o Promote optimal nutrition
o Pain management
o Provide psychosocial support
o Health education on home and
community based and transitional care
- Possible Nursing Diagnosis
o Anxiety
o Acute/Chronic pain
o Imbalance nutrition: less than body
requirements
o Self-care activities
o Knowledge Deficit