CMPA411 COMPETENCY APPRAISAL 1

GASTROINTESTINAL DISORDERS Onset: 30min

Onset: 2hrs (gastric
Key Terms: emptying)
 Hematemesis – vomiting of fresh blood Relieved by
Relieved by food
 “Coffee ground” emesis – vomiting of dark Vomiting
blood – blood exposed to gastric acid Weight loss Weight gain
 Melana – black, tarry stools Esophageal Ulcer
 Hematochezia – passage of fresh blood in – lower part of esophagus
feces
CAUSES
PEPTIC ULCER DISEASE - Gram-negative
- sore on the lining of stomach, small bacillus
intestine or esophagus (common cause - hides in between
Helicobacter
bacteria) mucus and epithelial
Pylori
cells
- most common cause
of PUD
- inhibit prostaglandin
- Mefenamic Acid
NSAIDS (Ponstan)
- Ibuprofen (Alaxan)
- Naproxen (Skelan)
Gastric acid - Injures the mucosa
(Hydrochloric cells and activates
acid) pepsin
Smoking and - Inc gastric
alcohol - Dec bicarbonate
production (neutralizer
acid)
- Delays healing

MANAGEMENT
Triple Therapy
- Amoxicillin (-cillin:
Penicillin)
- Clarithromycin (
Helicobacter - Omeprazole (-
Pylori prazole: PPI)
Duration: 14 days
Principle: at Quadruple Therapy
Gastric Ulcer Duodenal Ulcer
least 2 - Metronidazole
First part of small antibiotics - Tetracycline
In the stomach intestine -
- Ranitidine
duodenum
- Bismuth subsalicylate
s/sx: Pain (antacid)
s/sx: pain
(Epigastric) Duration: 10 days
trigger by eating NSAIDS - Limit use
(food) - Misoprostol (protect
Inc Hcl Cause by GERD lining – prostaglandin
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 CMPA411 COMPETENCY APPRAISAL 1
– agonist – dec hcl) 7. Maintain NPO status as prescribed for 1
-H2 (-tidine) receptor to 3 days until peristalsis returns.
antagonist (Cimetidine, 8. Progress the diet from NPO to sips of
Raniditine) clear water to 6 small bland meals a day,
-PPI (Omeprazole, as prescribed when bowel sounds return
Gastric acid
pantoprazole) 9. Monitor for postoperative complications
(Hydrochloric
-Mucosal protectants of hemorrhage, dumping syndrome,
acid)
(Sucralfate, Misoprostol) diarrhea, hypoglycemia, and vitamin B12
-Antacids (Aluminum OH – deficiency.
s/e: constipation, Mag
OH s/e: diarrhea) DUMPING SYNDROME
Smoking and - Encourage to stop – The rapid emptying of the gastric contents
alcohol into the small intestine that occurs following
gastric resection
Surgical Management
1. Total gastrectomy – removal of the Assessment
stomach with attachment of the esophagus  Symptoms occurring 30 minutes after
to the jejunum (esohagojejunostomy) or eating
duodenum (esophagoduodenostomy)  Nausea and vomiting
2. Vagotomy – surgical division of the vagus  Feelings of abdominal fullness and
nerve abdominal cramping
- To eliminate the vagal impulses that  Diarrhea
stimulate hydrochloric acid secretion in  Palpitations and tachycardia
the stomach  Perspiration
3. Bilroth I – partial  Weakness and dizziness
gastrectomy, with  Borborygmi
the remaining
segment
Client Education
anastomosed to the
 Preventing dumping syndrome
duodenum
 Avoid sugar, salt, and milk.
4. Bilroth II – partial
gastrectomy, with  Eat a high-protein, high-fat, low
the remaining carbohydrate diet.
segment  Eat small meals and avoid consuming
anastomosed to the fluids
jejunum with meals.
 Lie down after meals.
Post-op Interventions  Take antispasmodic medications as
1. Postoperative interventions prescribed to delay gastric emptying
2. Monitor vital signs
3. Place in a Fowler’s position for comfort LIVER CIRRHOSIS (hepatic failure)
and to promote drainage. – organ fails to fulfill its functions or is unable
4. Administer fluids and electrolyte to meet the demands placed upon it.
replacements intravenously as
prescribed; monitor intake and output Signs of liver disease
5. Assess bowel sounds  Jaundice
6. Monitor NG suction as prescribed.  Easy bleeding or bruising
 Ascites

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 CMPA411 COMPETENCY APPRAISAL 1
 Esophageal Varices
Complication
 Bleeding
Liver Failure: Symptoms
COMPLICATION: CIRRHOSIS
persistent increase in
pressure in the
Portal
portal vein that develops
hypertension
as a result of
obstruction to flow
Ascites -Accumulation of fluid in the
peritoneal cavity that
results from venous
congestion of the
hepatic capillaries
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-Capillary congestion leads
to plasma leaking
directly from the liver
surface and portal vein.
-Fragile, thin-walled,
Bleeding
distended esophageal
esophageal
veins that become
varices
irritated and rupture
Symptoms:
§ hematemesis
§ melena
§ light headedness
§ loss of
consciousness
in severe cases
Treatment: Esophageal Varices
1. Esophageal varices
§ Vasopressin
= first line treatment
2. Use of Balloon Tamponade
= Sengstaken-Blakemore
= Minnesota tubes
3. First-line treatment to decrease bleeding
§ volume replacement
= especially for signs of shock
§ IV fluid and/or blood products
§ Gastric lavage
Treatment:
§ Balloon tamponade
§ placing pressure on varices to
stop bleeding
§ inflating a balloon for up to
24 hours
§ a temporary measure before
other treatments can be
performed
§ carries a high risk of bleeding
recurrence after the balloon is
deflated
§ rupture in the esophagus
§ Blood transfusion
§ Limit: Hemoglobin level of 7 g/dL
§ Prophylactic Antibiotic
§ IV Ceftriaxone 1 gm daily x 7 days
 CMPA411 COMPETENCY APPRAISAL 1
§ Oral Norfloxacin 400 mg BID x 7 days the liver normally would filter are passed
§ Liver transplant through the shunt directly into the bloodstream

Treatment: RE-BLEEDING
§ Beta blocker
§ Non-selective beta-blockers (NSBBs)
§ cornerstone of treatment for prevention of
first
bleeding and rebleeding of oesophageal
varices
in patients with cirrhosis
§ Propranolol
§ Nadolol
§ Timolol
§ Carvedilol
= a new NSBB that is increasingly used
= has a greater portal pressure reducing
effect than propranolol
= safe in patients with compensated
and decompensated cirrhosis

Treatment: RE-BLEEDING
§ Endoscopic Band Ligation

COMPLICATIONS: CIRRHOSIS
4. Coagulation defects
ü Decreased synthesis of bile fats in the
liver prevents the absorption of fat-soluble
vitamins.
ü Without vitamin K and clotting factors II,
VII, IX, and X, the client is prone to
bleeding.
5. Hepatic Encephalopathy
ü End-stage hepatic failure

UGIB: 2. Esophageal Varices

Treatment: § Elastic bands to tie off bleeding
veins. § Medications: Vasoconstrictors § slow
the flow of blood to the portal vein § five days
after a bleeding episode § Octreotide
(Sandostatin) § Vasopressin (Vasostrict) §
Transjugular intrahepatic portosystemic shunt
(TIPS) § opening that is created between the
portal vein and the hepatic vein, which carries
blood from your liver to your heart. § reduces
pressure in the portal vein à stops bleeding
from esophageal varices § serious
complications; § liver failure § mental
confusion, which can develop when toxins that
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