Chapter 37

Management of Patients With

Gastric and Duodenal Disorders
Gastritis
• Acute VS chronic
• Benign or malignant ulcers or Helicobacter
pylori bacteria
• Medical Management includes nonirritating diet,
reducing stress, treating H. pylori and other
pharmacological interventions
• Nursing Management includes promoting
optimal nutrition, stress reduction techniques,
promoting fluid balance and pain relief
Gastric and Duodenal Ulcers

• Peptic ulcer is excavation in mucosal

wall of stomach, pylorus, duodenum, or
esophagus
• Result from infection with H. pylori or
Zollinger-Ellison syndrome
• Medical management of H. pylori
involves combination of antibiotics,
proton pump inhibitors, and bismuth
salts
Gastric and Duodenal Ulcers (cont’d)

• Smoking cessation encouraged

• Surgical management is recommended
for intractable ulcers
• Nursing management includes
monitoring and managing
complications of hemorrhage,
perforation, and pyloric obstruction
Morbid Obesity
• More than two times ideal body weight or body
mass index > 30 kg/m2 or more than 100
pounds greater than ideal body weight
• Medical management includes weight loss diet
in conjunction with behavior modification
• Pharmacologic management includes
medications that inhibit reuptake of serotonin
and norepinephrine and/or prevent digestion of
fats
• Surgical management options are gastric
bypass and vertical banded gastroplasty
Gastric Cancer

• Diet appears to be significant factor

• Prognosis poor
• Medical management involves removal
of tumor. Most care is palliative
• Nursing management involves
providing optimal nutrition, pain relief
and psychosocial support
Gastric Surgery

• Pyloroplasty, vagotomy, partial or total

gastrectomy
• Nursing interventions focus on reducing
anxiety, pain relief, and assisting the
client in resuming enteral nutrition
• Common problems include dysphagia
and gastric retention, bile reflux,
dumping syndrome and nutritional
deficiencies