Transcript Problems of the Upper GI Tract

Problems of the Upper GI Tract
Gastroesophageal reflux disease (GERD)
Hiatal hernia
Peptic ulcer disease (PUD)
Upper GI Bleeding
GERD
Definition & Predisposing Factors
Characterized by a reflux of gastric
secretions into the esophagus causing
esophagitis, dysphagia, & aspiration
Predisposing conditions include: hiatal
hernia, incompetent lower esophageal
sphincter (LES), & decreased esophageal
clearance and gastric emptying.
Gerd Con’t
signs/symptoms
Pyrosis
Regurgitation
Dysphagia
Bronchospasm/laryngospasm
GERD Con’t
Diagnosis & treatment
Diagnosis
Barium swallow
Esophagoscopy
esophageal motility studies
Treatment:
Preventative measures
Pharmacologic management(antacids, motility
agents, & H2 blockers)
Surgical intervention prn
Hiatal Hernia
Definition & Predisposing Factors
Herniation of a portion of the stomach into the
esophagus (aka diaphragmatic & esophageal
hernia).
Predisposing factors include: intrabdominal
pressure, increased age, trauma, congenital
weakness & a forced recumbent position
Classified into 2 types
Sliding
Rolling
Hiatal Hernia con’t
S/S, DX ,& RX
Sign and symptoms
Similar to those for GERD
Frequently asymptomatic
Diagnosis
Similar to those for GERD
Treatment
Similar to those for GERD
Surgical interventions: valvuloplasty or
antireflux procedures
PUD
Definition, Incidence, & Classification
Erosion of the GI mucosa r/t the digestive
action of HCL & pepsin
Approximately 10% of men & 4% of
women in the U.S. will have duodenal
ulcers in their lifetime.
Classified as:
Acute or chronic
gastric or duodenal
PUD Con’t
Sign and Symptoms & Diagnosis
Sign and Symptoms:
Pain
Diagnosis:
Endoscopy with cultures
Upper GI barium contrast studies
Serum and stool studies
PUD Con’t
Treatment
Rest and stress reduction
Nutritional management
Pharmacological management
NG suction
Surgical intervention
Bilroth 1 & 11
Vagotomy & pyloroplasty
Upper GI Bleeding
Definition, Predisposing Factors, &
Classification
Massive upper GI hemorrhage defined as > 1500
ml blood loss or 25% intravascular blood volume
loss.
Predisposing factors include: drugs, esophageal
varices/esophagitis, PUD/stress ulcer/ gastritis. &
carcinoma.
Classified as:
Bleeding: venous, capillary, or arterial
Origin: esophageal or stomach/duodenal
Upper GI Bleeding Con’t
Signs / Symptoms & Diagnosis
Anemia & weakness r/t bleeding (obvious
or occult)
Diagnosis:
Patient history
Serum/ stool/ vomitus studies
Endoscopy
Angiography
Barium contrast studies
Upper GI Bleeding Con’t
Treatments
Supportive therapies
Pharmacologic management
Gastric lavage/Sengstaken-Blakemore tube
Sclerotheraphy
Cautery
Surgical intervention
Comparison of Gastric and
Duodenal Ulcers
Gastric
Lesion
Duodenal
Superficial with
smooth margins;
round, oval or coneshaped
Predominantly
antrum, also in body
& fundus of stomach
Penetrating
Gastric Secretion
Normal to decreased
Increased
Incidence
Greater in women Greater in men
Peak age 50-60 yo Peak age 35-45 yo
Location of lesion
First 1-2 cm of
duodenum
Comparison of Gastric and
Duodenal Ulcers
Gastric
Duodenal
Malignancy
Potential
Occurs in
approx. 10% of
patients
Rare, no increase
in incidence
Associated
Gastritis
Common &
Increased
None
Bleeding pattern
Hematemesis
more common
then melena
Melena more
common the
hematemesis
Problems of the Lower GI
Tract
Peritonitis
Inflammatory Bowel Disease(IBD)
Intestinal Obstruction
Diverticulitis
Peritonitis
Definition
Inflammation of the peritoneum causing
varying degrees of pain depending on the
extent of the inflammatory process.
Peritonitis
Signs & Symptoms
Pain, front, back, sides, shoulders
Electrolytes fall, shock ensues
Rigidity or rebound of anterior abdominal wall
Immobile abdomen and patient
Tenderness with involuntary guarding
Obstruction
Nausea and vomiting
Increasing pulse, decreasing blood pressure
Temperature falls then rises;tachycardia
Increasing abdominal girth
Silent abdomen (no bowel sounds)
Peritonitis Con’t
Diagnosis and Treatment
Diagnosis
Patient history
CBC with differential
KUB (abdominal x-ray)
Barium enema
Colonoscopy
Treatment
Supportive therapies
Pharmacological management
NPO/NG tube
Surgical intervention prn
IBD
Definition,Causes, Classification
Characterized by chronic, recurrent
inflammation of the intestinal tract
Possible causes include: infectious
agent,an autoimmune reaction,& heridity
Classified as:
Ulcerative colitis
Crohn’s Disease
IBD Con’t
Diagnosis and Treatment
Diagnosis
Colonoscopy & sigmoidoscopy (with biopsy)
Barium enema
Serum and stool studies
Treatment
Pharmacological management
Nutritional management
NPO/NG tube
Surgical intervention
Intestinal Obstruction
Definition & Classification
Occurs when intestinal contents cannot pass
through the GI tract
Classified as:
Partial or complete
Mechanical or nonmechanical
Intestinal Obstruction Con’t
Diagnosis and Treatment
Serum and stool studies
KUB
Barium enema
Sigmoidoscopy or colonoscopy
Treatment
placement of NG or intestinal Tubes
Correction of fluid & electrolyte imbalance
Surgical Intervention