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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

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Problems of the Upper GI Tract

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  1. Problems of the Upper GI Tract • Gastroesophageal reflux disease (GERD) • Hiatal hernia • Peptic ulcer disease (PUD) • Upper GI Bleeding

  2. GERDDefinition & 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.

  3. Gerd Con’tsigns/symptoms • Pyrosis • Regurgitation • Dysphagia • Bronchospasm/laryngospasm

  4. GERD Con’tDiagnosis & treatment • Diagnosis Barium swallow Esophagoscopy esophageal motility studies • Treatment: Preventative measures Pharmacologic management(antacids, motility agents, & H2 blockers) Surgical intervention prn

  5. Hiatal HerniaDefinition & 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

  6. Hiatal Hernia con’tS/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

  7. PUDDefinition, 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

  8. PUD Con’tSign and Symptoms & Diagnosis • Sign and Symptoms: Pain • Diagnosis: Endoscopy with cultures Upper GI barium contrast studies Serum and stool studies

  9. PUD Con’tTreatment • Rest and stress reduction • Nutritional management • Pharmacological management • NG suction • Surgical intervention Bilroth 1 & 11 Vagotomy & pyloroplasty

  10. Upper GI BleedingDefinition, 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

  11. Upper GI Bleeding Con’tSigns / Symptoms & Diagnosis • Anemia & weakness r/t bleeding (obvious or occult) • Diagnosis: Patient history Serum/ stool/ vomitus studies Endoscopy Angiography Barium contrast studies

  12. Upper GI Bleeding Con’tTreatments • Supportive therapies • Pharmacologic management • Gastric lavage/Sengstaken-Blakemore tube • Sclerotheraphy • Cautery • Surgical intervention

  13. Comparison of Gastric and Duodenal Ulcers

  14. Comparison of Gastric and Duodenal Ulcers

  15. Problems of the Lower GI Tract • Peritonitis • Inflammatory Bowel Disease(IBD) • Intestinal Obstruction • Diverticulitis

  16. PeritonitisDefinition • Inflammation of the peritoneum causing varying degrees of pain depending on the extent of the inflammatory process.

  17. PeritonitisSigns & 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)

  18. Peritonitis Con’tDiagnosis 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

  19. IBDDefinition,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

  20. IBD Con’tDiagnosis and Treatment • Diagnosis Colonoscopy & sigmoidoscopy (with biopsy) Barium enema Serum and stool studies • Treatment Pharmacological management Nutritional management NPO/NG tube Surgical intervention

  21. Intestinal ObstructionDefinition & Classification • Occurs when intestinal contents cannot pass through the GI tract • Classified as: Partial or complete Mechanical or nonmechanical

  22. Intestinal Obstruction Con’tDiagnosis 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

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