Medical Surgical Nursing – GI
Lecture 6
Upper Gastrointestinal problems
Gastritis
· An inflammation of the gastric mucosa, is one of the most common problems affecting the
stomach.
· May be acute or chronic
· There is two types (A fundal and B antral)
Etiology and pathophysiology
· Gastritis occurs as the result of a breakdown in the normal gastric mucosal barrier.
· This mucosal barrier normally protects the stomach tissue from autodigestion by acid and
the enzyme pepsin.
· When the barrier is broken, acid can diffuse back into the muscosa.
· This allows hydrochloric (HCL) acid to enter.
· The HCL acid stimulates the conversion of pepsinogen to pepsin and stimulates the
release from Mast cells.
Etiology and Patho Continue
· The combined result of these occurrence is tissue edema, disruption of capillary walls
with loss of plasma into the gastric lumen and possible hemorrhage.
Causes of gastritis
· Aspirin
· Nonsteriodal anti-inflammatory drugs
· Alcohol
· radiation
· H. Plyori
· Salmonella
· Smoking
,· sepsis
· burns
· renal failure
Chronic Gastritis Type A and B
· Type A= Likely to be an autoimmune disorder.
· Type B= is related to H. Pylori
Clinical Manifestation Acute gastritis
· Anorexia
· Nausea and vomiting
· epigastric tenderness
· felling of fullness
· Hemorrhage is commonly associated with alcohol abuse
· Is self-limiting, lasting from a few hours to a few days, with complete healing of the
mucosa expected.
Clinical Manifestation of Chronic gastritis
· Similar to to those described for acute gastritis.
· Anemia (due to acid-secreting cells that are lost or do not function as a result of atrophy,
the source of intrinsic factor is lost.
· Intrinsic factor combines with B12. When b !2 is unavailable it cannot absorb in the ileum.
· The storage of B12 is depleted from the liver and the lack of this is essential for growth
and maturation of RBC8s, resulting in anemia.
Diagnostic Studies
· Endoscopic exam8
· Biopsy
· Breath
· Urine
, · Serum
· CBC (to check for anemia)
· Stools are tested for occult blood
Collaborative Care
· Elimination of the cause and preventing or avoiding it in the future are generally all that
is needed to treat acute gastritis.
· Bed rest
· NPO status
· IV fluids
· Vomiting
· Diarrhea
· Severe case an NG tube may be placed to either keep stomach empty or for a lavage.
Continue Collaborative Care
· Antiemetics (n/v)
· Antacids
· H2 antagonist (Zantac, Tagment, Prilosec, Prevcaid) This reduces gastric HCL acid
secretion.
· Chronic Gastritis-antibodies
· Patient with pernicious anemia= regular injections of B12
· bland diet
· antacids
Nursing Management
Nursing Assessment
· Dehydration can occur rapidly if patient is vomiting
· Keep patient quiet
· Maintain NPO
· Monitoring IVF
Lecture 6
Upper Gastrointestinal problems
Gastritis
· An inflammation of the gastric mucosa, is one of the most common problems affecting the
stomach.
· May be acute or chronic
· There is two types (A fundal and B antral)
Etiology and pathophysiology
· Gastritis occurs as the result of a breakdown in the normal gastric mucosal barrier.
· This mucosal barrier normally protects the stomach tissue from autodigestion by acid and
the enzyme pepsin.
· When the barrier is broken, acid can diffuse back into the muscosa.
· This allows hydrochloric (HCL) acid to enter.
· The HCL acid stimulates the conversion of pepsinogen to pepsin and stimulates the
release from Mast cells.
Etiology and Patho Continue
· The combined result of these occurrence is tissue edema, disruption of capillary walls
with loss of plasma into the gastric lumen and possible hemorrhage.
Causes of gastritis
· Aspirin
· Nonsteriodal anti-inflammatory drugs
· Alcohol
· radiation
· H. Plyori
· Salmonella
· Smoking
,· sepsis
· burns
· renal failure
Chronic Gastritis Type A and B
· Type A= Likely to be an autoimmune disorder.
· Type B= is related to H. Pylori
Clinical Manifestation Acute gastritis
· Anorexia
· Nausea and vomiting
· epigastric tenderness
· felling of fullness
· Hemorrhage is commonly associated with alcohol abuse
· Is self-limiting, lasting from a few hours to a few days, with complete healing of the
mucosa expected.
Clinical Manifestation of Chronic gastritis
· Similar to to those described for acute gastritis.
· Anemia (due to acid-secreting cells that are lost or do not function as a result of atrophy,
the source of intrinsic factor is lost.
· Intrinsic factor combines with B12. When b !2 is unavailable it cannot absorb in the ileum.
· The storage of B12 is depleted from the liver and the lack of this is essential for growth
and maturation of RBC8s, resulting in anemia.
Diagnostic Studies
· Endoscopic exam8
· Biopsy
· Breath
· Urine
, · Serum
· CBC (to check for anemia)
· Stools are tested for occult blood
Collaborative Care
· Elimination of the cause and preventing or avoiding it in the future are generally all that
is needed to treat acute gastritis.
· Bed rest
· NPO status
· IV fluids
· Vomiting
· Diarrhea
· Severe case an NG tube may be placed to either keep stomach empty or for a lavage.
Continue Collaborative Care
· Antiemetics (n/v)
· Antacids
· H2 antagonist (Zantac, Tagment, Prilosec, Prevcaid) This reduces gastric HCL acid
secretion.
· Chronic Gastritis-antibodies
· Patient with pernicious anemia= regular injections of B12
· bland diet
· antacids
Nursing Management
Nursing Assessment
· Dehydration can occur rapidly if patient is vomiting
· Keep patient quiet
· Maintain NPO
· Monitoring IVF
