APR 22, 2022 GERD – Gastroesophageal reflux Causes: 1. incompetent lower esophageal sphincter 2. aging 3. CASHT (caffeine, alcohol, spicy, hot food, TOMATO-BASED FOOD) 4. hiatal hernia Mechanism - Nagkakaroon ng acid backflow Feeling of fullness -nagkka Peptic ulcer Disease - Caused by H-pylori infection Mgt. - give antibiotics and lanzoprezole - PPI - antibiotics: amoxicillin or clarithromycin DIVIDED INTO TWO: 1. Gastric ulcer – because of long-term use of NSAIDs -- because of hposecretion of HCl - pain (during meals or after meals, 30 mins to 1 hr upon eating) - relief: pag nagvomit client patient magdedehydrate, mawawala ang fluids and electrolytes. Main proble,: fluid and electrolyte imbalance, for admission and patient kasi mawawala ang postassium at manghihina ang patient. - Hcl injury to mucosal lining (stomach) : magkakaroon ng hematemesis DUODENAL ULCER - Aldo called zylinger elison syndrome Mechanism There is hypersecretion of HCl Arrow Pain after meals (2-4 hours) A Relief: A Weight gain. 1. avoid NSAIDs 2. avoid aspirin (bc of bleeding) 3. avoid CASH-T 4. have small frequent bleeding 5. give prev pac - 2 antibiotuic – 1PPI 6. institute bleeding precaution 7. blood transfusion as ordered 8. give upper Gi meds 9. monitor HCT and HGB Hiatal Hernia - The sphincter is protruded above the hiatus/diaphragm that causes acid reflux Mgt and Surgery - Nissen Fundoplication or they call this Gastric Wrap Around wherein the fundus is wrapped around the esophagus to strengthen the cardiac sphincter. GASTRIC SURGERIES 1. Total – wherein the stomach is removed 2. Partial – a part of the stomach is removed Partial: Billroth 1 – this is the gastroduodenostomy Billroth II - gastrojejunostomy *First two is called Gastrectomy Vagotomy – resection of the vagus nerve Vagus nerve is cranial number number X - VAGUS NERVE PLAYS A ROLE IN DIGESTION Plays a production of hydrochloric acid (HCl) Most complex nerve because it innervates a lot of our organs Pag naresection: magdedecrease and Hcl reaction and production Effects of Gastrostomy 1. dumping syndrome – it happens because of post-gastrectomy - nagkakaroon ng rapid gastric emptying - increase bulk of digestive food - kaya there is feeling of fullness - at magkakaron ng hypoglycemia ang patient Early Stage: this would occur within 3o mins after eating - Client woul experience shock kapag hindi nagawan ng paraan like symptoms of tachycardia, hypotension, palpitations and nausea and vomiting Position px in low-fowler’s position during eating Supine position – after eating Late Stage: occurs within 1-4 hours after eating - Client may precipitate hypoglycemia Would require low carbs Need to increase protein and fats Have to drink in between meals 2. Pernicious anemia - this is due to post-gastrectomy Removal of parietal cells -no intrinsic factor production - no vit. B12 absorption Procedure should be done para makakain Percutaneous endoscopic gastrostomy (PEG feeding) 1. explain the procedure 2. wash hands 3. provide privacy 4. assemble materials 5. position the pt in semi-fowler’s position 6. wear clean gloves 7. place towel on the abdomen 8. check for placement and bowel sounds (find burburigmic sound) 9. unclamp and aspirate gastric residual 10. pinch the proximal end of the tube 11. flush with 30 ml of water 12. administer feeding 13. flush with 60 ml water thereafter 14. reclamp If there is absent bowel sound – stop feeding and notify physician Px must have more than 100 ml na feeding Pag matigas yung tiyan, notify physician and ask kung tumae na.
