UPPER GI DISORDERSNursing Care of Oral Disorders- Oral Assessment - Avoid irritantsPromote comfort and Manage pain- Encourage a supportive nutrition- Dietary teaching : - Foods to avoid: acidic foods, foods difficult to chew or swallow- Foods to choose: easy to chew and swallow, with adequate protein - Give oral analgesia 30-45 min before meals- Give small, frequent feedingsNursing Care of Oral Disorders (continued)• Oral care– Warm saline– Avoid harsh mouthwash (soft toothettes)– Relieve mouth dryness– Post op interventions– Maintain patent airway– Monitor for bleeding– Administer supplemental nutrition– Promote effective forms of communicationEsophageal Disorders• Dysphagia– Difficulty swallowing– Clinical manifestation of an esophageal disorder– Obstructive cause• Tumors• Congenital defects• Hiatal hernia– Motility cause• Diabetes• Parkinson’s disease• StrokeEsophageal Disorders- Regurgitation -incompetent lower esophageal sphincter (LES)- Acute pain- gastric vs. cardiac- Dyspepsia- reflux- Achalasia: incomplete relaxation of Lower Esophageal Sphincter (LES)o Motor disordero Cause unknowno < motility of lower 2/3 of esophaguso Dysphagia, emesis, progression of frequencyo Management Surgical: PEG, PEJ tubes, LES dilation Relax smooth muscle Small frequent feedings Semi-fowlers position; head of bed upGastro esophageal Reflux Disease GERD- Backward flow of GI contents into esophagus and stomach acid irritates lining- Caused by relaxed Lower esophageal sphincter (LES)- Associated with obesity, pregnancy, smoking, excessive intake of caffeine/chocolate, and ETOHSymptoms of GERD- Heartburn, dysphagia, salty secretions in mouth - Pain is described as burning that moves up and down- If severe, may radiate to neck, back, jaw and mimic a cardiac episode- Pain relieved by fluids or antacidsTreatment of GERDAdminister Medications: Antacids, H2 receptor antagonists, proton pump inhibitorsTeach about needed Lifestyle changes: • Small frequent meals• Eat slowly and drink fluids between bites• Avoid certain foods to  acid production such as: hot, spicy, fatty foods, alcohol, chocolate, citrus juices • Sleep with HOB  6-8 inches• Loose weight if overweight• Remain upright 3 hours after mealsMedications for GERD• Antacids– 1 hr. ac or 2-3 hr. pc– Relief 10-30 minutes– Neutralizes gastric acid– Soothes mucosal lining• H2 receptor blockers– 1 hr. before or after antacids BID– Taper to PRN– Inhibit histamine in the parietal cells– Proton Pump Inhibitors– Treatment failure – 30 minutes ac daily– Control acid secretion• Antiemetic cholinergic– Increases LES pressure– Increases gastric emptying– 30-60 minutes acHiatal Hernia• Part of stomach protrudes through diaphragm into thoracic cavity• Type I: Sliding – upper stomach & GE displaced upward into thorax (most common)• Type II: Rolling– GE junction stays below diaphragmNursing Care With Hiatal Hernia• Surgical Repair: Nissen fundoplication, or Ant reflux prosthesis • Major surgeries requiring opening of abdomen and thorax• Recovery time can be extensive• Post operative care after surgical intervention • Prevent respiratory complications• Prevent gas-bloat syndrome• Care of tubesEsophageal Cancer- Squamous cello Alcohol useo Smokingo HPV- Adenocarcinomao Barrett’s Esophaguso Obesityo Ingestion of smoked meatso Vitamin A & C deficiency Esophageal Cancer (continued)• Symptoms– progressive dysphagia– a severe sensation of burning squeezing pain while swallowing– Pain• 5 year survival rate 15%• Treatment depends on– Tumor size/location– Metastases– Status of patientClinical Manifestations of GI Dysfunction- Pain- Anorexia- Nausea and vomiting- Bleeding- Diarrhea- Belching and flatulence- IndigestionAcute Gastritis• Inflammation of gastric mucosa: breakdown in mucous lining• Incidence ↑ with age• At risk• Heavy smokers• Drinkers of ETOH• Use of Aspirin and NSAID’s• Signs & Symptoms• Severe N & V, abd tenderness, epigastric burning, aching, bleeding, diarrhea• Keep patient NPO until symptoms ease, then slowly increase dietChronic Gastritis• Type A (autoimmune)– Fundus of the stomach– Loss of parietal cells• Type B (most common)– H.Pylori– Peptic Ulcer Disease (PUD)– Gastric surgery• Complications: bleeding, pernicious anemia, gastric cancerNursing Management of Gastritis• Treat symptoms• Reduce pain• Reduce stress if possible• Teach about the causes• Encourage medical follow-up• Promote self care– Medication adherence– Adequate nutrition– avoid smoking, ETOHPeptic Ulcer Disease• Seen in all parts of upper GI tract• 90% caused by Helicobacter pylori bacteria • HELIVAX vaccine (2003)• Aspirin & NSAID’s breakdown gastric lining, allowing acids to damage mucosa• Stress stimulates vagus nerve, ↑ acid production, ↑ gastric motility– Stress ulcers occur in critically ill patients Aggressive v. Defensive Factors• Aggressive factors– Stomach acid– H. pylori– Smoking– Alcohol– Spicy foods• Defensive factors– Mucous – Adequate blood flow to stomach lining– Balanced dietSymptoms of GI Ulcer- Acute pain – burning, gnawing, cramping- Gastric ulcer – food causes pain, vomiting relieves pain- Duodenal ulcer – pain on empty stomach, food eases pain- N & V most freq in gastric ulcers- Bleeding if ulcer erodes through blood vessel see next slideTreatment Goal for GI Ulcer• Eliminate h. pylori- aggresive• Decrease acid production- aggressive• Strengthen mucous barrier- defensive• Modify diet– Coffee, ETOH, protein foods, milk• Treat/Prevent complications– Hemorrhage– Perforation– ObstructionMedical Treatment of GI Ulcers• Triple therapy for H Pylori– Biaxin (antibacterial)– Flagyl (antibacterial)– Prilosec (proton pump inhibitor)• Hypo secretory agents– H2 receptor blockers: Zantac, Pepcid, etc.– Prostaglandin analog: Cytotec •  acid,  mucous– Proton Pump Inhibitor (PPI): Prilosec or omeprazole– Antacids (neutralize gastric acid): Mylanta– Mucosal barrier fortifier: Carafate • increase healingNursing Care for GI Ulcers• Manage pain (no ASA, NSAID’s)• Promote rest and relaxation (< stress)• Encourage small frequent meals• Teach about causes & prevention; discuss stress reduction• ASA, NSAID, steroids and ACTH are ulcer causing. Advise patient to– discuss