AMS1

• Acidic Environment
• H. Pylori (heliobacter pylori)
• Medications (ASA, NSAIDS, Steroids)
• Lifestyle Factors
• Other Factors

• Duodenal-80%
• Intermittent, dull pain 2-5 hrs. post meal
• Burning/Cramping pain
• Pyrosis (Heartburn)
• Nighttime pain
• Relieved by eating or taking antacids
• Periodic/episodic
• Perforation/Hemorrhage/Obstruction
• Gastric
• Pain 1-2 hrs. after meal
• Burning or bloated
• Nausea/Vomiting
• Early Satiety/Weight loss
• Associated with NSAID use
• Food aggravates pain
• Perforation/Hemorrhage/ Obstruction

• H/P
• Upper GI X-ray with contrast
• Esophagogastroduodenoscopy (EGD)
• Occult Blood
• H. Pylori Tests (Urease)
• CBC
• Liver Enzymes
• Serum Amylase
• H/H

• Rest
• Diet Modifications
• Multiple meals
• No smoking or Etoh
• Drug therapy- PPI, H2 Blocker, antacids, antibiotics
• Stress reduction
• Blood transfusion
• Surgery
• Nutritional therapy

• Hemorrhage-- Most Common
• Perforation--Most Lethal
• Gastric Outlet Obstruction

Signs/Symptoms





Change in vital signs






Pain decreases





Management





Maintain NPO






Anticipate procedure/surgery






Post-surgical might see bleeding in the NG aspirate






Important to maintain patency of NG tube

• SnSs
• Sudden severe abdominal pain
• Boardlike abdomen
• Drawing up of knees
• Shallow/grunting respirations
• Diminished/absent bowel sounds
• Management
• Notify MD urgently
• Anticipate surgery
• Make NPO
• IV Fluids
• NG tube
• Pain Meds
• Antibiotics

• SnSs
• Abdominal pain (worse later in day)
• Vomiting (old food, projectile, offensive odor)
• Management
• NG tube to decompress stomach
• Keep NG tube patent (irrigate, reposition)
• Measure gastric residuals
• IV fluids/electrolytes
• Meds-PPI, H2 blocker if ulcer related
• I&O
• Pyloric obstruction=balloon dilation

• Billroth I (gastroduodenostomy): partial 2/3 gastric resection and reanastomosis to duodenum
• Billroth II (gastrojejunostomy): partial 2/3 gastric resection and reanastomosis to jejunum
• Vagotomy: severing of vagus nerve-decrease gastric acid secretion
• Pyloroplasty: urgical enlargement of pyloric sphincter-facilitates easy passage of contents out of stomach. Usually done after vagotomy b/c vagotomy decreases gastric motility and gastric emptying

• NG tube: assess patency, drainage (color, amount, odor)
• --ESSENTIAL FOR NG TUBE TO REMAIN PATENT!
• ----Rupture of sutures
• ----Leakage of gastric contents into peritoneal cavity
• ----Abscess formation
• ----Hemorrhage
• GI Assessment
• Incision
• Pain control
• IV fluids
• C&DB (splinting), IS, other general Post-op care

• Dumping Syndrome (test)
• --Bolus of Hypertonic Fluid in intestines
• --Sudden shift of fluid from plasma to intestines
• --Weak, diaphoretic, dizzy, palpitations
• Postprandial Hypoglycemia
• --Bolus of high carbs into intestines
• --Release of excessive amt of insulin
• Bile Reflux Gastritis
• --Pyloric surgery allows bile reflux
• --Pain after meals, vomiting helps
• --Questran (cholestyramine)-binds bile salts

• Tarry stools
• Signs of anemia
• Nutritional status
• Weight
• Complications
• Pain status
• Pain relief effectiveness
• Pharmacological effectiveness

Delayed gastric emptying & increased NSAID use.