Peptic Ulcer Disease
What is the cause of PUD??
Erosion of GI mucosa from digestive action of gastric secretions.
Clinical manifestations of GI hemorrhages?
-Bloody emesis or coffee ground
-Black, tarry stools
-Acute: VS changes (BP, HR, LOC)
Stomach Cancer Risk Factors
H. Pylori infection
Autoimmune related inflammation
Diets high in smoked foods, salted fish, meat, and pickled vegetables
Common diagnosis in older adults >68 yoa
Higher risk in Hispanic Americans, African Americans, and Asian/Pacific Islanders
Oral cancer risk factors
any tabacco use
execissive alcohol
Vaccine with HPV
poor oral hygiene
lip exposure to sun
Most common symptom of esophageal Cancer
progressive dysphagia
What are the causes or risk factors for PUD
NSAIDS
H. Pylori bacteria
Stress and depression
Alcohol
Excessive intake of caffeine
Smoking
What are older adults at risk for with a upper GI bleed?
At risk for fluid overload!
-Auscultate breath sounds and observe the respiratory effort
-Monitor for fluid overload
-Keep HOB elevated for comfort and prevent aspiration
-If NG- maintain placement, observe aspirate for blood
golden standard for diagnostic of stomach cancers
Esophagogastroduodenoscopy
Considerations for Oral cancers
Stomatitis- soft food diet
Nutrition
Self image due to disfiguring surgery
Xerostomia- dry mouth
post esophagectomy/laryngectomy what is the major concern we are looking for?
Airway concerns/always assess airway patency
NPO because high risk of aspiration & anastomosis needs time to heal
Intervention for dumping sydrome
-6 small meals
-No fluid with meals
-Avoid concentrated sweets
-Increased protein and fat
-Short rest period after eating
what are some interventions for a GI bleed?
-Keep NPO
-Establish 2 IV accesses (16 ga or 18 ga needle)
-IV NS or LR (priority)
-Transfusion with whole blood (pRBCs)
-IV PPI
-Supplemntal O2 nasal cannula or non-rebreather mask
-Place on ECG monitor
-Obtain labs; CBC, clotting studies, T&C
-Indwelling urinary cath
-NG as needed
Complication of partial gastrectomy or total gastrectomy
Dumping syndrome, postprandial hypoglycemia, bile reflux gastritis, vitamin B12 deficiency
oral cancer manifestations
Ulcers, changes in the mucosa, sore throat and mouth, voice changes
Painless hardened ulcers with raised edges
Weight loss, neck mass, enlarged cervical L-nodes
Increased salivation, slurred speech, toothache, pain on chewing, earache
Esophageal Cancer major complications
Esophageal perforation with fistula formation
Esophageal obstruction, malnutrition, and aspiration
What is Dumping Syndrome?
- Begins 15-30 minutes after eating
- Generalized weakness, sweating, palpitations, dizziness, and abdominal cramps
-Usually lasts less than 1 hour
Causes or risk factors of upper GI bleeds?
- Prolonged use of aspirin, NSAIDS, and corticosteroids
- Esophageal or gastric varcies
-Cancers
General prognosis of stomach cancers
Generally poor (32% five year survival rate)
Major thing to remmeber for post-laryngectomy
ABCs
Post-op care
NG tube will have bloody drainage for 8-12 hr
bloody drainage lasts longer than 12 hr- report!
Swallowing study
Maintain upright position
Turning and deep breathing q2hr
NPO until x-ray shows no esophageal anastomotic leak
What needs to be done for a patient going for an upper endoscopy
- Confirm consent is signed
- NPO after midnight
- Ask about dentures and jewlery
- After procedure instruct pt. to report any blood in BM, severe pain, or a fever
Difference between a Hematemesis and Melena
Hematemesis- Bright red and Massive hemorrhage >1500 mL blood loss
Melena- Black tarry stools with a foul smelling. Slow bleeding from an upper GI source
Ealry stage Manifestations
Abdominal tenderness
Interventions for oral cancers
Surgical resectioning + chemo
Radiation combined with surgery 6 weeks after
Surgery
Risk factors of Esophageal Cancer
Smoking
Alcohol abuse
Injury/chronic irritation of esophagus
Barrett's esophagus
GERD
Poor oral hygiene
Ingestion of hot food or liquids
Obesity
Fam history