Peptic Ulcer Disease
What is Peptic Ulcer Disease? Most common place for a peptic ulcer?
-A hollowewd-out area in the mucosa of the stomach, duodenum, or esophagus.
-Most common place is the duodenum
What is GERD? What does it stand for?
Gastroesophageal Reflux Disease
-Disorder involving the back flow of duodenal or gastric contents causing mucosal injury to the esophagus.
What is Pyloric Stenosis? When does it usually occur?
-An uncommon condition in infants that blocks food from entering the small intestine.
-Usually occurs in the first weeks of life.
-Genetic predisposition
What is a cleft lip/cleft palate?
-a split in the lip and roof of the mouth (palate) that affects one or both sides of the face.
-a split in the lips that appears as only a small notch in the lip or extends from the lip through the upper gum and palate into the bottom of the nose.
-a split in the roof of the mouth that doesn't affect the appearance of the face.
What is EA/TEF (Esophageal Atresia) and Tracheoesophageal fistula?
EA/TEF (Esophageal Atresia): a birth defect in which baby is born without part of their esophagus. Instead of the esophagus connecting the stomach and the mouth, it grows in 2 segments and does NOT connect.
Tracheoesophageal Fistula: Abnormal connection between the esophagus and trachea. Results in swallowed liquids being aspirated into the lungs.
Causes of a PUD (Peptic Ulcer Disease)?
-NSAID or corticosteroid use
-Severe stress
-Smoking and alcohol use
-Familial tendency
-Type O blood
-Zollinger-Ellison syndrome
Risk factors for GERD
-Excessive intake of fatty foods, spicy foods, peppermint, tomatoes, citrus fruits, fatty or fried foods, or alcohol
-Frequent abdominal distention from overeating
-Obesity, pregnancy
-Taking medications that relax the lower esophageal sphincter
-Lying flat (especially after big meal)
-H. pylori
-NSAIDS
-Stress
Clinical Manifestations of Pyloric Stenosis
-Vomiting after feedings (projectile)
-Persistant hunger
-Olive shaped mass in RUQ
-Visible stomach contractions
-Dehydration
-Changes in bowel movements
-Weight problems
Complications of a cleft lip/cleft palate
-Difficulty feeding: most babies with cleft lip can breast-feed, a cleft palate may make sucking difficult.
-Ear infections and hearing loss: babies with cleft palate are especially at risk for developing middle ear fluid and hearing loss.
-Dental problems: if the cleft extends through the upper gum, tooth development may be affected.
-Speech difficulties: Palate is used for forming sounds, so development of normal speech may be affected. Speech may sound too nasal.
-Challenges of coping with a medical condition: May face social, emotional and behavioral problems due to differences in appearance and the stress of intensive medical care.
Clinical manifestations of Esophageal Atresia
-Coughing and choking when eating
-Difficulty breathing
-Blue color of skin especially when eating
-Frothy bubbles in babys mouth
-NG tube won't go in
Clinical Manifestations of Peptic Ulcer Disease
-Dull, gnawing, burning pain that occurs in the back or mid epigastrium.
-Heart burn (Dyspepsia)
-Nausea and vomiting
-Abdominal distention
-Weight loss
-Bloody emesis or stools
Clinical manifestations of GERD (Adults, Children younger than 1yo, Children 1-5yo)
-Adults complain primarily of heartburn, which usually occurs after meals, when bending over, or when reclining.
Children younger than 1yo may experience spitting up, vomiting, irritability, poor weight gain, and arching of the back during feedings.
-Children ages 1-5 may vomit, have abdominal or chest pain, exhibit poor weight gain, and refuse to eat or have aversion to food.
-GERD may result in pulmonary complications, dental erosion, laryngeal damage, and esophageal strictures.
Diagnosis tests for Pyloric Stenosis
-Abdominal Ultrasound
-Upper Gastrointestinal Study (and X-ray)
LABS:
-Electrolytes
-BUN and creatinine
-HGB, HCT
Feeding for cleft lip and cleft palate
Cleft lip: Encourage breast feeding, use wide based nipple for bottle feeding, squeeze cheeks during feeding to decrease the gap.
Cleft palate: Position upright and cradle head while feeding, use a specialized bottle with a one way valve, burp frequently, may be necessary to syringe feed if unsuccessful otherwise.
Clinical manifestations of Tracheoesophageal Fistula
-Coughing while feeding
-Ling infections (aspirating milk/food)
-May not show symptoms at birth
Signs of a Gastric Ulcer
-Onset 30-60 minutes after eating
-pain occurs more in the daytime
-pain is worse when eating food (stomach acid gets ramped up)
-Malnourishment (don't want to eat bc it causes pain)
-Hematemesis (bloody vomit)
S/S of GERD
-Radiating pain to neck or jaw
-Pyrosis (burning sensation in esophagus)
-Worsening pain when changing positions
-Throat irritation
-Increased burping or flatus (farting)
-Pain relief from drinking water or taking antacids (TUMS)
-Dental caries
-wheezing and chest congestion
-Usually have manifestations 4-5 times per week
Treatment for pyloric stenosis (how is it done?) What are some preop considerations?
-Pyloromyotomy: typically done laparoscopically. Surgeon cuts through the thickened layer of pylorus and opens channel for food to flow through.
Preop Considerations:
-IV fluids (due to electrolyte imbalances)
-NG tube for decompression of stomach
-NPO
-Monitor I and O
-Daily weights
Diagnosis for cleft lip/cleft palate (when is usually found) and what are some major goals?
-Most cases of cleft lip and cleft palate are noticed right away at birth and don't require special tests for diagnosis. Increasingly, cleft lip and cleft palate are seen on ultrasound before the baby is born.
Major goals:
-Maintained adequate nutrition
-Increased family coping
-Reduced parents anxiety and guilt regarding the newborns physical defect.
Diagnosis and treatment for Esophageal Atresia
-Diagnosed with X-RAY
Treatment:
-Foker Process
-Jejunal interposition
Signs of a Duodenal Ulcer
-Onset of pain 1.5-3 hours
-Pain wastes patient up at night
-Pain relieved by the ingestion of food
-Well nourished (eating to relieve pain)
-Melena (bloody stools)
Complications of GERD
-Esophageal strictures (narrowed spots in esophagus, difficulty swallowing)
-Barrett esophagus (more common in men <50)
-Aspiration
Nursing care for Pyloric Stenosis
-Meet fluid and electrolyte needs
-Minimize weight loss
-Promote comfort and rest
-Prevent infection
-Provide supportive care and home teaching
Surgical treatment for cleft lip/cleft palate and when do they occur? What is the goal of surgical treatment?
GOAL: to improve the Childs ability to eat, speak and hear normally and to achieve a normal facial appearance.
Cleft lip repair- within the first 2-3 months of age.
Cleft palate repair- between the first 6-12 months of age.
Follow up surgeries- between age 2 and late teen years.
Diagnosis and treatment for Tracheoesophageal fistula
-Diagnosed with X-RAYs, endoscopy, or bronchoscopy.
Treatment:
-Surgery: incision made in Childs neck or back depending on the location . Fistula is divided and then connection is closed.