lecture week 2-1

8/6/2019 Lecture Week 2-1

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Hiatal Hernia

A hiatal hernia is a condition in whichthe upper part of the stomach moves

up through a small opening in the

diaphragm into the chest. Thediaphragm is the muscular wall that

separates the abdominal cavity from

the chest cavity.


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The different types of hiatal hernias include:Sliding hiatal herniaThe most common type

in which the herniated part of the stomach

slides back and forth, into and out of the chest.

Fixed hiatal herniaThe upper part of the

stomach permanently remains in the chest.

Complicated hiatal herniaSeveral other

types of stomach herniation may be seen.These are uncommon but more serious and

may require surgery.


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CausesMany people are born with the hiatal hernia but the cause is

still unknown. It may result from a weakening of the supportive

tissues.

Risk Factors

Age: 50 or older

Obesity

Smoking

Pregnancy

Abdominal injury


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SymptomsHeartburn, especially after eating or lying down

Pain or discomfort in the stomach, chest, or

esophagus (swallowing tube)

Belching

Hoarseness

Throat irritation (frequent clearing of the throat)

Chest painDifficulty swallowing

Bleeding from the stomach or esophagus


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Diagnosis

Upper GI series

Endoscopy

treatment

Weight Loss

Dietary ChangesAvoid foods that can relax the muscle that controls the opening

between the esophagus and the stomach including:

Chocolate

Peppermint

Fatty foods

Coffee

Alcoholic beverages


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Avoid foods and beverages that canirritate the internal lining of the

esophagus, such as:

CaffeineCitrus fruits and juices

Tomato products

Hot peppersCarbonated beverages


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To minimize acid reflux:

Consume smaller meals 4 to 6 times a

day versus three large mealsAvoid drinking large amounts of fluids

with meals

Do not eat within 2 to 3 hours of bedtime


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Smoking CessationIf you smoke, stop. Smoking weakens the lower

esophageal sphincter, a muscle that controls the

opening between the esophagus and the stomach.

Reduce Pressure on Your AbdomenWear clothes and belts that are loose around your

waist

Avoid stooping or bending after meals, which puts

increased pressure on the abdomen


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Medical management

For chronic reflux and heartburn, several types ofmedications may be prescribed to reduce acid in the

stomach. These include:

H2 blockers such as:

yCimetidine

yFamotidine

yNizatidine

yRanitidine

Proton pump inhibitors such as:

yOmeprazoleyEsomeprazole

yLansoprazole

yPantoprazole

yRabeprazole


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Surgery

Hernioraphy

hernioplasty


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Esophageal CancerSquamous cell carcinoma or adenocarcinoma of

the esophageal mucosa.Incidence is 3 times higher in males compared to

females.

Higher in African Americans


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Etiology and Risk factors

Cause is unknown

Smoking

Alcohol consumptionHuman papillomavirus

Smoked meats

Poor nutritional intake of vitamins A andC and minerals


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Clinical ManifestationsDysphagia

Pain

Swallowing problems

Loss appetite

MalaiseIncrease salivation

Nocturnal aspiration


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Diagnosis

Endoscopy with biopsy

CT scanPET (positron emission test) scan


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GastritisGastritis is a term that encompasses a series of

conditions that present with inflammation of the

gastric mucosa.


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Acute GastritisEtiology and risk factors

Bacterial causes: h. pylori, e. coli,

proteus, haemophilus, streptococci,staphylococcus.

Acute alcoholism

Aspirin and NSAIDHIV/AIDS

Excessive amounts of tea and coffee

Mustard and pepper


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Clinical manifestation

Burning or aching abdominal

tenderness

CrampingBelching

Reflux

Severe nausea and vomitingHematemesis uncommon


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Medical management

Anti emetics

H2 blockersSucralfate


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Chronic gastritisStages:

Superficial gastritis- inflammatory changes are

limited to surface mucosa, which causes an

erythemic, edematous mucosa, with small erosionsAtrophic gastritis- inflammation extends deeper in the

mucosa with progressive glandular destruction

Hypertrophic gastritis- inflammatory infiltrates

produce a dull nodular mucosa with irregular,thickened and irregular ruggae.


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Clinical manifestations

Gnawing or burning pain

Nausea and vomitingLoss of appetite

Weigh loss

Belching


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ComplicationsBleeding

Pernicious anemia

Gastric cancerMedical management

Aluminum hydroxide with magnesium

carbonate (gaviscon)


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Surgical management

Subtotal gastrectomy

Pyloroplasty

Vagotomy


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Peptic Ulcerdisease


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Involves the disruption of continuity of thelower esophageal, gastric or duodenal

mucosa, leading to a local defect resulting to

inflammation

Gastric Ulcer

Duodenal Ulcer


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Causes


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Risk Factors

Age: 60 or older

Sex: male

Race: Black and HispanicLower socio-economic group

A crowded and unsanitary living

environmentCigarette smoking

Family history of ulcer disease


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Symptoms include:

Gnawing pain

May awaken you from sleep

May change when you eat

May last for a few minutes or several hoursFeels like unusually strong hunger pangs

Nausea

Vomiting

Loss of appetite

Bloating

Burping


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Duodenal Ulcer


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Diagnosis

Rectal exam and stool guaiac test

Blood test or breath testUpper GI series

Endoscopy


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Medications may include:

Antacidsthey do not heal ulcers, but may

provide some relief from heartburn

Antibiotics (amoxicillin, tetracycline, and

clarithromycin)

Bismuth-containing drug (Pepto-Bismol)

Proton pump inhibitorsto decrease stomach acid

production (omeprazole, lansoprazole)

H 2 blockersto decrease stomach acid

production (famotidine, ranitidine, cimetidine,

nizatidine)

Medications to coat ulcer (sucralfate)

Medications to protect stomach against NSAID

dama e miso rostol


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Lifestyle ChangesIf you smoke, quit. Smoking interferes with ulcer

healing.

Do not drink alcoholic beverages.

Avoid NSAIDS, including over-the-counter drugslike aspirin and ibuprofen.

If spicy or fatty foods worsen symptoms, you can

temporarily stop eating them. Keep in mind they did

not cause the ulcer and probably do not affect ulcerhealing.

If stress increases ulcer pain, learn and practice

stress-management techniques.


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Surgical Management

Endoscopy

Vagotomy

Gastroduodenoscopy

Gastrojejunoscopy

Highly elective vagotomy

Vagotomy with antrectomy


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Complications of gastricsurgeries

Marginal ulcerHemorrhage

Alkaline reflux disease

Acute gastric dilationDumping syndrome


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Gastric

cancerRefers to the malignant neoplasms foundin the stomach, usually adenocarcinoma.


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signs and symptomsEarly

Indigestion or a burning sensation (heartburn)

Loss of appetite, especially for meat

LateAbdominal pain or discomfort in the upper abdomen

Nausea and vomiting

Diarrhea or constipation

Bloating of the stomach after meals

Weight lossWeakness and fatigue

Bleeding (vomiting blood or having blood in the stool), which

can lead to anemia

Dysphagia;


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DiagnosisGastroscopic exam

Upper GI seriesComputed tomography

Biopsy


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TreatmentChemotherapy

Radiation therapy

Surgery - Billroth I or Billroth II


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DiverticulaEsophageal diverticulum is a sac-like outpouching in one or

more layers of the esophagus.


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Etiology and Risk factorsCongenital defects

TraumaScar tissue

Inflammation


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Clinical manifestations

Dysphagia

Aspiration of fluidsRegurgitation in the mouth

HalitosisSour taste in the mouth


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DiagnosisBarium swallow

EGD

Medical managementPrevent reflux of food raise the

head of bead for 2 hours after meals.

Avoid constrictive clothes andvigorous exercise after eating.


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Surgical management

Excision of diverticulum

Nursing managementMaintain nasogastric tube

Promote comfort

lecture week 2-1

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