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GastroparesisNiccole CouseUniversity of South FloridaCollege of Nursing
Introduction (1)• Gastroparesis is “delayed gastric emptying inthe absence of a mechanical obstruction.”• Commonly caused ...
Pathophysiology (2)• HealthyThe interstitial cells of Cajal of thestomach are stimulated by the Vagusnerve to contract, wh...
Pathophysiology (2)• Disease stateIn gastroparesis the stomach does notcontract so food will sit in thestomach for longer ...
Diagnosis (1)• Gastroparesis can only be diagnosedafter mechanical obstruction is ruled out– Endoscopic and radiologic tec...
Risk Factors (2)• Diabetes– Diabetic neuropathy• Female– Higher Progesterone• Reduces smooth muscle activity• Viral infect...
Signs and Symptoms• Persistent nausea andvomiting• GERD• Constipation anddiarrhea• Abdominal pain• Bloating• Anorexia• Uni...
Treatments (1)• Dietary management– Dietary consult with patient– Evauate best tolerated foods– Reduce meal size and small...
Treatments• Medications– Prokinetic drugs (1)• Metoclopramide• Erythromycin• domperidone– Botulinum toxin injections (Boto...
Treatments• NG/NJ tube placement– If dietary changes and medications areineffective than an NG/NJ tube may beplaced to pro...
Treatments• Surgery– PEG-J tubes (1)• Allows food to skip the stomach• Relievs symptoms• Improves nutritional status in “8...
Gastric Pacemaker
Prognosis (4)• Many people with gastroparesis areable to live normally with long-termprokinetic therapy• Patients with gas...
Clinical Example• Admission Dx: intractable vomiting• Other diagnoses:– Gastroparesis– Chronic gastritis– Barrett esophagi...
Clinical Example• HPI:– 40y white female– Has been experiencing persistent nauseaand vomiting for the past six months• Thr...
Clinical Example• Medications– 0.9%NaCl IV– Pregabalin – pain– Baclofen – pain/fibromyalgia– Omeprazole – healing of erosi...
Assessment• Inspect– Swelling, abdominal distention, tenderness– Fluid output– Daily Weights• Auscultate– Presence of bowe...
Nursing Diagnosis• Risk for deficient fluid volume• Impaired nutrition: less than bodyrequirements• Risk for electrolyte i...
NCLEX style question• A client with diabetes has beendiagnosed with gastroparesis. Thenurse realizes this is considereda) ...
NCLEX style question• A client with diabetes has beendiagnosed with gastroparesis. Thenurse realizes this is considereda) ...
NCLEX style question• Which of the following treatmentswould NOT be appropriate for a clientwith gastroparesis?a) Botulinu...
NCLEX style question• Which of the following treatmentswould NOT be appropriate for a clientwith gastroparesis?a) Botulinu...
References(1) Athwal, V., Keld, R., Kinsley, L., & Lal,S. (2011). Pathogenesis, investigation and dietaryand medical manag...
Gastroparesis case study (2)
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Gastroparesis case study (2)

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Gastroparesis case study (2)

  1. 1. GastroparesisNiccole CouseUniversity of South FloridaCollege of Nursing
  2. 2. Introduction (1)• Gastroparesis is “delayed gastric emptying inthe absence of a mechanical obstruction.”• Commonly caused by autonomic neuropathy– Other causes are stress, infection, post-op• Occurrence in “0.01%” of men and “0.04%” ofwomen.– “36-49%” Idiopathic– “25-29%” Diabetes mellitus– “7-13%” Post surgical• Prognosis depends on the cause
  3. 3. Pathophysiology (2)• HealthyThe interstitial cells of Cajal of thestomach are stimulated by the Vagusnerve to contract, which churns anddigests food and stimulatesperistalsis.
  4. 4. Pathophysiology (2)• Disease stateIn gastroparesis the stomach does notcontract so food will sit in thestomach for longer than normal.The main cause is usually neuropathy!– The stomach does not get the signal tocontract
  5. 5. Diagnosis (1)• Gastroparesis can only be diagnosedafter mechanical obstruction is ruled out– Endoscopic and radiologic techniques used.• MRI, Ultrasound, EGG– Scintigraphy is “gold standard” for diagnosis• Ingest “radiolabelled meal” and check for residueat certain times• “Positive if more than 60% residual ingested mealcontent is detected within the stomach after 2 h,or more than 10% residual content is detected at4 h.”
  6. 6. Risk Factors (2)• Diabetes– Diabetic neuropathy• Female– Higher Progesterone• Reduces smooth muscle activity• Viral infections– Certain viruses can lead to damage to thestomach
  7. 7. Signs and Symptoms• Persistent nausea andvomiting• GERD• Constipation anddiarrhea• Abdominal pain• Bloating• Anorexia• Unintended weightloss• Inconsistent bloodglucose levels
  8. 8. Treatments (1)• Dietary management– Dietary consult with patient– Evauate best tolerated foods– Reduce meal size and smaller pieces offood– Low fat (liquid if needed)– No alcohol or carbonated beverages– Fiber consumption is debated• Most agree that insoluble fiber should beavoided
  9. 9. Treatments• Medications– Prokinetic drugs (1)• Metoclopramide• Erythromycin• domperidone– Botulinum toxin injections (Botox) (1)• Relaxes smooth muscle• Injected into pyloric sphyncter allows foreasier passage of food into the duodenum
  10. 10. Treatments• NG/NJ tube placement– If dietary changes and medications areineffective than an NG/NJ tube may beplaced to provide nutrition• Parenteral nutrition– May be considered– Weigh the risks of infection andthrombosis
  11. 11. Treatments• Surgery– PEG-J tubes (1)• Allows food to skip the stomach• Relievs symptoms• Improves nutritional status in “83%” of patients– Gastric pacemaker (3)• Electrical stimulation of the stomach• High frequency stimulation is shown to reducenausea and vomiting• Low frequency stimulation is shown to increasemotility and peristalsis
  12. 12. Gastric Pacemaker
  13. 13. Prognosis (4)• Many people with gastroparesis areable to live normally with long-termprokinetic therapy• Patients with gastroparesis caused bydiabetes often require a more seriousintervention along with prokinetictherapy
  14. 14. Clinical Example• Admission Dx: intractable vomiting• Other diagnoses:– Gastroparesis– Chronic gastritis– Barrett esophagitis– Fibromyalgia– hyperthyroidism
  15. 15. Clinical Example• HPI:– 40y white female– Has been experiencing persistent nauseaand vomiting for the past six months• Throws up at least once a day– Complains that she “can’t keep anythingdown”– Patient states that the nausea is constant– Patient denies any aggravating factors– Patient smokes marijuana and cigarettes
  16. 16. Clinical Example• Medications– 0.9%NaCl IV– Pregabalin – pain– Baclofen – pain/fibromyalgia– Omeprazole – healing of erosive esophagitis– Milnacipran – fibromyalgia management– Odansetron – nausea prevention– Lorazepam – anxiety• Current therapies– Full liquid diet– Strict monitoring of I & O– Vitals Q6H– Glucose monitoring at meal time
  17. 17. Assessment• Inspect– Swelling, abdominal distention, tenderness– Fluid output– Daily Weights• Auscultate– Presence of bowel sounds• Percuss– Tympany• Palpate– Pain, tenderness, masses
  18. 18. Nursing Diagnosis• Risk for deficient fluid volume• Impaired nutrition: less than bodyrequirements• Risk for electrolyte imbalance
  19. 19. NCLEX style question• A client with diabetes has beendiagnosed with gastroparesis. Thenurse realizes this is considereda) A long-term complication of diabeticneuropathy.b) A symptom of microvascular diseasec) A precursor to long-term woundinfections.d) A precursor to renal failure
  20. 20. NCLEX style question• A client with diabetes has beendiagnosed with gastroparesis. Thenurse realizes this is considereda) A LONG-TERM COMPLICATION OFDIABETIC NEUROPATHY.b) A symptom of microvascular diseasec) A precursor to long-term woundinfections.d) A precursor to renal failure
  21. 21. NCLEX style question• Which of the following treatmentswould NOT be appropriate for a clientwith gastroparesis?a) Botulinum Toxin injectionb) Bowel diversion surgeryc) NJ tube feedingsd) Gastric Electrical Stimulation/Pacemaker
  22. 22. NCLEX style question• Which of the following treatmentswould NOT be appropriate for a clientwith gastroparesis?a) Botulinum Toxin injectionb) BOWEL DIVERSION SURGERYc) NJ tube feedingsd) Gastric Electrical Stimulation/Pacemaker
  23. 23. References(1) Athwal, V., Keld, R., Kinsley, L., & Lal,S. (2011). Pathogenesis, investigation and dietaryand medical management of gastroparesis. Journal of Human Nutrition andDietetics, volume 24(issue5). DOI: 10.1111/j.1365-277X.2011.01190.x(2) Buckle D.C. Treatment of Gastroparesis in the Age of the Gastric Pacemaker: GastricElectrical Stimulation. Retrieved fromhttp://www.medscape.com/viewarticle/460632(3) Lin,Z. Forester, J. Sarosiek, I. & McCallum, W. Treatment of Gastroparesis with ElectricalStimulation. Digestive Diseases and Disorders, volume 48(issue5). DOI DOI:10.1023/A:1023099206939(4) Rayner, C. & Horowitz, M. New Management Approaches for gastroparesis. Medscape.Retrieved from http://www.medscape.com/viewarticle/514206_8

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