Treatment• 1. Restrict diet into small frequent feedings.• 2. Drink adequate fluid at meals to assist food passage.• 3. Eat slowly and chew thoroughly to add saliva to the food• 4. Avoid extremely hot or cold food, spices, fats, alcohol, coffee, chocolate & citrus juices.
Medications• Cytotec- preventing gastric ulcer formation & GERD manifestation• Antacids (30 ml 1hr before and 2 to 3hrs after meal) it helps to neutralize gastric acid secretions.• Histamine receptors antagonist• (zantac, pepcid) – It decreases gastric secretions.• Cholinergic ( bethanechol or urecholine) – for clients with severe manifestation it increase LES pressure and prevent reflux• Metoclopramide (raglan)- increase LES pressure by stimulating the smooth muscle of GIT and increase the rate of gastric emptying. This medication is taken before meal.• Cisapride (propulsid) 15min before meal and at bed time.• Proton pump inhibitor (prevacid) – suppresses secretion of gastric acid,
Nursing management• Identify specific manifestation• Document when sign and symptoms started ( frequency & severity)• Help client to identify risk factors for GERD• Instruct clients about lifestyle change• Explain the relationship of manifestation to food and various product.
PEPTIC ULCER DISEASE (PUD)- PUD involves break in continuity of theesophageal, gastric or duodenal mucosa
DUODENAL ULCER• Duodenal ulcer has an increase incidence than gastric ulcers.
Clinical Manifestation• Pain- aching, burning, cramp, gnawing pain• Gastric ulcer - food may cause pain and vomiting may relieve it.• Duodenal ulcer- empty stomach and ingestion of food or antacid may relieve pain.• Nausea and Vomiting – vomiting is more often in gastric ulcer• Gastric ulcer – anorexia, weight loss and dysphagia• Bleeding
Diagnosis• X-ray and Endoscopy• CBC• Stool testing• Urea Breath Test
GASTRIC CANCER• Gastric cancer refers to the malignant neoplasms found in the stomach, usually adenocarcinoma. Most stomach cancers occur in the pylorus or antrum of the stomach and are adenocarcinomas
Clinical Manifestation• Early stage – symptoms may be absent• indigestion• anorexia• dyspepsia• weight loss• abdominal pain• constipation• anemia• nausea & vomiting
Risk Factors• chronic atrophic gastritis• history of exposure to background radiation or trace metal soil• people usually eat pickled food, salted fish & nitrates• metal craft workers, miners, bakers• those working in dusty, smoky & sulfur dioxide containing environment
Diagnosis• X-ray the upper GIT• Double contrast barium swallow• followed by endoscopy for biopsy• cytologic test• CT scan• Gastroscopy
Nursing Management• assess the client history of diet (smoked fish, salty food,smoking)• family history• asked the patient if she/he has a previous gastric surgery• history of risk factors to the development of cancer.• chronic gastritis• pernicious anemia• presence of H.Pylori