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S • Sucralfate
P • Proton-Pump Inhibitors
H • H2-Receptor Antagonists
A • Antacids
ANTACIDS
MAGNESIUM
laxative
SE : diarrhea
ALUMINUM
SE: Constipation
Calcium
Carbonate Neutralize HCl Acid
Contraindication : Best time : 1-3 h after
high milk & vit.D content eating
H2-RECEPTOR ANTAGONISTS
Cimetidine
SE: Diarrhea; Crosses
blood-brain barrier esp.
in elderly
Side
Effects
Famotidine
SE: Headache, vertigo HCl
By competing
Ranitidine w/ histamine
on receptor
SE: Anaphylaxis, Burning sites of
parietal cells
& itching at injection site,
Angioedema
PROTON-PUMP INHIBITORS
PARAESOPHAGEAL / ROLLING
HERNIA
• part of the greater curvature rolls
through the diaphragmatic defect.
• usually doesn’t cause symptoms
but may cause strangulation of
herniated parts.
HIATAL HERNIA
Signs & Symptoms
PARAESOPHAGEAL /
SLIDING HIATAL HERNIAS ROLLING HERNIAS
• Heartburn • Feeling of fullness after eating
• Regurgitation • Breathlessness after eating
• Chest Pain • Feeling of suffocation
• Dysphagia
• Belching
• Chest pain that mimics angina
• Worsening of manifestations in
a recumbent position
HIATAL HERNIA
Diagnostic Exam:
• Barium swallow & chest x-ray
• Esophagogastroduodenoscopy
• Esophagoscopy
FUNDOPLICATION :
Causes
1. Impaired LES Function
2. Increased intra-abdominal
pressure
3. Risk Factors: Hiatal Hernia &
ingestion
GERD Signs & Symptoms
• Pain radiating to neck, jaws, • Chronic cough • Pain worsens with lying
& arms1 down / bending over
GASTROESOPHAGEAL REFLUX DISORDER
Diagnostic Procedures
• Endoscopy
• Esophageal manometry
Nursing Interventions
•Same with Hiatal Hernia
•Encourage diet that increase
LES Pressure e.g., CHO,
CHON, non-fat milk
Medical Management
Cholinergic Agent
GASTROESOPHAGEAL REFLUX DISORDER
COMPLICATIONS
•Esophagitis with possible
ulceration
•Esophageal bleeding
BARRETT’S ESOPHAGUS
Def’n: Complication from
persistent reflux predisposing to
cancerous transformation
(esophageal cancer)
CAUSE: GERD
MANIFESTATION: Difficulty in
swallowing
COMPLICATIONS
Hemorrhage & aspiration
pneumonia
GASTRITIS
DEF: Inflammation of the gastric mucosa (lining)
CAUSES: H. Pylori, Aspirin & other NSAIDs, Alcohol,
Smoking, Stress, Toxic Substances
TYPES: Acute (exposure to irritants) heals w/n a few days;
Chronic leads to pernicious anemia & gastric cancer
PEPTIC ULCER
DEFINITION: CAUSES:
Excavation (hollowed-out Helicobacter Pylori
area) that forms in areas Aspirin & other NSAIDs
exposed to acid secretion
Alcohol
Smoking
Type A Personality
Type O Blood
GASTRIC Ulcer DUODENAL Ulcer
Zollinger-Ellison
STRESS Ulcer
Syndrome
Vagotomy
Severing the Vagus Nerve1
Dumping Syndrome
DEFINITION: Unpleasant set of GI sypmtoms when food is
quickly “dumped” into the SI, usu d/t gastric surgery (Billroth II)
Early S&S:
• SENS’N OF full’ss (prematurely reaches duodenum)
• Anorexia
• Cramping pain
• Diarrhea (^ peristalsis, ^H20)
• Steatorrhea
• Weak’ss, faint’ss, dizziness, palpitations, diaphoresis (signs of
dehydration)
2. Asterixis, Confusion
4. Comatose
CHOLELITHIASIS
PANCREATITIS
DIVERTICULAR DISEASE
• DIVERTICULUM is the outpouching of
intestinal mucosa thru muscular wall
• DIVERTICULOSIS – presence of
diverticulum; asymptomatic
• DIVERTICULITIS – inflammation of
diverticula
• Typical sites : Sigmoid Colon &
Duodenum
Acute Inflammatory Bowel Disease:
APPENDICITIS
Psoas Sign
Chronic Inflammatory
Bowel Disease
Not explained by
any structural or
biochemical
abnormalities?!