Chapter 40
Management of Patients
with Gastric and Duodenal
Disorders
Gastritis
Disruption of the mucosal barrier that normally
protects the stomach tissue from digestive juices
Acute: rapid onset of symptoms usually caused by
dietary indiscretion; self-limiting. Other causes
include medications, alcohol, bile re?ux, and
radiation therapy. Ingestion of strong acid or alkali
may cause serious complications
Chronic: prolonged in?ammation, atrophy of gastric
tissue, due to benign or malignant ulcers of the
stomach or by Helicobacter pylori. May also be
associated with some autoimmune diseases, dietary
factors, medications, alcohol, smoking, or chronic
re?ux of pancreatic secretions or bile
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Erosive Gastritis
Image at left reproduced with permission from Strayer, D. S., SaHtz, J.
E., & Rubin, E. (2015). Rubin’s pathology: Mechanisms of human
disease (8th ed., Fig. 19-15). Philadelphia, PA: Lippincott Williams &
Wilkins.
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Manifestations of Gastritis
Acute: epigastric pain, dyspepsia, anorexia, hiccups,
nausea, vomiting. Erosive gastritis can lead to
melena, hematemesis or hematochezia
Chronic: fatigue, pyrosis, belching, sour taste in the
mouth, halitosis, early satiety, anorexia, nausea and
vomiting. May have pernicious anemia due to
malabsorption of B12. Some are asymptomatic
De[nitive diagnosis by endoscopy and histologic
examination of biopsy specimen
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Medical Management of Gastritis
Acute
o Refrain from alcohol and food until symptoms
subside
o Supportive therapy: IV ?uids, nasogastric
intubation, antacids, histamine-2 receptor
antagonists, proton pump inhibitors
Chronic
o Modify diet, promote rest, reduce stress, avoid
alcohol and NSAIDs
o Pharmacologic therapy including a variety of
medications (Table 40-2)
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Nursing Management of Gastritis
Reduce anxiety; use calm approach and explain all
procedures and treatments
Promote optimal nutrition; for acute gastritis, the
patient should take no food or ?uids by mouth.
Introduce clear liquids and solid foods as prescribed.
Evaluate and report symptoms. Discourage
caaeinated beverages, alcohol, cigarette smoking.
Refer for alcohol counseling and smoking cessation
Promote ?uid balance; monitor I&O, for signs of
dehydration, electrolyte imbalance, and hemorrhage
Measures to relieve pain: diet and medications
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Peptic Ulcer Disease
Erosion of a mucous membrane forms an excavation
in the stomach, pylorus, duodenum, or esophagus
Associated with infection of H. pylori
Risk factors include excessive secretion of stomach
acid, dietary factors, chronic use of NSAIDs, alcohol,
smoking, and familial tendency
Manifestations include a dull gnawing pain or
burning in the midepigastrium; heartburn and
vomiting may occur
Treatment includes medications (Table 40-3),
lifestyle changes, and occasionally surgery (Table
40-4) Copyright © 2022 Wolters Kluwer · All Rights Reserved
Deep Peptic Ulcer
Reprinted with permission from Strayer, D. S., SaHtz, J. E., & Rubin, E.
(2015). Rubin’s pathology: Mechanisms of human disease (8th ed., Fig.
19-23). Philadelphia, PA: Lippincott Williams & Wilkins.
Copyright © 2022 Wolters Kluwer · All Rights Reserved
Question #1
Is the following statement true or false?
The most common site for peptic ulcer formation is
the pylorus.
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Answer to Question #1
False
Rationale: The most common site for peptic ulcer
formation is not the pylorus. The most common site
for peptic ulcer formation is the duodenum.
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Assessment of the Patient with Gastritis
or Peptic Ulcer Disease
History including presenting signs and symptoms
Dietary history and dietary associations with
symptoms such as predictable time for pain
72-hour diet; diary may be helpful
Abdominal assessment, vital signs
Medications; include use of NSAIDs
Sign and symptoms of anemia or bleeding
Abdominal assessment
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Planning and Goals for the Patient with
Gastritis or Peptic Ulcer Disease
Major goals may include:
o Relief of pain
o Reduced anxiety
o Maintenance of nutritional requirements
o Absence of complications
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Nursing Interventions for the Patient with
Gastritis or Peptic Ulcer Disease
Relieving pain
Reducing anxiety
Maintaining optimal nutritional status
Monitoring and managing potential complications
o Hemorrhage
o Perforation and penetration
o Gastric outlet obstruction
Patient education
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Question #2
What is the duration of treatment for proton pump
inhibitors in a patient diagnosed with peptic ulcer
disease?
A. 1–2 weeks
B. 7 days
C. At least 2 years based on risk factors
D. 4–8 weeks
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Answer to Question #2
D. 4–8 weeks
Rationale: Proton pump inhibitors should be used for
4–8 weeks to allow complete peptic ulcer heading.
Patients at high risk require a maintenance dose for 1
year.
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Gastric Cancer #1
Incidence: more common among older adults (mean
age of 68); males; Hispanic Americans, African
Americans, and Asian/Paci[c Islanders at higher risk
than Caucasian Americans
Poor prognosis
95% of gastric cancers are adenocarcinomas and
lymph node involvement with metastasis occurs
early
Risk factors include diet, chronic in?ammation of the
stomach, H. pylori infection, pernicious anemia,
smoking, achlorhydria, gastric ulcers, previous
subtotal gastrectomy, and genetics
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Gastric Cancer #2
Manifestations include pain relieved by antacids,
dyspepsia, early satiety, weight loss, abdominal
pain, loss or decrease in appetite, bloating after
meals, nausea, and vomiting. Diagnosis of the
disease is often late
Treatment is chemotherapy, targeted therapy,
radiation therapy, and surgical removal of the tumor
if possible, and palliative care if the tumor is
unresectable or metastasized
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Tumors of the Small Intestine
64% malignant
Higher rates of cancer among older adults (mean
age 60), African Americans, and men
May be asymptomatic or present with pain, occult
bleeding, weight loss, nausea, vomiting, and
intestinal obstruction
Assessment includes CBC, bilirubin,
carcinoembryonic antigen (CEA)
Diagnose by upper GI radiograph or abdominal CT
Treat with surgery and chemotherapy
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Assessment of the Patient with Gastric
Cancer
Dietary history and nutritional status
Risk factors and smoking and alcohol history
Social support, individual and family coping
Resources
Physical assessment, including assessment of the
abdomen
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Planning and Goals for the Patient with
Gastric Cancer
Major goals include:
o Reduced anxiety
o Optimal nutrition
o Relief of pain
o Adjustment to the diagnosis and anticipated
lifestyle changes
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Nursing Interventions for the Patient with
Gastric Cancer
Reducing anxiety, promoting optimal nutrition,
relieving pain, providing psychosocial support (poor
prognosis), promoting self-care activities, education
on types of treatments and what to expect
If gastric surgery is required, manage the patient
postoperatively to avoid complications. Educate
patient and family regarding dumping syndrome and
steatorrhea post-op
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Question #3
Is the following statement true or false?
Older adults with gastric cancer may have no gastric
symptoms.
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Answer to Question #3
True
Rationale: Confusion, agitation, restlessness, and
reduced functional ability may be the only symptoms
in older adults with gastric cancer. These clinical
manifestations are often due to metastasis.
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