Gastrointestinal System: Peptic Ulcer Disease, GERD, and Hernias

Learning Objectives

• Understand key concepts related to peptic ulcer disease, gastroesophageal reflux disease (GERD), and hernias.
• Prepare to apply knowledge in clinical settings, not just for exams.
• Engage actively in the learning process and reflect on prior knowledge and experiences related to the content.

Peptic Ulcer Disease (PUD)

Pathophysiology

• Ulcers can occur in the stomach, duodenum, or esophagus.
• Ulcers result from a hollowed excavation in the mucosa, potentially penetrating muscle layers or peritoneum.
• 80-95% of gastric and duodenal ulcers are caused by Helicobacter pylori infection.
• Contributing factors include:
  • Inability of tissues to withstand acids and pepsin.
  • NSAIDs disrupting mucosal barriers.
  • Genetic factors (e.g., blood type O sensitivity).

Symptoms

• Gastric Ulcers: Pain after eating, weight loss, vomiting.
• Duodenal Ulcers: Pain 2-3 hours post-eating, may improve with food.

Assessment

• Assess for pain, distension, tenderness, blood in vomit or stool, anemia.
• Review medications (NSAIDs) and lifestyle factors (smoking, alcohol).

Diagnosis and Management

• EGD and H. pylori tests (blood, stool, breath test).
• Treatment: Antibiotics and proton pump inhibitors (PPIs).
• Patient Education: Complete full course of antibiotics, lifestyle changes, monitor for complications.

Complications

• Hemorrhage: GI tract bleeding, monitor symptoms like vomiting blood.
• Perforation: Ulcer penetrates through gastric serosa.
• Gastric Outlet Obstruction: Blockage due to ulcer-induced swelling.

Gastroesophageal Reflux Disease (GERD)

Pathophysiology

• Backflow of gastric contents due to incompetent lower esophageal sphincter.
• Associated with age, obesity, lifestyle factors (caffeine, alcohol, smoking).

Symptoms

• Heartburn (pyrosis), dyspepsia, regurgitation, dysphagia, esophagitis.

Diagnosis and Management

• Patient history, endoscopy, and possibly a barium swallow or esophageal pH monitoring.
• Avoid triggers, improve lifestyle (weight loss, dietary changes).
• Medications: PPIs, H2 blockers.

Complications

• Barrett’s Esophagus: Precancerous changes in the esophagus.
• Aspiration pneumonia due to reflux into the lungs.

Nursing Considerations

• Monitor for esophageal damage and potential hemorrhage.
• Educate on lifestyle and dietary changes.

Hiatal Hernias

Types

• Sliding Hernia: Upper stomach slides through diaphragmatic opening.
• Paraesophageal Hernia: Stomach bulges through another opening.

Symptoms

• May include heartburn, regurgitation, dysphagia, or be asymptomatic.

Diagnosis and Management

• X-ray, EGD for diagnosis.
• Smaller, frequent meals, avoid reclining post-eating.
• Surgical repair may be needed.

Complications

• Potential for obstruction or strangulation of herniated tissue.

Other Hernias

• Common locations: Epigastric, umbilical, inguinal, femoral.
• Can cause pain, obstruction, and complications if strangulated.

Summary

• Review learning objectives and test knowledge.
• Address gaps by reviewing materials and seeking further resources.