Management of Gastric and Duodenal Disorders

• Acute Manifestations: Patients often present with epigastric pain, dyspepsia, anorexia, hiccups, nausea, and vomiting. If the gastritis is erosive, clinicians must monitor for signs of bleeding, such as melena (dark, tarry stools), hematemesis (vomiting blood), or hematochezia (bright red blood per rectum).
• Chronic Manifestations: Symptoms may include fatigue, pyrosis (heartburn), belching, a sour taste in the mouth, halitosis, early satiety, nausea, and vomiting. Notably, chronic gastritis can lead to pernicious anemia due to the malabsorption of Vitamin B12. Some patients may remain entirely asymptomatic.

Exam Tip: When assessing a patient with suspected chronic gastritis, always check for signs of Vitamin B12 deficiency (such as neurological changes or macrocytic anemia), as this is a common complication of malabsorption.

Peptic Ulcer Disease (PUD)

Peptic ulcer disease occurs when an erosion of the mucous membrane forms an excavation (an ulcer) in the stomach, pylorus, duodenum, or esophagus.

Risk Factors and Pathophysiology

A primary driver of PUD is infection with Helicobacter pylori. However, several other risk factors increase the likelihood of developing ulcers, including:

• Excessive secretion of stomach acid
• Chronic use of Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
• Smoking and alcohol consumption
• Dietary factors and familial tendency

Patients typically report a dull, gnawing, or burning pain in the midepigastrium, often accompanied by heartburn and vomiting.

Clinical Assessment and Management

Patient Assessment

Effective management begins with a thorough assessment of the patient's history and physical status:

1. History: Identify presenting signs, symptoms, and a dietary history. A 72-hour food diary can help identify predictable patterns of pain related to food intake.
2. Medication Review: Specifically assess for the use of NSAIDs.
3. Physical Assessment: Conduct abdominal assessments and monitor vital signs.
4. Bleeding Screen: Look for signs of anemia or active bleeding.

Medical Management

The goals of medical therapy are to reduce acid production and allow the mucosa to heal:

• For Acute Gastritis: Patients may need to refrain from food and alcohol until symptoms subside. Supportive therapy includes IV fluids, nasogastric intubation, antacids, histamine-2 receptor antagonists, and proton pump inhibitors (PPIs).
• For Chronic Gastritis and PUD: Management focuses on lifestyle modifications (diet, stress reduction, avoiding alcohol/NSAIDs) and pharmacologic therapy. Surgery may be required in certain cases.

Nursing Management and Interventions

Nursing care focuses on pain relief, nutritional support, and the prevention of life-threatening complications.

Core Nursing Interventions

• Pain and Anxiety Management: Use a calm approach to explain all procedures and treatments to reduce patient anxiety. Implement prescribed medications and dietary changes to relieve pain.
• Nutritional Support: For acute gastritis, the patient should initially remain NPO (nothing by mouth). As tolerated, introduce clear liquids and then solid foods as prescribed. It is vital to discourage caffeinated beverages, alcohol, and smoking.
• Fluid and Electrolyte Balance: Monitor Intake and Output (I&O) closely for signs of dehydration, electrolyte imbalances, or hemorrhage.
• Patient Education: Provide counseling for smoking cessation and alcohol reduction.

Monitoring for Complications

Nurses must be vigilant for the following serious complications of PUD and gastritis:

1. Hemorrhage: Indicated by hematemesis, melena, or a drop in blood pressure and increase in heart rate.
2. Perforation and Penetration: A sudden, severe abdominal pain that may indicate the ulcer has breached the stomach wall.
3. Gastric Outlet Obstruction: Often caused by scarring or edema from chronic inflammation, preventing food from passing into the duodenum.

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Summary Table: Management Goals