Gastritis & Hiatal Hernia

cdunbar4's version from 2016-10-17 04:02


Question Answer
Inflammation of gastric mucosa. 3 Types:Autoimmune (body & fundus); diffuse antral (antrum); multifocal (diffuse throughout)
What happens?breakdown of mucosal barrier, stomach tissue unprotected from autodigestion by HCl acid and proteolytic enzyme, pepsin → tissue edema, disruption of capillary walls with loss of plasma into gastric lumen
Etiology: drugsNSAIDs, Aspirin, digitalis
Etiology: dietary indescretionsAlcoholic drinking binge
Etiology: infectionH. Pylori; other bacterial, viral and fungal infections (mycobacterium, cytomegalovirus and syphilis)
Clinical Manis: Acute & chronic symptoms are similiar:anorexia, n/v, epigastric tenderness, feeling of fullness, hemorrhage commonly associated with ETOH abuse
Diagnosticsendoscopic exam with biopsy, H. pylori presence test (breath, urine serum or gastric tissue)
Collaborative Care planRest bowel (NPO, fluids, rest, NG); drug therapy; eliminate cause; antibiotics + anti-secretory agents; correct anemia; lifestyle changes
ER Rule of Thumb: esophagitis + gastritis = ?DT: delirium tremors, which can kill you!

Hiatal Hernia

Question Answer
akadiaphragmatic hernia or esophageal hernia
Two types of herniassliding and paraesophageal (rolling)
slidingjunction of stomach and esophagus are above hiatus of diaphragm, part of stomach slides through opening when supine and goes back when upright.
paraesophageal or rolling hiatal herniajunction remains in normal position, but fundus rolls up through diaphragm
Etiologyweak muscles; factors that increase abdominal pressure (obesity, pregnancy, ascites, tumors, intense physical exertion, heavy lifting)
Clinical Manissome asymptomatic; most are similar to GERD....but big meals, alcohol and smoking are precipitating factors of pain
ComplicationsGERD, hemorrhage, ulcer, stenosis, regurgitation, strangulation
Diagnosticbarium swallow
Surgicallaproscopic nissen fundoplication
Gerontologic (medications that ↓ LES pressure)similar to GERD; Meds: nitrates, CCB's, antidepressants
herniotomyexcision of the hernia sac
herniorraphyclosure of hiatal defect
hastropexyattachment of stomach subdiaphragmatically to prevent reherniation
Goals: reduce hernia, provide acceptable LES pressure and prevent movement of gastroesophageal juntction

Section 3