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🟣 Exam 5 · Module 11 — Upper GI Guided Notes

GERD · Esophageal Cancer · Gastritis · PUD · Gastrectomy · Gastric Cancer · completed with answers

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🎯 Learning Objectives4 items
  • Explain the pathophysiology of common upper GI disorders.
  • Differentiate GERD, gastritis, gastric ulcers, duodenal ulcers, and cholecystitis.
  • Identify priority assessments and complications.
  • Apply the NCLEX Clinical Judgment Model to GI case studies.
Framework — Recognize Cues (history, assessment, risk factors, labs, diagnostics) → Analyze → Prioritize → Generate solutions → Take action → Evaluate.
🔥 GERD (Gastroesophageal Reflux Disease)8 items

GERD occurs when the lower esophageal sphincter (LES) is weak/incompetent, letting stomach acid reflux back up into the esophagus.

Classic manifestations

Major lifestyle modifications

🎗️ Esophageal Cancer3 items

Most patients are diagnosed: Late — early disease is silent; dysphagia (first solids, then liquids) appears only after the tumor is advanced.

Treatment may include

Major nursing concern after esophagectomy: Airway/respiratory protection + anastomotic leak & aspiration. Keep HOB elevated, monitor for leak (fever, pain, ↑HR), do NOT reposition the NG tube, watch respiratory status.

➡️ Transition to Gastric Disorders

Food now enters the: stomach

Main function of the stomach: Store food, secrete acid + pepsin, begin protein digestion, and produce intrinsic factor (needed for B12 absorption).

🩹 Gastritis3 items

Definition: Inflammation of the stomach (gastric mucosa) lining.

Causes

Acute: NSAIDs, alcohol, H. pylori, severe stress, spicy/irritating food.

Chronic: H. pylori (most common), autoimmune (attacks parietal cells), chronic NSAID use.

Risk factors — what damages the stomach lining

NSAIDs · Alcohol · H. pylori · Smoking · Stress · Caffeine · Radiation · Autoimmune disease (older age raises risk but is not itself a direct irritant)

Pathophysiology — complete the chain

Damage to stomach lining
↓ Protective mucus barrier breaks down / prostaglandins ↓
↓ Acid + pepsin reach and irritate the mucosa
↓ Inflammation, edema, and erosion of the lining
↓ Possible bleeding or ulcer formation

Clinical manifestations — WHY it happens

ManifestationWhy does it happen?
Epigastric painAcid directly irritates inflamed mucosa and nerve endings.
Nausea / VomitingIrritation stimulates the vomiting center; gastric emptying is delayed.
BurningAcid contacting the inflamed/eroded lining.
BloatingDelayed gastric emptying and gas buildup.
HematemesisErosion of mucosal blood vessels → vomiting bright/coffee-ground blood.
MelenaDigested blood from an upper GI bleed → black, tarry stool.
Weight lossAnorexia, nausea, and pain with eating reduce intake.

Diagnostics

Definitive diagnosis: EGD (esophagogastroduodenoscopy) with biopsy.

How do we test for H. pylori?

  1. Urea breath test
  2. Stool antigen test
  3. Endoscopic biopsy (rapid urease test) / blood antibody serology
💊 Pharmacology — Goals & Medications4 items

Instead of memorizing meds — complete the GOAL

  • Kill the H. pylori (antibiotics)
  • Reduce acid (PPIs, H2 blockers, antacids)
  • Protect the mucosa / stomach lining (sucralfate, misoprostol)
  • Prevent recurrence & NSAID-induced damage

Match each medication to its goal

MedicationGoal / Action
AntibioticsEradicate H. pylori (usually 2 antibiotics + a PPI).
PPIs (–prazole)Block the proton pump → strongest, longest acid reduction (e.g., omeprazole).
H2 blockers (–tidine)Block histamine (H2) receptors → less acid (e.g., famotidine).
AntacidsNeutralize acid already in the stomach — fast, short relief.
SucralfateCoats/forms a protective barrier over the ulcer (give on empty stomach).
MisoprostolProstaglandin analog — protects mucosa, prevents NSAID ulcers. Contraindicated in pregnancy.
🧑‍⚕️ Gastritis — Nursing Priorities4 items
  1. Monitor for GI bleeding — hematemesis, melena, ↓ H&H, vital-sign changes.
  2. Give/teach medications — PPIs, antibiotics; STOP NSAIDs.
  3. Pain management + diet teaching — avoid alcohol, caffeine, spicy foods, NSAIDs.
  4. Teach: finish the full H. pylori antibiotic course; stop smoking/alcohol.
🕳️ Peptic Ulcer Disease (PUD)4 items

Definition: Erosion of the mucosa of the stomach (gastric) or duodenum, from acid/pepsin + H. pylori or NSAIDs.

Gastric vs Duodenal Ulcers

FindingGastricDuodenal
Pain after mealsPain 30–60 min AFTER eating; worse with foodPain 2–3 h after eating
Pain relieved by foodNo — food makes it worseYes — food relieves it
Night painLess commonCommon — wakes patient at night
HematemesisMore commonLess common
MelenaLess commonMore common

Clinical reasoning — one clue that gives it away

DisorderOne clue
GERDHeartburn/regurgitation, worse lying down or bending over.
GastritisDiffuse epigastric burning, often after NSAIDs/alcohol.
Gastric ulcerPain WORSENS with food → weight loss.
Duodenal ulcerPain RELIEVED by food; night pain 2–3 h after meals.
CholecystitisRUQ pain after a fatty meal, radiates to right shoulder (+Murphy's sign).

Diagnostics

What confirms PUD? EGD (endoscopy) with biopsy.

Is H. pylori the cause? Urea breath test, stool antigen, or biopsy urease test.

Treatment goals

  • Kill H. pylori
  • Reduce acid
  • Protect the mucosa
  • Prevent recurrence

Complications

ComplicationSigns / SymptomsNursing Priority
HemorrhageHematemesis, melena, hypotension, tachycardia, ↓ H&H.NPO, IV fluids/blood, monitor VS & H&H, prepare for endoscopy.
PerforationSudden severe pain, rigid board-like abdomen, rebound tenderness, peritonitis/shock.NPO, NG suction, IV fluids + antibiotics, prepare for EMERGENCY surgery.
Pyloric stenosisVomiting, epigastric fullness/bloating, weight loss (gastric outlet obstruction).NG decompression, NPO, fluid & electrolyte replacement.
🔪 Gastrectomy & Post-Op4 items

Why might a patient require a gastrectomy? Gastric cancer, or severe PUD with complications (perforation, uncontrolled bleeding, or obstruction) not fixed by medical therapy.

Postoperative priorities

  • Airway/respiratory care — deep breathing, prevent atelectasis/pneumonia.
  • NG tube care — do NOT reposition; monitor drainage (report bright red).
  • Monitor for bleeding, anastomotic leak, and dumping syndrome.
  • Nutrition — small frequent meals + LIFELONG vitamin B12 (intrinsic factor lost).
🩸 Pernicious Anemia

Why does it occur? Loss of intrinsic factor (from gastric parietal cells) → vitamin B12 can't be absorbed.

Intrinsic factor is needed to absorb: Vitamin B12 (cobalamin), absorbed in the terminal ileum.

Treatment: Lifelong vitamin B12 replacement (IM injections or high-dose).

🍽️ Dumping Syndrome4 items

Why does it happen? After gastric surgery, hyperosmolar food dumps rapidly into the small intestine → fluid shifts into the bowel.

Early symptoms (15–30 min): Dizziness, tachycardia, diaphoresis, cramping, diarrhea, hypotension.

Late symptoms (1–3 h): Reactive hypoglycemia — sweating, shakiness, weakness, confusion (from a rebound insulin surge).

Teaching

  • Small, frequent meals.
  • High-protein, high-fat, LOW-carbohydrate; avoid concentrated sugars.
  • Drink fluids BETWEEN meals, not with them.
  • Lie down 20–30 min after eating.
🎗️ Gastric Cancer3 items

Risk factors

  • H. pylori infection, chronic/atrophic gastritis, pernicious anemia.
  • Smoking; diet high in salted, smoked, or pickled foods; low fruits/vegetables.
  • Family history.

How is it diagnosed? EGD with biopsy (+ CT for staging).

Treatment: Surgery (gastrectomy), chemotherapy, radiation.

⭐ The Four Things You MUST Remember4 items
  1. Follow the Pathophysiology. Damage → loss of mucosal protection → acid injures lining → inflammation → bleeding/ulcer. Symptoms follow the patho.
  2. Find the Clue That Separates the Diseases. Gastric ulcer = worse WITH food + weight loss; duodenal = RELIEVED by food + night pain; GERD = worse lying down; cholecystitis = after fatty meals, RUQ.
  3. Treatment Always Has the Same Goals. Kill H. pylori · Reduce acid · Protect mucosa · Prevent recurrence
  4. Recognize Emergencies. Hemorrhage: hematemesis/melena, hypotension, tachycardia → NPO, fluids/blood, EGD.  |  Perforation: sudden severe pain + rigid abdomen + peritonitis → NPO, NG suction, emergency surgery.
✅ NCLEX Success Check — I can now explain…6 items
  • How gastritis becomes an ulcer.
  • The difference between gastric and duodenal ulcers.
  • Why H. pylori matters.
  • When a GI patient is becoming unstable.
  • Why a patient develops dumping syndrome after a gastrectomy.
  • Why gastrectomy patients need lifelong B12 replacement.
⏱️ One-Minute Summary4 items
  1. GERD = weak LES → reflux → lifestyle changes + PPI.
  2. Gastric ulcer = pain WITH food; duodenal = pain RELIEVED by food.
  3. H. pylori → treat with antibiotics + PPI; test with breath/stool/biopsy.
  4. Emergencies: bleeding (melena/hematemesis) & perforation (rigid abdomen). Gastrectomy → lifelong B12 + dumping syndrome.