ZES - rare condition in which benign or malignant tumors form in the pancreas and duodenum that secrete excessive amounts of the hormone gastrin o suspected when client has multiple ulcers or resistant to tx o treated with H2 Blockers Achlorhydria- lack of hydrochloric acid (HCl) NSAIDS: Disrupt the mucosal permeability barrier, rendering the mucosa vulnerable to injury. Low dose Aspirin + risk factors PUD Damaged mucosa from NSAIDS decreased resistance to bacteria H. Pylori infection PUD
Symptoms: Dull, aching burning abdominal pain; may be in back as well. Gastric: pain immediately after eating Duodenal: pain 2-3 hours after meal *usually none <book> o hypoactive BS o distended abdomen o epigastric fullness/bloating o pyrosis (heartburn) o burping o vomiting (complication of ulcer) o constipation or diarrhea o bleeding o hematemesis (vomiting of blood) o melena (black tarry stools) o hypotension o increase temp Complications: Hemorrhage - check for bleeding- emesis /stool. Vitals ask about dizziness faintness check labs, check urine output Perforation - EMERGENCY require surgery (signs: rigid abdomen, Penetration - sudden severe upper abdomen. Pain - pain may go to shoulder (right), vomiting, fainting, extremely rigid board like tender abdomen Diagnosis: A physical examination may reveal pain, epigastric tenderness, or abdominal distention Endoscopy* CBC Test stool for blood Test gastric secretions
Treatment/ Management: Medications Antibiotic to treat H-pylori (Flagyl, Amoxicillin, Clindamycin) PPI (Proton Pump Inhibitor) H2 Blockers if ZES Bismuth salts Educate Stop smoking Potentially dangerous drugs: NSAIDS (Aspirin) Diet modifications o Avoid alcohol, tobacco, caffeine o Small frequent meals o Experiment (what foods exacerbate symptoms?) Medical Surgical management is unlikely NGT to decompress Vagotomy o severing the vagus nerve; decreases gastric acid by diminishing cholinergic stimulation. o Drainage procedure to assist with gastric emptying * only done if tx fails MORE ON NEXT PAGE Nursing Relieve pain Reduce anxiety Maintain nutritional status Monitor for complications o Hemorrhage o Perforation and penetration o Gastric outlet obstruction Monitor Post op o NGT o I&O o watch for infection, if peritonitis
Truncal vagotomy Severs the right and left vagus nerves as they enter the stomach at the distal part of the esophagus; most commonly used to decrease acid secretions. Some patients experience problems with feeling of fullness, dumping syndrome, diarrhea, or constipation. Selective vagotomy Severs vagal innervation to the stomach but maintains innervation to the rest of the abdominal organs. Fewer associated adverse effects than with truncal vagotomy Proximal (parietal cell) gastric vagotomy without drainage Denervates acid-secreting parietal cells but preserves vagal innervation to the gastric antrum and pylorus No associated dumping syndrome Pyloroplasty Longitudinal incision is made into the pylorus and transversely sutured closed to enlarge the outlet and relax the muscle; usually accompanies truncal and selective vagotomy.
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- Fall '16
- Denise Cauble
- Nursing, chronic diarrhea, Bowel obstruction, pyrosis