Chapter 40: Managing Gastric & Duodenal Disorders

Managing Gastric & Duodenal Disorders details the management and nursing care required for patients experiencing a range of gastric and duodenal disorders, including acute and chronic gastritis, peptic ulcer disease (PUD), gastric cancer, and tumors of the small intestine. The discussion differentiates between acute gastritis, which may be erosive (often caused by irritants like NSAIDs or alcohol) or non-erosive (frequently linked to the bacterium Helicobacter pylori (H. pylori)), and chronic gastritis, which can lead to complications such as pernicious anemia due to diminished intrinsic factor production. PUD involves the erosion of mucosa, forming an excavation in the stomach or duodenum, with the majority of cases resulting from H. pylori or chronic NSAID use. Key manifestations of ulcers differ by location: gastric ulcer pain occurs immediately after eating, while duodenal ulcer pain often occurs several hours post-meal or wakes the patient at night. Diagnosis for these conditions primarily relies on endoscopy and biopsy, complemented by blood tests or specialized methods like the urea breath test to detect H. pylori. Medical management focuses on healing the mucosa and, when necessary, eradicating H. pylori using combination drug therapy that includes proton pump inhibitors (PPIs) and antibiotics. For intractable ulcers or complications, surgical procedures such as vagotomy, pyloroplasty, and antrectomy (Billroth I or Billroth II) may be performed. Major complications addressed include hemorrhage (indicated by hematemesis or melena), perforation, and gastric outlet obstruction. Post-surgical risks include dumping syndrome, a rapid physiologic response to quick gastric emptying, and bile reflux. The chapter also covers gastric cancer, mostly adenocarcinomas, emphasizing the challenges of late diagnosis and the necessity of multimodal treatment involving gastrectomy, chemotherapy, and targeted therapies. Nursing interventions prioritize promoting optimal nutrition, monitoring fluid and electrolyte balance, recognizing early signs of hemorrhage (tachycardia, hypotension), providing pain relief, and extensive patient education regarding adherence to medication regimens and avoidance of gastric irritants such as caffeine, alcohol, and nicotine.