INTENSIVE PHASE

HANDOUTS
Gastrointestinal Disorders
GIT Hand out

Gastroesophageal Reflux Disease

Peptic Ulcer Disease

FACTORS:
● Stress
● Cigarette Smoking
● Alcohol
● Caffeine
● Aspirin and NSAID
● Zollinger–Ellison Syndrome
● Irregular & Hurried meals
● Type A personality
● Type O blood
● Genetics

Gastric Ulcer Duodenal Ulcer

● Poor Man’s or Laborer’s ulcer ● Executive Ulcer

● 20% incidence ● 80% incidence
● Common in people 50yrs old and above. ● Common in people 25-50yrs old.
● Malnourished ● Well Nourished
● Pain – ½ - 1 hour after meal ● Pain – 2-3 hours after meal
● Pain is triggered by food intake ● Pain is relieved by food intake
● Pain relieved by vomiting ● Pain is common at night
● Nausea, vomiting & Hematemesis ● Melena

● Weight loss ● Nausea and vomiting

● Pain common at night ● Pain triggered by food intake
● 25-50 years-old ● Melena
● Poor man’s ulcer
Management
● Stress related

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1. Monitor for signs of bleeding. ● Inflammation of 1 or more diverticula.
● Cause: Accumulation of fecal material
2. Diet:
● milk
● feeding 1.Inflammation
● Chew
● abdominal pain
● foods
2. Infection
3. Avoid factors
● Fever
4. Stress reduction
3. Injury
Medications
● Blood in stool
● Antacids
● Histamine 2 receptor blockers - Ranitidine 4. Obstruction
● Proton pump inhibitors - Omeprazole
● Cytoprotective drugs - Sucralfate ● Bloating & flatulence
● Prostaglandins - Misoprostol ● Chronic constipation with episodes of diarrhea.
● Hormone - Octreotide
Surgery Management
1. Vagotomy
2. Gastrectomy
● Total 1. fiber diet
● Subtotal/Antrectomy 2. fluid intake
3. Anastomosis: 3. Medication
● Billroth I – Gastroduodenostomy
● Billroth II – Gastrojejunostomy
Acute phase:
● Fiber
● Oral intake
● Activity
● Medication
● Monitor for perforation

Appendicitis
Clinical Manifestation

● McBurney’s point
● Rovsing’s sign
● Dunphy’s sign
● Blumberg’s sign
● WBC
● Bowel sound

Dumping Syndrome

Management
1. Diet:
● protein
● fat
● carbohydrate
● Meals
● fluids
● Salt, sugar & milk
2. Position
3. Medication
Diverticulosis
● Outpouching of intestinal mucosa.
● Common site:
● Cause: fiber diet
Diverticulitis

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 Types:
1. Laennec’s Cirrhosis
2. Post necrotic
3. Biliary Cirrhosis
4. Cardiac Cirrhosis

Clinical Manifestations

Laboratory Tests:
Psoas sign

1. Albumin (3.5-5 g/dL)

2. Partial Thromboplastin time or prothrombin time/INR (25-35
sec. / 11-14sec./.8-1.2)
3. Serum Bilirubin (.03-1.9 mg/dL)
4. Aspartate Aminotransferase (AST/SGOT) (10-40 U/L)
5. Alanine Aminotransferase (ALT/SGPT) (7-56 U/L)
6. BUN
Management:

1. Calorie
Obturator sign 2. Protein
3. Fat
4. Sodium
5. Fluid intake
6. Hepatic Encephalopathy
● Asterixis
● Constructional Apraxia
● LOC
● Fetor hepaticus
7. Esophageal varices

Liver Cirrhosis

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Medications: ● Belching
● Flatulence
3. Obstruction
● Spironolactone
● IV albumin ● Skin
● Lactulose ● Stool
● Neomycin ● urine
● Vitamin Deficiency
Cholecystitis
4. Infection
● Fever
Types:
● Dehydration
● Calculous
Management:
● Acalculous

1. Diet
Cholelithiasis
● Fat
Factors: “5F’s”
● Meal
● Fair ● Gas forming foods
● Fat
2. Medications
● Female
● Fertile ● Ursodeoxycholic acid (UDCA)
● Forty ● Chenodeoxycholic acid (chenodiol or CDCA)
● Antispasmodics/Anticholinergics
Clinical Manifestations:

Acute Pancreatitis
1. Inflammation
● Biliary colic
● Murphy’s sign 1. Inflammation
● Abdominal pain
● Pain
● Rebound tenderness
● Aggravated by:
● Radiating
● Diet
● Usually after a ______or ______ meal
● Beverage
● Position
● Bowel sound
2. Indigestion
● N&V
● N&V
2. Bleeding

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 ● Dehydration 2. Medications:
● Weight loss
● H2 receptor blocker
● Cullen’s & Grey turner’s Sign
● Proton pump inhibitor
● Morphine
Chronic Pancreatitis

1. Inflammation
● Abdominal pain
2. Fibrosis
● Mass
● Calcium
3. Loss of function
● Weight
Laboratory Findings: ● Bilirubin
● Stool
● Glucose
● WBC Management:
● Glucose
● Bilirubin
● Alkaline phosphate
1. Diet
● Serum and urinary amylase
● Serum lipase ● Food
● Meals
Management:
● fat
● protein
1. Acute phase
● NPO 2. Medications
● TPN
● Pancreatin
● NGT
● Pancrelipase
● Insulin & OHA

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