Etiology

IV. Nausea & Vomiting Nausea and vomiting, is a

response, triggered by conditions that
affect the vomiting center which is the
medulla.

Chain Reaction (Vomiting

Response)
Nausea is an unexplainable
sensation and is physiologically connected
• A feeling of sickness with an inclination to with problem in gastric motility of
to vomit. decreased action and hyperactive small
• Vomiting – the forceful expulsion intestine, causing reverse peristalsis.
voluntary or involuntary, of stomach
content through the mouth). o Retching (dry heaving)- a
retroperistaltic movement of the
• Multitude of reason may cause vomiting.
stomach and esophagus due to an
If not address properly and promptly
altered intestinal motility but without
may lead to serious outcomes such as
vomiting.
fluids and electrolyte imbalance,
o Vomition- act of vomiting or
aspiration pneumonia and even
propelling out of gastric contents
malnutrition.
CYCLIC VOMITING SYNDROME (CVS)
CONTROL OF VOMITING
▪ An unusual condition denoted by
Bilateral Vomiting Center – an isolated
severe, distinct attacks of vomiting
or occasionally just nausea source causes reticular formation and
occurring at different intervals, but excitement in the medulla which then
stimulate vomiting.
between episodes the patient is in
good health and no evident Vomition center receives sensatory signals
systemic abnormalities. Most from 4 vital origins:
common in childhood (onset
commonly at 5 years of age) i. Chemoreceptor trigger zone
- A bilaterally symmetric station in
CHRONIC NAUSEA & VOMITING the brainstem and is situated
SYNDROME beneath the fourth ventricle.
▪ Characterized by the symptoms Unscathed vomition center can be
that occur for at least 6 months. activated by emetic drugs, thus in
Nausea and vomiting occur at least the vomition center the
once a week, with no indication of chemoreceptor trigger zone acts as
organic, systemic, or metabolic the emetic chemoreceptor.
disorder. - Emetic drugs, and other conditions
such as uremia, hypoxia and
 diabetic ketoacidosis causes ASSESSMENT
chemical deviation in the body.
- These change in the chemical It should include:
component are then perceived by ✓ Character of vomitus
the chemoreceptor trigger zone ✓ Signs of aspiration
which will then send stimulative ✓ Presence of pain and abdominal
signal to the vomiting center. cramping
ii. Visceral afferents from the ✓ Signs of dehydration (dry skin,
gastrointestinal tract (cranial lips, and oral mucosa, sunken eyes,
nerve X – Vagus Nerve) – toxic sunken fontanelles in babies, poor
substances and mucosal irritation skin turgor, no tears when crying)
will cause the visceral afferent and F&E imbalances
from the GI tract to send signal to ✓ Signs of metabolic alkalosis
the brain to stimulate vomiting. (weakness, fatigue, seizures,
iii. Visceral afferent from outside muscle cramps, hypotension, etc.)
the gastrointestinal tract
(signals from bile ducts, Warning Signals that cause immediate
peritoneum, heart and other concern in adult patients:
organs). Information from these ✓ Signs of hypovolemia
organ’s visceral afferent also ✓ Headache, stiff neck, or mental
triggers vomiting. status change
iv. Afferents from extramedullary ✓ Peritoneal signs (i.e. rebound
centers in the brain – tenderness, rigidity, severe,
provocation from odors, fear, persistent abdominal pain, fever
tension, vestibular upset and brain and tachycardia)
injury can stimulate the vomiting ✓ Distended, tympanitic abdomen
center.

CAUSES
Causes of vomiting may arise from
the gastrointestinal tract, central nervous
system or because of some systemic
condition such as:
a) Acute infectious diseases
b) Increased intracranial pressure Warning Signals that cause immediate
c) Toxic ingestions concern in children and infants:
d) Food intolerance
✓ Bilious emesis (slight yellow-
e) Mechanical obstruction of the
tinged vomit)
gastrointestinal tract.
✓ Lethargy or listlessness
f) Metabolic disorders
✓ Inconsolability and bulging
g) Psychogenic disorders
fontanelle in infant
 blood in the vomitus, forceful
vomiting, or abdominal pain are
present.

TREATMENT
Only parenteral or sublingual
drugs should be given or used to actively
vomiting patient.
NOTE: The use of drug depends on the
✓ Nuchal rigidity, photophobia, and cause and severity of the manifestation or
fever in older child symptoms.
✓ Peritoneal signs or abdominal
distention (surgical abdomen) a) IV fluid therapy for dehydration
✓ Persistent vomiting with poor especially for children
growth or development b) Antiemetics

INTERVENTION
1. Maintain a patent airway.
2. Position the child on the side to
prevent aspiration.
3. Monitor the character, amount, and
frequency of vomiting.
4. Assess the force of the vomiting;
projectile vomiting may indicate
pyloric stenosis or increased
intracranial pressure.
5. Monitor strict intake and output.
6. Monitor for signs and symptoms of
dehydration, such as a sunken fontanel
(age-appropriate), nonelastic skin
turgor, dry mucous membranes,
decreased tear production, and
oliguria.
7. Monitor electrolyte levels.
8. Provide oral rehydration therapy as
tolerated and as prescribed; begin
feeding slowly, with small amounts of
fluid at frequent intervals.
9. Administer antiemetics as prescribed.
10. Assess for abdominal pain or diarrhea.
11. Children and infants: Advise the
parents to inform the health care
provider (HCP) if signs of dehydration,
V. Gastritis • In the early stages, atrophic gastritis
may not cause any symptoms, so the
condition can persist for years without
a person being aware that they have it.
• When a person has autoimmune
atrophic gastritis, their body
mistakenly attacks healthy stomach
cells, including a substance called
intrinsic factor.
• Intrinsic factor is responsible for
o Inflammation of the gastric mucosa or helping the body absorb vitamin B-12.
the stomach. When a person cannot absorb enough
B-12, they may develop pernicious
Types anemia.
A. Acute Gastritis • Pernicious anemia is a complication
- caused by the ingestion of food that makes it difficult for a person to
contaminated with disease-causing create red blood cells
microorganisms or food that is
irritating or too highly seasoned, the
PATHOPHYSIOLOGY
overuse of aspirin or other NSAIDs,
excessive alcohol intake, bile reflux, or
radiation therapy.

B. Chronic Gastritis
- caused by benign or malignant ulcers
or by the bacteria H. pylori, and may be
caused by autoimmune diseases,
dietary factors, medications, alcohol,
smoking, or reflux.

ATROPHIC GASTRITIS
CAUSES

• Doctors mostly find inflammation in

the mucous membrane of a person’s
stomach lining. This leads to various
▪ Bacterial infection by Helicobacter
digestive problems.
pylori or H. pylori, usually causes
 atrophic gastritis. Around half of • Heartburn after eating
people trusted sources with H. pylori- • Sour taste in the mouth
related gastritis will develop atrophic • Vitamin B12 deficiency
gastritis.
▪ Otherwise, atrophic gastritis can be an DIAGNOSTIC TESTS
inherited or genetic condition, which is • Upper GI x-ray series (esophagus,
called autoimmune atrophic stomach, duodenum
gastritis. Here, the immune system
• Endoscopy
attacks healthy cells in the stomach
• Histologic examination of tissue
lining.
specimen
▪ A H. pylori infection causes most
atrophic gastritis cases. This infection SYMPTOMS
is very common and often has no
symptoms or is asymptomatic, The symptoms differ, depending on
especially at its onset. whether bacteria or autoimmune
▪ Atrophic gastritis often starts when a condition are causing atrophic gastritis.
person is a child. Left untreated, it will When a bacterial infection is the
get worse over time and can lead to cause of atrophic gastritis, a person may
stomach ulcers. notice symptoms that include:
There are many ways a person can ✓Unusual or unintended weight loss
come into contact with the H. pylori ✓Vomiting
bacterium. These include: ✓Lack of appetite
✓Drinking contaminated water ✓Nausea
✓Eating food prepared or grown in ✓Iron deficiency anemia
contaminated water ✓Pain in the stomach
✓Having direct contact with saliva, ✓Ulcers
vomit, or feces of a person who has H. When autoimmune atrophic
pylori gastritis is the cause, a person may notice
symptoms of a vitamin B-12 deficiency
ASSESSMENT and pernicious anemia. Symptoms
Assessment Findings in Acute include:

• Abdominal discomfort ✓Pain in the chest

• Lassitude (Lack of energy) ✓General fatigue
• Anorexia, nausea, and vomiting ✓Tinnitus (ringing in the ears)
• Headache ✓Dizziness
• Hiccupping ✓Lightheadedness
• Reflux ✓Heart palpitations

Assessment Findings in Chronic A vitamin B-12 deficiency can, in

some cases, result in nerve damage. If this
• Anorexia nausea, and vomiting occurs, a person may notice:
• Belching
 ✓ Confusion ▪ Antibiotics to treat cases where
✓ Unsteadiness when walking bacteria is causing atrophic gastritis.
✓ Tingling or numbness in the arms ▪ In some cases, they may also prescribe
or legs medication to reduce the production of
stomach acids while the stomach
RISK FACTORS heals.
▪ A person is most at risk of atrophic ▪ In cases of autoimmune atrophic
gastritis if they come into contact with gastritis, a doctor may prescribe B-12
H. pylori. injections. These injections will
▪ This global disease is most common in prevent or eliminate complications of
areas of the world that have extreme a B-12 deficiency.
poverty or are over-crowded. ▪ Also, treatment for autoimmune
▪ Autoimmune atrophic gastritis is atrophic gastritis will likely focus on
much less common. It is more likely to ensuring a person is not iron
occur in people of African-American, deficient.
Asian, Hispanic, or northern European
DIET & LIFESTYLE
descent.
▪ People with other medical conditions • In addition to medical treatment,
are more at risk of autoimmune people can take steps at home to
atrophic gastritis. These conditions manage symptoms of atrophic
include: gastritis.
- Thyroid disease • For those with autoimmune atrophic
- Type I diabetes gastritis, a diet rich in vitamin B-12
- Vitiligo, a pigmentation disorder could help prevent further
- Addison’s disease complications due to the deficiency.
Good sources of B-12 include:
- Clams and fatty fish
- Beef
- Eggs
- Fortified Cereal
- Milk and Yogurt

TREATMENT
▪ A doctor will treat atrophic gastritis by
focusing on the underlying cause. Once
they have treated the cause, a person’s
symptoms will clear up.
 Chronic Gastritis
• Diet modification
• Rest promotion
• Stress reduction
• Avoid alcohol and NSAIDs
• Pharmacotherapy (H. pylori)

NURSING INTERVENTIONS
▪ Reducing anxiety
PREVENTION ▪ Promoting Optimal Nutrition
▪ To prevent contact with H. pylori, a ▪ Promoting Fluid Balance
person should take special care with ▪ Relieving Pain
regards to hygiene when traveling to ▪ Promoting Home and Community -
countries where contaminated water Based Care
is a concern.
▪ Some steps people can take to prevent
contact with these bacteria include:
- Practicing safe food handling by
washing all fruits and vegetables
thoroughly
- Avoiding food grown using
contaminated water
- Drinking bottled water when other
water may be contaminated

MEDICAL MANAGEMENT
Acute Gastritis
• NPO until the symptoms subside
(non-irritating diet once tolerated)
• Intravenous fluids administration
for persistent symptoms
• Diluting and neutralizing agent if
caused by acids (antacids) or
alkaline (diluted lemon juice or
diluted vinegar)
• NOTE: Avoid emetics and lavage if
corrosion is extensive.
• Supportive therapy
• Nasogastric intubation
• Analgesic agents and sedatives
VI. Peptic Ulcer ❑ Burning sensation in the mid
epigastrium or the back
❑ Vomiting (emesis- undigested
food) then it follows a bout of
severe pain & bloating
❑ Constipation or diarrhea (because
of diet and meds)
❑ e. Bleeding (for pts w/ bleeding
peptic ulcers)
hematemesis/melena

DIAGNOSIS
• Endoscopy with bx of gastric
• Excavation in the mucosal wall of the mucosa
stomach, pylorus, duodenum, or • Serologic testing for antibodies
esophagus due to gastric secretions as against H. pylori
a result of GERD. • CBC for patients with bleeding
• Ulceration may extend through • Stool PCR test (Polymerase Chain
muscle. It may be referred depending Reaction
to its location:
- gastric, duodenal, or esophageal MEDICAL MANAGEMENT
- The most common are gastric and
a) H2 (H2) blockers
duodenal ulcers.
b) Proton pump inhibitors (PPIs)–
PATHOPHYSIOLOGY omeprazole, pantoprazole
c) Antibiotics
• Should avoid NSAIDS

SURGICAL MANAGEMENT
• Gastrectomy- (subtotal/partial)-
removes part of stomach

SIGNS & SYMPTOMS

Symptoms may last for a few days, weeks,
or months and may dis
appear only to reappear

❑ Dull and gnawing pain

• Vagotomy- cutting the vagus nerve to
reduce acid secretion
VII. Gastric Ulcer

• Antrectomy- removes lower part of

stomach w/c produce a hormone that
❖ Involves ulceration of the mucosal
stimulates the stomach to secrete lining of the stomach that may also
juices
extend to the submucosal layer.
Potential Complications
RISK FACTORS
- Hemorrhage
▪ Stress
- Perforation
▪ Smoking
- Penetration
▪ Corticosteroid
- Gastric outlet obstruction
▪ NSAIDs
▪ Alcohol
NURSING DIAGNOSIS ▪ History of Gastritis
▪ Family history of gastric ulcers
• Acute pain r/t the effect of gastric ▪ Infection with H. pylori
acid secretion on damage tissue
• Anxiety r/t an acute illness INTERVENTIONS
• Impaired nutritional intake r/t
✓ Monitor vital signs and signs of
changes in the diet
bleeding.
✓ Small, frequent bland feedings
during the active phase.
✓ Decrease acid secretion by
administering H2-receptor
antagonists or proton pump
inhibitors as prescribed.
✓ Administer prescribed drugs such
as:
- Antacid
- Anticholinergic
 - Mucosal barrier protectants as 2. Vagotomy: Surgical division of the
prescribed, 1 hour before each vagus nerve to eliminate the vagal
meal impulses that stimulate hydrochloric
- Prostaglandins acid secretion in the stomach
3. Gastric resection: Removal of the
Client Education lower half of the stomach and usually
Advise the client to: includes a vagotomy; also called
antrectomy
- Avoid alcohol and substances that 4. Gastroduodenostomy: Partial
contain caffeine or chocolate. gastrectomy, with the remaining
- Avoid smoking. segment anastomosed to the
- Avoid aspirin or NSAIDs. duodenum; also called Billroth I
- Obtain adequate rest 5. Gastrojejunostomy: Partial
- Reduce stress. gastrectomy, with the remaining
segment anastomosed to the jejunum;
Interventions during active
also called Billroth II
bleeding
• Monitor vital signs closely.
• Assess for signs of dehydration,
hypovolemic shock, sepsis, and
respiratory insufficiency.
• Maintain NPO status and
administer intravenous (IV) fluid
replacement as prescribed,
monitor intake and output.
• Monitor hemoglobin and
hematocrit. 6. Pyloroplasty: Enlargement of the
• Administer blood transfusions as pylorus to prevent or decrease pyloric
prescribed. obstruction, thereby enhancing gastric
• Prepare to assist with emptying
administering medications as
prescribed to induce
vasoconstriction and reduce
bleeding.

SURGICAL INTERVENTIONS
1. Total gastrectomy: Removal of the
stomach with attachment of the
esophagus to the jejunum or
duodenum; also called
esophagojejunostomy or
esophagoduodenostomy