Upper GI: GERD, Ulcers and GI Bleeding
Reflux, peptic ulcer disease, bleeding and dumping syndrome
GERD and hiatal hernia
- Heartburn, regurgitation, worse after meals and lying down; chronic cough, hoarseness.
- Lifestyle: raise the head of the bed 6–8 in; small meals; nothing for 2–3 h before bed; lose weight; stop smoking; limit fatty foods, chocolate, peppermint, caffeine, alcohol, spicy or acidic foods if they trigger symptoms.
- PPIs or H2 blockers.
- Long-term: Barrett's esophagus (cancer risk): surveillance endoscopy.
Peptic ulcer disease
- Main causes: H. pylori and NSAIDs.
- Gastric ulcer: pain soon after eating; weight loss. Duodenal ulcer: pain 2–3 h after meals and at night, relieved by food.
- Treat H. pylori (PPI + antibiotics, retest for cure); stop NSAIDs; PPI.
- Perforation: sudden severe pain, rigid board-like abdomen, rebound tenderness, shock → surgical emergency.
GI bleeding
| Hematemesis | Bright red or coffee-ground vomit (upper GI) |
| Melena | Black, tarry stool (upper GI; iron and bismuth also darken stool) |
| Hematochezia | Bright red rectal blood (lower GI, or a massive upper bleed) |
- Two large-bore IVs, fluids, type and crossmatch; transfuse usually if Hgb <7 (higher in heart disease).
- IV PPI; NPO; endoscopy (usually within 24 h).
- Variceal bleeding (cirrhosis): octreotide, antibiotics, endoscopic banding.
- Watch for shock: tachycardia, ↓ BP, restlessness, cool skin, ↓ urine.
- BUN may rise (blood digested in the gut).
Dumping syndrome (after gastric surgery)
- Early (10–30 min after eating): cramping, diarrhea, dizziness, tachycardia, sweating.
- Late (1–3 h): hypoglycemia.
- Prevent: small frequent meals; higher protein and fat, low simple sugars; no fluids with meals (drink 30 min before or after); lie down after eating.
NG tubes
- Measure nose → earlobe → xiphoid; confirm placement by X-ray before first use for feeding or meds.
- Decompression: low intermittent suction; check output color and amount; irrigate per order.
- Watch for fluid and electrolyte loss (metabolic alkalosis, low K⁺).
- Oral care and nares care; keep head up.