Mental and physical rest is a basic requirement of ulcer treatment. The old regimen of frequent feedings of bland foods and milk is no longer an accepted practice. High dose antacid therapy is essential. Cimetidine, primarily in duodenal ulcers, blocks the secretion of gastric acids. Cimetidine is indicated during the acute stages of active ulcer disease but is not prescribed for long-term therapy. Diet should be as tolerated by the patient. The only real restrictions are coffee, tea, cola, chocolate, alcohol, and aspirin. The patient should be advised to avoid foods that tend to aggravate the condition. Complications to be alert for are GI bleeding
or perforation. Either is cause for immediate hospitalization.
Acute Simple Gastritis
This is the most common of all stomach disturbances. It is an acute inflammation and erosion of the stomach mucosa. Chemical irritants, bacterial and viral infections, and sometimes allergies are causes. The onset is sometimes sudden and violent.
Malaise, anorexia, sensations of fullness and pressure in the epigastrium, diarrhea, colicky pain, and cramping are common. There may be fever, chills, headache, nausea, and vomiting.
Remove the offending agent if chemical or allergic in origin, and treat the specific bacterial or viral cause. Keep the patient NPO until the acute symptoms have subsided. Compazine® may be indicated for nausea and vomiting. Diet should be clear liquid initially and progressive as tolerated. Antacids may help to relieve pain. Be alert for hematemesis, which may require hospitalization.
This is a chronic inflammatory disease of the small intestine that is normally seen in young adults. The etiology is unknown.
Steady or colicky pain in the right lower quadrant of the abdomen or periumbilical area is common. There maybe diarrhea with intervening periods of constipation or normal bowel function as well as fever, malaise, and anorexia.
Give a high caloric and high vitamin diet. Exclude all roughage, and during acute symptoms, exclude all milk products. Treat other symptoms symptomatically.
Usually there is obstruction of the appendiceal lumen (usually by feces), followed by infection, edema, and frequently infarction of the appendiceal wall.
Epigastric or periumbilical pain that shifts to and localizes in the right lower quadrant within 2 to 12 hours, with some early vomiting, is common. The pain is aggravated by coughing or movement. Localized abdominal findings
are absent at the onset. Rebound tenderness and muscle rigidity
and guarding are present and rectal tenderness is common. Temperature is slightly elevated and the WBC is elevated (10,000 to 12,000). Peristalsis may be diminished or absent.
The vermiform appendix must be removed by a surgeon. Until the patient is transferred for this purpose, place him or her on bed rest in the semi-Fowlers position, keep NPO, and place an ice pack on the abdomen. The primary complication to be alert for is perforation. The symptoms of perforation are a sudden increase in pain followed by temporary cessation, tenderness, generalized abdominal rigidity
, WBC rise, and a rapidly rising fever. If transfer and surgery are delayed for any reason, IV therapy and nasogastric suction are indicated, The patient should be placed on a broad-spectrum antibiotic.
Inguinal hernias may be either congenital or acquired. It is a protrusion of a portion of the bowel through the external inguinal ring into the scrotal sac.
The complaint of a heavy, dragging sensation in the groin, especially with heavy exercise, straining, or coughing, is common. There is localized tenderness and the peritoneal sac may be palpable and visible. The mass may disappear when the patient is recumbent. Digital examination may show a large external inguinal ring. If the hernia becomes incarcerated (intestinal loop is pinched in the opening of the inguinal ring and the intestinal flow is obstructed), the patient