TREATMENT—The   objective   of   treatment is to reestablish regular evacuation of feces. The diet is of primary concern. The patient should be instructed  to  maintain  an  adequate  intake  of  food. Many  times  an  inadequate  food  intake  alone  is sufficient to cause constipation. Foods consumed should  have  a  high  fiber  content,  such  as  bran, raw fruits, and vegetables. Encourage the patient to force fluids, exercise, and take mild laxatives. Laxatives  should  be  administered  only  until constipation  is  improved. Nausea and Vomiting Nausea and vomiting may be attributed to a wide variety of causes and may reflect underlying GI  or  systemic  disease.  Severe  complications  such as aspiration or esophageal rupture may result. TREATMENT—In  the  treatment  of  simple acute nausea and vomiting, little or no treatment is required. In more severe cases, force fluids to prevent  dehydration  and  give  antispasmodic drugs,  such  as  Compazine^®,  to  combat  nausea. Treat  the  underlying  cause. Psychologic GI Disorders Abdominal pain may have many names, such as indigestion or dyspepsia, and may involve all or  a  portion  of  the  GI  tract.  It  is  frequently caused  by  improper  diet  or  irregular  meals  as  well as  poor  living  and  hygiene  habits. SYMPTOMS—The   symptoms   produced   are varied.   They   include   hyperirritability,   altered motility  and  secretion  of  the  GI  tract,  foul breath,  cramps,  diarrhea,  and  flatulence.  Often there  is  a  history  of  nervousness  and  emotional upset. TREATMENT—The  patient  should  be  in- structed  about  personal  and  living  habits  and hygiene. Emphasize adequate and regular sleep, nourishing  meals,  and  exercise.  Treat  sympto- matically. Upper  GI  Hemorrhage This is rather a common medical emergency. It  results  from  such  conditions  as  peptic  ulcer perforation,  gastritis,  and  esophageal  varices. SYMPTOMS—The  patient  may  complain  of weakness,  fainting,  or  melena.  Hematemesis  is common. Shock may or may not be present. Loss of   large   amounts   of   blood   volume   produces hypovolemic   shock. TREATMENT—General   measures   include absolute  bed  rest,  recording  intake  and  output, nasogastric suction, ice water or ice and antacid lavages, monitoring vital signs at least once per hour,  replacing  blood  volume,  and  treating  for shock.  Keep  the  patient  NPO  for  the  first  24 hours. If the bleeding has subsided, start a liquid diet.  Mild  sedation  may  be  indicated.  For  cases involving  ulceration,  antacid  therapy  should  be begun as soon as bleeding and vomiting ceases. Hospitalize as soon as possible. Give Cimetidine, IV  therapy. Hiatal Hernia A hiatal hernia is caused by a portion of the stomach  passing  through  the  hiatus. SYMPTOMS—It  is  characterized  by  severe heartburn,  burning  and  pain  behind  the  sternum, and sensations of pressure. The pain may radiate down  the  arms  or  into  the  neck  and  jaw. Nocturnal   regurgitation   and   dyspnea   are common.   Lying   down   tends   to   aggravate   the symptoms,   while   sitting   or   standing   relieves them. TREATMENT—General   measures   include weight  reduction,  antacids,  and  surgical  correc- tion of large hernias. Advise the patient to avoid tight  or  constricting  clothing,  especially  belts  or corsets. Further advise the patient to avoid lying down immediately after meals and to sleep with the  head  of  the  bed  elevated. Peptic Ulcer This  is  an  acute  or  chronic  ulceration  of  the mucous membrane in the digestive tract that is accessible to gastric secretions. The oversecretion of  gastric  acids  is  an  important  factor  in  peptic ulcer  formation.  Psychic  disturbances,  such  as emotional   tension,   are   predisposing   factors. Peptic ulcers are normally found in the first por- tion of the duodenum or on the lesser curvature of  the  stomach. SYMPTOMS—The  patient  may  present  a history  of  pain,    heartburn,   and   abdominal distension.  Nausea,  vomiting,  excess  salivation, weight loss, and anorexia are common. The pain pattern is usually stable and is often relieved by food.  Research  indicates  that  food,  no  matter what  type,  and  even  though  it  may  relieve  the pain,  tends  to  aggravate  the  condition  by causing  gastric  acid  secretion. 2-10