TREATMENT—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  irri- tants,  bacterial  and  viral  infections,  and  some- times  allergies  are  causes.  The  onset  is  sometimes sudden  and  violent. SYMPTOMS—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. TREATMENT—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. Regional  Enteritis This is a chronic inflammatory disease of the small  intestine  that  is  normally  seen  in  young adults.  The  etiology  is  unknown. SYMPTOMS—Steady  or  colicky  pain  in  the right  lower  quadrant  of  the  abdomen  or  peri- umbilical area is common. There maybe diarrhea with   intervening   periods   of   constipation   or normal bowel function as well as fever, malaise, and  anorexia. TREATMENT—Give a high caloric and high vitamin  diet.  Exclude  all  roughage,  and  during acute symptoms, exclude all milk products. Treat other  symptoms  symptomatically. Appendicitis Usually  there  is  obstruction  of  the  appendiceal lumen  (usually  by  feces),  followed  by  infec- tion,   edema,   and   frequently   infarction   of   the appendiceal  wall. SYMPTOMS—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. TREATMENT—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-Fowler’s  position,  keep NPO, and place an ice pack on the abdomen. The primary  complication  to  be  alert  for  is  perfora- tion. 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 Hernia 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. SYMPTOMS—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 2-11