Transcript Basic Nursing: Foundations of Skills and Concepts Chapter 26

CHAPTER 35
GASTROINTESTINAL
SYSTEM
Revision by: Leslie Lehmkuhl, RN
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ANATOMY AND
PHYSIOLOGY REVIEW
The digestive system is also known as
the gastrointestinal (GI) tract or
alimentary system.
 Digestion is process of breaking down
the complex food into simple nutrients
the body can absorb and convert to
energy.

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THE DIGESTIVE SYSTEM
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ANATOMY AND
PHYSIOLOGY REVIEW

Digestive system

Organs and their functions
•
•
•
•
•
•
•
•
Mouth: beginning of digestion
Teeth: bite, crush, and grind food
Salivary glands: secrete saliva
Esophagus: moves food from mouth to stomach
Stomach: churn and mix contents with gastric juices
Small intestine: most digestion occurs here
Large intestine: forms and expels feces
Rectum: expels feces
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ANATOMY AND
PHYSIOLOGY REVIEW

Accessory organs of digestion

Organs and their functions
• Liver: produces bile; stores it in the gallbladder
• Pancreas: produces pancreatic juice + regulates
blood sugar levels

Regulation of food intake

Hypothalamus
• One center stimulates eating and another signals
to stop eating
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Location of Digestive Organs
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EFFECTS OF AGING
Decrease in peristalsis
 Oral changes
 Decrease in enzyme secretion
 Decrease in saliva

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ASSESSMENT



History of present
complaint
Medication history
including prescribed
and over-the-counter
medications
Complete nutritional
history




Psychosocial factors
Physical examination
Bowel elimination
patterns
Evaluation of
diagnostic data
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Diagnostic Tests











Upper GI series
Gastric analysis
Esophagogastroduodenoscopy (EGD)
Barium swallow
Bernstein test
Stool for occult blood
Sigmoidoscopy
Barium enema
Colonoscopy
Stool culture and sensitivity; stool for ova and parasites
Flat plate of the abdomen
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Barium Ingestion for Upper GI
Series
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Upper GI Series
Stomach cancer, X-ray
Stomach ulcer, X-ray
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Esophagogastroduodenoscopy
(EGD)
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Bernstein Test
Reproduces symptoms associated with heart burn in the stomach and stomach lining
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Stool Occult
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Colonoscopy verses
Sigmoidoscopy
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Barium Enema (AKA Lower GI Series)
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Barium Enema
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Stool Culture and Sensitivity
Salmonella typhi organism
Yersinia enterocolitica organism
Campylobacter jejuni
organism
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Worms
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Flat Plate of the Abdomen
X-ray
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Disorders of the Mouth

Dental plaque and caries

Etiology/pathophysiology
• Erosive process that results from the action of
bacteria on carbohydrates in the mouth, which
produces acids that dissolve tooth enamel

Medical management/nursing
interventions
• Removal of affected area and replace with dental
material
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Dental plaque stain
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Stomatitis


Inflammation and
ulcerations in the mouth
caused by infections,
damage to the mucous
membranes by irritants, or
chemotherapy.
S/S: c/o difficulty
swallowing, inflammed
mucosa

Topical anesthetics and
analgesics may be
ordered.

Monitor dietary (e.g. bland,
soft, liquids) and fluid
intake.

As sores heal may
advance DAT
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STOMATITIS
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Candidiasis

Etiology/pathophysiology
• Infection caused by a species
of Candida, usually Candida
albicans
• Fungus normally present in the
mouth, intestine, vagina, and
on the skin
• Also referred to as thrush and
moniliasis

Clinical
manifestations/assessment
• Small white patches on the
mucous membrane of the
mouth
• Thick white discharge from the
vagina

Medical
management/nursing
interventions
• Nystatin
• Half-strength hydrogen
peroxide/saline
mouthwash
• Ketoconazole oral
tablets
• Meticulous
handwashing
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THRUSH
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Oral Cancer




Cancers of the lips,
tongue, oral cavity,
and pharynx.
Treatment is primarily
surgical (excised
tissue & surrounding
lymoh nodes).
Chemotherapy is not
effective against most
oral cancers.
Medications ordered
are based on the
client’s symptoms.

Etiology/pathophysiology
• Malignant lesions on the lips, oral
cavity, tongue, or the pharynx
• Usually squamous cell
epitheliomas

S/S:
• Leukoplakia (white spots on
tounge or cheek)
• Roughened area on the tongue
• Difficulty chewing, swallowing, or
speaking
• Edema, numbness, or loss of
feeling in the mouth
• Earache, face ache, and
toothache
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Carcinoma of the oral cavity
(continued)

Diagnostic tests
• Indirect laryngoscopy
• Excisional biopsy

Medical
management/nursing
interventions
• Stage I: Surgery or
radiation
• Stage II & III: Both surgery
and radiation
• Stage IV: Palliative
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ORAL CANCER
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ADVANCED ORAL CANCER
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Esophageal Varicies


Enlarged, tortuous
veins, often
associated with
cirrhosis of the liver.
May be treated with
sclerotherapy, ligation
(banding) or balloon
tamponade.




No NSAIDs, aspirin,
anticoagulants.
Monitor vital signs.
(if B/P drop is 20mm/hg
suspect bleeding and plan
on Senstaken-Blakemore
use)
Assess for nausea and
dizziness
Pt on BR until bleeding
stops
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Sengstaken-Blakemore Tube
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Esophageal Varicies S/S




No abd pain
Occult blood
Melean (black, sticky,
tarlike stools)
Hematemesis


H+H will show
anemia
jaundice
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Disorders of the Esophagus

Achalasia

Etiology/pathophysiology
• Cardiac sphincter of the stomach cannot relax
• Possible causes: nerve degeneration, esophageal dilation,
and hypertrophy

Clinical manifestations/assessment
•
•
•
•
•
Dysphagia
Regurgitation of food
Substernal chest pain
Loss of weight; weakness
Poor skin turgor
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Disorders of the Esophagus

Achalasia (continued)

Diagnostic tests
• Radiologic studies; esophagoscopy

Medical management/nursing
interventions
• Medications: anticholinergics, nitrates, and
calcium channel blockers
• Dilation of cardiac sphincter
• Surgery
• Cardiomyectomy
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Gastroesophageal reflux disease (GERD)




Gastric secretions flow
upward into the
esophagus, damaging the
tissues.
Treat with diet,
medications, weight loss.
Encourage client to avoid
foods that increase the
symptoms.
Observe for melena (black
stools) and signs of
discomfort and pain.

Etiology/pathophysiology
• Backward flow of stomach
acid into the esophagus

Clinical
manifestations/assessment
• Heartburn (pyrosis) 20 min
– 2 hrs after eating
• Regurgitation
• Dysphagia or odynophagia
(squeezing or burning pain
while swallowing)
• Eructation (belching)
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Gastroesophageal reflux
disease (continued)

Diagnostic tests
• Esophageal motility
• Bernstein test
• The Bernstein test is a
provocative test used to
determine if small amounts of acid
infused into the esophagus
causes the patient’s symptoms.
The test involves nasally inserting
an NG tube and placing the distal
tip 5 cm above the LES. A normal
saline solution is infused at 7cc to
8cc per minute for 10 minutes
followed by a 0.1N hydrochloric
acid solution (20 minutes
maximum duration).

Medical
management/nursing
interventions
• Antacids or acid-blocking
medications
• Diet: 4-6 small meals/day,
low fat, adequate protein,
remain upright for 1-2
hours after eating
• Lifestyle: eliminate
smoking, avoid
constrictive clothing, HOB
up at least 6-8 inches for
sleep
• Barium swallow
• Endoscopy
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Gastritis




Inflammation of the
stomach mucosa.
Treatment is primarily
pharmacological.
Encourage client to
minimize or eliminate
smoking and alcohol
consumption and any
foods that aggravate
symptoms.
Teach client about
medications (no NSAIDS).

Etiology/pathophysiology
• Inflammation of the lining of the
stomach
• May be associated with
alcoholism, smoking, and
stressful physical problems

Clinical
manifestations/assessment
• Fever; headache
• Epigastric pain; nausea and
vomiting
• Coating of the tongue
• Loss of appetite
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Acute gastritis (continued)

Diagnostic tests
•
•
•
•
•

Stool for occult blood
WBC;
Electrolytes
UGI
EGD
Medical
management/nursing
interventions
•
•
•
•
Antiemetics
Antacids
Antibiotics
IV fluids
• NG tube and
administration of blood, if
bleeding
• NPO until signs and
symptoms subside
• No NSAIDS
• Eliminate aggravating
foods
• Avoid bedtime eating
(nocturnal acid secretions)
• No smoking/ETOH
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Disorders of the Stomach:
Gastritis
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Ulcers




Erosions that form in
esophagus, stomach, or
duodenum–acid/pepsin
imbalances, exposure to
irritants, H. pylori infections
or impaired mucosal
defenses.
Encourage necessary
lifestyle changes.
Teach relaxation
techniques.
Discourage bedtime
snacking.
 Peptic Ulcers (acid/pepsin
imbalance)
 Gastric Ulcers (irritants) pt
experiences pain two (2)
hours after eating
 Stress Ulcers (gastritis
becomes erosive and starts to
bleed)
 Duodenal Ulcers
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Disorders of the Stomach

Gastric ulcers and duodenal ulcers
Ulcerations of the mucous membrane or
deeper structures of the GI tract
 Most commonly occur in the stomach and
duodenum
 Result of acid and pepsin imbalances
 H. pylori

• Bacterium found in 70% of patients with gastric
ulcers and 95% of patients with duodenal ulcers
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Disorders of the Stomach

Gastric ulcers (continued)

Etiology/pathophysiology
• Gastric mucosa are damaged, acid is secreted,
mucosa erosion occurs, and an ulcer develops

Duodenal ulcers (continued)

Etiology/pathophysiology
• Excessive production or release of gastrin,
increased sensitivity to gastrin, or decreased
ability to buffer the acid secretions
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Disorders of the Stomach

Gastric and duodenal ulcers (continued)

Clinical manifestations/assessment
•
•
•
•

Pain: Dull, burning, boring, or gnawing, epigastric
Dyspepsia (painful digestion)
Hematemesis (throwing up blood)
Melena
Diagnostic tests
• Esophagogastroduodenoscopy (EGD)
• Breath test for H. pylori
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Disorders of the Stomach

Gastric and duodenal ulcers (continued)

Medical management/nursing interventions
•
•
•
•
•
•
Antacids
Histamine H2 receptor blockers
Proton pump inhibitor
Mucosal healing agents
Antibiotics
Diet: high in fat and carbohydrates; low in protein and milk
products; small frequent meals; limit coffee, tobacco,
alcohol, and aspirin use
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Disorders of the Stomach

Gastric and duodenal ulcers (continued)

Medical management/nursing interventions
• Surgery
•
•
•
•
•
•
Antrectomy
Gastrodudodenostomy (Billroth I)
Gastrojejunostomy (Billroth II)
Total gastrectomy
Vagotomy
Pyloroplasty
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Disorders of the Stomach
Types of gastric resections with anastomoses.
A- Billroth I. B- Billroth II.
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Disorders of the Stomach

Gastric and duodenal ulcers
(continued)

Complications after gastric surgery
• Dumping syndrome
• Dumping syndrome occurs when the contents of the
stomach empty too quickly into the small intestine. The
partially digested food draws excess fluid into the small
intestine causing nausea, cramping, diarrhea, sweating,
faintness, and palpatations.
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Disorders of the Stomach

Gastric and duodenal ulcers (continued)

Complications after gastric surgery
• Pernicious anemia
• Pernicious (causing great harm, destruction, or death)
anemia is a chronic illness caused by impaired
absorption of vitamin B-12 because of a lack of intrinsic
factor (IF) in gastric secretions. The disease was named
pernicious anemia because it was fatal before treatment
became available, first as liver therapy and,
subsequently, as purified vitamin B-12. The term
pernicious is no longer appropriate, but it is retained for
historical reasons.
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Disorders of the Stomach

Gastric and duodenal ulcers
(continued)

Complications after gastric surgery
• Iron deficiency anemia
• Iron deficiency is defined as a decreased total iron body
content. Iron deficiency is the most prevalent single
deficiency state on a worldwide basis.
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Disorders of the Stomach

Cancer of the stomach

Etiology/pathophysiology
• Most commonly adenocarcinoma
• Primary location is the pyloric area
• Risk factors:
•
•
•
•
•
•
History of polyps
Pernicious anemia
Hypochlorhydria
Gastrectomy; chronic gastritis; gastric ulcer
Diet high in salt, preservatives, and carbohydrates
Diet low in fresh fruits and vegetables
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Disorders of the Stomach
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Disorders of the Stomach

Cancer of the stomach (continued)

Clinical manifestations/assessment
•
•
•
•
•
•
•
•
Early stages may be asymptomatic
Vague epigastric discomfort or indigestion
Postprandial fullness
Ulcer-like pain that does not respond to therapy
Anorexia; weight loss
Weakness
Blood in stools; hematemesis
Vomiting after fluids and meals
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Disorders of the Stomach

Cancer of the stomach (continued)

Diagnostic tests
•
•
•
•

GI series
Endoscopic/gastroscopic examination
Stool for occult blood
RBC, hemoglobin and hematocrit
Medical management/nursing interventions
• Surgery
• Partial or total gastric resection
• Chemotherapy and/or radiation
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STOMACH CANCER
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Disorders of
the
Intestines
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Irritable Bowel Syndrome (IBS)


Includes Crohn’s disease
and ulcerative colitis–
characterized by
inflammation and
ulcerations of the bowel.
Treat to control
inflammation, relieve
symptoms, maintain fluid
and electrolyte balance,
provide adequate nutrition,
and prevent complications.

Etiology/pathophysiology
• Episodes of alteration in bowel
function
• Spastic and uncoordinated
muscle contractions of the
colon

Clinical
manifestations/assessment
• Abdominal pain
• Frequent bowel movements
• Sense of incomplete
evacuation
• Flatulence, constipation, and/or
diarrhea
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Irritable bowel syndrome
(continued)

Diagnostic tests
• History and physical
examination

Medical
management/nursing
interventions
• Diet and bulking agents
• Medications
• Anticholinergics
• Milk of Magnesia, fiber,
or mineral oil
• Opioids
• Antianxiety drugs
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Ulcerative colitis

Etiology/pathophysiology
• Ulceration of the mucosa and
submucosa of the colon
• Tiny abscesses form which
produce purulent drainage,
slough the mucosa, and
ulcerations occur

Clinical
manifestations/assessment
• Diarrhea—pus and blood; 15-20
stools per day
• Abdominal cramping
• Involuntary leakage of stool

Diagnostic tests
• Barium studies, colonoscopy,
stool for occult blood

Medical
management/nursing
interventions
• Medications
• Azulfidine, Dipentum,
Rowasa,
corticosteroids,
Imodium
• Diet: No milk products or
spicy foods; high-protein,
high-calorie; total
parenteral nutrition
• Stress control
• Assist patient to find
coping mechanisms
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Ulcerative colitis (continued)

Medical
management/nursing
interventions
• Surgical interventions
•
•
•
•
•
Colon resection
Ileostomy
Ileoanal anastomosis
Proctocolectomy
Kock pouch
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Crohn’s disease

Etiology/pathophysiology
• Inflammation, fibrosis,
scarring, and thickening of
the bowel wall

Clinical
manifestations/assessme
nt
• Weakness; loss of appetite
• Diarrhea: 3-4 daily; contain
mucus and pus
• Right lower abdominal pain
• Steatorrhea
• Anal fissures and/or
fistulas

Medical management/nursing
interventions
• Diet
• High-protein
• Elemental
• Hyperalimentation
• the eating of too great an
amount of nutrients.
• Avoid
• Lactose-containing foods,
brassica vegetables
(Cabbage, kale, broccoli,
cauliflower, rutabaga, turnip,
oilseed rape, and mustard are
brassica), caffeine, beer,
monosodium glutamate,
highly seasoned foods,
carbonated beverages, fatty
foods
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Crohn’s disease (continued)

Medical
management/nursing
interventions
• Medications
•
•
•
•
Corticosteroids
Azulfidine
Antibiotics
Antidiarrheals;
antispasmodics
• Enteric-coated fish oil
capsules
• B12 replacement
• Surgery
• Segmental resection of
diseased bowel
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Appendicitis




Inflammation of the
vermiform appendix.
Appendectomy
removes the appendix
before it can rupture.
Assess pain, monitor
vital signs, keep client
NPO, assess bowel
sounds, monitor lab.
Provide postoperative
care.

Etiology/pathophysiology
• Inflammation of the vermiform
appendix
• Lumen of the appendix
becomes obstructed, the
E. coli multiplies, and an
infection develops

Clinical
manifestations/assessment
• Rebound tenderness over
the right lower quadrant of the
abdomen (McBurney’s point)
• Vomiting
• Low-grade fever
• Elevated WBC
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Appendicitis
Diagnostic
tests
•WBC
•Roentgenogram
•Ultrasound
•Laparoscopy
Medical
management/nursing
interventions
•Appendectomy
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appendix

The appendix is a small, finger-shaped pouch
that sticks out from your colon on the right side.
The appendix has no known purpose anymore,
(maybe it did a long time ago), but that doesn’t
mean it can’t cause problems. Every year about
7 percent of Americans develop appendicitis, a
condition in which the appendix becomes
inflamed and filled with pus.
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Diverticulosis and
diverticulitis



Diverticula are saclike
protrusions of intestinal
 Etiology/pathophysiology
wall–may become
• Diverticulosis
inflamed.
• Pouch-like herniations
Most cases of diverticulitis
through the muscular layer
are treated with
of the colon
analgesics, antibiotics, bed
• Diverticulitis
rest, NPO, and IV fluids.
• Inflammation of one or more
Assess bowel sounds,
diverticula
monitor severity
of symptoms, check CBC
reports.
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Disorders of the Intestines:
Diverticulosis
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Diverticular disease
(continued)

Clinical manifestations/assessment
• Diverticulosis
• May have few, if any, symptoms
• Constipation, diarrhea, and/or flatulence
• Pain in the left lower quadrant
• Diverticulitis
•
•
•
•
•
Mild to severe pain in the left lower quadrant
Elevated WBC; low-grade fever
Abdominal distention
Vomiting
Blood in stool
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Diverticular disease
(continued)

Medical management/nursing
interventions
• Diverticulosis with muscular atrophy
• Low-residue diet; stool softeners
• Bedrest
• Diverticulosis with increased intracolonic pressure
and muscle thickening
• High-fiber diet
• Sulfa drugs
• Antibiotics; analgesics
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Diverticular disease
(continued)

Medical management/nursing
interventions (continued)
• Surgery
• Hartmann’s pouch
• Double-barrel transverse colostomy
• Transverse loop colostomy
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Peritonitis



Inflammation of the
peritoneum, the
membranous covering
of the peritoneum.
Can be a serious, lifethreatening condition.
Treatment is primarily
surgical with repair of
cause and irrigation of
the abdominal cavity
with saline and
antibiotic solutions.

Etiology/pathophysiology
• Inflammation of the abdominal
peritoneum
• Bacterial contamination of the
peritoneal cavity from fecal
matter or chemical irritation

Clinical
manifestations/assessment
• Severe abdominal pain;
nausea and vomiting
• Abdomen is tympanic; absence
of bowel sounds
• Chills; weakness
• Weak rapid pulse; fever;
hypotension
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Peritonitis (continued)

Diagnostic tests
• Flat plate of the abdomen
• CBE

Medical management/nursing interventions
• Position patient in semi-Fowler’s position
• Surgery
• Repair cause of fecal contamination
• Removal of chemical irritant
• Parenteral antibiotics
• NG tube to prevent GI distention
• IV fluids
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Hernias



Occur when the wall
of a muscle weakens
and the intestine
protrudes through the
muscle wall.
Some can be reduced
or pushed back into
place by a physician.
Hernias can be
repaired with surgery.
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External hernias


Etiology/pathophysiology
• Congenital or acquired
weakness of the
abdominal wall or
postoperative defect
• Abdominal
• Femoral or inguinal
• Umbilical

Clinical
manifestations/assessment
• Protruding mass or bulge
around the umbilicus, in the
inguinal area, or near an
incision
• Incarceration
• Strangulation
Diagnostic tests
• Radiographs
• Palpation
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External hernias (continued)

Medical
management/nursing
interventions
• If no discomfort, hernia is
left unrepaired, unless it
becomes strangulated or
obstruction occurs
• Truss
• Surgery
• Synthetic mesh is
applied to weakened
area of the abdominal
wall
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Bilateral inguinal hernia.
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Hiatal hernia

Etiology/pathophysiology
• Protrusion of the stomach and
other abdominal viscera through
an opening in the membrane or
tissue of the diaphragm
• Contributing factors: obesity,
trauma, aging

Clinical
manifestations/assessment
• Most people display few, if any,
symptoms
• Gastroesophageal reflux

Medical
management/nursing
interventions
• Head of bed should be
slightly elevated when lying
down
• Surgery
• Posterior gastropexy
• Transabdominal
fundoplication (Nissen)
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Disorders of the Intestines

Intestinal Obstruction
Occurs when the contents cannot pass
through the intestine.
 Treatment depends on cause, location.
 Most require surgery.
 Medical treatment: insert an NG tube for
decompression, provide IV fluids for
rehydration, and treat the cause.

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Disorders of the Intestines

Intestinal obstruction

Etiology/pathophysiology
•
•
•
•

Intestinal contents cannot pass through the GI tract
Partial or complete
Mechanical
Non-mechanical
Clinical manifestations/assessment
• Vomiting; dehydration
• Abdominal tenderness and distention
• Constipation
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Disorders of the Intestines

Intestinal obstruction (continued)

Diagnostic tests
• Radiographic examinations
• BUN, sodium, potassium, hemoglobin, and hematocrit

Medical management/nursing interventions
• Evacuation of intestine
• NG tube to decompress the bowel
• Nasointestinal tube with mercury weight
• Surgery
• Required for mechanical obstructions
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Disorders of the Intestines
Intestinal blockage caused by undigested
fruit and vegetable fibers
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Disorders of the Intestines

Colorectal Cancer

Third most common site of new cancers and deaths
in the United States.
• Colorectal cancer is the second leading cause of cancerrelated deaths in the United States and is expected to cause
about 52,180 deaths (26,000 men and 26,180 women)
during 2007. www.americancancerassociation.org



Prognosis is good if caught early.
Treatment involves surgery and chemotherapy.
Follow-up colonoscopies must be done
to monitor for recurrence.
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Disorders of the Intestines

Cancer of the colon

Etiology/pathophysiology
• Malignant neoplasm that invades the epithelium and
surrounding tissue of the colon and rectum
• Second most prevalent internal cancer in the U.S.

Clinical manifestations/assessment
•
•
•
•
Change in bowel habits; rectal bleeding
Abdominal pain, distention and/or ascites
Nausea
Cachexia- (a condition marked by loss of appetite, weight
loss, muscular wasting, and general mental and physical
debilitation, caused by chronic disease)
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Disorders of the Intestines

Cancer of the colon (continued)

Diagnostic tests
• Proctosigmoidoscopy with biopsy
• Colonoscopy
• Stool for occult blood

Medical management/nursing
interventions
• Radiation
• Chemotherapy
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Disorders of the Intestines

Cancer of the colon (continued)

Medical management/nursing
interventions (continued)
• Surgery
• Obstruction
• One-stage or two-stage resection
• Two-stage resection
• Colorectal cancer
• Right or left hemicolectomy
• Anterior rectosigmoid resection
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Disorders of the Intestines:
Colon Cancer Stages
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Disorders of the Intestines

Hemorrhoids
Swollen vascular tissues in the rectal area.
 Treatment may involve sitz baths, creams,
and suppositories to decrease inflammation
and swelling, fiber supplements, stool
softeners, or surgery.

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Disorders of the Intestines

Hemorrhoids

Etiology/pathophysiology
• Varicosities (dilated veins)
• External or internal
• Contributing factors
• Straining with defecation, diarrhea, pregnancy, CHF, portal
hypertension, prolonged sitting and standing

Clinical manifestations/assessment
•
•
•
•
Varicosities in rectal area
Bright red bleeding with defecation
Pruritis
Severe pain when thrombosed
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Disorders of the Intestines

Hemorrhoids (continued)

Medical management/nursing interventions
•
•
•
•
•
•
•
•
Bulk stool softeners; hydrocortisone cream
Analgesic ointment
Sitz baths
Ligation
Sclerotherapy; cryotherapy
Infrared photocoagulation
Laser excision
Hemorrhoidectomy
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Disorders of the Intestines
EXTERNAL
HEMORRHOID
INTERNAL
HEMORRHOID
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Disorders of the Intestines

Anal fissure
Linear ulceration or laceration of the skin of
the anus
 Usually caused by trauma
 Lesions usually heal spontaneously
 May be excised surgically

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Disorders of the Intestines
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Disorders of the Intestines

Anal fistula
Abnormal opening on the surface near the
anus
 Usually from a local abscess
 Common in Crohn’s disease
 Treated by a fistulectomy or fistulotomy

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Disorders of the Intestines
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Disorders of the Intestines

Constipation
Characterized by hard, infrequent stools that
are difficult and/or painful to pass.
 Treatment may include fiber supplements,
stool softeners, laxatives, enemas, diet
modifications, increased activities, and
increased fluids.

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Disorders of the Intestines

Cirrhosis
Chronic, degenerative changes in the liver
cells and thickening of surrounding tissue.
 A form of end-stage liver disease for which
there is no cure.
 Treatment includes paracentesis to remove
the fluid from the abdomen, medications, and
dietary changes

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Disorders of the Intestines
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Disorders of the Intestines

Cirrhosis (continued)


Cirrhosis has many causes. In the United States, chronic
alcoholism and hepatitis C are the most common ones.
Symptoms
•
•
•
•
•
•
•
•
exhaustion
fatigue
loss of appetite
nausea
weakness
weight loss
abdominal pain
spider-like blood vessels (spider angiomas) that develop on the
skin
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Disorders of the Intestines

Complications of Cirrhosis



Edema and ascites. When the liver loses its ability
to make the protein albumin, water accumulates in
the legs (edema) and abdomen (ascites).
Jaundice. Jaundice is a yellowing of the skin and
eyes that occurs when the diseased liver does not
absorb enough bilirubin.
Bruising and bleeding. When the liver slows or
stops production of the proteins needed for blood
clotting, a person will bruise or bleed easily. The
palms of the hands may be reddish and blotchy with
palmar erythema.
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Disorders of the Intestines

Treatment of Cirrhosis

Treatment will also include remedies for
complications. For example, for ascites and edema,
the doctor may recommend a low-sodium diet or the
use of diuretics, which are drugs that remove fluid
from the body. Antibiotics will be prescribed for
infections, and various medications can help with
itching. Protein causes toxins to form in the digestive
tract, so eating less protein will help decrease the
buildup of toxins in the blood and brain. The doctor
may also prescribe laxatives to help absorb the
toxins and remove them from the intestines.
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Disorders of the Intestines

Treatment of Cirrhosis (continued)

When complications cannot be controlled or when
the liver becomes so damaged from scarring that it
completely stops functioning, a liver transplant is
necessary. In liver transplantation surgery, a
diseased liver is removed and replaced with a
healthy one from an organ donor. About 80 to 90
percent of patients survive liver transplantation.
Survival rates have improved over the past several
years because of drugs such as cyclosporine and
tacrolimus, which suppress the immune system and
keep it from attacking and damaging the new liver.
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Disorders of the Intestines

Hepatitis
Chronic or acute inflammation of liver caused
by virus, bacteria, drugs, alcohol abuse, or
other toxic substances.
 Treat to rest the liver and detect
complications early.
 Treat based on signs, symptoms present and
the prevention of transmission.

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Disorders of the Intestines:
Hepatitis A

The disease is spread primarily through food or water
contaminated by stool from an infected person. You can
get HAV from:





Eating food prepared by someone with HAV who did not wash
their hands after using the bathroom
Having anal/oral sex with someone with HAV
Not washing your hands after changing a diaper
Drinking contaminated water
HAV can cause swelling of the liver, but it rarely causes
lasting damage. You may feel as if you have the flu, or
you may have no symptoms at all. It usually gets better
on its own after several weeks.
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Disorders of the Intestines:
Hepatitis B

Hepatitis B
The most common serious liver infection
in the world. It is caused by the hepatitis B
virus that attacks the liver. The virus is
transmitted through blood and infected bodily
fluids.
 Can occur through direct blood-to-blood
contact, unprotected sex, use of unsterile
needles, and from an infected woman to her
newborn during the delivery process.

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Disorders of the Intestines:
Hepatitis B

Approved Hepatitis B Drugs in the
United States



Intron A (interferon alpha) is given by injection several times a
week for six months to a year, or sometimes longer. The drug
can cause side effects such as flu-like symptoms, depression,
and headaches.
Pegasys (pegylated interferon) is given by injection once a
week usually for six months to a year. The drug can cause side
effects such as flu-like symptoms, depression and other mental
health problems. Approved May 2005 and available only for
adults.
Epivir-HBV (lamivudine) is a pill that is taken once a day, with
almost no side effects, for at least one year or longer. A primary
concern is the possible development of hepatitis B virus
mutants during and after treatment.
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Disorders of the Intestines:
Hepatitis B

Approved Hepatitis B Drugs in the United
States



Hepsera (adefovir-dipivoxil) is a pill taken once a day, with few
side effects, for at least one year or longer. The primary concern
is that kidney problems can occur while taking the drug.
Baraclude (entecavir) is a pill taken once a day, with almost no
side effects for up to one year. It is considered to be the most
potent oral antiviral drug for chronic hepatitis B to date.
Approved April 2005 and available only for adults. Pediatric
clinical trials may be planned for the future.
Although they do not provide a complete cure, except in
rare cases (a "cure" means that a person loses the
hepatitis B virus and develops protective surface
antibodies), they do slow down the virus and decrease
the risk of more serious liver disease later in life.
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Disorders of the Intestines:
Hepatitis C

Hepatitis C
Occurs when blood from an infected person
enters the body of a person who is not
infected.
 HCV is spread through sharing needles or
"works" when "shooting" drugs, through
needlesticks or sharps exposures on the job,
or from an infected mother to her baby during
birth.

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Disorders of the Intestines:
Hepatitis C

Common medications used to treat Hepatitis
C:




Interferon and ribavirin are two drugs licensed for the
treatment of persons with chronic hepatitis C.
Interferon can be taken alone or in combination with
ribavirin. Combination therapy, using pegylated
interferon and ribavirin, is currently the treatment of
choice.
Combination therapy can get rid of the virus in up to
5 out of 10 persons for genotype 1 and in up to 8 out
of 10 persons for genotype 2 and 3.
Drinking alcohol can make your liver disease worse.
Copyright 2005 Thomson Delmar Learning. Thomson and Delmar Learning are trademarks used herein under license.
Disorders of the Intestines:
Hepatitis C

Hepatitis C Statistics


Hepatitis C is a treatable disease if identified before significant
complications develop.
Regardless of what treatment choice a person makes, it is
recommended that:
• Individuals with HCV should avoid all use of alcohol and
recreational drugs.
• Individuals with HCV should be vaccinated against hepatitis A and
hepatitis B.



Chronic liver disease is among the top ten killers of Americans
25 years of age and older.
Hepatitis C is the most common cause of chronic liver disease
in the U.S. accounting for 40-60% of all cases.
Hepatitis C is the most common indication for adult liver
transplantation in the United States.
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Disorders of the Intestines:
Hepatitis C

Hepatitis C Statistics





An estimated 5 million Americans have been infected
with the hepatitis C virus.
2 out of 3 people are unaware that they have the
virus.
Hepatitis C can show no symptoms until advanced
liver damage develops.
There is no vaccine to protect against hepatitis C
infection.
Early diagnosis is essential to controlling the spread
of hepatitis C.
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Disorders of the Intestines:
Hepatitis D

The hepatitis D virus (also called delta virus) is a small circular
RNA virus. The hepatitis D virus is replication defective and
therefore cannot propagate in the absence of another virus. In
humans, hepatitis D virus infection only occurs in the presence
of hepatitis B infection.

Hepatitis D virus infection is transmitted by blood and blood
products. The risk factors for infection are similar to those for
hepatitis B virus infection. The hepatitis D virus most often infects
intravenous drug users.

A patient can acquire hepatitis D virus infection at the same time as
he/she is infected with the hepatitis B virus. This is called coinfection. A patient with hepatitis B can be infected with hepatitis D
virus at any time after acute hepatitis B virus infection. This is
called super-infection.
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Disorders of the Intestines:
Hepatitis D

Hepatitis D virus super-infection should be suspected in a patient
with chronic hepatitis B whose condition suddenly worsens. There
is usually an obvious history of continued exposure to blood or
blood products (eg. an active intravenous drug user). A particularly
aggressive acute hepatitis B infection could suggest hepatitis D coinfection.

Co-infection or super-infection with hepatitis D virus in a patient
with hepatitis B is diagnosed by the presence of antibodies against
the hepatitis D virus. IgM antibodies indicate acute infection.

Interferon-alpha is used to treat patients with chronic hepatitis B
and hepatitis D infection. Some studies have suggested that a dose
higher than that usually used for hepatitis B infection may be
beneficial.
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Disorders of the Intestines:
Hepatitis E

Hepatitis E (HEV):


Was not recognized as a distinct human disease until
1980.
HEV is transmitted via the fecal-oral route. Hepatitis
E is a waterborne disease, and contaminated water
or food supplies have been implicated in major
outbreaks. Consumption of fecally contaminated
drinking water has given rise to epidemics, and the
ingestion of raw or uncooked shellfish has been the
source of sporadic cases in endemic areas.
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Disorders of the Intestines:
Hepatitis F

Hepatitis F:

A rare form of liver inflammation caused by
infection with the so-called hepatitis F virus,
which may be a mutation of Hepatitis B.
There is no vaccine or treatment for hepatitis
F, although anti-viral drugs may be tried.
Copyright 2005 Thomson Delmar Learning. Thomson and Delmar Learning are trademarks used herein under license.
Disorders of the Intestines:
Hepatitis G

Hepatitis G:


A newly identified virus. It was found after people
who had a blood transfusion developed post
transfusion hepatitis which could not be identified as
any known virus.
Infection with the hepatitis G virus can lead to
persistent infection in 15 - 30% of adults. The long
term outcomes of the infection are not yet
known. People with hepatitis A, B, or C can be coor super- infected with hepatitis G. There is no
vaccination available for hepatitis G.
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GI Disorders

Pancreatitis
Acute or chronic inflammation of the
pancreas caused when pancreatic enzymes
digest the lining of pancreas.
 Occurs with obstruction of pancreatic
duct as a result of gallstones, tumors,
exposure to chemicals, alcohol, or injury.
 Treatment is dependent upon the cause.

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GI Disorders
Copyright 2005 Thomson Delmar Learning. Thomson and Delmar Learning are trademarks used herein under license.
GI Disorders

Pancreatitis
Normally, digestive enzymes do not become
active until they reach the small intestine,
where they begin digesting food. But if these
enzymes become active inside the pancreas,
they start "digesting" the pancreas itself.
 Acute pancreatitis is usually caused by
gallstones or by drinking too much alcohol,
but these aren't the only causes.

Copyright 2005 Thomson Delmar Learning. Thomson and Delmar Learning are trademarks used herein under license.
GI Disorders

Symptoms of acute pancreatitis

Acute pancreatitis usually begins with pain in the
upper abdomen that may last for a few days. The
pain may be severe and may become constant—just
in the abdomen—or it may reach to the back and
other areas. It may be sudden and intense or begin
as a mild pain that gets worse when food is eaten.
Someone with acute pancreatitis often looks and
feels very sick. Other symptoms may include
•
•
•
•
•
swollen and tender abdomen
nausea
vomiting
fever
rapid pulse
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GI Disorders

Treatment of acute pancreatitis




Monitor amylase and lipase blood levels. Will be increased
during pancreatitis.
Treatment, in general, is designed to support vital bodily
functions and prevent complications. A hospital stay will be
necessary so that fluids can be replaced intravenously.
An acute attack usually lasts only a few days. In severe cases,
a person may require intravenous feeding for 3 to 6 weeks
while the pancreas slowly heals. This process is called total
parenteral nutrition. (TPN)
Oftentimes, analgesics given intravenously ease the patient’s
pain.
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GI Disorders:
Cholecystitis and Cholelithiasis
Cholecystitis is an inflammation of the
gallbladder.
 Cholelithiasis is the presence of
gallstones (calculi) in the gallbladder.
 Treatment involves low-fat diets,
analgesics, and surgery.

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GI Disorders:
Cholecystitis and Cholelithiasis


Cholecystitis is usually caused by a gallstone in the cystic duct,
the duct that connects the gallbladder to the hepatic duct.
Symptoms may include:











intense and sudden pain in the upper right part of the abdomen
recurrent painful attacks for several hours after meals
pain (often worse with deep breaths and extends to lower part of right
shoulder blade)
nausea
vomiting
rigid abdominal muscles on right side
slight fever/chills
jaundice - yellowing of the skin and eyes.
itching (rare)
loose, light-colored bowel movements
abdominal bloating
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GI Disorders

Treatment for acute cholecystitis

Usually involves a hospital stay, to reduce
stimulation to the gallbladder. Antibiotics are
usually administered to reduce the
inflammation and/or fight the infection.
Sometimes, the gallbladder is surgically
removed. (cholecystectomy)
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Gallbladder full of gallstones
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GI Disorders

Liver Cancer
Primary liver cancer is rare.
 Most liver tumors are metastatic from other
sites in the body and are asymptomatic until
later stages.
 Treatment involves surgery, chemotherapy,
and radiation.

Copyright 2005 Thomson Delmar Learning. Thomson and Delmar Learning are trademarks used herein under license.
GI Disorders




Liver Cancer (continued)
Liver cancer is the fifth most common cancer in the
world. A deadly cancer, liver cancer will kill almost all
patients who have it within a year.
The most widely used biochemical blood test for liver
cancer is alpha-fetoprotein (AFP), which is a protein
normally made by the immature liver cells in the fetus.
In adults, high blood levels (over 500
nanograms/milliliter) of AFP are seen in only three
situations:



Liver cancer
Germ cell tumors (cancer of the testes and ovaries)
Metastatic cancer in the liver (originating in other organs)
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GI Disorders

Liver Cancer Treatments
The treatment options are dictated by the
stage of liver cancer and the overall condition
of the patient. The only proven cure for liver
cancer is liver transplantation.
 Chemotherapy
 Radiation Therapy

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GI Disorders: Liver Cancer
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