Transcript DISORDERS OF THE GASTROINTESTINAL SYSTEM

DISORDERS OF THE
GASTROINTESTINAL
SYSTEM
DIGESTIVE SYSTEM
• FUNCTIONS: ingest food
– DIGESTION:break it down into small
molecules
– ABSORPTION:absorb nutrient
molecules
– ELIMINATION:eliminate nondigested
wastes
• ASSESSORY ORGANS :
– pancreas, liver, gallbladder
Disorders affecting
Ingestion
• ANOREXIA: lack of appetite, could be from
emotional or physical factors
• lab tests may be done to assess nutritional
status
• Medical treatment:
supplements may
be ordered, TPN or enteral feedings
• Nursing Interventions:
– oral hygiene, clean room, determine
cause of nausea and treat, include
family and friends(socialization),
respect likes and dislikes, education
STOMATITIS
• Inflammation of the oral mucosa (mouth)
• Causes: trauma, organisms, irritants,
nutritional deficiency, diseases, chemotherapy
• S/S: swelling, pain, ulcerations, excessive
salivation, halitosis, sore mouth
• Treatment:
• pain relief, removal of causative factor, oral
hygiene, medications, soft bland diet
GINGIVITIS
• Inflammation of the gums
• Causes: poor oral hygiene, poorly
fitting dentures, nutritional deficiency
• S/S: red, swollen, bleeding gums,
painful
• Treatment: dental hygiene,
prevention of complications
Nursing Interventions:
Stomatitis and Gingivitis
• Assess mouth condition
• Administer medications
• Mouth care
• Soft bland diet, no spicy foods
• Observe for complications
• Teach importance of mouth and gum
care
HERPES SIMPLEX TYPE 1
• Infection affecting the lips and mucous
membranes of the mouth
• Causes: Herpes simplex virus
• S/S: Vesicles on the mouth, nose or lips,
malaise, edema of surrounding area
• Treatment: Antiviral medication(Zovirax),
analgesics, symptomatic relief
• Nsg Interventions: Administer meds, keep
lesions dry, provide symptomatic relief
LEUKOPLAKIA
• Abnormal thickening and whitening
of the epithelium of the mucous
membranes of the cheeks and
tongue
• Causes: Chronic irritation
• S/S: Thickened white or reddish
lesions on the mucous membrane,
lesions can not be rubbed off
• Treatment: May be surgically
removed or treated with
chemotherapy, meticulous oral
hygiene
• Interventions: Assess mouth
frequently, assist with oral
hygiene, discuss removal of
sources of irritation
ORAL CANCER
• Malignant lesions may develop on
the lips, oral cavity, tongue and
pharynx. Generally squamous cell
carcinomas
• Causes: high alcohol consumption,
tobacco use, external irritants
• S/S: Leukoplakia, swelling, edema,
numbness, pain
• Diagnosis: biopsy
• Treatment:
– Surgery
– Radiation or chemotherapy
• depends on the size and location and the lesion
• Interventions: consult MD for special mouth care,
monitor respiratory status, keep HOB elevated,
administer pain med, assess ability to swallow and talk,
assess for infection at incision site, education
ESOPHAGITIS
• Inflammation or irritation of the
esophagus
• Causes: Reflux of stomach contents,
irritants, fungal infections, trauma,
malignancy, intubation
• S/S: heartburn, pain, dysphagia
• Treatment: treat underlying cause
• Interventions: soft bland diet,
administer meds, elevate HOB, observe
for complications
ESOPHAGEAL VARICIES
• Tortuous, distended vessels of the
esophagus
– may rupture and bleed
• causes: Portal hypertension caused
by cirrhosis of the liver
• S/S Hematemesis, hemorrhage from
UGI, black tarry stools, pain, shock
• Treatment:
– Sengstaken-Blakemore tube to controll bleeding
– Iced saline lavage
– Medications( Vasopressin, antibiotics, analgesics)
– Surgeries: ligation, injection sclerotherapy
– Blood transfusions
• Interventions:
– administer meds
– provide pre/post op care
– administer blood transfusions
– monitor tube placement
– assess vital signs, bleeding
CANCER OF THE
ESOPHAGUS
• Prognosis is very poor, diagnosed at late
stages
• Causes- no known cause, predisposing
factors; irritation, poor oral hygiene
• S/S- progressive dysphagia, painful
swallowing, weight loss, vomiting,
hoarseness, coughing, iron deficiency,
anemia, occult bleeding or hemmorage
Treatment of CA of
Esophagus
• Palliative treatment is common
• Radiation, chemotherapy
• surgery:
– Esophagectomy
– Esophagogastrostomy
– Esophagoenterostomy
– Gastrostomy
Interventions
• Maintain NG tube after surgery
• Assess for signs of hemorrahage
• Monitor respiratory status
• monitor adequacy of nutritional
intake ( high protein, high calorie
diet)
• assess ability to swallow
• allow patient to ventilate feelings
DISORDERS OF DIGESTION
AND ABSORPTION
• N/V
• Hiatal Hernia
• Gastritis
• Peptic Ulcer
• Stomach Cancer
• Obesity
NAUSEA AND VOMITING
• Nausea: unpleasant sensation
usually preceding vomiting, may
have abdominal pain, pallor,
sweating, clammy skin
• Causes: irritating food, infection,
radiation, drugs, hormonal changes,
surgery, inner ear disorders,
distention of the GI tract
• Vomiting: forceful expulsions of
stomach contents through the
mouth. Occurs when vomiting reflex
in the brain is stimulated.
• Projectile vomiting- is forceful
ejection of stomach contents.
• Regurgitation- gentle ejection of
stomach contents without nausea or
retching
Complications and
Treatment
• May lead to dehydration, metabolic
alkalosis, aspiration
• Treatment: Antiemetics(
Phenergan, Dramamine,
Scopolamine patch Reglan), IV
fluids, NG tube, TPN
• Nursing care: through
assessment, keep patient
comfortable, offer liquids, position
on side, suction setup in the room
HIATAL HERNIA
• Protrusion of the lower esophagus and
stomach upward through the diaphragm into
the chest
– SLIDING-gastroesophageal junction above
the hiatus
– ROLLING( paraesophageal)-junction in place
portion of stomach rolls up through
diaphram
• Causes; weakness in the lower esophageal
sphincter, related to increased abdominal
pressure, long term bedrest, trauma
Signs and Symptoms
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Feelings of fullness
dysphagia
eruption
regurgitation
heartburn
Complications: Ulcerations, bleeding,
aspiration
• seen in 50% of people over 60.
Treatment for Hiatal Hernia
• Drug therapy
– H2 receptor antagonists:Tagamet,Zantac,
Pepsid- reduce stomach secretions
– Urecholine- increase LES tone
– Antacids- neutralize stomach acids
– Reglan, Propulsid- increase stomach emptying
• diet therapy- decrease caffeine fatty foods,
alcohol( reduce LES tone), acidic and spicy foods
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SURGERY
Nissen Fundoplication
Angelclik prothesis
NURSING CARE: assessment, pain
relief, watch for aspiration, nutrition,
education
GASTRITIS
• Inflammation of the lining of the
stomach
• ACUTE: excessive intake of food or
alcohol. Food poisoning, chemical
irritation
• CHRONIC: repeated episodes of
acute, H Pylori
Signs/Symptoms and
Complications
• Nausea, vomiting, feeling of fullness,
pain in stomach, indigestion. With
chronic may have only mild
indigestion
• changes in stomach lining with
decrease in acid and intrinsic factor
( high risk for pernicious anemia)
Treatment
• Treat symptoms, and fluid replacement
• Medications: antacids, H2 receptor
blockers, B 12 injections, corticosteroids
analgesics, antibiotics if H Pylori
• bland diet, frequent meals
• Eliminate the cause
• surgical intervention
• BEST DIAGNOSIS IS GASTROSOPY &
BIOPSY
NURSING CARE
• Good HX and review of present S/S
• pain relief, adequate nutrition,
hydration, stress management,
education
PEPTIC ULCER
• Loss of tissue from the lining of the
digestive tract. May be acute or
chronic.
• Classified as gastric or duodental
(stress- develop 24-48hr. After
event)
• CAUSES: drugs, stress, heavy
alcohol and tobacco use, infection (H
.pylori bacteria) Conditions that
cause high gastric acid concentration
Peptic Ulcer comparison
• Gastric Ulcers
• burning pain 1-2 hrs.
after meals, upper
left
abd/back,relieved by
food
• N/V, anorexia, wt
loss
• Shallow/ gastric
secretions deceased
• Older men, working
class, bld type A,
under stress
• Duodenal Ulcers
• burning/ cramping
pain 2-4hrs. P meal,
beneath xiphoid and
back, relieved by
antacids/food
• increased gastric
acid
• Young men, all social
classes, bld type O,
chronic illnesses
PEPTIC ULCER
COMPLICATIONS
• HEMORRHAGE
• PERFORATION
• PYLORIC OBSTRUCTION
TREATMENT
• Drug therapy
– Antacids
– H2 RECEPTOR BLOCKERS
– ANTICHOLINERGICS-Pro-Banthine, Robinul,
Bentyl
– SUCRALFATE- Carafate
– Antibiotics –Flagyl, tetracycline, Biaxin
• treatment goals- relieve symptoms,
promote healing, prevent complications
and recurrence
Nursing Interventions
• Three meals a day – decreases acid
production
• decrease foods that stimulate acid
secretions and cause discomfort
• treat pain with rest, diet and drug
therapy
• educate on stress management and
relaxation
Surgical options for gastric
ulcers
• To decrease acid secretion:
– vagotomy
– pyloroplasty
– gastroenterostomy
– antrectomy
– subtotal gastrectomy
• Billroth I
• Billroth II
Nursing care after gastric
surgery
• No signs of complications
– Gastric dilation
– Obstruction
– Perforation
• Maintenance of NG tube:
– Suction
– do not irrigate or reposition tube
– type of drainage
• Adequate nutrition:
– NPO gradually advance from clear liquids to
full liquids then solid foods
– Assess for N/V, abdominal distention
– Size of meals changes depending on type of
surgery
– Gastric surgeries can have serious effects
on absorption of vit. B12, folic acid, iron,
calcium, vit, D
• Decreased cardiac output
– Dumping syndrome common after gastric surgery:
• small stomach size causes chyme to move rapidly into
intestine (15-30min.), draws fluid from the blood.
Results- drop in bld volume, weakness, dizziness,
sweating. ^ in fluid in intestine causes cramping,
loud BS abd urge to defecate . Later ^ bld sugar
– Treatment: 6 small meals qd, low in carbs and refined
sugars, mod. Fat/high protein
– fluids between and not with meals
– lie down for 30 min. after meal
education
• Reinforce diet
• teach signs of complicatons
• Avoid risk factors
STOMACH CANCER
• Rare(25,000/yr.), common in males,
African American, over 70 and low
socioeconomic status. 60% decrease
in past 40 yrs.
• No S/S in early stages
• Late stages S/S: N/V, ascities, liver
enlargement, abd. Mass
• Mets to bone and lung
• 10% survival rate after 5 yrs.
• Risk factors: pernicious anemia,
chronic gastritis, cigarette smoking,
diet high in starch, salt, salted
meat, pickled foods, nitrates
• Treatment: surgery/
chemotherapy/ radiation
– subtotal gastrectomy, total
gastrectomy
OBESITY
• Increase in body weight, 20% over
ideal, caused by excessive fat.
Morbid obesity twice ideal
• Causes: heredity, body build,
metabolism, psychosocial factors.
Calorie intake exceeds demands.
•
Treatment and nursing care
• Weight reduction diet
• drug therapy, mainly Amphetamines
• Surgical procedures:
– Liposuction
– Lipectomy
– Jaw wiring
– Intragastric balloon
– Gastric bypass
– gastroplasty
– jejunoileal bypass
• Nursing care-assessment, diet monitoring, education
DISORDERS
AFFECTING
ABSORPTION
AND
ELIMINATION
MALABSORPTION
• CONDITION WHEN ONE OR MORE NUTRIENTS
ARE NOT DIGESTED OR ABSORBED
– multiple causes
– lactase deficiency
– sprue: celiac/tropical
• treatment/care: depends on type
– lactase- hold milk products
– celiac sprue- hold gluten products
– tropical sprue- antibiotics, folic acid
DIRRHEA
• The passage of loose liquid stools
with increased frequency, associated
with cramping, abd, pain
• Causes; (many), foods, allergies,
infections, stress, fecal impaction,
tube feedings, medications
• Complications- usually temporary/
can be dehydration, malnutrition
Treatment/Nursing care
• Treatment; GI rest, antidiarrheal
drugs(Lomotil, Imodium, Kaolin,
Aluminum hydroxide)
• Nursing Care: help determine
cause, assessVS, weight, skin turgor,
abdominal destention, perianal
irritation, skin integrity
CONSTIPATION
• HARD DRY INFREQUENT STOOLS
PASSED WITH DIFFICULTY
• Causes: (many),inactivity, ignored
urge, drugs,age related changes
• Complications: straining (Valsalva
maneuver) and fecal impaction
Treatment/Nursing care
• Laxatives, suppositorys, enemas for
prompt results
• stool softeners, increase
fluids,dietary fiber
• Nursing care: assessment, monitor
fluids and diet, education, check for
impaction
INTESTINAL
OBSTRUCTION
• Exists when there is obstruction in
the normal flow of intestinal contents
through the intestinal tract
– Mechanical- Pressure on the intestinal
wall
– Paralytic- Intestinal musculature unable
to propel contents along the bowel
• May be partial or complete
Intestinal obstruction
causes
• SMALL BOWEL:
– adhesions most common
– intussusception
– volvulus
– paralytic ilieus
– abdominal hernia
• LARGE BOWEL:
– carcinoma
– diverticulitis
– inflammatory bowel disorders
– volvulus
Small Bowel vs Large Bowel
• Small:
– abdominal pain
– vomiting
– pass blood and
mucous, no stool,
no gas
– over time signs of
dehydration
• Large:
– symptoms develop
slowly
– constipation
– distended abdomen
– crampy lower
abdominal pain
– fecal vomiting
Management of bowel
obstruction
• Small
– decompression
– is strangulated then surgery
• Large
– surgical resection with formation of
colostomy
• Nursing care: same as gastric
surgery, management of NG tube
APPENDICITIS
• Inflammation of the appendix
– appendix has no known function in the
body
– opening becomes obstructed
– obstruction interferes with the drainage
of secretions from the appendix
Signs and symptoms
• Generalized epigastric pain at first
that shifts to the RLQ
• pain at McBurney’s point
• elevated temp, N/V, elevated WBC’s(
over 10,000)
Treatment/nursing care
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NPO
surgical removal
IV’s and antibiotics
ice pack to the abd.
LAXATIVES AND HEAT ARE CONTRAINDICATED
Nursing Care:
– pain relief, fluid balance
– absence of infection, effective breathing
PERITONITIS
• Inflammation of the peritoneum
• Causes;
– chemical
– bacterial contamination
• S/S pain, rebound tenderness,
rigidity, distention, fever,
tachcardia, tachypnea,N/V
Treatment/Nursing care
• NG tube, IV fluids, antibiotics,
analgisics, surgery if indicated
• Nursing care;
– Assessment- VS, pain, abd distention,
BS, I/O, monitor cardiac output
ABDOMINAL HERNIA
• A protrusion of the intestine through
a weakness in the abdominal wall
– reducible
– irreducible
• Inguinal, umbilical, femoral,
incisional
• S/S: smooth lump in the abdomen,
usually not painful. If incarcerated,
severe pain present
Treatment/nursing care
• Treatment: Herniorrhaphy,
Hernioplasty
• Nursing care;
– absence of strangulation, monitor
activity
– general surgery interventions with
surgery