Transcript Gastrointestinal System

*
NUR 171 Professor Losicki MSN
*
* Oral mucosa
* Dentition
* Ulcers or lesions
*
*
* Incompetent LES
* Gastroparesis
*
* Sliding
* Paraesophageal or
Rolling
*
* Increase Pressure/Tone: Cholinergics
* • bethanechol (Urecholine)
* • metoclopramide (Reglan)
*Decrease Pressure/Tone
* • Alcohol
* • Anticholinergics:
* • Chocolate (theobromine)
* • Fatty foods
* • Nicotine
* • Peppermint, spearmint
* • Tea, coffee (caffeine)
* • Drugs: See note
* Heartburn (pyrosis)
* Dyspepsia
* Coughing
* Wheezing at night
* Hyper salivation (water brash)
* Complaints of non cardiac chest pain
* Common in older patients
*
*
Esophagitis with esophageal ulcerations.
*
* Barrett’s Esophagus
* EsophagealStricture →
* Esophageal Cancer
* Respiratory
* Cough
* Bronchospasm
* Laryngospasm
* Cricopharyngeal spasm
*
*
*
*
*Hpylori
*Medication-Induced Injury
*Lifestyle Factors
*
1228
FEATURE
GASTRIC ULCER
DUODENAL ULCER
Age
Usually 50 yr or older
Usually 50 yr or older
Gender
Male/female ratio of 1.1:1
Male/female ratio of 1:1
Blood group
No differentiation
Most often type O
General nourishment
May be malnourished
Usually well nourished
Stomach acid production
Occurrence
Normal secretion or
hyposecretion
Mucosa exposed to acidpepsin secretion
Hypersecretion
Mucosa exposed to acidpepsin secretion
Clinical course
Healing and recurrence
Healing and recurrence
Pain
Occurs 30-60 min after a
meal; at night: rarely
Worsened by ingestion of
food
Occurs -3 hr after a meal; at
night: often awakens patient
between 1 and 2 am
Relieved by ingestion of food
Response to treatment
Healing with appropriate
therapy
*
Healing with appropriate
therapy
*Acute Pain
*Ineffective Self-Health
Management
*Nausea
*
Antacids
*
Maalox
Mylanta
Gelusil
Histamine receptor blockers
Famotidine (Pepcid)
Ranitidine (Zantac)
Proton Pump Inhibitors
Patanoprezole (protonix)
Omeprezole (Prilosec)
Anticholinergics
Bethanecol (Urecholine)
*
Hemorrhage
Most common
Duodenal
Perforation
Most lethal
Duodenal
Lesser curvature
Gastric Outlet Obstruction
* Pain that is worse toward the end of the day as the stomach
fills and dilates
* Relief may be obtained by belching or by self-induced
vomiting.
* Vomiting is common and often projectile.
* Constipation occurs because of dehydration
*
*
*
*
Cholecystitis
* Inflammation
*
*
may be confined to the mucous lining or involve
the entire wall of the gallbladder.
Infection:
*
*
*
E Coli
Streptococci
Salmonellae
CLINICAL MANIFESTATION
Obstructive jaundice
Dark amber urine, which foams when shaken
No urobilinogen in urine
Clay-colored stools
Pruritus
Intolerance for fatty foods (nausea,
sensation of fullness, anorexia)
Bleeding tendencies
ETIOLOGY
No bile flow into duodenum
Soluble bilirubin in urine
No bilirubin reaching small
intestine to be converted to
urobilinogen
Same as above
Deposition of bile salts in skin
tissues
No bile in small intestine for fat
digestion
Lack of or decreased absorption of
vitamin K, resulting in
decreased production of
prothrombin
No bile salts in duodenum,
preventing fat emulsion and
digestion
Steatorrhea
*
*
*Topics
*IBS-irritable Bowel syndrome
*IBD- Inflammatory bowel disease
*UC-Ulcerative colitis
*Crohn’s
*SBO-small bowel obstruction
*Appendicitis
*Peritonitis
*Ostomies
*
*
*
Irritable bowel syndrome (IBS)
• chronic functional disorder
• With intermittent and recurrent abdominal pain and stool
pattern irregularities
• diarrhea, constipation, or both.
• 10% to 15% of Western populations
• twice as many women as men.
• Stress, psychologic factors, prior gastroenteritis, and specific
food intolerances have been identified as major factors that
precipitate IBS symptoms.
*
*Mechanical
*Non-mechanical
* Proximal bowel distends
* increased pressure leads to an increase in capillary permeability and
leakage of fluids and electrolytes into the peritoneal cavity.
* Cause a reduction of circulating blood volume causing hypotention
* Bowel can become ischemic, necrotic
* Possible perforation
* Distal bowel collapses
*
*
*
*Diverticulosis
*Diverticulitis
*Complications
*Perforation
*Peritonitis
*High interluminal
pressure in weak areas
*Inadequate dietary
fiber
*
* Inflammation of the GI tract
* IBD is an autoimmune disease.
* IBD is classified as either Crohn's disease or ulcerative colitis
* TABLE 43-14 COMPARISON OF ULCERATIVE COLITIS AND
CROHN'S DISEASE (Lewis 1023)
* Know this
*
*
Diagnostic
*History and physical examination
*CBC, erythrocyte sedimentation rate, genetic
studies
*Serum chemistries
*Testing of stool for occult blood
*Testing of stool for infection
*Capsule endoscopy
*Radiologic studies with barium contrast
*Sigmoidoscopy and colonoscopy with biopsy
*
*High-calorie, high-vitamin, high-protein, low-
residue, lactose-free (if lactase deficiency) diet
*•Aminosalicylates*
*•Antimicrobial agents*
* •Corticosteroid drugs*
*Immunosuppressants*
*•Biologic and targeted therapy
(immunomodulator)*
*Elemental diet or parenteral nutrition
*Physical and emotional rest
*Referral for counseling and/or support group
*Surgery†
*
*
*
* GERD: LES weakness causing esophageal reflux
* Erosions, Barret’s, Ca
* Dietary modifications, medications, surgical interventions
(fundoplication)
* PUD: Gastric and duodenal
* Duodenal: prone to hemorrhage and perforation
* Gastric: prone to perforation
* Dietary modifications:, medications, surgical intervention
* Bowel Obstruction
* NPO, NGT, Miller-Abbott tube, Cantor tube, IV fluid resuscitation
* Surgical intervention
* Peritonitis
* Pre op or non-operative: NPO, IV, ABX, NGT, analgesics, O2,
* Post op: NPO, NGTY, semi fowlers, IV, electrolyte replacement, abx,
blood transfusion PRN, analgesics
* Ignatavius & Workman 7th ed. Medical Surgical
Nursing: Patient-centered collaborative care.
Saunders, 2013.
* Lewis, Dirksen, Heitkemper, Bucher, & Camera
8th ed. Medical Surgical Nursing: Assessment
and management of clinical problems. Mosby,
2011
*