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Transcript of DISORDERS OF THE GASTROINTESTINAL SYSTEM. DIGESTIVE SYSTEM FUNCTIONS: ingest food –DIGESTION:break...
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DISORDERS OF THE DISORDERS OF THE GASTROINTESTINAL GASTROINTESTINAL
SYSTEMSYSTEM
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DIGESTIVE SYSTEMDIGESTIVE SYSTEM• FUNCTIONS: ingest food
– DIGESTION:break it down into small molecules
– ABSORPTION:absorb nutrient molecules
– ELIMINATION:eliminate nondigested wastes
• ASSESSORY ORGANS :– pancreas, liver, gallbladder
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Disorders of the upper GI Disorders of the upper GI systemsystem
Disorders affecting Disorders affecting IngestionIngestion
• 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
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STOMATITISSTOMATITIS
• 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
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GINGIVITISGINGIVITIS• 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
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Nursing Interventions:Nursing Interventions:Stomatitis and GingivitisStomatitis 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
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HERPES SIMPLEX TYPE 1HERPES 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
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LEUKOPLAKIALEUKOPLAKIA• 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
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• 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
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ORAL CANCERORAL 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
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• 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
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ESOPHAGITISESOPHAGITIS• 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
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ESOPHAGEAL VARICIESESOPHAGEAL 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
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• Treatment:– Sengstaken-Blakemore tube to controll bleeding
– Iced saline lavage
– Medications( Vasopressin, antibiotics, analgesics)
– Surgeries: ligation, injection sclerotherapy
– Blood transfusions
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• Interventions:
– administer meds
– provide pre/post op care
– administer blood transfusions
– monitor tube placement
– assess vital signs, bleeding
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CANCER OF THE CANCER OF THE ESOPHAGUSESOPHAGUS
• 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
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Treatment of CA of Treatment of CA of EsophagusEsophagus
• Palliative treatment is common• Radiation, chemotherapy• surgery:
– Esophagectomy– Esophagogastrostomy– Esophagoenterostomy– Gastrostomy
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InterventionsInterventions• 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
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DISORDERS OF DIGESTION DISORDERS OF DIGESTION AND ABSORPTIONAND ABSORPTION
• N/V• Hiatal Hernia• Gastritis• Peptic Ulcer• Stomach Cancer• Obesity
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NAUSEA AND VOMITINGNAUSEA 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
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• 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
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Complications and Complications and TreatmentTreatment
• 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
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HIATAL HERNIAHIATAL 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
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Signs and SymptomsSigns and Symptoms
• Feelings of fullness• dysphagia• eruption• regurgitation• heartburn• Complications: Ulcerations, bleeding,
aspiration
• seen in 50% of people over 60.
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Treatment for Hiatal HerniaTreatment 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
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GASTRITISGASTRITIS• 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
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Signs/Symptoms and Signs/Symptoms and ComplicationsComplications
• 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)
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TreatmentTreatment• 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
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NURSING CARENURSING CARE• Good HX and review of present S/S• pain relief, adequate nutrition,
hydration, stress management, education
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PEPTIC ULCERPEPTIC 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
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Peptic Ulcer comparisonPeptic 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
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PEPTIC ULCER PEPTIC ULCER COMPLICATIONSCOMPLICATIONS
• HEMORRHAGE
• PERFORATION
• PYLORIC OBSTRUCTION
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TREATMENTTREATMENT• 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
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Nursing InterventionsNursing 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
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Surgical options for gastric Surgical options for gastric ulcersulcers
• To decrease acid secretion:– vagotomy– pyloroplasty– gastroenterostomy– antrectomy– subtotal gastrectomy
• Billroth I• Billroth II
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Nursing care after gastric Nursing care after gastric surgerysurgery
• No signs of complications– Gastric dilation– Obstruction– Perforation
• Maintenance of NG tube:– Suction– do not irrigate or reposition tube– type of drainage
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• 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
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• 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
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educationeducation• Reinforce diet• teach signs of complicatons• Avoid risk factors
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STOMACH CANCERSTOMACH 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.
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• 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
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OBESITYOBESITY• 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.
•
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Treatment and nursing careTreatment 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
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DISORDERS DISORDERS AFFECTINGAFFECTING
ABSORPTION ABSORPTION AND AND
ELIMINATIONELIMINATION
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MALABSORPTIONMALABSORPTION
• 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
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DIRRHEADIRRHEA
• 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
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Treatment/Nursing careTreatment/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
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CONSTIPATIONCONSTIPATION• HARD DRY INFREQUENT STOOLS
PASSED WITH DIFFICULTY• Causes: (many),inactivity, ignored
urge, drugs,age related changes• Complications: straining (Valsalva
maneuver) and fecal impaction
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Treatment/Nursing careTreatment/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
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INTESTINAL INTESTINAL OBSTRUCTIONOBSTRUCTION
• 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
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Intestinal obstruction Intestinal obstruction causescauses
• SMALL BOWEL:
– adhesions most common– intussusception– volvulus– paralytic ilieus– abdominal hernia
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• LARGE BOWEL:– carcinoma– diverticulitis– inflammatory bowel disorders– volvulus
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Small Bowel vs Large BowelSmall 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
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Management of bowel Management of bowel obstructionobstruction
• Small– decompression– is strangulated then surgery
• Large– surgical resection with formation of
colostomy
• Nursing care: same as gastric surgery, management of NG tube
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APPENDICITISAPPENDICITIS• 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
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Signs and symptomsSigns 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)
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Treatment/nursing careTreatment/nursing care
• 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
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PERITONITISPERITONITIS
• Inflammation of the peritoneum• Causes;
– chemical– bacterial contamination
• S/S pain, rebound tenderness, rigidity, distention, fever, tachcardia, tachypnea,N/V
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Treatment/Nursing careTreatment/Nursing care• NG tube, IV fluids, antibiotics,
analgisics, surgery if indicated• Nursing care;
– Assessment- VS, pain, abd distention, BS, I/O, monitor cardiac output
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ABDOMINAL HERNIAABDOMINAL 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
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Treatment/nursing careTreatment/nursing care
• Treatment: Herniorrhaphy, Hernioplasty
• Nursing care;– absence of strangulation, monitor
activity– general surgery interventions with
surgery