Git Disturbances

7/31/2019 Git Disturbances

1/119

GASTROINTESTINAL SYSTEM


2/119

Gastrointestinal

AssessmentLaboratory Procedures


3/119

COMMON LABORATORY PROCEDURES

FECALYSIS

Examination of stool consistency,

color and the presence of occultblood.

Special tests for fat, nitrogen,

parasites, ova, pathogens andothers


4/119


FECALYSIS: Occult Blood Testing

Instruct the patient to adhere to a

3-day meatless diet

No intake of NSAIDS, aspirin and

anti-coagulantScreening test for colonic cancer


5/119


Upper GIT study: barium swallow

Examines the upper GI tract

Barium sulfate is usually used

as contrast


6/119


Upper GIT study: barium swallow

Pre-test: NPO post-midnight

Post-test: Laxative is ordered, increasept fluid intake, instruct that stools will

turn white, monitor for obstruction


7/119


8/119


9/119


Lower GIT study: barium enema

Examines the lower GI tract

Pre-test: Clear liquid diet and

laxatives, NPO post-midnight,

cleansing enema prior to the test


10/119


Lower GIT study: barium enema

Post-test: Laxative is ordered,

increase patient fluid intake,

instruct that stools will turn

white, monitor for obstruction


11/119


12/119


Gastric analysis

Aspiration of gastric juice to measure

pH, appearance, volume and contentsPre-test: NPO 8 hours, avoidance of

stimulants, drugs and smoking

Post-test: resume normal activities


13/119


EGD

(esophagogastroduodenoscopy)

Visualization of the upper GIT byendoscope

Pre-test: ensure consent, NPO 8hours, pre-medications likeatropine and anxiolytics


14/119


15/119


EGD

esophagogastroduodenoscopy

Intra-test: position : LEFTlateral tofacilitate salivary drainage and

easy access


16/119


EGD (esophagogastroduodenoscopy)

Post-test: NPO until gag reflex returns,

place patient in SIMS position until heawakens, monitor for complications,saline gargles for mild oral discomfort


17/119


Lower GI- scopy

Use of endoscope to visualize the

anus, rectum, sigmoid and colonPre-test: consent, NPO 8 hours,

cleansing enema until return is clear


18/119


19/119


Lower GI- scopy

Intra-test: position is LEFT

lateral, right leg is bent andplaced anteriorly

Post-test: bed rest, monitor forcomplications like bleeding andperforation


20/119


21/119


Cholecystography

Examination of the gallbladder todetect stones, its ability to

concentrate, store and release the bilePre-test: ensure consent, ask allergies

to iodine, seafood and dyes; contrast

medium is administered the nightprior, NPO after contrastadministration


22/119


Cholecystography

Post-test: Advise that

dysuria is common as thedye is excreted in the urine,resume normal activities


23/119


Paracentesis

Removal of peritonealfluid for analysis


24/119


Paracentesis

Pre-test: ensure consent,instruct to VOID and empty

bladder, measure abdominalgirth


25/119


Paracentesis

Intra-test: Upright on theedge of the bed, back

supported and feet restingon a foot stool


26/119


Liver biopsy

Pretest

Consent

NPO

Check for the bleeding

parameters


27/119


Liver biopsy

Intratest

Position: Semi fowlers LEFT lateral

to expose right side of abdomen


28/119


Liver biopsy

Post-test: position on RIGHT

lateral with pillow underneath,monitor VS and complications like

bleeding, perforation. Instruct toavoid lifting objects for 1 week


29/119

The NURSING PROCESS in GIT

Disorders

Assessment

Health history Nursing History

PE

Laboratory procedures


30/119

The ABDOMINAL examination

The sequence to follow is:

Inspection

Auscultation

Percussion

Palpation


31/119


32/119

The GIT System: Anatomy and

Physiology

The GIT is composed of two general parts

The main GIT starts from the

mouth Esophagus Stomach SI LI

The accessory organs are the

Salivary glands

Liver

Gallbladder

Pancreas


33/119

The GIT ANATOMY

The Mouth

Contains the lips, cheeks, palate, tongue,

teeth, salivary glands, masticatory/facial

muscles and bones

Anteriorly bounded by the lips

Posteriorly bounded by the oropharynx


34/119

The GIT Physiology

The Mouth

Important for the mechanical digestion of

food

The saliva contains SALIVARY AMYLASE or

PTYALIN that starts the INITIAL digestion of

carbohydrates


35/119

The GIT ANATOMY

The Esophagus

A hollow collapsible tube

Length- 10 inchesMade up of stratified squamos

epithelium


36/119

The GIT ANATOMY

The Esophagus

The upper third contains skeletal

muscles The middle third contains mixed

skeletal and smooth muscles

The lower third contains smoothmuscles and the esophago-gastric/cardiac sphincter is found here


37/119

The GIT PHYSIOLOGY

The Esophagus

Functions to carry or propel foods from the

oropharynx to the stomach

Swallowing or deglutition is composed of

three phases:


38/119

The GIT ANATOMY

The stomach

J-shaped organ in the epigastrium

Contains four parts- the fundus, the cardia,

the body and the pylorusThe cardiac sphincter prevents the reflux of

the contents into the esophagus

The pyloric sphincter regulates the rate ofgastric emptying into the duodenum

Capacity is 1,500 ml!


39/119

The GIT PHYSIOLOGY

The functions of the stomach aregenerally to digest the food (proteins)and to propel the digested materials into

the SI for final digestionThe Glands and cells in the stomach

secrete digestive enzymes:


40/119

The GIT PHYSIOLOGY

Stomach:

1. Parietal cells- HCl acid and Intrinsicfactor

2. Chief cells- pepsin digestion ofPROTEINS to POLYPEPTIDES

3. Antral G-cells- gastrinINC HCL acidproduction

4. Mucus neck cells- mucus


41/119

The GIT ANATOMY

The Small intestine

Grossly divided into the Duodenum, Jejunum

and Ileum

The duodenum contains the two openings for

the bile and pancreatic ducts

The ileum is the longest part (about 12 feet)


42/119

The GIT physiology

The intestinal glands secrete digestive

enzymes that finalize the digestion of all

foodstuff

Enzymes for carbohydrates disaccharidases

Enzymes for proteins dipeptidases and

aminopeptidases

Enzyme for lipids intestinal lipase


43/119

The GIT ANATOMY

The Large intestineApproximately 5 feet long, with parts:

1. The cecum widest diameter, prone to rupture

2. The appendix

3. The ascending colon

4. The transverse colon

5. The descending colon

6. The sigmoid most mobile, prone to twisting

7. The rectum


44/119

The GIT Physiology

Absorbs water

Eliminates wastes

Bacteria in the colon synthesize Vitamin K

Appendix participates in the immune system


45/119

The GIT Physiology

SYMPATHETIC

Generally INHIBITORY!

Decreased gastricsecretions

Decreased GIT motility

But: Increased sphincteric

tone and constriction ofblood vessels

PARASYMPATHETIC

Generally EXCITATORY!

Increased gastric secretions

Increased gastric motility

But: Decreased sphincterictone and dilation of blood

vessels


46/119


47/119

ANATOMY AND PHYSIOLOGY

Upper alimentary canal

Mouth

Pharynx (throat)

Esophagus

Stomach

1st

half of duodenum

GASTROESOPHAGEAL REFLUX


48/119


DISEASE

-Excessive reflux of hydrochloric acid into the

esophagus.

Predisposing Factors:

1.Incompetent LES

2.Pyloric Stenosis3.Other Esophageal disorder:



49/119


DISEASE

Signs and Symptoms:

Pyrosis

Dyspepsia

Regurgitation

Dysphagia

Odynophagia Heart-attack like symptom



50/119


DISEASE

Diagnostics:

EGD esophagogastroduodenoscopy

24 hr pH monitoring

Esophagoscopy



51/119


DISEASE

Nursing Management:

1.Administer Medications as ordered

2.HT

-Avoid irritants such as spicy or acidic foods,

alcohol, caffeine, and tobacco.

-avoid food or drink 2 hours before bedtime orlaying down after eating.

Elevate the head of the bed on 6-8in blocks

3. Assist in surgery. Nissen fundoplication -


52/119

PEPTIC ULCER DISEASE

Involves ulceration, circumscribed breaks in the

mucosa, occurring in the duodenum

(duodenal ulcer), the stomach (gastric ulcer),

and less commonly, the distal esophagus andthe jejunum.


53/119



1.Helicobacter Pylori

2.Hereditary

3.Psychological Factors (Stress, Anxiety, Type A)

4.Smoking and Alcohol use

5.Use of Ulcerogenic drugs6.Increased intake of caffeine, soda, choco, tea

7.Irregular Diet

8.Zollinger Ellison Syndrome


54/119


PATHOLOGY


55/119

PEPTIC ULCER DISEASEDUODENAL ULCER

Age 30-60

M:F 2:1 / 80%

Duodenal Bulb

Hypersecretion of HCL

Wt Gain Pain is Burning, aching, gnawing in

the right epigastrium; 2-3 hours p

eating; relieved by eating. 12-3am

Vomiting Uncommon

Bleeding less likely; Melena

Malignancy is rare

Complications: Perforation

GASTRIC ULCER

Age 50 and above

M:F 1:1 / 15%

Antrum/ Pylorus

Normal HCL

Wt loss Pain is Burning, aching, gnawing in

the upper epigastrium; 30 mins to 1

hour p eating;unrelieved by eating.

Vomiting Common

Bleeding more likely; Hematemesis

Malignacy occurs occasionally

Complications: G-CA, Hemorrhage


56/119


Diagnostics:

Barium swallow shows an ulcerated area

Endoscopy identifies the inflammatory

changes, ulcers and lesions.

Biopsy determines the presence of H. Pylori/

Urease test

Gastric Analysis determines Normal/Increased

gastric acid secretion

Occult blood test


57/119


58/119


59/119


Nursing Management:

Administer Medications as ordered:

Give bland diet and small frequent meals

(no hot/cold, meat, alcohol, caffeine,

milk/products)

Provide teaching on stress reduction and

relaxation techniques

Monitor for complications of PUD


60/119


Nursing Management:

Assisst in Surgery

1.Vagotomy Severing of the vagus nerve.

Decreases gastric acid by diminishing

choinergic stimulation to the parietal cells,

making them less responsive to gastrin.

2.Pyloroplasty a longitudinal incision is made

into the pylorus and transversely sutured

closed to enlarge outlet and relax the muscle.


61/119


ANTRECTOMY

1.Billroth 1 removal of the lower portion of

the antrum of the stomach (which contains

the cellls that secrete gastrin) as well as asmall portion of the duodenum and pylorus.

The remaining segment is anastomosed to the

duodenum. (Gastroduodenuostomy)2.Billroth 2 Lower portion of the antrum is

anatomosed to the jejunum.

(Gastrojejunostomy)


62/119


63/119


SURGICAL PROCEDURES FOR PUD

Post-operative Nursing management

1. Monitor VS2. Post-op position: FOWLERS

3. NPO until peristalsis returns

4. Monitor for bowel sounds

5. Assess surgical dressing


64/119

Conditions of the Stomach

Post-operative Nursing management

6. Monitor I and O, IVF

7. Maintain NGT8. Diet progress: clear liquid full

liquid six bland meals

9. Watch Out for Complication

DUMPING SYNDROME


65/119

DUMPING SYNDROME

DUMPING SYNDROME

A condition of rapid emptying of the gastric

contents into the small intestine usually after

a gastric surgery

Symptoms occur 30 minutes after eating

COMMON GIT SYMPTOMS AND


66/119


MANAGEMENT

PATHOPHYSIOLOGY

Foods high in CHO and

electrolytes must be diluted inthe jejunum before absorption

takes place.



67/119


MANAGEMENT

PATHOPHYSIOLOGY

The rapid influx of stomach

contents will cause distention ofthe jejunum early symptoms



68/119


MANAGEMENT

PATHOPHYSIOLOGY

The hypertonic chyme will draw

fluid from the blood vessels todilute the high concentrations

of CHO and electrolytes



69/119


MANAGEMENT

Later, there is increased blood

glucose stimulating the

increased secretion of insulin Then, blood glucose will fall

causing reactive hypoglycemia



70/119


MANAGEMENT

DUMPING SYNDROME

ASSESSMENT FINDINGS: early symptoms

1. Nausea and Vomiting 2. Abdominal fullness

3. Abdominal cramping

4. Palpitation

5. Diaphoresis



71/119


MANAGEMENT

DUMPING SYNDROME

ASSESSMENT FINDINGS: LATE

symptoms: 6. Drowsiness

7. Weakness and Dizziness 8. Hypoglycemia



72/119


MANAGEMENT

DS NURSING INTERVENTIONS

1. Advise patient to eat LOW-carbohydrate HIGH-fat and HIGH-protein diet

2. Instruct to eat SMALL frequent

meals, include MORE dry items. 3. Instruct toAVOID consuming

FLUIDS with meals



73/119


MANAGEMENT

DS NURSING INTERVENTIONS

4. Instruct to LIE DOWN after

meals 5. Administer anti-spasmodic

medications to delay gastric

emptying


74/119


II. Middle Alimentary canal Function: for

absorption

- Complete absorption large intestine

2nd half of duodenum

Jejunum

Ileum

1st half of ascending colon


75/119

APPENDICITIS

Appendicitis is inflammation of the vermiformappendix.

Male>Females

Ages 10 and 30 years Predisposing Factors (Obstruction):

a. Fecalith

b. Kinking of appendix

c. Inflammation

d. Neoplasm


76/119


77/119

APPENDICITIS

Obstruction

Fecalith, Kinked appendix,inflammation, neoplasm

Inflammatory response

Increased Intraluminal Pressure

WBC Infiltration

Pus formation

Necrosis

Perforation

Edema

Peritonitis


78/119

APPENDICITIS

Signs and Symptoms:

Acute abdominal pain, RLQ

Nausea and vomiting

Low-grade fever

Constipation or Diarrhea

Board-like abdomen or abdominal rigidity ifappendix ruptured.


79/119

APPENDICITIS

Diagnostics:

CBC Leukocytosis

UTZ reveals enlarged/inflammed appendix

X-ray reveals enlarged appendix


80/119

CONDITIONS OF THE LARGE INTESTINE

NURSING INTERVENTIONS

1. Preoperative care

NPO

Consent

Monitor for perforation and

signs of shock

C S


81/119

APPENDICITIS

Nursing Management:

1.Obtain VS

2.Assist in surgical procedure (appendectomy)


82/119

APPENDICITIS


1. Preoperative care

Monitor bowel sounds, fever and hydration

status POSITION of Comfort: RIGHT SIDELYING in

a low FOWLERS

Avoid Laxatives, enemas & HEATAPPLICATION

APPENDICITIS


83/119

APPENDICITIS

2. Post-operative care

Monitor VS and signs of surgical

complications Maintain NPO until bowel function

returns

If rupture occurred, expect drains

and IV antibiotics

APPENDICITIS


84/119

APPENDICITIS

2. Post-operative care

POSITION post-op: RIGHT side-

lying, SEMI- FOWLERS to decreasetension on incision, and legs flexed

to promote drainage

Administer prescribed pain

medications

PERITONITIS


85/119

PERITONITIS

Is acute or chronic inflammation of theperitoneum.


86/119

PERITONITIS


87/119

PERITONITIS


1.E. coli/ streptococcus faecalis infection of the

peritoneum

2.Chemical irritation: ruptured appendix,

bladder, bile spillage-gallbladder

3.Contamination of peritoneal cavity with

surgical glove powder, particles from suturematerials, lint from surgical drapes

4.Penetrating abdominal wound or bowel

stran ulation

PERITONITIS


88/119

PERITONITIS

PATHOLOGY

PERITONITIS


89/119

PERITONITIS

Signs and Symptoms:

Severe localized or diffused abdominal pain

Paralytic ileus produces abd distention

Nausea and vomiting

Bowel sounds are decreased or absent

Fever, tachycardia, and chills >>> sepsis Shallow, guarded respirations suggest

diaphragmatic involvement

Signs of dehydration and acidosis are late

PERITONITIS


90/119

PERITONITIS

DIAGNOSTICS:

CBC Leukocytosis

Paracentesis identifies the causative organism

X-ray reveals the location of the perforation

PERITONITIS


91/119

PERITONITIS

Nursing Management:

Administer Medications

Monitor respiratory status closely

Minimize pain. Position the client to maximize

comfort

Maintain aseptic technique



92/119


III. Lower Alimentary Canal Function:elimination

2nd half of ascending colon

Transverse

Descending colon

Sigmoid

Rectum

INTESTINAL OBSTRUCTION


93/119


Exists when blockage prevents the normal flowof intestinal contents through the intestinal

tract.

2 Types

1.Mechanical Obstruction intraluminal

obstruction fro pressure on the intestinal wall

occurs.2.Functional Obstruction the intestinal

musculature cannot propel the contents along

the bowel.



94/119


MECHANICAL OBSTRUCTION:

Adhesion loops of intestine become adherent

to areas that heal slowly or scar after

abdominal surgery.

Intussusception one part of the intestine slips

into another part located below it.

Volvulus bowel twists and turns on itself.

Hernia Protrusion of intestine through a

weakened area in the abdominal muscle or

wall.



95/119

INTESTINAL OBSTRUCTIONSmall Bowel Obstruction

Crampy abdominal pain that

is wavelike and colicky

Pass out blood and mucus

but no feces or flatus

Vomiting*

Reverse peristaltic waves

Dehydration (Thirst,

drowsiness, weakness, dry

mucous membranes)

Abdominal Distention

Large Bowel Obstruction

Constipation

Altered stool shape

Weakness

Weight Loss Anorexia

Abdominal Distention

Large bowel is visibly

outlined in the abd wall Crampy lower abd pain

Fecal Vomiting

Dehydration



96/119


Diagnostics:

Abdominal Xray CT, and MRI reveals abnormal

quantities of gas and/or fluid, distended

intestine and site of obstruction.

Laboratory studies reveals electrolye

imbalances



97/119


Nursing Management:

1. Maintain NGT decompression of the bowel

2. Assess NGT output

3. Monitor I&O strictly4. Assess for Improvement: Return of bowel sounds,

decreased abd distention, abd pain, and passage of

flatus or stool.

5. Report to AP if there is discrepancies in I&O,

worsening of pain and abd distention, & increased

ngt output.

6. Assisst in Surgery



98/119


Surgical Management:

Surgical Mgt depends on the cause of

intestinal obstruction.

Ileostomy, Cecostomy, Colostomy

Colonoscopy untwist and decompress the

bowel.

Surgical resection

DIVERTICULOSIS AND DIVERTICULITIS


99/119

Diverticulosis

Abnormal out-pouching of the intestinal

mucosa occurring in any part of the LI most

commonly in the sigmoid

Diverticulitis

Inflammation of the diverticulosis

DIVERTICULOSIS


100/119

DIVERTICULOSIS

PATHOPHYSIOLOGY

Increased intraluminal pressure, LOW volume

in the lumen and Decreased muscle strength

in the colon wall herniation of the colonicmucosa

DIVERTICULOSIS


101/119

DIVERTICULOSIS

ASSESSMENT findings for D/D

1. Left lower Quadrant pain

2. Flatulence

3. Bleeding per rectum

4. nausea and vomiting

5. Fever 6. Palpable, tender rectal mass



102/119


DIAGNOSTIC STUDIES

1. If no active inflammation, COLONOSCOPY

and Barium Enema

2. CT scan is the procedure of choice!

3. Abdominal X-ray



103/119


NURSING INTERVENTIONS 1. Maintain NPO during acute phase

2. Provide bed rest

3. Administer antibiotics, analgesics likemeperidine (morphine is not used) and anti-spasmodics

4. Monitor for potential complications likeperforation, hemorrhage and fistula

5. Increase fluid intake



104/119



6. Avoid gas-forming foods or HIGH-roughage

foods containing seeds, nuts to avoid

trapping

7. introduce soft, high fiber foods ONLY after

the inflammation subsides

8. Instruct to avoid activities that increaseintra-abdominal pressure

CHRONIC INFLAMMATORY BOWEL


105/119

DISEASE

REGIONAL ENTERITIS (Crohns Disease) - Is asubacute and chronic inflammation that

extends through all layers of the bowel wall

from the intestinal mucosa.

ULCERATIVE COLITIS is an inflammatory

disease of the submucosal layer of the colonand rectum characterized by continuously

occuring ulcerations of intestinal epithelium.

CIBD


106/119

CIBD

Cause: UNKNOWNIncidence Rate: Age 15&30; 50&70

M:F 1:1


Hereditary/ Family History

Pesticides, Food additives, Tobacco, Radiation

Race: Caucasians and Jewish Heritage

NSAIDs

CIBD


107/119

Crohns Disease

Course is prolonged,variable

Transmural thickening

Location: Ileum, ascendingC

Bleeding is unsual; if yes,tends to be mild.

Perianal involvement is

common

Fistulas are common

Rectal involvement 20%

Diarrhea is less severe

Ulcerative Colitis

Exacerbations andremissions

Mucosal Ulceration

Rectum, descending colon

Bleeding is common andsevere

Perianal involvement is

rare-mild

Fistulas are rare

Rectal involvement 100%

Diarrhea is severe

CIBD


108/119

CIBD

ASSESSMENT findings for CD1. Fever

2. Abdominal distention

3. Diarrhea4. Colicky abdominal pain

5. Anorexia/N/V

6. Weight loss7. Perianal fistulas and abscesses

CIBD


109/119

CIBD

ASSESSMENT findings for UC1. Anorexia

2. Weight loss

3. Fever4. SEVERE diarrhea with Rectal bleeding,

containing pus, and mucosa.

5. Anemia6. Dehydration

7. Abdominal pain and cramping

CIBD


110/119

CIBD

Diagnostics (CD):

Barium study of upper GIT reveals string sign

Barium enema shows ulceration and

cobblestone appearance

Colonoscopy reveals ulceration separated by

normal mucosa

CIBD


111/119

CIBD

Diagnostics (UC):

Barium enema shows mucosal irregularities,

shortening of the bowel and dilatation of

bowel loops. Colonoscopy reveals friable mucosa with

pseudopolyps or ulcers in the

descending/sigmoid colon Stool analysis is positive for blood.

NURSING INTERVENTIONS for CD and


112/119

UC

1. Maintain NPO during the active phase

2. Monitor for complications like severe

bleeding, dehydration, electrolyte imbalance

3. Monitor bowel sounds, stool and bloodstudies

4. Restrict activities, promote intermittent rest

and BR to minimize pain

5. Administer IVF, electrolytes and TPN if

prescribed

NURSING INTERVENTIONS for CD and


113/119

UC

6. Instruct the patient to AVOID gas-forming foods,MILK products and foods such as whole grains, nuts,RAW fruits and vegetables especially SPINACH,pepper, alcohol and caffeine

7. Diet progression- clear liquid LOW residue, highprotein diet

8. Administer drugs-

9. Assist in surgery

CIBD


114/119

CIBD

Surgery:

1.Total colectomy with Ileostomy.

2.Total colectomy with continent ileostomy

3.Total colectomy with ileo-anal anastomosis

IRRITABLE BOWEL SYNDROME


115/119


Is a common functional disorder ofgastrointestinal motility not associated with

anatomic changes.

Predisposing Factors:1.Psychologic Stress

2.Pre-diverticular disease with changes in the

bowel wall3.Low-fiber diet/ high in stimulating/irritating

food

4 Alcohol consumption and smoking



116/119


TRIAD S & Sx:

1.Abdominal Pain

2.Altered bowel habits

3.Absence of detectable disease



117/119


Diagnosis:

Barium enema and colonoscopy reveals

spasm, distention, or mucus accumulation in

the intestine. CBC normal

Stool analysis is normal



118/119


Nursing Management:

Administer Medications

Teach the client on stress reduction and

relaxation techniques

Eat a well balanced diet, high-fiber diet,

Adhere to a schedule of regular work and rest

periods

Drink six to eight glasses of h2o/day not with

meals to prevent constipation


119/119

THANK YOU

Git Disturbances

Documents

Transcript of Git Disturbances