Lower Gastrointestinal disorders

8/9/2019 Lower Gastrointestinal disorders

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LOWER GASTROINTESTINALLOWER GASTROINTESTINAL

TRACTTRACT


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Imperforated anusImperforated anus


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Hirschsprung D

isease

Hirschsprung D

isease

congenital aganglionic megacolon is acongenital aganglionic megacolon is amechanical obstruction caused bymechanical obstruction caused byinadequate motility of part of theinadequate motility of part of theintestine.intestine.


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Diagnostic EvaluationDiagnostic Evaluation

Rectal examinationRectal examination

xx--ray with barium enemaray with barium enema

rectal biopsyrectal biopsy--((--) or decrease ganglionic) or decrease ganglionicnerve cellsnerve cells


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ManifestationsManifestations

no meconium or ribbon like stoolno meconium or ribbon like stool

bile stained vomitingbile stained vomiting

abdominal distentionabdominal distention

constipationconstipation

anorexiaanorexia

FTTFTT


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TreatmentTreatment

removal of the agangionic, non functional,removal of the agangionic, non functional,dilated segment of the boweldilated segment of the bowel

anastomosisanastomosis improved functioning of internalimproved functioning of internalrectal sphincterrectal sphincter

colostomy or ileostomy to decompresscolostomy or ileostomy to decompressintestine and rest normal bowelintestine and rest normal bowel

definitive treatment:definitive treatment:

abdominoperineal pull throughabdominoperineal pull through

endorectal pull through, rectorectal pullendorectal pull through, rectorectal pullthrough at 9through at 9--12 mos.12 mos.--1515--20lbs20lbs


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olderolder-- isotonic enemas, stool softeners,isotonic enemas, stool softeners,

low residue dietlow residue diet


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IRRITABLE BOWEL SYND

ROME

IRRITABLE BOWEL SYND

ROME

also known as spastic bowel or functionalalso known as spastic bowel or functionalcolitiscolitis

a motility disorder of the gastrointestinala motility disorder of the gastrointestinaltracttract

no identifiable organic causeno identifiable organic cause

characterized by abdominal pain withcharacterized by abdominal pain withconstipation, diarrhea or bothconstipation, diarrhea or both


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MANIFESTATIONS OF IRRITABLE BOWELMANIFESTATIONS OF IRRITABLE BOWELSYNDROMESYNDROME

abdominal painabdominal pain

may be relieve by defecationmay be relieve by defecation

may be intermittent and colicky or dull andmay be intermittent and colicky or dull andcontinuouscontinuous

altered bowel eliminationaltered bowel elimination

constipationconstipation

diarrheadiarrhea

mucous stoolsmucous stools

abdominal bloating and flatulenceabdominal bloating and flatulence abdominal tendernessabdominal tenderness

nausea and vomitingnausea and vomiting


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DIAGNOSTIC TESTDIAGNOSTIC TEST

stoolstool

CBCCBC

sigmoidoscopy or colonoscopysigmoidoscopy or colonoscopy

small bowel series ( upper GI series withsmall bowel series ( upper GI series withsmall bowel follow through) and bariumsmall bowel follow through) and bariumenemaenema


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MEDICATIONSMEDICATIONS

medications may be prescribed to managemedications may be prescribed to managesymptoms ofIBSsymptoms ofIBS

bulk forming laxativesbulk forming laxatives may reduce bowelmay reduce bowel

spasm and normalize the number and form ofspasm and normalize the number and form ofbowel movementsbowel movements

anticholinergic drugsanticholinergic drugs inhibit bowel motility byinhibit bowel motility byinterfering with parasympathetic stimulation ofinterfering with parasympathetic stimulation of

the gastrointestinal tractthe gastrointestinal tract

antidepressantsantidepressants may help relieve abdominalmay help relieve abdominalpainpain


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nursing diagnoses and interventionsnursing diagnoses and interventions

constipation related to altered gastrointestinalconstipation related to altered gastrointestinalmotilitymotility

diarrhea related to altered gastrointestinaldiarrhea related to altered gastrointestinalmotility and excess mucous secretionmotility and excess mucous secretion

anxiety related to situational stressanxiety related to situational stress

ineffective coping related to effects of disorderineffective coping related to effects of disorderon lifestyleon lifestyle


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APPENDICITISAPPENDICITISinflammation of the vermiforminflammation of the vermiform

appendixappendix


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perforation, peritonitis and abcess are possibleperforation, peritonitis and abcess are possible

complicationscomplications perforation is manifested by increased pain andperforation is manifested by increased pain and

high feverhigh fever

ChronicChronic chronic abdominal pain , recurrent acute attackschronic abdominal pain , recurrent acute attacks

at intervals of several months or moreat intervals of several months or more


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Diagnostic testsDiagnostic tests

WBC count with differentialWBC count with differential

urinalysisurinalysis

abdominal xabdominal x--rayray

abdominal ultrasoundabdominal ultrasound pelvic examinationpelvic examination

intravenous pyelogram (IVP)intravenous pyelogram (IVP)


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MedicationsMedications

IVFIVF to restore or maintain volume andto restore or maintain volume andprevent electrolyte imbalanceprevent electrolyte imbalance

antibiotic therapy( 3antibiotic therapy( 3rdrd gen cephalosporin )gen cephalosporin )

-- initiated prior to surgery andinitiated prior to surgery andcontinued for at least 48 hrs operativelycontinued for at least 48 hrs operatively


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SurgerySurgery

acute appendicitisacute appendicitis surgical removal of thesurgical removal of the

appendixappendix

laparascopic approach ( insertion of anlaparascopic approach ( insertion of an

endoscope to view abdominal contents)endoscope to view abdominal contents) laparotomy ( surgical opening of thelaparotomy ( surgical opening of the

abdomen)abdomen)


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nursing diagnoses and interventionsnursing diagnoses and interventions

risk for infectionrisk for infection preventing complications during the operativepreventing complications during the operative

and post operative periodand post operative period

perforation and peritonitis are complicationsperforation and peritonitis are complications

preoperativelypreoperatively post operative wound infection, abscess andpost operative wound infection, abscess and

possible peritonitispossible peritonitis


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monitor vital signs inc. temperaturemonitor vital signs inc. temperature

maintain intravenous infusion until oralmaintain intravenous infusion until oralintake is adequateintake is adequate

Assess wound, abdominal girth andAssess wound, abdominal girth and

postoperative painpostoperative pain


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painpain

assess pain, including its characteristics,assess pain, including its characteristics,location, severity and duration. Report anylocation, severity and duration. Report anychanges in the nature of painchanges in the nature of pain

administer analgesics as orderedadminister analgesics as ordered assess effectiveness of medication 30assess effectiveness of medication 30

mints after administrationmints after administration


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periton

itisper

iton

itis

inflammation of the caused by peritoneuminflammation of the caused by peritoneum

caused by enteric bacteria entering thecaused by enteric bacteria entering the

peritoneal cavity through a perforated ulcer,peritoneal cavity through a perforated ulcer,ruptured appendix, perforated diverticulum,ruptured appendix, perforated diverticulum,necrotic bowel.necrotic bowel.


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Manifestations of PeritonitisManifestations of Peritonitis

abdominal manifestationsabdominal manifestations

diffuse or localized paindiffuse or localized pain

tendernesstenderness

boardlike rigidityboardlike rigidity

diminished or absent bowel sounddiminished or absent bowel sound distentiondistention

anorexia, nausea and vomitinganorexia, nausea and vomiting

systemic manifestationssystemic manifestations feverfever

MalaiseMalaise

RestlessnessRestlessness

ConfusionConfusion


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ComplicationsComplications

abscess formationabscess formation

septicemiasepticemia

septic shockseptic shock Hypovolemic shockHypovolemic shock


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Diagnostic TestsDiagnostic Tests

WBC countWBC count

blood culturesblood cultures

liver and renal function studies and serumliver and renal function studies and serum

electrolyteselectrolytes

abdominal xabdominal x--rayray

paracentesisparacentesis


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MedicationsMedications

broad spectrumbroad spectrum

antibiotic therapy( specific organism)antibiotic therapy( specific organism)

cephalosphorin antibiotic for gram (cephalosphorin antibiotic for gram (--) enteric) entericbacteriabacteria

ampicillinampicillin

metronidazolemetronidazole

clindamycinclindamycin

analgesicsanalgesics


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SurgerySurgery

laparotomylaparotomy-- to close the perforation or removeto close the perforation or removethe damaged and inflammed tissuethe damaged and inflammed tissue

peritoneal lavageperitoneal lavage washing of the peritonealwashing of the peritoneal

cavity with copious amounts of warm isotoniccavity with copious amounts of warm isotonicfluid to dilute residual bacteria and removesfluid to dilute residual bacteria and removesgross contaminants, blood and fibrin clots.gross contaminants, blood and fibrin clots.


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TreatmentsTreatments

IVF and electrolyte replacementsIVF and electrolyte replacements

parenteral nutritionparenteral nutrition

placed on bed rest in fowlers positionplaced on bed rest in fowlers position


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nursing diagnosesnursing diagnoses

PainPain-- abdominal distention and acute inflammationabdominal distention and acute inflammationcontribute to the pain associated with peritonitiscontribute to the pain associated with peritonitis

assess pain including location, severity and typeassess pain including location, severity and typeusing pain scale.using pain scale.

place in fowlers position or semi fowlers withplace in fowlers position or semi fowlers withknees and feet elevatedknees and feet elevated

administer analgesics as ordered or using PCAadminister analgesics as ordered or using PCA

teach and assist with adjunctive painteach and assist with adjunctive pain

management techniques such as meditation,management techniques such as meditation,visualization, massagevisualization, massage


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deficient fluid volumedeficient fluid volume

maintain accurate intake and output recordsmaintain accurate intake and output records monitor vital signs, CVP, cardiac output andmonitor vital signs, CVP, cardiac output and

pulmonary artery pressure every hourpulmonary artery pressure every hour

weigh dailyweigh daily

assess skin turgor , color, temperature andassess skin turgor , color, temperature andmucous membranesmucous membranes

measure or estimate fluid losses throughmeasure or estimate fluid losses throughabdominal drains and on dressingsabdominal drains and on dressings

monitor laboratory values, including hgb, hct,monitor laboratory values, including hgb, hct,urine, electrolytes and ABGsurine, electrolytes and ABGs

administerIVF and electrolytes as orderedadministerIVF and electrolytes as ordered

provide good skin care and oral hygieneprovide good skin care and oral hygiene


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AnxietyAnxiety

assess the client and familys anxiety level andassess the client and familys anxiety level andpresent coping skillpresent coping skill

present a calm, reassuring manner. Encouragepresent a calm, reassuring manner. Encourage

expression of concernsexpression of concerns maintain consistent caregivermaintain consistent caregiver

explain all treatments, procedures, tests andexplain all treatments, procedures, tests andexaminationexamination

reinforce and clarify information neededreinforce and clarify information needed

teach and assist with relaxation techniquesteach and assist with relaxation techniques


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Intestinal Obstruct

ionIntest

inal Obstruct

ion

Lower Gastrointestinal disorders

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