DISORDERS OF THE DISORDERS OF THE GASTROINTESTINAL GASTROINTESTINAL

SYSTEMSYSTEM

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

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

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

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

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

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

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

• 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 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

• 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

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

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

• 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 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

Treatment of CA of Treatment of CA of EsophagusEsophagus

• Palliative treatment is common• Radiation, chemotherapy• surgery:

– Esophagectomy– Esophagogastrostomy– Esophagoenterostomy– Gastrostomy

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

DISORDERS OF DIGESTION DISORDERS OF DIGESTION AND ABSORPTIONAND ABSORPTION

• N/V• Hiatal Hernia• Gastritis• Peptic Ulcer• Stomach Cancer• Obesity

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

• 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 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

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

Signs and SymptomsSigns and Symptoms

• Feelings of fullness• dysphagia• eruption• regurgitation• heartburn• Complications: Ulcerations, bleeding,

aspiration

• seen in 50% of people over 60.

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

• SURGERY• Nissen Fundoplication• Angelclik prothesis• NURSING CARE: assessment, pain

relief, watch for aspiration, nutrition, education

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

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)

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

NURSING CARENURSING CARE• Good HX and review of present S/S• pain relief, adequate nutrition,

hydration, stress management, education

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

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

PEPTIC ULCER PEPTIC ULCER COMPLICATIONSCOMPLICATIONS

• HEMORRHAGE

• PERFORATION

• PYLORIC OBSTRUCTION

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

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

Surgical options for gastric Surgical options for gastric ulcersulcers

• To decrease acid secretion:– vagotomy– pyloroplasty– gastroenterostomy– antrectomy– subtotal gastrectomy

• Billroth I• Billroth II

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

• 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

educationeducation• Reinforce diet• teach signs of complicatons• Avoid risk factors

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.

• 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

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.

•

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

DISORDERS DISORDERS AFFECTINGAFFECTING

ABSORPTION ABSORPTION AND AND

ELIMINATIONELIMINATION

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

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

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

CONSTIPATIONCONSTIPATION• 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 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

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

Intestinal obstruction Intestinal obstruction causescauses

• SMALL BOWEL:

– adhesions most common– intussusception– volvulus– paralytic ilieus– abdominal hernia

• LARGE BOWEL:– carcinoma– diverticulitis– inflammatory bowel disorders– volvulus

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

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

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

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)

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

PERITONITISPERITONITIS

• Inflammation of the peritoneum• Causes;

– chemical– bacterial contamination

• S/S pain, rebound tenderness, rigidity, distention, fever, tachcardia, tachypnea,N/V

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

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

Treatment/nursing careTreatment/nursing care

• Treatment: Herniorrhaphy, Hernioplasty

• Nursing care;– absence of strangulation, monitor

activity– general surgery interventions with

surgery