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Disorders of the Digestive System

Disorders of the Digestive System. Cathy Gibbs BSN, RN. Disorders of the Digestive System. Sources of digestive problems Mechanical Nervous Chemical Hormonal. Eating Disorders. Anorexia Chronic loss of appetite Possible emotional, social factors Anorexia Nervosa

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Disorders of the Digestive System

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  1. Disorders of the Digestive System Cathy Gibbs BSN, RN

  2. Disorders of the Digestive System • Sources of digestive problems • Mechanical • Nervous • Chemical • Hormonal

  3. Eating Disorders • Anorexia • Chronic loss of appetite • Possible emotional, social factors • Anorexia Nervosa • Psychological disorder • Bulimia • Binge-purge syndrome

  4. Causes of Anorexia • Anxiety, depression • Improper fit of dentures • Illness, physical discomfort • Constipation • Intestinal obstruction

  5. Anorexia, Nursing Implementation • Become familiar with patients eating habits • Permit patient to choose own food • Don’t force patient to eat • Provide pleasant environment • Serve small portions

  6. Dental Plaque and Caries • Erosive process that dissolves tooth enamel • Medical management • Removal of affected area and replace with dental material • Dental check ups • Fluoridated water • Nursing interventions • Teach patient oral care • Diet changes

  7. Gingivititis • Inflammation of the gums • Symptoms • Bleeding, swollen, tender gums • Difficulty chewing • Causes • Accumulation of food between teeth • Vitamin deficiency • Anemia • Leukemia • Prevention • Brushing teeth & gums • Daily flossing • Adequate diet

  8. Periodontitis • Untreated Periodontitis • Teeth loosen • Spreads to mandible • Prevention • Impeccable tooth & gum • Regular flossing • Adequate diet • Treatment • Drainage of abscess • Antibiotics • Extraction

  9. Recurrent Aphthous Stomatitis • Multi system disorder • Painful ulcers • Mouth • Genitals • Uveal tract of the eye • Causes • Viruses, bacteria, fungus • Chemotherapy • Vitamin deficiency • Four Forms • Minor Type • Canker sores • Lesions are 2- 4 mm in diameter • Usually fewer than 5 in number

  10. Recurrent Aphthous Stomatitis • Major Aphthous Stomatitis • Referred to as “Sutton’s disease” • 10 mm or greater in diameter • They frequently occur in the posterior portion of the mouth • Take four to six weeks to heal • These lesions may result in scarring • Herpetiform • Confused with herpes • Numerous, 1-2 mm ulcers, cropped together • When the neutrophil count returns to normal the lesions resolve

  11. Recurrent Aphthous Stomatitis • Fourth form is known as Behçet's disease • Complex multi-system disorder including • Synovitis • Uveitis • Vasculitis • Meningoencephalitis • Oral and/or genital mucosa are the first manifestation • It is a rare, non-infectious disease • Very uncommon in North America and Europe • Half of the patients have evidence of immune dysfunction

  12. Recurrent Aphthous Stomatitis • Immune Dysfunction seen with Behçet's disease • 5-20% of Crohn's patients develop disease • Ulcerative colitis • Malabsorption syndromes • Gluten-sensitive enteropathy • HIV infection • The lesions appear to be more severe, more painful and deeper • Cyclic neutropenia

  13. Behcet’s

  14. Herpes Simplex Virus • Acute viral infection • Two strains of herpes simplex virus • HSV-1 “Common cold sore” • Forms clusters of fluid filled blisters • HSV-2 • Sexually transmitted • Can develop in and around the mouth or genitals • Shingles • Form along nerve path

  15. Candidiasis • Etiology/Pathophysiology • Fungus normally present in the mouth, intestine, vagina, and on the skin • Also referred to as thrush and moniliasis • Clinical manifestations/assessment • Small pearly-white patches on the mucous membrane of the mouth • Thick white discharge from the vagina

  16. Candidiasis • Causes • Cancer • Diabetes • Alcoholism • Treatment • Nystatin • Gentician Violet • OTC medications • Nursing care • Good hand washing • Bland or soft food for patient • Oral care • Education on medication administration

  17. Mumps • Contagious viral infection of parotid salivary glands • Possible complications • Inflammation of testicles • Sterility in males • MMR vaccine

  18. Achalasia • Etiology/Pathophysiology • LES cannot relax (cardiospam) • Causes decreased motility of the lower portion of the esophagus • Absence of peristalsis and dilation of the lower portion of the esophagus • Decreased amount or no food can enter the stomach • The esophagus can hold as much as a liter • Possible causes • Nerve degeneration, esophageal dilation, and hypertrophy • Disruption of the normal neuromuscular activity of the esophagus

  19. Achalasia • Clinical manifestations/Assessment • Dysphagia-PRIMARY SYMPTOM • Regurgitation of food • Substernal chest pain • Loss of weight • Weakness • Poor skin turgor

  20. Achalasia • Diagnostic tests • Radiologic studies- Esophagoscopy • Medical management • Medications: anticholinergics, nitrates, and calcium channel blockers • Dilation of cardiac sphincter • Surgery-Cardiomyectomy

  21. Gastroesophageal Reflux Disease (GERD) • Etiology/Pathophysiology • Backward flow of gastric acid into the esophagus • Reduced LES pressure • Clinical manifestations • Pain may mimic angina • Heartburn (pyrosis) 20 min – 2 hrs after eating • Regurgitation • Dysphagia or odynophagia (painful swallowing) • Eructation (belching) • Cough • Wheezing • Hoarseness

  22. Gastroesophageal Reflux Disease (GERD) • Risk factors • Alcohol, tobacco, & smoking • Delayed gastric motility • Diagnostic tests to differentiate GERD from angina • Esophageal motility • Bernstein tests evaluate LES function • pH monitoring for 24 hours to record reflux episodes • Barium swallow & endoscopy to evaluate for hiatal hernia

  23. Gastroesophageal Reflux Disease (GERD) • Medical management & Nursing interventions • Antacids or acid-blocking medications • Diet • 4-6 small meals/day • Low fat, adequate protein • Remain upright for 1-2 hours after eating • Lifestyle • Eliminate smoking • Avoid constrictive clothing • HOB up at least 6-8 inches for sleep

  24. Barrett’s Esophagus • Etiology/Pathophysiology • Cells in esophagus change to cells normally found in the intestine (metaplasia) • Patients feel less discomfort as metaplastic cells are less sensitive • Can’t cure, treat GERD • Medications • Antacids • GI stimulants • Histamine H2 antagonists • Proton pump inhibitors • Surgery • Fundoplication

  25. Acute Gastritis • Etiology/Pathophysiology • Inflammation of the lining of the stomach • Associated with • Alcoholism & smoking • Bacteria & viruses • Chemical toxins • Stressful physical problems • Clinical manifestations • Fever • Headache • Epigastric pain • Nausea and vomiting • Coating of the tongue • Anorexia

  26. Acute Gastritis • Long term • Changes in the mucosal lining that interferes with acid and pepsin secretion • Gastritis usually resolves once the offending agent is removed • Diagnostic tests • Stool for occult blood • WBC • Electrolytes

  27. Acute Gastritis • Medical management • Antiemetics • Antacids • Antibiotics • IV fluids • NG tube • Nutritional Supplementation • Administration of blood • NPO until signs and symptoms subside

  28. Nausea • Etiology/Pathophysiology • Feeling the urge to vomit • May occur independently or precede vomiting • Specific neural pathways not identified • Probably controlled by parts of brain that control involuntary bodily functions • Signs and symptoms • Increased salivation • Diminished functional activities of the stomach • Altered small intestine motilility

  29. Vomiting • Etiology/Pathophysiology • Forceful expulsion of gastric contents • Increased intrathoracic pressure • Increased intracranial pressure • Controlled by • Vomiting center (medulla) • Initiates vomiting when stimulated • Chemo-receptor trigger zone • Must be stimulated by a drug or toxin

  30. Causes of Nausea & Vomiting • Stress, fear, and depression • Pain • Acute febrile illness • Medications • Food poisoning • Anesthesia • Diseases of the stomach • Intestinal obstruction • Pregnancy • Head injury

  31. Nursing Implementation for Nausea & Vomiting • Administer antiemetics • Monitor fluid & electrolyte replacement • Protect patient from unpleasant sight or smells • Attempt to keep stomach empty • Ventilate room • Observe & record the character and quantity of emesis

  32. Peptic Ulcers (PUD) • Gastric ulcers and duodenal ulcers • Ulcerations of the mucous membrane or deeper structures of the GI tract • Most commonly occur in the stomach and duodenum • Result of acid and pepsin imbalances • Chronic NSAID use • H. pylori • 70% of patients with gastric ulcers • 95% of patients with duodenal ulcers

  33. Peptic Ulcers (PUD) • Gastric ulcer • In the distal half of the stomach • Bleed more, harder to control • Duodenal ulcers • May or may not be caused by hypersecretion of gastrin • Ulceration occurs when the acid secretion exceeds the buffering factors • More likely to have chronic bleeding and perforate

  34. Peptic Ulcers (PUD)

  35. Peptic Ulcers (PUD) • Clinical manifestations • Pain: Dull, burning, boring, or gnawing, epigastric • Dyspepsia • Hematemesis • Melena • Diagnostic tests • Esophagogastroduodenoscopy (EGD) • Breath test for H. pylori

  36. Peptic Ulcers (PUD) • Complications of peptic ulcers • Bleeding • Hematemesis • Melena • Gastric outlet obstruction

  37. Peptic Ulcers (PUD) • Diagnosis • Esophagogastroduodenoscopy (EGD) • Visualize tissue and Biopsy if necessary • Wireless capsule endoscope • Complications • Stool impaction • Small bowel stricture

  38. Peptic Ulcers (PUD) • Medical management/Nursing interventions • NG tube until bleeding subsides • Antacids • Histamine H2 receptor blockers • Proton pump inhibitor • Mucosal healing agents • Antibiotics • Anticolingerics • Reclining for 1 hour post meal • IV fluid • Diet • High in fat and carbohydrates • Low in protein and milk products • Small frequent meals • Limit coffee, tobacco, alcohol, and NSAID use

  39. Peptic Ulcers (PUD) • Medical management/Nursing interventions • Surgery • Antrectomy- • Gastrodudodenostomy (Billroth I) • Gastrojejunostomy (Billroth II) • Total gastrectomy • Vagotomy • Pyloroplasty

  40. Types of gastric resections with anastomoses. A, Billroth I. B, Billroth II.

  41. Peptic Ulcers • Complications after gastric surgery • Dumping syndrome • Eat 6 small meals a day high in protein and carbohydrates • Eat slowly and avoid fluid with meals • Pernicious anemia • Iron deficiency anemia

  42. Diarrhea • Rapid movement through intestines of loose, watery stools resulting from increased peristalsis • Causes: • Fecal impaction • Ulcerative colitis • Intestinal infections • Drugs

  43. Diarrhea • Nursing implications • Meticulous skin care • Observe stool for color, odor, consistency, mucous, blood, or pus • Administer anticholinergics • Reduce bowel spasticity • Administer anti-diarrheal agents • Mild diarrhea • Moderate diarrhea • Severe diarrhea (infectious agent)

  44. Constipation • Etiology/Pathophysiology • Fecal mass in rectum • Water is absorbed and feces hardens • Painful to pass • Causes • Neurological conditions • Disease • Medications • Diet • Decreased activity • Ignoring the urge to defecate • Chronic laxative use

  45. Constipation • Clinical manifestations/Assessment • Abdominal distention • Indigestion • Rectal pressure • Hard, dry stools • Decrease appetite • Rectal pressure • Intestinal rumbling

  46. Constipation • Complications • Fecal impaction • Cardiac complications from straining • Dilation of colon (Megacolon) • Colonic mucosal atrophy • Fecal incontinence

  47. Constipation • Treatment • High fiber diet • 2-3 liters of fluid a day • Strengthening of abdominal muscles • Behavior changing • Diet • Whole grains • Fresh fruits • Vegetables

  48. Constipation • Medications • Bulk forming agents • Absorb fluid and swell in the intestine and increase peristaltic action • Laxatives • Bulk forming, stool softeners, stimulant, and saline • Stool softeners • Detergent like drugs that permit easier penetration and mixing of fats and fluids with the fecal mass • Stimulant • Increase the motility of GI tract by chemical irritation of the intestinal mucosa • Golytely • Causes a large volume of water to be retained in the colon • Results in diarrhea within 30-60 minutes

  49. Constipation • Enemas • Instilled directly into the lower colon • Retained in bowel • Cleansing • Types of enemas • Tap water • Saline • Soap • Oil • Medicated

  50. Infection • Etiology/Pathophysiology • Invasion by pathogenic microorganisms • Person-to-person contact • Fecal-oral transmission • Long-term antibiotic therapy • Clinical manifestations • Rectal urgency • Tenesmus • Nausea, vomiting & diarrhea • Abdominal cramping • Fever

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