The Gastrointestinal System

1. 20 Lecture Note PowerPoint Presentation The Gastrointestinal System

2. LEARNING OUTCOME 1 Describe age-related changes that affect gastrointestinal function.

3. Gastrointestinal Changes Associated with Aging • Begin before age 50 • Changes in the mouth • Decreased esophageal motility • Reduced peristalsis • Diminished ability of gastric mucosa to resist damage • Decreased production of intrinsic factor • Reduced intestinal absorption and blood flow • Intrinsic factor (IF) also known as gastric intrinsic factor (GIF) is a glycoprotein produced by the parietal cells of the stomach. It is necessary for the absorption of vitamin B12 later on in the terminal ileum

4. Figure 20-1Normal configuration of the GI tract.

5. Gastrointestinal Changes Associated with Aging • Begin before age 50 • Decreased pancreas size • Increased incidence of cholelithiasis, decreased production of bile synthesis • Decreased liver size and blood flow • Decreased thirst and hunger • Increased medication use

6. LEARNING OUTCOME 2 Describe the impact of age-related changes of gastrointestinal function.

7. Aging and the Gastrointestinal System • Aging has limited impact on system • Aging associated with increased prevalence of many GI disorders • Evaluate disorders closely

8. Figure 20-2Normal changes of aging related to the gastrointestinal tract.

9. Dysphagia • Number-one esophageal disorder in older people • Impacts oral intake • Seen in 50% of institutionalized persons

10. Dysphagia • Causes • Poor tongue control • Poor preparation of food bolus for swallowing • Poor dentition: pertains to the development of teeth and their arrangement in the mouth • Lack of saliva

11. Dysphagia • Signs and symptoms • Reports of difficulty swallowing • Difficulty controlling food or saliva in mouth • Facial droop • Dementia, frailty, confusion • Inability to sit upright

12. Dysphagia • Signs and symptoms • Choking or coughing while eating • Increased oral or nasal congestion after meals • Weak voice or slurred speech • Recurrent upper respiratory infections • Unexplained weight loss

13. Dysphagia • Risk factors • Incorrect positioning • Inappropriate intake • Rapid feeding • Older persons labeled as “difficult” • Comorbidities • Neurological disorders • Muscular disorders • Anatomical abnormalities

14. Dysphagia • Nursing assessment • Observation of individual during eating and drinking

15. Dysphagia • Nursing assessment • Question patient concerning • Choking • Dry mouth • Excess saliva • Inability to control food in mouth • Spitting up after meals • Need to frequently clear throat • Difficulty sitting up during mealtimes

16. Dysphagia • Nursing interventions • Minimize distractions while eating • Use consistent feeding techniques • Proper positioning during mealtime • Monitor respirations during feeding • Provide oral hygiene before and after eating • Offer intake consistencies as recommended • Do not forcefully feed

17. Gastroesophageal Reflux Disease • Caused by weakness of esophageal sphincter • Increased incidence of hiatal hernia • Risk factors • Aging • Thyroid disease • Scleroderma or connective tissue disorders • Diabetes

18. Gastroesophageal Reflux Disease • Risk factors • Aging • Thyroid disease • Scleroderma or connective tissue disorders • Diabetes

19. Gastroesophageal Reflux Disease • Signs and symptoms • Heartburn • Indigestion • Belching:(also known as burping, ructus, or eructation) involves the release of gas from the digestive tract (mainly esophagus and stomach) through the mouth. • Hiccups • Regurgitation of gastric contents • Voice hoarseness

20. Gastroesophageal Reflux Disease • Triggers • Eating large meals • Certain medications • High-fat foods • High caffeine intake • Alcohol and tobacco use • Reclining after eating • Obesity

21. Gastroesophageal Reflux Disease • Consequences for GERD • Nursing assessment of GERD • Diagnostic testing • Barium swallow • Endoscopy • Esophageal contents pH

22. Gastroesophageal Reflux Disease • Goals of treatment • Symptom control • Heal mucosal injury

23. Gastroesophageal Reflux Disease • Lifestyle modifications • Elevate head of bed • Reduce portion size • Avoid trigger foods • Drink 6 to 8 ounces of water with medications

24. Gastroesophageal Reflux Disease • Lifestyle modifications • Report all medications to physician • Avoid tight-fitting clothes and girdles(belt-shaped textile) • Remain upright after meals for 1 to 3 hours • Avoid right side-lying position • Stop smoking

25. Gastroesophageal Reflux Disease • Medications • Antacids • Aluminum-containing antacids • Histamine 2 receptor agonists • Proton pump inhibitors • Combination drugs • Surgery

26. Gastric Disorders • Gastritis • Inflammation of the gastric mucosa • Classification • Severity • Site involvement • Inflammatory cell type • Diagnosis • Endoscopy

27. Gastric Disorders • Gastritis • Treatment • Reducing contributing factors • Acid neutralization and suppression • Protection of gastric mucosa • Antibiotic therapy • Transfusions as needed

28. Gastric Disorders • Peptic and duodenal ulcer disease • An excoriated area of the gastric mucosa • Signs and symptoms • Bleeding • Positive fecal occult blood test • Pain • Diagnosis • H. pylori breath test • Endoscopy

29. Gastric Disorders • Peptic and duodenal ulcer disease • Treatment • Discontinue use of NSAIDs, alcohol, tobacco, and caffeine • Small, frequent meals • Medications

30. Gastric Disorders • Zollinger-Ellison syndrome • Caused by a gastrin-producing tumor • Characterized by gastric hypersecretion and peptic ulceration • Treatment may include tumor removal and surgical resection

31. Gastric Disorders • Gastric volvulus • Turning, twisting, or telescoping of the stomach onto or into itself • Symptoms • Acute pain • Shock and hypotension • Abdominal distention • Inability to vomit • Dyspnea

32. Lower Gastrointestinal Tract Disorders • Diverticular disease • Saclike mucosal projections protrude through muscular layer of GI tract • Projections may trap feces resulting in inflammation, infection, and rupture • Seen most in sigmoid and descending colon

33. Lower Gastrointestinal Tract Disorders • Diverticular disease • Risk factors • Physical inactivity • Constipation • Obesity • Smoking • NSAID therapy • Management • Increase fiber intake

34. Lower Gastrointestinal Tract Disorders • Diverticulitis • Normal bowel flora and fecal material becomes trapped in pouches resulting in inflammation, infection, and obstruction • Signs and symptoms • Fever • Leukocytosis • Pain or abdominal tenderness

35. Lower Gastrointestinal Tract Disorders • Assessment of diverticular disease • Physical examination • Questions regarding bowel history • Diagnosis • Abdominal CT scan • Ultrasound

36. Lower Gastrointestinal Tract Disorders • Goals of treatment • Eliminate bacterial infection • Liquid diet advancing to low fiber to allow colon to rest

37. Inflammatory Bowel Disease • Ulcerative colitis • Chronic inflammatory process • Impacts superficial layers of colon walls • Wide spread ulceration of colon walls • Signs and symptoms • Bloody diarrhea • Lower left quadrant abdominal pain • Weight loss

38. Inflammatory Bowel Disease • Ulcerative colitis • Diagnosis • Sigmoidoscopy • Colonoscopy • Rectal mucosa biopsy • Stool specimens • Treatment • Oral corticosteroids • 5-ASA drugs • Surgery

39. Inflammatory Bowel Disease • Crohn’s disease • Chronic inflammatory disorder of the terminal ileum or colon • Characterized by inflammation, linear ulcerations, and granulomas • Signs and symptoms • Diarrhea • Fever • Abdominal pain • Weight loss

40. Inflammatory Bowel Disease • Crohn’s disease • Diagnosis • Abdominal CT scan • Complete blood cell count • Barium enema colonoscopy • Treatment • Oral corticosteroids • Surgery

41. Benign and Malignant Tumors • Benign tumors or polyps seen in 75% of persons over age 50 • Predisposing factors • Age • Diet • Family history • Prior diagnosis polyps

42. Benign and Malignant Tumors • Malignant tumor • 2nd most common malignancy in the United States • Increase incidence with age • Predisposing factors • Family history • Inflammatory bowel disease • History of colorectal tumors

43. Benign and Malignant Tumors • Malignant tumor • Signs and symptoms • Change in bowel habits • Abdominal pain • Abdominal mass • Anemia • Rectal bleeding • Weight loss

44. Benign and Malignant Tumors • Malignant tumor • Diagnostic testing • Colonoscopy • Carcinoembryonic antigen levels • Sigmoidoscopy • Fecal occult blood testing • Treatment • Surgical resection

45. Antibiotic Therapy Associated Diarrhea and Colitis • Occurs during or shortly after administration of antibiotics • Caused by Clostridium difficile cytoxin, causing bowel inflammation and epithelial necrosis resulting in diarrhea and postmembranous colitis

46. Antibiotic Therapy Associated Diarrhea and Colitis • Signs and symptoms • Watery, nonbloody diarrhea • Low abdominal pain • Fever • Potential complications • Dehydration • Hypotension • Colonic perforation

47. Antibiotic Therapy Associated Diarrhea and Colitis • Diagnosis • Stool perforation • Treatment • Metronidazole • Vancomycin

48. Constipation • Definitions • Infrequent defecation • Hardened or reduced caliber of stool • Sensation of incomplete evacuation or need to strain with stools • Three bowel movements or less per week

49. Constipation • Predisposing factors • Aging • Certain medications • Metabolic and endocrine disorders • Muscular dystrophy • Neurologic disorders • Recent abdominal surgery • Obstructive disorders

50. Constipation • Complications • Abdominal discomfort • Loss of appetite • Nausea and vomiting • Excessive straining • Hemorrhoids, anal fissures, and rectal prolapse • Intestinal obstruction • Colonic ulceration • Overflow incontinence with stool leakage