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Gastrointestinal Disorders PN 4. Changes through the lifespan Relatively immature at birth Teeth at 6-7 months Peristalsis slows to allow formed stool.

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Presentation on theme: "Gastrointestinal Disorders PN 4. Changes through the lifespan Relatively immature at birth Teeth at 6-7 months Peristalsis slows to allow formed stool."— Presentation transcript:

1 Gastrointestinal Disorders PN 4

2 Changes through the lifespan Relatively immature at birth Teeth at 6-7 months Peristalsis slows to allow formed stool at 8 months Stomach acidity increases at 1-5 yrs Bowel control Stomach capacity increases; weight issues at 6-12 years

3 Lifespan Stomach capacity, increased acidity and peristalsis adult like at 13-19 years Stomach capacity 2000 to 3000 age 20-45 Obesity common Caloric needs decrease age 46-64 Stress = ulcers or reflux Increase gallbladder problems Taste buds begin atrophy = loss of sweet Liver begins to decrease size

4 Lifespan Age 65+ mucosa atrophies and secretions decrease Gag reflex weakens Dental disease Decrease hydrochloric acid and other enzymes Decrease of absorption of vitamins and nutrients Decreased motility, and nerve impulses

5 Alimentary Canal Begins at Pharynx; Ends at Anus

6 GI Track Continuous structure beginning with the oral cavity terminating with the anal sphincter Carries out activities of: ingestion, movement or passage of food, digestion, absorption and removal of waste (defecation)

7 Assessment Family Meds Travel Diet Smoking Pain “1- 10” Other

8 It begins with the mouth Lips, tongue, cheeks, teeth, taste buds and salivary glands prepare food for eventual absorption. Saliva contains mostly H2O; enzymes and electrolytes = 1000 to 1500 mL/day

9 What can go wrong? Stomatitis (primary and secondary) Leukoplakia and Erythroplakia Cancer Acute and Post irradiation Sialadenitis; Dental problems Facial fractures Lack of taste or smell

10 Pharynx Better known as the throat Beginning of the esophagus Tongue and saliva make ball of food called a bolus When you swallow the bolus bounces off the epiglottis and is diverted from the larynx and falls into the esophagus

11 Esophagus Two sphincters UES and LES 24 cm long Peristalsis moves bolus into stomach

12 Esophagus –Essential role in the ingestions of food and liquids –Disorders can be inflammatory, mechanical or cancerous –Esophageal disorders may mimic those of a variety of other illnesses because of its proximity to neighboring organs

13 What can go wrong? GERD Hiatal Hernia (sliding and rolling) Achalasia Cancer Diverticula Varicies

14 Gastric Reflux Disease (GERD )  Backward flow of GI contents = exposure of esophagus to gastric/duodenal contents = inflammatory changes of esophageal mucosa  Reflux esophagitis  Pathophysiology  Incompetent lower esophageal sphincter (LES)  Irritation due to refluxate  Abnormal esophageal clearance  Delayed gastric emptying

15 Gastric Reflux Disease-Clinical Manifestations  Dyspepsia (heartburn)  Regurgitation  Hypersalivation  Dysphagia/odynophagia  Other

16 Diagnostic Tests Barium swallow Upper endoscopy 24-hour ambulatory pH monitoring Esophageal manometry

17 Gastric Reflux Disease-Interventions Nonsurgical (conservative) management  Diet therapy  Client education  Lifestyle changes  Drug therapy 1. Antacids 2. Histamine receptor antagonists 3. Other drugs

18 Surgical management

19 Hiatus Hernia

20 Hiatal Hernia (Diaphragmatic Hernias)  Protrusion of stomach through esophageal hiatus into the thorax  Asymptomatic or S/S similar to GERD  Sliding hernia  Most common  Esophageal reflux and complications  Rolling hernia  Slow bleeding resulting from venous obstruction  Iron deficiency anemia

21 Hiatal Hernia-Interventions Nonsurgical management  Similar to GERD  Client education 1. HOB  8 to 12 inches 2. Remain  several hours after eating 3. Avoid straining or excessive vigorous exercise 4. Refrain from wearing tight constrictive clothing Surgical management

22 Stomach Few diseases affect stomach Those that do can be serious Pear-shaped; hollow; can distend Parts include: cardiac, fundus, body, antrum and pylorus Interior composed of rugae; glands that secrete gastric juice Food and gastric juice = chyme

23 What can go wrong? Most common include: gastritis; peptic ulcer; Zollenger-Ellison syndrome and Cancer

24 Gastritis Inflammation of the gastric mucosa Erosive or non erosive Acute or chronic Auto digestion of the stomach Chronic associated with risk of gastric cancer

25 Prevention Avoid increased amts of alcohol and smoking Caution when taking ASA, NSAID’s, corticosteroids Avoid excess caffeine Avoid contaminated foods Workplace hazards such as lead and nickel Seek medical help for Sx

26 Stress Ulcers Result from a “stress” situation Multiple and superficial May be asymptomatic until massive, painless gastric bleeding occurs What would you see in your client?

27 Peptic Ulcer Disease Common; caused by acid-protective barrier imbalance Associated with NSAID drugs and Helicobacter pylori (H pylori) infection Gastric and duodenal

28 Gastric Ulcers Usually solitary and small Caused by ingested substances; H pylori and chronic bile reflux Bleeding may occur Pre-malignant so follow up needed Diagnosed with ba swallow; endoscopy; bx Sx include epigastric pain

29 Peptic Ulcer Disease Gastric  Deep and penetrating  Occur on lesser curvature of stomach Duodenal  95% occur in first portion of duodenum  Deep, sharply demarcated lesions  Penetrate through mucosa and submucosa into muscle layer  95% to 100% due to H. pylori infection Stress ulcers

30 Duodenal Ulcer Usually in the pyloric region Type O blood type (genetic)? H pylori; alcoholic; hyperparathyroid; COPD; renal failure; chronic pancreatitis “pain-food-relief” pattern

31 Signs and Syptoms  Epigastric tenderness  With perforation  Rigid, board-like abdomen  Rebound tenderness  Hyperactive bowel sounds, that may diminish  Dyspepsia (indigestion)  Melena  Gastric ulcer pain/vomiting  S/S fluid volume deficit

32 Associated Nsg Diagnosis  Acute pain  Risk for deficient fluid volume  Ineffective therapeutic regimen management  Ineffective coping  Imbalanced nutrition  Disturbed sleep pattern  Risk for injury

33 Complications  Hemorrhage  Most serious complication  Most common in older adults with gastric ulcers  Perforation  Pyloric obstruction  Intractable disease

34 Pharmacological treatment  Hyposecretory drugs  Antisecretory agents  H 2 -receptor antagonists  Prostaglandin analogs  Antacids  Mucosal barrier fortifiers

35 Gastric Cancer Survival rate poor; greater if diagnosed early Etiology factors: ulcers, nitrates in food, type A blood, Early metastasis to lymph nodes in region Dx with biopsy S & S: loss of apetite; wt loss; abd pain; vomiting; change in bowel habits; anemia; blood in stool; massive hemorrhage.

36 Dumping Syndrome  Constellation of vasomotor symptoms after eating caused by:  Rapid emptying of gastric contents into small intestines  Fluid shift into gut  Abdominal distension  Early symptoms occur within 30 minutes of eating  Late dumping syndrome 90 minutes to 3 hours after eating  Managed by dietary measures

37 Moving to the Small Bowel Conditions of the small bowel

38 Small & Large Bowel Cancer Polyps Diverticulitis Colitis Irritable Bowel Hemorrhoids Obstruction Hernia

39

40 Parasites

41 Malabsorption & Maldigestion Most nutrient absorption occurs in small intestine Malabsorption refers to inadequate mucosal absorption of ingested water and nutrients; Maldigestion refers to inability to absorb foodstuff because it has not been broken down properly

42 Celiac or Gluten Intolerance Gluten proteins have antigenic properties Frequent foul smelling stools with a fatty or greasy appearance Wt loss; malabsorption of vitamins Muscle wasting Diet that removes barley; wheat; rye and oats = less malabsorption Usually diagnosed in children who fail to thrive

43 Inflammatory: Enteritis Caused by bacteria; virus; parasites or allergic reaction Usually returns to normal when precipitator is removed Vomiting and/or diarrhea

44 Inflammatory Bowel (Crohn’s) Idiopathic, chronic, inflammatory disease Affects any segment of the GI tract; most common terminal ileum or colon; S & S vary; Diarrhea dominant; fever and RLQ pain Stress and personality factors Wt loss, occult blood, N & V, fistulas and peritonitis

45 Moving to the Large Bowel Problems with the Colon

46 Paralytic ileus Functional obstruction of bowel (S or L) Lack of proulsive peristalsis; absence of bowel sounds and distention Causes: anesthesia; peritonitis; appendicitis; interruption of nerve supply; abd injury or surgical manipulation; intestinal ischemia and electrolyte imbalance (which one?)

47 Colorectal Cancer

48  Most prevalent in patients over the age of 50  70% occur in the right side of the proximal colon  Liver is the most frequent site of metastasis  Complications  Obstruction/perforation  Peritonitis  Abscess formation  Fistula formation to bladder/vagina

49 Etiology  Genetic predisposition  Personal factors  Age  Polyps  Dietary factors  Decreased bowel transit time  High-fat diet  Chemical mutagens  Refined carbohydrates  Inflammatory bowel disease

50 Signs and Symptoms  Rectal bleeding  Anemia  Changes in stool  Symptoms of obstruction  Gas pains, cramping, incomplete evacuation  Hematochezia  Straining to pass stools/narrowing of stools  Mass lower right quadrant  Changes in bowel sounds

51 Nursing Diagnosis  Pain  Disturbed body image  Compromised family coping  Imbalanced nutrition  Fear  Powerlessness  Alteration in bowel elimination

52 Colostomy sites

53 Bowel Obstruction

54 Signs and Syptoms  Midabdominal pain or cramping  Vomiting: bile/mucus  Obstipation/diarrhea  Colicky abdominal pain  Alternations in bowel patterns  Abdominal distention/peristaltic waves  Borborygmi  Decreased to absent bowel sounds  Abdominal tenderness

55 Intestinal Obstruction When blockage occurs, gas and air cause distention proximal to obstruction Secretions begin to pool = more distention Bowel wall edema = 3 rd spacing Decrease blood supply = infarction, ischemia, necrosis, perforation, peritinitis. Hypovolemic shock, septic shock, very ill

56 Other Conditions Hernia’s Megacolon Diverticular Disease Ulcerative Colitis (different to crohn’s) Hemorrhoids Polyps

57 Irritable Bowel

58 Liver, Pancreas and Gallbladder

59 Liver: Cirrhosis  Chronic, progressive  Irreversible reaction to hepatic inflammation/necrosis  Alteration in vascular system/lymphatic bile duct channels  Types:  Laënnec's or alcoholic  Postnecrotic  Biliary  Cardiac

60 Complications of cirrhosis  Portal hypertension  Ascites  Bleeding esophageal varices  Coagulation defects  Jaundice  Portal-systemic encephalopathy (PSE) with hepatic coma  Hepatorenal syndrome

61 Signs and Symptoms  Early signs  Generalized weakness  Weight loss  GI symptoms  Abdominal pain/liver tenderness  Late signs  GI bleeding  Jaundice  Ascites  Spontaneous bruising

62 Hepatitis  Widespread inflammation of liver cells  Most common viral hepatitis  Five major categories of viruses  Enteral forms 1. Hepatitis A and E 2. Transmitted by fecal-oral route  Parenteral forms 1. Hepatitis B, C, D 2. Transmitted through venous blood/sexual contact  Acute or chronic

63 Etiology  Hepatitis viruses  Drugs, chemicals, toxins  Blood transfusion reactions  Hyperthyroidism  Ingestion of ethyl alcohol (ETOH)  Wilson's disease  Other viruses: Epstein-Barr, cytomegalovirus, yellow fever

64 Disorders of the GB  Cholecystitis  Acute 1. Inflammation of gallbladder 2. Gallstones/bacterial invasion via lymphatic or vascular routes  Chronic 1. Repeated bouts of acute cholecystitis 2. Gallstones usually present 3. Pancreatitis/cholangitis  Cholelithiasis  Cancer of gallbladder

65 Gall Stones

66 Biliary Lithotripsy

67 Disorders of the Pancreas  Acute  Inflammatory process of the pancreas  Premature activation of pancreatic enzymes  Destruction of ductal tissue/pancreatic cells  Autodigestion/fibrosis of pancreas  Pathophysiologic processes 1. Lipolysis 2. Proteolysis 3. Necrosis of blood vessels 4. Inflammation  Theories of enzyme activation  Chronic

68 Acute Pancreatitis  Abdominal pain  Midepigastric/left upper quadrant  Radiates/intense, continuous  Affected by position  Generalized jaundice  Gray-blue discoloration of abdomen/periumbilical area (Cullen's sign)  Gray-blue discoloration of flanks (Turner's sign)  Decreased bowel sounds/paralytic ileus  Tenderness, rigidity/guarding  Palpable mass  Elevated temperature/tachycardia/  B/P

69 Chronic Pancreatitis  Progressive, destructive  Remissions/exacerbations  Inflammation/fibrosis  Repeated episodes of alcohol-induced acute pancreatitis  Types of chronic:  Calcifying pancreatitis (CCP) (alcohol-induced)  Obstructive pancreatitis


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