1. Intestinal Disorders Gastroenteritis Irritable bowel syndrome (IBS) Inflammatory bowel disease (IBD) Crohn disease Ulcerative colitis Appendicitis Diverticulitis Intestinal obstruction Intussusception Volvulus Ileus Hemorrhoids

2. Disorders of the Intestines  Infection  Etiology/pathophysiology  Invasion of the alimentary canal by pathogenic microorganisms  Most commonly enters through the mouth in food or water  Person-to-person contact  Fecal-oral transmission  Long-term antibiotic therapy can cause an overgrowth of the normal intestinal flora (C. difficile)

3. Disorders of the Intestines  Infection (continued)  Clinical manifestations/assessment  Diarrhea  Rectal urgency  Tenesmus  Nausea and vomiting  Abdominal cramping  Fever

4. Disorders of the Intestines  Infection (continued)  Diagnostic tests  Stool culture  Medical management/nursing interventions  Antibiotics  Fluid and electrolyte replacement  Kaopectate  Pepto-Bismol

5. Disorders of the Intestines  Irritable bowel syndrome  Etiology/pathophysiology  Episodes of alteration in bowel function  Spastic and uncoordinated muscle contractions of the colon  Clinical manifestations/assessment  Abdominal pain  Frequent bowel movements  Sense of incomplete evacuation  Flatulence, constipation, and/or diarrhea

6. Disorders of the Intestines  Irritable bowel syndrome (continued)  Diagnostic tests  History and physical examination  Medical management/nursing interventions  Diet and bulking agents  Medications  Anticholinergics  Milk of Magnesia, fiber, or mineral oil  Opioids  Antianxiety drugs

7. Gastrointestinal Surgery  Mechanical vs. Chemical Digestion  The Esophagus & Stomach  The Small Intestines  The Large Intestine  The Rectum  Accessory Organs of Digestion  The Liver, Gallbladder, & Biliary Tract  The Pancreas  The Spleen

8. Mechanical vs. Chemical Digestion

9. The Esophagus & Stomach  Anatomy & Physiology  Pathophysiology  Surgical Intervention

10. The esophagus is a thin narrow tube that acts like a conveyor belt carrying food from the pharynx to the stomach. It is about 25-30cm in length. The stomach is like a churning pot, with a very thick layer of mucosa called Rugae. Unlike the rest of the G.I. tract, the stomach has three distinct layers of muscle.

11. Pathophysiology  GERD (gastroesohageal Reflux Disease  Barrett's Esophagus  Hiatal Hernia  Esophageal Varices  Gastric Ulcers  Stomach Carcinoma

12.  GERD (gastroesophageal reflux disease) – is a condition where the acid of the stomach comes in contact with the delicate linings of the esophagus do to decreased tone of the LES (lower esophageal sphincter). GERD is a chronic condition which is initially treated with over the counter antacids, as well as prescription drugs. In many cases surgery may be indicated.

13.  Barrett’s Esophagus – if GERD goes untreated, dysplasia (Barrett’s esophagus) may result. In some cases a Barrett’s esophagus may result in erosion of the esophagus or worse yet carcinoma.

14.  Esophageal Varices – is a dilation and protrusion of the veins within the mucosa lining of the esophagus. Varicosing of these veins is thought to mainly be caused by portal hypertension. They may also develop do to esophageal erosion. The mode of treatment involves the placement of a Blakemore-Sangston tube, sclerotherapy, and in some cases partial esophagectomy.

15.  Gastric Ulcers – A gastric ulcer develops when there are high amounts of HCL (hydrochloric acid) present in the stomach over a long period of time. An ulceration is literally the burning of the mucosa in the G.I. tract. Other factors leading to gastric ulcers are due to excessive alcohol, drug use,and stress. In some cases a Partial Gastrectomy may be indicated.

16. Surgery of the Stomach and Esophagus  Nissen Fundoplication  Esophageal Myotomy  Vagotomy  Partial Gastrectomy  Total Gastrectomy  Gastric Bypass

17.  Nissen Fundoplication – A common way to treat reflux (GERD) is by performing a stomach wrap. Nissen Fundoplication has also been successful at treating hiatal hernia.

18.  Esophageal Myotomy (Heller Procedure) – An esophageal myotomy is indicated for patients who have an motitliy disorders of the esophagus. Achalasia for example is where there is an absence of muscular contractions in the lower half of the esophagus. Surgery is needed to incise the lower esophageal sphincter allowing food to pass into the stomach.

19.  Vagotomy – An indication to perform vagotomy is when the stomach is producing to much hydrochloric acid (HCL). When there is excessive acid secretion within the stomach, an individual as at risk of developing a gastric ulcer. The goal of surgery is to create a partial split in the nerve trunks.

20.  Partial Gastrectomy – Indicated for confined conditions of the stomach like gastric ulcer, a partial gastrectomy focuses on removing only a part of the stomach. Continuity is restored by either reattaching the stomach to the duodenum ( Gastroduodenostomy ) or in some cases where the disease process has effected the duodenum a connection between the stomach and jejunum would be done ( Gastrojejunostomy ).

21. Gastroduodenostomy Gastrojejunostomy ( Roux – en – Y )

22.  Total Gastrectomy – The main reason to remove the stomach is when cancer of the stomach is present. In some cases of advanced ulceration the stomach may also have to be removed.

23.  Gastric Bypass – The preferred method for treating morbid obesity today is by performing a procedure designed at reducing the volume of the stomach. The success rate for gastric bypass is very high.

24. The Intestinal Tract  Anatomy & Physiology  Pathophysiology  Surgical Intervention

25. The Duodenum is about 12 inches long. It contains Brunner’s Glands, which secrete high amounts of bicarbonate fluid… The Jejunum is about 71/2 feet long. multiple digestive enzymes are secreted In order to conclude the digestive process. The Ileum is about 10 feet long. With the break down of food just about complete, absorption of most of what we take in and digest is now absorbed into the blood stream. The Small Intestines

26. DISORDERS OF INTESTINES The Small Intestines  NEC (necrotizing enterocolitis)  Crohn’s Disease  Meckel’s Diverticulum  Intussusception  Volvulus The Large Intestines  Appendicitis  Diverticulitis  Polyps  Hirschsprung’s Disease  Colon Cancer

27.  Necrotizing Enterocolitis (NEC) – Seen in the newborn, NEC is best defined as a premature gut. When the layers of the intestines are underdeveloped they begin to separate or fall apart. The problem then causes gases to develop inside the linings of the bowel wall. In many cases if caught early, antibiotics are usually effective. In more severe cases the bowel often dies requiring it to be resected. X-ray showing profound Pneumatosis Intestinalis

28.  Meckel’s Diverticulum – The term diverticulum means abnormal or pouching of bowel. Most meckel’s diverticuli occur in the ileocecal region of the G.I. tract. It is believed that this form of diverticulum is left over from your umbilical cord when you were a fetus. The goal of treatment is surgical resection only when they are symptomatic.