DIGESTIVE DISEASES 1

GERD GERD - Gastro-esophageal reflux disease Not actually a disease but a syndrome of unknown cause where there is a reflux of gastric secretions into the esophagus. This reflux results in esophageal irritation, inflammation, and pain. More than 60 million Americans experience symptoms of GERD 17.5 million experience symptoms daily Predisposing Conditions Hiatal hernia Decreased gastric emptying Incompetent LES (lower esophageal sphincter) 2

GERD Signs & Symptoms Heartburn (burning, tight sensation below the sternum and radiates upward) Feeling of fullness Bloating N/V Reguritation Dysphagia Hoarsness Dyspnea Wheezing 3

GERD Complications Dx Scar tissue formation Lesions Dysphagia Pneumonia (d/t aspiration) Dx Ba swallow Esophagoscopy 4

GERD Tx Drug therapy Antacids - Maalox (1-3 hrs pc and hs) Proton pump inhibitors (Zantac, Pepcid) Histamine H2-receptor antagonist (Losec, Prevacid) Nutritional therapy High protein, low fat Avoiding chocolate, peppermint, coffee, tea, milk Avoid late meals and nocturnal snacking Small frequent meals Fluids b/t meals rather than with meals 5

CELIAC DISEASE Also called non-tropical sprue, is a mal-absorption condition . In celiac disease, there is atrophy and flattening of the intestinal villi caused by a hypersensitivity to gluten. Gluten is a protein found in wheat, barley, oats, and rye. The hypersensitivity leads to inflammation of the small intestine which greatly reduces its ability to absorb nutrients. Celiac can develop at any age but is most prevalent in children and those in their 40’s & 50’s. 6

CELIAC DISEASE Signs & Symptoms Risk Factors Dx Steatorrhea (bulky, foul smelling, yellow-grey, greasy stools) Wt. loss Abd distention Excessive flatulence Multiple vitamin deficiencies Risk Factors Type 1 diabetes Down Syndrome Genetics Dx Stool sample Intestinal biopsy 7

CELIAC DISEASE Tx Gluten free diet Corticosteroids (if not responsive to a gluten free diet) 8

INFLAMMATORY BOWEL DISEASE Inflammatory Bowel Disease (IBD) includes: Colitis Crohn's Disease Both diseases are characterized by chronic, recurrent inflammation of the intestinal tract. The cause of both diseases are unknown, however, possible causes include: Virus Bacteria Auto-immune reaction Food allergies Heredity 9

COLITIS Ulcerative colitis is characterized by inflammation and ulceration of the colon and rectum. It may occur at any age but happens most frequently b/t the ages of 15-25 and 50-80 Higher incidence in women More common in Jewish and upper middle class urban populations. Colitis has exacerbations and remissions 10

COLITIS SIGNS & SYMPTOMS Bloody diarrhea Abd pain varying from mild to severe In severe cases Fever Wt. loss Tachycardia Dehydration 11

COLITIS COMPLICATIONS Dx Hemorrhage Strictures Perforation Toxic megacolon Dx Bloodwork (CBC electrolytes) Stool culture Sigmoidoscope 12

COLITIS Tx Rest the bowel Control inflammation Correct malnutrition Combat infection Alleviate stress Symptom relief with drug therapy Surgery 13

CROHN'S DISEASE Crohn’s disease is a chronic, inflammatory bowel disorder that can affect any part of the GI tract. The cause is unknown Can occur at any age but occurs most often b/t the ages of 15 – 30 Higher incidence of women More common in Jewish and upper middle class urban populations Crohn’s disease has periods of exacerbation and remissions 14

CROHN'S DISEASE SIGNS & SYMPTOMS Depends on the site of involvement Diarrhea (usually non bloody) Fatigue Abd pain Wt. loss Fever 15

CROHN'S DISEASE Dx COMPLICATIONS Strictures Obstruction Physical signs and symptoms Ba enema/swallow Bloodwork Colonoscopy Biopsy Stool culture COMPLICATIONS Strictures Obstruction Fistulas Nutritional abnormality Arthritis 16

CROHN'S DISEASE Tx Control inflammation Corticosteriods Anti-inflammatories Relieve symptoms Correct nutritional problems High calorie High protein Promote healing Surgery

DIVERTICULAR DISEASE A diverticulum is a small pouch in the colon that bulge outward through weak spots in the colon. 18

DIVERTICULAR DISEASE Diverticular disease occurs in 2 forms: 1. Diverticulosis 2. Diverticulitis The condition of having these pouches is called diverticulosis. It is multiple non- inflamed diverticulum (pouches) When diverticula form, the smooth muscle of the colon wall becomes thickened. Diverticular disease is very common in older adults (50% by the age of 80 yrs) It affects men and women equally 19

DIVERTICULAR DISEASE When feces enters the diverticula, they can become inflamed and infected. This is called diverticulitis. 20

DIVERTICULAR DISEASE There is pain associated with diverticulitis. The pt. may also have some abd. discomfort/cramping which is usually relieved by passing flatus or having a BM. There is no known cause however, a low fiber diet is definitely associated with it Lack of dietary fiber slows peristalsis and more water is absorbed from the stool, making it more difficult to pass It is more prevalent in Western populations d/t our poor diets A Ba (Barium) emema is typically used to dx diverticular disease 21

DIVERTICULAR DISEASE SIGNS/SYMPTOMS Abd pain in the LLQ Fever N & V Chills Cramping Constipation Bloating Rectal bleeding 22

DIVERTICULAR DISEASE COMPLICATIONS Tx May include Abscesses Bowel obstruction Bleeding Ruptured diverticula Tx Antibiotics (if infection is present) Some of these complications may require surgery. A colostomy can be necessary as well as dietary changes. 23

VOMITING, GALLBLADDER DISEASE & IBS Vomiting – (red text) Pg 547 Definition What are the risks of vomiting? Review the measures to follow when a client vomits Gallbladder Disease - (yellow text) Pg 276 What is the gallbladder? Define cholecystitis Signs and symptoms Tx IBS – (yellow text) Pg 277 Definition What are the 2 types of IBS? Signs and symptoms of both types Causes Tx

DIGESTIVE SYSTEM ASSESSMENT SUBJECTIVE DATA Ask your pt. about: Appetite Dysphagia Food intolerances Abd pain N/V Bowel habits Past hx Meds Diet OBJECTIVE Inspect Auscultate Percuss Palpate

MAKE YOUR OWN CASE STUDY Using your knowledge of : The digestive system Bowel elimination Digestive diseases Digestive assessment Write your own case study and have a partner complete it. Remember, you want your partner to think critically and make connections between: