Functions Of The Digestive System

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Information about Functions Of The Digestive System
Health & Medicine

Published on November 24, 2008

Author: txnurse

Source: slideshare.net

Description

Class project for GIT Disorders, Batch 17-PCN



Functions of the Digestive System

Functions of the Digestive System Food Processing and Storage Manufacture Enzymes, HCl, intrinsic factor, mucus Vitamin K and some B-complex in large intestine Absorption Small intestine into capillaries Reabsorption and Elimination Reabsorbs water for reuse; minerals and vitamins; forms feces; produces defecation

Food Processing and Storage

Manufacture

Enzymes, HCl, intrinsic factor, mucus

Vitamin K and some B-complex in large intestine

Absorption

Small intestine into capillaries

Reabsorption and Elimination

Reabsorbs water for reuse; minerals and vitamins; forms feces; produces defecation

Structure GI System Mouth Palate Salivary Glands Teeth Tongue Pharynx Esophagus Stomach Small Intestine Large Intestine Accessory Organs Liver; gallbladder; pancreas; peritoneum

Mouth

Palate

Salivary Glands

Teeth

Tongue

Pharynx

Esophagus

Stomach

Small Intestine

Large Intestine

Accessory Organs

Liver; gallbladder; pancreas; peritoneum



System Physiology Process of Digestion Enzymes Mucus and water Digestion in the stomach Digestion in the small intestine Absorption in the Small Intestine Absorption in the Large Intestine Metabolism Catabolism Anabolism ATP (adenosine triphosphate) Elimination

Process of Digestion

Enzymes

Mucus and water

Digestion in the stomach

Digestion in the small intestine

Absorption in the Small Intestine

Absorption in the Large Intestine

Metabolism

Catabolism

Anabolism

ATP (adenosine triphosphate)

Elimination

Diagnostic Tests; Common Medical & Surgical Treatments & Procedures

Diagnostic Tests Laboratory Studies Blood Tests CBC, UA, Chemistry, CEA, cholesterol, LFT’s Stool Tests Detect the presence of pathogens, parasites, eggs (ova), blood, and fat; C&S; occult blood testing Radiographic Evaluations Barium Studies Upper GI and Lower GI series Nursing considerations/Client teaching Cholecystogram Endoscopic Procedures EGD; esophagoscopy; ERCP; gastroscopy Colonoscopy Nursing consideration

Laboratory Studies

Blood Tests

CBC, UA, Chemistry, CEA, cholesterol, LFT’s

Stool Tests

Detect the presence of pathogens, parasites, eggs (ova), blood, and fat; C&S; occult blood testing

Radiographic Evaluations

Barium Studies

Upper GI and Lower GI series

Nursing considerations/Client teaching

Cholecystogram

Endoscopic Procedures

EGD; esophagoscopy; ERCP; gastroscopy

Colonoscopy

Nursing consideration

Common Medical & Surgical Treatments Gastrointestinal Intubation Nursing Considerations Providing oral and skin care Assessing the tube Removing the tube Gastric Suction Nursing considerations NG Tube Irrigation Gastric Lavage

Gastrointestinal Intubation

Nursing Considerations

Providing oral and skin care

Assessing the tube

Removing the tube

Gastric Suction

Nursing considerations

NG Tube Irrigation

Gastric Lavage

Common Medical & Surgical Tx Enteral Nutrition Tube feedings Parenteral Nutrition TPN Central lines – Hickman, Port-A-Cath, PICC Biopsy Polypectomy Gastric Surgery Types of gastric surgeries Fecal Diversions Ostomy appliances

Enteral Nutrition

Tube feedings

Parenteral Nutrition

TPN

Central lines – Hickman, Port-A-Cath, PICC

Biopsy

Polypectomy

Gastric Surgery

Types of gastric surgeries

Fecal Diversions

Ostomy appliances

Types of Gastric Surgeries Gastroduodenostomy (Billroth I): A subtotal gastrectomy w/ removal of distal stomach; anastomosis to duodenum Gastrojejunostomy (Billroth II): A subtotal gastrectomy w/ removal of distal stomach and antrum; anastomosis to jejunum. Total gastrectomy: Removal of entire stomach Vagotomy: Resection of vagus nerves; may be done to reduce gastric acid secretion in selected segments of the stomach. Pyloroplasty: Incision made into the pylorus to enlarge the outlet and relax the muscle; may be done w/ vagotomy to produce less gastric acid and promote gastric emptying.

Gastroduodenostomy (Billroth I): A subtotal gastrectomy w/ removal of distal stomach; anastomosis to duodenum

Gastrojejunostomy (Billroth II): A subtotal gastrectomy w/ removal of distal stomach and antrum; anastomosis to jejunum.

Total gastrectomy: Removal of entire stomach

Vagotomy: Resection of vagus nerves; may be done to reduce gastric acid secretion in selected segments of the stomach.

Pyloroplasty: Incision made into the pylorus to enlarge the outlet and relax the muscle; may be done w/ vagotomy to produce less gastric acid and promote gastric emptying.

Postoperative Complications: Nursing Considerations Keep client NPO as ordered Use of NG suctioning for 2-3 days as ordered: keeps the operative area clean & eliminates pressure from accumulated fluids Keep NGT patent at all times. Irrigate the NGT as ordered (usually w/ approximately 20mL NS): irrigating the NGT incorrectly could disrupt the suture line Assess NG drainage carefully. It may be tingged w/ bright-red blood at first. Report if the amount of red blood increases or remains bright red: it is a sign of hemorrhage. The NG fluid should progress towards a normal greenish-yellow color. Keep the client in semi-fowler’s position to facilitate drainage. Monitor chest tube drainage and chest tube suction: the chest may be opened during the surgery, necessitating the use of test tube & suction postoperatively. Provide routine postoperative care, including attention to mouth care and to early ambulation.

Keep client NPO as ordered

Use of NG suctioning for 2-3 days as ordered: keeps the operative area clean & eliminates pressure from accumulated fluids

Keep NGT patent at all times. Irrigate the NGT as ordered (usually w/ approximately 20mL NS): irrigating the NGT incorrectly could disrupt the suture line

Assess NG drainage carefully. It may be tingged w/ bright-red blood at first. Report if the amount of red blood increases or remains bright red: it is a sign of hemorrhage. The NG fluid should progress towards a normal greenish-yellow color.

Keep the client in semi-fowler’s position to facilitate drainage.

Monitor chest tube drainage and chest tube suction: the chest may be opened during the surgery, necessitating the use of test tube & suction postoperatively.

Provide routine postoperative care, including attention to mouth care and to early ambulation.

Nursing Consideration Include deep breathing & incentive spirometer exercises. Encourage the client to cough gently. Support the incision with a small pillow. Monitor & control post-surgical pain. Give pain medications as prescribed. The client may be reluctant to breathe deeply or cough because of incisional pain. Medications facilitate exercise, w/c decreases to postoperative complications. Assess dressings for excess drainage. Reinforce dressings as needed. Usually the surgeon observes the incision & does the first dressing change. Excess drainage indicates infection or a rupture of the suture line. Give clear liquids when bowel sounds are present. The diet progresses as tolerated.

Include deep breathing & incentive spirometer exercises. Encourage the client to cough gently. Support the incision with a small pillow.

Monitor & control post-surgical pain. Give pain medications as prescribed. The client may be reluctant to breathe deeply or cough because of incisional pain. Medications facilitate exercise, w/c decreases to postoperative complications.

Assess dressings for excess drainage. Reinforce dressings as needed. Usually the surgeon observes the incision & does the first dressing change. Excess drainage indicates infection or a rupture of the suture line.

Give clear liquids when bowel sounds are present. The diet progresses as tolerated.

Fecal Diversions Stoma Colostomy/ileostomy Colostomy Irrigation Ostomy Appliances Types of Appliances Changing the Appliance Nursing considerations Clothing Bathing Activity Diet Skin care Client and family teaching

Stoma

Colostomy/ileostomy

Colostomy Irrigation

Ostomy Appliances

Types of Appliances

Changing the Appliance

Nursing considerations

Clothing

Bathing

Activity

Diet

Skin care

Client and family teaching

Continent Fecal Diversions Ileoanal Reservoir Surgical creation of a pouch fashioned from the small intestine that collects ileal drainage. Parks S pouch Parks J pouch Kock Pouch Continent ileostomy OTHER PROCEDURES Abdominal Paracentesis (abd. tap) Ascites Nursing Considerations

Ileoanal Reservoir

Surgical creation of a pouch fashioned from the small intestine that collects ileal drainage.

Parks S pouch

Parks J pouch

Kock Pouch

Continent ileostomy

OTHER PROCEDURES

Abdominal Paracentesis (abd. tap)

Ascites

Nursing Considerations

Abdominal Paracentesis “ abdominal tap” is a procedure that may be necessary for diagnostic purposes or to relieve ascites. It is considered diagnostic when fluid is withdrawn for microscopic study or culturing when bleeding or infection is suspected. Therapeutic abdominal tap is done when the client is distended with ascitic fluid. The abdominal cavity is punctured to obtain a specimen for analysis or to drain excess fluid. Because the client also may have difficulty breathing, removal of this fluid will frequently relieve the condition. US may be utilized to guide the aspiration of fluid from the abdomen with a large syringe and needle. Sometimes a catheter is inserted into the abdominal cavity for continuous drainage.

“ abdominal tap” is a procedure that may be necessary for diagnostic purposes or to relieve ascites.

It is considered diagnostic when fluid is withdrawn for microscopic study or culturing when bleeding or infection is suspected.

Therapeutic abdominal tap is done when the client is distended with ascitic fluid.

The abdominal cavity is punctured to obtain a specimen for analysis or to drain excess fluid.

Because the client also may have difficulty breathing, removal of this fluid will frequently relieve the condition.

US may be utilized to guide the aspiration of fluid from the abdomen with a large syringe and needle.

Sometimes a catheter is inserted into the abdominal cavity for continuous drainage.

GI System Disorders

Disorders of the Mouth Dental Problems Periodontal Disease Gingivitis Pyorrhea Alveolaris Stomatitis Candidiasis Precancerous Lesions Herpes Simplex Infections Trauma Cancer of the Mouth Treatment Nursing Considerations

Dental Problems

Periodontal Disease

Gingivitis

Pyorrhea Alveolaris

Stomatitis

Candidiasis

Precancerous Lesions

Herpes Simplex Infections

Trauma

Cancer of the Mouth

Treatment

Nursing Considerations

Periodontal Disease affects the bones & tissues around the teeth. It can result from poor oral hygiene, inadequate dental care, or poor nutrition. Gingivitis Inflammation of the gums Symptoms include: bleeding, erythematous, edematous, & tender gums Frequently associated w/ accumulation of bacterial plaque on the teeth as a result of ineffective oral hygiene May be a sign of vitamin deficiencies, DM, anemia, & leukemia Pyorrhea Alveolaris Inflammation of the gums & teeth sometimes w/ a purulent discharge Treatment includes impeccable tooth, gum, & mouth care: regular flossing, surgical scraping, & drainage of the infected area, ATBs, or extraction of the affected teeth

affects the bones & tissues around the teeth. It can result from poor oral hygiene, inadequate dental care, or poor nutrition.

Gingivitis

Inflammation of the gums

Symptoms include: bleeding, erythematous, edematous, & tender gums

Frequently associated w/ accumulation of bacterial plaque on the teeth as a result of ineffective oral hygiene

May be a sign of vitamin deficiencies, DM, anemia, & leukemia

Pyorrhea Alveolaris

Inflammation of the gums & teeth sometimes w/ a purulent discharge

Treatment includes impeccable tooth, gum, & mouth care: regular flossing, surgical scraping, & drainage of the infected area, ATBs, or extraction of the affected teeth

causes of stomatitis (inflammation of the mouth) primary lesions of the mouth; secondary lesions of the mouth (results from chemotherapy & radiation); Mechanical trauma (mouth breathing & cheek biting) Chemical trauma (sensitivities/allergies of the oral mucosa to ingested substances) TREATMENT depends on the cause; avoiding oral irritants & providing comfort w/ frequent oral hygiene; topical ATB ointments for bacterial infections

causes of stomatitis (inflammation of the mouth)

primary lesions of the mouth;

secondary lesions of the mouth (results from chemotherapy & radiation);

Mechanical trauma (mouth breathing & cheek biting)

Chemical trauma (sensitivities/allergies of the oral mucosa to ingested substances)

TREATMENT

depends on the cause; avoiding oral irritants & providing comfort w/ frequent oral hygiene; topical ATB ointments for bacterial infections

Candidiasis Known as thrush or moniliasis , is a fungal infection caused by the organism Candida albicans , w/c is part of the normal flora of the oral cavity. It is common in newborns, immunosuppressed clients, & clients w/ chronic debilitating diseases such as HIV/AIDS, DM, or alcoholism ATB therapies also can lead to candidiasis The infection appears as small, white patches on the mucous membranes of the mouth or tongue & may extend into the entire GI tract. Oral pharyngeal cultures are recommended when this infection is suspected Prophylactic treatment of high-risk clients is indicated Treatment consists of nystatin (Mycostatin), saline, & hydrogen peroxide mouth rinses, or vaginal suppositories

Known as thrush or moniliasis , is a fungal infection caused by the organism Candida albicans , w/c is part of the normal flora of the oral cavity.

It is common in newborns, immunosuppressed clients, & clients w/ chronic debilitating diseases such as HIV/AIDS, DM, or alcoholism

ATB therapies also can lead to candidiasis

The infection appears as small, white patches on the mucous membranes of the mouth or tongue & may extend into the entire GI tract.

Oral pharyngeal cultures are recommended when this infection is suspected

Prophylactic treatment of high-risk clients is indicated

Treatment consists of nystatin (Mycostatin), saline, & hydrogen peroxide mouth rinses, or vaginal suppositories

Candidiasis Known as thrush or moniliasis, is a fungal infection caused by the organism Candida albicans, w/c is part of the normal flora of the oral cavity. Herpes Simplex Infection Cold sores or fever blisters are painful vesicles that occur on the face, lips, perioral (around the mouth) area, cheeks, & nose. Usually caused by herpes simplex virus type 1 (HSV-1) & can be precipitated by stress.

Candidiasis

Known as thrush or moniliasis, is a fungal infection caused by the organism Candida albicans, w/c is part of the normal flora of the oral cavity.

Herpes Simplex Infection

Cold sores or fever blisters are painful vesicles that occur on the face, lips, perioral (around the mouth) area, cheeks, & nose.

Usually caused by herpes simplex virus type 1 (HSV-1) & can be precipitated by stress.

Cancer of the Mouth Many cancers of the mouth are asymptomatic until they have spread. Mouth cancer can be treated successfully if discovered early. Those who ingest large amounts of ETOH, or engage in risky behaviors such as smoking or using forms of smokeless tobacco (leaf, plug, or snuff), have an increased risk for developing oral cancer. Many people tend to ignore sores or irritations in the mouth because they think such symptoms are insignificant.

Many cancers of the mouth are asymptomatic until they have spread.

Mouth cancer can be treated successfully if discovered early.

Those who ingest large amounts of ETOH, or engage in risky behaviors such as smoking or using forms of smokeless tobacco (leaf, plug, or snuff), have an increased risk for developing oral cancer.

Many people tend to ignore sores or irritations in the mouth because they think such symptoms are insignificant.

Mouth Cancer

Treatment… Surgery Radium implants Deep x-ray therapy Combination therapies w/ chemotherapy are also common If possible, the malignancy is removed with as wide an excision as necessary to remove all affected structures & lymph nodes NG or gastrostomy feedings might be indicated The operation is often followed by reconstructive surgery to correct facial defects.

Surgery

Radium implants

Deep x-ray therapy

Combination therapies w/ chemotherapy are also common

If possible, the malignancy is removed with as wide an excision as necessary to remove all affected structures & lymph nodes

NG or gastrostomy feedings might be indicated

The operation is often followed by reconstructive surgery to correct facial defects.

Nursing Considerations… Caring for the client pre & post operatively Before surgery, design communication techniques, because the client may be unable to speak as he or she did before surgery Postoperatively, observe for hemorrhage & airway obstruction caused by facial edema or aspiration. Suction secretions & elevate the head of the bed to make breathing easier. As you support the client’s head by placing your hands on either side, instruct the client to breathe deeply & to use the incentive spirometer Do not encourage coughing unless congestion is present These measures are needed to prevent hypostatic pneumonia An emergency airway should be available at the client’s bedside. Give mouth care carefully to improve the client’s comfort & prevent odor. Take great care to prevent disruption of the suture line Give liquids through an NG tube until the client is able to swallow Self-care is the goal.

Caring for the client pre & post operatively

Before surgery, design communication techniques, because the client may be unable to speak as he or she did before surgery

Postoperatively, observe for hemorrhage & airway obstruction caused by facial edema or aspiration.

Suction secretions & elevate the head of the bed to make breathing easier.

As you support the client’s head by placing your hands on either side, instruct the client to breathe deeply & to use the incentive spirometer

Do not encourage coughing unless congestion is present

These measures are needed to prevent hypostatic pneumonia

An emergency airway should be available at the client’s bedside.

Give mouth care carefully to improve the client’s comfort & prevent odor.

Take great care to prevent disruption of the suture line

Give liquids through an NG tube until the client is able to swallow

Self-care is the goal.

Esophageal Varices Dilated vessels that occur at the lower end of the esophagus. Causes : Dilation of these vessels is usually a complication arising from cirrhosis of the liver Veins in the lower esophagus become distended as a result of increased portal pressure; the varices may rupture, causing hemorrhage & subsequent shock Signs and Symptoms : Usually, no s/sx appear until the varices become ulcerated Hematemesis & coffee-ground emesis Melena Tachycardia Hypotension Low Hgb & Hct levels

Dilated vessels that occur at the lower end of the esophagus.

Causes :

Dilation of these vessels is usually a complication arising from cirrhosis of the liver

Veins in the lower esophagus become distended as a result of increased portal pressure; the varices may rupture, causing hemorrhage & subsequent shock

Signs and Symptoms :

Usually, no s/sx appear until the varices become ulcerated

Hematemesis & coffee-ground emesis

Melena

Tachycardia

Hypotension

Low Hgb & Hct levels

Esophageal Varices

Hiatal Hernia The presence of  a hiatal hernia does not cause any symptoms. Hiatal hernia may increase acid reflux and may worsen GERD and cause esophageal ulcers. Lifestyle changes and dietary changes are very effective in the management of hiatal hernia. Avoiding caffeine, stopping smoking and avoiding alcohol use are all very important. Eating small meals, not wearing tight clothing are also effective. Going to bed with an empty stomach( not eating or drinking for at least 3 hours before bed time ) is also advocated SURGERY is very rarely recommended. Maria Nelson

Hiatal Hernia Maria Nelson

GERD: Gastro Esophageal Reflux Disease Gastroesophageal reflux disease, or GERD, occurs when the lower esophageal sphincter (LES) does not close properly, and stomach contents splash back, or reflux, into the esophagus. The LES is a ring of muscle located at the far end of the esophagus as it leads into the stomach. It's normal function is to act as a physical barrier between the esophagus and the stomach, protecting the esophagus from harmful gastric acid, and preventing food from being regurgitated. It does this by involuntary tonic contraction. When one eats, food is propelled into the esophagus toward the stomach. It is during swallowing that the LES relaxes and allows passage of food and liquids into the stomach. When refluxed stomach acid touches the lining of the esophagus, it causes a burning sensation in the chest or throat called heartburn. The fluid may even be tasted in the back of the mouth, and this is called acid indigestion. Occasional heartburn is common but does not necessarily mean one has GERD. Heartburn that occurs more than twice a week may be considered GERD, which can eventually lead to more serious health problems. Sophia Alvarado

Gastroesophageal reflux disease, or GERD, occurs when the lower esophageal sphincter (LES) does not close properly, and stomach contents splash back, or reflux, into the esophagus. The LES is a ring of muscle located at the far end of the esophagus as it leads into the stomach. It's normal function is to act as a physical barrier between the esophagus and the stomach, protecting the esophagus from harmful gastric acid, and preventing food from being regurgitated. It does this by involuntary tonic contraction. When one eats, food is propelled into the esophagus toward the stomach. It is during swallowing that the LES relaxes and allows passage of food and liquids into the stomach.

When refluxed stomach acid touches the lining of the esophagus, it causes a burning sensation in the chest or throat called heartburn. The fluid may even be tasted in the back of the mouth, and this is called acid indigestion. Occasional heartburn is common but does not necessarily mean one has GERD. Heartburn that occurs more than twice a week may be considered GERD, which can eventually lead to more serious health problems.

Typical symptoms include a burning sensation in the chest, and regurgitation of food. These symptoms are general, and not necessarily specific for reflux disease. For instance, patients may experience chest pain or burning as a result of a primary cardiac problem, or they may be a manifestation of another primary esophageal disorder. It is imperative that the cause of the symptoms be clearly delineated by your physician so the proper therapy may be instituted. Regurgitation is also a relatively common complaint. Atypical symptoms of GERD include: asthma; chronic sinusitis; chronic hoarseness; difficulty swallowing (dysphagia); vomiting; choking sensation at night time; pneumonias; excessive salivation Sophia Alvarado

Typical symptoms include a burning sensation in the chest, and regurgitation of food. These symptoms are general, and not necessarily specific for reflux disease. For instance, patients may experience chest pain or burning as a result of a primary cardiac problem, or they may be a manifestation of another primary esophageal disorder. It is imperative that the cause of the symptoms be clearly delineated by your physician so the proper therapy may be instituted. Regurgitation is also a relatively common complaint.

Atypical symptoms of GERD include:

asthma; chronic sinusitis;

chronic hoarseness; difficulty swallowing (dysphagia);

vomiting; choking sensation at night time;

pneumonias; excessive salivation

Heartburn

MEDICATIONS CAN DECREASE LES PRESSURE oral contraceptives nitrates theophllyine narcotics calcium channel blockers ß-adrenergic agonists a-adrenergic agonists diazepam dopamine nicotine patch CAN DIRECTLY INJURE ESOPHAGEAL LINING aspirin NSAIDS (i.e.: ibuprofen) quinidine tetracycline potassium iron Sophia Alvarado

CAN DECREASE LES PRESSURE

oral contraceptives nitrates theophllyine narcotics calcium channel blockers ß-adrenergic agonists a-adrenergic agonists diazepam dopamine nicotine patch

CAN DIRECTLY INJURE ESOPHAGEAL LINING

aspirin NSAIDS (i.e.: ibuprofen) quinidine tetracycline potassium iron

GERD: TREATMENT Treatment for GERD may involve one or more of the following lifestyle changes, medications, or surgery. The goals of therapy for GERD include - - - Symptomatic relief Resolution of esophagitis (inflammatory changes of the esophagus as a result of abnormal acid exposure) Prevention of complications. Sophia Alvarado

Treatment for GERD may involve one or more of the following lifestyle changes, medications, or surgery.

The goals of therapy for GERD include - - -

Symptomatic relief

Resolution of esophagitis (inflammatory changes of the esophagus as a result of abnormal acid exposure)

Prevention of complications.

Barrett’s Esophagus… Barrett's esophagus is a premalignant condition in which the normal stratified squamous epithelium of the esophagus is replaced by a metaplastic columnar epithelium as a complication of chronic gastroesophageal reflux disease (GERD). The metaplastic epithelium of Barrett's esophagus is variously called "Barrett's metaplasia", "specialized columnar metaplasia" or "intestinal metaplasia". This metaplasia predisposes to the development of esophageal adenocarcinoma and adenocarcinoma of the gastric cardia. Endoscopy with biopsy is therefore recommended in patients who have long-standing or frequent GERD symptoms to determine whether or not Barrett's esophagus has developed. If Barrett's esophagus is detected, the patient should be enrolled in a program of endoscopic surveillance for the detection of cancer when it is early and curable. Only about 5-10% of patients with Barrett's esophagus will progress to cancer, but esophagectomy is recommended for those who do. Surgery is the standard of care for patients who develop an early adenocarcinoma in Barrett's esophagus because it has a high cure rate and removes the residual premalignant metaplasia. Sophia Alvarado

Barrett's esophagus is a premalignant condition in which the normal stratified squamous epithelium of the esophagus is replaced by a metaplastic columnar epithelium as a complication of chronic gastroesophageal reflux disease (GERD). The metaplastic epithelium of Barrett's esophagus is variously called "Barrett's metaplasia", "specialized columnar metaplasia" or "intestinal metaplasia". This metaplasia predisposes to the development of esophageal adenocarcinoma and adenocarcinoma of the gastric cardia.

Endoscopy with biopsy is therefore recommended in patients who have long-standing or frequent GERD symptoms to determine whether or not Barrett's esophagus has developed. If Barrett's esophagus is detected, the patient should be enrolled in a program of endoscopic surveillance for the detection of cancer when it is early and curable. Only about 5-10% of patients with Barrett's esophagus will progress to cancer, but esophagectomy is recommended for those who do. Surgery is the standard of care for patients who develop an early adenocarcinoma in Barrett's esophagus because it has a high cure rate and removes the residual premalignant metaplasia.

Esophageal Cancer SYMPTOMS No symptoms until late in the disease for many individuals Difficulty swallowing solid food Pain on swallowing may occur Weight loss Coughing may occur late in the disease Chest or back pain may occur Hoarseness may occur Sophia Alvarado

SYMPTOMS

No symptoms until late in the disease for many individuals

Difficulty swallowing solid food

Pain on swallowing may occur

Weight loss

Coughing may occur late in the disease

Chest or back pain may occur

Hoarseness may occur

Sophia Alvarado

Diagnosis Laboratories Anemia Low albumin due to malnutrition Imaging CXR shows a widened mediastinum or metastases Barium esophagram Endoscopy – shows picture & biopsies taken CT scan of the chest & liver for metastases Endoscopy Ultrasound to check for local spread in the esophagus Bronchoscopy – sometimes done to check for metastases to the lungs Sophia Alvarado

Diagnosis

Laboratories

Anemia

Low albumin due to malnutrition

Imaging

CXR shows a widened mediastinum or metastases

Barium esophagram

Endoscopy – shows picture & biopsies taken

CT scan of the chest & liver for metastases

Endoscopy Ultrasound to check for local spread in the esophagus

Bronchoscopy – sometimes done to check for metastases to the lungs

Risk Factors Alcohol & tobacco use; smoking Food additives such as nitrates Tylosis (callus formation) Achalasia Caustic induced strictures Long-standing acid reflux (Barrett’s esophagus) Treatmen t Options -- cancer specialist determines the best options from among the following: Surgery Radiation Chemotherapy Stent placement to keep esophagus open Sophia Alvarado

Risk Factors

Alcohol & tobacco use; smoking

Food additives such as nitrates

Tylosis (callus formation)

Achalasia

Caustic induced strictures

Long-standing acid reflux (Barrett’s esophagus)

Treatmen t

Options -- cancer specialist determines the best options from among the following:

Surgery

Radiation

Chemotherapy

Stent placement to keep esophagus open

Gastritis Ulcers Peptic, Gastric, & Duodenal H. Pylori Signs and Symptoms Complications Abdominal Infection Hemorrhage Bleeding (Perforation) Obstruction Treatment Nursing Considerations Stomach Cancer Disorders of the Stomach

Gastritis

Ulcers

Peptic, Gastric, & Duodenal

H. Pylori

Signs and Symptoms

Complications

Abdominal Infection

Hemorrhage

Bleeding (Perforation)

Obstruction

Treatment

Nursing Considerations

Stomach Cancer

Gastritis “ stomach inflammation” or indigestion - occurs in acute, chronic, & toxic forms Causes of acute Gastritis: Overeating, ingesting irritating medications (eg, ASA or steroids) or poisonous food, abusing alcohol, or microbial infection Acute Gastritis is characterized by abdominal pain, often w/ anorexia, nausea, & enteritis Treatment Removing offending foods or medications Bland diet of liquids or soft foods, along w/ antacids

“ stomach inflammation” or indigestion - occurs in acute, chronic, & toxic forms

Causes of acute Gastritis:

Overeating, ingesting irritating medications (eg, ASA or steroids) or poisonous food, abusing alcohol, or microbial infection

Acute Gastritis is characterized by abdominal pain, often w/ anorexia, nausea, & enteritis

Treatment

Removing offending foods or medications

Bland diet of liquids or soft foods, along w/ antacids

Chronic Gastritis continues over time pain may occur after eating, but often the person has no pain Causes include excessive alcohol use, vitamin deficiencies, hiatal hernia, ulcers, & abnormalities in gastric secretions Treatment is similar for peptic ulcers Sophia Alvarado

continues over time

pain may occur after eating, but often the person has no pain

Causes include excessive alcohol use, vitamin deficiencies, hiatal hernia, ulcers, & abnormalities in gastric secretions

Treatment is similar for peptic ulcers

Toxic Gastritis Follows ingestion or poison Characterized by burning stomach sensation, nausea, vomiting, & diarrhea Emesis or diarrhea may be bloody Toxic gastritis is an emergency Poison control specialists in the emergency department treat the client by either - - - Flushing out the poison by gavage, or Neutralizing the poison, if possible, with a substance such as activated charcoal

Follows ingestion or poison

Characterized by burning stomach sensation, nausea, vomiting, & diarrhea

Emesis or diarrhea may be bloody

Toxic gastritis is an emergency

Poison control specialists in the emergency department treat the client by either - - -

Flushing out the poison by gavage, or

Neutralizing the poison, if possible, with a substance such as activated charcoal

Diagnostic Tests & Methods… Patient history & physical exam Identification of a causative agent Laboratory studies Stool culture Endoscopy with biopsy Gastric analysis

Patient history & physical exam

Identification of a causative agent

Laboratory studies

Stool culture

Endoscopy with biopsy

Gastric analysis

Nursing Interventions… Assess and document signs and symptoms and reactions to treatment Monitor vital signs at least every 4 hours Monitor intake and output Provide the prescribed diet Administer the medication as prescribed and monitor for side effects Note amount and character of emesis and diarrhea Monitor IV fluids Educate the patient and family concerning drug therapy, diet, activities, and any restrictions

Assess and document signs and symptoms and reactions to treatment

Monitor vital signs at least every 4 hours

Monitor intake and output

Provide the prescribed diet

Administer the medication as prescribed and monitor for side effects

Note amount and character of emesis and diarrhea

Monitor IV fluids

Educate the patient and family concerning drug therapy, diet, activities, and any restrictions

An ulcer is an open sore in the skin or mucous membrane that is accompanied by sloughing of inflamed & necrotic tissue A peptic ulcer is a break in the integrity of the mucosa of the esophagus, stomach, or duodenum Peptic ulcers include gastric and duodenal ulcers Exact cause is unknown; recurrent or refractory ulcers linked to Helicobacter pylori infections ULCERS Rowena Talavera

An ulcer is an open sore in the skin or mucous membrane that is accompanied by sloughing of inflamed & necrotic tissue

A peptic ulcer is a break in the integrity of the mucosa of the esophagus, stomach, or duodenum

Peptic ulcers include gastric and duodenal ulcers

Exact cause is unknown; recurrent or refractory ulcers linked to Helicobacter pylori infections

Predisposing Factors … Stress Smoking Heavy caffeine ingestion Ingestion of certain drugs (ASA, steroids, NSAIDs) Infection of the mucosa by H. pylori Rowena Talavera

Stress

Smoking

Heavy caffeine ingestion

Ingestion of certain drugs (ASA, steroids, NSAIDs)

Infection of the mucosa by H. pylori

Peptic Ulcers Gastric ulcers are thought to result from a break in the mucous barrier mechanisms that normally protect the stomach’s lining Duodenal ulcers are characterized by ↑’d gastric secretion of HCl The presence of gram-negative bacteria Helicobacter pylori is strongly associated with anthral gastritis, duodenal ulcers, & to a lesser degree, gastric ulcers and cancer. H. pylori is not linked to esophageal ulcers Rowena Talavera

Gastric ulcers are thought to result from a break in the mucous barrier mechanisms that normally protect the stomach’s lining

Duodenal ulcers are characterized by ↑’d gastric secretion of HCl

The presence of gram-negative bacteria Helicobacter pylori is strongly associated with anthral gastritis, duodenal ulcers, & to a lesser degree, gastric ulcers and cancer.

H. pylori is not linked to esophageal ulcers

Signs & Symptoms Loss of appetite Weight loss or gain Pain (gnawing, burning) Melena (black, tarry stool containing blood) from bleeding in the stomach may occur & is a significant finding Anemia Hematemesis; coffee-ground emesis Occasional nausea or vomiting Rowena Talavera

Loss of appetite

Weight loss or gain

Pain (gnawing, burning)

Melena (black, tarry stool containing blood) from bleeding in the stomach may occur & is a significant finding

Anemia

Hematemesis; coffee-ground emesis

Occasional nausea or vomiting

Diagnostic Tests & Methods Patient history & physical exam Gastroscopy & duodenoscopy Barium studies Gastric analysis Diagnosis of H. pylori infection can be accomplished by a gastric mucosal biopsy procedure Serum blood test for antibodies to the H. pylori, or a breath test Rowena Talavera

Patient history & physical exam

Gastroscopy & duodenoscopy

Barium studies

Gastric analysis

Diagnosis of H. pylori infection can be accomplished by a gastric mucosal biopsy procedure

Serum blood test for antibodies to the H. pylori, or a breath test

Complications . . . In an event of complications, an NG tube attached to suction will be inserted; client will be kept NPO for at least 24 hours, & IV fluids will be administered Abdominal infection Hemorrhage Perforation Obstruction Rowena Talavera

In an event of complications, an NG tube attached to suction will be inserted; client will be kept NPO for at least 24 hours, & IV fluids will be administered

Abdominal infection

Hemorrhage

Perforation

Obstruction

Treatment . . . Diet Bland diet while pain is present First few weeks, client should eliminate gas-forming & highly seasoned foods, & foods ↑ in roughage Omit caffeine, tea, cola beverages, chocolate, ETOH, & cigarette smoking = stimulate secretion of HCl Milk & cream in small quantities 3 normal meals & a bedtime snack Medications (In Practice-Important Medications 87-1 pg 1443) Rest and stress management Rest is important, not necessarily bedrest Relaxation Tranquilizers may be prescribed After the course of treatment is established, the client maintains the routine at home Rowena Talavera

Diet

Bland diet while pain is present

First few weeks, client should eliminate gas-forming & highly seasoned foods, & foods ↑ in roughage

Omit caffeine, tea, cola beverages, chocolate, ETOH, & cigarette smoking = stimulate secretion of HCl

Milk & cream in small quantities

3 normal meals & a bedtime snack

Medications (In Practice-Important Medications 87-1 pg 1443)

Rest and stress management

Rest is important, not necessarily bedrest

Relaxation

Tranquilizers may be prescribed

After the course of treatment is established, the client maintains the routine at home

Treatment … Surgical Intervention Closure if perforation has occurred Pyloroplasty and vagotomy if the gastric outlet is obstructed Total or partial resection of the stomach to remove the ulcerated areas Rowena Talavera

Surgical Intervention

Closure if perforation has occurred

Pyloroplasty and vagotomy if the gastric outlet is obstructed

Total or partial resection of the stomach to remove the ulcerated areas

Medications for Treating Ulcers Antibiotics: a 7-14 day course of clarithrymycin (Biaxin) & metronidazole (Flagyl) in combination with an H2 blocker or PPI is utilized for the treatment of Helicobacter pylori. Antacids: Amphogel, Mylanta, Maalox, Gelusil, Di-Gel, Riopan Histamine (H2) receptor antagonists (H2 blockers): cimetidine (Tagamet), ranitidine (Zantac), famotidine (Pepcid), nizatidine (Axid) Proton-pump inhibitors: omeprazole (Prilosec), lansoprazole (Prevacid), pantoprozole (Protonix), rabeprozole (Aciphex), esomeprazole (Nexium) Mucous enhancer or gastric-secretion inhibitor (protects against drug-induced ulcer formation): misoprostol (Cytotec) Antipeptic: sucralfate (Carafate) Rowena Talavera

Antibiotics: a 7-14 day course of clarithrymycin (Biaxin) & metronidazole (Flagyl) in combination with an H2 blocker or PPI is utilized for the treatment of Helicobacter pylori.

Antacids: Amphogel, Mylanta, Maalox, Gelusil, Di-Gel, Riopan

Histamine (H2) receptor antagonists (H2 blockers): cimetidine (Tagamet), ranitidine (Zantac), famotidine (Pepcid), nizatidine (Axid)

Proton-pump inhibitors: omeprazole (Prilosec), lansoprazole (Prevacid), pantoprozole (Protonix), rabeprozole (Aciphex), esomeprazole (Nexium)

Mucous enhancer or gastric-secretion inhibitor (protects against drug-induced ulcer formation): misoprostol (Cytotec)

Antipeptic: sucralfate (Carafate)

Medications: Nsg.Considerations… Remind the client to allow at least 1 hour between eating or taking doses of antacid, and taking H2 blocker medication. Some drugs such as Zantac & Tagamet, can cause leukopenia. Other side effects include constipation, diarrhea, headache, & dizziness Rowena Talavera

Remind the client to allow at least 1 hour between eating or taking doses of antacid, and taking H2 blocker medication.

Some drugs such as Zantac & Tagamet, can cause leukopenia. Other side effects include constipation, diarrhea, headache, & dizziness

Nursing Considerations . . . The goals in ulcer treatment are to prevent irritating the lesion, lessen acidic secretions, reduce activity of the stomach & intestine, & manage emotional stress Client teaching is an important component Encourage the client to verbalize his or concerns, rather than internalize them Physical activity also may help to alleviate frustrations Stress management workshops and support groups often are beneficial Rowena Talavera

The goals in ulcer treatment are to prevent irritating the lesion, lessen acidic secretions, reduce activity of the stomach & intestine, & manage emotional stress

Client teaching is an important component

Encourage the client to verbalize his or concerns, rather than internalize them

Physical activity also may help to alleviate frustrations

Stress management workshops and support groups often are beneficial

Ulcer Management Three meals and a bedtime snack should be routine Meal size and portions should be at a comfortable and tolerated level. Avoid overdistention. Determine and eliminate foods that aggravate symptoms Eat foods slowly and chew them well. Contact a physician if diarrhea or increased discomfort occur or if the condition is not improving Use methods of relaxation Verbalize concerns Establish a personal balance between exercise & physical & emotional rest, especially during stressful periods. Rowena Talavera

Three meals and a bedtime snack should be routine

Meal size and portions should be at a comfortable and tolerated level. Avoid overdistention.

Determine and eliminate foods that aggravate symptoms

Eat foods slowly and chew them well.

Contact a physician if diarrhea or increased discomfort occur or if the condition is not improving

Use methods of relaxation

Verbalize concerns

Establish a personal balance between exercise & physical & emotional rest, especially during stressful periods.

Gastric Ulcer Rowena Talavera

Stomach Cancer Known as the “silent neoplasm” because it is usually not detected until after metastasis to adjacent structures, thus the client’s prognosis is often poor Causes Exact cause is unknown Familial tendency is suspected Predisposing conditions: chronic gastric ulcers & gastritis Signs & symptoms Loss of appetite, early satiety Weigh loss; weakness & fatigue Pain; melena; anemia; hematemesis Dizziness; indigestion or dyspepsia Constipation Metastasis to the spleen, lymph nodes, liver, pancreas, & esophagus is common Kristine Ananyan

Known as the “silent neoplasm” because it is usually not detected until after metastasis to adjacent structures, thus the client’s prognosis is often poor

Causes

Exact cause is unknown

Familial tendency is suspected

Predisposing conditions: chronic gastric ulcers & gastritis

Signs & symptoms

Loss of appetite, early satiety

Weigh loss; weakness & fatigue

Pain; melena; anemia; hematemesis

Dizziness; indigestion or dyspepsia

Constipation

Metastasis to the spleen, lymph nodes, liver, pancreas, & esophagus is common

Symptoms of Ulcers & Stomach Cancer Ulcers Frequent dyspepsia Burning sensation in the stomach Pain that always begins in same place Pain relieved by eating, or possibly, vomiting Black, tarry stools (melena) Free HCl acid in stomach Tenseness, irritability; Difficulty sleeping Weight often maintained Stomach Cancer Sudden dyspepsia Absence of pain until cancer is advanced Pain unrelieved by eating or vomiting Coffee-ground emesis; Absence of free HCL acid in stomach Weakness, lethargy, tiredness much of the time Unexplained weight loss Cancer cells possibly visible in slides of gastric contents

Ulcers

Frequent dyspepsia

Burning sensation in the stomach

Pain that always begins in same place

Pain relieved by eating, or possibly, vomiting

Black, tarry stools (melena)

Free HCl acid in stomach

Tenseness, irritability; Difficulty sleeping

Weight often maintained

Stomach Cancer

Sudden dyspepsia

Absence of pain until cancer is advanced

Pain unrelieved by eating or vomiting

Coffee-ground emesis; Absence of free HCL acid in stomach

Weakness, lethargy, tiredness much of the time

Unexplained weight loss

Cancer cells possibly visible in slides of gastric contents

Stomach Cancer Diagnostic Tests & Methods Patient history & physical examination Laboratory studies; Stool analysis; gastric analysis Barium studies; gastroscopy Treatment Preoperative Therapy Correct nutritional deficiencies Treat anemias; Blood replacement Gastric decompression with a nasogastric tube Surgery : removal of the cancerous lesion or tumor along with a margin of normal tissue Radiation & chemotherapy may be used if the patient is not expected to undergo surgery Combination therapy has a better response Single-agent therapy has proved to be of little value Kristine Ananyan

Diagnostic Tests & Methods

Patient history & physical examination

Laboratory studies; Stool analysis; gastric analysis

Barium studies; gastroscopy

Treatment

Preoperative Therapy

Correct nutritional deficiencies

Treat anemias; Blood replacement

Gastric decompression with a nasogastric tube

Surgery : removal of the cancerous lesion or tumor along with a margin of normal tissue

Radiation & chemotherapy may be used if the patient is not expected to undergo surgery

Combination therapy has a better response

Single-agent therapy has proved to be of little value

Nursing Interventions… Preoperative Care Offer support to the patient and family Assess and document signs & symptoms & reactions to treatments Provide and encourage the prescribed diet Monitor vital signs at least every 8 hours Monitor blood a& fluid replacement therapy Provide preoperative teaching Postoperative Care (Immediate) Have patient turn, cough, & deep-breathe Monitor NG suctioning and tube patency Monitor VS as ordered Record I&O Administer prescribed medication, & monitor for side-effects Kristine Ananyan

Preoperative Care

Offer support to the patient and family

Assess and document signs & symptoms & reactions to treatments

Provide and encourage the prescribed diet

Monitor vital signs at least every 8 hours

Monitor blood a& fluid replacement therapy

Provide preoperative teaching

Postoperative Care (Immediate)

Have patient turn, cough, & deep-breathe

Monitor NG suctioning and tube patency

Monitor VS as ordered

Record I&O

Administer prescribed medication, & monitor for side-effects

Nursing Interventions… Postoperative Care (Immediate) … Assess dressing Assess for bowel sounds Encourage early ambulation & ROM exercises to prevent thrombosis Provide anti-embolism stockings Relieve pain with drugs & supportive measures Postoperative Period Provide 6-8 small feedings Weigh patient daily while in hospital to monitor weight loss Reduce fluids taken with meals if not tolerated Educate the patient and family concerning drug therapy, dietary restrictions, activity, wound care, and compliance with regimen Kristine Ananyan

Postoperative Care (Immediate) …

Assess dressing

Assess for bowel sounds

Encourage early ambulation & ROM exercises to prevent thrombosis

Provide anti-embolism stockings

Relieve pain with drugs & supportive measures

Postoperative Period

Provide 6-8 small feedings

Weigh patient daily while in hospital to monitor weight loss

Reduce fluids taken with meals if not tolerated

Educate the patient and family concerning drug therapy, dietary restrictions, activity, wound care, and compliance with regimen

Diverticulosis and Diverticulitis Hernias Intestinal Obstruction Irritable Bowel Syndrome (IBS) Constipation Diarrhea Inflammatory Bowel Disease Appendicitis Peritonitis Cancer of the Small Intestine Colon Cancer Disorders of the Small or Large Intestine

Diverticulosis and Diverticulitis

Hernias

Intestinal Obstruction

Irritable Bowel Syndrome (IBS)

Constipation

Diarrhea

Inflammatory Bowel Disease

Appendicitis

Peritonitis

Cancer of the Small Intestine

Colon Cancer

Diverticulosis Diverticulosis refers to a condition in w/c outpouches (ruptures) occur along the intestinal wall Diverticula can occur anywhere in the GI tract Symptoms that accompany diverticular disease are vague or absent; often found during dx procedures performed for other problems Barium enema can confirm the presence of diverticula, but the barium may become trapped in the diverticula & form hard masses Endoscopy can confirm the diagnosis by permitting direct visualization of the lesions Edmund Calvo

Diverticulosis refers to a condition in w/c outpouches (ruptures) occur along the intestinal wall

Diverticula can occur anywhere in the GI tract

Symptoms that accompany diverticular disease are vague or absent; often found during dx procedures performed for other problems

Barium enema can confirm the presence of diverticula, but the barium may become trapped in the diverticula & form hard masses

Endoscopy can confirm the diagnosis by permitting direct visualization of the lesions

DIVERTICULITIS occurs when the diverticula become inflammed, usually due to obstruction of the diverticula & bacterial invasion signs & symptoms: nagging, cramping pain & tenderness in the LL abdomen, abdominal distention, flatulence, & ↑ temperature increased pressure w/in the lumen of the bowel can cause rupture of the diverticulum & result in abscess formation and peritonitis Edmund Calvo

occurs when the diverticula become inflammed, usually due to obstruction of the diverticula & bacterial invasion

signs & symptoms: nagging, cramping pain & tenderness in the LL abdomen, abdominal distention, flatulence, & ↑ temperature

increased pressure w/in the lumen of the bowel can cause rupture of the diverticulum & result in abscess formation and peritonitis

Diverticula /Diverticulitis Edmund Calvo

Treatment . Dietary management of symptoms, medications, & possible surgery Consumption of high-residue foods is recommended to prevent the formation of diverticula & to prevent acute onsets of diverticulitis Diverticula present & inflamed = stool softeners, & bulk-forming agents (psyllium-Metamucil), help to produce soft, non-irritating, & unforced bowel movements Fever + abdominal pain = infection & inflammation = ATB given Low-residue diet, including avoidance of milk products is recommended Acute episode = NPO + NGT for suctioning to allow the bowel to rest Edmund Calvo

Dietary management of symptoms, medications, & possible surgery

Consumption of high-residue foods is recommended to prevent the formation of diverticula & to prevent acute onsets of diverticulitis

Diverticula present & inflamed = stool softeners, & bulk-forming agents (psyllium-Metamucil), help to produce soft, non-irritating, & unforced bowel movements

Fever + abdominal pain = infection & inflammation = ATB given

Low-residue diet, including avoidance of milk products is recommended

Acute episode = NPO + NGT for suctioning to allow the bowel to rest

Nursing Considerations . . . Client & family dietary teaching are important aspects of prevention of attacks Management of symptoms, & treatment during attacks Adequate water intake of 6-8 glasses/day Regular bowel habits, regular exercise, & plenty of fruit, vegetables, & fiber are key factors in preventing future problems Teach client when to use high-fiber and low-fiber foods Edmund Calvo

Client & family dietary teaching are important aspects of prevention of attacks

Management of symptoms, & treatment during attacks

Adequate water intake of 6-8 glasses/day

Regular bowel habits, regular exercise, & plenty of fruit, vegetables, & fiber are key factors in preventing future problems

Teach client when to use high-fiber and low-fiber foods

HERNIAS develop when abd. muscle weakness causes a portion of the GI tract to protrude through muscle; herniation often occurs when intra-abdominal pressure ↑s due to obesity, heavy lifting, coughing, blunt trauma to the abdomen, or pregnancy may be reducible (one that may be pushed back into the intestine by lying down & pressing on the abdomen), irreducible (cannot be manipulated back into the body cavity), incarcerated (occurs when the intestine’s peristaltic flow is obstructed), & strangulated (requires immediate surgical intervention because it interrupts blood flow to the tissue, resulting tissue necrosis – infarction) Maria Nelson

develop when abd. muscle weakness causes a portion of the GI tract to protrude through muscle;

herniation often occurs when intra-abdominal pressure ↑s due to obesity, heavy lifting, coughing, blunt trauma to the abdomen, or pregnancy

may be reducible (one that may be pushed back into the intestine by lying down & pressing on the abdomen), irreducible (cannot be manipulated back into the body cavity), incarcerated (occurs when the intestine’s peristaltic flow is obstructed), & strangulated (requires immediate surgical intervention because it interrupts blood flow to the tissue, resulting tissue necrosis – infarction)

Hernia Repair Maria Nelson

Types of Hernias . . . Hiatal: part of the stomach protrudes thru the diaphragm’s esophageal hiatus Inguinal: most common type; protrude thru the inguinal area in the groin, esp. males Femoral: weaknesses of the femoral canal that carries blood vessels & nerves into the thigh Umbilical: protrude thru the umbilicus Abdominal: a protrusion of the intestine through the abdominal wall Incisional: develops in an incisional area following surgery Congenital defects are responsible for a large # of hernias; often detected soon after birth; Acquired hernias may result from heavy lifting, pregnancy, coughing, or sneezing = obesity, & muscle weakness may cause hernias Maria Nelson

Hiatal: part of the stomach protrudes thru the diaphragm’s esophageal hiatus

Inguinal: most common type; protrude thru the inguinal area in the groin, esp. males

Femoral: weaknesses of the femoral canal that carries blood vessels & nerves into the thigh

Umbilical: protrude thru the umbilicus

Abdominal: a protrusion of the intestine through the abdominal wall

Incisional: develops in an incisional area following surgery

Congenital defects are responsible for a large # of hernias; often detected soon after birth; Acquired hernias may result from heavy lifting, pregnancy, coughing, or sneezing = obesity, & muscle weakness may cause hernias

Signs & symptoms . . . Varies and depends on location Appearance of protrusion when straining or lifting Some hernias are asymptomatic, although if they are left untreated they often enlarge and cause pain If condition is allowed to progress, the intestine may become constricted and the blood supply is cut off (strangulated) = this development is an obvious emergency Maria Nelson

Varies and depends on location

Appearance of protrusion when straining or lifting

Some hernias are asymptomatic, although if they are left untreated they often enlarge and cause pain

If condition is allowed to progress, the intestine may become constricted and the blood supply is cut off (strangulated) = this development is an obvious emergency

Treatment Surgery is the treatment of choice Herniorrhaphy: surgical repair of the hernia Hernioplasty: surgical reinforcement of the weakened area Use of a truss (a support worn over the hernia to keep it in place) Changes in patient’s lifestyle Avoiding lying down after meals Avoiding spicy or acidic foods, alcohol, and tobacco Eating small, frequent, bland meals Eating a high-fiber diet Maria Nelson

Surgery is the treatment of choice

Herniorrhaphy: surgical repair of the hernia

Hernioplasty: surgical reinforcement of the weakened area

Use of a truss (a support worn over the hernia to keep it in place)

Changes in patient’s lifestyle

Avoiding lying down after meals

Avoiding spicy or acidic foods, alcohol, and tobacco

Eating small, frequent, bland meals

Eating a high-fiber diet

Nursing Intervention Assess and document signs & symptoms and reactions to treatments Assess vital signs every shift before surgery Report any symptoms of coughing, sneezing, or upper respiratory tract infection noted before surgery because this will weaken the surgical repair Apply ice packs as ordered to control pain and swelling Monitor voidings following inguinal hernia repair Educate the patient and family concerning care of the operative site, activity restrictions, and avoidance of constipation Maria Nelson

Assess and document signs & symptoms and reactions to treatments

Assess vital signs every shift before surgery

Report any symptoms of coughing, sneezing, or upper respiratory tract infection noted before surgery because this will weaken the surgical repair

Apply ice packs as ordered to control pain and swelling

Monitor voidings following inguinal hernia repair

Educate the patient and family concerning care of the operative site, activity restrictions, and avoidance of constipation

Intestinal Obstruction Ileus is obstruction of the intestine = may be due to a mechanical or functional difficulty & occurs when gas or fluid cannot move normally through the bowel Mechanical obstructions occur when there is a blockage in the lumen or pressure exerted from outside the intestine: Stenosis, strictures, & adhesion scars from previous surgery; Volvulus (twisting of the bowels); Foreign bodies, such as fruit pit Intussusception (telescoping of the bowel); polyps & tumors (eg, diverticulosis), abscesses Functional obstructions occur when the intestinal motility is defective: Paralytic ileus; Muscle spasms (spastic ileus); disorders (eg, muscular dystrophy, DM, & Parkinson’s disease) Lito Salazar

Ileus is obstruction of the intestine = may be due to a mechanical or functional difficulty & occurs when gas or fluid cannot move normally through the bowel

Mechanical obstructions occur when there is a blockage in the lumen or pressure exerted from outside the intestine:

Stenosis, strictures, & adhesion scars from previous surgery; Volvulus (twisting of the bowels); Foreign bodies, such as fruit pit

Intussusception (telescoping of the bowel); polyps & tumors (eg, diverticulosis), abscesses

Functional obstructions occur when the intestinal motility is defective:

Paralytic ileus; Muscle spasms (spastic ileus); disorders (eg, muscular dystrophy, DM, & Parkinson’s disease)

A vascular obstruction, such as atherosclerosis or thrombus formation, also can cause gradual cessation of peristalsis due to ↓’d blood supply Pneumonia, pancreatitis, & peritonitis can produce obstruction of infectious origin; a ↓ or interruption of the nerve stimulus – w/c may result from post-anesthesia paralysis, trauma to the ANS, cx from peritonitis, inactivity, large doses of narcotics, or other nerve damage – causes paralytic obstruction (paralytic ileus) of the intestine Lito Salazar

A vascular obstruction, such as atherosclerosis or thrombus formation, also can cause gradual cessation of peristalsis due to ↓’d blood supply

Pneumonia, pancreatitis, & peritonitis can produce obstruction of infectious origin;

a ↓ or interruption of the nerve stimulus – w/c may result from post-anesthesia paralysis, trauma to the ANS, cx from peritonitis, inactivity, large doses of narcotics, or other nerve damage – causes paralytic obstruction (paralytic ileus) of the intestine

Lito Salazar

Intestinal Obstruction … Signs and Symptoms Abnormal pain and distention Projectile vomiting; nausea; cramping Possible absence of bowels sounds or ↑ bowel sounds Abdomen may be tense (distended) Obstipation (chronic constipation) Diagnostic Tests and Methods Patient history and physical examination Flat plate of the abdomen (x-ray) Laboratory studies Lito Salazar

Signs and Symptoms

Abnormal pain and distention

Projectile vomiting; nausea; cramping

Possible absence of bowels sounds or ↑ bowel sounds

Abdomen may be tense (distended)

Obstipation (chronic constipation)

Diagnostic Tests and Methods

Patient history and physical examination

Flat plate of the abdomen (x-ray)

Laboratory studies

Treatment Complete obstruction in the small intestine usually necessitates surgery; obstruction of the lower part of the large intestine may be treated medically Medical treatment of large bowel obstruction includes intestinal or gastric decompression, involving intubation w/ a nasoenteric tube - ↓ n/v Constant suction via rectal tube is used to keep the intestine empty Hydration with IV therapy Prophylactic ATBs A colonoscopy may be done to attempt to un-twist or unblock the bowel Lito Salazar

Complete obstruction in the small intestine usually necessitates surgery; obstruction of the lower part of the large intestine may be treated medically

Medical treatment of large bowel obstruction includes intestinal or gastric decompression, involving intubation w/ a nasoenteric tube - ↓ n/v

Constant suction via rectal tube is used to keep the intestine empty

Hydration with IV therapy

Prophylactic ATBs

A colonoscopy may be done to attempt to un-twist or unblock the bowel

Nursing Considerations . . . Monitor vital signs; I&O Monitor decompression tube & assess quantity & character of drainage assist with fluid and electrolyte replacement it is important to note the quality of bowel sounds if the client’s condition deteriorates, emergency surgery becomes necessary postoperative nursing care follows the protocol for abdominal surgery NPO Lito Salazar

Monitor vital signs; I&O

Monitor decompression tube & assess quantity & character of drainage

assist with fluid and electrolyte replacement

it is important to note the quality of bowel sounds

if the client’s condition deteriorates, emergency surgery becomes necessary

postoperative nursing care follows the protocol for abdominal surgery

NPO

Irritable Bowel Syndrome: IBS Also known as spastic colon, spastic colitis, mucous colitis, & irritable colon Most common functional disorder of the GI tract causing ↑’d motility of the small or large intestine It affects the intestine’s structure, but its specific cause is unknown IBS does not lead to, or cause, ulcerative colitis or canc er Ben Mayunga

Also known as spastic colon, spastic colitis, mucous colitis, & irritable colon

Most common functional disorder of the GI tract causing ↑’d motility of the small or large intestine

It affects the intestine’s structure, but its specific cause is unknown

IBS does not lead to, or cause, ulcerative colitis or canc er

IBS: S

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