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DISEASESDISEASES
DIGESTIVEDIGESTIVE
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GERDGERD• 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)
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GERDGERDSigns & Symptoms• Heartburn (burning, tight sensation below
the sternum and radiates upward)• Feeling of fullness• Bloating• N/V• Reguritation• Dysphagia• Hoarsness• Dyspnea• Wheezing
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GERDGERDComplications• Scar tissue formation• Lesions• Dysphagia• Pneumonia (d/t aspiration)
Dx• Ba swallow• Esophagoscopy
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GERDGERDTx• 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
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CELIAC DISEASECELIAC 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.
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CELIAC DISEASECELIAC DISEASESigns & Symptoms• Steatorrhea 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
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CELIAC DISEASECELIAC DISEASETx• Gluten free diet• Corticosteroids (if not responsive to a
gluten free diet)
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INFLAMMATORY INFLAMMATORY BOWEL DISEASEBOWEL 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
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COLITISCOLITIS• 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
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COLITISCOLITISSIGNS & SYMPTOMSSIGNS & SYMPTOMS• Bloody diarrhea• Abd pain varying from mild to severe• In severe cases
• Fever• Wt. loss• Tachycardia• Dehydration
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COLITISCOLITISCOMPLICATIONSCOMPLICATIONS• Hemorrhage• Strictures• Perforation• Toxic megacolon
DxDx• Bloodwork (CBC electrolytes)• Stool culture• Sigmoidoscope
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COLITISCOLITISTxTx• Rest the bowel• Control inflammation• Correct malnutrition• Combat infection• Alleviate stress• Symptom relief with drug therapy• Surgery
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CROHN'S DISEASECROHN'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
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CROHN'S DISEASECROHN'S DISEASESIGNS & SYMPTOMSSIGNS & SYMPTOMS• Depends on the site of involvement• Diarrhea (usually non bloody)• Fatigue• Abd pain• Wt. loss• Fever
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CROHN'S DISEASECROHN'S DISEASECOMPLICATIONSCOMPLICATIONS• Strictures• Obstruction• Fistulas• Nutritional abnormality• Arthritis
DxDx• Physical signs and symptoms
• Ba enema/swallow
• Bloodwork
•Colonoscopy
•Biopsy
•Stool culture
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CROHN'S DISEASECROHN'S DISEASETxTx• Control inflammation– Corticosteriods– Anti-inflammatories
• Relieve symptoms• Correct nutritional problems– High calorie– High protein
• Promote healing • Surgery
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DIVERTICULAR DIVERTICULAR DISEASEDISEASE
A diverticulum is a small pouch in the colon that bulge outward through weak spots in the colon.
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DIVERTICULAR DIVERTICULAR DISEASEDISEASE
• Diverticular disease occurs in 2 forms: 1.Diverticulosis2.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
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DIVERTICULAR DIVERTICULAR DISEASEDISEASE
• When feces enters the diverticula, they can become inflamed and infected. This is called diverticulitis.
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DIVERTICULAR DIVERTICULAR DISEASEDISEASE
• 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
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DIVERTICULAR DIVERTICULAR DISEASEDISEASE
SIGNS/SYMPTOMS• Abd pain in the LLQ• Fever• N & V• Chills• Cramping• Constipation• Bloating• Rectal bleeding
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DIVERTICULAR DIVERTICULAR DISEASEDISEASE
COMPLICATIONS• May include• Abscesses• Bowel obstruction• Bleeding• Ruptured diverticulaTx• Antibiotics (if infection is
present)• Some of these complications
may require surgery. • A colostomy can be necessary
as well as dietary changes.
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VOMITING, GALLBLADDER VOMITING, GALLBLADDER DISEASE & IBSDISEASE & 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
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DIGESTIVE SYSTEM DIGESTIVE SYSTEM ASSESSMENTASSESSMENT
OBJECTIVE• Inspect • Auscultate• Percuss• Palpate
SUBJECTIVE DATA
Ask your pt. about:
•Appetite
•Dysphagia
•Food intolerances
•Abd pain
•N/V
•Bowel habits
•Past hx
•Meds
•Diet
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MAKE YOUR OWN MAKE YOUR OWN CASE STUDYCASE 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:• The digestive system• Bowel elimination• Digestive diseases