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GASTROINTESTINAL DISORDERS

PREPARED BY

AL DIGNADICE CARUMBA

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HERNIAS- Abnormal protrusion of an organ, tissue or

part of an organ through the structure thatnormally contains it.

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image

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REDUCIBLE- when the contents of the hernial

sac can be placed into abdominal cavity

by manipulation

IRRIDUCIBLE AND INCARCERATED- contents of

the sac cannot be reduced or replaced by

manipulation

TYPES

1. INDIRECT INGUINALHERNIA- occurs thru the

inguinal ring and follows the spermatic

cord thru the inguinal canal

- most common in male

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2. DIRECT INGUINAL HERNIA- bowel passes thru

the abdominal wall in an area of muscular

weakness, not thru a canal

3. UMBILICALHERNIA- umbilical herniation due

to increased abdominal pressure usually

occurs in obese and multiparous women

3. INCISIONAL OR VENTRAL HERNIA- occurs at the

site of previous surgical incision

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b A. ETIOLOGYb 1. Portion of the stomach protruding

through a hiatus (opening) in thediaphragm into the thoracic cavity.

b 2. May result from a congenitalweakness of the diaphragm or frominjury, pregnancy, or obesity.

b 3. Function of the cardiac sphincter islost, gastric juices enter the esophaguscausing inflammation.

HIATAL HERNIA

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HIATALHERNIA

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B. CLINICAL FINDINGS:

1. Subjective: substernal burning pain or fullness

after eating; dyspepsia in the recumbent position;nocturnal dyspnea.

2. Objective: GI series and endoscopy showprotrusion of the stomach through the diaphragm;

regurgitation

C. THERAPEUTIC INTERVENTIONS:

1. Small, frequent, bland feedings.

2. Pharmacologic management: antacids,antisecretory agents, antiemetics, especially thosethat promote gastric emptying

3. Surgical repair (done infrequently)

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NURSING CARE:

1. Teach the client and family about the

dietary regimen.

2. Encourage attempts at weight loss.

3. Avoid constricting clothing and heavy

lifting.

4. Encourage the client to sit up for at least 1

hour after eating.

5. Encourage the client to eat slowly and

avoid drinking fluids with meals to limit the

volume in the stomach.

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GASTRITIS

GASTRITIS is an inflammation of the gastric

mucosa (the stomach lining). It may be acute

or chronic. Acute gastritis produces mucosal

reddening, edema, hemorrhage, and erosion.

Chronic gastritis is common among elderly

people and people with pernicious anemia.In chronic atrophic gastritis, all stomach

mucosal layers are inflamed.

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POSSIBLE CAUSES:

Acute gastritis

1. Chronic ingestion of irritating foods, spicy foods oralcohol

2. Drugs, such as aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs)(in large doses),

cytotoxic agents, caffeine, corticosteroids,antimetabolites, phenylbutazone, and indomethacin

3. Ingestion of poisons, especiallydichlorodiphenyltrichloroethane (DDT), ammonia,

mercury, carbon tetrachloride, and corrosivesubstances

4. Endotoxins released from infecting bacteria, suchas staphylococci, Escherichia coli, and salmonella,

viruses (gastroenteritis)

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CHRONIC GASTRITIS:

1. Alcohol ingestion2. Cigarette smoke

3. Environmental irritants

4. Peptic ulcer diseaseASSESSMENT FINDINGS:

- Abdominal cramping

- Epigastric discomfort- Hematemesis

- Indigestion

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DIAGNOSTIC EVALUATION:1. Fecal occult blood test can detectoccult blood in vomitus and stools if theclient has gastric bleeding.2. Blood studies show low Hgb level and

Hct when significant bleeding hasoccurred.3. Upper GI endoscopy with biopsy

confirms the diagnosis when performedwithin 24hrs of bleeding.4. Upper GI series may be performed toexclude serious lesions.

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TREATMENT:-Blood transfusion-

I.V. fluid therapy-NG lavage to control bleeding-Oxygen therapy, if necessary-Partial or total gastrectomy (rare)-Vagotomy and pyloroplasty (limitedsuccess when conservative treatmentshave failed)

IMPLEMENTATION:1.If the client is vomiting, giveantiemetics and I.V. fluids to preventdehydration and electrolyte imbalance.

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2. Monitor fluid intake and output and electrolytelevels.3. Provide a bland diet to prevent recurrence.

4. Offer smaller, more frequent meals to reduceirritating gastric secretions. Eliminate foods thatcause gastric upset.5. If surgery is necessary, prepare the clientpreoperatively and provide appropriatepostoperative care to decrease preoperative anxietyand prevent intraoperative and postoperativecomplications.6. Administer antacids and other prescribed

medications7. Urge the client to take prophylactic medicationsas prescribed to prevent recurring symptoms.8. Provide emotional support.

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PEPTIC ULCER DISEASE (PUD)

A. ETIOLOGY:

1. Ulcerations of the gastrointestinal

mucus and underlying tissues caused by

gastric secretions that have a low pH (acid)2. Causes include conditions that increase

the secretion of hydrochloric acid by the

gastric mucosa or that decrease the tissues

resistance to the acid.

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a. infection of the gastric and / or duodenal

mucusa by Campylobacter pylori or

Helicobacter pylori.b. Zollinger Ellison syndrome: tumors

secreting gastrin, which will stimulate the

production of excessive hydrochloric acid.

c. certain drugs such as aspirin,steroids, andindomethacin will decrease tissue resistance.

d. smoking

3. Peptic ulcers may be present in theesophagus, stomach, or duodenum ( most

common site ).

4. Complication include pyloric or duodenal

obstruction, hemorrhage and or perforation.

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C. THERAPEUTIC INTERVENTIONS:1. Bland foods, and restriction of irritating

substances.2. Antibiotic therapy if microorganism isidentified; tetracycline, metronidazole, andbismuth

3. Histamine H2 receptor antagonists orproton pump inhibitors, antacids4. Sedatives, tranquilizers, anticholinergics,and analgesics

5. Antiemetics6. A nasogastric tube for decompression,

installation of vasocontrictors, and/or salinelavages when hemorrhage occurs.

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7. Surgical intervention:a. Vagotomy

b. Billroth I: removal of the lower portion of thestomach and attachment of the remaining portion tothe duodenum.

c. Billroth II: removal of the antrum and distalportion of the stomach and subsequent anastomosis

of remaining section to the jejunum.d. Antrectomy: removal of the antral

portion of the stomach.e. Gastrectomy: removal of 60%-80% of

the stomach.f. Esophagojejunostomy (total

gastrectomy): removal of the entire stomachwith a loop of jejunum anastomosed to theesophagus.

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g. Common complications of total or partial

gastric resection:(1) Dumping syndrome

(2) Hemorrhage

(3) Pneumonia

(4) Pernicious anemia

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NURSING CARE:

1. Allow ample time for the client to

express feelings and concerns.

2. Administer and assess effects of

sedatives, antacids, anticholinergics, H2

receptor antagonists, antibiotics, anddietary modifications.

3. Encourage hydration to reduce

anticholinergic side effects and dilute the

hydrochloric acid in the stomach.

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. Instruct client to:

a. Eat small to medium-sized meals

because this helps prevent gastric

distention; encourage between-meal

snacks to achieve adequate calories

when necessary.b. Avoid foods that increase gastric acid

secretion or irrigate gastric mucosa.

c.

Avoid foods that cause distress; variesfor individuals but common offenders

are the gas producers (legumes,

carbonated beverages, vegetables).

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7. Provide postoperative care after gastric

resection :

a. monitor vital signs; assess the dressingfor drainage.

b. maintain a patent nasogastric tube to

suction to prevent stress on the suture lines.c. observe the color and amount of

nasogastric drainage; excessive bleeding or

the presence of bright red blood after 12

hours should be reported immediately

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MEDICAL DIAGNOSIS AND TREATMENTSurgical removal of the appendixManagement of peritonitis, shock, dehydration, and infection

Chest x-ray to differentiate appendicitis frompneumonia(pneumonia may cause referred pain in the rightlower quadrant and thus may be misdiagnosed asappendicitis)Barium GI series and ultra-sonography to differentiate

appendicitis from other abdominal problemsNURSING CAREDont administer enemas or laxatives or apply heat to theabdomenWhen the appendix is not perforated, perform the same

postoperative care as for any abdominal surgeryWhen the appendix is perforated (and Penrose drains are inplace), place the child in semi-Fowlers position or on hisright side after surgery

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CROHNs DISEASE

(Regional Enteritis

CROHNs DISEASE is a chronic inflammatorydisease of the small intestine, usually affecting theterminal ileum. It also sometimes affects the largeintestine, usually in the ascending colon. Its

slowly progressive with exacerbations andremissions.POSSIBLE CAUSES:Emotional upsetsFried foodsMilk and milk productsUnknown

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Low albumin and protein levels reflect poor

absorption of protein.

Erythrocyte sedimentation rate (ESR) is elevated

due to inflammation.

TREATMENT:

DRUG THERAPY OPTIONS:

Analgesic: meperidine (Demerol), morphine

Antianemic: ferrous sulfate (Feosol), ferrous

gluconate (Fergon)

Antibiotic: sulfasalazine (Azulfidine),

metronidazole (Flagyl)

Anticholinergic: propantheline (Pro-Banthine),

dicyclomine (Bentyl)

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Antidiarrheal: diphenoxylate (Lomotil)

Antiemetic: prochlorperazine (Compazine)Anti-inflammatory: olsalazine (Dipentum)

Corticosteroid: prednisone (Deltasone)

Immunosupressant: mercaptopurine

(Purinethol), azathioprine (Imuran)Potassium supplement: potassium chloride

(K-Lor) administered with food, potassium

gluconate (Kaon)

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Administer medications, as prescribed, tomaintain or improve the clients condition.Maintain the clients diet; withhold food and

fluid as necessary to minimize GI discomfort.Minimize stress and encourage verbalizationof feelings to allay the clients anxiety.If surgery is necessary, provide postoperativecare (monitor vital signs; monitor dressingsfor drainage; monitor ileostomy drainage andperform ileostomy care as needed; assess

incision for signs of infection; assist withturning, coughing, and deep breathing; getthe client out of bed on the 1st postoperativeday if stable) to promote healing and prevent

complications.

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ULCERATIVE COLITIS is a major health problemand a potentially debilitating disease. Its a type of

inflammatory bowel disease that produces lesionsprimarily confined to the large bowel, withulcerations of the large bowels mucosa andsubmucosa. Healing of lesions causes scarring andstrictures, leading to bowel obstruction, and ulcers

may perforate, causing hemorrhage and peritonitis.Ulcerative colitis usually develops in people betweenages 18-35 and occurs more commonly in womenthan in men.

POSSIBLE CAUSES:GeneticsIdiopathicAllergies

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Autoimmune diseaseEmotional stressViral and bacterial infections

ASSESSMENT FINDINGS:Abdominal cramping, distention, andtendernessAnorexiaBloody, purulent, mucoid, watery stools (15to 20 per day)Dehydration

FeverHyperactive bowel soundsNausea and vomitingWeakness

Weight loss

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DIAGNOSTIC EVALUATION:

Barium enema shows ulcerations.

Blood chemistry shows decreased potassium leveland increased osmolality.

Hematology shows decreased Hgb level and Hct.

Intestinal biopsy helps to differentiate between

ulcerative colitis and regional enteritis.Stool specimen is positive for blood and mucus.

Urine chemistry displays increased urine specific

gravity.

TREATMENT:

Colectomy or ileostomy

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IMPLEMENTATION:Assess GI status and fluid balance todetermine deficient fluid volume.

Monitor and record vital signs, intake andoutput, laboratory studies, daily weight, urinespecific gravity, calorie count, and fecal occultblood to determine deficient fluid volume.Monitor the number, amount, and characterof stools to determine status of nutrientabsorption.

Maintain the clients diet; withhold food andfluid as necessary to prevent nausea andvomiting.Administer I.V. fluids and TPN to maintain

hydration and improve nutritional status.

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Maintain position, patency, and low

suction of NG tube to prevent nausea

and vomiting.Keep the client in semi-Fowlers

position to promote comfort.

Administer medications, as prescribed,to maintain or improve the clients

condition.

Provide skin, mouth, nares, andperianal care to promote comfort and

prevent skin breakdown.

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