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Presented by: Kymberly McCoy RN MSN Spring 2010

Gastrointestinal System Function and Disorders
GI Tract includes: includes: Mouth Esophagus Stomach Small Intestine Large Intestine Rectum

Gastrointestinal System Function and Disorders
Small Intestine consist of three portions: Duodenum 10-12in 10Jejunum 8ft long Ileum 11ft long

Gastrointestinal System Function and Disorders Functions of GI Tract: Breakdown of food for digestion Absorption of nutrients into bloodstream Elimination of undigested food & other waste products Major enzymes: MouthMouth-saliva. intrinsic factor Small Intestine-amylase. pepsin. salivary amylase StomachStomach-hydrochloric acid. Intestinelipase. trypsin and bile .

constipation .between stomach & large intestine IleocecalIleocecal.between esophagus & stomach PyloricPyloric.controls passage of fluids and fecal material Assessment: History Abdominal pain Dyspepsia Gas.Gastrointestinal System Function and Disorders Sphincters: EsophagealEsophageal. Nausea/vomiting Bowel Habits/pattern Stool Characteristics Eating habits Past GI surgeries Nutritional intake Weight loss Diarrhea.between small & large intestine AnalAnal.

abdomen & rectum Abdominal Assessment Inspect Auscultate Percuss Palpate .Gastrointestinal System Function and Disorders Assessment: Physical Includes mouth.

PTT/PT/INR Triglycerides Amylase. CMP.Gastrointestinal System Function and Disorders Diagnostic Evaluation: CBC. Lipase Liver Function Panel Carcinoembryonic Antigen (CEA) Cancer Antigen (CA 19-9) 19Stool test Diagnostic Procedures: Abdominal Ultrasound Computed Tomography(CT) Magnetic Resonance Imaging (MRI) Positron Emission Tomography (PET) .

malabsorption syndromes and more Exam may extend to duodunum & small bowel (SBFT) NPO after midnight Drink Barium Sulfate morning of test Possibly Laxatives Monitor stools Encourage increased oral intake to assist with passage of barium Stool should return to normal within 72 hours . varicies. tumors.Gastrointestinal System Function and Disorders Diagnostic Procedures: Upper GI Study (UGI) diagnose structural abnormalities & problems of esophagus & stomach Diagnosis of ulcers.

tumors or lesions Bowel prep Low residue diet 1-2 days 1prior exam NPO after Midnight Lower GI study should be done first before UGI Diagnostic Procedures: Gastric Emptying Study liquids & solids tagged with radionuclide markers Measures rate of passage of substance from stomach Dx disorders of gastric motility.help detect lower GI abnormalities. diabetic gastroparesis and dumping syndrome . polyps.Gastrointestinal System Function and Disorders Diagnostic Procedures: Lower GI Study (Barium enema)enema).

Able to obtain biopsies. stomach & duodenum.Gastrointestinal System Function and Disorders € Endoscopic Procedures: € Esophagogastroduodenoscopy (EGD) € Direct visualization of the esophagus. € NPO 6-8 hrs prior to exam 6€ Clear liquids 1-2 days prior 1€ Obtain Consent .

difficulty bleeding. epigastric pain .Gastrointestinal System Function and Disorders € Endoscopic Procedures: € EGD (cont) € Maintain NPO until gag reflex returns € Position to prevent aspiration € Observe for signs of aspiration bleeding. fever.

Gastrointestinal System Function and Disorders
€ Endoscopic Procedures: € Colonoscopy-direct Colonoscopyvisualization exam that evaluates large intestine € Biopsies & polypectomies can be performed € Commonly used as cancer screening € Evaluate diarrhea of unknown cause, occult bleeding, anemia, etc.

Gastrointestinal System Function and Disorders
€ Endoscopic Procedures: € Colonoscopy (cont) € Performed w/client lying on left side € Bowel prep day before € Clear liquid diet day before € NPO after midnight € Monitor for s/s bowel perforation & peritonitis

Gastrointestinal System Function and Disorders
€ Endoscopic procedures: € Sigmoidoscopy-direct Sigmoidoscopyvisualization of distal sigmoid colon to evaluate chronic diarrhea, ischemic colitis, fecal incontinence, fissures, etc. € Mild bowel prep includes warm tap h2o enema or soap suds enema € Nursing care same as colonoscopy

encourage diet high in fiber & minimum of 1500ml of fluid daily. encourage frequent small meals high in vitamins € Decreased peristalsis & decreased sensation to defecate.Gastrointestinal System Function and Disorders € Gerontologic Considerations: € Decreased hydrochloric acid & decreased absorption of vitamins. encourage physical activity € Decrease lipase from pancreas to aid in fat digestion € Decrease liver activity with decreased production of enzymes for drug metabolism .

usually affects lower lip. from excessive exposure to sunlight y Squamous Cell Carcinoma .most common.Gastrointestinal System Function and Disorders € Oral Cancer € Uncontrollable growth of abnormal cells € Can occur in any area of the oral cavity € Frequently curable if discovered early y Types of Oral Cancer: y Basal Cell Carcinoma occurs primarily on lips. tongue & floor of mouth .

Gastrointestinal System Function and Disorders y Oral Cancer y Etiology y Tobacco use y Excessive alcohol intake y Poor dental care y Exposure to ultraviolet y Oral Cancer y Clinical manifestations: y Leukoplakia y Erythroplakia y Oral lesion may be fixed rays & hard y Dysphasia (late) y Pain (late) y Neck mass .

Gastrointestinal System Function and Disorders y Oral Cancer y Diagnostic Studies y Biopsy y Oral exam y History and physical y Assessment of cervical y Oral Cancer y Treatment y Chemotherapy y Radiation y Surgery lymph nodes .

Gastrointestinal System Function and Disorders y Oral Cancer y Surgery y Hemiglossectomy y Glossectomy y Radical neck dissection y Oral Cancer y Nursing Management y Prepare for surgery y Maintain patent airway y Maintain oral hygiene y Prevent injury & infection y Maintain nutritional status .

Gastrointestinal System Function and Disorders y Esophageal Cancer y Malignant neoplasm of the esophagus y Higher incidence in African Americans & men y Types of Esophageal CA: y Adenocarcinoma y Squamous Cell y Risk Factors y Barrett s Esophagus y Smoking y Excessive alcohol intake y Diet low in fruits and veggies .

Gastrointestinal System Function and Disorders y Esophageal Cancer y Clinical Manifestations: y Progressive dysphagia y Pain y Weight loss y Advanced Ulcerated Lesion y Esophageal Cancer y Diagnostic Studies y Endoscopy with biopsy y CT scan y PET Scan y Bronchoscopy .

Gastrointestinal System Function and Disorders y Esophageal Cancer y Complications y Perforation y Hemorrhage y Aspiration Pneumonia y Anastomotic leak y Esophageal Cancer y Treatment y Radiation y Chemotherapy y y Treatment y Curative y Palliative Surgery y Esophagectomy y Esophagogastrostomy y Esophagoenterostomy .

Gastrointestinal System Function and Disorders .

Gastrointestinal System Function and Disorders y Esophageal Cancer y Nursing Management y Maintain nutritional status y NPO y Secure NG tube y Vigorous pulmonary plan y Oral Suction y Patient teaching .

Gastrointestinal System Function and Disorders y Radical Neck Dissection removal of all cervical lymph nodes from the mandible to clavicle. internal jugular vein & spinal accessory muscle on one side of the neck . removal of the sternoceidomastoid muscle.

Gastrointestinal System Function and Disorders y Radical Neck Dissection y Potential Complications y Hemorrhage y Chyle fistula y Nerve injury y Radical Neck Dissection y Nursing Management y Provide pre-op education prey Post-op care Posty Maintain airway y Relieve pain y Provide wound care y Adequate nutrition y Support coping measures y Effective communication .

Gastrointestinal System Function and Disorders y Gastroesophageal Reflux Disease (GERD) y The backflow of gastric and duodenal contents into the esophagus. pyloric stenosis. y Caused by an incompetent lower esophageal sphincter. or a motility disorder. y Symptoms may mimic those of a heart attack . hiatal hernia.

Gastrointestinal System Function and Disorders y GERD y Risk Factors y Obesity y Smoking y Excess alcohol intake y High-fat. spicy or acidic foods y Caffeine and carbonated beverages .

Gastrointestinal System Function and Disorders GERD y Clinical Manifestations y Pyrosis y Dyspepsia y Regurgitation y Pain and difficulty with y GERD y Diagnostics y History and physical y Endoscopy y Barium swallow y pH monitoring swallowing y Hypersalivation .

Gastrointestinal System Function and Disorders y GERD y Treatment y Lifestyle modifications y Nutritional therapy y Drug therapy y Surgery .

Gastrointestinal System Function and Disorders y GERD y Nursing Intervention y Avoid the use of anticholinergics. histamine H2-receptor antagonists. which delay stomach emptying y Instruct the client regarding prescribed medications. such as antacids. or protein pump inhibitors y Instruct the client regarding the administration of prokinetic medications if prescribed. which accelerate gastric emptying .

Gastrointestinal System Function and Disorders y GERD y Surgical Intervention y If conservative therapy is unsuccessful. . surgery may be required and involves a fundoplication (wrapping a portion of the gastric fundus around the sphincter area of the esophagus).

Gastrointestinal System Function and Disorders y Barrett s Esophagus y Serious complication of GERD y Normal tissue lining of esophagus changes to resemble tissue lining of intestine y Increases risk for esophageal cancer .

Gastrointestinal System Function and Disorders y Barrett s Esophagus y Clinical Manifestations y Non-specific to BE Nony Treatment regimen same as GERD to control acid reflux y Barrett s Esophagus y Surgical Intervention y Photodynamic Therapy (PDT) y Endoscopic Mucosal Resection (EMR (EMR) .

Gastrointestinal System Function and Disorders y Hernias a protrusion of the intestine through an abnormal opening or weakened area of the abdominal wall y Usually occur in the abdominal cavity y Can be reduced manually or may reduce spontaneously when the person lies down .

blood supply Strangulated& intestinal flow are obstructed .Gastrointestinal System Function and Disorders y Types of Hernias: y Esophageal (Hiatal) y Inguinal y Femoral y Umbilical y Classification: y Reducible.may be Reduciblereplaced by manual manipulation y Incarcerated.imprisoned Incarceratedcan not be pushed back into place y Strangulated.

Gastrointestinal System Function and Disorders y Risk Factors: y Chronic cough y Obesity y Weakened musculature y Pregnancy y Clinical Manifestations: y Hernia protrudes over affected area while standing y Pain y Heartburn y Nausea/vomiting y Feeling of fullness .

Gastrointestinal System Function and Disorders y Diagnostics: y Complete H & P y X-Ray y Nursing Management: y Small frequent meals y Do not recline at least 1 hour y Treatment: y Antacids y General elective surgery y Strangulated hernia may require resection of affected bowel y Types of Surgery: y Herniorrhaphy y Hernioplasty after meals y Elevate HOB while sleep y Avoid anticholinergics. which delay stomach emptying .

duodenum.Gastrointestinal System Function and Disorders y Peptic Ulcer Disease y An ulceration in the mucosal lining wall of the stomach. . duodenal. y May be referred to as gastric. or esophageal ulcer depending on the location. pylorus. Erosion may extend through the muscle. or esophagus. y The most common peptic ulcers are gastric and duodenal ulcers.

Gastrointestinal System Function and Disorders y Normal Gastric and Duodenal Mucosa .

y Types of Peptic Ulcers: y Duodenal y Gastric y Stress-induced Stressy Drug-induced Drug- . Increased concentration of acidacidpepsin or decreased resistance of mucosa.Gastrointestinal System Function and Disorders y Pathophysiology: y Mucosa cannot withstand digestive action of HCL and pepsin.

Pylori y NSAIDS y Medications y Physical/Psychosocial Stress y Alcohol y Smoking .Gastrointestinal System Function and Disorders y Common Sites: y Risk Factors: y H.

Gastrointestinal System Function and Disorders y Clinical Manifestations Duodenal Ulcers y Burning pain in midepigastric region 2-3 hours after meal 2and during night (awakened by pain) y Melena more common y Pain often relieved by food .

ASA. caffeine. small frequent meals y Provide adequate rest y Avoid alcohol intake.Gastrointestinal System Function and Disorders y Nursing Management y Monitor vital signs y Bland diet. NSAIDS & corticosteroids y y y y y y y y y Diagnostics Physical exam X-Ray EGD Treatment Antacids H2-receptor antagonist Lifestyle modifications Surgical intervention only if unresponsive to meds .

Gastrointestinal System Function and Disorders y Gastric Ulcers y Involves ulceration of the mucosal lining that extends to the sub mucosal layer of the stomach y Predisposing factors include stress. and pyloric obstruction . a family history of gastric ulcers. or infection with Helicobacter pylori y Complications include hemorrhage. smoking. the use of corticosteroids. perforation. a history of gastritis. nonsteroidal anti-inflammatory drugs anti(NSAIDs). alcohol.

Gastrointestinal System Function and Disorders y Clinical Manifestations Gastric Ulcers 60 y Gnawing. sharp pain in left midepigastric region 30 minutes after meal y Hematemesis more common y Food accentuates pain .

Gastrointestinal System Function and Disorders y Gastric Ulcers y Nursing Intervention y Monitor vital signs and for signs of bleeding y Administer small. bland feedings during the active phase y Administer histamine H2-receptor antagonists as prescribed to decrease the secretion of gastric acid y Administer antacids as prescribed to neutralize gastric secretions . frequent.

Gastrointestinal System Function and Disorders y Gastric Ulcers y Nursing Intervention y Administer anticholinergics as prescribed to reduce gastric motility y Administer mucosal barrier protectants as prescribed 1 hour before each meal y Administer prostaglandins as prescribed for their protective and antisecretory actions .

Gastrointestinal System Function and Disorders y Gastric Ulcers y Patient Teaching y Avoid consuming alcohol and substances that contain caffeine or chocolate y Avoid smoking y Avoid aspirin or NSAIDs y Obtain adequate rest and reduce stress .

monitor I&O Monitor hemoglobin and hematocrit . hypovolemic shock. and respiratory insufficiency Maintain NPO status and administer IV fluid replacement as prescribed.Gastrointestinal System Function and Disorders y Gastric Ulcers y Intervention y y y y Active Bleeding Monitor vital signs closely Assess for signs of dehydration. sepsis.

Gastrointestinal System Function and Disorders y Gastric Ulcers y Intervention y y y y Active Bleeding Administer blood transfusions as prescribed Assist with the insertion of a nasogastric (NG) tube for decompression and for lavage access Assist with normal saline or tap water lavage at room temperature to reduce active bleeding Prepare to assist with administering vasopressin (Pitressin) by IV as prescribed to induce vasoconstriction and reduce bleeding .

Gastrointestinal System Function and Disorders y Gastric Ulcers y Surgical Interventions y TOTAL GASTRECTOMY Also called esophagojejunostomy Removal of the stomach with attachment of the esophagus to the jejunum or duodenum y VAGOTOMY y Surgical division of the vagus nerve to eliminate the vagal impulses that stimulate hydrochloric acid secretion in the stomach y GASTRIC RESECTION y Also called antrectomy y Involves removal of the lower half of the stomach and usually includes a vagotomy y y .

partial gastrectomy. with remaining segment anastomosed to duodenum y BILLROTH II y Also called gastrojejunostomy.Gastrointestinal System Function and Disorders y Gastric Ulcers y Surgical Intervention y BILLROTH I Also called gastroduodenostomy. with remaining segment anastomosed to jejunum y PYLOROPLASTY y Enlarges the pylorus to prevent or decrease pyloric obstruction. partial gastrectomy. thereby enhancing gastric emptying y .

Gastrointestinal System Function and Disorders y Total Gastrectomy y Vagotomies .

Gastrointestinal System Function and Disorders y Billroth I y Billroth II .

Gastrointestinal System Function and Disorders y Gastric Ulcers y Postoperative Care y Monitor vital signs y Position in Fowler's for comfort and to promote drainage y Administer fluids and electrolyte replacements by IV as prescribed. monitor I&O y Assess bowel sounds y Monitor NG suction as prescribed .

bland meals a day as prescribed when bowel sounds return Monitor for postoperative complications of hemorrhage. hypoglycemia. dumping syndrome. and vitamin B12 deficiency . diarrhea.Gastrointestinal System Function and Disorders y Gastric Ulcers Postoperative Care Do not irrigate or remove the NG tube. assist the physician with irrigation or removal Maintain NPO status as prescribed for 1 to 3 days until peristalsis returns Progress the diet from NPO to sips of clear water to 6 small.

Gastrointestinal System Function and Disorders y Gastric Cancer y Malignant growth of mucosal cells in the lining of the stomach y Most gastric cancers are adenocarcinomas y Can spread to nearby lymph nodes and organs such as the liver. and colon. . pancreas.

Gastrointestinal System Function and Disorders y Risk Factors: y H. Pylori infection y Diet y History of gastric ulcers y Alcohol y Incidence higher in men y Higher in persons of eastern Asian descent y Clinical Manifestations: y Pain (relieved by antacids) y Indigestion y Anorexia (late) y Weight loss (late) y Anemia (late) y Fatigue (late) y Malnourishment (late) y Palpable mass (late) .

Gastrointestinal System Function and Disorders y Gastric Cancer y Diagnostic studies y Endoscopy with biopsy y Upper GI (barium y Treatment y Surgery y Radiation y Chemotherapy swallow) y CT Scan .

hemorrhage. hypoglycemia . dumping syndrome. vitamin B deficiency.Gastrointestinal System Function and Disorders y Nursing Management y Reduce anxiety y Promote optimal nutrition y Relieve pain y Prepare for chemo/radiation y Prepare for surgery y Nursing Post-op Care Posty Monitor vital signs y NPO 1-3 days until 1peristalsis returns y Do not irrigate/remove NG tube y Monitor for complications.

y Most common GI condition y Seen more in women y Cause remains unknown y Risk Factors y Heredity y Stress y Diet high in fat y Diagnostics y X-ray y Stool studies y Protoscopy or Colonoscopy .Gastrointestinal System Function and Disorders y Irritable Bowel Syndrome (IBS) y Recurrent abdominal pain with an alteration in bowel function (diarrhea or constipation).

Gastrointestinal System Function and Disorders y Pathophysiology y Functional disorder of intestinal motility y Neuroendocrine dsyregulation y Peristaltic wave intensity .

Gastrointestinal System Function and Disorders y Clinical Manifestations y Alteration in bowel pattern y Constipation/Diarrhea y Flatulence y Pain y Bloating y Abdominal distention y Medical Management y Control diarrhea/constipation y Food diary y High fiber diet y Medications y y y y Bentyl (dicyclomine) Zelnorm (tegaserod) Antidepressants AntiAnti-diarrheals .

y Avoid drinking fluids while eating to prevent abdominal distention. y Surgery not required . y Avoid cigarettes and alcohol mgmt.Gastrointestinal System Function and Disorders y Nursing Management y Encourage clients to eat y Treatment y Behavior modification y Stress and relaxation and chew foods slowly.

y Common causes: Obstruction of the lumen with feces. or tumors. foreign bodies.Gastrointestinal System Function and Disorders y Appendicitis y Inflammation of the appendix. and accumulation of mucus and bacteria y . venous engorgement. y Obstruction results in distention.

edematous & eventually fills with pus in a matter of hours. becomes inflamed.Gastrointestinal System Function and Disorders y Pathophysiology y Small lumen easily occluded. y Clinical Manifestations y Periumbilical pain that y y y y y shifts to the RLQ Anorexia Nausea Vomiting Low grade fever Rebound tenderness .

Gastrointestinal System Function and Disorders y Diagnostics y History and physical y CBC y Ultrasound y Treatment y Appendectomy y IV therapy y Antibiotics y Complications y Perforation y Peritonitis y Abscesses .

to avoid enemas and laxatives NPO Start IV fluids Administer antibiotics Encourage ambulation on the same day following surgery or POD#1 Advance diet as tolerated Resume normal activity 2-4 2weeks after surgery y Age-related AgeConsiderations y Uncommon in elderly y S/S altered greatly y Pain may be absent y Symptoms may be vague suggesting bowel obstruction y Fever & leukocytosis may be absent y Don t seek health care .Gastrointestinal System Function and Disorders y Nursing Management y y y y y y y Encourage pt.

Gastrointestinal System Function and Disorders
y Diverticular Disease y Common GI disorder that affects increasing # of person over age 40. y Affects men and women equally y Men have a higher complication rate y Caused by a deficiency in dietary fiber y y Pathophysiology y Occurs when mucosa or sub mucosal layers of colon herniate through muscular wall because of: y Intraluminal pressure y Low volume in colon y Decreased muscle strength

Gastrointestinal System Function and Disorders
y Diverticulosis - the presence of pouch like herniations through the muscular wall of the colon. (sigmoid colon) y Diverticulitis occurs when one or more of the diverticula are inflamed.

Gastrointestinal System Function and Disorders
y Clinical Manifestations y Diverticulosis y Can be asymptomatic y S/S relatively mild y Bowel irregularities with intervals of diarrhea y Bloating y Abdominal distention y Clinical Manifestations y Diverticulitis y Acute onset LLQ pain y Nausea/Vomiting y Fever y Leukocytosis y Palpable mass LLQ y Blood in stools

Can cause perforation and peritonitis formation y Bowel obstruction y bleeding .Gastrointestinal System Function and Disorders y Diagnostics y y y y y y y Complications y Perforation y Peritonitis y Abscess and fistula CT Scan (preferred test of choice) Colonoscopy CBC UA Fecal occult blood test *A barium enema should not be performed.

Gastrointestinal System Function and Disorders y Medical Management y Rest y High fiber diet y Bulk laxatives y Nursing Management y Patient/family education y Maintain normal bowel pattern y Monitor for signs of potential complications y Prep for surgery if indicated (Metamucil) y Anticholinergics (Bentyl) y Antibiotics y Pain management .

Gastrointestinal System Function and Disorders y Surgical Management y Partial Resection y Temporary Colostomy y Percutaneous drain y Age-related Agey Increases with age y Symptoms less pronounced y Degeneration & structural changes .

food additives. theorize that it s triggered by environmental agents such as pesticides. y Ulcerative Colitis y Crohn s Disease (Regional enteritis) . tobacco & radiation. Cause still unknown.Gastrointestinal System Function and Disorders y Inflammatory Bowel Disease refers to two chronic disorders.

ulcers Scar tissue develops Periods of exacerbations .Gastrointestinal System Function and Disorders y Ulcerative Colitis y Inflammation & ulceration of y y y y the colon and rectum that results in poor absorption of nutrients Begins in colon and spreads upward Colon becomes edematous. may develop bleeding lesions.

small amounts of blood. malaise. anorexia y y Ulcerative Colitis y Clinical Manifestations y Severe Bloody diarrhea.Gastrointestinal System Function and Disorders y Ulcerative Colitis y Clinical Manifestations Bloody diarrhea y Abdominal pain (LLQ) y Mild y Diarrhea with two semisemiformed stool. y Moderate y 4-5 stools daily. increased bleeding y Fever. tachycardia. y . dehydration. weight loss(10% of TBW) y Anemia. 10-20 10stools/day y Fever.

OCB Intestinal y y y y Hemorrhage perforation Toxic megacolon( dilation and paralysis of the colon) Strictures Malabsorption Uveitis Hepatobiliary disease y Extraintestinal y y y . electrolytes Colonoscopy Sigmoidoscopy Barium enema Stool cultures.Gastrointestinal System Function and Disorders y Diagnostics y y y y y y y Complications y History and physical CBC.

Gastrointestinal System Function and Disorders y Treatment & Management y y y y y y y Drug Therapy y Aminosalicylates Rest the bowel Control the inflammation Combat infection Correct malnutrition Alleviate stress Drug therapy Azulfidine (suslfasalzine) y Asacol (mesalamine) y Rowasa (retention enema) y Antibiotics y Flagyl (metronidazole) y Corticosteroids y Prednisone y Immunosuppressant's y 6-MP y .

Zinc y Immunomodulators y Remicade permanent ileostomy y Proctocolectomy with continent ileostomy (Kock pouch) y Total colectomy y Preoperative care y Postoperative care . Folate.Gastrointestinal System Function and Disorders y Drug Therapy (cont) y Antidiarrheals y Lomotil y Surgical Management y Proctocolectomy with y Hematinics and vitamins y Ferrous sulfate.

Gastrointestinal System Function and Disorders y Kock Pouch .

Gastrointestinal System Function and Disorders y Preoperative Care y Antibiotics y Low residue diet y Abdominal markings for y Postoperative Care Assess stoma for color and size y I&O y stoma y Postoperative complications Hemorrhage y Abdominal abscess y SBO y dehydration y .

highhighhigh-protein diet -Low residue diet provides foods that are low in fiber. which will reduce the amount of fecal material in the lower GI tract .Gastrointestinal System Function and Disorders y Nutritional Therapy y Nutritional Therapy y TPN y Parenteral therapy y Procalamine y Iron -Low residue. high-calorie.

fistulas. y Cause is unknown y Occurs most often between the ages of 15 and 30. narrowed lumen. scarring. most often affects distal ileum (small bowel) which leads to thickening. ulcerations and abscesses. y High incidence in women .Gastrointestinal System Function and Disorders y Crohn s Disease (Regional Enteritis) y Chronic inflammatory disease that can occur anywhere in GI tract.

y Diagnostics y H&P y CBC y Barium studies y Sigmoidoscopy y Colonoscopy y Stool exam rectovaginal) y Malabsorption y Electrolyte imbalance y Abscess formation .Gastrointestinal System Function and Disorders y Complications y Obstruction y Fistulas (perianal.

and fatty foods should be avoided. y Milk. milk-products.Gastrointestinal System Function and Disorders y Drug Therapy y Sulfasalazine y Corticoidsteroids y Immunosuppressant's y Biaxin (clarithromycin) y Vitamin B12 y Nutritional Therapy y Parenteral nutrition y Diet should be high in calories and proteins. milkroughage. .

Elderly clients are more prone to volume depletion and dehydration. Estrogen can exacerbate colitis . y Drugs such as Allopurinol. NSAIDS. Digoxin.Gastrointestinal System Function and Disorders y Surgical Management y Depends on affected area y Intestinal resection with anastomosis y *Crohn s disease not cured by surgery y Age-related Considerations y The elderly clients have higher morbidity with surgical procedures. especially if they have renal and cardiovascular disorders.

Gastrointestinal System Function and Disorders
y Colorectal Cancer y 3rd most common form of cancer and 2nd leading cause

of cancer-related deaths in the United States. cancery Highly treatable and often curable if found early. y Half of all colorectal cancers occur in the sigmoid region of the colon. y More common in men than women

Gastrointestinal System Function and Disorders
y Pathophysiology y Adenocarcinoma y Starts as benign polyp y Destroys normal tissues y Migrates away from primary tumor (most often liver) y Risk Factors y Increasing age > 50 y May be associated with Ulcerative Colitis y Family hx colon cancer or polyps y High-fat, low-residue diet, Highlowhigh protein y Crohn s disease

Gastrointestinal System Function and Disorders
y Clinical Manifestations
y Change in bowel habits y Hematochezia y Melena y Weight loss y Unexplained anemia

y Clinical Manifestations y Ascending colon

diarrhea

y Descending colon constipation or diarrhea; ribbonribbon-like stool r/t partial obstruction y Rectal alternating constipation and diarrhea

Gastrointestinal System Function and Disorders y Diagnostics y H&P y Digital rectal exam y Fecal occult blood test y Barium enema y Sigmoidoscopy y Colonoscopy y CEA test y Complications y Partial or complete obstruction y Ulceration y Hemorrhage y Perforation y Abscess formation .

Gastrointestinal System Function and Disorders y Age-related AgeConsiderations y Closely associated with dietary carcinogens y Lack of fiber (major factor) y Elderly have difficulty managing colostomy care y Poor vision. decreased motor function y Skin care major concern y Management & Treatment Surgery y Chemotherapy y Radiation y y Preoperative Care Bowel preparation y Antibiotic administration y Patient education y .

Gastrointestinal System Function and Disorders y Postoperative Care y Monitor vital signs y Assess bowel sounds y Wound care y Monitor I&O y Pain control .

Gastrointestinal System Function and Disorders y Ostomy y An ostomy is a surgical y Types of Ostomies y Ascending colostomy y Descending colostomy y Ileostomy y Sigmoid colostomy (single(singlebarreled) y Transverse colostomy (double(double-barreled) procedure in which an opening is made to allow passage intestinal contents from the bowel to an incision or stoma. .

Gastrointestinal System Function and Disorders y Types of Colostomies y Ascending colon y Semi liquid stool semi liquid to semi formed stool formed stool liquid to semi liquid y Transverse colon y y Sigmoid colon y y Ileostomy y .

Gastrointestinal System Function and Disorders y Ostomy Surgery y Pre-op care Prey Colostomy care y Nutritional therapy y Post-op care Posty Nursing Management y Provide emotional support y Maintain optimal nutrition y Provide wound care y Monitor for complications .

Gastrointestinal System Function and Disorders y Hemorrhoids y Dilated veins in the rectum y May be internal or external y Clinical Manifestations Rectal Pain y Rectal bleeding with defecation y Rectal Itching y Burning y y Etiology y y y y y Occurs as a result of straining during defecation Constipation Pregnancy Prolonged standing and sitting Portal Hypertension .

Gastrointestinal System Function and Disorders y Diagnostics Digital examination y Sigmoidoscopy y Visual inspection (external hemorrhoids) y Surgical Intervention Hemorrhoidectomy y Laser treatments y Cryotherapy y Rubber-band ligation y y Nursing Intervention Apply icepacks y Stool softeners y Sitz baths y Encourage high-fiber diet y .

high-fiber diet .Gastrointestinal System Function and Disorders y Postoperative care y Assist client to side-lying position y Maintain ice packs over dressing y Monitor for urinary retention y Stool softeners as prescribed y Instructive client to increase fluid intake.

bladder rupture. stomach or intestinal rupture. y Common injuries include laceration of the liver. penetration injuries. . ruptured spleen.Gastrointestinal System Function and Disorders y Abdominal Trauma y Injuries to the abdomen that occur as a result of blunt trauma. y Surgical intervention must be done ASAP to repair damaged organs and stop bleeding.

Gastrointestinal System Function and Disorders y Clinical Manifestations y Guarding and splinting of the abdomen y *Hard distended abdomen y Decreased or absent bowel sounds y Bruising over the abdomen y Abdomen and scapula pain y Hematemesis and hematuria y Signs of hypovolemic shock y Cullen s sign .

Gastrointestinal System Function and Disorders y Diagnostics y y y y y y Nursing Management y Establish a patent CBC UA Abdominal x-ray xPeritoneal lavage CT scan airway y Prevent hypovolemic shock y Replace fluids .

Gastrointestinal System Function and Disorders y Anorexia Nervosa y Self imposed weight loss. endocrine function. y Abnormal weight loss y Deliberate self-starvation selfy Intense fear of gaining weight . and a distorted psychopathologic attitude toward weight and eating.

athletes y Clinical Manifestations y Refusal to eat y Continuous dieting y Hair loss y Sensitivity to cold y Compulsive exercise y Dry skin y constipation . dancers. actors.Gastrointestinal System Function and Disorders y Anorexia Nervosa y Who s at Risk? y Early adolescent y Caucasian y Middle & upper socioeconomic y Models.

Gastrointestinal System Function and Disorders y Anorexia Nervosa y Diagnostics y Iron deficiency anemia y Elevated BUN y Treatment y Nutritional support y Psychiatric care y Weight gain .

Gastrointestinal System Function and Disorders y Bulimia Nervosa y Frequent binge eating and selfself-induced vomiting y Persistent concern with body image y Clinical Manifestations y Frequent vomiting y Macerated knuckles y Swollen salivary glands y Broken blood vessels in the eyes y Dental problems .

Gastrointestinal System Function and Disorders y Bulimia Nervosa y Complications y Acid reflux y Dental cavities y Electrolyte imbalance y Treatment y Psychological counseling y Diet therapy y Emotional support y Refer to support groups .

or jejunum .Gastrointestinal System Function and Disorders y Nutrional Support y Oral Feedings y Tube Feedings y Total Parenteral Nutrition y Tube Feedings y The administration of a nutritionally balanced liquefied food or formula through a tube inserted into the stomach. duodenum.

Gastrointestinal System Function and Disorders y Types of Feedings y Bolus y Continuous y Cyclical .

approximately 300 to 400 ml of formula is administered over a 30.Gastrointestinal System Function and Disorders y Bolus Feedings y Resembles normal meal feeding patterns y Can be administered via a syringe or via an intermittent feeding y With an intermittent feeding.to 60-minute 30.60period every 3 to 6 hours .

Gastrointestinal System Function and Disorders y CONTINUOUS y Administered continuously for 24 hours y An infusion pump regulates the flow y CYCLICAL y Administered either in the daytime or nighttime for 8 to 16 hours y An infusion pump regulates the flow y Feedings at night allow for more freedom during the day .

hold the feeding . if greater than 200 ml.Gastrointestinal System Function and Disorders y Administering Tube Feedings y Position the client on right side in high-Fowler s highy Warm feeding to room temperature to prevent diarrhea and cramps y Aspirate stomach contents (residual). usually if the residual is less than 100 to 150 ml. and return the contents to the stomach to prevent electrolyte imbalances y Check physician s order and agency policy regarding residual amounts. measure the amount. feeding is administered.

keep the client in a semisemi-Fowler s position at all times . hold feeding and notify the physician if bowel sounds are absent y Use a feeding pump for continuous or cyclical feedings y For bolus feeding. leave the client in a high-Fowler s highposition for 30 minutes after feeding y For a continuous or cyclical feedings.Gastrointestinal System Function and Disorders y Administering Tube Feedings y Assess tube placement by aspirating gastric contents and measuring the pH (should be 4 or less) y Assess bowel sounds.

or via gravity flow (intermittent. bolus feedings) with a 60-ml syringe with the 60plunger removed y Gently flush with 30 to 50 ml of water or normal saline (depending on agency policy) with the irrigation syringe after the feeding . try flushing with water. saline y Administer feeding at prescribed rate.Gastrointestinal System Function and Disorders y Tube Feeding Precautions y If an obstruction occurs.

Gastrointestinal System Function and Disorders y Types of Tubes y Nasogastric Tube y Nasointestinal y Gastrsotomy Tube y Jejunostomy Tube y Complications y Diarrhea y Aspiration y Vomiting y Tube Obstruction y Hyperglycemia .

and vitamins that is given intravenously (IV). proteins. y The goal of TPN is to meet the patient s nutritional needs and to allow growth of new body tissue.Gastrointestinal System Function and Disorders y Total Parenteral Nutrition y Hypertonic solution that consists of glucose. minerals. .

(Crohn s disease. AIDS) y Patient unable to ingest food orally or by tube impaired. malnutrition. hyperemesis gravidarium) y Patient is unwilling to ingest nutrients (anorexia nervosa) .Gastrointestinal System Function and Disorders y Total Parental Nutrition: Indications y Patient s intake is insufficient to maintain an anabolic state (burns.

Gastrointestinal System Function and Disorders y Composition y Calories y Protein y Electrolytes y Trace Elements y Vitamins y Fats y Methods of Administration y PICC (Peripherally Inserted Central Catheter) y CVC (Central Venous Catheter) .

Gastrointestinal System Function and Disorders y Complications y Infection y Metabolic problems y Mechanical problems y Nursing Management y Vital signs y Daily weights y Blood chemistries y CBC y Blood glucose levels .

THE END! .