Gasrtointestinal bleeding & obstruction

GASTRO INTESYINAL DISORDERSGASTRO INTESYINAL DISORDERS

Intestinal Obstruction & GI bleedingIntestinal Obstruction & GI bleeding

BY:BY:Iman Qasim Iman Qasim Alhussein.Alhussein.

Intestinal obstructionIntestinal obstruction

In an intestinal obstruction, the lumen of the

small or large bowel becomes partly or fully

blocked. Small-bowel obstruction is far more

common (affecting 90% of patients) and

usually more serious.

INTESTINAL INTESTINAL OBSTRUCTIONOBSTRUCTION

The obstruction can be partial or complete.

Its severity depends on:

** the region of bowel affected,

** the degree to which the lumen is occluded,

**and especially the degree to which the

vascular supply to the bowel wall is

disturbed

INTESTINAL OBSTRUCTIONINTESTINAL OBSTRUCTION

A, Intussusception;

invagination or

shortening of the colon

B, Volvulus of

the sigmoid colon

C, Hernia (inguinal) and

adhesion.

Mechanical obstructionMechanical obstruction

Other Cause of mechanical obstructionOther Cause of mechanical obstruction

• carcinomas (usually large-bowel

obstruction)

• foreign bodies (fruit pits, gallstones, worms)

• compression

• stenosis

• tumors

• atresia.

Non mechanical (FUNCTIONAL) Non mechanical (FUNCTIONAL)

obstruction can result fromobstruction can result from:

electrolyte imbalances

toxicity

neurogenic abnormalities

thrombosis or embolism of mesenteric

vessels

paralytic ileus

fluid, air, and gas collectnear the site.

Mechanical and non mechanical causes

decrease invenous and arteriolar capillary

pressure.

necrosis,congestionedema

rupture or perforation ofthe intestinal wall,

peritonitis

abdominal distention and retention leading to increases intestinal lumen pressure

Colicky Abdominal pain Abdominal Distention Vomiting Fecal material vomiting( luminal obstruction) Discharge from rectum without fecal or gases Breath odor Inability to pass gas The signs of dehydration become evident:** intense thirst, drowsiness, generalized malaise,

aching,** and a parched tongue and mucous membranes.

Clinical Manifestations

COMPLICATION

If the obstruction continues

uncorrected, hypovolemic shock

occurs from dehydration and loss of

plasma volume.

Hole (perforation) in the intestine

Infection

INVESTIGATIONINVESTIGATION Abdominal x-ray and CT findings include

abnormal quantities of gas, fluid, or both

Laboratory studies (ie, electrolyte studies

and a complete blood cell count)

• In large-bowel obstruction, barium

enema reveals a distended

Upper GI and small bowel series

Medical Management

Restoration of intravascular volume,

correction of electrolyte Abnormalities

nasogastric aspiration and decompression are

instituted immediately

A rectal tube may be used to decompress an area

that is lower in the bowel

surgical resection to remove the obstructing lesion

the surgical procedure involves repairing the

hernia

or dividing the adhesion to which the

intestine is attached

the portion of affected bowel may be

removed and an anastomosis performed

A temporary or permanent colostomy may be

necessary.

NURSING PROCESS FOR

PATIENT WITH GIT

DISORDERS

Assessment

**The nurse obtains a health history about the, abdominal or rectal pain (eg, location, frequency, duration, association with eating or defecation)

**past and present elimination patterns, and characteristics of stool

(eg, color, odor, consistency, presence of blood or mucus.)

** The nurse assesses dietary patterns, including fat and fiber intake.

** palpation of the abdomen for areas of tenderness, distention, and solid masses .

NURSING DIAGNOSISNURSING DIAGNOSIS

•Acute pain and discomfort related to abdominal

distention , obstruction and surgical incision

•Imbalanced nutrition, less than body requirements,

related to nausea and anorexia

•Risk for deficient fluid volume related to vomiting

and

dehydration

•Anxiety related to impending surgery and the

diagnosis of cancer

PLANNINGPLANNING

** Relieving pain

** prevention of fluid volume deficit,

** maintenance of optimal nutrition and

weight

** Relieving anxiety

Nursing InterventionsNursing Interventions

RELIEVING PAINRELIEVING PAIN

* The nurse records the intensity, duration,

and location of pain to determine if the

obstruction process worsens or subsides.

* Comfort position .

* Analgesics to relieve the pain as order.

*prevention of fatigue also are helpful for

reducing pain

MAINTAINING FLUID INTAKE

*the nurse keeps an accurate record of oral and intravenous fluids and maintains a record of output

*The nurse monitors daily weights for fluid gains or losses

*assesses the patient for signs of fluid volume deficit (ie, dry skin and mucous membranes)

*It is important to encourage oral intake of fluids and to monitor the intravenous flow rate .

IMPROVE NUTRITIONAL STATUSIMPROVE NUTRITIONAL STATUS

**assessing improvement (eg, return of normal bowel sounds, decreased abdominal distention,, passage of flatus or stool)**maintaining the function of the nasogastric tube

**A complete nutritional assessment for the patient with a colostomy.

**The patient avoids foods that cause excessive odor and gas, such as peanuts.

**It is important to determine whether the elimination of specific foods is causing any nutritional deficiency .

** For constipation, prune or apple juice or a mildlaxative is effective .

**The nurse suggests fluid intake of at least 2 L per day.

Relieving anxietyRelieving anxiety

** The patient is encouraged to verbalize feelings and concerns about altered body image and to discuss the surgery and the stoma (if one was created).

** explain the procedure for patient and his family

**Provide emotional support

** accepting manner and by encouraging the patient to talk about his or her feelings about the stoma.

EVALUATIONEXPECTED PATIENT OUTCOMES

Consumes a healthy diet

Maintains fluid balance

Feels less anxious

Comfortable without pain

GASTROINTESTINAL GASTROINTESTINAL

(GIT) BLEEDING(GIT) BLEEDING

GASTROINTESTINAL (GI) BLEEDING

Gastrointestinal (GI) bleeding is a common

clinical problem frequently requiring

hospitalization. It can vary in degrees, from

massive life threatening hemorrhage to a

slow, insidious chronic blood loss

GASTROINTESTINAL BLEEDING CAN BE ROUGHLY DIVIDED INTO TWO CLINICAL SYNDROMES : 

• Peptic ulcers

• Gastritis

• upper Gastrointestinal cancers

• Inflammation of the gastrointestinal

lining from ingested materials

UPPER GASTROINTESTINAL UPPER GASTROINTESTINAL BLEEDINGBLEEDING

LOWER GASTROINTESTINAL LOWER GASTROINTESTINAL BLEEDINGBLEEDING

Diverticular disease

Gastrointestinal cancers

Inflammatory bowel disease (IBD)

Hemorrhoids and anal fissure

Infectious diarrhea

Angiodysplasia

Polyps

CLINICAL MANIFESTATIONSCLINICAL MANIFESTATIONS

HaematemesisHaematemesis

CLINICAL MANIFESTATIONS

Others:

Fatigue

Weakness

Shortness of breath

Abdominal pain

Pale appearance

Anemia

TESTS THAT MAY BE DONE TESTS THAT MAY BE DONE INCLUDEINCLUDE:

Abdominal CT scan , Abdominal MRI scan , Abdominal x-ray

Angiography

Bleeding scan (tagged red blood cell scan)

Blood clotting tests

Capsule endoscopy (camera pill that is swallowed to look at the small intestine)

Colonoscopy

Complete blood count (CBC), clotting tests, platelet count, and other laboratory tests

Enteroscopy , Sigmoidoscopy

MANAGEMENTMANAGEMENTPriorities are:

Assess clinical status

**PR, BP, RR, Conciousness

Large bore IV access – 2

Stabilize haemodynamics

**IV fluids, PRBC, Whole blood

Vasopressors

NG aspirate – Large bleeds, doubtful bleeds

MEDICAL MANAGEMENT

H2 receptor antagonist - cimetidine, ranitidine

Proton pump inhibitors – omeprazole, lanzoprazole

H. pylori irradication

Triple regimen – proton pump inhibitor + 2

antibiotics given for 1 week (elimination rate >

90%)

e.g. Omeprazol + metronidazole/amoxycillin +

clarithromycin

SURGICAL INTERVENTIONSURGICAL INTERVENTION

Endoscopic therapy with:Endoscopic therapy with: Diagnostic

Therapeutic – Ligation, Banding, Clipping, Sclero

Balloon tamponade

surgery should be done if

-failed medical treatment

-vagotomy, gastrectomy, pyloroplasty

NURSING PROCESS FOR

PATIENT WITH GIT

DISORDERS

Assessment

**The nurse obtains a health history about the, abdominal or rectal pain (eg, location, frequency, duration, association with eating or defecation)

**past and present elimination patterns, and characteristics of stool

(eg, color, odor, consistency, presence of blood or mucus.)

** The nurse assesses dietary patterns, including fat and fiber intake.palpation of the abdomen for areas of tenderness, distention, and solid masses .

NURSING DIAGNOSISNURSING DIAGNOSIS

•Acute pain and discomfort related to abdominal

distention , obstruction and surgical incision

•Imbalanced nutrition, less than body requirements,

related to nausea and anorexia

•Risk for deficient fluid volume related to vomiting

and

dehydration

•Anxiety related to impending surgery and the

diagnosis of cancer

PLANNINGPLANNING

** Relieving pain

** prevention of fluid volume deficit,

** maintenance of optimal nutrition and

weight

** Relieving anxiety

RELIEVING PAINRELIEVING PAIN

* The nurse records the intensity, duration,

and location of pain to determine if the

inflammatory process worsens or subsides.

* Comfort position .

* Analgesics to relieve the pain as order.

*prevention of fatigue also are helpful for

reducing pain

MAINTAINING FLUID INTAKE

*the nurse keeps an accurate record of oral and intravenous fluids and maintains a record of output

*The nurse monitors daily weights for fluid gains or losses

*assesses the patient for signs of fluid volume deficit (ie, dry skin and mucous membranes)

*It is important to encourage oral intake of fluids and to monitor the intravenous flow rate .

IMPROVE NUTRITIONAL STATUSIMPROVE NUTRITIONAL STATUS

**assessing improvement (eg, return of normal bowel sounds, decreased abdominal distention,, passage of flatus or stool)**maintaining the function of the nasogastric tube

**A complete nutritional assessment for the patient with a colostomy.

**The patient avoids foods that cause excessive odor and gas, such as peanuts.

**It is important to determine whether the elimination of specific foods is causing any nutritional deficiency .

** For constipation, prune or apple juice or a mildlaxative is effective .

**The nurse suggests fluid intake of at least 2 L per day.

Relieving anxietyRelieving anxiety

** The patient is encouraged to verbalize feelings and concerns about altered body image and to discuss the surgery and the stoma (if one was created).

** explain the procedure for patient and his family

**Provide emotional support

** accepting manner and by encouraging the patient to talk about his or her feelings about the stoma.

EVALUATIONEXPECTED PATIENT OUTCOMES

Consumes a healthy diet

Maintains fluid balance

Feels less anxious

Comfortable without pain

THANK YOUTHANK YOU