gastrointestinal updated version - napavalley.edu 150 PowerPoint...•Stool culture – Medical ... –Double-barrel transverse colostomy ... Microsoft PowerPoint - gastrointestinal

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Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 111

Care of the Patient with aGastrointestinal DisorderCare of the Patient with aGastrointestinal Disorder



Figure 45Figure 45--11

Location of digestive organs. (From Thibodeau, G.A., Patton, K.T. [1987]. Anatomy and physiology. St. Louis: Mosby.)

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Overview of the Digestive Overview of the Digestive System System

•• Digestive systemDigestive system

•• Stomach: churn and mix contents with Stomach: churn and mix contents with gastric juicesgastric juices

•• Small intestine: most digestion occurs hereSmall intestine: most digestion occurs here•• Large intestine: 80% of water absorbed, Large intestine: 80% of water absorbed,

forms and expels fecesforms and expels feces•• Rectum: stores and expels fecesRectum: stores and expels feces


Overview of Anatomy and Overview of Anatomy and PhysiologyPhysiology

–– Organs and their functionsOrgans and their functions••Liver: produces bile; stores it in the Liver: produces bile; stores it in the gallbladdergallbladder

••Pancreas: produces pancreatic juicePancreas: produces pancreatic juice•• Regulation of food intakeRegulation of food intake

–– Hypothalamus Hypothalamus ••One center stimulates eating and One center stimulates eating and another signals to stop eatinganother signals to stop eating


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Disorders of the MouthDisorders of the Mouth•• CandidiasisCandidiasis

••Infection caused by Infection caused by Candida albicansCandida albicans••FungusFungus normally present in the mouth, normally present in the mouth,

intestine, vagina, and on the skinintestine, vagina, and on the skin••Also referred to as Also referred to as thrushthrush

••Clinical manifestations/assessmentClinical manifestations/assessment••Small white patches on the mucous Small white patches on the mucous

membrane of the mouthmembrane of the mouth



Disorders of the EsophagusDisorders of the Esophagus•• Gastroesophageal reflux diseaseGastroesophageal reflux disease

•• Backward flow of stomach acid into the esophagusBackward flow of stomach acid into the esophagus

–– Clinical manifestations/assessmentClinical manifestations/assessment•• Heartburn 20 min Heartburn 20 min –– 2 hrs after eating2 hrs after eating•• RegurgitationRegurgitation•• Dysphagia Dysphagia •• EructationEructation

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Disorders of the EsophagusDisorders of the Esophagus•• GERD disease: Medical GERD disease: Medical

management/nursing interventionsmanagement/nursing interventions••Antacids or acidAntacids or acid--blocking medicationsblocking medications••Diet: 4Diet: 4--6 small meals/day, low fat, 6 small meals/day, low fat, adequate protein, remain upright for adequate protein, remain upright for 11--2 hours after eating2 hours after eating

••Lifestyle: eliminate smoking, avoid Lifestyle: eliminate smoking, avoid constrictive clothing, HOB up at least constrictive clothing, HOB up at least 66--8 inches for sleep8 inches for sleep



Disorders of the StomachDisorders of the Stomach•• Gastric ulcers and duodenal ulcersGastric ulcers and duodenal ulcers

–– Most commonly occur in the stomach and Most commonly occur in the stomach and duodenumduodenum

–– Result of acid and pepsin imbalancesResult of acid and pepsin imbalances

–– H. pyloriH. pylori••Bacterium found in 70% of patients Bacterium found in 70% of patients with gastric ulcers and 95% of with gastric ulcers and 95% of patients with duodenal ulcerspatients with duodenal ulcers

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Disorders of the StomachDisorders of the Stomach•• Gastric and duodenal ulcersGastric and duodenal ulcers•• Clinical manifestations/assessmentClinical manifestations/assessment

•• Pain: Dull, burning, boring, or gnawing, Pain: Dull, burning, boring, or gnawing, epigastricepigastric

•• DyspepsiaDyspepsia•• HematemesisHematemesis

–– Diagnostic testsDiagnostic tests•• Esophagogastroduodenoscopy (EGD)Esophagogastroduodenoscopy (EGD)•• Breath test for Breath test for H. pyloriH. pylori



Fiberoptic endoscopy of the stomach.

(From Phipps, W.J., Monahan, F.D., Sands, J.K., Marek, J.F., Neighbors, M. [2003]. Medical-surgical nursing: health and illness perspectives. [7th ed.]. St. Louis: Mosby.)

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Disorders of the StomachDisorders of the Stomach

•• Gastric and duodenal ulcers Gastric and duodenal ulcers •• Medical management/nursing Medical management/nursing

interventionsinterventions•• AntacidsAntacids•• Histamine HHistamine H22 receptor blockers receptor blockers •• AntibioticsAntibiotics•• Diet: high in fat and carbohydrates; low in protein Diet: high in fat and carbohydrates; low in protein

and milk products; small frequent meals; limit and milk products; small frequent meals; limit coffee, tobacco, alcohol, and aspirin usecoffee, tobacco, alcohol, and aspirin use


Disorders of the IntestinesDisorders of the Intestines

•• InfectionInfection–– Etiology/pathophysiologyEtiology/pathophysiology

•• Invasion of the alimentary canal by pathogenic Invasion of the alimentary canal by pathogenic microorganismsmicroorganisms

•• Most commonly enters through the mouth in food Most commonly enters through the mouth in food or wateror water

•• PersonPerson--toto--person contactperson contact•• FecalFecal--oral transmissionoral transmission•• LongLong--term antibiotic therapy can cause an term antibiotic therapy can cause an

overgrowth of the normal intestinal flora overgrowth of the normal intestinal flora ((C. difficileC. difficile))

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•• InfectionsInfections•• Clinical manifestations/assessment Clinical manifestations/assessment

••DiarrheaDiarrhea•• Nausea and vomitingNausea and vomiting•• Abdominal crampingAbdominal cramping•• FeverFever



•• Diagnostic testsDiagnostic tests•• Stool cultureStool culture

–– Medical management/nursing interventionsMedical management/nursing interventions•• AntibioticsAntibiotics•• Fluid and electrolyte replacementFluid and electrolyte replacement•• KaopectateKaopectate•• PeptoPepto--BismolBismol


•• Ulcerative colitisUlcerative colitis–– Etiology/pathophysiologyEtiology/pathophysiology

•• Ulceration of the mucosa and submucosa of the Ulceration of the mucosa and submucosa of the coloncolon

•• Tiny abscesses form which produce purulent Tiny abscesses form which produce purulent drainage, slough the mucosa, and ulcerations drainage, slough the mucosa, and ulcerations occuroccur

–– Clinical manifestations/assessmentClinical manifestations/assessment•• DiarrheaDiarrhea——pus and blood; pus and blood; 1515--20 stools per day20 stools per day•• Abdominal crampingAbdominal cramping•• Involuntary leakage of stoolInvoluntary leakage of stool

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•• Ulcerative colitis Ulcerative colitis •• Diagnostic testsDiagnostic tests

•• Barium studies, Barium studies, colonoscopycolonoscopy, stool for occult , stool for occult bloodblood

–– Medical management/nursing interventionsMedical management/nursing interventions•• MedicationsMedications

–– Azulfidine, Dipentum, Rowasa, corticosteroids, ImodiumAzulfidine, Dipentum, Rowasa, corticosteroids, Imodium

••Diet: No milk products or spicy foods; highDiet: No milk products or spicy foods; high--protein, protein, highhigh--calorie; total parenteral calorie; total parenteral nutritionnutrition



•• Ulcerative colitis Ulcerative colitis •• Medical management/nursing Medical management/nursing

interventionsinterventions•• Surgical interventionsSurgical interventions

––Colon resectionColon resection––IleostomyIleostomy

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Disorders of the IntestinesDisorders of the Intestines•• Crohn’s diseaseCrohn’s disease

–– Etiology/pathophysiologyEtiology/pathophysiology•• Inflammation, fibrosis, scarring, and thickening of Inflammation, fibrosis, scarring, and thickening of

the bowel wallthe bowel wall–– Clinical manifestations/assessmentClinical manifestations/assessment

•• Weakness; loss of appetiteWeakness; loss of appetite•• Diarrhea: 3Diarrhea: 3--4 daily; contain mucus and pus4 daily; contain mucus and pus•• Right lower abdominal painRight lower abdominal pain

••SteatorrheaSteatorrhea



Crohn’s diseaseCrohn’s disease•• Medical management/nursing Medical management/nursing

interventionsinterventions••DietDiet

––HighHigh--proteinprotein––HyperalimentationHyperalimentation––AvoidAvoidLactoseLactose--containing foods, brassica containing foods, brassica

vegetables, caffeine, beer, vegetables, caffeine, beer, monosodium glutamate, highly monosodium glutamate, highly seasoned foods, carbonated seasoned foods, carbonated beverages, fatty foodsbeverages, fatty foods

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•• Crohn’s disease Crohn’s disease •• Medical management/nursing Medical management/nursing

interventionsinterventions•• MedicationsMedications

–– CorticosteroidsCorticosteroids–– AntibioticsAntibiotics–– Antidiarrheals; antispasmodicsAntidiarrheals; antispasmodics–– EntericEnteric--coated fish oil capsulescoated fish oil capsules–– BB1212 replacementreplacement

•• SurgerySurgery–– Segmental resection of diseased bowelSegmental resection of diseased bowel



Disorders of the IntestinesDisorders of the Intestines•• AppendicitisAppendicitis

–– Etiology/pathophysiologyEtiology/pathophysiology•• Inflammation of the vermiform appendixInflammation of the vermiform appendix•• Lumen of the appendix becomes obstructed, the Lumen of the appendix becomes obstructed, the

E. coliE. coli multipliesmultiplies, and an infection develops, and an infection develops

–– Clinical manifestations/assessmentClinical manifestations/assessment•• Rebound tenderness over the right lower Rebound tenderness over the right lower

quadrantquadrant of the abdomen (McBurney’s point)of the abdomen (McBurney’s point)•• VomitingVomiting•• LowLow--grade fevergrade fever•• Elevated WBCElevated WBC

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Right lower Quadrant PainRight lower Quadrant Pain


Disorders of the IntestinesDisorders of the Intestines•• Appendicitis Appendicitis

–– Diagnostic testsDiagnostic tests•• WBCWBC•• ExEx--rayray•• UltrasoundUltrasound•• LaparoscopyLaparoscopy

–– Medical management/nursing interventionsMedical management/nursing interventions•• AppendectomyAppendectomy


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Disorders of the IntestinesDisorders of the Intestines•• Diverticular diseaseDiverticular disease

–– Etiology/pathophysiologyEtiology/pathophysiology••DiverticulosisDiverticulosis

––PouchPouch--like herniations through the like herniations through the muscular layer of the colonmuscular layer of the colon



Diverticulosis.


Diverticular diseaseDiverticular disease•• Clinical manifestations/assessmentClinical manifestations/assessment

•• DiverticulosisDiverticulosis–– May have few, if any, symptomsMay have few, if any, symptoms–– Constipation, diarrhea, and/or flatulenceConstipation, diarrhea, and/or flatulence–– Pain in the left lower quadrantPain in the left lower quadrant

••DiverticulitisDiverticulitis–– Mild to severe pain in the left lower quadrantMild to severe pain in the left lower quadrant–– Elevated WBC; lowElevated WBC; low--grade fevergrade fever–– Abdominal distentionAbdominal distention–– VomitingVomiting–– Blood in stoolBlood in stool

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•• Diverticular disease Diverticular disease •• Medical management/nursing Medical management/nursing

interventionsinterventions

••Diverticulosis with muscular Diverticulosis with muscular atrophyatrophy––LowLow--residue diet; stool residue diet; stool softenerssofteners

––BedrestBedrest


•• Diverticular diseaseDiverticular disease•• Medical management/nursing Medical management/nursing

interventions Surgeryinterventions Surgery––Hartmann’s pouchHartmann’s pouch––DoubleDouble--barrel transverse colostomybarrel transverse colostomy––Transverse loop colostomyTransverse loop colostomy


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PeritonitisPeritonitis–– Etiology/pathophysiologyEtiology/pathophysiology

•• Inflammation of the abdominal peritoneumInflammation of the abdominal peritoneum•• Bacterial contamination of the peritoneal cavity Bacterial contamination of the peritoneal cavity

from fecal matter or chemical irritationfrom fecal matter or chemical irritation

–– Clinical manifestations/assessmentClinical manifestations/assessment•• Severe abdominal pain; nausea and vomitingSevere abdominal pain; nausea and vomiting•• Abdomen is tympanic; absence of bowel soundsAbdomen is tympanic; absence of bowel sounds•• Chills; weaknessChills; weakness•• Weak rapid pulse; fever; hypotensionWeak rapid pulse; fever; hypotension


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Peritonitis Peritonitis •• Diagnostic testsDiagnostic tests

•• Flat plate of the abdomenFlat plate of the abdomen•• CBECBE

–– Medical management/nursing interventions Medical management/nursing interventions •• Position patient in semiPosition patient in semi--Fowler’s positionFowler’s position•• SurgerySurgery

–– Repair cause of fecal contaminationRepair cause of fecal contamination–– Removal of chemical irritantRemoval of chemical irritant

•• Parenteral antibioticsParenteral antibiotics•• NG tube to prevent GI distentionNG tube to prevent GI distention•• IV fluidsIV fluids


••External herniasExternal hernias–– Etiology/pathophysiologyEtiology/pathophysiology

••Congenital or acquired weakness of Congenital or acquired weakness of the abdominal wall or postoperative the abdominal wall or postoperative defectdefect––AbdominalAbdominal––Femoral or inguinalFemoral or inguinal––UmbilicalUmbilical


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•• External herniasExternal hernias•• Clinical manifestations/assessmentClinical manifestations/assessment

•• Protruding mass or bulge around the Protruding mass or bulge around the umbilicus, in the inguinal area, or near an umbilicus, in the inguinal area, or near an incisionincision

•• IncarcerationIncarceration•• StrangulationStrangulation

–– Diagnostic testsDiagnostic tests•• RadiographsRadiographs•• PalpationPalpation


•• External hernias External hernias

•• Medical management/nursing Medical management/nursing interventionsinterventions

••If no discomfort, hernia is left unrepaired, If no discomfort, hernia is left unrepaired, unless it becomes strangulated or unless it becomes strangulated or obstruction occursobstruction occurs


•• Hiatal herniaHiatal hernia–– Etiology/pathophysiologyEtiology/pathophysiology

••Protrusion of the stomach and other Protrusion of the stomach and other abdominal viscera through an opening in abdominal viscera through an opening in the membrane or tissue of the diaphragmthe membrane or tissue of the diaphragm

••Contributing factors: obesity, trauma, agingContributing factors: obesity, trauma, aging–– Clinical manifestations/assessmentClinical manifestations/assessment

••Most people display few, if any, symptomsMost people display few, if any, symptoms••Gastroesophageal refluxGastroesophageal reflux

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Hiatal hernia. A, Sliding hernia. B, Rolling hernia.


••Hiatal hernia Hiatal hernia •• Medical management/nursing Medical management/nursing

interventionsinterventions••Head of bed should be slightly elevated Head of bed should be slightly elevated

when lying downwhen lying down


•• Intestinal obstructionIntestinal obstruction–– Etiology/pathophysiologyEtiology/pathophysiology

•• Intestinal contents cannot pass through the GI Intestinal contents cannot pass through the GI tracttract

•• Partial or completePartial or complete•• MechanicalMechanical•• NonNon--mechanicalmechanical

–– Clinical manifestations/assessmentClinical manifestations/assessment•• Vomiting; dehydrationVomiting; dehydration•• Abdominal tenderness and distentionAbdominal tenderness and distention•• ConstipationConstipation

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•• HemorrhoidsHemorrhoids–– Etiology/pathophysiologyEtiology/pathophysiology

•• Varicosities (dilated veins)Varicosities (dilated veins)–– External or internalExternal or internal

•• Contributing factorsContributing factors–– Straining with defecation, diarrhea, pregnancy, CHF, Straining with defecation, diarrhea, pregnancy, CHF,

portal hypertension, prolonged sitting and standingportal hypertension, prolonged sitting and standing

–– Clinical manifestations/assessmentClinical manifestations/assessment•• Varicosities in rectal areaVaricosities in rectal area•• Bright red bleeding with defecationBright red bleeding with defecation•• PruritusPruritus•• Severe pain when thrombosedSevere pain when thrombosed



•• Hemorrhoids Medical Hemorrhoids Medical management/nursing interventionsmanagement/nursing interventions

•• Bulk stool softeners; hydrocortisone creamBulk stool softeners; hydrocortisone cream•• Analgesic ointmentAnalgesic ointment•• Sitz bathsSitz baths•• LigationLigation•• Sclerotherapy; cryotherapySclerotherapy; cryotherapy•• Infrared photocoagulationInfrared photocoagulation•• Laser excisionLaser excision•• HemorrhoidectomyHemorrhoidectomy

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The End The End

gastrointestinal updated version - napavalley.edu 150 PowerPoint...•Stool culture – Medical ... –Double-barrel transverse colostomy ... Microsoft PowerPoint - gastrointestinal

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