Other GI Disorders

1. Other GI Disorders NPN 200 Medical Surgical Nursing I

2. Diverticulosis / Diverticulitis • Bulging pouches (diverticuli) found n the GI wall • Most common site is the sigmoid colon but can develop anywhere • Mickel’s diverticulum is a congenital disease found in the ilium, and is trhe most common GI congenital disease • 2 forms – diviterculitis and diverticulosis

3. Diverticulosis / Diverticulitis • Diverticulosis • Diverticuli present, but no symptoms • Possibly asymptomatic • Usually occurs before age 35 • May have change in bowel habits • Might exhibit bleeding, pain in lower abd, N/V, or urinary problems

4. Diverticulosis / Diverticulitis • Diverticulitis • Diverticular are inflamed and may cause svere obstruction, infection, or hemorrhage • Retained, undigested food mixing with bacteria may cause a large mass • Blood supply is cut off • Inflammation results • Condition usually occurs between 50-70 years of age, and may result in spasms, obstruction and hemorrhage • Inflamed colon may result in fistula formation to the bladder or other organs

5. Diverticulosis / Diverticulitis • Complications • Bleeding • Rupture • Peritonitis • Fistula formation

6. Diverticulosis / Diverticulitis • Diagnosis • Based on symptoms • Occult blood • ABD CT and barium enema • Medical treatment • High residue diet, without spicy foods • Stool softeners • Analgesics, no opioids • Antibiotics • If acute problems may need NPO, fluids and NG • Temporary colostomy may be needed to rest bowel 0r colon resection

7. Diverticulosis / Diverticulitis • Symptoms – may have none unless acute • Recurrent constipation/diarrhea • Pain • Bleeding • Nausea • Vomiting if obstruction is present • Low grade fever • Increased WBC • If rupture – rigid abd, pain, signs of sepsis, hemorrhage, absent bowel sounds, N/V

8. Diverticulosis / Diverticulitis • Nursing care • Dietary management • Analgesics • Stool softeners • Vitals • Monitor stools • Antibiotics • Prepare for surgery

9. Anal Fissure and Fistula • Fissure - a tear between the anus and the perianal area • Related to S/S • Constipation bleeding, pain • Diarrhea • Trauma , childbirth • Treatment • Sitz baths • Stool softeners • Pain RX

10. Anal Fissure and Fistula • Fistula – abnormal opening between anus or bowel, which connects to another area. • Can be between the anal canal and the perianal tissue or can occur between the bowel and the bladder • Most serious if the bowel and bladder • Causes chronic UTI • If simple, sitz baths and pain RX or may need colostomy to relieve problem

11. Anorectal Abscess • Infection of tissue around the anus • S/S – rectal pain, swelling and redness • Treated with antibiotics • May require surgery to remove • Very painful • Post-op • Sitz baths • Pain RX • Ice packs • Cleansing after BM

12. Cystocele and Rectocele • Vaginal disorders caused by weakness in the vaginal walls between the vagina and the bladder or the vagina and the rectum • Bulging is visible and palpable • Caused by pregnancy and childbirth • Large ones may cause difficulty in emptying the bowel or bladder • May also cause leakage , stress incontinence, incomplete bladder emptying. • Can perforate the vaginal wall

13. Cystocele and Rectocele • Treatment • Small – Kegel exercises, estrogen replacement to improve tone of vagina • Large – surgery • A & P repair ( anterior and posterior colporrhaphy) • Risk of vaginal stenosis,

14. Cystocele and Rectocele • Nursing care • Teaching Kegel’s • Stool softeners • Surgical teaching • Post op care • Perineal care – hot and cold to relieve pain • Self cath • Low residue diet • Avoid sexual intercourse for a time • May need to use vaginal dilators