Disorders of the Digestive System

1. Disorders of the Digestive System Cathy Gibbs BSN, RN

2. Disorders of the Digestive System • Sources of digestive problems • Mechanical • Nervous • Chemical • Hormonal

3. Eating Disorders • Anorexia • Chronic loss of appetite • Possible emotional, social factors • Anorexia Nervosa • Psychological disorder • Bulimia • Binge-purge syndrome

4. Causes of Anorexia • Anxiety, depression • Improper fit of dentures • Illness, physical discomfort • Constipation • Intestinal obstruction

5. Anorexia, Nursing Implementation • Become familiar with patients eating habits • Permit patient to choose own food • Don’t force patient to eat • Provide pleasant environment • Serve small portions

6. Dental Plaque and Caries • Erosive process that dissolves tooth enamel • Medical management • Removal of affected area and replace with dental material • Dental check ups • Fluoridated water • Nursing interventions • Teach patient oral care • Diet changes

7. Gingivititis • Inflammation of the gums • Symptoms • Bleeding, swollen, tender gums • Difficulty chewing • Causes • Accumulation of food between teeth • Vitamin deficiency • Anemia • Leukemia • Prevention • Brushing teeth & gums • Daily flossing • Adequate diet

8. Periodontitis • Untreated Periodontitis • Teeth loosen • Spreads to mandible • Prevention • Impeccable tooth & gum • Regular flossing • Adequate diet • Treatment • Drainage of abscess • Antibiotics • Extraction

9. Recurrent Aphthous Stomatitis • Multi system disorder • Painful ulcers • Mouth • Genitals • Uveal tract of the eye • Causes • Viruses, bacteria, fungus • Chemotherapy • Vitamin deficiency • Four Forms • Minor Type • Canker sores • Lesions are 2- 4 mm in diameter • Usually fewer than 5 in number

10. Recurrent Aphthous Stomatitis • Major Aphthous Stomatitis • Referred to as “Sutton’s disease” • 10 mm or greater in diameter • They frequently occur in the posterior portion of the mouth • Take four to six weeks to heal • These lesions may result in scarring • Herpetiform • Confused with herpes • Numerous, 1-2 mm ulcers, cropped together • When the neutrophil count returns to normal the lesions resolve

11. Recurrent Aphthous Stomatitis • Fourth form is known as Behçet's disease • Complex multi-system disorder including • Synovitis • Uveitis • Vasculitis • Meningoencephalitis • Oral and/or genital mucosa are the first manifestation • It is a rare, non-infectious disease • Very uncommon in North America and Europe • Half of the patients have evidence of immune dysfunction

12. Recurrent Aphthous Stomatitis • Immune Dysfunction seen with Behçet's disease • 5-20% of Crohn's patients develop disease • Ulcerative colitis • Malabsorption syndromes • Gluten-sensitive enteropathy • HIV infection • The lesions appear to be more severe, more painful and deeper • Cyclic neutropenia

13. Behcet’s

14. Herpes Simplex Virus • Acute viral infection • Two strains of herpes simplex virus • HSV-1 “Common cold sore” • Forms clusters of fluid filled blisters • HSV-2 • Sexually transmitted • Can develop in and around the mouth or genitals • Shingles • Form along nerve path

15. Candidiasis • Etiology/Pathophysiology • Fungus normally present in the mouth, intestine, vagina, and on the skin • Also referred to as thrush and moniliasis • Clinical manifestations/assessment • Small pearly-white patches on the mucous membrane of the mouth • Thick white discharge from the vagina

16. Candidiasis • Causes • Cancer • Diabetes • Alcoholism • Treatment • Nystatin • Gentician Violet • OTC medications • Nursing care • Good hand washing • Bland or soft food for patient • Oral care • Education on medication administration

17. Mumps • Contagious viral infection of parotid salivary glands • Possible complications • Inflammation of testicles • Sterility in males • MMR vaccine

18. Achalasia • Etiology/Pathophysiology • LES cannot relax (cardiospam) • Causes decreased motility of the lower portion of the esophagus • Absence of peristalsis and dilation of the lower portion of the esophagus • Decreased amount or no food can enter the stomach • The esophagus can hold as much as a liter • Possible causes • Nerve degeneration, esophageal dilation, and hypertrophy • Disruption of the normal neuromuscular activity of the esophagus

19. Achalasia • Clinical manifestations/Assessment • Dysphagia-PRIMARY SYMPTOM • Regurgitation of food • Substernal chest pain • Loss of weight • Weakness • Poor skin turgor

20. Achalasia • Diagnostic tests • Radiologic studies- Esophagoscopy • Medical management • Medications: anticholinergics, nitrates, and calcium channel blockers • Dilation of cardiac sphincter • Surgery-Cardiomyectomy

21. Gastroesophageal Reflux Disease (GERD) • Etiology/Pathophysiology • Backward flow of gastric acid into the esophagus • Reduced LES pressure • Clinical manifestations • Pain may mimic angina • Heartburn (pyrosis) 20 min – 2 hrs after eating • Regurgitation • Dysphagia or odynophagia (painful swallowing) • Eructation (belching) • Cough • Wheezing • Hoarseness

22. Gastroesophageal Reflux Disease (GERD) • Risk factors • Alcohol, tobacco, & smoking • Delayed gastric motility • Diagnostic tests to differentiate GERD from angina • Esophageal motility • Bernstein tests evaluate LES function • pH monitoring for 24 hours to record reflux episodes • Barium swallow & endoscopy to evaluate for hiatal hernia

23. Gastroesophageal Reflux Disease (GERD) • Medical management & Nursing interventions • Antacids or acid-blocking medications • Diet • 4-6 small meals/day • Low fat, adequate protein • Remain upright for 1-2 hours after eating • Lifestyle • Eliminate smoking • Avoid constrictive clothing • HOB up at least 6-8 inches for sleep

24. Barrett’s Esophagus • Etiology/Pathophysiology • Cells in esophagus change to cells normally found in the intestine (metaplasia) • Patients feel less discomfort as metaplastic cells are less sensitive • Can’t cure, treat GERD • Medications • Antacids • GI stimulants • Histamine H2 antagonists • Proton pump inhibitors • Surgery • Fundoplication

25. Acute Gastritis • Etiology/Pathophysiology • Inflammation of the lining of the stomach • Associated with • Alcoholism & smoking • Bacteria & viruses • Chemical toxins • Stressful physical problems • Clinical manifestations • Fever • Headache • Epigastric pain • Nausea and vomiting • Coating of the tongue • Anorexia

26. Acute Gastritis • Long term • Changes in the mucosal lining that interferes with acid and pepsin secretion • Gastritis usually resolves once the offending agent is removed • Diagnostic tests • Stool for occult blood • WBC • Electrolytes

27. Acute Gastritis • Medical management • Antiemetics • Antacids • Antibiotics • IV fluids • NG tube • Nutritional Supplementation • Administration of blood • NPO until signs and symptoms subside

28. Nausea • Etiology/Pathophysiology • Feeling the urge to vomit • May occur independently or precede vomiting • Specific neural pathways not identified • Probably controlled by parts of brain that control involuntary bodily functions • Signs and symptoms • Increased salivation • Diminished functional activities of the stomach • Altered small intestine motilility

29. Vomiting • Etiology/Pathophysiology • Forceful expulsion of gastric contents • Increased intrathoracic pressure • Increased intracranial pressure • Controlled by • Vomiting center (medulla) • Initiates vomiting when stimulated • Chemo-receptor trigger zone • Must be stimulated by a drug or toxin

30. Causes of Nausea & Vomiting • Stress, fear, and depression • Pain • Acute febrile illness • Medications • Food poisoning • Anesthesia • Diseases of the stomach • Intestinal obstruction • Pregnancy • Head injury

31. Nursing Implementation for Nausea & Vomiting • Administer antiemetics • Monitor fluid & electrolyte replacement • Protect patient from unpleasant sight or smells • Attempt to keep stomach empty • Ventilate room • Observe & record the character and quantity of emesis

32. Peptic Ulcers (PUD) • Gastric ulcers and duodenal ulcers • Ulcerations of the mucous membrane or deeper structures of the GI tract • Most commonly occur in the stomach and duodenum • Result of acid and pepsin imbalances • Chronic NSAID use • H. pylori • 70% of patients with gastric ulcers • 95% of patients with duodenal ulcers

33. Peptic Ulcers (PUD) • Gastric ulcer • In the distal half of the stomach • Bleed more, harder to control • Duodenal ulcers • May or may not be caused by hypersecretion of gastrin • Ulceration occurs when the acid secretion exceeds the buffering factors • More likely to have chronic bleeding and perforate

34. Peptic Ulcers (PUD)

35. Peptic Ulcers (PUD) • Clinical manifestations • Pain: Dull, burning, boring, or gnawing, epigastric • Dyspepsia • Hematemesis • Melena • Diagnostic tests • Esophagogastroduodenoscopy (EGD) • Breath test for H. pylori

36. Peptic Ulcers (PUD) • Complications of peptic ulcers • Bleeding • Hematemesis • Melena • Gastric outlet obstruction

37. Peptic Ulcers (PUD) • Diagnosis • Esophagogastroduodenoscopy (EGD) • Visualize tissue and Biopsy if necessary • Wireless capsule endoscope • Complications • Stool impaction • Small bowel stricture

38. Peptic Ulcers (PUD) • Medical management/Nursing interventions • NG tube until bleeding subsides • Antacids • Histamine H2 receptor blockers • Proton pump inhibitor • Mucosal healing agents • Antibiotics • Anticolingerics • Reclining for 1 hour post meal • IV fluid • Diet • High in fat and carbohydrates • Low in protein and milk products • Small frequent meals • Limit coffee, tobacco, alcohol, and NSAID use

39. Peptic Ulcers (PUD) • Medical management/Nursing interventions • Surgery • Antrectomy- • Gastrodudodenostomy (Billroth I) • Gastrojejunostomy (Billroth II) • Total gastrectomy • Vagotomy • Pyloroplasty

40. Types of gastric resections with anastomoses. A, Billroth I. B, Billroth II.

41. Peptic Ulcers • Complications after gastric surgery • Dumping syndrome • Eat 6 small meals a day high in protein and carbohydrates • Eat slowly and avoid fluid with meals • Pernicious anemia • Iron deficiency anemia

42. Diarrhea • Rapid movement through intestines of loose, watery stools resulting from increased peristalsis • Causes: • Fecal impaction • Ulcerative colitis • Intestinal infections • Drugs

43. Diarrhea • Nursing implications • Meticulous skin care • Observe stool for color, odor, consistency, mucous, blood, or pus • Administer anticholinergics • Reduce bowel spasticity • Administer anti-diarrheal agents • Mild diarrhea • Moderate diarrhea • Severe diarrhea (infectious agent)

44. Constipation • Etiology/Pathophysiology • Fecal mass in rectum • Water is absorbed and feces hardens • Painful to pass • Causes • Neurological conditions • Disease • Medications • Diet • Decreased activity • Ignoring the urge to defecate • Chronic laxative use

45. Constipation • Clinical manifestations/Assessment • Abdominal distention • Indigestion • Rectal pressure • Hard, dry stools • Decrease appetite • Rectal pressure • Intestinal rumbling

46. Constipation • Complications • Fecal impaction • Cardiac complications from straining • Dilation of colon (Megacolon) • Colonic mucosal atrophy • Fecal incontinence

47. Constipation • Treatment • High fiber diet • 2-3 liters of fluid a day • Strengthening of abdominal muscles • Behavior changing • Diet • Whole grains • Fresh fruits • Vegetables

48. Constipation • Medications • Bulk forming agents • Absorb fluid and swell in the intestine and increase peristaltic action • Laxatives • Bulk forming, stool softeners, stimulant, and saline • Stool softeners • Detergent like drugs that permit easier penetration and mixing of fats and fluids with the fecal mass • Stimulant • Increase the motility of GI tract by chemical irritation of the intestinal mucosa • Golytely • Causes a large volume of water to be retained in the colon • Results in diarrhea within 30-60 minutes

49. Constipation • Enemas • Instilled directly into the lower colon • Retained in bowel • Cleansing • Types of enemas • Tap water • Saline • Soap • Oil • Medicated

50. Infection • Etiology/Pathophysiology • Invasion by pathogenic microorganisms • Person-to-person contact • Fecal-oral transmission • Long-term antibiotic therapy • Clinical manifestations • Rectal urgency • Tenesmus • Nausea, vomiting & diarrhea • Abdominal cramping • Fever