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2. Acute Gastritis. Causes: 1. Eating too much or too rapid. 2. Eating contaminated foods. 3. Alcohol, NSAID, and bile reflux.Clinical Manifestations: 1. Abdominal discomfort. 2. Nausea, vomiting, and anorexia. 3. Headache. 4. Hiccuping. . 3. Acute Gastritis (cont'd). Manageme
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1. 1 Chapter 5 Nursing Care of Patients With Digestive & Gastrointestinal Disorders
2. 2 Acute Gastritis Causes:
1. Eating too much or too rapid.
2. Eating contaminated foods.
3. Alcohol, NSAID, and bile reflux.
Clinical Manifestations:
1. Abdominal discomfort.
2. Nausea, vomiting, and anorexia.
3. Headache.
4. Hiccuping.
3. 3 Acute Gastritis (cont’d) Management:
1. The patient usually recovers within few days
spontaneously.
2. If bleeding present, it needs surgery.
4. 4 Chronic Gastritis Causes:
1. Benign or malignant ulcers of stomach.
2. Bacteria Helicobacter Pylori (H. Pylori).
3. Smoking and alcohol.
Diagnostic Investigation:
1. Upper GIT endoscopy and biopsies.
2. Serologic testing for H. Pylori antigen- antibodies.
5. 5 Chronic Gastritis (cont’d) Clinical Manifestations:
1. Heart burn after eating.
2. Anorexia, nausea and vomiting.
3. Sour taste in the stomach.
4. Belching.
5. Vitamin B12 deficiency.
Medical Management:
1. No irritating diet.
2. Antibiotics.
3. Vit. B12 IM injection.
6. 6 Chronic Gastritis (cont’d) Nursing Management:
1. Stress reduction techniques.
2. Promoting optimal nutrition:
a. Keep patient NPO.
b. When the symptoms subside , offer ice chips
followed by clear fluid diet then regular diet.
3. Promoting fluid and electrolytes balance.
4. Relief pain:
a. Avoid irritating foods.
b. Discourage smoking and alcohol.
7. 7 Gastric & Duodenal Ulcers Peptic ulcer is excavation in mucosal wall of stomach, pylorus, duodenum, or esophagus.
Causes:
1. Result from infection with H. pylori or Zollinger-
Ellison syndrome.
2. Stress ulcer caused by stressful event such as:
a. Burns.
b. Shock.
c. Sever sepsis.
8. 8 Gastric & Duodenal Ulcers (cont’d) Predisposing Factors:
1. Heredity.
2. Blood group O.
3. Smoking and alcohol.
4. Long use of NSAIDs.
5. Anxiety.
Clinical Manifestations:
1. Epigastric pain or in the back.
2. Vomiting ( in duodenal ulcer).
3. Constipation.
4. Bleeding.
9. 9 Gastric & Duodenal Ulcers (cont’d) Medical Management:
1. Smoking cessation encouraged.
2. Medications:
a. Histamine receptor antagonists ( H2 receptor
antagonist); ranitidine.
b. Proton pump inhibitors; (Omeprazole)
c. Antibiotics.
3. Surgical intervention is recommended for intractable
ulcers( those who fail to heal after 12-16 weeks).
Vagotomy, Pyloroplasty, Partial or total
gastroectomy.
10. 10 Gastric & Duodenal Ulcers (cont’d)
11. 11 Gastric & Duodenal Ulcers (cont’d)
12. 12 Gastric & Duodenal Ulcers (cont’d)
13. 13 Gastric & Duodenal Ulcers (cont’d) Nursing Management:
1. Preoperative care;
a. preparing patient for diagnostic procedures.
b. Limiting oral intake.
c. Clearing and emptying the GIT.
- NGT inserting.
- Mechanical (Gumco) and manual /2hrs suctioning.
- enema for emptying colon.
2. Monitoring and managing complications of
hemorrhage, perforation, and pyloric obstruction.
14. 14 Gastric Cancer Causative Factors:
1. Heredity.
2. Gastric ulcers.
3. Pernicious anaemia.
4. Chronic gastritis.
5. Foods lacking fruits and vegetables.
Clinical Manifestations:
1. Indigestion, abdominal pain.
2. Anorexia, weight loss.
3. Anaemia, constipation.
15. 15 Gastric Cancer (cont’d) Diagnostic Evaluation:
1. Endoscopy and biopsy.
2. Barium swallow.
3. CT scan to the other organs to evaluate the extent of
the metastasis.
Medical Management:
1. Surgical removal of tumour.
2. Chemotherapy.
3. Radiotherapy.
16. 16 Gastric Cancer (cont’d) Nursing Management:
1. Providing optimal nutrition.
a. Provide small frequent diet (nonirritating)
b. Supplements high calories, high vitamin A, C and
iron diet.
c. Intake and output monitoring and weight daily.
d. Administer B12 IM inj. If total gastrectomy
performed.
2. Relief of pain.
a. Pharmacologic (analgesics, opiods in severe pain)
b. Non pharmacologic (relaxation techniques)
3. Psychosocial support.
17. 17 Hepatic Dysfunction Clinical Manifestations:
1. Jaundice- hemolytic, hepatocellular, obstructive, and
hereditary hyperbilirubinemia.
2. Portal hypertension.
3. Esophageal varices.
4. Ascites.
Hepatitis refers to inflammation of the liver.
18. 18 Hepatic Dysfunction (cont’d)
19. 19 Hepatitis (cont’d) Hepatitis Causes:
1. Infection.
2. Chemical.
3. Radiation.
Viral Hepatitis:
1. Hepatitis A Virus (HAV)
2. Hepatitis B Virus (HBV)
3. Hepatitis C Virus (HCV)
4. Hepatitis D Virus (HDV)
5. Hepatitis E Virus (HEV)
20. 20 Hepatitis (cont’d) Hepatitis A Virus (HAV)
- Transmitted through faecal- oral route.
- Incubation period: 1-7 weeks.
- Prognosis: rarely progress to acute liver necrosis or death. No carrier state exists.
Hepatitis B Virus (HBV)
- Transmitted through blood.
- Incubation period: 4-12 weeks.
21. 21 Hepatitis (cont’d) - Prognosis:
a. Mortality rate is 10%.
b. 10% of patients progress to carrier state or chronic
hepatitis.
c. It is the main cause of cirrhosis and hepatocellular
carcinoma.
- Signs & symptoms:
a. Jaundice, abdominal pain.
b. Fever, loss of appetite.
22. 22 Hepatitis (cont’d) - Prevention:
a. Preventing transmission.
b. Active immunization (hepatitis B vaccine)
c. Passive immunity (hepatitis B immune globulin)
Hepatitis C Virus (HCV)
- Transmitted through blood, needles, sharp objects.
- Incubation period: 15-160 days.
- Signs & symptoms are similar to HBV.
- Prognosis:
a. Liver cirrhosis and cancer.
b. Chronic carrier state occurs frequently.
23. 23 Hepatic Encephalopathy and Coma
Results from accumulation of ammonia and other toxic metabolites in the blood.
Hepatic coma represents most advanced stage of hepatic encephalopathy.
Clinical manifestations:
1. Mental changes.
2. Motor disturbances.
3. Asterixis.
4. Constructional apraxia.
24. 24 Cholecystitis & Cholelithiasis Inflammation of gallbladder and stone formed in the gallbladder.
Clinical Manifestations:
1. Changes in the urine and stool colour.
2. Fat soluble vitamin deficiency.
3. Pain and billiary colic.
4. Jaundice.
Diagnostic Evaluation:
1. Abdominal X ray.
2. Ultrasonography.
25. 25 Cholecystitis & Cholelithiasis (cont’d) Medical Management:
1. Medications to dissolve stone.
2. Antibiotics.
3. Removal of gallbladder (cholecystectomy)
Nursing Management:
1. Provide rest.
2. NG suctioning.
3. Provide low fat diet.
4. Provide pre & post op. care.
26. 26 Appendicitis Appendicitis is an inflammation of appendix.
Causes:
1. Kinking.
2. Occlusion.
Clinical Manifestations:
1. Right lower quadrant pain.
2. Nausea, vomiting and anorexia.
3. Lower grade fever.
4. Rebound tenderness.
27. 27 Appendicitis (cont’d) Diagnostic Evaluation:
1. CBC (WBCs > 10,000/mmł)
2. X-ray and abdominal ultrasound.
Medical Management:
1. IV fluids and antibiotics.
2. Surgical removal of appendix (appendectomy)
Nursing Management:
Pre & postoperative patient care (see chapt. 1)
28. 28 Haemorrhoids Haemorrhoids are dilated portions of veins in the anal canal.
Causes:
1. Pregnancy.
2. Obesity.
3. Chronic constipation.
4. long sitting or standing.
Clinical Manifestations:
1. Itching and pain with defecation.
2. Bright red bleeding with defecation.
29. 29 Haemorrhoids (cont’d) Medical Management:
Surgical removal of haemorrhoids (haemorrhoidectomy)
Nursing Management:
1. Provide high fibers diet and increase fluids intake.
2. Administer stool softeners, analgesics as prescribed.
3. Provide sitz baths or warm compresses.
4. Instruct the patient to do proper personal hygiene and
to avoid excessive straining during defecation
