GASTROINTESTINAL SYSTEM  Physical assessment

 Oral cavity inspection and palpation

Three Phases of Gastric Secretion  Lips
1) Cephalic Phase  Gums
 Tongue
 Abdominal inspection, auscultation, palpation and
percussion
 Rectal inspection and palpation

DIAGNOSTIC EXAMS
 SERUM LABORATORY STUDIES
 CBC, PT, aPTT
 Liver functions tests
 Amylase, lipase
 CEA

1. FECALYSIS
2) Gastric Phase  inspecting the specimen for consistency, color,
occult not visible blood
 Random specimen should be sent promptly to the
laboratory for the analysis .
 A careful assessment of the patient’s diet and
medication regimen is essential to avoid incorrect
interpretation of results.
 Examination of stool consistency, color and the
presence of occult blood.
 Special tests for fat, nitrogen, parasites, ova,
pathogens and others
 Test for ova- fresh stool
 Test for lipids- no alcohol 3 days prior
 72 hr stool specimen- store in ice
3) Intestinal Phase no mineral oil, no neomycin SO4
Occult Blood Testing
 3-day meatless diet
 No intake of NSAIDS, aspirin, iron, steroids & anti-
coagulant 48 Hrs prior
 3 stool specimen
 Screening test for colonic cancer

2. BREATH TESTS
 The hydrogen breath test was developed to
evaluate carbohydrate absorption in addition, to
aiding in the diagnosis of bacterial overgrowth
intestine and in the short bowel syndrome.
 UREA BREATH TEST detect the prescience of
Helicobacter pylori, the bacteria that can live in
ASSESSMENT
 the mucosal lining of the stomach and cause  Because the adequacy of detail in the test depends
peptic ulcer disease. on the prescience of fat this diagnostic tool is not
INTERVENTIONS: useful for very thin and cachetic patients.
 After The patient ingests a capsule of carbon INTERVENTIONS:
labeled urea a breath sample is obtained 10 to 20  CT maybe performed with or without oral or
minutes later. intravenous contrast, but the enhancement of the
 The patient is instructed to avoid antibiotics or study is greater with the use of a contrast agent.
loperamide for 1 month before the tests,  Patients allergic to the contrast agent may be
sucralfate and omeprazole for 1 week before the premedicated with IV prednisone 24 hours, 12
tests and cimetidine, famotidine and ranitidine for hours, and 1 hour before the scan.
24 hours before the tests.  Both sodium bicarbonate or mucomyst are free
radical scavengers that sequester the contrasts
3. IMAGING STUDIES byproducts that are destructive to renal cells.
 Numerous minimal invasive and noninvasive
imaging studies including x-ray and contrast MAGNETIC RESONANCE IMAGING-
studies, computed tomography, three dimensional  It is used in gastroenterology to supplement
CT, magnetic resonance imaging, positron ultrasonograpy and CT.
emission tomography, and scintigraphy and virtual  The use of the oral contrast agents to enhance the
colonoscopy are available today. image has increased the application of this
ABDOMINAL ULTRASONOGRAPY technique for the diagnosis of the GI diseases.
 Ultrasonograpy is a noninvasive diagnostic NURSING MANAGEMENT:
technique in which high frequency sound waves  Pre-study patient education includes NPO status 6
are passed into internal body structures and the to 8 hours before the study and removal of all
ultrasonic echoes are recorded on an oscillascope jewelry and other metals.
as they strike tissues of different densities.  The close fitting scanners used in many MRI’s
 Advantages of the abdominal ultrasonograpy facilities may induce feelings of claustrophobia and
include an absence of ionizing radiation, non- the machine will make a knocking sound during
noticeable side effects, relatively low costs, and the procedure.
immediate results.  Open MRI’s that are less close fitting eliminate the
INTERVENTIONS: claustrophobia that many patients experience.
 The patient is instructed to fast for 8 to 12 hours
before the test to decrease the amount of gas in
the bowel. POSITRON EMISSION TOMOGRAPHY
 If gallbladder studies are being preformed the  PET scans produce images of the body by
patient should eat a fat free meal the evening detecting the radiation emitted from the
before the tests. radioactive substances.
 If barium studies are to be preformed they should  The atoms decay quickly do not harm the body
be schedule after ultrasonography otherwise the have lower radiation levels than a typical x-ray or
barium could interfere with the transmission of CT scan and are eliminated in the urine or feces.
the of the sound waves.  The scanner essentially captures where the
radioactive substances are in the body , transmits
COMPUTED TOMOGRAPHY the information to a scanner and produce a scan
 CT provides cross sectional images of abdominal with “hot spots” for evaluation by the radiologists
organs and structures. or oncologists.
 As the sensitivity and specificity of CT have  SCINTIGRAPHY
increased in recent years so has its use.  Radionuclide testing relies on the use of
radioactive isotopes technetium, iodine, and
 indium to reveal displaced anatomic structures,  After ingestion of the meal, the patient is
changes in organ size, and the presence of positioned under a scintiscanner which measures
neoplasm or other fecal lesions, such as cysts and the rate of passage of the radioactive substance
abscess. from the stomach.
 Tagging of red blood cells and leukocytes by  Colonic transits studies are used to evaluate
injection of a radionucleotide is performed to colonic motility and obstructive defecation
define areas of inflammation, abscess, blood loss syndromes.
or neoplasm.  Abdominal x-rays are taken every 24 hours until all
markers are passed.
4. UPPER GASTROINTESTINAL TRACT STUDY
 Barium swallow 7. UPPER GASTROINTESTINAL FIBROSCOPY
 An upper GI fluoroscopy delineates the entire GI  Fibroscopy of the upper GI tract allows direct
tract after the introduction of a contrast agent. visualization of the esophageal, gastric, and
 The GI series enables the examiner to detect or duodenal mucosa, through a lighted endoscope.
exclude anatomic or functional disorders of the  This procedure also can be used to evaluate
upper GI organs or sphincters. esophageal and gastric motility and to collect
 Pre-test: NPO post-midnight secretions and tissue specimen for further
 Post-test: Laxative is ordered, increase pt fluid analysis.
intake, instruct that stools will turn white, monitor EGD
for obstruction  Pre-test: ensure consent, NPO 8 hours, pre-
INTERVENTIONS: medications like atropine and anxiolytics, remove
 Education regarding dietary changes prior to the dentures, local spray to post. Pharynx-advise not
study should include a clear liquid diet with to swallow
nothing by mouth from midnight the night before  Intra-test: position : LEFT lateral to facilitate
the study however each physician may prefer a salivary drainage and easy access
specific bowel preparation for specific studies.  Post-test: NPO until gag reflex returns, place
 Typically oral medications are with held on the patient in SIMS position until he awakens, monitor
morning of the study and resumed that evening for complications, saline gargles for mild oral
but each patient’s medication regimen should be discomfort
elevated on an individual basis. NURSING MANAGEMENT
 The patient should be NPO for 8 hours prior to the
5. LOWER GASTROINTESTINAL TRACT STUDY examination.
 Barium enema  Midazolam a sedative that drives moderate
 Visualization of the lower GI tract is obtained after sedation and relieves anxiety during the procedure
rectal instillation of barium. may be administered.
 After proper preparation and evacuation of the  The patient is positioned in the left lateral position
entire colon each portion of the colon may be to facilitate clearance of pulmonary secretions and
readily observed. provide smooth entry of the scope.
 Pre-test: Clear liquid diet and laxatives, NPO post-
midnight, cleansing enema prior to the test 8. FIBEROPTIC COLONOSCOPY
 Post-test: Laxative is ordered, increase patient  Historically, direct visualization of the bowel was
fluid intake, instruct that stools will turn white, only means to evaluate the color, but virtual
monitor for obstruction colonoscopy also known as CT colonoscopy has
brought a more patient friendly approach to this
6. GASTROINTESTINAL MOTILITY STUDIES study.
 Radionuclide testing also used to assess gastric  Direct visual inspection of the large intestines
emptying and colonic transit time. anus, rectum, sigmoid, transcending, and
 ascending colon is possible by means of a flexible 11. ENDOSCOPY THROUGH OSTOMY
fiberoptic colonoscope.  Endoscopy through an ostomy stoma is useful for
 Still and video recordings can be used to document visualizing a segment of the small and large
the procedure and findings. intestine and may be indicated to evaluate the
NURSING MANAGEMENT: anastomosis for recurrent disease or to visualize
 The success of the procedure depends on how and treat bleeding in a segment of the bowel.
well the colon is prepared and on adequate
sedation. 12. MANOMETRY AND ELECTROPHYSIOLOGIC STUDIES
 Pre-test: consent, clear liquids 24 hrs,NPO 8 hours,  Manometry and electrophysiologic studies are
cleansing enema until return is clear methods for evaluating patients with GI motility
 Intra-test: position is LEFT lateral, right leg is bent disorders.
and placed anteriorly  Esophageal manometry is used to detect motility
 Post-test: supine for few minutes to prevent disorders of the esophagus and the upper and
orthostatic hypotension, bed rest, monitor for lower esophageal sphincters.
complications like bleeding and perforation  The patient must refrain from eating and drinking
for 8 to 12 hours before the test.
9. ANOSCOPY, PROCTOSCOPY, SIGMOIDOSCOPY  A pressure sensitive catheter is inserted through
 Endoscopic examination of the anus, rectum, and the nose and is connected to a transducer and a
sigmoid and descending colon is used to evaluate video recorder.
chronic diarrhea, fecal incontinence, ischemic
colitis, and lower GI hemorrhage and to observe 13. GASTRIC ANALYSIS, GASTRIC ACID STIMULATION
for ulceration, fissures and abscesses, tumors, TEST, PH MONITORING
polyps or other pathologic processes.  Analysis of the gastric juice yields information
 The flexible fiberoptic sigmoidoscope permits the about the secretory activity of the gastric mucosa
colon to be examined up to 40 to 50cm from the and the presence or degree of gastric retention in
anus much more than the 25cm that can be patients thought to have pyloric or duodenal
visualized with the rigid sigmoidoscope. obstruction.
NURSING MANAGEMENT:  The patient is NPO for 8-12 hours before the
 These examination required only limited bowel procedure.
preparation including a warn tap water or Fleet’s  Smoking is not allowed in the morning of the test
enema until returns are clear. because its increases gastric secretions.
 During the procedure the nurse monitors vital
sign, skin color, and temperature, pain tolerance 14. LAPAROSCOPY
and vagal response.  With the tremendous advancement in minimal
 On completion of the examination the patient can invasive surgery, diagnostic laparascopy is
resume his or her regular activities and diet. efficient, cost effective and useful in the diagnosis
of the GI disease.
10. SMALL BOWEL ENTEROSCOPY  This permit directs visualization of the organs and
 There are several methods available for structures within the abdomen, permitting
visualization of the small intestine, including visualization and identification of any growths,
capsule endoscopy and double balloon endoscopy. anomalies, and inflammatory processes.
 It is particularly useful in the evaluation of obscure  This procedure can be used to evaluate peritoneal
gastrointestinal bleeding. disease, chronic abdominal pain, abdominal
 The capsule is the size of a large vitamin pill 26mm masses, gallbladder and liver disease.
long, 11mm wide, 3.7grams in weight.
 Images are transmitted from the end of the
capsule to a recording device worn on a belt.
 DISORDERS OF THE TEETH  Malocclusion makes the teeth difficult to clean and
1. PLAQUE AND CARIES can lead to decay, gum disease and excess wear
 Tooth decay is an erosive process that begins with on supporting gum and bone tissues.
action of bacteria on fermentable carbohydrates in MEDICAL MANAGEMENT:
the mouth which produces acids that dissolves  People with malocclusion have an obviously
tooth enamel. misaligned bite or crocked, crowded, widely
 Mouth care spaced, or protruding teeth.
 Diet  Braces may be unattractive but this psychological
 Flouridation burden must be overcome if good results are to be
 Pity and fissure sealants - the occlusal surfaces of achieved.
the teeth's have pits and fissures and areas that NURSING MANAGEMENT:
are prone to carries.  The patient must practice meticulous oral hygiene
and the nurse encourages the patient to continue
2. DENTOALVEOLAR ABSCESS OR PERIAPICAL ABSCESS this important part of the treatment.
 More commonly referred to as an abscessed  An adolescent of adult undergoing orthodontic
tooth, involves a collection of pus in the apical correction who is admitted to the hospital for
dental periosteum fibrous membrane supporting some other problem may have to be reminded to
the tooth structure and the tissue surrounding the continue wearing the retainer if does not interfere
apex of the tooth where it is suspended in the jaw with the condition requiring hospitalization.
bone. Acute periapicel abscess is usually
secondary to a suppurative pulpitis a pus DISORDERS OF THE JAW
producing inflammation of the dental pulp that 1. TEMPOROMANDIBULAR DISORDERS
arises from an infection extending from dental  Abnormal conditions affecting the mandible and of
caries the temporomandibular joint which connects the
SIGNS AND SYMPTOMS mandible to the temporal bone at the side of the
 Dull, gnawing and continuous pain head in front of the ear include congenital
 Cellulitis malformation, fracture, chronic, dislocation,
 Edema of facial features cancer, and syndromes characterized by pain and
 Mobility of the tooth limited motion.
 Swollen on cheek side  Myofascial pain – a discomfort in the muscles
 Systemic infection controlling jaw function and in the neck and
 Fever shoulder muscles.
 Malaise  Internal dearangement of the joint- a dislocated
NURSING MANAGEMENT: jaw, a displaced disks or an injured condyle.
 Nurse assess the patient for bleeding after SIGNS AND SYMPTOMS
treatment and instructs the patients to use a  Jaw pain
warm saline or warm water mouth rinse to keep  Debilitating pain radiating to the ears, teeth, neck,
the are clean. muscles and facial sinuses
 The patient is also instructed to take antibiotics  Restricted jaw motion
and analgesics are prescribed to advance from a  Locking of the jaw
liquid diet to a soft diet as tolerated and to keep a  Clicking. Popping and grating sounds when mouth
follow up appointments. is opened, chewing, swallowing
 Headaches
3. MALOCCLUSION  Dizziness
 Is a misalignment of the teeth of the upper and DIAGNOSIS:
lower dental; arcs when the jaws are closed.  Is based on the patient’s report of pain, limitation
in range of motion, dysphagia, difficulty in
 chewing, difficulty with speech, or hearing  The onset is sudden
difficulties.  With an exacerbation of both fever
 Magnetic resonance Imaging and x-rays studies  Swelling of the glands
are generally only used for severe or chronic  The glands Becomes tense and tender
symptoms.  Ear pain
MEDICAL MANAGEMENT:  Swollen glands interfere with swallowing
 Signs and symptoms improve over time for the MEDICAL MANAGEMENT:
majority of patients with temporomandibular joint  Maintain adequate nutritional and fluid intake,
disorders with or without treatment. good oral hygiene and discontinue medication that
 Patients may also benefit from range of motion can diminish salivation
exercises.  Parotidectomy
 Occasionally, intraoral orthotics a plastic guard
worn over the upper and lower teeth may be worn 2. SIALADENITIS
to repositions the condyle head in the joint space  Inflammation of the salivary glands may be caused
to a more normal position which in turn relieves by dehydration, radiation therapy, stress,
the stress and pressure on the tissues of the joint. malnutrition, salivary gland calculi, improper oral
hygiene.
JAW DISORDERS REQUIRING SURGICAL MANAGEMENT  In hospitalized or institutionalized patients the
 Correction of the mandibular structural infecting organism methicilin resistant S.aureus
abnormalities may require surgery involving SIGNS AND SYMPTOMS:
repositioning or reconstruction of the jaw.  Pain
 Jaw reconstruction may be necessary in the  Swelling
aftermath of trauma from a severe injury or cancer  Purulent discharge
both of which can cause tissue or bone loss. MEDICAL MANAGEMENT:
NURSING MANAGEMENT:  Massage, hydration, warm compress and
 The patient who has rigid fixation should be corticosteroids frequently cure the problem.
instructed not to chew food in the first 1 to 4  Chronic sialadenitis with uncontrolled pain is
weeks after surgery. treated by surgical drainage of the gland or
 Promoting home and community based care- the excision of the gland and its ducts.
patient need specific guidelines for mouth care
and feeding. 3. SALIVARY CALCULUS(SIALOLITHIASIS)
 The importance of keeping scheduled  Usually occurs in the submandibular gland.
appointments to assessed the stability of the  Salivary calculi are form mainly from calcium
fixation appliance is emphasized. phosphate.
 Nutritional supplements may be recommended. DIAGNOSTIC EXAMS:
 S0alivary gland ultrasonography or sialography
DISORDERS OF THE SALIVARY GLANDS x-ray studies filmed after the injection of a
1. PAROTITIS radiopaque substance into the duct may be
 Inflammation of the parotid gland is the most required to demonstrate the obstruction of the
common of the inflammatory condition of the duct by stenosis.
salivary glands, although inflammation can occur  On physical assessment the gland is swollen and
in the other salivary glands as well. tender, the stone itself can be palpable, and it’s
 Elderly, acutely ill, old debilitated people with shadow may be seen on x-ray films.
decreased salivary flow from general dehydration SIGNS AND SYMPTOMS:
or medications are at high risks for parotitis.  Calculi are irregular
 Vary in diameter from 3 to 30mm
SIGNS AND SYMPTOMS:  Sudden, local and colicky pain
  Disclosed in the patient’s health history  Diffuse spasm is a motor disorder of the esphagus.
MEDICAL MANAGEMENT:  It is more common in women and usually
 The calculus can be extracted fairly easily from the manifests in the middle age.
duct in the mouth. SIGNS AND SYMPTOMS:
 Occasionally, lithotripsy a procedure that uses  Dysphagia
shock waves to disintegrate the stone may be used  Odynophagia
instead of surgical extraction for parotid stones  Chest pain
and smaller submandibular stones. DIAGNOSTIC FINDINGS:
 Esophageal manometry, which measures the
DISORDERS OF THE ESOPHAGUS motility of the esophagus and the pressure within
1. ACHALASIA the esophagus, indicates that simultaneously a
 Is absent or ineffective peristalsis of the distal contraction of the esophagus occurs irregularly.
esophagus, accompanied by the failure of the MEDICAL MANAGEMENT:
esophageal sphincter to relax in response to  Conservative therapy includes administration of
swallowing. sedatives and long acting nitrates to relived pain.
 Achalasia may progress slowly and occurs most  Small frequent feedings and a soft diet are usually
often when people 40 years of age or older. recommended to decrease the esophageal
SIGNS AND SYMPTOMS: pressure and irritation that lead to spasm.
 Difficulty in swallowing
 Sensation of food sticking 3. HIATAL HERNIA
 Prolonged distention of the esophagus  In the condition known as hiatus hernia the
 Food is commonly regurgitated opening in the diaphragm through which the
 Chest pain esophagus passes becomes enlarged and part of
 Heartburn (pyrosis) the upper stomach tends to move up into the
 Secondary pulmonary complications lower portion of the thorax.
ASSESSMENT AND DIAGNOSTIC:  There are 2 types of hiatal hernias sliding and
 X-ray studies shows esophageal dilation above the paraesophageal.
narrowing at the gastroesophageal junction. SIGNS AND SYMPTOMS
 barium swallow, computed tomography  Heartburn
 of the chest and endoscopy may be used for  Regurgitation
diagnosis however manometry a process in which  Dysphagia
the esophageal pressure is measured by a  Asymptomatic
radiologists or gastroenterologists confirms the  Sense of fullness
diagnosis.  Chest pain after eating
MEDICAL MANAGEMENT:  Hemorrhage
 The patient is instructed to eat slowly and to drink  Obstruction
fluids with meals.  Strangulation
 Injection of Botillium Toxin into quadrants of the DIAGNOSTIC:
esophagus via endoscopy has been helping  Diagnosis is confirmed by x-ray studies, barium
because it inhibits the contraction of the smooth swallow and fluoroscopy.
muscles. MEDICAL MANAGEMENT:
 Achalasia may be treated surgically by pneumatic  Management for hiatal hernia includes frequent,
dilation to stretch the narrowed area of the small feedings that can pass easily through the
esophagus. esophagus.
 Although perforation is a potential complication,  Surgery is indicated in about 15% of patients.
its incidence is low.  The patient is advised to not to recline 1 hour after
2. DIFFUSE ESOPHAGAEL SPASM eating to prevent reflux or movement of the
 hernia and to elevate the head of the bed on 4 to  X-ray studies and fluoroscopy by either a barium
8 inches blocks to prevent the hernia from sliding swallow or esophagram are used to identify the
upward. site of the injury.
MEDICAL MANAGEMENT:
4. DIVERTICULUM  Because of the high risk of infection broad
 It is an out pouching of mucosa and submucosa spectrum antibiotic therapy is initiated.
that protrudes to the weak portion of the  The patient is immediately made nothing by
musculature. mouth status.
 The most common type of diverticulum which is
found at 3 times more frequently in men than in 6. FOREIGN BODIES
women is Zenker’s diverticulum also known as  Many swallowed foreign bodies pass through the
pharyngoesophageal pulsion diverticulum or a gastrointestinal tract without the need for medical
pharyngeal pouch. intervention.
SIGNS AND SYMPTOMS  Pain and dysphagia may be present and dyspnea
 Difficulty in swallowing may occur as a result of pressure in the trachea.
 fullness in the neck  Perforation may have occurred.
 Belching  An endoscope with a covered a hood or overtube
 Regurgitation of undigested food may be used to removed the impacted food or
 gurgling noises after eating object from the esophagus.
 The pouch becomes filled with food
 Coughing 7. CHEMICAL BURNS
 Halitosis  Chemical burns of the esophagus occur most often
 Sour taste in the mouth when a patient either intentionally or
 Chest pain unintentionally swallows a strong acid or base.
 Dysphagia  Chemical burns of the esophagus may also be
DIAGNOSTIC caused by undissolved medications in the
 A barium swallow may determine the exact nature esophagus.
and location of a diverticulum.  A chemical burn may also occur after swallowing
of a battery which releases a caustic alkaline.
5. PERFORATION  There may be difficulty in breathing due to either
 The esophagus is the common site of injury. edema of the throat or collection of mucus in the
 Perforation may result from stab or bullet wounds pharynx.
of the neck or chest trauma from a motor vehicle
crash, caustic injury from a chemical burn or 8. GASTROESOPHAGEAL REFLUX DISEASE
inadvertently puncture by a surgical instrument  Some degree of gastroesophageal reflux backflow
during examination or dilation such as endoscopy. of gastric or duodenal contents into the esophagus
SIGNS AND SYMPTOMS is normal in both adults and children.
 Persistent pain SIGNS AND SYMPTOMS
 Dysphagia  Pyrosis
 Infection  Dyspepsia
 Fever  Regurgitation
 Leukocytosis  Dysphagia
 Severe hypotension  Hyper salivation
 Signs of pneumothorax  Esophagitis

DIAGNOSTIC
DIAGNOSTIC:
  Diagnostic testing may include a endoscopy or  Hematemesis
barium swallow to evaluate damage to the  Melena
esophageal mucosa.  Ascites
 Bilirubin monitoring is used to measure bile reflux  Signs of Shock
patterns. NURSING MANAGEMENT:
NURSING MANAGEMENT:  Monitor LOC and VS
 Management begins in teaching the patient to  Maintain NPO
avoid situations that decrease lower esophageal  Administer O2
sphincter irritation.  Prepare for blood transfusion
MEDICAL MANAGEMENT  Prepare to administer Vasopressin and
 If reflux persists antacids or H2 receptors Nitroglycerin
antagonists such as famotidine, nizatidine,  Assist in NGT and Sengstaken-Blakemore tube
ranitidine may be prescribed. insertion for balloon tamponade
 In addition the patient may receive prokinetic  Prepare to assist in surgical management:
agents which accelerate gastric emptying.  Endoscopic sclerotherapy
 Variceal ligation
9. BARRETT’S ESOPHAGUS  Shunt procedures
 Barrett’s esophagus is a condition in which lining
of the esophageal mucosa is altered. DISORDERS OF THE STOMACH
 Reflux eventually causes the changes in the cells 1. GASTRITIS
lining the lower esophagus.  Inflammation of the gastric mucosa
 These precancerous cells initiate the healing  May be acute or chronic
process and can be a precursor to esophageal  Etiology: bacteria, irritating foods, NSAIDS, alcohol,
cancer. bile and radiation, Autoimmune disease, diet,
SIGNS AND SYMPTOMS smoking
 Frequent heartburn  POSSIBLE CAUSES:
 Symptoms related to peptic ulcer ACUTE GASTRITIS
 Symptoms related to esophageal stricture  Chronic ingestion of irritating foods, spicy foods or
DIAGNOSTIC alcohol
 An esophagealgastroduodenoscopy is performed.  Drugs, such as aspirin and other non-steroidal
 Biopsies are performed and high grade dysplasia is anti-inflammatory drugs (NSAIDs)(in large doses),
evidence by the squamous mucosa of the cytotoxic agents, caffeine, corticosteroids,
esophagus replaced by columnar epithelium that antimetabolites, phenylbutazone, and
resembles that of the stomach or intestines. indomethacin
NURSING MANAGEMENT:  Ingestion of poisons, especially ammonia,
 Monitoring varies depending on the extent of mercury, and corrosive substances
changes.  Endotoxins released from infecting bacteria, such
 Treatment is individualized for each patient. as staphylococci, Escherichia coli, and salmonella,
viruses (gastroenteritis)
10. ESOPHAGEAL VARICES CHRONIC GASTRITIS:
 Dilation and tortuosity of the submucosal veins in 1. Alcohol ingestion
the distal esophagus 2. Cigarette smoke
ETIOLOGY: commonly caused by PORTAL hypertension 3. Environmental irritants
secondary to liver cirrhosis 4. Peptic ulcer disease
 This is an Emergency condition!

ASSESSMENT ASSESSMENT FINDINGS:

  Abdominal cramping 7. Urge the client to take prophylactic medications as
 Epigastric discomfort prescribed to prevent recurring symptoms.
 Hematemesis 8. Provide emotional support.
 Indigestion
DIAGNOSTIC PROCEDURE 2. PEPTIC ULCER DISEASE
 EGD- to visualize the gastric mucosa for  An ulceration of the gastric and duodenal lining
inflammation, confirms diagnosis if performed  Causes include conditions that increase the
within 24 hours of bleeding secretion of hydrochloric acid by the gastric
 Low levels of HCl mucosa or that decrease the tissue’s resistance to
 Biopsy to establish correct diagnosis whether the acid
acute or chronic a. infection of the gastric and / or duodenal mucosa by
 Fecal occult blood test can detect occult blood in Campylobacter pylori or Helicobacter pylori.
vomitus and stools if the client has gastric bleeding b. Zollinger – Ellison syndrome: tumors secreting
 Blood studies show low Hgb level and Hct when gastrin, which will stimulate the production of
significant bleeding has occurred. excessive hydrochloric acid.
NURSING INTERVENTIONS c. certain drugs such as aspirin, steroids, and
 Give BLAND diet indomethacin will decrease tissue resistance.
 Monitor for signs of complications like bleeding, d. smoking
obstruction and pernicious anemia
 Instruct to avoid spicy foods, irritating foods,
alcohol and caffeine
 Administer prescribed medications- H2 blockers,
antibiotics, mucosal protectants
 Inform the need for Vitamin B12 injection if
deficiency is present
TREATMENT:
 Blood transfusion
 I.V. fluid therapy
 NG lavage to control bleeding
 Oxygen therapy, if necessary
 Partial or total gastrectomy (rare)
 Vagotomy and pyloroplasty (limited success when
conservative treatments have failed)
IMPLEMENTATION: DIAGNOSTIC TESTS
1. If the client is vomiting, give anti-emetics and I.V.  EGD and Biopsy
fluids to prevent dehydration and electrolyte DRUGS:
imbalance. Histamine H2 receptors antagonists (po/iv)
2. Monitor intake and output and electrolyte levels.  Axn: ¯ HCl production
3. Provide a bland diet to prevent recurrence.  Taken with meals or at h.s., cigarettes reduces the
4. Offer smaller, more frequent meals to reduce axn.
irritating gastric secretions. Eliminate foods that  SE: headache, skin rash, bleeding and dizziness
cause gastric upset.  8 weeks medication (if s/sx will not improve start
5. If surgery is necessary, prepare the client antibiotics)
preoperatively and provide appropriate  Cimetidine (Tagamet)
postoperative care.  Ranitidine (Zantac)
6. Administer antacids and other prescribed  Famotidine (Pepcid)
medications
  Nizatidine (Axid) c. Billroth II: removal of the antrum and distal portion
Mucosal Barrier of the stomach and subsequent anastomosis of
 Axn: adheres to ulcer surface remaining section to the jejunum.
 30 min interval before taking antacids d. Antrectomy: removal of the antral portion of the
 SE: constipation, diarrhea and n/v stomach.
 Give 1-2 hour after meal or during bedtime on an e. Gastrectomy: removal of 60%-80%
empty stomach f. Esophagojejunostomy (total gastrectomy): removal
 5 hours duration of the entire stomach with a loop of jejunum
 Sucralfate (Carafate) anastomosed to the esophagus.
Antacids (non absorbable) g. Common complications of total or partial gastric
 Axn: ¯ gastric acidity resection:
 Chew thoroughly then swallow  Dumping syndrome
 Taken 1 hour after meals or at bedtime  Hemorrhage
 Aluminum Hydroxide SE: constipation  Pneumonia
 Don’t give other drugs within 1-2 hour after taking  Pernicious anemia
antacids
 Magnesium Oxide SE: diarrhea GASTRIC SURGERIES
 Taken in between meals or at bedtime
 May increase serum Magnesium level in RF client
 Chew follow with water
 Calcium Carbonate SE: uric acid
 Taken in between meals or at bedtime with milk
 NaHCO3 SE: metabolic alkalosis and tetani
Proton Pump Inhibitor
 Axn: block HCl release from parietal cell
 4-8 weeks medications
 Omeprazole (Prilosec)
 Lansoprazole (Prevacid)

THERAPEUTIC INTERVENTIONS:
1. Bland foods, and restriction of irritating substances.
2. Antibiotic therapy if microorganism is identified;
tetracycline, metronidazole, and bismuth NURSING CARE:
3. Histamine H2 receptor antagonists or proton pump 1. Allow ample time for the client to express feelings and
inhibitors, antacids concerns.
4. Sedatives, tranquilizers, anticholinergics, and 2. Administer and assess effects of sedatives, antacids,
analgesics anticholinergics, H2 receptor antagonists, antibiotics,
5. Antiemetics and dietary modifications.
6. A nasogastric tube for decompression, installation of 3. Encourage hydration to reduce anticholinergic side
vasocontrictors, and/or saline lavages when effects and dilute the hydrochloric acid in the stomach.
hemorrhage occurs. 4. Instruct client to:
SURGICAL INTERVENTION  Eat small to medium-sized meals because this
a. Vagotomy helps prevent gastric distention; encourage
b. Billroth I: removal of the lower portion of the between-meal snacks to achieve adequate calories
stomach and attachment of the remaining portion when necessary.
to the duodenum.  Avoid foods that increase gastric acid secretion or
irrigate gastric mucosa.
  Avoid foods that cause distress; varies for dysrhythmmias or kidney disease by those taking
individuals but common offenders are the gas antidepressant or monoamine oxidase inhibitors
producers (legumes, carbonated beverages, or by pregnant or nursing women.
vegetables). SURGICAL MANAGEMENT
 Eat meals in pleasant, relaxing surrounding to  Bariatric surgery or surgery for morbid obesity is
reduce acid secretions. performed only after other nonsurgical attempts
 e. administer calcium and iron supplements as at weight control have failed.
ordered if client's medication increases gastric pH.  Bariatric surgical procedures work by restricting a
5. Refrain from administering drugs such as salicylates, patient’s ability to eat restrictive procedure,
NSAIDS, steroids, and ACTH. interfering with ingested nutrients (malabsorptive
6. Observe for complications such as gastric hemorrhage, procedures) or both.
perforation and drug toxicity.  Studies have shown that the average weight loss
7. Provide postoperative care after gastric resection : of after bariatric surgery in the majority of patient
 a. assess the dressing for drainage is approximately 61% of previous body weight.
 b. maintain a patent NGT to suction to prevent Comorbid conditions such as diabetes mellitus,
stress on the suture lines. hypertension and sleep apnea are resolved and
 c. observe the color and amount of NGT drainage; dyslipidemia improves.
excessive bleeding or the presence of bright red NURSING MANAGEMENT
blood after 12 hours should be reported  Nursing management focuses on care of the
patient after surgery.
3. MORBID OBESITY  Complications that may occur in the immediate
 Is a term applied to people who are more than postoperative period include peritonitis, stomal
two times their ideal body weight or whose body obstructions, stomal ulcers, atelectasis and
mass index exceeds 30kg/m2. pneumonia, thromboembolism, and metabolic
 Patients with morbid obesity are higher risks for imbalances resulting from prolonged vomiting and
health complications such as diabetes, heart diarrhea and altered gatsrointestinal function.
disease, stroke hypertension, gallbladder disease,  The patient is usually discharged in 4 days for
osteoarthritis, sleep apnea and other breathing patients who have had laparascopy procedures
problems and some forms of cancer like uterine, with detailed dietary instructions.
breast, colorectal, kidney and gallbladder.
ABNORMALITIES OF FECAL ELIMINATION
MEDICAL MANAGEMENT: 1.DIARRHEA
 Conservative management of obesity consists of CAUSES
placing the person on a weight loss diet in 1. Chronic bowel d/o
conjunction with behavioral modification and 2. Mal-absorption
exercise however dietary and behavioral 3. Intestinal infections
approaches of approaches to obesity has have 4. Biliary tract d/o
limited success. 5. Hyperthyroidism
 Depression may contribute to weight gain and 6. Laxatives
treatment of the depression with an S/Sx
antidepressant may be helpful.  Poor turgor
 Thirst
 Dry mucosa
PHARMACOLOGIC MANAGEMENT  Lethargy
 Sibutramine may increase blood pressure and  Watery stool
should not be taken by people with a history of Nursing Interventions:
coronary artery disease, angina pectoris,  I and O
  Antibiotics  Although there is known cure for fecal
 Oral/IV rehydration incontinence, specific management techniques can
 Antidiarrheals help the patient achieve a better quality of life.
 Good hand washing  Fecal incontinence is frequently a symptom of a
fecal impaction.
2. CONSTIPATION NURSING MANAGEMENT
-lengthening of normal time between bowel movement  The nurse obtains a thorough health history.
CAUSES:  If a fecal impaction is noted it must be removed
1. Inadequate bulk or liquid in the diet before instituting any preventive therapies.
2. Lack of physical activity  Sometimes it is necessary to use suppositories to
3. Barium enema stimulate the anal reflex.
4. Prolonged use of constipation meds
NURSING INTERVENTIONS: 4. IRRITABLE BOWEL SYNDROME
 Increase fluid and fiber intake  Is one of the most common GI conditions.
 Meds as ordered –cathartics (dulcolax, metamucil,  Irritable bowel syndrome accounts for 3.5 million
senokot),stool softeners (colace) office visits and leading cause of workforce
 Prevent accumulation of stool in rectum absenteeism.
 Discharge plan-diet, regular time of defecation, PATHOPHYSIOLOGY
medication and position(toilet)  IBS results from a functional disorders of intestinal
motility.
3. FECAL INCONTINENCE  Changes in intestinal motility may also result from
 Describes the involuntary passage of stool from infection or other inflammatory disorders or
the rectum. vascular or metabolic disturbances.
 It is an embarrassing and socially incapacitating SIGNS AND SYMPTOMS:
problem.  Alteration in bowel patterns
 Constipation
RISK FACTORS:  Diarrhea
 Trauma(after surgical involving the rectum  Pain
 Neurologic disorders(stroke, multiple sclerosis,  Bloating
diabetic neuropathy, dementia  Abdominal distention
 Inflammation DIAGNOSTIC FINDINGS
 Infection  Barium enema and colonoscopy may reveal
 Chemotherapy spasm, distention or mucus accumulation in the
 Radiation treatment intestines.
SIGNS AND SYMPTOMS: MEDICAL MANAGEMENT:
 Minor soiling  The goals of then treatment are relieving
 Occasional urgency abdominal pain, controlling the diarrhea or
 Loss of control constipation, and reducing stress.
DIAGNOSTIC  A high fiber diet is prescribed to help control the
 X-rays such as barium enema, computed diarrhea and constipation.
tomography, anorectal manometry and transit NURSING MANAGEMENT:
studies may be helpful in identifying alterations in  The nurse’s role is to provide patient and family
intestinal mucosa, and muscle tone or in detecting education.
other structural of functional problems.  A good method for identifying problem food
MEDICAL MANAGEMENT involves keeping a symptoms and a food diary for
1 to 2 weeks.
  They should understand that although adequate  The nurse conducts ongoing assessments to
fluid intake is necessary, fluid should not be taken determine whether the clinical manifestations
with meals because this results in abdominal related to the nutritional deficits have abated.
distention.
 Stress management via relaxation techniques, ACUTE INFLAMMATORY INTESTINAL DISORDERS
yoga and exercise can be recommended. 1. APPENDICITIS
 Inflammation of the appendix due to obstruction
5. MALABSORPTION from fecalith, lymphoid hyperplasia, helminth,
 The inability of the digestive system to absorb one foreign body
or more of the major vitamins especially A and DIAGNOSIS
B12, minerals like iron and calcium and nutrients  Chest x-ray to differentiate appendicitis from
such as carbohydrates, fats and proteins. pneumonia
 Diseases of the small intestines are the most  Barium GI series and ultra-sonography to
common cause of malabsorption. differentiate appendicitis from other abdominal
CAUSES: problems
 Mucosal disorders
 Infectious diseases TREATMENT
 Luminal disorders  Appendectomy
 Surgical procedures  Management of complications such as peritonitis,
shock, dehydration, and infection
SIGNS AND SYMPTOMS ASSESSMENT
 Diarrhea  Key Test – IPPA, Lab results (WBC)
 Frequent, loose and bulky stools  Pain-periumbilical that localizes to RLQ
 Grayish stools  Check for rebound tenderness (peritonitis)
 Abdominal distention  Slight in temperature
 Pain  Nausea and vomiting
 Increased flatus  Abdominal distention and paralytic ileus
 Weakness  Rovsing’s sign-pressure on the LLQ causes pain in
 Weight loss the RLQ
 Decreased sense of well being  Mc Burney’s sign-pain at RLQ upon palpation
DIAGNOSTIC FINDINGS  Psoas and obturator sign
 Several diagnostic tests may be prescribed
including stool studies for quantitative and
qualitative fat analysis, lactose tolerance tests,
delta xylose absorption tests and schillings tests.
 Endoscopy with biopsy with the mucosa is the
best diagnostic tool.
MEDICAL MANAGEMENT:
 Intervention is aimed at avoiding dietary
substances that aggravate malabsorption and at
supplementing nutrients that have been lost.
 Folic acid supplements are prescribed.
NURSING MANAGEMENT:
 The nurse provides patient and family education
regarding diet and the use of nutritional
supplements. SIGNS AND SYMPTOMS
  Abdominal pain, localized tenderness, and fever  Barium enema (contraindicated in clients with
Initially, generalized pain around the umbilicus, acute diverticulitis) shows inflammation, narrow
then localized pain in the right lower quadrant lumen of the bowel, and diverticula.
 Changes in behavior, anorexia, or  Hematologic study shows increased WBC count
vomiting(common early signs) and ESR.
 White blood cell(WBC) count of 15,000 to  Sigmoidoscopy (contraindicated in clients with
20,000/ul acute diverticulitis) shows a thickened wall in the
 Constipation or diarrhea diverticula.
 Possible perforation(indicated by sudden pain  Computed tomography scan shows abscesses or
relief) or peritonitis(indicated by increased pain, thickening of the bowel.
rigid abdomen, obvious guarding of the abdomen, NURSING INTERVENTIONS
high fever, and elevated WBC count) if untreated  Maintain NPO during acute phase
NURSING CARE  Provide bed rest
 Don’t administer enemas or laxatives or apply heat  Administer antibiotics, analgesics like meperidine
to the abdomen (morphine is not used) and anti-spasmodics
 When the appendix is perforated (and Penrose  Monitor for potential complications like
drains are in place), place the patient in semi- perforation, hemorrhage and fistula
Fowler’s position or on his right side after surgery  Increase fluid intake
 Semi fowler’s to relieve pain and discomfort  Avoid gas-forming foods or HIGH-roughage foods
 NPO til bowel sounds present (postop) containing seeds, nuts to avoid trapping
 No laxatives and enemas as it may rupture  Introduce soft, high fiber foods ONLY after the
 NGT insertion inflammation subsides
 Rectal tube to pass flatus  Instruct to avoid activities that increase intra-
abdominal pressure
2. DIVERTICULAR DISEASE TREATMENT:
Diverticulosis occurs when the intestinal mucosa  Generally no treatment for asymptomatic
protrudes through the muscular wall. diverticulosis
Diverticulitis is an inflammation of the diverticula  Colon resection (for diverticulitis refractory to
that may lead to infection, hemorrhage, or medical treatment)
obstruction.  Bland diet, stool softeners, and occasional doses of
CAUSES: mineral oil for diverticulosis with pain, mild GI
 Age distress, constipation, or difficult defecation.
 Chronic constipation
 Straining during defecation 3. PERITONITIS
 Congenital weakening of intestinal wall  It is the inflammation of the peritoneum, the
ASSESSMENT FINDINGS: serous membrane lining the abdominal cavity and
 Anorexia covering the viscera.
 Stool with blood and mucus  Peritonitis can also result from external sources
 Change in bowel habits such as injury or trauma like gunshot wound and
 Constipation and diarrhea stab wound or an inflammation that extends from
 Fever the organ outside the peritoneal area such as
 Flatulence kidney.
 Intermittent left lower quadrant pain or SIGNS AND SYMPTOMS
midabdominal pain that radiates to the back  Diffuse pain
 Nausea  Peritoneal irritation
 Rectal bleeding  Abdominal are tender and distended
DIAGNOSTIC EVALUATION:  Paralytic ileus
  Neuropathy  dehydration and anemia
 Cirrhosis POSSIBLE CAUSES:
 Anorexia  Emotional upsets
 Nausea and vomiting  Fried foods
 Increased body temperature and heart rate  Milk and milk products
 Hypotension  Autoimmune (common in Jewish people)
DIAGNOSTIC FINDINGS
 The white blood cell count is always elevated.
 An abdominal x-ray may show air and fluid levels
as well as distended bowel loops.
 A CT scan of the abdomen may show abscess
formation.
COMPLICATIONS
 The inflammation is the most commonly not
localized, and the entire abdominal cavity show
evidence of widespread infection.
 The inflammatory process may cause intestinal
obstruction, primary from the development of
bowel adhesions.
NURSING MANAGEMENT
 Intensive care is often needed.
 The central venous pressure or pulmonary artery  Abdominal cramps and spasms after meals
wedge pressure and urine output are monitored  Chronic diarrhea / steatorrhea
frequently.  Fever
 The nurse reports the nature of the pain, its  Flatulence
location in the abdomen and any changes in  Nausea
 The patient is placed on the side with knees flexed  Pain in the lower right quadrant
this position decreases tension on the abdominal  Weight loss
organs.  3-4 semisoft stools / day with mucus and pus.
DIAGNOSTIC EVALUATION:
INFLAMMATORY BOWEL DISEASE  Abdominal x-ray shows congested, thickened,
1. CROHN’S DISEASE (Regional enteritis) fibrosed, and narrowed intestinal wall.
 a chronic inflammatory disease of the small  Barium enema shows lesions (granulomas) in the
intestine, usually affecting the terminal ileum. It terminal ileum.
also sometimes affects the large intestine, usually  Fecal occult blood test is positive.
in the ascending colon  Proctosigmoidoscopy shows ulceration.
 inflammation of the GI tract(anywhere)  Upper GI series shows a classic string sign
 chronic and relapsing  A CBC usually shows a decreased Hgb level and
 thickening and scarring causing the lumen to Hct; WBC may be elevated.
narrows, fistulas, ulcerates to inflammation  Low albumin and protein levels reflect poor
ASSESSMENT: absorption of protein.
 assess for perforation and peritonitis  Erythrocyte sedimentation rate (ESR) is elevated.
 chronic diarrhea DRUG THERAPY OPTIONS:
 cramp-like pain after meals  Analgesic
 weight loss  Anti-anemic
 fever  Antibiotic
 mucus bloody stool  Anticholinergic
  Immuno supressant  Blood chemistry shows decreased potassium level.
 Potassium supplement  Hematology shows decreased Hgb level and Hct.
MEDICAL MANAGEMENT:  Intestinal biopsy helps to differentiate between
 calories and CHON, ¯ residue ulcerative colitis and regional enteritis.
 bland diet with iron  Stool specimen is positive for blood and mucus.
 vitamin B12  Urine chemistry displays increased urine specific
NURSING MANAGEMENT: gravity.
 Bed rest, weigh daily TREATMENT:
 NPO in acute stage, TPN as ordered.  No fiber during acute attack
 High CHON, calorie, bland, low residue diet.  Prevent acute attack (stress and infection)
 Avoid gas-producers, irritating food, and milk  CHON and calories, avoid gas forming foods, all
products. foods must be cooked
 Offer small frequent feedings.  TPN
 Vitamin replacement ADEK.  replace fluids 3-4L/day, add KCl
 IVF, I/O, tepid fluids up to 3L/day.  steroids
 Perianal care with lubricants and ointments.  sulfonamides (antibiotics)
 Hot sitz baths, monitor stools.  immunosuppressive
 Emotional support esp. family members.  tranquilizer (to ¯ peristalsis)
 anticholinergics (sympa)
2. ULCERATIVE COLITIS  surgery (hemicolectomy), colectomy, or ileostomy
 a major health problem and a potentially NURSING MANAGEMENT:
debilitating disease  Assess GI status and fluid balance.
 type of inflammatory bowel disease that produces  Monitor and record vital signs, intake and output,
lesions primarily confined to the large bowel, with laboratory studies, daily weight, urine specific
ulcerations of the large bowel’s mucosa and gravity, calorie count, and fecal occult blood to
submucosa determine deficient fluid volume.
 inflammation of the colon and rectum only  Make a stool charting.
POSSIBLE CAUSES:  Maintain the client’s diet; withhold food and fluid
 Genetics as necessary to prevent nausea and vomiting.
 Idiopathic  Administer I.V. fluids and TPN.
 Allergies  Maintain position, patency, and low suction of NG
 Stress tube to prevent nausea and vomiting.
 Infection  Keep the client in semi-Fowler’s position to
ASSESSMENT FINDINGS: promote comfort.
 Abdominal cramping, distention, and tenderness
 Anorexia OSTOMY CARE
 Bloody, purulent, mucoid, watery stools (15 to 20  Encourage verbalization of fears/concerns.
per day)  Teach character of drainage:
 Dehydration  ileostomy – liquid 4-6x/day
 Fever  transverse colostomy – mushy OD
 Hyperactive bowel sounds  descending/sigmoid – soft formed every
 Nausea and vomiting 2-3 days
 Weakness  Skin care – nystatin, karaya powder, soap/H2O pat
 Weight loss dry
 Anemia  Odor control – deodorant drops, bismuth tabs,
DIAGNOSTIC EVALUATION: mouthwash solutions, spinach, parsley added to
 Barium enema shows ulcerations. ostomy bag, avoid gas-formers (cabbage, beans,
 broccoli, cauliflower, corn, onions, eggs, fish,  Hypovolemic shock
condiments. DIAGNOSTIC
 Diet :  Ultrasound
 ileostomy (clear liquids, strained  Laboratory studies like electrolyte studies and a
fruits/veggies progress to regular diet, complete blood cell count revealed a picture of
Na/K rich food, avoid fried, seasoned dehydration, loss of plasma volume, and possible
food, nuts, raisins, raw fruits) infection.
 colostomy – clear liquid, solid low-residue MEDICAL MANAGEMENT:
1st 6 weeks  Decompression of the bowel through a nasogastric
 Ileostomy drainage q 4-6 hrs emptied, pouch 5-7 tube is successful in most cases.
days max  Before4 surgery IV fluids are necessary to replaced
the depleted water, sodium, chloride, and
OSTOMY IRRIGATION potassium.
 Only colostomies are irrigated; ileostomy no need NURSING MANAGEMENT:
 Purposes – stimulate emptying of colon to avoid  Nursing management of the nonsurgical patient
use of appliance with a small bowel obstruction includes
 Started 5-7 days post-op in the bathroom maintaining the function of the nasogastric tube
preferably assessing and measuring the nasogastric output,
 Equipment: irrigating solution, catheter with assessing for fluid and electrolyte imbalance,
stoma tip, irrigating sleeve monitoring nutritional status and assessing
 Tepid water used 18-24 in above stoma (shoulder improvement such as return of bowel sounds,
height) decreased abdominal distention, subjective
 500-1000ml irrigated slowly improvement in the abdominal pain and
 Done same time everyday / as preferred tenderness, passage of flatus or stool.
 Return flow expected within 15-45 mins  If the patient’s condition does not improve the
nurse prepares him or her for surgery.
INTESTINAL OBSTRUCTION
1. SMALL BOWEL OBSTRUCTIONS 2. LARGE BOWEL OBSTRUCTION
PATHOPHYSIOLOGY  As in small bowel obstruction, large bowel
 Intestinal contents, fluids and gas accumulate obstruction results in an accumulation of intestinal
above the intestinal obstructions. contents, fluid and gas proximal to the
 With increasing distention pressure within the obstructions.
intestinal lumen increases, causing a decrease in  Large bowel obstruction even if complete may be
venous and arteriolar capillary pressure. un-dramatic if the blood supply to the colon is not
 Reflux vomiting may cause by abdominal disturbed.
distention. DIAGNOSTIC FINDINGS
SIGNS AND SYMPTOMS  Diagnosis is based on symptoms and on imaging
 Crampy, and colicky pain studies.
 No fecal matter and no flatus  Abdominal x-ray and abdominal CT scan of MRI
 Vomiting findings reveal a distended colon and pinpoint the
 Fecal may pass the mouth instead of toward the site of the obstruction.
rectum SIGNS AND SYMPTOMS
 Fecal vomiting if obstructions in the ileum  Constipation
 Dehydration intense thirst  Shape of the stool is altered
 Drowsiness  Iron deficiency anemia
 Perched tongue  Weakness
 Abdominal distention loss of plasma volume  Weight loss
  Anorexia 3. ANAL FISSURE
 Abdominal distention  An anal fissure is longitudinal tear or ulceration in
 Crampy, lower abdominal pain the lining of the anal canal.
 Fecal vomiting  Other causes include childbirth, trauma, and
 Shock overuse of laxatives.
MEDICAL MANAGEMENT SIGNS AND SYMPTOMS
 Restoration of the intravascular volume,  Bright red blood
correction of the electrolyte abnormalities, and MEDICAL MANAGEMENT:
nasogastric aspiration and decompression are  A novel therapy, perianal or intra-anal application
instituted immediately. of nitroglycerin ointment has increased the rate of
 Colostomy healing and lowered pain levels in chronic anal
NURSING MANAGEMENT fissures.
 Monitor the patient for symptoms that indicate
the intestinal obstruction is worsening and to 4. SEXUALLY TRANSMITTED DISEASE ANORECTAL DISEASE
provide emotional support and comfort.  Three infectious syndromes that are related to STD
 After surgery, general abdominal wound care and have been identified proctitis, proctocolitis, and
routine postoperative nursing care are provided. enteritis.
 It is commonly associated with recent anal recent
DISEASES OF THE ANORECTUM intercourse with an infected partner.
1. ANORECTAL ABSCESS ASSESSMENT
 An anorectal abscess is caused by obstructions of  Mucopurulent discharge or bleeding
an anal gland, resulting in retrograde infection.  Rectal pain
 If the abscess is superficial, swelling, redness, and  Diarrhea
tenderness are observed.  PROCTOCOLITIS involves the rectum and the
MEDICAL MANAGEMENT lowest portion of the descending colon.
 sitzs bath and analgesics  ENTERITIS involves more of the descending colon
 When a deeper infection exists with the possibility and symptoms include watery, bloody diarrhea,
of a fistula, the fistulous tract must be excised. abdominal pain and weight loss.
NURSING MANAGEMENT DIAGNOSTIC FINDINGS
 The wound may be packed with an absorptive  Sigmoidoscopy is performed to identify the
dressing like calcium alginate or hydrofiber and portions of the anorectum involved.
allowed to heal by granulation.  Antibiotics like rocephin or cefixime, deoxycline
and penicillin are the treatment of the choice for
2. ANAL FISTULA the bacterial infections.
 An anal fistula is a tiny, tubular, fibrous, tract that MEDICAL MANAGEMENT
extends into the anal canal from an opening  Anti-amebic therapy metronidazole is appropriate
located beside the anus in the perianal skin. for infections with E.histolytica and G.Lamblia.
MEDICAL MANAGEMENT  The antibiotics erythromycin and ciprofloxacin are
 Medical therapy includes antibiotics or anti the treatment of choice for Campylobacter
inflammatory type agents. infection.
 Surgery is recommended because fistulas heal
spontaneously.
 The lower bowel is evacuated thoroughly with
several prescribed enemas.
NURSING MANAGEMENT 5. PILONIDAL SINUS OR CYSTS
 The wound is packed with gauze.
  A pilonidal sinus or cysts is found in the  Post-operative care for hemorrhoidectomy
intergluteal cleft in the posterior surface of the  Position: Prone or Side-lying
lower sacrum.  Maintain dressing over the surgical site
 It may also be formed congenitally by an infolding  Monitor for bleeding
of the epithelial tissue beneath the skin which may  Administer analgesics and stool softeners
communicate with the skin surface through one or  Advise SITZ bath 3-4x a day after each movement
several small sinus openings.  Dietary modification (low-residue, soft progress to
 The cyst rarely cause symptoms until adolescence high fiber/fresh fruits, force fluids 2.5-3L/day)
or early adult life when infection produces an  Reporting immediately the ff:
irritating drainage or an abscess.  Rectal bleeding
 In the early stages of the inflammation the  Continued pain on defecation
infection may be controlled by an antibiotic  Pus-like drainage from rectal area
therapy but after an abscess has formed surgery is
indicated. CANCERS
 After the acute process resolves further surgery is 1. CANCER OF THE ORAL CAVITY AND PHARYNX
performed to excised the cysts and the secondary  Cancers of the oral cavity and pharynx which can
sinus tracts. occur in any part of the mouth or throat are
 Absorptive dressings are placed in the wound to curable if discovered early.
keep its edges separated while healing occurs.  Oral cancers are often associated with the
combined used of alcohol and tobacco these
6. HEMORRHOIDS substances have a synergistic carcinogenic effect.
 Dilated varicose veins of the anal canal (internal RISKS FACTORS
and external may be affected)  Cigarette, cigar and pipe smoking
CAUSES:  Use of smokeless tobacco
 Irritation and diarrhea  Excessive use of alcohol
 Occupations requiring long periods of standing SIGNS AND SYMPTOMS
 Increased intra-abdominal pressure caused by  Painless sore mass that does not heal
prolonged constipation, pregnancy, heavy lifting,  Red or white patch that persists
obesity, straining at defecation; portal  Typical lesion is painless indurated
hypertension  Ulcer with raised edges
DIAGNOSTICS:  Tenderness
 Proctoscopy reveals presence of internal  Difficulty In chewing, swallowing or speaking
hemorrhoids  Coughing out of blood tinged sputum
 Hgb and Hct decreased if bleeding is excessive  Enlarged cervical lymph nodes
ASSESSMENT: DIAGNOSTIC EXAMINATIONS
 Itchiness  Diagnostic evaluation consists of an oral
 Pain ( external) examination as well as an assessment of the
 Bleeding cervical lymph nodes to detect possible
 Protrusion of external hemorrhoids metastases.
 Hard stools with streaks of blood  Biopsies are performed on suspicious lesions those
MANAGEMENT: who have not healed in 2 weeks.
 Stool softeners MEDICAL MANAGEMENT:
 Laxative for constipation  Management varies with the nature of the lesion,
 Analgesic the preference of the physician and patient choice.
 Hot sitz bath  Addition of chemotherapy may be useful in
 Infrared photocoagulation and laser therapy advanced disease.
 Hemorrhoidectomy
2. CANCER OF THE ESOPHAGUS
 Benign tumor can arise along the esophagus
RISK FACTORS
 Chronic esophageal irritation
 Ingestion of alcohol
 The use of tobacco
 Chronic ingestion of hot liquids
 Nutritional deficiencies
 Poor oral hygiene
 Exposure to nitrosamine
 Cigarette smoking
 Caustic injury
SIGNS AND SYMPTOMS:
 Ulcerated lesion of the esophagus
 Dysphagia
 Mass in the throat
 Substernal pain
 Fullness
 Regurgitation
DIAGNOSTIC
 Currently diagnosis is confirmed most often by
EGD with biopsy and brushings.
MEDICAL MANAGEMENT:
 If esophageal cancer is detected an early stage
treatment goals may be directed toward cure
however, it is often detected in late stages making
relief of symptoms the only reasonable goal of
therapy.
 A standard treatment plan of a person who is
newly diagnosed with esophageal cancer includes
the preoperative combination chemotherapy and
radiation therapy for 4 to 6 weeks followed by a
period of no medical intervention for 4 weeks and
lastly, surgical resection of the esophagus.
NURSING MANAGEMENT:
 Intervention is directed toward improving the
patient’s nutritional and physical status in
preparation for surgery , radiation therapy or
chemotherapy.
 If this is not possible parenteral or enteral
nutrition is initiated.