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Disorders of the Digestive System

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Title: 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
  • Dont 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 Suttons 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
Behcets
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
Barretts 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
  • Cant 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

51
Infection
  • E-coli 0157H7
  • Not part of normal human intestinal flora
  • Found in 1 of food cattle
  • Contaminated or under cooked meat or contaminated
    water
  • Signs and symptoms
  • Bloody diarrhea, abdominal cramping and
    tenderness
  • Avoid-anti-diarrheals and anti-mobility
  • C-Difficle
  • Complication of antibiotic because it inhibits
    the growth of normal intestinal flora and allows
    for the overgrowth of C-Difficile
  • A toxin is produced that causes tissue damage in
    the intestine
  • Stop the offending antibiotic
  • Diagnosis-stool culture
  • Treatment-Flagyl or Vancomycin

52
Infection
  • Risk Factors
  • Recent travel to endemic area
  • Food borne Illness
  • Waterborne Illness
  • Day care exposure
  • High-risk sexual behavior
  • Antibiotic use within 6 months (C-Difficile)

53
Infection
  • Diagnostic tests
  • Stool culture
  • Blood chemistry
  • Medical management/nursing interventions
  • Antibiotics
  • Fluid and electrolyte replacement
  • Kaopectate
  • Pepto-Bismol

54
Irritable Bowel Syndrome (IBS)
  • Etiology/Pathophysiology
  • Episodes of alteration in bowel function
  • Spastic and uncoordinated muscle contractions of
    the colon
  • Related to eating coarse or highly seasoned food
  • Clinical manifestations
  • Abdominal pain and distention relieved by BM
  • Frequent bowel movements
  • Sense of incomplete evacuation
  • Flatulence, constipation, and/or diarrhea

55
Irritable Bowel Syndrome (IBS)
  • Red Flags Suggestive of other diagnosis
  • Nighttime Diarrhea
  • Nocturnal stool incontinence
  • Nocturnal awakening due to abdominal discomfort
  • Abdominal pain that interferes with normal sleep
  • Visible or occult blood in stool
  • Weight loss
  • Recurrent Fever
  • Family History of Colon Cancer
  • Family History of Inflammatory Bowel Disease
  • Laboratory abnormality
  • Leukocytosis
  • Anemia
  • Increased Erythrocyte Sedimentation Rate (ESR)

56
Irritable Bowel Syndrome (IBS)
  • Increase in functional diarrhea with stress
  • Associated with psychiatric issues
  • Panic attacks
  • Chronic pelvic pain
  • Childhood sexual abuse
  • Diagnostic tests
  • History and physical examination
  • Often by exclusion

57
Irritable Bowel Syndrome (IBS)
  • Medical management Nursing interventions
  • Diet and bulking agents
  • Education
  • Medications
  • Anticholinergics
  • Milk of Magnesia, fiber, or mineral oil
  • Opioids
  • Anti-anxiety drugs

58
Ulcerative Colitis
  • Etiology/Pathophysiology
  • Ulceration of the mucosa and submucosa of the
    colon
  • Tiny abscesses form
  • Produce purulent drainage, slough the mucosa, and
    ulcerations occur
  • Starts on the left and progresses to the right
    side of colon
  • The capillaries become friable and bleed
  • bloody diarrhea
  • Pseudopolyps may turn cancerous
  • Scar tissue may form
  • Loss of elasticity and absorption abilities

59
Ulcerative Colitis
  • Clinical manifestations/Assessment
  • Diarrhea-pus and blood
  • 15-20 stools per day
  • Fluid/electrolyte imbalance
  • Abdominal cramping
  • Involuntary leakage of stool
  • The urge to defecate lessons as scar tissue
    replaces functional tissue
  • Weight loss and deficient nutrition
  • Megacolon

60
Ulcerative Colitis
  • Diagnostic tests
  • Barium studies
  • Colonoscopy biopsy
  • Stool for occult blood
  • X-rays
  • Labs such as chemistries, CBC
  • Medical management/Nursing interventions
  • Diet
  • No milk products or spicy foods
  • High protein, high calorie
  • Total parenteral nutrition (TPN)
  • Stress control
  • Assist patient to find coping mechanisms

61
Ulcerative Colitis
  • Medical management/Nursing interventions
  • Medications
  • Azulfidine
  • Dipentum Rowasa
  • Corticosteroids
  • Imodium
  • Anticholinergic drugs are avoided
  • Surgical interventions
  • Colon resection
  • Ileostomy
  • Ileoanal anastomosis
  • Proctocolectomy
  • Kock pouch

62
Crohns Disease
  • Etiology/Pathophysiology
  • Inflammation, fibrosis, scarring, and thickening
    of bowel wall
  • Inflammation of segments of the GI tract from
    mouth to anus
  • Possible association between Crohns and altered
    immune mechanisms
  • Typically occurs in the small intestine (jejunum
    and terminal ileum)
  • Clinical manifestations/Assessment
  • Weakness, loss of appetite, dehydration
  • Diarrhea, 3-4 daily, contain mucus and pus
    (steatorrhea)
  • Right lower abdominal pain
  • Anal fissures and/or fistulas
  • Anemia

63
Crohns Disease
  • Complications
  • Malabsorption
  • Pernicious anemia
  • Acid/base disturbance related to diarrhea
  • Fistulas may occur
  • Medical management/Nursing interventions
  • Diet
  • High protein
  • High in nutrients
  • Avoid lactose-containing foods, vegetables,
    caffeine, beer, MSG, highly seasoned foods,
    carbonated beverages, fatty foods

64
Crohns Disease
  • Medical management/Nursing interventions
  • Medications
  • Corticosteroids
  • Antibiotics
  • Anti-diarrheals
  • Antispasmodics
  • Enteric-coated fish oil capsules
  • B12 replacement
  • Surgery
  • Segmental resection of diseased bowel
  • Diagnostic tools
  • Small bowel barium
  • Colonoscopy with biopsy

65
Crohns Disease
66
Colon surgery and colostomy procedure
67
Colostomy and Bowel Resections
  • Sigmoid Resection Right
  • with colostomy Hemicoloctomy

68
Bowel Resections
  • Left Hemicolotomy Anterior Recto
    Sigmoidectomy

69
Appendicitis
  • Etiology/Pathophysiology
  • Inflammation of the vermiform appendix
  • Lumen of the appendix becomes obstructed
  • Clinical manifestations/Assessment
  • Rebound tenderness over McBurneys point
  • Vomiting
  • Low-grade fever
  • Diagnostic tests
  • WBC
  • CT scan
  • Ultrasound

70
Appendicitis
  • Medical management/Nursing interventions
  • Laparoscopy
  • Appendectomy
  • Post-op complications
  • Peritonitis
  • Intra-abdominal abscess
  • Mechanical bowel obstruction

71
Diverticular Disease
  • Etiology/Pathophysiology
  • Diverticuli become inflamed
  • Fecal matter becomes stuck in the pouches
  • Perforation is a risk
  • Diverticulosis
  • Pouch-like herniations through the muscular layer
    of the colon
  • Diverticulitis
  • Inflammation of one or more diverticuli

72
Diverticular Disease
  • Clinical manifestations/Assessment
  • Patient can become septic
  • Diverticulosis
  • May have few, if any, symptoms
  • Constipation, diarrhea, and/or flatulence
  • Pain in the left lower quadrant
  • Diverticulitis
  • Mild to severe pain in the left lower quadrant
  • Elevated WBC
  • Low-grade fever
  • Abdominal distention
  • Vomiting
  • Blood in stool

73
Diverticular Disease
  • Medical management/Nursing interventions
  • A temporary colostomy may be indicated with
    closure in 6 weeks to 3 months
  • Diverticulosis with muscular atrophy
  • Low-residue diet stool softeners
  • Bedrest
  • Diverticulosis with increased intracolonic
    pressure and muscle thickening
  • High-fiber diet
  • Sulfa drugs
  • Antibiotics if indicated
  • Analgesics

74
Diverticular Disease
  • Medical management/Nursing interventions
  • Surgery
  • Hartmanns pouch
  • Double-barrel transverse colostomy

75
Diverticulosis
76
Progression of Diverticular Disease
77
Diverticulitis
78
Umbilical Stoma Stoma Infected with Candida
Albicans
79
Prolapsed Loop Colostomy
80
Colostomy Pouch
81
Colostomy Irrigation
82
Pancreatitis
  • Pancreatic enzymes back up into pancreas
  • Can be fatal
  • Inflammation of the peritoneum following
    infection
  • Localized
  • Generalized

83
Peritonitis
  • Etiology/Pathophysiology
  • Inflammation of the abdominal peritoneum
  • Bacterial contamination of the peritoneal cavity
    from fecal matter or chemical irritation
  • Medical emergency
  • The prognosis for untreated peritonitis is very
    poor

84
Peritonitis
  • Causes
  • Internal perforation of the gastrointestinal
    tract
  • Intestinal foreign body
  • Colonic diverticulum
  • A ruptured appendix

85
Peritonitis
  • Clinical manifestations/Assessment
  • Severe abdominal pain
  • May present in the fetal position with knees
    drawn up
  • Pain with movement
  • Nausea and vomiting
  • Abdomen is rigid
  • Tympanic or absent bowel sounds
  • Chills
  • Weakness
  • Weak rapid pulse
  • Fever
  • Hypotension

86
Peritonitis
  • Diagnostic tests
  • Flat plate of the abdomen
  • CT scan
  • Medical management
  • Semi-Fowlers position
  • Surgery
  • Fecal contamination
  • Removal irritants
  • Parenteral antibiotics
  • NG tube
  • IV fluids

87
Meconium peritonitis
88
External Hernias
  • Etiology/Pathophysiology
  • Congenital or acquired weakness of the abdominal
    wall or postoperative defect
  • Hernia is a protrusion of viscus through an
    abnormal opening or weakened wall of the cavity
    in which it was normally contained
  • Abdominal or Ventral
  • Femoral or inguinal
  • Umbilical

89
External Hernias
  • Clinical manifestations
  • Protrusion at umbilicus, groin or incision
  • Pain may or may not be present
  • Complications
  • Incarceration
  • Strangulation
  • Diagnostic tests
  • Radiographs
  • Palpation

90
External Hernias
  • Medical management/Nursing interventions
  • If no discomfort, hernia is left unrepaired,
    unless it becomes strangulated or obstruction
    occurs
  • Truss
  • Surgery
  • Synthetic mesh is applied to weakened area of the
    abdominal wall

91
Umbilical Hernia
92
Hiatal Hernia
  • Etiology/Pathophysiology
  • Protrusion of the stomach and other abdominal
    viscera through an opening in the membrane or
    tissue of the diaphragm
  • Contributing factors obesity, trauma, aging
  • Clinical manifestations/Assessment
  • Most people display few, if any, symptoms
  • Gastroesophageal reflux

93
Hiatal Hernia
  • Medical management/Nursing intervention
  • Head of bed should be slightly elevated when
    lying down
  • Small frequent meals
  • OTC medications for GERD
  • Surgery
  • Posterior gastropexy
  • Transabdominal
  • fundoplication (Nissen)

94
Hiatal Hernia
  • Intestinal obstruction
  • Etiology/pathophysiology
  • Intestinal contents cannot pass
  • Partial or complete
  • Mechanical
  • Non-mechanical
  • Clinical manifestations/assessment
  • Vomiting dehydration
  • Abdominal tenderness and distention
  • Constipation

95
Hiatal Hernia
Sliding hernia
Rolling hernia
96
Intestinal Obstruction
  • Etiology/Pathophysiology
  • Mechanical
  • An occlusion of the lumen of the intestinal tract
  • Adhesions, incarcerated hernias, impacted feces,
    tumor, intussusception, volvulus, strictures of
    inflammatory bowel disease
  • Non-mechanical
  • Neuromuscular or vascular disorder
  • Paralytic ileus, trauma to the spine, mesenteric
    thrombosis that reduces blood flow to the bowel

97
Intestinal Obstruction
Intestinal obstructions. A, Adhesions. B,
Volvulus.
98
Intestinal Obstruction
  • Clinical manifestations/Assessment
  • Loud high pitched bowel sounds above the
    obstruction and absent bowel sounds below
  • Inability to pass stool or gas
  • Vomiting, abdominal cramps, abdominal distention
  • Diagnostic tests
  • Radiographic examinations
  • BUN, sodium, potassium,
  • hemoglobin and hematocrit

99
Intestinal Obstruction
  • Medical management/Nursing interventions
  • Evacuation of intestine
  • NG tube to decompress the bowel
  • Intestinal tube to evacuate the contents
  • Surgery
  • Required for mechanical obstructions
  • Bowel resection

100
Hemorrhoids
  • Etiology/Pathophysiology
  • Varicosities (dilated anorectal vessels/veins)
  • External or internal
  • Contributing factors
  • Straining with defecation, diarrhea,
    constipation, pregnancy, obesity, CHF, portal
    hypertension, family history, prolonged sitting
    and standing
  • Anatomic abnormalities
  • Intrinsic weakness of anal blood vessels

101
Hemorrhoids
  • Clinical manifestations/Assessment
  • Varicosities in rectal area
  • Bright red bleeding with defecation
  • Pruritus
  • Rectal Pain
  • Prolapsed hemorrhoid
  • Fullness or mass sensation

102
Hemorrhoids
  • Diagnostic tests
  • Visual inspection
  • Digital Rectal Exam
  • Anoscopy
  • Differential Diagnosis
  • Fissure
  • Perirectal Abscess
  • Rectal Fistula
  • Condyloma
  • Rectal carcinoma

103
Hemorrhoids
  • Medical management/Nursing interventions
  • Bulk stool softeners
  • Hydrocortisone cream
  • Analgesic ointment
  • Sitz baths
  • Ligation
  • Sclerotherapy
  • Cryotherapy
  • Infrared photocoagulation
  • Hemorrhoidectomy

104
Anal Fissure
  • Etiology/Pathophysiology
  • Linear ulceration or laceration of the skin of
    the anus
  • Usually caused by trauma
  • Lesions usually heal spontaneously
  • May be excised surgically
  • Usually follows trauma or diarrheal illness
  • Increased anodermal blood flow causes fissures
  • Affects young and middle-aged adults

105
Anal Fissure
  • Clinical manifestations/Assessment
  • Onset after forced hard bowel movement
  • Bright red rectal bleeding
  • Pain during bowel movement
  • Cut with sharp glass sensation
  • Pain persists for an hour after stooling
  • Avoid anoscopy if possible
  • Painful and usually not needed
  • Use local anesthesia if performed

106
Anal Fissure
  • Clinical manifestations/Assessment (continued)
  • Crack or crevice in anoderm at anal verge
  • Usually in canal midline (anterior or posterior)
  • Lateral suggests other diagnosis
  • Best seen with lateral traction on opposite
    buttock
  • Sentinel pile (distal skin tag)
  • Tag-like swelling of fissure end
  • Results from infection and edema

107
Anal Fistula
  • Etiology/Pathophysiology
  • Abnormal opening on the surface near the anus
  • Usually from a local abscess
  • Common in Crohns disease
  • Treated by a fistulectomy or fistulotomy
  • Perirectal abscess sequelae of rupture or surgery
  • Anal Fissure
  • Anorectal cancer
  • Tuberculosis
  • Local radiation therapy
  • Lymphogranuloma venereum

108
Anal Fistula
  • Clinical manifestations/Assessment
  • Chronic seropurulent or mucus drainage from
    fistula
  • Communicating tract between perianal skin and
    anus
  • One or several external openings tracking toward
    anus
  • Associated conditions
  • Perirectal Abscess
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