CHAPTER 46 CARING FOR CLIENTS WITH DISORDERS OF THE LOWER GASTROINTESTINAL TRACT, Chapter 45-Caring for Clients With Disorders of the Upper Gastrointestinal Tract

Medical and surgical management of Diarrhea?

*Resting bowel by limiting intake to clear liquids for one to two meals and gradually advancing to a regular diet. MEDICAL MANANGMENT MAY INCLUDE: -administration antidiarrheal- diphenoxylate hydrochloride with atropine sulfate(Lomotil), loperamide hydrochloride(Imodium) or a combination product such as kaolin and pectin (kaopectate) -fluid and electrolyte replacement by either the oral or IV route -dietary adjustments, which may involve eliminating foods that cause diarrhea -TPN if diarrhea is severe and prolonged *chronic diarrhea depletes the bowel of helpful organisms and allows yeast and fungi to thrive unchecked, to recolonize the bowel, capsules or granules containing Lactobacillus acidophilus (bacid or lactinex) are prescribed < they are probiotics

Medical and surgical management of peritonitis ?

*a nasogastric rube is used to relieve abdominal distention. *IV fluids and electrolytes replace substances relocated in the peritoneal cavity. *large doses of antibiotics are prescribed to combat infection *antiemetics are for nausea and vomiting *the perforation is surgically closed so that intestinal content can no longer escape,

Medical and Surgical management of Ulcerative colitis?

*achieving and maintaining remission *the client is constructed temporarily to refrain from eating foods associated with discomfort *the client may be given TPN an intermittent lipid infusions to rest the bowel. *Blood transfusions and iron given to correct anemia> *when colectomy is performed and rejoining the bowel may be impossible, creating a permanent ileostomy is necessary.

Precautions when assessing a client for appendicitis ?

*avoid multiple or frequent palpation of the abdomen - there is danger of causing the appendix to rupture *perform the test for rebound tenderness at the end of the examination. A positive response causes pain and muscle spasm and makes it difficult to complete the rest of the assessment *Do not administer laxatives or enemas to a client who is experiencing fever, nausea, and abdominal pain, even though the client may complain of feeling constipated. laxatives and cathartics may cause the appendix to rupture.

During the fecal occult blood test the nurse should instruct the client to ?

*collect stool within a toile liner or bedpan *use applicator to remove sample form center of stool *apply thin smear of tool on test area supplied with kit *take care to cover the entire space *place two drops of developer solution onto the test area. *wait precisely 60 seconds *observe for blue color indicating positive reaction, test samples from several stool over 3 to 6 days

Two days before and throughout the fecal occult blood testing the nurse should instruct?

*consume a high fiber diet and avoid red meat, substitute with poultry and fish *avoid turnips, cauliflower, broccoli, cantaloupe, horseradish, and parsnips.

Seven to ten days before and through the fecal occult blood testing, the nurse should instruct?

*do not drink alcohol, take aspirin, NSAIDS, vitamin c or iron preparations *Check with physician if anticoagulants, steroids, colchicines(treat gout) or cimetidine(peptic ulcer) have been prescribed

Surgical management of hemorrhoids?

*hemorrhoidectomy -performed using conventional surgery or laser surgery, -internal packing of lubricated gauze, external gauze or pad to absorb blood. A T binder holds the absorbent material in place. *Hemorrhoid stapling is a procedure that interrupts blood flow to the hemorrhoid. although it is less painful than a hemorrhoidectomy and has a shorter recovery period, there is a higher chance of recurrence and rectal prolapse.

Diagnostic finding of Peritonitis?

*results of a WBC count show marked leukocytosis, *abnormal x-rays reveal free air and fluid in the peritoneum. *a ct scan or ultrasonography identifies structural changes. *cultures of peritoneal fluid and blood usually reveal bacteria such as E.choli , klebsiella, proteus, and psedomonas

Medical management of crohn's disease ?

-TPN for intestinal rest -Antidiarrheal agents -Corticosteroids used during acute exacerbations -immune-modulating agent if patient fails to maintain remission

peptic ulcers

-abdominal pain -burning -1 to several hours after meals, interrupts sleep -eating food relieves pain -back pain= pancreas irritation -bleeding= first sign of ulcer -hemorrhage, hematemesis, melena

GERD

-antacids -sodium bicarbonate tablet -histamine2 receptor antagonists -proton pump inhibitors -fundoplication

esophageal cancer

-barium swallow -biopsy -bronchoscopy -endoscopic ultrasound/mediastinoscopy -CT scan of chest

hiatal hernias

-barium swallow -esophagoscopy

GERD

-barium swallow -upper endoscopy with biopsy -pH monitoring

esophageal diverticulum

-bland, soft, semisoft, or liquid diet -eat 4-6 small meals a day -surgical excision

gastritis

-cbc -stool testing -gastroscopy

esophageal cancer

-chemotherapy/radiation -esophageal resection -palliative measures

esophageal cancer

-chronic irritation due to alcohol abuse and cigarette smoking -GERD -habitual indigestion of hot foods or liquids -chewing tobacco -poor or inadequate oral hygiene -poor intake of fruits and vegetables -obesity -history of radiation therapy to the upper abdomen or chest

esophageal diverticulum

-congenital -acquired weakness of the esophageal wall -they trap food and secretions, which then narrow the lumen; interfere with the passage of food into the stomach; and exert pressure on the trachea. The trapped food decomposes in the esophagus causing esophagitis or mucosal ulceration

hiatal hernia

-defect in the diaphragm -congenital muscle weakness or weakness resulting from trauma -factors that increase intra-abdominal pressure: multiple pregnancies, obesity, and loss of muscle tone that occurs with aging -smoking -aging

gastritis

-dietary indiscretions -reflux of duodenal contents -use of NSAIDS -alcohol -caffeine -cigarette smoking -ingestion of poisons or corrosive substances -food allergies -infection -gastric ischemia secondary to vasoconstriction caused by stress response

n/v

-drugs -infections -inflammatory conditions of GI tract -intestinal obstruction -systemic infections -lesions of the CNS -food poisoning -emotional stress -early pregnancy -uremia

GERD

-dyspepsia -pyrosis -dysphagia -odynophagia -esophagitis -aspiration pneumonia -respiratory distress -vomited blood -tarry stools -occult bleeding

stomach cancer

-endoscopy with barium swallow -ct scan -tissue biopsy obtained by gastroscopy -gastric analysis

gastritis

-epigastric fullness -pressure -pain -anorexia -n/v -bacterial or viral: vomiting, diarrhea, fever, abdominal pain -blood in emesis/stool

peptic ulcers

-eradicate the bacteria -reduce the acid levels in the digestive system to relieve pain and promote healing -vagotomy -pyloroplasty -antrectomy -gastroduodenostomy (billroth 1) -gastrojejunostomy (billroth 2) -total gastrectomy -see pg. 732-733 for medications

esophageal diverticulum

-foul breath -difficulty or pain when swallowing -belching -regurgitation -coughing -auscultation reveal gurgling sounds

extreme obesity

-genetic predisposition -excessive caloric intake -ready access to an abundance of food -sedentary lifestyle -low resting metabolic rate -pregnancy -lack of sleep -medications

hiatal hernia

-heartburn -belching -nausea -substernal, epigastric pressure -pain after eating when laying down -dysphagia

anorexia

-hemoglobin decreased -CBC decreased -RBC enlarged -serum albumin, electrolytes, and protein levels low with accompanying cardiac dysthythmias

stomach cancer

-hereditary -chronic inflammation -achlorhydria -chronic ingestion of highly salted, smoked, or pickled foods -nitrates and nitrites, nitrogen based chemical additives in cured meats -diet low in fresh fruits and veggies -infection of H. pylori -tobacco and alcohol use -stomach polyps

anorexia

-hunger is usually absent -nausea with smell or thought of food -hypoviaminosis

GERD

-inability of the lower esophageal sphincter to close fully, allowing stomach contents to flow freely into the esophagus -obesity -pregnancy

oral cancer

-lesion -lump -abnormalities of lips or mouth -pain, soreness, bleeding to follow -difficulty swallowing/persistent hoarseness -leukoplakia -red patch that does not heal

anorexia

-short term = no medical intervention -persistent = high calorie diet, high calorie supplemental feedings, tube feedings, TPN, psychological support, psychiatric tx

n/v

-short term: no medical attention -long term: NPO, IV fluids, electrolytes, drug therapy, NGT

hiatal hernia

-similar to GERD tx -narrowed esophagus is stretched endoscopically -stomach surgically restored to proper position and repairing the diaphragmatic defect

stomach cancer

-small tumors are removed with endoscopic mucosal resection -subtotal or total gastrectomy is used for large -chemotherapy -palliative radiation

oral cancer

-smoking -chewing -drinking excessive alcohol -prolonged exposure to wind and sun

oral cancer

-surgical excision followed by radiation or chemo -neck dissection -advanced: palliative only -tracheostomy and tube feedings to maintain adequate airway and provide nourishment

extreme obesity

-unable to engage in physical activity without getting severely short of breath -cannot participate in ADL's -poor self esteem and suffering of depression

peptic ulcers

-upper GI series or EGD -biopsy -hemoglobin low -RBC low -alteration of electrolyte levels -H. pylori test

esophageal cancer

-vague discomfort/ difficulty swallowing -weight loss -regurgitation of liquids or food -expansion of tumor: back pain, respiratory distress -weakness

peptic ulcers

-when normal balance between factors that promote mucosal injury (gastric acid, pepsin, bile acid, ingested substances) and factors that protect the mucosa (intact epithelium, mucus, and bicarbonate secretion) is disrupted -h. pylori -family history -nsaids -smoking -physiologic stress

Medical and surgical management of IBS?

Anticholinergic, dicyclomine(bentyl) has an antispasmodic effect if taken before meals. *either a prescription or non prescription antidiarrheal is used for temporary relief from diarrhea. Antidepressant medications may be prescribed not only to help with depression, but also to inhibit neuron activity that impacts intestinal motility.

Assessment Findings of Constipation?

Bowel elimination is infrequent or irregular *rectal bleeding may result as tissue stretches and tears while the person tries to pass the hard, dry stool. when a nurse inserts a gloved and lubricated finger in the rectum, the stool may feel like small rocks, condition know as SCYBALA the client may begin passing liquid stool around an obstructive mass (encopresis), a phenomenon sometimes misinterpreted as diarrhea.

What facilitates stool passage by accelerating peristalsis?

Gastrocolic reflex

Medical and Surgical management of intestinal obstruction ?

IV fluids with electrolytes are administered to correct fluid and electrolyte imbalances and antibiotics are ordered to treat infections. Intestinal decompression is accomplished by suctioning large amounts of accumulated secretions and gas through NG tube or intestinal tube. colonoscopy by removing obstructing polyps or destroying benign tumors with laser therapy or electrocautery.

lips, mouth, pharynx

When cancer affects the oral cavity, cells in the ________, ________ or ____________ undergo malignant changes

vagotomy

a branch of the vagus nerve is cut to reduce gastric acid secretion

Pilonidal sinus?

a infection in the hair follicles in the sacrococcygeal area above the anus. pilonidal sinus and pilonidal cyst are both used to describe the condition

fundoplication

a procedure that tightens the LES by wrapping the gastric fundus around the lower esophagus and suturing it into place.

leukoplakia

a white patch on the tongue or inner cheek that may become cancerous

achlorhydria

absence of free hydrochloric acid in the stomach, which may promote bacterial growth

gastritis

acute: -eating restricted -IV fluids -anti-emetics -antibiotics chronic: -avoidance of alcohol/nsaids -avoidance of spicy/hot foods, caffeine -antacids, H2 receptor antagonists, proton pump inhibitors prescribed

foods that increase GERD

alcohol, chocolate, peppermint, licorice, citrus fruits, caffeine, high fat foods

Irritable bowel syndrome?

also known as spastic bowel, if a functional motility disorder primarily affecting the colon. it refers to a cluster of symptoms that occur despite the absence of an identifiable disease process. the intestinal mucosa does not exhibit any changes. *people with IBS experience abdominal pain and cramping, bloating and flatus, as well as diarrhea and/or constipation, with or without the presence of mucus.

PEG tube

an endoscope is introduced orally and advance into the stomach so that the physician can see the correct location for the tube. Can be done in endoscopy suite or at bedside with minimal sedation.

Diagnostic Findings of Crohn's disease?

an examination of stool specimens reveals steatorrhea or excessive fat and occult blood and white blood cells. stool cultures fail to disclose an etiologic microorganism or parasite. Results of blood studies indicate anemia from chronic blood loss and nutritional deficiencies. The wbc count and erythrocyte sedimentation rate may be elevated, confirming and inflammatory disorder. Serum protein and albumin levels may be low because of malnutrition. Low serum levels of the fat-soluble vitamins also reflect the clients malnourished state.

Anorectal abscess?

an infection with a collection of pus in an area between the internal and external sphincters

Medical and surgical management of anorectal abscess ?

analgesics and sitz baths are prescribed to relieve symptoms. Antibiotic therapy is used to treat gonorrheal staphylococcal, streptococcal, or other drug-sensitive bacteria

Medical and Surgical management of Appendicitis ?

antibiotics are given and the client is restricted from eating or drinking while a decision is made about surgery. IV fluids are prescribed tp meet the client's fluid needs. Analgesics may be withheld initially to avoid masking symptoms that may affect the diagnosis. *If symptoms worsen, the surgeon performs and appendectomy, either via several small laparoscopic incisions or as an open incision to remove the appendix before it spontaneously ruptures.. the appendix has no known function in the body. its removal results in cure with no physiologic changes. if the appendix perforates or ruptures am abscess or peritonitis can develop

Medical and surgical management of anal fistula?

antibiotics are prescribe. *most simple low-lying fistulae can be managed by fistulotomy. this procedure involves incising the fistula along with partial sphincter division and is reserved for those fistulae that arise from relatively normal surrounding tissue. *fistulectomy involves an excision of the fistulous tract-usually recommended -a seton is a nonabsorbable suture or drain that is passed from the cutaneous opening of the fistula into the lumen of the anal canal and then back out onto the skin, where it is tied to itself. the seton can be gradually tightened to cut through the sphincter or left in place as a drain

What are acute abdominal inflammatory disorders ?

appendicitis and peritonitis.

Hemorrhoids ?

are dilated veins outside or inside the anal sphincter. thrombosed hemorrhoids are veins that contain clots.

esophageal diverticula

are found at the junction of the pharynx and the esophagus or in the middle or lower portion of the esophagus

Diarrhea may be related to?

bacterial or viral infections affecting the intestine; lactose intolerance; fructose intolerance; food allergies or intolerance; artificial sweeteners, such a sorbitol or mannitol; uremia; intestinal disease such as diverticulitis, ulcerative colitis, malabsorption, or intestinal obstruction; rapid addition of fiber to the diet; consumption of highly spiced or seasoned food; food positioning, overuse of laxatives, effects of drugs- antibiotics or concentrated tube feedings. *may be caused by surgical resection of large portions of the small bowel (short bowel syndrome)

Diagnostic findings of Ulcerative Colitis?

barium enema reveals evidence of inflammation. Definitive diagnosis requires proctosigmoidoscopy or colonoscopy with biopsy. Endoscopic exam and biopsy of lining of the colon. biopsies reveal evidence of chronic inflammation.

oral cancer

biopsy

pyrosis

burning sensation in esophagus

Assessment findings of colon and rectum cancer?

change in bowel habits, such as alternating constipation an diarrhea, and a narrowing of the stool. *clients complaint may not be specific, *stool will appear black or tarry because of blood loss from the surround tissue. there can be iron deficiency anemia and fatigue. *tumors in the descending colon, which has a narrower circumference, are more likely to cause obstruction *client often complain of pain an cramping , constipation or diarrhea abdominal distention in the stools, tumor, narrowing of stools, and bright red blood in stools. tumors in the rectum also cause blood stools and rectal pain. constipation or diarrhea.

Although primary malignant growth may remain in situ it can?

change the shape of the stool, compressing it or making it appear pencil- like as it passes by protruding mass. untreated the cancer extends to other organs by way of the mesentery lymph nodes or portal vein leading to the liver.

Cause of Hemorrhoids ?

chronic straining to have a bowel movement or frequent defecation with chronic diarrhea likely weakens the tissue supporting veins

Assessment findings of Anal fistula?

client repots pain on defecation. opening of fistula appears red and pus leaks from the external opening of the fistula or can be expressed if the area is compressed. if the fistula is superficial, it feels cordlike on palpation

If the appendix perforates during appendicitis ?

clients experience more diffuse abdominal pain. *the abdomen appears distended secondary to paralytic ileus (intestine lacks peristalsis). perforation generally occurs 24hours following the onset of abdominal pain. *Fever of 37.7c (100F) or higher and very ill

Anorectal disorders ?

clients with anorectal disorders usually experience localized pain and bleeding. *may delay defecation secondary to pain and other discomfort

Assessment findings with diverticula ?

constipation alternating with diarrhea, flatulence, pain and tenderness in the LLQ, fever, and rectal bleeding may occur. a palpable mass may be felt in the lower abdomen. when the diverticula bleed, the stools appear maroon and are sometimes described as resembling "currant jelly" *ct scan generally is used first as an alternative to a barium enema

Cause of anal fissure?

constipation is leading cause of anal fissures. other factors that may lead to formation of a slit-like tear include eversion of the anus during delivery and trauma to anus, such as during anal intercourse or through the insertion of foreign body or instruments. when the anal is stretched, the skin rips apart, exposing the underlying tissue.

What are the most common inflammatory bowel diseases?

crohn's disease and ulcerative colitis

Opiates bind to nerve receptors in the bowel to ?

decrease motility and delay transit of bowel contents. Methylnaltrexone is a drug which blocks receptors and reduces constipation due to opioid use.

Three major problems associated with severe or prolonged diarrhea include?

dehydration, electrolyte imbalances, and vitamin deficiencies.

Asymptomatic diverticula are called?

diverticulosis , when the diverticula become inflamed they are called diverticulitis

stomach cancer

early: -vague symptoms later: -prolonged feeling of fullness after eating -indigestion -heartburn -n/v -anorexia -weight loss -fatigue -anemia -pain

dyspepsia

epigastric pain or discomfort

Signs and Symptoms of IBS?

experience various degrees of abdominal pain that defecation relieves. they describe having chronic constipation with sporadic bout of diarrhea. Some report the opposite pattern, although less commonly. many clients suffer with belching and flatulence. *in general symptoms do not awaken people from sleep. some clients with IBS report anxiety, insecurity, depression or anger.

Assessment findings of Hemorrhoids ?

external hemorrhoids may cause few symptoms, or they can produce pain, itching, and soreness of the anal area. They appear as small, reddish-blue lumps at the edge of the anus. *thrombosed external hemorrhoids are painful but seldom cause bleeding *internal hemorrhoids cause bleeding but are less likely to cause pain, unless they protrude through the anus. the amount of bleeding varies from an occasional drop or two of blood on toilet tissue or underwear to chronic loss of blood, leading to anemia. *internal hemorrhoids usually protrude each time the client defecates but retract after defecation . as the masses enlarger, they remain outside the sphincter

Oncogene ?

genetic messenger that stimulates tumor growth, is not adequately suppressed. -without growth inhibition, the neoplastic cells reproduce rapidly and later proceed to invade the muscle wall.

Medical and surgical management of Abdominal hernia?

herniorrhaphy- surgical repair *some types of hernias can be repaired using a laparoscopic approach. *obese people who have put off surgical repair for a prolonged period are especially prone to recurrence of the hernia despite surgical repair. for these cases, the surgeon also may perform a hernioplasty, the weakened area is reinforced with wire, fascia or mesh.

Medical and Surgical management of Diverticula ?

high fiber IV fluids for several days with no oral intakes *if diverticulitis does not respond to medical treatment surgery is needed colostomy is closed 3 to 6 weeks later.

Medical and Surgical management of Colon and rectum cancer?

if the tumor is in the upper third of the rectum, a segmental resection is performed. in this procedure the surgeon removes the cancerous portion of the colon and rejoins the remaining portion of the GI tract to restore normal intestinal continuity *cancers in the lower third of the rectum are treated with an abdominoperineal resection- wide excision of the rectum and creation of a sigmoid colostomy.

With crohn's disease barium enema findings may show?

inflammation in the large intestine, but confirmation of the diagnosis requires endoscopic examination (colonoscopy or sigmoidoscopy)

Appendicitis ?

inflammation of a narrow, blind protrusion called the vermiform appendix located at the tip of the cecum just below the ileocecal valve in the right lower quadrant of the abdomen/

gastritis

inflammation of the stomach lining (acute or chronic)

Constipation may result from ?

insufficient dietary fiber and water, ignoring or resisting the urge to defecate, emotional stress, use of drugs that tend to slow intestinal motility or inactivity. *may also result from chronic use of laxatives- they can cause a loss of normal colonic motility and intestinal tone. Laxatives also dull the gastrocolic reflex. Chronic lead poisoning or concurrent medications such as opioids, tranquilizers, antidepressants, and antihypertensive may also result in constipation.

Cancers of the colon and rectum?

intestinal malignancies may develop anywhere in the lower GI tract. colorectal cancer ranks as the third most common cancer among men and women in the US.

Inflammatory bowel disease ?

is a chronic illness, characterized by exacerbations and remissions. The term IBD refers to several chronic digestive disorders believed to result from the immune system attacking the bowel. -it causes severe diarrhea with pain, weight loss, and chronic fatigue. *unlike Irritable bowel syndrome, inflammatory bowel disease does not resolve without medical intervention.

peptic ulcer disease

is a circumscribed loos of tissue in an area of the GI tract that is in contact with hydrochloric acid and pepsin

GERD

is a common disorder that develops when gastric contents flow upward into the esophagus

Anal fissure?

is a linear tear in the anal canal tissue

hiatal hernia

is a protrusion of part of the stomach into the lower portion of the thorax

diverticulum

is a sac or pouch in one or more layers of the wall of an organ or structure

extreme obesity

is defined as a body mass index of 40 or higher or a body weight of more than 20% of the ideal

Irreducible or incarcerated hernia?

is one in which the intestine cannot be replaced in the abdominal cavity because of edema of the protruding segment and constriction of the muscle opening through which it has emerged. if the process continues without treatment, the blood supply to the trapped segment of bowel can be cut off, leading to gangrene. this development is referred to as a STRANGULATED HERNIA

GERD

is only considered a disease process when it is excessive or causes undesirable symptoms such as pain or respiratory distress

GI intubation

is performed to provide nutrition, medications, or both to carry out gastric depression; to lavage the stomach to remove ingested toxins; to diagnose GI disorders; to treat GI obstruction; to apply pressure to a GI bleed

Diarrhea?

is the frequent passage of larger than normal amounts of liquid or semiliquid stool (more than three bowel movements per day) *results from increased peristalsis

The cause of Crohn's disease ?

is unknow. because incidence is increased among family members, a genetic predisposition is presumed. other possible contributing factors include allergic and autoimmune responses triggered by diet or infectious microbial antigens.

cause of diverticula ?

low intake of dietary fiber, congenital predisposition. *other factors: obesity, lack of exercise, smoking and certain medications, steroids, opiates, NSAIDS diverticula become inflamed when fecal material is trapped in one or more blind pouches. the inflammation causes swelling of the tissue in the area. *Abscesses form when the inflamed tissue becomes infected with intestinal bacteria present in the bowel. the swollen tissue has the potential to rupture into the peritoneal cavity or form a fistular

Cause of intestinal obstruction?

mechanical obstructions result from a narrowing of the bowel lumen with or without a space-occupying mass. a mass may include a tumor, adhesions. incarcerated or strangulated hernias, volvulus, intussusception, or impacted feces or barium the intestine can become adynamic from an absence of normal nerve stimulation to intestinal muscle fibers. paralytic ileus is common 12 to 36 hours after abdominal surgery. can also result from inflammatory conditions, electrolyte disturbances pr adverse drug effects. even a vascular embolus or low blood flow during shock can interfere with the neuromuscular function of the bowel.

Signs and Symptoms of Crohn's disease ?

most clients have abdominal pain, distention, and tenderness in the lower abdominal quadrants, especially on the right side. *growth failure is common early symptom in children and adolescents. *fever may be present. As crohn's disease progresses, anorexia, more weight loss, dehydration, and signs of nutritional deficiencies occur.

squamous cell carcinoma

most common type of oral cancer?

Cause of Colon and rectum cancer?

most malignant colorectal tumors develop from benign adenomas in the mucosal and submucosal intestinal layers *a benign polyp may become malignant and then invade the surrounding tissues and structures. *cancer cells break away and spread to other body parts, most commonly the liver and the lungs. *having a blood relative with this disease is high-risk factor.<genetic testing may be done

Signs and Symptoms of Intestinal obstruction?

nausea and abdominal distention are common. . *When an obstruction occurs high in the GI tract, the client usually vomits whatever contents are in the stomach and small intestine. *the emesis appears to contain bile or fecal material. if the obstruction is lower, vomiting may occur later or not at all *in a functional obstruction, peristalsis is absent; therefore, bowel sounds are not heard. in a mechanical obstruction, the bowel sounds usually are high-pitched above the obstructed area. pulse and respiratory rates are elevated, BP falls and urine output decreases if shock develops

Intestinal obstruction ?

occurs when a blockage interferes with the normal progression of intestinal contents through the intestinal tract *causes are classified as mechanical or functional also called paralytic ileus, or pseudo-obstruction and as partial or complete *an intestinal obstruction is extremely dangerous and may be fatal if not treated promptly

Who are more prone to constipation ?

older adults because they take more drugs that can interfere with bowel elimination, have more chronic illnesses, and many have decreased mobility.

Cause of Anorectal Abscess ?

original source of the infection may be microorganism harbored in the intestine itself. An anorectal abscess is common in clients with crohn's disease.

Assessment findings of Pilonidal sinus?

pain and swelling at the base of the spine and purulent drainage occur. On inspection the sinus opening may be located in the gluteal fold. dilated pits of the hair follicles in the sinus are a unique characteristic.

Assessment findings of anorectal abscess?

pain, fever, drainage, foul smelling drainage, straining to have bowel movement.

odynophagia

painful swallowing

gastroduodenostomy (billroth 1)

part of the stomach is removed; while the remaining portion is connected to the duodenum. Usually, a vagotomy also performed. This procedure is done to remove an ulcerated area in the stomach that is prone to hemorrhage, perforation, and obstruction

What facilitates the signal to release stool?

peristalsis

Abdominal hernia

protrusion of the intestine through a defect in the abdominal wall. certain areas in the abdominal wall are weaker than other areas and more vulnerable to the development of a hernia. These areas include the inguinal ring, the point on the abdominal wall where the inguinal canal begins; the femoral ring at the abdominal opening of the femoral canal and the umbilicus.

If protruding structures can be replaced in the abdominal cavity it is called ?

reducible hernia

gastric depression

removal of gas and fluids from the stomach

Diagnostic findings of Diarrhea?

routine stool cultures -identifying parasites involves placing stool specimens in special preservatives for analysis of parasites and their ova by the microbiology department. *routine ova and parasite analysis may identify amebic infections; however, such infections may require serologic (blood) tests.

Diverticula ?

sacs or pouches caused by herniation of the mucosa through a weakened portion of the muscular coat of the intestine or other structure. they can appear anywhere in the GI tract, but they can appear most commonly in the colon, especially the sigmoid area, in people older than 50 years of age

gastrojejunostomy (billroth 2)

same as Billroth 1, except the remaining portion is connected to the jejunum in cases of extensive duodenal inflammation or perforation

esophageal cancer

see pg. 730

Signs and Symptoms of Peritonitis ?

severe abdominal pain, distention, tenderness, nausea and vomiting, anorexia, and diarrhea initially, followed by Inability to pass stool or gas. Fever may be absent initially but the temperature rises as infection becomes established Abdomen feels rigid and board like as it distends with gas an intestinal contents. Bowel sounds typically are absent. The pulse rate is elevated, and respirations are rapid and shallow. If peritonitis is unresolved, severe weakness, hypotension, and a drop in body temperature occur as the client nears death.

Signs and symptoms of ulcerative colitis ?

severe diarrhea and expel blood, pus and mucus along with fecal matter. *despite intense tenesmus, clients may expel very little stool, or they may have 10 to 20 stools/day. *this disease is usually marked by exacerbations and remissions.

Assessment findings of anal fissure?

severe pain and bleeding on defecation are common. constipation most client don't defecate bc of pain

Cause of Ulcerative colitis ?

some believe that multiple factors trigger: genetic predisposition, infection, allergy, and abnormal immune response. *clients often have other coexisting immune-related disorders *no healthy tissue appears between inflamed areas. toxic megacolon -a complication in which the colon dilates and become atonic

appetite center

stimulates or suppresses the appetite, is located in the hypothalamus.

Assessment findings of Diarrhea?

stools are watery and frequent. -SEVERE diarrhea> blood and mucus will pass.

melena

tarry stools

Diagnostic findings of intestinal obstruction ?

tests of serum electrolyte may indicate low levels of sodium, potassium an chloride. metabolic alkalosis is evidenced by arterial blood gas results. CBC shows an increased WBC count in instances of infection. The hematocrit level is elevated if dehydration develops

Medical and surgical management Pilonidal sinus?

the abscess is drained and the tissue is incised. packing is inserted into the cavity and the wound heals by secondary intention, in some cases the wound edges are approximated. healing by primary intention, however, sometimes allows the purulent material to reform and collect, causing another abscess. because the infection is localized, systemic antibiotics usually are not prescribed.

antrectomy

the antrum (lower portion of the stomach, including the pylorus) is removed to eliminate a benign ulcer in the lesser curvature of the stomach if the ulcer has not healed after 12 weeks of medical treatment is recurring

Ulcerative Colitis is?

the chronic inflammation usually is limited to the mucosal and submucosal layers of the colon and rectum. the inflammation causes small ulcers to form that produce mucus and pus and result in bleeding.

Cause pilonidal sinus?

the condition typically occurs after puberty. people who have a deep intergluteal cleft and those who have abundant hair in the perianal and lower back regions are predisposed to the condition. inadequate personal hygiene, obesity and trauma to the area also contribute ot its development. * a sinus or cyst begins to from where the skin deep in the cleft softens as a result of being chronically moist. stiff hairs then irritate and pierce the soft, macerated skin, becoming embedded in it. the irritation inflames the tissues. infection readily follows because the break in the skin allows microorganisms to enter. several channel may lead from the sinus to the skin

glycogenolysis

the conversion of glycogen to glucose

total gastrectomy

the entire stomach is removed and the esophagus is joined to the jejunum to remove an ulcer high in the stomach near the gastroesophageal junction. It is performed to treat gastric malignancy

paraesophageal

the fundus is displaced upward, with greater curvature of the stomach going through the diaphragm next to the gastroesophageal junction

Cause of Crohn's Disease

the inflamed areas occur randomly, a phenomenon described as skip lesions. the bowel is described as having a "cobblestone" appearance because of the deep ulcerations that form amid the edematous tissue in a longitudinal and transverse manner. *Fistulae may form a channel between the bowel and the skin surface ( enterocutaneous fistulae) *common sites for enterocutaneous fistulae are perianal and perilabial sites. *inflammation also may extend between the bowel and other pelvic organs, between the bowel and bladder or between loops of bowel. *fistulae may also for between the rectum and vagina in women evidenced by passage of stool form the vagina

axial or sliding hiatal hernia

the junction of the stomach and esophagus and part of the stomach slide in and out through the weakened portion of the diaphragm

zenker's diverticulum

the most common esophageal diverticulum, occurs at the pharyngeal-esophageal juncture

Assessment findings of Appendicitis ?

the pain localizes in the right lower quadrant at McBurneys point- an area midway between the umbilicus and the righ tiliac crest. -rebound tenderness *when an examiner deeply palpates the LEFT LOWER QUADRANT and the patient feels pain in the RIGHT LOWER QUADRANT referred to as POSITIVE ROVSING'S SIGN and suggests acute appendicitis.

Cause of Peritonitis ?

the peritoneum, a serous sac lining the abdominal cavity, becomes inflamed. peritonitis may be cause by perforation of a peptic ulcer, the bowel, or the appendix; abdominal trauma, such as gunshot or knife wounds; IBD; ruptured ectopic pregnancy or infection introduce during peritoneal dialysis, a procedure used to treat kidney failure.

pyloroplasty

the pylorus is repaired or reconstructed to expand the stomach outlet narrowed by scarring or improve gastric motility and emptying

Assessment findings of abdominal hernia?

the severe pressure on the loop of intestine protruding outside the abdominal cavity causes intestinal obstruction.

medulla

the vomiting center is located in the?

Diagnostic findings of IBS?

there are two international sets of criteria used to diagnose IBS, because diagnosis often is made by ruling out other intestinal disorders. - the first is the Rome set of criteria, which includes abdominal pain for at least 3 days a month for at least 3 months, accompanied by two of the following: relief of pain with defecation, alteration in frequency of stools and or a change in the consistency of stool. either harder or softer. -the manning criteria are similar. they focus on relief of pain with defecation, incomplete emptying of the bowel with each movement, the presence of mucus in the stools, and changes in stool consistency.

Anal Fistula?

tract that forms un the anal canal

Medical and surgical management of anal fissure?

treatment includes applying anesthetic creams, ointments or suppositories, taking sitz bath and analgesics and preventing constipation. surgical excision may be necessary.

Surgical Management of Crohn's disease?

treatment is reserved for complications such as intestinal obstruction, perforation, or fistula formation. more than 75% of clients with crohn's disease require surgery within 20 years of the onset of symptoms, and 90% require surgery within 30years. *surgical removal of a large amount of intestine results in the loss of absorptive surface, called short bowel syndrome. *Massive bowel resection result in dependence of TPN, possibly for life. Removal of the colon requires a permanent ileostomy because the disease tends to recur in any rectal pouch

jejunostomy

tube enters jejunum or small intestine through a surgically created opening into abdominal wall

gastrostomy

tube enters the stomach through a surgically created opening into the abdominal wall

orogastric intubation

tube passes through mouth into the stomach

nasogastric intubation

tube passes through nose into stomach via esophagus

nasoenteric intubation

tube passes through the nose, esophagus, and stomach into the small intestine

bariatric surgery

weight loss surgery, or gastric bypass surgery are procedures designed to help clients reduce their weight through surgical changes to the upper GI digestive system

squamous cell carcinoma, adenocarcinoma

what are the two types of esophageal cancer?

Cause of anal fistula?

when healing of an anorectal abscess is inadequate, an inflamed tunnel develops, connecting the area of the original abscess with perineal skin. purulent draining drains from the opening.

duodenum

where to most peptic ulcers often occur at?

dumping syndrome

which produces weakness, dizziness, sweating, palpitations, abdominal cramps, and diarrhea, results from the rapid emptying of large amounts of hypertonic chyme, into the jejunum

sliding

which type of hernia is most often associated with reflux?

Diagnostic findings of Constipation ?

x-rays -anorectal motility and/or colonic motility studies may be performed to confirm a motility disorder. these studies use flexible catheters with sensors that measure the pressure of muscle contractions. -colonic transit or marker studies are used to determine how long it takes for food to travel through the intestines.