Gastrointestinal disorders and conditions:

Question 1

Oesophageal cancer:

Answer 1

• malignant neoplasm of oesophagus
• cause is unknown but common risk factors include smoking, excessive alcohol intake, central obesity
• more common in men than woman

Question 2

S&S and diagnosis of oesophageal cancer:

Answer 2

• progressive dysphagia
• pain is a late symptom, may have a sore throat, choking, hoarseness depending on location
• regurgitation of blood-flecked oesophagual content
• weight loss
• endoscopy with biopsy
• ultrasound, CT, MRI, bronchoscopy

Question 3

Treatment for oesophagael cancer:

Answer 3

• treatment depends on location and spread - treatment may be localised or radical
• surgical interventions
• radiation and chemotherapy
• palliative care and nutritional therapy

Question 4

Peptic ulcers:

Answer 4

• localised area of erosion occurring in the stomach or duodenum
• most commonly associated with infection with the H.Pylori bacteria
• symptoms include pain described as gnawing, dull, aching or hunger-like, fullness, bloating and nausea
• duodenal ulcers often heal spontaneously but recur if not treated

Question 5

Complications of peptic ulcers:

Answer 5

• bleeding, perforation and obstruction of the duodenum or outlet of the stomach
• Bleeding from duodenal ulcers causes haematemesis (vomiting blood) or melaena (digested blood appearing in the faeces)
• Perforation occurs with destruction of all layers of the duodenal wall, causing sudden severe epigastric pain

Question 6

Bowel obstruction:

Answer 6

• most common cause is adhesions from previous abdominal surgery
• other causes include foreign bodies, volvulus, strictures, tumors, faecal impaction
• bowel contents accumulate above the obstruction leading to rapid accumulation of anaerobic and aerobic bacteria
• necrosis and perforation lead to peritonitis and sepsis

Question 7

S&S of bowel obstruction:

Answer 7

• abdominal pain. distention, tenderness, rigidity, constipation, nausea and vomiting
• vomitus usually has a faecal odour
• hyperactive bowel sounds or absent bowel sounds may be noted
• x-ray will show dilated fluid-filled loops of bowel with visible air-fluid levels

Question 8

Nursing management of bowel obstruction:

Answer 8

• correct and maintain electrolyte and fluid balance (IVT)
• mouth care, pain relief
• insertion of nasogastric (NG) tube to decompress the GI tract, remove any gastric secretions (or food and fluids) to prevent build up

Question 9

Peritonitis:

Answer 9

• the peritoneum becomes inflamed and oedematous, resulting in decreased intestinal mobility and intestinal obstruction
• the inflammatory process causes accumulation of fluid in the abdominal cavity, leading to abdominal distention and rigidity, severe pain, n&v

Question 10

Paralytic ileus:

Answer 10

• non-mechanical obstruction results when muscle activity of the intestine decreased, and movement of content slows
• associated with abdominal surgery, peritonitis, hypokalaemia, ischemic bowel, trauma and other acute disease process such as pancreatitis
• affects small and large intestines
• signs and symptoms as per bowel obstruction

Question 11

Nasogastric tubes:

Answer 11

• an NG tube is inserted through the persons nasopharynx into the stomach
• the tube is hollow that allows removal of gastric secretions and introduction of solution into the stomach
• several purposes such as decompression, lavage (irrigation), compression of bleeding blood vessels and feeding

Question 12

Complications associated with NG tubes:

Answer 12

• trauma to mucosa
• incorrect positioning of NG tube into airway and subsequent damage to respiratory organs
• aspiration
• kinking or dislodging/migration of NG tube following coughing or vomiting

Question 13

Stomas:

Answer 13

• surgical creation of an artificial opening
• required when passage of faeces is not possible e.g. obstruction, resection of large portion of colon, secondary to cancer or inflammatory disease
• may be temporary or permanent
• temporary stomas are used to allow for healing at the site of surgery or healing of a diseased part of the colon

Question 14

Types of stomas:

Answer 14

• colostomy
• ileostomy
• location depends on a persons specific issue and state of health

Question 15

Loop colostomy;

Answer 15

• usually performed when closure of the colostomy is anticipated
• two openings in one stoma, the proximal end drains stool, the distal portion drains mucous

Question 16

Colostomy;

Answer 16

• formed from the large bowel or colon
• the stool is more solid and formed
• can be a single-barrel, double-barrel or loop colostomy

Question 17

End colostomy:

Answer 17

• one stoma formed from the proximal end of the bowel with the distal portion of the GI tract either removed or sewn closed and left in the abdominal cavity
• patients with diverticulitis who are treated surgically often have a temporary end colostomy

Question 18

Ileostomy:

Answer 18

• formed in the ileum and bypasses the entire large intestine
• output of gas and stools is frequent, stools have a thickened liquid consistency. output ranges from 300-1500 mls daily
• active throughout the day and the appliance needs to be emptied between 4-6 times per day

Question 19

Multidisciplinary care of a person with a stoma:

Answer 19

• selection and management of appliances
• care of the stoma and surrounding skin
• meeting nutritional needs - dietary changes as needed
• stoma therapist
• providing psychological support

Question 20

Stoma appearance:

Answer 20

• a healthy stoma should be rosy pink to red and ‘proud’
• a dusky blue stoma indicates ischaemia
• brown-black stoma indicated necrosis
• check new stomas every 4 hours and ensure that there is no excessive bleeding