Gastrointestinal System Flashcards
What are some contributing factors to gastrointestinal tract conditions?
Bleeding, trauma, perforation, obstruction
Inflammation, infections, infestations
Tumours; benign and malignant
Congenital disorders
Circulatory and nervous system faults
Ageing
High levels of stress and anxiety
Irregular eating habits
Low fibre and water intake
Low levels daily exercise
Congenital /genetic influences
What are the signs and symptoms of Gastrointestinal disease?
Change in appetite
*Weight gain or loss
*Dysphagia
*Intolerance to certain foods
*Nausea and vomiting
Change in bowel habits
Abdominal pain
Flatus
These are sometimes ignored, not recognised by patients or treated by over the counter (OTC) medications
What is Cholecystitis?
Gall bladder inflammation
Associated with:
A mixture of particulate solids precipitated from bile. Consists of cholesterol crystals, calcium bilirubinate pigment, and other calcium salts.
Gallstones (may be asymptomatic)
Incidence higher in females >40yrs
Acute cholecystitis:
Pain + rigidity of upper abdomen
pain radiates to mid sternum or right shoulder region
Associated with nausea and vomiting.
If the common bile duct becomes obstructed = jaundice (yellow tinge to the skin associated with itchiness)
What are the causes of Constipation?
Colonic disorders e.g. volvulus, irritable bowel syndrome (IBS), diverticular disease
Drug induced e.g. antacids, barium sulphate, laxative abuse, opioids, antidepressants.
Opioid induced constipation is a significant issue for post surgical patients.
Management includes regular aperients(prescribed) avoiding use of other constipating medications. Mobilisation and fluids.(Brown, Edwards, Seaton & Buckley,2015 pg. 65)
Systemic disorders e.g. diabetes, spinal cord lesions, stroke
Pregnancy
What is Appendicitis?
Results from kinking or occlusion by faecalith.(hardened mass of faecal matter)
Pain periumbilical progressing to RT lower quadrant at McBurney’s point
Rebound tenderness on palpation
Low grade fever/nausea vomiting
Complications
Peritonitis or localised abscess can occur within 24 hours after onset of pain
What is Irritable Bowel Syndrome?
Results from functional disorder of intestinal motility
Symptoms are present for at least 3 days a month
Chronic intermittent & recurrent abdominal pain
Irregular bowel habit
Diarrhoea, constipation, abdominal distension, flatulence, bloating
Continual defecation urge, urgency, feeling of incomplete evacuation
What is Crohns Disease?
Crohn’s disease:
Common in young adults and adolescents. More common in women and older population (50-80 years).(Farrell,M (2017 p 1011)
Subacute ,chronic inflammation of all layers of colon(transmural)
Oedema and thickening progressing to ulceration of mucosa
Skip lesions separated by normal tissue
Scar tissue and formation of granulomas interfere with normal colon function
What is Ulcerative Colitis?
More common in Caucasian and people of Jewish descent. Peak incidence between 30-50 years 5% patients may go on to develop colon cancer. (Farrell,M ,2017, p 1013)
Affects superficial mucosa rectum and colon
Multiple ulcerations, desquamation of epithelium,
Abscesses form infiltrating submucosa layers
Bowel narrows, shortens presence of fistulas
What are the signs and symptoms of inflammatory bowel disease?
Common for both conditions:
Abdominal pain – usually mild – moderate (Crohn’s) onset in right lower quadrant
Diarrhoea
Bloody stools (more likely with UC)
Weight loss (Crohn’s)
Fever (UC during acute attacks. Common with Chron’s)
Fatigue
Malabsorption
What are the two inflammatory bowel diseases?
Crohn’s disease and Ulcerative colitis
What is the treatment for inflammatory bowel diseases?
Rest the bowel, control inflammation, combat infection, correct malnutrition, alleviate stress, symptomatic relief
Medications
Surgery – 75% of Crohns require surgical intervention either stricturoplasty or resection +/- temp ostomy or ileostomy
Nutritional therapy - according to triggers, malnutrition etc +/- TPN
Some people with IBD suffer extra-intestinal manifestations of disease including arthritis, ankylosing spondylitis, eye inflammation and skin lesions thought to be cause by circulation products of inflammation triggering inflammation in other areas.
What is Volvulus?
Latin word - rolled up, twisted
Twisting of part of intestine around itself = obstruction
Frequently in colon, but can occur in stomach and small bowel
Can lead to: gangrene, obstruction, perforation, peritonitis & death
What are risk factors for colorectal cancer?
Gender ↑males
Age > 55
Family history, familial adenomatous polyposis (FAP)
Colorectal polyps
Inflammatory bowel disease (IBD)
Obesity
Smoking
Excess alcohol consumption
High fat diet
Low fibre diet
What are the tests leading up to a disgnosis of CA Bowel (cancer)
Biopsy from colonoscopy – histology report and mass visualised
CEA( carcinoembryonic antigen) elevated readings.
Abnormal blood results
Mass visualised on CT scan
Palpable mass felt during abdominal examination.
AFTER DIAGNOSIS
Staging /classification of colorectal cancer dictates the management.
Surgery required to remove tumour and part of bowel e.g. hemicolectomy. Abdominal-perineal resection. Laparoscopic colectomy.
May require chemotherapy , radiotherapy, biological and targeted therapy.
What is Colorectal Surgery - Colectomy?
Partial removal of the colon or removal of the entire colon is one of the most common forms of colorectal surgery
The name of the procedure describes the extent of the surgery e.g. hemicolectomy - part of the ascending or descending colon
What is a left hemi colectomy?
Removal of diseased area of bowel and length of normal bowel either side of it.
Removal of any potentially diseased areas.
Two ends of healthy bowel are anastomosed (joined together by stitching or stapling the ends together).
Wound closed with clips or stitches.
Commonly performed laparoscopically or may start this way and proceed to open surgery.
+/- stoma / ostomy (ileostomy, transverse, sigmoid)
Temporary – loop, double barrelled, Hartman’s pouch
Permanent – rectal
What is the nursing management for Colorectal Surgery - Colectomy?
Haemodynamic stability
Pain Control
Fluid & electrolyte balance
Number & appearance stools
Bristol Stool Chart
Wound care
Nutrition status
Skin integrity
Education
-Identifies coping patterns
-Lifestyle modification
Rest versus exercise
Knowledge of disease
Signs & symptoms to prevent complications
What is a Ostomy?
An ostomy is a surgical opening that connects an organ or underlying structure directly to the skin.
There are different types of ostomies created for different purposes to maintain normal body function. They are named after the organ or structure they connect to. e.g.
Tracheostomy is an opening through the neck connecting the trachea allowing the patient to breathe.
What is a Stoma?
A stoma (Greek word for mouth or opening).
The end of the organ or structure on the skin surface.
What is a stoma colostomy?
Part of the colon is brought through the surface of the skin through an opening on to the abdomen.
The output from a stoma is related to the location of the stoma.
Normal bowel habits can be generated with colostomies.
Stools are formed if the stoma is functioning correctly.
They are they are usually active from as frequently as twice a day to as infrequently as second daily.
Usually located on the transverse or descending colon.
May be permanent or temporary (reversible).
What are the Genito-Urinary Stomas?
UROSTOMY - Permanent diversion of the urinary tract involving a stoma.
Common indications include: bladder cancer, urinary incontinence,
congenital abnormalities, interstitial cystitis.
ILEAL CONDUIT- most common type of urostomy
the ureter is implanted into a segment of the ileum
that is led out through the abdominal wall. The
loop of ileum is a passageway for the urine to
pass (sometimes the sigmoid colon is used).
UTEROSTOMY - More common in paediatrics
the ureter is brought to surface of the abdomen
creating the stoma on the surface
What is the Colostomy and Ileostomy formation?
Techniques used:
Terminal or end formation (Colostomy or Ileostomy)
Following a bowel resection. The section of bowel that remains attached to the upper GI tract is brought out onto the abdominal surface. The stoma is created by folding the intestine back onto itself and suturing the end to the abdomen. The other end of the colon is either removed or over sewn. It may be temporary
Specific Indications:
Colostomy - cancer sigmoid colon, inflammatory
bowel disease, diverticulitis, trauma, volvulus,
May be created to rest a portion of bowel.
Ileostomy - When removal of the colon
is required, most commonly for inflammatory
bowel disease.
What is the Preoperative nursing care for stoma surgery?
Management:
Physical:
Manage pain,
Replace fluid & electrolytes
Administer prescribed medications e.g. antibiotics,
Physically prep the patient for surgery (may require bowel prep)
Psychological & emotional support:
Listen to the patients/ family whānau concerns
provide a safe environment and offer opportunities for discussion.
Identify the patients support systems
Offer a visit from a person who has a stoma
Offer to be present when the stoma is first viewed
What is the pre-op education for stoma surgery?
What to expect post op
What to expect for pain management
What to expect with bowel/bladder function
Introduce the patient to the types of appliances and how to fit them.
How to clean their stoma
Diet changes that they may have to make
What are the post operative nursing assessments for stoma surgery?
Colour (beware of the dusky stoma)
should be red / pink
Output
type, colour, consistency
Shape, (spout & size)
Note changes in size particularly if it increases in size
Surrounding skin
condition of skin, redness, ulceration etc
If rod or bridge is in place
Note the position of the rod and if it is holding the stoma in place
Sutures
loose, detached, signs of infection
What is the post operative management for stoma surgery?
Ongoing assessment for post op complications/ report changes
Stoma Nurse specialist consult
Medical team review if problems develop
Good skin care
Appliance review
Stoma output, medication and diet review
Assess and manage fluid and electrolyte balance
Education and support)
Listen to the patient regarding their feelings about their altered body image
Support groups
