GI Disorders Flashcards
GI assessment
Asses:
- swallowing
- indigestion
- belching
- nausea and vomiting
- appearance of emesis
- medications
- ask about laxatives
- infections
- abdominal pain (type and location)
- weight changes
- bowel movements
- diet
dysphagia
- difficulty swallowing
- begins with solid food and progresses to liquids
- usually a neuromuscular dysfunction/problem with cranial nerves
- structural abnormalities of esophagus (like strictures or achalasia)
odynophagia
painful swallowing
how is dysphagia diagnosed
with a barium swallow test
what is the main concern with dysphagia
aspiration
what do we teach patients with dysphagia
sit up while eating
nursing considerations for dysphagia
nutrition, reduce aspiration risk, rely on speech therapy for help
GERD
a problem with the tone of the lower esophageal sphincter allows stomach acid to regurgitate into the esophagus
gastoparesis
- delayed stomach emptying
- will exacerbate GERD
- metaplasia of esophageal cells may occur resulting in Barret’s esophagus
s/s GERD
- dysphagia
- heartburn
- epigastric pain
- regurgitation
- dyspepsia
common causes of GERD
- obesity
- pregnancy
left untreated GERD can cause
- GI bleeds
- high risk for cancer (neoplasia)
how is GERD diagnosed
upper endoscopy
treatment for GERD
- lifestyle changes: weight loss, smoking cessation, HOB elevation
- laparoscopic antireflux fundoplication
causes of upper GI bleed
- peptic ulcer disease
- esophageal varices
- esophageal cancer
acute upper GI bleed
- worse for the client than chronic
- caused by rupture, tear, perforation, immediate blood loss
- hypotension
- tachycardia
- hypovolemia
- hematemesis
what will client complain of with an acute upper GI bleed
- weakness
- fatigue
- SOB
- high anxiety
- severe mental status changes
- feelings of impending doom
chronic upper GI bleed
- body is able to compensate better
- caused by small tear or opening causing gradual blood loss
- iron deficiency
- melena (dark tarry stool)
- occult blood in stool
what will a client complain of will a chronic GI bleed
- tiredness
- iron deficiency anemia
- pain
how is an upper GI bleed diagnosed
- CBC: hematocrit/hemoglobin decreased
- fecal occult blood test
treatment for acute GI bleed
- this is an emergency situation!!!
- hemodynamic stabilization- STOP THE BLEEDING!!
- endoscopic techniques to stop bleeding
treatment for chronic GI bleed
- meds
- PPIs: (proton pump inhibitors) pt on this med for 6-8 weeks and then reevaluate
hiatal hernia
- stomach pushes up through an opening in the diaphragm- may be asymptomatic
sliding hiatal hernia
- stomach pushes up through esophagus
- LES weakened
- same s/s as GERD:
- dysphagia
- heartburn
- belching
- epigastric discomfort
rolling hiatal hernia
- sits next to esophagus
- structural abnormality in diaphragm
- s/s:
- acute chest pain (feels like an MI)
- bloating
- trouble swallowing
- upset stomach
how are hiatal hernias diagnosed
upper endoscopy
treatment for hiatal hernias
- PPIs
- H2 blockers
- prevent reflux
- treat sliding like GERD (sit up after eating), sleep with HOB up
- surgery
- lifestyle changes
gastritis
- inflammation of the stomach lining
causes of acute gastritis
- erosive
- similar to GERD
- meds (NSAIDs, aspirin, corticosteroids
- infection
- acute stress
- bile reflux
- alcohol abuse
s/s acute gastritis
- heartburn
- epigastric pain
how is acute gastritis diagnosed
upper endoscopy
treatment for acute gastritis
- remove causative agents
- PPIs, H2 blockers
- remove underlying cause and it is usually reversible
causes of chronic gastritis
- worse for the body
- non erosive, more irritating
- H. pylori, may have it for months before coming in
- decreased intrinsic factor (vitamin B12 absorption)
s/s chronic gastritis
- atrophy of glandular stomach lining
- gnawing pain
- hematemesis
- weight loss
how is chronic gastritis diagnosed
- upper endoscopy
- biopsy (can be precancerous to stomach cancer
treatment for chronic gastritis
- antibiotics for H. pylori (long term treatment)
- PPIs, H2 blockers
gastroenteritis
- stomach flu
- irritation of lining of the stomach, small or large intestine by a pathogen or toxin
- always caused by infection
- characterized by diarrhea
other s/s of gastroenteritis
- nausea/vomiting
- diarrhea
- lost electrolytes
-borborygmi
treatment for gastroenteritis
- IV fluid replacement/ID (in severe cases)
- treat causative agent
- symptom management
- if viral normally lasts about 12-72 hrs
- if bacterial it lasts until the bacteria is killed off
peptic ulcer disease
inflammatory erosion of stomach or duodenum (duodenum more common)
causes of PUD
- hypersecretion of stomach acid, not enough protection from acid
- H. pylori! (most common cause)
- NSAIDs
- stress
- alcohol abuse
- excessive caffeine
- smoking
- sometimes genetic
s/s PUD
- sudden, excruciating epigastric pain and abdominal rigidity
- intense pain
- once perforated = vomit blood
how is PUD diagnosed
upper endoscopy
treatment for PUD
- reduce acid levels
- protect gastric lining
- no spicy/fatty foods
- antibiotic therapy (if H. pylori)
- smoking cessation
- avoid foods that cause problems
- stress management
- avoid late night eating
- surgery:
- gastrojejunostomy (Billroth 2)
- gastroduodenostomy (Billroth 1)
short bowel syndrome
- any process that leaves fewer than 200 cm of small intestine (normal length is 600 cm)
- remaining intestine eventually adapts and increase the organ’s ability to absorb nutrients
- will never go back to normal
what is the small intestine responsible for
nutrient absorption
acute phase(short bowel syndrome)
- first 3 months after bowel removal
- careful monitoring of nutrition/supplements
- look for signs of dehydration
- high intestinal fluid loss and gastric hypersecretion
- dramatic weight loss
- vitamin indeficient
adaptation phase (short bowel syndrome)
- next 12 to 18 months after bowel removal
- foods introduced slowly, one at a time
- small intestine will begin to adapt to the new regimen
- villi will grow/increase in length to increase absorption of nutrients
maintenance phase (short bowel syndrome)
- lifelong
- clients will be on lifelong medications, dietary plans
- maintaining new normal, education
small bowel obstruction
- something is obstructing the movement of food through small intestine
- can be acute or chronic and partial or complete
- post surgery is a common cause of acute SBO (complete)
- chronic is bc of an inflammatory process
- usually starts partial and can become complete
s/s small bowel obstruction
will depend on the severity of the blockage and what is causing it
- pain
- nausea/vomiting
- hyperactive bowel sounds (partial)
- diarrhea (partial)
- absent bowel sounds (complete)
how is SBO diagnosed
abdominal xray
treatment for SBO
- depends on what is causing it
- for partial obstruction:
- NG tube for gastric decompression
- NPO
- Medications
- for complete obstruction:
- surgery
constipation
- common problem, especially in the elderly
- can result in fecal impaction and obstipation(sensation to defecate with no passage of stool or gas)
- very hard stool
- less than 3 stools per week or very difficult bowel movements
how is constipation diagnosed
barium contrast`
treatment for constipation
- dietary fiber (20-35 g/day)
- adequate fluids
- laxatives
- suppositories
- medications
inflammatory bowel disease
bowel = infalmed
Crohn’s disease
- chronic, full thickness inflammatory processes
- skip lesions/cobblestoning
- malabsorption/nutritional deficiencies common
what is the location of Crohn’s disease
GI tract from mouth to anus, but more common in the ileum
s/s Crohn’s disease
- diarrhea
- abdominal pain
- distension
how is Crohn’s disease diagnosed
colonoscopy, biopsy
Crohn’s disease treatment
- diet management
- antidiarrheals
- immunosuppressants
- surgery to remove diseased tissue
complications of Crohn’s disease
- obstruction
- microperforations
- chronic inflammation
- increased DVT and PE risk
ulcerative colitis
- pseudo polyps in colon only
- just lining that ulcerates
- continuous lesions
location of ulcerative colitis
colon and rectum
s/s ulcerative colitis
- diarrhea
- abdominal pain
- distention
how is ulcerative colitis diagnosed
colonoscopy to distinguish from Crohn’s
treatment for ulcerative colitis
- corticosteroids
- antinflammatorys
- mesalime enema
- surgery
large bowel obstruction
- contents cannot move through large intestine
- high mortality rate if not diagnosed/treated w/in first 24 hours
- bowel becomes dilated above obstruction
s/s large bowel obstruction
- abdominal pain
- abdominal distention
- abdominal tenderness
- abdominal rigidity
s/s large bowel obstruction partial blockage
high pitched bowel sounds
s/s large bowel obstruction complete blockage
- no bowel sounds
- no feces in rectum
how is a large bowel obstruction diagnosed
- abdominal xray
- elevated WBC
treatment for large bowel obstruction
- fluid replacement !
- intestinal decompression with NG tube or colorectal tube
- surgery:
- anastomosis
- colectomy
irritable bowel syndrome
- bowel is irritated
- abdominal pain and altered bowel activity
- diarrhea
- constipation
- pain
- bloating
- common condition
- chronic abdominal pain lasting at least 6 months with bouts of diarrhea and constipation
- no known etiology
risk factors for IBS
- female
- under 40 yo
- stress
alarm symptoms for IBS
- weight loss
- family GI history
- iron deficiency anemia
- rectal bleeding
- age >50 years
how is IBS diagnosed
- patient symptoms
- rule out other causes
treatment for IBS
- regulate bowel movements
- bulk laxatives, antidiarrheals
- stress management
diverticulosis
happens when bowel wall weakens, not inflamed
diverticulitis
diverticula collect intestinal content and become inflamed
diverticular disease
diverticula form due to weakened bowel wall, collect intestinal contents, become diverticulosis, become inflamed, and then diverticulitis
s/s diverticular disease
- depends on severity and location
how is diverticular disease diagnosed
- abdominal xray
- lower GI series
- CT scan
treatment for diverticular disease
- dietary modification (high fiber, low amounts of red meat
- adequate fluid/fiber intake
- severe cases may require resting the colon (NPO)
volvulus
- twisting of large intestine
- most common in sigmoid colon
- results in LBO
- twisting = blood supply cut off
- will not untwist by itself, must be done surgically
volvulus
- twisting of large intestine
- most common in sigmoid colon
- results in LBO
- twisting = blood supply cut off
- will not untwist by itself, must be done surgically
s/s volvulus
- bilious vomiting
- abdominal pain
- colicky then steady pain
- abdominal tenderness
