GROUP 6 Flashcards
GASTROESOPHAGEAL REFLUX DISEASE (GERD)
ETILOGY/RISK FACTORS…
Unknown Cause:
The exact cause of GERD is not fully understood, but several factors can contribute to its development:
Weight Gain and Obesity:
Increased abdominal pressure can lead to reflux.
Pregnancy:
Hormonal changes and physical pressure from the uterus can exacerbate GERD.
Lying Flat:
Supine position can promote reflux due to gravity.
Medications:
Certain drugs (e.g., sedatives, antihistamines) can relax the LES.
Hiatal Hernia:
A condition where part of the stomach pushes through the diaphragm, affecting the LES.
Smoking:
Weakens the LES and reduces saliva production, which neutralizes acid.
Dietary Factors:
Certain foods and beverages, including:
Alcohol:
Relaxing effect on the LES.
Caffeine:
Stimulant that can increase gastric acid secretion.
Chocolate:
Contains theobromine, which relaxes the LES.
Carbonated Beverages:
Can distend the stomach and increase pressure.
Demographics:
More prevalent in the elderly due to decreased LES tone and increased abdominal pressure.
PATHOPHYSIOLOGY…
LES Dysfunction:
Incompetent lower esophageal sphincter (LES) allows stomach contents to reflux into the esophagus.
Angle of Junction:
Displacement or alteration of the gastroesophageal junction angle can promote reflux.
Mucosal Damage: Repeated exposure to gastric acid leads to inflammation (esophagitis) and damage to the esophageal lining.
Severity Factors:
Frequency of Reflux: More frequent episodes increase risk of complications.
Contents of Reflux:
Acidic contents cause more damage compared to less acidic contents.
Buffering Ability:
Saliva and mucous help neutralize acids; impaired production can worsen symptoms.
Gastric Emptying:
Delayed gastric emptying can increase gastric volume and pressure.
CLINICAL MANIFESTATIONS…
Dyspepsia:
Burning Sensation: Characteristic heartburn, typically after meals, often relieved by antacids.
Pain:
Post-Activity Pain:
Pain may occur after eating or during physical activities.
Supine Position: Symptoms often worsen when lying flat.
Radiation:
Pain may radiate to the neck, jaw, or back, potentially mimicking angina.
Esophageal Symptoms:
Spasms: Esophageal spasms can cause severe discomfort.
Odynophagia: Sharp, constricting, or stabbing pain during swallowing.
Intermittent Dysphagia: Difficulty swallowing, particularly at the start of a meal.
Regurgitation and Other Symptoms:
Acid Regurgitation: Sour or bitter-tasting liquid backing up into the throat.
Water Brash: Sudden increase in saliva production.
Eructation: Frequent burping or belching.
Distended Abdomen: Abdominal bloating may occur.
Common Signs of GERD:
Heartburn: Most prominent symptom.
Acid Regurgitation: Sensation of acid backing up.
Dysphagia: Difficulty or pain with swallowing.
Excessive Burping: Increased belching.
Chronic Sore Throat: Due to acid irritation.
Gum Inflammation and Tooth Erosion: Acid exposure can damage dental enamel.
Morning Hoarseness: Due to nighttime reflux.
Sour Taste in Mouth: Often noted upon waking.
DIAGNOSTIC TESTS…
Barium Swallow:
Imaging to assess swallowing and reflux.
Esophagoscopy: Direct visualization of the esophagus to identify inflammation or damage.
Esophageal Biopsy: To rule out other conditions.
Cytology: Analysis of cells from the esophagus.
Gastric Secretions and Acid Tests: Measurement of acid levels to assess gastric function.
MEDICAL MANAGEMENT…
Mild GERD:
Antacids: (e.g., Maalox, Mylanta) increase gastric pH and neutralize acid; effects occur within 30 minutes.
Persistent GERD:
Histamine Receptor Antagonists (H2 Blockers): (e.g., Zantac, Pepcid) reduce gastric acid secretion; administered 1 hour before or after antacid.
Severe GERD:
Cholinergic Drugs: (e.g., Metoclopramide) increase LES pressure and gastric emptying; given with antacids and H2 blockers before meals.
Proton Pump Inhibitors (PPIs): (e.g., omeprazole, Nexium) suppress gastric acid secretion and promote healing of the esophagus.
NURSING DIAGNOSES…
Imbalanced Nutrition: Less than body requirements related to dietary restrictions and avoidance of certain foods.
Risk for Aspiration: Due to potential reflux into the airway.
Pain: Related to esophageal irritation and inflammation.
Deficient Knowledge: Regarding disease management and dietary modifications.
GI TRACT OVERVIEW .
Mouth:
Chews food; saliva buffers HCl in the stomach.
Epiglottis:
Closes during swallowing to prevent backflow to the nostril and aspiration.
Esophagus:
Uses peristalsis to move food to the stomach; lower esophageal sphincter (LES) prevents reflux.
Stomach:
Stores and mixes food with gastric juices; passes chyme to the small intestine; empties in 4-6 hours.
Small Intestines:
Breaks down carbohydrates, fats, and proteins; absorbs amino acids, glucose, fatty acids, vitamins, and minerals.
Large Intestine:
Absorbs excess water and electrolytes; stores food residue, bacteria, and bile for elimination.
HIATAL HERNIA
TYPES…
Type 1 – Sliding Hernia:
Description: The upper stomach and gastroesophageal junction are displaced into the thoracic cavity.
Associated Condition: Often leads to GERD (Gastroesophageal Reflux Disease).
Type II – Rolling or Paraesophageal Hernia:
Description: The gastroesophageal junction remains below the diaphragm, but all or part of the stomach pushes into the thoracic cavity.
Associated Condition: GERD is not typically a problem; however, this type can lead to strangulation and obstruction.
ETIOLOGY…
Age: Increased risk with age due to weakening of the diaphragm.
Trauma: Injuries that affect the diaphragm or abdominal cavity can lead to hernias.
Congenital Muscle Weakness: Some individuals may have a predisposition due to inherent muscle weakness.
Surgery: Previous surgeries may weaken the area around the diaphragm.
Increased Intra-abdominal Pressure: Factors such as obesity, pregnancy, or heavy lifting can contribute.
CLINICAL MANIFESTATIONS…
Type 1 (Sliding):
Heartburn: Commonly experienced after meals.
Substernal Pain: A burning sensation or pain beneath the sternum.
Type 2 (Rolling):
Fullness After Meals: Feeling of fullness or pressure after eating.
Dyspnea: Difficulty breathing due to pressure on the diaphragm.
Chest Pain: Discomfort that may worsen in a supine position.
NURSING MANAGEMENT…
Post-operative Care:
NG Tube: Monitor placement and drainage.
Prevent Respiratory Complications: Monitor for signs of pneumonia and encourage deep breathing exercises.
Avoid Gas-Bloat Syndrome:
Dietary Modifications: Avoid gassy foods and carbonated beverages.
Ambulation: Encourage movement to assist with eructation (belching).
Health Promotion:
Prevent or Delay Hiatal Hernia: Educate patients to avoid activities that increase intra-abdominal pressure (e.g., heavy lifting, straining).
ESOPHAGEAL CANCER
RISK FACTORS…
Alcohol Consumption: Increases risk of esophageal irritation and cancer development.
Tobacco Use: Strongly associated with a higher incidence of esophageal cancer.
Chronic GERD: Prolonged acid reflux can lead to Barrett’s esophagus, a precursor to cancer.
Chronic Esophageal Irritation: Repeated injury to the esophagus can increase cancer risk.
Barrett’s Esophagus: A condition where the esophageal lining changes, increasing the risk of cancer.
CLINICAL MANIFESTATIONS…
Dysphagia: Difficulty swallowing, often worsening over time.
Painful Swallowing (Odynophagia): Sharp pain that may accompany swallowing.
Weight Loss and Weakness: Due to difficulty eating and maintaining nutrition.
Substernal Pain or Fullness: Discomfort in the chest area.
Regurgitation of Undigested Food: Difficulty processing food leading to regurgitation.
Foul Breath (Halitosis): Resulting from poor swallowing and food accumulation.
Hiccups: Frequent and persistent.
Hemorrhage: Potential bleeding from the tumor.
Nocturnal Aspiration: Increased risk of aspiration during sleep.
Sialorrhea: Excessive saliva production.
MEDICAL MANAGEMENT…
Cure: Surgical resection may be curative for localized disease.
Palliation: Focus on symptom relief in advanced cases.
Surgery: Options include:
Esophagectomy: Removal of part or all of the esophagus.
Esophagogastrostomy: Connecting the esophagus to the stomach.
Esophagoenterostomy: Connecting the esophagus to the intestine.
Radiation: Often used postoperatively or as palliative care.
Chemotherapy: Systemic treatment for advanced cancer.
NURSING MANAGEMENT…
N/G Tube: Monitor for proper placement and function.
Foley Catheter: Ensure adequate urinary output and monitor for complications.
Chest Tube: Manage drainage and monitor for respiratory complications post-surgery.
PEG Tube: Ensure proper feeding and hydration.
Positioning: Elevate the head of the bed 30 degrees before and after feeds to prevent aspiration.
Feeding Management:
Change Tube Feed Every 24 Hours: To prevent infection.
Patent Airway: Monitor respiratory status and maintain airway patency.
Pain Control: Administer prescribed medications and assess pain regularly.
Nutritional Support: Work with dietitians to provide appropriate nutritional interventions.
Early Ambulation: Encourage movement to prevent complications.
Receptacle for Saliva: Manage excessive salivation and provide appropriate hygiene care.
High Risk for Impaired Swallowing: Monitor swallowing ability and consult speech therapy as needed.
GASTRIC CANCER
RISK FACTORS…
Helicobacter Pylori (H. Pylori): Infection increases risk of gastric cancer through chronic inflammation and mucosal changes.
Smoking: Tobacco use is a significant risk factor due to carcinogenic compounds.
Alcohol Ingestion: Chronic alcohol consumption is associated with increased risk due to potential mucosal damage.
Late Diagnosis: Often diagnosed at advanced stages due to nonspecific symptoms.
SURGICAL MANAGEMENT
Billroth I (Gastroduodenostomy):
Procedure: The distal stomach is removed, and the remaining stomach is connected to the duodenum.
Billroth II (Gastrojejunostomy):
Procedure: The distal stomach is removed, and the remaining stomach is connected to the jejunum.
Total Gastrectomy:
Procedure: Complete removal of the stomach, followed by esophagojejunostomy, connecting the esophagus to the jejunum.
NURSING CARE…
Respiratory Care:
Cough and Deep Breathe: Encourage to prevent atelectasis and promote lung expansion.
Incentive Spirometer: Use to enhance lung capacity and promote deep breathing.
Nutritional Support:
TPN (Total Parenteral Nutrition): Administer if oral intake is poor to ensure nutritional needs are met.
PEG (Percutaneous Endoscopic Gastrostomy): Consider for long-term feeding needs.
HOB (Head of Bed) Elevation: Maintain elevated position before and after feeding to prevent aspiration.
ASSESSMENT…
Abdominal Distention: Monitor for signs of distention and discomfort.
NG Tube: Assess placement, patency, and output regularly.
DIETARY MANAGEMENT…
Progressive Diet: Introduce a gradual diet if the patient is tolerating food.
MEDICATION EDUCATION…
Teach Patients: Take anti-inflammatory drugs with food to minimize gastric irritation.
Avoid Foods: Advise against foods that increase gastric acidity.
DUMPING SYNDROME
DEFINITION…
A condition occurring when food rapidly enters the jejunum following gastric surgery, leading to various symptoms due to vasomotor disturbances.
SYMPTOMS…
Vasomotor Disturbances (10-30 mins post-meal):
Vertigo: Dizziness or lightheadedness.
Tachycardia: Increased heart rate.
Syncope: Fainting or loss of consciousness.
Sweating: Excessive perspiration.
Pallor: Unusual paleness of the skin.
Palpitations: Irregular or forceful heartbeats.
Diarrhea: Watery stools shortly after eating.
Nausea: Feelings of sickness and queasiness.
Weakness: Generalized fatigue and lack of energy.
Hypoglycemia: Low blood sugar levels can occur after rapid gastric emptying.
Intestinal Manifestations (2-3 hours post-meal):
Epigastric Fullness: Sensation of fullness or pressure in the upper abdomen.
Distention: Swelling or bloating in the abdomen.
Abdominal Discomfort: General discomfort or pain in the abdominal area.
Cramping: Painful contractions in the abdomen.
Nausea: Recurrent feelings of sickness.
Borborygmi: Rumbling or gurgling sounds from the intestines.
PATIENT EDUCATION…
Dietary Management:
Small Feedings: Encourage small, frequent meals to prevent overwhelming the digestive system.
Nutritional Focus: Maintain a high protein, high fat, low carbohydrate, low fiber, and dry diet to minimize symptoms.
MEDICATIONS:
Provide Antispasmodics: As needed to alleviate cramping and discomfort.
KEY POINTS…
Self-Limiting Condition: Symptoms typically resolve on their own after a short duration.
Avoid Fluids with Meals: Encourage patients to drink fluids between meals rather than during meals.
Limit Carbohydrates: Advise patients to minimize carbohydrate intake to reduce the risk of symptoms.
PEPTIC ULCER DISEASE
Types of Peptic Ulcers
Stress Ulcer:
Definition: Increased gastric secretions, blood supply, and motility due to thalamic stimulation of the vagus nerve.
Duodenal Ulcer:
Definition: Most common type of ulcer, characterized by a chronic break in the mucosal lining of the duodenum.
Gastric Ulcer:
Definition: A deep break in the lesser curvature of the stomach; usually heals within a few weeks.
PATHOPHYSIOLOGY…
Mucosal Lesion: Lesion in the stomach or duodenum caused by aggressive factors:
H. Pylori: Bacterial infection from contaminated foods.
HCl and Biliary Acids: Contribute to mucosal erosion.
Impaired Mucosal Defense: Often exacerbated by NSAIDs (Non-Steroidal Anti-Inflammatory Drugs).
CLINICAL MANIFESTATIONS…
Dyspepsia: Indigestion and discomfort in the upper abdomen.
Epigastric Pain: Varies between duodenal and gastric ulcers.
Pyrosis: Heartburn or acid reflux sensation.
Bloating and Nausea: Feelings of fullness and queasiness.
Vomiting: Presence of undigested food may indicate pyloric obstruction.
Burning Sensation: In the esophagus and stomach.
Bleeding: Possible indicator of complications.
MEDICAL TREATMENT…
H. Pylori Treatment: Antibiotics to eradicate H. Pylori.
Manage Gastric Acid Secretion:
Proton Pump Inhibitors (PPIs): Reduce stomach acid production.
H2 Receptor Antagonists: Decrease acid secretion.
Antacids: Neutralize stomach acid.
Cholinergics: Stimulate gastric secretions.
Stress Reduction: Lifestyle modifications.
No Smoking: Eliminating tobacco use is crucial.
Dietary Changes: Avoid irritating foods and beverages.
Prevent Complications: Monitor for bleeding and perforation.
COMPLICATIONS…
Hemorrhage: Can lead to significant blood loss.
Perforation: Ulcer penetrates the wall of the stomach or duodenum.
Pyloric Obstruction: Caused by scarring and swelling.
Intractable Disease: Ulcers resistant to medical management.
DIVERTICULAR DISEASE
Definitions
Diverticula: Pouch-like herniations of the mucosa through the wall of the small intestine or colon, commonly found in the sigmoid colon.
Diverticulosis: Presence of diverticula; typically asymptomatic.
Diverticulitis: Inflammation of diverticula, which may lead to complications.
ETIOLOGY/RISK FACTORS…
Low Fiber Diet: Increases the risk of developing diverticula.
Chronic Constipation: Contributes to diverticula formation.
Pathophysiology
Weakness in Musculature: Herniations occur where intestinal muscle is weak.
Fecalith Formation: Trapped food particles can lead to infection and inflammation.
Blood Supply Compromise: Inflammation can compromise blood flow to the diverticula.
COMPLICATIONS…
Fistulas: Abnormal connections between the intestine and other organs.
Obstruction: Blockage of the intestines.
Abscess Formation: Pockets of infection may develop.
Perforation: Can lead to peritonitis (inflammation of the peritoneum).
Bleeding: From inflamed diverticula.
CLINICAL MANIFESTATIONS…
Bowel Irregularity: Fluctuating bowel habits.
Diarrhea: Possible change in stool consistency.
Cramps: Abdominal pain or cramping.
Occult Bleeding: May indicate internal bleeding.
Weakness and Fatigue: General malaise.
Anorexia: Loss of appetite.
Fever: Indication of infection.
LLQ Pain: Left lower quadrant pain is common.
Tachycardia: Increased heart rate may occur with infection.
Nausea/Vomiting: Symptoms may develop with complications.
Guarding and Rigidity: Signs of peritonitis if present.
Palpable Tender Mass: May indicate an abscess or inflamed diverticula.
Hypotension: May occur if bleeding is present.
DIAGNOSTICS…
Laboratory Tests:
Decreased Hct and Hgb: Indicates GI bleeding.
Elevated WBC: Suggests infection or inflammation.
Occult Blood: Positive test for hidden blood in stool.
Imaging Studies:
X-rays with Barium Contrast: Visualizes diverticula.
Barium Enema: Useful in diagnosis.
Colonoscopy/Sigmoidoscopy: Direct visualization of the colon.
Upper GI Series: Assesses the upper digestive tract.
CT Scan/Abdominal Ultrasound: Evaluates complications.
MANAGEMENT…
Diet and Medications:
Mild to Moderate Diverticulitis:
Clear Liquids: Until inflammation subsides.
High Residue/Low Fat Diet: Increases fiber intake gradually.
Antibiotics: Treat infection.
Bulk-Forming Laxatives: Help with bowel regularity; ensure adequate water intake.
Hospitalization:
Severe Cases:
NPO (Nothing by Mouth): With IV and NG suction as needed.
Nutrition: May require IV nutrition initially.
Surgery:
Indicated for Complications:
Resection of Affected Area: In severe cases.
Temporary Colostomy: May be necessary post-surgery.
MEDS…
Outpatient:
Metronidazole or Ciprofloxacin: To treat infection.
Hospitalized:
Metronidazole and Cefoxitin IV: Broad-spectrum coverage.
Anticholinergics: Reduce motility and spasm.
Analgesics: Morphine or Demerol for pain management.
Avoid: Laxatives or enemas, as they can increase colonic pressure.
POST - OP CARE…
NPO with Progression: Gradual diet advancement as tolerated.
NG Tube: Usually placed immediately post-op.
Abdominal Drain: May be in place for several days post-op.
PATIENT TEACHING…
Avoid Seeded Vegetables: Prevent obstruction of diverticula.
Fiber-Rich Diet: Encourage intake of whole grains and vegetables.
NURSING DIAGNOSES…
Acute Pain: Related to increased peristalsis and GI inflammation.
Activity Intolerance: Related to generalized weakness.
Deficient Fluid Volume: Related to anorexia, nausea, and diarrhea.
IRRITABLE BOWEL DISEASE (IBD)
Inflammatory Bowel Disease (IBD) is a chronic inflammatory condition affecting the gastrointestinal (GI) tract. It encompasses two primary forms: Ulcerative Colitis (UC) and Crohn’s Disease. Both conditions share similarities but have distinct characteristics in terms of location, symptoms, and complications.
ETIOLOGY
The precise cause of IBD remains unknown, but several factors are believed to contribute:
Genetic Factors:
A familial predisposition suggests a genetic component, as individuals with a family history of IBD are at higher risk.
Immune Response:
IBD is thought to be an abnormal immune response to intestinal flora or pathogens. The immune system may mistakenly attack the GI tract, leading to inflammation.
Environmental Triggers:
Pesticides:
Exposure to certain pesticides has been linked to increased IBD risk.
NSAIDs:
Nonsteroidal anti-inflammatory drugs may exacerbate or trigger flare-ups.
Tobacco Use:
While tobacco is a known risk factor for Crohn’s disease, it appears to have a protective effect against UC.
Radiation Exposure:
Past radiation therapy to the abdominal area may increase risk.
Microbiome Changes:
Dysbiosis (imbalance of gut microbiota) may play a role in disease development.
Psychosocial Factors:
Stress and psychological issues can exacerbate symptoms, although they are not direct causes.
ULCERATIVE COLITIS
PATHOPHYSIOLOGY…
UC primarily affects the mucosal layer of the colon and rectum. The inflammatory process typically starts in the rectum and may extend proximally, affecting varying lengths of the colon.
Inflammation and Ulceration: The inflammation leads to the formation of ulcers on the mucosal surface, resulting in symptoms like diarrhea and bleeding.
Abscess Formation:
Ulcers may coalesce to form abscesses, which can cause further complications.
Colon Wall Changes:
Chronic inflammation causes the colon wall to thicken, leading to decreased nutrient absorption and electrolyte imbalance.
Potential for Carcinogenesis:
Long-standing inflammation increases the risk of colorectal cancer.
CLINICAL MANIFESTATIONS…
Patients with UC often experience a range of symptoms, including:
Diarrhea:
Frequent, watery stools, often containing blood and mucus.
Abdominal Pain:
Cramping and tenderness, typically localized in the lower abdomen.
Rectal Bleeding:
Blood may be observed in the stool or on toilet paper.
Tenesmus:
A sensation of incomplete evacuation or a persistent urge to defecate.
Dehydration and Weight Loss:
Due to diarrhea and poor absorption, leading to malnutrition.
Fever and Fatigue:
Systemic manifestations due to inflammation.
Extraintestinal Manifestations:
Joint pain, skin lesions, and eye inflammation may occur.
DIAGNOSTICS…
Diagnosis involves a combination of clinical evaluation, laboratory tests, and imaging studies:
Colonoscopy:
The gold standard for diagnosis, allowing direct visualization and biopsy of the colonic mucosa.
Sigmoidoscopy: Useful for assessing rectal and sigmoid involvement.
Barium Enema:
Provides radiographic imaging of the colon but is less commonly used now due to colonoscopy’s efficacy.
Stool Tests:
To check for the presence of blood, pathogens, and other abnormalities.
Blood Tests:
Including complete blood count (CBC) to identify anemia, low hemoglobin, and electrolyte levels, indicating malnutrition and dehydration.
Inflammatory Markers:
Elevated C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) indicate inflammation.
MEDICAL MANAGEMENT…
Management focuses on inducing and maintaining remission, controlling symptoms, and preventing complications.
PHARMACOLOGICAL INTERVENTIONS…
5-Aminosalicylic Acid (5-ASA):
Mesalamine and Sulfasalazine are commonly used for anti-inflammatory effects.
Corticosteroids:
Used for short-term flare control; options include prednisone and hydrocortisone.
Immunomodulators:
Azathioprine and 6-mercaptopurine may be prescribed to suppress the immune response.
Biologics:
Infliximab (Remicade):
An IgG monoclonal antibody targeting TNF-alpha, used in moderate to severe cases unresponsive to other treatments.
Other biologics include adalimumab and vedolizumab.
Antidiarrheal Medications:
Such as loperamide, to control diarrhea.
Anticholinergics:
May be prescribed before meals to alleviate cramping.
NUTRITIONAL MANAGEMENT…
Dietary Modifications:
Low-fiber, low-residue diet during flare-ups to minimize bowel irritation.
High-protein, high-calorie diet to prevent malnutrition.
Avoidance of spicy, fried, and gas-producing foods.
Trials of dairy avoidance may help some patients.
Total Parenteral Nutrition (TPN):
May be necessary during severe exacerbations to bypass the GI tract and provide essential nutrients.
SURGICAL INTERVENTIONS…
Indicated for patients who do not respond to medical therapy or have severe complications:
Total Colectomy with Ileostomy: Permanent removal of the colon, leading to a stoma for waste elimination.
Ileoanal Anastomosis:
Removal of the colon, with surgical creation of a pouch from the terminal ileum, allowing for bowel movement through the anus.
Segmental Colectomy:
Partial removal of the colon, preserving some bowel function.
CROHNS DISEASE
Crohn’s disease is a type of Inflammatory Bowel Disease (IBD) that can affect any part of the gastrointestinal (GI) tract, from the mouth to the anus. However, it most commonly involves the terminal ileum (the last part of the small intestine). It is characterized by transmural inflammation (affecting all layers of the intestinal wall) and can lead to complications such as strictures, fistulas, and abscesses.
PATHOPHYSIOLOGY…
Inflammatory Process:
The exact cause is unknown, but it involves an inappropriate immune response to intestinal bacteria, leading to chronic inflammation.
Skip Lesions:
Crohn’s disease is characterized by “skip lesions,” where healthy segments of the intestine are interspersed with diseased segments.
Transmural Inflammation:
The inflammation penetrates the full thickness of the bowel wall, which can result in complications such as:
Strictures: Narrowing of the bowel that can cause obstruction.
Fistulas:
Abnormal connections between the intestine and adjacent organs (e.g., bladder, vagina, skin).
Abscesses:
Pockets of pus that can form in the abdominal cavity.
CLINICAL MANIFESTATIONS…
Symptoms can vary depending on the affected area of the GI tract and the severity of the disease:
Diarrhea: Frequent, non-bloody stools, but can include blood and mucus in severe cases.
Abdominal Pain: Often localized to the right lower quadrant and can be crampy or steady.
Steatorrhea: Fatty stools due to malabsorption of nutrients.
Weight Loss: Resulting from malnutrition, decreased appetite, and increased energy expenditure due to inflammation.
Fatigue: Due to chronic disease and nutritional deficiencies.
Systemic Symptoms: Low-grade fever, joint pain, and skin rashes may occur.
Nutritional Deficiencies: Due to malabsorption, including iron deficiency anemia and vitamin B12 deficiency.
Fistulas and Abscesses: May present with symptoms like fever, localized pain, and drainage from sinuses.
DIAGNOSTICS…
Diagnosis of Crohn’s disease involves a combination of clinical evaluation, laboratory tests, and imaging studies:
Colonoscopy: The gold standard for diagnosis, allowing direct visualization of the mucosa, biopsy for histological assessment, and determination of disease extent.
Endoscopy: Can evaluate the upper GI tract if the disease is suspected in that area.
Imaging Studies:
CT Enterography: Provides detailed images of the small intestine and can identify complications such as strictures and abscesses.
MRI: Useful for assessing perianal disease and soft tissue involvement.
Stool Tests: To check for occult blood, pathogens, and other abnormalities.
Blood Tests: Including complete blood count (CBC) to assess for anemia, inflammatory markers (CRP, ESR) to evaluate inflammation, and nutritional deficiencies.
MEDICAL MANAGEMENT…
Management strategies aim to reduce inflammation, control symptoms, and maintain remission:
PHARMACOLOGICAL INTERVENTIONS…
5-Aminosalicylic Acid (5-ASA):
Medications such as Mesalamine are used for mild disease.
Corticosteroids:
Used for managing active inflammation during flare-ups; options include prednisone and budesonide.
Immunomodulators:
Azathioprine and 6-mercaptopurine may be used to suppress the immune response and maintain remission.
Biologics:
Infliximab (Remicade): An anti-TNF agent used in moderate to severe cases.
Adalimumab and Vedolizumab are other options for those who do not respond to conventional treatments.
Antidiarrheal Medications: Such as loperamide may be prescribed to control frequent bowel movements, although caution is advised.
NUTRITIONAL THERAPY…
Dietary Therapy:
High-protein, low-fiber diets may help minimize bowel irritation during flare-ups.
Avoidance of trigger foods (e.g., dairy, caffeine, high-fat foods).
Elemental Diets: Can be effective in reducing inflammation and aiding healing.
Total Parenteral Nutrition (TPN): May be necessary during severe exacerbations to provide nutrients bypassing the GI tract.
SURGICAL INTERVENTIONS…
Surgery may be required for complications such as strictures, fistulas, or abscesses:
Bowel Resection: Involves removal of affected bowel segments; can include ileostomy or anastomosis.
Strictureplasty: Widening narrowed bowel segments without resection.
Fistula Repair: Surgical correction of abnormal connections between the intestine and other organs.
NURSING INTERVENTIONS…
Nursing management for patients with Crohn’s disease includes:
Assessment: Monitor for signs of flare-ups, nutritional status, and hydration levels.
Patient Education: Teach patients about disease management, dietary modifications, and the importance of medication adherence.
Pain Management: Implement pain relief measures and provide support during flare-ups.
Nutritional Support: Collaborate with a dietitian for individualized meal planning.
Psychosocial Support: Address the emotional and psychological impact of chronic illness.
NURSING DIAGNOSES…
Common nursing diagnoses for patients with Crohn’s disease may include:
Diarrhea related to inflammation of the bowel.
Acute or chronic pain related to abdominal cramping and bowel inflammation.
Fluid volume deficit related to diarrhea and inadequate intake.
Imbalanced nutrition: Less than body requirements related to malabsorption and decreased appetite.
Cholecystitis
Definition: Inflammation of the gallbladder.
Types:
Calculous Cholecystitis (95% of cases): Associated with gallstones, empyema, perforation, edema, secondary infection, or gangrene.
Acalculous Cholecystitis: Occurs without gallstones; risk factors include major surgery, trauma, severe burns, cysts, primary infections, or multiple blood transfusions.
Clinical Manifestations:
Severe right upper quadrant (RUQ) pain
Tenderness and rigidity in RUQ
Pain radiates to back and right shoulder
Nausea, vomiting, feeling of fullness
Fever, exacerbations
Jaundice (with common bile duct (CBD) obstruction)
Pruritus, clay-colored stools, steatorrhea, tea-colored urine
Cholelithiasis
Definition: Presence of calculi (gallstones) in the gallbladder.
Types of Gallstones:
Pigment Stones (25% in U.S.): Composed of bile pigments.
Cholesterol Stones (75% in U.S.): Formed by cholesterol.
Clinical Manifestations:
Biliary colic: Sudden, severe pain due to obstruction of the cystic duct
Stone may retreat or pass through duct
Risk Factors:
Obesity, Native American descent, increasing age, women (70% cases), hormone therapies, frequent weight changes, and certain diseases.
