Gastrointestinal Disorders
By: Keith Kainne “D” Garino, RN, LPT, MAEd
TOPRANK | Nursing
Gastroesophageal Reflux Disease
Cause:
•
•
•
TOPRANK | Nursing
Gastroesophageal Reflux Disease
Clinical Manifestations:
“Indigestion Burns your throat, larynx and esophagus”
TOPRANK | Nursing
Interventions: “Food should go down”
• Avoid “5CAFPS”
TOPRANK | Nursing
Interventions: “Food should go down”
Avoid
• IAP
• Drugs: Motility & HCl
•A
•N
•A
•C
TOPRANK | Nursing
Interventions: “Food should go down”
Diet
• Carbs
• Fiber
• Meal
Position
• HOB
• Turned to
TOPRANK | Nursing
Interventions: “Food should go down”
Medications:
•
•
•
•
TOPRANK | Nursing
• High fat
• Semi-fowlers
• High fiber
• 3 meals per day
• Atropine
• Spicy foods
• Avoid coffee
• High carbohydrate
• Turn to right side
• Tight clothing
• Aspirin
TOPRANK | Nursing
Peptic Ulcer Disease
TOPRANK | Nursing
Peptic Ulcer Disease
Factors:
• Stress
• Drinks
• Caffeinated and decaffeinated
• Vices
• Drugs
• Infection
TOPRANK | Nursing
Gastric Ulcer Duodenal Ulcer
•Poor Man’s or Laborer’s ulcer •Executive Ulcer
•20% incidence •80% incidence
•Common in people 50yrs old and •Common in people 25-50yrs old.
above.
•Malnourished •Well Nourished
•Pain – ½ - 1 hour after meal •Pain – 2-3 hours after meal
•Pain is triggered by food intake •Pain is common at night
•Pain relieved by vomiting •Pain is relieved by food intake
•Nausea, vomiting & Hematemesis •Melena
TOPRANK | Nursing
• Weight loss
• Pain is relieved by food intake
• Pain common at night
• 25-50 years-old
• Poor man’s ulcer
• Stress related
• Pain – 2-3 hours after meal
• Nausea and vomiting
• Pain triggered by food intake
• Melena
TOPRANK | Nursing
Interventions:
1. Meal
2. Diet
•
• Chew
• Milk
• Active phase
3. Avoid Factors
TOPRANK | Nursing
Medications:
1. Antacids
• Action
• Time
•S
•C
•A
•M
TOPRANK | Nursing
Medications:
2. Gastric Protectants/Cytoprotective
• Sucralfate
• Time
• Action
• Misoprostol
• Time
• Action
• Contraindication
TOPRANK | Nursing
Medications:
3. Histamine-2 Receptor Antagonist
• Action
• Time
4. Proton Pump Inhibitors
• Action
• Time
TOPRANK | Nursing
A.Antacid
B.Histamine 2 receptor blocker
C.Proton pump inhibitor
D.Cytoprotective
TOPRANK | Nursing
Surgery
1. Vagotomy
2. Gastrectomy
• Total
• Subtotal/Antrectomy
3. Anastomosis:
• Billroth I – Gastroduodenostomy
• Billroth II – Gastrojejunostomy
TOPRANK | Nursing
• Partial gastrectomy, with remaining segment anastomosed to the duodenum.
• Removal of the lower half of the stomach.
• Surgical division of the vagus nerve to eliminate the vagal impulses that stimulate
hydrochloric acid secretion in the stomach.
• Partial gastrectomy, with remaining segment anastomosed to the jejunum.
• Removal of the stomach, with attachment of the esophagus to the jejunum or
duodenum.
A. Vagotomy
B. Billroth 1
C. Billroth 2
D. Total Gastrectomy
E. Antrectomy
TOPRANK | Nursing
TOPRANK | Nursing
Dumping Syndrome
TOPRANK | Nursing
• Pallor
• Decreased bowel sound
• Bradycardia
• Hypotension
• Weakness
• Flat abdomen
• Diaphoresis
• Constipation
• Light headedness
• Nausea and vomiting
TOPRANK | Nursing
Management
1. Diet:
• protein
• fiber
• carbohydrate
• Meals
• fluids
• Salt, sugar ,milk & caffeine
2. Position
3. Medication
TOPRANK | Nursing
• Oatmeal
• Antispasmodics
• Coffee
• Drink fluids during meals
• Lie down after eating
• Candy
• Eat 6 meals per day
• Fried chicken
• Soda
• Cheese
TOPRANK | Nursing
Diverticulosis
• Outpouching of intestinal mucosa.
• Common site:
• Cause: fiber diet
Diverticulitis
• Inflammation of 1 or more diverticula.
• Cause: Accumulation of fecal material
TOPRANK | Nursing
TOPRANK | Nursing
1. Inflammation
• abdominal pain
2. Infection
• Temperature & WBC
3. Injury
• Stool
4. Obstruction
• Gas
TOPRANK | Nursing
Management
Diverticulosis
1. fiber diet
2. fluid intake
3. Medication
Diverticulitis
• Fiber
• Monitor for perforation
• “ACUTE PHASE”
TOPRANK | Nursing
Acute Phase:
• Oral intake
• Activity
• Fluids
• N&V
• Malnutrition
• DOC:
TOPRANK | Nursing
Appendicitis
TOPRANK | Nursing
• McBurney’s point • Blumberg’s sign
Clinical • Rovsing’s sign • WBC
Manifestation
• Dunphy’s sign • Bowel sound
TOPRANK | Nursing
Psoas sign
TOPRANK | Nursing
Obturator sign
TOPRANK | Nursing
A. Dunphy
B. McBurney
C. Obturator
D. Rovsing
E. Blumberg
F. Psoa
TOPRANK | Nursing
Management:
1. “Refer to acute phase”
2. Avoid:
•
•
•
3. Analgesics
4. Compress
TOPRANK | Nursing
Liver Cirrhosis
Types:
1. Laennec’s Cirrhosis
2. Post necrotic
3. Biliary Cirrhosis
4. Cardiac Cirrhosis
TOPRANK | Nursing
Clinical Manifestations
• Hemoglobin
TOPRANK | Nursing
Clinical Manifestations
• Protein
TOPRANK | Nursing
Clinical Manifestations
• Portal Circulation
TOPRANK | Nursing
Laboratory Tests:
• Partial Thromboplastin time or prothrombin time/INR (25-35 sec. / 11-
14sec./.8-1.2)
• Serum Bilirubin (.03-1.9 mg/dL)
• Aspartate Aminotransferase (AST/SGOT) (10-40 U/L)
• Alanine Aminotransferase (ALT/SGPT) (7-56 U/L)
• BUN (10-20 mg/dL)
TOPRANK | Nursing
TOPRANK | Nursing
Management:
1. Bile
• Diet
2. Hepatic Encephalopathy
Monitor
Avoid
Diet
DOC
L
N
TOPRANK | Nursing
Management:
3. Portal HPN
• DOC
• Procedure
4. Esophageal Varices
• Avoid
• Rupture
TOPRANK | Nursing
TOPRANK | Nursing
Cholecystitis
Types:
• Calculous
• Acalculous
Cholelithiasis
TOPRANK | Nursing
Clinical Manifestations:
1. Inflammation
• Biliary colic
• Abdominal pain
• Rebound tenderness
• Radiating
• Usually after a ______or ______ meal
2. Indigestion
• N&V
• Belching
• Flatulence
TOPRANK | Nursing
Murphy’s sign
TOPRANK | Nursing
Boa’s Sign
TOPRANK | Nursing
Clinical Manifestations:
3. Obstruction
• Skin
• Stool
• urine
• Vitamin Deficiency
4. Infection
• Fever
TOPRANK | Nursing
Management:
1. “Refer to Acute phase”
2. Diet
• Fat
• Meal
• Gas forming foods
3. Medications
• Ursodeoxycholic acid (UDCA)
• Chenodeoxycholic acid (chenodiol or CDCA)
TOPRANK | Nursing
TOPRANK | Nursing
Acute Pancreatitis
1. Inflammation 2. Bleeding
• Pain • Dehydration
• Radiating • Weight loss
• Aggravated by: • Cullen’s & Grey turner’s Sign
• Diet
• Beverage
• Position
• Bowel sound
• N&V
TOPRANK | Nursing
TOPRANK | Nursing
Laboratory Findings:
• WBC
• Glucose
• Bilirubin
• Alkaline phosphate
• Serum and urinary amylase
• Serum lipase
TOPRANK | Nursing
Management:
1. “Refer to Acute phase”
2. Medications:
• H2 receptor blocker
• Proton pump inhibitor
• Morphine
TOPRANK | Nursing
Chronic Pancreatitis
1. Inflammation 3. Loss of function
• Abdominal pain • Weight
• Bilirubin
2. Fibrosis • Stool
• Mass • Glucose
• Calcium
TOPRANK | Nursing
Management:
1. Diet 2. Medications
• Food • Pancreatin
• Meals • Pancrelipase
• fat • Insulin & OHA
• Protein
• Calorie
TOPRANK | Nursing
TOPRANK | Nursing
