The gastrointestinal tract (GIT)consists of a hollow muscular tubestarting from the oral cavity, wherefood enters the mouth, continuingthrough the pharynx, oesophagus,stomach and intestines to the rectumand anus, where food is expelled.
The primary purpose of thegastrointestinal tract is tobreak food down intonutrients, which can beabsorbed into the body toprovide energy
The Strategy• Digestive enzymes are secreted from cells lining the inner surfaces of various exocrine glands.• The enzymes hydrolyzethe macromolecules infood into small, solublemolecules that can be• absorbed into cells.
• IngestionThe Topology• -Food placed in the mouth -Ground into finer particles by the teeth,• -Moistened and lubricated by saliva• -small amounts of starch are digested by the amylase present in saliva• the resulting bolus of food is swallowed into the esophagus and• carried by peristalsis to the stomach.
• THE STOMACH• The wall of the stomach is lined with millions of gastric glands, which together secrete 400–800 ml of gastric juice at each meal. Several kinds of cells are found in the gastric glands• parietal cells• chief cells• mucus-secreting cells• hormone-secreting (endocrine) cells
• The Liver• The liver secretes bile. Between meals it accumulates in the gall bladder. When food, especially when it contains fat, enters the duodenum, the release of the hormone cholecystokinin (CCK) stimulates the gall bladder to contract and discharge its bile into the duodenum.• Bile contains:• bile acids..• bile pigments..
• The Hepatic Portal System• Glucose is removed and converted into glycogen.• Other monosaccharides are removed and converted into glucose.• Excess amino acids are removed and deaminated. – The amino group is converted into urea. – The residue can then enter the pathways of cellular respiration and be oxidized for energy.• The liver serves as a gatekeeper between the intestines and the general circulation.• the liver releases more to the blood by converting its glycogen stores to glucose (glycogenolysis),• converting certain amino acids into glucose (gluconeogenesis).
• The Pancreas• The pancreas consists of clusters of endocrine cells (the islets of Langerhans) and exocrine cells whose secretions drain into the duodenum. Pancreatic fluid contains:• sodium bicarbonate (NaHCO3).• pancreatic amylase• pancreatic lipase• 4 "zymogens• trypsin• chymotrypsin.• elastase.• carboxypeptidase
• The Small IntestineDigestion within the small intestine produces amixture of disaccharides, peptides, fatty acids,and monoglycerides.• The Large Intestine (colon)• The large intestine receives the liquid residue after digestion and absorption are complete. This residue consists mostly of water as well as any materials that were not digested.
CONDITION NO-1 ORAL CAVITY CANCER• There are several types of oral cancers, but around 90% are squamous cell carcinomas originating in the tissues that line the mouth and lips. Oral or mouth cancer most commonly involves the tongue. It may also occur on the floor of the mouth, cheek lining, gingiva (gums), lips, or palate (roof of the mouth).
The Mouth(Cavum Oris; Oral Or Buccal Cavity)The cavity of the mouth is placed at thecommencement of the digestive tube . it is anearly oval-shaped cavity which consists of twoparts: an outer, smaller portion,the vestibule, and an inner, larger part,the mouth cavity proper.
SIGN AND SYMPTOMS OF ORAL CANCER• Common symptoms of oral cancer include:• Patches inside your mouth or on your lips White patches (leukoplakia) –Mixed red and white patches (erythroleukoplakia) –Red patches (erythroplakia) are brightly colored
• A sore on your lip or in your mouth that wont heal• Bleeding in your mouth• Loose teeth• Difficulty or pain when swallowing• Difficulty wearing dentures• A lump in your neck• An earache
Diagnosis of oral cancer• HISTORY OF THE PATIENT• PHYSICAL EXAMINATION OF THE MOUTH• Biopsy• Dental x-rays• Chest x-rays:• CT scan:• MRI:
Treatment for oralcancer• surgery, radiation therapy, or chemotherapy. Other health care include a dentist, speech pathologist, nutritionist, and mental healthcounselor.
1-Surgery• Maxillectomy (can be done with or without Orbital exenteration)• Mandibulectomy (removal of the mandible or lower jaw or part of it)• Glossectomy (tongue removal, can be total, hemi or partial)• Radical neck dissection• Mohs procedure or CCPDMA• Combinational e.g. glossectomy and laryngectomy done together.• Feeding tube to sustain nutrition
• •partial maxillectomy removes portions of maxilla, incisive bone, palatine bone ± portions of the zygomatic and lacrimal bones• •premaxillectomy: unilateral or bilateral with removal of incisive bone and perhaps rostral maxilla• •central maxillectomy: maxilla and portions of hard palate resected• •caudal maxillectomy: maxilla, hard palate, zygomatic, and lacrimal bones removed• •hemimaxillectomy: removal of entire maxilla on 1 side extending dorsally to ventral orbit• •orbitectomy: removal of orbit ± caudal maxilla and vertical mandibular ramus•
POSTOPERATIVE MANAGEMENT• sedation may be required if anxious when cannot nose breathe• •analgesic drug• • nutrition-• Cosmetic Appearance
COMPLICATIONS• Oronasal Fistula• Mucosal Ulceration on Labial Flap or Lateral Skin of Lip• Hemorrhage• Infection• Sneezing and Nasal Discharge• Epiphora• Other Complications• •prehension and mastication problems, pain, cosmetic alterations, dehiscence, infection, tumor recurrence, subcutaneous emphysema, and failure to nose breathe•
• Esophageal cancer (or oesophageal cancer) is malignancy of the esophagus. There are various subtypes, primarily squamous cell cancer and adenocarcinoma , Squamous cell cancer arises from the cells that line the upper part of the esophagus. Adenocarcinoma arises from glandular cells that are present at the junction of the esophagus and stomach
• Classification• Most esophageal cancers fall into one of two classes: squamous cell carcinomas, which are similar to head and neck cancer in their appearance and association with tobacco and alcohol consumption, and adenocarcinomas, which are often associated with a history of gastroesophageal reflux disease and Barretts esophagus.
Signs and symptoms• Dysphagia (difficulty swallowing) and odynophagia (painful swallowing• Pain behind the sternum or in the epigastrium, often of a burning, heartburn-like nature, may be severe• Another sign may be an unusually husky, raspy, or hoarse-sounding cough, a result of the tumor affecting the recurrent laryngeal nerve
• nausea and vomiting,• regurgitation of food,• coughing and an increased risk of aspiration pneumonia.• The tumor surface may be fragile and bleed, causing hematemesis (vomiting up blood).• upper airway obstruction• superior vena cava syndrome• Fistulas may develop between the esophagus and the trachea, increasing the pneumonia risk; this condition is usually heralded by cough, fever or aspiration.
• If the disease has spread elsewhere, this may lead to symptoms related to this: liver metastasis could cause jaundice and ascites,• lung metastasis could cause shortness of breath, pleural effusions, etc.
Causes• Barretts esophagus is considered to be a risk factor for esophageal adenocarcinoma.• There are a number of risk factors for esophageal cancer.• Age - most patients are over 60, and the median in US patients is 67.• Sex - the disease is more common in men.• Heredity - it is more likely in people who have close relatives with cancer.• Tobacco smoking and heavy alcohol
• Gastroesophageal reflux disease (GERD• Human papillomavirus (HPV)• Corrosive injury• A medical history of other head and neck cancers increases• Plummer-Vinson syndrome(anemia and esophageal webbing)• Tylosis and Howel-Evans syndrome(hereditary thickening of the skin of the palms and soles)
• Radiation therapy for other conditions in the mediastinum• Coeliac disease predisposes towards squamous cell carcinoma.• Obesity• Thermal injury as a result of drinking hot beverages• Alcohol consumption in individuals predisposed to alcohol flush reaction• Achalasia
Types of esophagectomy:• The thoracoabdominal approach opens the abdominal and thoracic cavities together.• The two-stage Ivor Lewis (also called Lewis- Tanner) approach involves an initial laparotomy and construction of a gastric tube, followed by a right thoracotomy to excise the tumor and create an esophagogastric anastomosis.
• The three-stage McKeown approach adds a third incision in the neck to complete the cervical anastomosis• Laser• Photodynamic therapy,• Chemotherapy• Radiotherapy
CONDITION NO-3 STOMACH CANCER• Stomach cancer, or gastric cancer, refers to cancer arising from any part of the stomach. Stomach cancer causes about 800,000 deaths worldwide per year
Signs and symptoms• Endoscopic image of linitis plastica, a type of stomach cancer where the entire stomach is invaded, leading to a leather bottle-like appearance with blood coming out of it.
• Discomfort or pain in the stomach area• Difficulty swallowing• Nausea and vomiting• Weight loss• Feeling full or bloated after a small meal• Vomiting blood or having blood in the stool
• Stage 1 (Early)• Indigestion or a burning sensation (heartburn)• Loss of appetite, especially for meat• Abdominal discomfort or irritation
• Stage 2 (Middle)• Weakness and fatigue• Bloating of the stomach, usually after meals
• Stage 3 (Late)• Abdominal pain in the upper abdomen• Nausea and occasional vomiting• Diarrhea or constipation• Weight loss• Bleeding (vomiting blood or having blood in the stool) which will appear as black. This can lead to anemia.• Dysphagia; this feature suggests a tumor in the cardia or extension of the gastric tumor in to the esophagus..
Causes• Infection by Helicobacter pylori.• gastritis, intestinal metaplasia and various genetic factors• smoked foods, salted fish and meat, and pickled vegetables• Nitrates and nitrites are substances commonly found in cured meats.• Smoking increases the risk of developing gastric cancer
• consumption of alcohol.• Alcohol along with tobacco smoking increase the risk of developing other cancers .• Gastric cancer shows a male predominance in its incidence as up to three males are affected for every female• Some researchers showed a correlation between Iodine deficiency or excess, iodine- deficient goitre and gastric cancer
Diagnosis• To find the cause of symptoms, asks about the patients medical history, does a physical exam, and may order laboratory studies. The patient may also have one or all of the following exams:
• These are the stages of stomach cancer:• Stage 0: The tumor is found only in the inner layer of the stomach. Stage 0 is also called carcinoma in situ.• Stage I is one of the following: – The tumor has invaded only the submucosa. Cancer cells may be found in up to 6 lymph nodes. – Or, the tumor has invaded the muscle layer or subserosa. Cancer cells have not spread to lymph nodes or other organs.
• Stage II is one of the following: –The tumor has invaded only the submucosa. Cancer cells have spread to 7 to 15 lymph nodes. –Or, the tumor has invaded the muscle layer or subserosa. Cancer cells have spread to 1 to 6 lymph nodes. –Or, the tumor has penetrated the outer layer of the stomach. Cancer cells have not spread to lymph nodes or other
• Stage III is one of the following: –The tumor has invaded the muscle layer or subserosa. Cancer cells have spread to 7 to 15 lymph nodes. –Or, the tumor has penetrated the outer layer. Cancer cells have spread to 1 to 15 lymph nodes. –Or, the tumor has invaded nearby organs, such as the liver, colon, or spleen. Cancer cells have not spread to lymph nodes or to distant organs.
• Stage IV is one of the following: –Cancer cells have spread to more than 15 lymph nodes. –Or, the tumor has invaded nearby organs and at least 1 lymph node. –Or, cancer cells have spread to distant organs
Management• Treatment for stomach cancer may include surgery,chemotherapy, and/or radiation therapy.
1-Surgery-----Total gastrectomy• 2- Chemotherapy• The use of chemotherapy to treat stomach cancer has no firmly established standard of care.• Some drugs used in stomach cancer treatment have included:• 5-FU (fluorouracil) or its analog capecitabine,• BCNU (carmustine), methyl-CCNU (Semustine), and• doxorubicin (Adriamycin), as well as Mitomycin C, and• more recently cisplatin and taxotere, often using drugs in various combinations
• 3-Radiation therapy• Nutrition• Nutrition after stomach surgery• Some people have problems eating and drinking after stomach surgery. Liquids may pass into the small intestine too fast, which causes dumping syndrome. The symptoms are cramps, nausea, bloating, diarrhea, and dizziness. To prevent these symptoms, it may help to make the following changes:• Plan to have smaller, more frequent meals (some doctors suggest 6 meals per day)• Drink liquids before or after meals• Cut down on very sweet foods and drinks (such as cookies, candy, soda, and juices)
• Supportive care• Stomach cancer and its treatment can lead to other health problems. You can have supportive care before, during, and after cancer treatment.• Supportive care is treatment to control pain and other symptoms, to relieve the side effects of therapy, and to help you cope with the feelings that a diagnosis of cancer can bring. You may receive supportive care to prevent or control these problems and to improve your comfort and quality of life during treatment.•
CONDITION NO-4 Colorectal cancerColorectal cancer, commonly known asbowel cancer, is a cancer fromuncontrolled cell growth in the colon orrectum (parts of the large intestine), or inthe appendix. Symptoms typically includerectal bleeding and anemia which aresometimes associated with weight lossand changes in bowel habits.
Signs and symptoms• worsening constipation,• blood in the stool,• weight loss,• fever,• loss of appetite,• nausea or vomiting in someone over 50 years• While rectal bleeding or anemia are high- risk features in those over the age of 50,
Cause• Greater than 75-95% of colon cancer occurs in people with little or no genetic risk.• While some risk factors such as older age and male gender cannot be changed many can.• A high fat, alcohol or red meat intake are risk factors for colorectal cancer .• obesity,• smoking• a lack of physical exercise.• Inflammatory bowel disease
Diagnosis• Appearance of the inside of the colon showing one invasive colorectal carcinoma (the crater-like, reddish, irregularly shaped tumor).
• Diagnosis of colorectal cancer is via tumor biopsy typically done during sigmoidoscopy or colonoscopy.• The extent of the disease is then usually determined by a CT scan of the chest, abdomen and pelvis.• There are other potential imaging test such as PET and MRI which may be used in certain cases. Colon cancer staging is done next and based on the TNM system .
NURSESRESPONCIBILITIES FOR THE TREATMENT FORCANCER RELATED TO G I TRACT
• Find the condition of the patient disease symptoms• Watch the vital sign of the patient• Watch the site of the operation for bleeding or infection• Maintain proper position after surgery.• Provide proper and safe environment after surgery.• Maintain proper intravenous fluid therapy as per doctor order.• Observe patient for any abnormal
• Common nursing diagnosis related to cancer of G I tract with nursing intervention
1)-knowledge deficit relted to disease condition• Intervention-• Determine present knowledge base and concerns regarding the diagnosis of disease.• Discuss the treatment plan and explain the expected effects of treatment.• Provide written information about cancer treatment and disease condition.•
2) body image disturbance• Intervention-• Encourage patient to verbalize feeing both positive and negative about actual changes.• Acknowledge the appropriateness of patient’s response to the change and loss of body fuction and control.• Encourage the patient to look at, touch and care of the stoma.• Identify and include family members in education and care of ostomy site.• Identify at risk for unsuccessful adjustment to body image change as evidence by –• 1 --lack of motivation
3) Altered nutrition less than body requirement• Intervention-• Assess nutritional status ,current, weight, appetite, food and caloric intake.• Monitor serum level of the patient.• Assess for sign and symptoms that interfere with nutritional intake.• Educate the patient about the sign and symptoms of treatment that can interfere with adequate nutritional intake.• Determine time of day when appetite may be greater.
4) Ineffective Airway clearance-InterventionAssess patient’s ability to swallow liquids and solidfoodsAssess breathing sound,rate and depth ofrespiration at rest .Assess patient’s ability to clear secretions,coughmechanism and amount of sputum.Administer oxyzen therapy as required.Educate patient for self care of cough .
5) Diarrhea• Intervention-• Assess hydration level of the patient.• Monitor intake and output• Provide law residue, bland, high protein diet. Avoid too hot and too cool diet.• Give fluids, avoid fluids such as orange juice, milk, alcoholic beverages.• Monitor serum level of patient.• Administer antidiarrheal treatment• Provide skin care to perineal area.
6) Altered oral mucous membrane• Intervention• Assess mucous membrain for pain,ulcers,lesions and dryness.• Monitor oral intake.• Encourage oral care.• Teach patient for oral care protocol.• Teach patient for sign and symptoms for bleeding.• Keep lips moist and lubricanted.
BIBLIOGRAPHY• MICHAEL B. KASTAN,T/B OF CLINICAL ONCOLOGY,ELSEVIER,• PAGENO-1179,1211TO1212,1431TO1459,1399TO1423,1477TO1525.• DANIEL F. HAYES,T/B OF ONCOLOGY(AN EVIDENCE-BASED APPROACH),SPRINGER• PAGE NO-12,704TO721• BLACK,T/B OF MEDICAL SURGICAL NURSING,JAYPEE• PAGE NO-• WEBSITES• WWW.ONCOLOGY.NURSING.OM• WWW.CANCER.ORG• WWW.WIKIPEDIYA.COM• WWW.CANCERTREATMENT.COM