GI System

1. Management of the patient with Chronic GIT
Disorders
1

2. Learning Objectives
• At the end of this session, learners will be able to:
– Define and identify causes/risk factors for GERD,
PUD, Hernia, Constipation, Hemorrhoid, CLD.
– Describe pathophysiology and C/M for GERD,
PUD, Hernia, Constipation, Hemorrhoid, CLD
– Identify appropriate diagnostic methods and
possible differentials for GERD, PUD, Hernia,
Constipation, Hemorrhoid, CLD
– Manage the patient using medical and nursing
approaches.
2

3. Brainstorming
• Being in a group of TWO and discuss the following
points:
– Definitions, causes/risk factors, pathophysiology,
C/M, diagnosis methods, DDX, medical and
nursing management for:
• GERD, PUD, Constipation, Hemorrhoid,
– Discussion: five minutes
– Presentation: five minutes
3

4. Gastro Esophageal Reflux Disease
(GERD)
4

5. Gastro Esophageal Reflux Disease (GERD)
• Is a digestive disorder that occurs when acidic
stomach juices, or food and fluids back up from the
stomach into the esophagus and irritates the food
pipe lining.
• Acid reflux and heartburn more than twice a week
may indicate GERD.
5

6. Epidemiology
• GERD affects people of all ages: from infants to older
adults.
• It’s prevalence is 20% in USA.
• Men are at greater risk than women to develop the
disease (general overview), but no association with
sex in North America and Europe.
• People with asthma are at higher risk of developing
GERD.
6

7. Causes / Risk factors
• Occasional acid reflux is quite common, often
occurring as a result of eating a large meal, lying
down after eating (2-3Hrs), or eating particular
foods.
• People with obesity or people who are overweight
because of increased pressure on the abdomen.
• Mothers who are pregnant, affecting around 40–85%
of mothers during pregnancy.
7

8. Causes / Risk factors
• People who are taking certain medications, including
some asthma medications, calcium channel blockers,
antihistamines, sedatives, and antidepressants.
• People who are smokers and those who use alcohol,
caffeine.
• Using fatty foods, using large meals at night.
• People with hiatal hernia.
8

9. Clinical manifestations
• Heartburn (usually after eating, during night/ while
lying down)
• Backwash (regurgitation) of food / fluid
• Chest pain
• Trouble swallowing (dysphagia)
• Sudden excess of saliva
• Chronic sore throat
• Bad breath
• A recurrent or chronic cough
9

10. Diagnostic studies
• X-ray of the upper digestive system
• Endoscopy (examines the inside of the esophagus)
• Ambulatory acid (pH) test (monitors the amount of
acid in the esophagus)
• Esophageal impedance test (measures the
movement of substances in the esophagus)
• Transnasal esophagoscopy (done to look for any
damage in esophagus)
• Esophageal manometry test (measures muscle
contractions in the esophagus during swallowing)
10

11. DDX
• PUD
• Achalasia
• Dyspepsia
• Gastritis
11

12. Management
• Antacids (antacids which contains calcium carbonate)
• H2 blockers (Reduces the amount of acid in the
stomach but are not as good at healing the lining of the
esophagus: Cimetidine, Famotidine, Nizatidine)(not fast
act as antacids but longer stay (12hr)
• PPIs (block acid production: Omeprazole, Lansoprazole)
• Emptying stomach faster (E.g. use Erythromycin)
• Surgery (fundoplication- wrapping and tightening the
sphincter)
12

13. Management
• Lifestyle changes to treat GERD :
• Elevate the head of the bed 6-8 inches
• Lose weight
• Stop smoking
• Decrease alcohol intake
• Limit meal size and avoid heavy evening meals
• Do not lie down within two to three hours of eating
• Decrease caffeine intake
• Avoid theophylline (if possible for asthma patient)
13

14. Prognosis/outlook
• Extremely good with 80-90% of the affected
individuals recovering with the help of antacids.
14

15. Complications of GERD
• Esophagitis
• Esophageal stricture (Repeated irritation can cause
scarring in the esophagus, making it narrow).
• Barrett’s esophagus (The cells lining the esophagus can
change into cells similar to the lining of the intestine
which can develop into esophageal cancer.
• Respiratory problems: It is possible to breathe
stomach acid into the lungs, which can cause a range
of problems, such as chest congestion, hoarseness,
asthma, laryngitis, and pneumonia.
15

16. Prevention of GERD
– Eat small meals frequently (avoid large meals)
– Stay upright after eating
– Finish eating 2–3 hours before going to bed
– Quit or avoid smoking, avoid using caffeine,
– Avoid strenuous activities after eating
– Lose weight if overweight
– Minimize wearing tight clothing around the
abdomen
– Sleep at a slight angle with the head slightly
elevated
– Avoid using greasy and spicy food
16

17. Common Nursing Diagnosis
• Imbalanced nutrition less/more than body
requirement
• Acute pain
• Risk for aspiration
• Deficient knowledge
17

18. Nursing Interventions
• Measuring the weight of the patient
• Encourage small and frequent meals
• Instruct the patient to remain upright after eating
• Instruct patient to eat slowly and masticate food well
18

19. Peptic
Ulcer
Disease
(PUD)
19

20. Peptic Ulcer Disease
• Peptic ulcers are sores/excavation that develop in
the lining mucosal wall of the stomach, pylorus,
lower esophagus, or small intestine.
• Sites:
– Lower esophagus
– Stomach
– Duodenum
– 10% of men, 4% of women
20

21. Types (Based on the duration)
 Acute (shorter)
• Superficial erosion
• Minimal erosion
 Chronic (longer)
• Muscular wall erosion with formation of fibrous
tissue
• Present continuously for many months or
intermittently
21

22. Types (based on site of involvement)
• Gastric ulcer –in the lesser curvature of the stomach
• Duodenal ulcer –in the duodenum
• Esophageal ulcer – lower parts of esophagus because
of HCl back flow
22

23. Epidemiology
• One in 10 people develops an ulcer.
• Occurs with greatest frequency between 40-60 years
of age.
• Relatively uncommon in women of child bearing age.
• After menopause the incidence is equal in male and
female.
23

24. Causes /Risk factors/
• Helicobacter pylori (H. pylori)
• Use of NSAIDS
• Smoking
• Drinking too much alcohol
• Radiation therapy
• Stomach cancer, illnesses like chronic pancreatitis, ...
• Family history and blood type (Gastric-A, Duodenal-O)
• Excessive HCl secretion
• Irritants (caffeine, milk, ...accelerate gastric empting)
24

25. Pathophysiology
25

26. Disruption of Gastric Mucosal Barrier
26

27. Pathophysiology
• Erosion - caused by increased concentration of acid
pepsin/decreased resistance of mucosa.
• Damage – damaged mucosa cannot act as a barrier
against HCl.
• Acid secretion – duodenal ulcers secrete more acids
whereas in gastric ulcers hypo/normal acid secretion.
• Decreased resistance - infections from H/pylori can
easily occur.
27

28. Gastric Ulcers (Characteristics)
• A normal to low secretion of gastric acid
• Back diffusion of acid is greater (chronic )
• Critical pathologic process is amount of acid able to
penetrate mucosal barrier
• H pylori is present in 50% to 70%
• Factors: Drugs users like aspirin, corticosteroids,
NSAIDs, Chronic alcohol users, chronic gastritis,...
• Pain intensifies after meal
28

29. Duodenal Ulcers
• Common: between ages of 35 to 45 years
• Account for 80% of all peptic ulcers
• Associated with ↑HCl acid secretion
• H.pylori associated in 90- 95 % of cases
• Diseases with ↑risk of duodenal ulcers: COPD,
cirrhosis of liver, chronic pancreatitis,
hyperparathyroidism, chronic renal failure
• Pain improves after meal
29

30. Clinical Manifestations /Common/
• Changes in appetite
• Nausea
• Bloody or dark stools
• Unexplained weight loss
• Indigestion
• Vomiting, sometimes with blood
• Epigastric abdominal pain
• Bloating, gas,
• Trouble breathing
30

31. 31

32. Diagnostic Studies
• Hx and Physical examination (tenderness, distension)
• Endoscopy-Determines degree of ulcer healing after
treatment, is preferred test
• H. Pylori tests- A breath test is the easiest way to
discover H. pylori
• Esophagogastroduodenoscopy (for biopsy, to r/o cancer)
• Barium contrast studies - widely used
• Occult blood
• Carbon 13 (13C) urea breath test-reflects activity of
H/Pylori
32

33. DDX
• Gastritis
• GERD
• Acute pancreatitis
• Cholelithiasis
• MI
• Pleural empyema
• Primary biliary cirrhosis
33

34. Management
• Medical regimen consists of:
• Adequate rest
• Dietary modification
• Drug therapy
• Elimination of smoking
• Long-term follow-up care
• Aim of treatment program:
• ↓ degree of gastric acidity
• Enhance mucosal defense mechanisms
• Minimize harmful effects on mucosa
34

35. Management
• Proton pump inhibitors (PPI): These drugs reduce
acid flow, which allows the ulcer to heal
(Omeprazole,Lansoprazole,Rabeprazole,
pantoprazole)
• Histamine receptor blockers (H2 blockers): These
drugs also reduce acid production (Famotidine,
Cimetidine, Nizatidine)
• Antibiotics: These medications kill bacteria
(Amoxacillin, Clarithromycin,Metronidazole,..).
35

36. Management
• Protective medications: Like a liquid bandage, these
medications cover the ulcer in a protective layer to
prevent further damage from digestive acids and
enzymes (misoprostol, sucralfate).
• Antacids – Increase gastric PH (Aluminum hydroxide
and Magnesium hydroxide)
• Anticholinergic – Decrease HCl secretion stimulation
(Glycopyrrolate)
• Combination of drugs during treatments:
– PPIs + clarithromycin/or/bismuth compound +
amoxicillin/or/ metronidazole/
36

37. Management /Surgical Procedures/
• < 20% of patients with ulcers need surgical intervention
• Indications for surgical interventions:
• History of hemorrhage, ↑ risk of bleeding
• Prepyloric or pyloric ulcers
• Multiple ulcer sites
• Drug-induced ulcers
• Possible existence of a malignant ulcer
• Obstruction
37

38. Management /Surgical procedures/
• Gastroduodenostomy
• Gastrojejunostomy
• Vagotomy
• Pyloroplasty
38

39. Nutritional Therapy
• Dietary modifications may be necessary so that foods
and beverages irritating to patient can be avoided
• Nonirritating or bland diet consisting of 6 small
meals a day during symptomatic phase
• Protein considered best neutralizing food
• Stimulates gastric secretions
• Carbohydrates and fats are least stimulating to HCl
acid secretion
• Do not neutralize well
• Stress reduction and rest
39

40. Complications of a Peptic Ulcer Disease
• Perforation…2nd common cxn
• Internal bleeding…most common cxn
• Gastric outlet obstruction …least common /pylorus
region/
• Scar tissue
• Seek urgent medical attention if the patient experiences the
following symptoms:
• Sudden, sharp abdominal pain
• Fainting, excessive sweating, or confusion, as these may be
signs of shock
• Blood in vomit or stool
• Abdomen that’s hard to the touch, abdominal pain
40

41. Common Nursing Diagnosis
• Acute pain
• Anxiety
• Imbalanced nutrition
• Deficient knowledge
41

42. Nursing Interventions
• Administer prescribed medication
• Encourage relaxation methods
• Encourage patient to eat regularly,
• Health education:
– Nature of the disease
– Preventive methods
– Treatment modalities
42

43. Preventions of PUD
• Avoid tobacco products
• Avoid irritant foods
• Avoid alcohol
• Don’t ignore any symptoms of ulcer
• Washing your hands frequently to avoid infections
• Use caution with aspirin, and/or NSAIDS
• Reduce stress
• Practice relaxation exercise
43

44. Outlook / Prognosis
• Are ulcers curable?
• For most people, treatment that targets the
underlying cause (usually H. pylori bacterial infection
or NSAID use) is effective at eliminating peptic ulcer
disease.
• Ulcers can reoccur, though, especially if H. pylori isn’t
fully cleared from system or you continue to smoke
or use NSAIDs.
• How long does it take an ulcer to heal?
• It generally takes several weeks of treatment for an
ulcer to heal.
44

45. Questions?
• Will drinking milk help an ulcer?
– No. Milk may temporarily soothe ulcer pain because it coats
the stomach lining. But milk also causes stomach to produce
more acid and digestive juices, which can make ulcers worse.
• Is it safe to take antacids?
– Antacids temporarily relieve ulcer symptoms. However, they
can interfere with the effectiveness of prescribed medications.
Check with doctor to find out if antacids are safe to take while
undergoing treatment.
• What should ulcer patients eat?
– No foods have been proven to negatively or positively impact
ulcers. However, eating a nutritious diet and getting enough
exercise and sleep is good for your overall health.
45

46. Hernia
• A hernia occurs when an organ pushes through an
opening in the muscle or tissue that holds it in place.
• Many hernias occur in the abdomen between your
chest and hips, but they can also appear in the upper
thigh and groin areas.
• Most hernias aren’t immediately life threatening, but
they don’t go away on their own.
46

47. Common Types
• Inguinal hernia: fatty tissue or a part of the intestine pokes into
the groin at the top of the inner thigh.
• Is the most common type, and affects men more than women.
• Femoral hernia: Fatty tissue or part of the intestine protrudes
into the groin at the top of the inner thigh.
• It is much less common than inguinal and mainly affect older
women.
• Umbilical hernia: Fatty tissue or part of the intestine pushes
through the abdomen near the navel (belly button).
• Hiatal (hiatus) hernia: Part of the stomach pushes up into the
chest cavity through an opening in the diaphragm.
47

48. Common Types
• Incisional hernia: Tissue protrudes through the site
of an abdominal scar from a remote abdominal or
pelvic operation.
• Epigastric hernia: Fatty tissue protrudes through the
abdominal area between the navel and lower part of
the sternum (breastbone).
• Spigelian hernia: The intestine pushes through the
abdomen at the side of the abdominal muscle, below
the navel.
• Diaphragmatic hernia: Organs in the abdomen move
into the chest through an opening in the diaphragm.
48

49. How common are hernias?
• Of all hernias that occur:
– 75 to 80% are inguinal or femoral.
– 2% are incisional or ventral.
– 3 to 10% are umbilical, affecting 10 to 20% of
newborns; most close by themselves by 5 years of
age.
– 1 to 3% are other types.
49

50. 50

51. Causes /Risk factors
• Damage from an injury or surgery
• Strenuous exercise or lifting heavy weights
• chronic coughing or COPD
• Pregnancy, especially having multiple pregnancies
• Constipation, /which causes straining/
• Being overweight or having obesity
• Ascites
• Being older
• Cystic fibrosis
• Smoking, which leads to the weakening of connective
tissue
• A personal or family history of hernias
51

52. Clinical Manifestation
• A bulge or lump (more likely to be felt through touch
when standing up, bending down, or coughing).
• Discomfort or pain in the area around the lump may
also be present
• Some types of hernia, such as hiatal hernias, can
have more specific symptoms like heartburn, trouble
swallowing, and chest pain.
• In many cases, hernias have no symptoms.
52

53. Diagnostic Studies
• History
• Abdominal ultrasound: uses high-frequency sound waves
to create an image of the structures inside the body.
• Abdominal CT scan: combines X-rays with computer
technology to produce an image.
• Abdominal MRI scan: uses a combination of strong
magnets and radio waves to create an image.
• X-rays: The patient will drink a liquid containing
gastrografin or a liquid barium solution.
• These liquids help digestive tract appear highlighted on X-
ray images.
• Endoscopy: During an endoscopy, a healthcare professional
threads a small camera attached to a tube down the throat
and into esophagus and stomach.
53

54. Management
• The only way to effectively treat a hernia is through
surgical repair (open surgery, laparoscopic surgery).
• Whether or not patient need surgery depends on the
size of hernia and the severity of symptoms.
• If the patient have a hiatal hernia, over-the-counter
(OTC) and prescription medications that reduce
stomach acid can relieve the discomfort and improve
symptoms (Antacids, H2 receptor blockers, and
proton pump inhibitors).
54

55. Home remedies for hernia
• Increasing fiber intake may help relieve constipation.
• Constipation can cause straining during bowel movements,
which can aggravate a hernia.
• Some examples of high fiber foods include whole grains,
fruits, and vegetables….
• Dietary changes can also help with the symptoms of a hiatal
hernia.
• Try to avoid large or heavy meals, don’t lie down or bend over
after a meal, and keep your body weight in a moderate range.
• To prevent acid reflux, avoid foods that may cause it, such as
spicy foods and tomato-based foods.
• Additionally, giving up cigarettes may also help, for smokers.
55

56. Complications
• Strangulation (leading to ischemia, cell death)
• Bowl obstruction
• Scrotal swelling
• Infection
• Numbness at surgical site
• Back pain
• Groin pain
• Inner thigh pain
56

57. Prevention
• If you smoke, consider quitting
• See a health professionals when you’re sick to avoid
developing a persistent cough.
• Maintain a healthy /moderate body weight.
• Try not to strain while having a bowel movement or during
urination.
• Eat enough high fiber foods to prevent constipation (fruits,
vegetables, whole grains).
• Perform exercises that help to strengthen the muscles of your
abdomen.
• Avoid lifting weights that are too heavy for you.
57

58. Common Nursing Diagnosis
• Acute pain
• Deficient knowledge
• Risk for injury
• Risk for fluid volume deficit
• Risk for infection
58

59. Nursing Interventions
• Administering antipain
• Health education on the nature of the disease,
prevention methods and managements
• Providing support/comfort/
• Monitoring IP vs OP
• Wound care
59

60. Constipation
• Technically defined as: Having fewer than three bowel
movements a week; However, how often you “go” varies
widely from person to person.
• Some people have bowel movements several times a day
while others have them only one to two times a week.
• Whatever the bowel movement pattern is, it’s unique and
normal for everybody.
• Other key features that usually define constipation include:
– Stools are dry and hard
– Bowel movement is painful and stools are difficult to pass
– You have a feeling that you have not fully emptied your
bowels
60

61. Epidemiology
• Constipation is one of the most frequent
gastrointestinal complaints in the United States.
• At least 2.5 million people see their doctor each year
due to constipation.
• People of all ages can have an occasional attack of
constipation.
• There are also certain people and situations that are
more likely to lead to becoming more consistently
constipated (“chronic constipation”).
61

62. Epidemiology (Risk groups)
• These include:
– Older age
– Being a woman, especially during pregnancy and
after childbirth.
– Those not eating enough high-fiber foods.
– Those taking certain medications
– Having certain neurological (diseases of the brain
and spinal cord) and digestive disorders
62

63. Causes of constipation
• Eating foods low in fiber
• Not drinking enough water (dehydration)
• Not getting enough exercise
• Changes in regular routine, such as traveling or eating or
going to bed at different times
• Eating large amounts of milk or cheese
• Stress
• Resisting the urge to have a bowel movement
• Medications: NSAIDS, Strong antipain, antidepressant,
antacids, allergy medication, certain anti HTN drugs
• Diseases: hypothyroidism, DM, colorectal Cancer, stroke,
intestinal obstruction, pregnancy (though not a disease)
63

64. How does constipation happen?
• Constipation happens because colon absorbs too much water
from waste (stool/poop), which dries out the stool making it
hard in consistency and difficult to push out of the body.
• To back up a bit, as food normally moves through the digestive
tract, nutrients are absorbed.
• The partially digested food (waste) that remains moves from the
small intestine to the large intestine, also called the colon.
• The colon absorbs water from this waste, which creates a solid
matter called stool.
• During constipation, food may move too slowly through the
digestive tract.
• This gives the colon more time to absorb water from the waste.
• The stool becomes dry, hard, and difficult to push out.
64

65. Clinical manifestations
• Fewer than three bowel movements a week
• Stools are dry, hard and/or lumpy
• Stools are difficult or painful to pass
• Stomach ache or cramps
• Feeling bloated and nauseous
• Feeling that you haven’t completely emptied your
bowels after a movement
65

66. Diagnostic studies
• Medical history
– What are your current and past diseases/health
conditions?
– Have you lost or gained any weight recently?
– Have you had any previous digestive tract surgeries?
– What medications and supplements do you take for
other disorders and for the relief of constipation?
– Does anyone in your family have constipation or
diseases of the digestive tract or a history of colon
cancer?
– Have you had a colonoscopy?
66

67. Diagnostic studies
• Bowel movement history
– How often do you have a bowel movement?
– What do your stools look like?
– Have you noticed any blood or red streaks in your
stool?
– Have you ever seen blood in the toilet bowl or on the
toilet paper after you wipe?
• Lifestyle habits and routines
– What food and beverages do you eat and drink?
– What is your exercise routine?
67

68. Diagnostic studies
• Lab tests: Blood and urine tests for ( hypothyroidism, anemia,
and diabetes).
• Imaging tests: CTS, MRI may be ordered to identify other
problems that could be causing constipation.
• Colonoscopy: To test for cancer or other problems and any
found polyps will be removed.
• Colorectal transit studies: These tests involve consuming a
small dose of a radioactive substance, either in pill form or in
a meal, and then tracking both the amount of time and how
the substance moves through your intestines.
68

69. Management
• Fiber supplements (calcium ploycarbophil)
• Stimulants (bisacodyl)
• Osmotic laxatives (oral magnesium hydroxide)
• Lubricants (mineral oils)
• Stool softeners (docusate sodium)
• Enema
• Suppositories (glycerin)
• Serotonin 5-hydroxytryptamine 4 receptors (helps move
stool through the colon)
• Surgery (if the cause is rectocele or stricture)
69

70. Managements
• Increase fluid intake
• Increase fiber intake (fruits, vegetables whole grains )
• Exercise most days of the week
• Don’t ignore the urge to have a bowl movement
• Training pelvic muscles
70

71. Complications of constipation
• Hemorrhoids
• Infections like diverticulitis
• Fecal impactions
• Bowel incontinence
• Stress urinary incontinence (during straining)
71

72. Preventions of constipation
• Eat a well-balanced diet with plenty of fiber.
• Good sources of fiber are fruits, vegetables, legumes, and
whole-grain breads and cereals.
• Fiber and water help the colon pass stool.
• Most of the fiber in fruits is found in the skins, such as in
apples. Fruits with seeds you can eat, like strawberries,
have the most fiber.
• People with constipation should eat between 18 and 30
grams of fiber every day.
• Drink eight 8-ounce glasses of water a day. (Note: Milk can
cause constipation in some people.) Liquids that contain
caffeine, such as coffee and soft drinks, can dehydrate you.
• Exercise regularly.
• Move your bowels when you feel the urge. Do not wait.
72

73. Common Nursing diagnosis
• Constipation related to immobility secondary to hip
fracture surgery as evidenced by difficulty to pass
stool and no bowl movement for 4 days post surgery.
• Constipation related to reduced muscle control
secondary to neurologic disease as evidenced by
reduced bowl movement, verbalization of having to
strain when on the toilet.
73

74. Nursing interventions
• Administer recommended fluid and food
• Provide time to use toilet
• Provide privacy
• Encourage high fiber diets
74

75. Hemorrhoid
• Hemorrhoids also called piles, are swollen veins in anus
and lower rectum, similar to varicose veins.
• It can develop inside the rectum (internal hemorrhoids)
or under the skin around the anus (external
hemorrhoids).
• Nearly three out of four adults will have hemorrhoids
from time to time.
• It has a number of causes, but often the cause is
unknown.
• Many people get relief with home treatments and
lifestyle changes.
75

76. Causes
• Hemorrhoids can develop from increased pressure in the
lower rectum due to:
– Straining during bowel movements
– Sitting for long periods of time on the toilet
– Having chronic diarrhea or constipation
– Being obese, Being pregnant
– Having anal intercourse
– Eating a low-fiber diet, Regular heavy lifting
• Risk factors
– Family hx, sedentary life style, episiotomy, rectal surgical
procedures, spinal cord injury, rectal muscle tone loss
76

77. Types of hemorrhoid
Internal
• Occurs within rectum
• Usually not visible or
uncomfortable
• May bleed / bright red
blood/
• Can get out during straining,
child birth, heavy lifting
...which can cause
prolapsed hemorrhoid
/greater discomfort/
External
• Found outside of rectum
• Can easily bleed and pain
• Walking or sitting can cause
irritation
• Pool blood /clot/
77

78. Clinical manifestation
External hemorrhoids
• These are under the skin
around your anus.
• Itching or irritation in anal
region
• Pain or discomfort
• Swelling around anus
• Bleeding /clotting/
Internal hemorrhoids
• They rarely cause
discomfort.
• But straining or irritation
when passing stool can
cause:
– Painless bleeding during
bowel movements.
– Small amounts of bright red
blood on toilet tissue or in the
toilet.
– Perception/urge to defecate
78

79. Diagnostic studies
• Physical examination
• DRE /Digital Rectal Examination/
• Anoscopy ... To detect internal hemorrhoid
• Sigmoidoscopy ... Examines inside section of large
intestine (sources of pain, diarrhea, constipation)
• Colonoscopy .. To examine abnormal growths,
inflamed tissues, ulcers,
79

80. Pharmacological and non pharmacological
managements
• Consume high fiber diets
• Soak in a warm bath or sitz bath regularly
• Analgesics and NSAIDS
• Sclerotherapy... Destroying the tissues by injecting
chemicals.
• Electrocoagulation ... Cut off blood flow to
hemorrhoid with electric current.
• Hemorrhoidectomy... Surgical removal (all type)
• Hemorrhoid stapling ...removes internal type and
retains if prolapsed.
80

81. Complications
• Anemia: Rarely, chronic blood loss from hemorrhoids may
cause anemia.
• Strangulated hemorrhoid: If the blood supply to an internal
hemorrhoid is cut off, the hemorrhoid may be "strangulated,"
which can cause extreme pain.
• Blood clot: Occasionally, a clot can form in a hemorrhoid
(thrombosed hemorrhoid).
• Although not dangerous, it can be extremely painful and
sometimes needs to be cut and drained.
• Sepsis
• Perianal thrombosis
81

82. Prevention
• Eat high-fiber foods: Eat more fruits, vegetables and whole grains.
• Drink plenty of fluids: Drink six to eight glasses of water and other
liquids (not alcohol) each day to help keep stools soft.
• Consider fiber supplements: Most people don't get enough of the
recommended amount of fiber — 20 to 30 grams a day — in their
diet.
• Don't strain
• Go as soon as you feel the urge. If you wait to pass a bowel
movement and the urge goes away, your stool could dry out and be
harder to pass.
• Exercise. Stay active to help prevent constipation and to reduce
pressure on veins, which can occur with long periods of standing or
sitting.
• Avoid long periods of sitting. Sitting too long, particularly on the
toilet, can increase the pressure on the veins in the anus.
82

83. Common Nursing Diagnosis
• Impaired tissue integrity
• Constipation
• Acute pain
• Deficient knowledge
• Impaired comfort
83

84. Nursing Intervention
• Apply topical treatments / antibiotics, lotions/
• Administer stool softeners / laxatives/
• Administer analgesics
• Health education: the nature of the disease,
treatments, complications, prevention
• Providing the patient comfort environments
84