It include many disorder related to inflammation, obstruction,infection and perfusion

1. TOPIC: SMALL INTESTINE DISORDER RELATED TO INFLAMMATION,
INFECTION, MALABSORPTION & OBSTRUCTION, PERFORATION
B.SC (H)NSG
RAKCON

2. INTRODUCTION
In all ages group, a fast placed lifestyle, high level of stress,
irregular eating habits, and insufficient intake of water and minerals
and lack of fibers and water, and lack of daily exercise contribute to
GI disorder. There is a growing understanding of the biopsychosocial
implications of GI disease. That is, the mind & emotion can have a
profound impact on the GI system. Nurse can have an impact on
their GI disorders by identifying behavior patterns that put patients
risk, by educating the public about prevention and management and
by helping those affect to improve their condition and present the
complication.

3. ANATOMY OF SMALL INTESTINE

4. PHYSIOLOGY
• Stomach food duodenum small intestine.
• Bile & enzymes from liver, pancreases& gall bladder help in further
breakdown.
• Ileum& jejunum fuctions: absorb nutrient from blood stream.
• Once the digested food leaves ileum, more than 95% nutrients of food
is absorbed.

5. SMALL BOWEL INFLAMMATION
• DEFINITION:
Inflammatory Bowel Disease (IBD) represents a group of intestinal
disorder that cause prolonged inflammation of the digestive tract .
Many disorder are included in this IBD umbrella term.

6. ThemostcommondiseaseareCROHN`SDISEASE&ULCERATIE
DISEASE.
• CROHN`S DISEASE
• Crohn`s disease is usually first
diagnosed in young adult &
adolescents. It causes inflammation
in small intestine which leads to
abdominal pain, fatigue.
•
• ULCERATIVE
DISEASE
• A Chronic, inflammatory
bowel disease that causes
inflammation in large
intestine.
• It is usually only in the
innermost lining of large
intestinal ( colon & rectum) .

7. CROHN`S DISEASE
Crohn’s disease is a sub acute and
chronic inflammation of the GI
tract wall that Extends through all
layers. I
t most commonly occurs in distil
ileum and to a lesser degree the
ascending colon. It is characterised
by periods of remission and
exacerbation
*/

8. RISK FACTOR

9. PATHOPHYSIOLOGY
The disease process begins with edema and thickening of the
mucosa.
Ulcers begin to appear on the inflamed mucosa. The clusters of ulcers tend
to take an classic cobblestone appearance as the lesions are not in
continuous contact with one another.
Fistulas ,fissures And abscesses foam as the
inflammation extends into the peritoneum.
As the disease advances, the bowel wall thickens And becomes fibrotic and the intestinal
lumen narrows.

10. CLINICAL MANIFESTATIONS
• Lower quadrant abdominal pain
• Persistent watery diarrhoea
• Pain with passing stool ( tenesmus)
• Unintentional weight loss
• Anorexia
• Steatorrhea
• Fistula
• oral ulcer

11. DIAGNOSTIC TEST

12. COMPLICATIONS
Obstructions or strUcture formation ,Perianal
disease, Fluid electrolyte imbalance.
The most common type of fistula caused by
crohn’s disease is enterocutaneous fistula..
Patients with Crohn’s disease are also at an
increased risk of colon cancer.

13. ASSESSMENT
• PATIENT & FAMILY HISTORY
• Abdominal pain, diarrhoea, Weight loss, fever
• PHYSICAL ASSESSMENT
• Distention of abdomen, guarding, bowel sound, ulceration or
fistula in perianal area
• LABORATORY ASSESSMENT
• CBC
• Chemistry
• Genetic testing
• Anti saccharomyces cerevisiae antibodies( ASCA)
• IMAGING ASSESSMENT
• Barium swallow or enema
• Ultrasound
• MRI
• CT

14. MEDICAL MANAGMENT
• Treatment of CD : location of inflammation
,severity of disease, complications,& response
of patient .
pharmalogic therapy :
AMINOSALICYLATES -Sulfasalazine
effective for mild and moderate inflammation

15. Surgical management
• Ultimately 75% patients of Crohn’s disease undergo
surgery within 10 years of diagnosis and Between 25%
and 60% require further repeat surgery within the
same time frame.
• intestinal transplant.

16. SMALL BOWEL INFECTION
• Numerous bacteria,
virus and parasites
causes diseases in
the intestine..

17. PERFORATION PERITONITIS:
INFLAMMATIONOFPERITONEUM,RESULTOFBACTERIA
INFECTION.
COMMONBACTERIA:E.COLI,PROTEUS,STREPTOCOOCUS.

18. RISK
FACTOR
Liver
cirrhosis
Appendicitis
Crohn's
disease

19. PATHOPHYSIOLOGY
Bacterial perforation
occurs |
Edema of the tissue
occurs |
Exudation of fluid occurs
Fluid in peritonial cavity
becomes turbid

20. CLINICAL
MANIFESTATION

25. DIAGNOSTIC TEST
White blood cell count
Serum electrolyte study
X ray
Abdominal ultrasound
CT scan
MRI
Peritonial aspiration and culture sensitivity studies of aspirated fluid.

26. COMPLICATION
• Inflammation is most commonly not localised And the
entire abdominal cavity shows evidence of widespread
infection.
• Shock may result from septicemia or hypovolemia.
• The inflammatory process may cause intestinal obstruction,
primarily from the development of bowel adhesions .

27. Assessment
Vital signs Pain
Tissue
perfusion
GI functions
Fluid
electrolyte
balance
Tenderness
Bowel sounds

32. Management
MEDICAL
FLUID:
• ANALGESICS:
• INTUBATION & SUCTION: I
• OXYGEN THERAPY:
• ANTIBIOTIC THERAPY:
• SURGICAL
• Surgical objectives include
removing the infected
material and Correcting the
cause. Surgical treatment is
directed towards excision,
resection with or without
anastamosis, repair and
damage .

33. Clinical example

34. SMALL INTESTINE
MALABSORPTION
Malabsorption is the ability of the digestive system absorb one or more
of the major vitamins ( A& B12) , minerals (Fe& Ca) .

35. RISK FACTORS

36. CAUSES:

37. PATHOPHYISOLOGY
Conditions that cause
malabsorption can be
grouped into the following
categories:
Mucosal (transport)
Disorders causing
genralised malabsorption
Infectious diseases
causing generalised
malabsorption
Lumenal disorders causing
malabsorption
Post operative
malabsorption
Disorders that cause
malabsorption of specific
nutrients

38. CLINICAL MANIFESTATIONS

39. DIAGNOSTIC EVALUATION
• Stool studies
• Endoscopy with biopsy of mucosa
• Biopsy of small intestine
• Ultrasound studies
• CT scan
• X-ray
• CBC count

40. ASSESSEMENT
• Nutritional history
• Serum albumin
• Transferrin
• RBC & WBC count
• Serum electrolyte value
• Physical signs of poor nutritional intake
• Exact weight

41. MANAGEMENT
MEDICAL MANAGEMENT SURGICAL MANAGEMENT
Primary disease states may be
treated surgically as well.
Administration of supplements .
Dietary therapy
Folic acid supplements
Antibiotics
Antidiarrheal drugs
Parenteral therapy

42. Small bowel obstruction
• DEFINITION:: Intestinal obstruction exists when blockage prevents the
normal flow of intestinal contents through the intestinal tract. The
obstruction can be partial or complete. Its severity depends upon the site
of obstruction
• RISK FACTORS
• Hernia
• Crohn’s disease
• Abdominal, joint or spine surgery
• Swallowing a foreign body
• Decreased blood supply to small bowel

43. • CAUSES :

44. DIAGNOSIS
• Diagnosis is based on
symptoms described
previously and on
imaging studies.
• Abdominal xray
• CT findings
• Laboratory studies
(electrolyte studies and
CBC count)
COMPLICATIONS:
• Tissue death – Lack of
blood supply leads to
dead intestinal wall
• Infection – peritonitis

45. ASSESSMENT
• History collection
• Past medical and surgical history
• Color and characteristics of vomitus
• Stool examination for occult blood
• Assess vitals
• Assess I/O

46. MANAGEMENT
• MEDICAL MANAGEMENT:
• Decompression of bowel
through a nasogastric tube
• Enema can be given to
stimulate bowel movement
• Antibiotics, antiemetics,
analgesics
• SURGICAL
MANAGEMENT:
• Laparoscopic surgery
• Exploratory
laparotomy
• Bowel resection

47. PERFORATION
• Intestinal perforation, defined as a loss of continuity of the bowel wall
, is a potentially devastating complication that may result from a
variety of disease processes.

48. RISK FACTORS

49. CAUSES
•
• Trauma
• Instrumentation
• Inflammation
• Infection
• Malignancy
• Ischemia
• Obstruction

50. PATHOPHYSIOLOGY
LEAKAGE OF
ACIDIC GASTRIC
JUICE INTO
PERITONIAL
CAVITY .
CHEMICAL
PERFORATION
IF LEAKAGE IS
NOT CLOSED,&
FOOD
PARTICLEREACH
TO PERITONINAL
CAVITY,
CHEMICAL
PERFORATION
LEADS TO
BACTERIAL
PERFORATION

51. CLINICAL MANIFESTATIONS

52. DIAGNOSTIC TEST &
COMPLICATIONS
• Ultrasound abdomen
• Abdominal X-ray
• CT scan
• Laproscopy
• COMPLICATION
• Wound infection
• Abdominal abscess
• Septic shock
• GI mucosal
haemorrhage
• Mechanical
obstruction of
intestine

53. ASSESSMENT
• History of abdominal trauma
• History of pain, vomiting, hiccups
• Assess abdomen for any external signs of Injury, abrasion,
echymosis
• Assess breathing pattern
• Assess for tenderness
• Assess bowel sound

54. MANAGEMENT
MEDICAL MANAGEMENT
• Patient kept NPO
• Crystalloid therapy
• IV administration of
antibiotics
SURGICAL MANAGEMENT
• Treatment for intestinal
perforation is only
surgical
• Conventional laparotomy
• Laproscopic laparotomy

55. NURSING CARE PLAN
• NURSING CARE PLAN:
• PLANNING & GOALS:
• The major goals for the patient include relief of abdominal pain
and cramping, prevention of fluid volume deficit, maintenance of
optimal nutrition and weight, avoidance of fatigue, reduction of
anxiety
• NURSING DIAGNOSIS 1: risk for deficient fluid volume related
to vomiting and dehydration
• INTERVENTIONS:
• Maintain fluid volume: nurse keeps an accurate record of intake
of oral and IV fluid and output .
• The nurse monitors daily weight for fluid gains or losses and assess the
patient for signs of fluid volume deficit ( dry skin , oliguria )
• The nurse initiates measures to decrease diarrhoea ( Dieatry restrictions,
antidiarrheal agents)

56. NURSING DIAGNOSIS 2
• NURSING DIAGNOSIS 2:Acute pain related to increased
peristalsis and GI inflammation
• INTERVENTIONS:
• Relieving pain:Assess the character of pain and ask
about its onset
• Administer anticholinergic medication 30 minutes before meal
as prescribed to decrease intestinal motility
• Administer analgesics as prescribed for pain
• Position changes, diversional therapy and prevention of fatigue
are useful for reducing pain.

57. NURSING DIAGNOSIS
• NURSING DIAGNOSIS 4: Activity intolerance related to
generalized weakness
• Promoting rest: The nurse recommends intermittent rest
period during the day
• The nurse restrict or schedule Activities to conserve energy
And reduce the metabolic rate
• Nurse encourages activity within limits of patient’s capacity
• The nurse suggests bedrests to the patient who is febrile

58. NURSING DIAGNOSIS
• NURSING DIAGNOSIS 4: Anxiety related to impending surgery
• Reduce anxiety: the nurse tailors information about possible
impending surgery to the patients level of understanding and desire
for detail.
• If surgery is planned pictures and illustrations help explain the
surgical procedure .

59. NURSING DIAGNOSIS
• NURSING DIAGNOSIS 5: Imbalanced nutrition, less than body
requirement related to dietary restrictions come on nausea
and malabsorption
• INTERVENTIONS:
• Maintaining optimal nutrition: Parenteral nutrition is used for
example in cases of severe cases of IBD
• The nurse maintains an accurate record of intake and output of fluid
as well as weights daily
• Blood glucose level is monitored every six hours
• The nurse notes Intolerance if the patient exhibits nausea, vomiting,
abdominal distention

60. CLINICAL RESEARCH
ABSTRACT:
AIM: To evaluate the major clinical symptom,
etiology and diagnostic method in patients with
primary small intestinal disease in order to
improve the diagnosis .
METHODS:
A total of 309 cases with primary small intestinal
disease were reviewd and the major clinical symptoms,
etiology, and diagnosis ,methods were analyzed.

61. RESULTS:
THE MAJOR CLINICAL SYMPTOMS INCLUDED ABDOMINAL PAIN(71%),
ABDOMINA MASS (14%), VOMITING(10%), MALENA (10%), AND
FEVER((9%). THE MOST COMMON DISEASE WERE MAIGNANT TUMOR
(40%). DUODENAL DISEASE WAS INVOLVED IN 36% OF THE PATIENTS
WITH PRIMARY SMALL INTESTINAL DISEASES,.
CONCLUSION: abdominal pain is the most common clinical
symptom in patients with primary small intestinal disease.
Malignant tumors are the most common diseases . However , more
practical diagnostic method should be explored to improve the
diagnostic accuracy

62. summary
• IN THIS,WE ALL HAVE DISCUSSED ABOUT VARIOUS DISORDER OF
SMALL INTESTINE , ETHiOLOgY , PATHOPHYSIOLOGY, DIAGNOSTIC
TEST, ASSESSMENT, MEDIACL, SURGICAL MANAGEMENT&
SURGICAL . DISORDER DUE TO INFLAMMATION, INFECTION ,
MALABSORPTION AND OBSTRUCTION, perforation.

63. THANKYOU