Assessment of Digestive and Gastrointestinal Function
Mouth
Parotid- largest salivary gland
Salivary amylase or thialine- ...
Hematochesia
Acholic stool- biliary problem
steatorrhea- fatty stool
Kidney stones- nephrolithiasis
Bladder cancer- painle...
- Pruritus itchiness
- Acholic stool- gray stool bilirubin more in the blood not in the GI tract
- Stercobilin comes fr...
Ascites: Low Na diet,
Hyerbilirubenia, hypoalbuminemia, hypoprothrobenia, hepatic e, portal hypertension
Liver Biopsy liv...
NGT
DBCT exercises
Diet
Ambulation
Laparoscopic Cholecystectomy
Cholelithiasis:
- Medical management
o Reduce pain
o Monit...
o Degenerative joint disease
- Fractures (of bone)
- Parotitis
- Sialdenitis (inflame of salivary glands)
- Sialolithiasis...
o Hiatal hernia (opening in the diaphragm)hurtburn
o Perforation because of dx test
o Foreign bodies
o Chemical burns
o ...
 ASA
 NSAIDs
 Steroids
o Gastritis
 Increase HCL
o Irregular, hurried meals (stressful)
o Fattu , spicy, highly acidic...
o Rapid emptying of hypertonic food from the stomach
jejunum fluid shift from the blood stream into jejunum
decreased b...
o Gastrectomy (Partial/Total)
- Radiation
- Chemo
Diseases of the colon
- Colon adenocarcinoma or colon cancer
- Colonic p...
o Colonoscopy with biopsy (direct visual)
- Stages
o Stage 0
o 1
o 2
o 3
o 4 (metastasis with tumor)
o Recurrent cancer
- ...
o Protrude by ½ - ¾” over abdomen
o Flatus and fecal drainage-4-7 days
o 1/3 -1/2 full of stool- empty the pouch
- Stoma C...
o Rebound tenderness (Blumberg sign)
o Psoas sign (lateral position with right hip flexion)
o Rovsing’s sign (referred pai...
o Increased intraabdominal pressure
o Heavy lifting
o Obesity
o Pregnancy
- Common hernia in male (inguinal)
Types of Hern...
o Side-lying position
o Analgestics as prescribed
- Intussusception (nagpatong)
- Bolbulus
- Fistula (Fistuletomy)
- Adhes...
o Borborygmus
o Painful spasmodic contractions of the anus
o Tenesmus (
- Complications
o Fluid and electrolyte imbalances...
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GI TRACT

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GI TRACT

  1. 1. Assessment of Digestive and Gastrointestinal Function Mouth Parotid- largest salivary gland Salivary amylase or thialine- digesting carbohydrates Food will become bolus when chewed- saliva, digestive juices Mastication or chewing by CNS V Swallowed- Glossopharyngeal Peristaltic movement stomach (more on the left) behind the stomach is pancreas2 openings cardiac opening and pyloric opening guided by pyloric sphincter-> There is digestion in the stomach by pepsin Major Enzymes and Secretions Mouth: saliva, salivary amylase Stomach: hydrochloric acid, pepsin, intrinsic factor Small intestine: amylase- digest carbon, lipase-fat, trypsin- protein, bile (pancreas) Intrinsic factor- necessary for absorption of Vit B12 cyanocobalamin maturation of RBCs Lack of Vit B12- pernicious anemia after gastrectomy din.. Deuodenum (common bile duct) gallbladder, Jejunum, Ilium Digestion in the duodenum in S.I Absorption in the S.I Nutrients goes to liver via portal vein then metabolize then heart circulates in the body Large intestineCecum, ascending- watery ,transverse- semi formed mushy, descending, sigmoid, rectum absorption of water Gastro- stomach Chole- Colon- Cole Hepato- Liver Hystere-Uterus Salpingo- fallopian Prastate- Colpo- vagina Protoscopy- view rectum T-tube drains bile Liver- largest organ Common Sites of Referred Abdominal Pain Shoulder pain- Abdoments – four quadrants Cholecystitis- gallbladder fat female forty Pancreatitis Ulcer Diverticulitis—pouching? Upper- hypochondria, epigastric Middle- Lumbar, umbilical Lower- iliac, lumbar Duodenal- ulcer relieved by food (right) Gastric- Melena- upper GI beeding
  2. 2. Hematochesia Acholic stool- biliary problem steatorrhea- fatty stool Kidney stones- nephrolithiasis Bladder cancer- painless hematuria Abdominal Assessment General Approach - Good light - Full exposure of the abdomen o Place the patient on supine with head and legs flexed (less tension) o Auscultate first then palpate o Note for enlargement of abdmen o Enlargement (Fluid- ascites, gas- flatus, feces- impaction, fetus, parasitism, ) - Diagnostic Tests o Stool specimens  Acolic stool- biliary  Melena- cause by ulcer and cancer.. black tarry stool  Hematochizia- lower GI bleeding colon cancer  Steatorrhea  Current jelly stool Intussusception  Guaiac test- stools in blood (occult blood) NC: No red meat 2-3 days before  no drugs (iron) o Abdominal ultrasound  KUBP Full bladder  Liver Gall bladder  NPO midnight then laxative, empty bladder o Imaging studies: CT, PET, MRI o Upper GI study/ Ba swallow (upper gi studies) There is a Dye..- barium o Lower GI study/ Ba enema (both: common denominator: increase fluid intake because to excrete barium causes constipation o Endoscopic procedures- esophago- gastroduodenoscopy, proctosigmoidoscopy, colonoscopy  NPO, local anesthesia to depress gag reflex, pre op- atrophine sulphate to reduce secretions  Assess gag reflex. NPO til gag reflex return  aspiration o Gastroscopy: Local—Lidocaine o Sigmoidoscopy: before NPO, cleansing enema, Left lateral… o Colonoscopy o Ultrasonography LIVER AND THE BILIARY SYSTEM Anatomy and Physiology of the liver - Largest gland of the body - Secretes bile (water, bile salts (emulsifies fats), bilirubin (pigment color to stool and urine), cholesterol) - A very vascular organ that receives blood from the GI tract via the portal vein and from the hepatic artery - Alterations: Obstruction- impaired biliary excretion can cause increase serum bilirubin (hyperbilirubinemia) - Jaundice discoloration - Icteric Sclera yellow eyes
  3. 3. - Pruritus itchiness - Acholic stool- gray stool bilirubin more in the blood not in the GI tract - Stercobilin comes from by product of bile - Biliary obstruction - Tea colored urine output(more colored urine) - Mngt: Monitor serum bilirubin, skin for jaundice, eyes for icteric sclera, stool for acolic stool, urine for tea color urine, skin care cut the nails - PRODUCES Albumin colloidal osmotic pressure (pulls water from IV-IT) to maintain IV - Hydrostatic pressure pushes outside - Liver cirrhosis not enough albumin formhypoalbuminemia decrease COP decrease pulling of water from IT to IV causes edema if in tyan,  ascites (kwashiorkor) - Reduced clotting due to reduce prothrombin (hypoprothrombenemia)purpura sign of bleeding (petechiaepurpura ecchymosis hematoma; nose bleeding (epistaxis) - Nursing Care: Vitamin K, test prothrombin time (11-16 secs), bleeding precaution, soft bristle toothbrush, - Mngt: Monitor I and O, weigh once a day, measure abdominal grth, high protein diet, give egg white (3 egg whites per day) - Management to ascites: paracentesis (local anesthesiaxylocaine bed side) skin preparation: cutasept or betadine with consent: Sitting position, monitor VS especially BP to prevent hypotension.. Before procedure: empty bladder void to prevent accidental puncture of the bladder- opposite ng ultrasound - Liver produces Prothrombin clotting factor convert to thrombin then fibrinogen - Prothrombin is used for clotting… - LIVER IS FOR METABOLISM carbohydrates, fats and protein… Detoxification process (of amino acids ammonia- toxic to the blood less toxic urea- kidney) - Alteration: Liver Cirrhosis- not detoxify ammonia(need bacteria to form)  ammonia intoxication hepatic encephalophaty disoriented, confuse, lethargic, comatose, drowsy - Ketones (irreversible liver cirrhosis) - MNGT: GCS, low protein, low bacteria – antibiotics (neomycin), monitor asterixis (dorsiflex the hand, there is a flapping tremor), cleansing anemia lactulose (reduces bacteria) - Hepatic artery- oxygenated blood 30% - Portal vein- non oxygenated, nutrient rich 70% - Portal hypertension many fluid in the portal vein hydrostatic pressure- pushing IV-IT Cause edema and ascites Congested anal vein- haemorrhoids caput medusa  Esophagealvarices- like aneurysm in the esophagus cough rupture-> hematemesis (blood vomit)- TB, lung cancer hypovolemic shock (alcohol) o Four types of L.C  Pirtal/ Laennec’s due to alcoholism  Biliary cirrhosis- caused by colelithiasis (stones)  Post necrotic (caused by infection – Hep B)  Cardiac cirrhosis- CHF right causes more liver failure (more veins) Right CHF- liver Left CHF- lungs Mngt: Sengstaken-Blakemore Tube- pressure on the varicesprevent rupture—prepare scissors Endoscopic Sclerotherapy- Esophageal Banding Portal Systemic Shunts Assessing for Abdominal Fluid Wave
  4. 4. Ascites: Low Na diet, Hyerbilirubenia, hypoalbuminemia, hypoprothrobenia, hepatic e, portal hypertension Liver Biopsy liver cancer/ cirrhosis With consent, MNGT: Vit K After biopsy, place the patient in affected sidepressureto prevent bleeding to prevent shock death EdemaAsicites: Hyperaldosterone, hyperbiliburinemia, Hypoalbunemia, portal hypertension Paracentesis: Sitting position, empty bladder to prevent puncture of bladder, BP potential hypotension because of sudden lost of fluid Assessment of Liver Cirrhosis caput medusa, pair of scissors should be prepared. Asterixisdorsiflex hands, there is tremors Esophageal Banding Sclerotherapy PortaSystemic Shunting Cholelithiasis with cholecystitus female forty fat Cause: Cholesterol Presiposing factors: 5s Theories Gallstone pressure/obstruction BILE STATIS (fat emulsification, fat intolerance, anorexia, n/v, weight loss, gaseous eruction, flatulence, steatorrhea) Inflammation - Pain RUQ - Fever - Leukocytosis - Murphy’s sign (pain in RUQ area) Decrease bile flow into the colon - Acholoc stool - Decrease vit K. absorption Increas s. bilirubin - Kaundice - Pruritus - Tea-colored urine Infection - Cholecustitis - Pancreatistis Collaborative Management - Relief of pain - Narcotics: Morphine, Demerol: Monitor RR Narcan, Reverse Depression:Naloxone - Diet - Bile Salts o Pre op  DeepBreathingCoughTurning exercises  Vitamin K injection o Cholecystectomy Right Subscostal incision o Surgery  Post op Position
  5. 5. NGT DBCT exercises Diet Ambulation Laparoscopic Cholecystectomy Cholelithiasis: - Medical management o Reduce pain o Monitor fluid/electrolyte balance o Nonsurgical eradication of stones  Endoscopy; galsstone dissolution  Extracorpeal shock wave lithotripsy o Monitor for complication Pancreatitis - Acute - Chronic - Causes: o Alcohol; abuse o Drigs o Biliary obstruction o Damage to pancreatic cells— o > inflammationedema of the pancreas and pancreatic duct o Obstruction to the flow of pancreatic enzyme  activation of pancreatic enzymes inside pancreas AUTODIGESTION of the pancreas o  Cullen’s Sign(umbilical region) and Grey Turner’s sign (flank).. o Assessment o Pain(LUQ), anorecxia, fever, increase s. amylase, increase, s. lipase, hypocalemia o Hyperglycemeia o Severe dehydration, vomiting, nausea, weight loss, post hemorrhagic necrosis Collaborative Management - Relieve pain - Diet - Total PN/ hyperalementationhyperglycemia and infection - IVF therapy - NGT - Digestive enzymes, antimicrobials, Ca sup, vit D, insulin do not drink ALCOHOL PANCREATIC CANCER - Anorexia, vomiting, weight loss Whipple’s Surgery (pancreatoduodenectomy) o Portacabal shunting o Penrose drain FUNCTIONS OF GALLBLADDER Disorders of the Jaw and Salivary Glands - Temporomandibular disorders: o Myofascial pain o Internal derangement of joint
  6. 6. o Degenerative joint disease - Fractures (of bone) - Parotitis - Sialdenitis (inflame of salivary glands) - Sialolithiasis - Neoplasms Disorders of Teeth - Dental plaque - Dental caries - Periapical abscess - Malocclusion (sungki)  x-ray braces orthodontist Promotion of oral Health - Effective mouth care - Reduce intake of startches and sugars, and maintain good nutrition - Fluoride application or fluorinated water Disorders of the Lips, Mouth, and Gums - Lipes o Actinic cheilitis o Herpes simplex 1 (“cold sore”) o Chancre - Mouth o Leukoplakia (predisposition to cancer), hairy leukoplakia, lichen planus o Candidiasis o Stomatitis o Gums: gingivitis, periodontitis - Oral Cancer o Risk factos  Tobacco use, uncluding smokeless tobacco  Alcohol o Increased incidence in men, 40, Africo-American o Usually a squamous cell cancer o May occur in any area, but lips, lateral tongue and floor of the mouth are most ferequently affected o Manifestation  Painless mass or sore that does not heal  Any lesion that is present more than 2 weeks or that does not heal should be examined and biopsied.  Leter manifestations include tenderness; difficulty in chewing, swallowing or speaking; coughing up blood-tinged sputum; and enlarged cervical lymph node o Medicamngt:  Surgical resection  Radiation therapy  Chemotherapy - Disorders of the esophagus o Dysphagia o Achalasia- lower end ngesophagus has stricture? That causes regurgitation Treatment: Pneumatic dialation o Diffuse spasm
  7. 7. o Hiatal hernia (opening in the diaphragm)hurtburn o Perforation because of dx test o Foreign bodies o Chemical burns o GERD (gastroesophageal reflux disease) MnGT: Upright to prevent reflux o Esophageal cancer  Dysphagia Gastritis - Acute: causes include medications, alcohol - Chronic: prolonged inflammation due to …Cause by helicobacter pylori - Manifestations o Acute: abdominal discomfort, headache, lassitude o Chronic: epigastric comfort, anorexia, heartburn after eeating, belching, sour taste - Diagnosis: upper gi x-ray(barium swallow) or endoscopy and biopsy Peptic Ulcer - Erosion of a mucous membrane forms an excavation in the stomach, pylous, duodenum, or esophagous - Stress, spicy foods, hurried irregular meal, Type-O, type-A personality (stress personality) - H. pylori - Excessive secretion of stomach acid, dietary factors - Chronic use of NSAIDs, steroids (dexa),ASA , alcohol, smoking, and familial tendency - Manifestations include a dull gnawing pain or burning in the midepigastrim; heartburn and vomiting may occur - Treatment includes medications, lifestyle changes, surgery Duodenal: executive ulcer, 80%, 25-50 years, well nourished, over secretion of HCL, radiates to right, 3-4 hrsp.c, relieved by food, commonly experienced 12MN to 3AM, melena, more common, complications: obstruction, haemorrhage, perforation, peritonitis (board like pain) Gastric: Poor man ulcer, 20%, 50 years and above, malnourished, normal HCL secretion, normal gastric emptying rate, increase back-diffusion of HCL, 1/2 – 2 hrsp.c, radiates to left, nausea and vomiting - Remissions and exacerbations - Emergent, acute and rehab- burns stages - Impairement of the mucosa and deeper structures of the esophagous, stomach, duodenum or jejenum - Curling’s ulcer- common ulcer in burns - Cushing’s ulcer-Ulcer that Post cerebral comma - Deep peptic ulcer - Predisposing factors o Coffee, cola and chocolate o Stress o Cigarette smoking  Stimulant; vasoconstrictor o Alcohol  Irritant; vasoconstrictor; beer increase gastric acid secretion o Caffeine  Stimulant o Drugs
  8. 8.  ASA  NSAIDs  Steroids o Gastritis  Increase HCL o Irregular, hurried meals (stressful) o Fattu , spicy, highly acidic foods (stimulants, irritants) - Collaborative Mangement o Medications  Antacids Neutralize HCl Taken 1-2 hrsp.c Amphogel Histamine (H2) receptor angatonists- reduces HCL secretion  Cytoprotective Coats ulcer Taken on an empty stomach (30-60 minutes before meals) Carafate  Proton pump inhinbitor Gastric acid secretion inhibitor (omeprazole)  Prostagalnding analogue Replaces gastric prostaglandin o Surgery  Vagotomy Resection of the vagus nerve Decrease cholinergic stimulation decrease HCL and gastric motility  Pyloroplasty Surgical dilatation of the pyloric sohincter Improves gastric emptying of acidic chime  Antrectomies Removal of 50% of the lower part of the stomach Types: o Billroth I (Gastroduodenostomy) o Billroth II 9Gastrojejunostomy)  Deudenum is bypassed to permit the flow of the bile  Subtotal Gastrectomy o Nursing mngt:  Relive pain  Post op: airway  Prevent potential complications Bleeding- first 24 hrs o Monitor NG drainage for blood o Avoid unnecessary irrigation r repositioning of the NGT Dumping Syndrome o A group of unpleasant vasomotor and GI symptoms caused by rapid emptying of gastric content in the jejenum
  9. 9. o Rapid emptying of hypertonic food from the stomach jejunum fluid shift from the blood stream into jejunum decreased blood volume o Shock like manifestation (feels drowsy) Early Sign and symptoms (5-30 minutes) Weakness, tachycardia, lie down after meals, dizziness, diaphoresis, pallor, feeling of fullness or discomfort, nausea, diarrhea, take fluids in between meals, semi-recumbent, prevent carbo and promote protein MnGT: Eat in a recumbent or semi recumbent position Moderate fat, high protein Limit carbo, no simple sugars Avoid very hot and col foods Give fluids after meals Loe down after meal (left) Anticholinergic or anti spasmodic Gastric Cancer - Increase n middle- aged males - Predisposing factors o Diet- nitrite-cured, salt-cured and smoke cured foods (sashimi, bacon, sausage) o Raw food (meat) o Cigarette smoking o Chronic achlirhydria (chlorine) o + family history o Excess intake of raw foods o Drinking large, volume of hot tea o Atrophic gastritis o Digestion problem: early sign (dyspepsia) o Change in bowel o A sore that does not heal o Unusual bleeding elsewhere (late sign of colon cancer) o Thickening o Indigestion (early sign of gastric cancer) o Obvious change in warts or moles o Nagging cough (lung cancer), persistent hoarseness(laryngeal cancer) o Unusual weight loss, unexplained anemia - Assessment o Progeressive loss of appetite o Gastric fullness (early satiety) o Dyspepsia (4 weeks or more) o + guaiac stool exam o Nausea and vomiting o Hematemesis/ melena (upper GI bleeding black tarry stool) o Pain induced by eating, relieved by vomiting (late symptom) - How to eat? TPN or jejunostomy - Surgery
  10. 10. o Gastrectomy (Partial/Total) - Radiation - Chemo Diseases of the colon - Colon adenocarcinoma or colon cancer - Colonic polyps-extra tissue growing in the colon that can become cancerous - Ulcerative colitis- ulcers of the colon and rectum - Diverticulitis- inflammation or infection of pouches in the colon - Irritable bowel syndrome- an uncomfortable condition causing abdominal cramping and other symptoms Colon Cancer - Happens in more distal - Rectum is most partkasidoonnaiiponyungdumi. Formed stool - Causes o 40 and above o Obesity o History of familial polyposis or colon polyps o Low fiber diet o History of chronic constipation o Diet o Colon polyps o Ulcerative colitis - Symptoms o Fatigue o Weakness o Change in bowel habits o Narrow stools, diarrhea or constipation o HEMATOCHEZIA o Weight loss o Abdominal pain o Cramps o Bloating - Assessment o Ascending Right Colon Cancer  Occult blood in stool  Anemia  Anorexia and weight loss  Abdominal pain above umbilicus  Papable mass o Distal Colon/ Rectal Cancer  Rectal bleeding  Changed bowel habits  Constipation or diarrhea  Pencil or ribbon- shaped stool (because of the tumor)  Tenesmus  Sensation of incomplete bowel emptying - Diagnosis o Barium enema
  11. 11. o Colonoscopy with biopsy (direct visual) - Stages o Stage 0 o 1 o 2 o 3 o 4 (metastasis with tumor) o Recurrent cancer - Complete removal can provide cure but can be back again (recurrent) - Treatment o Surgery  Segmental Resection with anastomosis  Abdominoperineal Resection (APR) with permanent colostomy  Permanent colostomy  Colostomy- surgical creation of an opening (stoma) into the colon created temporarily or permanently to allow drainage or evacuation of colon contents outside the body.  Black- necrosis- lack of blood supply  Pinkish red- normal o Chemo o Radiation - Before bowel surgery o Bowel Prep Mechanical cleansing:  Cleansing enema  Laxative as ordered o Ascending colostomy  Right side of the abdomen  Discharge: o Transverse- Double Barreled  Divides the bowel completely  Separate stoma  Separate stoma  May or may bit be separated by skin  Proximal: food Right Close to the small instestine Discharge: feces  Distal: mucous only and in the left o Transverse Loop  Appear like one very large stoma  Has two openings Discharges feces Expels mucus o Descending and Ascending - Stoma Monitoring o Stoma: Color-RED with slight edema (5-7 days) o Necrosis.ischemia= dark, dusky brown- black stoma
  12. 12. o Protrude by ½ - ¾” over abdomen o Flatus and fecal drainage-4-7 days o 1/3 -1/2 full of stool- empty the pouch - Stoma Care o Encourage client t look at stoma o Stoma has no touch and pain sensation o Report purple/ black discoloration o Initially clean with antispectic o KARAYA- skin barrier - Skin Care o Wash skin with warm water: pat dry o Assess for signs of infection/irritation o When pouch seal leaks, change immediately o Use skin barrier o Nystatinpowder- skin infection caused by Candida Albicans - COLOSTOMY IRRIGATION o NSS o Recommended with sigmoid colostomy o Stimulate peristalsis o Initiated 5-7 days post op o Initial colostomy irrigation is done to stimulate peristalsis; subsequent irrigations are done to promote evacuation of feces at a regular and convenient time o Done in semi-Fowler’s position; then sittin on a toilet bowl once ambulatory o Use warm normal saline solution o Initially, introduce 200 mls. Of NSS then 500 to 1,000 mls. Subsequently o Dilate stoma with lubricated gloved finger before insertion of catheter o Lubricate catheter before insertion o Insert 2-4 inches of the cath onto the stoma o Height of solution 18 inches abouve the stoma o If abdominal cramps, temporariy stop the flow then resume later o Avoid gas-forming and foul odor foods, (dairy prodicts, highly seasoned foods, fish, cabbage, celery, cauliflower, eggs, carbonated bev, nuts o Include ff foods to reduce odor: parsley, yogurt APPENDICITIS - Inflammation of the vermiform appendix - More common in males, 10-30 years of age - Causes o Obstruction by fecalith or foreign bodies infection o Low fiber diet o High intake of refined carbohydrates - Ruptured appendix (major appendectomy) - McBurney;s incision - Rocky-Davis incision - Median incision - Peritoneal toilett (pronounced as; twaley’ hahaha!)/ peritoneal lavage - Laparoscopic Appendectomy - Assesment o RLQ/Mc Burney’s point (bet umbilicus and iliac)
  13. 13. o Rebound tenderness (Blumberg sign) o Psoas sign (lateral position with right hip flexion) o Rovsing’s sign (referred pain) o No bowel sound (paralytic ileus) o Fever(temperature=38-38.5) o Elevated wbc (above 10,000/cu. Mm) o Acute abdominal pain that usually starts in the epigastric or umbilical region - Management o Bed rest o NPO (parahindi ma-aggreviate, potential for surgery) o Reliev pain (cold application over the abdomen) o Avoid factors that increase peristalsis, thereby rupture:  Heat application over the abdomen  Laxative  Enema o IVF therap to maintain fluid-electrolyt balance o Antibiotic therapy o Surgery: Appendectomy - APPENDECTOMY o Flat on bed 6-8 hrs DIVERTICULITIS - Diverticulum is outpouching of the mucosal…. - Low fiber diet - Assessment: o Crampy lower left quadrant abdominal pain worsens with movement, coughing or straining o Low grade fever o Chronic constipation with episodes of diarrhea - Management: o High fiber diet except diverticulitis o Liberal fluid intake 2,500 to 3,000 mls/day o Avoid nuts and seeds which can become trapped in the diverticula o Bulk-forming laxatives Chronic Inflammatory Bowel Disease (CIBD) Regional Enteritis (Crohn’s Disease) - Transmural - Ileum/ascending colon - Cause: unknown, jewish, environmental - Pus, mucous and soft stool (5-6x/day) - MNGT: Diet, TPN, Steroids Ulcerative Colitis (severe) - Pus mucous and watery diarrhea(20-30x/day) - MNGT: Proctocolectomy, Diet, TPN, Steroids, Azulfidine, Ileostomy Abdominal Hernias - Protrusion of an organ or structure through a weakend abdominal muscle; a congenital or acquired defect - Causes: o Congenital/acquired muscle weakness
  14. 14. o Increased intraabdominal pressure o Heavy lifting o Obesity o Pregnancy - Common hernia in male (inguinal) Types of Hernia - Incarcerated Hernia o Characterized bu bowel obstruction - Strangulated hernia o Characterized by compromised blood flow Assessment - Lump: groin/ around umbilicus, from an old surgical incision o Disappears when lying down, reappears with standing, coughing, straining or lifting o Sensation of heaviness o Vague Discomfort MNGT: Surgery: Herniorrhaphy/ Hernioplasty Pre Op Care: - Assess for presence of URTI. Sneezing or Coughing is avoided. HEMORRHOIDS - Dilated blood vessels beneath the lining of the skin in the anal canal - Types: o External Hemorrhoid- occur below the anal sphincter o Internal- occur above the anal sphincter - Causes: o Chronic constipation o Pregnancy o Obesity o Prolonged sitting or standing o Wearing constricting clothings o Disease conditions like liver cirrhosis - Assessment: o Anal pain o Rectal pain o Constipation (in an effort to prevent pain or bleeding associated with defecation) o Anal itchiness o Mucous secretion from the anus o Sensation of incomplete evacuation of the rectu, o Internal haemorrhage - MGNT o High fiber diet, liberal fluid intake o Bulk laxatives o Hemorroidectomy o Sclerotherapy (5% phenol in oil) o Cryosurgery - Post op Care: o Promotion of comrot o Hot Sitz bath 12-24 hrs. post op
  15. 15. o Side-lying position o Analgestics as prescribed - Intussusception (nagpatong) - Bolbulus - Fistula (Fistuletomy) - Adhesion - Evisceration - Dehiscence Management of Patients with Intestinal and Rectal Disorders Constipation - Abnormal infrequency or irregularity of defecation; any variation from normal habts may be a problem - Causes include medications, chronic laxative use, weakness, immobility, fatigue, inability to increase intraabdominal pressure, diet, ignoring urge to defecate, and lack of regular exercise - Older age - Fiber, fruits, ambulate (post op: 1 day after), increase fluid intake - Manifestations: o Fewer than 3 bowel movements per week o Abdominal distention o Decreased appetite o Headache o Fatigue o Indigestion o A sensation of incomplete evacuation o Straining at stool o Elimination of small-volume, hard, dry stools - Myxedema - Complications: o Hypertension o Fecal impaction o Haemorrhoids o Fissures o Megacolon - Patient Learning needs o Establishment of normal pattern o Prevent chronic laxative use Diarrhea - Increased frequency of bowel movements (more than 3 per day), increased amount of stool (more than 200 g per day), and altered consistency (looseness) of stool - Usually associated with urgency, perianal discomfort, incontinence, or a combination of these factors - May be acute or chronic - Causes include infections, medications, tube feeding formulas, metabolic and endocrine (hyperthyroidism) disorders - Manifestations: o Increased frequency and fluid content of stools o Abdominal cramps o Distention
  16. 16. o Borborygmus o Painful spasmodic contractions of the anus o Tenesmus ( - Complications o Fluid and electrolyte imbalances o Dehydration o Cardiac dysrhythmias (vagal stimulation)- bradycardia: atrophine Diverticular Disease - Diverticulum: sac like herniation - Diverticulosis: multiple diverticula without inflammation - Diverticulitis: infection - Patient Learning Needs o Avoid milk, fat, whole grains, fresh fruit and vegetables o Recognition of need for medical treatment o Rest o Diet and fluid intake o Lactose intolerance o Avoid irritating foods (caffeine, carbonated beverages and very hot and cold foods) o Perianal care - Left lower quadrant pain - Maintaining Normal Elimination patter o Fluid intake of at least 2L/d o Increased fiber, such as cooked vegetables o Use bulk laxatives (psyllium) and stool softeners o Participate in an individualized exercise program Colorectal cancer - Change in bowel habits, blood in stool Sigmoid Colon Cancer- to remove- abdominoperineal resection (APR) – permanent colostomy Ileostomy: Skin care- skin barrier- karaya Anorectal Conditions - Abcess - Lesion (Hot sitz bath) - Fistula - Fissure (may hiwa)- post op mngt: control pain – give analgesic

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