Git presentation

1. َ‫ص‬ ‫ي‬ِّ‫ل‬ ْ‫ح‬َ‫ر‬ْ‫ش‬‫ا‬ ِّ‫ب‬َ‫ر‬
‫ي‬ ِّ
‫ر‬ْ‫د‬
َ‫ي‬ َ‫و‬
ْ‫ر‬ِّ‫س‬
ْ‫ل‬ُ‫ل‬ْ‫اح‬ َ‫و‬ ‫ي‬ ِّ
‫ر‬ْ‫م‬َ‫أ‬ ‫ي‬ِّ‫ل‬
ِّ‫م‬ ً‫ة‬َ‫د‬ْ‫ق‬ُ‫ع‬
‫ن‬
ُ‫ه‬َ‫ق‬ْ‫ف‬َ‫ي‬ ‫ي‬ِّ‫ن‬‫ا‬َ‫س‬ِّ‫ل‬
‫ي‬ِّ‫ل‬ ْ‫و‬َ‫ق‬ ‫وا‬
‫الرحيم‬ ‫الرحمن‬ ‫هللا‬ ‫بسم‬
‫العظيم‬ ‫هللا‬ ‫صدق‬

2. Gastrointestinal system
Prepared by:
Asmaa Sadawy
Gehad Mohamed
Zeinab Mahrous
Ahmed Abdeltawab
Under supervision:
Prof. Dr. Zinab Hussien Ali
Professor of adult health nursing
Vice Dean for Environmental Affairs
and community service of the
Faculty of Nursing – HelwanUniversity

3. Outlines:
• Introduction of GIT
• Anatomy of GIT
• Function of GIT
• Common disorder of GIT .
 Stomatitis (def. ,types, clinical manifestation, treatment(
 Appendicitis:(Def, function, clinical manifestation ,
complication, treatment, nursing care(
 Intestinal obstruction :(Def, function, , clinical
manifestation , treatment, nursing care(
 Liver cirrhosis
 hepatic encephalopathy
• Nursing Concepts

4. Introduction
Digestive disorders and diseases significantly affect
millions of persons worldwide inducing a highly
significant economical impact.

5. GIT consist of the following parts:
• mouth and salivary glands.
• Pharynx.
• esophagus.
• Stomach.
• Small intestine.
• Large intestine.
• Liver and biliary system.
• Pancreas.

6. Function of the digestive system
• To break down food particles into the molecular form
for digestion.
• To absorb into the bloodstream the small molecules
produced by digestion.
• To eliminate undigested and unabsorbed foods and
other waste products from the body.

7. COMMON GIT DISORDERS
Appendicitis

8. Appendicitis
• Is the inflammation of the appendix caused by an
obstruction of the intestinal lumen from infection,
foreign body, or tumor.
• It may be acute or chronic.
• The perforation of the appendix is most common and
fetal complication.

9. Function of the appendix
Researchers now say that the appendix acts as a safe
house for good bacteria. The body uses this to
essentially “reboot” the digestive system when one
suffers from a bout of dysentery or cholera.

10. Pathophysiology
Path physiology
Obstruction of the appendix lumen
Mucosal inflammation and bacterial proliferation
Increase intra- luminal pressure
Decrease venous pressure
Gangrene
Perforation(24-32hrs)
peritonitis

11. Clinical manifestation
• Sudden pain in the lower right abdomen
• Pain that worsens if you cough, walk or make
other jarring movements
• Nausea and vomiting
• Loss of appetite
• Low-grade fever that may worsen as the illness
progresses
• Constipation or diarrhea
• Abdominal bloating

12. Investigations
• Routine blood tests: to determine an increase
in leukocytes is a sign of infection.
• CT scan
• Ultrasound

13. Medical treatment
Appendectomy
• An appendectomy is the surgical removal of
the appendix .This procedure is normally
performed as an emergency procedure when
the patient suffers from acute appendicitis.
• Performed as soon as possible to decrease the
risk of perforation

14. Nursing management
Preoperative nursing diagnosis:
• Risk for fluid volume deficient related to
preoperative vomiting.
• Activity intolerance related to acute pain.
• Anxiety related to change in health status.

15. Preoperative nursing care
• Patients fasting midnight on the day before surgery.
• If there are any known allergies it should be
mentioned
• An intravenous line for fluids and a pre-operative
antibiotic may be administered.
• An informed consent is taken from the patient.
• Observation of vital signs.
• Auscultation of bowel sounds
• Assess the status of pain characteristics.
• Teach relaxation techniques and give information
about the disease process and actions.

16. Postoperative nursing diagnosis
• Acute pain related to the presence of
postoperative wound appendectomy.
• Impaired nutrition less than body
requirements related to reduced anorexia ,
nausea.
• Risk for infection related to surgical incision.
• Deficient knowledge: about the care and
diseases related to lack of information.

17. Postoperative nursing care
• Monitor vital signs for sign of infection and shock such as fever,
hypotension and tachycardia.
• Monitor I and O for sign of imbalance, dehydration, and shock.
• Assess abdomen for increased pain, distention, rigidity, and rebound
tenderness because these may indicate post operative complications.
• Wound care
• Auscultation of bowel sounds
• Evaluate the passing of flatus or feces
• Diet is advanced as ordered.
• Administration of medications as ordered
• Wound drains I.V and all other catheter are monitored and evaluated
for signs of infections.
• Laboratory values are monitored and patient is evaluated for sign and
symptoms of electrolyte imbalances.

18. Gastritis
Gastritis:
• Gastritis is an inflammation of the stomach lining.
Gastritis may be acute or chronic.

19. Pathophysiology
• The mechanisms of mucosal injury in gastritis
is thought to be an imbalance of aggressive
factors such as acid production or pepsin and
Defensive factors such as mucus production ,
bicarbonate buffer and blood flow

20. Causes of gastritis
• Helicobacter pylori
• NSAIDs
• Alcohol
• Bile reflux
• Fungal infections
• Stress reaction
• Radiation

21. Symptoms of Gastritis
• Epigastric pain (intermittent or constant burning),
often accompanied by nausea and vomiting and
occasionally, diarrhea, other symptoms such as loss
of appetite ,bloating ,Epigastria tenderness ,
hemoptysis and black stools.

22. treatment
• Medical treatment :
• Medications:
• Medications for gastritis help relieve
symptoms and help heal the stomach lining
• H-2 blockers
• Proton pump inhibitors
• Antibiotics if an infection is present or possible

23. Management of gastritis
Lifestyle
changes
Diet
Stop
Smoking
Avoid
Alcohol
Avoid
beverages

24. Nursing diagnoses
• Imbalanced nutrition, less than body requirements,
related to inadequate intake of nutrients
• fluid volume deficit related to insufficient fluid intake
and excessive vomiting
• Impaired daily activity due to abdominal pain
• Anxiety related to coping with an acute disease

25. Bowel obstruction
Case presentation
A 50 year old man presents with abdominal pain,
distension and absolute constipation, with repeated
episodes of vomiting associated with fecal content. His
vital sign were stable.
Intestinal Obstruction:
• Intestinal obstruction exists when blockage prevents
the normal flow of intestinal contents through the
intestinal tract.

26. Types of intestinal obstruction
• Mechanical obstruction: Is a partial or
complete blockage in the intestine. It can
happen at any point along the intestine tract
but it is more common in the small bowel.
Examples are intussusceptions, hernias and
abscesses.
• Functional obstruction: A condition in which
the bowel does not work correctly. Example
muscular dystrophy.

28. Symptoms of intestinal obstruction
• Abdominal swelling (distention(
• Abdominal pain and cramping.
• Decrease or absent bowel sound.
• Constipation
• Inability to pass gas
• Vomiting

29. Medical treatment of intestinal obstruction
Supportive treatment:
• Insertion NGT to help relieve abdominal swelling
(distention) and vomiting.
• Correction of dehydration and electrolyte
abnormalities.
• Pain relievers :for patients with severe pain.
• Antiemetic

30. Surgical treatment
• Intestinal obstruction repair: According cause of
obstruction e.g. :
- Repairing the hernia or dividing
the adhesion bowel resection , Sometimes, part of
the intestine is remove ,This may be done using a
colostomy
ileostomy.

31. Nursing diagnosis
• Deficient Fluid Volume R/T nausea ,vomiting.
• Breathing Pattern related to R/T abdominal
distension and or rigidity.
• Disturbance sleeping pattern related to R/T
acute pain.
• Anxiety related to changes in health status.

32. Nursing care
Assessment
• Pain ,tenderness of the abdomen with
palpation .
• Decrease or absent bowel sound.
• vital signs (fever, low blood pressure(
• Signs of dehydration.
• Assessing intake and out put.
• psychological needs

33. Nursing intervention
• Measuring the nasogastric output.
• Monitor and record intake and output.
• Take care of pain.(medication, relaxation technique(
• Provide comfort measures through simply raising the head
of the bed to 45 degrees helps the patient breathe better
and can help create a more restful environment.
• Assessing improvement : eg ,return of normal bowel
sounds, decreased abdominal distention, subjective
improvement in abdominal pain and tenderness ,passage
of flatus or stool
• Provide emotional support and comfort; include family
members in your care and patient education.

34. Patient teaching
• Purpose of any tubes and clarify the sequence of
procedures to alleviate his anxiety.
• Advise the patient to engage in the level of activity
that's appropriate for his condition.
• Teach him to recognize signs and symptoms of
recurrent problems, such as infection ,so he'll know
when to seek help from his health care provider.

35. Liver
Scenario
Mr. X is 39 years old patient alcoholic
admitted to emergency room in the
hospital complains from sever dyspnea,
ascites .he is suffering from abdominal
pain, distension and discomfort, loss of
appetite and itchy skin, lower limb edema
& he has history of hepatitis C. His blood
pressure is 90/60 mmHg. His temperature is
37. HR 80 The last investigation for this
patient show that Na 123 meq /l and
albumin 1.8 g/L 1. ALT 60 U/L hemoglobin is
11.5 gm/dl the patient undergoing to upper
GI endoscopy. The patient is diagnosed
(hepatic cirrhosis).

36. Anatomy of the liver
• The liver is a large, highly vascular organ
located behind the ribs in the upper right
portion of the abdominal cavity. It weighs
between 1200 and 1500 g in the average adult
and is divided into four lobes. A thin layer of
connective tissue surrounds each lobe,
extending into the lobe itself and dividing the
liver mass into small, functional units called
lobules

38. Functions of the liver
• Glucose metabolism
• Ammonia conversion
• Protein metabolism
• Fat metabolism
• Vitamin and iron storage
• Bile formation
• Biliary excretion
• Drug metabolism

39. Liver Cirrhosis
Cirrhosis is a chronic disease characterized by
replacement of normal liver tissue with diffuse fibrosis
that disrupts the structure and function of the liver.

40. Types of cirrhosis
1- Alcoholic cirrhosis, in which the scar tissue
characteristically surrounds the portal areas. This is
most frequently caused by chronic alcoholism
and is the most common type of cirrhosis.
2- Postnecrotic cirrhosis, This is a late result of a
previous bout of acute viral hepatitis.
3- Biliary cirrhosis, in which scarring occurs in the liver
around the bile ducts. This type of cirrhosis usually
results from chronic biliary obstruction and cholangitis
(bile duct infection); it is much less common.

41. Pathophysiology of liver cirrhosis
• Several factors have been implicated in the etiology
of cirrhosis. Nutritional deficiency with reduced
protein intake contributes to liver destruction in
cirrhosis, but excessive alcohol intake is the major
causative factor in fatty liver and its consequences.
However, cirrhosis can occur in people who do not
consume alcohol and in those who consume a
normal diet and have a high alcohol intake.

42. Pathophysiology of liver cirrhosis
• Other factors may play a role, including exposure to
certain chemicals (carbon tetrachloride, arsenic, or
phosphorus) . Twice as many men as women are
affected, although, for unknown reasons, women are
at greater risk for development of alcohol-induced
liver disease. Most patients are between 40 and 60
years of age. Alcohol-associated cirrhosis contributes
to up to 50% of the overall cirrhosis burden in the
United States and worldwide . From 1999 to 2016 in
the United States, annual deaths from cirrhosis
increased by 65%

43. Pathophysiology of liver cirrhosis
• Although several factors have been implicated in the
etiology of cirrhosis, alcohol consumption is
considered the major causative factor.
• Necrosis is characterized by episodes of necrosis
involving the liver cells.
Scar tissue the destroyed liver cells are gradually
replaced with a scar tissue. Fibrosis there is diffuse
destruction and fibrotic regeneration of hepatic cells.
• Alteration as necrotic tissue yields to fibrosis, the
disease alters the liver structure and normal
vasculature, impairs blood and lymph flow, and
ultimately causes hepatic insufficiency.

45. Gross of liver cirrhosis
Size: reduced- enlarged in (Alcoholic-biliary-
cardiac-metabolic)
Surface: nodular
Color: grayish-except(Alcoholic : Yellow, Biliary:
green, cardiac:
nutmeg)
Consistency: firm

46. Clinical manifestation and Complications of
liver cirrhosis
• GI system: Early indicators usually involve
gastrointestinal signs and symptoms such as
anorexia, indigestion, nausea, vomiting
constipation, or diarrhea. Last indicator is
esophageal varices.
• Respiratory system: Respiratory symptoms
occur late because of hepatic insufficiency and
portal hypertension, such as pleural effusion
and limited thoracic expansion due to
abdominal ascites.

47. Con,…
• Central nervous system: Signs of hepatic
encephalopathy
• Hematologic: anemia, leukopenia and
thrombocytopenia.
• Endocrine: The male patient experiences the female
patient may
have menstrual irregularities, and gynecomastia and
loss of chest and axillary hair.

48. Con,…
• Liver enlargement
• Edema
• Vitamin deficiency( vitamin K deficiency)
• Severe fatigue
• Infection and peritonitis

49. Diagnosis of liver cirrhosis
• Liver scan (ultrasound scanning, CT, MRI)
• Liver biopsy
• Percutaneous trans hepatic cholangiography
• CBC, Arterial blood gases
• Liver function tests (ALT, AST, Albumin)

50. Medical management of liver cirrhosis
Antacids or H2
antagonists
Vitamins and
nutritional
supplements
Potassium-
sparing
diuretics
Avoidance of
Alcohol
Herb milk
thistle

51. Nursing management
Assessment of the patient with cirrhosis should
be depend on history taking and physical
examination and include assessing for:
Oxygenation: ABCDE
Bleeding: Check the patient’s skin, gums, stools
and vomitus for bleeding.
Fluid retention: To assess for fluid retention,
weigh the patient and measure abdominal girth
at least once daily.

52. Nursing management of liver cirrhosis
Promoting rest
Improving
nutritional status
Providing Skin care
Reducing risk of
injury
Monitoring and
managing
potential
complications

53. Nursing diagnosis
Based on the assessment data, the major nursing diagnosis by
priority for this patient are:
• Impaired breathing pattern related to restriction of thoracic
excursion secondary to ascites and abdominal distention
• Chronic pain and discomfort related to enlarged liver and
ascites.
• Fluid volume excess related escaping of intravascular fluid into
interstitial space manifested by ascites and edema formation.
• Fluid and electrolyte imbalance related to edema formation.
• Imbalanced nutrition: less than body requirements related to
abdominal distention, discomfort, anorexia, loss of appetite
and abdominal pain.
• Edema or swelling in the body tissues related to liver
dysfunction

54. Con, ND.
• Activity intolerance related to fatigue, lethargy, and
malaise.
• Impaired skin integrity related to pruritus, itchy skin
from jaundice and edema.
• Disturbed body image related to changes in appearance,
sexual dysfunction, role function and ascites.
• High risk for injury related to altered clotting mechanism
and altered level of consciousness.
• High risk for pressure sore related to itchy skin, jaundice
and pruritus

55. Hepatic Encephalopathy
• Hepatic encephalopathy, or portosystemic
encephalopathy, is a life-threatening complication of
liver disease that occurs with profound liver failure. .
Hepatic encephalopathy is the neuropsychiatric
manifestation of hepatic failure associated with
portal hypertension and the shunting of blood from
the portal venous system into the systemic
circulation. This reversible metabolic form of
encephalopathy can improve with recovery of liver
function.

56. Pathophysiolgy
• Ammonia is considered the major etiologic factor in
the development of encephalopathy. Ammonia enters
the brain and excites peripheral benzodiazepine-type
receptors on astrocyte cells, increasing neurosteroid
synthesis, and stimulating gamma-aminobutyric acid
(GABA) neurotransmission.
• GABA causes depression of the central nervous system
that inhibits neurotransmission and synaptic regulation
,producing sleep and behavior patterns associated with
hepatic encephalopathy.

57. Clinical manifestations
• The earliest symptoms of hepatic encephalopathy
include mental status
changes and motor disturbances. The patient appears
confused and unkempt and has alterations in mood
and sleep patterns.
• The patient tends to sleep during the day and has
restlessness and insomnia at night. As hepatic
encephalopathy progresses, the patient may become
difficult to awaken and completely disoriented with
respect to time and place. With further
progression, the patient lapses into frank coma and
may have seizures.

58. Cont,….
• Asterixis, an involuntary flapping of the hands,
may be seen in stage II encephalopathy.
Simple tasks, such as handwriting, become
difficult.
• fetor hepaticus, a sweet, slightly fecal odor to
the breath that is presumed to be of intestinal
origin, may be noticed.

60. Medical management
• Lactulose is given to reduce serum ammonia levels. It acts by
trapping and expelling the ammonia in the feces . Two or
three soft stools per day are desirable; this indicates that
lactulose is performing as intended
• Other management strategies include IV administration of
glucose to minimize protein breakdown, administration of
vitamins to correct deficiencies, and correction of electrolyte
imbalances (especially potassium). Antibiotics may also be
added to the treatment regimen

61. Cont,….
• Dietary protein intake should not be restricted
in hepatic encephalopathy as recommended
in the past. Protein intake should be
maintained at 1.2 to 1.5 g/kg/day . The danger
of protein malnutrition far outweighs the risk
of worsening hepatic encephalopathy caused
by increased protein intake
.

62. Nursing management
• The nurse is responsible for maintaining a safe
environment to prevent injury, bleeding, and
infection.
• The nurse administers the prescribed treatments and
monitors the patient for the numerous potential
complications.
• The nurse encourages deep breathing and position
changes to prevent the development of atelectasis,
pneumonia, and other respiratory complications.

63. Cont,…
• The nurse communicates with the patient’s family
to inform them about the patient’s status and
supports them by explaining the procedures and
treatments that are part of the patient’s care.
• If the patient recovers from hepatic
encephalopathy and coma, rehabilitation is likely
to be prolonged

64. Concept related to scenario
• Oxygenation
• Pain
 Fluid and electrolyte imbalance
 Nutrition
 Edema
• Change body image

65. Edema:
60% of lean body weight is water, two third of which is
intracellular and one third is extra cellular mostly as interstitial
fluid
Edema: is increase fluid in interstitial space (collection in body
cavities called hydrothorax or hydropericardium or
hydroperitoneum (ascites).

67. Causes & pathogenesis
1.High hydrostatic pressure
2.Low colloid osmotic pressure
3.Lymphatic obstruction
4.Na & water retention

68. 1-High hydrostatic pressure
• Rt side heart failure (congestive)
• Constrictive pericarditis (diastole&
systole)
• Thrombosis of SVC
• Thrombosis of hepatic vein
• Liver cirrhosis

69. 2- Low colloid osmotic pressure
• Proteins-liver-amino acid-plasma
protein(albumin)
• Renal failure
• Protein energy malnutrition
• Liver disease

70. 3-Lymphatic obstruction
• Lymph vessels-lymph node
• Lymphadenopathy
• Breast cancer

71. 4-Na, water retention
• Hypotension-kydiny-renal artery –vasoconstriction –
renal activation-RAAS(Renin-Aniotensinogen-Angiotensin
1-lung- Angiotensin 2-ACE( Angiotensin converting
enzyme)
• Angiotensin 2- suprarenal gland-Aldosterone-kidney
absorption Na &water (protective mechanism)
• Chronic hypertension-atherosclerosis renal artery-vaso
construction-activation-RAAS-(renin-Angiotensiongen –
Angiotensin1-lung-Angiotensin 2 –activation suprarenal-
Aldosterone-kidney-absorption Na & water

73. • Types of edema
• According to site:
• Generalized
• Localized
• According clinical
• Pitting
• Non pitting

74. 1-Generalized edema
 cardiac edema( pitting edema gravitational edema)
 Renal failure( pitting ,puffiness of the eye-
generalized)
 Hepatic edema(low plasma oncotic, ascites-
lower limp)
 Nutritional edema(ascites, Generalized edema

75. 2-Localized edema
• Venous obstruction (DVT)
• Inflammation (abscess)
• Lymphatic obstruction (Elephantiasis)

76. Complications
• According to site:
 Lung (Lt side heart failure)
 Brain ( intracranial pressure-seizure-fetal:
brain herniation

77. Management and treatment
 treatment the cause
 Put a pillow under your legs when you are lying
down or sitting forprolonged periods. (Keep your
legs elevated above the level of your heart.)
 Do not sit or stand for long periods of time without
moving.
 Wear support stockings, which put pressure on
your legs and keep fluids from collecting in your
legs and ankles. These stockings can be
purchased at most drugstores.
 Ask your doctor about limiting your salt intake.
 Follow your doctor’s directions for taking
prescriptionmedications.

78. Nutrition

79. Nutrition:
• It is the biochemical and physiological process
by which an organism uses food to support its
life. Includes ingestion, absorption, assimilation,
biosynthesis, catabolism and excretion.

80. Function of nutrition
 provide energy,
 contribute to body structure
 regulate chemical processes in the body.
These basic functions allow us to detect
and respond to environmental
surroundings, move, excrete wastes,
respire (breathe), grow, and reproduce.

81. Types of nutrition
• Carbohydrates.
• Proteins.
• Fats.
• Vitamins.
• Minerals.
• Dietary fiber.
• Water

82. What is a hepatic diet?
• Assuring the adequate intake of protein and of
the correct types of proteins.
• Assuring an adequate supply of energy.
• Increased dietary intake of fiber.
• Reduced intake of sodium.
• Restriction of fluid.
• Increased intake of potassium.