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Functions Of The Digestive System


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Class project for GIT Disorders, Batch 17-PCN

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Functions Of The Digestive System

  1. 1.
  2. 2. Functions of the Digestive System
  3. 3. Functions of the Digestive System <ul><li>Food Processing and Storage </li></ul><ul><li>Manufacture </li></ul><ul><ul><li>Enzymes, HCl, intrinsic factor, mucus </li></ul></ul><ul><ul><li>Vitamin K and some B-complex in large intestine </li></ul></ul><ul><li>Absorption </li></ul><ul><ul><li>Small intestine into capillaries </li></ul></ul><ul><li>Reabsorption and Elimination </li></ul><ul><ul><li>Reabsorbs water for reuse; minerals and vitamins; forms feces; produces defecation </li></ul></ul>
  4. 4. Structure GI System <ul><li>Mouth </li></ul><ul><li>Palate </li></ul><ul><li>Salivary Glands </li></ul><ul><li>Teeth </li></ul><ul><li>Tongue </li></ul><ul><li>Pharynx </li></ul><ul><li>Esophagus </li></ul><ul><li>Stomach </li></ul><ul><li>Small Intestine </li></ul><ul><li>Large Intestine </li></ul><ul><li>Accessory Organs </li></ul><ul><ul><li>Liver; gallbladder; pancreas; peritoneum </li></ul></ul>
  5. 5.
  6. 6. System Physiology <ul><li>Process of Digestion </li></ul><ul><ul><li>Enzymes </li></ul></ul><ul><ul><li>Mucus and water </li></ul></ul><ul><ul><li>Digestion in the stomach </li></ul></ul><ul><ul><li>Digestion in the small intestine </li></ul></ul><ul><li>Absorption in the Small Intestine </li></ul><ul><li>Absorption in the Large Intestine </li></ul><ul><li>Metabolism </li></ul><ul><ul><li>Catabolism </li></ul></ul><ul><ul><li>Anabolism </li></ul></ul><ul><ul><li>ATP (adenosine triphosphate) </li></ul></ul><ul><li>Elimination </li></ul>
  7. 7. Diagnostic Tests; Common Medical & Surgical Treatments & Procedures
  8. 8. Diagnostic Tests <ul><li>Laboratory Studies </li></ul><ul><ul><li>Blood Tests </li></ul></ul><ul><ul><ul><li>CBC, UA, Chemistry, CEA, cholesterol, LFT’s </li></ul></ul></ul><ul><ul><li>Stool Tests </li></ul></ul><ul><ul><ul><li>Detect the presence of pathogens, parasites, eggs (ova), blood, and fat; C&S; occult blood testing </li></ul></ul></ul><ul><li>Radiographic Evaluations </li></ul><ul><ul><li>Barium Studies </li></ul></ul><ul><ul><ul><li>Upper GI and Lower GI series </li></ul></ul></ul><ul><ul><ul><li>Nursing considerations/Client teaching </li></ul></ul></ul><ul><ul><li>Cholecystogram </li></ul></ul><ul><ul><li>Endoscopic Procedures </li></ul></ul><ul><ul><ul><li>EGD; esophagoscopy; ERCP; gastroscopy </li></ul></ul></ul><ul><ul><ul><li>Colonoscopy </li></ul></ul></ul><ul><ul><ul><li>Nursing consideration </li></ul></ul></ul>
  9. 9. Common Medical & Surgical Treatments <ul><li>Gastrointestinal Intubation </li></ul><ul><ul><li>Nursing Considerations </li></ul></ul><ul><ul><ul><li>Providing oral and skin care </li></ul></ul></ul><ul><ul><ul><li>Assessing the tube </li></ul></ul></ul><ul><ul><ul><li>Removing the tube </li></ul></ul></ul><ul><ul><li>Gastric Suction </li></ul></ul><ul><ul><ul><li>Nursing considerations </li></ul></ul></ul><ul><ul><li>NG Tube Irrigation </li></ul></ul><ul><ul><li>Gastric Lavage </li></ul></ul>
  10. 10. Common Medical & Surgical Tx <ul><li>Enteral Nutrition </li></ul><ul><ul><li>Tube feedings </li></ul></ul><ul><li>Parenteral Nutrition </li></ul><ul><ul><li>TPN </li></ul></ul><ul><ul><li>Central lines – Hickman, Port-A-Cath, PICC </li></ul></ul><ul><li>Biopsy </li></ul><ul><ul><li>Polypectomy </li></ul></ul><ul><li>Gastric Surgery </li></ul><ul><ul><li>Types of gastric surgeries </li></ul></ul><ul><li>Fecal Diversions </li></ul><ul><ul><li>Ostomy appliances </li></ul></ul>
  11. 11. Types of Gastric Surgeries <ul><li>Gastroduodenostomy (Billroth I): A subtotal gastrectomy w/ removal of distal stomach; anastomosis to duodenum </li></ul><ul><li>Gastrojejunostomy (Billroth II): A subtotal gastrectomy w/ removal of distal stomach and antrum; anastomosis to jejunum. </li></ul><ul><li>Total gastrectomy: Removal of entire stomach </li></ul><ul><li>Vagotomy: Resection of vagus nerves; may be done to reduce gastric acid secretion in selected segments of the stomach. </li></ul><ul><li>Pyloroplasty: Incision made into the pylorus to enlarge the outlet and relax the muscle; may be done w/ vagotomy to produce less gastric acid and promote gastric emptying. </li></ul>
  12. 12. Postoperative Complications: Nursing Considerations <ul><li>Keep client NPO as ordered </li></ul><ul><li>Use of NG suctioning for 2-3 days as ordered: keeps the operative area clean & eliminates pressure from accumulated fluids </li></ul><ul><li>Keep NGT patent at all times. Irrigate the NGT as ordered (usually w/ approximately 20mL NS): irrigating the NGT incorrectly could disrupt the suture line </li></ul><ul><li>Assess NG drainage carefully. It may be tingged w/ bright-red blood at first. Report if the amount of red blood increases or remains bright red: it is a sign of hemorrhage. The NG fluid should progress towards a normal greenish-yellow color. </li></ul><ul><li>Keep the client in semi-fowler’s position to facilitate drainage. </li></ul><ul><li>Monitor chest tube drainage and chest tube suction: the chest may be opened during the surgery, necessitating the use of test tube & suction postoperatively. </li></ul><ul><li>Provide routine postoperative care, including attention to mouth care and to early ambulation. </li></ul>
  13. 13. Nursing Consideration <ul><li>Include deep breathing & incentive spirometer exercises. Encourage the client to cough gently. Support the incision with a small pillow. </li></ul><ul><li>Monitor & control post-surgical pain. Give pain medications as prescribed. The client may be reluctant to breathe deeply or cough because of incisional pain. Medications facilitate exercise, w/c decreases to postoperative complications. </li></ul><ul><li>Assess dressings for excess drainage. Reinforce dressings as needed. Usually the surgeon observes the incision & does the first dressing change. Excess drainage indicates infection or a rupture of the suture line. </li></ul><ul><li>Give clear liquids when bowel sounds are present. The diet progresses as tolerated. </li></ul>
  14. 14. Fecal Diversions <ul><li>Stoma </li></ul><ul><li>Colostomy/ileostomy </li></ul><ul><li>Colostomy Irrigation </li></ul><ul><li>Ostomy Appliances </li></ul><ul><ul><li>Types of Appliances </li></ul></ul><ul><ul><li>Changing the Appliance </li></ul></ul><ul><li>Nursing considerations </li></ul><ul><ul><li>Clothing </li></ul></ul><ul><ul><li>Bathing </li></ul></ul><ul><ul><li>Activity </li></ul></ul><ul><ul><li>Diet </li></ul></ul><ul><ul><li>Skin care </li></ul></ul><ul><ul><li>Client and family teaching </li></ul></ul>
  15. 15. Continent Fecal Diversions <ul><li>Ileoanal Reservoir </li></ul><ul><ul><li>Surgical creation of a pouch fashioned from the small intestine that collects ileal drainage. </li></ul></ul><ul><ul><ul><li>Parks S pouch </li></ul></ul></ul><ul><ul><ul><li>Parks J pouch </li></ul></ul></ul><ul><li>Kock Pouch </li></ul><ul><ul><li>Continent ileostomy </li></ul></ul><ul><li>OTHER PROCEDURES </li></ul><ul><ul><li>Abdominal Paracentesis (abd. tap) </li></ul></ul><ul><ul><ul><li>Ascites </li></ul></ul></ul><ul><ul><ul><li>Nursing Considerations </li></ul></ul></ul>
  16. 16. Abdominal Paracentesis <ul><li>“ abdominal tap” is a procedure that may be necessary for diagnostic purposes or to relieve ascites. </li></ul><ul><li>It is considered diagnostic when fluid is withdrawn for microscopic study or culturing when bleeding or infection is suspected. </li></ul><ul><li>Therapeutic abdominal tap is done when the client is distended with ascitic fluid. </li></ul><ul><li>The abdominal cavity is punctured to obtain a specimen for analysis or to drain excess fluid. </li></ul><ul><li>Because the client also may have difficulty breathing, removal of this fluid will frequently relieve the condition. </li></ul><ul><li>US may be utilized to guide the aspiration of fluid from the abdomen with a large syringe and needle. </li></ul><ul><li>Sometimes a catheter is inserted into the abdominal cavity for continuous drainage. </li></ul>
  17. 17. GI System Disorders
  18. 18. Disorders of the Mouth <ul><li>Dental Problems </li></ul><ul><li>Periodontal Disease </li></ul><ul><ul><li>Gingivitis </li></ul></ul><ul><ul><li>Pyorrhea Alveolaris </li></ul></ul><ul><li>Stomatitis </li></ul><ul><li>Candidiasis </li></ul><ul><li>Precancerous Lesions </li></ul><ul><li>Herpes Simplex Infections </li></ul><ul><li>Trauma </li></ul><ul><li>Cancer of the Mouth </li></ul><ul><ul><li>Treatment </li></ul></ul><ul><ul><li>Nursing Considerations </li></ul></ul>
  19. 19. Periodontal Disease <ul><li>affects the bones & tissues around the teeth. It can result from poor oral hygiene, inadequate dental care, or poor nutrition. </li></ul><ul><li>Gingivitis </li></ul><ul><ul><li>Inflammation of the gums </li></ul></ul><ul><ul><li>Symptoms include: bleeding, erythematous, edematous, & tender gums </li></ul></ul><ul><ul><li>Frequently associated w/ accumulation of bacterial plaque on the teeth as a result of ineffective oral hygiene </li></ul></ul><ul><ul><li>May be a sign of vitamin deficiencies, DM, anemia, & leukemia </li></ul></ul><ul><li>Pyorrhea Alveolaris </li></ul><ul><ul><li>Inflammation of the gums & teeth sometimes w/ a purulent discharge </li></ul></ul><ul><ul><li>Treatment includes impeccable tooth, gum, & mouth care: regular flossing, surgical scraping, & drainage of the infected area, ATBs, or extraction of the affected teeth </li></ul></ul>
  20. 20. <ul><li>causes of stomatitis (inflammation of the mouth) </li></ul><ul><ul><li>primary lesions of the mouth; </li></ul></ul><ul><ul><li>secondary lesions of the mouth (results from chemotherapy & radiation); </li></ul></ul><ul><ul><li>Mechanical trauma (mouth breathing & cheek biting) </li></ul></ul><ul><ul><li>Chemical trauma (sensitivities/allergies of the oral mucosa to ingested substances) </li></ul></ul><ul><li>TREATMENT </li></ul><ul><li>depends on the cause; avoiding oral irritants & providing comfort w/ frequent oral hygiene; topical ATB ointments for bacterial infections </li></ul>
  21. 21. Candidiasis <ul><li>Known as thrush or moniliasis , is a fungal infection caused by the organism Candida albicans , w/c is part of the normal flora of the oral cavity. </li></ul><ul><li>It is common in newborns, immunosuppressed clients, & clients w/ chronic debilitating diseases such as HIV/AIDS, DM, or alcoholism </li></ul><ul><li>ATB therapies also can lead to candidiasis </li></ul><ul><li>The infection appears as small, white patches on the mucous membranes of the mouth or tongue & may extend into the entire GI tract. </li></ul><ul><li>Oral pharyngeal cultures are recommended when this infection is suspected </li></ul><ul><li>Prophylactic treatment of high-risk clients is indicated </li></ul><ul><li>Treatment consists of nystatin (Mycostatin), saline, & hydrogen peroxide mouth rinses, or vaginal suppositories </li></ul>
  22. 22. <ul><li>Candidiasis </li></ul><ul><li>Known as thrush or moniliasis, is a fungal infection caused by the organism Candida albicans, w/c is part of the normal flora of the oral cavity. </li></ul><ul><li>Herpes Simplex Infection </li></ul><ul><li>Cold sores or fever blisters are painful vesicles that occur on the face, lips, perioral (around the mouth) area, cheeks, & nose. </li></ul><ul><li>Usually caused by herpes simplex virus type 1 (HSV-1) & can be precipitated by stress. </li></ul>
  23. 23. Cancer of the Mouth <ul><li>Many cancers of the mouth are asymptomatic until they have spread. </li></ul><ul><li>Mouth cancer can be treated successfully if discovered early. </li></ul><ul><li>Those who ingest large amounts of ETOH, or engage in risky behaviors such as smoking or using forms of smokeless tobacco (leaf, plug, or snuff), have an increased risk for developing oral cancer. </li></ul><ul><li>Many people tend to ignore sores or irritations in the mouth because they think such symptoms are insignificant. </li></ul>
  24. 24. Mouth Cancer
  25. 25. Treatment… <ul><li>Surgery </li></ul><ul><li>Radium implants </li></ul><ul><li>Deep x-ray therapy </li></ul><ul><li>Combination therapies w/ chemotherapy are also common </li></ul><ul><li>If possible, the malignancy is removed with as wide an excision as necessary to remove all affected structures & lymph nodes </li></ul><ul><li>NG or gastrostomy feedings might be indicated </li></ul><ul><li>The operation is often followed by reconstructive surgery to correct facial defects. </li></ul>
  26. 26. Nursing Considerations… <ul><li>Caring for the client pre & post operatively </li></ul><ul><li>Before surgery, design communication techniques, because the client may be unable to speak as he or she did before surgery </li></ul><ul><li>Postoperatively, observe for hemorrhage & airway obstruction caused by facial edema or aspiration. </li></ul><ul><li>Suction secretions & elevate the head of the bed to make breathing easier. </li></ul><ul><li>As you support the client’s head by placing your hands on either side, instruct the client to breathe deeply & to use the incentive spirometer </li></ul><ul><li>Do not encourage coughing unless congestion is present </li></ul><ul><li>These measures are needed to prevent hypostatic pneumonia </li></ul><ul><li>An emergency airway should be available at the client’s bedside. </li></ul><ul><li>Give mouth care carefully to improve the client’s comfort & prevent odor. </li></ul><ul><li>Take great care to prevent disruption of the suture line </li></ul><ul><li>Give liquids through an NG tube until the client is able to swallow </li></ul><ul><li>Self-care is the goal. </li></ul>
  27. 27. Esophageal Varices <ul><li>Dilated vessels that occur at the lower end of the esophagus. </li></ul><ul><li>Causes : </li></ul><ul><ul><li>Dilation of these vessels is usually a complication arising from cirrhosis of the liver </li></ul></ul><ul><ul><li>Veins in the lower esophagus become distended as a result of increased portal pressure; the varices may rupture, causing hemorrhage & subsequent shock </li></ul></ul><ul><li>Signs and Symptoms : </li></ul><ul><ul><li>Usually, no s/sx appear until the varices become ulcerated </li></ul></ul><ul><ul><li>Hematemesis & coffee-ground emesis </li></ul></ul><ul><ul><li>Melena </li></ul></ul><ul><ul><li>Tachycardia </li></ul></ul><ul><ul><li>Hypotension </li></ul></ul><ul><ul><li>Low Hgb & Hct levels </li></ul></ul>
  28. 28. Esophageal Varices
  29. 29. Hiatal Hernia The presence of  a hiatal hernia does not cause any symptoms. Hiatal hernia may increase acid reflux and may worsen GERD and cause esophageal ulcers. Lifestyle changes and dietary changes are very effective in the management of hiatal hernia. Avoiding caffeine, stopping smoking and avoiding alcohol use are all very important. Eating small meals, not wearing tight clothing are also effective. Going to bed with an empty stomach( not eating or drinking for at least 3 hours before bed time ) is also advocated SURGERY is very rarely recommended. Maria Nelson
  30. 30. Hiatal Hernia Maria Nelson
  31. 31. GERD: Gastro Esophageal Reflux Disease <ul><li>Gastroesophageal reflux disease, or GERD, occurs when the lower esophageal sphincter (LES) does not close properly, and stomach contents splash back, or reflux, into the esophagus. The LES is a ring of muscle located at the far end of the esophagus as it leads into the stomach. It's normal function is to act as a physical barrier between the esophagus and the stomach, protecting the esophagus from harmful gastric acid, and preventing food from being regurgitated. It does this by involuntary tonic contraction. When one eats, food is propelled into the esophagus toward the stomach. It is during swallowing that the LES relaxes and allows passage of food and liquids into the stomach. </li></ul><ul><li>When refluxed stomach acid touches the lining of the esophagus, it causes a burning sensation in the chest or throat called heartburn. The fluid may even be tasted in the back of the mouth, and this is called acid indigestion. Occasional heartburn is common but does not necessarily mean one has GERD. Heartburn that occurs more than twice a week may be considered GERD, which can eventually lead to more serious health problems. </li></ul>Sophia Alvarado
  32. 32. <ul><li>Typical symptoms include a burning sensation in the chest, and regurgitation of food. These symptoms are general, and not necessarily specific for reflux disease. For instance, patients may experience chest pain or burning as a result of a primary cardiac problem, or they may be a manifestation of another primary esophageal disorder. It is imperative that the cause of the symptoms be clearly delineated by your physician so the proper therapy may be instituted. Regurgitation is also a relatively common complaint. </li></ul><ul><li>Atypical symptoms of GERD include: </li></ul><ul><ul><li>asthma; chronic sinusitis; </li></ul></ul><ul><ul><li>chronic hoarseness; difficulty swallowing (dysphagia); </li></ul></ul><ul><ul><li>vomiting; choking sensation at night time; </li></ul></ul><ul><ul><li>pneumonias; excessive salivation </li></ul></ul>Sophia Alvarado
  33. 33. Heartburn
  34. 34. MEDICATIONS <ul><li>CAN DECREASE LES PRESSURE </li></ul><ul><ul><li>oral contraceptives nitrates theophllyine narcotics calcium channel blockers ß-adrenergic agonists a-adrenergic agonists diazepam dopamine nicotine patch </li></ul></ul><ul><li>CAN DIRECTLY INJURE ESOPHAGEAL LINING </li></ul><ul><ul><li>aspirin NSAIDS (i.e.: ibuprofen) quinidine tetracycline potassium iron </li></ul></ul>Sophia Alvarado
  35. 35. GERD: TREATMENT <ul><li>Treatment for GERD may involve one or more of the following lifestyle changes, medications, or surgery. </li></ul><ul><li>The goals of therapy for GERD include - - - </li></ul><ul><ul><li>Symptomatic relief </li></ul></ul><ul><ul><li>Resolution of esophagitis (inflammatory changes of the esophagus as a result of abnormal acid exposure) </li></ul></ul><ul><ul><li>Prevention of complications. </li></ul></ul>Sophia Alvarado
  36. 36. Barrett’s Esophagus… <ul><li>Barrett's esophagus is a premalignant condition in which the normal stratified squamous epithelium of the esophagus is replaced by a metaplastic columnar epithelium as a complication of chronic gastroesophageal reflux disease (GERD). The metaplastic epithelium of Barrett's esophagus is variously called &quot;Barrett's metaplasia&quot;, &quot;specialized columnar metaplasia&quot; or &quot;intestinal metaplasia&quot;. This metaplasia predisposes to the development of esophageal adenocarcinoma and adenocarcinoma of the gastric cardia. </li></ul><ul><li>Endoscopy with biopsy is therefore recommended in patients who have long-standing or frequent GERD symptoms to determine whether or not Barrett's esophagus has developed. If Barrett's esophagus is detected, the patient should be enrolled in a program of endoscopic surveillance for the detection of cancer when it is early and curable. Only about 5-10% of patients with Barrett's esophagus will progress to cancer, but esophagectomy is recommended for those who do. Surgery is the standard of care for patients who develop an early adenocarcinoma in Barrett's esophagus because it has a high cure rate and removes the residual premalignant metaplasia. </li></ul>Sophia Alvarado
  37. 37. Esophageal Cancer <ul><li>SYMPTOMS </li></ul><ul><ul><li>No symptoms until late in the disease for many individuals </li></ul></ul><ul><ul><li>Difficulty swallowing solid food </li></ul></ul><ul><ul><li>Pain on swallowing may occur </li></ul></ul><ul><ul><li>Weight loss </li></ul></ul><ul><ul><li>Coughing may occur late in the disease </li></ul></ul><ul><ul><li>Chest or back pain may occur </li></ul></ul><ul><ul><li>Hoarseness may occur </li></ul></ul>Sophia Alvarado
  38. 38. Sophia Alvarado
  39. 39. <ul><li>Diagnosis </li></ul><ul><ul><li>Laboratories </li></ul></ul><ul><ul><ul><li>Anemia </li></ul></ul></ul><ul><ul><ul><li>Low albumin due to malnutrition </li></ul></ul></ul><ul><ul><li>Imaging </li></ul></ul><ul><ul><ul><li>CXR shows a widened mediastinum or metastases </li></ul></ul></ul><ul><ul><ul><li>Barium esophagram </li></ul></ul></ul><ul><ul><li>Endoscopy – shows picture & biopsies taken </li></ul></ul><ul><ul><li>CT scan of the chest & liver for metastases </li></ul></ul><ul><ul><li>Endoscopy Ultrasound to check for local spread in the esophagus </li></ul></ul><ul><ul><li>Bronchoscopy – sometimes done to check for metastases to the lungs </li></ul></ul>Sophia Alvarado
  40. 40. <ul><li>Risk Factors </li></ul><ul><ul><li>Alcohol & tobacco use; smoking </li></ul></ul><ul><ul><li>Food additives such as nitrates </li></ul></ul><ul><ul><li>Tylosis (callus formation) </li></ul></ul><ul><ul><li>Achalasia </li></ul></ul><ul><ul><li>Caustic induced strictures </li></ul></ul><ul><ul><li>Long-standing acid reflux (Barrett’s esophagus) </li></ul></ul><ul><li>Treatmen t </li></ul><ul><ul><li>Options -- cancer specialist determines the best options from among the following: </li></ul></ul><ul><ul><ul><li>Surgery </li></ul></ul></ul><ul><ul><ul><li>Radiation </li></ul></ul></ul><ul><ul><ul><li>Chemotherapy </li></ul></ul></ul><ul><ul><ul><li>Stent placement to keep esophagus open </li></ul></ul></ul>Sophia Alvarado
  41. 41. <ul><li>Gastritis </li></ul><ul><li>Ulcers </li></ul><ul><ul><li>Peptic, Gastric, & Duodenal </li></ul></ul><ul><ul><li>H. Pylori </li></ul></ul><ul><ul><ul><li>Signs and Symptoms </li></ul></ul></ul><ul><ul><ul><li>Complications </li></ul></ul></ul><ul><ul><ul><ul><li>Abdominal Infection </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Hemorrhage </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Bleeding (Perforation) </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Obstruction </li></ul></ul></ul></ul><ul><ul><ul><li>Treatment </li></ul></ul></ul><ul><ul><ul><li>Nursing Considerations </li></ul></ul></ul><ul><li>Stomach Cancer </li></ul>Disorders of the Stomach
  42. 42. Gastritis <ul><li>“ stomach inflammation” or indigestion - occurs in acute, chronic, & toxic forms </li></ul><ul><li>Causes of acute Gastritis: </li></ul><ul><ul><li>Overeating, ingesting irritating medications (eg, ASA or steroids) or poisonous food, abusing alcohol, or microbial infection </li></ul></ul><ul><li>Acute Gastritis is characterized by abdominal pain, often w/ anorexia, nausea, & enteritis </li></ul><ul><li>Treatment </li></ul><ul><ul><li>Removing offending foods or medications </li></ul></ul><ul><ul><li>Bland diet of liquids or soft foods, along w/ antacids </li></ul></ul>
  43. 43. Chronic Gastritis <ul><li>continues over time </li></ul><ul><li>pain may occur after eating, but often the person has no pain </li></ul><ul><li>Causes include excessive alcohol use, vitamin deficiencies, hiatal hernia, ulcers, & abnormalities in gastric secretions </li></ul><ul><li>Treatment is similar for peptic ulcers </li></ul>Sophia Alvarado
  44. 44. Toxic Gastritis <ul><li>Follows ingestion or poison </li></ul><ul><li>Characterized by burning stomach sensation, nausea, vomiting, & diarrhea </li></ul><ul><li>Emesis or diarrhea may be bloody </li></ul><ul><li>Toxic gastritis is an emergency </li></ul><ul><li>Poison control specialists in the emergency department treat the client by either - - - </li></ul><ul><ul><li>Flushing out the poison by gavage, or </li></ul></ul><ul><ul><li>Neutralizing the poison, if possible, with a substance such as activated charcoal </li></ul></ul>
  45. 45. Diagnostic Tests & Methods… <ul><li>Patient history & physical exam </li></ul><ul><li>Identification of a causative agent </li></ul><ul><li>Laboratory studies </li></ul><ul><li>Stool culture </li></ul><ul><li>Endoscopy with biopsy </li></ul><ul><li>Gastric analysis </li></ul>
  46. 46. Nursing Interventions… <ul><li>Assess and document signs and symptoms and reactions to treatment </li></ul><ul><li>Monitor vital signs at least every 4 hours </li></ul><ul><li>Monitor intake and output </li></ul><ul><li>Provide the prescribed diet </li></ul><ul><li>Administer the medication as prescribed and monitor for side effects </li></ul><ul><li>Note amount and character of emesis and diarrhea </li></ul><ul><li>Monitor IV fluids </li></ul><ul><li>Educate the patient and family concerning drug therapy, diet, activities, and any restrictions </li></ul>
  47. 47. <ul><li>An ulcer is an open sore in the skin or mucous membrane that is accompanied by sloughing of inflamed & necrotic tissue </li></ul><ul><li>A peptic ulcer is a break in the integrity of the mucosa of the esophagus, stomach, or duodenum </li></ul><ul><li>Peptic ulcers include gastric and duodenal ulcers </li></ul><ul><li>Exact cause is unknown; recurrent or refractory ulcers linked to Helicobacter pylori infections </li></ul>ULCERS Rowena Talavera
  48. 48. Predisposing Factors … <ul><li>Stress </li></ul><ul><li>Smoking </li></ul><ul><li>Heavy caffeine ingestion </li></ul><ul><li>Ingestion of certain drugs (ASA, steroids, NSAIDs) </li></ul><ul><li>Infection of the mucosa by H. pylori </li></ul>Rowena Talavera
  49. 49. Peptic Ulcers <ul><li>Gastric ulcers are thought to result from a break in the mucous barrier mechanisms that normally protect the stomach’s lining </li></ul><ul><li>Duodenal ulcers are characterized by ↑’d gastric secretion of HCl </li></ul><ul><li>The presence of gram-negative bacteria Helicobacter pylori is strongly associated with anthral gastritis, duodenal ulcers, & to a lesser degree, gastric ulcers and cancer. </li></ul><ul><li>H. pylori is not linked to esophageal ulcers </li></ul>Rowena Talavera
  50. 50. Signs & Symptoms <ul><li>Loss of appetite </li></ul><ul><li>Weight loss or gain </li></ul><ul><li>Pain (gnawing, burning) </li></ul><ul><li>Melena (black, tarry stool containing blood) from bleeding in the stomach may occur & is a significant finding </li></ul><ul><li>Anemia </li></ul><ul><li>Hematemesis; coffee-ground emesis </li></ul><ul><li>Occasional nausea or vomiting </li></ul>Rowena Talavera
  51. 51. Diagnostic Tests & Methods <ul><li>Patient history & physical exam </li></ul><ul><li>Gastroscopy & duodenoscopy </li></ul><ul><li>Barium studies </li></ul><ul><li>Gastric analysis </li></ul><ul><li>Diagnosis of H. pylori infection can be accomplished by a gastric mucosal biopsy procedure </li></ul><ul><li>Serum blood test for antibodies to the H. pylori, or a breath test </li></ul>Rowena Talavera
  52. 52. Complications . . . <ul><li>In an event of complications, an NG tube attached to suction will be inserted; client will be kept NPO for at least 24 hours, & IV fluids will be administered </li></ul><ul><ul><li>Abdominal infection </li></ul></ul><ul><ul><li>Hemorrhage </li></ul></ul><ul><ul><li>Perforation </li></ul></ul><ul><ul><li>Obstruction </li></ul></ul>Rowena Talavera
  53. 53. Treatment . . . <ul><li>Diet </li></ul><ul><ul><li>Bland diet while pain is present </li></ul></ul><ul><ul><li>First few weeks, client should eliminate gas-forming & highly seasoned foods, & foods ↑ in roughage </li></ul></ul><ul><ul><li>Omit caffeine, tea, cola beverages, chocolate, ETOH, & cigarette smoking = stimulate secretion of HCl </li></ul></ul><ul><ul><li>Milk & cream in small quantities </li></ul></ul><ul><ul><li>3 normal meals & a bedtime snack </li></ul></ul><ul><li>Medications (In Practice-Important Medications 87-1 pg 1443) </li></ul><ul><li>Rest and stress management </li></ul><ul><ul><li>Rest is important, not necessarily bedrest </li></ul></ul><ul><ul><li>Relaxation </li></ul></ul><ul><ul><li>Tranquilizers may be prescribed </li></ul></ul><ul><ul><li>After the course of treatment is established, the client maintains the routine at home </li></ul></ul>Rowena Talavera
  54. 54. Treatment … <ul><li>Surgical Intervention </li></ul><ul><ul><li>Closure if perforation has occurred </li></ul></ul><ul><ul><li>Pyloroplasty and vagotomy if the gastric outlet is obstructed </li></ul></ul><ul><ul><li>Total or partial resection of the stomach to remove the ulcerated areas </li></ul></ul>Rowena Talavera
  55. 55. Medications for Treating Ulcers <ul><li>Antibiotics: a 7-14 day course of clarithrymycin (Biaxin) & metronidazole (Flagyl) in combination with an H2 blocker or PPI is utilized for the treatment of Helicobacter pylori. </li></ul><ul><li>Antacids: Amphogel, Mylanta, Maalox, Gelusil, Di-Gel, Riopan </li></ul><ul><li>Histamine (H2) receptor antagonists (H2 blockers): cimetidine (Tagamet), ranitidine (Zantac), famotidine (Pepcid), nizatidine (Axid) </li></ul><ul><li>Proton-pump inhibitors: omeprazole (Prilosec), lansoprazole (Prevacid), pantoprozole (Protonix), rabeprozole (Aciphex), esomeprazole (Nexium) </li></ul><ul><li>Mucous enhancer or gastric-secretion inhibitor (protects against drug-induced ulcer formation): misoprostol (Cytotec) </li></ul><ul><li>Antipeptic: sucralfate (Carafate) </li></ul>Rowena Talavera
  56. 56. Medications: Nsg.Considerations… <ul><li>Remind the client to allow at least 1 hour between eating or taking doses of antacid, and taking H2 blocker medication. </li></ul><ul><li>Some drugs such as Zantac & Tagamet, can cause leukopenia. Other side effects include constipation, diarrhea, headache, & dizziness </li></ul>Rowena Talavera
  57. 57. Nursing Considerations . . . <ul><li>The goals in ulcer treatment are to prevent irritating the lesion, lessen acidic secretions, reduce activity of the stomach & intestine, & manage emotional stress </li></ul><ul><li>Client teaching is an important component </li></ul><ul><li>Encourage the client to verbalize his or concerns, rather than internalize them </li></ul><ul><li>Physical activity also may help to alleviate frustrations </li></ul><ul><li>Stress management workshops and support groups often are beneficial </li></ul>Rowena Talavera
  58. 58. Ulcer Management <ul><li>Three meals and a bedtime snack should be routine </li></ul><ul><li>Meal size and portions should be at a comfortable and tolerated level. Avoid overdistention. </li></ul><ul><li>Determine and eliminate foods that aggravate symptoms </li></ul><ul><li>Eat foods slowly and chew them well. </li></ul><ul><li>Contact a physician if diarrhea or increased discomfort occur or if the condition is not improving </li></ul><ul><li>Use methods of relaxation </li></ul><ul><li>Verbalize concerns </li></ul><ul><li>Establish a personal balance between exercise & physical & emotional rest, especially during stressful periods. </li></ul>Rowena Talavera
  59. 59. Gastric Ulcer Rowena Talavera
  60. 60. Stomach Cancer <ul><li>Known as the “silent neoplasm” because it is usually not detected until after metastasis to adjacent structures, thus the client’s prognosis is often poor </li></ul><ul><li>Causes </li></ul><ul><ul><li>Exact cause is unknown </li></ul></ul><ul><ul><li>Familial tendency is suspected </li></ul></ul><ul><ul><li>Predisposing conditions: chronic gastric ulcers & gastritis </li></ul></ul><ul><li>Signs & symptoms </li></ul><ul><ul><li>Loss of appetite, early satiety </li></ul></ul><ul><ul><li>Weigh loss; weakness & fatigue </li></ul></ul><ul><ul><li>Pain; melena; anemia; hematemesis </li></ul></ul><ul><ul><li>Dizziness; indigestion or dyspepsia </li></ul></ul><ul><ul><li>Constipation </li></ul></ul><ul><li>Metastasis to the spleen, lymph nodes, liver, pancreas, & esophagus is common </li></ul>Kristine Ananyan
  61. 61. Symptoms of Ulcers & Stomach Cancer <ul><li>Ulcers </li></ul><ul><ul><li>Frequent dyspepsia </li></ul></ul><ul><ul><li>Burning sensation in the stomach </li></ul></ul><ul><ul><li>Pain that always begins in same place </li></ul></ul><ul><ul><li>Pain relieved by eating, or possibly, vomiting </li></ul></ul><ul><ul><li>Black, tarry stools (melena) </li></ul></ul><ul><ul><li>Free HCl acid in stomach </li></ul></ul><ul><ul><li>Tenseness, irritability; Difficulty sleeping </li></ul></ul><ul><ul><li>Weight often maintained </li></ul></ul><ul><li>Stomach Cancer </li></ul><ul><ul><li>Sudden dyspepsia </li></ul></ul><ul><ul><li>Absence of pain until cancer is advanced </li></ul></ul><ul><ul><li>Pain unrelieved by eating or vomiting </li></ul></ul><ul><ul><li>Coffee-ground emesis; Absence of free HCL acid in stomach </li></ul></ul><ul><ul><li>Weakness, lethargy, tiredness much of the time </li></ul></ul><ul><ul><li>Unexplained weight loss </li></ul></ul><ul><ul><li>Cancer cells possibly visible in slides of gastric contents </li></ul></ul>
  62. 62. Stomach Cancer <ul><li>Diagnostic Tests & Methods </li></ul><ul><ul><li>Patient history & physical examination </li></ul></ul><ul><ul><li>Laboratory studies; Stool analysis; gastric analysis </li></ul></ul><ul><ul><li>Barium studies; gastroscopy </li></ul></ul><ul><li>Treatment </li></ul><ul><ul><li>Preoperative Therapy </li></ul></ul><ul><ul><ul><li>Correct nutritional deficiencies </li></ul></ul></ul><ul><ul><ul><li>Treat anemias; Blood replacement </li></ul></ul></ul><ul><ul><ul><li>Gastric decompression with a nasogastric tube </li></ul></ul></ul><ul><ul><li>Surgery : removal of the cancerous lesion or tumor along with a margin of normal tissue </li></ul></ul><ul><ul><li>Radiation & chemotherapy may be used if the patient is not expected to undergo surgery </li></ul></ul><ul><ul><ul><li>Combination therapy has a better response </li></ul></ul></ul><ul><ul><ul><li>Single-agent therapy has proved to be of little value </li></ul></ul></ul>Kristine Ananyan
  63. 63. Nursing Interventions… <ul><li>Preoperative Care </li></ul><ul><ul><li>Offer support to the patient and family </li></ul></ul><ul><ul><li>Assess and document signs & symptoms & reactions to treatments </li></ul></ul><ul><ul><li>Provide and encourage the prescribed diet </li></ul></ul><ul><ul><li>Monitor vital signs at least every 8 hours </li></ul></ul><ul><ul><li>Monitor blood a& fluid replacement therapy </li></ul></ul><ul><ul><li>Provide preoperative teaching </li></ul></ul><ul><li>Postoperative Care (Immediate) </li></ul><ul><ul><li>Have patient turn, cough, & deep-breathe </li></ul></ul><ul><ul><li>Monitor NG suctioning and tube patency </li></ul></ul><ul><ul><li>Monitor VS as ordered </li></ul></ul><ul><ul><li>Record I&O </li></ul></ul><ul><ul><li>Administer prescribed medication, & monitor for side-effects </li></ul></ul>Kristine Ananyan
  64. 64. Nursing Interventions… <ul><li>Postoperative Care (Immediate) … </li></ul><ul><ul><li>Assess dressing </li></ul></ul><ul><ul><li>Assess for bowel sounds </li></ul></ul><ul><ul><li>Encourage early ambulation & ROM exercises to prevent thrombosis </li></ul></ul><ul><ul><li>Provide anti-embolism stockings </li></ul></ul><ul><ul><li>Relieve pain with drugs & supportive measures </li></ul></ul><ul><li>Postoperative Period </li></ul><ul><ul><li>Provide 6-8 small feedings </li></ul></ul><ul><ul><li>Weigh patient daily while in hospital to monitor weight loss </li></ul></ul><ul><ul><li>Reduce fluids taken with meals if not tolerated </li></ul></ul><ul><ul><li>Educate the patient and family concerning drug therapy, dietary restrictions, activity, wound care, and compliance with regimen </li></ul></ul>Kristine Ananyan
  65. 65. <ul><li>Diverticulosis and Diverticulitis </li></ul><ul><li>Hernias </li></ul><ul><li>Intestinal Obstruction </li></ul><ul><li>Irritable Bowel Syndrome (IBS) </li></ul><ul><li>Constipation </li></ul><ul><li>Diarrhea </li></ul><ul><li>Inflammatory Bowel Disease </li></ul><ul><li>Appendicitis </li></ul><ul><li>Peritonitis </li></ul><ul><li>Cancer of the Small Intestine </li></ul><ul><li>Colon Cancer </li></ul>Disorders of the Small or Large Intestine
  66. 66. Diverticulosis <ul><li>Diverticulosis refers to a condition in w/c outpouches (ruptures) occur along the intestinal wall </li></ul><ul><li>Diverticula can occur anywhere in the GI tract </li></ul><ul><li>Symptoms that accompany diverticular disease are vague or absent; often found during dx procedures performed for other problems </li></ul><ul><li>Barium enema can confirm the presence of diverticula, but the barium may become trapped in the diverticula & form hard masses </li></ul><ul><li>Endoscopy can confirm the diagnosis by permitting direct visualization of the lesions </li></ul>Edmund Calvo
  67. 67. DIVERTICULITIS <ul><li>occurs when the diverticula become inflammed, usually due to obstruction of the diverticula & bacterial invasion </li></ul><ul><li>signs & symptoms: nagging, cramping pain & tenderness in the LL abdomen, abdominal distention, flatulence, & ↑ temperature </li></ul><ul><li>increased pressure w/in the lumen of the bowel can cause rupture of the diverticulum & result in abscess formation and peritonitis </li></ul>Edmund Calvo
  68. 68. Diverticula /Diverticulitis Edmund Calvo
  69. 69. Treatment . <ul><li>Dietary management of symptoms, medications, & possible surgery </li></ul><ul><li>Consumption of high-residue foods is recommended to prevent the formation of diverticula & to prevent acute onsets of diverticulitis </li></ul><ul><li>Diverticula present & inflamed = stool softeners, & bulk-forming agents (psyllium-Metamucil), help to produce soft, non-irritating, & unforced bowel movements </li></ul><ul><li>Fever + abdominal pain = infection & inflammation = ATB given </li></ul><ul><li>Low-residue diet, including avoidance of milk products is recommended </li></ul><ul><li>Acute episode = NPO + NGT for suctioning to allow the bowel to rest </li></ul>Edmund Calvo
  70. 70. Nursing Considerations . . . <ul><li>Client & family dietary teaching are important aspects of prevention of attacks </li></ul><ul><li>Management of symptoms, & treatment during attacks </li></ul><ul><li>Adequate water intake of 6-8 glasses/day </li></ul><ul><li>Regular bowel habits, regular exercise, & plenty of fruit, vegetables, & fiber are key factors in preventing future problems </li></ul><ul><li>Teach client when to use high-fiber and low-fiber foods </li></ul>Edmund Calvo
  71. 71. HERNIAS <ul><li>develop when abd. muscle weakness causes a portion of the GI tract to protrude through muscle; </li></ul><ul><li>herniation often occurs when intra-abdominal pressure ↑s due to obesity, heavy lifting, coughing, blunt trauma to the abdomen, or pregnancy </li></ul><ul><li>may be reducible (one that may be pushed back into the intestine by lying down & pressing on the abdomen), irreducible (cannot be manipulated back into the body cavity), incarcerated (occurs when the intestine’s peristaltic flow is obstructed), & strangulated (requires immediate surgical intervention because it interrupts blood flow to the tissue, resulting tissue necrosis – infarction) </li></ul>Maria Nelson
  72. 72. Hernia Repair Maria Nelson
  73. 73. Types of Hernias . . . <ul><li>Hiatal: part of the stomach protrudes thru the diaphragm’s esophageal hiatus </li></ul><ul><li>Inguinal: most common type; protrude thru the inguinal area in the groin, esp. males </li></ul><ul><li>Femoral: weaknesses of the femoral canal that carries blood vessels & nerves into the thigh </li></ul><ul><li>Umbilical: protrude thru the umbilicus </li></ul><ul><li>Abdominal: a protrusion of the intestine through the abdominal wall </li></ul><ul><li>Incisional: develops in an incisional area following surgery </li></ul><ul><li>Congenital defects are responsible for a large # of hernias; often detected soon after birth; Acquired hernias may result from heavy lifting, pregnancy, coughing, or sneezing = obesity, & muscle weakness may cause hernias </li></ul>Maria Nelson
  74. 74. Signs & symptoms . . . <ul><li>Varies and depends on location </li></ul><ul><li>Appearance of protrusion when straining or lifting </li></ul><ul><li>Some hernias are asymptomatic, although if they are left untreated they often enlarge and cause pain </li></ul><ul><li>If condition is allowed to progress, the intestine may become constricted and the blood supply is cut off (strangulated) = this development is an obvious emergency </li></ul>Maria Nelson
  75. 75. Treatment <ul><li>Surgery is the treatment of choice </li></ul><ul><ul><li>Herniorrhaphy: surgical repair of the hernia </li></ul></ul><ul><ul><li>Hernioplasty: surgical reinforcement of the weakened area </li></ul></ul><ul><li>Use of a truss (a support worn over the hernia to keep it in place) </li></ul><ul><li>Changes in patient’s lifestyle </li></ul><ul><ul><li>Avoiding lying down after meals </li></ul></ul><ul><ul><li>Avoiding spicy or acidic foods, alcohol, and tobacco </li></ul></ul><ul><ul><li>Eating small, frequent, bland meals </li></ul></ul><ul><ul><li>Eating a high-fiber diet </li></ul></ul>Maria Nelson
  76. 76. Nursing Intervention <ul><li>Assess and document signs & symptoms and reactions to treatments </li></ul><ul><li>Assess vital signs every shift before surgery </li></ul><ul><li>Report any symptoms of coughing, sneezing, or upper respiratory tract infection noted before surgery because this will weaken the surgical repair </li></ul><ul><li>Apply ice packs as ordered to control pain and swelling </li></ul><ul><li>Monitor voidings following inguinal hernia repair </li></ul><ul><li>Educate the patient and family concerning care of the operative site, activity restrictions, and avoidance of constipation </li></ul>Maria Nelson
  77. 77. Intestinal Obstruction <ul><li>Ileus is obstruction of the intestine = may be due to a mechanical or functional difficulty & occurs when gas or fluid cannot move normally through the bowel </li></ul><ul><li>Mechanical obstructions occur when there is a blockage in the lumen or pressure exerted from outside the intestine: </li></ul><ul><ul><li>Stenosis, strictures, & adhesion scars from previous surgery; Volvulus (twisting of the bowels); Foreign bodies, such as fruit pit </li></ul></ul><ul><ul><li>Intussusception (telescoping of the bowel); polyps & tumors (eg, diverticulosis), abscesses </li></ul></ul><ul><li>Functional obstructions occur when the intestinal motility is defective: </li></ul><ul><ul><li>Paralytic ileus; Muscle spasms (spastic ileus); disorders (eg, muscular dystrophy, DM, & Parkinson’s disease) </li></ul></ul>Lito Salazar
  78. 78. <ul><li>A vascular obstruction, such as atherosclerosis or thrombus formation, also can cause gradual cessation of peristalsis due to ↓’d blood supply </li></ul><ul><li>Pneumonia, pancreatitis, & peritonitis can produce obstruction of infectious origin; </li></ul><ul><li>a ↓ or interruption of the nerve stimulus – w/c may result from post-anesthesia paralysis, trauma to the ANS, cx from peritonitis, inactivity, large doses of narcotics, or other nerve damage – causes paralytic obstruction (paralytic ileus) of the intestine </li></ul>Lito Salazar
  79. 79. Lito Salazar
  80. 80. Intestinal Obstruction … <ul><li>Signs and Symptoms </li></ul><ul><ul><li>Abnormal pain and distention </li></ul></ul><ul><ul><li>Projectile vomiting; nausea; cramping </li></ul></ul><ul><ul><li>Possible absence of bowels sounds or ↑ bowel sounds </li></ul></ul><ul><ul><li>Abdomen may be tense (distended) </li></ul></ul><ul><ul><li>Obstipation (chronic constipation) </li></ul></ul><ul><li>Diagnostic Tests and Methods </li></ul><ul><ul><li>Patient history and physical examination </li></ul></ul><ul><ul><li>Flat plate of the abdomen (x-ray) </li></ul></ul><ul><ul><li>Laboratory studies </li></ul></ul>Lito Salazar
  81. 81. Treatment <ul><li>Complete obstruction in the small intestine usually necessitates surgery; obstruction of the lower part of the large intestine may be treated medically </li></ul><ul><li>Medical treatment of large bowel obstruction includes intestinal or gastric decompression, involving intubation w/ a nasoenteric tube - ↓ n/v </li></ul><ul><li>Constant suction via rectal tube is used to keep the intestine empty </li></ul><ul><li>Hydration with IV therapy </li></ul><ul><li>Prophylactic ATBs </li></ul><ul><li>A colonoscopy may be done to attempt to un-twist or unblock the bowel </li></ul>Lito Salazar
  82. 82. Nursing Considerations . . . <ul><li>Monitor vital signs; I&O </li></ul><ul><li>Monitor decompression tube & assess quantity & character of drainage </li></ul><ul><li>assist with fluid and electrolyte replacement </li></ul><ul><li>it is important to note the quality of bowel sounds </li></ul><ul><li>if the client’s condition deteriorates, emergency surgery becomes necessary </li></ul><ul><li>postoperative nursing care follows the protocol for abdominal surgery </li></ul><ul><li>NPO </li></ul>Lito Salazar
  83. 83. Irritable Bowel Syndrome: IBS <ul><li>Also known as spastic colon, spastic colitis, mucous colitis, & irritable colon </li></ul><ul><li>Most common functional disorder of the GI tract causing ↑’d motility of the small or large intestine </li></ul><ul><li>It affects the intestine’s structure, but its specific cause is unknown </li></ul><ul><li>IBS does not lead to, or cause, ulcerative colitis or canc er </li></ul>Ben Mayunga
  84. 84. IBS: Signs & Symptoms… <ul><li>IBS causes alternately tense & flaccid bowel segments; resulting symptoms can include nausea, abd. pain, cramps, flatulence, altered bowel function, & hypersecretion of colonic mucus </li></ul><ul><li>Symptoms vary in intensity & pattern , & may be aggravated by foods, ETOH ingestion, stress, and fatigue </li></ul><ul><li>Diagnosis is accomplished by tests such as the upper GI series and barium enema </li></ul><ul><li>Colonoscopy is appropriate for older adults, because these tests also eliminate other pathologies with similar symptoms </li></ul>
  85. 85. IBS: Treatment… <ul><li>Explore lifestyle patterns & emotional stressors </li></ul><ul><li>Counseling may be needed, along w/ biofeedback & relaxation training, w/c has proven helpful for people w/ IBS; High-fiber diet & agents that add bulk = help to promote an even and consistent stool to pass through the bowel; adequate oral fluids & regular meal patterns </li></ul><ul><li>Medications: sedatives or tranquilizers; Xanax (alprazolam) = help to quiet the bowel’s activity & provide relaxation; dicyclomine Hcl (Bentyl) + hyoscyamine (Donnatal) = antispasmodic that can relieve pain & cramping </li></ul><ul><li>Common S/E: dry mouth, blurred vision, & dizziness; some clients require occasional antidiarrheal agents (loperamide-Immodium) </li></ul>
  86. 86. Nursing Considerations . . . <ul><li>Remind the client to be consistent and follow the prescribed treatment plan closely </li></ul><ul><li>Many times clients with IBS get discouraged by seemingly slow improvement or small setbacks, w/c may keep them from allowing the bowel to establish a more normal pattern </li></ul><ul><li>Keeping a log or diary can help the client track progress or identify needed changes </li></ul>Ben Mayunga
  87. 87. CONSTIPATION <ul><li>A condition in which the client has infrequent, hard bowel movements accompanied by mucus. </li></ul><ul><li>May be acute or chronic; the client may have a fecal impaction with loose, watery stool & mucus traveling around the constipated stool. </li></ul><ul><li>Dehydration, cancer, chemical dependency, or mechanical obstruction may cause this condition; it also may be a psychomatic disorder. </li></ul>Ben Mayunga
  88. 88. Constipation… <ul><li>Warn client not to strain while having a stool </li></ul><ul><li>Encourage to avoid worrying about constipation because undue concern can compound the problem </li></ul><ul><li>Teach client to drink a great deal of fluids, drink prune juice or eat bran, ↑ dietary bulk, exercise, & follow a regular schedule for defecation. </li></ul><ul><li>Explain the importance of evacuating the bowel whenever the client feels the urge; postponing the act desensitizes the bowel to the presence of feces. </li></ul><ul><li>Enemas for diagnostic tests/procedure; alleviate symptoms of constipation or distention, or to administer specific medications & fluids </li></ul><ul><li>Digital removal of fecal impaction may be necessary for severely constipated or paralyzed clients – only done after stool softeners & enemas failed </li></ul><ul><li>CAUTION: </li></ul><ul><ul><li>Loose, watery stools may not be diarrhea; they may signify severe constipation with leakage of water around the blockage; assess the client for fecal impaction </li></ul></ul>Ben Mayunga
  89. 89. DIARRHEA <ul><li>Consists of stools that are liquid or semi-liquid & often very light colored. </li></ul><ul><li>They may be foul-smelling, & contain mucus, pus, blood, or fats </li></ul><ul><li>Often accompanied by flatus & severe, painful abdominal cramps or spasms (tenesmus), w/c defecation relieves </li></ul><ul><li>Complications: dehydration, electrolyte disturbances, cardiac dysrhythmias, & hypovolemic shock </li></ul><ul><li>Generally a symptom of some underlying conditions: bacterial invasion by S. dysenteriae or Salmonella ; C. botulinum is an anaerobic bacterium that if often the cause of nosocomial diarrhea. This infection occurs most frequently in acutely ill clients who have received numerous courses of ATB’s </li></ul><ul><li>IBS/IBD often is the cause of diarrhea </li></ul><ul><li>Meds (ATBs) can cause diarrhea that stops when treatment stops. </li></ul>Ben Mayunga
  90. 90. Ben Mayunga
  91. 91.
  92. 92. Diagnosis… <ul><li>If chronic and not self-limiting, diarrhea symptoms must be evaluated for possible causes (particularly before the client self-medicates). </li></ul><ul><li>Diarrhea that continually awakens a client from normal sleep often indicates intestinal pathology. A bacterial infection and IBS should be ruled out. </li></ul><ul><li>Stool tests, including cultures, occult blood tests, & O&P smears, are performed. </li></ul><ul><li>Hematology studies indicate infection or inflammatory processes. </li></ul><ul><li>Lower GI barium exams are done to rule out pathologic causes </li></ul>Ben Mayunga
  93. 93. Therapeutic Interventions… <ul><li>Give antidiarrheal drugs as ordered.Most antidiarrheal drugs suppress GI motility, thus allowing for more fluid absorption. </li></ul><ul><li>Withhold food for 24 hours during the first 24-hour period of diarrhea. It allows & promote bowel rest & relaxation & avoidance of irritation. </li></ul><ul><li>Provide the following alterations as allowed - - - </li></ul><ul><ul><li>Bulk fiber (ie, cereal, grains, Metamucil) </li></ul></ul><ul><ul><li>“ Natural” antidiarrheals (ie, pretzel, matzos, cheese) </li></ul></ul><ul><ul><li>Avoidance of stimulants (ie, caffeine, carbonated beverages) Stimulants may ↑ GI motility & worsen diarrhea </li></ul></ul><ul><li>Check for fecal impaction by digital examination. Liquid stool (apparent diarrhea) may seep past a fecal impaction. </li></ul>Ben Mayunga
  94. 94. <ul><li>Encourage fluids; consider nutritional support. Fluids compensate for malabsorption & loss of nutrients. </li></ul><ul><li>Evaluate appropriateness of physician’s radiograph protocols for bowel preparation on basis of age, weight, condition, disease, and other therapies. Elderly, frail, or those patients already depleted may require less bowel preparation or additional intravenous (IV) fluid therapy during preparation. </li></ul><ul><li>Assist with or administer perianal care after each bowel movement (BM). This prevents perianal skin excoriation. </li></ul><ul><li>For patients with enteral tube feeding, employ the following: </li></ul><ul><ul><li>Change feeding tube equipment according to institutional policy, but no less than every 24 hours. Contaminated equipment can cause diarrhea. </li></ul></ul><ul><ul><li>Administer tube feeding at room temperature. Extremes of temperature can stimulate peristalsis. </li></ul></ul><ul><ul><li>Initiate tube feeding slowly. </li></ul></ul><ul><ul><li>Decrease rate or dilute feeding if diarrhea persists or worsens. This prevents hyperosmolar diarrhea. </li></ul></ul>Ben Mayunga
  95. 95. Medications for Treating Diarrhea <ul><li>Motility reduction: loperamide (Imodium), diphenoxylate (Lomotil) </li></ul><ul><li>Bile salt-binding agent: cholestyramine (Questran) </li></ul><ul><li>Antibiotics: to treat bacterial/microbial diarrhea </li></ul><ul><li>Nursing Considerations </li></ul><ul><ul><li>Meds C/I in poisoning until the poison is removed from the digestive tract. </li></ul></ul><ul><ul><li>Loperamide & diphenoxylate have the potential for drug dependence, they may cause sedation, dizziness, constipation, & drying of mucous membranes </li></ul></ul><ul><ul><li>Diphenoxylate is not recommended for use in pregnancy </li></ul></ul><ul><ul><li>Cholestyramine may cause constipation, nausea, bloating, abdominal pain, and rash. To administer, sprinkle powder on surface of liquid or wet food; carbonated beverages may foam excessively. Do not administer with other medications because it blocks their absorption </li></ul></ul>Ben Mayunga
  96. 96. Inflammatory Bowel Disease (IBD) <ul><li>a general term for ulcerative colitis & Crohn’s disease. </li></ul><ul><li>research suggests that environmental, immunologic, hereditary, age, & cultural factors influence this disease. </li></ul><ul><li>the causes & cure, however, are unknown </li></ul><ul><li>Ulcerative colitis involves inflammation & ulceration of mucosa & submucosa (colon’s lining). It can span the entire length of the colon, but most frequently begins in the rectum & distal colon. </li></ul><ul><li>a chronic ulcerative colitis (CUC) implies long-standing disease. A client’s risk of colon cancer increases if CUC lasts longer than 8-10 years </li></ul>Marissa Dacumos
  97. 97. <ul><li>Crohn’s disease can occur in any part of the intestinal tract, the most common location being the terminal ileum. </li></ul><ul><li>Unlike colitis, it involves inflammatory processes of the entire thickness of the bowel wall. It is usually patchy and often skips segments of healthy bowel. </li></ul><ul><li>The risk of cancer for the client with Crohn’s disease is the same as that for the general population. </li></ul>Marissa Dacumos
  98. 98. Signs & Symptoms… <ul><li>Diarrhea, blood and mucus in the stool, abdominal pain, cramps, urgency, bowel incontinence, loss of appetite, weight loss, fever, nausea, & vomiting </li></ul><ul><li>Electrolyte imbalance may result from loss of body fluids </li></ul><ul><li>Symptoms may develop gradually or suddenly </li></ul><ul><li>Most clients experience patterns of exacerbation (attacks) and remission </li></ul>Marissa Dacumos
  99. 99. Complications… <ul><li>Bowel obstruction & perforation =may result from scar tissue or a fistula & are the most serious complications </li></ul><ul><li>Perforation is an emergency </li></ul><ul><ul><li>symptoms include: rapid, thready pulse; extreme anxiety; severe abdominal pain; fever; abdominal rigidity (boardlike); cold, clammy skin </li></ul></ul><ul><li>Hemorrhage & peritonitis may develop </li></ul><ul><li>Removal of the colon and permanent ileostomy are often necessary </li></ul>Marissa Dacumos
  100. 100. Treatment… <ul><li>Anti-diarrheal = allows client to maintain normal work & daily activity patterns </li></ul><ul><li>Steroids (cortisone) which reduce inflammation & generate healing are given IV, orally, or rectally (foam, suppositories, or enema) </li></ul><ul><li>Aminosalicylates are the most commonly used drugs to treat IBD, especially ulcerative colitis </li></ul><ul><li>Mercaptopurine, methotrexate, & azathioprine are potent immunosuppresants that are useful in treating IBD, especially Crohn’s disease </li></ul><ul><li>Infliximab blocks tumor necrosis factor, which acts to suppress intestinal inflammation. </li></ul><ul><li>Close monitoring of blood counts & the client’s clinical condition is necessary with these medications </li></ul>Marissa Dacumos
  101. 101. Treatment… <ul><li>IV antibiotics may be indicated during severe flare-ups </li></ul><ul><li>Ulcerative colitis is eliminated by removal of the entire colon, which is the treatment of choice when surgery is necessary </li></ul><ul><li>Standard ileostomy allows fecal waste to collect in an appliance attached to the abdomen </li></ul><ul><li>Approximately 66% of clients with Crohn’s disease require surgery, & 40% of these require a second surgery. These high percentages are due to the typical recurrence of Crohn’s disease in another bowel segment </li></ul><ul><li>The continent fecal diversion procedure of ileoanal reservoir has been effective for those with Crohn’s disease </li></ul>Marissa Dacumos
  102. 102. Nursing Considerations… <ul><li>use of anticholinergic, antidiarrheal, & antispasmodic, are used to promote optimal bowel rest. </li></ul><ul><li>NPO or limited clear liquids. TPN often used when a client has not responded to medical intervention, & is being prepared for, or has undergone, intestinal resection. The client may receive oral supplements only if tolerated </li></ul><ul><li>diet will be high in protein and calories, low residue, & lactose restricted. </li></ul><ul><li>anemia & vitamin deficiencies can be treated nutritionally or with supplements </li></ul><ul><li>emotional stress can aggravate & stimulate physical symptoms = be sensitive & supportive </li></ul>Marissa Dacumos
  103. 103. Marissa Dacumos
  104. 104. APPENDICITIS <ul><li>an inflammation of the approximately 4 inches (10cm) of slender blind tube that open off the tip of the ceccum. </li></ul><ul><li>may become obstructed by a hard mass of feces, with subsequent inflammation, infection, gangrene, & possible perforation </li></ul><ul><li>a ruptured appendix is serious because intestinal contents can escape into the abdomen & cause peritonitis or an abscess </li></ul>Imelda de los Sanstos
  105. 105. Imelda de los Sanstos
  106. 106. Signs & symptoms… <ul><li>Acute attack - begins with progressively severe generalized abdominal pain, which later localizes as pain & tenderness in the right lower quadrant midway between the umbilicus & the crest of the ilium (McBurney’s point). An attack may subside and recur. </li></ul><ul><li>Ultrasound can often diagnose an enlarged appendix </li></ul><ul><li>Rebound tenderness usually present; the quality of tenderness relates to the exact location of the appendix; or relief of pain when palpation pressure applied to RLQ followed by pain on pressure release. </li></ul><ul><li>Nausea, vomiting, a mild to moderate fever, and an increase in leukocytes accompany the pain. </li></ul><ul><li>A ruptured appendix will result in more severe symptoms associated with peritonitis </li></ul>Imelda de los Sanstos
  107. 107. PERITONITIS <ul><li>An inflammation of the peritoneum, the membrane that lines the abdominal cavity and covers the abdominal organs </li></ul><ul><li>It usually results from perforation of the intestine or appendix, through which intestinal contents escape into the abdomen. </li></ul><ul><li>Intestinal tract + bacteria = perforation, inflammation, & peritoneal infection </li></ul><ul><li>Most common causes - - - </li></ul><ul><ul><li>Appendicitis; ulcer, IBD; abscessed diverticula; cancer </li></ul></ul><ul><ul><li>Infected uterine tube </li></ul></ul><ul><ul><li>Ruptured tubal pregnancy </li></ul></ul><ul><ul><li>Ruptured uterus </li></ul></ul><ul><li>May be generalized, extending throughout the peritoneum, or it may be localized as an abscess </li></ul>Steven Dorn
  108. 108. Steven Dorn
  109. 109. Peritonitis… <ul><li>Signs & symptoms </li></ul><ul><ul><li>severe abdominal pain, nausea, vomiting </li></ul></ul><ul><ul><li>gradual temperature ↑; weak, rapid pulse; low BP; shallow respirations (breathing hurts the abdomen) </li></ul></ul><ul><ul><li>abdomen tense & boardlike & distended (pt tries to avoid moving the abdomen & draws up the knees to prevent pressure from the bedclothes & to relieve pain) </li></ul></ul><ul><ul><li>paralytic ileus </li></ul></ul><ul><li>Prognosis </li></ul><ul><ul><li>if infection does not respond to treatment, client grows weaker, pulse is thready, breathing shallow, temperature falls, and death follows… </li></ul></ul><ul><li>Diagnostic tests </li></ul><ul><ul><li>Patient history & physical examination </li></ul></ul><ul><ul><li>Laboratory studies; Abdominal x-ray; US; CT scan </li></ul></ul>Steven Dorn
  110. 110. Peritonitis… <ul><li>Treatment </li></ul><ul><ul><li>Surgery: to close the perforation & promote drainage </li></ul></ul><ul><ul><ul><li>Peritoneum irrigated w/ saline & ATB solution </li></ul></ul></ul><ul><ul><li>Less common today largely due to improvements in surgery & the use of ATBs </li></ul></ul><ul><li>Nursing Considerations </li></ul><ul><ul><li>Focus on postoperative care; Administer ATBs and analgesics </li></ul></ul><ul><ul><li>Elevate HOB (semi-Fowler’s) </li></ul></ul><ul><ul><li>Closely observe the abdominal wound, pulse, and temperature </li></ul></ul><ul><ul><li>Monitor incisional or drainage-tube output (amount & type), vomiting, drainage through the GI tube, & fluid I&O; replace fluid & electrolytes </li></ul></ul><ul><ul><li>Document bowel sounds, gas & feces passing through the rectum </li></ul></ul><ul><ul><li>Prevent abdominal distention by using a rectal or NG tube </li></ul></ul><ul><ul><li>Mouth care </li></ul></ul><ul><ul><li>Encourage early, progressive activity </li></ul></ul>Steven Dorn
  111. 111. Cancer of the Small Intestine <ul><li>CA occurs rarely in the small intestine. However, an ↑’d risk of CA accompanies ulcerative colitis; if it does occur in the small intestine, the person’s prognosis is usually poor because the disease is difficult to discover in its early stage; usually it’s asymptomatic </li></ul><ul><li>As the cancer advances, pain may be present; diarrhea, anorexia, nausea, & vomiting; perforation or obstruction may occur </li></ul><ul><li>Portion of the bowel containing the tumor may be removed & the ends of the bowel joined; such anastomosis is impossible if malignancy is extensive </li></ul><ul><li>Suction relieves distention; IV fluids; ATB’s </li></ul><ul><li>postoperative nursing care is routine </li></ul>Jessica Barrientos
  112. 112. Colon Cancer <ul><li>Believed to arise from a single polypoid lesion; early detectionr equires surveillance for polyps </li></ul><ul><li>ACS recommends screening procedures in an effort to locate polyps; monitoring for occult blood also may be done as part of screening </li></ul><ul><li>S/sx: n/v, wt loss, abd. Cramping or fullnes, change in bowel habits, excessive flatus, anemia, rectal bleeding, anorexia, cachexia </li></ul><ul><li>Diagnosis is made by colonoscopy w/ biopsy of polyps </li></ul><ul><li>Treatment: various regimen of chemotherapy, radiation, & surgery </li></ul><ul><li>Nursing considerations relate to the stage of the disease & the course of treatment; ostomy care </li></ul>Jose Jaramillo
  113. 113. Jose Jaramillo
  114. 114. Hemorrhoids <ul><li>Swollen (varicose) veins of the anus or rectum; external hemorrhoids protrude as lumps around the anus; painful, esp. if the client is constipated & strains to have a BM; they may alternately appear & disappear </li></ul><ul><li>S/sx: usually external hemorrhoids do not bleed, but they may become large, painful, & itchy; uterine pressure on the rectum during pregnancy, intra-abdominal tumors, constipation, diarrhea, obesity, CHF, & portal HTN are major causes; internal hemorrhoids may bleed, unlikely to be painful – always protrude on defecation & clients can push it back w/ a finger; Proctoscope allows the provider to inspect inside the rectum, to visualize hemorrhoids, & take a biopsy sample </li></ul>Milton Marino
  115. 115. Milton Marino
  116. 116. Treatment . . . <ul><li>Sometimes disappear w/o treatment </li></ul><ul><li>Warm sitz baths, anesthetic, ointments, or witch hazel compresses (Tucks) </li></ul><ul><li>Keeping stools soft through proper diet & stool softeners; correcting constipation can prevent & eliminate hemorrhoids </li></ul><ul><li>If surgery is necessary, the veins are tied off & excised or cauterized; Sometimes a solution is injected to shrink (sclerose) the tissues </li></ul><ul><li>Occasionally, hemorrhoidectomy must be done if the hemorrhoid is thrombosed, causing vascular obstruction </li></ul><ul><li>This situation is not life-threatening; surgery is done to relieve pain </li></ul>Milton Marino
  117. 117. Nursing Considerations … <ul><li>Cleansing enema night before surgery – given “until returns run clear” the morning of the operation </li></ul><ul><li>Cleanse rectal area & shave it </li></ul><ul><li>Position patient on the side or abdomen post-surgery to relieve pressure on the operative area </li></ul><ul><li>Give analgesics as ordered </li></ul><ul><li>Liquid diet permitted for the 1 st meal post surgery; thereafter, a full-diet is allowed </li></ul><ul><li>Emphasize early ambulation </li></ul><ul><li>Allow client to sit-up – rubber ring or flotation pad under buttocks helps relieve pressure on the operative area </li></ul>Milton Marino
  118. 118. ANAL FISSURE <ul><li>An ulcer in the skin of the anal wall </li></ul><ul><li>Causes severe pain on defecation & sometimes slight bleeding </li></ul><ul><li>Client may dread the pain so much that he or she delays defecation & becomes constipated </li></ul><ul><li>Sitz baths & local anesthetic ointments are commonly used to treat this problem </li></ul><ul><li>Stool softeners are given </li></ul><ul><li>The only cure for this condition is surgical removal of the ulcer </li></ul>
  119. 119. Anal Abscess & Anal Fistula <ul><li>Anal abscess is caused by infected tissue around the rectal area; painful & may be accompanied by fever & chills; abscess is usually incised & drained, or it may rupture spontaneously </li></ul><ul><li>Anal fistula usually develops as a result of an anal abscess; small tunnel forms in the tissues that discharges pus & feces through one or more opening onto the skin </li></ul>
  120. 120. Treatment … <ul><li>Surgery is necessary to open fistulous tract; </li></ul><ul><li>Medication-impregnated packing is inserted to keep the wound’s edges apart = allow the tissues to heal by granulation, thus eliminating the fistula; </li></ul><ul><li>The fistula must heal inside out, or another abscess will form </li></ul>
  121. 121. Nursing Considerations … <ul><li>Generally, nursing care is similar to that for any client after rectal surgery, w/ the following differences - - - </li></ul><ul><ul><li>Pack the fistula wound w/ petroleum gauze & change the dressing every day </li></ul></ul><ul><ul><li>Drainage from the abscess is profuse, purulent, & foul smelling – need to change the dressing on the wound frequently </li></ul></ul><ul><ul><li>Dispose of dressings properly & wear gloves to prevent the spread of disease </li></ul></ul><ul><ul><li>Keep fistula draining – if it stops draining before the entire area is filled in with granulation tissue, another abscess will form </li></ul></ul>
  122. 122. Cancer of the Rectum <ul><li>Exact cause is unknown </li></ul><ul><li>Risk factors: family hx of colon or rectal cancer, hx of rectal polyps, hx of IBD, & a diet high in fat & protein & low in fiber </li></ul><ul><li>Symptoms: rectal pain, alternating constipation & diarrhea, feeling of incomplete evacuation after a BM,bloody stool, & tenesmus </li></ul><ul><li>Rectal is not common as colon cancer </li></ul><ul><li>Diagnosis is made by sigmoidoscopy with biopsy of polyps </li></ul>
  123. 123. Treatment … <ul><li>Growth upper part of rectum = can be removed w/o removal of the rectal sphincter; ultimately the bowel will function normally </li></ul><ul><li>If tumor involves rectal opening, a dual operation is necessary through the abdomen from above (including a colostomy) & through the perineum below = surgery called abdominal-perineal resection </li></ul><ul><li>W/ staplers & other newest instruments, some surgeons have successfully retained the rectal sphincter, performing a low resection & anastomosis to eliminate the need for a permanent colostomy </li></ul>
  124. 124. Nursing Considerations… <ul><li>Carefully assess vital signs </li></ul><ul><li>Check dressings for bleeding at regular intervals </li></ul><ul><li>The danger of shock after the surgery is great </li></ul><ul><li>Colostomy care; administering parenteral fluids (including blood transfusion); NG suctioning, caring for bladder drainage (a FC is usually inserted in the bladder), & irrigating & caring for drainage from the perineal wound </li></ul><ul><li>Turn client frequently to prevent respiratory complications & thrombophlebitis; finding a comfortable position may be difficult </li></ul><ul><li>Encourage to ambulate usually w/in 2 days </li></ul>
  125. 125. Disorders of the Liver
  126. 126. Disorders of the LIVER <ul><li>Liver Failure </li></ul><ul><ul><li>Overdose on Acetaminophen </li></ul></ul><ul><ul><li>Signs and Symptoms </li></ul></ul><ul><ul><li>Treatment </li></ul></ul><ul><li>Cirrhosis </li></ul><ul><ul><li>Signs and symptoms; Treatment; Nursing Considerations </li></ul></ul><ul><li>Hepatitis </li></ul><ul><ul><li>Signs and Symptoms </li></ul></ul><ul><ul><li>Types of Hepatitis; Nursing Considerations </li></ul></ul><ul><li>Liver Abscess </li></ul><ul><li>Trauma </li></ul><ul><li>Liver Transplantation </li></ul><ul><li>Liver Cancer </li></ul>
  127. 127. Liver Failure <ul><li>Hepatic coma is a failure of the liver cells to clear toxins – waste products build up in the body = diminished cerebral function </li></ul><ul><li>can be an acute or chronic condition </li></ul><ul><li>causes: extensive damage to liver cells, such as may occur after massive GI hemorrhage, as a complication of some surgical procedures, after massive infections, & following an overdose of certain drugs </li></ul><ul><li>also occurs in the client with alcoholic liver disease such as cirrhosis </li></ul>Martin Villamor
  128. 128. Signs & Symptoms: Liver Failure <ul><li>Tremors & mental changes (seizures, stupor, & coma) </li></ul><ul><li>Fulminant hepatic failure involves progressive multi system failure -massive liver cell death </li></ul><ul><li>Acute hepatitis B infections may be the initial causative agent </li></ul><ul><li>confused, somnolent, or comatose & usually have ascites, edema, coagulopathy, & a shrinking liver </li></ul><ul><li>Mortality rate - high, & care is supportive </li></ul><ul><li>Diagnosis is made by liver function tests; blood ammonia levels are ↑ because liver cell cannot convert ammonia to urea; ammonia, a by-product of protein metabolism, is toxic to the brain </li></ul>Martin Villamor
  129. 129. TREATMENT: Liver Failure <ul><li>Symptomatic, including control of bleeding, a low-protein diet, & careful management of f/e balance </li></ul><ul><li>Antibiotics may be given, and in some cases, corticosteroids </li></ul><ul><li>Client’s prognosis is guarded, & the possibility of successful treatment decreases w/ each episode </li></ul><ul><li>In Practice: Nursing Care Guidelines 87-4 pg 1453 for nursing care of the client with a liver failure </li></ul>Martin Villamor
  130. 130. CIRRHOSIS <ul><li>Cirrhosis is a disease in which the cells throughout the liver are progressively destroyed. The liver tissue is replaced by areas with normal new cells as well as scar tissue, which alters the structure of the organ. The flow of blood and lymph through the damaged liver is much less efficient, and eventually the liver fails. </li></ul>Chairat Sampanpaisal
  131. 131. Cirrhosis: Causes … <ul><li>Cirrhosis represents an attempt by the liver to rebuild itself and continue despite injury. The injury may be a sudden and massive infection, as in acute hepatitis, or it may occur in a less dramatic manner over a period of months or years, as in chronic active hepatitis or obstruction of the bile ducts within the liver. </li></ul><ul><li>The process of obstruction starts with inflammation and progresses to scarring and then closure of the ducts. A similar condition is caused by obstruction of the external bile ducts by a stone, scar, inborn defect, or tumor. The damage can also be caused, slowly and steadily, by alcohol abuse, which is by far the most common cause of cirrhosis. Other causes include the following: </li></ul><ul><ul><li>Use of certain medications </li></ul></ul><ul><ul><li>Inborn errors in physical or chemical processes of the body </li></ul></ul><ul><ul><li>Syphilis </li></ul></ul><ul><ul><li>Passive liver congestion, due to inability of the heart to accept a normal flow of blood from the liver or to obstruction of one of the drainage systems of the liver </li></ul></ul><ul><ul><li>Long-term infection with hepatitis B or C virus </li></ul></ul>Chairat Sampanpaisal
  132. 132. Cirrhosis: Symptoms … <ul><li>Frequently, because it imitates many other diseases, cirrhosis is not suspected until it is well advanced. </li></ul><ul><li>Many symptoms of cirrhosis are the result of high blood pressure in the portal vein, which brings blood from the intestinal area to the liver. In cirrhosis, the liver cannot handle a normal flow of blood, so the pressure in the portal vein rises. </li></ul><ul><li>One result is that fluid from the blood is lost into the abdominal cavity, a condition called ascites. The fluid may accumulate and press against the diaphragm (the muscular wall separating the abdominal and chest cavities) and interfere with breathing. Collateral blood vessels form to carry away the excess blood into the general circulation. There may be bleeding in the esophagus or stomach when these smaller collateral vessels burst under pressure. The patient may vomit blood. Serious, life-threatening hemorrhage may occur. </li></ul>Chairat Sampanpaisal
  133. 133. Symptoms: <ul><li>Symptoms include general weakness, a vague feeling of being unwell, loss of appetite, loss of weight, and a loss of interest in sex. </li></ul><ul><li>There may be a dull abdominal ache, nausea, constipation, or diarrhea. In a malnourished patient, the tongue may be inflamed. </li></ul><ul><li>The liver may be enlarged and firm or, in advanced cases, shrunken. </li></ul><ul><li>Other symptoms include an enlarged spleen, mottled redness of the mound at the base of the thumb, &quot;spider veins&quot; on the skin of the upper body, loss of hair from the chest and the pubic area, diminished size of the testes, and tingling sensations in the skin of the hands and feet. </li></ul>Chairat Sampanpaisal
  134. 134. Cirrhosis: Diagnosis … <ul><li>A liver biopsy is used to diagnose cirrhosis of the liver. A hollow needle is inserted through the skin and into the liver itself to obtain a tissue sample for analysis. Examination of tissue from a diseased liver reveals destruction of cells and scarring. </li></ul><ul><li>Other diagnostic procedures include nuclear medicine scanning, in which radioactive material is administered and its distribution to the liver is recorded on X-ray film. X-ray pictures are taken of the gallbladder and of bile ducts both inside the liver and leading from it. Important clues that may be found in blood and urine tests include the presence of high levels of bile pigments in the blood, a low red blood cell count (anemia), vitamin and mineral deficiencies, and low levels of protein in the blood </li></ul>Chairat Sampanpaisal
  135. 135. Chairat Sampanpaisal
  136. 136. Cirrhosis: Treatment … <ul><li>Treatment is aimed first at removing the cause of the original injury. For example, an alcoholic patient is told to stop drinking and is placed on a well-balanced diet. Often, thiamin (vitamin B1) and folate supplements are also given. </li></ul><ul><li>If a stone is obstructing an external bile duct, it can be removed. Fluids and salt are usually restricted, to prevent fluid buildup. </li></ul><ul><li>Liver transplantation is sometimes considered. </li></ul><ul><li>Good care includes getting plenty of rest and avoiding infection, which places stress on the liver. </li></ul><ul><li>Avoidance of alcohol intake is paramount in the treatment of cirrhosis and most other liver diseases. A physician should be consulted before any medication, including over-the-counter preparations, is taken. </li></ul>Chairat Sampanpaisal
  137. 137. Treatment … <ul><li>In the client with liver failure, at least 2 months are needed before improvements can be noted. </li></ul><ul><li>The treatment goal is to stop or delay the progression of symptoms. </li></ul><ul><li>The medication lactulose (Cephulac) will promote ammonia retention & excretion through the GI tract. </li></ul><ul><li>To relieve pressure from the fluid of ascites, abdominal paracentesis may be performed. </li></ul><ul><li>Providing a safe & controlled environment will prolong life & stabilize the condition. </li></ul><ul><li>Care must be taken to prevent complications associated with the client’s activity intolerance, such as pneumonia & thrombophlebitis. </li></ul>Chairat Sampanpaisal
  138. 138. Hepatitis <ul><li>An acute or chronic condition of liver inflammation that also may be accompanied by liver tissue damage. </li></ul><ul><li>Viruses are the most prevalent causes affecting several hundred million people throughout the world. </li></ul><ul><li>Alcohol, some drugs, & some autoimmune conditions also cause forms of hepatitis </li></ul>Pavel
  139. 139. Pavel
  140. 140. Hepatitis: Signs & Symptoms … <ul><li>Fatigue and lethargy </li></ul><ul><li>Nausea (sometimes vomiting and diarrhea) </li></ul><ul><li>Loss of appetite </li></ul><ul><li>Abdominal pain </li></ul><ul><li>Joint and muscle aches </li></ul><ul><li>Mild fever (more common in Hepatitis A) </li></ul><ul><li>Malaise </li></ul><ul><li>Jaundice </li></ul><ul><li>Liver enlargement (hepatomegaly </li></ul><ul><li>Dark urine </li></ul>Pavel
  141. 141. Hepatitis A <ul><li>signs & symptoms : (Adults will have signs and symptoms more often than children) </li></ul><ul><ul><li>jaundice, fatigue, abdominal pain; loss of appetite, N/V, fever </li></ul></ul><ul><li>cause : Hepatitis A Virus (HAV) </li></ul><ul><li>long-Term Effects : </li></ul><ul><ul><li>there is no chronic (long-term) infection </li></ul></ul><ul><ul><li>once you have had hepatitis A you cannot get it again </li></ul></ul><ul><ul><li>about 15% of people infected with HAV will have prolonged or relapsing symptoms over a 6-9 month period </li></ul></ul><ul><li>Transmission : oral-fecal </li></ul><ul><li>Persons at Risk of Infection </li></ul><ul><ul><li>Household contacts of infected persons; Sex contacts of infected persons; Persons, especially children, living in areas with increased rates of hepatitis A during the baseline period from 1987-1997 </li></ul></ul><ul><ul><li>Persons traveling to countries where hepatitis A is common </li></ul></ul><ul><ul><li>Men who have sex with men; injecting and non-injecting drug users </li></ul></ul>Pavel
  142. 142. Hepatitis A… <ul><li>Prevention </li></ul><ul><ul><li>Hepatitis A vaccine is the best protection. </li></ul></ul><ul><ul><li>Short-term protection against hepatitis A is available from immune globulin. It can be given before and within 2 weeks after coming in contact with HAV.  </li></ul></ul><ul><ul><li>Always wash your hands with soap and water after using the bathroom, changing a diaper, and before preparing and eating food. </li></ul></ul><ul><li>Vaccine Recommendations </li></ul><ul><ul><li>Vaccine is recommended for the following persons from 12 months of age and older; Travelers to areas with increased rates of hepatitis A </li></ul></ul><ul><ul><li>Men who have sex with men; Injecting and non-injecting drug users </li></ul></ul><ul><ul><li>Persons with clotting-factor disorders (e.g. hemophilia); Persons with chronic liver disease; Children living in areas with increased rates of hepatitis A during the baseline period from 1987-1997. </li></ul></ul><ul><li>Trends & Statistics </li></ul><ul><ul><li>Occurs in epidemics both nationwide and in communities </li></ul></ul><ul><ul><li>During epidemic years, the number of reported cases reached 35,000. </li></ul></ul><ul><ul><li>In the late 1990s, hepatitis A vaccine was more widely used and the number of cases reached historic lows. </li></ul></ul><ul><ul><li>One-third of Americans have evidence of past infection (immunity). </li></ul></ul>Pavel
  143. 143. Hepatitis B <ul><li>Hepatitis B is a serious disease caused by a virus that attacks the liver. The virus, which is called hepatitis B virus (HBV), can cause lifelong infection, cirrhosis (scarring) of the liver, liver cancer, liver failure, and death. </li></ul><ul><li>Hepatitis B vaccine is available for all age groups to prevent hepatitis B virus infection. </li></ul>Pavel
  144. 144. Hepatitis C <ul><li>Hepatitis C is a disease of the liver caused by the hepatitis C virus (HCV). You may be at risk for hepatitis C and should contact your medical care provider for a blood test if you: </li></ul><ul><ul><li>were notified that you received blood from a donor who later tested positive for hepatitis C. </li></ul></ul><ul><ul><li>have ever injected illegal drugs, even if you experimented a few times many years ago </li></ul></ul><ul><ul><li>have evidence of liver disease (e.g., persistently abnormal ALT levels) </li></ul></ul>Pavel
  145. 145. Hepatitis D <ul><li>Hepatitis D is a liver disease caused by the hepatitis D virus (HDV), a defective virus that needs the hepatitis B virus to exist. </li></ul><ul><li>Hepatitis D virus (HDV) is found in the blood of persons infected with the virus. </li></ul>Pavel
  146. 146. Hepatitis E <ul><li>Hepatitis E is a liver disease caused by the hepatitis E virus (HEV) transmitted in much the same way as hepatitis A virus. </li></ul><ul><li>Hepatitis E, however, does not occur often in the United States. </li></ul>Pavel
  147. 147. LIVER ABSCESS <ul><li>caused by the spread of infection from some part of the intestinal tract, perhaps the appendix or gallbladder, or by obstruction of the bile tracts. </li></ul><ul><li>Symptoms are chills, fluctuating temperature, extreme weight loss, n/v, abdominal distention, & right-sided pain in the abdomen & shoulder. Jaundice occurs frequently; pain over the liver is a later symptom. </li></ul><ul><li>If the abscess burst – scatters infection through the abdominal or chest cavity. </li></ul><ul><li>ATBs are given, & the outcome depends on how successful the person is at combating the infection. </li></ul><ul><li>Sometimes an attempt is made to establish drainage by surgery. </li></ul><ul><li>Standard Precautions help prevent the spread of infection </li></ul>
  148. 148. Liver Transplantation <ul><li>Life-threatening end-stage liver diseases have been treated with transplant. </li></ul><ul><li>The success of the transplant relates closely to the body’s acceptance of the foreign organ, technical difficulties, the hazards of immunusuppression, & the availability of a functioning liver for transplant. </li></ul><ul><li>The transplanted liver may be a total replacement or a liver segment. </li></ul><ul><li>During the surgical procedure, hemorrhage is likely and many units of blood are needed. </li></ul>
  149. 149. Liver transplant
  150. 150. Liver Cancer <ul><li>The liver is rarely the site of primary cancer; more often cancer of the liver is metastatic. </li></ul><ul><li>A cancer that does not begin in the liver can be removed surgically by removing the affected part of the liver. </li></ul><ul><li>If cancer is due to metastasis, surgery usually is not indicated; the client is treated palliatively with radiation or chemotherapy. </li></ul><ul><li>Antineoplastic drugs may be infused directly into the liver (intrahepatic). </li></ul>
  151. 151.
  152. 152. Gallbladder Disorders <ul><li>Cholecystitis and Cholelithiasis </li></ul><ul><ul><li>Signs and Symptoms </li></ul></ul><ul><ul><li>Treatment </li></ul></ul><ul><ul><li>Nursing Considerations </li></ul></ul><ul><li>Common Bile Duct Obstruction </li></ul><ul><li>Cancer of the Gallbladder </li></ul>
  153. 153. Cholecystitis & Cholelithiasis <ul><li>common forms of gallbladder disease </li></ul><ul><li>cholecystitis is an inflammation of the gallbladder </li></ul><ul><li>cholelithiasis indicates gallstones – these often occur together & each aggravates the other </li></ul><ul><li>stones may block the duct that leads from the gallbladder – may injure the wall, leading to infection; bacterial contamination of bile often develops, causing serious complications </li></ul>Mariela Trigo
  154. 154. Medical Treatment <ul><li>IV hydration </li></ul><ul><li>Analgesics, ATBs, antispasmodics </li></ul><ul><li>Low-fat diet; alcoholic beverages are contraindicated </li></ul><ul><li>Meperidine (Demerol) may be given for pain’ Morphine should not be used because it is believed to increase the spasms </li></ul><ul><li>Some cases, drugs may be effective in dissolving cholesterol-based gallstones: chenodiol )Chenix); ursodiol (Actigall), a a naturally occuring bile acid that is taken orally & dissolves non-calcium stones by diluting the thick bile that is present. </li></ul><ul><li>Lithotripsy (use of shock waves to disintegrate stones)-useful if only few stones </li></ul><ul><li>Surgical removal of gallbladder (cholecystectomy) or gallstones (cholecystostomy) </li></ul>Mariela Trigo
  155. 155. Nursing Interventions <ul><ul><li>monitor dressing & T-tube (may be inserted into the common bile duct) </li></ul></ul><ul><ul><li>T-tube bag remains at floor level for a short time to allow the release of excess bile; then the bag is raised </li></ul></ul><ul><ul><li>Note level of the container on the NCP, & gradually wean the client from the drainage tube </li></ul></ul><ul><ul><li>Measure & record the amount & character of the bile every 24 hours; if the amount is not diminish in a few days, it may indicate that the bile is not entering the intestine properly </li></ul></ul><ul><ul><li>Protect skin surrounding the tube w/ zinc oxide or petrolatum </li></ul></ul><ul><ul><li>Observe the client’s stools & urine for presence or absence of bile; the bile should disappear, 7 the stools & urine should become normal in color & consistency as function returns; document I&O </li></ul></ul><ul><ul><li>Teach client to maintain low-Fowler’s to facilitate drainage </li></ul></ul><ul><ul><li>Monitor the tube closely to prevent blockage or dislodgement </li></ul></ul><ul><ul><li>After the T-tube has drained for 24 hours, you may be asked to clamp it or 1-2 days before removal </li></ul></ul><ul><ul><li>Client may go home w/ the T-tube in place; teach clamping procedures & what to watch for before discharge; document all teaching; client must watch for signs of jaundice or discomfort when the tube is clamped or removed </li></ul></ul>Mariela Trigo
  156. 156. Nursing Interventions… <ul><li>Advise patient to remain on low-fat diet; avoid alcohol and gas-forming foods </li></ul><ul><li>If abdominal laparotomy is done, nursing care is essentially the same as for any major surgery, w/ the additional responsibilities of assessing & monitoring the amount of bile drainage, protecting the skin around the tube, & providing client teaching regarding bile drainage and tube care. </li></ul><ul><li>TCDB, & use of incentive spirometer </li></ul><ul><li>Regular diet as tolerated after surgery; most clients have no trouble digesting a small amount of fat </li></ul><ul><li>Client may be referred to a dietitian for counseling </li></ul>Mariela Trigo
  157. 157. Common Bile Duct Obstruction <ul><li>a client may retain or develop biliary stones that block bile flow within the common bile duct. Flow blockage may even follow a cholecystectomy. </li></ul><ul><li>sign and symptoms: pt very ill; severe abdominal pain, nausea, and vomiting </li></ul><ul><li>on examination, other symptoms include fever, jaundice, elevated WBC count, or elevated liver and pancreatic enzymes </li></ul>David Vieyra
  158. 158. David Vieyra
  159. 159. Disorders of the Pancreas <ul><li>Pancreatitis </li></ul><ul><ul><li>Signs and Symptoms </li></ul></ul><ul><ul><ul><li>Intractable pain in the epigastric area w/c radiates to the back or upper left side </li></ul></ul></ul><ul><ul><ul><li>Fever, anorexia, N/V are common </li></ul></ul></ul><ul><ul><ul><li>Jaundice may exists if CBD is obstructed </li></ul></ul></ul><ul><ul><li>Treatment </li></ul></ul><ul><ul><ul><li>Medications: analgesics (Demerol, no opiates –may cause spasms), smooth muscle relaxants, anticholinergics, antacids, ATBs </li></ul></ul></ul><ul><ul><ul><li>NPO, IV fluids </li></ul></ul></ul><ul><ul><ul><li>Bed rest </li></ul></ul></ul><ul><ul><ul><li>Bland diet – CHO, low fat, low protein; no spices, alcohol, tea, coffee </li></ul></ul></ul><ul><ul><ul><li>Pancreatic enzyme replacements if needed </li></ul></ul></ul><ul><ul><ul><li>Surgery </li></ul></ul></ul><ul><li>Pancreatic Cancer </li></ul>Yok Thongsingh
  160. 160. Pancreatitis: acute or chronic inflammation of the pancreas, often associated with alcoholism <ul><li>Medical Diagnosis </li></ul><ul><ul><li>High blood sugar </li></ul></ul><ul><ul><li>History & clinical signs </li></ul></ul><ul><ul><li>↑ serum amylase and lipase; pancreatic scan </li></ul></ul><ul><ul><li>X-ray; endoscopy </li></ul></ul><ul><li>Nursing Interventions </li></ul><ul><ul><li>Administer medications </li></ul></ul><ul><ul><li>Position patient on side or semi-Fowelr’s; Maintain NG tube </li></ul></ul><ul><ul><li>Small frequent feedings when food started </li></ul></ul><ul><ul><li>Monitor blood glucose </li></ul></ul><ul><ul><li>Assess bowel function </li></ul></ul><ul><ul><li>Monitor for electrolyte imbalances & report to RN –especially hypocalcemia & dehydration </li></ul></ul>Yok Thongsingh
  161. 161. OBESITY <ul><li>A condition of being over fat, not necessarily overweight </li></ul><ul><li>Defines as being more than 45% over ideal body weight (IBW) </li></ul><ul><li>Body Mass Index (BMI) is another method of quantifying obesity; a BMI of 27kg/m2 is characteristic of obesity </li></ul><ul><li>Charts of “desirable weight” are available, usually from insurance companies, listing desirable weights in relation to height, bone structure, sex, and age </li></ul><ul><li>The ideal percentage of body fat in an adult man is 20%; in adult woman is 25%; a person exceeding this amount is over fat </li></ul><ul><li>Some people, such as athletes, may be overweight, but the weight may be from muscle tissue & not excess fat. </li></ul><ul><li>The percentage of fat is estimated by using calipers to measure skinfold thickness or is measured directly by weighing the person underwater on a special scale </li></ul>Judith Borisoff
  162. 162. obesity Judith Borisoff
  163. 163. Complications … <ul><li>Circulatory disorders (eg, arteriosclerosis, atherosclerosis, HTN, heart attack, or stroke) </li></ul><ul><li>DM (4x the rate of people of normal weight) </li></ul><ul><li>Respiratory difficulties, ranging from SOB & dyspnea to actual lung pathology </li></ul><ul><li>Musculoskeletal disorders </li></ul><ul><li>More susceptible to contagious disease </li></ul><ul><li>Hyperlipidemia develops and fat is deposited in the liver, causing liver damage </li></ul><ul><li>Dermatitis in moist skin folds, chafing, excessive perspiration, and heat intolerance </li></ul>Judith Borisoff
  164. 164. Treatment … <ul><li>If a physical cause is found, it is treated </li></ul><ul><li>Nutritionally sound diet & exercise program are planned </li></ul><ul><li>Client must see a provider at regular intervals to ensure that he/she is maintaining weight loss & new eating patterns & that no other physical problems develop </li></ul><ul><li>Various diets & group counseling systems (Weight Watchers) are available </li></ul><ul><li>Morbidly obese clients need much emotional supports as well </li></ul><ul><li>Surgery may be performed in whom all other forms of treatment have failed (gastric partitioning or stapling –w/c reduces stomach volume by 90%) </li></ul>Judith Borisoff
  165. 165. Treatment… <ul><li>Surgery for morbid obesity (100lb overweight) is normally considered high risk. </li></ul><ul><li>One type of surgery includes intestinal bypass (Roux en Y procedure), in w/c large portion of the intestine is removed, eliminating the body’s ability to absorb calories </li></ul><ul><li>In-depth teaching & pre-and post-op counseling are required </li></ul><ul><li>The person must understand the added surgical risk & must alter eating patterns or he/she will regain the weight </li></ul><ul><li>Complications of gastric stapling or intestinal bypass include fluid & electrolyte imbalance & dumping syndrome </li></ul>Judith Borisoff
  166. 166. Nursing Considerations <ul><li>Client & family teaching concepts include the knowledge that obesity occurs when the number of calories a person takes into the body exceeds the number of calories he/she expends </li></ul><ul><li>Exercise can be highly beneficial; explain types of exercise does not have to be intense but should be routine, at least 3-4/week </li></ul><ul><li>Also, teach client that eating the wrong type of foods (fats) & emotional stress contribute to obesity </li></ul><ul><li>Reinforce the concept that obesity usually occurs with time, & successful weight loss also takes time </li></ul>Judith Borisoff
  167. 167. Anorexia Nervosa <ul><li>characterized by self-imposed starvation. </li></ul><ul><li>an eating disorder characterized by refusal to maintain a minimally accepted body weight, intense fear of weight gain, and distorted body image. </li></ul><ul><li>inadequate calorie intake or excessive energy expenditure results in severe weight loss </li></ul>Aram Z
  168. 168. Anorexia Nervosa Aram Z
  169. 169. Anorexia Nervosa: Overview, Causes, & Risk Factors <ul><li>The exact cause of this disorder is not known, but social attitudes towards body appearance and family factors are believed to play a role in its development. The condition usually occurs in adolescence or young adulthood. It is more common in women, affecting 1-2% of the female population and only 0.1-0.2% of males. </li></ul><ul><li>Anorexia is seen mainly in Caucasian women who are high academic achievers and have a goal-oriented family or personality. Some experts have suggested that conflicts within a family may contribute to anorexia. It is thought that anorexia is a way for a child to draw attention away from marital problems, for example, and bring the family back together. </li></ul><ul><li>Other psychologists have suggested that anorexia may be an attempt by young women to gain control and separate from their mothers. The causes, however, are still not well understood. </li></ul>Aram Z
  170. 170. Anorexia Nervosa: S/S <ul><li>weight loss of 15% or greater below the expected weight </li></ul><ul><li>inappropriate use of laxatives, enemas, or diuretics (water pills) in an effort to lose weight </li></ul><ul><li>self-imposed food intake restrictions, often hidden </li></ul><ul><li>absence of menstruation </li></ul><ul><li>skeletal muscle atrophy </li></ul><ul><li>loss of fatty tissue </li></ul><ul><li>low BP </li></ul><ul><li>dental cavities may be present with self-induced vomiting </li></ul><ul><li>blotchy or yellow skin </li></ul><ul><li>depression may be present in addition to the eating disorder </li></ul><ul><li>most individuals with anorexia nervosa refuse to recognize that they have an eating disorder (denial) </li></ul>
  171. 171. Anorexia Nervosa: Treatment <ul><li>The biggest challenge in treating anorexia nervosa is having the patient recognize that their eating behavior is itself a problem, not a solution to other problems. This means that most individuals enter treatment when their condition is fairly advanced. </li></ul><ul><li>The purpose of treatment is first to restore normal body weight and eating habits, and then attempt to resolve psychological issues. Hospitalization may be indicated in some cases (usually when body weight falls below 30% of expected weight). </li></ul><ul><li>Supportive care by health care providers, structured behavioral therapy, psychotherapy, and anti-depressant drug therapy are some of the methods that are used for treatment. Severe and life-threatening malnutrition may require IV feeding. </li></ul>
  172. 172. Anorexia Nervosa: Complications <ul><li>The presence of any of these suggests a severe disease, and hospitalization may be required: </li></ul><ul><ul><li>severe dehydration, possibly leading to cardiovascular shock </li></ul></ul><ul><ul><li>electrolyte imbalance (such as potassium insufficiency) </li></ul></ul><ul><ul><li>cardiac arrythmias related to the loss of cardiac muscle and electrolyte imbalance </li></ul></ul><ul><ul><li>severe malnutrition </li></ul></ul><ul><ul><li>thyroid gland deficiencies which can lead to cold intolerance and constipation </li></ul></ul><ul><ul><li>appearance of fine baby-like body hair (lanugo) </li></ul></ul><ul><ul><li>bloating or edema </li></ul></ul><ul><ul><li>decrease in white blood cells which leads to increased susceptibility to infection </li></ul></ul><ul><ul><li>osteoporosis </li></ul></ul><ul><ul><li>tooth erosion and decay with self-induced vomiting </li></ul></ul><ul><ul><li>seizures related to fluid shifts due to excessive diarrhea or vomiting </li></ul></ul>Aram Z
  173. 173. BULIMIA <ul><li>Bulimia is an illness defined by food binges, or recurrent episodes of significant overeating, that are accompanied by a sense of loss of control. The affected person then uses various methods -- such as vomiting or laxative abuse -- to prevent weight gain. </li></ul><ul><li>Someone with bulimia may also suffer from anorexia nervosa, an eating disorder involving severe, chronic weight loss that proceeds to starvation, but many bulimics do not suffer from anorexia. </li></ul>Aram Z
  174. 174. Bulimia: Overview, Causes, & Risk Factors <ul><li>In bulimia, eating binges may occur as often as several times daily for many months. These binges cause a sense of self-disgust, which leads to compensatory behaviors like self-induced vomiting or excessive exercise. A person with bulimia may also abuse laxatives, diuretics or enemas in order to prevent weight gain. </li></ul><ul><li>Such behaviors can be quite dangerous and may lead to serious medical complications over time. For example, the stomach acid which is introduced into the esophagus (the tube from the mouth to the stomach) during frequent vomiting can permanently damage this area. </li></ul><ul><li>Women are much more commonly affected than men. The affected person is usually aware that her eating pattern is abnormal and may experience fear or guilt associated with the binge-purge episodes. Although the behavior is usually secretive, clues to this disorder include overactivity, peculiar eating habits or rituals, and frequent weighing. Body weight is usually normal, although the person may perceive themselves as overweight. If bulimia is accompanied by anorexia, body weight may be extremely low. The exact cause of bulimia is unknown, but factors thought to contribute to its development are family problems, perfectionist personalities, and an overemphasis on physical appearance. Bulimia may also be associated with depression and occurs most often in adolescent females. </li></ul>Aram Z
  175. 175. Bulimia… <ul><li>signs & symptoms </li></ul><ul><ul><li>binge eating; self-induced vomiting </li></ul></ul><ul><ul><li>inappropriate use of diuretics or laxatives </li></ul></ul><ul><ul><li>overachieving behavior </li></ul></ul><ul><li>diagnosis & tests </li></ul><ul><ul><li>dental caries or gum infections (gingivitis); the enamel of the teeth may be eroded or pitted because of excessive exposure to acid in vomitus. </li></ul></ul><ul><ul><li>chem-20 may show an electrolyte imbalance (such as hypokalemia) or dehydration. </li></ul></ul>Aram Z
  176. 176. Bulimia… <ul><li>Treatment </li></ul><ul><ul><li>focuses on breaking the binge-purge cycles. </li></ul></ul><ul><ul><li>outpatient treatment may include behavior modification techniques as well as individual, group, or family counseling. </li></ul></ul><ul><ul><li>antidepressant drugs may also be used in cases that are coincide with depression. </li></ul></ul><ul><li>Complications </li></ul><ul><ul><li>pancreatitis; dental cavities </li></ul></ul><ul><ul><li>inflammation of the throat </li></ul></ul><ul><ul><li>electrolyte abnormalities </li></ul></ul><ul><ul><li>dehydration </li></ul></ul><ul><ul><li>constipation </li></ul></ul><ul><ul><li>hemorrhoids </li></ul></ul><ul><ul><li>esophageal tears/rupture </li></ul></ul>Aram Z