Organs of Digestive tract
Mouth; stomach; small intestine; large intestine; rectum and anus
Small intestine
Location where most absorption occurs
Large intestine
Most important function is to absorb water and electrolytes
Inflammation and Damage to the GI lining
Hemorrhage- anemia; Perforation- peritonitis; Decreased mucosal function- malabsorption; Decreased bacterial containment- sepsis
S&S Common to GI disorders
Anorexia; nausea; vomiting; GI bleeding- blood in stools, melana (dark tarry foul smelling), hematemesis (bloody emesis), coffee grounds
Peptic Ulcer Disease (PUD)
Can be caused by stress which decreases blood flow to cells that make bicarb layer which creates an ulcer that allows acid to eat into stomach wall which can lead to blood in stools.
Can also be caused by bacteria such as H. pylori
gnawing or burning pain
One kind of bowel problem leads to the other
Inflammation causes obstruction and obstruction causes inflammation and they both lead to malabsorption
Dysphagia (disorder of the esophagus)
Difficulty swallowing- the muscles and nerves that help move food through the throat and esophagus are not working right
Things that cause Dysphagia
CVA; narrowing of esophagus; lack of salivary secretions; weakness of the muscles; disruption of nerves;
Something is blocking your throat or esophagus- GERD, Esophagitis, Tumor
Teaching for patient with Dysphagia
Chin tuck and then swallow
Hiatal Hernia
Stomach bulges up into the chest through the hiatus
Sliding hiatal hernia
Stomach and the section of the esophagus that joins the stomach slide up into the chest through the hiatus (most common type)
Paraesophageal Hiatal hernia
Esophagus and stomach stay in their normal locations, but part of the stomach squeezes through the hiatus, landing it next to the esophagus. You may have no symptoms, but it is a medical emergency. The danger is that they stomach can become "strangled", o
Hiatal hernia symptoms
No symptoms; burning or chest pain; heartburn; dysphagia; GERD
Cause for GERD
Failure of upper or lower esophageal sphincter
Nurse teaching for Patient with GERD
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Predisposing causes of GERD
Hiatal hernia; incompetent lower esophageal sphincter(LES); decreased esophageal clearance; decreased gastric emptying
Triggered by ingestion of foods that decrease the LES pressure:
Fatty foods, chocolate, peppermint, ETOH, nicotine, tea, coffee
GERD
S&S: Heartburn (pyrosis) 30-60 minutes after meal, evening onset; pain in epigastric area that radiates to throat, shoulder, or back
Disorders of the stomach
Acute gastritis; chronic gastritis; Ulcer disease (peptic and stress); Cancer of the stomach
Gastric mucosa
Irritated by the inhibition of prostaglandins as a result of NSAIDs, ETOCH, and bacteria (H. pylori)- which thrives in acid environment of the stomach and disrupts mucosal barrier that protects the stomach from harmful effects of its digestive enzymes
Acute gastritis
Hemorrhage into the mucosa and maybe cause sloughing; transient inflammation of gastric mucosa; most commonly associated with local irritants such as bacterial endotoxins, alcohol, and aspirin
Chronic gastritis
No visible signs of erosion and the inflammatory changes have lead to atrophy of stomach epithelium
Peptic ulcer necrosis
Will eventually lead to perforation which will allow bowel fluid to get out and cause patient to become septic
Gastric Peptic ulcer
- Stomach
- Left epigastric pain
- Pain increases with food intake- 1-2 hour
- Hematemesis is more common than melena
Duodenal Peptic ulcer
- Duodenum
- Midepigastric pain 2-4 hours after eating
- Pain decreases with food intake
Upper GI bleeding
- Arterial (bright red, profuse)
- Venous coffee ground, brown; has been partially digested; melena- tarry stools from a slow UGI bleed
Complications of Peptic Ulcer
Hemorrhage- caused by bleeding from granulation tissue or from erosion of an ulcer into an artery or vein
Obstruction- caused by edema, spasm, or contraction of scar tissue and interference with the free passage of gastric contents through the pylorus or
Frank Hematemesis
Hemorrhage above the stomach
Coffee-grounds vomitus
Hemorrhage into the stomach with partial digestion of blood
Occult blood
Hemorrhage into the intestines with blood mixing into stools
Melena
Hemorrhage into the intestines with large volumes of blood
Red blood coating stools
Hemorrhage in the rectum
Inflammations of the Small and large intestines
Infectious enterocolitis (viral and bacterial infections); Inflammatory bowel disease (Crohn's and UC); Diverticular disease; appendicitis
Intestinal Obstruction
Mechanical - most common- Adhesion, hernia, neoplasm, most are in small intestine, in ileum
Non-mechanical- Paralytic ileus, acute pancreatitis, appendicitis, electrolyte abnormalities, ischemia
Paralytic Ileus
Obstruction of the intestine due to paralysis of the intestinal muscles. Common after abdominal surgery
Obstruction High in small intestine
Usually rapid onset with projectile vomiting of bile-containing emesis and pain relieved with vomiting
Obstruction low in small intestine
Gradual onset; orange brown, fecal smelling emesis; persistent colicky abdominal pain
Treatment of obstruction
Intentional decompression by removing gas and fluid with NG tube placed to suction; correction and maintenance of fluid and electrolyte balance; relief or removal of obstruction- may require surgery
S&S Crohn's
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S&S UC
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Diverticular Disease
Caused by: Increased intraluminal pressure causes out pouching; usually a weakness in intestinal wall from effects of diets; Bacteria from food become trapped in pouches
Chronic form- causes thickening of intestinal walls leading to obstruction which may
S&S of Diverticulitis
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Appendicitis
- Inflammation of the appendix by an obstruction (feces, foreign object, or tumor)
S&S:
- Dull pain near the naval or upper abdomen can become sharp (usually first sign)RLQ
- Loss of appetite
- N/V
- Abdominal swelling
- fever of 99-102
- Inability to pas
Peritonitis
Inflammatory response of the peritoneum. Occurs when bacteria or another irritant enters the area following a defect in the wall of an abdominal organ- perforated peptic ulcer, ruptured appendix, perforated diverticulum, abdominal trauma and wounds
S&S
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Common causes of constipation
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When to seek care
- Symptoms are severe and last longer than 3 weeks
- Recent and significant change in bowel habits, for instance, constipation alternates with diarrhea
- Symptoms of other diseases in addition to constipation (for ex. tiredness, fatigue, poor tolerance to