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Yolanda Chandler, MSN,RN
Lower GI and Accessory System Alterations
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Increased frequency of BMIncreased amount of stoolAltered consistencyAll acute diarrhea considered infectious until
cause knownViralBacterialParasitic
Diarrhea
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Antidiarrheal DrugsDemulcent
Soothes, coats, protects mucous membranes Pepto-Bismol
AnticholinergicInhibits GI motility
Lomotil/ImodiumAntisecretory
Prolongs intestinal transit time Sandostatin
OpiodDecreases CNS stimulation of GI tract motility &
secretion-directly inhibits GI motility Paregoric
Diarrhea
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Involuntary passage of stoolRisk factors:
ConstipationDiarrheaObstetric traumaFecal impactionOther
Prevention/tx may be managed by bowel training program
Fecal Incontinence
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Decrease in frequency of BM from pt. “normal”
Hard, difficult-to-pass stoolsDecrease in stool volumeRetention of feces in rectumGoals:
Increase intake of fiber/fluidsIncrease physical activityHave soft, formed stoolsNo complications
Constipation
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Drug TherapyBulk forming
MetamucilStool softeners
Colace Lubricants
Oil retention enemaSaline and osmotic solutions
MOM, GoLYTELY, Fleet enemaStimulants
Cascara, DulcolaxSelective chloride channel activator
AmitizaSerotonin type 4 receptor partial agonist
Zelnorm
Constipation
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Intermittent & recurrent abd. pain and stool pattern irregularities-classified as:
IBS w/diarrheaIBS w/constipationIBS w/diarrhea & constipation
Irritable Bowel Syndrome
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Management
Irritable Bowel Syndrome
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Most common causesObstruction of lumen by fecalith (accumulated feces)Foreign bodiesTumor of cecum or appendix Intramural thickening from excessive growth of
lymphoid tissue Clinical manifestations
Persistent/continuous pain beginning in peri umbilical area eventually shifting to right lower quadrant (McBurney’s point)
AnorexiaNausea/vomitingLocalized/rebound tendernessMuscle guardingMay or may not have low grade feverRovsing’s sign
Appendicitis
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Diagnostic StudiesComplete history/physicalWBC countUA*Ultrasound*CT
ManagementAppendectomy
PreoperativePostoperative
Appendicitis
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Etiology/pathophysiologyClinical Manifestations
Abdominal pain-most common symptomTenderness over involved area-universal signRebound tendernessMuscle rigidity/Spasm Lie still/shallow respirationsAbd distention/ascitesFever 100-101TachycardiaTachypneaN/VAltered bowel habits
Peritonitis
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ComplicationsDiagnosticsManagement
Peritonitis
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Crohn’s DiseaseUlcerative Colitis
Inflammatory Bowel Disease
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PathophysiologyClinical ManifestationsAssessment/Diagnostic FindingsComplications
Inflammatory Bowel Disease-Crohn’s
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PathophysiologyClinical ManifestationsAssessment/Diagnostic FindingsComplications
Inflammatory Bowel Disease-Ulcerative Colitis
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ManagementNutritional TherapyPharmacologic TherapySurgical Management
Inflammatory Bowel Disease
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May occur in small intestine/colonMay be partial/complete
MechanicalFunctional
Intestinal Obstruction
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Small BowelPathophysiologyClinical ManifestationsAssessment/Diagnostic Management
Intestinal Obstruction
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Large BowelPathophysiologyManifestationsAssessment/diagnosticManagement
Intestinal Obstruction
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NeoplasticNon –neoplastic
ManifestationsDiagnosis
Polyps
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PathophysiologyManifestationsAssessment/Diagnostic FindingsComplicationsManagement
Colorectal Cancer
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Ostomy Surgical procedure that allows intestinal contents
to pass from bowel through opening in skin on abdomen
Used when normal elimination route no longer possible
Described according to location and typeIleostomy
ostomy in ileum Sigmoid colostomy
ostomy in sigmoid colonTransverse colostomy
ostomy in transverse colon, etc.
Ostomies
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Major types End stomaLoop stomaDouble barreled ostomy
Ostomies
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Ostomy surgeryPre-op
Selection of op siteAssess
Physical Psychological Social Cultural Educational
Bowel prepProphylactic antibiotics
Post-opAssess
Stoma /surrounding tissue/pouching system
TeachOstomy care
Ostomies
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Colostomy care Ascending/transverse colon
Semiliquid stools Sigmoid/descending colon
Semiformed/formed stools Dietary modifications to decrease gas/odor Irrigations
Ileostomy care Liquid stool Stoma protrusion of 1-1.5 cm makes care easier Pouch at all times Always use skin barrier Monitor for fluid/electrolyte imbalances Increase fluid to 2-3Liters daily (include sports drinks) Low fiber initially-reintroduce fiber gradually Stoma may bleed easily
Ostomies
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Adaptation to ostomyGrief reactionADLs resumed 6-8 weeks-avoid heavy liftingSexual dysfunction
Pelvic surgeryRadiationChemoMedsFatigue Body image
Ostomies
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PathophysiologyClinical ManifestationsAssessment/DiagnosticsComplicationsManagement
Diverticular Disease
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May be:ReducibleIrreducible/incarceratedStrangulated
Types
Hernias
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Clinical ManifestationsManagement
Hernias
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PathophysiologyClinical ManifestationsAssessment/DiagnosticManagement
Conditions of Malabsorption
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Dilated veins of anal canalRectal bleeding w/defecation-bright redPruritisProlapsePainBurning
Hemorrhoids
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Nursing Management
Hemorrhoids
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Anorectal Abscess
Collections of perianal pusSecondary to:
Anal fissures Trauma Inflammatory Bowel
disease Immunosuppressive
(AIDS)Diagnosed by
Rectal examSurgical therapy
I&DPossible packingTeaching
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Anal Fistula
Abnormal tunnel leading from anus or rectum
Complication of Crohn’s
Feces may enter fistula causing infection
Surgical Therapy
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Pilonidal Sinus
Hairs penetrate into epithelium/SQ tissue
No symptoms unless infected
Abscess requires I&D
Pack woundsSitz baths
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Yellowish discoloration of body tissuesResults when concentration of bilirubin in
blood becomes abnormally increasedA symptom rather than a diseaseUsually 1st detected in sclera and skinTypes
HemolyticHepatocellularObstructive
Jaundice
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Viral Hepatitis
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Fecal-oral routeSources of infection/spread of disease
Crowded conditionsPoor personal hygienePoor sanitationContaminated food/drinkInfected food handlers
Hepatitis A
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Sources of infection/spread of diseasePerinatally by mothers infected w/ HBVPercutaneous (IV drug use)Mucosal exposure to infectious blood, blood
products, or other body fluids (semen, vaginal secretions, saliva)
Tattoos/body piercing w/contaminated needlesBites
Hepatitis B
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Mode of transmission/sources of infectionPrimarily PercutaneousMucosal exposureHigh risk sexual contactPerinatal contact
Hepatitis C
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Cannot survive on its ownRequires HBV to replicateRoutes of infection same as Hepatitis BSource of infection same as Hepatitis BBlood is infectious at all stages of HDV
infection
Hepatitis D
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TransmissionFecal-oralMost common mode of transmission-drinking
contaminated waterPrimarily in underdeveloped countries
Hepatitis E
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TransmissionParenteralSexually
Coexists with other viral infections
Hepatitis G
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Toxic HepatitisDrug Induced Hepatitis
Non Viral Hepatitis
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Hepatitis
Manifestations-Acute Anorexia N/V Right upper quad pain Constipation/diarrhea Decreased taste/smell Malaise/fatigue Headache Fever Arthralgia Urticaria Hepatomegaly/
splenomegaly Weight loss Jaundice/pruritis Dark urine Bilirubinuria Light stools
Manifestations-chronic
MalaiseFatigueHepatomegaly
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ManifestationsDiagnosticsManagement
Cirrhosis
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TypesAlcoholicPost necrotic Biliary
Cirrhosis
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Tortuous veins at lower end of esophagus, enlarged & swollen as result of portal HTN
Bleeding esophageal varicies most life threatening complication of cirrhosis
*Massive hemorrhage is medical emergency
Esophageal Varices
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Management of nonbleeding variciesβ-blockers
Management of bleeding variciesDrugsSandostatinVasopressinNitroglycerinβ-adrenergic blockers
Endoscopic therapiesSclerotherapyLigation of varicesShunt therapyBalloon tamponade
Minnesota or Sengstaken-Blakemore tube
Esophageal Varices
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ManifestationsManagement
Ascites
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Neuropsychiatric manifestation of liver damageDisorder of protein metabolism/excretionLarge quantities ammonia in systemic
circulationGrading system used to classify stages Asterixis Fetor hepaticus
TreatmentAntibioticsLactuloseCathartics/enemasTreat precipitating causes (Table 44-12)Possible liver transplant
Hepatic Encephalopathy
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IndicationsComplicationsManagement
Liver Transplant
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Liver Cancer
Primary carcinomaHepatocellular carcinoma most common
primary CACholangiomasCommonly metastasize to lung
Metastatic carcinomaMore common than primary
ManifestationsDiagnosticsManagement
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PathoManifestationsDiagnosticsManagement
Acute Pancreatitis
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Chronic Pancreatitis
ManifestationsAssessment/DiagnosticsManagement
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Causes ManifestationsDiagnosticsManagement
Pancreatic Cancer
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Cholecystitis (inflammation of gallbladder)
Cholecystitis
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Gall stones
Cholelithiasis
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Primary cancer uncommonOften not detected until advanced diseaseTreatmentNursing management
Gallbladder Cancer
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Major indication for liver transplant in childrenManifestations
Appears healthy at birthAcholic stools (light in color d/t absence of bile)Bile-stained urineHepatomegaly
DiagnosticsLiver function studiesClotting studiesUrine/stool studiesPercutaneous liver biopsyCholangiography
Biliary Atresia
Biliary Atresia
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ManagementExploratory laparotomyKasai procedureMange malnutritionProvide symptom relief
Biliary Atresia
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Nursing interventions directed toward:Nutritional supportSkin careDevelopmental stimulationContinued assessmentEducationEmotional support
Biliary Atresia
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Serious inflammatory condition of intestinesMost common GI medical/surgical emergency in
neonatesEtiology remains elusiveManifestations-(one or more of following)
Feeding intoleranceDelayed gastric emptyingAbdominal distention/tenderness Ileus/decreased bowel soundsAbdominal wall erythema (advanced stages) Change in stool patternPalpable abdominal mass
Necrotizing Enterocolitis
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