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ANATOMY PHYSIOLOGY &DISORDERS

GASTROINTESTINAL SYSTEM
ORGANS OF GI 9 QUADRANTS
ORGANGS OF GI SYSTEM
FUNCTIONS IN SHORT
1. DUODENUM ,JEJUNUM &ILEUM(21FEET)
2. DIGESTION AND ABSORPTION OF END
PRODUCTS
SMALL INTESTINE:
3. BRUNNER,S GLAND IN SUBMUCOSA OF
DUDENUM SECRETES MUCUS
4. CRPTS OF LIBERKULIN SECRETION CONTAINS
DIGESTIVE ENZYMES.

1. CECUM,COLON,RECTUM,ANUS(5 FEET)
2. PRODUCTION OF BILE &SYNTHESIS OF
LARGE INTESTINE
3.
COAGULATION FACTORS
CONJUGATION &EXCRETION OF BILIRUBIN
4. STROAGE OF VIT A ,D ,B12 &IRON.
5. MTB OF FATS,CARBS &PROTEINS
6. CONJUGATION OF SEX HORMONES.

PANCREAS 1. AMYLASE-BREAKDOWN OF STARCH


&CARBOHYDRATES
2. LIPASE-FAT BREAKDOWN
3. TRYPSINOGEN-PROTEIN BREAKDOWN
UGI LGI

BARRIUM SWALLOW;
Colonoscopy: visualization of large
PRE TEST: intestine.
keep NPO(MNS)
Npo-8hrs
Explain procedure lasting for 45 min Laxatives for 1-3 days before
Explain about taste of test ,enema
barium(UNPLEASANT) Consent
Post test : increase fluid intake and taught
about white color stools
Low fat diet for one day before
Endoscopy: visualization of esophagus, test. High fiber for 3 days prior
stomach &duodenum Cholecystogram: Injection of a
Pre test: npo,local anesthetic spray ,remove radio opaque dye to visualize gall
dentures if any. bladder through x-ray
Post test: sore throat and hoarseness of
voice normal, later may develop perforation.
Pre-check for iodine sensitivity
If gag reflex returns then can start feeds

DIAGNOSTICS TESTS
Gastric analysis: requires the
passage of ng tube into stomach to PARACENTESIS:
aspirate gastric contents for Trans abdominal removal of fluid
anlaysis.(evry 15 min for
from the peritoneal cavity.
1hr).administer histamines to
stimulate gasrtic secretions.
Position fowlers
Npo
ERCP: Examination of hepatobiliary
Obtain vitals &weight
system.(Liver,Pancreas.Gallbladder Empty the bladder, and measuring
duodenum ,stomach). abdominal girth
Post test apply dressing
Percutaneous transheaptic Mention amount color of fluid.
cholongiography: with the help of
dye can visualize cystic duct,
common bile duct,gall bladder.
GERD
CAUSES SIGNS&SYMPTOMS

Incompetent lower Heart burn after meals


esophageal sphincter Epigastric pain
Pyloric stenosis Dyspepsia
Motility disorder Regurgitation
Painful swallowing

GERD.
INTERVENTIONS SUGICAL MANAGEMENT

Avoid risk factors.


Avoid eating or drinking 1 hour
beforre bed
Avoid too tight cloths to wear
Low fat food and high fiber
food
Avoid anticholeinergics
Administer histamines (h2
receptors, proton pump
inhibitors, prokinetic
medication)
Head end elevation 40 degre

GERD..
HERNIAS
Protrusion of an organ from its original
cavity through another opening or weak
area.

Types:
1. Reducible

2. irreducible
LOCATION

Inguinal hernia: Weakness in


abdominal wall
Femoral hernia: Protrusion
through the femoral ring(below
groin)
Incisional hernia: Previous
sugery (non-healing)
Umblical hernia: Due to failure
of orifice to close after birth.
Hiatal hernia: Bulging of some
part stomach into diaphragm.

HERNIAS..
RISK FACTORS SIGNS & SYMPTOMS

Congenital Vomiting
Chronic constipation
Protrusion of involved
area
Chronic cough Crampy abdominal pain
Child birth Feeling of fullness
heavy weight lifting SOB
obesity constipation
MANGEMENT POST OP CARE
Manual reduction Assess for possible distended
bladder
Bowel surgery Discourage coughing 7
Herniprraphy/ encourage deep breathing
hernioplasty Asses to splint incision when
Use hernia belt cough or sneeze
Apply ice bags to scrotal
Support abdomen while area(inguinal repair)
coughing Avoid sternous
activities(6weeeks)
Report urinary retention or
difficulty in urination.
GASTRITIS
Inflammation of gastric mucosa or stomach.
Acute gastritis:
By ingestion of food contaminated with disease causing micro organisms or over use of
NSAIDS.

Chronic gastritis:
by benign or malignant or ny autoimmune ,may cause pernicious anemia due
decreased vit b12

CHRONIC
ACUTE GASTRITIS GASTRITIS
Abdominal Anorexia nausea
discomfort vomiting
Anorexia,nausea, Belching
vomiting Heart burn after
Headache eating
Hicupping Sour taste
reflux Vit b12 deficiency
INTERVENTIONS
Keep NPO until symptoms subside
Ice chips and clear liquids
Monitor signs of haemorragic
gastritis,hematemesis,tachycardia,hyp
otension.
Avoid irritating foods
Vit b12 defeciency,antibiotics.
antacids
PEPTIC ULCER DISEASE
Predisposing factors
Smoking
Alcohol
Stress
Drugs(steroid,salicylates.aspir
in)
Signs &symptoms
1. Pain in left epigastrium & radiate
to back
2. Pain occurs after meals (30-60
min)
3. Weight loss
4. Anemic
5. Normal gastric acidity
6. Relieved pain with antacid
GASTRIC ULCER DUODENAL ULCER

Involves ulceration of mucosal Breakdown of mucosa of the


lining that extends to the sub duodenum
mucosal layer of the stomach. Assesment:
Assesment: Burning pain
Gnawing, sharp pain Mid epigastric 2-3 hrs after
Mid epigastric pain(30- meal 7 during night
60min)after meal Melena is common
Food ingestion accentuates the Pain relieve by ingestion of
pain. food
Hematemesis more common than
malena Complications:dumping
R/F:NSAIDS,OH,Streoids.H.pylo syndrome
ri
PUD..
MEDICAL MGT
NURSING MANGEMENT

Rest,bland diet,stress Most priority for PUD= insertion


management. of NG tube
Drug therapy: Antacids
Antacids,histamines,receptor
Bland diet (6meals per day)
antagonists Eat meals slowly
Anticholinergic(omeprazole,
Avoid acids producing
sucralfate) substances(caffeine,alcohol, highly
seasoned foods)
Metronidazole and amoxicillin Avoid late bed snacls
for Pylori All 6 right of medications
Surgery : Various continuous of Teach stress relaxation techniques
gastric resections and Plan for rest periods after meals.
anastomosis.

INTERVENTIONS
GASTRIC SURGERY

Vagotomy =severing of part of


the vagus nerve innervating the
stomach to decrease gastric
acid secretion.
Anterectomy :removal of
antrum to eliminate the gastric
phase of digestion
Pyloroplasty :enlargement of
the pyloric sphincter with
accelaration of gastric
emptying
DUMPING SYNDROME
Rapid emptying of stomach
contents into the intestine
Nursing intervntions:
Avoid milk sugar,salt
Small frequent meals
Monitor weight daily
Avoid concentrated sweets
Flat position after meals
after 30 min,later semi
fowlers
High protein ,fat low carbs
Antispasmodics to administer
CROHN'S DISEASE
ULCERATIVE COLITIS

Inflammation of bowel both Is a disease that spans the entire


small and large intestine. length of the colon & involves only
(terminal ileum, ascending colon the mucosa & submucosa.
&cecum)
Character:inflammation,thickening,
congestion,edema,&minute
Character: thickness of the lacerations, that ooze blood to
bowel wall,particularly develo abcess.
submucosa. Etiology:
Etiology: 1. Contributing factors
1. Autoimmune reaction 2. Autoimmune factors\emotional
2. Pschologic disorders factors
3. Viral infections
3. Food allergies
4. Food allergies

INFLAMMATORY BOWEL DISORDERS


CHRONS (REGIONAL ENTERITIS) ULCERATIVE COLITIS

Right lower quadrant pain (cramp ) Colicky pain in left lower


quadrant.
Abdominal distension
Severe diarrhea
Nausea vomiting,dairrhea
Severe weight loss
Stool soft or semiliquid
Malena
Rare malena
Anorexia
Steatorrhea
Decreased skin turgor
Weight loss due anorexia
Abdominal tenderness over
Malabsorption of vitamins
the colon
electrolytes
Colicky pain after meals
Decreased skin turgor
SIGNS AND SYMPTOMS
MEDICAL MANAGEMENT
SURGICAL MANAGEMENT

Anticholinergics Resection of diseased


Antidiarheals portion
Antimicrobials Ileostomy
Antispasmodics Temporary or
Corticosteroids permanent anastomosis
of bowel
Immunosuppresants

ULCERATIVE COLITIS & CROHNS


DISEASE
ULCERATIVE COLITIS CROHNS DISEASE

Avoid spicy foods,caffeine TPN


,milk. Provide high protein high
Low fibre & bland diet calorie,low fibre diet &iron
Increase fluid intake Avoid milk & milk products
If severe keep NPO Record n.o.t and
IV & electrolyte replacement charecteristics of stool daily
Blood transfusion Omit gas producing foods
&fluids from diet
Provide sitz bath & perineal
care .

NURSING MANAGEMENT
COLOSTOMY CARE
Asses stoma for color and intactness
Prevent skin breakdown, use a skin barrier to protect skin around stoma
Avoid the use od adhesives
Monitor characteristics of stool
Record type, amount color of drainage
Cover wound with dry dressing use petroleum gauze
Change pouch or seal whenever neccesary
Empty or clean bag frequently
Avoid gas producing foods
Fecal matter should not touch the skin
Should not give supository
During colostomy irrigation maintain in high fowelers position if patient
in bed or use toilet
CHARACTERISTIC OF STOOLS IN COLOSTOMY

If transverse colon =semisolid


If ascending solon =liquid
If descending colon =normal stools
INTESTINAL OBSTRUCTION

Mechanical intestinal
obstruction Paralytic ileus
Vascular obstruction

Physical blockage of the


passage by subsequent Interference with
distension of fluid and the nerve supply to
gas the intestine
resulting in
decreased or
Interference with
absent peristalsis the blood supply to &
Adhesions
Hernias
portion of the
Volvulus
intestine resulting in
Intussusption
ischemia and
IBD
Abdominal surgery gangrene of the
Foreign vodies
Peritonitis bowel
Pancreatic toxic conditions
Strictures Shock
Neoplasms Spinal cord injuries
Fecal impaction Electrolyte imbalance
SIGNS &SYMPTOMS

Small intestine; non- fecal vomiting,colicky


intermittent abdominal pain.

Large intestine: cramp like pain abdominal pain


Occasional fecal type vomitus
Unable to pass stools or flatus
Abdominal distension
Rigidity & vomit after eating
High pitched bowel sounds above the level of the
obstruction
Bowel sounds above obstruction will increase and if below
decreases.
INTERVENTIONS
Npo ,iv fluids
NG tube intestinal tube
Fowlers position
Encourage nasal breathing to minimize
swallowing of air
Abdominal girth daily monitor u/o & signs
of peritonitis
Manage with decompression
DIVERTICULITIS
Is a outpouching of
intestinal mucosa
Causes:stress
Congenital weakness of
muscular fibers of
intestine.
Dietery deficiceny of
fibre
Iap incerased
SIGNS & SYMPTOMS
Cramp like pain(Lt) Complication
Diarrhea or constipation
with blood or mucus
Nausea or vomiting Perforation
flatulence\ Hemorrhage
Fever Inflammation
Pain increase with Fistula
coughing or lifting
abscess
MANAGEMENT
No seeds and high Resection of
residue fiber diseased portion of
Low residue diet for colon with
diverticulities temporary
Drugs like bulk colostomy may be
laxatives
indicated
Stool softeners
Anticholinergics
antibiotics
APPENDICITIES
Inflammation of the Dont give enema or
appendix due to infection cathartics or heat pad
in the cecum. ,laxatives
Causes:mechanical Antipyretics& antibiotics
obstruction Appendecetomy: npo & IV
Prolonged constipation fluids
Low fiber diet Semi fowlers position
s/s:nausea ,vomiting Antibiotics
Mcburns point pain Complication:ischemia,gang
Fever,diarrhea rene,rupture,peritonitis
Abdominal distension
PERITONITIES
Causes: trauma(blunt or Abdominal distension& pain
penetrating) Hypovolemic shock
Inflammation(ulcerative Absence of bowel sounds
colities Tachycardia,ht muscular
Volulus rigidity
Intestinal obstruction or
ischemia
s/s: Edema,vascular Mgt:
congestion Antibiotics
Hperosmolarity of the bowel Laporotomy
Plasma like fluid out pouring Bowel resection
from the abdomen ,shallow Monitor for septic shock
respirations,ANV.fever Fowelrs positioing
HEMORRHOIDS
Dilation of the veins
of the rectum and
the anus
Due to impairment
of flow of blood
through venous
plexus
HEMORRHOIDS
Predisposing factors s/s
Long standing
Pain with defecation
Prolonged constipation
Bleeding with
Pregnancy
defecation
Heavy lifting
Hard stools with
Obesity

Straining defecation
streaks of blood
Portal hypertension Protrusing of

Increased intra external hemorrhoids


abdominal pressure
MANAGEMENT
Stool softeners Assess rectal
Local anesthetics bleeding
High fiber and Dressing every 2-3
adequate fluids hours
Cold application Side lying or prone
position
Provide flotation pad
while sitting
Sitz bath perineal
care
Ice pack
HEPATITIS
SIGNS & SYMPTOMS
Fatigue,ANV Amenorrhea
Weight loss Jaundice
Flatulence Briusing
Irregular bowel habits
Indigestion
Spider angiomas
Hepatomegaly
palmar erthyema,
Mood changes
Mucular atrophy
alertness mental ability
Gynocomastia
Decreased axillary
&Pubic hairs in males
NURSING MANAGEMENT
Bed rest Adminster
Hand wash
immunization
Administer antiemetic

before 30 min of meals


Personal hygiene
Small frequent meals Admin steroids
Cloths to be light ,cool Isg for hep a& b
&non restrictive clothing
Keep nails short
Diet high calorie,carb
&low fat
Skin care
Provide positive isolation
Vitamin supplements
Avoid sedatives opiates ABCD & K
drugs
CIRRHOSIS OF LIVER
Is characterised by Postnecrotic
progressive cirrhosis:severe
inflammation,fibrosis &
degeneration of the liver
inflammation with massive
parenchymal cells.-destroyed necrosis-complication viral
liver cells-scar tissue- hepatitis
malfunction of liver. Biliary cirrhosis: due to
Larnners cirrhosis: due billiary obstruction in
to alcohol abuse & common bile duct-chronic
malnutrition-accumulation impairmrnt of bile
of fat in liver-scar excreation
formation Cardiac due to rt side
HF,hepatomegaly
S/S COMPLICATIONS

ANV Persistant HT- due to


persistent increase in portal
Changes in mental state vein pressure that develops as
a obstruction.
On percussion +fluid wave & shifting
dullness on percussion.

Abdominal distension with striae Ascities: accumulation of free


&prominent veins fluid in the abdominal cavity-
produces
SOB hypoalbunemia,increased portal
pressure,hyperaldosteronism
Peripheral edema

CIRRHOSIS OF LIVER
MEDICAL SURGICAL

Restrict: Paracentesis
Na to 200to 500mg /day Leveev shunt
Fliud 1lit-1.5/day
Peritoneal venous shunt
High calorie
Ligation of esophageal
Diuressis and gastric veinsto stop
High fowlers acute bleed.
Abdominal girth Spllenorenal sshunt
Inspect and palapate Mesocaval shunt
exttremities
Apply lotion on skin

MANAGEMENT
CHOLECYSTITIS

Causes: obesity Npo with NG tube & iv


Oral contraceptives fluids
Post menopause with estrogen
Analgesics,norcotics


therapy
except morphine sulfate
s/s
Anticholinergics &
Epigastric pain antiemetics
After a heavy meal pain To releive prurities
Intolerance for fatty foods Provide small frequent
Pruritis easy bruising meals if oral allowed
Jaundice, morphys sign
SURGICAL MANAGEMENT
Cholecystectomy First 24 hrs:bile will
Choledochostomy
appaer brown to yelllow

ERCP
500-1000ml/day
Ph=7.8
Care of T- tube:
Stomach content gastric


Semi fowlers
Amount,color,consistency and odour juice-1500ml/day,ph1.0-
of drain. 3.0
If bile drain increase or fowl odor
report HCP
Avoid clamp,irriagte aspiarte of T-
tube
With dr.order clamp the tube
before the meal & observe for
abdominal discomfort & distension.
ACUTE CHRONIC
Shortness of breath Abdominal pain
Oliguria
,tendernesss

Mid epigastric pain (lt upper quadrant )


radiating to back Steotorrhea &foul
Pain agravated by
smellingstools

fatty meal-OH-recumbent position


ANV,weight los Weight loss
Absence of bowel sounds
Muscle wasting

Cullens sign: discolaration of


Jaundice
periumblical and abdominal area s/s of DM
Turners sign: bluish discolation
around flanks

PANCREATITIS
INTERVENTIONS
Administer
analgesics,antacids,anticholinergics,OHA,h2
receptors as ordered
With hold food and fluids and eliminate odour
NG tube for continues drainage
High carb, high protein and low fat,
Complications
TPN Abdominal
distension
Avoid alcohol.caffeine Weight loss
Epigastric pain
Frothy /foul smelling
,bowel movement
Hyperthermia
irritability
ACUTE CHRONIC
Shortness of breath Abdominal pain
Oliguria
,tendernesss

Mid epigastric pain (lt upper quadrant )


radiating to back Steotorrhea &foul
Pain agravated by
smellingstools

fatty meal-OH-recumbent position


ANV,weight los Weight loss
Absence of bowel sounds
Muscle wasting

Cullens sign: discolaration of


Jaundice
periumblical and abdominal area s/s of DM
Turners sign: bluish discolation
around flanks

PANCREATITIS