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Disease Information
Name(s) of Disease: Colo-Rectal Cancer, 3rd most common cancer in the US
General description: Malignant tumors on the bowel.
Pathology/ Causes: NSAIDS, hormone replacement therapy in post menopausal women,
those with Lynch Syndrome are more likely to get it.
family history,
Signs and Symptoms: Adenomatus Polyps: Aden carcinomas in rectum and sigmoid colon, Often produces no
symptoms until it is advanced. Change in bowel habits, bleeding (anemia), pain, and anorexia
DX: CBC, Fecal Occult Blood Testing, CEA (carcinoembryonic antigen) a specific tumor marker,
Sigmoidoscopy, Colonoscopy, Chest X-ray (for metastasis), CT scan, Tissue Biopsy is the main thing used to
confirm dx.
TX: Surgery: Laser photon coagulation: endoscopically use heat to destroy small tumors and for palliative
measures.
Excision/Fulgration: used to reduce the size of some large tumors, palliative
Colostomy/illeostomy: used to reroute waste out of the abdomen. Used when parts of the colon become
damaged.
Commonly used drugs: Radiation: used along with resection for rectal tumors used pre and post
operatively to prevent reoccurrence and to reduce the size of the tumor
Chemotherapy: used to reduce spreading and post-op to prevent reoccurrence.
Diet: Low residue, or whatever the client can tolerate. May be NPO if they are on bowel rest.
Nursing interventions: Pallative
Nursing Diagnosis: Pain, Imbalanced nutrition, less than body requirements, anticipatory grieving, Risk
for sexual dysfunction.
Major Complications: bowel obstruction (caused by tumor), perforation of bowel by tumor, and direct
extension of tumor into adjacent organs.
Other: Early Diagnosis is important, everyone should have an anal digital rectal exam by age 40, with fecal
occult testing by age 50, with sigmoidoscoopy or colonoscopy every 3-5 years after age 50.
Disease Information
Name(s) of Disease: Diverticular Disease
General description: Saclike projections (pockets) of mucusa through the muscular layer of colon, 90-95% in
sigmoid colon
Pathology/ Causes: Diverticula form when bowel mucosa herniates through defects in the colon wall. Highly
refined and fiber deficient foods is major factor. Postponement of defecation can contribute. Increased
incidence with age.
Signs and Symptoms: left sided pain, abdominal cramping, constipation or diarrhea, narrow stools, occult
bleeding, weakness and fatigue
DX: WBC – leukocytosis with a left shift (increased number of immature WBC)
Hemocult (presence of occult blood)
Barium enema – not when acute episode – may leak into peritoneal cavity
Abdominal x-ray
CT scan, flexible sigmoidoscopy or colonoscopy
TX:
Commonly used drugs: Broad band antibiotics (Flagyl, Cipro, Septra, Bactrim)
Pentazocine (Talwin) for pain
Stool softener (Dulcolax) but NO laxative (may increase pressure in colon)
Diet:VERY IMPORTANT
High fiber, Bran, Metamucil
NO seeds (popcorn, caraway, figs, berries
Nursing interventions: Bowel rest for acute episode
Impaired Tissue Integrity – risk of perforation, sepsis
PAIN
ANXIETY
Major Complications: Bowel obstruction, fistulas, and hemorrhage
Other:
Disease Information
Name(s) of Disease:
Gastritis (p. 555-559)
General description:
Inflammation of the stomach lining, results from irritation of the gastric mucosa.
Acute Gastritis: Most common form; generally a benign, self limiting disorder associated with the ingestion of
gastric irritants such as aspirin, alcohol, caffeine, or foods contaminated with certain bacteria.
Chronic Gastritis: A separate group of disorders characterized by progressive and irreversible changes in the
gastric mucosa. More common in the elderly, chronic alcoholics, and cigarette smokers.
Pathology/ Causes:
Acute Gastritis: Disruption of the mucosal barrier by a local irritant which allows hydrochloric acid and
pepsin to come into contact with the gastric tissue, resulting in irritation, inflammation, and superficial erosions.
The gastric mucosa rapidly regenerates with resolution and healing occurring within several days.
Caused by ingestion of aspirin or other NSAIDS, corticosteroids, alcohol, and caffeine
Erosive Gastritis: A severe form of Acute Gastritis. Erosive or stress-induced gastritis. Occurs as a
compication of other life-threatening conditions such as shock, severe trauma, major surgery, sepsis, burns, or
head injury. When these erosions are caused by burns they are called Curling’s Ulcers. When followed by a
head injury or CNS surgery, they are called Cushing’s Ulcers.
Caused by ischemia of the gastric mucosa resulting from sympathetic vasoconstriction, and tissue injury due to
gastric acid.
Chronic Gastritis: A progressive disorder that begins with superficial inflammation and gradually leads to
atrophy of gastric tissues. Initial phase is a change in gastric mucosa with a decrease in mucus. Two different
forms: Type A and Type B
Type A Gastritis: Less common form of chronic gastritis…usu. Affects people of Northern European heritage.
Thought to have an autoimmune component where body produces antibodies which destroy gastric mucosal
cells, resulting in tissue atrophy, loss of pepsin secrection and HCL acid. This immune response also results in
pernicious anemia because the antibodies made for intrinsic factor which is required for the absorption of Vit.
B12.
Type B Gastritis: More common form. Incidence increases with age, reaching nearly 100% in people over
70y/o. Caused by chronic infection of gastric mucosa by Helicobacter Pylori (H.Pylori). This bacteria is
associated with an increased risk for Peptic Ulcer Dz. and Gastric Ca.
Signs and Symptoms:
Acute Gastritis: may range from asymptomatic to mild heartburn to severe gastric distress, vomiting, and
bleeding with hematemesis (vomiting blood).
Erosive Gastritis: Not typically associated with pain. Initial Sx is often painless gastric bleeding occurring 2 or
more days after the initial stressor. Corrosive Gastritis can cause severe bleeding, signs of shock, and an acute
abdomen (severely painful, rigid, boardlike abd.) if perforation occurs. Other Sx of erosive gastritis include
anorexia, mild epigastric discomfort relieved by belching or defecation, severe symptoms such as abd. Pain,
N/V , gastric bleeding with hematemesis or melena.
Acute Gastritis:
Gastrointestinal Sx Include:

Anorexia

N/V

Hematemesis

Melena

Abd. Pain
Systemic Sx Include:

Possible Shock
Chronic Gastritis:
Gastrointestinal Sx Include:

Vague discomfort after eating; maybe asymptomatic
Systemic Sx Include:

Anemia

Fatigue
Chronic Gastritis: Symptoms often vague, ranging from a feeling of heaviness in the epigastric region after
meals to gnawing, burning, ulcerlike epigastric pain unrelieved by antacids. Fatigue and other sx associated
with anemia, if intrinsic factor is lacking, paresthesias and other neurologic manifestations of Vit. B12
deficiency may be present.
DX:

Gastric Analysis

Hb & Hct, and red blood cell indices

Serum Vit. B 12 levels

Upper endoscopy
TX:
Acute Gastritis:

GI tract rest for 6 to 12 hours of NPO status, then slowly reintroduce clear liquids followed by heavier
liquids…then finally solids.

If N/V threaten fluid and electrolyte balance then IV fluids and electrolytes are ordered.

Gastric Lavage; after ingestion of poisonaous or corrosive substance. Do not induce vomiting because it
will damage esophagus and trachea.
Maintaining the gastric pH at greater than 3.5 and inhibiting gastric acid secretion with medications help
prevent erosive gastritis.
Commonly used drugs: See Pg. 549-550 lemone
For Acute stress gastritis

PPI’s…blocks effects of HCL: Lansoprazole (Prevacid), omeprazole ( Prilosec)

H2 receptors blocker…blocks effects of HCL: Cimetidine (Tagamer), ranitidine
(Zantac), famotidine (Pepcid), nizatidine (Axid).

Sucralfate (Carafate)…works locally to prevent dmg of acid, does not neutralize or
decrease acid
For Type B chronic Gastritis:

Eradicate H.pylori infection with combo therapy of two antibiotics and a PPI:
metronidazole and clarithromycin or tetracycline and a PPI
Diet:
Nursing interventions:
Deficient Fluid Volume d/t N/V and abd. Distress
Monitor VS q2h until stable then q4h, Check wt. daily, measure I & O, UOP q 1 to 4 h, monitor skin turgor and
color and oral mucosa, Monitor lab values for F & E, Administer oral or parenteral fluids as ordered,
Administer antiemetic as ordered
Imbalanced Nutrition: Less than
Monitor I & O, wt daily, dietary consult, nutritional supplements, maintain tube feedins or parenteral nutrition
Major Complications:
Other:
Disease Information
Name: HEMORRHOIDS
DESCRIPTION:Hemorrhoids are varicosities or dilated hemorrhoid veins in the rectal and anal area that
interfere with venous return. It may occur internally,externally or both incidence. It is high in adults between
age 20 and 50, involves both sexes. When enlarged may prolapse, protrude through the anus. Prolapsed may
become strangulated leading to thrombosis due to congestion and edema. It is painful and may lead to infarction
of skin. It is bluish following heavy lifting, cough, straining.
CAUSES
Extended periods of standing or sitting, pregnancy, heredity, straining, obesity, chronic constipation, increase
venous pressure in hemorrhoid vessel.
Signs and Symptoms:
INTERNAL HEMORRHOID MANIFESTATION
Painful (rare), bleeding is bright red, mucous discharge, feeling of incomplete evacuation of stool, Anemia
EXTERNAL HEMORRHOID MANIFESTATION
Bleeding (rare), anal irritation, itching, swelling, difficulty cleaning anal region.
DX: Digital exam
Anechoic test for internal bleeding
Stool for occult
Sigmoidoscopy
TX:
Sclerotherapy is procedure that injects chemical irritant into tissues surround hemorrhoid to induce
inflammation, causing it to swell and stick together, and the blood to clot. Over time, the vessel turns into scar
tissue that fades from view
Rubber band ligation put around hemorrhoid plexus to necroses , slough 7 to 10 days.
Cryosurgery necrotized hemorrhoid by freezing them with infrared with photocoagulation or electro
coagulation
Treat surgically with hemorrhoidectomy to excised hemorrhoids
MEDICATIONS
Metamucil, colace. Local ointment for itching as preparation H or nupercaine it has anesthetic effect.
DIET: High fiber, Increase water, Regular exercise
Nursing DX: Pain, Constipation, Risk for infection
POST OP CARE
Monitor vs. q 4hr
Inspect rectal bleeding dressing
Monitor urine output
Assist with comfort side lying position
Fresh ice pack over rectal dressing
Give stool softner
Analgesic before first bowel movement
Sitz bath 4 times a day
Encourage fluid intake at least 2000 cc a day
COMPLICATIONS: Chronic bleeding, Thrombosis, Prolapse
Disease Information
Name(s) of Disease:
Hiatal Hernia (p. 551-552)
General description:
Occurs when part of the stomach protrudes through the esophageal hiatus of the diaphragm into the thoracic
cavity.
Sliding Hiatal Hernia: gastroesophageal junction and the fundus of the stomach slide upward through the
esophageal hiatus. A small sliding HH may produce no Sx.
Paraesophageal Hiatal Hernia: esophagus and stomach junction remain in its normal position below the
diaphragm, while part of the stomach herniates through the esophageal hiatus. A paraesophageal HH can
become incarcerated (see complications) and strangulate, impairing blood flow to the herniated tissue.
Pathology/ Causes:
Sliding Hiatal Hernia: weakened gastroesophageal-diaphragmatic anchors, shortening of the esophagus,
increased intra-abdominal pressure
Signs and Symptoms:

Most affected pts are asymptomatic

Reflux, heartburn

Substernal chest pain

Occult bleeding

Feeling of fullness

Dysphagia

Belching, indigestion
DX:

Barium swallow

Upper endoscopy
TX:
Many pts require no treatment
Commonly used drugs: If symptoms are present – same treatment as GERD
(antacids, H2 receptor
blockers, proton-pump inhibitors) – see p. 549
Diet: Eliminate acidic foods, fatty foods, chocolate, peppermint, alcohol
Nursing interventions: Pt teaching, nutrition management, nutrition monitoring
Major Complications:
If medical management is not effective or the HH becomes incarcerated, surgery may be required. Most
common surgery is Nissen fundoplication (fundus of stomach is wrapped around lower esophagus and the edges
are sutured together).
Pts with Paraesophageal Hiatal Hernia may develop gastritis, or chronic/acute gastrointestinal bleeding
Other:
Incidence of HH increases with age.
Disease Information
Name(s) of Disease: Intestinal Obstruction, may be partial or complete.
General description: failure of the intestinal contents to move through the bowel lumen.
Pathology/ Causes: Cancer, impaction,
Mechanical obstruction: problem outside the intestine such as bands of scar tissues or hernia, problems with the
intestine, such as tumors or inflammatory bowel disease.
Functional Obstruction: occurs when peristalsis fails to propel contents through and the is no mechanical
obstruction.
Signs and Symptoms: Abdominal pain, bowel distention and tightness. Projectile vomiting, self-induced
vomiting to relieve pain in upper abdominal region, will contain food.
DX: WBC for leukocytosis, elevated Serum amylase, elevate serum osmolality and electrolyte levels, arterial
blood gases for metabolic ketoacidosis, abdominal x-ray or CT scan with contrast, barium enema,
sigmoidoscopy, colonoscopy.
TX: NPO, Gastrointestinal Decompression, surgery –bowel resection to remove obstructed portion
Commonly used drugs: antibiotics
Diet: Moderate fats and proteins, small frequent meals (6), lowcarb, restrict sugar, and have solids and liquids
taken at different times to prevent fast movement through the GI tract.
Nursing interventions: monitor intake
Nursing Diagnoses: Defecit fluid volume, ineffective tissue perfusion: gastrointestinal, Ineffective breathing
pattern
Major Complications: Paralytic ileus, Hypovolemic shock, respiratory distress, strangulation and gangrene,
perforation, and peritonitis.
Other:
Disease Information
Name(s) of Disease: Polyps
General description: Growths in the lining of any portion of the Bowel, most commonly in the sigmoid colon.
Mostly benign, but can become malignant. Rare cases of Familial polposis is hundreds of polyps develop in the
lrg intestine with 100% malignancy if left untreated.
Pathology/ Causes: caused by disruption in the normal cell proliferation.
Signs and Symptoms: Often asymptomatic, discovered during regular checkups. Occasionally lrg. Polyps may
cause painless rectal bleeding.
DX: Diagnosed by colonoscopy, and occasionally by digital exam
TX: Removed during colonoscopy.
Commonly used drugs: N/A
Diet: N/A
Nursing interventions: Colonoscopy prep with enema or cathartics
Major Complications: May develop into Cancer if not removed.
Other: Colonoscopies are recommended every 5 years after the age of fifty.
Disease Information
Name(s) of Disease: Irritable Bowel Syndrome AKA: Spastic Bowel or Functional Colitis
General description: A motility disorder of the GI tract; a functional disorder with no identifiable organic
cause. More prevalent in younger adults and women.
Pathology/ Causes: No identifiable cause…may be related to situational stress. Diagnosis is made by ruling
out other diseases.
Signs and Symptoms:
 Hypersecretion of colonic mucous
 Abd. Pain…may be relieved by defecation.
-may be intermittent and colicky
-may be dull and continuous
 Altered Bowel elimination; constipation, diarrhea, mucousy stools
 Abd. Bloating/ flatulence
 Abd. Tenderness, esp. over sigmoid
 Possible N/V
 Anorexia
 Fatigue
 Depression
 Anxiety
DX: Based on abd. Pain that has two of the following three characteristics:
1. relieved by defecation
2. assoc. with a change in freq. of elimination
3. assoc. with a change in stool form
Tests: Ruling Out Other Possiblilities
 Stool; occult blood, parasites, culture, WBC count
 CBC Diff and ESR
 Sigmoidoscopy / Colonoscopy
- With IBS the bowel appears normal with inc. mucous, marked spasms, and possible hyperemia.
*Small Bowel Series…see pg. 628….low residue diet 48hrs.c prior to procedure, chalky stool 72hrs. post
procedure, etc.
-Low Residue Diet: Basically a low fiber diet but more restrictive…used to reduce the size and
number of stools. Avoid whole grains, vegetables, fruits
TX: Relieve manifestations and precipitating factors
 stress reduction
 exercise
 counseling
 diet…balanced, high fiber, inc. H2O but avoid fluids with meals, avoid ETOH, avoid
smoking, eat at regular meal times
Commonly used drugs: IBS is not curable…only can mng. Sx
- Bulk Forming Laxatives…Bran, Methylcellulose, Psyllium
*These may help reduce bowel spasm and normalize the number and form BM’s
-
Anticholinergic Drugs…Dicyclomine (Antispas, Bentyl) or Hyoscyamine
(Anaspaz)
*Given 30-60 mins. Before meals to help post prandial abd. Pain by inhibiting bowel motility…interferes with
parasymp. Stimulation of GI tract
-
Anti-diarrhea Drugs….Loperamide (Imodium) and diphenoxylate ( Lomotil)
-
Anti-depressants…tricyclics and SSRI’s
*May relieve abd. Pain…tricyclics (desipramine, Norpramine) and (imipramine, Tofranil) have anticholinergic
effects which dec. diarrhea
- Herbal Remedies…refer to naturopathic doctor
Herbs with Antispasmotic effects…anise, chamomile, peppermint, and sage
Diet:
- Additional fiber and water
- Limit lactose, fructose and sorbitol
- With flatulence, reduce gas forming foods
- Limit caffeinated drinks
Nursing interventions: Assess for effects of IBS on client
- Primary Nrsg. Responsibility is EDUCATION
- Provide referrals and counseling
- Teach stress reduction
- Teach imp. Of follow up care: report bldy. Stool, inc. abd. Pain, significant diarrhea or
constipation, and wt. loss
Nurs. Dx:
- Constipation r/t altered bowel motility
- Diarrhea r/t ‘
‘
‘
‘
- Anxiety r/t situational stress
- Ineffective copint
Major Complications:
Other:
Disease Information
Name(s) of Disease: Appendicitis
General description: Acute abdominal pain, most common emergency abdominal surgery
Most common in male adolescents and young adults peak age 20-30
Pathology/ Causes: Fecalith (hard mass of feces), stone, tumor, parasite
Simple – inflamed and intact
Gangrenous or perforated (end stage)
Signs and Symptoms: upper abdominal pain initially, next 4 hours intensifies and localized in right lower
quadrant. Aggravated by movement
McBurney’s point – usual site for rebound tenderness
Nausea and vomiting, fever, loss of appetite, coated tongue (haven’t eaten)
DX: WBC – 10,000 – 20,000
Urinalysis - to rule out urinary infection
Abdominal x-rays and ultrasound
Pelvic exam on child-bearing age female to rule out pregnancy
TX:
Commonly used drugs: Pain meds only after diagnosis complete
Diet:
Nursing interventions: Oral food and fluid withheld, IV fluids and test immediately – can rupture within 24
hours
NPO, NO laxatives or enemas (may cause perforation), NO heat
Risk for infection re: surgery
If rupture, infected wound – wound care to clear the infection, may not be completely sutured until infection
cleared
Pain – NOTE: sudden relief of pre-op pain may signal rupture of appendix
Assess abdomen frequently – increased pain & rigid board like abdomen and distention may be peritonitis
Major Complications: Surgery, rupture, peritonitis
Other:
Disease Information
Name(s) of Disease: Gastric Cancer (stomach)
General description: Adrenocacinomas, usually found at the distal portion of the stomach, half of all
occurrences are in the antrum or pyloric region. Gastric cancer begins as a lesion that progresses to involve the
mucosa and sub mucosa. Has a fast metastasizing rate because of the blood supply to the stomach, to the liver in
particular.
Pathology/ Causes: H. Pylori is a major risk factor, 35-89% of persons who develop H. Pylori will develop
gastric cancer. Genetic predisposition, chronic gastritis, pernicious anemia, gastric polyps, and carcinogenic
factors of the diet such as smoking and nitrates. Achlorydria, lack of hydrochloric acid in the stomach is also a
known risk factor. Cancer risk is also higher for those people who have had a partial gastric resection.
Signs and Symptoms: Usually asymptomatic until the cancer has metastasized. Anorexia, indigestion, and
possibly vomiting. May experience ulcer like pain unrelieved by antacids, typically occurring after meals.
Eventually weight loss occurs and the client has become cachectic (in very poor health and malnourished) at the
time of diagnosis.
DX: CBC for anemia, upper GI X-ray with barium swallow, ultrasound or other radiology tests, upper
endoscope with biopsy of the mass is the only definitive diagnosis.
TX: partial mastectomies:
Billroth 1: gastroduodenostomy-common partial gastrectomy procedure in which a potion of the
stomach is removed and the regional lymph nodes
Bilorith2: gastrojejunostomy, preferred for duodenal ulcers
Total Gastrectomy: removal of the entire stomach: may be done for diffuse cancer that has spread
throughout the gastric mucosa but limited to the stomach. The esophagus is now anstomosises to the small
intestine
Commonly used drugs: Radiation and Chemotherapy may be used to eliminate any metastases or lymphatic
spread.
Diet: Whatever is tolerable, unless a gastronomy or jejunostomy is in place, then tube feedings would be
appropriate. Have nutritional problems because digestion has been altered.
Nursing interventions: Teaching client to eat small amounts often
Nursing Diagnosis: Imbalanced nutrition: less than body requirements, Anticipatory grieving
Major Complications: Dumping Syndrome: The entry of hyperosmolar chyme into the jejunum that causes a
rapid rise in the blood glucose. This stimulates the release of excessive amounts of insulin, leading to
hypoglycemic symptoms 2-3 hours after the meal. Systemic manifestations of hypervolemia: tachycardia,
orthostatic hypotension, dizziness, flushing and diaphoresis. Also nausea and vomiting may occur.
Anemia: can occur 1-2 years after the surgery.
Poor absorption of nutrients post-op.
Other: Gastric cancer is highest in Hispanics, African Americans, and men are twice as affected as women.
Older adults and Lower socioeconomic groups are more often affected by gastric cancer.
Disease Information
Name(s) of Disease: (GERD) Gastroesophageal Reflux (is not a disease, is a syndrome)
General description: Persistent Heartburn
Pathology/ Causes: lower esophageal sphincter allows excess gastric acid to backflow into the esophagus
Signs and Symptoms: Pyrosis(burning sensation in esophagus) Dyspepsia (indigestion), dysphagia,
regurgitation, belching, pain especially when one bends over or lays down
MAY HAVE BURNING BELOW THE STERNUM AND UP TOWARD THE THROAT AND JAW – MAY
THINK IT’S A HEART ATTACK
DX: EDG
Barium swallow
Ambulatory 12-36 hr. esophageal pH testing
TX: Commonly used drugs:
ANTACIDS – inexpensive OTC alkaline compounds
2 hours before or after other drugs – effects absorption
Aluminum hydroxide (Amphojel) – possible constipation
Magnesium containing antacids (Rolaids, Milk of Magnesia, Mylanta, Maalox) – renal dysfunction
clients should avoid, possible diarrhea
Sodium containing antacids (Alka-Seltzer) – avoid with salt restricted diets, CHF, hypertension
Proton Pump Inhibitors
H2 antagonist
Diet: small, frequent meals, low fat, AVOID caffeine, tobacco, beer, milk, peppermint, spearmint and
carbonated beverages
Nursing interventions: no eating or drinking 1-2 hours before bedtime
Do not lay down for 1 hour after eating
Elevate HOB 6-8 inch blocks
Weight loss referral if appropriate
Major Complications: If not relieved, laproscopic nissins fundification
Other: Aggravated by smoking, large meals, being overweight, bending, laying, straining
Disease Information
Name(s) of Disease: Hepatitis
General Description: Inflammation of the liver due to virus, exposure to alcohol, drugs toxins, may be
acute/chronic
You have three phases of Hepatitis: preiteric, iteric, and convalescent phase
1. Preiteric-before jaundice, -it is the period after exposure
pt will experience flu-like sx, malaise, anorexia, fatigue, muscle, body aches, N/V, diarrhea, constipation, and
mild RUQ pain and some abdominal pain. They may also experience chills and fever.
2. Iteric-pt will dev. Jaundice of the sclera, skin and mucus membranes, they will have an elev. Bilirubin,
pruitis, stool may become light or clay colored, urine is a brownish color.
3. Convalescent-pt may experience a spontaneous recovery (in uncomplicated cases) after jaundice appears
about 2 weeks, and liver enzymes will continuously improve.
*Hep A virus- Infectious hepatitis is transmitted fecal oral route, often by contaminated foods or direct contact.
It is contagious thru stool for up to 2 weeks before sx occur. It is benign and self limiting only last about 2 mo.
*Hep B virus- Is transmitted by blood and body fluids, liver cells are damaged by the immune response people
who have Hep B, are at an increased risk for primary liver cancer. People at a higher risk for dev. Hep B are
healthcare workers, IV drug users, homosexual men, persons w/ multiple sex partners, and pts exposed to blood
products (eg dialysis pts).
*Hep C virus- Is transmitted by infected blood & body fluids. The main way to catch Hep C is thru IV drug
use, needle sticks to health care workers, and tattoos. Initially the virus starts off mild and nonspecific. It is
primarily worldwide the cause of Chronic Hepatitis, cirrhosis, and liver cancer.
*Hep B assoc. Delta virus- Is transmitted by infected blood, it is cal HDV virus it affects those with Hep B
*Hep E virus- Is transmitted fecal oral route, you get it thru contaminated water supplies usually in developing
countries rarely in the U.S. Affects young adults and pregnant women.
Chronic Hepatitis: chronic infection from Hep B (HBV), Hep C(HCV), Hep B assoc. Delta (HBD)
characterized by very few symptoms (check above)
Toxic Hepatitis- hepatocellular damages result from toxic substances: such as benzene, carbon tetrachloride,
acetaminophen, chloroform, and poisonous mushrooms.
Hepatobiliary hepatitis- due to interruption of normal bile flow.
Pathology/Cause: infected blood and bodily fluids, contaminated foods and water supply, damaged liver cells,
IV drug use, homosexual men, and persons with multiple sexual partners, and persons exposed to blood
products. Needle sticks (healthcare workers, and child care providers catch it from contaminated stool.
S/S: malaise, anorexia, fatigue, muscle, body aches, N/V, diarrhea, constipation, and mild RUQ pain and some
abdominal pain. They may also experience chills and fever.
pt will dev. Jaundice of the sclera, skin and mucus membranes, they will have an elev. Bilirubin, pruitis, stool
may become light or clay colored, urine is a brownish color.
Dx: Liver function test: ALT (specific to the liver), AST(heart and liver cells), ALP(liver and bone cells), GGT
(rises with hepatitis and obstructive biliary disease), LDH, LDH5, serum Bilirubin.
Liver biopsy ( sample of liver tissue to determine if dx present)
Tx: Commonly used drugs> interferon and ribavairin. The only treatment for acute
hepatitis is bedrest, adequate nutrition and avoidance of toxic substances to the
liver especially alcohol. Milk thistle can also be used to help with symptoms.
Diet: Alcohol avoidance, and or taking medications with alcohol.
Nursing Interventions: teaching the importance of not stressing, good hygiene, hand washing
(especially food handlers), avoidance of blood and bodily fluids, and vaccine for persons at high risk.
Major complications: cirrhosis of the liver and death
Disease Information
Name(s) of Disease:
Inflammatory Bowel Disease (p. 648-661)
1. Ulcerative Colitis = continuous lesion disease
2. Chron’s disease = skip lesion disease
General description:
1. Ulcerative Colitis: a chronic inflammatory bowel disorder that affects the mucosa and submucosa of the
colon and rectum.
a. Chronic Intermittent Colitis: most common form
b. Fulminant Colitis: 15% of pts develop this which affects the entire colon
2. Chron’s Disease (regional enteritis): chronic, relapsing inflammatory disorder affecting the GI tract (any
portion form mouth to anus)
Pathology/ Causes:
1. Ulcerative Colitis

Cause unknown

Inflammatory process usually confined to rectum & sigmoid colon

Inflammation → mucosal hemorrhages & abscess formation → necrosis & sloughing of bowel
mucosa

Chronic inflammation causes atrophy, narrowing & shortening of the colon

Acute: abrupt with rapid course
2. Chron’s Disease
• Can affect any portion of GI, but terminal ileum & ascending colon are more commonly involved
• Inflammatory aphthoid lesion (shallow ulceration) of mucosa and submucosa develops into ulcers &
fissures which involve entire bowel wall
• Fibrotic changes occur leading to local obstruction, abscess formation & fistula formation
• Fistulas develop between loops of bowel (enteroenteric fistulas), bowel & bladder (enterovesical
fistulas), or bowel & skin (enterocutaneoius fistuals)
• Absorption problem develops → protein loss & anemia
Signs and Symptoms:
Disease
Ulcerative Colitis
Fulminant
Severe cases
Chron’s Disease
Clinical Manifestations
• Diarrhea with blood & mucous
• 5-10 stools/day → anemia, hypovolemia, malnutrition
• fecal urgency & tenesmus (constant feeling of the need to empty the bowel)
• LLQ cramping
• Fever
• Fatigue, weakness
• Anorexia, weight loss
• Mild to severe pain
• Severe bloody stool (15-20/day)
• N/V
• F & E imbalance
• Colon perforation/dilation
• ↓ bowel sounds
• Rigid abdomen
• Arthritis, uveitis
•
c/o crampy abd pain
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•
•
•
•
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Continuous or episodic diarrhea (liquid or semi-formed)
RLQ abd pain/tenderness relieved by defecation
Fatigue, weakness, malaise
Weight loss, anemia
Fissures, fistulas, abscesses
Palpable RLQ mass
Febrile
↑ WBC/ESR
N/V
DX:
Disease
Ulcerative Colitis
Chron’s Disease
Dx Tests
• H&P
• Colonoscopy/sigmoidoscopy to determine area & pattern of involvement; can
cause perforation so only do annually
• Upper GI: barium enema
• Stool examination/cultures to r/o infection (NO red meat for 24-48 hrs)
• CBC: shows anemia; leukocytosis from inflammation/abscess formation; ↓
H&H due to blood loss
• Serum albumin, folic acid: ↓ due to malabsorption & protein loss
• Liver function test: shows enzyme elevation
• See above
TX:
1. Ulcerative Colitis/Chron’s Disease
• Medications:
- Sulfonamides: Sulfasalazine (Axulfidine) has a topical effect in colon. Check for allergy to sulfur;
may cause anemia, nausea, leucopenia, anorexia
- Corticosteriods: Methylprednisolone (Solu-Medrol), Prednisolone, Prednisone ↓ inflammation &
induce remission
- Immunosuppressive Agents: Mercaptopurine (6-MP, Purinethol), Azathioprine (Imuran) or
cyclosporine for pts that do not respond to steroid therapy
- Anti-diarrheal Agents: Lopermide, diphenozylate to slow GI motility and ↓ diarrhea
- Anticholinergics: Pro-Banthene to ↓ gastric motility, GI secretions & peristalsis
- Antispasmodics:
• Diet: eliminate irritating foods. Eat ↑ calorie, ↑ protein, low residue with vitamin & iron supplements.
Avoid cold foods, high residue, whole grains, fried eggs, nuts, raw fruit, smoking. Dietary fiber is
contraindicated in pts with strictures. Pt may be NPO or given PPN/TPN nutrition
•
Surgical Tx: performed when failure of other measures
Ulcerative Colitis:
Total colectomy
Total colectomy with ileal pouch-anal anastomsis (IPPA): choice procedure for extensive ulcerative
colitis
Chron’s Disease
Bowel resection
*disease process tends to recur in area remaining after resection
•
Nursing Implications:
Provide emotional support to pt
Alternating pressure mattress
Bed rest
Private room
Good peri-rectal care: wash with soap/water after bathroom
Observe for dehydration
Increase fluid intake
Major Complications:
1. Ulcerative Colitis
• Hemorrhage: can be massive
• Toxic megacolon: usually involves transverse colon which dilates & lacks peristalsis
• Colon perforation: rare, but leads to peritonitis and 15% mortality rate
• Increased risk for colorectal cancer (20-30 times) – need yearly colonoscopies
• Sclerosing cholangitis: an inflammatory disease of the bile duct, which leads to cholestasis (blockage of bile
transport)
• Vitamin K & iron deficincies
2. Chron’s Disease
• Intestinal obstruction: caused by repeated inflammation & scarring
• Fistulas → abscess formation, recurrent UTI (if bladder involved)
• Perforation of bowel may occur with peritonitis
• Massive hemorrhage
• Increased risk of bowel cancer (5-6 times)
Other:
Pts with Ulcerative Colitis are at risk for cardiac arrhythmias because of a loss of potassium (hypokalemic)
Iliostomy – opening in ileum, may be permanent or temporary
• Ascending: drains liquid stool
• Descending
• Transverse
• Continent (Koch’s) ileostomy: intra-abd reservoir with nipple valve formation to allow cath insertion to drain
stool
Disease Information
Name(s) of Disease: Peptic Ulcer Disease
General description: a break in the mucous lining of the GI tract where it comes in contact with gastric juice
Pathology/ Causes: stress, milk, caffeine, smoking, alcohol…all of these increase HCL acid secretion. Stress
and spicy foods make it worse. Familial. Type O blood. H pylori. NSAIDS, b/c they inhibit the secretion of
the mucus that protects the mucosa. An ulcer develops when the mucosal barrier is unable to protect the
mucosa from damage by HCL acid and pepsin.
Signs and Symptoms: asymptomatic, pain (gnawing, burning, aching, or hunger like), heartburn, chest pain,
Duodenal ulcer:
30 – 55, more common in men than women but increases in women w/ menopause, hyper HCL, weight gain,
pain 2 – 3 hours after a meal, awakened in middle of night, food relieves pain, melena more common, vomiting
uncommon, hemorrhage less likely, more likely to perforate, malignancy is rare.
Gastric Ulcer:
55 – 70, more often effect older clients, more in smokers and users of NSAIDS, normal HCl, weight loss, pain
½ hour – hour after meal, rarely occurs at night, food doesn’t relieve pain, vomiting common, hemorrhage more
likely, hematemesis more common, malignancy occasionally.
DX: upper GI series, endoscopy (always check for a gag reflex), gastroscopy, Urea breathe test,
TX:
Surgery: billroth 1 & 2 (2 is the most common), vagotomy, and pyloroplasty.
Commonly used drugs: carafate (coats the stomach like a band aid),
antacids (take 1 – 3 hours after meals and HS, if pt has CHF avoid antacids high in NA),
sulcrafate (the generic carafate, take 30 min before meals, it coats the stomach),
Pepto-Bismol ,
if pt takes NSAIDS put pt on cytotec
Diet: low fiber, small, frequent meals. Avoid extreme temperature of foods, beverages, meat extract, alcohol,
coffee, caffeine, milk and milk products,
Nursing interventions: reduce stress, slow life down, massage, acupuncture
Major Complications: hemorrhage, obstruction, perforation (most lethal, will have sudden severe upper adb
pain, shallow respirations, absence of bowel sounds, rigid board like adb), peritonitis
Other:
Dumping Syndrome: complication of surgery - eat small frequent meals, liquids and solids at different
times b/c liquids push solids through faster but we want them to stay in the stomach longer, lay down after
eating, diet moderate in fat and protein and bedtime does of antacids
Disease Information
Name(s) of Disease: Stomatitis
General description: Inflammation of the mouth. Four main types are: Cold sore/ fever blister, Canker sore
(aphthous ulcer), Candidiasis (thrush), Trench mouth (Vincent’s infection).
Pathology/ Causes: Can generally be caused by trauma, tobacco, chemotherapy or infection. Specific causes
include Cold sore- Herpes simplex, canker sore- unknown, possibly herpes, candidiasis – candida albicans,
trench mouth – spirochetes and bacilli
Signs and Symptoms: Cold sore: burning, vesicular lesions on lip or oral mucosa, Cankor sores: Well defined,
painful, shallow erosions with white or yellow center w/red ring, less than 1 cm in diameter. Canidiasis:
creamy white, curdlike patches, erythematous mucosa. Trench mouth: Acute gingival inflammation and
necrosis, bleeding, halitosis, fever, cervical lymphadenopathy.h
DX: Direct physical examination, cultures, and evaluation for systemic illness.
TX:
Commonly used drugs: Cold sore: antiviral (acyclovir), cankor sore: topical steroid reduce swelling,
Amlexanox oral paste (Aphthasol) protects site, oral prednisone, Candidiasis: Fluconazole, Ketoconazole,
Clotrimazole, Nystatin vaginal troches Orally dissolved, Trenchmouth: half strength peroxide mouthwash, oral
penicillin.
Diet: avoid foods that irritate, high calorie, high protein, soft, lukewarm or cool foods. i.e. eggnog, milk
shakes, nutritional suppliments, puddings, etc.
Nursing interventions: Assess food intack, and ability to swallow. Offer us of straws or feeding
syringe.
Major Complications: none
Other: Avoid alcohol mouthwashes, undiagnosed oral lesions lasting longer than one week should be checked
for malignancy.