Download GI Disorders PPT (part two)

Gastrointestinal
Disorders (part 2)
N250, Spring 2015
CSULB School of Nursing
Inflammatory Bowel Disease (IBD)
 Immunologic disease that results in
idiopathic intestinal inflammation
 Includes two distinct but similar
conditions:
Crohn's disease
Ulcerative colitis
Ulcerative Colitis (UC)
Involves chronic inflammation of
mucosal and submucosal layers of
colon and rectum
 Begins at base of crypts of Lieberkün;
causes congestion and edema leading to
ulcers
 Ulcers bleed easily causing bloody stools

Crohn's Disease
Can occur in any portion of GI tract
 Involves all layers of intestinal wall (full
thickness disease
 Usually affects the jejunum and ileum

Epidemiology & Manifestations
Approximately 1.4 million in the United
States have IBD
 Incidences of Crohn's and UC are similar
 Men and women affected equally with IBD;
higher in Whites
 UC and Crohn's both have:

 Abdominal pain, diarrhea, rectal urgency
 Systemic manifestations
Laboratory & Diagnostic Tests
Colonoscopy (avoid with severe
inflammation)
 Serologic tests to distinguish between UC
and Crohn's disease
 Two genetic markers have been developed
for clinical use

Medical Management
 Eliminate intestinal inflammation
 Medication and dietary changes is first
course
 Surgery: depends on type of IBD and
location and extent of lesions
Severe UC: ileal pouch anal anastomosis
(IPAA) or continent ileostomy
Nursing Management
Most managed with medications, dietary
changes, and stress reduction
 Educate patient about medications,
stress, diet
 Suggest support networks

Diverticular Disease
Diverticular Disease
Results from abnormal saclike
outpouchings of intestinal wall
 Can occur anywhere in GI tract except
rectum
 Includes diverticulosis and diverticulitis

Diverticular Disease

Diverticulosis small, bulging pouches
(diverticuli) form inside the lower part of
the intestine, usually in the colon.
Constipation and straining during bowel
movements can worsen the condition.

Diverticulitis occurs when the pouches in
the colon become infected or inflamed.
Pathophysiology, Etiology, and
Epidemiology



Diverticula form where weak points exist in
intestinal wall
If a fecalith forms, ischemia and perforation
can occur
Risk increases with
age; particularly
after age 60
Clinical Manifestations &
Diagnostic Tests
Patients are often asymptomatic
 With exacerbation get left lower quadrant
pain, fever, chills
 Complications are rare
 Complete blood count (CBC) with
differential for bleeding and infection
 Ultrasonography or CT scan to assess
inflammation

Medical Management
Diet change (high fiber)
 Rest, drug therapy for mild symptoms
 IV fluids, IV antibiotics, pain management
for more severe symptoms
 If no improvement in 3 days, bowel
resection with anastomosis may be needed

Dietary Management



High-fiber diet (25 to 30 g daily) to prevent
flare-ups
2000 ml of fluid daily (unless contraindicated)
When exacerbated (diverticulitis)
 Clear liquid diet
 Then low residue (low fiber) diet
 Resume a high fiber diet when symptoms subside
Colon Cancer
Colon Cancer
 Epidemiology and etiology
Abnormal cell growth in colon or rectum
Only 39% of cases found early
Screenings: colonoscopy, double-contrast
barium enema, CT colonography (age 50
years)
Pathophysiology
Risk factors: IBD, family history, increased
age, lifestyle factors (diet, smoking, alcohol)
 Larger the polyp, more likely to be
malignant
 Evidence to a link between C-reactive
protein and colon cancer
 Adenocarcinoma is most common type,
accounts for 95% of colon tumors

Incidence of colon cancer related to location
Clinical Manifestations






Usually asymptomatic until it is advanced
Symptoms depend on location and of growth
Most common symptoms: change in bowel
habits or stool texture (Constipation is
predominant symptom)
Rectal bleeding, hematochezia, passage of red
blood via the rectum
Anemia
Mass in abdomen, Obstruction
Laboratory & Diagnostic Tests
Hemoglobin and hematocrit values usually
decreased
 Fecal occult blood test
 Colonoscopy with tissue biopsy
 CT scan to detect possible metastasis
 C-reactive protein and carcinoembryonic
antigen (CEA): inflammation and as tumor
marker

Medical/Surgical Management
Polypectomy
 Colectomy
 Resection

 Postoperative care includes:
Colostomy and wound management
 Nasogastric tube
 Colostomy management
 Wound management


Chemotherapy and radiation therapy
Nursing Management
Early detection is key for prognosis
 Focus on pre-and postoperative care and
support
 Emotional support is paramount
 Dietary modifications (give specific
information about good/bad food choices)
 Exercise, reducing obesity

Collaborative Management

Interdisciplinary team of health care
professionals
 Diagnosis, management, follow-up care
 Dietary, lifestyle changes, long-term
management
 Stomas and stoma care
Colostomy Care
Normal appearance of the stoma
 Signs and symptoms of complications
 Choice, use, care, and application of
appropriate appliance to cover stoma
 Measures to protect the skin
 Dietary measures to control gas and odor
 Resumption of normal activities

Interventions for Anticipatory
Grieving

Observe and identify:
 Client and family’s current methods of coping
 Effective sources of support
in past crises
 Client and family’s present methods of coping
 Signs of anticipatory grieving, such as crying
Intestinal Obstruction
Intestinal Obstruction
 Impairment of the forward movement
of intestinal contents
Mechanical cause
 Adhesions
 Tumors
 Hernias
 Intussusception,
volvulus
Functional cause (a.k.a. paralytic ileus)
Causes of
obstruction
Intestinal Obstruction:
Etiology and Epidemiology
Can occur anywhere from the pylorus to the
rectum
 Can be partial or complete
 Most bowel obstructions occur in the small
intestine
 Obstructions can be classified by severity,
extent, or location

Intestinal Obstruction:
Etiology and Epidemiology

Severity: includes
simple or strangulated
effects
 Simple: no impairment
of blood or nerves on
intestinal wall
 Strangulated: extremely
serious and requires
immediate medical
attention
Pathophysiology
Pathophysiology same regardless of cause
 When obstructed, fluid and gas accumulate

 Fluid due to inability to reabsorb water
 Gas due to bacteria and swallowed air

Distension can increase risk for pneumonia
and atelectasis
Clinical Manifestations
Most common symptom: cramping or
colicky pain that increases
 Distension
 Absent or decreased bowel sounds
 If obstruction in proximal small bowel:
vomiting
 Obstruction in distal small bowel: pain
intense; patient may vomit fecal material

Laboratory & Diagnostic Tests
X-rays, CT scan,
complete blood count
with differential WBC
 Barium swallow or
barium edema
 Careful history and
physical examination

Medical & Surgical Management
Relieving obstruction and pressure to avoid
perforation
 Nasogastric (NG) tube used to decompress
the bowel
 Surgery if mechanical obstruction or
strangulation

 Bowel resection
 Colostomy
 Bypass procedure
Nursing Management
Assessment of present condition
 Instituting fluid and electrolyte
replacement
 Performing bowel decompression via NG
tube placement
