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Overview of Anatomy and PhysiologyDigestive systemOrgans and their functionsMouth: Beginning of digestionTeeth: Bite, crush, and grind foodSalivary glands: Secrete salivaEsophagus: Moves food from mouth to stomachStomach: Churn and mix contents with gastric juicesSmall intestine: Most digestion occurs hereLarge intestine: Forms and expels fecesRectum: Expels fecesOverview of Anatomy and PhysiologyAccessory organs of digestionOrgans and their functionsLiver: Produces bile; stores it in the gallbladderPancreas: Produces pancreatic juiceRegulation of food intakeHypothalamus One center stimulates eating and another signals to stop eatingLaboratory and Diagnostic ExaminationsUpper GI seriesGastric analysisEsophagogastroduodenoscopy (EGD)Barium swallowBernstein testStool for occult bloodSigmoidoscopyBarium enemaColonoscopyStool culture and sensitivity; stool for ova and parasitesFlat plate of the abdomenDisorders of the MouthDental plaque and cariesEtiology/pathophysiologyErosive process that results from the action of bacteria on carbohydrates in the mouth, which produces acids that dissolve tooth enamelMedical management/nursing interventionsRemove affected area and replace with dental materialDisorders of the MouthCandidiasisEtiology/pathophysiologyInfection caused by a species of Candida, usually Candida albicansFungus normally present in the mouth, intestine, and vagina, and on the skinAlso referred to as thrush and moniliasisClinical manifestations/assessmentSmall white patches on the mucous membrane of the mouthThick white discharge from the vaginaDisorders of the MouthCandidiasis (continued)Medical management/nursing interventionsPharmacological managementNystatinKetoconazole oral tabletsHalf-strength hydrogen peroxide/saline mouthwashMeticulous handwashingComfort measuresDisorders of the MouthCarcinoma of the oral cavityEtiology/pathophysiologyMalignant lesions on the lips, oral cavity, tongue, or pharynxUsually squamous cell epitheliomasClinical manifestations/assessmentLeukoplakiaRoughened area on the tongueDifficulty chewing, swallowing, or speakingEdema, numbness, or loss of feeling in the mouthEarache, face ache, and toothacheDisorders of the MouthCarcinoma of the oral cavity (continued)Diagnostic testsIndirect laryngoscopyExcisional biopsyMedical management/nursing interventionsStage I: Surgery or radiationStage II & III: Both surgery and radiationStage IV: PalliativeDisorders of the EsophagusGastroesophageal reflux diseaseEtiology/pathophysiologyBackward flow of stomach acid into the esophagusClinical manifestations/assessmentHeartburn (pyrosis) 20 min to 2 hours after eatingRegurgitationDysphagia or odynophagiaEructationDisorders of the EsophagusGastroesophageal reflux disease (continued)Diagnostic testsEsophageal motility and Bernstein testsBarium swallowEndoscopyMedical management/nursing interventionsPharmacological managementAntacids or acid-blocking medicationsDietary recommendationsLifestyle recommendations Comfort measuresSurgeryDisorders of the EsophagusCarcinoma of the esophagusEtiology/pathophysiologyMalignant epithelial neoplasm that has invaded the esophagus90% are squamous cell carcinoma associated with alcohol intake and tobacco use6% are adenocarcinomas associated with reflux esophagitisClinical manifestations/assessmentProgressive dysphagia over a 6-month periodSensation of food sticking in throatDisorders of the EsophagusCarcinoma of the esophagus (continued)Medical management/nursing interventionsRadiation: May be curative or palliativeSurgery: May be palliative, increase longevity, or curativeTypes of surgical proceduresEsophagogastrectomyEsophagogastrostomyEsophagoenterostomy GastrostomyDisorders of the EsophagusAchalasiaEtiology/pathophysiologyCardiac sphincter of the stomach cannot relaxPossible causes: Nerve degeneration, esophageal dilation, and hypertrophyClinical manifestations/assessmentDysphagiaRegurgitation of foodSubsternal chest painLoss of weight; weaknessPoor skin turgorDisorders of the EsophagusAchalasia (continued)Diagnostic testsRadiologic studies; esophagoscopyMedical management/nursing interventionsPharmacological managementAnticholinergics, nitrates, and calcium channel blockersDilation of cardiac sphincterSurgeryCardiomyectomyDisorders of the StomachAcute gastritisEtiology/pathophysiologyInflammation of the lining of the stomachMay be associated with alcoholism, smoking, and stressful physical problemsClinical manifestations/assessmentFever; headacheEpigastric pain; nausea and vomitingCoating of the tongueLoss of appetiteDisorders of the StomachAcute gastritis (continued)Diagnostic testsStool for occult blood; WBC; electrolytesMedical management/nursing interventionsPharmacological managementAntiemeticsAntacidsAntibioticsIV fluidsNG tube and administration of blood, if bleedingNPO until signs and symptoms subsideMonitor intake and outputDisorders of the StomachGastric ulcers and duodenal ulcersUlcerations of the mucous membrane or deeper structures of the GI tractMost commonly occur in the stomach and duodenumResult of acid and pepsin imbalancesH. pyloriBacterium found in 70% of patients with gastric ulcers and 95% of patients with duodenal ulcersDisorders of the StomachGastric ulcers (continued)Etiology/pathophysiologyGastric mucosa are damaged, acid is secreted, mucosal erosion occurs, and an ulcer developsDuodenal ulcers (continued)Etiology/pathophysiologyExcessive production or release of gastrin, increased sensitivity to gastrin, or decreased ability to buffer the acid secretionsDisorders of the StomachGastric and duodenal ulcers (continued)Clinical manifestations/assessmentPain: Dull, burning, boring, or gnawing, epigastricDyspepsiaHematemesisMelenaDiagnostic testsEsophagogastroduodenoscopy (EGD)Breath test for H. pyloriDisorders of the StomachGastric and duodenal ulcers (continued)Medical management/nursing interventionsPharmacological managementAntacidsHistamine H2 receptor blockers Proton pump inhibitorMucosal healing agentsAntibioticsDietary recommendations High in fat and carbohydrates; low in protein and milk products; small frequent meals; limit coffee, tobacco, alcohol, and aspirin useDisorders of the StomachGastric and duodenal ulcers (continued)Medical management/nursing interventionsSurgeryAntrectomyGastroduodenostomy (Billroth I)Gastrojejunostomy (Billroth II)Total gastrectomyVagotomyPyloroplastyDisorders of the StomachGastric and duodenal ulcers (continued)Complications after gastric surgeryDumping syndromePernicious anemiaIron deficiency anemiaDisorders of the StomachCancer of the stomachEtiology/pathophysiologyMost commonly adenocarcinomaPrimary location is the pyloric areaRisk factors:History of polypsPernicious anemiaHypochlorhydriaGastrectomy; chronic gastritis; gastric ulcerDiet high in salt, preservatives, and carbohydratesDiet low in fresh fruits and vegetablesDisorders of the StomachCancer of the stomach (continued)Clinical manifestations/assessmentEarly stages may be asymptomaticVague epigastric discomfort or indigestionPostprandial fullnessUlcer-like pain that does not respond to therapyAnorexia; weight lossWeaknessBlood in stools; hematemesisVomiting after fluids and mealsDisorders of the StomachCancer of the stomach (continued)Diagnostic testsGI seriesEndoscopic/gastroscopic examinationStool for occult bloodRBC, hemoglobin, and hematocritMedical management/nursing interventionsSurgeryPartial or total gastric resectionChemotherapy and/or radiationDisorders of the IntestinesInfectionEtiology/pathophysiologyInvasion of the alimentary canal by pathogenic microorganismsMost commonly enters through the mouth in food or waterPerson-to-person contactFecal-oral transmissionLong-term antibiotic therapy can cause an overgrowth of the normal intestinal flora (C. difficile)Disorders of the IntestinesInfection (continued)Clinical manifestations/assessment DiarrheaRectal urgencyTenesmusNausea and vomitingAbdominal crampingFeverDisorders of the IntestinesInfection (continued)Diagnostic testsStool cultureMedical management/nursing interventionsAntibioticsFluid and electrolyte replacementKaopectatePepto-BismolDisorders of the IntestinesIrritable bowel syndromeEtiology/pathophysiologyEpisodes of alteration in bowel functionSpastic and uncoordinated muscle contractions of the colonClinical manifestations/assessmentAbdominal painFrequent bowel movementsSense of incomplete evacuationFlatulence, constipation, and/or diarrheaDisorders of the IntestinesIrritable bowel syndrome (continued)Diagnostic testsHistory and physical examinationMedical management/nursing interventionsPharmacological managementAnticholinergicsMilk of magnesiaMineral oilOpioids Antianxiety agentsDietary recommendations Bulking agentsDisorders of the IntestinesUlcerative colitisEtiology/pathophysiologyUlceration of the mucosa and submucosa of the colonTiny abscesses form that produce purulent drainage, slough the mucosa, and ulcerations occurClinical manifestations/assessmentDiarrhea—pus and blood; 15 to 20 stools per dayAbdominal crampingInvoluntary leakage of stoolDisorders of the IntestinesUlcerative colitis (continued)Diagnostic testsBarium studies, colonoscopy, stool for occult bloodMedical management/nursing interventionsPharmacological managementAzulfidine, Dipentum, Rowasa, corticosteroids, ImodiumDietary recommendations: No milk products or spicy foods; high-protein, high-calorie; total parenteral nutritionStress controlAssist patient to find coping mechanismsDisorders of the IntestinesUlcerative colitis (continued)Medical management/nursing interventionsSurgical interventionsColon resectionIleostomyIleoanal anastomosisProctocolectomyKock pouchDisorders of the IntestinesCrohn’s diseaseEtiology/pathophysiologyInflammation, fibrosis, scarring, and thickening of the bowel wallClinical manifestations/assessmentWeakness; loss of appetiteDiarrhea: 3 to 4 daily; contain mucus and pusRight lower abdominal painSteatorrheaAnal fissures and/or fistulasDisorders of the IntestinesCrohn’s disease (continued)Medical management/nursing interventionsPharmacological management CorticosteroidsAzulfidineAntibioticsAntidiarrheals; antispasmodicsEnteric-coated fish oil capsulesB12 replacementDisorders of the IntestinesCrohn’s disease (continued)Medical management/nursing interventionsDietary recommendationsHigh-proteinElementalHyperalimentationAvoidLactose-containing foods, brassica vegetables, caffeine, beer, monosodium glutamate, highly seasoned foods, carbonated beverages, fatty foodsSurgerySegmental resection of diseased bowelDisorders of the IntestinesAppendicitisEtiology/pathophysiologyInflammation of the vermiform appendixLumen of the appendix becomes obstructed, the E. coli multiplies, and an infection developsClinical manifestations/assessmentRebound tenderness over the right lower quadrant of the abdomen (McBurney’s point)VomitingLow-grade feverElevated WBCDisorders of the IntestinesAppendicitis (continued)Diagnostic testsWBCRoentgenogramUltrasoundLaparoscopyMedical management/nursing interventionsAppendectomyDisorders of the IntestinesDiverticular diseaseEtiology/pathophysiologyDiverticulosisPouch-like herniations through the muscular layer of the colonDiverticulitisInflammation of one or more diverticulaDisorders of the IntestinesDiverticular disease (continued)Clinical manifestations/assessmentDiverticulosisMay have few, if any, symptomsConstipation, diarrhea, and/or flatulencePain in the left lower quadrantDiverticulitisMild to severe pain in the left lower quadrantElevated WBC; low-grade feverAbdominal distentionVomitingBlood in stoolDisorders of the IntestinesDiverticular disease (continued)Medical management/nursing interventionsDiverticulosis with muscular atrophyLow-residue diet; stool softenersBed restDiverticulosis with increased intracolonic pressure and muscle thickeningHigh-fiber dietSulfa drugsAntibiotics; analgesicsDisorders of the IntestinesDiverticular disease (continued)Medical management/nursing interventions (continued)SurgeryHartmann’s pouchDouble-barrel transverse colostomyTransverse loop colostomyDisorders of the IntestinesPeritonitisEtiology/pathophysiologyInflammation of the abdominal peritoneumBacterial contamination of the peritoneal cavity from fecal matter or chemical irritationClinical manifestations/assessmentSevere abdominal pain; nausea and vomitingAbdomen is tympanic; absence of bowel soundsChills; weaknessWeak rapid pulse; fever; hypotensionDisorders of the IntestinesPeritonitis (continued)Diagnostic testsFlat plate of the abdomenCBEMedical management/nursing interventions Pharmacological managementParenteral antibioticsAnalgesicsIV fluids Position patient in semi-Fowler’s positionSurgeryRepair cause of fecal contaminationRemoval of chemical irritantNG tube to prevent GI distentionDisorders of the IntestinesExternal herniasEtiology/pathophysiologyCongenital or acquired weakness of the abdominal wall or postoperative defectAbdominalFemoral or inguinalUmbilicalDisorders of the IntestinesExternal hernias (continued)Clinical manifestations/assessmentProtruding mass or bulge around the umbilicus, in the inguinal area, or near an incisionIncarcerationStrangulationDiagnostic testsRadiographsPalpationDisorders of the IntestinesExternal hernias (continued)Medical management/nursing interventionsIf no discomfort, hernia is left unrepaired, unless it becomes strangulated or obstruction occursTrussSurgerySynthetic mesh is applied to weakened area of the abdominal wallDisorders of the IntestinesHiatal herniaEtiology/pathophysiologyProtrusion of the stomach and other abdominal viscera through an opening in the membrane or tissue of the diaphragmContributing factors: obesity, trauma, agingClinical manifestations/assessmentMost people display few, if any, symptomsGastroesophageal refluxDisorders of the IntestinesHiatal hernia (continued)Medical management/nursing interventionsHead of bed should be slightly elevated when lying downSurgeryPosterior gastropexyTransabdominal fundoplication (Nissen)Disorders of the IntestinesIntestinal obstructionEtiology/pathophysiologyIntestinal contents cannot pass through the GI tractPartial or completeMechanicalNon-mechanicalClinical manifestations/assessmentVomiting; dehydrationAbdominal tenderness and distentionConstipationDisorders of the IntestinesIntestinal obstruction (continued)Diagnostic testsRadiographic examinationsBUN, sodium, potassium, hemoglobin, and hematocritMedical management/nursing interventionsEvacuation of intestineNG tube to decompress the bowelNasointestinal tube with mercury weightSurgeryRequired for mechanical obstructionsDisorders of the IntestinesColorectal cancerEtiology/pathophysiologyMalignant neoplasm that invades the epithelium and surrounding tissue of the colon and rectumSecond most prevalent internal cancer in the United StatesClinical manifestations/assessmentChange in bowel habits; rectal bleedingAbdominal pain, distention, and/or ascitesNauseaCachexiaDisorders of the IntestinesCancer of the colon (continued)Diagnostic testsProctosigmoidoscopy with biopsyColonoscopyStool for occult bloodMedical management/nursing interventionsRadiationChemotherapyDisorders of the IntestinesCancer of the colon (continued)Medical management/nursing interventions (continued)SurgeryObstructionOne-stage or two-stage resectionTwo-stage resectionColorectal cancerRight or left hemicolectomyAnterior rectosigmoid resectionDisorders of the IntestinesHemorrhoidsEtiology/pathophysiologyVaricosities (dilated veins)External or internalContributing factorsStraining with defecation, diarrhea, pregnancy, CHF, portal hypertension, prolonged sitting and standingClinical manifestations/assessmentVaricosities in rectal areaBright red bleeding with defecationPruritusSevere pain when thrombosedDisorders of the IntestinesHemorrhoids (continued)Medical management/nursing interventionsPharmacological managementBulk stool softeners Hydrocortisone creamTopical analgesicsSitz bathsLigationSclerotherapy; cryotherapyInfrared photocoagulationLaser excisionHemorrhoidectomyDisorders of the IntestinesAnal fissureLinear ulceration or laceration of the skin of the anusUsually caused by traumaLesions usually heal spontaneouslyMay be excised surgicallyAnal fistulaAbnormal opening on the surface near the anusUsually from a local abscessCommon in Crohn’s diseaseTreated by a fistulectomy or fistulotomyNursing ProcessNursing diagnosesDisorders of the IntestinesFecal incontinencePotential causesMedical management/nursing interventionsBiofeedback trainingBowel trainingPatient educationDietary recommendations ................
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