GI DISORDERS

Tests to diagnose Pancreatitis

Pancreatitis is inflammation of the pancreas. This can be due to: infections, trauma, alcohol or drugs. It can be acute or chronic. Bile may enter causing it to be inflamed. This can lead to hemorahge, edema and sever pain. S/S: pain in the epigastric area, anorexia, nausea, and vomiting. Jaundice may appear if the common bile duct is obstructed. Diagnosis is made by: Ultrasound, CT/endoscopic exams as well as physical examination, ERCP- can diagnose presence of tumor, ^ pancreatic enzymes. Treatment: analgesics to relieve pain, Low-fat high protein high carbohydrate diet.

Care of pt with Liver Biopsy/Paracentesis

Liver biopsies are most often done to verify suspected liver cancer or to detect other liver disorders. However a liver biopsy is not done if the patient has a bleeding tendency because of the possibility of hemorrhage- the liver is a highly vascular organ. Liver biopsy is done through the skin with a large needle. Instruct the patient not to breath while the needle is being inserted so that the physician does not enter it in the wrong place. Following a liver biopsy position the client on the right side. Apply pressure to the biopsied site for 4 to 6 hours using a sandbag or folded bath blanket to help prevent bleeding. Take vital signs every 15 min for 1 hour and every 30 min for 4 hours and then hourly for 8 hours. Observe the client for signs of bleeding- bleeding may be into the abdomen watch for signs of shock! Paracentesis is a procedure that can be done for diagnostic purposes or to relieve fluid accumulation in the abdomen. It is considered diagnostic when fluid is withdrawn for microscopic study/culture or when bleeding/infection is suspected. Removal of excess abdominal fluid usually helps the person with breathing difficulties because of this. Nursing considerations: Ask the client to void immediately before the procedure Perform sterile scrub of the abdomen before insertion of the needle Monitor vital signs before and after procedure- watch for dizziness/fainting

Measure the amount of fluid obtained After procedure monitor for bleeding/signs of shock Check the dressing to make sure it is tight and dry Keep the patient in Fowlers position Observe urine output- observe male clients scrotum for edema Monitor for signs of infection

S/S of GI Bleed

-Black tarry stool upper GI bleed - Vomiting blood - Blood in stool- lower GI bleed - Shock- pallor, weak and rapid pulse, low blood pressure, faintness and collapse. - Vomit with coffee-ground consistency If blood loss is great and sudden the client will most likely vomit, and if it is small and gradual they will pass it in the stool. Endoscopic procedures can be done to close bleeding vessels with heat. Injection by epinephrine by sclerotherapy will also stop acute bleeding. Treatment of a bleeding ulcer includes rest enforced by sedatives. Surgery if bleeding continues, blood transfusion and IV fluids may also be ordered.

Reasons for Gastric Suctioning

Suctioning is used for periodic or continuous use in many GI conditions such as: - To obtain a specimen of stomach or intestinal contents for examination To treat intestinal obstruction

To prevent and treat postoperative distension by removing gas and toxic fluid material from the stomach or intestines To empty the stomach before emergency surgery or after poisoning (alcohol)

To protect the suture line after GI surgery

NG suction is usually low pressure and intermittent. Electrolyte balance is crucial since electrolytes can be diminished by gastric suctioning!! Note the amount of drainage of gastric fluids and consider it as part of the output when calculating I&O. Report vomiting at once because it indicates a malfunction of the suction apparatus. Gastic lavage aka stomach pumping places a large tube in the mouth and nuetrilizes a poision using charcoal, to remove stomach contents and wash out the stomach this process is called lavage. For acute bleeding stomach ulcers the stoach is washed out using saline or tap water to clean out stomach before endoscopic procedures.

Care of the pt after a Gastroscopy

Inform the client that the endoscope tube will not inhibit normal breathing. Before the test the pt may be advised not to use aspiring, ibuprofen, or any anticoagulants because this may prolong bleeding. During the procedure air will be instilled into the stomach so it can expand and be able to see the whole surface. Another driver should be there to take the client home because of the effects of conscious sedation. Do not give any food or fluids until the gag reflex has returned. Observe the client for dyspnea because the tube may have irritated the throat and caused swelling. If the had undergone dialation (stretching procedure) observe for bleeding, pain, dysphagia, and change in vital signs. Because of the dye used diarrhea is a common side effect. Frequent vital signs, IV hydration, anti-biotics, and lab work is important for the next 12-24 hours.

GERD

Gastroesophageal Reflux Disease occurs when the lower esophageal sphincter (LES) leading into the stomach is weak or relaxes inappropriately. Acidic stomach acids then move back up into the esophagus. Aspiration of stomach acid may cause asthma, pneumonia, and chronic lung disease. Obesity and desk jobs are considered important contributing factors to the development of GERD. Esophagitis is the acute or chronic inflammation/irritation of the lining of the esophagus which may be cause by LES weakness. Many medications and food irritate GERD such as: aspirin, chocalte, peppermint, spicy food, coffee, tomato, citrus, and fried foods. Overeating and alcohol worsens the condition. Bacterial or yeast infections may also be causes. Treatment- Treatment is aimed at alleviating or minimizing the causes. Diet counseling, medication may help: antacids, and GI stimulants. Surgical treatment is for those who do not respond to medication treatment. The client should elevate the bed, avoid gastric irritants, eat small meals, drink

adequate fluids, not lay down for at least 2 hours after meals. Barretts esophagus is a condition of chronic irritation of the lower esophagus the cells become precancerous. Gastric/duodenal ulcers/ca stomach

An ulcer is an open sour in the mucous membrane/skin that is accompanied by sloughing of inflamed and necrotic tissue. Peptic ulcer is an ulcer in the esophagus, stomach and duodenum. Gastric ulcers are thought to result from a break in the mucous barrier mechanisms that normally protect the stomachs lining. Duodenal ulcers are characterized by increased gastric secretion of hydrochloric acid. The presence of H. pylori is associated with duodenal/gastric ulcers and stomach cancer. Signs and symptoms- Black tarry stool (Melena) from bleeding may occur and is a significant finding. Gastroscopy and X-ray help diagnose the ulcer and differentiate it from cancer lesion. Diagnosis of H. Pylori infection is done by gastric mucosal biopsy, breath test, blood test for H. Pylori antibodies. Duodenal ulcers are 4X more common than gastric, more common in men and more common in people younger than 35, associated with weight gain and mid-epigastric pain 2-4 hours after meals and relieved by eating, it is also more likely to perforate that gastric ulcers. Gastric ulcers are more common in women, more common in those older than 65, high mortality rate- more malignant than duodenal, high epi-gastric pain 1-2 hours after meals, eating does not relieve, and weight loss may occur. Incase of complications NG tubes are inserted and attached to suction, NPO for at least 24 hours, and IV fluids given. Abdominal infection- massive doses of antibiotics, abdominal distention with no passing of gas/feces is a serious disruption in peristalsis. GI bleeding is also a complication. Perforation is when the ulcer penetrates the wall of the stomach/intestine and the contents spill out into the abdomen, causing peritonitis- symptoms start with sudden sharp abdominal pain, pallor and diaphoresis. The abdomen is harden, tender, and painful. Peritonitis can be fatal! It requires immediate surgery! This can occur without warning. Obstruction may occurs when scar tissue builds up and prevent food to pass through the pyloric sphincter. Symptoms include- vomiting undigested good, and stomach pains. Only vomiting relieves the pain. Peritonits is a serious threat in this case. Treatment- Diet and medication are effective treamtment. Medication regimes such as taking peptobismal and anti-biotics to eradicate H. Pylori have been effective in healing and preventing further ulcers. A bland diet while pain is present. The patient should omit coffee, tea, soda pop, chocolate, and alcohol because they stimulate hydrochloric acid secretions. Milk and cream are good. The goals in ulcer treatment are to lesson lesion irritatement, lessen acid secreations, and reduce activity of the stomach and intestine. Stomach Cancer- known as the silent neoplasm because it is usually not detected until after it has spread to other structures. The prognosis is often very poor. S/S- sudden dyspepsia unrelieved by eating- this is the most important symptom. Others are: unexplained weight loss, and weakness. Coffee-

ground emesis, and absence of free hydrochloric acid are other findings. Surgical removal of the tumor, or part/entire stomach may be done.

Chrohns Disease

Crohns disease can occur anywhere in the intestinal tract from the mouth to the anus. The most common location is in the ileum. It involves inflammatory process of the entire thickness of the bowel wall. It is usually patchy and skips segments of healthy bowel. Typical signs and symptoms are: Diarrhea, blood and mucus in the stool, abdominal pain, cramps, urgency, bowel incontinence, anorexia, weight loss, nausea, and vomiting. Electrolyte imbalance may occur. Most people expierence episodes, and times of remission. Many people with Crohns disease require surgery. Complications include: malabsorption of nutrients, abscesses, fistulas, bowel obstruction, perforation of colon.

Hepatitis

Hepatitis can be acute or chronic inflammation of the liver, that may be accompanied by liver tissue damage. Viruses are the most common cause of hepatitis. Alcohol, some drugs, and some autoimmune diseases can cause hepatitis, but the main cause is a virus. S/S- sign and symptoms are subtle, making diagnosis and prevention difficult. Diagnosis is made by LFT and specific antibody testing for viruses. S/S are: fatigue, nausea (sometimes vomiting and diahrea), anorexia, abdominal pain, joint aches, mild fever (Hep A), jaundice, dark urine, liver enlargement. Types: Hepatitis A- most common form of viral. It is spread by the oral- fecal route and is transmitted by contaminated food, water, food handlers. Oral-anal sexual practices also can spread hepatitis A. Primarily affects children and young adults. It is preventable by immunization. The greatest excreation of the virus occurs before the jaundice appear. As the disease runs its course the person becomes less infectious. Prophylactic measures include immune serum globulin. The person recover 4-6 weeks, do not develop chronic hepatitis and are immune to it thereafter. Hepatitis B- transmitted by: percutaneouse transmission through infected blood, blood products, or instruments, sexual transmission in semen/saliva, perinatal transmission from mother to child at birth. Those at risk for exposure include- IV drug users, sexually active homosexuals, hemodialysis, people in

mental institutions, infants born to HBV mothers. There is also a vaccine for type B. Some people who receive the vaccine are non-reactors meaning they do not develop antibodies for reasons unknown. Usually symptoms are more sever and longer lasting than those with type A. Only 17% of people recover and others go into hepatic failiure within weeks of clinical onset. Persistant HBV infection increases risk for liver cancer. Hepatitis C- those at risk are: IV drug users, patients who receive blood products that were not tested, there are at least 4 diff subtypes. Incubation period is 35-70 days. The symptoms are mild and are overlooked. 50% later present chronic disease and of those 20% develop liver cirrhosis. 50% of those who newly contact the disease will become lifetime carriers. Liver cancer is associated with HCV. Hepatitis D- only those who have HBV can get HDV. The severity depends on the severity of the HBV. Everything else is the same as with HBV. Hepatitis E is extreamly rare in the US, fatal in pregnant women, very similar to HAV.

Cirrhosis of Liver

Cirrhosis is a chronic, degenerative disease of the normal functioning cells in the liver. Basically and ultimately the liver can longer do its work. The hepatocytes become infiltrated by fatty and fibrous tissue that cannot detoxify waste. Jaundice occurs and all body functions ultimately deteriorate. Uncontrolled cirrhosis will lead to hepatic coma. Toxins are not broken down and therefore circulate freely in the body causing toxicity. The liver becomes enlarged because it tries to heal itself- this causes the blood vessles supporting it to become obstructed- known as portal hypertension. This leads to the formation of esophageal varices. The esophageal varices often rupture causing massive hematemesis and hypovolemic shock. If the person survives this hemorrhage the are likely to get an infection. Cirrhosis is more common in men, and alcohol is the main cause as well as drugs, and hepatitis. Cirrhosis may be so gradual the person will not suspect anything and only expierence dyspepsia and anorexia. As cirrhosis advances the patient will expierence abdominal pain, rapid pulse, and breathing difficulties. They will bleed easily, have dialated veins, and nosebleeds. Treatment is long and aimed at increasing liver function. Diet and fluid restrictions, diet is: high in vitamins, moderate crabs, and fats, low in sodium, the amount of protein depends on the livers functionality. Diuretics may be ordered, monitor I&O because it will display the function of the liver.

Esophageal Varices

Are abnormal dilations of the blood vessels of the esophagus. They are most often assoctiated with cirrhosis of the liver. Treatment is immediate untreated can hemorrhage! EGD may be used to treat. Sclerotherapy is when caustic agents are injected near the varices causing scar tissue to form and stop bleeding. Monitor for bleeding before, after surgery and treatments. Band ligation is also used small rubber bands placed around the varices and stop bleeding.

Care of a client with an Ostomy

The new stoma which is mucous membrane should be moist, ranges from dark red to rich pink. Stomas can be temporary or permanent, temporary stomas are often double-barrel stoma- the proximal stoma drains fecal matter while the distal does not. Colostomy irrigation is similar an enema- most clients irrigate with 1,000 ml of tap water every other day or as needed. The pouch must be cut to fit the ostomy so no leakage occurs. The skin may breakdown if leakage occurs. One month after surgery the client should have a low fiber diet and after that they can have a regular diet. The person with an ileostomy needs plenty of fluids (with electrolytes). Danger Signs in the new colostomy or ileostomy: Abnormal sounds Excessive bleeding Darkening in color- means blood supply is being cutoff Blanching or very light in color- lack of circulation in stoma Drying of the stoma Edema of the stoma Stoma goes back into the abdomen Skin irritation around stoma Signs of infection Herniation around stoama

Cleanliness is important, clean around the stoma, skin care around the stoma, teach the client how to care for the stoma site.

Cholecystitis

Is the inflammation of the gallbladder. This often occurs with gallbladder stones and each condition aggravates the other. The stones may block the duct that runs out of the gallbladder, and they may injure the wall and lead to infection. Victims are obese woman over 45, change in diet, and rapid weight loss. If the gallbladder fills with pus and explodes causing peritonitis! Chronic gallbladder disease can damage the liver. S/S- acute pain in upper right abdominal quadrant that radiates to the back or right shoulder. Fatty foods make this condition worse, indigestion, light colored stools (with no bile), fatty floating stools, jaundice, fever, belching, N/V. Treatment- Non fat foods, lean meat, no alcohol. Immediately after the attack the client can only have liquids. Removal of the gallbladder may be done.

2012125001-17