ALTERATIONS IN

GIT FUNCTION
 DIVERTICULITIS
Is an acute inflammation and infection caused by
trapped fecal material and bacteria in an
outpouching of the mucosal lining of the colon
Diverticulum
Diverticula
Most commo cause: Low fiber diet
 DIVERTICULITIS
Clinical Manifestations:
1. Crampy, abdominal pain in the left lower quadrant
that worsens with movement, coughing or
straining.
2. Chronic constipation with episodes of diarrhea
3. Low grade fever
4. Nausea and Vomiting
 DIVERTICULITIS
Clinical Manifestations:
5. Abdominal distention and tenderness.
6. Occult bleeding
7. Signs and symptoms of peritonitis
 DIVERTICULITIS
Collaborative Management
1. High fiber diet
2. Liberal fluid intake of 2,500-3,000ml/day
3. Avoid nuts and seed
4. Bulk-forming laxatives: Metamucil, Citrucel,
FiberCon
 DIVERTICULITIS
Collaborative Management
5. During an acute episode:
a. Bed rest
b. NPO, then clear liquids
c. Avoid high fiber foods
d. IV fluid
e. Antibiotics
f. Antispasmodics/anticholinergics
g. NGT insertion
6. Weight reduction of obese
 CHRONIC INFLAMMATORY
BOWEL DISORDERS (CIBDS)
2 types:
1. Crohns Disease
2. Ulcerative colitis
 CHRONIC INFLAMMATORY
BOWEL DISORDERS (CIBDS)
Chrons disease is a subacute and
chronic inflammation of the GI tract wall
that extends through all layers
Clinical Manifestations of Crohns disease
1. Diarrhea
2. Transmural inflammation
3. Ileum and ascending colon are
commonly affected.
 CHRONIC INFLAMMATORY
BOWEL DISORDERS (CIBDS)
Clinical Manifestations of Crohns disease
1. Diarrhea
2. Transmural inflammation
3. Ileum and ascending colon are
commonly affected.
4. Stool is with pus and mucus
5. Fistula formation
6. Abdominal pain and weight loss
 CHRONIC INFLAMMATORY
BOWEL DISORDERS (CIBDS)
Collaborative management for Crohns
disease
1. Low fiber diet
2. Total parenteral nutrition
3. Steroid
4. Azulfidine
5. Antibiotics
6. Surgery: ileostomy, colectomy
 CHRONIC INFLAMMATORY
BOWEL DISORDERS (CIBDS)
Ulcerative colitis is a recurrent ulcerative and
inflammatory disease of the mucosal and
submucosal layers of the colon and rectum.
Clinical Manifestations of Ulcerative Colitis
1. Diarrhea
2. Mucous ulceration of the intestine
3. Inflammation starts from the rectum
4. Stool is with pus, mucus and blood
5. Rectal involvement is 100%
6. Abdominal pain and weight loss
 CHRONIC INFLAMMATORY
BOWEL DISORDERS (CIBDS)
Collaborative Management for Ulcerative
Colitis
1. Low fiber diet
2. Total parenteral nutrition
3. Steroid
4. Azulfidine
5. Surgery: ileostomy, proctocolectomy
 ABDOMINAL HERNIA
Is the protrusion of an organ or structure
through a weakened abdominal muscle.
Causes:
1. Congenital or acquired muscle weakness
2. Increased abdominal pressure due to:
Heavy lifting
Obesity
pregnancy
 ABDOMINAL HERNIA
Types of abdominal hernia
1. Reducible hernia
2. Irreducible hernia
3. Inguinal hernia
Indirect inguinal hernia
Direct inguinal hernia
 ABDOMINAL HERNIA
Types of abdominal hernia
4. Umbilical hernia
5. Femoral hernia
6. Incisional hernia
7. Incarcerated hernia
8. Strangulated hernia
 ABDOMINAL HERNIA
Clinical Manifestations
1. Lump in the groin, around umbilicus, or
from an old surgical incision,
2. Sensation of heaviness in the area. With
vague discomfort
3. Nausea, vomiting, distention, pain
indicates strangulated hernia
 ABDOMINAL HERNIA
Collaborative Management
Surgery Herniorrhapy
1. Preoperative care: assess for presence
of respiratory tract infection
 ABDOMINAL HERNIA
Collaborative Management
Surgery Herniorrhapy
2. Postoperative Care
a. Encourage the client to deep breathe,
but not coughing exercises
b. Increase fluid intake
c. Monitor for bladder distention
 ABDOMINAL HERNIA
d. Elevate the scrotum with rolled small towel,
apply ice bag over the scrotum.
e. Discharge patient teaching
Avoid heavy lifting, pushing, pulling for about
6 weeks
Avoid driving, climbing stairs for 2 weeks
Stool softeners or bulk laxatives as prescribed.
Monitor incision for signs of infection
Sexual activity may be resumed once
healing is complete and comfort is assured.
 COLORECTAL CANCER
Commonly affected is the rectosigmoid
area
Predisposing factors:
1. Age above 40 years
2. Dietary factors
3. Other factors: obesity, history of chronic
constipation, history of inflammatory
bowel disorder, family history
 COLORECTAL CANCER
Assessment findings in distal colon and rectal
cancer:
1. Rectal bleeding
2. Changed bowel habits
3. Pencil or ribbon shaped stool
4. Tenesmus
5. Sensation of incomplete bowel emptying
6. Abdominal pain below the umbilicus
 COLORECTAL CANCER
Guidelines for early detection
1. Annual digital rectal examination (DRE)
after age 40 years
2. Annual occult blood test after age 50
years
3. Proctosigmoidoscopy
 COLORECTAL CANCER
Collaborative Management
1. Surgery: Hemicolectomy, Abdomino-
perineal resection
2. Chemotherapy
3. Radiotherapy
 COLORECTAL CANCER
Care of the client undergoing colonic surgery
1. Preoperative care:
Provide psychological support
Promotion of thorough bowel cleansing
If the client received cleansing enema,
vitamin C and K are ordered.
Colostomy: ascending colostomy, transverse
colostomy and descending and sigmoid
colostomy
 COLORECTAL CANCER
Care of the client undergoing colonic surgery
2. Postop care
a. Manage perineal wound in APR
Wound irrigations with normal saline and
absorbent dressings until wound closes
Drain drainage at regular basis
Warm sitz bath
Foam pads or soft pillow
advise client to assume side lying position
during sleep
 COLORECTAL CANCER
Care of the client undergoing colonic surgery
2. Postop care
b. Stoma Monitoring
notify physician if signs and symptoms of
ischemia occurs
notify physician if the stoma is prolapsed or
retracted
monitor return of peristalsis
Empty pouch when it is 1/3 to full of stool
 COLORECTAL CANCER
Care of the client undergoing colonic surgery
2. Postop care
c. Colostomy Irrigation
Enema
position in semi fowlers if bedrest, or sitting of
ambulatory
hang the irrigation bag
Use 500 to 1000 ml of warm normal saline
solution or lukewarm water
Lubricate catheter before insertion
 COLORECTAL CANCER
Care of the client undergoing colonic surgery
2. Postop care
c. Colostomy Irrigation
Enema
position in semi fowlers if bedrest, or sitting of
ambulatory
hang the irrigation bag
Use 500 to 1000 ml of warm normal saline
solution or lukewarm water
Lubricate catheter before insertion
 COLORECTAL CANCER
Care of the client undergoing colonic surgery
2. Postop care
c. Colostomy Irrigation
Dilate stoma with lubricated gloved pinky finger
before insertion.
Insert 2-4 inches of the catheter to stoma without force
If cramping occurs during irrigation, clamp tubing.
Allow catheter to remain in place for 5-10 mins and
massage. Remove catheter to drain for 15-20 mins
Clean the stoma, apply new pouch
Perform irrigation the same time each day
Perform irrigation 1 hour after meal
 COLORECTAL CANCER
Care of the client undergoing colonic surgery
2. Postop care
d. Managing Odor
Avoid gas forming- and foul odor foods
include foods that reduce odor
rinse pouch with tepid water or weak vinegar
solution
Place deodorant tablet or small amount of
mouthwash on the pouch
 COLORECTAL CANCER
Care of the client undergoing colonic
surgery
2. Postop care
e. Teaching for self-care
Stoma care
Skin care
Supporting a positive self-concept
Resolving grief
Preventing sexual dysfunction
 HEMORRHOIDS
Are dilated blood vessels of the anal
canal
External hemorrhoids occur below the anal
sphincter
Internal hemorrhoids occur above the anal
sphincter
Prolapsed hemorrhoids can become
thrombosed or inflamed
Most common cause is constipation
 HEMORRHOIDS
Collaborative Management:
1. High fiber diet, increase fluid intake, stool
softeners.
2. Apply cold packs to the anal area
followed by warm sitz bath
3. Apply topical anesthetics
4. Surgery: hemorrhoidectomy, cryosurgery
 HEMORRHOIDS
Collaborative Management:
5. Preop care of the client undergoing
hemorrhoidectomy
low residue diet
Stool softeners
 HEMORRHOIDS
Collaborative Management:
6. Postop care of the client undergoing
hemorrhoidectomy
Promotion of comfort
Assist client to a side lying position
Apply ice packs over the dressing as prescribed for
the first 12 hours postop
Warm sitz bath 12-24 hours postop
Monitor client for urinary retention
Administer stool softener
Increased fluids and high fiber foods
Instruct client to report for the following signs: rectal
bleeding, suppurative drainage, continued pain,
continued constipation
 INTUSSUSCEPTION
Is the telescoping of one portion of bowel
into another portion.
The condition results in an obstruction to
the passage of intestinal contents.
 INTUSSUSCEPTION
Clinical Manifestation:
1. Currant jelly stools
2. Colicky abdominal pain
3. Vomiting of gastric content
4. Bile-stained fecal emesis
5. Hypoactive or hyperactive bowel sounds
6. Tender, distended abdomen with palpable
sausage-shaped mass in the right upper
abdomen
 INTUSSUSCEPTION
Collaborative management:
1. Monitor signs of perforation and shock
2. Hydrostatic reduction as prescribed
3. Administer clear fluid and advance the
diet gradually
4. Surgery is required if not resolved by
barium enema
 VOLVULOUS
Is the twisting of the intestine due to
impaired innervation
Leads to intestinal obstruction
Surgery is required to remove the
affected area and end-to-end
anastomosis is done
 ADHESIONS
is the formation of fibrous bands that cause
sticking of loops of colon.
Impaired peristalsis causes accumulation of
gas and feces in the area affected
Risk factors:
Clients who had undergone surgery
clients in bed rest for a long period of time
Adhesiolysis surgical removal of adhesions
 FISTULA
Is abnormal opening that connects two
body cavities.
If fistula forms connecting the small and
large intestine, contamination of nutrients in
the small intestine by the fecal waste of the
large intestine occurs
This leads to sepsis
 DEHISCENCE
Is the interruption or opening of a skin
wound.
A sharp pain in the suture line
Increased serosanguinous drainage from
the wound frequently precede dehiscence.
Treated as an open wound.
 EVISCERATION
Is the opening of a wound with exposure of
internal organs
This condition is an emergency
Collaborative management:
1. Return the client to bed. Place in supine
or semi-fowlers position with knees flexed
2. Do not attempt to replace the organs
3. Cover the wound with sterile dressings
moistened with normal saline
 EVISCERATION
Collaborative management:
4. Monitor clients vital signs and symptoms
of shock
5. Keep the client as calm as possible
6. Notify the surgeon immediately
 CLOSTRIDIUM DIFFICILE
Caused by anaerobic spore-forming
bacterial pathogen.
Produces toxins that affect bowel mucosa
Major cause of nosocomial diarrhea in
clients receiving antibiotic therapy.
MOT: feco-oral route
Management: Flagyl or vancomycin
Implement contact precaution when caring
for the client
 SHIGELLOSIS
Is a type of gastroenteritis caused by
shigella dysenteriae, a gram negative
bacilli.
It is also called bacillary dysentery
MOT: feco-oral route
Implement contact precaution when caring
for the client
 BOTULISM
Is a serious paralytic illness caused by a
nerve toxin that is produced by bacterium
clostridium botulinum
Spore is found in the soil and can spread
through the air or food or via contaminated
wound
It cannot be spread from person to person
 Clinical Manifestation:
BOTULISM
1. Abdominal cramps
2. Diarrhea
3. Nausea and vomiting
4. Double vision
5. Blurred vision
6. Drooping eyelids
7. Difficulty swallowing or speaking
8. Dry mouth
9. Muscle weakness
10. Can progress to paralysis of the arms, legs, trunk,
respiratory muscles.
 BOTULISM
Collaborative managemet
1. Antitoxin
2. Induction of vomiting
3. Enemas
4. penicillin