Feb 17 - GI system

Feb 17 - GI system - Gastrointestinal System Disorders...

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Unformatted text preview: Gastrointestinal System Disorders Disorders NURS 216 Spring 2010 Sabra Smith, MS, RN Peritoneum Peritoneum Esophageal Disorders Esophageal Achalasia – hypomotility disorder in which Achalasia peristalsis is weak and/or ineffective, food accumulates in lower esophagus accumulates -a problem of neurologic control? Esophagitis – inflammation of the mucosal Esophagitis layer, causing burning pain layer, -acid reflux, infectious agents (H. pylori), -acid injestion of strong acidic/basic substances injestion Esophageal Disorders Esophageal Chronic reflux – most common cause of Chronic esophagitis, LES is “incompetent” and allows gastric contents back into the esophagus esophagus -often associated with hiatal hernias -normally LES maintains a high-pressure -normally closure at entrance to stomach, can be weakened by drugs, high gastric pressure weakened Gastric Reflux Gastric Hiatal Hernia Hiatal Hiatal Hernia Hiatal A portion of the upper stomach and/or portion LES pushes through the hiatus across the diaphragm diaphragm Sliding type - most common, often no Sliding symptoms, happens when supine symptoms, Rolling type – LES and junction stay below Rolling diaphragm, portion of stomach pushes up diaphragm, -strangulation may occur -strangulation Symptoms Symptoms Dysphagia – difficulty swallowing (not to Dysphagia be confused with dysphasia) dysphasia Pyrosis – heartburn, pain high in epigastric Pyrosis area, behind sternum area, Odynophagia – pain caused by Odynophagia swallowing swallowing Regurgitation – backflow of liquid/food into Regurgitation oral cavity, feels like a hot liquid (different from vomiting) from Nausea & Vomiting Nausea The result(s) of several GI disorders Nausea – a symptom, feeling of Nausea queasiness, faintness, etc queasiness, Retching – involuntary spasms of glottis Retching and chest wall and Vomiting – reflex causing expulsion of Vomiting stomach/intestinal contents back through mouth mouth Vomiting Vomiting Results from stimulation of emetic center Results (in the brainstem) (in Acute vs. chronic nausea/vomiting Consider relation to meals, time of day, Consider contents of vomitus, menstrual cycle contents Can be life-threatening if severe and Can extended extended Gastritis Gastritis Inflammation or hemorrhage of the gastric Inflammation mucosa mucosa Acute – common, usually self-limiting, in Acute response to irritants response -causes: bacterial endotoxins, caffeine, -causes: ETOH, aspirin, NSAIDs ETOH, -vague s/sx: anorexia, belching, nausea, -vague epigastric pain, vomiting, bleeding epigastric Gastritis Gastritis Chronic – gradual thinning and smoothing Chronic of mucosa, loss of secretory cells of -Type B more common, often in elderly -causes: H. pylori infection, heavy ETOH, -causes: smoking, bile reflux smoking, -similar s/sx to acute gastritis, increases -similar risk of ulcers and carcinomas risk Erosive gastritis Acute gastritis Peptic Ulcer Disease Peptic A break in the mucosal layer below the break epithelium epithelium Anywhere in esophagus, stomach, or Anywhere duodenum that is exposed to acid gastric juice juice H. pylori found in majority of patients with H. ulcers ulcers Peptic Ulcer Disease Peptic Mucosa is normally protected by tight Mucosa epithelial lining and gastric mucus epithelial Damage to this protective layer allows HCl Damage through the epithelium, inflammation of mucosa, ulceration begins mucosa, Chronic/intermittent gastric pain 2-3 hrs Chronic/intermittent after eating, nausea, coffee-ground emesis emesis Ulcers Ulcers This sharply punched out gastric ulcer has been present for some time as judged by the amount of puckering of the surrounding mucosa and by the undermining and depth of the ulcer. Complications of Ulcers Complications Hemorrhage – most common, often in Hemorrhage duodenal ulcers, s/sx depend on speed of blood loss blood Perforation – ulcer burrows through entire Perforation gastric wall, gastric acid released into abdomen causing acute peritonitis, rigidity Obstruction – pyloric sphincter is blocked from edema, spasm, scarring from Malabsorption Malabsorption A syndrome that results from several syndrome diseases of small and large intestines diseases A failure of the intestine to absorb one or failure several nutrients across the mucosa into the blood the Symptoms result from abnormal contents Symptoms in lumen and nutrient deficiency in -steatorrhea, flatulence, diarrhea, weight -steatorrhea, loss, edema, anemia, weakness loss, Small Intestine Disorders Small Celiac Disease – an intolerance to gluten, Celiac a protein found in many grains protein -gluten causes atrophy of the villi, -gluten flattening of the mucosa of SI, this reduces absorption of all nutrients absorption -diarrhea, steatorrhea, weakness, general -diarrhea, sx of malabsorption sx -control with a gluten-free diet Small Intestine Disorders Small Lactase deficiency – lack of the enzyme Lactase lactase, which breaks down lactose (milk sugar), have abdominal cramps, bloating and diarrhea after drinking milk and Crohn Disease Crohn A chronic, granulomatous inflammation of chronic, GI tract, usually the ileum, possibly an infectious cause infectious - llesions thicken mucosa and stiffen the esions intestine, lymphedema intestine, -diarrhea, flatulence, fever, lower -diarrhea, abdominal pain, bloody stools, steatorrhea, weight loss, obstruction, perforation perforation Appendicitis Appendicitis The appendix is a 6-9 cm tubular pouch The off the end of the ileum off Something in the intestine obstructs the Something opening, causes swelling and infection which progress to gangrene/perforation which s/sx: RLQ pain develops over 1-2 days, s/sx: also n/v, rebound tenderness, low-grade fever, leukocytosis fever, Peritoneum Peritoneum Peritonitis Peritonitis Inflammation of the peritoneum, can be Inflammation acute or chronic acute Often from ruptured appendix, perforated Often ulcer, penetrating abdominal wounds ulcer, Exudate with fibrin surrounds and isolates Exudate initial infection by forming adhesions initial If infection spreads, this occurs throughout If peritoneum – paralytic ileus, loss of f&e, obstructions obstructions Peritonitis Peritonitis Obstructions Obstructions Acute/chronic, partial/complete Non-mechanical causes: toxins, infection, Non-mechanical loss of neural control stop peristalsis loss Mechanical causes: adhesions, tumors, Mechanical volvulus, hernias, intussusception volvulus, Gas and fluid build up above obstruction, Gas intestine distends, increasing pressure, dehydration in rest of body dehydration Obstructions Obstructions As bowel becomes ischemic, tissue may As necrose and release bacteria into abdomen abdomen S/sx: abdominal distension, cramping S/sx: pain, vomiting, absolute constipation pain, Without treatment, progresses to either Without hypovolemic shock or peritonitis and septicemia septicemia Diverticular Disease Diverticular Weak spots in the muscularis layer of the Weak colon herniate, trapping fecal matter Related to fiber in the diet, increased intraluminal pressures in the colon intraluminal Often unnoticed until saccules become Often inflamed, burst, perforate inflamed, Symptoms and survival depend on size of Symptoms perforations perforations Ulcerative Colitis Ulcerative Inflammatory condition causing lesions in Inflammatory the mucosa of the colon the Cause unknown, possibly genetic, viral or Cause autoimmune reaction autoimmune Acute fulminating type: abrupt onset, 1020 bloody stools a day, n/v, fever Chronic intermittent type: slow onset, short Chronic periods of flare-ups, milder symptoms periods Colon Cancer Colon Polyps: abnormal growths of tissue from Polyps: the mucosal layer into the lumen the Fairly common with increasing age Vague relationship between polyps and Vague colon cancer: larger, multiple or suspicious polyps more likely malignant Change in bowel habits, bleeding, pain, anemia, weight loss anemia, Colon Polyps Colon Hemorrhoids Hemorrhoids Varicose veins in the anal canal Internal and external 35% of people over age 25 Caused by congestion that interferes with Caused venous return from hemorrhoidal veins venous -constipation, pregnancy, prostate -constipation, enlargement, rectal tumors enlargement, Bleeding, thrombosis, strangulation Accessory Digestive Organs: Liver, Gallbladder, Pancreas Liver, Liver Liver Largest gland in the body ~3 lbs in adults On right side of body, below diaphragm Right and left lobes Structural unit: up to 100,000 lobules Venous blood supply from hepatic portal Venous vein, arterial supply from hepatic artery vein, 1500mL of blood/min through liver Lobules Lobules Each lobule is hexagonal, made up of Each plates of cuboidal hepatic cells around a central vein central Sinusoids are capillaries between the Sinusoids plates, contain Kupffer cells plates, Kupffer cells are part of the monocytemacrophage system (contain 50% of macrophage macrophages in the body) macrophages Functions of the Liver Functions Formation and excretion of bile Formation -Bilirubin is an end-product of bile, serves as a measure of liver function as Metabolism of all three macronutrients - storage of extra glucose as glycogen -degradation of aas, synthesis of proteins Drug metabolism Hormone synthesis Bilirubin and Jaundice Bilirubin Most bilirubin produced by RBC Most breakdown breakdown Bilirubin is the byproduct of heme Bilirubin breakdown, it is fat-soluble so must be processed by the liver processed Three steps: uptake, conjugation, Three excretion excretion Once processed, bilirubin can be excreted Once through bile or urine through Hyperbilirubinemia Hyperbilirubinemia Excess of bilirubin can occur from Excess problems in these areas: problems -excess production -excess -reduced uptake by the liver -reduced -reduced conjugation of bilirubin -reduced excretion into bile Excess bilirubin causes skin color Excess changes, itching, toxic to CNS changes, Hepatitis Hepatitis A viral infection that focuses on the liver Low mortality, but high morbidity A, B, C, D, E, F, G All produce similar effects, but are All separate viruses and are transmitted differently differently Hepatitis A,B,C are the most common Hepatitis A Hepatitis Transmitted mainly through fecal-oral Transmitted route route Incubation period of 30 days before Incubation symptoms begin symptoms Infectivity is highest during 14 days before Infectivity jaundice jaundice Vaccination available Hepatitis B Hepatitis Transmission is parenteral, oral, perinatal Incubation period of 60 – 90 days 25% of people with HBV will progress to 25% cirrhosis and liver failure cirrhosis The rest are called “carriers” 3-step vaccine available Hepatitis C Hepatitis Worldwide, most common cause of Worldwide, chronic hepatitis, cirrhosis, liver cancer chronic Transmission is parenteral or sexual Incubation averages 6 – 12 weeks Minimal symptoms with acute infection Delayed increase in cirrhosis, liver cancer No vaccine Cirrhosis Cirrhosis Chronic disease of the liver Abnormal connective tissue develops Abnormal (fibrosis) and abnormal liver cells begin to reproduce reproduce Interferes with blood circulation in the liver, Interferes may progress to liver failure may Can result from hepatitis or alcohol abuse Alcoholic Cirrhosis Alcoholic Most common type, develops in 10-15% of Most alcoholics alcoholics 5th leading cause of death in United States Progressive -fatty infiltration: fat cells accumulate -fatty within the liver, making it larger and greasy, this interferes with liver function greasy, -alcoholic hepatitis -widespread fibrosis, abnormal nodules Fatty, enlarged liver Cirrhotic liver Portal Hypertension Portal Sustained pressure in the portal vein Sustained > 22 mmHg 22 Causes: -prehepatic -intrahepatic -posthepatic Portal Hypertension Portal Complications: -ascites -splenomegaly -portosystemic shunts -caput medusae, esophageal varices Liver Failure Liver The end-stage of various liver disorders Develops when liver is at 10-20% capacity Bleeding/hematologic disorders Endocrine disorders Skin disorders Hepatic encephalopathy Gallbladder Disorders Gallbladder Cholelithiasis – 80% are cholesterol -risk factors: -S/sx: develop when bile flow is obstructed Cholecystitis – acute or chronic -S/sx: PAIN, vomiting, may spread to -S/sx: peritoneum peritoneum Exocrine Pancreas Functions Exocrine Lobules contain acinar cells that secrete Lobules digestive enzymes digestive Most enzymes are not activated until in Most the duodenum the – Examples: trypsin, amylase, lipases Acute Pancreatitis Acute Severe & life-threatening Often d/t gallstones or alcoholism Active pancreatic enzymes are released Active into the pancreas and surrounding tissue into S/sx: severe, radiating abd pain, abd S/sx: distenstion, may lose fluid into retroperitoneal cavity or abd cavity retroperitoneal Chronic Pancreatitis Chronic Gradual destruction d/t calcification (alcoholics) or obstructions d/t (gallstones) (gallstones) Also caused by cystic fibrosis, pancreatic Also duct stenosis duct Frequent, less severe painful episodes Eventually, exocrine and endocrine Eventually, functions of pancreas will diminish functions ...
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