Chapter 88: Digestive Disorders

Digestion Major organs Within the GI tract, which begins with the mouth and ends with the anus Accessory organs Liver, gallbladder, and pancreas Gastroenterologist Enterostomal therapist (ET)

Laboratory Studies Complete blood count (CBC) Routine chemistries, liver function tests (LFT) Carcinoembryonic antigen (CEA), serum cholesterol, and triglycerides Urinalysis (UA) Stool tests Culture and sensitivity study Hematest—fecal occult blood testing HemoQuant stool testing

Common Breath Tests Hydrogen and/or methane gas test Lactose intolerance testing Fructose intolerance testing Bacterial overgrowth syndrome

Radiographic Evaluations Barium studies Upper GI series Lower GI series Cholecystogram

Question Is the following statement true or false? If a client is unable to maintain a liquid diet completely, he or she is allowed to have a small meal 24 hours before the GI evacuation, at the latest.

Answer False The entire GI tract is prepared, emptying it as thoroughly as possible, using liquid diets for several days before the procedure, and using enemas or cathartic drinks the day before and/or the morning of the procedure. The radiologist cannot visualize abnormal or malignant structures without a thorough evacuation of the intestines. The procedure may have to be cancelled and repeated later starting with a new bowel preparation.

Endoscopic Procedures Esophagoscopy Esophagogastroduodenoscopy (EGD) Endoscopic retrograde cholangiopancreatography (ERCP) Gastroscopy Colonoscopy Sigmoidoscopy or proctosigmoidoscopy Endoscopic ultrasonography (EUS) Video capsule endoscopy (VCE)

Biopsy Many endoscopic procedures of the lower bowel allow biopsy samples to be taken concurrently The removed tissue is examined for the presence of cancer cells and other abnormalities Polypectomy Liver biopsies

Gastrointestinal Intubation Nasogastric (NG) tubes Providing oral and skin care Verifying NG tube placement Removing the tube Common GI suction tubes Levin or Wangensteen Salem sump Sengstaken-Blakemore

Gastric Suction To obtain a specimen of stomach or intestinal contents for examination To treat intestinal obstruction To prevent and treat postoperative distention by removing gas and toxic fluid materials from the stomach or intestines To empty the stomach before emergency surgery or after poisoning To protect the suture line after GI surgery

Common Treatments NG tube irrigation Gastric lavage Enteral nutrition Parenteral nutrition Hickman catheter Port-A-Cath Peripherally inserted central catheter (PICC)

Gastric Surgeries Total gastrectomy Subtotal gastrectomy Vagotomy Gastroduodenostomy (Billroth I) Gastrojejunostomy (Billroth II) Pyloroplasty Postoperative complications

Bariatric Surgeries Laparoscopic gastric band Roux-en-Y gastric bypass Biliopancreatic diversion with duodenal switch Vertical sleeve gastrectomy

Bowel Diversion Colostomy or ileostomy Colostomy irrigation Ostomy appliances Nursing considerations Clothing, bathing, activity, diet, skin care, client and family teaching Continent bowel diversions Ileoanal reservoir or pelvic pouch or J-pouch Kock pouch or the continent ileostomy

Ostomy Pouches and Accessories

Disorders of the Mouth Dental problems Periodontal disease Gingivitis, pyorrhea alveolaris Stomatitis Candidiasis Herpes simplex infections Trauma Precancerous lesions Cancer of the mouth

Disorders of the Esophagus Esophageal varices Esophageal diverticulum Hiatal hernia Achalasia Heartburn Gastroesophageal reflux disease (GERD) Barrett esophagus Esophageal cancer

Disorders of the Stomach Gastritis Chronic gastritis Toxic gastritis Peptic ulcer disease Stomach cancer

Question Which of the following is a complication from gastritis? a. Chronic diarrhea b. Bowel obstruction c. Perforation d. Toxic megacolon e. Dyspepsia

Answer c. Perforation Other complications include abdominal infection, obstruction, and hemorrhage. Chronic diarrhea and bowel obstruction may be due to a disorder of the bowel. Certain types of diarrhea may cause toxic megacolon. Frequent dyspepsia may be a symptom of stomach ulcer.

Medications for the GI System Classifications Antacids Histamine (H2) receptor antagonists Proton pump inhibitors (PPI) Cholinergic blockers Miscellaneous antiulceratives, antilipidemic Peptic ulcer disease due to H. pylori Antidiarrheals and antiemetics Laxatives, cathartics, and stool softeners

Disorders of the Small or Large Bowel Diverticulosis and diverticulitis Hernias Inguinal hernias Femoral hernias Umbilical hernias Abdominal hernia Incisional hernia Intestinal obstruction Irritable bowel syndrome (IBS)

Disorders of the Small or Large Bowel (cont.) Constipation Diarrhea Inflammatory bowel disease (IBD) Ulcerative colitis Crohn disease Appendicitis Cancer of the small intestine Colorectal cancer

Disorders of the Sigmoid Colon and Rectum Hemorrhoids Anal fissure Anal abscess Anal fistula

Disorders of the Liver Liver failure (hepatic coma) Cirrhosis Hepatitis Hepatitis A, hepatitis B, hepatitis C, hepatitis D, hepatitis E, toxic hepatitis Liver abscess Trauma Liver transplantation Liver cancer

Disorders of the Gallbladder Cholecystitis and cholelithiasis Common bile duct obstruction Cancer of the gallbladder

Disorders of the Pancreas Pancreatitis Inflammation of the pancreas May develop from infectious or traumatic damage, alcohol, or drugs Pancreatic cancer Tumors of the pancreas are usually malignant Cancer of the body or tail of the pancreas is usually not detected until metastasis has occurred

Conditions of Overnutrition and Undernutrition Obesity The condition of being overly fat, not necessarily overweight Calculated body mass index (BMI) as diagnosis Anorexia nervosa Self-imposed starvation Bulimia Binge syndrome

Question Is the following statement true or false? It is safe for a nursing mother to be on a drastic weight- loss program, provided she drinks large amounts of water.

Answer False The nursing mother should not be on a drastic weight- loss program because toxins and pollutants, which are stored in fat tissue, enter the mother’s blood and can pass to the baby. Weight-loss programs requiring ingestion of large amounts of water may be dangerous to the person with glaucoma (it may increase intraocular pressure) or certain kidney or liver disorders.

End of Presentation