1. Alteration of the Gastrointestinal System (GI) M. DuBois Fennal, PhD, RN, CNS

2. Anorexia Definition: The lack of the desire to eat. Etiology: Other disorders and psychological stress

3. Vomiting Definition: Forceful emptying of the stomach and the intestines

4. Constipation Definition: Difficult or infrequent defecation

5. Diarrhea Definition: Increase frequency of defecation and fluidity and volume of feces.

6. Abdominal Pain A feeling of discomfort in the abdominal area, describe by the individual experiencing the discomfort. Description of discomfort may vary based on the general make up of the individual, socialization, sex, race. Abdominal pain is individualized (Fennal, 2005)

7. Dysphagia Definition: Difficulty swallowing

8. Intestinal Obstruction (Bowel Obstruction) Definition: Prevention of flow, movement or expulsion of intestinal contents. Incidence: Higher in individuals who have had abdominal surgery. Usually related to adhesions; in individuals with tumors and hernias

9. Pathophysiology Loss of mechanical, chemical, or neurological function, that halts, blocks, or fail to initiate action of intestinal content. Loss of movement Loss of chemical secretion Changes in the structure of the GI Tract

10. Clinical Manifestations Colicky pain Sweating, nausea, hypotension Vomiting and distention Dehydration Hypovolemia Metabolic Acidosis Necrosis, perforation, peritonitis Atelectasis, pneumonia

11. Peptic Ulcer Disease Definition: A break or ulceration in the lining of the lower esophagus, stomach, or duodenum. Etiology: Smoking, Non-steroidal anti- inflammatory drugs, alcohol abuse, Chronic diseases, infection. Incidence: Higher in men than in women, more common in individuals with high alcohol intake and exceptional stress

12. Pathophysiology Duodenal Ulcers: Conditions that cause increase in the secretion of acid and pepsin and inadequate secretion of bicarbonate

13. Gastric Ulcers: Conditions that cause decrease secretion of gastric acid, which promotes decrease protection of the lining of the stomach from certain bacteria (heliocobacter pylori).

14. Clinical Manifestations Intermittent pain, relived by eating and/or antacids Feeling of fullness after eating just a small amount Nausea Vomiting Blood

15. Appendicitis Inflammation of the appendix Etiology: Theoretical assumptions regarding the etiology of appendicitis. What is known is that it becomes infected. Incidence: Most frequent surgery Occurs equally in men and women Most frequent between the ages of 20 and thirty years.

16. Pathophysiology Obstruction of the lumen Decrease blood flow Hypoxic tissue Invasion by bacteria Thrombosis, gangrene, perforation

17. Clinical Manifestations Lower right quadrant pain Nausea, vomiting, low grade fever Diarrhea (children) or constipation (adults) The inability to assume the fetal position or raise the right knee toward the chin. Increase WBC > 10,000

18. Obesity Definition: more than 20 % over the recommended body weight for age and height. Etiology: Heredity, excess calorie intake, decrease exercise, increase size of fat cells Incidence: More that 60% of the population in the United States is overweight. Obesity in children is increasing at such an alarming rate, the government is now involved in. Obesity is epidemic

19. Pathophysiology Theories: GeneticNa++, K+, ATP pump Fat-cellDiabetes Assoc. Lipoprotein-lipasePsychologic cause LipostaticThermogenic

20. Clinical Manifestations Carrying 20% or more body weight than is recommended for height and age Coronary artery disease Diabetes Gallstones Cancer Pulmonary Disease (sleep apnea) Joint disease

21. Anorexia Definition: A physiological and psychological syndrome characterized by fear of becoming obese, distorted body image, body weight less than 15% of “normal” and the absence of three menstrual periods in women

22. Etiology: Unknown Incidence: 5-10 million young women and 1 million young men.

23. Pathophysiology Deprivation of nutrients and auto- digestion? Loss of twenty to thirty percent of body weight (muscle and fat).

24. Bulimia Definition: The consumption of abnormally large amounts of food, followed by induced vomiting, and or purging of the bowels with laxatives. Etiology: Unknown Incidence: Same as anorexia, older in age, less affluent women, fifty percent of individuals with anorexia

25. Pathophysiology Destruction of teeth Pharyngeal and esophageal inflammation Rectal bleeding Isolation Depression

26. Clinical Manifestations Difficult to diagnose, No weight loss Depression Spending a lot of time alone and especially in the bath room Going to the bathroom immediately after eating.

27. Hepatitis Definition: Systemic disease that affect the liver Etiology: Viral in nature and depends on the type (p 1007, table 34-8) Incidence: Dependant

28. Pathophysiology Infiltration by a virus Hepatic cell necrosis Kuffer cell hyperplasia Infiltration of mononuclear phagocytes Obstruction of the bile duct, cholestasis, and jaundice

29. Clinical Manifestations None to severe illness Abnormal liver function studies (AST & ALT) Can take twenty weeks for recovery Prodromal (1-2 weeks after exposure) Icteric (1-2 weeks after prodromal phase lasting 2-6 weeks) Recovery (6-8 weeks after exposure).

30. May take 12 weeks for liver functions to return to normal. Disease may be acute or chronic

31. Cirrhosis Definition: Irreversible inflammatory disease of the liver that alters structure and function of the processes of the liver. Etiology: Alcohol, obstruction, postnecrotic or metabolic Incidence: Higher in men than in women, a leading cause of death in the US

32. Pathophysiology Impaired mitochondrial function Decrease oxidation of fatty acid Depressed enzyme and protein synthesis Decrease ammonia and hormone breakdown Altered metabolism of vitamins and minerals and induced malnutrition Destruction of liver cells, harden rock like appearance of liver tissue.

33. Clinical Manifestation Abnormal liver function studies Enlarged liver Anorexia, nausea, jaundice, and edema Weight loss Abdominal pain Ascites

34. Choleithiasis/Cholecystitis Definition: Stones in the gallbladder, inflammation of the gallbladder Etiology: Cholesterol stones, pigmented stones, obstruction of the cystic duct. Incidence: 10 to 20 % in developed countries. More prevalent in women, obese individuals, middle age, Native Americans

35. Pathophysiology Cholesterol stones are more prevalent Formed from bile saturated with cholesterol produced by the liver. Crystals are formed and grow as more bile passes the area. Pigmented stones are formed from increased levels of unconjugated bilirubin that binds with calcium

36. Clinical Manifestations Abdominal pain Jaundice Heartburn Flatulence Food intolerance (fats, flatulence producing foods such as cabbage) Abdominal tenderness and guarding Perforation of gallbladder

37. Clinical Manifestations Skeleton like appearance, hypotension, edema, bradycardia, hypothermia, constipation, sleep disturbances, and eventually heart failure and death.