1. Chapter 88: Digestive Disorders

2. 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)

3. 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

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

5. Radiographic Evaluations
Barium studies
Upper GI series
Lower GI series
Cholecystogram

6. 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.

7. 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.

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

9. 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

10. 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

11. 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

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

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

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

15. 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

16. Ostomy Pouches and Accessories

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

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

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

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

21. 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.

22. 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

23. 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)

24. 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

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

26. 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

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

28. 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

29. 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

30. 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.

31. 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.

32. End of Presentation