1. DIGESTIVE
DISEASES 1

2. GERD GERD - Gastro-esophageal reflux disease
Not actually a disease but a syndrome of unknown cause where there is a reflux of gastric secretions into the esophagus.
This reflux results in esophageal irritation, inflammation, and pain.
More than 60 million Americans experience symptoms of GERD
17.5 million experience symptoms daily
Predisposing Conditions
Hiatal hernia
Decreased gastric emptying
Incompetent LES (lower esophageal sphincter) 2

3. GERD
Signs & Symptoms
Heartburn (burning, tight sensation below the sternum and radiates upward)
Feeling of fullness
Bloating
N/V
Reguritation
Dysphagia
Hoarsness
Dyspnea
Wheezing 3

4. GERD Complications Dx Scar tissue formation Lesions Dysphagia
Pneumonia (d/t aspiration) Dx
Ba swallow
Esophagoscopy 4

5. GERD Tx Drug therapy Antacids - Maalox (1-3 hrs pc and hs)
Proton pump inhibitors (Zantac, Pepcid)
Histamine H2-receptor antagonist (Losec, Prevacid)
Nutritional therapy
High protein, low fat
Avoiding chocolate, peppermint, coffee, tea, milk
Avoid late meals and nocturnal snacking
Small frequent meals
Fluids b/t meals rather than with meals 5

6. CELIAC DISEASE
Also called non-tropical sprue, is a mal-absorption condition .
In celiac disease, there is atrophy and flattening of the intestinal villi caused by a hypersensitivity to gluten.
Gluten is a protein found in wheat, barley, oats, and rye.
The hypersensitivity leads to inflammation of the small intestine which greatly reduces its ability to absorb nutrients.
Celiac can develop at any age but is most prevalent in children and those in their 40’s & 50’s. 6

7. CELIAC DISEASE Signs & Symptoms Risk Factors Dx
Steatorrhea (bulky, foul smelling, yellow-grey, greasy stools)
Wt. loss
Abd distention
Excessive flatulence
Multiple vitamin deficiencies
Risk Factors
Type 1 diabetes
Down Syndrome
Genetics Dx
Stool sample
Intestinal biopsy 7

8. CELIAC DISEASE Tx Gluten free diet
Corticosteroids (if not responsive to a gluten free diet) 8

9. INFLAMMATORY BOWEL DISEASE
Inflammatory Bowel Disease (IBD) includes:
Colitis
Crohn's Disease
Both diseases are characterized by chronic, recurrent inflammation of the intestinal tract.
The cause of both diseases are unknown, however, possible causes include:
Virus
Bacteria
Auto-immune reaction
Food allergies
Heredity 9

10. COLITIS
Ulcerative colitis is characterized by inflammation and ulceration of the colon and rectum.
It may occur at any age but happens most frequently b/t the ages of and 50-80
Higher incidence in women
More common in Jewish and upper middle class urban populations.
Colitis has exacerbations and remissions 10

11. COLITIS SIGNS & SYMPTOMS Bloody diarrhea
Abd pain varying from mild to severe
In severe cases
Fever
Wt. loss
Tachycardia
Dehydration 11

12. COLITIS COMPLICATIONS Dx Hemorrhage Strictures Perforation
Toxic megacolon Dx
Bloodwork (CBC electrolytes)
Stool culture
Sigmoidoscope 12

13. COLITIS Tx Rest the bowel Control inflammation Correct malnutrition
Combat infection
Alleviate stress
Symptom relief with drug therapy
Surgery 13

14. CROHN'S DISEASE
Crohn’s disease is a chronic, inflammatory bowel disorder that can affect any part of the GI tract.
The cause is unknown
Can occur at any age but occurs most often b/t the ages of 15 – 30
Higher incidence of women
More common in Jewish and upper middle class urban populations
Crohn’s disease has periods of exacerbation and remissions 14

15. CROHN'S DISEASE SIGNS & SYMPTOMS Depends on the site of involvement
Diarrhea (usually non bloody)
Fatigue
Abd pain
Wt. loss
Fever 15

16. CROHN'S DISEASE Dx COMPLICATIONS Strictures Obstruction
Physical signs and symptoms
Ba enema/swallow
Bloodwork
Colonoscopy
Biopsy
Stool culture
COMPLICATIONS
Strictures
Obstruction
Fistulas
Nutritional abnormality
Arthritis 16

17. CROHN'S DISEASE Tx Control inflammation Corticosteriods
Anti-inflammatories
Relieve symptoms
Correct nutritional problems
High calorie
High protein
Promote healing
Surgery

18. DIVERTICULAR DISEASE
A diverticulum is a small pouch in the colon that bulge outward through weak spots in the colon. 18

19. DIVERTICULAR DISEASE Diverticular disease occurs in 2 forms:
1. Diverticulosis
2. Diverticulitis
The condition of having these pouches is called diverticulosis. It is multiple non- inflamed diverticulum (pouches)
When diverticula form, the smooth muscle of the colon wall becomes thickened.
Diverticular disease is very common in older adults (50% by the age of 80 yrs)
It affects men and women equally 19

20. DIVERTICULAR DISEASE
When feces enters the diverticula, they can become inflamed and infected. This is called diverticulitis. 20

21. DIVERTICULAR DISEASE There is pain associated with diverticulitis.
The pt. may also have some abd. discomfort/cramping which is usually relieved by passing flatus or having a BM.
There is no known cause however, a low fiber diet is definitely associated with it
Lack of dietary fiber slows peristalsis and more water is absorbed from the stool, making it more difficult to pass
It is more prevalent in Western populations d/t our poor diets
A Ba (Barium) emema is typically used to dx diverticular disease 21

22. DIVERTICULAR DISEASE SIGNS/SYMPTOMS Abd pain in the LLQ Fever N & V
Chills
Cramping
Constipation
Bloating
Rectal bleeding 22

23. DIVERTICULAR DISEASE COMPLICATIONS Tx May include Abscesses
Bowel obstruction
Bleeding
Ruptured diverticula Tx
Antibiotics (if infection is present)
Some of these complications may require surgery.
A colostomy can be necessary as well as dietary changes. 23

24. VOMITING, GALLBLADDER DISEASE & IBS
Vomiting – (red text)
Pg 547
Definition
What are the risks of vomiting?
Review the measures to follow when a client vomits
Gallbladder Disease - (yellow text)
Pg 276
What is the gallbladder?
Define cholecystitis
Signs and symptoms Tx
IBS – (yellow text)
Pg 277
Definition
What are the 2 types of IBS?
Signs and symptoms of both types
Causes Tx

25. DIGESTIVE SYSTEM ASSESSMENT
SUBJECTIVE DATA
Ask your pt. about:
Appetite
Dysphagia
Food intolerances
Abd pain
N/V
Bowel habits
Past hx
Meds
Diet
OBJECTIVE
Inspect
Auscultate
Percuss
Palpate

26. MAKE YOUR OWN CASE STUDY
Using your knowledge of :
The digestive system
Bowel elimination
Digestive diseases
Digestive assessment
Write your own case study and have a partner complete it.
Remember, you want your partner to think critically and make connections between: