Gastrointestinal-diseases — Free NHRA Study Notes

MOUTH:

GASTROINTESTINAL DISEASES

SIGNS AND SYMPTOMS

1. Bleeding gums – Vit. C deficiency
2. Glossitis, cheilosis – Vit. B2 deficiency
3. Smooth beefy red tongue – Vit. B12 deficiency
4. Strawberry tongue – scarlet fever
5. Koplik's spots – measles
6. Thrush (white, removable plaques) – Candida albicans

🖼️ [Diagram]: An illustration of the upper digestive system, showing the mouth, pharynx, esophagus, salivary glands (parotid, submandibular, sublingual), and their relation. Key components are labeled with arrows pointing to the relevant parts of the illustration.

GI BLEEDING

Hematemesis

• Vomiting bright red blood (rapid bleed)
• Vomiting “coffee-ground” (slow bleed) Melena
• Black, tarry stool
• Source: upper GI, or small bowels Hematochezia
• Bright red blood in stool
• Source: lower GI (or upper GI if massive)

REFLUX ESOPHAGITIS (GERD)

Gastroesophageal reflux disease (GERD) occurs when stomach acid frequently flows back into the tube connecting your mouth and stomach (esophagus). This backwash (acid reflux) can irritate the lining of your esophagus

Symptoms

• Burning substernal pain
  • After meals, at night
  • May radiate to left arm.
• A burning sensation in your chest (heartburn), usually after eating, which might be worse at night
• Chest pain
• Difficulty swallowing
• Regurgitation of food or sour liquid
• Sensation of a lump in your throat
• If you have nighttime acid reflux, you might also experience:
  • Chronic cough
  • Laryngitis
  • New or worsening asthma
  • Disrupted sleep

Position: Reverse Trendelenburg position is a position in which patients' hip and knee are notflexed but the head and chest are elevated at 30° than the abdomen and legs.

After meal 1hour

Pedia- Prone with head of the bed elevated.

Risk factors

• Obesity
• Bulging of the top of the stomach up into the diaphragm (hiatal hernia)
• Pregnancy
• Delayed stomach emptying Factors that can aggravate acid reflux include:
• Smoking
• Eating large meals or eating late at night
• Eating certain foods (triggers) such as fatty or fried foods
• Drinking certain beverages, such as alcohol or coffee
• Taking certain medications, such as aspirin

Management :

• Between meals drink water otherwise regurgitation.
• No Coughing, alcohol, chocolate, spicy food, peppermint, cola.
• Chewing gum is good.

Medication:

• Proton pump inhibitors(omeprazol) 30 min before meal. Long term use may lead to impairedcalcium absorption that can lead to fracture.
• Long term use promote acid reduction leading to pneumonia.

Complication:

• ✓ Clostridium difficile infection- large intestine infection leading to hypomagnesaemia, tremours, increase in refluxes and hypocalcaemia
• ✓ Narrowing of the esophagus (esophageal stricture).
• ✓ An open sore in the esophagus (esophageal ulcer).
• ✓ Precancerous changes to the esophagus (Barrett's esophagus). Damage from acid can cause changes in the tissue lining the lower esophagus. These changes are associated with an increasedrisk of esophageal cancer.

ESOPHAGEAL VARICES-

Esophageal varices are enlarged veins in the esophagus. They're often due to obstructed blood flow through the portal vein, which carries blood from the intestine, pancreas and spleen to the liver.

Causes of esophageal varices include:

• Severe liver scarring (cirrhosis). A number of liver diseases — including hepatitis infection, alcoholic liver disease, fatty liver disease and a bile duct disorder called primary biliary cirrhosis can result in cirrhosis.
• Blood clot (thrombosis). A blood clot in the portal vein or in a vein that feeds into the portal vein (splenic vein) can cause esophageal varices.
• Parasitic infection. Schistosomiasis is a parasitic infection found in parts of Africa, South America, the Caribbean, the Middle East and East Asia. The parasite can damage the liver, as well as the lungs, intestine, bladder and other organs.

Symptoms

Esophageal varices usually don't cause signs and symptoms unless they bleed. Signs and symptoms of bleeding esophageal varices include:

• ✓ Vomiting large amounts of blood
• Black, tarry or bloody stools
• ✓ Lightheadedness
• ✓ Loss of consciousness in severe cases

Suspect esophageal varices if you have signs of liver disease, including:

• Yellow coloration of your skin and eyes (jaundice)
• Easy bleeding or bruising
• Fluid buildup in your abdomen (ascites)

Diagnosis

• Endoscopic exam
• CT scans and Doppler ultrasounds
• Capsule endoscopy. In this test, you swallow a vitamin-sized capsule containing a tiny camera, which takes pictures of the esophagus as it goes through your digestive tract. This might be an option for people who are unable or unwilling to have an endoscopic exam.

Treatment to prevent bleeding

Treatments to lower blood pressure in the portal vein may reduce the risk of bleedingesophageal varices. Treatments may include:

• Medications to reduce pressure in the portal vein. A type of blood pressure drug called a beta-blocker may help reduce blood pressure in your portal vein,eg: propranolol (Inderal, InnopranXL) and nadolol (Corgard).
• Using elastic bands to tie off bleeding veins- Endoscopic Band Ligation.
  • Using an endoscope, use suction to pull the varices into a chamber at the end of the scope and wraps them with an elastic band, which essentially "strangles" the veins so they can't bleed.Endoscopic band ligation carries a small risk of complications, such as bleeding and scarring of the esophagus.

Liver cirrhosis: elevated portal vein pressure > esophageal varices

Assessment

1. History of alcohol (liver cirrhosis)
2. Hematemesis = vomiting blood
3. Melena = black, tarry stools
4. Signs of shock if bleeding is severe

Implementation

1. Watch for hemorrhage, hypotension, signs of shock
2. Monitor vital signs if acute bleeding
3. Watch for signs of hepatic encephalopathy
4. Check weight
5. Assist with Sengstaken tube Sengstaken tube (to compress varices)
   • Monitor bleeding in gastric drainage
   • Watch for signs of asphyxiation
   • Watch for tube displacement

🖼️ [Diagram]: A diagram showing the Sengstaken-Blakemore tube. The diagram includes the gastric balloon inflation port, gastric aspiration port, depth markers, esophageal balloon inflation port, esophageal balloon (up to 45 mmHg air), distal suction holes, and gastric balloon (200-250 mL air). The balloons compress hemorrhaging blood vessels (varices) in the esophagus and stomach. The text provides details on its use: routine ETT intubation before SB tube, inflate gastric balloon in 2 steps (50cc then X-ray to 200-250cc), 1-kg traction to reduce EV blood flow, inflate esophageal balloon if traction failed, esophageal balloon not inflated for more than 6 hours, and admit to ICU for monitoring.

Complication ; Bleeding, Shock

GASTRITIS

Inflammation of gastric mucosa

ACUTEGASTRITIS (Erosive)

• Acute hemorrhagic lesions
• Stress ulcers
• Aspirin, NSAIDs
• Alcohol

CHRONIC GASTRITIS TYPE A (Non-erosive)

• Autoimmune gastritis
• Involves body and fundus
• Pernicious anemia

CHRONIC GASTRITIS TYPE B (Non-erosive)

• Involves body and fundus
• H. pylori

Assessment

1. Nausea, anorexia
2. Sour taste in mouth
3. Belching
4. Cramping, pain

Implementation

1. Watch for signs of GI bleeding (“coffee-ground” vomit)
2. CBC if suspected pernicious anemia

Medications

1. Antacids
2. Antihistamine (to reduce acid secretion)
3. Antibiotics (to eradicate H. pylori)

PEPTIC ULCER DISEASE

Peptic ulcer disease is a condition in which painful sores or ulcers develop in the lining of the stomach or the first part of the small intestine (the duodenum). Normally, a thick layer of mucus protects the stomach lining from the effect of its digestive juices.

Cause: Helicobacter pylori (H. pylori) bacteria. Pain-relieving NSAID medications.

Risk Factor

• Frequent use of nonsteroidal anti-inflammatory drugs (NSAIDs), a group of common painrelievers that includes ibuprofen.
• A family history of ulcers.
• Illness such as liver, kidney or lung disease.
• Regularly drinking alcohol.
• Smoking.

Symtoms

• Gnawing or burning pain in your middle or upper stomach between meals or at night.
• Pain that temporarily disappears if you eat something or take an antacid.
• Bloating.
• Heartburn.
• Nausea or vomiting.

In severe cases, symptoms

• Dark or black stool (due to bleeding).
• Vomiting.
• Weight loss.
• Severe pain in your mid- to upper abdomen.

Diagnosis:

• Endoscopy
• x-Ray
• CT Scan

GASTRIC ULCER

• Normal or decreased acid production
• Decreased mucosal resistance
• Chronic NSAID use
• Pain gets worse after meals, pain in left upper and mid part of stomach.
• Hematemesis
• Melena

DUODENAL ULCER

• Increased acid production
• Pain typically relieved by meals- pain in right upper part and mid part of stomach.
• Melena

Assessment

1. Gnawing, burning epigastric pain
2. Vomiting
3. GI bleeding > anemia

Diagnosis

1. upper GI series or endoscopy (Barium)
2. Urea breath test- test for presence of Helicobacter pylori
3. GUAIAC TEST- A fecal occult blood test checks a bowel movement (stool) sample for blood that can't be seen with the naked eye. If there is blood in the stool, the color changes very quickly.

Causes: False Positive Guaiac tests (Hemoccult)

• Red meat.
• Cantaloupe and other melon.
• Grapefruit.
• Figs.
• Broccoli.
• Turnips.
• Radishes.
• Horseradish.

Medications such as antiplatelet agents (eg, low-dose aspirin), nonsteroidal anti-inflammatory drugs, and oral anticoagulants can result in a false-positive.

Implementation

1. Watch for signs of bleeding- “coffee-ground” vomit, tarry stools
2. Avoid irritating food
3. Avoid cigarette smoking
4. Avoid aspirin, NSAIDs and steroids

Serious complication:

Perforation of Ulcer (surgical emergency priority)

Sign & Symptoms:

1. guarding pain
2. Tachycardia
3. Fever
4. Lies Still & take shallow breath to avoid fatigue.
5. Not move patient.

Medications

1. Antihistamine
2. Antibiotics to eradicate H. pylori
3. Antacid – omeprazol
4. Avoid Aspirin/NSAID
5. Misoprostol- Patient with long term use NSAID.
6. Sucralfate is used to treat and prevent ulcers
   • Before food taken
   • Take other medication after 2hrs

7. Laxative or Enema
   • Milk of Magnesia (Antacid)
8. Small bowel follow through radiology
   • Small bowel follow-through uses a form of real-time x-ray called fluoroscopy and a barium-based contrast material to produce images.

Diet – Bland Diet

foods that are soft, not very spicy, and low in fiber.

Liver Cirrhosis

A chronic progressive disease of the liver characterized by replacement of normal liver tissue with diffuse fibrosis that disrupts the structure and function of the liver.

PORTAL HYPERTENSION (persistent increase in the pressure within the portal vein that develops as a result of obstruction to blood flow

LIVER: SIGNS & SYMPTOMS

• Jaundice - diminished bilirubin secretion
• Fetor hepaticus - sulfur compounds produced by intestinal bacteria, not cleared by liver
• Spider angiomas palmar, erythema gynecomastia - elevated estrogen levels
• Ecchymoses (easy bruising) - decreased synthesis of clothing factors
• Xanthomas (yellow skinplaque / nodules) - elevated cholesterol levels
• Hypoglycemia - decreased liver glycogen stores, decreased liver glucose production
• Splenomegaly - portal hypertension
• Encephalopathy asterixis (hand-flapping tremor) - portosystemic shunt (digestive products bypass liver and are not detoxified)

DRUG INDUCED LIVER DISEASE

CHLORPROMAZINE ACETAMINOPHEN/ CARBON TETRACHLORIDE ESTROGENS AFLATOXIN HEPATITIS B AND C

IMPLEMENTATION

1. Check skin, gums and stool for bleeding
2. Avoid aspirin
3. Monitor weight
4. Monitor abdominal cicumference
5. If ascites interferences with breathing > high Fowler's

DIET:

1. High carbohydrate, high calorie, vitamins (low protein diet if client has hepatic encephalopathy)
2. Provide counseling if client abuses alcohol.

GALLBLADDER

1. CHOLICYSTITIS- Inflammation of the gall bladder

Cause : CHOLELITHIASIS

• presence of gallstones in the gallbladder
• Usually asymptomatic (70%)
• May cause biliary colic (20%)
• May cause cholecystitis

(10%)

Etiology: Female, old age, obesity

Diagnostic Evaluation:

• CHOLYCYSTOGRAPHY- (Before procedure night avoid fatty foods otherwise gallbladder will squeeze.
• ERCP- Endoscopic retrograde cholangiopancreatography.
  • Complication- Damage to pancrease.
• Magnetic resonance cholangiopancreatography
• USG

Assessment

• ✓ Right upper quardent (RUQ) pain that radiates to right shoulder and right scapula.
• ✓ RUQ Tenderness.
• ✓ BILIARY COLIC
  • Steady, cramp like pain in epigastrium.
  • Murphy's sign (inspiratory arrest during palpation of liver margin).
  • Pain does not subside spontaneously.
• Indigestion (when fatty food eaten pain triggers)
• Blenching
• ✓ Vomiting
• ✓ Steatorrhea
• Low grade fever
• ✓ Chills
• ✓ Clay color stool
• ✓ Orange color Urine
• ✓ Sclera-Yellow
• ✓ Pluritis

Medications

1. Analgesics
2. Antibiotics
3. Ursodiol: (resolves small cholesterol stones, but does not help in acute attack)

Management:

• ✓ If admitted with pain then pain management(NSAID)
• NPO if vomiting.
• Avoid fatty foods(fried, cheese, milk, custard, red meat, cake)

Surgery

• ✓ Cholecystectomy- removal of gall bladder (RUQ incision done)
• ✓ After open Cholecystectomy when to resume activity- 4 to 6wks
• ✓ Lapro then 2wks

Post Operative

1. Pain Management
2. Deep breathing and coughing exercise
3. Monitor T-tube drainage (up to 500ml in first 24h is normal)(jackson bratt drain)
4. Drain will be greenish brown colour(500 to 1000ml will be normal)
5. After Abdominal surgery diet order: 1st Ice cubes 2nd clear liquid 3rd juice 4th soft diet then regular diet.
6. Abdominal lapro surgery patient has left shoulder pain its normal. If it's Right shoulderpain than abnormal.
7. After surgery wound infection bacteria is streptococcus aureus.

2. PANCREATITIS

Is an acute or chronic inflammation of the pancreas with associated escape of pancreatic enzyme into surrounding tissue itself leading to hemorrhage and necrosis

ACUTE PANCREATITIS

• Causes – Alcohol abuse, cholelithiasis
• Features – Elevate lipase(3times increase), amylase(5times increases)

Chronic pancreatitis

• Causes – Alcohol abuse
• Features – pancreatic calcifications

Clinical manifestations:

1. Pain – located in mid-epigastrium or left upper quadrant (LUQ) with radiation to the back; pain is intensified by a fatty meal, alcohol
2. Nausea and vomiting
3. Abdominal tenderness and distention due to paralytic ileus that follows peritonitis
4. Fever
5. Anorexia and weight loss (due to inadequate metabolism of nutrients)
6. Severe dehydration (excessive fluid loss from fever, nausea/vomiting, blood loss) and signs of hypovolemia
7. Steatorrhea – fatty/greasy, bulky, foul-smelling stools result from inadequate fat digestion
8. Hypocalcemia (calcium is deposited in areas of fatty necrosis; calcium is lost in the steatorrhea)
9. Hyperglycemia (hormonal functions of the pancreas is disrupted from tissue damage esp. Islet of Langerhans)
10. Jaundice (caused by common bile duct obstruction by pancreatic edema and seen in clients with gallstone-associated pancreatitis)
11. Hemorrhagic pancreatitis – produces post- hemorrhagic necrosis (purplish discoloration)
    • Grey-Turner's sign (left flanks)
    • Cullen sign (periumbilical area)

• Laboratory
  1. Elevate amylase, lipase
  2. If serum calcium low> poorer prognosis

Implementation

• Relieve pain; Meperidine is DOC
• ✓ Morphine is contraindicated because it may cause spasm of the sphincter of oddi, which potentiate pancreatic tissue injury)
• Pain relief by sitting in bed with knees flexed and pressing a pillow over the abdomen
• ✓ NPO status is maintained during acute phase.
• Food ingestion increases pancreatic secretion, which may increase inflammation and pain.
• IV therapy to maintain fluid-electrolyte balance
• Digestive enzymes (pancreatin) as prescribed.
• These medication should be taken with each (sprinkling) meal and snack.
• Food help buffer stomach acid
  • a) A high fiber diet may enhance efficacy
  • b) Absence of steatorrhea indicates effectiveness
  • c) S.E include abdominal cramps/pain and diarrhea
• Administer fat-soluble vitamins (Vit. A, D, E, K) as prescribed.
• Fat-soluble vitamins are lost in the steatorrhea
• Administer antacids to neutralize gastric secretion
• Administer H2 receptor antagonists as prescribed. (to decrease HCL production and prevent activation of pancreatic enzymes)

Complication-

1. Pancreatic abscess (fever, leucocytosis, pain)
2. ERCP patient – Pancreatic damage.

Client Education

1. Strict avoidance of alcohol

Exocrine pancreatic cancer-

dark tea colored urine, clay colored stool, Jaundice.

CHRONIC PANCREATITIS :

• Pancreatectomy (monitor blood sugar)
• Whipple procedure also known as a pancreaticoduodenectomy — is a complex operation to remove the head of the pancreas, the first part of the small intestine (duodenum), the gallbladder and the bile duct. The Whipple procedure is used to treat tumors and other disorders of the pancreas, intestine and bile duct.

DIARRHEA

Secretory

• Large volume watery stools
• Persists with fasting
• (cholera, dysentery)

Osmotic

• Bulky, greasy stools
• Improves with fasting

• (lactase deficiency, pancreatic insufficiency, short bowel syndrome)

Inflammatory

• Frequent but small stools
• Blood and/or pus
• (inflammatory bowel disease, irradiation, shigella, amebiasis)

Dysmotility

• Diarrhea alternating with constipation
• (irritable bowel syndrome, diabetes mellitus)

LOWER ABDOMINAL PAIN

APPENDICITIS

Appendicitis is an inflammation of the appendix, a finger-shaped pouch that projects fromyour colon on the lower right side of your abdomen. Appendicitis causes pain in your lower right abdomen. However, in most people, pain begins around the navel and then moves. As inflammation worsens, appendicitis pain typically increases and eventually becomes severe.

Cause:

Obstruction

Symptoms:

• Sudden pain that begins on the right side of the lower abdomen
• ✓ Sudden pain that begins around your navel and often shifts to your lower right abdomen
• ✓ Pain that worsens if you cough, walk or make other jarring movements
• Nausea and vomiting
• ✓ Loss of appetite
• Low-grade fever that may worsen as the illness progresses
• ✓ Constipation or diarrhea
• ✓ Abdominal bloating
• ✓ Flatulence

REBOUND TEST FOR APPENDICITIS

• Rebound tenderness(above the right hip, steady pain at right ileac fossa)
• Rovsing's sign, in which you experience pain in the lower right side of your abdomen when pressure is applied and released on the lower left side of your abdomen.
• Psoas sign, in which flexing your psoas muscles(located in the lower lumbar region of the spine and extends through the pelvis to the femur) near your appendix causes abdominal pain.

Management

• NPO
• No pain management because of rupture, if no rupture confirm then provide morphine.
• I/V fluids

• Dont put head on abdomen- lead to rupture, ice can be applied.
• No laxative or enema.

DIVERTICULITIS

Diverticulitis is the infection or inflammation of pouches that can form in your intestines (symptomatic). These pouches are called diverticula. The pouches generally aren't harmful. They can show up anywhere in your intestines. If you have them, it's called diverticulosis (asymptomatic)

• (Diverticulosis - presence of diverticula
• Diverticulitis - inflammation of diverticula)

🖼️ [Diagram]: An illustration depicting small pouches, labeled as "Diverticula," protruding from the wall of an intestine, likely representing the condition of diverticulosis.

Assessment:

• ➤ Elderly patients
• Steady pain in the left lower quardrant that intensified on coughing, sneezing, heavy lifting and bending.(left ilieac fossa pain)
• ► Palpable mass in the left lower quardrant.

• Low grade fever

• Melena
• Flatulence

Diagnosis:

1. Barium enema
2. Sigmoidoscopy
3. Colonoscopy

Complication: Perforation

• Progressive pain to other quardrants
• Rigidity
• Rebound Tenderness
• Tachycardia

Management:

1. NPO or clear liquid diet.( peritonitis or massive bleeding)
2. Bed rest
3. Reduce or avoid abdominal pressure activities.
4. Give plenty of fluids.
5. High fiber diet (diverticulosis)
6. Low fiber diet (diverticulitis)
7. Avoid laxative and enema.

HEMORRHOIDS

• Varicosities of anal and rectal veins

Predisposing factors

1. Hereditary
2. Chronic constipation
3. Pregnancy
4. Liver cirrhosis

Assessment

• Rectal pain and itching
• Bleeding (bright red blood on stool)

Implementation

1. Warm sitz baths to ease pain and swelling
2. Stool softeners, high fiber diet
3. Avoid straining
4. Surgery: ligation, sclerotherapy or surgical excision

Topical Medications

1. Anti-inflammatory: hydrocortisone cream
2. Astringents: witch hazel cream

Post Operative

1. Watch for rectal bleeding
2. Good anal hygiene – keep dry

INFLAMMATORY BOWEL DISEASE

Inflammatory bowel disease (IBD) is a group of disorders that cause chronic inflammation (pain and swelling) in the intestines. IBD includes Crohn's disease and ulcerative colitis.

• Crohn's disease causes pain and swelling in the digestive tract. It can affect any part from the mouth to the anus. It most commonly affects the small intestine and upper part of the large intestine.
• Ulcerative colitis causes swelling and sores (ulcers) in the large intestine (colon and rectum).

1. CROHN'S DISEASE (regional enteritis)

It most commonly affects the small intestine ie; ileum

Causes:

• Heredity
• Autoimmune

Assessment

• ➤ Cramping abdominal pain ie; in right lower quardrent pain relieved after defecation.
• ➤ Fever, anorexia, weight loss

• < Severe Malnutrition (decrease in pre albumin)
• Diarrhea character- semi solid diarrhea without blood.
• Steatorrhea- foul smell and motion is frothy.

Pathology

1. Transmural thickening
2. Granulomas
3. Usually involves ileum
4. Rectum often spared
5. Affects several bowel segments

Complications

1. Perianal disease
2. Fistulas
3. Perforation
4. Intestinal Obstruction

Outcome

Many patients will have disease recurrence a few years after surgery

Management:

1. Nutrition- Elementary diet given to absorb diet.
2. Decrease in tension and stress - listen to music.

2. ULCERATIVE COLITIS

Inflammation of large intestine.

Assessment

• Dehydration- Hypokalemia (vomiting, diarrhea, diuretic)
• ➤ Less abdominal pain
• More bloody diarrhea
• ➤ Vitamin K deficiency.

• Tenesmus is the feeling that you need to pass stools, even though your bowels are already empty. It may involve straining, pain, and cramping.

Pathology

1. Mucosal ulceration
2. Begins at rectum and progresses
3. Towards ileocecal junction
4. Limited to colon (but involve terminal ileum)

Diagnosis

1. Barium enema
2. endoscopy with biopsy

Complications

1. Toxic Megacolon (enlargement of large intestine)
2. Increased risk for colon carcinoma

Outcome

Surgery is curative

Management:

1. Fluid Administration
2. Check weight
3. Low fiber diet
4. Pain management
5. Avoid gas forming food.- curd/ rice/yogurt is good option.

Diet :

• High protein
• High Calorie
• Multivitamin containing calcium

Medications

1. Sulfasalazine (anti-inflammatory disease) corticosteroids
2. Dicyclomine (Anticollernergic antispasmodic) Contraindicated in Paralytic Ileus.

IRRITABLE BOWEL SYNDROME

Complaint of Large Intestine.

Sign & Symptoms

• Gas
• Constipation
• Diarrhoea
• Pain in stomach

Management

• Life Style change
• Diet Modification
• Maintain Record(write)
  • Potato – gas then remove it for 12wks. If improvement avoid.
  • Avoid gas forming food.
  • Fructose food avoid- apple, honey etc
  • Avoid Spicy food.
  • Avoid hot and cold food.
  • Avoid Stress.
  • Regular exercise.
  • No fasting.
  • Eat in time & eat morning breakfast.
  • High Fiber Diet.
  • Eat Protien
  • Bland diet
  • Low fat
  • Caffaine Avoid

INTESTINAL OBSTRUCTION

MECHANICAL OBSTRUCTION

Due to adhesions, tumors, vovulus (twisting) Increased bowel sounds

PARALYTIC ILEUS

Due to toxins, infections or postoperative Absent bowel sounds

Assessment

1. Nausea
2. Colicky pain
3. Constipation
4. Vomiting (fecal vomiting in severe lower bowel obstruction)

Diagnosis

1. abdominal film: intestinal gas
2. endoscopy

Implementation

1. Maintain NPO
2. Monitor vital signs
3. Turn client supine to prone (helps passing flatus and relief abdominal pressure)
4. Monitor patency of decompression tube

Post Operative

• Encourage coughing, turning, deep breathing
• Monitor bowel sounds (return of peristalsis)

PERITONITIS

Acute inflammation of peritoneum

Bacterial

1. Perforated duodenal ulcer
2. Ruptured appendicitis
3. Volvulus (twisting of bowel, strangulation, obstruction)
4. Abdominal trauma

Chemical

1. Pancreatitis
2. Perforated gastric ulcer

Note: Mortality dramatically decreased with antibiotics!

Assessment

1. Constant, intense, diffuse abdominal pain
2. Nausea
3. Weakness
4. Abdominal rigidity
5. Absent bowel sounds
6. Signs and symptoms of shock

Diagnostic: paracentesis: cytology, bacterial culture

Implementation

1. NPO to reduce peristalsis
2. Monitor vital signs
3. Maintain bed rest
4. Semi-Fowler's position
5. IV electrolytes and antibiotics are ordered

COLORECTAL CANCER

Second most common cancer in US 5 year mortality about 50% Early diagnosis significantly improves survival

Assessment

1. Vague abdominal discomfort
2. Nausea, loss of appetite
3. Weakness, fatigue
4. Family history of colorectal cancer
5. Ribbon – or pencil – shaped stools
6. Black of tarry stools
7. Anemia
8. Signs of intestinal obstruction

Diagnosis

1. sigmoidoscopy,
2. colonoscopy with biopsy
3. CEA (carcinoembryonic antigen)blood test to detect recurrence after surgery

Implementation

1. Monitor intake and output
2. Monitor consistency and color of stool
3. Prepare client for surgery

COLOSTOMY

A colostomy is an opening in the belly (abdominal wall) that's made during surgery.

4 Types of Colostomies

• Ascending colostomy — is made from the ascending part of the colon. liquid stool
• Transverse colostomy — is made from the transverse part of the colon. semi liquid/mushy
• Descending colostomy — is made from the descending part of the colon. semi solid
• Sigmoid colostomy — is made from the sigmoid colon. solid

🖼️ [Diagram]: Colostomy types illustrating the typical locations of ascending, transverse, descending, and sigmoid colostomies on the abdomen.

Points:

1. Normal stoma color beefy red/red/pink moist & shiny
2. Pale pink indicate of anemia
3. Black/brown/grey/dusky/cyanotic- necrosis.
4. Stoma white patches indicate fungal infection
5. Redness around stoma indicate allergy
6. NPO preoperatively
7. High fiber diet with colostomy patient but immediate post operative low fiber diet.
8. Colostomy surgery after 24hrs stool should pass otherwise surgery complication paralytic ileus.
9. After surgey 24h-48hr bloody mucous., with in 72 hr normal motion.
10. Colostomy solution to irrigate colostomy- luke warm tap water.
11. Hard stool area needs irrigation.
12. Colostomy foul smell prevention by avoiding gas forming food- Brocolli, cauliflower, drybeans etc.
13. Colostomy irrigation if pain arises- then temporary stop and then restart.
14. After surgery 1 month takes its size to decrease.
15. Drink plenty of water.

COLOSTOMY IRRIGATION

1. Remove pouch when 1/3 full.
2. Cleanse stoma with soft cloth and water or mild soap
3. Dry skin thoroughly before applying pouch
4. 500 to 1000ml luke warm tap water.
5. Irrigation container bag should be in shoulder level with i/v stand hooker, 18 to 24 inchabove stoma.
6. Patient should sit in toilet
7. Irrigation Sleeve kept up on stoma and other part in toilet
8. Tubing from the container tip is like cone.
9. Lubricate cone and insert in stoma.
10. Open roller clamp so that irrigation solution goes inside pr for 10min.
11. After irrigation remove cone and vest part goes on sleeves to toilet.
12. Use skin barrier powder or paste to protect from fecal drainage
    • Irrigaton of stoma - never force catheter
    • If patient has cramps then clamp tube and stop for few time ans continue.
    • Allow client to verbalize feelings about colostomy.

nursing diagnosis: Altered body image due to colostomy

🖼️ [Diagram]: A diagram showing the process of colostomy irrigation. It depicts an irrigation cone inserted into a stoma, with a fluid bag hanging above and a catheter leading to a toilet. Labels include "Irrigation cone," "Stoma," "Fluid," and "Catheter."