Gastrointestinal System

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Gastrointestinal System
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Patient History

• Present/Past Problems
• Weight Hx
• Loss? Gains?
• Medications
• Surgery/TX
• Travel Outside US
• Elimination Patterns

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Gastrointestinal System

• PHYSCIAL EXAM
• Inspection
• Auscultation
• Percussion
• Palpation

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Inspection

• Lips
• Symmetry, color, size, pallor, cyanosis,
  cracking, ulcers, fissures
• Mouth
• Lesions
• Teeth caries, loose
• Breath odor

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Abdominal Inspection

• Symmetry, distention, bulges
• Mottling, scars, splinting of muscles
• Shallow breathing
• Bruises or other discoloration

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Abdominal Inspection

• Cullens Sign
• Bluish discoloration around umbilicus
• Associated with bleeding (hemorrhagic
  pancreatitis or ectopic preg)
• Grey Turners Sign
• Sub Q bruising flank area
• Retroperitoneal hematoma

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Abdominal Inspection

• Prominent dilated veins
• Portal hypertension
• Cirrhosis
• Ascites
• Venal cava obstruction

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Rectum

• Color
• Texture
• Lumps
• Rashes
• Hemorrhoids

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Auscultation

• Nl 535 xs / min
• Hi pitched, gurgling sounds
• Absent only after 5 min. no sound
• Listen in
• Epigastric area All 4 quad
• 3 5 min

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Hyperactive Bowel Sounds

• Borborygmi - Increase motility.
• Hi pitched, tinkling
• Inflammation
• Early bowel obstruction (mechanical)
• 24 48 hrs.
• Gastroenterisits
• Laxative use

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Hypoactive Bowel Sounds

• Diminished or Absent
• Decreased motility
• Inflammation Peritonitis
• Paralytic Ileus
• Late Bowel Obstruction

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Abdominal Vascular Sounds

• Use bell lightly
• Bruit abn sound
• Swoosh turbulence
• Aortic aneurysm
• superior to or left of umbilicus
• Partial occlusion femoral arteries
• Renal stenosis
• Midline or toward flank

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Percussion

• Tympany - predominant
• Hi pitched, hollow sound
• Air
• Dullness
• Short, dull sound with little resonance
• Fluid or masses
• Feces

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Palpation

• Light palpation
• Hernias, masses, pulsation, enlarged organs,
  bladder distention
• Rebound Tenderness
• Press slow firm over painful site
• Withdraw fingers quickly
• Pain peritoneal inflammation

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Nutrition

• Carbohydrates
• 4 kcal/gram
• Fat
• 9kcal/gram
• 20-30 of intake
• Proteins
• 4kcal/gram

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Obtain of Fat in Diet

• of grams of fat
• Multiply it by 9 calories
• Equal calories of fat in diet
• Ex
• 720 cal divided by 2000 cal 36 of diet is fat

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Anorexia

• Psych diagnosis.
• Refusal to maintain body wt to gt 85 of expected
  for age ht.
• Severely malnourished.
• Pursuit of thinness morbid fear of being fat.

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Bulimia

• Compulsive binge eating purging
• Use self-induced vomiting, laxative abuse,
  excessive exercise, diuretics
• Maintain nl wt
• Primary SS is gorging

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Treatment

• Psychotherapy
• Nutritional Counseling
• Cognitive Behavior
• Drug Therapy
• Support Groups

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Protein-calorie Malnutrition

• Primary
• Poor Eating Habits
• Secondary
• Alteration or Defect in
• Ingestion
• Digestion
• Absorption
• Metabolism

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Marasmus

• Deficiency of Calorie Protein Intake
• Leading to generalized
• Loss of body fat
• Loss of muscle

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Kwashiorkor

• Deficiency of protein intake
• Occurs in underdeveloped countries (Kids with lg
  bellies )
• Superimposed on a catabolic stress event
• GI obstruction, OR, Cancer, Malabsorption synd,
  AIDS, TB

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Starvation
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Obesity
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Oral Cancer

• Lip
• Basal cell
• Mouth, Tongue, Lower Lip
• Squamous cell
• Poorer prognosis

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Oral Cancers

• Leukoplakia
• Benign
• Yellow white or gray white leathery or smooth
  lesions
• Due to irritation

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Oral Cancers

• Erythroplakia
• Pre-cancerous
• 90 chance of becoming malignant
• Red patch in os or on tongue
• Bleeds easily

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Radical Neck Dissection

• Ineffective airway clearance
• Ineffective breathing pattern
• Acute pain
• Altered nutrition
• Altered oral mucous membranes
• Impaired verbal communication
• Body-image disturbance

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Radical Neck Dissection

• Complications
• Airway obstruction
• Aspiration
• Hemorrhage

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Esophageal Cancer

• Predisposing Factors
• Tobacco, ETOH, poor oral hygiene, exposure to
  asbestos, metal
• Diet smoked, nitrate or salt cured meats, spicy
  or very hot fds low fruits veget
• SS
• Dysphagia, Pain
• TX
• OR Radiation

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Cancer of Stomach

• Predisposing Factors
• Smoked, highly salted, or spiced fds
• H pylori in stomach
• SS
• vague abd distress, dyspepsia
• !st SS may be bone pain from mets

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Cancer of Stomach

• Treatment
• OR Biliroth I or II
• Post-op
• Airway
• Nutrition
• N/G NO IRRIGATING NO REPOSITIONING
• Complications
• Dumping Syndrome
• Hemorrhage

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Dumping Syndrome Early Syndrome Treatment

• Lie Down for 45 Min
• Eat Low Sugar Simple Carbohydrates
• Increase Fat Protein
• Eat 6 sm, evenly spaced meals/day

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Dumping Syndrome Late Syndrome

• Eat small amt. of sugar candy
• Avoid refined sugar

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Cancer of Colon Rectum Predisposing
Factors

• Age gt 40 yrs
• Polyps Ademnocarcinoma
• Chronic Inflam. Bowel synd
• Family Hx
• Diet
• Hi calorie, Hi fat

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Cancer of Colon Rectum SS

• Left colon
• Bld in stool (hematochezia) brt red
• Alternating constipation diarrhea
• Sensation of incomplete evacution
• Narrow ribbon-like stool

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Cancer of Colon Rectum SS

• Right Colon
• Usually asymptomatic
• Vague abd discomfort or
• Crampy, colicky abd pain
• Fe def anemia occult bleeding

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Cancer of Colon Rectum Treatment

• Staging
• Dukes TNM
• Surgery only cure
• Pre-op
• Antibiotic noc before
• Lt Hemicolectomy colostomy
• Stoma - healthy
• Abd-peritoneal resection
• Infection

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Cancer of Colon Rectum Treatment

• Chemo
• Radiation

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Enteral Nutrition

• Check placement
• Room temp
• Turn on right side/ HOB up
• Use gravity to run in
• Check for residual
• Flush with water
• Document

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Complications of Enteral Feedings

• Vomiting or Aspiration
• Diarrhea
• Constipation
• Dehydration

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Peritonitis

• Inflammation of peritoneum
• SS
• PAIN
• Abd distention
• TX
• Antibiotics
• N/G

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Peritonitis Nursing Diagnosis

• Pain
• Fluid Vol Deficit
• Ineffective Breathing Pattern
• Altered Nutrition

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Intussusception

• Invagination or telescoping of 1 portion of the
  intestine into another
• Most common site ileocecal valve
• Ileum invaginates into cecum colon
• Results bowel obstruction
• Causing inflammation, edema, decreased bld flow

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Incidence of Intussusception

• 3mo 5 yrs
• ½ occur lt 1yr of age

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Intussusception SS

• Currant jelly stools (bld mucous)
• Severe colicky abd pain
• Vomiting
• Palpable abd. mass

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IntussusceptionTreatment

• Barium Enema
• Water-soluble contrast air press
• Hydrostatic reduction
• pushing inverted finger out of a glove
• Surg
• Nl brn stool indicates intuss has reduced itself

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Inflammatory Bowel Disease

• Umbrella term to describe bowel inflammation
• 2 Major Forms
• Crohns Disease
• Ulcerative Colitis