GI

1
GI

• Complex

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Factors affecting GI functioning

• Genetics
• Dietary considerations
• Lifestyle
• Chronic use of ulcerogenic medications
• High stress levels

• Chronic alcohol use
• Long-term GI conditions
• Chronic diseases

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Diagnostic Tests

• Upper GI series
• Barium enema
• Colonoscopy
• ERCP
• Stool specimen

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Acute Gastrointestinal Bleeding

• 350,000 hospitalizations per year
• Elderly 30 of admissions
• Mortality rate 5-12

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Sources of GI bleeding

• Duodenal ulcer
• Gastric erosions
• Gastric ulcers
• Esophago-gastric varices
• Mallory-Weiss tear
• Esophagitis

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Sources of GI bleeding

• Diverticulitis
• Tumors
• Colitis

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Goals

• Hemodynamic stability
• Restored tissue perfusion
• Coagulation deficits corrected
• Respiratory stability
• Electrolytes within normal limits

• Though processes and neuromuscular function
  returned to baseline
• Comfort maintained

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Interventions

• Hemodynamic stabilization
• Gastric lavage
• Pharmacologic management
• Endoscopic therapies

• Balloon tamponade
• Surgical interventions
• teaching

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Esophageal Varices

• -Common Complication
• Collateral vessels are fragile and tolerate high
  pressure poorly
• Likely to bleed
• Recurrence is high
• Patients with bleeding esophageal varicies have
  high mortality rate
• Treatment Goal
• Absence of bleeding and hemorrhage
• Patient should avoid ingesting alcohol, aspirin,
  and irritating foods

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Treatment

• Bleeding Varices
• Emergency treatment
• Vasopressin and NGT
• Therapeutic treatment
• Balloon Tamponade
• Sclerotherapy
• Prophylactic treatment
• Ligation of varices shunt therapy

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Nursing Management Bleeding Varices

• Observe for any signs of bleeding from the
  varices
• Hematemesis
• Melena
• If bleeding occurs, patient is admitted
  immediately to the ICU
• Patent airway is critical

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Mallory-Weiss Syndrome

• Linear, non-perforating tear of gastric mucosa or
  lining of esophagus

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Peptic Ulcer Disease

• Risk Factors
• ASA
• NSAIDS
• Cigarette Smoking
• Heredity
• H. Pylori

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Pathophysiology

• Break in mucosa, extending through the muscularis
  mucoa

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Stress Ulcer Syndrome

• Predisposing conditions
• Alcohol
• NSAIDs
• Severe physiological stress

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Pharmacological Management

• Antacids and mucosal protective agents
• H2 Receptor blockers
• Antibiotics
• Proton pump inhibitors

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Pernicious Anemia

• Results form lack of intrinsic factor essential
  for the absorption of cyanocobalamin (Vit B 12).

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Inflammatory Bowel Disease

• A condition which involves faulty regulation of
  the intestinal mucosas immune response usually
  develops during adolescence
• Two Types of Inflammatory Bowel Disease
• Crohns Disease
• Ulcerative Colitis

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Clinical Manifestations

• Crohns Disease
• Abdominal cramping with diarrhea
• Recurrent fever
• Anorexia
• Weight loss
• Growth failure
• Malaise
• Joint pain

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Clinical Manifestations

• Ulcerative Colitis
• Diarrhea with low abdominal pain cramping
  relieved with passage of stool mixed with blood,
  mucus, and flatus
• Weight loss/delayed growth
• Nutritional deficiencies

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Therapeutic Management

• Medication
• Prednisone
• Colostomy
• Temporary
• Permanent
• TPN

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Nursing Management

• Diet of patient should consist of small frequent
  meals
• Diet should be high in calories
• Fiber should not be included

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Peritonitis
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Ascites

• Accumulation of serous fluid in the peritoneal or
  abdominal cavity. Common manifestation of
  cirrhosis
• When blood pressure is elevated in the liver and
  the lymphatic system is unable to carry off the
  excess proteins and H20, they leak into the
  peritoneal cavity. Osmotic pressure of the
  proteins pulls fluid into the peritoneal cavity
• Other causes of ascites are
• Hypoalbuminemia and Hyperaldosteronism

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Nursing Management Ascites

• Low sodium diet (250 to 500 mg per day)
• Diuretics
• Aldactone, Amiloride, Dyrenium
• Fluid removal
• Paracentesis (needle puncture of the abdominal
  cavity) to remove ascetic fluid
• With severe ascites and abdominal and respiratory
  impairment
• Temporary and reaccumulates
• Peritoneovenous Shunt
• provides continuous reinfusion of ascitic fluid
  into the venous system

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Paracentesis
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Nursing ManagementParacentesis

• Accurate intake and output
• Daily weights
• Measure extremities and abdominal girth for
  extent of edema
• Before paracentesis, the nurse must have patient
  void to prevent the puncture of the bladder
• Client may receive salt-poor albumin IV, after
  procedure to replace lost protein

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Hepatic Encephalopathy

• May also be called coma
• Terminal complication in liver disease
• Occurs when liver damage causes ammonia to enter
  the systemic circulation without liver
  detoxification
• Source of ammonia is the bacterial and enzymatic
  deamination of amino acids in the intestines
• the liver is unable to convert the ammonia to
  urea, which means it remains systemic

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Clinical Manifestations Hepatic Encephalopathy

• Changes in neurologic and mental responsiveness
• From lethargy to deep coma
• Early stages include euphoria, depression,
  apathy, irritability, memory loss, confusion,
  yawning and drowsiness
• Clinical manifestations of impending coma include
  disorientation X4 and flapping tremors

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ManagementHepatic Encephalopathy

• Intensive care
• The goal is to reduce the ammonia formation
• Protein restriction and reduction of ammonia
  formation in the intestines
• Protein restriction may be as low as 0-40g per
  day
• Sterilization of the intestines with antibiotics
  - neomycin sulfate
• Lactulose (Cephulac) discourages bacteria

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Acute Pancreatitis

• Acute inflammatory process of the pancreas
• May be mild edema to severe hemorrhagic necrosis
• Most common in middle-aged men and women, however
  more common in men
• Some patients recover completely, however others
  have recurring attacks and others develop chronic
  pancreatitis

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Etiology and Pathophysiology

• Primary factors are biliary tract disease and
  alcoholism
• In U.S., alcoholism is number 1 cause followed by
  gallbladder disease
• Less common factor
• Trauma
• Viral infections

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Pancreatitis

• 70 of cases are caused by gallstones or ETOH
  abuse
• The pancreatic digestive enzymes are prematurely
  activated by the chemical inflammatory process
• The enzymes start auto digestion which leads to
  pancreas damage

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Pancreatitis

• The enzymes cause vasodilation and vascular
  permeability
• Trypsinogen,
• Phospholipase A,
• Elastase along with Kallikrein
• Shock can ensue when extravazation of plasma and
  RBCs redistribute to the bowel and
  retroperitoneal space.

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Diagnostic Studies

• Serum amylase and lipase
• Urinary amylase
• Blood sugar
• ERCP
• Abdominal X-Ray
• Abdominal ultrasound

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Clinical Manifestations

• Pain, vomiting, fever
• Abdominal distention, guarding,hypoactive or
  absent bowel sounds
• Elevated amylase, WBCs, blood sugar,
  triglycerides, prothrombin time
• ABGs hypoxemia with metabolic acidosis
• Severe cases peritoneal signs, ascites, jaundice,
  palpable mass, Grey Turners sign, Cullens sign,
  hypovolemic shock

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Clinical Manifestations

• Abdominal pain is predominant symptom located in
  the left upper quadrant but may be in the
  midepigastrium
• Commonly radiates to the back because of the
  retroperitoneal location of the pancrease
• The pain has a sudden onset and is steady
• It is aggravated by eating and frequently has its
  onset when the patient is recumbent.
• Not relieved by vomiting
• Often accompanied by flushing, cyanosis and
  dyspnea

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Pain Management Pancreatitis

• Morphine sulfate is now the drug of choice over
  Demerol
• Position in knee to chest position
• Teach how to avoid future episodes

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Nursing Management

• 1) Relieve pain
• 2) Prevention or alleviation of shock
• 3) Reduction of pancreatic secretions
• 4) Control of fluid and electrolyte imbalances
• 5) Prevention or treatment of infections
• 6) Removal of precipitating cause
• 7) Health promotion and maintenance

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Pharmacology

• Antacids and mucosal protective agents
• H2 Receptor Blockers
• Antibiotics
• Proton Pump Inhibitors

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NUTRIENTS

• TO BUILD AND MAINTAIN BODY TISSUES
• FURNISH ENERGY
• REGULATE BODY PROCESS
• WOUND HEALING

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METABOLISM

• THE PROCESS BY WHICH CELLS USE OR STORE ENERGY
  FROM NUTRIENTS
• ANABOLIC BUILD UP SUBSTANCES AND BODY TISSUES
• CATABOLIC BREAK DOWN SUBSTANCES OR BODY STORES

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NUTRIENT GUIDELINES

• New pyramids just released in 2005. Go to
  mypyramid.gov to see the pyramid for you.

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WHO

• World Health Organization together with United
  Nations Food and Agriculture Organization
  developed nutritional guidelines

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CARBOHYDRATES

• Monosaccharides and disaccharides
• Polysaccharides
• Main purpose is to provide energy
• Oxidizing fats
• Promote desirable bacterial growth in GI tract
• Synthesis of Vit K and Vit B12
• Dietary Fiber

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PROTEINS

• Complete or partially complete or incomplete
• Carbon, hydrogen, oxygen and nitrogen
• Can contain iron or copper
• Hemoglobin, Insulin, Albumin
• Vital to growth, development and functioning
• Involved in almost all body systems
• 4kcal/g

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NITROGEN

• Should be in balance between intake and output

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FATS

• Include neutral fats, oils, fatty acids,
  cholesterol, phospholipids.
• Made of carbon, hydrogen, and oxygen
• In all body cells
• Duties cellular transport, insulation,
  protection of organs, provision of energy, energy
  storage, vitamin absorption, and transport of
  fat-soluble vitamins
• 9 kcal/g
• Saturated and unsaturated

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VITAMINS

• Essential for growth, development, maintenance,
  and reproduction
• Do not supply energy
• Fat soluble
• Water soluble

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MINERALS

• Inorganic elements occurring in nature
• Responsible for building body tissue and
  regulating body processes
• Essential part of many hormones and enzymes
• Essential as a catalyst in blood clotting
• Transmitter of nerve impulses and muscle
  contractions
• Maintainer of water balance
• Maintainer of Acid-Base balance