LOWER GASTROINTESTINAL DISORDERS
Presented by-MSc nsg 1st yr.Neha Maurya
LEARNING OBJECTIVES
GENERAL: After the class student will be able to understand about the diagnostic tools and therapeutic measures.
SPECIFIC: Student will able to-• Enlist the diagnostic tools• Describe type of therapeutic intervention• Differentiate small and large intestine diagnostic measures.
INTRODUCTION
• Lower gastrointestinal disorders characterized by disease which occur in small and large intestines.
• The small and large intestines may be affected by infectious, autoimmune, physiological states& anatomical changes.• Inflammation of the intestines is called
enterocolitis e.g. ulcerative colitis, gastroenteritis.
CLASSIFICATION OF LOWER GI DISEASES
SMALL INTESTINE DISEASES• Gastroenteritis• Duodenal ulcer• Malabsorption• celiac disease• Intestinal obstruction• diarrhea
LARGE INTESTINE DISEASES• Ulcerative colitis• Intestinal obstruction and
tumor• Appendix disorder• Hemorrhoids• Constipation• Diverticulitis
ASSESSMENT
• PATIENT HISTORY-past history-present history
• PHYSICAL EXAMINATION - observation - auscultation - Palpation - percussion
DIAGNOSTIC TOOLS
Lower GI assessment includes:• Lab test: e.g. stool test, blood test • Proctoscopy• Sigmoidoscopy• Endoscopic ultrasound• Capsule endoscopy• Colonoscopy• Barium enema• Gastric analysis e.g. pernicious anemia, ulcer and carcinoma
Diagnostic Procedures in GI Diseases
BLOOD TEST • Liver function tests (LFT’S)• Hepatitis serology • S. Amylase & Lipase• Alfa- Feto Protein (AFP)• Carcino- Embryonic Antigen (CEA)
STOOL TEST • Stool microscopy• Stool ova & parasites• Stool culture• Stool C. difficile toxin• Stool occult blood
PROCTOSCOPY EXAMINATION
• Proctoscopy is an invasive, endoscopic procedure for examining the anal canal and lower part of rectum.
Indications:• Hemorrhoids• Proctitis • Polyps • Tumors Position: left lateral
Proctoscope:
• It is a short, straight, rigid, hollow metal tube, usually has a small light bulb mounted at the end.
• Proctoscope is lubricated and inserted into the rectum, and then the obturator is removed, allowing an unobstructed view of the interior of the rectal cavity.
TYPES
FLEXIBLE SIGMOIDOSCOPY(mo
st common)
RIGID SIGMOIDOSCOPY(chil
dren)
INDICATION:• Intestinal Bleeding• Inflammation• Abnormal Growth• Ulcers, fissuresTime: 10-20 minutePosition: left side
PREPERATION:• Colon and rectum must be
empty• Drink clear liquid 12 hrs before• E.g. water, strained juice, plain
coffee, soft drinks• Or enema and laxative
ENDOSCOPIC ULTRASOUND
• The ultrasound probe is placed at the tip of the endoscope
• Allows ultrasonography of organs from a close distance
• Allows close evaluation of the bowel wall
• Can be used to take fine needle aspiration samples from adjoining regions/organs
Endoscopic Ultrasound
A T3 Rectal Tumor on EUS
INDICATION
• Visualize wall of the organs• Rectum imaging• Colon imaging• FNAC• Lymph nodes biopsy
CAPSULE ENDOSCOPY
After patient swallows the capsule, it takes picture of the inside of the GI.
Indication: Contraindication:• Crohn’s disease -obstruction(tumor)• Peptic ulcer -paralytic ileus
Capsule Endoscopy
COLONOSCOPY
Examination of large bowel& distal part of small bowel
Indication: position: left lateral
• Ulceration contraindication:
• Polyp -intestinal obstruction• Biopsy -IBD• Removal of colorectal cancer lesions(1mm)• GI haemorrhage
INSTRUCTIONS:Bowel Cleaning 2 Night BeforePolyethylene Glycol Electrolyte
LavageSide effect: N/V, cramps,
bloating, hypothermia(elderly)Sedativeglucagon
Nursing consideration during procedure: Oxygen saturationVitalsLOCPain intensityVagal responseAbdominal distensionReport of bleeding
BARIUM ENEMA
• It is a type of X-ray imaging. Delivering contrast solution metallic element barium into rectum.-Allows internal organs in motion by tracking the flow of the barium solution.
Indication: Time: 40-50 minute
• Blood in stool Contraindication:• Chronic diarrhoea - perforation• IBD - obstruction• Polyps& tumors• diverticulitis
NURSING CONSIDERATION
PRE PROCEDURE:• Consent• Feeling of warmness• Low residue diet• Empting and cleaning of lower
bowel
POST PROCEDURE:• Bowel movement• Fluid intake• White colour stool
THERAPEUTIC INTERVENTION
•Nasogastric feed•Gastrostomy feed• Jejunostomy feed•Total parenteral nutrition•Bowel wash
NASOGASTRIC FEEDING
GASTROSTOMY FEEDING
INDICATION
• Sucking Swallowing Problems• Abnormalities In Intestine• Food Allergy • Metabolic Disorder
JEJUNOSTOMYFEEDING
Parenteral nutrition
Indication:• Inadequate absorption• Gastrointestinal fistula• Bowel obstruction• Prolonged bowel rest• Severe malnutrition
BOWEL WASH
Chronic constipation
Undergoing stoma procedure
Hirschsprungs disease
Meconium ileus
INDICATION
Decompress the bowel
EVALUATION QUESTIONS
1. Instrument Use For Visualization Of ascending colon?2. Three indication of sigmoidoscopy?3. Type of total parenteral nutrition?4. Instrument used in visualization of rectum?5. Indication of jejunostomy feeding?
BIBLIOGRAPHY
• BRUNNER’S AND SIDDHARTH, “MEDICAL SURGICAL NURSING”, VOL 1.• ROSS& WILSON, “ANATOMY AND PHYSIOLOGY”,11 EDITION.• BT BASVANTHAPA, “MEDICAL SURGICAL NURSING”.• www.medline.in• www.myoclonic.in• www.pubmed.com
LEARNING OBJECTIVES
GENERAL: After the class student will be able to understand about the gastroenteritis disease.
SPECIFIC: Student will able to-• Define gastroenteritis?• Enlist causes of gastroenteritis.• Explain pathophysiology of GE.• Illustrate management of GE.
GASTROENTERITIS
DEFINITION: Gastroenteritis is an
inflammation of the mucosa of the digestive tract, mainly the stomach and intestine Acute gastroenteritis is defined as sudden diarrhea accompanied by nausea, vomiting and abdominal cramping.
stomach
Alimentary canal
EPIDEMIOLOGY
Can occur at all ages, but infants principal groupMore common in countries with poor hygiene standards, water sanitation problems It is estimated that three to five billion cases of gastroenteritis
resulting in 1.4 million deaths occur globally each year. Children and those in the developing world are most commonly affected.
As of 2011, in those below age five, there were about 1.7 billion cases resulting in 0.7 million deaths.
It is less common in adults, partly due to the development of immunity.
ETIOLOGY:
BACTERIA
VIRUSES
PARASITES
NON ENTERIC:OTITIS MEDIA, MENINGITIS,
SEPSIS
NON INFECTIOUS:MILK/FOOD ALLERGIES, MALABSORPTION,
SIDE EFFECTS OF DRUG
bacteria
Campylobacter jejuni E. hystolytica Clostridium difficile
Shigella Escherichia coliCryptosporidium
VIRUSES
Rotavirus is the most common cause of severe diarrhea among infants and young children.
Noroviruses are the most common cause of viral gastroenteritis in humans. The viruses are transmitted by fecally-contaminated food or water; by person-to-person
PARASITES
• Giardia lamblia • ENTAMOEBA HYSTOLYTICA• CRYPTOSPORIDIUM
PATHOPHYSIOLOGY:Intake of unhygienic food
↓inflammatory reaction in
mucosal wall ↓
injury to mucosal wall↓
disturbed bowel movement ↓
gastroenteritis
SIGNS AND SYMPTOMS:
• Diarrhea• Vomiting• Abdominal cramps• Headache• Fever• Muscle pain• Bloody stool• Dehydration • Skin turgor• Malnutrition
DIAGNOSTIC EVALUATION:• Stool
culture(pathogens, parasites, consistency, color& occult blood)• Blood profile (LFT,
triglycerides, CEA, AFP)• Electrolytes• skin turgor
MEDICAL MANAGEMENT 1. REHYDRATION: Sodium chloride 3.5g. Potassium chloride 1.5g. Tri sodium citrate 2.9g. glucose anhydrous 20.0g.
PHARMACOLOGICAL THERAPY:Antiemetic's (Ondansetron, Metoclopramide)Antibiotic (azithromycin, Metronidazole, Vancomycin, Tinidazole)Antimotility agents (Loperamide, bismuth Subsalicylate)
DIETARY MANAGEMENT:• high in simple sugar should be avoided• fermented milk products• zinc supplementation
NURSING MANAGEMENTNURSING GOALS:• management of diarrhea, acute pain, deficient fluid volume,
activity intolerance
NURSING ASSESSMENT: • Bowel sound• Poor skin turgor• Dry lips and oral mucosa• Pain stomach cramping• Restlessness• Limited range of motion• Nausea/Vomiting• Passage of loose watery stool• Fever/weakness• Nervousness• Low hgb and hct
NURSING DIAGNOSIS• Diarrhoea related to hyperactivity of intestine• Acute pain related to inflammation response• Deficient fluid volume related to excessive losses of body fluid
through diarrhoea• Activity intolerance related to weakness& abdominal pain• Imbalanced nutrition : less than body requirement due to
insufficient intake
NURSING INTERVENTIONS:
• Assess general condition and vitals• Auscultate abdomen• Restrict solid food intake• Review factor that alleviate pain• Massage the area where pain is elicited if not contraindicated• Assess skin turgor and hydration• Maintain adequate hydration, increase fluid intake
PREVENTION
EVALUATION QUESTION
1. What is the most common cause of viral gastroenteritis?2. What is the first symptom of gastroenteritis?3. What is the prevention of gastroeteritis?
BIBLIOGRAPHY
• BRUNNER’S AND SIDDHARTH, “MEDICAL SURGICAL NURSING”, VOL 1.
• ROSS& WILSON, “ANATOMY AND PHYSIOLOGY”,11 EDITION.• BT BASVANTHAPA, “MEDICAL SURGICAL NURSING”.• www.medline.in• www.myoclonic.in• www.pubmed.com