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