GI Disorders/Diseases

Peptic Ulcer Disease (PUD)

• GI defense is impaired

• H. Pylori infection most common cause

• Doesn’t cause illness in most people

• H. Pylori increases risk for PUD & Gastric Cancer

Types of Ulcers

• Duodenal (Most common)

• Gastric (Antrum of stomach)

• Stress (After stressful event: Can be medical)

Complications of PUD

• Hemorrhage (Monitor S/S of bleeding: Inc. HR, Dec. BP, Hematemesis)

• Perforation leading to Peritonitis

• Pyloric obstruction

Rec. Cues for PUD

• OTC Meds (NSAIDS)

• GI Surgeries

• Alcohol/Caffeine/Tobacco

• Acidic Foods (Orange Juice)

• Pain

• Dyspepsia (Indigestion/Stomach pain: Sharp, Burning)

• Psychosocial

Assessments for PUD

• CBC (H/H)

• Breath test & Stool Sample (Can detect H. Pylori)

• EGD (Most Accurate)

• Bleeding Scan

Treatments/Meds for PUD

• PPI Triple Therapy

• PPI-Lansoprazole + 2 antibiotics (Metronidazole & Tetracycline, Clarithromycin & Amoxicillin, For 10-14 Days)

Other Treatments for PUD

• Diet

• Yoga/Hypnosis/Reducing Stress

• Lifestyle Alterations

• Smoking Cessation

• EGD, Surgery

Gastro Esophageal Reflux Disease (GERD)

Most common upper GI disease in the US, Obesity is the HIGHEST risk, H. Pylori, Causes inflammation, NGT, Barret’s Esophagus (Pre-cancer/Pre-Malignant)

Rec. Cues/ Assessment for GERD

History of heartburn/ Atypical Chest pain(CP), Newly diagnosed w/ ASTHMA, Dysphagia/odynophagia, No definitive diagnostic test, EGD, 24 hr pH monitoring

Clinical Manifestations of GERD

Dyspepsia, Reflux/Regurgitation, Pyrosis (Heartburn), Freq. Eructation, Nocturnal coughing/Wheezing, Pain may radiate to neck/jaw/ or back, Psychosocial: ED fearing MI

Gen. Solutions/ Education for GERD

Avoid peppermints, chocolate, fatty foods, caffeine, carbonated drinks, Avoid spicy & acidic foods, No eating before bedtime, 4-6 small meals/day, Dot NOT sleep flat, Smoking/ alcohol cessation, Weight loss

Goals of Drug Therapy for GERD

Pain relief, Decrease gastric acid secretion, Protect gastric mucosa, Increase gastric emptying, Prevent recurrence & complications

Meds used to treat GERD

Antacids, Histamine Blockers, Proton Pump Inhibitors, GI Protectant

Inflammatory Bowel Disorder: Diverticular Disease

• Diverticulosis:

  • Formation of abnormal pouches in the bowel wall (Large intestine)

• Diverticulitis:

  • Inflammation of these pouches

Rec. Cues/ S/S of Diverticular Disease

• Diverticulosis:

  • Usually asymptomatic

• Diverticulitis:

  • Inc. Temp

  • Abd. Pain/Distention

  • Bleeding

  • Peritonitis

Diagnostic Tests & Labs for Diverticular Disease

• CT Abd.

• Ultrasound Abd.

• Dec. H/H

• Colonoscopy

Gen. Solutions/ Interventions for Diverticular Disease

• Broad Spectrum Antibiotics

• Analgesics

• If Severe: IV fluids

• NO laxatives or enemas

• LOW fiber diet

• Freq. Abd. assessment

• If Ruptured: Surgery for colon resection

Rec. Cues & S/S of Intestinal Bowel Obstructions

Nausea & Vomiting, Abd. pain, Ask about BM’s, Fever, Tachycardia, Hypotension

Rec. Cues: Labs & Diagnostic Tests for Intestinal Bowel Obstructions

CT Scan, Ultra sound, MRI, WBC, H/H, BMP

Small Bowel Obstruction

Abd. pain with visible peristaltic waves in upper & middle Abd., Nausea & vomiting (Fecal material), Severe fluid & electrolyte imbalances, Obstipation (Severe constipation)

Large Bowel Obstruction

Lower Abd. cramping, Minimal or no vomiting, Obstipation or ribbon like stools, No major fluid & electrolyte imbalances

Gen. Solutions: Take Action for Intestinal Bowel Obstructions

NPO, NGT DISIMPACTION, IV fluids & electrolyte replacement, Freq. VS monitoring/ I&O’s, TPN if prolonged NPO, Analgesics & antiemetics, Surgery: Colectomy (Mechanical)

Crohn’s Disease

• Inflammatory disease involving small intestine

• Terminal ileum

• Progressive & unpredictable

• Remissions & exacerbations

• Severe complications, COBBLESTONE appearance

Rec. Cues: Assessments for Crohn’s Disease

• Weight loss

• BM

• Fever

• Abd. Pain

• Nutrition/ Hydration

• Steatorrhea (Excess amounts of fat in stools)

Labs & Diagnostics for Crohn’s Disease

• Decreased H/H

• Decreased Folic acid

• Xray

• Colonoscopy

Interventions & Drug Therapy for Crohn’s Disease

• 5-ASA drugs

• Azathioprine

• 6-mercaptopurine

• Biological response modifiers

• Glucocorticoids

Other Interventions for Crohn’s Disease

• Nutrition

• Fistula Management

• Relaxation Techniques

• Surgery

Ulcerative Colitis

• Inflammation in rectum & rectosigmoid colon

• Remissions & Exacerbations

• Lining bleeds & Ulcers, Abscesses

• Stool contains blood & mucous

• Urgent sensation to defecate

Rec. Cues: Assessment for Ulcerative Colitis

• Diet

• BM

• Abd. pain

• VS: Fever/ Tachycardia

Labs & Diagnostics for Ulcerative Colitis

• H/H

• WB

• ESR

• BMP

• Albumin

• MRE/Colonoscopy

What is the goal to help treat Ulcerative Colitis?

Decreased BM

Interventions & Drug Therapy for Ulcerative Colitis

• 5-aminosalicylates

• Glucocorticoids

• Antibiotics

• Immunomodulators

Other Interventions for Ulcerative Colitis

• NPO

• Diet

• Smoking cessation

• Rest

Acute Cholecystitis

• Inflammation of the Gallbladder caused by an obstruction with a gallstone blocking the cystic duct

Gallstone Production

Mechanism not fully understood, Impaired gall bladder motility leads to stones, Composed of substances found in bile

Gallstone Risk Factors

Diets high in cholesterol, Pregnancy can affect gallbladder motility, 4 F’s (Female, Forty, Fertile, & Fat)

Rec. Cues: Assessments for Acute Cholecystitis

Diet, Nausea/Vomiting, Pain

Labs for Acute Cholecystitis

Inc. WBC, ALP, AST, LDH, Inc. Indirect & Direct Bilirubin, Amylase/Lipase

Diagnostics for Acute Cholecystitis

Abd. US, HIDA Scan, ERCEP/MRCP

What is the most common cause of Acute Pancreatitis?

Acute Cholecystitis

Gen. Solutions: Take Action for Acute Cholecystitis

Nutrition, Pain management, Tx Nausea/ Vomiting, Surgery: Lap Choly or Open Choly

Post-Choly Syndrome

S/S after a choly: Pain in the upper Abd., Nausea/Vomiting, Dyspepsia, Bloating, Diarrhea

Hernia Types

Indirect, Femoral, Umbilical, & Incisional

Hernia Classifications

Reducible, Irreducible (Incarcerated), Strangulated (EMERGENCY)

Rec. Cues: Assessments for Hernias

Abd. Assessment, Is it reducible?, Scrotal Assessment (For Male Patients)

Take Actions: Interventions for Hernias

Surgery (Herniorrhaphy), Bowel resection (Strangulation), Avoid Strenuous activities for several days, Avoid coughing, Stool softeners, Stand to urinate (For Male Patients)