NURS3190 GI Disorders

Anatomy of Digestive System KEY FACTORS

• Stomach has CHYME (stomach acid and digested food)

• Small Intestine absorbs most nutrients

• Big Intestine absorbs water

Liver Disorders

Portal Hypertension, Varisces, Hepatic Encepalopathy

Portal Hypertension

Obstruction of the portal vein causes shunting of blood through espohageal and splenic veins

Portal hypertension → Increased pressure in portal vein → Blood backs up → Varices and ascites

Varisces

Pooling and rupturing of blood in the esophageal veins

Hepatic Encephalopathy

Secondary to liver failure

Build-up of ammonia

TREAT WITH OSMOTIC LAXATIVE ***LACTULOSE

Emesis

Forceful emptying of stomach content (chyme)

Vomiting Center

CTZ (Chemoreceptor Trigger Zone)

Causes of Emesis

• Chemotherapy Induced = CINV

• Pregnancy/Hormone Induced = Hyperemesis Gravidarum

• Enterochromaffin Cells

  • Substance P (SP) and 5-hydroxytryptamine (5-HT)

Nonpharmacological Treatment of Hyperemesis

1ST LINE TREATMENT IS FLUID AND ELECTROLYTE REPLACEMENT

Serotonin 5-HT3 Receptor Antagonists Generic Names

Ondansetron/Granisetron

Serotonin 5-HT3 Receptor Antagonists Action

• Blocks serotonin receptor in CTZ

• Tablet disintegrates sublingually

Serotonin 5-HT3 Receptor Agonists Side Effects

• Prolonged QT interval, Hepatotoxicity

• Serotonin Syndrome (Hyperreflexia, HTN, tachycardia)

Anticholinergic Generic Name

Scopaline

Anticholinergic Action

Decreases CTZ stimulation

Anticholinergic Uses

• For motion sickness

• 72-hour release transdermal patch

Anticholinergic Side Effects

“Can’t Spit, Can’t Sh*t, Can’t See, Can’t Pee”

***CONTRAINDICATED IN GLAUCOMA

Antihistamine Generic Name

Promethazine, Diphenhydramine

Antihistamine Action

Inhibits vestibular stimulation in middle ear

Antihistamine Uses

• Motion sickness

• Nausea and vomiting caused by pregnancy

Antihistamine Side Effects

“Can’t See, Can’t Pee, Can’t Spit, Can’t Sh*t”

***CONTRAINDICATED IN GLAUCOMA

Anticholinergic Toxicity: Agitation/Delirium

Cannabinoid Generic Name

Dronabinol

Cannabinoid Action

• Inhibits 5-HT receptors in CTZ

• Interacts with CB1 receptors in CNS

Cannabinoid Uses

• Nausea and vomiting from chemotherapy

• Appetite stimulant

• ***Take ONE HOUR before chemotherapy

Cannabinoid Side Effects

• Euphoria, dry mouth

• Depression, anxiety, manic psychosis

Dopamine Antagonist (Prokinetic Agent) Generic Name

Metoclopramide

Dopamine Antagonist Action

• Blocks dopamine receptor in CTZ

• Stimulates motility

• Give 30 minutes before meals and before bedtime

Dopamine Antagonist Uses

• N/V secondary to anesthesia/chemotherapy/hyperemesis gravidarum

• Gastroparesis = slowed stomach emptying

Dopamine Antagonist Side Effects

• Extrapyramidal Syndrome (EPS) and Tardive Dyskinesia

• ***DO NOT USE WITH POSSIBILITY OF OBSTRUCTION

Antiulcer Drugs that Reduce Acid

H2, PPIs, and Potassium-Competitive Acid Blockers

Antiulcer Drugs that Create Protective Patch

Mucosal Protectants

Antiulcer Drug that Prevents Ulcers

Misoprostol

H2 Blocker Generic Name

Famotidine, Ranitidine, Cimetidine

Ends in -tidine

PPI Generic Name

Esomeprazole, Omeprazole, Lansoprazole, Pantoprazole

Ends in -prazole

Antacids Generic Names

Aluminum Hydroxide, Calcium Carbonate, Magnesium Hydroxide

Mucosal Protectant Generic Name

Sucralfate

Mucosal Protectant Use

Take thirty minutes before meals and bedtime

Syndrome

Group of symptoms with no pathologic cause

Crohn’s Disease

• Inflammatory Bowel Disease

• Inflammation of the GI tract

• Cause:

  • Smoking, Low Fiber, NSAIDS

Ulcerative Colitis

• BLEEDING

• Ulcers of the rectum to the sigmoid colon

Treatment of Inflammatory Bowel Disease

Prednisone, Infliximab

Four Types of Laxatives and Generic Names

Bulk-Forming - Methyllcellulose, Psyllium

Surfactant (Stool Softeners) - Docusate Sodium

Stimulant - Bicasodyl, Senna

Osmotic Laxative - Lactulose, Magnesium Hydroxide

Uses and Nursing Consderations for Laxative Types

Bulk-Forming

• Everyday use

• Take with water

Stimulant

• Everyday use

• Take with water

Surfactant

• Use night before GI procedure

• NOT FOR EVERYDAY USE

Osmotic Laxative Nursing Considerations

• Pulls ammonia from body FOR SURGICAL PREP

• NOT FOR EVERYDAY USE

  • Lactulose = Hepatic Encephalopathy

  • Magnesium Hydroxide DOES NOT CAUSE ELECTROLYTE IMBALANCE

Osmotic Laxatives are contraindicated in who?

HEART FAILURE PATIENTS

ALL LAXATIVES ARE CONTRAINDICATED FOR ULCERATIVE COLITIS AND DIVERTICULITIS EXCEPT FOR

BULK-FORMING!!!

Traveler’s Diarrhea (E.Coli) Pharmalogical Treatments

• Should resolve in 3-5 days

  • If longer than 5 days:

    • w/fever = Ciproflaxin

    • w/out fever = Rifiximab

Rifixmab Action and Nursing Considerations

• GI ANTIBIOTIC ONLY

• SHOULD NOT BE USED FOR FEVER (SYSTEMIC)

Antidiarrheal Generic Names

Diphenoxylate + Atropine, Loperamide

Antidiarrheal Action and Nursing Considerations

• Decreases motility

• SHOULD NOT BE USED MORE THAN 2 days or with FEVER

Medication for GERD

PPI (-prazole) and Metoclopramide