Digestive and Skin Disorders

Assessment Questions

  • Diet: "How's your diet? Are you eating? If not, why not?"
  • Vomiting: "Are you vomiting? What color is the vomiting? How much are you vomiting?"
  • Diarrhea: "How many loose stools have you had? What do the stools look like? Is there any blood in these stools?"

Anatomy and Physiology of the Digestive System

  • Esophagus:
    • Located after the oral cavity.
    • Important structure at the bottom.
  • Stomach:
    • Starts to break down food.
  • Small Intestines:
    • Three parts:
      • Duodenum
      • Jejunum
      • Ileum
  • Colon:
    • Receives contents from the ileum.
    • Sections:
      • Ascending
      • Transverse
      • Descending
    • Function: Absorbs water from the chyme (partially digested food), leaving stool.
  • Pancreas:
    • Role in storing sugar.
    • Enzymes released:
      • Amylase
      • Lipase helps break down food.

Liver Function

  • Carbohydrate Storage:

    • Insulin transports carbs into cells.
    • Excess carbs are stored in the liver.

  • Protein Synthesis:

    • Produces nonessential proteins needed to make other proteins.
    • Essential proteins are obtained from the diet.
    • Albumin production: Important for preventing edema and maintaining fluid balance.
      • Indication: Albumin levels are important lab values to assess.

  • Lipoproteins:

    • HDLs.

    • LDLs.

    • Function: Transport cholesterol.

      • LDLLDL transports cholesterol to cells.
      • Importance: Assessing HDL and LDL levels is important.

  • Immunoglobulins:

    • The liver is responsible for immunoglobulins like IgA, IgD, IgE, IgG, IgM.
    • Importance: Necessary for preventing infection.

  • Clotting Factors:

    • The liver produces clotting factors.
    • Vitamin K: Important clotting factor to monitor.

  • Detoxification:

    • The liver detoxifies substances consumed.
    • Importance: Ensuring the liver is not overloaded.

  • Bilirubin Recycling:

    • The liver recycles old or destroyed red blood cells, producing bilirubin.
    • Bile: Produced by the liver to aid in fat digestion. Stored in the gallbladder.

  • Liver Labs:

    • ALT (Alanine Aminotransferase)
    • AST (Aspartate Aminotransferase)
    • Alkaline phosphatase

  • Ammonia Management:

    • Ammonia is a byproduct that the liver eliminates.
    • High ammonia levels indicate liver malfunction, leading to patient confusion.

Pancreas: Exocrine Function

  • Enzyme Release:
    • Amylase: Breaks down starches.
    • Lipase: Breaks down fats.
  • Labs to Monitor:
    • Amylase levels. Amylase or Lipase tests are done to make sure the pancreas is functioning correctly.
    • Lipase levels.

Cancer: Oral Cancer

  • Causes:
    • Smoking
    • Chewing Tobacco.

GERD and Esophageal Cancer

  • GERD: If GERD persists, it can lead to Barrett's esophagus.
  • Barrett's Esophagus: Change in cells that elevate someone's risk for developing esophageal cancer.

Nausea and Vomiting

  • Nausea:
    • Definition: A feeling of discomfort and the sensation of being about to vomit.
    • Causes: Particular foods (especially smells), medications, infection.
  • Vomiting:
    • Causes: Anorexia.

Anorexia

  • Causes:
    • Body dysmorphia.
    • Depression.
    • Bullying.
    • Psychiatric disorders/
  • Treatment:
    • Establishing a schedule.
    • Identifying the patient's food preferences.

Obesity

  • Types (based on BMI):
    • Type 1: BMI 30 to 34.9
    • Type 2: BMI 35 to 39.9
  • Treatment:
    • Diet and exercise are always the first things to try.
    • Medications if diet and exercise are not effective.
    • Bariatric surgery as a last resort for patients with a BMI greater than 40.

Bariatric Surgeries

  • Types Gastric bypass (Roux-en-Y).
  • Complications:
    • Dumping syndrome.

Dumping Syndrome

  • Definition: Undigested food moves too rapidly from the stomach to the small intestine.
  • Symptoms: Nausea, vomiting, diarrhea, cramping.
  • Complications: Hypoglycemia.
    • Signs and symptoms of hypoglycemia: Diaphoresis (sweating), also known as Liposine.
  • Prevention:
    • Chew food thoroughly.
    • Lie down after eating.
    • Avoid drinking fluids while eating.

Pernicious Anemia

  • Definition: Decrease in Vitamin B12.
  • Cause: Lack of intrinsic factor (due to surgery), which is needed for B12 absorption.
  • Result: Risk of becoming anemic due to B12 deficiency.

Hiatal Hernia

  • Definition: Stomach slides up through the hiatus (opening in the diaphragm).
  • Causes/Risk Factors: Pressure from obesity or pregnancy.
  • Signs/Symptoms: Similar to GERD (heartburn, regurgitation), aspiration (acid in the trachea), nighttime cough.

GERD (Gastroesophageal Reflux Disease)

  • Primary Cause: Weakening of the lower esophageal sphincter (LES).
  • Prevention: Medications, elevating the head of the bed, surgery (fundoplication to correct the LES).

Peptic Ulcer Disease

  • Definition: Break down of the lining of the stomach.
    • The stomach lining secretes mucus to protect against acid.
  • Cause: Break in the mucosa lining, often due to H. pylori bacteria or NSAID use (aspirin, ibuprofen).
  • Location of pain: Epigastric or upper gastric region.
  • Diagnosis: Endoscopy (EGD) to visualize the ulcer.
  • Post-Endoscopy: Ensure gag reflex returns before feeding the patient.
  • Treatment: Medications to correct the ulcer, followed by continued medication.

Appendicitis

  • Definition: Inflammation of the appendix.
  • Symptoms: Pain (typically in the right lower quadrant), fever, nausea.
  • This is an emergency and requires immediate surgical intervention to prevent rupturing.

Diverticulitis

  • Definition: Infection of the diverticula (pouches in the colon).
  • Cause: Chronic constipation.
  • Symptoms (of diverticulosis): Pain (left lower quadrant).
  • Treatment:
    • Mild: Analgesics, increased fluids, antibiotics.
    • Severe: NPO (nothing by mouth), IV antibiotics, IV fluids, IV analgesics; potential surgery if perforation occurs.

Peritonitis

  • Definition: Infection of the peritoneum (lining of the abdominal cavity).
  • Causes: Ruptured appendix, diverticulitis, peptic ulcers.
  • Symptoms: Rigid abdomen, abdominal distension, fever, chills.
  • Treatment: IV antibiotics, IV analgesics, IV hydration, potential surgery.

Constipation

  • Definition: Fewer than three bowel movements per week (less than 3 in 7 days).
  • Causes: Diet lacking fiber, opioids, dehydration, poor bowel function.
  • Treatment: Stool softeners, increased fiber, increased fluids.

Diarrhea

  • Definition: Three or more loose stools in 24 hours.
  • Causes: Medications, diet, bacteria.
  • Treatment: Identifying and treating the underlying cause, increasing fluids, antidiarrheal medications.

Irritable Bowel Syndrome (IBS)

  • Definition: Bowel function disorder where nerves aren't working properly, leading to diarrhea, constipation, or both.
  • Triggers: Stress.
  • Treatment: Avoiding stress, medications to treat diarrhea/constipation, dietary changes (FODMAP diet).

Crohn's Disease and Ulcerative Colitis

  • Crohn's Disease:
    • Affects the entire GI tract.
    • Characterized by inflammation.
  • Ulcerative Colitis:
    • Typically impacts the colon.
  • Symptoms (Common to Both): Bloody stools (tarry/black or bright red), malnutrition.
  • Treatment: Anti-inflammatories, antidiarrheals, potential surgery.
  • Crohn's cannot be cured by surgery, but ulcerative colitis can.

Bowel Obstructions

  • Types: Small bowel obstruction, large bowel obstruction.
  • Causes: Mechanical, nonmechanical.
    • Mechanical: Something physically blocking the bowel (stool, tumor, volvulus - twisted bowel, intussusception - telescoping bowel).
    • Nonmechanical: Disruption of peristalsis (dehydration, electrolyte imbalances, anemia).
  • Symptoms: Pain, abdominal distension, nausea, vomiting, absent/hypoactive bowel sounds.
  • Treatment: NPO, decompression with a nasogastric tube.

Tube Feedings

  • Assessment with Every Shift: Check residual volume (leftover content in the stomach).
  • Bag Assessment: Monitor color, amount, time initiated (bags are typically only good for 24 hours).
  • Placement Verification: X-ray confirmation after initial placement.
  • Ongoing Assessment: Check acidity (pH) with each assessment using pH paper.
  • Medication Administration:
    • Not all medications can be given via feeding tube.
    • Do not crush capsules or enteric-coated medications; use liquid formulas instead.

Absorption Disorders

  • Celiac Disease:
    • Gluten intolerance.
    • Symptoms: Pain, diarrhea, steatorrhea (fatty stools).
    • Treatment: Gluten-free diet.
  • Lactose Intolerance:
    • Inability to tolerate dairy.
    • Symptoms: Bloating, cramping, diarrhea.
    • Treatment: Avoiding dairy.

Hepatitis (A, B, C)

  • Transmission:
    • Hepatitis A: Oral-fecal route.
    • Hepatitis B & C: Bloodborne.
  • Prevention:
    • Vaccines available for Hepatitis A and B.
  • Cure:
    • All three types (A, B, C) are now curable.
  • Complications: Liver failure.

Liver Failure

  • Causes: Hepatitis, alcohol abuse, Tylenol (acetaminophen) toxicity (primary cause of acute liver failure).
  • Symptoms (J-SAB-E):
    • Jaundice
    • Ascites
    • Bleeding
    • Encephalopathy
  • Treatment (for Tylenol Toxicity): Acetylcysteine.
  • PT, INR is impaired, so there is bleeding.
  • Ammonia is impaired which leads to encephalopathy.
  • Albumin is not there, so spacing occurs, leading to ascites.
  • Bilirubin is impaired, which causes jaundice.

Chronic Liver Failure (Cirrhosis)

  • Causes: Chronic alcohol use, hepatitis, hepatotoxic medications (other than Tylenol), fatty liver disease.
  • Symptoms (C-HAP-EC): acronym to remember related diseases associated:
    • t, p stands for Portal Hypertension: Increased pressure in the portal vein, leading to backflow of blood, formation of esophageal varices (engorged vessels in the esophagus that can rupture and cause bleeding).
      • Treatment: Vasoconstrictors (octreotide) to decrease bleeding; procedures to remove varices.
    • A stands for Ascites: Increased fluid buildup in the abdominal cavity.
    • E stands for Encephalopathy: Altered mental status due to high ammonia levels.
    • H stands for Hepatorenal Syndrome:
      Dysfunction related to renal system. Kidney failure due to low blood pressure (caused by the blockage in blood flow from the portal vein). Affects blood flow.
    • C stands for Clotting Factor: Lack of clotting factors can cause dysfunction in many different diseases. There is no single medication to help, it focuses more on other symptom relief.
  • Treatment: Supportive measures only (avoiding alcohol, lactulose for ammonia, managing PT/INR, giving albumin), liver transplant (strict guidelines for candidacy).

Liver Transplant

  • Rejection Signs: Sudden severe pain, elevated pulse, rising temperature, increasing jaundice.

Liver Cancer

  • Causes: Metastasis (spread from other cancers).
  • Symptoms: Jaundice, weight loss, anorexia.
  • Diagnosis: Biopsy (patient should lie on the right side for 1-3 hours post-procedure).
  • Treatment: Chemoradiation.

Pancreatitis

  • Causes: Blockage of enzyme release, alcoholism.
  • Acute pancreatitis is when pancreatic enzymes are released.
  • Enzymes: Lipase and amylase.
  • Autodigestion: Enzymes start to autodigest tissues.
  • Jaundice occurs in cases of related to the liver, galbladder, and pancreas. Reducing fatty food intake can also aid recovery.

Chronic Pancreatitis

  • Rapidly reoccurring issues causing inflmation from constant alchohol poisoning cases causing scarring.
  • Symptoms: Epigastric pain (left upper quadrant), steatorrhea (fatty stools).
  • Treatment: Pancreatic enzyme replacement with every meal (since the body can no longer produce/secrete them).

Pancreatic Cancer

  • Symptoms: Pain, nausea, symptoms related to liver malfunctions such as jaundice, anorexia, and weight loss due to malignancy.
  • Treatment: Chemoradiation.

Gallbladder

  • Cholecystitis: Inflammation of the gallbladder.
  • Cholelithiasis: Gallstones.
  • Choledocholithiasis: Gallstone has passed into the bowel.
  • Symptoms: Right upper quadrant pain (radiating to the back), jaundice, fever.
  • Treatment: IV antibiotics, increased fluids, low-fat diet.

Skin Disorders

  • Dermatitis Inflammation on the skin.
  • Psoriasis- Cell inflammation that causes cells growing rapidly, causing: Red lesions, scales, gray color to lesion.
    • Corticosteroids used in patients.
    • Usuals. Salicylic acids used to clear scale.
  • Herpes Simplex- Located into two locations, two for the genitals. Location one for the waist.
  • Herpes poster, medication acyclovir and anti convulsos used.
  • Woodsland is used for fungal infections.
  • Skin cancers are often related to stap.
  • Pressure injuries stage 1-4
  1. Stage one: Redness of the area,
  2. Stage two: partial thickness.
  3. Stage three: Full thickness damage to dermis.
  4. Stage four: Bone and tendon destruction. Muscle.