GI Disorders Stomach

THE STOMACH

NAUSEA / VOMITING

  • Definitions:
      - Nausea: A feeling of discomfort sometimes referred to as queasiness.
      - Vomiting: The forceful expulsion of stomach contents through the mouth.

  • Descriptors of Vomiting (COCA):
      - Coffee ground: Indicates old blood in vomit.
      - Bright red: Suggests fresh blood.
      - Projectile: Forceful ejection of vomit.
      - Fecal: Indicates an obstruction.
      - Bile: Typically yellow or greenish and suggests a blockage below the stomach.

Causes of Nausea / Vomiting

  • Medications: Can trigger nausea as a side effect.

  • Food Intolerance: Body may react negatively to certain foods.

  • Infections: Commonly referred to as “bugs.”

  • Poisoning: Ingestion of toxins can lead to vomiting.

  • Early Liver Dysfunction: Can cause nausea as a symptom.

  • Brain Stem Injury / Increased Intracranial Pressure (IICP): Can affect areas that control vomiting.

  • Concussions: May lead to nausea as a symptom.

  • Nursing school: Stress and anxiety related to learning can induce nausea.

Complications of Nausea / Vomiting

  • Dehiscence: Surgical wound may reopen due to increased abdominal pressure.

  • Aspiration: Inhalation of vomit into the lungs.

  • Metabolic Alkalosis: Results from loss of gastric acid through vomiting.

  • Nutritional Deficits: Prolonged vomiting can lead to malnutrition.

  • Fluid and Electrolyte (F/E) Imbalance: Loss of fluids through vomiting can disrupt body chemistry.

Treatment of Nausea / Vomiting

  • Restrict Oral Fluids: Limit fluid intake until vomiting ceases.

  • Antiemetics: Medications to alleviate nausea.

  • IV Fluids: Administer hydration and electrolytes if necessary.

  • NG Tube: Nasogastric tube may be used to remove contents from the stomach.

  • TPN: Total Parenteral Nutrition for severe or prolonged vomiting situations.

ANTIEMETICS: 5-HT3 Receptor Antagonists

  • Mechanism: Block the effects of serotonin at 5-HT3 receptor sites leading to a decrease in the incidence/severity of nausea.

  • Examples:
      - Ondansetron (Zofran)
      - Granisetron (Kytril)
      - Palonosetron (Aloxi)

  • Precautions: Use with caution in patients with hepatic dysfunction.

  • Side Effects:
      - Headache (HA)
      - Constipation
      - Diarrhea
      - Torsades de Pointes (a form of arrhythmia).

DIARRHEA

  • Definition: Passage of loose, liquid stools with increased frequency.

  • Complications:
      - Dehydration: Loss of fluids can lead to severe dehydration.
      - Electrolyte Imbalance: Loss of electrolytes can affect body functions.
      - Metabolic Acidosis: Caused by severe loss of bicarbonate.
      - Malnutrition: Prolonged diarrhea can lead to lack of nutrients.
      - Anemia: Due to malabsorption or loss of iron.

Causes of Diarrhea

  • Viruses: Commonly cause acute gastroenteritis.

  • Bacteria: Such as E. coli, Salmonella.

  • Parasites: Can infect the gastrointestinal tract.

  • Food Intolerance: Can lead to adverse reactions after eating certain foods.

  • Medications: Side effects of various medications.

  • Surgery: Can affect digestive processes.

  • Digestive Disorders: Diseases like Crohn's or IBS can cause diarrhea.

  • Diet: High fat or sugar diets can prompt gastrointestinal disturbances.

Nursing Care for Diarrhea

  • Skin Breakdown: Monitor for skin integrity due to frequent bowel movements.

  • Dehydration: Assess hydration status and administer fluids.

  • Vital Signs: Monitor for changes that may indicate severe dehydration.

  • Antidiarrheals: Use medications to control symptoms if medically appropriate.

  • IVF or TPN: May be needed if diarrhea is severe and prolonged.

ANTIDIARRHEALS

  • Loperamide (Imodium):
      - Mechanism: Slows peristalsis by directly acting on the muscles of the intestinal wall.
      - Nature: Symptomatic treatment.
      - Precautions: Use caution in liver issues and ulcerative colitis (UC).
      - Side Effects: Dizziness, drowsiness, tiredness, constipation, rash & itching.

  • Diphenoxylate/Atropine (Lomotil):
      - Controlled Substance: Diphenoxylate is an opioid.
      - Mechanism: Binds to proteins in the intestines to control and slow movement; atropine blocks acetylcholine, reducing secretions.
      - Precautions: Cannot be given with potassium supplements.
      - Side Effects: Drowsiness, nausea/vomiting (N/V), headaches (HA), confusion, anorexia.

CONSTIPATION

  • Definition: Hard, dry, infrequent stools that are difficult to pass.

  • Important Note: If the stool is soft and passed without difficulty, the patient is NOT constipated, regardless of how often they have a bowel movement.

Nursing Implications for Constipation

  • Risk of Valsalva Maneuver: Teach heart patients to avoid straining.

  • Monitor for Megacolon: Potentially life-threatening condition from severe constipation.

  • Monitor for Impaction: Assess for fecal impaction in patients.

Remedies for Constipation

  1. Eat laxatives: Increase fiber intake.

  2. Drink a lot of water: Hydration is key.

  3. Eat fruit: High in fiber to promote bowel movement.

  4. Avoid tea, coffee, alcohol: May contribute to dehydration.

  5. Eat foods high in fiber: Promotes healthier stools.

  6. Drink orange juice: Natural laxative effects.

  7. Daily exercise: Stimulates bowel function.

  8. Positive emotions: Reduce stress which can inhibit bowel function.

  9. Routine stool schedule: Encourage regularity.

  10. Do not hold back stool: Can lead to worsened symptoms.

Laxative Types

  • Bulk Forming Laxatives:
      - Examples: Ispaghula husk, Benefiber, Fybogel.
      - How They Work: Add volume to stool by absorbing water, making passage easier.
      - Side Effects: Gas, bloating, abdominal cramps, constipation if not taken with water.

  • Osmotic Laxatives:
      - Examples: Milk of Magnesia, Movicol, Miralax.
      - How They Work: Draw water into the bowel to soften stool.
      - Side Effects: Nausea, bloating, abdominal cramps, diarrhea, dehydration, increased thirst.

  • Stimulant Laxatives:
      - Examples: Dulcolax, Senokot.
      - How They Work: Irritate colon muscles to induce bowel movement.
      - Side Effects: Dehydration, diarrhea, bloating, abdominal cramps, vomiting, nausea, rectal irritation, lazy bowel leading to further constipation if taken long-term.

GI BLEEDING

  • Definition: Not a disease but a symptom of several diseases.

  • Types of GI Bleeding:
      - Upper GI Bleeding: From mouth to outflow of the stomach.
      - Lower GI Bleeding: From outflow of the stomach to anus.

Nursing Care for GI Bleeding

  • Approach: Dependent on location and extent of bleeding.

  • Interventions:
      - IV Fluids: Provide support to the vascular system.
      - Blood Administration: May be necessary to replace lost blood.
      - Medications: H2 antagonists and PPIs to reduce acid secretion.
      - Endoscopy and/or Surgery: For direct intervention.
      - Monitoring for Shock: Vital signs should be continuously monitored.

WHAT IS GASTRITIS?

  • Definition: Inflammation of the stomach that can be acute or chronic, leading to damage of the stomach lining.

  • Symptoms:
      - Loss of Appetite
      - Belching or Burping
      - Feeling of Fullness
      - Stomach Pain
      - Heartburn
      - Nausea and Vomiting

GASTRITIS Etiology

  • Causes:
      - Bacteria: Primarily Helicobacter pylori.
      - Toxins: Environmental or food-related toxins.
      - Medications: Certain medications can irritate the stomach lining.

Complications of Gastritis

  • Hemorrhage: Potential for bleeding within the stomach.

  • Pernicious Anemia: Resulting from impaired absorption of vitamin B12.

  • Ulcers: Chronic gastritis can lead to the formation of ulcers.

Gastritis Diagnosis

  • Methods:
      - Blood tests
      - Urinalysis
      - Stool tests
      - X-ray
      - ECG
      - Endoscopy
      - Stomach Biopsy

GASTRITIS Treatment

  • Goal: Focus on eliminating the cause of gastritis.

  • Interventions:
      - Monitor for hemorrhage and shock.
      - NPO (Nothing per Os - nothing by mouth)
      - IV fluids for hydration.
      - Progressive diet including bland foods.
      - Medications:
        - Antiemetics: For nausea and vomiting.
        - H2 blockers: To reduce stomach acid.
        - Proton Pump Inhibitors (PPIs): Provide acid suppression.
        - Antacids: Neutralize stomach acid.
        - Analgesics: For pain management.

GASTRITIS Nursing Considerations

  • Monitor: For bleeding, hemorrhage, and shock.

  • Dehydration / Electrolyte Imbalance: Assess and correct as needed.

  • Support for Lifestyle Changes: Discuss dietary and lifestyle modifications to prevent recurrence.

  • Patient Education: Teach patients to recognize and report symptoms indicative of recurrence.

STOMACH CANCER

  • Definition: Malignancy of mucous membranes that can invade muscle, regional organs, and distant sites.

  • Prognosis: 5 year survival rate is very poor.

Risk Factors & Symptoms of Stomach Cancer

  • Risk Factors:
      - Family history of stomach cancer.
      - Long-term inflammation of the stomach.
      - Previous infection with Helicobacter pylori.

  • Symptoms:
      - Discomfort or pain in the stomach area.
      - Weight loss.
      - Smoking.
      - Poor diet, lack of physical activity, or obesity may contribute.
      - Nausea and vomiting.
      - Heartburn.
      - Loss of appetite.
      - Vomiting blood or having blood in stool.
      - Feeling full or bloated after a small meal.

STOMACH CANCER Diagnostics

  • Tools and Methods:
      - Gastroscopy: Direct visualization of stomach lining.
      - Biopsy: To confirm malignancy.
      - CT Scan: Imaging to assess spread of cancer.
      - PET Scan: For metabolic activity evaluation.
      - MRI: For detailed imaging.
      - Serum Studies: Blood tests for tumor markers.

STOMACH CANCER Surgery

  • Procedure:
      - Gastrectomy: Surgical removal of part or all of the stomach.

  • Risks of Surgery:
      - Evisceration: Complication where internal tissues protrude through an incision.
      - Dumping Syndrome: Rapid gastric emptying leading to digestive issues.
      - Pernicious Anemia: Resulting from loss of intrinsic factor post-surgery.
      - Chemotherapy / Radiation: Adjuvant therapies to manage cancer spread.
      - Palliative Measures: Focus on comfort if curative treatment is not possible.

STOMACH CANCER Nursing Care

  • Post-Gastrectomy Care:
      - Administration of IV fluids.
      - Monitoring vital signs (VS).
      - Consideration for palliative or hospice care focusing on supportive and comfort measures.