2. 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.
3. 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.
4.
5. 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
10. • Proctoscopy is an invasive, endoscopic procedure for
examining the anal canal and lower part of rectum.
Indications:
• Hemorrhoids
• Proctitis
• Polyps
• Tumors
Position: left lateral
11. 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.
14. INDICATION:
• Intestinal Bleeding
• Inflammation
• Abnormal Growth
• Ulcers, fissures
Time: 10-20 minute
Position: 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
15. 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
19. 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
22. 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
23. INSTRUCTIONS:
Bowel Cleaning 2 Night Before
Polyethylene Glycol Electrolyte
Lavage
Side effect: N/V, cramps,
bloating, hypothermia(elderly)
Sedative
glucagon
Nursing consideration during
procedure:
Oxygen saturation
Vitals
LOC
Pain intensity
Vagal response
Abdominal distension
Report of bleeding
25. • 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
26. 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
36. 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?
40. 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.
41. 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
42. EPIDEMIOLOGY
Can occur at all ages, but infants principal group
More 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.
45. 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
52. DIETARY MANAGEMENT:
• high in simple sugar should be avoided
• fermented milk products
• zinc supplementation
NURSING MANAGEMENT
NURSING GOALS:
• management of diarrhea, acute pain, deficient fluid volume,
activity intolerance
53. 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
54. 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
55. 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
57. 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?
