this presentation includes brief AP and MSN of GI disorders

1. Gastrointestinal
disorders
Roma Bhatti

2. objectives
At the end of this presentation students will be able
to:
• Review the anatomy and physiology of
gastrointestinal system.
• Discuss the causes, pathophysiology and
manifestation of the following.
1. Disorders of mouth and esophagus.
2. Disorders of stomach
3. Disorders of small and large intestine.

3. Continue…
4. Alteration in hepatobiliary system.
• Discuss the diagnostic, medical and surgical
management of the below mentioned
disorders:
1. Disorders of mouth and esophagus.
2. Disorders of stomach
3. Disorders of small and large intestine.
4. Alteration in hepatobiliary system.

4. Continue…
• Apply nursing process including assessment,
planning, implementation and evaluation of
care provided to the clients with GIT
disorders.

5. Gastrointestinal system
• Anatomy physiology review.

6. Major enzymes
• Enzymes that digest
carbohydrate:
1. Ptyalin
2. Amylase
3. Maltase
4. Sucrase
5. Lactase
• Enzymes that digest
proteins:
1. Pepsin
2. Trypsin
3. Aminopeptidase
4. Dipeptidase
5. Hydrochloric acid

7. Continue…
• Enzymes that digest fat (triglyceride)
1. Pharyngeal lipase
2. Steapsin
3. Pancreatic lipase
4. Bile

8. Assessment of the gastrointestinal
System
• Health history:
• GI assessment begins with complete history
 information about abdominal pain.(referred
pain)
 Dyspepsia (indigestion)
 Gas, nausea and vomiting
 Diarrhea
 Constipation
 Fecal incontinence

9. Pass health, family and social history
• Nurse ask’s about the:
• Brushing and flossing routine
• Frequency of dental visits
• Lesions or irritation in mouth, tongue or throat
• Recent history of sore throat or bloody sputum
• Discomfort
• Daily food intake
• Use of alcohol or tobacco(type, length of use,
amount and date of discontinuation)

10. Continue…
• Past and current medication
• Previous Diagnostic tests, surgeries and
treatment
• Current nutritional status
• Appetite or eating patterns
• Unexplained weight loss or gain
• Laboratory tests( Assignment)

11. Physical assessment
• The physical examination includes assessment of
the mouth, abdomen and rectum
Requirements:
1. good source of light
2. full exposure of abdomen
3. Warm hands with short fingernails
4. Stethoscope
5. Tongue depressor
6. Gloves
7. Patient with empty bladder

12. Oral cavity examination
• Lips: inspect the lips for moisture, hydration,
color, texture, symmetry & the presence of
ulceration and fissures.
• Gums: check the inflammation, bleeding,
retraction and discoloration. Hard palate for color
and shape. Mouth odor is also checked
• Tongue: texture, color and lesions, symmetry and
strength.
• Pharynx: depress the tongue with the tongue
depressor and visualize pharynx, tonsils and
uvula.

13. Abdominal examination
• Position: patient lies supine with knees flexed
slightly.
• The examination proceeds in the following
order:
1. inspection
2. Auscultation
3. Percussion
4. Palpation

14. Continue…
Inspection
• is performed first noting
• skin changes
• Nodules
• Lesions
• Scarring
• Discolorations
• Inflammation
• Bruising
Auscultation
• always precedes percussion
and palpation.
• hear the sounds to
determine the character,
location and frequency of
bowel sounds
• They occur irregularly
ranging from (5-35/min)

15. Continue…
Percussion
• Percussion is used to assess
the size and density of the
abdominal organs.
• To detect the presence of
air filled, fluid filled or solid
masses
• All quadrants are purcussed
for over all tympani and
dullness
Palpation
• Light palpation is used to
identify area of tenderness
and muscular resistance.
• Deep palpation is used to
identify masses.

16. Rectal inspection and palpation
• The final part of the examination is the
evaluation of the terminal portion of the GI
tract.
• Requirement: gloves, water, soluble
lubrication, a penlight and drapes
• Positions for the rectal examination: knee
chest, left lateral with hips and knees flexed,
standing with hips flexed and upper body
supported by examination table.

17. Diagnostic evaluation
• GI diagnostic studies can confirm, rule out or
diagnose disease.
• General nursing interventions for the patients
who are undergoing a GI diagnostic evaluation.
1. Establishing the nursing diagnosis
2. Providing needed information about the test
and the activities required of the patient
3. Providing instruction about post procedure care
and activity restrictions

18. Continue…
3. Providing health information and procedural
teaching to patients and significant others
4. Helping the patient cope with discomfort and
alleviating anxiety.
5. Informing the primary care provider of known
medical condition or abnormal laboratory values
that may affect the procedure.
6. Assessing for adequate hydration before, during,
and immediately after the procedure, and
providing education about maintenance of
hydration.

19. Diagnostic tests
• Serum laboratory studies
• Stool test
• Breath tests
• Abdominal ultrasonography
• DNA testing
• Imaging studies ( x-ray, contrast studies,
computed tomography CT, MRI, Positron
emission tomography PTI, colonoscopy.)

20. Continue…
• Lower/upper gastrointestinal tract study
• Gastrointestinal motility studies
• Endoscopic procedures (fibroscopy,
esophagogastroduodenoscopy, enoscopy,
proctoscopy, sigmoidoscopy, small bowel
enteroscopy)
• Gastric analysis, gastric acid stimulation test,
PH monitoring
• Laparoscopy.

21. Disorder of mouth and esophagus
• Stomatitis: mild redness (erythema) and edema;
if severe, painful ulcerations, bleeding and
secondary infection.
• Gingivitis: painful, inflamed, swollen gums;
usually the gums bleed in response to light
contact.
• Periodontitis: little discomfort at onset; may have
bleeding, infection, gum recession and loosening
of teeth, later in the disease tooth loss may occur.

22. Nursing interventions
• Prophylactic mouth care, including brushing,
flossing and rinsing.
• Teach patient proper oral hygiene, including
the use of soft-bristled toothbrush and
nonabrasive toothpaste for painful ulcers.
• Avoid hot or spicy foods
• Apply topical anti-inflammatory, antibiotic,
and anesthetic agents as prescribed.

23. Periapical abscess
• Dentoalveolar abscess referred to as an
abscessed tooth, involves a collection of pus in
the apical dental periosteum and the tissues
surrounding the apex of the tooth.
• Clinical manifestation: dull, gnawing,
continues pain with surrounding cellulitis and
the edema of the adjacent facial structure,
mobility of involved teeth.

25. MEDICAL MANAGMENT
Medical management
• needle aspiration or drill an opening into the
pulp chamber to relieve pressure and pain and
to provide drainage.
• Tooth extraction/root canal therapy
• Antibiotics and opioids.

26. Nursing management
• Assess the patient for bleeding after
treatment
• Instruct the patient to use a warm saline or
water mouth rinse to keep the area clean.
• Take liquid diet to a soft diet as tolerated.
• Keep follow up appointments.

27. Parotitis
• Inflammation of the parotid gland which is most
common inflammatory condition of the salivary
glands. E.g. MUMPS (epidemic parotitis)
• MEDICAL management: discontinuation of
tranquilizers and diuretics, Antibiotic therapy is
necessary. Drainage by procedure known as
parotidectomy.
• Nursing management: maintaining adequate
nutritional and fluid intake, good oral hygiene,
compliance with prescribed medicine.

29. Oral cavity cancer/tumor
• Cancer of oral cavity which can occur any part of
the mouth or throat.
• Risk factors includes: cigarette, cigar and pipe
smoking, use of tobacco, excessive use of alcohol.
• Increase risk in men older than 50 years.
• Pathophysiology: malignancies of the oral cavity
are usually squamous cell cancers. Any area of
the orophayrnx can be a site of malignant
growths, but the lips, the lateral aspects of the
tongue, and the floor of the mouth are the most
commonly affected.

30. Clinical manifestations
• Many oral cancers produce few or no symptoms
in the early stages. Later on the most frequent
symptoms are:
• painless sore or mass that does not heal.
• It may bleed easily
• Presented as a red or white patch
• Typical lesion in oral cancer is painless hardened
ulcer with raised edges.
• Xerostomia
• Stomatitis because of chemotherapy.

31. Assessment and diagnostic findings
• Oral examination
• Assessment of Cervical lymph nodes
• Biopsy

32. Medical management
• Surgical resection
• Radiation therapy
• Chemotherapy
• Neck dissection and reconstructive surgery of
the oral cavity

33. Nursing management
• Assess the nutritional status.
• Patient may need enteral or parenteral
nutrition.
• In case of radial graph perform Allen test.
• Assess the patients writing ability before the
surgery because of verbal communication
impairment
• Assessing patent airway after the surgery

34. General nursing management of
patient with conditions of oral cavity
• Promote mouth care
• Ensure adequate food and fluid intake
• Supporting a positive self image
• Minimizing pain and discomfort
• Preventing infection
• Promoting home and community based care
• Relieving pain
• Promoting wound care
• Supporting coping measures
• Maintaining physical mobility
• Promoting effective communication

35. Nursing diagnosis
• Deficient knowledge about preoperative and postoperative
procedures
• Ineffective airway clearance related to obstruction by mucus,
hemorrhage or edema
• Acute pain related to surgical incision
• Risk for infection related to surgical intervention secondary to
decreased nutritional status
• Impaired tissue integrity secondary to surgery and grafting
• Imbalance nutrition, less than body requirements related to disease
process or treatment.
• situational low self esteem related to diagnosis or prognosis
• Impaired verbal communication secondary to surgical resection
• Impaired physical mobility secondary to nerve injury.

36. Disorders of esophagus
• Achalasia: absence or ineffective peristalsis of the
distal esophagus, accompanied by failure of the
esophageal sphincter to relax in response to
swallowing.
• Odynophagia: (pain on swallowing)
• Clinical manifestation: difficulty in
swallowing, sensation of food sticking in the
lower portion of esophagus, regurgitation,
distention of esophagus, chest pain and heart
burn (pyrosis)

38. Assessment and diagnostic findings
• X-ray
• Barium swallow
• Computed tomography (CT) of the chest
• manometry

39. Med./ Nursing Management
• Patient is instructed to eat slowly and to drink
fluids with meals
• Calcium channel blockers and nitrates to
reducesophageal pressure
• Injection of botulinum ( BOTOX ) into
quadrants of the esophagus
• Pneumatic dilation
• Esophagomyotomy

40. Hiatal Hernia
• In this condition the opening in the diaphragm
through which the esophagus passes
becomes enlarged, and part of the upper
stomach tends to move up into the lower
portion of the thorax.
• There are two Types of Hiatal hernia:
1. Sliding
2. Paraesophageal.

42. Clinical manifestation
• Patients with sliding hernia may experience:
• Heart burn
• Regurgitation
• Dysphagia
• Sense of fullness or chest pain
• Hemorrhage
• Obstruction can occur with any type of hernia.
• Strangulation
• Diagnostic findings are based upon x-ray studies, barium
swallow, and fluoroscopy.

43. Med./nursing management
• Management of hiatal hernia includes
frequent, small feedings that can pass through
esophagus easily.
• Not to recline after 1 hour of eating.
• Elevate the head of the bed on 4 to 8 inch.
• Med. And surgical management is similar to
that of gastroesophageal reflux.

45. GERD
• Gastroesophageal reflux disease:
• the backflow of gastric or duodenal contents
into the esophagus without belching or
vomiting. Excessive reflux may occur because
of incompetent lower esophageal sphincter,
pylori stenosis or motility disorder.
• Also known as heart burn
• Incidence increase with aging.

47. Assessment and diagnostic findings
• It may include:
• Endoscopy
• Barium swallow
• Ambulatory 12-36 hours esophageal PH
monitoring.
• Bilirubin monitoring to measure bile reflux.

48. Medical management
• Antacids
• H2 receptor antagonists e.g. famotidine (pepcid), nizatidine
(axid), or ranitidine (zantac).
• Proton pump inhibitor that reduce the release of gastric acid.
e.g. lansoprazole (prevacid), rabeprazole (AcipHex),
esomeprazole (Nexium), omeprazole (prilosec), pantoprazole
(prtonix).
• Prokinetic agents which accelerate gastric emptying. E.g.
Bethanechol (utrecholine). Domperidone (motillium),
metoclopramide (reglan).

49. Surgical management
• If medical management is unsuccessful,
surgical intervention may be necessary.
Surgical management involves a nissen
fundoplication ( wrapping a portion of the
gastric fundus around the sphincter area of
the esophagus. Done by laparoscopy.

50. Nursing management

51. Cancer of the esophagus
• Esophageal cancer can be of two cell types:
Adenocarcinoma and squamous cell carcinoma.
• Risk factors for esophageal cancer include chronic
esophageal irritation.
• Chronic ingestion of hot liquid or foods,
nutritional deficiencies, poor oral hygiene,
exposure to nitrosamines in the environment or
food, cigarette smoking or chronic alcohol
exposure.

52. Clinical Manifestation
• Symptoms include:
• Dysphagia
• Sensation of mass in the throat.
• Painful swallowing
• Substernal pain or fullness
• Regurgitation of undigested food with foul breath and hiccups.
• Proceeding obstruction.
• Hemorrhage
• Progressive loss of weight
• Persistent hiccups
• Respiratory difficulty
• The delay between onset of symptoms and patient seeking medical
advice is often 12 to 18 months.

53. Assessment and diagnostic findings
• diagnosis is conformed by EGD with biopsy
and brushings.
• CT of the chest and abdomen
• Positron emission tomography PET
• Endoscopic ultrasound
• Exploratory laparoscopy

54. Medical management
• Treatment may include surgery, radiation,
chemotherapy or combination of both depending
upon the type of cancer cell, the extent of the
disease and the patients condition.
• A standard treatment plan for a person who is
newly diagnosed with esophageal cancer include
the following:
• Pre operative combination therapy of 4-6 weeks;
followed by a period of no medical intervention
for 4 weeks and lastly surgical resection of the
esophagus.

55. Surgical Management
• Total resection of the esophagus
(esophagectomy).
• When tumors occur in the cervical or upper
thoracic area, esophagus continuity may be
maintained by a free jejunal graft transfer in
which the tumor is removed and the area is
replaced with a portion of the jejunum.

56. Continue…
• Surgical resection of the esophagus has a relatively
high mortality rate because of infection, pulmonary
complication, or leakage through the anastomosis.
Postoperatively, the patient has a nasogastric tube in
place that should not be manipulated. The patient
should not be given anything by mouth until x-ray
studies confirm the anastomosis is free from esophgeal
leak, no obstruction and there is no evidence of
pulmonary aspiration
• Laser therapy
• Placement of an endoprostheses (stent) via EGD.

57. Nursing management
• Interventions are directed toward improving the
patients nutritional and physical status.
• A program to promote weight gain ( high calorie high
protein diet.
• Soft diet
• Parentral or enteral nutrition initiation
• Nutritional status monitoring
• Patient is informed about the postoperative equipment
that will be used ( closed chest drainage, nasogastric
suction, parental food therapy and gastric intubation.

58. Continue…
• Place patient in fowler’s position
• To prevent aspiration do incentive spirometery,
sitting up in a chair, nebulizer treatments
• Chest physiotherapy
• Nasogastric tube care
• After each meal patient should stay upright at
least 2 hours.

59. Gastric Disorders
• Gastritis
– Inflammation of the gastric mucosa
– Classification
• Severity
• Site involvement
• Inflammatory cell type
• Can be acute or chronic.
• Causing factors: dietary indiscretion, disease
causing microorganisms (H.pylori), Usage of
NSAIDS, alcohol intake, bile reflux, radiation
therapy.
23/12/2010 59

60. Clinical manifestation
• Rapid onset of symptoms
• Abdominal discomfort
• Headache
• Nausea, vomiting
• Hiccupping
• Anorexia
• Heart burn after eating

61. Assessment and diagnostic finding
• Upper GI x-ray studies
• Endoscopy
• Histological examination by biopsy.

62. Medical Management
• Refrain from alcohol and food.
• Nonirritating diet
• If reason is strong acid or alkalies dilute and
neutralize it.
• Nasogastric intubation
• Analgesic agents
• Sedatives
• Antacids
• Iv fluids

63. Nursing Management
• Reduce anxiety
• Promote optimal nutrition
• Promote fluid balance
• Relieving pain
• Promote home and community based care

64. Peptic ulcer disease
• A peptic ulcer may be referred to as a gastric,
duodenal, or esophageal ulcer, depending
upon its location.
• It forms in the mucosal wall of the stomach.
• This erosion may extend deeply as the muscle
layers or through the muscle to the
peritoneum.
• Mostly occur in the duodenum than in the
stomach.

65. Pathophysiology
• Peptic ulcers occur mainly in the
gastroduodenal mucosa this tissue cannot
withstand the digestive action of gastric acid
(HCL) and pepsin.
• The erosion is caused by the increased
concentration or activity of acid pepsin or by
decreased resistance of the mucosa.

66. Clinical manifestation
• Dull, gnawing pain
• Burning sensation in the midepigastrium or the
back.
• Pain that is relieved by eating,
• Pyrosis (heart burn)
• Vomiting
• Constipation or diarrhea
• Bleeding
• Melena (tarry stools)

67. Assessment and diagnostic finding
• Physical examination may reveal pain, epigastric
tenderness or abdominal distention.
• Barium study
• Endoscopy
• Biopsy of gastric mucosa
• Stool test
• Gastric secretory studies
• Urea breath test
• Stool Antigen test

68. Medical management
• Commonly used therapy is a combination of
antibiotics + proton pump inhibitors + bismuth
salts.
• Recommended therapy for 10 to 14 days include
triple therapy with two antibiotics e.g.
metronidazole or amoxcillin plus proton pump
inhibitor e.g. lansoprazole.
• Histamine -2 (H2) receptor antagonist and
proton pump inhibitor are used to treat NSAID
induced ulcers and other ulcers that are not
associated with H.pylori infection.

69. Continue…
• Adherence and completion of regimen.
• Stress reduction and rest
• Smoking cessation
• Dietary modification
• Surgical management
• Follow up care

70. Surgical management
• Surgical procedures include:
• Vagotomy, with or without pyloroplasty.
• Antrectomy with anastomosis to either the
duodenum or jejunum.

71. Nursing Management
Assessment:
• Ask about the pain(usually starts after two hours of eating meal)
• Vomiting (coca)
• Presence of Bloody or tarry stools.
• Describe food habits(speed of eating, regularity of meals,
preference for spicy foods , use of caffeine)
• 72 h usual food intake chart.
• Lifestyle
• Smoking habits
• Use of NSAID
• Anxiety & stress
• Vital signs (report tachycardia & hypotension)

72. Nursing Diagnosis
Based on assessment data, the patient’s nursing
diagnosis may include:
• Acute pain related to the effect of gastric acid
secretion on damaged tissue.
• Anxiety related to acute illness.
• Imbalanced nutrition related to change in diet
• Deficient knowledge about prevention of
symptoms and management of the condition.

73. Planning and goals
• The goals of the patient may include relief of
pain, reduced anxiety, maintenance of
nutritional requirement, knowledge about the
management and prevention of ulcer
recurrence, and absence of complications.

74. Nursing interventions
• Relieving pain
• Reducing anxiety
• Maintaining optimal nutritional status
• Monitoring and managing potential
complications.
• Promoting home and community based care.

75. Evaluation
• Expected patient outcome may include:
• Reports freedom from pain between meals
• Reports feeling less anxiety
• Complies with therapeutic regimen
1. Avoid irritating foods and beverages
2. Eats regularly scheduled meals
3. Take medications as prescribed
• Maintains weight
• Show no complications.

76. Morbid Obesity
Morbid obesity is the term applied to people
who are more than two times than their ideal
weight.
Or morbid obesity is body weight that is more
than 100 pounds greater than the ideal body
weight (Fabricatore & wadden, 2006; kushner,
2007).

77. Continue…
• Patients with morbid obesity are at high risk of
health complications, such as diabetes, heart
disease, stroke, hypertension, gallbladder
disease, osteoarthritis, sleep apnea, breathing
problems.

78. Medical/surgical management
• Management of obesity consists of placing the
person on a weight loss diet along with
behavioral modification and exercise.
• Bariatric surgery is performed if nonsurgical
treatments have failed.

79. Nursing Management
• Provide dietary guidelines
• Reduce anxiety
• Advise Lifestyle modification
• Pre/post operative care for patients
undergoing surgery.
• Follow up appointments.

80. Gastric cancer
• Most gastric cancers are adenocarcinomas.
They can occur anywhere in the stomach.
• The tumor can infiltrate the surrounding
mucosa, penetrating the wall of the stomach
and adjacent organs and structures.

81. Clinical manifestation
• Earlier symptoms such as pain are relieved by
antacids,
• Symptoms of progressive disease include
dyspepsia (indigestion), early satiety, weight
loss, abdominal pain just above the umbilicus,
loss or decrease in appetite, bloating after
meals, nausea & vomiting.

82. Assessment and diagnostic finding
• Esophagogastroduodenoscopy biopsy
• Cytologic washing
• Barium x-ray examination
• Endoscopic ultrasound
• CT of chest, abdomen and pelvis.

83. Medical management
• Removal of the tumor if it is not metasitized.
• Chemotherapy
• Radiotherapy

84. Nursing management
• Reduce anxiety
• Promoting optimal nutrition
• Relieving pain
• Providing psychosocial support
• Promoting home and community based care.
• Recognizing obstacles to adequate nutrition
• Resuming enteral intake.

85. constipation
• Abnormal infrequency or irregularly of
defecation, abnormal hardening of stools that
make their passage difficult and sometimes
painful.

86. Causes
• Certain medication
• Rectal or renal
• Metabolic neurologic or
neuromuscular
conditions
• Endocrine disorders
• Lead poisoning
• Connective tissue
disorder
• Appendicitis
• Weakness, fatigue or
immobility
• Ignorance to the urge to
defecate.

87. Clinical manifestation
• Abd. Distention
• Borborygmus. Intestinal rumbling
• Pain and pressure
• Decreased appetite
• Headache
• Feeling of fullness
• Restlessness
• Indigestion
• Straining at stool
• Elimination of small volume hard and dry stools.S

88. Assessment and diagnostic findings
• Barium enema
• Sigmoidoscopy
• Anorectal manometry ( pressure exertion
measurement)

89. Complication
• Hypotension
• Faecal impaction
• Hemorrhoids
• Fissure and mega colon

90. Medical Management
• Increase fiber intake
• Discontinue laxatives
• Enema and rectal suppository
• Patient is encouraged to learn to relax the
sphincter mechanism to expel stools.

91. Nursing Management
• History of onset and duration of constipation
• Past elimination patterns
• Life style changes
• Relieve anxiety
• Stress coping
• Restore and maintain regular pattern of
elimination

92. Diarrhoea
• Increase frequency of bowel movement more
than 3 per day.
• Causes : medication, tube feeding, infection,
nutritional or malabsorptive disorder,
• Types: acute / chronic

93. Clinical manifestation
• Increased frequency & loose stools
• ABD. Cramps, distention
• Anorexia & thrust
• Spasmodic contraction of anus

94. Assessment and diagnostic findings
• Routine stool examination
• Urinalysis
• Complete blood count
• Stool examination for micro-organisms, blood,
fats etc.

95. Complication of Diarrhoea
• Muscle- weakness
• Anorexia
• Drowsiness
• Decreased urine output
• Cardiac dysarhythmias

96. Medical management
• Control symptoms
• Antibiotics, anti-inflammatory agents
• Iv therapy
• Electrolyte replacement
• Milk products, fat, whole grain product and
fresh vegetable restricted.

97. Nursing Management
• Assess and monitor the characteristics and
pattern of diarrhoea
• Assess the skin of abdomen and mucus
membrane to determine dehydration status
• Encourage the pt. for bed rest, intake of fluids,
low fiber diet

98. Irritable bowel syndrome
• It is common problem of GI, most common in
female, causes are unknown some factors are
associated with:
• Hereditary
• Psychological stress or illness
• Alcohol intake and smoking
• Diet rich in irritating foods

99. Clinical manifestation
• Constipation, diarrhoea or both
• Pain i.e. relieve by defecation
• Abdominal distension
• Diagnostic finding: x-ray, barium enema,
colonoscopy, proctoscopy, manometry.

100. Medical management
• Exercises to reduce anxiety and increase
intestinal motility is recommended
• Special diet which should not involve irritants
such as caffeinated products, spicy foods,
beans.
• To relieve abdominal pain, calcium channel
blocker and anti-cholinergic are given
• Anti depressants.
• Anti diarrhoea.

101. Nursing Management
• Provide health education
• Chew food slowly and thoroughly.
• Discourage, alcohol & cigarette use.
• Adequate fluid intake but restrict fluid intake
between meals to avoid distension.

102. Inflammatory disease of intestine
• Appendicitis: small structure about 4 inches,
attached to cecum, below the ileocecal valve.
• Sometimes food particles enter in it and due
to small lumen size it empties inefficiently.
• That’s why it is always vulnerable to infection.

103. Clinical manifestations
• Right lower quadrant pain is present
• Low grade fever
• Nausea & vomiting
• Local tenderness
• Loss of appetite
• Rebound tenderness
• Constipation or diarrhoea
• Mcburney’s point

104. Diagnostic findings
• Complete physical examination
• X-ray findings
• Complete blood count
• Ultra-sound

105. Complications
• Perforation of the appendix
• Fever
• Abdominal pain & tenderness

106. Surgical/medical management
• Appendectomy
• Antibiotics administration
• Iv fluid to prevent & correct electrolyte
imbalance.

107. Nursing management
• Iv infusion
• Antibiotic therapy
• Pain relief opoids
• Contradiction of enemas
• Place the patient in semi fowler’s position
• Monitor the pt for any discharge
• Instruct the pt for revisit on fifth & seventh
day for the removal of sutures.

108. Diverticulitis
• Diverticulum is a sac like pouch of the lining of
intestine that extends through a defect in
muscle layer.
• Complications: peritonitis, abscess formation,
localized abdominal pain, loss of bowel
sounds, massive rectal bleeding, sign &
symptoms of Shock.

109. Clinical manifestations
• Chronic constipation
• Bowel irregularities
• Diarrhoea
• Abrupt onset of crampy pain in left quadrant of
abdomen
• Low grade fever
• Nausea & vomiting
• Abdominal distension
• Weakness, fatigue
• Narrow stool.

110. Diagnostic findings
• X-ray studies
• Stool examination
• Complete blood count
• colonoscopy

111. Medical/surgical management
• Two stage resection
• Faecal diversion
• Double barrel colostomy is done.
• Dietary & medication therapy
• Low fat diet
• Antibiotics
• Laxatives
• Anti spasmodic

112. Nursing Management
• Life style changes
• Dietary modification
• Help to cope with the sign and symptoms.

113. Peritonitis
• Assignment: Define peritonitis, explain its
causing factors, sign & symptoms
complications, clinical and nursing
management.

114. Inflammatory bowel Disease
• Consists of two main diseases:
1. Regional Enteritis (crohn’s Disease)
2. Ulcerative Colitis.

115. Crohn’s Disease
• Can occur anywhere along the GI tract
• Most common site is: distal ileum and colon
• Subacute or chronic inflammation, extends
through intestinal wall from the intestinal
mucosa.
• Mucosa has cobble stone appearance, as the
disease progress the wall thickens, become
fibrotic and lumen narrows.

116. Clinical manifestation
• Abd. Pain & diarrhoea relieved by defecation
• Decrease food intake to avoid pain
• Malnutrition, weight loss and anemia
• Fever & leucocytosis.
• Inflammed intestine.
• Perforation which may result intra abdominal
and anal abscess.

117. Crohn’s Disease
Diagnosis
• Proctosigmoidoscopy
• Barium enema
• CT scan
• Complete blood count is
preformed.
Complications
• Intestinal obstruction
• Perianal disease
• Fluid & electrolyte balance
• mal-nutrition
• Abscess formation as fistula
• Colon cancer

118. Management
• Management is aimed at relieving symptoms
such as:
• Inflammation and diarrhoea.
• Dehydration and malnutrition
• Abd pain and cramping

119. Continue…
• Oral steroid
• Corticosteroids
• Anti diarrhoeal
• Antibiotics
• Immunosuppressant's

120. Continue…
• Surgery may be indicated if obstruction,
stricture, fistula or abscess is present.

121. Ulcerative colitis
• Multiple ulceration, defuse inflammation and
shedding of colon epithelium affecting
superficial mucosa of colon.

122. Clinical manifestation
• Bleeding
• Diarrhoea, abd. Pain
• Anorexia, weight loss
• Vomiting, dehydration and cramping
• Feeling of urgency to defecate and 10-20
liquid stools are passed per day.
• Hypocalcemia & anemia
• Rebound tenderness at rt. lower quad.

123. Diagnosis
• Stool test
• Hb levels
• Sigmoidoscopy
• Barium enema and endoscopy

124. Ulcerative colitis
Complications
• Perforation
• Hypovolemia
• Mega colon due to
inflammation.
Surgical treatment
• Resection of affected area
with anastomosis.
• Colectomy with ileostomy.

125. Medical management
• Treatment for both aims at reducing
inflammation, suppressing in appropriate
immune response and providing rest to
diseased bowel so that healing take place.
• Nutrition therapy
• Fluid and electrolyte
• Pharmacological therapy
• Surgical management : Total colectomy,
segmental colectomy

126. Nursing Management
• Patient is assessed for parental nutrition, fluid
replacement, possible surgery.
• Management of normal elimination pattern.
• Relieve pain
• Maintain fluid intake an accurate
• Maintain nutrition
• Promote rest
• Reduce anxiety
• Enhance coping measures
• Prevent skin breakdown
• Monitor and manage possible complications.

127. Hernia
• A hernia is an abnormal protection of an organ or
structure from normal cavity through a congenital
or acquired defect.
• No blood supply: strangulated hernia.
a. indirect inguinal Hernia.
b. Direct inguinal Hernia.
c. Femoral Hernia.
d. Umbilical Hernia.
e. Incisional Hernia.

128. Clinical Manifestation
• Complain of having lump in the groin around
umbilicus.
• Protrusion from an old surgical incision.
• Swelling suddenly after coughing, straining,
lifting or exertion.
• Pain
• Nausea, vomiting & distention may appear.

129. Medical Management
• Truss, a pad made of firm material may be
placed over the opening through which the
Hernia protrudes and is held in place with a
belt.
• Hernio-plasty
• Fluid and food restriction
• Narcotics to reduce pain
• Antibiotics

130. Hemorrhoids
• Hemorrhoids are dilated portion of veins in
the anal canal, congestion occurs in the veins
of hemorrhoidal plexus and leads to varicosity
within the lower rectum and anus.
• Causes: Heredity, long periods of sitting or
standing, structural abscess, inc. intra-
abdominal pressure such as in constipation,
straining at defecation and Pregnancy.

131. Types
• Internal Hemorrhoids: they appear above the
internal sphincter and are not visible.
• External Hemorrhoids: they appear outside
the anal-sphincter.
• SIGN/SYMPTOMS: Itching, pain, Bright red
bleeding, discomfort, ischemia of the area.

132. Management
• Infrared photo coagulation
• Bipolar diathermy
• Laser therapy
• Rubber band ligation
• Hemorrhoidectomy.

133. Summarization

134. Reference
• 1. Brunner, L.S., & Suddarth, D.S. (2001). Text
Book of Medical- Surgical Nursing (9th
Edition). Philadelphia: Lippincott.
• 2.lakhwinder kaur, sukhminder kaur, Kanta
Ajay Kumar text book of Medical Surgical
Nursing

135. THANKYOU