Lisorders of digestive system

IBS is one of the most common GI disorders.
IBS results from a functional disorder of intestinal motility
occurs more commonly in women than in men
the cause remains unknown
no anatomic or biochemical abnormalities have been found
The diagnosis is made only after tests confirm the absence of structural or other disorders

heredity, depression and anxiety, a diet high in fat and stimulating or irritating foods, alcohol consumption, smoking and infections, inflammation and vascular or metabolic changes.
neuroendocrine dysregulation
Changes in intestinal motility
constipation, diarrhea or both, Pain, bloating, and abdominal distention

Nursing Management
1- Restriction and then gradual reintroduction of foods that are possibly irritating may help determine what types of food are acting as irritants
e.g ( beans, caffeinated products, corn, wheat, dairy lactose, fried foods, alcohol, spicy foods).
A high-fiber diet is prescribed to help control the diarrhea and constipation.
encouraged patient to eat at regular times and to chew food slowly.

adequate fluid intake and avoid drinking fluid with meals because this results in abdominal distention.
use relaxation techniques, or exercise to reduce anxiety and increasing intestinal motility.
discouraged alcohol use and cigarette smoking.

Peptic Ulcer
A peptic ulcer is an excavation (hollowed-out area) that forms in the mucosal wall of the stomach, in the pylorus (opening between stomach and duodenum), in the duodenum (first part of small intestine), or in the esophagus. it is frequently referred to depending on its location.
Erosion of mucosal membrane may extend as deeply as the muscle layers or through the muscle to the peritoneum.

Causes
1- Infection with the gram-negative bacteria H. Pylori 2- Stress and anxiety
3- Ingestion of milk and caffeinated beverages 4- Smoking, and alcohol
5- People with blood type O 6- Chronic use of NSAIDs
Family history
Eating spicy foods

pathophysiology
Medication such as NSAIDs
Stress ,milk, caffeine , smoking , alcohol
H. Pylori bacteria
inhibits
prostaglandins
↑Acid production
Release toxin that
↓ efficiency of mucosa
Inflammatory response
Erosion and ulceration
of the mucosa lining

Clinical Manifestation
Pain in the midepigastrium or the back that is relieved by eating.
Pyrosis (heartburn) is a burning sensation in the stomach and esophagus that moves up to the mouth.
Vomiting results from obstruction of the pyloric orifice, caused by either muscular spasm of the pylorus or mechanical obstruction from scarring.
constipation and/ or diarrhea may occur, probably as a result of diet and medications.
Bleeding 15% of patients may present with GI bleeding as evidenced by the passage of melena (tarry stools).

Complication of Peptic Ulcer
Hemorrhage—cool skin, confusion, increased heart rate, labored breathing, blood in stool
Penetration and perforation—severe abdominal pain, rigid and tender abdomen, vomiting, elevated temperature and increased heart rate
Pyloric obstruction—nausea and vomiting, distended abdomen, abdominal pain

Nursing Care Plan for Patient with Peptic Ulcer
Nursing diagnosis
Acute pain related to the effect of gastric acid secretion on damaged tissue.
Imbalanced nutrition less than body requirement related to changes in the diet habitus .
Anxiety related to an acute illness.
Deficient knowledge about prevention of symptoms and management of the condition.

Planning
Relieving Pain
Improving Nutritional status
Reducing patient anxiety
Provide knowledge about the management and prevention of ulcer recurrence.
Absence of complications.

Nursing Intervention of Peptic Ulcer
Encourage patient to eat regular meals in a relaxed setting and to avoid overeating.
Instruct patient to avoid a particular foods that will upset
the gastric mucosa, such as coffee, tea, colas, and alcohol, which have acid-producing potential.
Teach patient about prescribed medications, including
name, dosage, frequency, and possible side effects. Also identify medication such as aspirin which is an anticoagulant that patient should avoid.
Encourage relaxation techniques.

Assess what patient wants to know about the disease and evaluate level of anxiety; encourage patient to express fears openly and without criticism.
Explain diagnostic tests and administering medications on schedule.
Interact in a relaxing manner, help in identifying stressors, and explain effective coping techniques and relaxation methods.
Encourage family to participate in care, and give emotional support.
Explain that smoking may interfere with ulcer healing; refer patient to programs to assist with smoking cessation.
Alert patient to signs and symptoms of complications to be reported.
Administer prescribed medications.

Ulcerative colitis
Ulcerative colitis :-
is a recurrent ulcerative and inflammatory disease of the mucosal and submucosal layers of the colon and rectum.

pathophysiology
The diseases process
Begin in the rectum and spread to involve entire
colon
Causative agents
poor nutrition , genetic factors , infection , stress
Affects the superficial mucosa of the colon
Inflammation process

mucosa becomes edematous and inflamed
invasion of leukocytes and the
formation of abscesses
Bowel narrow and thickens because of
muscular hypertrophy & fat deposits
Rectal bleeding Diarrhea , Abdominal pain Fever, Weight loss

Clinical Manifestations
1- Diarrhea with passage of mucus and pus 2- Left lower quadrant abdominal pain
3- Rectal bleeding may be mild or severe 4- Pallor,
Anemia
Fatigue
Anorexia
Weight loss
Fever
Vomiting
Dehydration
Cramping as well as the feeling of an urgent to defecate

Nursing Diagnosis for Patient with Ulcerative Colitis
Diarrhea related to the inflammatory process
Deficient fluid volume related to anorexia, nausea, and diarrhea
Imbalanced nutrition, less than body requirements, related to dietary restrictions, nausea, and malabsorption
Acute pain related to increased peristalsis and GI inflammation
Risk for impaired skin integrity related to malnutrition and diarrhea

Planning and Goals
Attainment of normal bowel elimination patterns
Maintaining of normal fluid volume
Maintenance of optimal nutrition and weight
Relief of abdominal pain and cramping
Preventing of skin breakdown
Increased knowledge about the disease process and therapeutic regimen, and avoidance of complications.

Nursing Intervention
Provides ready access to a bathroom, commode, or bedpan and keeps the environment clean and odor-free.
Encourage bed rest to decrease peristalsis and relieving pain .
Cold foods and smoking that exacerbate diarrhea avoided because both increase intestinal motility.
Give the patients IV therapy or oral fluids to correct fluid and electrolyte imbalances from dehydration caused by diarrhea.
monitoring and record of output (ie, urine, liquid stool, vomitus, wound or fistula drainage).

High-protein, high-calorie diet with supplemental vitamin
therapy and iron replacement are prescribed to meet nutritional needs, reduce inflammation, and control pain and diarrhea.
monitors daily weights for fluid gains or losses and assesses the patient for signs of fluid volume deficit (ie, dry skin and mucous membranes, decreased skin turgor, oliguria, fatigue, decreased temperature, increased hematocrit, elevated urine specific gravity, and hypotension).

Parenteral nutrition may be indicated.
Using local application of heat to reduce pain
gives attention to reddened or irritated areas over bony prominences immediately
uses pressure-relieving devices to prevent skin breakdown.
Administer antidiarrheal medications as prescribed, to record the frequency and consistency of stools after therapy is initiated
administers anticholinergic medications 30 minutes before a meal as prescribed to decrease intestinal motility
administers analgesics as prescribed for pain