GI disorders • Dysphagia Difficulty swallowing o Causes Nero disease: Parkinson’s, dementias, muscular dystrophy, Huntington’s, ALS, MN, Guillain Barre Syndrome. Other: Congenital issues/cerebral palsy, Esophagealstenosis, esophageal diverticula, tumors, stroke, achalasia • Vomiting – why and consequences Why: protect against substance, reverse peristalsis, increase intracranial pressure,severe pain. Consequences: lead to fluid, electrolyte, pH imbalance, aspiration o Emesis types and why the emesis would be a problem Hematemesis: blood in vomit (protein), Yellow/green: presence of bile. Deep brown: fecal matter. Undigested food o Treatment of vomiting disorders Antiemetic med., fluid replacement, correct electrolyte imbalance, restore acid-base • Esophageal disorders o Hiatal hernia Stomach section protrudes through diaphragm ▪ Causes: Weakening of diaphragm muscle, trauma, congenital defects. Manifestation: Indigestion; heartburn; frequent belching; nausea; chest pain; strictures; dysphagia; and soft abdominal mass. diagnosis: H & P; barium swallow; upper GI Xrays; EGD, treatment: eat small meals, sleep elevated, antacid o GERD ▪ Causes: Certain foods: chocolate, caffeine, carbonated beverages, citrus fruit, tomatoes, spicy or fatty foods, peppermint , Alcohol consumption; nicotine, Hiatal hernia, Obesity; pregnancy, Certain medications – such as corticosteroids; beta blockers; calcium-channel blockers; anticholinergics, NG intubation, Delayed gastric emptying ▪ Manifestations: Heartburn, Epigastric pain, Dysphagia, Dry cough, Laryngitis Pharyngitis, Food regurgitation, Sensation of lump in throat ▪ Diagnosis: H & P; barium swallow; EGD; esophageal pH monitoring ▪ Treatments: Avoid triggers; avoid restrictive clothing, Eatsmall frequent meals; high Fowler’s positioning, Weight loss; stress reduction; Antacids; acid reducing agent; mucosal barrier agents, Herbal therapies(licorice, chamomile), Surgery ▪ Complications: Esophagitis; strictures; ulcerations; esophageal cancer; chronic pulmonary disease o Gastritis/gastroenteritis ▪ Acute: Can be mild, transient irritation or can be severe ulceration with hemorrhage, Usually develops suddenly, Likely to also have nausea & epigastric pain ▪ Chronic: Develops gradually ▪ May be asymptomatic but usually accompanied by dull epigastric pain and a sensation of fullness after minimal intake ▪ Complications: peptic ulcer; gastric cancer; hemorrhage ▪ H. pylori: Most common cause of chronic gastritis ▪ Bacteria embeds in mucous layer; activates toxins & enzymes that cause inflammation ▪ Genetic vulnerability & lifestyle behaviors (smoking,stress) may increase susceptible ▪ Other causes: Organismsthrough food/water contamination, LT NSAID use, Excess alcohol use, Severe stress, Autoimmune conditions ▪ Manifestations of GI bleeding: Indigestion; heart burn, Epigastric pain; abdominal cramping, N/V; anorexia, Fever; malaise, Hematemesis, Dark, tarry stools = ulceration & 2 bleeding 3 • GI tract disorders o Peptic ulcer disease ▪ Duodenal: Most commonly associated with excess acid or H.pylori infections, Typically present with epigastric pain relieved by food ▪ Gastric: Lessfrequent; more deadly, typically associated with malignancy and NSAIDs, Pain worsens with food ▪ Symptoms: ▪ Curling’s ulcer from what: associated with burns ▪ Cushing’s ulcer from what: associated with head injuries ▪ Complications of ulcers: GI hemorrhage; obstruction; perforation; peritonitis ▪ Manifestations: Epigastric or abdominal pain, Abdominal cramping, Heartburn; indigestion, N/V ▪ Diagnosis: same as gastritis ▪ Treatment: Same asfor gastritis, Surgical repair may be necessary for perforated or bleeding ulcers, Prevention is crucial – may need prophylactic medications (ex: acidreducers) for at-risk clients o Gallbladder disorders ▪ Cholelithiasis: Gallbladder stones ▪ Cholecystitis: Inflammation or infection in the biliary system caused by calculi ▪ Manifestations: Biliary colic; abdominal distension; N/V; jaundice; fever; leukocytosis ▪ Diagnosis: H & P; abdominal Xray; gallbladder US; laparoscopy ▪ Treatments: Low-fat diet, medicationsto dissolve calculi, Antibiotic therapy, NG tube with intermittent sxn, Lithotripsy, Choledochostomy, Laparoscopic surgery o Liver disorders ▪ Hepatitis – infectious: A, B, C, D, E vs. noninfectious: Giant cell hepatitis, Ischemic hepatitis, Non-alcoholic fatty liver hepatitis, Autoimmune hepatitis, Toxic & drug-induced hepatitis, Alcoholic hepatitis ▪ Transmission of viral hepatitis: If it’s a Vowel, it comesfrom the Bowel. All others are blood ▪ Define: acute: Proceeds through 4 stages—asymptomatic stage then 3 symptomatic stages chronic: Characterized by continued liver disease > 6 months, Symptom severity and disease progression vary by degree of liver damage, Can quickly deteriorate with declining liver integrity fulminant: Uncommon, rapidly progressing form that can quickly lead to ▪ Liver failure, hepatic encephalopathy, or death within 3 wks • Diagnosis: H & P, Serum hepatitis profile, Liver enzymes, Clotting studies, Liver biopsy, Abdominal US • treatment for viral hepatitis: treat with interferon & antiviral mediations ▪ Cirrhosis • Common causes: Hep C and chronic alcohol abuse most common cause in U.S. Hepatitis and all factors that can lead to hepatitis • What happensto liver: Leads to fibrosis, nodule formation, impaired blood flow, and bile obstruction