DISEASESDISEASES

DIGESTIVEDIGESTIVE

GERDGERD• GERD - Gastro-esophageal reflux disease• Not actually a disease but a syndrome of

unknown cause where there is a reflux of gastric secretions into the esophagus.

• This reflux results in esophageal irritation, inflammation, and pain.

• More than 60 million Americans experience symptoms of GERD

• 17.5 million experience symptoms daily

Predisposing Conditions• Hiatal hernia• Decreased gastric emptying• Incompetent LES (lower esophageal

sphincter)

GERDGERDSigns & Symptoms• Heartburn (burning, tight sensation below

the sternum and radiates upward)• Feeling of fullness• Bloating• N/V• Reguritation• Dysphagia• Hoarsness• Dyspnea• Wheezing

GERDGERDComplications• Scar tissue formation• Lesions• Dysphagia• Pneumonia (d/t aspiration)

Dx• Ba swallow• Esophagoscopy

GERDGERDTx• Drug therapy

• Antacids - Maalox (1-3 hrs pc and hs)• Proton pump inhibitors (Zantac, Pepcid)

• Histamine H2-receptor antagonist (Losec, Prevacid)

• Nutritional therapy• High protein, low fat• Avoiding chocolate, peppermint, coffee, tea,

milk• Avoid late meals and nocturnal snacking• Small frequent meals• Fluids b/t meals rather than with meals

CELIAC DISEASECELIAC DISEASE• Also called non-tropical sprue, is a mal-

absorption condition .• In celiac disease, there is atrophy and

flattening of the intestinal villi caused by a hypersensitivity to gluten.

• Gluten is a protein found in wheat, barley, oats, and rye.

• The hypersensitivity leads to inflammation of the small intestine which greatly reduces its ability to absorb nutrients.

• Celiac can develop at any age but is most prevalent in children and those in their 40’s & 50’s.

CELIAC DISEASECELIAC DISEASESigns & Symptoms• Steatorrhea Steatorrhea (bulky, foul smelling, yellow-grey,

greasy stools)• Wt. loss• Abd distention• Excessive flatulence• Multiple vitamin deficiencies

Risk Factors• Type 1 diabetes• Down Syndrome• Genetics

Dx• Stool sample• Intestinal biopsy

CELIAC DISEASECELIAC DISEASETx• Gluten free diet• Corticosteroids (if not responsive to a

gluten free diet)

INFLAMMATORY INFLAMMATORY BOWEL DISEASEBOWEL DISEASE

• Inflammatory Bowel Disease (IBD) includes:• Colitis• Crohn's Disease

• Both diseases are characterized by chronic, recurrent inflammation of the intestinal tract.

• The cause of both diseases are unknown, however, possible causes include:• Virus• Bacteria• Auto-immune reaction• Food allergies• Heredity

COLITISCOLITIS• Ulcerative colitis is characterized by

inflammation and ulceration of the colon and rectum.

• It may occur at any age but happens most frequently b/t the ages of 15-25 and 50-80

• Higher incidence in women• More common in Jewish and upper middle

class urban populations.• Colitis has exacerbations and remissions

COLITISCOLITISSIGNS & SYMPTOMSSIGNS & SYMPTOMS• Bloody diarrhea• Abd pain varying from mild to severe• In severe cases

• Fever• Wt. loss• Tachycardia• Dehydration

COLITISCOLITISCOMPLICATIONSCOMPLICATIONS• Hemorrhage• Strictures• Perforation• Toxic megacolon

DxDx• Bloodwork (CBC electrolytes)• Stool culture• Sigmoidoscope

COLITISCOLITISTxTx• Rest the bowel• Control inflammation• Correct malnutrition• Combat infection• Alleviate stress• Symptom relief with drug therapy• Surgery

CROHN'S DISEASECROHN'S DISEASE• Crohn’s disease is a chronic, inflammatory

bowel disorder that can affect any part of the GI tract.

• The cause is unknown • Can occur at any age but occurs most

often b/t the ages of 15 – 30• Higher incidence of women• More common in Jewish and upper middle

class urban populations• Crohn’s disease has periods of

exacerbation and remissions

CROHN'S DISEASECROHN'S DISEASESIGNS & SYMPTOMSSIGNS & SYMPTOMS• Depends on the site of involvement• Diarrhea (usually non bloody)• Fatigue• Abd pain• Wt. loss• Fever

CROHN'S DISEASECROHN'S DISEASECOMPLICATIONSCOMPLICATIONS• Strictures• Obstruction• Fistulas• Nutritional abnormality• Arthritis

DxDx• Physical signs and symptoms

• Ba enema/swallow

• Bloodwork

•Colonoscopy

•Biopsy

•Stool culture

CROHN'S DISEASECROHN'S DISEASETxTx• Control inflammation– Corticosteriods– Anti-inflammatories

• Relieve symptoms• Correct nutritional problems– High calorie– High protein

• Promote healing • Surgery

DIVERTICULAR DIVERTICULAR DISEASEDISEASE

A diverticulum is a small pouch in the colon that bulge outward through weak spots in the colon.

DIVERTICULAR DIVERTICULAR DISEASEDISEASE

• Diverticular disease occurs in 2 forms: 1.Diverticulosis2.Diverticulitis• The condition of having these pouches is

called diverticulosis. It is multiple non-inflamed diverticulum (pouches)

• When diverticula form, the smooth muscle of the colon wall becomes thickened.

• Diverticular disease is very common in older adults (50% by the age of 80 yrs)

• It affects men and women equally

DIVERTICULAR DIVERTICULAR DISEASEDISEASE

• When feces enters the diverticula, they can become inflamed and infected. This is called diverticulitis.

DIVERTICULAR DIVERTICULAR DISEASEDISEASE

• There is pain associated with diverticulitis. • The pt. may also have some abd.

discomfort/cramping which is usually relieved by passing flatus or having a BM.

• There is no known cause however, a low fiber diet is definitely associated with it

• Lack of dietary fiber slows peristalsis and more water is absorbed from the stool, making it more difficult to pass

• It is more prevalent in Western populations d/t our poor diets

• A Ba (Barium) emema is typically used to dx diverticular disease

DIVERTICULAR DIVERTICULAR DISEASEDISEASE

SIGNS/SYMPTOMS• Abd pain in the LLQ• Fever• N & V• Chills• Cramping• Constipation• Bloating• Rectal bleeding

DIVERTICULAR DIVERTICULAR DISEASEDISEASE

COMPLICATIONS• May include• Abscesses• Bowel obstruction• Bleeding• Ruptured diverticulaTx• Antibiotics (if infection is

present)• Some of these complications

may require surgery. • A colostomy can be necessary

as well as dietary changes.

VOMITING, GALLBLADDER VOMITING, GALLBLADDER DISEASE & IBSDISEASE & IBS

Vomiting – (red text)

• Pg 547• Definition• What are the risks

of vomiting?• Review the

measures to follow when a client vomits

Gallbladder Disease - (yellow text)

• Pg 276

•What is the gallbladder?

•Define cholecystitis

•Signs and symptoms

•Tx

IBS – (yellow text)

• Pg 277

•Definition

•What are the 2 types of IBS?

•Signs and symptoms of both types

•Causes

•Tx

DIGESTIVE SYSTEM DIGESTIVE SYSTEM ASSESSMENTASSESSMENT

OBJECTIVE• Inspect • Auscultate• Percuss• Palpate

SUBJECTIVE DATA

Ask your pt. about:

•Appetite

•Dysphagia

•Food intolerances

•Abd pain

•N/V

•Bowel habits

•Past hx

•Meds

•Diet

MAKE YOUR OWN MAKE YOUR OWN CASE STUDYCASE STUDY

• Using your knowledge of :• The digestive system• Bowel elimination• Digestive diseases• Digestive assessment

• Write your own case study and have a partner complete it.

• Remember, you want your partner to think critically and make connections between:• The digestive system• Bowel elimination• Digestive diseases