Gasrtointestinal bleeding & obstruction
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Transcript of Gasrtointestinal bleeding & obstruction
GASTRO INTESYINAL DISORDERSGASTRO INTESYINAL DISORDERS
Intestinal Obstruction & GI bleedingIntestinal Obstruction & GI bleeding
BY:BY:Iman Qasim Iman Qasim Alhussein.Alhussein.
Intestinal obstructionIntestinal obstruction
In an intestinal obstruction, the lumen of the
small or large bowel becomes partly or fully
blocked. Small-bowel obstruction is far more
common (affecting 90% of patients) and
usually more serious.
INTESTINAL INTESTINAL OBSTRUCTIONOBSTRUCTION
The obstruction can be partial or complete.
Its severity depends on:
** the region of bowel affected,
** the degree to which the lumen is occluded,
**and especially the degree to which the
vascular supply to the bowel wall is
disturbed
A, Intussusception;
invagination or
shortening of the colon
B, Volvulus of
the sigmoid colon
C, Hernia (inguinal) and
adhesion.
Mechanical obstructionMechanical obstruction
Other Cause of mechanical obstructionOther Cause of mechanical obstruction
• carcinomas (usually large-bowel
obstruction)
• foreign bodies (fruit pits, gallstones, worms)
• compression
• stenosis
• tumors
• atresia.
Non mechanical (FUNCTIONAL) Non mechanical (FUNCTIONAL)
obstruction can result fromobstruction can result from:
electrolyte imbalances
toxicity
neurogenic abnormalities
thrombosis or embolism of mesenteric
vessels
paralytic ileus
fluid, air, and gas collectnear the site.
Mechanical and non mechanical causes
decrease invenous and arteriolar capillary
pressure.
necrosis,congestionedema
rupture or perforation ofthe intestinal wall,
peritonitis
abdominal distention and retention leading to increases intestinal lumen pressure
Colicky Abdominal pain Abdominal Distention Vomiting Fecal material vomiting( luminal obstruction) Discharge from rectum without fecal or gases Breath odor Inability to pass gas The signs of dehydration become evident:** intense thirst, drowsiness, generalized malaise,
aching,** and a parched tongue and mucous membranes.
Clinical Manifestations
COMPLICATION
If the obstruction continues
uncorrected, hypovolemic shock
occurs from dehydration and loss of
plasma volume.
Hole (perforation) in the intestine
Infection
INVESTIGATIONINVESTIGATION Abdominal x-ray and CT findings include
abnormal quantities of gas, fluid, or both
Laboratory studies (ie, electrolyte studies
and a complete blood cell count)
• In large-bowel obstruction, barium
enema reveals a distended
Upper GI and small bowel series
Medical Management
Restoration of intravascular volume,
correction of electrolyte Abnormalities
nasogastric aspiration and decompression are
instituted immediately
A rectal tube may be used to decompress an area
that is lower in the bowel
surgical resection to remove the obstructing lesion
the surgical procedure involves repairing the
hernia
or dividing the adhesion to which the
intestine is attached
the portion of affected bowel may be
removed and an anastomosis performed
A temporary or permanent colostomy may be
necessary.
Assessment
**The nurse obtains a health history about the, abdominal or rectal pain (eg, location, frequency, duration, association with eating or defecation)
**past and present elimination patterns, and characteristics of stool
(eg, color, odor, consistency, presence of blood or mucus.)
** The nurse assesses dietary patterns, including fat and fiber intake.
** palpation of the abdomen for areas of tenderness, distention, and solid masses .
NURSING DIAGNOSISNURSING DIAGNOSIS
•Acute pain and discomfort related to abdominal
distention , obstruction and surgical incision
•Imbalanced nutrition, less than body requirements,
related to nausea and anorexia
•Risk for deficient fluid volume related to vomiting
and
dehydration
•Anxiety related to impending surgery and the
diagnosis of cancer
PLANNINGPLANNING
** Relieving pain
** prevention of fluid volume deficit,
** maintenance of optimal nutrition and
weight
** Relieving anxiety
RELIEVING PAINRELIEVING PAIN
* The nurse records the intensity, duration,
and location of pain to determine if the
obstruction process worsens or subsides.
* Comfort position .
* Analgesics to relieve the pain as order.
*prevention of fatigue also are helpful for
reducing pain
MAINTAINING FLUID INTAKE
*the nurse keeps an accurate record of oral and intravenous fluids and maintains a record of output
*The nurse monitors daily weights for fluid gains or losses
*assesses the patient for signs of fluid volume deficit (ie, dry skin and mucous membranes)
*It is important to encourage oral intake of fluids and to monitor the intravenous flow rate .
IMPROVE NUTRITIONAL STATUSIMPROVE NUTRITIONAL STATUS
**assessing improvement (eg, return of normal bowel sounds, decreased abdominal distention,, passage of flatus or stool)**maintaining the function of the nasogastric tube
**A complete nutritional assessment for the patient with a colostomy.
**The patient avoids foods that cause excessive odor and gas, such as peanuts.
**It is important to determine whether the elimination of specific foods is causing any nutritional deficiency .
** For constipation, prune or apple juice or a mildlaxative is effective .
**The nurse suggests fluid intake of at least 2 L per day.
Relieving anxietyRelieving anxiety
** The patient is encouraged to verbalize feelings and concerns about altered body image and to discuss the surgery and the stoma (if one was created).
** explain the procedure for patient and his family
**Provide emotional support
** accepting manner and by encouraging the patient to talk about his or her feelings about the stoma.
EVALUATIONEXPECTED PATIENT OUTCOMES
Consumes a healthy diet
Maintains fluid balance
Feels less anxious
Comfortable without pain
GASTROINTESTINAL (GI) BLEEDING
Gastrointestinal (GI) bleeding is a common
clinical problem frequently requiring
hospitalization. It can vary in degrees, from
massive life threatening hemorrhage to a
slow, insidious chronic blood loss
• Peptic ulcers
• Gastritis
• upper Gastrointestinal cancers
• Inflammation of the gastrointestinal
lining from ingested materials
UPPER GASTROINTESTINAL UPPER GASTROINTESTINAL BLEEDINGBLEEDING
LOWER GASTROINTESTINAL LOWER GASTROINTESTINAL BLEEDINGBLEEDING
Diverticular disease
Gastrointestinal cancers
Inflammatory bowel disease (IBD)
Hemorrhoids and anal fissure
Infectious diarrhea
Angiodysplasia
Polyps
CLINICAL MANIFESTATIONS
Others:
Fatigue
Weakness
Shortness of breath
Abdominal pain
Pale appearance
Anemia
TESTS THAT MAY BE DONE TESTS THAT MAY BE DONE INCLUDEINCLUDE:
Abdominal CT scan , Abdominal MRI scan , Abdominal x-ray
Angiography
Bleeding scan (tagged red blood cell scan)
Blood clotting tests
Capsule endoscopy (camera pill that is swallowed to look at the small intestine)
Colonoscopy
Complete blood count (CBC), clotting tests, platelet count, and other laboratory tests
Enteroscopy , Sigmoidoscopy
MANAGEMENTMANAGEMENTPriorities are:
Assess clinical status
**PR, BP, RR, Conciousness
Large bore IV access – 2
Stabilize haemodynamics
**IV fluids, PRBC, Whole blood
Vasopressors
NG aspirate – Large bleeds, doubtful bleeds
MEDICAL MANAGEMENT
H2 receptor antagonist - cimetidine, ranitidine
Proton pump inhibitors – omeprazole, lanzoprazole
H. pylori irradication
Triple regimen – proton pump inhibitor + 2
antibiotics given for 1 week (elimination rate >
90%)
e.g. Omeprazol + metronidazole/amoxycillin +
clarithromycin
SURGICAL INTERVENTIONSURGICAL INTERVENTION
Endoscopic therapy with:Endoscopic therapy with: Diagnostic
Therapeutic – Ligation, Banding, Clipping, Sclero
Balloon tamponade
surgery should be done if
-failed medical treatment
-vagotomy, gastrectomy, pyloroplasty
Assessment
**The nurse obtains a health history about the, abdominal or rectal pain (eg, location, frequency, duration, association with eating or defecation)
**past and present elimination patterns, and characteristics of stool
(eg, color, odor, consistency, presence of blood or mucus.)
** The nurse assesses dietary patterns, including fat and fiber intake.palpation of the abdomen for areas of tenderness, distention, and solid masses .
NURSING DIAGNOSISNURSING DIAGNOSIS
•Acute pain and discomfort related to abdominal
distention , obstruction and surgical incision
•Imbalanced nutrition, less than body requirements,
related to nausea and anorexia
•Risk for deficient fluid volume related to vomiting
and
dehydration
•Anxiety related to impending surgery and the
diagnosis of cancer
PLANNINGPLANNING
** Relieving pain
** prevention of fluid volume deficit,
** maintenance of optimal nutrition and
weight
** Relieving anxiety
RELIEVING PAINRELIEVING PAIN
* The nurse records the intensity, duration,
and location of pain to determine if the
inflammatory process worsens or subsides.
* Comfort position .
* Analgesics to relieve the pain as order.
*prevention of fatigue also are helpful for
reducing pain
MAINTAINING FLUID INTAKE
*the nurse keeps an accurate record of oral and intravenous fluids and maintains a record of output
*The nurse monitors daily weights for fluid gains or losses
*assesses the patient for signs of fluid volume deficit (ie, dry skin and mucous membranes)
*It is important to encourage oral intake of fluids and to monitor the intravenous flow rate .
IMPROVE NUTRITIONAL STATUSIMPROVE NUTRITIONAL STATUS
**assessing improvement (eg, return of normal bowel sounds, decreased abdominal distention,, passage of flatus or stool)**maintaining the function of the nasogastric tube
**A complete nutritional assessment for the patient with a colostomy.
**The patient avoids foods that cause excessive odor and gas, such as peanuts.
**It is important to determine whether the elimination of specific foods is causing any nutritional deficiency .
** For constipation, prune or apple juice or a mildlaxative is effective .
**The nurse suggests fluid intake of at least 2 L per day.
Relieving anxietyRelieving anxiety
** The patient is encouraged to verbalize feelings and concerns about altered body image and to discuss the surgery and the stoma (if one was created).
** explain the procedure for patient and his family
**Provide emotional support
** accepting manner and by encouraging the patient to talk about his or her feelings about the stoma.
EVALUATIONEXPECTED PATIENT OUTCOMES
Consumes a healthy diet
Maintains fluid balance
Feels less anxious
Comfortable without pain