Chapter 26Gastrointestinal Conditions

Chapter 26Gastrointestinal Conditions

Gastrointestinal ProblemsGastrointestinal Problems

• Indigestion

• Belching

• Diarrhea

• Constipation

• Nausea

• Vomiting

• Anorexia

• Weight gain or loss

• Flatulence

Factors Influencing Gastrointestinal Tract HealthFactors Influencing Gastrointestinal Tract Health

• Poor nutrition

• Medications

• Emotions

• Inactivity

• A variety of other factors

Causes of AnorexiaCauses of Anorexia

• Medication side effects

• Inactivity

• Physical illness

• Age-related changes

• Anxiety and depression

Management of AnorexiaManagement of Anorexia

• Depending on the cause, treatment could consist:

– A high-calorie diet

– Referral to social programs

– Tube feeding

– Hyperalimentation

– Psychiatric therapy

– Medications 

Xerostomia (Dry Mouth)Xerostomia (Dry Mouth)

• Causes:

– Drugs

– Sjogren’s syndrome

– Mouth breathing

– Altered cognition

• Interventions:

– Sipping water

– Hard candies

– Saliva substitutes

Factors That Could Lead to Poor Dental Status in EldersFactors That Could Lead to Poor Dental Status in Elders

• Limited funds

• Lack of knowledge

• Diseases

• Fear of Dentists

Causes of DysphagiaCauses of Dysphagia

• Gastroesophageal reflux disease (GERD)

• Stroke

• Structural disorders

Types of DysphagiaTypes of Dysphagia

• Oropharyngeal

– Difficulty transferring food from the mouth into the the pharynx and esophagus.

• Esophageal

– Difficulty transferring food down the esophagus.

Interview Questions for Patients with DysphagiaInterview Questions for Patients with Dysphagia

• When did the problem begin?

• What other symptoms accompany the dysphagia?

• What types of foods are most problematic?

• Is the problem intermittent or present with every meal?

Types of Hiatal HerniasTypes of Hiatal Hernias

• Sliding (axial)

– A part of the stomach and the junction of the stomach and esophagus slide through the diaphragm.

• Rolling (paraesophageal)

– The fundus and greater curvatures of the stomach roll up through the diaphragm.

Symptoms of Hiatal HerniasSymptoms of Hiatal Hernias

• Heartburn

• Dysphagia

• Belching

• Vomiting

• Regurgitation

Symptoms of Esophageal CancerSymptoms of Esophageal Cancer

• Dysphagia

• Weight loss

• Excessive salivation

• Thirst

• Hiccups

• Anemia

• Chronic bleeding

Factors Contributing to Peptic UlcersFactors Contributing to Peptic Ulcers

• Stress

• Diet

• Genetic predisposition

• Longevity

• More precise diagnostic evaluation

• Increasing prevalence of chronic obstructive pulmonary disease

Symptoms of Peptic UlcersSymptoms of Peptic Ulcers

• Pain

• Bleeding

• Obstruction

• Perforation

Complications of Peptic UlcersComplications of Peptic Ulcers

• Constipation or diarrhea caused by antacid therapy

• Pyloric obstruction resulting in dehydration, peritonitis, hemorrhage, and shock

Factors Causing Stomach Cancer to Be Common Problem in Late LifeFactors Causing Stomach Cancer to Be Common Problem in Late Life

• Chronic constipation

• Obesity

• Age-related atrophy of intestinal walls

• Low-fiber diet

Factors Contributing to Diverticular DiseaseFactors Contributing to Diverticular Disease

• Chronic constipation

• Obesity

• Hiatal hernia

• Atrophy of the intestinal wall muscles with aging

Medical Management of Diverticular DiseaseMedical Management of Diverticular Disease

• Increase in dietary fiber intake

• Weight reduction

• Avoidance of constipation

Factors Contributing to DiverticulitisFactors Contributing to Diverticulitis

• Overeating

• Straining during a bowel movement

• Alcohol

• Irritating foods

Nursing Interventions for DiverticulitisNursing Interventions for Diverticulitis

• Acute Phase

– Reduce infection.

– Provide nutrition.

– Relieve discomfort.

– Promote rest.

• Following Acute Phase

– Consume a low-residue diet.

Symptoms of Cancer of the ColonSymptoms of Cancer of the Colon

• Bloody stools

• Change in bowel function

• Anorexia

• Nausea

• Epigastric pain

• Jaundice

Screening Measures for Colon CancerScreening Measures for Colon Cancer

• Digital rectal examination

• Fecal occult blood testing

• Barium enema

• Sigmoidoscopy with biopsy

Factors Contributing to Chronic ConstipationFactors Contributing to Chronic Constipation

• An inactive lifestyle

• Low fiber and fluid intake

• Depression

• Laxative abuse

• Certain medications

• Dulled sensations for bowel elimination

• Failure to allow sufficient time for complete emptying of the bowel

Measures to Promote Bowel EliminationMeasures to Promote Bowel Elimination

• Scheduling a regular time for it.

• Incorporating high-fiber foods into the diet.

• Rocking the trunk from side to side and back and forth while sitting on the toilet.

Causes of Bowel ObstructionCauses of Bowel Obstruction

• Cancer of the colon

• Diverticulitis

• Ulcerative colitis

• Hypokalemia

• Vascular problems

• Paralytic ileus

Symptoms of Bowel ObstructionSymptoms of Bowel Obstruction

• Small Bowel Obstruction

– Upper and midabdominal pain in rhythmic recurring waves; vomiting may occur.

• Obstructions Occuring Past the Ileum

– Abdominal distension so severe that the raised diaphragm can inhibit respirations.

– Vomiting is more severe.

Symptoms of Bowel Obstruction (cont.)Symptoms of Bowel Obstruction (cont.)

• Obstruction of the Colon

– Lower abdominal pain, altered bowel habits, distension, and a sensation of the need to defecate. Vomiting usually does not occur until late.

Possible Causes of IncontinencePossible Causes of Incontinence

• Decreased contractile strength

• Impaired automaticity of the puborectal and external anal sphincter

• Reduced reservoir capacity

Symptoms of Pancreatic CancerSymptoms of Pancreatic Cancer

• Anorexia

• Weakness

• Weight loss and wasting

• Dyspepsia

• Belching

• Nausea

• Vomiting

Symptoms of Pancreatic Cancer (cont.)Symptoms of Pancreatic Cancer (cont.)

• Diarrhea

• Constipation

• Obstructive jaundice

• Fever may or may not be present.

• Epigastric pain radiating to the back may be experienced.

Treatment Measures for Biliary Tract DiseaseTreatment Measures for Biliary Tract Disease

• Nonsurgical Therapies

– Rotary lithotrite treatment

– Extracorporeal shock wave lithotripsy

• Standard Surgical Procedures

SourceSource

• Eliopoulos, C. (2005).  Gerontological Nursing, (6th ed.).  Philadelphia: Lippincott, Williams & Wilkins (ISBN 0-7817-4428-8).