Chapter 46 Digestive and Endocrine Disorders Copyright 2017

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Chapter 46 Digestive and Endocrine Disorders Copyright © 2017, Elsevier, Inc. All rights reserved.

Chapter 46 Digestive and Endocrine Disorders Copyright © 2017, Elsevier, Inc. All rights reserved.

Digestive Disorders Digestive system Breaks down food for the body to absorb Ø Eliminates

Digestive Disorders Digestive system Breaks down food for the body to absorb Ø Eliminates solid wastes Ø Copyright © 2017, Elsevier, Inc. All rights reserved. 2

Digestive Disorders (Cont. ) Gastroesophageal reflux disease (GERD) Ø GERD is a disease in

Digestive Disorders (Cont. ) Gastroesophageal reflux disease (GERD) Ø GERD is a disease in which stomach contents flow back from the stomach into the esophagus. • Stomach contents contain acid. The acid can cause irritation and inflame the esophagus lining. Ø This is called esophagitis. Heartburn is the most common symptom of GERD. • Heartburn is a burning sensation in the chest and sometimes the throat. • If heartburn occurs more than twice a week, the person may have GERD. Copyright © 2017, Elsevier, Inc. All rights reserved. 3

Digestive Disorders (Cont. ) Risk factors for GERD include: • Being overweight • Alcohol

Digestive Disorders (Cont. ) Risk factors for GERD include: • Being overweight • Alcohol use • Pregnancy • Smoking • Hiatal hernia Ø Treatment may include: • The doctor ordering drugs to prevent stomach acid Ø production or to promote stomach emptying. • Surgery • Lifestyle changes No smoking or drinking alcohol; losing weight; eating small meals; wearing loose belts and loose-fitting clothes; not lying down for 3 hours after meals Copyright © 2017, Elsevier, Inc. All rights reserved. 4

Digestive Disorders (Cont. ) Vomiting Vomitus (emesis) is the food and fluids expelled from

Digestive Disorders (Cont. ) Vomiting Vomitus (emesis) is the food and fluids expelled from the stomach through the mouth. Ø Vomiting signals illness or injury. Ø Aspirated vomitus can obstruct the airway. Ø Vomiting large amounts of blood can lead to shock. Ø Copyright © 2017, Elsevier, Inc. All rights reserved. 5

Digestive Disorders (Cont. ) Ø These measures are needed. • Follow Standard Precautions and

Digestive Disorders (Cont. ) Ø These measures are needed. • Follow Standard Precautions and the Bloodborne • • • Pathogen Standard. Turn the person’s head well to one side. Place a kidney basin under the person’s chin. Move vomitus away from the person. Provide oral hygiene. Observe vomitus for color, odor, and undigested food. Measure, report, and record the amount. Save a specimen for laboratory study. Dispose of vomitus after the nurse observes it. Eliminate odors. Provide for comfort. Copyright © 2017, Elsevier, Inc. All rights reserved. 6

Digestive Disorders (Cont. ) Diverticular disease Small pouches can develop in the colon. The

Digestive Disorders (Cont. ) Diverticular disease Small pouches can develop in the colon. The pouches bulge outward through weak spots in the colon. • Each pouch is a called a diverticulum. Ø The condition of having these pouches is called diverticulosis. • The pouches can become infected or inflamed Ø (diverticulitis). Ø Risk factors include: • Age • A low-fiber diet • Constipation Copyright © 2017, Elsevier, Inc. All rights reserved. 7

Digestive Disorders (Cont. ) Ø When feces enter the pouches, they can become inflamed

Digestive Disorders (Cont. ) Ø When feces enter the pouches, they can become inflamed and infected. The person may have: • Abdominal pain and tenderness in the lower left abdomen • Fever, nausea and vomiting, chills, cramping, and constipation • Bloating, rectal bleeding, frequent urination, and pain while voiding Ø Complications • A ruptured pouch is a rare complication. • A pouch also can cause a blockage in the intestine (intestinal obstruction). Ø Treatment • Diet changes are ordered. • Sometimes antibiotics are ordered. • Surgery is done for severe disease, obstruction, and ruptured pouches. Copyright © 2017, Elsevier, Inc. All rights reserved. 8

Digestive Disorders (Cont. ) Inflammatory bowel disease Crohn’s disease. The lining of the large

Digestive Disorders (Cont. ) Inflammatory bowel disease Crohn’s disease. The lining of the large intestine, small intestine, or both is inflamed. Ø Ulcerative colitis. The lining of the large intestine and rectum is inflamed and has ulcers. Ø Copyright © 2017, Elsevier, Inc. All rights reserved. 9

Digestive Disorders (Cont. ) Signs and symptoms include: Diarrhea Ø Abdominal pain and cramping

Digestive Disorders (Cont. ) Signs and symptoms include: Diarrhea Ø Abdominal pain and cramping Ø Fever Ø Bleeding—bright red blood in the toilet, dark blood in the stools, or occult blood Ø Loss of appetite Ø Weight loss Ø Copyright © 2017, Elsevier, Inc. All rights reserved. 10

Digestive Disorders (Cont. ) Serious complications can result. They include bowel obstruction, ulcers in

Digestive Disorders (Cont. ) Serious complications can result. They include bowel obstruction, ulcers in the GI tract (including the mouth and anus), colon cancer, osteoporosis, and liver disease. Treatment involves diet changes and drug therapy for inflammation, infection, diarrhea, pain, and nutrition. Surgery may be needed to remove damaged parts of the small intestine or colon. Copyright © 2017, Elsevier, Inc. All rights reserved. 11

Digestive Disorders (Cont. ) Gallstones Ø Bile is a liquid made in the liver.

Digestive Disorders (Cont. ) Gallstones Ø Bile is a liquid made in the liver. • It is stored in the gallbladder until needed to digest fat. Ø Ø Ø Gallstones form when the bile hardens into stone-like pieces. Bile is carried from the liver to the gallbladder through ducts (tubes). Bile is carried to the small intestine through the common bile duct. Gallstones can lodge in any of the ducts. Gallstones vary in size. • A person may have one large stone. • Some people have large and small stones. Copyright © 2017, Elsevier, Inc. All rights reserved. 12

Digestive Disorders (Cont. ) Ø Persons at risk for gallstones include those who are:

Digestive Disorders (Cont. ) Ø Persons at risk for gallstones include those who are: • Women—especially women who are pregnant, use hormone • • • Ø replacement therapy or take birth control pills Over age 60 American Indians Mexican Americans Overweight or obese Taking cholesterol-lowering drugs Diabetics Signs and symptoms of a “gallbladder attack” or “gallstone attack” • Occur suddenly • Often follow a fatty meal Ø Surgical removal of the gallbladder is common. Copyright © 2017, Elsevier, Inc. All rights reserved. 13

Digestive Disorders (Cont. ) Hepatitis is an inflammation of the liver. It can be

Digestive Disorders (Cont. ) Hepatitis is an inflammation of the liver. It can be mild or cause death. Ø Protect yourself and others. Ø • Follow Standard Precautions and the Bloodborne Pathogen Standard. • Isolation Precautions are ordered as necessary. • Assist the person with hygiene and hand washing as needed. There are five major types of hepatitis. Ø Ø Ø Hepatitis A Hepatitis B Hepatitis C Hepatitis D Hepatitis E Copyright © 2017, Elsevier, Inc. All rights reserved. 14

Digestive Disorders (Cont. ) Ø Hepatitis A is spread by food or water contaminated

Digestive Disorders (Cont. ) Ø Hepatitis A is spread by food or water contaminated with feces from an infected person. • Spread through the fecal-oral route, hepatitis A virus is ingested when eating or drinking: Food or water contaminated with feces From a contaminated vessel • Treatment involves: Rest A healthy diet Fluids No alcohol • Recovery takes 1 to 2 months. • The hepatitis A vaccine provides protection against the disease. Copyright © 2017, Elsevier, Inc. All rights reserved. 15

Digestive Disorders (Cont. ) Ø Hepatitis B is caused by the hepatitis B virus

Digestive Disorders (Cont. ) Ø Hepatitis B is caused by the hepatitis B virus (HBV). • It is spread through infected blood or blood products and body fluids of infected persons. Body fluids include saliva, semen, and vaginal secretions. • The HBV virus can be spread by: IV (intravenous) drug use and sharing needles and syringes Accidental needle-sticks Sex without a condom (especially anal sex) Contaminated tools used for tattoos or body piercings Sharing a toothbrush, razor, or nail clippers with an infected person • HBV vaccine is available. Drugs are ordered for chronic hepatitis B. Copyright © 2017, Elsevier, Inc. All rights reserved. 16

Digestive Disorders (Cont. ) Ø Hepatitis C is spread by blood contaminated with the

Digestive Disorders (Cont. ) Ø Hepatitis C is spread by blood contaminated with the hepatitis C virus. • A person may have no symptoms but can transmit the disease. Serious liver disease and damage may show up years later. Blood contaminated with the virus IV drug use and sharing needles and syringes Inhaling cocaine through contaminated straws Contaminated tools used for tattoos or body piercings High-risk sexual activity: • Hepatitis C is treated with drugs. • The virus is spread by: – Sex with an infected person – Multiple sex partners Sharing a toothbrush, razor, or nail clippers with an infected person Copyright © 2017, Elsevier, Inc. All rights reserved. 17

Digestive Disorders (Cont. ) Hepatitis D occurs only in people infected with hepatitis B.

Digestive Disorders (Cont. ) Hepatitis D occurs only in people infected with hepatitis B. • It is spread the same way as HBV. Ø Hepatitis E is spread through food or water contaminated by feces from an infected person. • It is spread by the fecal-oral route. • This disease is not common in the United States. Ø Copyright © 2017, Elsevier, Inc. All rights reserved. 18

Digestive Disorders (Cont. ) Ø Cirrhosis is a liver condition caused by chronic liver

Digestive Disorders (Cont. ) Ø Cirrhosis is a liver condition caused by chronic liver damage. • Healthy tissue is replaced by scar tissue. • Blood flow through the liver is blocked. • Normal liver functions are affected. Controlling infection Removing bacteria and toxins from the blood Processing nutrients, hormones, and drugs Making proteins for blood clotting Producing bile for fat digestion • Common causes are: Chronic alcohol abuse Chronic hepatitis B and C Obesity Copyright © 2017, Elsevier, Inc. All rights reserved. 19

Digestive Disorders (Cont. ) • Signs and symptoms of cirrhosis do not appear early

Digestive Disorders (Cont. ) • Signs and symptoms of cirrhosis do not appear early in the disease. • Cirrhosis has many serious complications. Edema Infection, jaundice, bruising, and bleeding Blood vessels in the esophagus and stomach may enlarge and burst. Gallstones may develop. Toxins build up in the brain. • Diabetes and liver cancer are risks. Copyright © 2017, Elsevier, Inc. All rights reserved. 20

Digestive Disorders (Cont. ) Ø Treatment of cirrhosis is aimed at preventing scar tissue

Digestive Disorders (Cont. ) Ø Treatment of cirrhosis is aimed at preventing scar tissue and includes: • A healthy diet • • • Limited in protein Low sodium Diuretic drugs (water pills) Antibiotics for infection Drugs and enemas to remove toxins No alcohol A liver transplant may be needed. Copyright © 2017, Elsevier, Inc. All rights reserved. 21

Endocrine Disorders The endocrine system is made up of glands. The endocrine glands secrete

Endocrine Disorders The endocrine system is made up of glands. The endocrine glands secrete hormones that affect other organs and glands. Diabetes is the most common endocrine disorder. Ø In diabetes, the body cannot produce or use insulin properly. • Without enough insulin, sugar builds up in the blood. • Blood glucose (sugar) is high. • Cells do not have enough sugar for energy and cannot function. Copyright © 2017, Elsevier, Inc. All rights reserved. 22

Endocrine Disorders (Cont. ) Ø There are three types of diabetes. • Type 1

Endocrine Disorders (Cont. ) Ø There are three types of diabetes. • Type 1 diabetes—occurs most often in children; more common in whites The pancreas produces little or no insulin. Onset is rapid. • Type 2 diabetes—more common in older persons The pancreas secretes insulin but the body cannot use it well. Onset is slow. Infections are frequent. Wounds heal slowly. • Gestational diabetes—develops during pregnancy The mother is at risk for type 2 diabetes later in life. Copyright © 2017, Elsevier, Inc. All rights reserved. 23

Endocrine Disorders (Cont. ) Ø Signs and symptoms of diabetes include: • Being very

Endocrine Disorders (Cont. ) Ø Signs and symptoms of diabetes include: • Being very thirsty • Urinating often • Feeling very hungry or tired • Losing weight without trying • Having sores that heal slowly • Having dry, itchy skin • Tingling or loss of feeling in the feet • Blurred vision Copyright © 2017, Elsevier, Inc. All rights reserved. 24

Endocrine Disorders (Cont. ) Ø Diabetes must be controlled to prevent the following complications:

Endocrine Disorders (Cont. ) Ø Diabetes must be controlled to prevent the following complications: • • • Ø Blindness Renal failure Nerve damage Damage to the gums and teeth Heart and blood vessel diseases Foot and leg wounds and ulcers Treatment • Type 1 is treated with daily insulin therapy, healthy eating, and • • exercise. Type 2 is treated with healthy eating and exercise. Many persons with type 2 take oral drugs. Some need insulin. Overweight persons need to lose weight. Control blood pressure, cholesterol, and the risk factors for coronary artery disease Copyright © 2017, Elsevier, Inc. All rights reserved. 25

Endocrine Disorders (Cont. ) Ø Good foot care is needed. • Corns, blisters, calluses,

Endocrine Disorders (Cont. ) Ø Good foot care is needed. • Corns, blisters, calluses, and other foot problems can lead to an infection and amputation. Ø Blood glucose is monitored daily or 3 or 4 times a day for: • Hypoglycemia (low sugar in the blood) • Hyperglycemia (high sugar in the blood) Copyright © 2017, Elsevier, Inc. All rights reserved. 26