DIGESTIVE DISEASES GERD GERD Gastroesophageal reflux disease Not

DIGESTIVE DISEASES

GERD • 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)

GERD Signs & Symptoms • Heartburn (burning, tight sensation below the sternum and radiates upward) • Feeling of fullness • Bloating • N/V • Reguritation • Dysphagia • Hoarsness • Dyspnea • Wheezing

GERD Complications • • Scar tissue formation Lesions Dysphagia Pneumonia (d/t aspiration) Dx • Ba swallow • Esophagoscopy

GERD Tx • Drug therapy • Antacids - Maalox (1 -3 hrs pc and hs) • Proton pump inhibitors (Zantac, Pepcid) • Histamine H 2 -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 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 DISEASE Signs & Symptoms • 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 DISEASE Tx • Gluten free diet • Corticosteroids (if not responsive to a gluten free diet)

INFLAMMATORY BOWEL 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

COLITIS • 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

COLITIS SIGNS & SYMPTOMS • Bloody diarrhea • Abd pain varying from mild to severe • In severe cases • Fever • Wt. loss • Tachycardia • Dehydration

COLITIS COMPLICATIONS • • Hemorrhage Strictures Perforation Toxic megacolon Dx • Bloodwork (CBC electrolytes) • Stool culture • Sigmoidoscope

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

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

CROHN'S DISEASE COMPLICATIONS • • • Strictures Obstruction Fistulas Nutritional abnormality Arthritis Dx • Physical signs and symptoms • Ba enema/swallow • Bloodwork • Colonoscopy • Biopsy • Stool culture

CROHN'S DISEASE Tx • Control inflammation – Corticosteriods – Anti-inflammatories • Relieve symptoms • Correct nutritional problems – High calorie – High protein • Promote healing • Surgery

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

DIVERTICULAR DISEASE • 1. 2. • Diverticular disease occurs in 2 forms: Diverticulosis 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 DISEASE • When feces enters the diverticula, they can become inflamed and infected. This is called diverticulitis.

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

DIVERTICULAR DISEASE COMPLICATIONS • • • May include Abscesses Bowel obstruction Bleeding Ruptured diverticula Tx • Antibiotics (if infection is present) • Some of these complications may require surgery. • A colostomy can be necessary as well as dietary changes.

VOMITING, GALLBLADDER DISEASE & IBS Vomiting – (red text) • Pg 547 • Definition • What are the risks of vomiting? • Review the measures to follow when a client vomits Gallbladder Disease IBS – (yellow text) - (yellow text) • Pg 277 • Pg 276 • Definition • What is the gallbladder? • What are the 2 types of IBS? • Define cholecystitis • Signs and symptoms • Tx • Signs and symptoms of both types • Causes • Tx

DIGESTIVE SYSTEM ASSESSMENT 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 CASE 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