Definition:

GERD is not a disease but a heterogeneous syndrome resulting from esophagus reflux. Most cases are attributed to the inappropriate relaxation of the lower esophageal sphincter (LES) in response to unknown stimulus.

Etiology:

1. Common cause is Hiatus Hernia
2. Increases intra-abdominal pressure (Obesity, Pregnancy)

Clinical features:

1. Heart burn
2. Wheezing
3. Hoarseness
4. Dysphonea
5. Nausea
6. Vomiting
7. Regurgitation
8. Dysphagia
9. Odynophagia
10. Bleeching

Investigations:

1. Gastro-esophagealscopy
2. Barium swallow
3. Biopsy

Medical Management:

1. Antacids (to relieve heart burn)
2. Histamine 2 receptors
3. Prokinetic drugs (to increase LES)
4. Proton pump inhibitor (to inhibit the enzymatic activity)

Surgery:

1. Anti-reflux surgery

Nursing Management:

1. Patient should be encouraged to eat 4-6 small meals daily
2. Follow a low-fat, adequate protein diet
3. Eliminate alcohol, beverages and tobacco
4. Avoid constrictive clothing over the abdomen
5. Elevate the bed at least 6-8 inches
6. Never sleep flat on the bed

Hiatus: an opening
Hernia: protrusion of any part of the intestinal organ through the structure enclosing them

Definition:

Hiatus Hernia is herniation of a portion of the esophagus through an opening or hiatus, in the diaphragm. It is also referred as diaphragmatic hernia & esophageal hernia. Hiatus hernia is common in older adults & occurs more frequently in women than in men.

Classification of Hiatus Hernia:

Sliding Hiatus Hernia:

Description: The junction of the stomach & esophagus is above the hiatus of diaphragm

1. a part of the stomach slides through the hiatus opening in the diaphragm. It slides into the thoracic cavity when the patient is supine & usually goes back into the abdominal cavity when the patient is standing upright.

Para-esophageal or Rolling Hernia:

Description: The esophagus-gastric junction remains in the normal position but the fundus and the greater curvature of the stomach roll up through the diaphragm forming a pocket alongside the esophagus.

Etiology:

1. Weakling of the muscles in the diaphragm
2. Obesity
3. Pregnancy
4. Ascites
5. Poor nutrition
6. Congenital weakness (in rare cases)

Clinical features:

Sliding Hiatus Hernia:

1. Heart burn (30-60 min after meal)
2. Reflux
3. Nocturnal attack Para-esophageal or Rolling Hernia:
4. Feeling of fullness after eating
5. Dysponea
6. Anginal pain (worst at recumbent position)

Complications:

1. Hemorrhage
2. Stenosis
3. Ulceration
4. Strangulation of Hernia
5. Regurgitation with tracheal aspiration
6. Oesophagitis

Investigation:

1. Barium swallow
2. Biopsy
3. Gastro-esophagealscopy

Medical Management:

1. Antacids
2. Anti-secretory agents

Surgical Management:

1. Hernioplasty
2. Herniotomy
3. Herniarraphy

Nursing Management:

Pre-operative care:

1. Elimination of constricting garments
2. Avoidance of lifting & straining
3. Elimination of alcohol & smoking
4. Elevation of bed on 4-6 inch blocks
5. Try to prevent from reflux & tracheal aspiration
6. If obese, the client is encouraged to lose weight
7. Nurse should teach about NG tube that will be inserted during surgery
8. Post-operative care:
9. Maintains of fluids & electrolytes balance
10. Preventive measures of the infection
11. Observe for regurgitation & heart burn
12. General Management:
13. Normal diet can be resumed within 6 weeks
14. Monitor TPR & BP
15. Patient should be avoided for foods those causing gas problems
16. Try to prevent the patient from gastric distention
17. Food should be thoroughly chewed

Definition:

Gastritis, an inflammation of the gastric mucosa, is one of the most problems affecting the stomach. Gastritis refers to the diffuse of localized response of the gastric mucosa to injury or infection.

Types of Gastritis:

1. Acute Gastritis
2. Chronic Gastritis

Acute Gastritis:

Definition:

Acute Gastritis is short-term inflammatory process that can be initiated by numerous factors:

1. Excessive alcoholism
2. Drug affects (Aspirin, NSAIDS, and Corticosteroids)
3. Stress
4. Trauma
5. Contaminated food: (Staphylococcus, Salmonella) Clinical features:
6. Anorexia
7. Nausea
8. Vomiting
9. Abdominal cramps
10. Epigastria pain
11. Fever

Medical Management:

1. Antacid
2. Histamine 2 receptors antagonists (to reduce HCl secretion)
3. IV fluid & electrolytes

Chronic Gastritis

Definition:

Chronic Gastritis, a long-term inflammatory process that can be initiated by numerous factors:

1. Reflux of bile salts from the duodenum
2. Repeated episodes of the acute Gastritis
3. Kinds of Chronic Gastritis:

Types A Gastritis:

Type A is believed to be auto-immune in nature & involves all of the acid-secreting gastric tissue, particularly the tissue in the fundus. Circular antibodies are produced that attack the gastric parietal cells and eventually may cause pernicious anemia from loss of the intrinsic factors.

• Pernicious anemia =
• Intrinsic factor =

Types B Gastritis:

Type B is related to presence of Helico-bacter pylori (H-pylori). It primarily involves the antrum of the stomach. There is less reduction in the acid-secretion, gastrin levels remains normal & Vitamin B- 12 absorption is rarely impaired.

Clinical features:

1. Anemia
2. Anorexia
3. Nausea
4. Vomiting
5. Abdominal cramps
6. Epigastric pain
7. Fever

Medical management:

1. Anti-bacterial
2. Antacids
3. Histamine 2 receptors antagonists
4. IV fluid & electrolytes
5. Or new triple therapy as amoxicillin, Clarithromycin, Omeprazole X 7 days
6. Regular Inj: Cobolmin

Investigations:

1. Gastroscopy
2. Doudenoscopy
3. Biopsy
4. Pylori test
5. CBC
6. Stool test

Nursing Management:

1. Patient should be put NPO status to support healing of the mucosa
2. Slowly advancement of liquids & returns to a normal diet
3. Health education to prevent bacterial food borne illness
4. Wash hands before handling food
5. Never leave perishable foods un-refrigerated for more than 2 hours-less in hot water.

Definition:

Appendicitis is an inflammation of the vermiform appendix, a narrow blind tube extends from the inferior part of the caecum usually just below the ileo-cecal valve, mostly found in males at the age 15-25 years.

Etiology:

1. Active cause idiopathic
2. Passive cause as:
3. Constipation
4. Intestinal obstruction
5. Lymphoid hyperplasia
6. Bacteria (e-coli)

Clinical features:

1. Pain in RLQ
2. Pain in Mc Burney point (localized at half may between the umbilicus & right iliac crest)
3. Anorexia
4. Nausea
5. Tenderness
6. Low Grade fever
7. Furred moist tongue

Complication:

1. Perforation
2. Ulceration
3. Peritonitis
4. Gangrene
5. Abscesses

Investigations:

1. X ray
2. Blood for leukocytes
3. CBC

Medical Management:

1. Anti-inflammatory drug
2. Anti-pyretic

Surgical Management:

1. Appendectomy

Nursing Management:

1. Avoidance from self-treatment
2. NPO for empty gastric if surgery needed
3. Ice bags applied to the right lower quadrant to decrease flow of blood to the area & impede the inflammatory process
4. Never provide heat that may lead to appendix rupture
5. Observe for any complication

Definition:

Peritonitis is defined as local or generalized inflammation of the peritoneum, the membrane lining the abdomen that covers the viscera.

Classification of the peritonitis:

1. Primary Peritonitis
2. Secondary Peritonitis
3. Acute Peritonitis
4. Chronic Peritonitis
5. Septic Peritonitis
6. Aseptic Peritonitis

Etiology:

Primary Peritonitis:

1. Bacteria Secondary Peritonitis
2. Trauma
3. Chemical irritants
4. Risk factors, which may cause Peritonitis: o Appendicitis

o Perforated Peptic Ulcer

o Diverticulitis (Small herniation of mucosal lining of GI Tract) o Pelvic inflammation

o UTI

o Bowel obstruction

o Surgical complication o Pancreatitis

Clinical features:

1. Abdominal pain (typical sign)
2. Tenderness in abdomen (Universal sign)
3. Muscular rigidity
4. Spasm (Major sign)
5. Abdominal distension
6. Ascites
7. Tachycardia
8. Tachyponea
9. Nausea
10. Vomiting

Complications:

1. Hypo-volumic shock
2. Septicemia
3. Intra-abdominal abscess
4. Paralytic ileus
5. Organ failure

Investigation:

1. Serum electrolyte
2. Abdominal X-ray
3. Culture of fluid
4. CT scan
5. Ultrasound
6. Peritoscopy
7. Serum amylase
8. CBC

Medical Management:

1. Antibiotic
2. Analgesic
3. IV fluid administration
4. NG suction

Surgical Management:

1. Paracenthesis

Nursing Management:

• Blood pressure monitoring. The patient’s blood pressure is monitored by arterial line if shock is present.
• Medications. Administration of analgesic and anti emetics can be done as prescribed.
• Pain management. Analgesics and positioning could help in decreasing pain.
• I&O monitoring. Accurate recording of all intake and output could help in the assessment of fluid replacement.
• IV fluids. The nurse administers and closely monitors IV fluids.
• Drainage monitoring. The nurse must monitor and record the character of the drainage postoperatively.

Definition:

Inflammatory is an umbrella term used to describe conditions that are characterized by bowel inflammation:

1. Crohn’s Disease
2. Ulcerative colitis

Etiology:

1. Active cause is idiopathic
2. Passive cause includes:
3. Bacteria
4. Virus
5. Auto-immune reaction
6. Food allergy
7. Heredity

Crohn’s Disease

Definition:

Crohn’s disease is a chronic, non-specific inflammatory bowel disorder of unknown origin that can affect any part of the GI tract. It may occur at any age but 25-30 years is most often in females.

Clinical features:

1. Diarrhea
2. Fatigue
3. Abdominal pain
4. Weight loss
5. Fever
6. Cramping
7. Tenderness
8. Abdominal distension
9. Finger clubbing
10. Complications:
11. Fistula
12. Strictures
13. Anal abscesses
14. Perforation
15. Toxic
16. megacolon Investigations:
17. CBC
18. Stool for occult blood
19. Barium enema of small & large intestine
20. Protosigmoid scopy
21. Sigmoid colon scopy
22. Biopsy

Medical Management:

1. Anti-inflammatory drug (to relieve pain)
2. Nutritional therapy
3. Antipyretic Nursing Management:
4. Promote for nutritional balance
5. Plan for regular follow-up care

Definition:

Ulcerative colitis characterized by inflammation & ulceration of colon & rectum. It occurs at any age but peaks between 15-25 years, often in females.

Clinical features:

1. Anorexia
2. Nausea
3. Weight loss
4. Weakness
5. Malaise
6. Fever
7. Leukocytosis
8. Anemia iron deficiency
9. Profuse diarrhea (15-20 stools per day)
10. Stool containing blood, mucus & possible pus
11. Abdominal cramps

Complications:

1. Hemorrhage
2. Strictures perforation
3. Toxic mega colon
4. Colon dilation
5. Renal stone
6. Conjunctivitis
7. Perforation
8. Iritis
9. Stomatitis

Investigations:

1. Fiber optic colon scopy
2. Sigmoid scopy
3. Barium enema
4. CBC
5. Stool for blood, culture & sensitivity

Medical Management:

1. Anti-inflammatory drugs
2. Corticosteroids (Oral/IV)
3. Immunosuppressive agents
4. Azothropine
5. Cobolmin Inj:

Surgical Management:

1. Ileostomy
2. Ileorectostomy

Nursing Management:

1. Advised for high calorie, well balanced diet and sufficient sleep
2. Keep rectal area clean, use rectal ointment or Sitz bath

Definition:

Any factor either narrows intestinal passage way or interfere with peristalsis can result in bowel obstruction.

Intestinal obstruction occurs when intestinal contents can not pass through GI tract, and it requires prompt treatment. The obstruction may either be partial or complete.

Etiology:

Classification of Etiology:

Mechanical Obstruction:

1. Adhesion
2. Hernia (Inguinal/ Umbilical Hernia)
3. Tumor
4. Volvulus
5. Intussusceptions

Non-mechanical obstruction may result from a neuro-muscular or vascular disorder

1. Paralytic ileus
2. Vascular distention
3. Clinical features:
4. Nausea
5. Vomiting (orange-brown, foul smelling due to bacterial growth)
6. Abdominal pain (Universal pain)
7. Abdominal distension
8. Constipation
9. High pitched bowel sounds
10. Decrease urine out put
11. Hypokalaemia
12. Hyponatraemia

Complication:

1. Shock
2. Dehydration
3. Necrosis of tissue
4. Perforation
5. Aspiration Pneumonia

Investigation:

1. X-ray
2. Barium enema
3. CBC
4. Serum electrolyte
5. Amylase test

Medical Management:

1. NG insertion before surgery
2. Analgesic

Nursing Management:

1. Observe for color, odor & amount of vomiting
2. Patient should be monitor for dehydration & electrolyte imbalance
3. Nurse should provide comfort measures to promote a restful environment
4. Keep visitors to minimize
5. Record TPR & BP
6. Record for any complication

Definition:

Swollen veins (varicose veins = dilated veins due to the stretching of the vein valves) at or near the anus.

Type of the Hemorrhoids

External Hemorrhoids:

The varicose dilation of the inferior haemorrohdest pelvis and covered with modified skin.

Internal Hemorrhoids:

The varicose dilation of the superior haemorroidal plexus and covered by the mucus membrane

Degrees of the Hemorrhoids

1. 1^st Degree:

In this varicose veins are in small size and patient complains stool with blood and pain.

1. 2^nd Degree:

The varicose veins prolapsed out from anal canal at the evacuator but return in size with little pressure.

1. 3^rd Degree:

The hemorrhoids are prominently prolapsed and unable to return inside.

Etiology:

1. Constipation
2. Straining at stool
3. Prolonged sitting
4. Pregnancy
5. Obesity
6. Low fiber diet
7. Clinical features:
8. Bright red mucosal discharge
9. Varicose veins
10. Discomfort
11. Severe itching, bleeding may occurs
12. Hypotension
13. Anxious

Complications:

1. Thrombosis
2. Ischemic of the vein
3. Anemia
4. Gangrene
5. Ulceration
6. Rupture of varicose veins

Investigations:

1. Protosigmoid scopy
2. CBC
3. Urine DR

Medical Management:

1. Tab: Lexobron 1-2 tab: at bed time
2. Syp; Levolac 10-15 ml BD
3. Syp: Cremafin 20ml in milk
4. Advised for fiber diet and liquid intake

Surgical Management:

1. Hemorroidectomy

Nursing Management:

1. Position the patient in prone
2. For to control on pain warm compress should be provided
3. Fiber diet, fruit juices and liquids relieve the constipation and to relieve defecation
4. Oral laxatives should be given for easy bowel elimination
5. In case of spinal anesthesia the foot part of the bed should be elevated.

Definition:

Hepatitis is the inflammation of the hepatic cells (Kuffer’s cells)

Etiology:

1. Viral (Often)
2. Bacteria or toxic (due to injury)

Types of the Hepatitis

1. Hepatitis A, B, C, D, E, F, G, H.

Clinical features:

1. Anorexia
2. Nausea
3. Vomiting
4. Lethargy
5. Elevated ALT & AST level
6. Hepatomegaly
7. Tenderness
8. Dark urine
9. Elevated serum bilirubin level
10. Clay color stool
11. Malaise
12. Discomfort
13. Fever
14. Urticaria
15. Hepatomegaly

Incubation periods:

© HAV is a RNA virus 15-25 days

© HBV is a DNA virus 18-45 days

© HCV is a RNA virus 15-160 days

1. HDV (Delta Virus) is a RNA 02-25 days
2. HEV is a RNA virus
3. HGV is a RNA virus

Complication:

1. Cirrhosis of the liver
2. Death

Investigations:

1. Liver function studies
2. Hepatic serology
3. HGs Ag
4. Anti-HBs-IgH & Ig G
5. Anti-HAV-Igh & Ig G
6. Anti-HCV
7. PCR

Medical management :

1. HA vaccine/ HB vaccine (Prevention)
2. HC, HD, HE, HF, HG, HH (Treatment) Inj: Interferon.

Transmission:

HAV

1. Poor personal hygiene
2. Poor sanitation
3. Contaminated food, milk
4. Sexual contact
5. Feco-oral

HBV

1. Blood transmission
2. Semen transmission
3. Saliva transmission
4. Contaminated needles
5. Infected partners

HCV

1. Tattoo
2. Organ transplantation
3. Less frequent routes is sexual contact

HDV

1. Blood transmission
2. Semen transmission
3. Saliva transmission
4. Contaminated needles
5. Infected partners

HEV

1. Feco-oral route
2. Most common is drinking water

HGV

1. Blood donor

HCV

1. Blood transmission

Nursing Diagnosis:

1. Fatigue
2. Activity intolerance
3. Fluid volume deficit
4. Infection
5. Nutritional altered
6. Pain
7. Health maintenance
8. Skin integrity
9. Injury

Prevention Measures:

For Feco-oral transmission:

1. Proper hand washing by patient & staff
2. Wearing gloves when handling feces & urine
3. Proper handling of contaminated utensils & linens For Percutaneous:
4. Wearing gloves while handling blood & body fluids
5. Proper disposable of needles & Body fluids
6. Avoidance from open cuts
7. Teaching patients to avoid sexual contact until result of liver function tests have returned to the normal.