Category Archives: Nursing leadership and management

Gastro Intestinal System

Gastro-intestinal system

Gastro-intestinal tract

The Gastro-intestinal Tract is also termed as Digestive System and alimentary canal, consists of GI Tract and its accessory organs. The GI Tract is a hollow muscular tube that extends from mouth o anus. Its principal function is to provide the body with fluids, nutrients and electrolyte. This is accomplished through the process of ingestion (taking alcohol), digestion (breakdown of food) and absorption (transfer of food into circulation). Another main function of GI system is the storage and final excretion of solid waste products of digestion i.e.: elimination.

Location of organs in each abdominal Quadrant    
1. Right upper Quadrant (RUQ) 2. Right lower Quadrant (RLQ)
§ Liver · Caecum
§ Gall bladder · Appendix
§ Duodenum · Right ovary & tube
  1. Right Kidney
  2. Hepatic flexure of colon
3. Left upper Quadrant (LUQ) 4. Left lower Quadrant (LLQ)
§ Stomach · Sigmoid colon
§ Spleen · Left ovary & tube
  1. Left Kidney
  2. Pancreas
  3. Splenic flexure of colon
  4. Esophageal Carcinoma

Definition:

Carcinoma of the esophagus is unique in its geographic distribution. Both benign & malignant tumor occurs in the esophagus. Benign tumor are usually leimyomas, and extremely rare & usually asymptomatic. They require no intervention unless symptoms necessitate local excision. Malignant tumors of the esophagus are not common but they assume increased importance because of their virulence.

Location of esophagus:

Esophagus lies behind the trachea to which it adopts and in front of the vertebral column. Passing through the thorax it pierces the diaphragm to enter in abdomen where it communicates with the stomach. Its size is 9-10 inches.

Causes:

  1. Exact cause is idiopathic,
  2. Pre-disposing factors are:
  3. Taking alcohol
  4. Usage of tobacco and opium
  5. Excessive usage of beverages
  6. Induced caustic esophagus sphincter
  7. Ultra-violet radiations

Sign and Symptoms

  1. Tumor
  2. Dysphagia
  3. Odynophagia (typically)
  4. Heart burn
  5. Anorexia
  6. Weight loss
  7. Feeling mass in throat
  8. Painful swallowing
  9. Regurgitation
  10. Hiccup
  11. Chest pain
  12. Supera-clavicular lymphodenopathy

Complication:

  1. Hemorrhage
  2. Esophageal perforation
  3. Esophageal obstruction

Investigations:

  1. Chest X-ray
  2. CT scan
  3. Barium esophagography
  4. Bronchoscopy
  5. Biopsy
  6. MRI
  7. Blood CP

Medical treatment:

  1. Poly-functional alkyl ting agents:
  2. Antimetabolytes:
  3. e.g.: Folic acid, purine antagonistic
  4. ACTH
  5. Castration
  6. Miscellaneous drugs:
  7. Antibiotics drugs such as Actinomycin-D, Mytomycin

Surgical treatment:

  1. Surgical, the resection of the esophagus provides the most rapid durable relief of the Dysphagia, the standard surgical Management including partial removal of the esophagus.
  2. Esophagectomy
  3. Esophagogastrotomy
  4. Esophagoenterostomy

Radio-therapy:

  1. The radiotherapy may be given for a short time to provide relief to pain. Nursing Management:
  2. Please revise the general Nursing Management of the Neoplasm.
  3.  

Peptic Ulcer

Definition:

Peptic (Stomach + Duodenum) ulcer is an erosion of the Gastro-intestinal (GI) mucosa resulting from the digestive action of HCl and pepsin.

  1. HCl is produced by stomach parietal cells.
  2. Pepsin produced by___________________

Duodenal ulcer is common than gastric ulcer.

Classification of PUD:

Classification depends upon degree of the mucosal involvement & gastric or duodenal

Acute Ulcer:

Acute associated with superficial erosion & minimal inflammation. It is short-duration & resolves quickly when the cause is identified & removed.

Chronic Ulcer:

A long duration, eroding through the muscular wall with the formation of fibrous tissue. It is present continuously for many months or intermitely throughout the person’s life time. A chronic Ulcer is at least four times as common as acute erosions.

Difference between Gastric Ulcer & Duodenal Ulcer

No: Gastric Ulcer Duodenal Ulcer
1 Lesion: Lesion:
  Superficial, Smooth, Round shape Deep, Bulb shape (1-2 cm)
2 Gastric Secretion: Gastric Secretion:
  Increase, More found in women Increase, More found in men
3 Clinical features: Clinical features:
  Burning, Pain 1-2 hour after meal Burning, Cramping, pain 2-4 hours
    after meal
4 Pain: Pain:
  Left Epigastric region, often retrieved Mid-epigastria region, often not relieved
  by food by food

Causes:

  1. Idiopathic but Helico pylori bacterium is the major cause, and risk factors are:
  2. Smoking
  3. Stress
  4. Alcohol
  5. Excessive secretion of the HCl
  6. Heredity (Blood Group O)
  7. Hurry, Worry & Curry
  8. NSAID

Types of Peptic Ulcer:

  1. Gastric Ulcer
  2. Duodenal Ulcer
  3. Esophageal Ulcer
  4. Joudjenal Ulcer

Sign and Symptoms

  1. Epigastria pain
  2. Discomfort
  3. Vomiting (Gastric Ulcer)
  4. Weight loss (Gastric Ulcer)
  5. Weight gain (Duodenal Ulcer)
  6. Hunger (Duodenal Ulcer)
  7. Epigastria tenderness
  8. Dyspepsia
  9. Diaphoresis
  10. Constipation
  11. Endoscopy (Gastro scopy)
  12. Barium radiotherapy
  13. Biopsy
  14. Barium meal X-ray
  15. Blood CP
  16. Blood ESR
  17. Hemorrhage
  18. Perforation
  19. Pyloric stenosis
  20. Malignant Chance
  21. Gastric-intestinal obstruction
  22. Meal should be taken at regular interval
  23. Hurry, Worry, Curry, Spicy, Fry, Vinegary food should be avoided
  24. Avoid alcohol, smoking and beverages
  25. NSAID discontinues
  26. Syp: MOM
  27. Syp: Simeco
  28. Syp: Cremafin

H2 antagonistic receptors

  1. Tab: Zantac 150mg
  2. Tab: Anzol
  3. Cap: Zoton
  4. Cap: Benzin

Bosom pump inhibitor (more effective than H2 receptors)

  1. Omeprazole
  2. Pentaprazole
  3. Famotidine at night for 24 weeks
  4. Tab: Flodin
  5. Tab: Famodin
  6. Tab: Peptin Antibiotics
  7. Tab: Amoxicillin

If Medical therapy fails to heal, surgery is managed for the patient if chances of complications are.

  1. Partial gastrectomy
  2. Vagotomy
  3. Pyloroplasty

Nursing Management:

  1. Recumbent position should be maintained to prevent from severe hemorrhage
  2. Advised for left-lateral position for 20-30 minutes after eating
  3. Avoidance from alcohol, beverages, tobacco & spicy food
  4. Advice for small frequent meals
  5. Administration of anti-cholergic or anti-spasmodic medication as prescribed by the physician
  6. Maintain I/O chart
  7. TPR & BP should be monitored
  8. Tachyponea may occur due to loss of blood
  9. Provide psychological support
  10. Health education
  11. Observe for vomiting
  12. Assess for faintness