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• The note cover a range of gastrointestinal (GI) and colorectal conditions and procedures to address them

Current Health Assessment:

• Includes questions of last bowel movement (and whether normal), current changes (color, consistency, frequency), and last menstrual period (for 10-65 year olds).

Patient History:

• Includes surgical history and skin changes (itching, color, bruising, tendency to bleed)

Nutrition History Assessment:

• Inquires about normal eating habits, stopped foods (due to stomach issues), cultural preferences (spicy foods, fasting), and lactose intolerance.
• Notes any health problems that affect nutrition which could lead to decreased appetite, changes/loss of taste, or anorexia.
• Checks for difficulty swallowing or pain with swallowing/chewing.
• Considers dentition (condition as well as ill fitted dentures) and unintentional weight loss or gain.
• Includes use of a large amount of caffeine/ETOH, smoking.
• Assesses access to a balanced diet (consider income limitations), which includes no assess to fresh fruits and vegetables (food desert)
• Checks for use of OTC medications and herbal remedies for abdominal issues

Family History:

• Assess for any Colon cancer history (especially within first degree relatives)

Physical Assessment:

• Requires that the bladder is emptied
• Patient should be lying flat with the arms relaxed at the sides and knees slightly flexed.
• Inspect the abdomen for movement, color, symmetry, and distention.
• Auscultate to check for high-pitched sounds (q 5-15 seconds), decreased/absent sounds (listen for full 5 minutes), bruits (whooshing sound), and borborygmi (loud, high-pitched gurgling).
• Percuss to determine the size of solid organs.
• Palpate to detect masses/fluid/air and tympanic/dull sounds and tenderness or masses.

Labs:

• A complete blood count (CBC): checks for anemia and infection.
• Blood tests for decreased calcium, potassium, and sodium.
• Liver function tests: aspartate aminotransferase (AST) and alanine aminotransferase (ALT).
• Amylase and lipase: for acute pancreatitis (elevated within 24 hours and can last up to 5 days).
• Ammonia levels: especially in alcoholics, pancreatitis, and cholecystitis patients.
• Cancer antigen 19-9 (CA 19-9)/carcinoembryonic antigen (CEA): oncofetal antigen test for cancer therapies/recurrency.
• Blood test for levels of: bilirubin and coagulation studies (PT).
• Stool tests: fecal occult blood test (FOBT), ova and parasites, fecal fats (for malabsorption), and Clostridium difficile.

Diagnostic Assessments:

• Abdominal ultrasound, X-ray, Magnetic Resonance Imaging (MRI), and Computed Tomography (CT).
• Abdominal CT: Assess allergies to shellfish/iodine. Hold metformin (diabetics) 24 hours before and 48 hours after (can cause contrast-induced renal failure).
• Endoscopies: small bowel endoscopy, esophagogastroduodenoscopy (EGD), endoscopic retrograde cholangiopancreatography (ERCP), virtual colonoscopy (CT colonography), and a colonoscopy (age 45 or older; every 10 years).
• Bowel prep (liquid/pill form; enema), hold anticoagulants/aspirin 5 days prior, drink electrolyte replacements (clear liquid diet), and no red, orange, or purple dye. Biopsy may cause a small amount of blood, report larger amounts due to risk of perforation and no fluids until flatus occurs after surgery
• Sigmoidoscopy performed every five years in patients 45 years and older.
• Liver-Spleen Scan uses of a radioactive chemical through IV and requires checking pregnant/breastfeeding status. Use careful hand hygiene because residual chemical will be excreted.

Effects of Aging on the GI Tract:

• Atrophy of gastric mucosa: risk for decreased food breakdown, decreased protein/vitamin B12/iron absorption, and increased bacterial growth. Interventions: dietary changes, easier-to-digest foods, supplemental vitamins/minerals (calcium, zinc, iron, vitamin B12).
• Decreased peristalsis: can cause decreased sensation on urge to defecate, constipation, and fecal impaction. Interventions: dietary changes, laxatives, and scheduled bowel routine.
• Calcification of pancreatic vessels: can cause distention/dilation of pancreatic duct, inability to absorb fat solute vitamins (A, E, D, K), inability to digest and store fat, fatty stools, and decreased lipase levels. Interventions: pancreatic enzymes, vitamin supplements.
• Decreased number/size of hepatic cells: can cause decreased ability to metabolize drugs, leading to toxicity. Adjust medication dose.
• Decreased aerobic/anaerobic flora: impacts disease response, obesity, and inflammatory disease. Interventions include prebiotics and probiotics.
• Function of the stomach includes digestion and as an endocrine organ and reservoir.

Gastritis:

• Inflammation/breakdown of gastric mucosa, it is not typically treated in hospital unless there is GI bleed or fluid/electrolyte imbalance.
• Acute gastritis has a sudden onset with a short duration due to exposure of gastric mucosa to a local irritant (H. pylori, contaminated food/water), changes to the stomach/duodenum, NSAID use, ETOH, caffeine, steroids, smoking, stress, reflux of bile salts, contaminated foods/water. Check if they have traveled anywhere.
• Diagnosis is confirmed viewing irritation with a colonoscopy.
• Recognizing this condition includes rapid onset of epigastric pain (increased/decreased with eating), hiccupping (several hours/days), N/V, anorexia, intolerance of spicy/fatty foods, cramping, dyspepsia, and hematemesis/melena.
• The gastric mucosa during acute conditions can resolve on its own within a few days of onset.
• Chronic gastritis is often related to autoimmune disorder with persistent inflammation deep into the mucosa, and inflammation is more widespread. The gastric walls thin and atrophy.
• Causes include: pernicious anemia, H. pylori, age (declining stomach lining), and GERD.
• Visual appearance on colonoscopy will show very deep erosions coving almost the entire gastric mucosa.
• Recognizing this condition includes nausea/vomiting, epigastric discomfort after eating, and abdominal pain (deep, persistent, and widespread).
• Diagnosis of gastritis includes EGD with biopsy (gold standard). NPO 6-8 hours prior; outpatient basis but need driver due to IV sedation; sore throat can occur (lidocaine spray can be given); and monitor for manifestations of perforation (chest/abdominal pain, fever, nausea, vomiting, abdominal distention).
• Blood samples check for elevated levels IgG/IgM (anti-H pylori antibodies produced by immune system in response to H. pylori infection) and CBC to check for anemia (less than 12 in females and less than 14 in males).
• Treatment includes treating the cause and limit foods that cause irritation (spicy, alcohol, caffeine).
• Surgical interventions are rare.

Medications for the Treatment of Gastritis:

• H2-receptor antagonist decreases gastric secreations, blocking histamine receptors in peridontal cells.
• Mucosal barrier fortifiers protect stomach mucosa: sucralfate (Carafate) give one hour before or two hours after meals, at bedtime (food interferes with drug adhering to mucosa.)
• Antacids increase the pH. Magnesium Hydroxide with aluminum hydroxide (give 2 hrs after meals and at bedtime for higher hydrogen ion load and use liquid rather than tablets.
• Proton pump inhibitors (PPIs) suppress HK-ATPase enzyme system of gastric acid secretion to suppress acid: Omeprazole, Lansoprazole, Rabeprazole, Pantoprazole, Esomeprazole.
• Antimicrobials treat H. pylori infection: Metronidazole, Clarithromycin, Amoxicillin, and Tetracycline.
• Prostaglandin analogs stimulate mucosal and decreases gastric secretions: Misoprostol

Gastric Cancer:

• Adenocarcinoma that begins in the glands and cells of the stomach mucosa is curable if caught early.
• The 5-year survival rate of adults with stomach cancer in US is poor due to lack of symptoms until disease advances thus there are high chane of metastasis. Increase in those older then 50.
• Causes include H. pylori infection, HPV, Streptococcus Bovis, chronic gastritis, gastric pollyps, gastric surgery, smoking, heavy alcohol use, diet (pickled foods, low intake of fruits and vegetables
• Early recognizing cues include diet changes, most often ignore or tumor grows. advanced includes weight and fatigue due to lack of nutrition
• Diagnostic includes EDG with biopsey and endoscopic ultrasound

Gastric Cancer Treatment:

• Involves chemotherapy to prolong survival, and radiation for palliative care.
• Surgery: resection is preferred, plus insertion to remove secretions.
• Post-op: monitor chest and abdominal pain, CT and MRI scans, elevated CEA in people with CRC.

Colostomys:

• Total gastrectomy entire stomach removed and small intestine connected to oesophagus which requires Pre-op care.
• Ascending colostomy and descending colostomy are to prevent tumor growth
• Aftercare: Perineal wound care, prevent compliations, and pain releif
• Treatment for UC and Crohn's Disease to decrease diarhea using non surgical and surgical inventions. Provide skin protect and Nutrition for the patient. Total Colectomy to remove colon if other treatments wont work

Intestinal and Rectal Disorders:

• Irritable bowel syndrome includes abnominal swelling causing pain due to bowl issues. Which can cause stress or anxiety and make the patient smoke more.
• Hydrogen breath test, small frequent meals and pain medication can treat bowel bacterial
• Diverticula: hypertrophy and thickening of colon and infection in those area. Needs high fiber high fluid or may cause a bleed

Chron's Disease:

• Is a chronic disorder with symptoms like Diarrhea and fatigue. Its test and lab are decrease album and folic acis levels with elevated
• Treat with medications that are Non Surgical
• Ulcerarive Coltis is similar but requires more surgical and drug therapy.