BSN213_Lesson10 & 11_Gastrointestinal Function.pdf

Hand Hygiene BSN213 Pathophysiology Gastrointestinal Function Sem. 2 – Week 10 & 11 2023/2024 Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, ori...

Hand Hygiene BSN213 Pathophysiology Gastrointestinal Function Sem. 2 – Week 10 & 11 2023/2024 Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org fchs.ac.ae Hand Hygiene Outline ✓ ✓ ✓ ✓ ✓ ▪ ✓ ✓ ✓ ✓ ✓ ✓ Disorders of the Upper Gastrointestinal Tract Dysphagia & Hiatal Hernia Gastroesophageal Reflux Disease , Gastritis and Peptic Ulcers Cholelithiasis Disorders of the Liver Cirrhosis Disorders of the Pancreas Pancreatitis Disorders of the Lower GI Tract Intestinal Obstruction Peritonitis Celiac Disease Inflammatory Bowel Disease Irritable Bowel Syndrome Diverticular disease Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org fchs.ac.ae Understanding Gastrointestinal Conditions https://youtu.be/bFczvJp0bpU Hand Hygiene Altered nutrition These conditions include issues consuming, digesting, and absorbing food. Affected individuals are often underweight and vitamin deficient. Disorders of the upper GI tract: congenital defects (cleft lip and palate and pyloric stenosis), dysphagia, vomiting, hiatal hernia, gastroesophageal reflux disease, gastritis, peptic ulcers, cholelithiasis. Disorders of the liver: hepatitis, cirrhosis Disorders of the pancreas: pancreatitis Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org fchs.ac.ae Understanding Gastrointestinal Conditions Hand Hygiene Impaired elimination These conditions may be symptoms of another secondary condition, or the primary one. They may alter nutrition as well as impair elimination. Disorders of the lower GI tract: diarrhea, constipation, intestinal obstruction, appendicitis, peritonitis, celiac disease, inflammatory bowel disease, irritable bowel syndrome, diverticular disease. Cancers: oral cancer, esophageal cancer, gastric cancer, liver cancer, pancreatic cancer, colorectal cancer. Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org fchs.ac.ae Pyloric Stenosis Hand Hygiene Also known as infantile hypertrophic pyloric stenosis. Narrowing and obstruction of the pyloric sphincter. The pyloric sphincter muscle fibers become thick and stiff, making it difficult for the stomach to empty food into the small intestine. May be present at birth or develop later in life. The exact cause of pyloric stenosis is unknown, but it is thought to be multifactorial—that is, a combination of environmental and hereditary factors. Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org fchs.ac.ae Pyloric Stenosis Hand Hygiene Manifestations appear within several weeks after birth and include: ✓A hard mass in the abdomen ✓Regurgitation ✓Projectile vomiting ✓Wavelike stomach contractions ✓Small and infrequent stools ✓Failure to gain weight ✓Dehydration ✓Irritability. Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org fchs.ac.ae Hand Hygiene Dysphagia Difficulty in swallowing. Manifestations: ✓a sensation of food being stuck in the throat ✓choking ✓coughing ✓pocketing” food in the cheeks ✓difficulty forming a food bolus ✓delayed swallowing ✓odynophagia Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org fchs.ac.ae Causes of dysphagia Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org Hand Hygiene fchs.ac.ae Hand Hygiene Hiatal Hernia A stomach section protrudes upward through an opening in the diaphragm toward the lung. Causes: weakening of the diaphragm muscle, frequently resulting from increased intrathoracic pressure or increased intra-abdominal pressure; trauma; and congenital defects. Risk factors: advancing age and smoking Vary in severity depending on size Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org fchs.ac.ae Hiatal hernia Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org Hand Hygiene fchs.ac.ae Hiatal Hernia Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org Hand Hygiene fchs.ac.ae Hiatal Hernia Hand Hygiene Manifestations Indigestion Heartburn Frequent belching Nausea Chest pain Dysphagia, and soft upper abdominal mass (protruding stomach pouch) Worsen with recumbent positioning, eating (especially after large meals), bending over, and coughing. Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org fchs.ac.ae Hand Hygiene Gastroesophageal Reflux Disease (GERD) Chyme periodically backs up from the stomach into the esophagus. Bile can also back up into the esophagus. These gastric secretions irritate the esophageal mucosa. Causes: ✓ Certain foods (e.g., chocolate, caffeine, carbonated beverages, citrus fruit, tomatoes, spicy or fatty foods, and peppermint), alcohol consumption, nicotine, ✓ Hiatal hernia, obesity, pregnancy, ✓ Certain medications (e.g., corticosteroids, beta blockers, calciumchannel blockers, and anticholinergics), ✓ Nasogastric intubation, and delayed gastric emptying Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org fchs.ac.ae Gastroesophageal Reflux Disease Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org Hand Hygiene fchs.ac.ae Hand Hygiene Gastroesophageal Reflux Disease Manifestations: ✓Heartburn, epigastric pain (usually after a meal or when recombinant), ✓Dysphagia, dry cough, laryngitis, pharyngitis, ✓Regurgitation of food, and sensation of a lump in the throat Often confused with angina and may warrant ruling out cardiac disease. Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org fchs.ac.ae Hand Hygiene Gastritis Inflammation of the mucosal lining of stomach (may involve the entire stomach or a region) Acute gastritis Can be a mild, transient irritation, or it can be a severe ulceration with hemorrhage Usually develops suddenly and is likely to be accompanied by nausea and epigastric pain Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org fchs.ac.ae Hand Hygiene The layers of the gastrointestinal tract Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org fchs.ac.ae Hand Hygiene Gastric Mucosa Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org fchs.ac.ae Hand Hygiene Gastritis Chronic gastritis Develops gradually. May be asymptomatic, but usually accompanied by a dull, epigastric pain and a sensation of fullness after minimal intake. Gastritis can be further categorized as erosive or non-erosive. Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org fchs.ac.ae Gastritis Hand Hygiene Gastroenteritis Inflammation of the stomach and intestines, usually because of an infection or allergic reaction Helicobacter pylori Most common cause of chronic gastritis. Embeds itself in the mucous layer, activating toxins and enzymes that cause inflammation. Genetic vulnerability and lifestyle behaviors (e.g., smoking and stress) may increase the susceptibility. Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org fchs.ac.ae Gastritis Hand Hygiene Other causes: ✓Organisms transmitted through food and water contamination, ✓Long-term use of non-steroidal anti-inflammatory drugs, ✓Excessive alcohol use, ✓Severe stress, ✓Autoimmune conditions, and other chronic diseases Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org fchs.ac.ae Hand Hygiene Gastritis Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org fchs.ac.ae Gastritis Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org Hand Hygiene fchs.ac.ae Gastritis Hand Hygiene Complications of chronic gastritis: ✓ peptic ulcers, gastric cancer, and hemorrhage Manifestations Include indigestion, heartburn, epigastric pain, abdominal cramping, nausea, vomiting, anorexia, fever, and malaise. Hematemesis and dark, tarry stools can indicate ulceration and bleeding. Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org fchs.ac.ae Hand Hygiene Peptic Ulcer Disease Lesions affecting the lining of the stomach or duodenum. Risk factors: being male, advancing age, nonsteroidal anti-inflammatory drug use, H. pylori infections, certain gastric tumors, and those for GERD (e.g., smoking and alcohol use). Vary in severity from superficial erosions to complete penetration through the GI tract wall. Develops because of an imbalance between destructive forces and protective mechanisms. Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org fchs.ac.ae Hand Hygiene Peptic Ulcer Disease Duodenal ulcers Most commonly associated with excessive acid or H. pylori infections Typically present with epigastric pain that is relieved in the presence of food Gastric ulcers Less frequent but more deadly. Typically associated with malignancy and nonsteroidal anti-inflammatory drugs. Pain typically worsens with eating. Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org fchs.ac.ae Hand Hygiene Peptic Ulcer Disease Stress ulcers Develop because of a major physiological stressor on the body due to local tissue ischemia, tissue acidosis, bile salts entering the stomach, and decreased GI motility. Curling’s ulcers: stress ulcers associated with burns. Cushing’s ulcers: stress ulcers associated with head injuries. Most frequently develop in the stomach; multiple ulcers can form within hours of the precipitating event. Often hemorrhage is the first indicator because the ulcer develops rapidly and tends to be masked by the primary problem. Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org fchs.ac.ae Peptic Ulcer Disease Hand Hygiene Manifestations: ✓Epigastric or abdominal pain, abdominal cramping, heartburn, indigestion, nausea, and vomiting Complications: GI hemorrhage, obstruction, perforation, and peritonitis Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org fchs.ac.ae Hand Hygiene Cholelithiasis Gallstones. A common condition that affects both genders. Risk factors: advancing age, obesity, diet, rapid weight loss, pregnancy, hormone replacement, and long-term parenteral nutrition. Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org fchs.ac.ae Location of Cholelithiasis Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org Hand Hygiene fchs.ac.ae Cholelithiasis Hand Hygiene Cholecystitis: inflammation or infection in the biliary system caused by calculi Varies in severity depending on size May obstruct bile flow and cause gallbladder rupture, fistula formation, gangrene, hepatitis, pancreatitis, and carcinoma Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org fchs.ac.ae Hand Hygiene Normal Cholesterol Excretion Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org fchs.ac.ae Cholelithiasis Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org Hand Hygiene fchs.ac.ae Hand Hygiene Cholelithiasis Manifestations: ✓Biliary colic ✓Abdominal distension ✓Nausea & Vomiting ✓Jaundice ✓Fever ✓Leukocytosis Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org fchs.ac.ae Bilirubin Excretion Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org Hand Hygiene fchs.ac.ae PATHOPHYSIOLOGY OF CBD OBSTRUCTION Hand Hygiene High Fat diet Gallstone formation (Cholelithiasis) Obstruction Decreased fat emulsification GB becomes inflamed, swollen, distended with bile steatorrhea Altered fat-soluble vitamin absorption Increased serum bilirubin Bile stasis Decreased bile flow to colon Jaundice, urticaria, Tea-colored urine Clay-colored stool (absence of bile pigment) Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org 36 fchs.ac.ae Cirrhosis of Liver Hand Hygiene Chronic, progressive, irreversible, diffuse damage to the liver resulting in decreased liver function Leads to fibrosis, nodule formation, impaired blood flow, and bile obstruction that can result in liver failure May take up to 40 years to develop. Causes: hepatitis and all those factors that can lead to hepatitis Hepatitis C infection and chronic alcohol abuse are the most frequent causes of cirrhosis in the United States. Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org fchs.ac.ae Hand Hygiene Cirrhosis of Liver Portal hypertension- Pressures rise as the hepatic artery and the portal vein become constricted by scar tissue in the liver. Esophageal varices- due to high pressure in the portal vein, there will be back flow of blood from the portal vein to its branches. Veins in the lower esophagus becomes engorged and varicosities develop. This varices may rupture easily. The spleen, pancreas, and stomach enlarge as it is using same circulation. Ascites - Fluid accumulates in the peritoneal cavity. As a result of: 1. Portal hypertension pushes fluid back into the abdominal cavity 2. The damaged liver can no longer produce sufficient amounts of albumin. Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org 38 fchs.ac.ae Hand Hygiene Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org fchs.ac.ae Hand Hygiene Development of esophageal varices Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org fchs.ac.ae Hand Hygiene Manifestations of Cirrhosis Portal hypertension Varicosities in the esophagus and abdomen Enlargement of nearby organs Bleeding, either slow or severe, particularly in the esophagus Ascites Changes in clotting factors Muscle wasting Hyperlipidemia Hyperglycemia or hypoglycemia Bile accumulation in the liver causes inflammation and necrosis Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org fchs.ac.ae Hand Hygiene Manifestations of Cirrhosis Jaundice Intolerance to fat and fatsoluble vitamin deficiency Clay-colored stools Dark urine Intense itching Excessive estrogen leads to female characteristics in men and irregular menstruation in women Numerous toxins and waste products accumulate Neurologic impairment Ulcers and GI bleeding Encephalopathy Spontaneous bacterial peritonitis Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org fchs.ac.ae Hand Hygiene Hepatic Encephalopathy - HE Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org fchs.ac.ae Effects of cirrhosis Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org Hand Hygiene fchs.ac.ae Pancreatitis Hand Hygiene Inflammation of the pancreas. Can be acute or chronic. Causes: Cholelithiasis (most common acute cause) Alcohol abuse (most common chronic cause) Biliary dysfunction ✓ Hepatotoxic drugs ✓ Metabolic disorders ✓ Trauma ✓ Renal failure ✓ Endocrine disorders(e.g., hyperthyroidism) ✓ Pancreatic tumors ✓ Penetrating peptic ulcer. Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org fchs.ac.ae Pancreatitis with gall stones Hand Hygiene Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org fchs.ac.ae Hand Hygiene Pancreatitis with peptic ulcer Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org fchs.ac.ae Hand Hygiene Pancreatitis Pancreas injury causes pancreatic enzymes (lipase, and elastase) to leak into the pancreatic tissue and initiate autodigestion. Break down of tissue and cell membranes, resulting in edema, vascular damage, hemorrhage, and necrosis. Pancreatic tissue is replaced by fibrosis, which causes exocrine and endocrine changes and dysfunction of the islets of Langerhans. Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org fchs.ac.ae Hand Hygiene Effects of Acute Pancreatitis Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org fchs.ac.ae Pancreatitis Hand Hygiene Acute pancreatitis Considered a medical emergency. Mortality increases with advancing age and comorbidity. Manifestations usually sudden and severe Upper abdominal pain that radiates to the back, worsens after eating, and is somewhat relieved by leaning forward or pulling the knees toward the chest Nausea and vomiting Mild jaundice Low-grade fever Blood pressure and pulse changes Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org fchs.ac.ae Pancreatitis Hand Hygiene Complications: ✓Acute respiratory distress syndrome ✓Diabetes mellitus ✓Infection ✓Shock ✓Disseminated intravascular coagulation ✓Renal failure ✓Malnutrition ✓Pancreatic cancer ✓Pseudo cyst, and abscess Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org fchs.ac.ae Hand Hygiene Intestinal Obstruction Blockage of intestinal contents in the small intestine or large intestine Two types: ✓ Mechanical- obstructions consist of physical barriers due to foreign bodies, tumors, adhesions, hernias, intussusception (telescoping of a portion of the intestine into another portion), volvulus. ✓ Functional (also called paralytic ileus) - obstructions result from GI tract dysfunction. Due to neurologic impairment; intra-abdominal surgery complications; chemical, electrolyte, and mineral disturbances; intra-abdominal infections; abdominal blood supply impairment; renal and lung disease; and use of certain medications (e.g., narcotics) Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org fchs.ac.ae Hand Hygiene Causes of intestinal obstruction Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org fchs.ac.ae Adhesion Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org Hand Hygiene fchs.ac.ae Intestinal Obstruction stricture & intussusception Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org Hand Hygiene fchs.ac.ae Intestinal Obstruction- volvulus Hand Hygiene Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org fchs.ac.ae Hand Hygiene Effects of intestinal obstruction Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org fchs.ac.ae Intestinal Obstruction Hand Hygiene Manifestations: ✓ abdominal distension, abdominal cramping, colicky pain, nausea, vomiting, constipation, diarrhea, borborygmi (audible bowel sounds; associated with mechanical obstruction), ✓ intestinal rushes, decreased or absent bowel sounds, ✓ restlessness, diaphoresis, ✓ tachycardia progressing to weakness, ✓ confusion, and shock. Complications: perforation, Peritonitis, pH imbalances, fluid disturbances, shock, and death. Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org fchs.ac.ae Appendicitis Hand Hygiene Inflammation of the vermiform appendix. Most often caused by an infection. Triggers local tissue edema, which obstructs the small structure. As fluid builds inside the appendix, microorganisms proliferate. The appendix fills with purulent exudate and the blood vessels become compressed. Ischemia and necrosis develop. The pressure inside the appendix escalates and forcing bacteria and toxins out to the surrounding structures. Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org fchs.ac.ae Appendicitis Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org Hand Hygiene fchs.ac.ae Appendicitis Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org Hand Hygiene fchs.ac.ae Appendicitis Hand Hygiene Manifestations: Vary from asymptomatic to sudden and severe. Sharp abdominal pain develops, gradually intensifies (over about 12–24 hours) and becomes localized to the lower right quadrant of the abdomen (McBurney point). Nausea, vomiting, abdominal distension, and bowel pattern changes Indications of inflammation and infection (e.g., fever, chills, and leukocytosis) Indications of peritonitis (e.g., abdominal rigidity, tachycardia, and hypotension) Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org fchs.ac.ae Appendicitis Hand Hygiene Complications: ✓Abscesses ✓Peritonitis ✓Gangrene ✓Death. Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org fchs.ac.ae Peritonitis Hand Hygiene Inflammation of the peritoneum, the membrane that lines the abdominal wall and abdominal organs. Causes: chemical irritation (e.g., ruptured gallbladder or spleen) or direct organism invasion (e.g., appendicitis and peritoneal dialysis) Several protective mechanisms are activated along with the inflammatory response to localize the problem. ✓A thick, sticky exudate that bonds nearby structures and temporarily seals them off. ✓Abscesses may form in an attempt to wall off the infections. ✓Peristalsis may slow down in a response to the inflammation, decreasing the spread of toxins and bacteria. Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org fchs.ac.ae Development of peritonitis Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org Hand Hygiene fchs.ac.ae Manifestations - Peritonitis Usually sudden and severe Classical manifestation = abdominal rigidity A rigid, boardlike abdomen Abdominal tenderness and pain Large volumes of fluid leak into the peritoneal cavity Nausea and vomiting Hand Hygiene Decreased peristalsis Intestinal obstruction Indicators of infection (e.g., fever, malaise, and leukocytosis) Indications of sepsis and shock (e.g., tachycardia, hypotension, restlessness, and diaphoresis) Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org fchs.ac.ae Peritonitis Manifestations fluid leakage Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org Hand Hygiene fchs.ac.ae Celiac Disease Hand Hygiene Also known as celiac sprue or gluten-sensitive enteropathy Inherited, autoimmune, malabsorption disorder Primarily a childhood disease, but can develop at any age Results from a combination of the immune response to an environmental factor (gliadin) and genetic predisposition Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org fchs.ac.ae Hand Hygiene Celiac Disease Villi of the small intestines Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org © Donna Beer Stolz, PhD, Center for Biologic Imaging, University of Pittsburgh Medical School fchs.ac.ae Celiac Disease Hand Hygiene Most common in Caucasians and females. Tropical sprue is a related disorder that occurs in tropical regions and is thought to be caused by a bacterial, viral, parasitic, or amoebic infection. Can be resolved with antibiotic therapy Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org fchs.ac.ae Celiac Disease Hand Hygiene Results from a defect in the intestinal enzymes that prevents further digestion of gliadin (a product of gluten digestion). Gluten is an ingredient of some grains. Intestinal villi atrophy and flatten, resulting in decreased enzyme production and making less surface area available for nutrient absorption. Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org fchs.ac.ae Celiac Disease Hand Hygiene Manifestations In infants, generally appear as cereals are added to their diet (usually around 4–6 months of age) Include abdominal pain, abdominal distension, bloating, gas, indigestion, constipation, diarrhea, changes in appetite, lactose intolerance, nausea, vomiting, steatorrhea, unexplained weight loss, irritability, lethargy, malaise, and behavioral changes. Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org fchs.ac.ae Hand Hygiene Celiac Disease Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org fchs.ac.ae Celiac Disease Hand Hygiene Complications: ✓anemia, arthralgia, myalgia, bone disease, dental enamel defects and discoloration, intestinal cancers, depression, growth and development delays in children, hair loss, hypoglycemia, mouth ulcers, increased bleeding tendencies, neurologic disorders, skin disorders, vitamin or mineral deficiency, and endocrine disorders. Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org fchs.ac.ae Hand Hygiene Inflammatory Bowel Disease (IBD) Chronic inflammation of the GI tract, usually the intestines Chiefly seen in women, Caucasians, persons of Jewish descent, and smokers Includes Crohn’s disease and ulcerative colitis Characterized by periods of exacerbations and remissions Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org fchs.ac.ae Hand Hygiene Inflammatory Bowel Disease Thought to be caused by a genetically associated autoimmune state that has been activated by an infection. Immune cells located in the intestinal mucosa are stimulated to release inflammatory mediators that alter the function and neural activity of the secretory and smooth muscle cells. Fluid, electrolyte, and pH imbalances develop. Can be painful, debilitating, and life-threatening. Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org fchs.ac.ae Crohn’s Disease Hand Hygiene Insidious, slow-developing, progressive condition Often develops in adolescence Characterized by patchy areas of inflammation involving the full thickness of the intestinal wall and ulcerations (skip lesions) Form fissures divided by nodules, giving the intestinal wall a cobblestone appearance Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org fchs.ac.ae Crohn’s Disease Hand Hygiene The entire wall becomes thick and rigid, and the intestinal lumen becomes narrowed and potentially obstructed. Granulomas develop on the intestinal wall and nearby lymph nodes. The damaged intestinal wall loses the ability to digest and absorb. The inflammation also stimulates intestinal motility, decreasing digestion and absorption. Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org fchs.ac.ae Crohn’s Disease Hand Hygiene Manifestations: ✓ Abdominal cramping and pain (typically in the right lower quadrant), diarrhea, steatorrhea, constipation, palpable abdominal mass, melena, anorexia, weight loss, and indications of inflammation (e.g., fever, fatigue, arthralgia, and malaise) Complications: ✓ Malnutrition, anemia (especially iron deficiency), fistulas, adhesions, abscesses, intestinal obstruction, perforation, anal fissure, and delayed growth and development as well as fluid, electrolyte, and pH imbalances. Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org fchs.ac.ae Crohn’s Disease Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org Hand Hygiene fchs.ac.ae Crohn’s Disease Crohn’s Disease Hand Hygiene Cobblestone appearance 81 Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org fchs.ac.ae Ulcerative Colitis Hand Hygiene Progressive condition of the rectum and colon mucosa. Usually develops in the second or third decade of life. Inflammation triggered by T-cell accumulation in the colon mucosa causes epithelium loss, surface erosion, and ulceration that begins in the rectum and extends to the entire colon. Rarely affects the small intestine. The mucosa becomes inflamed, edematous. Necrosis of the epithelial tissue can result in abscesses. Granulation tissue forms that is fragile and bleeds easily. The ulcers merge, creating large areas of stripped mucosa that results in an inadequate surface area for absorption. Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org fchs.ac.ae Ulcerative Colitis Hand Hygiene Manifestations: ✓ Diarrhea (usually frequent [as many as 20 daily], watery stools with blood and mucus), tenesmus, proctitis, abdominal cramping, nausea, vomiting, weight loss, and indications of inflammation (e.g., fever, fatigue, arthralgia, and malaise) Complications: ✓ Malnutrition, anemia, hemorrhage, perforation, strictures, fistulas, pseudo polyps, toxic megacolon, colorectal carcinoma, and liver disease, as well as fluid, electrolyte, and pH imbalances. Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org fchs.ac.ae Ulcerative Colitis Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org Hand Hygiene fchs.ac.ae Hand Hygiene Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org fchs.ac.ae Irritable Bowel Syndrome Hand Hygiene Chronic, non-inflammatory, GI condition characterized by exacerbations associated with stress. Includes alterations in bowel pattern and abdominal pain not explained by structural or biochemical abnormalities. Less serious than IBD, is non-inflammatory, and does not cause permanent intestinal damage Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org fchs.ac.ae Irritable Bowel Syndrome Hand Hygiene More common in women than in men Three theories of its etiology: altered GI motility, visceral hyperalgesia, and psychopathology Thought to be an intensified response to stimuli with increased intestinal motility and contractions—may have a low tolerance for stretching and pain in the intestinal smooth muscle Complications: ✓hemorrhoids, nutritional deficits, social issues, and sexual discomfort Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org fchs.ac.ae Irritable Bowel Syndrome Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org Hand Hygiene fchs.ac.ae Irritable Bowel Syndrome Hand Hygiene Manifestations Stress, mood disorders, food, and hormone changes often worsen symptoms. Abdominal distension, fullness, flatus, and bloating Intermittent abdominal pain exacerbated by eating and relieved by defecation. Chronic and frequent constipation or diarrhea, usually accompanied by pain Non bloody stool that may contain mucus Bowel urgency Intolerance to certain foods (usually gas-forming foods and those containing sorbitol, lactose, and gluten) Emotional distress Anorexia Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org fchs.ac.ae Hand Hygiene Diverticular disease It refers to conditions related to the development of diverticula. Diverticula (singular: diverticulum) are outwardly bulging pouches of the intestinal wall that develop when mucosa sections or large intestine submucosa layers herniate through a weakened muscular layer. Causes: A low-fiber diet that results in chronic constipation. Poor bowel habits (e.g., straining and delaying defecation) Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org 90 fchs.ac.ae Diverticular disease 91 Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org Hand Hygiene fchs.ac.ae Hand Hygiene Diverticular disease Diverticulosis describes asymptomatic diverticular disease, usually with multiple diverticula present. Diverticulitis refers to a state in which diverticula have become inflamed, usually because of retained fecal matter. It can result in potentially fatal obstructions, infection, abscess, perforation, peritonitis, hemorrhage, and shock. Clinical manifestations: abdominal cramping, followed by passing a large quantity of frank blood, Bleeding. Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org 92 fchs.ac.ae