UPPER GI SYSTEM DISORDER.pdf

UPPER GI SYSTEM DISORDER PELLAGRA Vitamin B3 (Niacin) deficiency Organs Part of the Upper GI System Scaly rashes Mouth Mucosal inflammatio...

UPPER GI SYSTEM DISORDER PELLAGRA Vitamin B3 (Niacin) deficiency Organs Part of the Upper GI System Scaly rashes Mouth Mucosal inflammation Mental changes (e.g. dementia) Pharynx Sensitivity to sunlight Esophagus Diarrhea Stomach Alopecia Duodenum Edema Insomnia 4D’s of Pellagra MANAGEMENT OF PATIENTS WITH 1. Dermatitis MALNUTRITION 2. Diarrhea Starvation and obesity 3. Dementia 4. Death TWO TYPES OF STARVATION Treatment: Niacin or Nicotinamide 1. Primary Malnutrition occurs when adequate nutrition is not delivered to the upper GI tract METABOLIC SYNDROME over an extended period of time (e.g. famine, Increased BP anorexia, mechanical obstructions of the GI Insulin resistance tract, fad diets). Excess body 2. Secondary Malnutrition occurs when the upper fats/obesity around GI tract fails to absorb, metabolize or use the waist (apply nutrients (e.g. ischemic bowel or Crohn’s shape)/ central disease). obesity Elevated triglycerides DIFFERENT TYPES OF MALNUTRITION Low HDL levels High blood pressure 1. KWASHIORKOR Inadequate protein intake with adequate calorie intake. Management of Patients with Ingestive Body weight at or above ideal weight. Disorders Edema sometimes present. Visceral proteins (albumin, prealbumin, ORAL DISORDER transferrin) below normal. 1. STOMATITIS caused by mechanical, chemical trauma Aphthous stomatitis (canker sores). Recurrent small ulcerated lesions of the soft tissues of the mouth (lips, tongue, inside the cheeks). Causes: Stress, trauma, 2. MARASMUS vitamin deficiency, food or Inadequate calorie and protein intake. drug allergies, endocrine Cachectic appearance. imbalances and viral infections. Body weight and anthropometric Signs and symptoms: Well-circumscribed measurements are below normal. erythematous macule that undergoes Visceral proteins within normal range. necrosis. Collaborative management: Avoid tomatoes, chocolates, eggs, shellfish, milk products, nuts and citrus fruits. These are irritating to the lesions.  4. ORAL CANDIDIASIS 2. HERPES SIMPLEX (HSV) Also called oral thrush Type 1- fever caused by Candida blister (Herpes albicans. Labialis) “Cold Risk factors: sore” immunosuppression, Viral infection prolonged antibiotic that causes therapy blisters in the Signs and symptoms: mouth and in - White patches of the lips and the tongue, palate, tongue; buccal mucosa (“milk curds”) appears Nursing Interventions: coated. - Assess for pain, tenderness, bleeding in It is contagious oral cavity, fever Lasts about a week - Assess for history of infections, use of Collaborative Management: antibiotics, treatments with radiation or - Analgesics chemotherapy - Antimicrobials - Analgesic as prescribed (ASA, - Local anesthetics Acetaminophen) - Mouthwash - Topical agents, swishes - Acyclovir (Zovirax) - Liquid or pureed diet - Avoid spicy foods, citrus juices, hot liquids. To prevent irritation of lesions. - Good oral hygiene. 3. VINCENT’S ANGINA - Warm water, half strength hydrogen Necrotizing peroxide. Ulcerative - Avoid astringent mouthwash. Its alcohol Gingivitis, Trench content is irritating. mouth Acute bacterial TUMORS OF THE ORAL CAVITY infection of the a. Benign tumors – fibromas, lipomas, gingival tissues neurofibromas, hemangiomas. Causes: fusiform bacteria, spirochetes, poor b. Premalignant tumors oral hygiene, nutritional deficiency, lack of rest or sleep, local tissue damage, systemic 1. LEUKOPLAKIA BUCCALIS infections, blood dyscrasias, diabetes - Precancerous, yellow- mellitus white or gray-white SIGNS AND SYMPTOMS lesions. o Ulcers covered with pseudomembranes - Due to chronic irritation o Elevated WBC of the mucosa o Foul taste (physical, thermal, o Pain chemical) e.g smoking, o Choking sensation spicy foods. o Fever - May accompany poor nutrition or syphilis o Thick secretions - Avoid tobacco, very hot drinks, spicy foods o Anorexia o Lymphadenopathy 2. ERYTHROPLAKIA - Red, velvety appearing patch often indicative of early squamous cell carcinoma. MALIGNANT TUMORS LIP DISORDERS 1. SQUAMOUS CELL CARCINOMA This arises from tiny flat squamous cell of the 1. ACTINIC CHEILITIS mucous membranes. Whitish keratosis Most common type of oral cancer. May lead to cancer CAUSES This is associated - Chronic irritation of the mucous lining of the to too much sun mouth and oral cavity (e.g. smoking, exposure alcohol) Prevention and - Poor oral hygiene treatment is to use - Jagged tooth lip gloss during hot weather - Improperly fitted dentures - Hot, spicy foods, drinks - Malnutrition 2. CONTACT DERMATITIS - Syphilis- due to leukoplakia This is due to allergy to cosmetics, - Liver cirrhosis – due to alcohol toothpaste, powder - Positive family history and anything that Occurs in the lips, buccal mucosa. Tongue, comes in contact with floor of the mouth, tonsils the lips. COLLABORATIVE MANAGEMENT This is characterized - Surgery by itching and - Chemotherapy erythema of the lips. - Radiation Therapy Prevention is to identify and avoid the cause. Surgery - Hemiglossectomy (partial removal of the tongue) 3. LIP CANCER - Glossectomy (total removal of the tongue) Usually squamous cell cancer - Radical Neck Dissection Lower lip is commonly affected - Mandibulectomy Higher incidence in men - Commando operation Risk factors to lip cancer are as follows: - Tracheostomy Excessive sun exposure - NGT feeding; gastrostomy feeding; TPN Tobacco smoking Alcohol Constant irritation SALIVARY GLAND DISORDERS 1. PAROTITIS DISORDERS OF THE ESOPHAGUS  Due to prolonged NPO, diuretic therapy, AtSO4 administration 1. Dysphagia  It occurs among postop clients. It is Difficulty in swallowing called “surgical parotitis” 2. Odynophagia Collaborative Management Painful swallowing, which is usually severe and long lasting 2. SIALOLITHIASIS It is accompanied by diffuse esophageal Stones or calculi spasm in the salivary Triggered by cold beverage, carbonated glands beverage or solid foods This is due to 3. Regurgitation inactive glands, Ejection of small amounts of chyme or gastric metabolic juice from the mouth and antecedent nausea. conditions, precipitation of salts. 4. Heartburns/Pyrosis/Indigestion/Dyspepsia Signs: swelling, pain Painful sensation of warmth and burning in Treatment: Local excision the lower retrosternal midline area. Triggered by gastroesophageal reflux. 5. Achalasia 8. Esophageal Diverticulum Impaired motility of the lower 2/3 of the Outpouching of the mucosa of the esophagus esophagus. LES fails to relax swallowing Types: TREATMENT: a) Pulsion – weakness through the muscle Bougienage – esophageal dilatation (lower wall of the esophagus part and sphincter) with b) Traction – pulling outward of the pneumatic/hydrostatic balloon into the esophageal wall due to cardiac sphincter, under fluoroscopy. scarred/enlarged peri-bronchial lymph Esophagomyotomy node SIGNS AND SYMPTOMS 6. Esophagitis - Dysphagia  This is due to bacteria, trauma or irritation - Fullness in the neck from food or tobacco. - Regurgitation - Tracheal irritation 7. GASTROESOPHAGEAL REFLUX DISEASE - Coughing/belching (GERD/REFLUX ESOPHAGITIS) MANAGEMENT Backward flow of gastric contents into the - Blenderized food esophagus - Antacids as ordered This is due to inappropriate relaxations of the - Small frequent feedings LES - Backrest for several hours after eating Risk Factors - Avoid irritating foods - Nicotine - Surgery - High fat foods - Care of clients with chest tubes during - Xanthine derivatives (Theophylline, the post op period Caffeine) - Ganglionic stimulants 9. Cancer of the Esophagus - Beta adrenergic agents Lower 2/3 of the esophagus is most - Elevated estrogen/progesterone levels commonly affected. Signs and Symptoms Predisposing factors: - Heartburn - Alcohol - Odynophagia - Smoking - Dysphagia - Spicy foods - Water brash - Poor oral hygiene - Acid Regurgitation - Family history - Eructation - Obesity Management - Drinking large volume of hot tea - Antacids MANAGEMENT bn - Histamine blockers - Esophagogastrectomy and Gastrostomy - Bethanecol feedings - Reglan - Small Frequent feedings - Fluids with meals - Eat slowly and and chew food thoroughly - Avoid very hot or cold foods, spices, fats, alcohol, coffee, chocolates, citrus juices, eating and drinking 3 hours before retiring at night. - Elevate head of bed 6-8 inches - Weight reduction - Avoid tobacco, salicylates, phenylbutazone Surgery - Nissen’s Fundoplication - Hill’s operation - Belsey’s repair (Mark IV) GASTRITIS An inflammation of the gastric mucosa, 2. CHRONIC GASTRITIS classified as either acute or chronic 3 DIFFERENT FORMS 1) SUPERFICIAL GASTRITIS 1. ACUTE GASTRITIS It causes a reddened, edematous RISK FACTORS mucosa with small erosions and Ingestion of corrosive, erosive or infectious hemorrhages. substance (ASA, NSAIDS, Digoxin, 2) ATROPHIC GASTRITIS chemotherapeutic drugs, steroids, Characterized by a decreased alcoholism, poisoning). number of parietal and chief cells. It Excessive amounts of tea, coffee, mustard, occurs in all layer of the stomach, paprika, cloves and pepper. develops frequently in association Foods with rough texture or those eaten at with gastric ulcer and gastric cancer high temperature. and is invariably present in pernicious Ingestion of corrosive agents such as lye or anemia. drain cleaner. 3) HYPERTROPHIC GASTRITIS Prolonged emotional tension. It produces a dull and modular CLINICAL MANIFESTATIONS mucosa with irregular, thickened or - Epigastric discomfort modular rugae. Hemorrhage occur - Abdominal tenderness frequently. - RISK FACTORS OF CHRONIC GASTRITIS - Cramping - Age chronic gastritis is more common in - Belching older adults. - Reflux - Peptic ulcer disease (PUD) - Severe nausea and vomiting - Helicobacter pylori infection - Hematemesis - Gastric surgery - Diarrhea (within 5 hours of ingestion of - Other risk factors are similar to acute contaminated food gastritis NURSING MANAGEMENT CLINICAL MANIFESTATIONS OF REMOVE THE CAUSE AND TREAT THE CHRONIC GASTRITIS MANIFESTATIONS - Anorexia - Antiemetics for vomiting - Feeling of fullness - Antacids or Histamine (H2) receptor - Dyspepsia antagonists for pain - Belching - NPO until nausea and vomiting subside - Vague epigastric pain - Once the patient tolerates food, the diet - Nausea and vomiting includes decaffeinated coffee, tea, - Intolerance of spicy or fatty foods gelatin, toast and simple bland foods MANAGEMENT OF CHRONIC GASTRITIS - Avoid spicy foods, caffeine and large - Bland diet, small frequent meals, heavy meals antacids, anticholinergics, sedatives and avoidance of foods that causes manifestations. - If H.pylori infection is present: Clarithromycin (Baxin), Metronidazole (Flagyl), Omeprazole (Prilosec) is prescribed. - Corticosteroids may be prescribed for parietal cell regeneration. - Vitamin B12 intramuscular injections, monthly if the client has pernicious anemia REDUCE PAIN - Avoid food and beverages that cause pain - Avoid alcohol consumption - Avoid smoking  - Aluminum hydroxide with Magnesium trisilicate (Gaviscon) which produces a soothing foam is the best antacid for gastritis - H2 receptor antagonists, proton pump inhibitors (PPIs), antisecretory agents also provide pain relief. GASTRIC CANCER More common in middle aged males PREDISPOSING FACTORS - Diet high in complex carbohydrates, grains and salt - Smoked fish or meats - Low in fresh, green leafy vegetables and fresh fruits - Smoking - Alcohol ingestion - Use of nitrates, nitrite food preservatives - Overheated fat products - H. pylori infection - Chronic atrophic gastritis - Pernicious anemia - History of gastric ulcers CLINICAL MANIFESTATIONS - Progressive loss of appetite - Gastric fullness - Dyspepsia or indigestion - Positive Guaiac stool exam - Hematemesis - Melena - Weight loss - Anemia - Pain when eating - Relieved by vomiting - Palpable abdominal mass MANAGEMENT - Surgery - Total gastrectomy. After removal of the stomach, the esophagus is anastomosed to the jejunum. The duodenum is not removed. To allow the common bile duct to transport bile into the duodenum. - Chemotherapy and radiation therapy.