Overview
This lecture covers alterations in digestion and bowel elimination, including the pathophysiology, risk factors, clinical presentations, nursing roles, and patient education for various gastrointestinal (GI) disorders.
Digestive System Anatomy & Physiology
- The digestive process begins in the mouth with chewing (mastication) and enzymatic breakdown.
- Major organs: mouth, salivary glands, esophagus, stomach, small and large intestines, liver, gallbladder, pancreas.
- The esophageal sphincters (upper and lower) prevent reflux; the lower sphincter is key in gastroesophageal reflux disease (GERD).
- The stomach breaks down proteins, carbs, and fats; small intestine absorbs nutrients; large intestine absorbs water and electrolytes.
Common Oral and Esophageal Disorders
- Oral health impacts nutrition and overall health; lesions can be caused by cancer, infections, or immunosuppression.
- Poor oral hygiene increases risk for tooth loss, malnutrition, and even cardiac disease.
- Nurses should educate on oral hygiene, nutrition, and regular dental care.
Gastroesophageal Reflux Disease (GERD)
- GERD is caused by malfunctioning lower esophageal sphincter allowing acid reflux.
- Risk factors: hiatal hernia, stress, obesity, pregnancy, and connective tissue disorders.
- Chronic GERD increases risk for Barrett’s esophagus and esophageal cancer.
- Nurse's role: educate on lifestyle changes and coordinate interprofessional care.
Stomach and Duodenal Disorders
- Hiatal hernia: stomach protrudes through diaphragm, causing heartburn and pain.
- Dumping syndrome: rapid gastric emptying often post-surgery; manage with diet modifications.
- Peptic ulcers: caused by H. pylori, NSAIDs, or alcohol; main treatment is proton pump inhibitors (PPIs).
- Complications: bleeding, perforation, stenosis, penetration, and risk of malignancy.
Small and Large Intestinal Disorders
- Small intestine absorbs nutrients; large intestine consolidates and expels waste.
- Irritable Bowel Syndrome (IBS): functional disorder with pain, bloating, and altered bowel habits.
- Diverticulitis: inflammation of colon pouches, risk of perforation and abscess.
- Celiac disease: immune reaction to gluten causing malabsorption.
- Crohn’s Disease: affects any GI area, transmural inflammation; Ulcerative Colitis: only colon, superficial inflammation.
Liver and Pancreatic Disorders
- Liver diseases include hepatitis, alcoholic, and nonalcoholic fatty liver disease; can progress to cirrhosis.
- Pancreatitis: inflammation of the pancreas, treated with bowel rest (NPO/IV nutrition if severe).
- Education: avoid alcohol, monitor liver function, encourage healthy lifestyle.
Ostomies and Bowel Obstruction
- Type and location of ostomy affect stool consistency and risk of dehydration/nutrient loss.
- Nurses must closely monitor stoma color, output, and signs of dehydration.
Nursing Assessment & Education
- Comprehensive assessment includes nutrition, medication, risk factors, and signs of complications.
- Education on oral and bowel health, healthy diet, hydration, stress management, and adherence to treatment plans is critical.
Key Terms & Definitions
- GERD (Gastroesophageal Reflux Disease) — reflux of stomach acid into the esophagus causing irritation.
- Peptic Ulcer — open sores in the stomach/duodenum caused by acid, H. pylori, or NSAIDs.
- Hiatal Hernia — stomach herniation through the diaphragm.
- Dumping Syndrome — rapid gastric emptying post-stomach surgery.
- Celiac Disease — gluten-triggered immune reaction damaging the small intestine.
- Crohn’s Disease — inflammatory bowel disease affecting any GI tract area, full thickness.
- Ulcerative Colitis — inflammatory bowel disease affecting only the colon’s inner lining.
- Ostomy — surgical opening for waste elimination.
- Pancreatitis — inflammation of the pancreas.
- Hepatitis — inflammation of the liver, often viral.
Action Items / Next Steps
- Review current medications and risk factors with patients.
- Educate patients on nutrition, oral hygiene, and lifestyle changes.
- Assess for signs of GI complications and monitor stoma output if relevant.
- Complete assigned reading on GI disorders and nursing management.