hi class my name is Professor Pula and we're going to talk about alterations in digestion and bowel elimination learning objectives we're going to explain uh pathophysiology of digestion explore epidemiological and Theological risk factors describe the impact of alterations on overall function differentiate the clinical presentations or different alterations explore the role of the nurse and apply the n ing process through use of the clinical judgment functions while providing care to clients experiencing alterations and gastrointestinal function digestive system begins when food enters the mouth and begins the process of breaking down into absorbed elements several enzymes begin to break down food and the process of chewing mastication uh Works to make smaller food particles the cell of glands excrete lipase and many other substances that help break down food the organs contribute to digestion through secretion of digestive substance are and the gold bladder stores uh you can see digestive system here we have upper GI it's a mouse salivary glands esophagus and stomach and lower GI uh small intestine large intestine and rectum and also organs such as Li liver pancreas and GBL also helping with um digestion fresh Anatomy the intact anatomy and health of the mouth oral cavity D Joe strain tongue OVA fairings EP epiglottis and esophagus support the process of breaking down nutrition uh the esophagal sphincter upper and lower when intact prevent reflecting of the food from larynx in the upper swinter of the H acid a acidic stomach from the lower esag Gil or a cardiac swinter any changes in the Integrity of the structures of the oral environment and salivary glands can compromise the initial breakdown of food and alter digestion saliva has a low ph and lots of fluid so that the acidic environment helps break down food and you can see on uh slide that oral structures uh present uh Ora fings heart palet uh gums teeth soft pallate Tong and bual mucosa salivary glands is the fragile Integrity is essential to the movement of the partially digested food eplus and a leaf likee structure that protect the larynx from food going down this picture you have two zad finkers you can see it which are closed at rest um one is upper as a fagil swinter and lower as a fagil swinter uh lower is a fagil s relaxation or ability to transfer food particles is managed by the a third sensory branch of the uh vagus nerve and when we are going to talk about gir we actually going to talk about this LS of aginal sphincter because this low vaginal spher is not working properly when uh reflux happen each anatomical structure works on various types of food or molecules the mouth Begins the breakdown of carbohydrates and fat but enzimatic activity and fat begins to be broken down in the mouth and then in the stomach all types of molecules are broken down further by each structure and with various heart hormones is indicated in table stomach for example absorption of vam vitamin 12 um and if patient will have uh gastro atomy that lifelong B12 in injections going to be prescribed by The Physician um right here you can see that Mouse actually um process carbohydrates and fat stomach protein carbohydrates and fat and small intestin carbohydrates fat F protein in nucleic acid low Gast intestinal it's a small intestine has a brush border plasma reach lining brush border is a small intestine in small intestine with uh passageway uh entos sites and enzymes that are key in moving nutrients from the Lumin to the intestinal fluid in and blood um large intestine uh and colon absorb water and electrolytes nin vitamin B B1 and vitamin K synthesized in Colon feces should be eliminated through anus as bow movement many diseases can cause mouth and esapa lesions or impact the mucosa of both the oral cavity and the esophagus cancer and chemotherapy can cause painful lesions that impair intake thrash caner Source or hsv1 can all impair the intake and digestion of food um the erosion of the esophagus from chronic refling of Highly acidic fluid causes severe damage to the mucosa which can lead to cancer of the esophagus what is the bar esophagus it is alterations in cell cells that cause tissue lining to be replaced and those cells are precancerous and link to the Adena carcinoma of esophagus alterations in oral cavities compromise oral mucosa and loss of teeth are more common in an um impoverished population and this affects nutritional status healthy mouth and teeth better health and nutrition uh onethird of people globally are affected by oral herpes oral candidasis 2 million cases annually most common fungal disease candidasis happen when a client is immun compromised what clients are immun compromised it is clients who are older clients who have cancer and on chema C who has some inflammatory autoimmune diseases and and on ster oids perod uh uh dentitis leads to tooth loss and then destruction of the alal bone oral cancer accounts for 48% off of the head and neck cancers perodontal tooth loss affected 75% of the US population 3.1 billion suffer from a dental car carers um worldwide social determinance of Health are related to dental cares and loss of teeth promised oral mucosa and loss of teeth are more common in elderly Community dwelling persons such as nursing homes the community living can affect nutritional status nurses need to promote healthy gum and tooth care healthy Mouse teeth better health and nutrition and um untreated gum disease uh gum disease can increase the risk of coronary artery disease because infected tooth uh infection is so close to the heart that it can travel to the to the patient heart if patient is uh about to have any for example heart surgeries the um patient needs to see dentist first and remove or bad teeth because infection from this teeth can go to the heart oral swollowing challenges can lead to changes in tissue composition and uh increase cancer risk nurses must be aware of the oral health challenges of people who are older aged or living in poverty and social determinance of Health are related to nutrition and overall cardiovascular health what is environmental factors um it is genetic and environment environmental factors it's like heridity alcohol and alcohol intake smoking long-term stress on body and we are the nurses we're supposed to educate clients on hygiene washing hands Oral Care proper toothbrush care and care of denters or braces we need to teach client about nutrition tobacco use and regular Dental Care uh with professional with a professional the nurse should assess and analyze all the potential alteration in oral and metabolic health risk factor should be carefully reviewed and teaching regarding health promotion and disease prevention should be focused on healthy food water andtake limiting smoking alcohol weaping um and high fate highly prised and high sugar foods uh we need to identify recognize the client's potential for uh increased risk factors in we need to inspect the color texture on any manifestation of dry mouth and the Integrity of all structures visualized in the oral cavity and throat assess for any indication of noticeable mouth OD or bleeding inspect Dentures removable Dental restoration or arod doting devices as indicated palpate local lymph nodes as needed obtain Vital Signs review the list of current medication especially over the counter and some herbal vitamin supplements use the client past knowledge and experience of Prior manifestations as evidence to assess and make comparisons with new subjective and objective presentation of the condition the Integrity of teeth and bone structure of The Mouse and the throat and esophagus are critical for maintaining Health prevention of mouse Source GI disease and maintaining healthy eating uh no alcohol and no smoking can help people stay active and fit first condition we're going to talk it's a gir um Girt Is We I was we already talking about lower esag sphincter when lower Seagal sphincter is closed that uh all content of the stomach cannot go up but if swinter or open it's allowed reflux um uh because what is gir gir is a gasta is a fagil reflux dis disease acid travels up to esophagus and a roads lining stress can exacerbate the psychological stressor of Life can manifest with physical symptoms and when stress is not managed the uh psychological um physiological erosion of structures can cause serious illness including cancer uh some chronic eport of Gir incre uh increase risk of Barett as esophagus we were talking about and increase risk of strictures some comorbidities with G it's heal hernia connective tissue disorders pregnancy stress embarrassing burping and flatulence what is the uh um nurse role G disorders can cause um uh psychological and uh quality of the life changes the interprofessional team can optimize clinical recovery enhance outcomes and reduce complications for Optimal Health nurses should help client adopt Health Care delivery to meet the client's language social and C cultural needs okay let's talk about sto and do adal the stomach is a muscular Holo organ that secretes digestive juices and stores kind it connects to the duad via the pyloric sphincter oneway valve and and dunum play important roles in in digestion and the pancreas is involved in secretion enzymes into the dueno each part of the GI system has specific functions including secreting hormones or digestive juices and pancreas is secreted into the duodenum to neutralize acid one of the conditions is hiatal hernia uh hial hernia is when the stomach herniates through the diaphragm uh usually symptoms are heartburn and sour test and mounts after food and intake and also it can cause pain uh how to diagnose we need to do some testing it can be EGD or pH monitoring or one of the number one is um barium swallow next condition we're going to cover now is dum in syndrome ures when food especially sugar moves too quickly from the stomach to the dadum what caus dumping syndrome it's a removal of all of the part of the stomach and it is happened with stomach cancer when partial of the stomach removed or all stomach or it's really popular with gastric bypass what symptoms cramping nausea diarrhea changes in blood sugars blood pressures and uh heart rates and again important thing what is the nursing education what we need to educate our patients about we need to educate our patient about avoiding fluids 30 60 minutes before a meal before because if the we will drink before the meal that uh this this food will go too quickly um through the stomach it's smaller but more frequent meals eat slowly too carefully avoid sugar drinks eat more protein but be cautious with milk and dairy products and eat more complex carbohydrates stomach alers um what is the diagnostic criteria uh uh we will identify open source in a stomach lining may be caused by H py long-term nonsteroid inflammat drug may cause ulceration um family history excessive alcohol use older than 60 years old and common comorbidities is a type O blood and cron disease 4.6 million a year have pepsic aler pepsic ulcer in the US common in over 40 years old do adinal alers more common in 20 to 50 years old and said have not um surpass the age polar causation patient has a ulcer we definitely will educate patient about some food restrictions no alcohol or smoking limit stress because stress can exacerbate um the alcer and um number one medication to use with alter it's a PPI proton PP Inhibitors uh PPI treatment must be followed closely to ensure safety uh um what PPI actually doing it's in inhibit gastic a acid secretion and relief manifestations of heartburn and regurgitation what some adverse effects of PPI headache diarrhea constipation abdominal pain and flatulence we need to teach um patient individuals who take PPI medication on a regular and long B basis are more prone to such disorders as hypocalcemia and hypomagnesemia some epidemiological anthological risk factors for ulcer Anthology is unknown for ulcer formation uh we can find a cold blood and stool um uh Ura breast test stool antigen as safe for h pylori history of excessive alcohol in coffee drinking fatty food intake rich dorts and high sugar intake higher risk patients with alter and higher risk for dehydration and nutritional deficit okay impacting overall health the nurse should educate the client and their significant other family member about ptic also risk factors such as potential infection with h pylor the possible overuse andet for pain and excessive alcohol intake or and smoking the nurse will need to assist the client in obtaining access to gust enterologist for potential diagnostic evaluation as necessary the nurse should also assist the individual with obtaining more education regarding alcohol recovery programs or smoking sensation and healthy lifestyle options to manage diet and stress as needed um as a nurse it's important to know that uh alter needs to be treated because if alter is untreated besides pain and discomfort nausea and vomiting it can cause some really major complications and uh five major complications for ales are bleeding uh perforation if the alcer will per perforate and the stomach content will go outside of the stomach it can called peritonitis stenosis it can cause stenosis in in um uh stomach and food would not be actual to go down from the stomach penetration and um it happened when alter is getting bigger and not Perforating but actually connecting to other or organs such as duodenum and actually penetrating to the wall of other organ and malignancy also can can become a cancer okay lower G intestinal system the junam is responsible for absorbing sugars amino acids and fatty acids the last segment of the small intestine is called the ilium it measures at estimated 3 m in length and its major role is to absorb any remaining nutrients in particular vitamin B12 and bile acids and will be reused by the body the large intestine commonly known as the colon follows the ilum view the connection known as the ille valve it is divided into five parts the ascending colon transverse colon and descending colon and sigmoid colon its function it to absorb water and salt into the body and synthesize and absorb vitamins such as nasin Vitamin B1 and vitamin K lastly it's a solidifies the uh indigestible waste into form stool and holds the feces until it is ready to be eliminated by defecation the descending colon is where most of the stool is store until it's ready to enter the sigmoid colon and then into the rectum there is an array of disorder that can impact the intestines and colon common conditions of cerns are irritable balling syndrome cron disease ulcer of colitis bowel obstruction Diverticulitis and celic disease um ital ball syndrome is a frequently seen disorder that can manifest manifest with complaints of cramping abdominal pain bloating gas diarrhea or constipation it is known as a functional disorder meaning an or gaining cause cannot be found um the cause of iral bowel syndrome is still not understood also many theories exist diverticulitis can present with abdominal pain NAA NAA or vomiting fever abdominal tenderness and constipation on diarrhea uh patient can have a divertical and their sigmoid colon when this divertical divertical is uh inflamed we call it diverticulitis and of course uh we are really concerned about complications compli appliations may include absis formation bowel blockage fishal development or peritonitis because we are afraid of peroration CAG disease is an immune reaction to eating gluten and protein found in wheat bodle and Ry can exhibit diarrhea fatigue weight loss bloating and anemia the inability to absorb nutrients can lead to loss of bone density mouth alers neuropathy joint pain or reduced function of the Spen uh we're going to talk about cron disease and alcer of colitis uh in a couple slides the nurse should perform an indepth history on on admission paying particular attention to the history of the present illness the nurse should complete a review of all body system during the assessment nurses must verify when manifestations began how long they lasted and how often they occur as well as ass set for nutritional deficit or signs of internal bleeding with bleeding ulcer here are listed all parts of lower gastrointestinal truct starts with gunum ilum seeum ascending colon descending colon It's also transverse colon in between sigmoid rectum and anus okay uh Chron disase and Al of colitis I'm going to give you some information in comparison between these two um diseases cron disease is an autoimmune inflammatory bowel disease that can affect any part of GI truck from the mouth to the anus and can affect the entire thickness of the intestinal wall alter of colitis is an ideopathic inflammatory that only affect the colon but symptoms can be triggered by stress in Cross Crohn's disease the manifestations typically include diarrhea rectal bleeding AB absess formation or fulus around the anus it can also cause skin lesions and joint pain alterative colitis displays manifestations such as stool urgency fatigue increased bowel movements mucus in the stool nocturnal bowel movements and abdominal pain if we are talking about diet diet is similar we're trying to educate patient to consume uh protein to find a good source of protein and eat less fiber because both of them have diarrhea um lbs when we are doing for both of them are uh similar if because it is inflammation and um and diarrhea happen we have common symptoms uh it's definitely going to cause some low electrolytes uh but it's also going to because it's inflammation it's going to increase white blood cells and it increase arite sedimentation rate cellc disease can exhibit diarrhea fatigue weight loss bloating and anemia the inability to absorb nutrients can lead to loss of bone density mouth Alters neuropathy join pain and um or reduce function of the spleen testing is done by anti- gladine antibodies which are elevated with gluten intolerance and small B biopsy the most common disorders that affect the liver are hepatitis alcoholic liver disease nonalcoholic fatty liver disease and uh please know that the uh the uh term met metabolic Associated um fatty liver disease is also utilized internationally to indicate some conditions therosis carcinoma and liver failure viral hepatitis is the most common type of hepatitis and it's caused by hepatitis viruses a b c d and e globally it has been reported that approximately uh 2 billion people have been infected with the Hepatitis B virus and 130 to 170 million people have a chronic hepatitis um uh C infection alcoholic liver disease is one of the principal contribution to Chronic liver disease worldwide in worldwide in fact just in the United States alone approximately 48% of therosis related death are Trace to alcoholic liver disease alcohol use disorder is the leading cause of alcohol liver disease and it is estimated that one in 12 adults meet the criteria for overuse of alcohol other social determinant of health and comorbidities that can worsen the course of liver disease an individual with alcohol use are genetic um propensities to alcohol abuse obesity hepatitis and cigarette smoking absten ISM from alcohol care assist in reduction um the progression of further liver damage um non-alcoholic fatty liver diseases becoming increasingly prominent in westernized culture in recent years and account for progressively more endstage liver disease uh requiring liver trans uh transplantation um uh non-alcoholic fat liver disease uh um has some comorbidities it's like central obesity D lipidemia hypertension type 2 diabetes and a hyperglycemia um hypatius disease affects daily lifestyle and uh patient can miss many work work days if patient has Hepatitis what education we can provide first of all no alcohol um patient with any liver disease it can be therosis or um alcoholic liver disease or non-alcoholic or especially hepatitis no alcohol because alcohol is damaging liver uh we need to uh promote diet low in fat monitor liver enzymes promote healthy activities and limit exposure to friends and family it means we need to educate our patient um about all types of um hepatitis and we we we're talking about hepatitis which can be transmitt as a contact um like hepatitis A can be given with the dirty uh when you're drinking like uh dirty water or with some food we need to educate uh our line about all transmissions way and how to prevent it to transmit to the family and friends individuals suffering from disorders of intestine may experience electrolyte imbalance dehydration vitamin and mineral deficit malabsorption and even malnutrition due to increased intestinal and rectal inflammation and diarrhea issues in addition this client can lose blood in their stools and potentially become anemic they may also develop electrolyte disturbance from the medication that they take to their intestinal issues a bowel obstruction will often cause sharp on cramping pain and bloating and dist distension of the abdomen clients will experience diarrhea or conversely the ability to pass gas or stool along with the loss of appe di nausea and vomiting uh in the beginning when we are doing assessment of patients with some bowel obstructions uh we think we maybe patient has no bow sound or their hyper but it's not true um uh abstraction can happen for any reason for example if tumor is growing but peristaltic is still there and they're trying to push it through it means you will hear hyperactive bow sounds and the beginning um also uh you need to assess patient patterns of stool and it's really important to include in assessment pancreatitis there is an array of other internal and external factors that can contribute to or or risk factors for developing pancreatitis of those the following are most common cigarette smoking drug IND Ed used autoimmune increased age family history of pancreatitis postendoscopic retrograd colang pancreatography abdominal surgery trauma infection injury to abdomen IND the apathic some comorbidities are obesity diabetes hyper glycer uh High hyper uh cholester Amia um high calcium level in the blood pancreatic cancer cystic fibrosis patient will complain of severe pain and it come uh suddenly also patient can complain about uh nausea and vomiting and when we do lb uh for this patient of course we take we are checking ferments produced by pancreas am for ex for example lipase and amas and they are elevated if the patient has pancreatitis as a nurse we need to know that number one thing can treat pancreatitis we need to let it rest how we can let it rest it means we patient needs to stop eating patient is going to be strict and pure they might be able to drink some water but most of the time they're strict and pure with when they have pancreatitis if and for a couple days and then we start re re in reduce the food but if the patient has really bad pancreatitis and this a couple days uh is is not helping in some cases we are actually put patient uh on IV nutrition individuals suffering from disorders of the intestines may experience electrolyte imbalance dehydration vitamin and mineral deficiencies malabsorption and even malnutrition due to increased intestinal rectal inflammation and diarrhea issues in addition these clients can lose blood and their stools and potentially become anemic they may also develop electrolyte disturbance from the medication uh that they take to treat there um why I'm telling you this information because when patient has some condition with required surgery and then asy placement it is important what what each part of our GI system is responsible for because uh depends when patient has a Emy those those nutrients um uh maybe patient will be um has deficit of sub nutrients then lower is um asy for example if we have like left colostomy uh that usually patient does not have any deficit of the nutrients and stool which is coming from lower left colostomy is going to be normal looks like normal sto but then higher is colostomy if we are going to transfer colostomy or even right colostomy then major amount of uh colon is gone and what the colon is doing colon is actually pulling back water it means we're not expecting to see normal forms stool it's sto going to be some semi semi um uh uh formed if we're talking about ostomy with when all colon is gone this tool is going to be watery especially uh in the beginning when this um uh elasy just start working it's going to be liquid only and first a couple weeks doctors are replacing uh fluids for example by protocol some to some doctors you need to replace with one half or maybe one to one of whatever patient uh lost if in um you empty IL aomy and it was one liter and you emptying it it's every hour a patient losing like one liter every hour or every two hours every 3 hours you have to replace it with the same same amount of normal saline through IV to keep the balance uh it's going to slow down later and um iloom and and um um small intestine would be able to absorb some some fluid but it's never going to be never all going to be the same again uh because our colon is responsible to uh pull pull water make sure the patient who has elastom in the high risk of dehydration uh another thing besides what kind of stool or uh how much is output we also need need to assess our asamy every four hours when you're doing assessment especially in new asomia you need to check that uh asomia needs to be pink or beef red and it's supposed to be moist individual s uffing from disorders of the intestines may experience electrolyte imbalance dehydrations vitamin and mineral deficiencies malabsorption and even Mal nutrition due to increased intestinal and rectal inflammation and diarrhea issues in addition this clients can lose blood be anemic they may also develop electrolyte disturbance the uh the nurse should educate the CL client of their significant others and family members about the disorder and how to improve their Quality of Life by limiting or discontinuing alcohol smoking increasing water intake improving or maintaining a healthy uh nutrition style they should be taught to keep a food Di diar and monitor the food that can cause them issue with any intestinal flare ups that are uncomfortable or cause diarrhea bloating cramping constipation or a NAA uh and of course we need to teach our clients uh healthy exercise and stress reduction because they can prevent serious GI issues this lecture is over if you have any questions please email me Ana mccn.edu