gastrointestinal disease&treatment

• Complications of GERD include esophagitis, esophageal strictures, aspiration of gastric contents, and aspiration pneumonia.

• dyspepsia, difficulty with swallowing

• nausea, regurgitation

• hypersalivation

• Instruct the client to eat a low-fat, high-fiber diet and to avoid eating and drinking 2 hours before bedtime and wearing tight clothes. Provide small frequent meals and limit the amounts of liquids taken with meals.  Advise the client not to recline for 1 hour after eating. Also, elevate the head of the bed on 6 to 8-inch blocks.

• Instruct the client regarding prescribed medications, such as antacids, H2-receptor antagonists, or proton pump inhibitors. Instruct the client regarding the administration of prokinetic medications, if prescribed, which accelerate gastric emptying.

• Avoid the use of anticholinergics, which delay stomach emptying. Also, NSAIDs and other medications that contain acetylsalicylic acid need to be avoided.

• [Pediatric] Breastfeeding may continue, and the mother may provide more frequent feeding times or express milk for thickening with rice cereal. For infants, the formula may be thickened by adding rice cereal to the formula. For toddlers, feed solids first, followed by liquids. Instruct the parents that the child should avoid vigorous play after feeding and avoid feeding just before bedtime.

• caused by the ingestion of food contaminated with disease-causing microorganisms or food that is irritating or too highly seasoned, the overuse of aspirin or other NSAIDs, excessive alcohol intake, bile reflux, or radiation therapy

heartburn after eating

• anorexia, nausea, vomiting

• vitamin B12 deficiency

• Instruct the client in the use of prescribed medications, such as antibiotics and antacids. Provide the client with information about the importance of vitamin B12 injections if a deficiency is present.

• Predisposing factors include stress, smoking, alcohol, caffeine, spicy foods, history of gastritis, family history of gastric ulcers, the use of corticosteroids, NSAIDs, aspirin, or infection with H. pylori.

훈제음식 (ⅹ)

• Complications include hemorrhage, perforation, and pyloric obstruction.

• Hematemesis is more common than melena. → absent bowel sound: priority

• Monitor for signs of bleeding.

• Administer small, frequent bland feedings during the active phase.

• Administer H2 receptor antagonists or proton pump inhibitors as prescribed to decrease the secretion of gastric acid. Administer antacids to neutralize gastric secretions. Administer anticholinergics to reduce gastric motility. Administer mucosal barrier protectants as prescribed 1 hour before each meal. Administer prostaglandins as prescribed for their protective and antisecretory actions.

• surgical interventions :

total gastrectomy, vagotomy, gastric resection, Billroth 1, Billroth 2, pyloroplasty

• melena: more common than hematemesis

• feelings of abdominal fullness and abdominal cramping

• borborygmus

• nausea and vomiting

• diarrhea

• palpitation and tachycardia

• perspiration (sweating)

• weakness and dizziness

worst food: milkshake ∵ 달고 차가워서 장의 운동을 촉진하기 때문

• Gastric disease or surgery (ex) gastrectomy) can result in a lack of intrinsic factor.

• fatigue, disturbance with gait and balance, paresthesia of the hands and feet: neuralgia sign

• weight loss

• smooth, beefy red tongue: anemia sign

• slight jaundice

• Administer vitamin B12 injections as prescribed, weekly initially, and then monthly for lifelong maintenance if the anemia is the result of a deficiency of intrinsic factor or disease or surgery of the ileum.

• commonly begins in the rectum and spreads upward toward the cecum,

occurs in continuous areas

• characterized by various periods of remissions and exacerbations

• curable with surgery

• colorectal ca. 의 위험요인

• severe diarrhea that may contain blood, mucus, and pus

• anorexia, weight loss, malaise

• malnutrition, dehydration, and electrolyte imbalances

• vitamin K deficiency, anemia

• Monitor bowel sounds for abdominal cramping.

• Monitor stools, noting color, consistency, and the presence or absence of blood.

• In the acute phase, maintain NPO status and administer fluids and electrolytes intravenously or via parenteral nutrition as prescribed. Restrict the client’s activity to reduce intestinal activity.

• Following the acute phase, the diet progresses from clear liquids to a low-fiber diet as tolerated. Usually, a low-fiber, low-fat, high-protein diet with vitamins and iron supplements are prescribed. Instruct the client to avoid gas-forming foods, milk products, and foods such as whole wheat grains, nuts, raw fruits and vegetables, pepper, alcohol, and caffeine-containing products.

• Administer medications as prescribed, which may include a combination of medications such as salicylate compounds, corticosteroids, immunosuppressants, and antidiarrheals.

• surgical interventions :

total proctocolectomy with a permanent ileostomy, Kock ileostomy, ileoanal reservoir, ileoanal anastomosis

• occurs in sporadic areas

• characterized by remissions and exacerbations

• incurable

• colorectal ca.의 위험요인

cramp-like and colicky pain after meals

• diarrhea (semi-solid) that may contain mucus and pus, steatorrhea

• anorexia, weight loss

• malnutrition, dehydration, and electrolyte imbalances

• anemia

• Diverticulitis is the inflammation of one or more diverticula that occurs from penetration or fecal matter through the thin-walled diverticula.

abdominal distention and tenderness

• nausea, vomiting

• blood in the stools

• Instruct the client to increase fluid intake to 2500 to 3000mL daily, unless contraindicated.

• Administer antibiotics, analgesics, and anticholinergics.

• Instruct the client to consume a small amount of bran daily and to take bulk-forming laxatives as prescribed to increase stool mass.

• Introduce a fiber-containing diet gradually to prevent constipation when the inflammation has resolved (when diverticulosis). Instruct the client to eat soft high-fiber foods, such as whole grains. The client should avoid high-fiber foods and eat low-residue foods when inflammation occurs (when diverticulitis) because these foods will irritate the mucosa further.

Instruct the client to avoid gas-forming foods or foods containing indigestible roughage, seeds, or nuts (ex) berries, cucumber, squash, popcorn) because these food substances become trapped in diverticula and cause inflammation.

• surgical intervention: colon resection, temporary or permanent colostomy

• the feeling of fullness, dysphagia, nausea, regurgitation

• Cholecystitis is the inflammation of the gallbladder that may occur as an acute or chronic process

• care of a T-tube

• types of hepatitis: HAV (Hepatitis A Virus), HBV, HCV, HDV, HEV

• icteric stage: jaundice, pruritus, clay-colored stools, dark-color urine

• post-icteric stage: the convalescent stage of hepatitis

• transmission: fecal-oral route, parenteral, poorly washed utensils,  person-to-person contact

• incubation period: 2 to 6 weeks

• infectious periods: 2 to 3 weeks before and 1 week after the development of jaundice

• fulminant

• IgM and IgG are normally present in the blood, increased levels indicate infection and inflammation.

• Ongoing inflammation of the liver is evidenced by the presence of elevated levels of IgM antibodies, which persist in the blood for 4 to 6 weeks.

• Previous infection is indicated by the presence of elevated levels of IgG antibodies.

Provide enteric precautions for at least 1 week after the onset of jaundice with HAV. P The hospitalized child usually is not isolated in a separate room unless he or she is (fecal) incontinent and items are likely to become contaminated with feces.

• stool and needle precaution

• hepatitis A vaccine (HAVRIX, VAQTA)

• immune globulin: For individuals exposed to HAV who have never received the hepatitis A vaccine, administer immune globulin during the period of incubation and within 2 weeks of exposure.

• Pre-exposure prophylaxis with immunoglobulin is recommended to individuals traveling to countries with poor or uncertain sanitation conditions.

• transmission: blood or body fluid contact, parenteral, sexual contact, perinatal period

• incubation period: 6 to 24 weeks

• chronic, fulminant

• The presence of HBsAg is the serological marker establishing the diagnosis of hepatitis B. The client is considered infectious if these antigens are present in the blood. Hepatitis B early antigen (HBeAg) is detected in the blood about 1 week after the appearance of HBsAg and its presence determines the infective state of the client.

• The presence of anti-HBs indicates recovery and immunity to hepatitis B.

• needle precaution

• Avoiding intimate sexual contact if the test for HBsAg is positive.

• testing of all pregnant women

• hepatitis B vaccine (Engerix-B, Recombivax HB)

• Hepatitis B immune globulin is for individuals exposed to HBV through sexual contact or through the percutaneous or transmucosal routes who have never had hepatitis B and have never received the hepatitis B vaccine.

• transmission: same as for HBV, blood or body fluid contact

• incubation period: 5 to 10 weeks

• chronic

• needle precautions

• individuals at increased risk; same as for HBV

• transmission: same as for HBV, blood or body fluid contact

• incubation period: 7 to 8 weeks

• fulminant

• vaccine 있음.

• transmission: same as for HAV, fecal-oral route

• incubation period: 2 to 9 weeks

• coagulation defects: decreased synthesis of bile fats in the liver prevents the absorption of fat-soluble vitamins

• jaundice: occurs because the liver is unable to metabolize bilirubin and because the edema, fibrosis, and scarring of the hepatic bile ducts interfere with normal bile and bilirubin secretion

• Monitor intake and output and electrolyte balance.

• Monitor coagulation laboratory results.

• If ascites and edema are absent and the client does not exhibit signs of impending coma (when stable LC), a high-protein diet supplemented with vitamins is prescribed. Provide supplemental vitamins (B complex, vitamin A, C, and K, folic acid, and thiamine) as prescribed. Restrict protein, sodium intake, and fluid intake as prescribed. Initiate enteral feedings or parenteral nutrition as prescribed.

• Prepare the client for paracentesis to remove the abdominal fluid.

• Administer diuretics as prescribed.

• Administer blood products as prescribed.

Administer vitamin K if prescribed.

• Avoid medications such as opioids, sedatives, and barbiturates, and any hepatotoxic medications or substances.

• a persistent increase in pressure in the portal vein that develops because of obstruction to flow

• Esophageal varices are dilated and tortuous veins in the submucosa of the esophagus. Esophageal varices are at high risk for rupture if portal circulation pressure rises.

• Bleeding varices are an emergency.

• melena

• Elevate the head of the bed. Instruct the client to avoid activities that will initiate the vasovagal response.

• Maintain NPO status. Administer fluids intravenously as prescribed to restore fluid volume and electrolyte imbalances.

• Monitor hemoglobin and hematocrit values and coagulation factors.

• Administer blood transfusions or clotting factors as prescribed.

• Prepare to assist with administering medications to induce vasoconstriction and reduce bleeding.

• Assist in inserting a nasogastric tube or a balloon tamponade as prescribed. Balloon tamponade is not used frequently because it is very uncomfortable for the client and its use is associated with complications.

• Prepare the client for endoscopic procedures or surgical procedures as prescribed; endoscopic injection (sclerotherapy), endoscopic variceal ligation, shunting (TIPS, TransJugular Intrahepatic Portosystemic Shunt)

• Administer lactulose (Constulose, Enulose, Generlac) as prescribed, which decreased the pH of the bowel, decreases the production of ammonia by bacteria in the bowel, and facilitates the excretion of ammonia.

pain aggravated by a fatty meal, alcohol, or lying in a recumbent position

abdominal tenderness

• nausea, vomiting

• steatorrhea and foul-smelling stools

• positive Cullen’s sign: the discoloration of the abdomen and periumbilical area

• positive Turner’s sign: the bluish discoloration of the flanks

• elevated serum lipase and amylase level

Administer parenteral nutrition for severe nutritional depletion. Administer supplemental preparations and vitamins and minerals to increase caloric intake if prescribed.

• Maintain the nasogastric tube to decrease gastric distention and suppress pancreatic secretion.

• Maintain hydration with IV fluids as prescribed.

• Administer opiates as prescribed.

• Administer antacids, H2 receptor antagonists, proton pump inhibitors, anticholinergics as prescribed.

• Instruct the client about the importance of avoiding alcohol. Instruct the client on the prescribed dietary measures. Fat and protein intake may be limited. Instruct the client to avoid heavy meals, and instruct the client to eat small, regular, frequent meals.

abdominal pain that is most intense at McBurney’s point,

rebound tenderness,

client in the side-lying position, with abdominal guarding and legs flexed

• low-grade fever

• Avoid the application of heat to the abdomen of a client with appendicitis. Heat can cause rupture of the appendix leading to peritonitis, a life-threatening condition. Apply ice packs to the abdomen for 20 to 30 minutes every hour as prescribed.

• surgical interventions: appendectomy

• bright red bleeding with defecation

• Apply witch hazel soaks and topical anesthetics as prescribed.

• Encourage a high-fiber diet and fluids to promote bowel movements without straining.

• Administer stool softeners as prescribed.

• surgical interventions: hemorrhoidectomy

• Monitor for signs and symptoms of dehydration.

• Provide oral rehydration therapy as tolerated and as prescribed. Begin feeding slowly, with small amounts of fluid at frequent intervals.

• For mild to moderate dehydration, provide oral rehydration therapy with Pedialyte or a similar rehydration solution as prescribed. Supply low-fiber meals. Avoid carbonated beverages because they are gas-producing and fluids that contain high amounts of sugar, such as apple juice. For several dehydrations, maintain NPO status to place the bowel at rest and provide fluid and electrolyte replacement by IV route as prescribed. If potassium is prescribed for IV administration, ensure that the child has voided before administering and has an adequate renal function. Reintroduce a normal diet when rehydration is achieved.

• Encopresis (분변 실금) is constipation with fecal incontinence.

• Administer stool softeners or laxatives as prescribed.

• Administer enemas as prescribed until impaction is cleared. Monitor for hypernatremia or hyperphosphatemia when administering repeated enemas.

• Encourage the child to sit on the toilet for 5 to 10 minutes approximately 20 to 30 minutes after breakfast and dinner to assist with defecation.

• Monitor treatment regimen for severe encopresis for 3 to 6 months.

• Monitor daily weight.

• Modify feeding techniques. Plan to use specialized feeding techniques, obturators, and special nipples and feeders. Teach the parents special feeding or suctioning techniques. Teach the parents the ESSR method of feeding (Enlarge the nipple, Stimulate the sucking reflex, Swallow, Rest to allow the infant to finish swallowing what has been placed in the mouth).

• Hold the infant in an upright position and direct the formula to the side and back of the mouth to prevent aspiration. Feed small amounts gradually and burp frequently.

• Keep suction equipment and a bulb syringe at the bedside.

• Encourage parental bonding with the infant, including holding the infant and calling the infant by name.

• Closure of a cleft lip defect precedes closure of the cleft palate and is usually performed by age 3 to 6 months Cleft palate repair is usually performed between 6 and 24 months of age to allow for the palatal changes that occur with normal growth. A cleft palate is closed as early as possible to facilitate speech development.

• cleft lip repair postoperative interventions: Provide lip protection. A metal appliance or adhesive strips may be taped securely to the cheeks to prevent trauma to the suture line. Restraint should be used to prevent the infant from injuring the surgical site. Avoid positioning the infant on the side of the repair or in the prone position. Position on the back upright and position to prevent airway obstruction by secretions, blood, or the tongue. After feeding, gently cleanse the suture line of formula or serosanguineous drainage with a solution such as normal saline (면봉으로 톡톡). Avoid the use of oral suction or placing objects in the mouth such as a tongue depressor, thermometer, straws, spoons, forks, or pacifiers.

• cleft palate repair postoperative interventions: Oral packing may be secured to the palate. Restraint may be used. Instruct the parents to avoid offering hard food items to the child, such as toast or cookies. Feedings are resumed by bottle, breast, or cup. Do not allow the child to brush his or her teeth. After feeding, gently cleanse the suture line of formula or serosanguineous drainage with a solution such as normal saline (면봉으로 톡톡 치면 안됨). Avoid the use of oral suction or placing objects in the mouth such as a tongue depressor, thermometer, straws, spoons, forks, or pacifiers.

• Initiate appropriate referrals such as a dental referral and speech therapy referral.

• tracheoesophageal fistula: A fistula is present that forms an unnatural connection with the trachea.

• Prevent aspiration.

• gastric or blind pouch decompression

• surgical repair

• olive-shaped mass in the epigastrium

• Prepare the child and parents for pyloromyotomy if prescribed.

• A child with lactose intolerance can develop calcium and vitamin D deficiency.

Substitute soy-based formulas for cow’s milk formula or human milk. Limit milk consumption to one glass at a time. Instruct the child and family that the child should drink milk with other foods rather than by itself. Encourage consumption of hard cheese, cottage cheese, and yogurt, which contain the inactive lactase enzyme. Encourage consumption of small amounts of dairy foods daily to help colonic bacteria adapt to ingested lactose.

• Administer an enzyme tablet replacement.

• celiac crisis

• Maintain a gluten-free diet, substituting corn, rice, and millet as grain sources. Instruct the parents and child about lifelong elimination of gluten sources such as wheat, rye, oats, and barley.

• Administer mineral and vitamin supplements, including iron, folic acid, and fat-soluble vitamins A, D, E, and K.

• bile-stained vomitus

• ribbon-like and foul-smelling stools

• surgical management

• vomiting

• currant jelly-like stools containing blood and mucus

• a palpable sausage-shaped mass in the upper right quadrant

• hydrostatic reduction

• surgical management

• Omphalocele refers to herniation of the abdominal contents through the umbilical ring, usually with an intact peritoneal sac.

• surgical management

• Gastroschisis occurs when the herniation of the intestine is lateral to the umbilical ring. No membrane covers the exposed bowel.

• surgical management

• umbilical hernia, inguinal hernia

• incarcerated hernia

• non-communicating hydrocele,

communicating hydrocele