Presentation on small intestine disorder
- 1. TOPIC: SMALL INTESTINE DISORDER RELATED TO INFLAMMATION, INFECTION, MALABSORPTION & OBSTRUCTION, PERFORATION B.SC (H)NSG RAKCON
- 2. INTRODUCTION In all ages group, a fast placed lifestyle, high level of stress, irregular eating habits, and insufficient intake of water and minerals and lack of fibers and water, and lack of daily exercise contribute to GI disorder. There is a growing understanding of the biopsychosocial implications of GI disease. That is, the mind & emotion can have a profound impact on the GI system. Nurse can have an impact on their GI disorders by identifying behavior patterns that put patients risk, by educating the public about prevention and management and by helping those affect to improve their condition and present the complication.
- 3. ANATOMY OF SMALL INTESTINE
- 4. PHYSIOLOGY • Stomach food duodenum small intestine. • Bile & enzymes from liver, pancreases& gall bladder help in further breakdown. • Ileum& jejunum fuctions: absorb nutrient from blood stream. • Once the digested food leaves ileum, more than 95% nutrients of food is absorbed.
- 5. SMALL BOWEL INFLAMMATION • DEFINITION: Inflammatory Bowel Disease (IBD) represents a group of intestinal disorder that cause prolonged inflammation of the digestive tract . Many disorder are included in this IBD umbrella term.
- 6. ThemostcommondiseaseareCROHN`SDISEASE&ULCERATIE DISEASE. • CROHN`S DISEASE • Crohn`s disease is usually first diagnosed in young adult & adolescents. It causes inflammation in small intestine which leads to abdominal pain, fatigue. • • ULCERATIVE DISEASE • A Chronic, inflammatory bowel disease that causes inflammation in large intestine. • It is usually only in the innermost lining of large intestinal ( colon & rectum) .
- 7. CROHN`S DISEASE Crohn’s disease is a sub acute and chronic inflammation of the GI tract wall that Extends through all layers. I t most commonly occurs in distil ileum and to a lesser degree the ascending colon. It is characterised by periods of remission and exacerbation */
- 8. RISK FACTOR
- 9. PATHOPHYSIOLOGY The disease process begins with edema and thickening of the mucosa. Ulcers begin to appear on the inflamed mucosa. The clusters of ulcers tend to take an classic cobblestone appearance as the lesions are not in continuous contact with one another. Fistulas ,fissures And abscesses foam as the inflammation extends into the peritoneum. As the disease advances, the bowel wall thickens And becomes fibrotic and the intestinal lumen narrows.
- 10. CLINICAL MANIFESTATIONS • Lower quadrant abdominal pain • Persistent watery diarrhoea • Pain with passing stool ( tenesmus) • Unintentional weight loss • Anorexia • Steatorrhea • Fistula • oral ulcer
- 11. DIAGNOSTIC TEST
- 12. COMPLICATIONS Obstructions or strUcture formation ,Perianal disease, Fluid electrolyte imbalance. The most common type of fistula caused by crohn’s disease is enterocutaneous fistula.. Patients with Crohn’s disease are also at an increased risk of colon cancer.
- 13. ASSESSMENT • PATIENT & FAMILY HISTORY • Abdominal pain, diarrhoea, Weight loss, fever • PHYSICAL ASSESSMENT • Distention of abdomen, guarding, bowel sound, ulceration or fistula in perianal area • LABORATORY ASSESSMENT • CBC • Chemistry • Genetic testing • Anti saccharomyces cerevisiae antibodies( ASCA) • IMAGING ASSESSMENT • Barium swallow or enema • Ultrasound • MRI • CT
- 14. MEDICAL MANAGMENT • Treatment of CD : location of inflammation ,severity of disease, complications,& response of patient . pharmalogic therapy : AMINOSALICYLATES -Sulfasalazine effective for mild and moderate inflammation
- 15. Surgical management • Ultimately 75% patients of Crohn’s disease undergo surgery within 10 years of diagnosis and Between 25% and 60% require further repeat surgery within the same time frame. • intestinal transplant.
- 16. SMALL BOWEL INFECTION • Numerous bacteria, virus and parasites causes diseases in the intestine..
- 19. PATHOPHYSIOLOGY Bacterial perforation occurs | Edema of the tissue occurs | Exudation of fluid occurs Fluid in peritonial cavity becomes turbid
- 25. DIAGNOSTIC TEST White blood cell count Serum electrolyte study X ray Abdominal ultrasound CT scan MRI Peritonial aspiration and culture sensitivity studies of aspirated fluid.
- 26. COMPLICATION • Inflammation is most commonly not localised And the entire abdominal cavity shows evidence of widespread infection. • Shock may result from septicemia or hypovolemia. • The inflammatory process may cause intestinal obstruction, primarily from the development of bowel adhesions .
- 27. Assessment Vital signs Pain Tissue perfusion GI functions Fluid electrolyte balance Tenderness Bowel sounds
- 32. Management MEDICAL FLUID: • ANALGESICS: • INTUBATION & SUCTION: I • OXYGEN THERAPY: • ANTIBIOTIC THERAPY: • SURGICAL • Surgical objectives include removing the infected material and Correcting the cause. Surgical treatment is directed towards excision, resection with or without anastamosis, repair and damage .
- 33. Clinical example
- 34. SMALL INTESTINE MALABSORPTION Malabsorption is the ability of the digestive system absorb one or more of the major vitamins ( A& B12) , minerals (Fe& Ca) .
- 35. RISK FACTORS
- 36. CAUSES:
- 37. PATHOPHYISOLOGY Conditions that cause malabsorption can be grouped into the following categories: Mucosal (transport) Disorders causing genralised malabsorption Infectious diseases causing generalised malabsorption Lumenal disorders causing malabsorption Post operative malabsorption Disorders that cause malabsorption of specific nutrients
- 39. DIAGNOSTIC EVALUATION • Stool studies • Endoscopy with biopsy of mucosa • Biopsy of small intestine • Ultrasound studies • CT scan • X-ray • CBC count
- 40. ASSESSEMENT • Nutritional history • Serum albumin • Transferrin • RBC & WBC count • Serum electrolyte value • Physical signs of poor nutritional intake • Exact weight
- 41. MANAGEMENT MEDICAL MANAGEMENT SURGICAL MANAGEMENT Primary disease states may be treated surgically as well. Administration of supplements . Dietary therapy Folic acid supplements Antibiotics Antidiarrheal drugs Parenteral therapy
- 42. Small bowel obstruction • DEFINITION:: Intestinal obstruction exists when blockage prevents the normal flow of intestinal contents through the intestinal tract. The obstruction can be partial or complete. Its severity depends upon the site of obstruction • RISK FACTORS • Hernia • Crohn’s disease • Abdominal, joint or spine surgery • Swallowing a foreign body • Decreased blood supply to small bowel
- 43. • CAUSES :
- 44. DIAGNOSIS • Diagnosis is based on symptoms described previously and on imaging studies. • Abdominal xray • CT findings • Laboratory studies (electrolyte studies and CBC count) COMPLICATIONS: • Tissue death – Lack of blood supply leads to dead intestinal wall • Infection – peritonitis
- 45. ASSESSMENT • History collection • Past medical and surgical history • Color and characteristics of vomitus • Stool examination for occult blood • Assess vitals • Assess I/O
- 46. MANAGEMENT • MEDICAL MANAGEMENT: • Decompression of bowel through a nasogastric tube • Enema can be given to stimulate bowel movement • Antibiotics, antiemetics, analgesics • SURGICAL MANAGEMENT: • Laparoscopic surgery • Exploratory laparotomy • Bowel resection
- 47. PERFORATION • Intestinal perforation, defined as a loss of continuity of the bowel wall , is a potentially devastating complication that may result from a variety of disease processes.
- 48. RISK FACTORS
- 49. CAUSES • • Trauma • Instrumentation • Inflammation • Infection • Malignancy • Ischemia • Obstruction
- 50. PATHOPHYSIOLOGY LEAKAGE OF ACIDIC GASTRIC JUICE INTO PERITONIAL CAVITY . CHEMICAL PERFORATION IF LEAKAGE IS NOT CLOSED,& FOOD PARTICLEREACH TO PERITONINAL CAVITY, CHEMICAL PERFORATION LEADS TO BACTERIAL PERFORATION
- 52. DIAGNOSTIC TEST & COMPLICATIONS • Ultrasound abdomen • Abdominal X-ray • CT scan • Laproscopy • COMPLICATION • Wound infection • Abdominal abscess • Septic shock • GI mucosal haemorrhage • Mechanical obstruction of intestine
- 53. ASSESSMENT • History of abdominal trauma • History of pain, vomiting, hiccups • Assess abdomen for any external signs of Injury, abrasion, echymosis • Assess breathing pattern • Assess for tenderness • Assess bowel sound
- 54. MANAGEMENT MEDICAL MANAGEMENT • Patient kept NPO • Crystalloid therapy • IV administration of antibiotics SURGICAL MANAGEMENT • Treatment for intestinal perforation is only surgical • Conventional laparotomy • Laproscopic laparotomy
- 55. NURSING CARE PLAN • NURSING CARE PLAN: • PLANNING & GOALS: • The major goals for the patient include relief of abdominal pain and cramping, prevention of fluid volume deficit, maintenance of optimal nutrition and weight, avoidance of fatigue, reduction of anxiety • NURSING DIAGNOSIS 1: risk for deficient fluid volume related to vomiting and dehydration • INTERVENTIONS: • Maintain fluid volume: nurse keeps an accurate record of intake of oral and IV fluid and output . • The nurse monitors daily weight for fluid gains or losses and assess the patient for signs of fluid volume deficit ( dry skin , oliguria ) • The nurse initiates measures to decrease diarrhoea ( Dieatry restrictions, antidiarrheal agents)
- 56. NURSING DIAGNOSIS 2 • NURSING DIAGNOSIS 2:Acute pain related to increased peristalsis and GI inflammation • INTERVENTIONS: • Relieving pain:Assess the character of pain and ask about its onset • Administer anticholinergic medication 30 minutes before meal as prescribed to decrease intestinal motility • Administer analgesics as prescribed for pain • Position changes, diversional therapy and prevention of fatigue are useful for reducing pain.
- 57. NURSING DIAGNOSIS • NURSING DIAGNOSIS 4: Activity intolerance related to generalized weakness • Promoting rest: The nurse recommends intermittent rest period during the day • The nurse restrict or schedule Activities to conserve energy And reduce the metabolic rate • Nurse encourages activity within limits of patient’s capacity • The nurse suggests bedrests to the patient who is febrile
- 58. NURSING DIAGNOSIS • NURSING DIAGNOSIS 4: Anxiety related to impending surgery • Reduce anxiety: the nurse tailors information about possible impending surgery to the patients level of understanding and desire for detail. • If surgery is planned pictures and illustrations help explain the surgical procedure .
- 59. NURSING DIAGNOSIS • NURSING DIAGNOSIS 5: Imbalanced nutrition, less than body requirement related to dietary restrictions come on nausea and malabsorption • INTERVENTIONS: • Maintaining optimal nutrition: Parenteral nutrition is used for example in cases of severe cases of IBD • The nurse maintains an accurate record of intake and output of fluid as well as weights daily • Blood glucose level is monitored every six hours • The nurse notes Intolerance if the patient exhibits nausea, vomiting, abdominal distention
- 60. CLINICAL RESEARCH ABSTRACT: AIM: To evaluate the major clinical symptom, etiology and diagnostic method in patients with primary small intestinal disease in order to improve the diagnosis . METHODS: A total of 309 cases with primary small intestinal disease were reviewd and the major clinical symptoms, etiology, and diagnosis ,methods were analyzed.
- 61. RESULTS: THE MAJOR CLINICAL SYMPTOMS INCLUDED ABDOMINAL PAIN(71%), ABDOMINA MASS (14%), VOMITING(10%), MALENA (10%), AND FEVER((9%). THE MOST COMMON DISEASE WERE MAIGNANT TUMOR (40%). DUODENAL DISEASE WAS INVOLVED IN 36% OF THE PATIENTS WITH PRIMARY SMALL INTESTINAL DISEASES,. CONCLUSION: abdominal pain is the most common clinical symptom in patients with primary small intestinal disease. Malignant tumors are the most common diseases . However , more practical diagnostic method should be explored to improve the diagnostic accuracy
- 62. summary • IN THIS,WE ALL HAVE DISCUSSED ABOUT VARIOUS DISORDER OF SMALL INTESTINE , ETHiOLOgY , PATHOPHYSIOLOGY, DIAGNOSTIC TEST, ASSESSMENT, MEDIACL, SURGICAL MANAGEMENT& SURGICAL . DISORDER DUE TO INFLAMMATION, INFECTION , MALABSORPTION AND OBSTRUCTION, perforation.
- 63. THANKYOU