Med Surg 116

●​ Esophageal manometry – To
Hiatal Hernia measure esophageal pressure
-​ Opening in the diaphragm through
which esophagus becomes enlarge Treatment:
-​ Common in women than men.
1. Lifestyle & Medication (Mild Cases)
Types of Hiatal Hernia:
✔ Eat small, frequent meals​
1.​ Sliding Hiatal Hernia (most ✔ Avoid lying down after eating​
common) – The stomach and lower ✔ Raise the head of the bed​
esophagus slide up into the chest. ✔ Avoid trigger foods (spicy, acidic, fatty
2.​ Paraesophageal Hiatal Hernia – foods)​
The stomach moves up next to the ✔ Lose weight if overweight​
esophagus, which can cause ✔ Medications:
complications like strangulation.
●​ Antacids (Tums, Maalox) –
Neutralize acid
Symptoms:
●​ H2 blockers (Ranitidine,
Famotidine) – Reduce acid
●​ Acid reflux (heartburn)
production
●​ Difficulty swallowing (dysphagia)
●​ Proton Pump Inhibitors (PPIs)
●​ Chest pain
(Omeprazole, Pantoprazole) –
●​ Belching
Stronger acid reduction
●​ Feeling full quickly
●​ Vomiting (rare but possible)
2. Surgery (Severe Cases/Complications)

Causes & Risk Factors: ●​ Nissen Fundoplication –

Strengthens the lower esophageal
●​ Weakening of the diaphragm sphincter
(aging, obesity, pregnancy) ●​ Laparoscopic Hernia Repair –
●​ Increased abdominal pressure Reduces the herniated stomach and
(heavy lifting, chronic coughing, reinforces the diaphragm
constipation, vomiting)
●​ Congenital defect (born with a Nursing Intervention:
larger hiatal opening)
●​ Low fat, low sodium
Diagnosis: ●​ No spicy
●​ Upright after eating. 2hr.
●​ X-ray with contrast (Barium
●​ Small eating
Swallow)
●​ No full meal 3 hrs before sleep
●​ Endoscopy (EGD) – To check for
esophageal damage
Gastroenteritis (Stomach Flu)
Gastroenteritis is the inflammation of the 1. Rehydration (Most Important)
stomach and intestines, usually caused by
viral, bacterial, or parasitic infections. It ✔ Oral Rehydration Solution (ORS) –
leads to diarrhea, vomiting, abdominal WHO-recommended (for mild dehydration)​
cramps, and dehydration. ✔ IV Fluids – For severe dehydration

2. Medications
Causes:
●​ Antidiarrheals (use cautiously)
1.​ Viral Gastroenteritis (most
○​ Loperamide (Imodium) – For
common)
non-bloody diarrhea
○​ Norovirus (highly contagious,
○​ Bismuth subsalicylate
foodborne outbreaks)
(Pepto-Bismol) – Helps with
○​ Rotavirus (common in
mild diarrhea
children)
●​ Antibiotics (only for bacterial
2.​ Bacterial Gastroenteritis
infections)
○​ Salmonella (contaminated
○​ Ciprofloxacin, Azithromycin
food)
(for severe bacterial cases)
○​ Escherichia coli (E. coli)
●​ Antiemetics (for vomiting)
○​ Campylobacter
○​ Ondansetron (Zofran)
3.​ Parasitic Gastroenteritis
○​ Giardia lamblia 3. Dietary Management (BRAT Diet)
○​ Cryptosporidium
4.​ Non-Infectious Causes ✔ Bananas, Rice, Applesauce, Toast –
○​ Food intolerance (lactose Easy-to-digest foods​
intolerance) ✔ Avoid dairy, fatty, and spicy foods
○​ Medication-induced
(antibiotics, NSAIDs) Prevention:

Symptoms: ✔ Handwashing (most effective)​

✔ Safe food handling​
✔ Diarrhea (watery, sometimes bloody)​ ✔ Rotavirus vaccine for children
✔ Vomiting​
✔ Abdominal cramps & pain​ Nursing Interventions:
✔ Fever (if bacterial)​
✔ Dehydration (dry mouth, sunken eyes, ●​ Monitor Hydration Status: Assess
decreased urination) for signs of dehydration and
administer fluids accordingly.
Diagnosis: ●​ Provide Comfort Measures: Offer
pain relief and antiemetic
●​ Stool tests (for bacteria, parasites) medications as prescribed.
●​ Blood tests (for dehydration signs) ●​ Educate Patients and Families:
●​ Electrolyte panel (for imbalances) Instruct on proper hand hygiene,
safe food handling, and when to
Treatment: seek medical attention.
 ●​ Support Nutritional Needs: ●​ Blood tests – To check for anemia
Encourage appropriate dietary (if bleeding is present)
choices during recovery.
Treatment:
Gastritis
1. Medications
- inflammation of the stomach lining,
which can be acute (short-term) or chronic ✔ Proton Pump Inhibitors (PPIs) –
(long-lasting). It may be caused by Reduce stomach acid
infections, irritants, or autoimmune
conditions. ●​ Omeprazole, Pantoprazole,
Esomeprazole​
✔ H2-receptor blockers –
Causes & Risk Factors:
Decrease acid production
✔ Helicobacter pylori (H. pylori) ●​ Ranitidine, Famotidine​
infection – Most common cause​ ✔ Antacids – Neutralize stomach
✔ Excessive NSAIDs (Aspirin, Ibuprofen) acid
– Irritate stomach lining​ ●​ Maalox, Tums, Mylanta​
✔ Alcohol abuse – Increases stomach ✔ Antibiotics (if H. pylori
acid, damages lining​ positive) – Clarithromycin +
✔ Smoking – Delays healing and Amoxicillin + PPI (Triple therapy)​
increases risk​ ✔ Cytoprotective agents – Protect
✔ Stress (physiological or stomach lining
psychological) – Can trigger gastritis​ ●​ Sucralfate, Misoprostol
✔ Autoimmune gastritis – Immune
2. Lifestyle & Dietary Changes
system attacks stomach lining
✔ Avoid spicy, acidic, and fried foods​
Symptoms: ✔ Reduce alcohol and caffeine intake​
✔ Quit smoking​
✔ Epigastric pain (burning sensation in ✔ Manage stress (relaxation techniques)
the upper abdomen)​
✔ Nausea and vomiting​
Complications (if untreated):
✔ Loss of appetite​
✔ Bloating and belching​ ⚠ Peptic ulcers​
✔ Indigestion (dyspepsia)​ ⚠ Stomach bleeding​
✔ In severe cases: Black, tarry stools ⚠ Increased risk of stomach cancer
(sign of bleeding)
Nursing Interventions
Diagnosis:
●​ Monitor Vital Signs: Watch for
●​ Endoscopy (EGD) – To examine signs of bleeding, such as
stomach lining and take biopsies hypotension.
●​ H. pylori testing (urea breath test, ●​ Assess Pain: Evaluate the severity
stool antigen test) and location of abdominal pain.
 ●​ Educate Patients: Teach about ✔ Regurgitation (acid or food coming
medication adherence and lifestyle back up)​
changes. ✔ Chronic cough or sore throat​
●​ Promote Rest: Encourage ✔ Difficulty swallowing (dysphagia)​
adequate rest to aid healing. ✔ Bloating and burping​
●​ Monitor Laboratory Results: Keep ✔ Hoarseness or voice changes​
track of hemoglobin and hematocrit ✔ Feeling of lump in the throat
levels for signs of bleeding.
Diagnosis:
Gastroesophageal Reflux Disease
(GERD) ●​ Endoscopy (EGD) – To check for
esophageal damage
GERD is a chronic digestive disorder ●​ 24-hour pH monitoring – Measures
where stomach acid frequently flows back acid levels in the esophagus
into the esophagus, causing heartburn ●​ Barium swallow X-ray – Shows
and irritation. It occurs due to weakening reflux and structural issues
of the lower esophageal sphincter (LES). ●​ Esophageal manometry – Tests
LES function
Causes & Risk Factors:
Treatment:
✔ Weak or relaxed LES (lower esophageal
sphincter), bending or lying flat when 1. Medications
stomach is full​
✔ Obesity – Increases abdominal ✔ Proton Pump Inhibitors (PPIs) –
pressure​ Reduce acid production (Omeprazole,
✔ Hiatal hernia – Allows acid to move up​ Pantoprazole, Esomeprazole)​
✔ Pregnancy – Hormonal changes & ✔ H2-receptor blockers – Decrease acid
pressure on the stomach​ (Ranitidine, Famotidine)​
✔ Smoking – Weakens LES and ✔ Antacids – Neutralize acid (Tums,
increases acid production​ Maalox, Mylanta)​
✔ Certain foods & drinks – Spicy, fatty ✔ Prokinetics – Improve gastric emptying
foods, chocolate, coffee, alcohol​ (Metoclopramide)
✔ Medications – NSAIDs, calcium
2. Lifestyle & Dietary Changes
channel blockers, antihistamines
✔ Eat small, frequent meals​
●​ Zollinger-ellison syndrome -
✔ Avoid trigger foods (spicy, acidic, fatty,
presence of gastrinomas, which are
caffeine, chocolate)​
tumors that produce excessive
✔ Avoid lying down immediately after
amounts of gastrin
eating (wait 2-3 hours)​
✔ Elevate head of the bed (6-8 inches)​
Symptoms: ✔ Lose weight if overweight​
✔ Quit smoking and limit alcohol
✔ Heartburn (burning sensation in chest,
worse after eating or lying down)​ 3. Surgical Treatment (Severe Cases)
 ●​ Nissen Fundoplication – of adherence to treatment plans. -
Strengthens LES by wrapping Teach techniques for stress
stomach around it management, as stress can worsen
●​ LINX device – Magnetic ring placed GERD symptoms.
around the esophagus to prevent
reflux

Complications (if untreated): Peptic Ulcer Disease (PUD)

⚠ Esophagitis (inflammation of the Peptic Ulcer Disease (PUD) is a condition

esophagus)​ where open sores (ulcers) form in the
⚠ Barrett’s esophagus (precancerous stomach lining (gastric ulcer) or the
changes)​ upper part of the small intestine
⚠ Esophageal strictures (narrowing of (duodenal ulcer) due to acid erosion.
the esophagus)​
⚠ Aspiration pneumonia (acid entering Causes & Risk Factors:
the lungs)
✔ Helicobacter pylori (H. pylori)
Nursing Interventions infection – Most common cause​
✔ Excessive NSAID use – (Aspirin,
●​ Administer prescribed Ibuprofen, Naproxen) damages the stomach
medications such as proton pump lining​
inhibitors (PPIs) or H2-receptor ✔ Smoking – Increases acid production &
antagonists to reduce gastric acid delays healing​
production. ✔ Alcohol consumption – Irritates the
●​ Advise patients to avoid trigger stomach lining​
foods and beverages, including ✔ Stress – May worsen symptoms but
spicy, fatty, and acidic items. - does not directly cause ulcers​
Recommend smaller, more ✔ Spicy foods & caffeine – Do not cause
frequent meals to reduce gastric ulcers but may aggravate symptoms
pressure.
●​ Encourage weight loss for Symptoms:
overweight or obese patients to
decrease abdominal pressure. - ✔ Burning epigastric pain – Often
Advise cessation of smoking and relieved by food in duodenal ulcers but
alcohol consumption, as they can worsened in gastric ulcers​
exacerbate GERD symptoms. ✔ Bloating and belching​
●​ Instruct patients to elevate the ✔ Nausea and vomiting​
head of the bed by 6-8 inches to ✔ Loss of appetite and weight loss​
prevent nocturnal reflux. - ✔ Black, tarry stools (melena) or
Recommend avoiding lying down coffee-ground vomit – Signs of GI
immediately after meals to reduce bleeding
reflux episodes.
●​ Provide information on the chronic Diagnosis:
nature of GERD and the importance
 ●​ Endoscopy (EGD) – Direct ●​ Pyloroplasty – Widening the
visualization of the ulcer opening of the stomach into the
●​ H. pylori tests – Urea breath test, small intestine
stool antigen test, or biopsy
●​ Barium swallow X-ray – Identifies Complications (if untreated):
ulcers indirectly
●​ Blood tests – Check for anemia (if ⚠ GI bleeding – Life-threatening if severe​
there is chronic bleeding) ⚠ Perforation – Hole in the
stomach/intestine, causing peritonitis​
Treatment: ⚠ Gastric outlet obstruction – Blockage
due to ulcer-related swelling or scarring​
1. Medications ⚠ Increased risk of stomach cancer (if
due to H. pylori)
✔ Proton Pump Inhibitors (PPIs) –
Reduce acid production (Omeprazole, Nursing Interventions
Pantoprazole, Esomeprazole)​
✔ H2-receptor blockers – Decrease acid ●​ Assess pain level and monitor for
(Ranitidine, Famotidine)​ signs of GI bleeding (black stools,
✔ Antacids – Neutralize stomach acid coffee-ground vomit).
(Maalox, Tums, Mylanta)​ ●​ Administer prescribed medications:
✔ Cytoprotective agents – Protect the PPIs, H2 blockers, antacids,
stomach lining (Sucralfate, Misoprostol)​ cytoprotective agents, and
✔ Antibiotics for H. pylori – antibiotics (for H. pylori).
Clarithromycin + Amoxicillin + PPI (Triple ●​ Encourage small, frequent meals to
therapy) reduce irritation and promote
healing.
2. Lifestyle & Dietary Changes ●​ Educate the patient on avoiding
NSAIDs, smoking, alcohol, spicy,
✔ Eat small, frequent meals​ acidic, and fatty foods.
✔ Avoid NSAIDs (Aspirin, Ibuprofen) – ●​ Encourage fluid intake to prevent
Use Acetaminophen instead​ dehydration and maintain nutritional
✔ Avoid smoking and alcohol​ balance.
✔ Reduce stress with relaxation ●​ Monitor for signs of bleeding
techniques​ (tachycardia, hypotension, pale skin,
✔ Limit spicy, acidic, and fatty foods​ and black stools).
✔ Avoid eating late at night ●​ Teach stress-reduction techniques to
reduce gastric acid production.
3. Surgical Treatment (Severe ●​ Monitor daily weight to assess for
Cases) malnutrition and support proper
dietary habits.
●​ Partial gastrectomy – Removing ●​ Encourage rest and positioning
part of the stomach (semi-Fowler's) to reduce discomfort
●​ Vagotomy – Cutting vagus nerve to and improve digestion.
reduce acid secretion
 ●​ Educate on the importance of Causes:
medication adherence to prevent
recurrence and complications. ●​ Surgery-related: Most commonly, it
occurs after surgeries that alter the
Dumping Syndrome stomach or small intestine (like
gastric bypass).
is a group of symptoms that can occur after ●​ The stomach is unable to regulate
eating, typically following surgery involving the speed of food entering the
the stomach, such as a gastrectomy or intestines, leading to rapid gastric
bariatric surgery (like a gastric bypass). It emptying.
happens when food, especially sugar,
moves too quickly from the stomach into the Risk Factors:
small intestine.
●​ Bariatric surgery (gastric bypass or
Types of Dumping Syndrome: sleeve gastrectomy)
●​ Gastrectomy (partial removal of the
1.​ Early Dumping Syndrome – stomach, often due to cancer or
Symptoms occur 10 to 30 minutes ulcers)
after eating. ●​ Larger meals (especially foods high
2.​ Late Dumping Syndrome – in sugar or fats)
Symptoms occur 1 to 3 hours after
eating. Diagnosis:

Symptoms: ●​ Clinical evaluation based on

symptoms and post-surgery history.
Early Dumping Syndrome: ●​ Blood tests (to evaluate blood
sugar levels, especially for late
●​ Nausea dumping syndrome).
●​ Vomiting ●​ Oral glucose tolerance test (to
●​ Abdominal cramps assess for hypoglycemia).
●​ Diarrhea
●​ Dizziness, lightheadedness Management and Treatment:
●​ Sweating
●​ Rapid heartbeat (tachycardia) Dietary Changes:
●​ Feeling of fullness
●​ Eat smaller, more frequent meals
Late Dumping Syndrome: (5-6 meals/day instead of 3 large
ones).
●​ Hypoglycemia (low blood sugar) ●​ Avoid sugary foods and drinks that
due to rapid insulin release: are quickly absorbed.
○​ Sweating ●​ High-protein, low-carbohydrate
○​ Shaking meals to slow down food movement.
○​ Weakness ●​ Avoid drinking fluids with meals
○​ Confusion (drink 30 minutes before or after
○​ Dizziness
 eating to prevent rapid stomach Risk Factors:
emptying).
●​ Eat slowly to allow the stomach ●​ Helicobacter pylori infection (H.
more time to digest and absorb food. pylori): A common stomach infection
that can lead to ulcers and increase
Medications: the risk of gastric cancer.
●​ Chronic gastritis or long-term
●​ Octreotide (a medication that slows stomach inflammation.
down stomach emptying). ●​ Family history: A history of gastric
●​ Acarbose (helps slow carbohydrate cancer in the family can increase the
absorption). risk.
●​ Age: More common in people over
Surgical Interventions (in severe cases):
60 years old.
●​ Revision surgery or stomach ●​ Gender: Men are more likely to
reconstruction may be considered develop gastric cancer than women.
if symptoms are severe and cannot ●​ Smoking: Smoking increases the
be managed with diet or risk.
medications. ●​ Diet: Diets high in smoked, pickled,
or salty foods and low in fruits and
vegetables can increase the risk.
Nursing Responsibilities:
●​ Obesity: Being overweight or obese
●​ Education: Instruct patients about increases the risk, particularly for
diet modifications to avoid triggering cancer in the upper stomach.
symptoms. ●​ Previous gastric surgery: People
●​ Monitoring blood sugar levels who have had part of their stomach
(especially for late dumping removed are at a higher risk.
syndrome, to detect hypoglycemia). ●​ Blood type: People with blood type
●​ Postoperative care: Ensure A may have an increased risk.
patients follow dietary
recommendations after surgery to Types of Gastric Cancer:
reduce the risk of dumping
syndrome. 1.​ Adenocarcinoma: The most
●​ Assess for dehydration and common type, developing from the
electrolyte imbalances from vomiting glandular cells of the stomach lining.
or diarrhea. 2.​ Lymphoma: A cancer of the
immune system cells that can
sometimes occur in the stomach.
Gastric Cancer (Stomach Cancer)
3.​ Gastrointestinal Stromal Tumors
Gastric cancer is a type of cancer that (GISTs): A type of tumor originating
develops in the lining of the stomach. It can in the digestive tract's connective
occur in various parts of the stomach and tissues, often found in the stomach.
often begins as a small area of inflammation 4.​ Carcinoid Tumors: Rare tumors
that can develop into a tumor. that develop from
 hormone-producing cells in the Staging is crucial to determine the extent of
stomach. cancer and plan treatment. The stages
range from Stage 0 (in situ) to Stage IV
Symptoms of Gastric Cancer: (spread to distant organs). The TNM
system (Tumor, Node, Metastasis) is
●​ Indigestion (dyspepsia) commonly used for staging:
●​ Stomach pain or discomfort,
particularly in the upper abdomen. ●​ T (Tumor): Size and extent of the
●​ Nausea and vomiting (especially primary tumor.
after meals) ●​ N (Node): Spread to nearby lymph
●​ Loss of appetite or feeling full after nodes.
eating small amounts. ●​ M (Metastasis): Spread to other
●​ Unintentional weight loss. distant organs, like the liver or lungs.
●​ Difficulty swallowing (dysphagia).
●​ Blood in stools or vomiting blood Treatment:
(may appear as dark or black
stools). 1. Surgery:
●​ Fatigue or weakness (due to blood
loss or anemia). ●​ Gastrectomy: Removal of part or all
●​ Bloating after eating. of the stomach, depending on the
●​ Acid reflux or heartburn. tumor's size and location.
○​ Partial gastrectomy:
Removal of part of the
Diagnosis:
stomach.
1.​ Endoscopy (EGD): A flexible tube ○​ Total gastrectomy:
with a camera is inserted into the Complete removal of the
stomach to look for abnormal areas. stomach.
2.​ Biopsy: A tissue sample is taken ●​ Lymph node removal: Removing
from the stomach during endoscopy surrounding lymph nodes to check
to check for cancer cells. for cancer spread.
3.​ Barium swallow X-ray: A special
2. Chemotherapy:
liquid is ingested to help outline the
stomach and detect abnormalities. ●​ Can be used before surgery
4.​ CT scan: To determine the size of (neoadjuvant) to shrink the tumor, or
the tumor and whether the cancer after surgery (adjuvant) to kill
has spread. remaining cancer cells.
5.​ Ultrasound: Sometimes used to ●​ Common chemotherapy drugs for
assess nearby organs like the liver. gastric cancer: 5-fluorouracil
6.​ Blood tests: For anemia, liver (5-FU), cisplatin, and docetaxel.
function, or tumor markers (like CEA
or CA 19-9). 3. Radiation Therapy:

Staging of Gastric Cancer: ●​ May be used to shrink tumors before

surgery or for palliative care to
 relieve symptoms in advanced overwhelming for patients and
cancer. families.
●​ Chemotherapy/radiation
4. Targeted Therapy: management: Monitor for side
effects of chemotherapy (nausea,
●​ Drugs that target specific cancer cell vomiting, fatigue, hair loss) and
mechanisms, such as Herceptin provide supportive care.
(trastuzumab), for cancers that
overexpress the HER2 gene.
Prognosis:
5. Immunotherapy:
The prognosis depends on the stage at
●​ A newer treatment option that helps which the cancer is diagnosed. Early
the immune system recognize and detection and surgery give a better chance
fight cancer cells. of survival, while advanced stages have a
poorer prognosis due to metastasis and
6. Palliative Care: complications.

●​ If the cancer is diagnosed at an Gallbladder Disorders:

advanced stage, palliative care may Cholelithiasis and Cholecystitis
be used to alleviate symptoms and
improve quality of life. 1. Cholelithiasis (Gallstones)

Nursing Responsibilities: > refers to the formation of stones

(gallstones) in the gallbladder. These stones
●​ Preoperative care: Educate the are hardened deposits of bile, a digestive
patient on what to expect from fluid produced by the liver. Gallstones can
surgery (gastrectomy, lymph node vary in size and may be composed of
removal), diet changes, and cholesterol, bilirubin, or a combination of
potential complications. both.
●​ Postoperative care: Monitor for
complications such as infection, Types:
leakage, or bleeding. Assess for
difficulty swallowing or nutrition ●​ Cholesterol Stones: The most
problems. common type, made primarily of
●​ Pain management: Provide hardened cholesterol. They form
effective pain relief and manage any when there's too much cholesterol in
discomfort post-surgery. the bile.
●​ Nutritional support: Patients with ●​ Pigment Stones: These are
gastrectomy may need special smaller, darker stones made from
dietary modifications or enteral excess bilirubin (a byproduct of red
feeding (tube feeding) if necessary. blood cell breakdown), often
●​ Psychological support: Provide associated with conditions like liver
emotional support, as cancer cirrhosis, biliary tract infection, or
diagnoses and surgeries can be certain blood disorders.
Risk Factors: ●​ HIDA Scan: A nuclear imaging test
that can check for blockage or
●​ Obesity: Increased cholesterol in dysfunction in the gallbladder.
the bile.
●​ Age: More common in people over Treatment:
40.
●​ Gender: Women are more likely to ●​ Watchful Waiting: If gallstones do
develop gallstones, especially those not cause symptoms, no treatment
who have had multiple pregnancies may be needed.
or use hormonal birth control. ●​ Medications: Bile acid pills (e.g.,
●​ Pregnancy: Hormonal changes ursodeoxycholic acid) can help
during pregnancy can increase the dissolve cholesterol gallstones, but
risk. this is typically not effective for larger
●​ Diabetes: Insulin resistance and stones.
increased cholesterol production. ●​ Surgical Removal
●​ Family history: A family history of (Cholecystectomy): The most
gallstones increases the likelihood of common treatment for symptomatic
developing them. gallstones, especially if they cause
●​ Diet: High-fat, high-cholesterol, and pain or complications. This involves
low-fiber diets can contribute to the the removal of the gallbladder, often
formation of gallstones. done laparoscopically.
●​ Non-Surgical Approaches:
Symptoms of Cholelithiasis: Shockwave therapy or lithotripsy can
sometimes be used to break up
●​ Asymptomatic (Silent Gallstones): stones, but this is not commonly
Many people with gallstones don't performed.
experience symptoms and may not
need treatment. Nursing Responsibilities:
●​ Pain (Biliary Colic): Sudden,
intense pain in the upper right ●​ Preoperative care: Educate the
abdomen or back, typically after patient on what to expect from
eating fatty foods. This pain can last surgery (laparoscopic
from 30 minutes to several hours. cholecystectomy). Ensure the
●​ Nausea and vomiting. patient is fasting before surgery.
●​ Indigestion. ●​ Postoperative care: Monitor for
●​ Bloating or discomfort after signs of complications such as
meals. infection, bleeding, or bile leakage.
Provide pain management and
Diagnosis: promote early ambulation to reduce
the risk of complications.
●​ Ultrasound: The most common and ●​ Dietary advice: After surgery,
reliable method for detecting patients may need to follow a low-fat
gallstones. diet for a while to help their digestive
●​ CT Scan: Sometimes used but not system adjust to the absence of the
as effective as ultrasound. gallbladder.
2. Cholecystitis (Inflammation of the ●​ Tenderness when pressing on the
Gallbladder) abdomen.
●​ Jaundice (yellowing of the skin or
Definition: Cholecystitis is the inflammation eyes) in some cases, especially if
of the gallbladder, usually caused by a the bile ducts are blocked.
gallstone blocking one of the bile ducts. This ●​ Pain that worsens after eating,
blockage can cause bile to accumulate in particularly fatty foods.
the gallbladder, leading to irritation, swelling,
and infection. Diagnosis:

Types of Cholecystitis: ●​ Ultrasound: The most common

imaging test used to diagnose
●​ Acute Cholecystitis: Sudden cholecystitis.
inflammation of the gallbladder, often ●​ CT Scan: Can also help identify
due to gallstones blocking the cystic complications, like abscesses or
duct, causing bile buildup and perforation.
infection. ●​ Blood Tests: Elevated white blood
●​ Chronic Cholecystitis: Long-term cell count (indicating infection) and
inflammation due to repeated liver enzymes may be seen.
episodes of acute cholecystitis, ●​ HIDA Scan: This can assess
leading to gallbladder dysfunction gallbladder function and bile duct
and scarring. obstruction.

Risk Factors: Treatment:

●​ Cholelithiasis (Gallstones): The ●​ Antibiotics: To treat any infection

most common cause of cholecystitis. associated with acute cholecystitis.
●​ Infections: Bacterial infections can ●​ Pain management: NSAIDs (like
contribute to cholecystitis, especially ibuprofen) or opioids for severe pain.
in people with diabetes. ●​ Surgical Removal
●​ Trauma or surgery: Injury or recent (Cholecystectomy): The treatment
surgery in the abdominal area can of choice for acute cholecystitis,
increase the risk. especially if caused by gallstones.
●​ IV drug use: People who inject This is often done after the acute
drugs may have an increased risk symptoms are controlled.
due to the potential spread of ●​ Percutaneous Cholecystostomy:
infection. In critically ill patients who are not
candidates for surgery, a tube may
Symptoms of Cholecystitis: be inserted into the gallbladder to
drain infected bile.
●​ Severe pain in the upper right
abdomen or center of the Nursing Responsibilities:
abdomen.
●​ Fever and chills.
●​ Nausea and vomiting.
 ●​ Pain management: Administer Causes:
prescribed pain medications and
ensure comfort for the patient. The exact cause of appendicitis is not
●​ Monitor vital signs: Watch for signs always clear, but some common causes
of sepsis (elevated heart rate, fever) include:
or complications such as perforation
or abscess formation. 1.​ Blockage: A blockage in the lumen
●​ Preoperative care: If surgery is of the appendix (by stool, foreign
necessary, ensure the patient is bodies, or cancer) can lead to an
well-prepared for cholecystectomy. infection.
●​ Postoperative care: Monitor for 2.​ Infection: Infections, particularly
signs of infection, bleeding, or bile viral or bacterial infections (like
leakage following surgery. Provide gastrointestinal infections), can lead
instructions for post-discharge care, to appendicitis.
including diet modifications (low-fat 3.​ Inflammatory Bowel Disease
diet) and activity restrictions. (IBD): Conditions like Crohn’s
disease or ulcerative colitis may
increase the risk of appendicitis.
Complications of Cholelithiasis
4.​ Trauma: Physical injury to the
and Cholecystitis: abdomen may sometimes trigger
appendicitis.
1.​ Cholestasis: Blockage of bile flow
leading to bile accumulation. Symptoms:
2.​ Gallbladder perforation: A ruptured
gallbladder can cause peritonitis, a ●​ Abdominal pain: The hallmark
severe and life-threatening infection. symptom is pain that starts around
3.​ Pancreatitis: Gallstones can also the belly button and then shifts to the
block the pancreatic duct, leading to lower right side of the abdomen (the
pancreatitis. "McBurney's point"). The pain
4.​ Cholangitis: An infection of the bile typically becomes more intense and
ducts, usually due to blockage by sharp over time.
stones. ●​ Nausea and vomiting: Often occurs
5.​ Biliary Cirrhosis: Long-term bile shortly after the abdominal pain
duct obstruction can cause liver starts.
damage and cirrhosis. ●​ Loss of appetite: A common early
sign.
Appendicitis ●​ Fever: A low-grade fever that can
increase as the condition
Its the inflammation of the appendix, a progresses.
small, finger-shaped pouch attached to the ●​ Constipation or diarrhea: Either
large intestine. It is typically caused by a may occur, along with an inability to
blockage in the appendix that leads to pass gas.
infection. If left untreated, the appendix can ●​ Tenderness: The abdomen
burst, leading to severe complications. becomes very tender, particularly in
the lower right side.
 ●​ Rebound tenderness: When the usually still recommended to
abdominal wall is pressed and then prevent recurrence.
quickly released, the patient may 2.​ Surgical Treatment
experience pain (this is a sign of (Appendectomy):​
peritonitis if the appendix bursts).
○​ Laparoscopic
Diagnosis: Appendectomy: A minimally
invasive surgery where the
1.​ Physical Examination: appendix is removed through
○​ Abdominal exam: The small incisions. This is the
doctor will palpate the most common method.
abdomen to identify pain, ○​ Open Appendectomy: A
particularly around the lower larger incision is made to
right side. remove the appendix, often
○​ Rebound tenderness: Pain used if the appendix has
upon releasing pressure on ruptured or if there are
the abdomen is a typical complications.
sign. 3.​ Preoperative Care:​
2.​ Blood Tests:
○​ Elevated white blood cell ○​ NPO status: The patient is
count indicating infection. kept without food or drink (nil
3.​ Imaging: per os) in preparation for
○​ Ultrasound: Often the first surgery.
choice in children and ○​ IV fluids: To prevent
pregnant women to confirm dehydration and support the
appendicitis. patient during surgery.
○​ CT Scan: The gold standard ○​ Antibiotics: Administered to
for diagnosing appendicitis, reduce the risk of infection
especially in adults, as it before and after surgery.
provides more detailed 4.​ Postoperative Care:​
imaging of the abdomen.
○​ MRI: Sometimes used in ○​ Pain management: Pain
pregnant women as it avoids relief is provided
radiation exposure. post-surgery.
○​ Monitoring: The patient’s
Treatment:
vital signs and wound healing
1.​ Non-surgical Treatment (Rare are closely monitored.
cases):​ ○​ Diet: Gradual reintroduction
of food and fluids.
○​ In some cases, especially in ○​ Activity restrictions:
mild or non-complicated Limited physical activity,
appendicitis, antibiotics may avoiding strenuous
be given to reduce the movements to allow proper
infection, but surgery is healing.
 5.​ If the Appendix Bursts ○​ Encourage early ambulation
(Peritonitis):​ to prevent complications like
deep vein thrombosis (DVT).
○​ A ruptured appendix can lead ○​ Gradually reintroduce a soft
to peritonitis (infection of the diet and monitor for
abdominal cavity), which is tolerance.
life-threatening. The ●​ Education:​
treatment involves:
■​ Emergency surgery to ○​ Teach the patient about signs
remove the appendix of infection, such as fever,
and clean the increased pain, or redness at
abdominal cavity. the surgical site.
■​ Prolonged IV ○​ Encourage follow-up care to
antibiotics to treat the monitor recovery.
widespread infection. ○​ Advise the patient to avoid
strenuous activity for several
Nursing Responsibilities: weeks after surgery.

●​ Preoperative Care:​ Complications:

○​ Ensure that the patient is 1.​ Appendix Rupture (Perforation):​

informed about the
procedure. ○​ This can cause peritonitis, a
○​ Monitor for signs of life-threatening condition that
complications such as sepsis requires immediate surgical
or a perforated appendix intervention.
(fever, tachycardia, 2.​ Abscess Formation:​
worsening abdominal pain).
○​ Ensure the patient is NPO ○​ Infected material can form a
and administer IV fluids. localized collection of pus
○​ Provide emotional support within the abdomen.
and pain management. 3.​ Sepsis:​
●​ Postoperative Care:​
○​ If the infection spreads to the
○​ Monitor for signs of infection bloodstream, it can cause
at the surgical site (redness, sepsis, which is a medical
swelling, increased emergency.
temperature). 4.​ Wound Infection:​
○​ Assess for any signs of
complications, such as ○​ After surgery, the incision site
abscess formation or wound may become infected.
dehiscence.
○​ Assist with pain Key Points:
management.
 ●​ Appendicitis is a medical emergency contribute to the inflammation
that requires prompt treatment to associated with Crohn’s disease.
avoid serious complications like a
ruptured appendix or peritonitis. Symptoms:
●​ Surgery (appendectomy) is the most
effective treatment. Symptoms can vary based on the severity
●​ Early detection and intervention are of the disease and the part of the digestive
crucial for a positive outcome, and tract affected, but common symptoms
postoperative care is essential for include:
preventing infection and ensuring
1.​ Abdominal pain and cramping:
recovery.
Often in the lower right abdomen.
2.​ Diarrhea: Can be chronic and
Crohn's Disease sometimes bloody.
3.​ Fatigue: Persistent tiredness due to
A type of inflammatory bowel disease (IBD)
inflammation or nutritional
that causes inflammation of the digestive
deficiencies.
tract. It can affect any part of the
4.​ Weight loss: Can occur due to poor
gastrointestinal (GI) tract from the mouth to
nutrient absorption or reduced
the anus, but it most commonly impacts the
appetite.
ileum (the end of the small intestine) and
5.​ Reduced appetite: Often caused by
the beginning of the colon. The exact cause
abdominal discomfort and bloating.
of Crohn's disease is not known, but it is
6.​ Fever: A low-grade fever may occur
believed to be a combination of genetic,
during active disease flare-ups.
environmental, and immune system factors.
7.​ Anemia: Due to chronic blood loss
Causes: or malabsorption of iron and
nutrients.
1.​ Genetic Factors: A family history of 8.​ Mucus in stool: Due to the
Crohn’s disease increases the inflammation of the colon.
likelihood of developing the 9.​ Bloating and gas: Common with
condition. Certain genetic mutations bowel inflammation.
are linked to the disease.
2.​ Immune System Response: Complications:
Crohn's disease is believed to be an
1.​ Intestinal Obstruction: Scar tissue
autoimmune disorder, where the
(strictures) from inflammation may
body’s immune system mistakenly
cause narrowing of the intestines,
attacks the digestive tract, causing
leading to blockages.
inflammation.
2.​ Fistulas: Abnormal connections
3.​ Environmental Factors: Certain
between different parts of the
environmental factors, such as diet,
intestines, or between the intestines
smoking, or infections, may trigger
and other organs (such as the
or exacerbate Crohn's disease.
bladder or skin).
4.​ Microbiome Imbalance: An
imbalance in gut bacteria may
 3.​ Abscesses: Pockets of infected ○​ CT Scan or MRI: These can
fluid can form in the abdomen or help detect complications
around the anus. such as strictures,
4.​ Perforation: In severe cases, abscesses, and fistulas.
Crohn's disease can cause a hole in ○​ Small Bowel Series: A type
the wall of the intestine, leading to of X-ray used to view the
peritonitis (infection of the abdominal small intestine, particularly in
cavity). patients with Crohn's disease
5.​ Malnutrition: Due to the difficulty in affecting the ileum.
absorbing nutrients properly, leading
to deficiencies. Treatment:
6.​ Colon Cancer: Long-term
inflammation increases the risk of 1.​ Medications:​
colorectal cancer, especially in those
with Crohn’s disease affecting the ○​ Anti-inflammatory drugs:
colon. ■​ Aminosalicylates
7.​ Gallstones: Crohn’s disease can (5-ASAs): Drugs like
lead to an increased risk of mesalamine are often
gallstones, especially if the ileum is used to reduce
affected. inflammation.
○​ Immunosuppressants:
Diagnosis: ■​ Corticosteroids
(e.g., prednisone):
1.​ Medical History and Physical Used during flare-ups
Exam: A doctor will assess to reduce
symptoms, family history, and inflammation.
perform a physical examination. ■​ Immunomodulators
2.​ Blood Tests: Blood tests may show (e.g., azathioprine,
elevated white blood cells, indicating methotrexate):
inflammation or infection, as well as Suppress the immune
anemia. system to prevent
3.​ Stool Tests: To rule out infections further inflammation.
and check for signs of blood in the ○​ Biologics:
stool. ■​ TNF inhibitors (e.g.,
4.​ Endoscopy: infliximab,
○​ Colonoscopy: A long tube adalimumab): Target
with a camera is inserted into and block TNF, a
the colon to look for protein involved in the
inflammation, ulcers, and inflammation process.
other abnormalities. ■​ Interleukin
○​ Upper Endoscopy (EGD): inhibitors: Target
Used if Crohn's disease specific molecules
affects the upper GI tract. involved in
5.​ Imaging Studies: inflammation.
 ○​ Antibiotics: For treating colostomy or ileostomy may
infections, especially if be needed.
abscesses or fistulas are 4.​ Management of Complications:​
present.
○​ Anti-diarrheal medications: ○​ Abscess drainage: If an
Sometimes used to help abscess forms, it may need
manage symptoms, but they to be drained either surgically
must be used cautiously, or percutaneously.
especially in active disease. ○​ Management of fistulas:
2.​ Dietary Modifications:​ Depending on the type and
location, fistulas may require
○​ Low-residue diet: To reduce surgery or long-term
irritation to the intestines management with
during flare-ups. medications.
○​ Nutritional support:
Patients may need vitamin Nursing Responsibilities:
and mineral
supplementation, particularly 1.​ Assessment:​
vitamin B12, iron, and
calcium. ○​ Monitor for signs of active
○​ Avoiding trigger foods: flare-ups and complications
Some individuals find that (e.g., fever, severe
certain foods worsen abdominal pain, bloating,
symptoms (e.g., dairy, blood in stool).
high-fat foods, or spicy ○​ Monitor nutritional status,
foods). including weight, lab values,
3.​ Surgery:​ and any signs of malnutrition.
○​ Assess for signs of
○​ Resection of damaged dehydration, especially
intestines: In cases of during diarrhea or vomiting
severe inflammation, episodes.
strictures, or complications, 2.​ Education:​
part of the intestine may
need to be surgically ○​ Teach patients about disease
removed. management, including the
○​ Strictureplasty: Surgical importance of medication
widening of narrowed adherence and follow-up
sections of the intestine. appointments.
○​ Fistula repair: Surgery to ○​ Educate on dietary
correct abnormal passages modifications and how to
between organs or tissues. recognize and avoid trigger
○​ Stoma: In severe cases, a foods.
temporary or permanent ○​ Provide information on the
signs of complications, such
 as bowel obstruction, 5.​ Fistulas and Strictures: Abnormal
abscess, or perforation. connections between organs or
○​ Discuss the need for regular narrowing of the intestines due to
screenings, especially for scarring.
colon cancer in long-standing
disease. Key Points:
3.​ Medication Administration:​
●​ Crohn’s disease is a chronic,
○​ Administer prescribed relapsing condition that causes
medications, including inflammation in the digestive tract.
biologics, ●​ Symptoms can vary greatly, but
immunosuppressants, and abdominal pain, diarrhea, weight
corticosteroids. loss, and fatigue are common.
○​ Monitor for potential side ●​ Management includes medication,
effects, including infections or dietary changes, and possibly
complications related to surgery.
immunosuppressive drugs. ●​ Regular monitoring for
4.​ Support:​ complications, such as bowel
obstruction, fistulas, and infections,
○​ Offer emotional support to is essential.
help patients cope with the ●​ Emotional support and patient
chronic nature of the disease education are important in helping
and the impact on quality of individuals cope with the disease's
life. chronic nature.
○​ Provide resources for
support groups and Irritable Bowel Syndrome (IBS)
counseling for coping with
chronic illness. Irritable Bowel Syndrome (IBS) is a
common gastrointestinal disorder that
Complications: affects the large intestine (colon). It is
characterized by a group of symptoms
1.​ Peritonitis: If a section of the bowel including abdominal pain, bloating, and
perforates, it can lead to peritonitis, changes in bowel habits, such as diarrhea,
which is a life-threatening infection constipation, or alternating between both.
of the abdominal cavity. IBS is a functional disorder, meaning that
2.​ Abscess Formation: Infection may the digestive system looks normal but does
lead to abscesses, especially in the not function properly. It is not caused by
abdomen. structural abnormalities or diseases.
3.​ Colon Cancer: Long-standing
Crohn's disease increases the risk of Causes:
developing colorectal cancer,
especially if the colon is involved. The exact cause of IBS is not fully
4.​ Osteoporosis: Due to understood, but several factors are believed
malabsorption of calcium and the to contribute to its development:
use of corticosteroids.
 1.​ Abnormal Gut Motility: The ○​ Constipation (IBS-C):
muscles in the intestine may Infrequent, hard, or
contract more strongly or more difficult-to-pass stools.
weakly than usual, leading to ○​ Alternating diarrhea and
diarrhea or constipation. constipation (IBS-Mixed or
2.​ Hypersensitivity of the Gut: The IBS-M): Fluctuations
intestines may become more between both symptoms.
sensitive to pain or discomfort 4.​ Mucus in Stool: Some people with
(visceral hypersensitivity), leading to IBS may notice mucus in their
cramping and bloating. stools.
3.​ Infections: Gastrointestinal 5.​ Urgency: A sudden need to have a
infections can sometimes trigger bowel movement, often associated
IBS, particularly if the person with diarrhea.
experiences post-infectious IBS after
a bout of gastroenteritis. Diagnosis:
4.​ Changes in Gut Microbiome:
Alterations in the bacteria that There is no specific test for IBS, and the
normally live in the intestines can diagnosis is primarily based on symptoms
influence IBS symptoms. and the exclusion of other gastrointestinal
5.​ Stress and Psychological Factors: conditions. The following are commonly
Emotional stress, anxiety, and used for diagnosis:
depression can exacerbate IBS
1.​ Medical History and Physical
symptoms. The gut and brain are
Exam: The healthcare provider will
closely linked, so mental health can
ask about the patient's symptoms,
influence gut function.
their duration, frequency, and
6.​ Genetic Factors: A family history of
triggers.
IBS may increase the risk, but it is
2.​ Rome IV Criteria: IBS is diagnosed
not directly inherited.
if a person has abdominal discomfort
Symptoms: or pain for at least one day per week
in the last three months, along with
Symptoms of IBS can vary from person to two or more of the following:
person and may include: ○​ Improvement with defecation.
○​ Onset associated with a
1.​ Abdominal Pain and Cramping: change in the frequency of
Often relieved by passing stool or stool.
gas. The pain is typically located in ○​ Onset associated with a
the lower abdomen. change in the appearance of
2.​ Bloating and Gas: Feeling of stool.
fullness or distention in the 3.​ Stool Tests: To rule out infections,
abdomen. parasites, or blood in the stool.
3.​ Changes in Bowel Movements: 4.​ Blood Tests: To check for anemia or
○​ Diarrhea (IBS-D): Frequent inflammatory markers to rule out
loose or watery stools. conditions like Crohn’s disease or
celiac disease.
 5.​ Colonoscopy: May be done to rule can help regulate bowel
out other conditions, especially if movements.
there are alarming symptoms such ○​ Laxatives: Short-term use of
as unexplained weight loss or blood laxatives may be
in the stool. recommended for
6.​ Imaging: Tests such as abdominal constipation, but they should
X-rays or ultrasounds may be used be used cautiously.
to rule out other structural issues. ○​ Anti-diarrheal Medications:
Medications like loperamide
Treatment: (Imodium) can help control
diarrhea.
There is no cure for IBS, but treatment ○​ Antispasmodics: These
focuses on managing symptoms and medications (e.g.,
improving quality of life. Treatment may hyoscyamine, dicyclomine)
include: help relax the muscles in the
gut and reduce cramping.
1.​ Dietary Changes:​
○​ Antidepressants: Low
doses of tricyclic
○​ Low FODMAP Diet: This is
antidepressants or selective
a restrictive diet that
serotonin reuptake inhibitors
eliminates foods that are
(SSRIs) may be prescribed
poorly absorbed by the small
to help with pain and
intestine, which may help
symptoms related to stress
reduce symptoms of IBS.
and anxiety.
○​ Fiber Intake: Increasing fiber
○​ Medications to regulate
may help with constipation,
bowel function: Such as
but it can worsen bloating in
alosetron for
some individuals, so it’s
diarrhea-predominant IBS or
important to tailor fiber intake
lubiprostone for
to the individual's needs.
constipation-predominant
○​ Avoid Trigger Foods:
IBS.
Certain foods, such as fatty
3.​ Psychological Therapy:​
foods, caffeine, alcohol, and
spicy foods, can worsen
○​ Cognitive Behavioral
symptoms.
Therapy (CBT): This can
○​ Probiotics: Some studies
help individuals manage
suggest that probiotics may
stress, anxiety, and
help with IBS symptoms by
depression that may trigger
restoring the balance of gut
or worsen IBS symptoms.
bacteria.
○​ Mindfulness and
2.​ Medications:​
Relaxation Techniques:
Stress management
○​ Fiber Supplements: For
practices, such as deep
constipation-predominant
IBS, fiber such as psyllium
 breathing exercises, may ○​ Provide emotional support
help alleviate symptoms. and assist with coping
4.​ Probiotics and Gut Health: Some strategies for stress and
people find relief from IBS symptoms anxiety, which can
by taking probiotics or by improving exacerbate IBS symptoms.
gut health through dietary changes 4.​ Collaboration:
and prebiotics.​ ○​ Work with dietitians,
gastroenterologists, and
mental health professionals
Nursing Responsibilities: to provide comprehensive
care.
1.​ Assessment:
○​ Monitor and assess for Complications:
common IBS symptoms
(abdominal pain, changes in ●​ Dehydration: Severe diarrhea can
bowel habits, bloating). lead to dehydration, which may
○​ Monitor for any alarming require treatment with fluids and
symptoms that may indicate electrolytes.
a more serious underlying ●​ Impact on Quality of Life: Although
condition, such as blood in IBS does not lead to more serious
the stool, unexplained weight diseases, its symptoms can
loss, or fever. significantly affect a person's
2.​ Education: day-to-day life, leading to missed
○​ Provide information on the work, social isolation, and emotional
low FODMAP diet and help distress.
the patient identify possible ●​ Mental Health Issues: Chronic pain
trigger foods. and the unpredictability of symptoms
○​ Educate on stress can lead to anxiety, depression, and
management techniques and reduced quality of life.
encourage relaxation
exercises. Key Points:
○​ Advise on the use of
medications (e.g., fiber ●​ IBS is a chronic but manageable
supplements, laxatives, condition characterized by
antidiarrheal agents) and abdominal pain, bloating, and
their potential side effects. changes in bowel habits (diarrhea,
○​ Stress the importance of constipation, or both).
regular exercise, which can ●​ The exact cause of IBS is unknown,
help improve bowel function but it involves factors like abnormal
and reduce stress. gut motility, gut sensitivity, stress,
3.​ Encourage Lifestyle and changes in gut bacteria.
Modifications: ●​ Treatment focuses on symptom
○​ Encourage regular physical relief, including dietary changes,
activity, which can improve medications, and stress
digestion and reduce stress. management.
 ●​ Nurses play a key role in educating 3.​ Other conditions: It may occur in
patients, monitoring for children with other genetic disorders,
complications, and helping such as Down syndrome, or certain
individuals manage the impact of other syndromes like Mowat-Wilson
IBS on their lives. syndrome.
4.​ Premature birth: Premature infants
may be at higher risk for developing
Hirschsprung disease.
Hirschsprung Disease
Symptoms:
its a congenital condition that affects the
large intestine (colon). It is characterized by Symptoms of Hirschsprung disease can
the absence of ganglion cells (nerve cells) vary based on the severity and the length of
in a portion of the colon, leading to a lack of the affected colon. They are most
normal peristalsis (the wave-like muscle commonly seen in newborns, but older
contractions that move food and waste children may also present with symptoms.
through the digestive system). This results Key symptoms include:
in bowel obstruction and difficulty passing
stool. In newborns:

Causes: 1.​ Failure to pass meconium within

24-48 hours: Meconium is the first
Hirschsprung disease is caused by a stool passed by a newborn, and its
developmental defect in the nerves that delay is often the first sign of
form in the colon during fetal development. Hirschsprung disease.
Normally, nerve cells (ganglion cells) form in 2.​ Abdominal distension: The
the colon, helping to control muscle abdomen may appear swollen or
contractions. In Hirschsprung disease, bloated due to an accumulation of
these ganglion cells do not develop in a stool in the intestines.
segment of the colon, causing that section 3.​ Vomiting: The infant may have
to be unable to contract and move stool. bile-stained or greenish vomiting, a
The exact cause of the absence of these sign of intestinal obstruction.
cells is not fully understood, but it is 4.​ Constipation: Infants may have
believed to involve both genetic and difficulty passing stool, leading to
environmental factors. chronic constipation.

Risk Factors: In older children:

1.​ Genetics: Hirschsprung disease can 1.​ Chronic constipation: This is the
run in families, and certain gene most common symptom in children
mutations may increase the risk. It is who are diagnosed later.
more common in children with a 2.​ Abdominal bloating and pain: The
family history of the disease. child may have persistent abdominal
2.​ Gender: It is more common in males distension, pain, and discomfort due
than females. to stool accumulation.
 3.​ Failure to thrive: Children may not reflexes are often abnormal.​
grow and gain weight as expected
due to the difficulty in passing stool
and poor absorption of nutrients. Treatment:
4.​ Foul-smelling stools or diarrhea:
If stool gets stuck in the colon, it may The primary treatment for Hirschsprung
cause foul-smelling diarrhea due to disease is surgery. The goal of surgery is to
bowel irritation. remove the portion of the colon that lacks
ganglion cells, allowing normal bowel
Diagnosis: function to resume. There are two main
types of surgical procedures:
Hirschsprung disease is typically diagnosed
through a combination of clinical 1.​ Pull-Through Procedure:
examination, imaging, and biopsy. Key ○​ This is the most common
diagnostic methods include: surgical approach. The
affected segment of the
1.​ Physical Examination: The doctor colon is removed, and the
will assess the baby or child for healthy part of the colon is
signs of bowel obstruction, pulled down to the anus,
abdominal distension, and lack of restoring normal bowel
meconium.​ function.
○​ This can usually be done in
2.​ X-ray (Abdominal Radiographs): one or two stages,
An abdominal X-ray can reveal signs depending on the severity of
of intestinal obstruction and the disease.
abnormal bowel gas patterns.​ 2.​ Colostomy (Temporary or
Permanent):
3.​ Barium Enema: A special contrast ○​ In some cases, a temporary
medium (barium) is introduced into colostomy may be performed
the rectum to highlight the colon and to divert stool away from the
identify areas where the bowel may affected area, allowing the
be dilated or abnormal.​ bowel to rest and heal.
○​ The colostomy may be
4.​ Rectal Biopsy: The most definitive reversed once the child is
test for Hirschsprung disease is a older and stronger.
biopsy of the rectal tissue. This 3.​ Postoperative Care:
biopsy checks for the presence or ○​ After surgery, children will
absence of ganglion cells in the need follow-up care to
affected segment of the colon.​ monitor their bowel function
and recovery.
5.​ Anorectal Manometry: This test ○​ Some children may continue
measures the reflexes of the to experience constipation or
muscles of the anus and rectum. In have problems with bowel
Hirschsprung disease, these movements, which may
 require additional eating, provide appropriate
interventions or medications. nutritional support and
hydration.
Nursing Responsibilities: ○​ Pain management: Assess
for pain and provide
1.​ Preoperative Care: appropriate analgesia as
○​ Monitor for signs of bowel needed.
obstruction: Watch for 3.​ Long-term Follow-up Care:
abdominal distension, ○​ Monitor growth and
vomiting, and failure to pass development: Children with
stool. Hirschsprung disease may
○​ Prepare for diagnostic have difficulties with growth,
tests: Ensure that the child is so regular checkups to
ready for diagnostic monitor weight gain and
procedures such as a rectal developmental milestones
biopsy or barium enema. are important.
○​ Provide emotional support ○​ Education for parents:
to parents: The diagnosis of Teach parents about signs of
Hirschsprung disease may complications, such as
be overwhelming, so offering infection, constipation, or
education and support is bowel obstruction, and when
important. to seek medical care.
○​ Preoperative education: ○​ Support: Offer emotional
Educate the family about the support for both the child and
upcoming surgery, what to family, as long-term issues
expect, and the recovery like constipation or bowel
process. control problems may persist.
2.​ Postoperative Care:
○​ Monitor vital signs and Complications:
bowel function: After
surgery, ensure the child’s 1.​ Enterocolitis: This is a potentially
vital signs are stable and serious complication that can cause
monitor bowel movements inflammation of the intestines and
for signs of return to normal lead to infection, fever, and sepsis. It
function. is more common in infants with
○​ Wound care: Monitor the Hirschsprung disease.
surgical site for signs of 2.​ Bowel Obstruction: If the affected
infection and ensure proper portion of the bowel is not removed
care of any colostomy if or if there are complications
performed. post-surgery, bowel obstruction can
○​ Provide nutritional occur.
support: Since the child may 3.​ Constipation: Some children may
be recovering from surgery continue to have difficulty with bowel
and may experience movements, even after surgery.
constipation or difficulty
 4.​ Failure to Thrive: If the disease is
not treated early, it can lead to
growth and nutritional problems.
5.​ Incontinence: In some cases,
children may experience issues with
bowel control after surgery.

Key Points:

●​ Hirschsprung disease is a congenital

disorder caused by the absence of
ganglion cells in a part of the colon,
leading to bowel obstruction and
difficulty passing stool.
●​ The main treatment is surgical
removal of the affected part of the
colon, usually via a pull-through
procedure.
●​ Early diagnosis and intervention are
critical to preventing complications
and improving outcomes for
children.
●​ Nurses play a vital role in
preoperative education,
postoperative care, and long-term
support for the child and family.