DIGESTIVE
SYSTEM
2
DISORDERS 4
5
3
PREPARED BY: 6
7
KATHLEEN GRACE A. NAGANAG
8
1
DISTURBANCES 2
IN
INGESTION
4
3
6
7
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LEARNING OBJECTIVES
Identify Ingestion Disorders: characteristics, signs and
symptoms.
Identify the diagnostic procedures, medical, surgical and
nursing management appropriate for each disturbance.
Explain the pathophysiology of each disturbance.
GLOSSARY
Achalasia Parotitis
Dysphagia Periapical Abscess
Dysplasia Pyrosis
EGD Sialadenitis
GERD Temporomandibular
Hernia disorders
Lithotripsy Vagotomy Syndrome
Odynophagia Xerostomia
What are the Disturbances in
1
Ingestion? 2
GERD
HIATAL HERNIA
I M P A I R E D E S O P H A G E A L M O T I L I T Y4
ESOPHAGEAL DIVERTICULA 3
6
7
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GERD
- Gastroesophageal REflux Disease 1
- occurs when the Lower Esophageal
Sphincter ( LES) doesn't close properly,
thus, stomach contents splash back or
reflux into the esophagus
2
CAUSES
Abdominal esophageal clearance
Deficient LES pressure 1
Stomach pressure exceeding LES pressure
Delayed gastric emptying resulting from
partial gastric outlet obstruction or
gastroparesis 2
PREDISPOSING
FACTORS
ROH
Nicotine (smoking)
More than 4 days NGT
Alteration/removal of pylorus
iNtake of foods that decrease LES pressure
Position/condition that decrease abdominal pressure
Hiatal Hernia
Drug
1
PATHOPHYSIOLOGY 4
3
6
7
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SIGNS AND SYMPTOMS
(TYPICAL)
Asymptomatic
Bleeding (bright red or Dark brown); belching
Chronic pain; Chronic Pulmonary Disease; Cough
Dysphagia; dyspepsia
Esophagitis; excessive salivation
Morning hoarseness
Nocturnal wheezing and regurgitation
Odynophagia
Pyrosis; possibly dull substernal ache
SIGNS AND SYMPTOMS
(ATYPICAL)
Vomiting
Asthma
Chronic sinusitis
Chronic hoarseness
Infection of the lungs
Night time choking sensation
Excessive salivation
COMPLICATIONS
CHRONIC PULMONARY DISEASES
ULCERATION (ESOPHAGUS)
REFLUX ESOPHAGITS
ESOPHAGEAL STRICTURE
ASSESSMENT AND
DIAGNOSTIC FINDINGS
1. Esophageal pH Probe
2. Barium Swallow Fluoroscopy
3. Endoscopy and Esophagoscopy
4. Bilirubing Monitoring (Bilitec)
TREATMENT
May involve one or
more of the GOAL: Control
symptoms and
following lifestyle heal esophageal
changes, mucosal injury
medications or
surgery
MANAGEMENT
1. TEACH PATIENT: Avoid situations that decrease LES pressure or
cause esophageal irritation.
Low- fat diet
Avoidance of caffeine, tobacco, beer, milk, foods with peppermint
or spearmint, carbonated beverages
Maintain normal body weight
Avoid tight- fitting clothes
Reverse Trendelenburg the head of the bed with elevated on 6-8 in
blocks for sleeping
Elevate the upper body on pillows
MANAGEMENT
2. IF REFLUX PERSIST, GIVE THE FOLLOWING
MEDICATIONS:
PPIs
Antacids or H2 Receptor Antagonists
Prokinetic Agents
Antisecretory Agents
MANAGEMENT
3. SURGICAL
INTERVENTION:
Nissen Fundoplication
BARRETT'S
ESOPHAGUS
- premalignant condition in which
the normal stratified squamous
epithelium of the esophagus is
replaced by a metaplastic columnar
epithelium
-predisposes the development of
esophageal adenocarcinoma and
adenocarcinoma of the gastric cardia
1
HIATAL HERNIA
2
Happens when part of the stomach
bulges up through the diaphragm
and into your chest
4
3
TYPES OF HIATAL
HERNIAS
TYPE I: SLIDING
- most common type, accounting for
95% of all hiatal hernias
- part of your esophagus that
connects to your stomach slides up
through the widened hiatus at times
and then slides back down
TYPES OF HIATAL
HERNIAS
TYPE II: PARAESOPHAGEAL
- also called a rolling hiatal hernia
- the upper part of your stomach
pushes up through the hiatus
alongside your esophagus, forming
a bulge next to it
TYPES OF HIATAL
HERNIAS
TYPE III: MIXED
- The part of your esophagus that
connects to your stomach — the
gastroesophageal junction — slides
up through the hiatus at times, and
another part of your stomach also
bulges through, alongside the
gastroesophageal junction at times
TYPES OF HIATAL
HERNIAS
TYPE IV: SHORT ESOPHAGUS
- rare type but is more complicated
- the hiatus is wide enough for two
different organs to herniate through
it
- the hernia involves your stomach
together with another abdominal
organ, such as one of your
intestines, your pancreas or your
spleen.
CAUSES
Muscle weakening
Increased intra-abdominal pressure
Loosening of the muscular dollar
around the esophageal and
diaphragmatic juntion
Diaphragmatic malformations
1
PATHOPHYSIOLOGY 4
3
6
7
8
SIGNS AND SYMPTOMS
Feeling of fullness of chest/ chest pain
Dysphagia
Asymptomatic (possible)
Reflux of gastric contents with associated
indigestion
ASSESSMENT AND
DIAGNOSTIC FINDINGS
1. Barium Swallow
2 Upper Endoscopy
MANAGEMENT
1. Lifestyle changes/ dietary changes:
Avoid caffeine
Stop smoking
Eating small meals; empty stomach
(bedtime)
Alcohol use avoidance
Not wearing tight clothing
*Surgery is rarely recommended.
MANAGEMENT
TO AVOID:
Anticholinergics
2. MEDICATIONS Xanthine
(To take) derivatives
Histamine H2 Calcium channel
Receptor antagonist blockers
Antiemetics Diazepam
Antacids
PPIs
NURSING CONSIDERATIONS
Give medications as prescribed.
Explain preparations required for diagnostic testing
Teach how to avoid and treat reflux..
Post surgery:
- Watch and record chest tube drainage and
respiratory status.
- Give chest physiotherapy and oxygen.
- Encourage incentive spirometry use.
- Place patient with NGT on semi- Fowler's to help
prevent reflux.
- Offer reassurance and emotional support.
1
Thank You! 4
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