DISEASES OF THE SMALL INTESTINES.pptx final

DISEASES OF THE SMALL INTESTINES.pptx final

1. DISEASES OF THE SMALL INTESTINES AND COLON

2. OVERVIEW The small intestines are part of the lower gastrointestinal tract. It has three parts duodenum, jejunum & ileum, length is 4 to 7 meters long The small intestine begins at the angle of Treitz and ends up in the colon at the ileo-cecal valve. Its function is to reabsorb sugar, proteins, fats, minerals, vitamins and water. The colon is about 1.5 meters long. It begins at the level of the right iliac fossa, then is subdivided into the ascending colon (right part), the transverse colon (part under the ribs), the descending colon (left part), and then into the sigmoid colon (which is located in the left iliac fossa) which continues to the rectum. The colon completes the absorption of water and the constitution of the stool. The rectum is about 15 cm long and serves as a reservoir for the stool, regulating the defecation mechanism .

3. structure

4. Diseases of the small bowel include: The common ones include: Inflammatory bowel disease, there are two types of IBD,namely: Crohn’s disease of the ileum (regional enteritis) and, ulcerative colitis- inflammation and sores (ulcers) along the lining of the large intestine (colon) and rectum . Small intestinal bowel over growth (SIBO) Celiac disease (gluten disorders) Irritable bowel syndrome

5. Others include(uncommon) Colonic cancer Obscure gastrointestinal bleeding( can be due to tumours in the intestines, vascular anomalies) Iron deficiency anemia Malabsorption Functional gastrointestinal disorders (can affect any part of the GI), they are disorders of function Antibiotic associated diarrhea

6. Chrons disease of the ileum Definition Chrons disease also called regional enteritis or ileitis, is a lifelong form of inflammatory bowel disease ( IBD ) . The condition inflames and irritates the digestive tract — specifically the small and large intestines. Crohn’s disease can cause diarrhea and stomach cramps . It’s common to experience periodic disease flare-ups.

7. Epidemiology The prevalence of CD has an incidence of 3 to 20 cases per 100,000 . Crohn disease is more common in the industrialized world, particularly in North America and Western Europe, though the incidence is rising in Asia and South America. There may be a slightly higher predominance of CD in women and it is more common in individuals of Ashkenazi Jewish origin than in non-Jews.

8. Types of chrons disease Ileocolitis: Inflammation occurs in the small intestine and part of the large intestine, or colon. Ileocolitis is the most common type of Crohn’s disease. Ileitis: Swelling and inflammation develop in the small intestine (ileum). Gastro duodenal: Inflammation and irritation affect the stomach and the top of the small intestine (the duodenum). Jejunoileitis: Patchy areas of inflammation develop in the upper half of the small intestine (called the jejunum).

9. Causes/etiology There’s no known cause of Crohn’s disease. Certain factors may increase your risk of developing the condition, including: Autoimmune disease : Bacteria in the digestive tract may cause the body’s immune system to attack your healthy cells. Genes : Inflammatory bowel disease (IBD) often runs in families. There are several specific mutations (changes) to your genes that can predispose people to developing Crohn’s disease. Smoking : Cigarette smoking could as much as double your risk of Crohn’s disease.

10. Investigations Complete Blood count Stool test : to rule out infections that cause chronic diarrhea. Colonoscopy : to examine the inside of your colon .. Computed tomography (CT) scan Upper gastrointestinal (GI) endoscopy

11. Treatment and management The goal in treatment is to: D ecrease ( the time between symptom flare-ups ) M anage any complications of Crohn’s disease over time . Antibiotics : to prevent or t reat infections. Prescription medications like loperamide (Imodium A-) can stop severe diarrhea Bowel rest: To give the intestines a chance to heal. intravenous (parenteral) nutrition may be indicated. Corticosteroids: Cortisone, prednisone and other corticosteroids ease inflammation brought on by autoimmune disease. Immunomodulators : These drugs calm inflammation by suppressing an overactive immune system. They include azathioprine and cyclosporine

12. Surgery : does not cure Crohn’s disease, but it can treat complications - intestinal perforations (holes), blockages or bleeding . Diet . A special diet (an essential diet) can treat Crohn's disease in some situation, symptoms are made worse by milk, alcohol, hot spices, or fiber. Nutritional supplements or special, high-calorie liquid formulas. Lifestyle changes. Smoking makes Crohn's disease symptoms worse. Stress and emotions make symptoms worse- counseling

13. Complications Abscesses : Infected pus-filled pockets form in the digestive tract or abdomen. Anal fissures: Small tears in the anus (anal fissures) can cause pain, itching and bleeding. Bowel obstructions: Scar tissue from inflammation, fistulas or a narrowed intestine can block the bowel partially or completely. Waste matter and gases build up. A blockage in the small large bowel requires surgery.

14. Colon cancer: Crohn’s disease in the large intestine increases the risk of colon cancer Fistulas : IBD can cause abnormal tunnel-like openings, called fistulas, to form in the intestinal walls. These fistulas sometimes become infected. Malnutrition especially in chronic diarrhea Ulcers: Open sores called ulcers can form in your mouth, stomach or rectum .

15. Irritable bowel syndrome (IBS) Definition Irritable bowel syndrome (IBS) is a common disorder that affects the lower GI area( stomach and intestines), also called the gastrointestinal tract IBS is a chronic condition that needs to manage long term . Only a small number of people with IBS have severe symptoms. Some people can control their symptoms by managing diet, lifestyle and stress . More-severe symptoms can be treated with medication and counseling

16. Epidemiology IBS affects around 11% of the population globally. Around 30% of people who experience the symptoms of IBS will consult physicians for their IBS symptoms. IBS is common – 10% to 15% of people in the United States have it. It is more common in women before the age of 50 due to flactuations of oestrogrn and progesterone

17. Causes The exact cause of IBS is unknown, the following are predisposing factors Muscle contractions in the intestine. Contractions that are stronger and last longer than usual can cause gas, bloating and diarrhea. Weak contractions can slow food passage and lead to hard, dry stools. Nervous system. Issues with the nerves in your digestive system may cause discomfort when your abdomen stretches from gas or stool. Poorly coordinated signals between the brain and the intestines can cause your body to overreact to changes that typically occur in the digestive process. This can result in pain, diarrhea or constipation. Severe infection. IBS can develop after a severe bout of diarrhea caused by bacteria or a virus. This is called gastroenteritis. IBS might also be associated with a surplus of bacteria in the intestines (bacterial overgrowth ).

18. Causes cont Early life stress. People exposed to stressful events, especially in childhood, tend to have more symptoms of IBS. Changes in gut microbes i.e. changes in bacteria, fungi and viruses, which typically in the intestines as normal flora. Research indicates that the microbes in people with IBS might differ from those in people who don't have IBS . Types of IBS There are four subcategories of IBS, each with equal prevalence: Mostly diarrhea and abdominal discomfort (IBS-D). Mostly constipation and abdominal discomfort (IBS-C). Alternating loose stools and constipation with abdominal discomfort (IBS-mixed). Undefined subtype (IBS-U) — symptoms vary.

19. Risk factors Age. IBS occurs more frequently in people under age 50. Gender. In the United States, IBS is more common among women. Estrogen therapy before or after menopause also is a risk factor for IBS. Genetics. Genes may play a role, as may shared factors in a family's environment or a combination of genes and environment. A nxiety , depression or other mental health issues. A history of sexual, physical or emotional abuse also might be a risk factor.

20. Symptoms Symptoms of IBS vary but are usually present for a long time. The most common include: Abdominal pain, cramping or bloating that is related to passing a bowel movement Changes in appearance of bowel movement Changes bowel movement Sensation of incomplete evacuation and increased gas or mucus in the stool.

21. More-serious symptoms include: Weight loss Diarrhea at night Rectal bleeding Iron deficiency anemia Unexplained vomiting Pain that isn't relieved by passing gas or a bowel movement

22. Diagnosis and treatment IBS present like IBD, investigations are the same Medications to control muscle spasms Anti-constipation drugs T ricyclic antidepressants to ease pain Antibiotics Diet modifications and change in life style

23. Complications Poor quality of life. Many people with moderate to severe IBS report poor quality of life. · Mood disorders. Experiencing the symptoms of IBS can lead to depression or anxiety. Depression and anxiety also can make IBS worse

24. Celiac disease Celiac disease (also known as celiac sprue or gluten-sensitive enteropathy) is a digestive and multisystem disorder . Celiac disease is a complex immune-mediated disorder, one in which the immune system causes damage to the small bowel when affected people eat gluten (a protein in some grains such as wheat, barley, and rye ). Epedimiology Celiac disease is a common chronic condition and is estimated to affect approximately 0.5 to 1 percent of the general population worldwide. In Europe, the United States, and Australia, prevalence estimates 3 to 13 per 1000 children. Females are affected approximately twice as often as males,

25. Celiac disease is a common chronic condition and is estimated to affect approximately 0.5 to 1 percent of the general population worldwide. In Europe, the United States, and Australia, prevalence estimates 3 to 13 per 1000 children. Females are affected approximately twice as often as males

26. Causes It is an autoimmune disease When people with celiac disease eat foods that contain gluten, their immune systems attack the lining of the intestine. This causes inflammation (swelling) in the intestines and damages the villi, the hair-like structures on the lining of the small intestine, hence causing malabsorption of nutrients and ends up malnourished .

27. Signs and symptoms Digestive problems (abdominal bloating, pain, gas, constipation diarrhea pale stools and weight loss). A severe blistering skin rash called dermatitis herpetiformis and sores in the mouth (called aphthous ulcers ). Unexplained anemia (low blood count) or hepatitis (inflammation of the liver). Musculoskeletal problems (muscle cramps, joint and bone pain) and defects in dental enamel. Growth problems and failure to thrive (in children). This is because they cannot absorb the nutrients. Tingling sensation in the legs (caused by nerve damage and low calcium). Depression

28. Diagnosis A detailed physical examination Blood tests such as Complete blood count(CBC), HB estimation Blood test to measure levels of antibodies to gluten. People with celiac disease have higher levels of certain antibodies in their blood . Treatment Avoid foods containing gluten (including wheat, rye and barley), and this improves the condition and ends the symptoms of the disease, however the villi usually needs some months heal completely E ncouraged to visit with a dietitian for formal diet instruction

29. Complications Malnutrition. Osteoporosis a disease that weakens bones and leads to fractures due to malabsorption of nutrients (calcium and vitamin D). Infertility. Cancer of the intestine (very rare). People who have celiac disease may have other autoimmune diseases, including: Thyroid disease or liver disease. Type 1 diabetes. Lupus. Rheumatoid arthritis. Sjogren's syndrome (a disorder that causes insufficient moisture production by the glands). Autoimmune liver disorders.

30. Small intestinal bowel overgrowth SIBO The change in bacteria is thought to potentially be caused by slow motility (decreased movement), low levels of stomach acid, or having surgery on the small bowel   The bacteria which live as normal flora in the small and large intestines (gut flora), can get out of balance and overgrow. This can lead to symptoms such as gas, bloating, constipation, or diarrhea, as well as weight loss or other symptoms outside the digestive system

31. Nursing concerns Abdominal pain or discomfort Constipation Diarrhea Vomiting Anxiety

32. Nursing diagnosis Goal Intervention Rationale Evaluation Acute pain related to abdominal spasms secondry to inflammatory process of the gastrointestinal as evidenced by a pain scoreof 10 out of 10, patient verbalizing abdominal pain and cramping, guarding sign on the abdomen To relieve the patient from pain which will be evidenced by a pain score of 2 out of 10 in the period of two hours Administer the prescribed medication such as analgesics- paractemol 1gram qid To block the pain receptors and relieve patient from pain The patient’s pain score was 3 out of 10 in the period of two hours Patient feels comfortable and reduced guarding sign on the abdomen

33. Nursing diagnosis Goal Intervention Rationale Evaluation Imbalanced nutrition less than body requirements related to altered absorption of nutrients secondry to inflammation of the small intestines as evidenced by diarrhea,vomiting and loss of appetite To maintain the normal nutritional status of the patient by demonstrating healthy eating habbits and choices before discharge Create a daily weight, food and fluid chart, discuss with the patient the short and long term nutrition and weight goals To effectively monitor daily nutritional intake and progress in weight gain Patient was able to gain weight and regian the normal body mass index(BMI) befor the discharge date

34. Nursing diagnosis Goal Intervention Rationale Evaluation Risk for deficient fluid volume related to excessive vomiting and diarrhoea To prevent dehydration and maintain the normal fluid volume of the body. Administer intravenous fluids as prescribed such as ringers lactate and normal saline Give plenty of oral fluids To replace lost fluids and nutrients through diarrhea and vomiting Patients hydration staus maintaned