Question

Describe and discuss two disorders of the GI system or accessory organs (liver, gallbladder, pancreas) that can affect nutritional status. Discuss the nursing implications while caring for a patient with these disorders.

Answer 1

Peptic ulcer disease

It is a andcondition characterized by erosion of the GI mucosa resulting from the digestive action of HCL acid and pepsin .Any portion of the GI tract that comes into contact with the gastric secretions is susceptible to ulcer development including the lower esophagus,stomach ,duodenum and margin of gastrojejunal anastomosis after surgical procedures.it develops only in in the presence of an acid environment .Patients with achlorhydria rarely have PUD.An excess of HCL may not be necesssary for ulcer development . Protein is considered the best neutralizing food,but it also stimulates HCL acid secretion ,but they do not neutralize well.The patient must determine a suitable combination of nutrients without causing undue distress.

Nursing implications

• Explain to the patient about the importance of dietary modifications and why they are important for recovery and health maintenance.
• The nurse and dietician should elicit a dietary history from the patient and plan for ways that dietary modifications can be easily incorporated into the patients home and work setting.
• The nurse should provide useful information about the detrimental effects of alcohol and cigarettes on PUD and ulcer healing.

Irritable bowel syndrome

it is a symptom complex characterized by intermittent and recurrent abdominal pain and stool pattern irregularities.it is classified as IBS with diarrhea.,IBS with constipation,and IBS with mixed diarrhea and constipation.Stress,psychologic factors ,prior gastroenteritis and specific food intolerances have been identified as major factors that precipitate IBS symptoms.The abdominal pain or discomfort associated with IBS is most likely due to increased visceral sensitivity .Several neuro chemicals,including serotonin are likely involved in bowel symptoms of diarrhea,constipation and pain sensitivity.

• The nurse should establish a trusting relationship with the patient at the onset of treatment.
• Patients are provided with traditionally prescribed diet containing atleast 20 g per day of dietary fiber or a bulking agent such as Metamucil.But fermentation of large amounts of fiber can increase bloating and gas pain.
• The patients whose primary symptoms are are abdominal distension and increased flatulence should be advised to eliminate common gas-producing foods.

Patients