Chapter 41
Digestive and Endocrine System Disorders
LEARNING OUTCOMES:
· Define the key terms and key abbreviations listed in this chapter
· Describe gastroesophageal reflux disease and the care required
· Describe the care required for vomiting
· Describe diverticular disease and the care required
· Describe gallstones and the care required
· Describe hepatitis and the care required
· Describe diabetes and the care required
DIGESTIVE DISORDERS
Ø The digestive system:
• Breaks down food so the body can absorb it
• Eliminates solid wastes
Ø Gastroesophageal reflux disease (GERD)
• GERD is a disease in which stomach contents flow back from the stomach into the esophagus.
The acid in stomach contents can cause irritation and inflammation of the lining of the esophagus.
– This is called esophagitis.
• Heartburn is the most common symptom of GERD.
Heartburn is a burning sensation in the chest and sometimes the throat.
If heartburn occurs more than twice a week, the person may have GERD.
• Risk factors for GERD include:
Being overweight
Alcohol use
Pregnancy
Smoking
Hiatal hernia
• Treatment may include:
The doctor may order drugs to prevent stomach acid production.
Some drugs promote emptying of the stomach.
Life-style changes may be needed.
• If drugs and life-style changes do not work, surgery may be needed.
Ø Vomiting means expelling stomach contents through the mouth.
• It signals illness or injury.
• Vomitus (emesis) is the food and fluids expelled from the stomach through the mouth.
• Aspirated vomitus can obstruct the airway.
• Vomiting large amounts of blood can lead to shock.
• These measures are needed:
Follow Standard Precautions and the Bloodborne Pathogen Standard.
Turn the person’s head well to one side.
Place a kidney basin under the person’s chin.
Move vomitus away from the person.
Provide oral hygiene.
Observe vomitus for color, odor, and undigested food.
Measure, report, and record the amount.
Save a specimen for laboratory study.
Dispose of vomitus after the nurse observes it.
Eliminate odors.
Provide for comfort.
Ø Diverticular disease
• Many people have small pouches in their colons.
Each pouch is a called a diverticulum.
• The condition of having these pouches is called diverticulosis.
The pouches can become infected or inflamed (diverticulitis).
• Risk factors include:
Age (Persons over 60 years of age are at risk.)
A low-fiber diet
Constipation
• Signs and symptoms include:
Abdominal pain and tenderness in the lower left abdomen
Fever, nausea and vomiting, chills, cramping, and constipation
Possibly bloating, rectal bleeding, frequent urination, and pain while voiding
• Complications
A ruptured pouch is a rare complication.
A pouch can cause a blockage in the intestine (intestinal obstruction).
• The doctor orders needed dietary changes.
• Sometimes antibiotics are ordered.
• Surgery is needed for severe disease, obstruction, and ruptured pouches.
Ø Gallstones
• Bile is a greenish liquid made in the liver.
It is stored in the gallbladder until the body needs it to digest fat.
• Gallstones form when the bile hardens into stone-like pieces.
• Bile is carried from the liver to the gallbladder through ducts.
• Bile is carried to the small intestine through the common bile duct.
• Gallstones can lodge in any of the ducts.
• Gallstones vary in size.
• A person may have one large stone.
• Persons at risk for gallstones include those who are:
Women
Over age 60
Native Americans
Mexican Americans
Overweight (men and women)
Fasting
Losing weight quickly
Pregnant
Using birth control pills
On estrogen replacement therapy
• Signs and symptoms of a “gallbladder attack” or “gallstone attack”:
Occur suddenly
Often follow a fatty meal
• The most common treatment is surgical removal of the gallbladder.
Ø Hepatitis is an inflammation of the liver.
• It can be mild or cause death.
• Protect yourself and others.
Follow Standard Precautions and the Bloodborne Pathogen Standard.
Isolation Precautions are ordered as necessary.
Assist the person with hygiene and hand washing as needed.
Ø There are five major types of hepatitis.
Ø Hepatitis A is spread by the fecal-oral route.
• Causes include:
Poor sanitation
Crowded living conditions
Poor nutrition
Poor hygiene
Anal sex
• Treatment involves rest, a healthy diet, fluids, and no alcohol.
• The hepatitis A vaccine provides protection against the disease.
Ø Hepatitis B is caused by the hepatitis B virus (HBV).
• It is present in the blood and body fluids of infected persons.
• It is spread by:
IV drug use and sharing needles
Accidental needle sticks
Sex without a condom (especially anal sex)
Contaminated tools used for tattoos or body piercings
Sharing a toothbrush, razor, or nail clippers with an infected person
• HBV vaccine is available.
• The doctor orders drugs to treat chronic hepatitis B.
Ø Hepatitis C is spread by blood contaminated with the hepatitis C virus.
• A person may have the virus but no symptoms.
Serious liver disease and damage may show up years later.
• Even without symptoms, the person can transmit the disease.
• Hepatitis C is treated with drugs.
• The virus is spread by:
Blood contaminated with the virus
IV drug use and sharing needles
Inhaling cocaine through contaminated straws
Contaminated tools used for tattoos or body piercings
High-risk sexual activity
Sharing a toothbrush, razor, or nail clippers with an infected person
Ø Hepatitis D occurs only in people infected with hepatitis B.
• It is spread the same way as HBV.
Ø Hepatitis E is spread through food or water contaminated by feces from an infected person.
• It is spread by the fecal-oral route.
• This disease is not common in the United States.
THE ENDOCRINE SYSTEM
Ø The endocrine system is made up of glands.
Ø The endocrine glands secrete hormones that affect other organs and glands.
Ø Diabetes is the most common endocrine disorder.
• In this disorder, the body cannot produce or use insulin properly.
The pancreas secretes insulin. Insulin is needed for glucose to move from the blood into the cells.
The cells need glucose for energy.
Without enough insulin, sugar builds up in the blood.
• Risk factors include:
A family history of the disease
For type 1, whites are at greater risk than non-whites are.
Type 2 is more common in older and overweight persons.
These ethnic groups are at risk for type 2:
– African-Americans
– Native Americans
– Hispanics
• Signs and symptoms of diabetes:
Being very thirsty
Urinating often
Feeling very hungry or tired
Losing weight without trying
Having sores that heal slowly
Having dry, itchy skin
Losing feeling or tingling in the feet
Blurred vision
• There are three types of diabetes:
Type 1 occurs most often in children, teenagers, and young adults.
– The pancreas produces little or no insulin.
Type 2 can occur at any age.
– The pancreas secretes insulin. The body cannot use it well.
– Persons over 45 years of age are at risk.
– Being overweight, not exercising regularly, and having hypertension are risk factors.
Gestational diabetes develops during pregnancy.
– It usually goes away after the baby is born.
– The mother is at risk for type 2 diabetes later in life.
• Diabetes must be controlled to prevent the following complications:
Blindness
Renal failure
Nerve damage
Damage to the gums and teeth
Heart and blood vessel diseases
Foot and leg wounds and ulcers
• Treatment
Type 1 is treated with daily insulin therapy, healthy eating, and exercise.
Type 2 is treated with healthy eating and exercise.
Many persons with type 2 take oral drugs. Some need insulin.
Overweight persons need to lose weight.
• Types 1 and 2 involve controlling blood pressure, blood cholesterol, and the risk factors for coronary artery disease.
• Good foot care is needed.
• Blood glucose is monitored daily or 3 or 4 times a day for:
Hypoglycemia (low sugar in the blood)
Hyperglycemia (high sugar in the blood)