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mouth

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Where teeth, tongue, and salivary glands begin food digestion

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Pharynx

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-Muscular structure shared by the digestive and respiratory tracts -It joins the mouth and nasal passages to the esophagus

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Esophagus

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Long muscular tube that passes through the diaphragm into the stomach

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Stomach

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Churns and mixes food with gastric secretions until a semiliquid mass called chyme

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Small intestine

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-Chemical digestion and absorption of nutrients take place Approximately 20 feet long and consists of three sections: the duodenum, the jejunum, and the ileum - Liver and pancreatic secretions enter the digestive tract in the duodenum

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Large intestine and anus

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-The first section of the large intestine is the cecum -Ascending colon goes up right side of the abdomen -Transverse colon crosses abdomen just below waist -Descending colon goes down left side of abdomen -The last 6 to 8 inches of the large intestine is the rectum, which ends at the anus, where wastes leave the body

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Age-Related Changes

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-Teeth are mechanically worn down with age -The jaw may be affected by osteoarthritis -A significant loss of taste buds with age -Xerostomia (dry mouth) is common -Walls of esophagus and stomach thin with aging, and secretions lessen -Production of hydrochloric acid and digestive enzymes decreases Gastric motor activity slows Movement of contents through the colon is slower -Anal sphincter tone and strength decrease

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Functional assessment:

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Information about general dietary habits should include the daily pattern of food intake Attitudes and beliefs about food, and changes in dietary habits related to health problems Effects of chief complaint on usual functioning Note whether the patient is able to obtain and prepare food, and eat independently

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Physical Examination:

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Head and neck Inspect the mouth Abdomen Inspection Auscultation Percussion Palpation Rectum and anus Palpate for lumps and tenderness in the rectum

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Gastrointestinal Intubation:

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Tube feedings= Delivered by gravity flow or by infusion pump Gastrointestinal decompression= For the relief or prevention of distention Levin and gastric sump tubes

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Total Parenteral Nutrition:

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Bypasses digestive tract by delivering nutrients directly to the bloodstream

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Preoperative nursing care:

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-The digestive tract is usually cleansed Magnesium citrate or large-volume cathartic (laxative) solutions; enemas -Diet limited to liquids 24 hours before surgery -Intravenous fluids -Oral antibiotics -Nasogastric tube inserted and attached to suction

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Postoperative nursing care:

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-Be sure gastrointestinal suction is draining -Inspect, describe, and measure the drainage -Abdomen for distention and bowel sounds -Administer intravenous fluids -Keep strict intake and output records -Drug therapy Emetics, antiemetics, laxatives, cathartics, antidiarrheals, antacids, anticholinergics, mucosal barriers, histamine-2 (H2)-receptor blockers, prostaglandins, and antibiotics

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Anorexia:

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Cause=Nausea, decreased sense of taste or smell, mouth disorders, and medications Emotional problems such as anxiety, depression, or disturbing thoughts

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Anorexia Medical diagnosis:

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Physician assesses for malnutrition Weight may be monitored over several weeks Complete history and physical examination Serum hemoglobin, iron, total iron-binding capacity, transferrin, calcium, folate, B12, zinc Thyroid function tests

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Anorexia Medical treatment:

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-Correctable causes of anorexia are treated, but sometimes no physical cause is found -Nutritional supplements

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Anorexia Interventions:

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-Assist with oral hygiene before and after meals -Teach proper oral hygiene; refer for dental care -Relieve nausea before presenting a meal tray -Before serving meal tray, remove bedpans/emesis basins from sight, conceal drains and drainage collection devices, deodorize room if necessary -Socialization during mealtime -Respect food likes and dislikes -Position patient comfortably with easy access to food

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Feeding Problems:

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Patients with paralysis, arthritis, neuromuscular disorders, confusion, weakness, or visual impairment are likely to need assistance

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Feeding problems Medical diagnosis and treatment:

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Identifying problems, prescribing treatment Patients often referred to physical therapy and occupational therapy

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Feeding Problems Interventions:

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-Proper positioning and arrangement of the meal tray -Provide assistive devices -Open milk cartons, cut meat, butter bread, and season food

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Stomatitis:

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A general term for inflammation of the oral mucosa

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Stomatitis Medical treatment:

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is directed toward determining the cause and eliminating it; a soft, bland diet may be ordered

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Herpes Simplex:

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Caused by the herpes simplex virus, type 1 Ulcers and vesicles in mouth and on lips Occur with upper respiratory tract infections, excessive sun exposure, or stress

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Herpes Simplex medical treatment:

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Spirits of camphor, topical steroids, and antiviral agents as treatment

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Aphthous Stomatitis ("Canker Sore"):

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May be caused by a virus Characterized by ulcers of the lips and mouth that recur at intervals

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Aphthous Stomatitis ("Canker Sore") medical treatment:

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Topical or systemic steroids may be used

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Candida albicans:

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Yeastlike fungus causes the oral condition known as thrush or candidiasis Bluish white lesions on the mucous membranes Patients at high risk include those on steroid or long-term antibiotic therapy

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Candida albicans medical treatment:

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Treated with oral or topical antifungal agents; vaginal nystatin tablets can be used like lozenges and allowed to dissolve in the mouth

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Nursing Care Interventions:Candida,Canker Sore,Herpes,Vincent's Infection, Stomatitis

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Gentle oral hygiene, prescribed mouthwashes The teeth and tongue can be cleansed with a soft-bristle toothbrush, sponge, or cotton-tipped applicator Medications must be given as ordered

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Nursing Care Interventions:Dental Caries,Periodontal Disease

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Most patients are treated for dental and gum conditions in dentists' offices Interventions directed at minimizing pain until the problem can be corrected by a dentist Provide oral care for patients who cannot do it themselves

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Oral Cancer: Squamous cell carcinoma and basal cell carcinoma

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Risk factors Cancer of the lip related to prolonged exposure to irritants, including sun, wind, and pipe smoking Factors that increase the risk of cancers inside the mouth include= tobacco and alcohol use, poor nutritional status, and chronic irritation

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Oral Cancer Signs and symptoms:

answer

Tongue irritation, loose teeth, and pain in the tongue or ear Malignant lesions may appear as ulcerations, thickened or rough areas, or sore spots Leukoplakia: hard, white patches in the mouth; premalignant

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Oral Cancer Medical diagnosis and treatment:

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A biopsy of suspicious lesions Treatment includes surgery, radiation, or chemotherapy, or a combination of these

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Oral Cancer Assessment:

answer

History of prolonged sun exposure, tobacco use, or alcohol consumption Assess for difficulty swallowing or chewing, decreased appetite, weight loss, change in ?t of dentures, and hemoptysis The physical examination should focus on examination of the mouth for lesions Assess the neck for limitation of movement and enlarged lymph nodes

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Parotitis:

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Inflammation of the parotid glands Causes painful swelling of the salivary glands below the ear next to the lower jaw; pain increases during eating

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Parotitis medical treatment:

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Treated with antibiotics, mouthwashes, and warm compresses; surgical drainage or removal may be necessary

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Achalasia:

answer

Progressively worsening dysphagia Failure of the lower esophageal muscles and sphincter to relax during swallowing Thought to be a neuromuscular defect affecting the esophageal muscles

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Achalasia Treatment:

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includes drug therapy, dilation, and surgical measures

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Esophageal Cancer Pathophysiology:

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No known cause, but predisposing factors are cigarette smoking, excessive alcohol intake, chronic trauma, poor oral hygiene, and eating spicy foods Signs and symptoms Progressive dysphagia

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Hiatal Hernia Pathophysiology:

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Protrusion of lower esophagus and stomach up through the diaphragm and into the chest Causes Weakness of diaphragm muscles where esophagus and stomach join, but exact cause is not known Factors are excessive intra-abdominal pressure, trauma, and long-term bed rest in a reclining position

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Hiatal Hernia Signs and symptoms:

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Many people have no symptoms at all; others report feelings of fullness, dysphagia, eructation, regurgitation, and heartburn

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Hiatal Hernia Medical diagnosis:

answer

Barium swallow examination with fluoroscopy Esophagoscopy Esophageal manometry Medical treatment Drug therapy, diet, and measures to avoid increased intra-abdominal pressure Surgery: fundoplication and placement of the synthetic Angelchik prosthesis

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Hiatal Hernia Postoperative care:

answer

Turning, coughing, and deep breathing Patient might have nasogastric tube in place and connected to suction for a day or two Until bowel function returns, the patient is given only intravenous fluids Tell the patient to expect mild dysphagia for several weeks

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GERD:

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Backward flow of gastric contents from the stomach into the esophagus

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GERD Pathophysiology:

answer

Abnormalities around the LES, gastric or duodenal ulcer, gastric or esophageal surgery, prolonged vomiting, and prolonged gastric intubation Eventually causes esophagitis

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GERD Signs and symptoms:

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Painful burning sensation that moves up and down, commonly occurs after meals, and is relieved by antacids

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GERD Medical diagnosis:

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Suggested by the signs and symptoms Endoscopy, biopsy, gastric analysis, esophageal manometry, 24-hour monitoring of esophageal pH, and acid perfusion tests

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GERD Medical treatment:

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Medical treatment and nursing care Like those described earlier for hiatal hernia Drug therapy may include H2-receptor blockers, prokinetic agents, and proton pump inhibitors If medical care unsuccessful, surgical fundoplication

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Gastritis Pathophysiology:

answer

Inflammation of the lining of the stomach Mucosal barrier that normally protects the stomach from autodigestion breaks down Hydrochloric acid, histamine, and pepsin cause tissue edema, increased capillary permeability, possible hemorrhage Helicobacter pylori thought to be prime culprit

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Gastritis Signs and symptoms:

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Nausea, vomiting, anorexia, a feeling of fullness, and pain in the stomach area

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Gastritis Medical diagnosis:

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Gastroscopy Laboratory studies to detect occult blood in the feces, low blood hemoglobin and hematocrit, and low serum gastrin levels; H. pylori can be confirmed by breath, urine, stool, or serum tests, or by gastric tissue biopsy

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Gastritis Medical treatment:

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Oral fluids and foods withheld until the acute symptoms subside; IV fluids administered Medications to reduce gastric acidity and relieve nausea Analgesics for pain relief and antibiotics for H. pylori Surgical intervention may be needed

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Peptic Ulcer Pathophysiology:

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Loss of tissue from lining of the digestive tract Classified as gastric or duodenal

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Peptic Ulcer Causes:

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Contributing factors: drugs, infection, stress Most ulcers are caused by the microorganism H. pylori

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Peptic Ulcer Signs and symptoms:

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Burning pain Nausea, anorexia, weight loss Complications Hemorrhage, perforation, or pyloric obstruction

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Peptic Ulcer Medical diagnosis:

answer

Barium swallow examination, gastroscopy, and esophagogastroduodenoscopy H. pylori can be detected by antibodies in the blood or stool, and by a breath test

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Peptic Ulcer Medical treatment:

answer

Drug therapy Diet therapy Managing complications

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Stomach Cancer Pathophysiology:

answer

Begins in the mucous membranes, invades the gastric wall, and spreads to the regional lymphatics, liver, pancreas, and colon No specific signs or symptoms in the early stages Late signs and symptoms are vomiting, ascites, liver enlargement, and an abdominal mass

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Stomach Cancer Risk factors:

answer

H. pylori infection, pernicious anemia, chronic atrophic gastritis, and achlorhydria, type A blood, and a family history Cigarette smoking, alcohol abuse, and a diet high in starch, salt, pickled foods, salted meats, and nitrates

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Stomach Cancer Medical diagnosis:

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Gastroscopy, endoscopic ultrasound, upper GI series, CT, PET scan, MRI, laparoscopy Laboratory studies include hemoglobin and hematocrit, serum albumin, liver function tests, and carcinoembryonic antigen

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Stomach Cancer Medical treatment:

answer

Surgery, chemotherapy, and radiation therapy

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Stomach Cancer Preoperative care:

answer

of the patient with stomach cancer Inform about the nasogastric tube and IV fluids; teach coughing, deep breathing, and leg exercises Identify/support patient's coping methods Include sources of support, such as family members or a spiritual counselor, in the preoperative care

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Stomach Cancer Postoperative care:

answer

of the patient with stomach cancer Assessment Comfort, appetite, and nausea and vomiting Monitor weight changes and determine dietary preferences Identify the patient's support system and coping strategies

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Obesity:

answer

Increased weight caused by= excessive body fat Causes Heredity, body build/metabolism, psychosocial factors Basic problem: caloric intake exceeds metabolic demands Complications= Cardiovascular and respiratory problems, polycythemia, diabetes mellitus, cholelithiasis (gallstones), infertility, endometrial cancer, and fatty liver infiltration

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Obesity Medical diagnosis:

answer

Standard weight tables Measuring skinfold thickness Endocrine function tests

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Obesity Medical and surgical treatment:

answer

Weight reduction diet accompanied by a planned exercise program Drug therapy Bariatric surgery

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Obesity Assessment:

answer

Identify factors that contribute to obesity Ask about usual dietary practices Identify factors that trigger overeating and reactions to overeating Collect data about previous efforts to lose weight and current interest in losing weight

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Malabsorption:

answer

One or more nutrients are not digested or absorbed Many causes: bacteria, deficiencies of bile salts or digestive enzymes, alterations in the intestinal mucosa, and absence of all or part of the stomach or intestines

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Malabsorption Signs and symptoms:

answer

Steatorrhea Weight loss, fatigue, decreased libido, easy bruising, edema, anemia, and bone pain Bloating, cramping, abdominal cramps, and diarrhea are symptoms of lactase deficiency

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Malabsorption Medical diagnosis:

answer

Sprue: based on laboratory studies, endoscopy with biopsy, and radiologic imaging studies Lactase deficiency: based on the health history, the lactose tolerance test, a breath test for abnormal hydrogen levels, and if necessary, biopsy of the intestinal

question

Malabsorption Medical treatment:

answer

Sprue: diet and drug therapy; foods that aggravate symptoms eliminated from the diet Celiac disease: avoid products that contain gluten Tropical sprue: antibiotics, oral folate, and vitamin B12 injections Lactase deficiency: eliminate milk and milk products

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Malabsorption Nursing care:

answer

Document the patient's symptoms Note stool characteristics In the case of celiac sprue, teach the patient how to eliminate gluten from the diet Give antibiotics as ordered for tropical sprue If folic acid therapy continued, instruct patient in self-medication The effect of therapy is evaluated by the return of normal stool consistency Advise the patient with lactase deficiency of dietary restrictions and alternative products

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Constipation:

answer

Hard, dry, infrequent stools that are passed with difficulty

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Constipation Causes:

answer

Frequently ignoring the urge to defecate Frequent use of laxatives or enemas Inactivity Inadequate water intake Diet low in fiber and high in cheese, lean meat, pasta Drugs that slow intestinal motility/increase urine output Diseases of the colon or rectum, as well as brain or spinal cord injury; abdominal surgery

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Constipation Complications:

answer

Valsalva maneuver The rapid changes in blood flow can be fatal to a patient with heart disease Hemorrhoids Fecal impaction Medical treatment= Laxatives, suppositories, enemas, or combination for prompt results Stool softeners

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Constipation Assessment:

answer

Usual pattern of bowel elimination, including frequency, amount, color, unusual contents, and pain associated with defecation Information about diet, exercise, and drug therapy Any aids to elimination; type and frequency of use Examine abdomen for distention or visible peristalsis Auscultate for bowel sounds in all four quadrants of the abdomen

question

Constipation Interventions:

answer

Maintained with diet, fluids, exercise, and regular toilet habits Megacolon Regular enemas for bowel cleansing Fecal impaction Assess for impaction by inserting a gloved, lubricated finger into the rectum Remove impaction following agency protocol or specific physician's orders

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Intestinal Obstruction:

answer

Causes= Strangulated hernia, tumor, paralytic ileus, stricture, volvulus (twisting of the bowel), intussusception (telescoping of the bowel into itself), and postoperative adhesions

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Intestinal Obstruction Signs and symptoms:

answer

Vomiting (possibly projectile), abdominal pain, and constipation Blood or purulent drainage passed rectally Abdominal distention, especially with colon obstruction

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Intestinal Obstruction Complications:

answer

Fluid and electrolyte imbalances and metabolic alkalosis Gangrene and perforation of the bowel

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Intestinal Obstruction Medical diagnosis:

answer

History, physical examination, and laboratory studies; confirmed by radiologic studies Medical treatment Gastrointestinal decompression; intravenous fluids; and surgical intervention

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Intestinal Obstruction Interventions:

answer

Acute Pain Deficient Fluid Volume Risk for Infection Ineffective Breathing Pattern Anxiety

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Appendicitis Pathophysiology:

answer

Inflammation of the appendix A ruptured appendix allows digestive contents to enter the abdominal cavity, causing peritonitis

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Appendicitis Signs and symptoms:

answer

Pain at McBurney's point, midway between the umbilicus and the iliac crest Temperature elevation, nausea, and vomiting Elevated WBC count (10,000-15,000/mm3 ) Peritonitis: absence of bowel sounds, severe abdominal distention, increased pulse and temperature, nausea/vomiting; rigid abdomen

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Appendicitis Medical treatment:

answer

Nothing by mouth A cold pack to the abdomen may be ordered Laxatives and heat applications should never be used for undiagnosed abdominal pain Immediate surgical treatment indicated Ruptured appendix: surgery may be delayed 6-8 hours while antibiotics and IV fluids given

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Appendicitis Preoperative interventions:

answer

Semi-Fowler or side-lying position with the hips flexed Until physician determines the diagnosis, analgesics may be withheld If rupture suspected, elevate patient's head to localize the infection

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Appendicitis Postoperative interventions:

answer

Administer antibiotics, intravenous fluids, and possibly gastrointestinal decompression Assist the patient in turning, coughing, and deep breathing; incentive spirometry Splint the incision during deep breathing Early ambulation Assess abdominal wound for redness, swelling, and foul drainage Wound care as ordered or according to agency policy

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Peritonitis Pathophysiology:

answer

Inflammation of peritoneum caused by chemical or bacterial contamination of the peritoneal cavity Signs and symptoms Pain over affected area, rebound tenderness, abdominal rigidity and distention, fever, tachycardia, tachypnea, nausea, and vomiting

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Peritonitis Medical diagnosis:

answer

History and physical Complete blood cell count, serum electrolyte measurements, abdominal radiography, computed tomography, and ultrasound Paracentesis

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Peritonitis Medical treatment:

answer

Gastrointestinal decompression, intravenous fluids, antibiotics, and analgesics Surgery to close a ruptured structure and remove foreign material and fluid from the peritoneal cavity

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Peritonitis Interventions:

answer

Acute Pain Decreased Cardiac Output Imbalanced Nutrition: Less Than Body Requirements Anxiety

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Abdominal Hernia Pathophysiology:

answer

Weakness in the abdominal wall that allows a portion of the large intestine to push through Weak locations include the umbilicus and the lower inguinal areas of the abdomen; may also develop at the site of a surgical incision Classified as reducible or irreducible

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Abdominal Hernia Signs and symptoms:

answer

A smooth lump on the abdomen With incarceration, the patient has severe abdominal pain and distention, vomiting, and cramps

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Abdominal Hernia Medical diagnosis:

answer

Health history and physical examination Medical treatment Surgical repair Herniorrhaphy Hernioplasty

question

Abdominal Hernia Assessment:

answer

Chief complaint Ask about pain and vomiting Inspect for abnormalities, and listen for bowel sounds in all four abdominal quadrants

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Inflammatory Bowel Disease Pathophysiology:

answer

Ulcerative colitis and Crohn's disease Inflammation and ulceration of intestinal tract lining Exact cause is unknown Possible causes: infectious agents, autoimmune reactions, allergies, heredity, and foreign substances

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Inflammatory Bowel Disease Signs and symptoms:

answer

Ulcerative colitis Diarrhea with frequent bloody stools, abdominal cramping Crohn's disease If the stomach and duodenum are involved, symptoms include nausea, vomiting, and epigastric pain Involvement of the small intestine produces pain and abdominal tenderness and cramping An inflamed colon typically causes abdominal pain, cramping, rectal bleeding, and diarrhea Systemic signs and symptoms include fever, night sweats, malaise, and joint pain

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Inflammatory Bowel Disease Complications:

answer

Hemorrhage, obstruction, perforation (rupture), abscesses in the anus or rectum, fistulas, and megacolon

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Inflammatory Bowel Disease Medical diagnosis:

answer

History and physical examination Abdominal radiography Barium enema examination with air contrast; colonoscopy with biopsy, ultrasonography, CT, and cell studies Video capsule Medical treatment Drug therapy, diet, and rest

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Inflammatory Bowel Disease Assessment:

answer

Onset, location, severity, and duration of pain Note factors that contribute to the onset of pain Onset and duration of diarrhea; presence of blood Vital signs, height and weight, measures of hydration Inspect perianal area for irritation or ulceration Maintain accurate intake and output records Measure diarrhea stools if possible and count as output

question

Diverticulosis Pathophysiology:

answer

Small saclike pouches in intestinal wall: diverticula Weak areas of the intestinal wall allow segments of the mucous membrane to herniate outward Risk factors Lack of dietary residue Age, constipation, obesity, emotional tension

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Diverticulosis Signs and symptoms:

answer

Often asymptomatic, but many people report constipation, diarrhea, or periodic bouts of each Rectal bleeding, pain in left lower abdomen, nausea and vomiting, and urinary problems

question

Diverticulosis Complications:

answer

Diverticulitis Bleeding, obstruction, perforation (rupture), peritonitis, and fistula formation Medical diagnosis Symptoms Abdominal CT and barium enema examination

question

Diverticulosis Medical treatment:

answer

High-residue diet without spicy foods Stool softeners or bulk-forming laxatives; antidiarrheals; broad-spectrum antibiotics; anticholinergics Surgical intervention may be necessary

question

Diverticulosis Assessment:

answer

Assess patient's comfort and stool characteristics; note nausea and vomiting Monitor patient's temperature Assess abdomen for distention and tenderness

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Diverticulosis Interventions:

answer

Fluids as permitted; monitor intake and output Antiemetics, analgesics, anticholinergics as ordered Be alert for signs of perforation Teach patient about diverticulosis, including the pathophysiology, treatment, and symptoms of inflammation

question

Colorectal Cancer Pathophysiology:

answer

Cancer of the large intestine People at greater risk for colorectal cancer are those with histories of inflammatory bowel disease, or family histories of colorectal cancer or multiple intestinal polyps High-fat, low-fiber diet and inadequate intake of fruits and vegetables also contribute to development Can develop anywhere in the large intestine Three fourths of all colorectal cancers are located in the rectum or lower sigmoid colon

question

Colorectal Cancer Signs and symptoms:

answer

Right side of the abdomen Vague cramping until the disease is advanced Unexplained anemia, weakness, and fatigue related to blood loss may be the only early symptoms Left side or in the rectum Diarrhea or constipation and may notice blood in the stool Stools may become very narrow, causing them to be described as pencil-like Feeling of fullness or pressure in the abdomen or rectum

question

Colorectal Cancer Medical and surgical treatment:

answer

Usually treated surgically Combination chemotherapy postoperatively if tumor extends through the bowel wall or if lymph nodes involved Early stage rectal cancer sometimes treated with radiation and surgery

question

Colorectal Cancer Assessment:

answer

Vital signs, intake and output, breath sounds, bowel sounds, and pain Appearance of wounds and wound drainage If there is a colostomy, measure and describe the fecal drainage

question

Colorectal Cancer Interventions:

answer

Risk for Injury Ineffective Tissue Perfusion Acute Pain Sexual Dysfunction Ineffective Coping

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Polyps:

answer

Small growths in the intestine Most benign but can become malignant Inherited syndromes: familial polyposis and Gardner's syndrome Usually asymptomatic; found on routine testing Complications are bleeding and obstruction Diagnosed by barium enema or endoscopic exam Colectomy for familial polyposis or Gardner's syndrome because of the high risk of malignancy

question

Hemorrhoids Internal or external:

answer

dilated veins in the rectum Thrombosed Blood clots form in external hemorrhoids; become inflamed and very painful Risk factors Constipation, pregnancy, prolonged sitting or standing Signs and symptoms Rectal pain and itching Bleeding with defecation External hemorrhoids easy to see; appear red/bluish

question

Hemorrhoids Medical diagnosis and treatment:

answer

Diagnosed by visual inspection Nonsurgical treatment Topical creams, lotions, or suppositories soothe and shrink inflamed tissue Sitz baths often comforting The physician may order heat or cold applications Outpatient procedures: ligation, sclerotherapy. Thermocoagulation/electrocoagulation, laser surgery Hemorrhoidectomy The surgical excision (removal) of hemorrhoids

question

Hemorrhoids Assessment:

answer

After hemorrhoidectomy, monitor vital signs, intake and output, and breath sounds. Assess the perianal area for bleeding and drainage Interventions Acute Pain Impaired Skin Integrity Constipation

question

Anorectal Abscess:

answer

An infection in the tissue around the rectum Signs and symptoms are rectal pain, swelling, redness, and tenderness Treated with antibiotics followed by incision and drainage Preoperatively, pain is treated with ice packs, sitz baths, and topical agents as ordered

question

Anorectal Abscess:

answer

Postoperatively, pain treated with opioid analgesics Patient teaching emphasizes importance of thorough cleansing after each bowel movement Advise patient to consume adequate fluids and a high-fiber diet to promote soft stools

question

Anal Fissure:

answer

Laceration between the anal canal and the perianal skin May be related to constipation, diarrhea, Crohn's disease, tuberculosis, leukemia, trauma, or childbirth Signs and symptoms include pain before and after defecation and bleeding on the stool or tissue If fissure chronic, the patient may experience pruritus, urinary frequency or retention, and dysuria Usually heal spontaneously, but can become chronic Conservative treatment: sitz baths, stool softeners, and analgesics Surgical excision may be necessary

question

Anal Fistula:

answer

Abnormal opening between anal canal and perianal skin Develops from anorectal abscesses or related to inflammatory bowel disease or tuberculosis Patient typically complains of pruritus and discharge Sitz baths provide some comfort Surgical treatment is excision of fistula and surrounding tissue Sometimes a temporary colostomy to allow the surgical site to heal Postoperative care: analgesics and sitz baths for pain

question

Pilonidal Cyst:

answer

Located in the sacrococcygeal area Results from an infolding of skin, causing a sinus that is easily infected because of its closeness to the anus Once infected, it is painful and swollen and may form an abscess Surgical excision usually recommended Care is similar to that for the patient having a hemorrhoidectomy

question

Patient Education to Promote Normal Bowel Function:

answer

Good hand washing and proper food handling People who recognize that stress affects their gastrointestinal function may benefit from relaxation techniques and stress management training Signs and symptoms of digestive problems should be reported for prompt diagnosis and treatment if indicated Teaching patients what is normal, how to promote normal function, and how to detect problems can help to avoid serious gastrointestinal dysfunction

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