DIGESTIVE SYSTEM - Increase HCA; relax pressure, open LES =

Main Function: chocolate, fatty foods (took time to abs.),

- Distribution of nutrient to body cell. coffee, smoking, alcohol, Calcium blocker,
- To distribute nutrients to body cell nitroglycerin, anticholinergic acid
- Innervated by the SINS & PNS
➢ Stomach:
SNS: decrease peristalsis 1. Hydrochloric Acid
Stress, activity ▪ Breakdown of ingested food
▪ Destruction of ingested
Gastrointestinal (GI) tract / Alimentary canal bacteria
- GI tract is a 23 to 26 foot long (7 m to 7.9 m) 2. Pepsin
pathway ▪ For protein digestion
- A muscular tube 3. Mucus
- Oral cavity to anus 4. Intrinsic factor
Function of Digestive System: ▪ Precursor of B12; without
1. Ingestion leads to Anemia
▪ Occurs when materials enter Parts:
digestive tract via mouth 1. Fundus & Cardia
2. Mechanical ▪ Chief cells:
▪ Crushing and shearing pepsinogen→digest protein
▪ Makes materials easier to propel ▪ Parietal cells→water, IF,
along digestive gastrin
3. Digestion 2. Body
▪ Chemical breakdown of food ▪ Storage of food; last 3-4 hours
▪ For absorption by digestive average
epithelium. 3. Antrum
▪ Lipase ▪ Curvature: site usually of
▪ Amylase: Carbs; Gastritis, cause HCA settle on
saliva(mouth) the curvature & irritates the
▪ Tryptase lining
4. Secretion
▪ The release and production of water, Pyloric sphincter
acids, enzymes, buffers, and salts - If obstruction (pylorus)
▪ By epithelium of digestive tract ▪ Pyloroplasty-open dilate,
5. Absorption passage of food
▪ Movement of organic substrates,
electrolytes, vitamins, and water ➢ Duodenum
▪ Across digestive epithelium 1. Secretin (GIP: Gastric Inhibitory
6. Excretion Peptide)
▪ Removal of waste products from body — inhibitory hormone to gastrin
fluids 2. Gastrin
— secrete hydrochloric acid
GI functions: Ingestion, digestion, absorption ▪ Promote stomach motility
(diarrhea and flatus)
Enzymes Involve:
➢ Mouth ➢ Small intestines
1. Amylase ▪ Brush border enzymes
▪ Breakdown of carbohydrates 1. Contains enzymes from pancreases:
]]? a. Trypsin: protein
Epiglottis aka deglutition b. Amylase: starch
Lower Esophageal Sphincter c. Lipase: fats
- one-way; always close (increased pressure) =
antacids, milk, histamine
 Pancreas: release enzymes HCO3 = 1. Electrolyte solution
neutralize the acidity ▪ Bicarbonate
Vitamin ADEK Diarrhea: Metabolic Acidosis;
hypokalemia
2. Liver (produce bile) / Gallbladder Vomiting: Metabolic Alkalosis
(store bile) 2. Mucus
a. Bile ▪ Protection the colonic mucosa
• (stones) pain abd. ▪ Provide adherence for fecal mass
after eating fats Waste product of digestion:
3. Gallbladder 1. Fecal matter
a. Release CCK—stimulate ▪ 75% fluids and 25% solid material
release of bile ▪ Brown color due to bile breakdown
▪ Odor is due to the chemical from
Duodenum: bacteria
CHO & CHON → blood stream Chalk: dye / barium;
Fats→lymphatic vessels gallbladder problems

4. Jejunum
▪ Start of absorption
5. Ilium
▪ Vit B12 absorption and Bile
Vitamin K
Appendix: Role in Lymphatic and Immune System
Bacteria Formation
Biotin: glucose metabolism
Phases of Digestions
1. Cephalic
▪ medulla oblongata

Hypothalamus Hormones:
Ghretin – stimulate hunger
Leptin – suppress hunger

2. Gastric
▪ Release of enzymes for digestion
3. Intestinal
▪ Pancreatic enzymes
Types of contraction:
1. Segmentation
▪ Mixing waves that moves back and
forth in churning motion
2. Peristalsis
▪ Propels the chyme toward the colon
▪ Cause by involuntary muscles
(smooth muscles)
▪ Four Layers:
• Mucosa—epithelial
cells
• Sub-mucosa
• Muscularis
• Serosa—outer
Colon Function:
Two colonic secretions:
 ASSESSMENT BREATH TEST
DYSPEPSIA (INDIGESTION) 1. HYDROGEN BREATH
1. Abdominal discomfort associated with ▪ For IBS, food intolerance
eating ▪ Hydrogen is measured
▪ Usually fatty foods ▪ Higher gas expelled means
2. Related symptoms malabsorption such as fructose,
▪ Belching (eructation), lactose
regurgitation, bloating, heartburn 2. UREA BREATH TEST
▪ Detect the presence of [Link] when
NAUSEA AND VOMITING isotope is detected in the breath
Cause: Teaching:
- Visceral afferent stimulation ▪ NPO; avoid 1 month prior
- CNS disorders ▪ Antibiotic and loperamide;
- Irritation of the chemoreceptor and avoid 1 week prior
mechanoreceptor reflexes in the GI ▪ Omeprazole, sucralfate,
ranitidine; avoid 24 hrs. prior
CHANGE IN BOWEL HABITS AND STOOL RADIOLOGY
CHARACTERISTIC o Upper GI or barium swallow
- Increase or decrease in frequency and 1. FLUOROSCOPIC X-RAY STUDY
volume ▪ Using medium
- Liquidity o Small Bowel series or ENTEROCLYSIS
- Hard, dry ▪ Contrast medium is ingested, and
films taken q 30 minutes until reaches
IAPPa Method
Auscultation UGI and ENDOCROLYSIS
- High pitched and gurgling (click) sounds - NPO midnight
- Normal: 5 – 35 clicks/minutes - Clear liquid diet
- Hypoactive: 1 – 2 clicks in 2 min - Avoid smoking
- Hyperactive: 5 – 6 clicks in <30 secs LOWER GI SERIES
- Absent: no sounds in 3 – 5 min - Cleansing enema
- Low residue diet 1-2 days prior
Percussion - Clear liquid diet and laxative night prior
- Dull: liver, spleen
- Tympany: stomach NURSING MANAGEMENT
1. Allergies
Palpation 2. Increase fluids
- Light palpation 3. Expect constipation
- Deep palpation 4. Expected white stools to 72 hrs.
▪ Visceral organs / Liver
▪ Two-hand method EUS endoscopic utz
Prepare fast 8—12 hrs. to decrease amount of gas
DIAGNOSTIC
SERUM LABORATORIES CT scan
STOOL TESTS - Cross sectional image
1. RANDOM SPECIMEN - Prednisone → 24, 12, 1
2. FECAL OCCULT BLOOD TEST FOBT
▪ Contraindicated→hemorrhoid MRI
▪ Avoid red meat, aspirin, - NPO 6-8 hrs.
NSAIDS - Remove patches (may burn)
▪ Vitamin C
3. STOOL DNA TEST SCINTIGRAPHY
▪ Can detect neoplasia - Measure the uptake of tagged RBC and
leukocytes
POSITNRON EMISSION TOMOGRAPHY GASTRIC ANALYSIS, pH MONITORING AND
- Looking for HOT SPOT STIMULATION TEST
- For cancer diagnosis - Can determine Zollinger-Ellison Syndrome
- NPO 8-12 hrs.
- Withhold for 24-48 hrs. any medication that
GASTROINTESTINAL MOTILITY stimulates gastric secretions
- Gastric emptying time - Stimulation: Histamine SQ given
- Foods (eggs) tagged with radionuclide Normal: 4-5 pH of gastric contents
- 20 capsules are administered
- Normal diet and activities
- Average 4-5 days

MANOMETRY
- Assess motility disorder in esophagus
- Measurement of pressure within the colon
- Measure the strength of muscle contractions
inside the colon
- NPO; withhold Ca-Channel blocker, sedatives

UPPER GI FRIBROSCOPY OR EGD

- NPO 8 hrs.
- Give local anesthesia and Midazolam
(decrease anxiety)-don’t drive after
- Atropine-decrease secretion
- Left-lateral position

CAPSULE ENDOSCOPY
- Travels through the GI tract
- Visualization of the small intestine
- NPO overnight
- May have bowel preparation like colonoscopy
- After swallow:
▪ Clear liquids resumed after 2 hr.
▪ Food and medications after 4 hrs.

FIBEROPTIC COLONSOCPY
- Cleansing enema (laxative or fleet enema)
▪ Contraindicated for appendicitis
- Sodium phosphate 32 tabs may be given
▪ 20-tab (4-tab q 15 min) evening
▪ 12-tab 1 hr. prior
- MONITOR FOR PERFORATION!

ORAL CHOLECYSTOGRAM
- Visualization of GB for GB disease / stones
- Assess allergy to iodine and shellfish

Preparation:
▪ Fat free diet night before
▪ Ingestion of radiopaque dye tablets at
7 pm
▪ NPO after midnight
 DISORDERS OF THE GSTROINTESTINAL SYSTEM Tx:
▪ Sengstaken-Blakemore tube to control
DISORDERS OF INGESTION bleeding
ANOREXIA ▪ Saline lavage
- Lack of appetite ▪ Blood transfusion
- Medical.: supplements may be ordered, TPN ▪ Medications: vasopressin, atbx., analgesics
or enteral feeding Sx: ligation, injection sclerotherapy
- Treat blood vessels or blood vessel
Nursing: Oral hygiene, clean room, determine malformations
cause of nausea and treat, include socialization,
respect likes and dislikes, education CANCER OF THE ESOPHAGUS
- Causes: no known cause, predisposing,
STOMATITIS irritation, poor oral hygiene
- Inflammation of the gums
- Cause: trauma, organisms, irritants, SS: progressive dysphagia, painful swallowing,
chemotherapy weight loss, vomiting, hoarseness, coughing,
occult bleeding or hemorrhage
SS: swelling, pain, ulcerations, excessive
salivation, halitosis, sore mouth Tx:
Palliative tx
Tx: pain relief, oral hygiene, soft bland diet Radiation, chemotherapy

GINGIVITIS Sx:
- Inflammation of the gums ▪ Esophagectomy
- Cause: poor oral hygiene, poorly fitting ▪ Esophagogastrostomy
dentures, nutritional deficiency ▪ Esophagoenterostomy
▪ Gastrostomy
SS: red, swollen, bleeding gums, painful Post-op:
▪ NGT
Tx: dental hygiene, prevention of complications ▪ Signs of bleeding
▪ Respiratory status
ESOPHAGITIS ▪ Nutritional intake; protein (healing), high
- Inflammation or irritation of the esophagus calorie (energy) diet
- Cause: Reflex of stomach contents, irritants, ▪ Swallow
infections, malignancy, intubation ▪ Ventilate feelings

SS: heartburn, pain, dysphagia

Tx: soft bland diet, elevate HOB, observe for

complications, medication (anti-emetic,
antacids)

Complication: BARRETTE’S SYNDROME

ESOPHAGEAL VARICIES
- Tortuous, distended vessels of the esophagus
- Causes: Portal HTN

SS: hematemesis, hemorrhage from UGI, black

tarry stools, pain, shock
Melena- upper
Hematikinetia ??!- lower
 DISORDERS OF DIGESTION AND ABSORPTION ▪ Reglan, Propulsid – increase stomach
NAUSEA AND VOMITING emptying
NAUSEA
- unpleasant sensation usually preceding Diet therapy: decrease caffeine, fatty foods,
vomiting alcohol, acidic and. Spicy foods
- Cause: irritating food, infection, radiation,
drugs, hormonal changes, surgery, inner ear Sx: Nissen Fundoplication
disorders, distention of the GI tract ▪ Gastric fundus of the stomach is
wrapped around the lower end of the
Projectile vomiting esophagus and stitched in place.
- Forceful ejection of stomach contents
GASTRITIS
Regurgitation - Inflammation of the lining of the stomach
- gentle ejection of stomach contents
without nausea or retching ACUTE: excessive intake of the food or alcohol.
Food poising, chemical irritation
Complication: lead to dehydration, metabolic
alkalosis, aspiration CHRONIC: repeated episodes of acute H. Pylori

Tx: antiemetics (Phenergan, Dramamine, SS:

Scopolamine path Reglan), IV, fluids, NGT, TPN - Nausea, vomiting, feeling of fulness, pain in
stomach, indigestion
Nursing: assessment, comfortable, offer liquids, - Changes in stomach lining with decrease in
position on side, suction setup acid and intrinsic factor
TX:
HIATAL HERNIA - Fluid resuscitation
- protrusion of lower esophagus and stomach - B12 injections
upward through. The diaphragm into the - Antibiotics
chest. - Bland diet, frequent meals

Sliding Dx: Gastroscopy & Biopsy

- gastroesophageal junction above hiatus
Rollin (paraoesophageal)
- junction in place portion of stomach rolls
up through diaphragm

- Cause: weakness in the LES, rt increased

abdominal pressure, long term bedrest,
trauma

SS: feeling fullness, dysphagia, eruption,

regurgitation, heartburn

Complications: ulcerations, bleeding, aspiration

Tx:
Drug therapy:
▪ H2 receptor antagonists: Tagament,
Zantac
▪ Pepsid – reduce stomach sections
▪ Urecholine – increase LES tone
▪ Antacids – neutralize stomach acids
PEPTIC ULCER Sx:
- Loss of tissue from lining of the digestive To decrease acid secretion:
tract. May be acute or chronic - Vagotomy
▪ Truncal vagotomy
- Classified as Gastric or Duodenal ▪ Selective vagotomy
(stress – develop 24-48 hrs. after event) ▪ Proximal Gastric vagotomy
Stress- accident, stressful events - Pyloroplasty
- Widen/dilate/open the pylorus
- Cause: drugs, stress, heavy alcohol, tobacco, - Gastroenterostomy
H. Pylori - Antrectomy
- Subtotal gastrectomy
Gastric Ulcer Duodenal Ulcer (80%) ▪ Billroth I Gastroduodenostomy
- Normal HCL - Hypersecretion of ▪ Bilroth II Gastrojejunostomy
- Weight loss HCL Nursing:
- Pain: ½ - 1 hr after - Weight gain - No signs of complications:
meal - Pain – 2-3 hrs. after ▪ Gastric dilation
o Relieve by meal ▪ Obstruction
vomiting o 1-2 Am ▪ Perforation
o Increase w food o Relieve w food - Maintenance of NGT
o High left o Mid-epigastrium ▪ Suction
epigastrium - Vomiting – uncmmn. ▪ Don’t irrigate or reposition tube
- Vomiting – common - Melena (MD’s work)
- Hematemesis - Psychological stress ▪ Type of drainage
- Lower - Adequate nutrition:
socioeconomic ▪ NPO gradually advance from clear
status liquids to full liquids then solid foods
Pain: With food Pain: Empty stomach ▪ Assess NV, abdominal distention
Relieve w vomit Relieve w food ▪ Gastric surgeries can have serious
Weight loss Weight gain effects on absorption of Vit B12, folic
acid, iron, calcium, Vit D

Complication: DUMPING SYNDROME

1. Hemorrhage—common - Common after gastric surgery:
2. Perforation→peritonitis ▪ Small stomach size cause chyme to move
3. Gastric outlet obstruction (pylorus) rapidly into intestine 15-30 min, draws fluid
- Associated with long history of ulcer pain from the blood
- Pain progress to upper abdomen towards ▪ Results: drop in blood vol, weakness,
the end of the day dizziness, sweating, increase in fluids in
Tx: intestine case cramping, loud BS abdomen,
▪ anticholinergics (pro-Banthine, Robinul, urge to defecate, later increase in blood sugar
Bentyl)
▪ Sucralfate (Carafate) Tx:
▪ Antibiotics (Flagyl, tetracycline, Biaxin) - 6 meals every day, low carbs and refined
sugars; moderate fat or high protein
Nursing: - Fluids between and not with meals
▪ Three meals a day—decrease acid - Lie down for 30 min after meal—for gastric
production emptying
▪ Decrease foods stimulate acid secretions
and cause discomfort OBESITY
▪ Treat pain with rest, diet, and drug therapy - Increased in body weight, 20% over ideal,
▪ Educate on stress management and caused by excessive fats. Morbid obesity
relaxation twice ideal
 - Cause: heredity, body build, metabolism,
psychosocial factors. Calorie intake exceeds DISORDERS OF LOWER
demands.
BMI MALABSORPTION
Normal: 18.5 -24.9 - Condition when one or more nutrients are not
Overweight: 25-29.9 digested or absorbed
Obese: 30-34.9 ▪ MULTIPLE CASUE
Severe Obese: 35-39.9 ▪ LACTASE DEFICIENCY
Morbidly Obese: >40 ▪ SPRUE: CELIAC / TROPICAL
- Treatment / care: depends on type
BMI = wt. (kg) / (ht. meters)2 A. Lactase – hold milk product
B. Celiac sprue – hold gluten products
Android (Abdominal) Obesity BROW
- Fat distributed in & around abdomen C. Tropical sprue – antbx
- Common for boys
Gynoid obesity DIARRHEA
- Fat distributed evenly & peripherally - Loose liquid stools with increased frequency,
associated with cramping, abd pain
Tx: - Cause: allergies, infections, stress, tube
- Weight reduction feedings, medications
▪ Drug therapy: Amphetamines - Complications: usually temporary / can be
Sx: dehydration, malnutrition
- Liposuction
- Intragastric balloon Tx: gi rest, antidiarrhea (Lomotil, Imodium, kaolin,
- Gastric bypass aluminum, hydroxide)
- Gastroplasty
- Jejunoileal bypass Nursing: assess VS, wt, skin turgor, abd distention,
- Gastric banding perianal irritation, skin integrity

CONSTIPATION
- Hard dry infrequent stools passed difficulty
- Cause: inactivity, ignored urge, drugs, age
related changes
- Complications: Straining (Valsalva maneuver)
and fecal impaction

Tx: fiber, fluids, exercise, regular defecation, don’t

delay defecation, don’t overuse laxatives, and
enemas

Enemas
1. Bulk forming: absorb water, increase bulk
▪ Psyllium (Metamucil)
2. Stool softeners and Lubricants
▪ Softeners: Colace
▪ Lubricants: Mineral oil (Fleet’s Oil
Retention Enema)
3. Saline and Osmotic Solutions: retention of
fluid
▪ Magnesium salts (Magnesiumcitrate,
Milk of Magnesium)
4. Stimulants: increase peristalsis
▪ Senna (Senokot)
 ▪ Dulcolax
5. Intestinal secretagogue: increase fluid
secretion SS:
▪ Linaclotide (Linzess) ▪ Generalized epigastric pain at first that shift
to the RLQ
INTESTINAL OBSTRUCTION ▪ Pain at McBurney’s point
- Obstruction in the normal flow of intestinal ▪ Elevated temp, NV, elevated WBC
contents through intestinal tract
- May be partial or complete Dx:
▪ Mechanical – pressure on the intestinal 1. Iliopsoas Sign
wall ▪ Extending the right hip causes pain
▪ Paralytic – intestinal musculature along posterolateral back and hip,
unable to propel contents along the suggesting retrocecal appendicitis
bowel 2. Obturator muscle test
▪ Flex right leg at hip and knee at 90
A. Small Bowel degrees, then rotate the leg internally
▪ Adhesions – most common and externally
▪ Intussusception 3. Rovsing’s signs
▪ Volvulus – twisted colon ▪ Tenderness felt I the RLQ when
▪ Paralytic ileus palpation is performed on the left
▪ Abdominal hernia 4. Blumberg’s sign
SS: ▪ Aka rebound tenderness
Abd pain ▪ Pain on removal of pressure
Vomiting Tx:
Pass bld and mucous ▪ NPO
Not stool ▪ Surgical removal
No gas ▪ IV and atbx
▪ Ice pack on abdomen
Mgt: ▪ Laxatives and Heat are contraindicated
Decompression
Strangulated then surgery Nursing:
▪ Pain relief, fluid balance
B. Large Bowel ▪ Absence of infection, effective breathing
▪ Carcinoma
▪ Diverticulitis
▪ Inflammatory bowel disorders PERITONITIS
▪ Volvulus - inflammation of the peritoneum
SS: - cause: chemical, bacterial contamination
Develop slowly
Constipation SS: Pain, rebound tenderness, rigidity, distention,
Distended abdomen fever, tachycardia, tachypnea, NV
Crampy lower abdominal pain
Fecal vomiting Tx: NGT, IV fluids, antbx, analgesics

Sx: ABDOMINAL HERNIA

Surgical resection with formation of - protrusion of the intestinal through weakness
colostomy in abdominal wall
▪ reducible
APPENDICITIS ▪ irreducible
- Inflammation of the appendix - inguinal, umbilical, femoral, incisional
- Opening becomes obstructed
- Interferes with drainage of secretions from SS: smooth lump in abdomen, not painful;
appendix incarcerated, severe pain present
 Complications:
Sx: 1. Intestinal
1. herniotomy - Hemorrhage
– removal hernia sac - Strictures – narrowing of a section of the
2. herniorrhaphy intestine
– hernia and weakness in the abdominal wall - Perforation
3. hernioplasty - Toxic megacolon
– hernia repair with mesh being used over the - Colon cancer
weakened region of the abdominal wall
Tx:
Tx: herniorrhaphy, hernioplasty - Rest the bowel
- Control inflammatory
Nursing: absence of strangulation, monitor activity, - Combat infection
general surgery interventions with surgery - Correct malnutrition
- Alleviate stress
- Provide symptomatic relief
INFLAMAMTORY BOWEL DISEASE (IBD)
- immunologically related disorders Immunosuppressants
characterized by chronic, recurrent - 6-mercaptopurine (6-MO)
inflammation of the intestinal tract ▪ SE: bone marrow suppression
- Autoimmune disorder ▪ Maintain 1.8--2.4 L of fld/day
▪ Take with milk or food
1. Ulcerative colitis - Cyclosporine
2. Crohn’s disease (regional enteritis) - Methotrexate
- Monoclonal antibodies
- Vitamin D deficiency - IL-10
▪ More common in persons with IBD
Drug therapy:
Possible cause: 1. Aminoacylates
- infections virus, bacteria a. Sulfasalazine – mainstay therapy;
- Autoimmune reaction usually taken for at least one year
- Food allergies b. Corticosteroids – Prednisolone (PO);
- Heredity- 84 risk for identical twins hydrocortisone (IV), monitor signs of
Cushing Syndrome
ULCIRATIVE COLITIS Sx:
- Characterized by. Inflammation of colon and Indications:
rectum 1. Failure of treatment
- Affects both sexes, with increased incidence 2. Massive bleeding, perforation, strictures,
in women obstruction
- Inflammation is diffuse and involves the 3. Changes that suggest dysplasia
mucosa and submucosa with periods of 4. Frequent exacerbations
remissions and exacerbations 5. Carcinoma
- Usually begins in the rectum and sigmoid
colon CROHN’S DISEASE:
- Mucosa is hyperemic and edematous - Chronic, non-specific inflammatory bowel
disease of unknown origin that can affect any
SS: part of the GIT
Major: bloody diarrhea - Incidence: 15 – 20-year-old
Mild: 1-2 semi formed stools/day - Both sexes affected, higher in women
Moderate: 4-5 stools per day + systemic symptoms
Severe: bloody 10-20 times/day c abdominal pain
 - Inflammation: most often in terminal ileum, Characteristics Ulcerative Crohn’s
jejunum, colon colitis disease
- Involves all layer (transmural) Weight loss Rare Common rare
- Usually discontinuous Rectal bleeding Common Infrequent
- Bowel wall thickens, lumen narrows with Tenesmus Common Rare
strictures Malabsorption Rare Common
- Fistula may develop Location Rectum Anywhere in GI
- Granuloma occurs in 50% of cases tract
Mucosa and (skip lesions)
SS: sub mucosa Terminal
Onset: insidious—diarrhea, fatigue, abdominal pain, ileum-most
weight loss, fever common site
enture
Principal: diarrhea (non-bloody) thickness
▪ Abdominal pain (transmural)

Complications:
- Strictures and obstruction most frequent Sx:
- Fistula 1. Total proctocolectomy with permanent
- Impaired absorption—nutritional ileostomy
abnormalities 2. Ileostomy & Colectomy
- Fat malabsorption 3. Total colectomy and ileal reservoir
- Systemic involvement - Criteria: absence of colon cancer, no disease
in small intestine, competent anorectal
sphincter, physical status
- Combination of procedures, usually 8-12
Drug therapy: weeks apart
1. Aminosalycilates a. Colectomy, rectal mucosectomy, ileal
a. Sulfasalazine reservoir, ileoanal anastomosis,
b. Mesalazine (Salofalk) temporary ileostomy
▪ May cause yellowish orange b. Closure of ileostomy
discoloration of skin and urine
▪ Avoid sunlight exposure Post-op:
2. Corticosteroids - Stoma visibility
3. Immunosuppressants - Mucocutaneous juncture
4. Metronidazole – Crohn’s in perineal area - Peristomal skin integrity
5. Fish oil – prevents recurrence - Output maybe as high as 1.5-2.0 Lin 24 hrs.
- Observes s/s of hemorrhage, abdominal
Nutritional therapy: abscess, small bowel disease, dehydration
- Elemental diet
o High calorie, fat free, no-residue diet - Ostomy bags emptied when one-third full
o Parental nutrition
o Avoid milk
o Vitamin supplement

DIVIRTICULITIS