Day: February 10, 2024

Peptic ulcers | Nursing Management

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Introduction

A peptic ulcer is characterized by the erosion or breakage of the mucous membrane or tissues within the digestive tract, which are regularly exposed to gastric juices containing hydrochloric acid (HCl) and pepsin. This erosion can extend through the muscle layer and even perforate the outer layers, leading to bleeding or perforation. Essentially, a peptic ulcer involves ulceration that affects the mucosal lining and deeper structures of the upper gastrointestinal tract and is caused by the corrosive action of gastric juices. It manifests as an excavation or hollowed-out area formed within the mucosal wall of the esophagus, stomach, or duodenum.

Epidemiology

  • The highest frequency occurs between the ages of 40 and 60.
  • The peak age for duodenal ulcers is between 30 and 60 years.
  • Gastric ulcers typically peak in individuals aged 50 and older.
  • The male-to-female ratio for duodenal ulcers is 2-3:1.
  • For gastric ulcers, the male-to-female ratio is 1:1.
  • Approximately 80% of peptic ulcer diseases (PUD) manifest as duodenal ulcers, while gastric ulcers account for about 15%

Common Sites:

  • Lower esophagus
  • Stomach
  • Proximal portion of the duodenum

Types

Ulcers can be classified according to their degree and location.

Type according to degree:

  • Peptic ulcers may be acute or chronic. Acute ulcers are often multiple and usually located in the fundus of the stomach. These ulcers are thought to be stress-related, superficial, and self-limiting. Occasionally, they penetrate a blood vessel, causing hemorrhages of varying degrees of severity.
  • Chronic ulcers are more common than acute ulcers. These ulcers usually occur as a single lesion with margins that are thickened, hyperemic, and edematous. Chronic ulcers tend to recur frequently, causing extensive scarring.

Type according to location:

  • Esophageal ulcers: These ulcers affect the lower portion of the esophagus and are usually due to a weaker esophageal sphincter, which allows gastric contents to escape into the esophagus.
  • Gastric ulcers: These occur in the stomach, mainly in the lesser and greater curvatures and pyloric antrum. The occurrence is due to the defective ability of the stomach to heal faster.
  • Duodenal ulcers: These are the commonest and are seen in the first portion of the duodenum. Ulcers result from the high secretion of hydrochloric acid.

Etiology

The erosion of the gastric mucosa is caused by the digestive action of hydrochloric acid and pepsin, although the exact cause is not fully understood. However, several factors precipitate the occurrence of peptic ulcers:

  1. The gram-negative bacteria Helicobacter pylori, present in 70% of patients with gastric ulcers and 95% of patients with duodenal ulcers, has been associated with peptic ulcers.
  2. Emotional factors: Emotional tension, anxiety, frustration, and stress may cause an imbalance in the autonomic nervous system, resulting in increased vagal stimulation of gastric secretion.
  3. Inflammation: Gastritis and trauma to the mucosa reduce the resistance of the membrane to digestion. Cell destruction is accelerated, and cell reproduction, which normally renews the superficial layers quickly, may be retarded.
  4. Hereditary factors: gastric ulcers are common in people with type A blood, while duodenal ulcers are common in people with type O blood. Duodenal ulcers are three times more common in first-degree relatives of duodenal ulcer patients than in the general population.
  5. Trauma and serious illness: Critical illnesses, especially those characterized by hypotension or respiratory insufficiency, may complicate peptic ulcers. Conditions such as severe burns, shock, etc., may lead to peptic ulceration.
  6. Prolonged use of irritants: Certain drugs, including non-steroidal anti-inflammatory drugs (NSAIDs), may predispose to peptic ulcer disease (e.g., acetylsalicylic acid, adrenal steroids, indomethacin, and phenylbutazone). Alcohol inhibits prostaglandin secretion. Nicotine in cigarette smoking inhibits pancreatic secretion of bicarbonate; it also may accelerate the emptying of gastric acid into the duodenum and promote mucosal breakdown.
  7. Bile Reflux: The reflux of bile and pancreatic enzymes into the stomach due to an incompetent pyloric sphincter may lead to a gastric ulcer. The bile salts damage the gastric mucosa, predisposing it to ulceration.
  8. Normal aging may also wear down the pyloric sphincter, which in turn permits the reflux of bile into the stomach.
  9. Zollinger Ellison Syndrome: A condition characterized by excessive production of hydrochloric acid, which erodes the gastric mucosa.

Epidemiology

Duodenal ulcers are very common, occurring 2–3 times more frequently than gastric ulcer disease.

Pathophysiology

Ulceration occurs due to a decrease in the resistance of the gastric mucosa to pepsin and acid injury. After the ingestion of food, acetylcholine, gastrin, and histamine bind to specific receptors and stimulate the parietal cells in the fundus of the stomach to secrete gastric acid. The parietal cells, with the assistance of H+ and K+ ATPases, transport the HCL to the stomach lumen. Meanwhile, the chief cells in the stomach secrete pepsinogen, which converts to pepsin in the presence of HCL to break down food.

Duodenal cells in the epithelium secrete a mucus barrier to protect the lining of the gastric-duodenal area. This mucus barrier dilutes the secretion of acid and provides a protective coating against acid action. Peptic ulcers may develop when the secretory output of hydrochloric acid exceeds that of pepsin, thereby eroding the gastric mucosa membrane due to inadequate defense secretion of mucus to neutralize the imbalance, thereby promoting ulcer development.

Signs and symptoms

Signs and symptoms of peptic ulcers include:

  • Epigastric pain: gnawing or burning pain in the upper abdomen, often related to food intake and radiating to the back due to erosion of the mucosal lining.
  • Heartburn (pyrosis): A burning sensation experienced in some patients due to excessive acid presence in the esophagus and stomach.
  • Vomiting: Occurs due to severe pain and may also be caused by obstruction resulting from muscular spasms of the pylorus.
  • Weight loss is especially common in individuals with gastric ulcers.
  • Dyspepsia: Symptoms include belching, bloating, distention, and intolerance to fatty foods.
  • Chest discomfort
  • Anorexia: loss of appetite.
  • Hematemesis, or melena, results from gastrointestinal bleeding from eroded small blood vessels. Melena stool, characterized by black, tarry stool, is more common in duodenal ulcers.
  • Constipation: Occurs due to inadequate intake of fluids and fiber-rich foods.

Characteristic differences between gastric ulcers and duodenal ulcers:

Location of the Lesion:

  • Gastric ulcers are predominantly found in the antrum of the stomach, as well as in the body and fundus.
  • Duodenal Ulcers: typically occur in the first 2cm of the duodenum.

Lesion Characteristics:

  • Gastric Ulcers: superficial lesions with smooth margins, often round, oval, or cone-shaped.
  • Duodenal Ulcers: Penetrating lesions associated with deformity of the duodenum from the healing of previous ulcers.

Gastric Secretion:

  • Gastric Ulcers: normal to decreased secretion.
  • Duodenal Ulcers: increased secretion.

Incidence and Peak Age:

  • Gastric Ulcers: Higher incidence in women; peak age typically between 50 and 60 years; more common in people of lower socioeconomic status.
  • Duodenal Ulcers: higher incidence in men but also prevalent in post-menopausal women; peak age typically between 35 and 45 years.

Associated Factors:

  • Gastric Ulcers: are associated with an incompetent pyloric sphincter and bile reflux.
  • Duodenal Ulcers: are associated with other diseases such as pancreatic disease and Zollinger-Ellison syndrome.

Clinical Manifestations:

  • Gastric Ulcers: Burning or gaseous pressure in the high left epigastric region, pain occurs 1-2 hours after meals and is aggravated by food, weight loss, and hematemesis may occur.
  • Duodenal Ulcers: Burning and crampy pain across the mid-epigastrium and upper abdomen, pain occurs 2-4 hours after meals but is relieved with food, weight may be normal or the patient may gain more weight, melena may occur.

Blood Group:

  • No significant difference was observed.
  • Duodenal Ulcers: common in blood group O.

Cancerous Tendencies:

  • Gastric Ulcers: More common to develop cancer.
  • Duodenal Ulcers: Less common to develop cancer.

Diagnosis:

History Taking:

  • Assess abdominal pain, including location, timing, severity, associated symptoms, and precipitating factors.

Physical Assessment:

  • Carefully examine and palpate the abdomen, focusing on pain, typically present in the upper epigastrium, left of the midline.

Endoscopy (Esophagogastroduodenoscopy):

  • Visualize and identify inflammatory changes, ulcers, and lesions in the upper gastrointestinal tract, including the duodenal mucosa.

Special Radiology:

  • Perform a barium swallow and barium meal to visualize the ulcer after the patient has ingested barium sulfate.

Stool Examination:

  • Detect the presence of blood (occult or fresh) in the stool, which may indicate bleeding from the gastrointestinal tract.

Biopsy:

  • Conduct a biopsy for gastric ulcers to determine the benign or malignant status of the lesion.

Gastric Analysis:

  • Aid in differentiating gastric ulcers from gastric cancer by analyzing gastric secretions.

Exfoliative Cytology:

  • Examine secretions and cells brushed or scraped from the mucous membranes to further aid in diagnosis.

Drug Therapy Objectives:

  1. Provide pain relief.
  2. Eradicate the H. pylori infection.
  3. Promote ulcer healing by reducing gastric secretions and protecting the mucosa from further damage.
  4. Prevent the recurrence of ulcers.

Eradication Therapy

First-Line Therapy:

A recommended regimen for eradicating Helicobacter pylori in patients with gastric and duodenal ulcers is the use of a proton pump inhibitor (PPI) in combination with two antibiotics, such as Omeprazole, clarithromycin, and metronidazole.

Omeprazole:

  • Dosage: 20mg orally twice daily for 4 to 8 weeks.
  • Action: It inhibits the activity of the acid pump and binds to hydrogen-potassium adenosine triphosphatase to block the formation of gastric acid.
  • Side Effects: headache, hallucinations, dizziness, diarrhea, abdominal pain, nausea, vomiting, constipation.
  • Nursing Implications: Caution the patient not to perform hazardous activities if dizziness occurs; instruct the patient to swallow capsules whole and not to open or crush them.

Amoxicillin:

  • Dosage: 500mg three times daily orally.
  • Action: Blocks protein synthesis.
  • Side Effects: Nausea, vomiting, diarrhea, abdominal pain, or discomfort.
  • Nursing Implications: Use cautiously in patients with hepatic or renal impairment; obtain a urine specimen for culture and sensitivity tests before the first dose. Begin therapy pending results; monitor the patient for superinfection.

Metronidazole:

  • Dosage: 400–500 mg orally three times daily.
  • Side Effects: metallic taste, nausea, and vomiting.
  • Nursing Implications: Instruct the patient to take the drug with food to minimize gastrointestinal discomfort.

Second-Line Therapy:

In cases where first-line therapy fails, a second-line regimen may be considered. This regimen typically includes a proton pump inhibitor along with bismuth, metronidazole, and tetracycline.

Bismuth:

  • Dosage: 120mg four times daily.
  • Action: Provides a protective coating to the gastrointestinal tract.
  • Side Effects: May cause darkening of the tongue and stools.
  • Nursing Implications: Monitor for signs of gastrointestinal upset and dark stools.

Metronidazole:

  • Dosage: 400mg twice daily.
  • Side Effects: metallic taste, nausea, and vomiting.
  • Nursing Implications: Administer food to reduce gastrointestinal side effects.

Tetracycline:

  • Dosage: 500mg twice daily.
  • Action: inhibits bacterial protein synthesis.
  • Side Effects: photosensitivity, gastrointestinal upset, tooth discoloration (avoid use in children).
  • Nursing Implications: Advise patients to avoid prolonged exposure to sunlight and use sun protection measures. Monitor for gastrointestinal side effects and tooth discoloration.

Other Drugs

  1. Antacids:
    • Mechanism: Antacids work by neutralizing gastric acid, thereby decreasing acidity in the stomach. They do not influence ulcer healing or prevent recurrence. Antacids aim to raise the pH in the stomach to around 3.0–3.5. They are typically taken after meals.
    • Examples: aluminum hydroxide, magnesium trisilicate.
  2. Histamine Receptor Antagonists:
    • Mechanism: Histamine receptor antagonists block the action of histamine, which stimulates acid secretion in the stomach. They are effective in managing ulcer disease by inhibiting acid secretion. Examples include Ranitidine (150mg twice daily) or Cimetidine (400mg twice daily for 4-6 weeks).
  3. Mucosal Barrier Fortifiers:
    • Mechanism: Mucosal barrier fortifiers, such as sucralfate, stimulate mucus production and enhance ulcer healing. They form a protective barrier by adhering to the ulcer surface, preventing further damage to the mucosa. Sucralfate is typically administered as 1g orally four times daily or 2g twice daily, 1 hour before meals and at bedtime. It should not be administered within 30 minutes of antacids or other drugs.
  4. Anticholinergic Drugs:
    • Mechanism: Anticholinergic drugs, like propantheline, are less commonly used compared to histamine receptor antagonists. They reduce gastric motility and secretion by decreasing vagal stimulation. This delay in gastric emptying time may promote ulcer healing and provide pain relief. However, they are not used in cases of bleeding or pyloric obstruction.

Nursing Management

Aims

  • Alleviating Symptoms and Promoting Healing
  • Reducing Anxiety
  • Maintaining Nutritional Requirements
  • Providing Education about Disease and Management
  • Preventing Complications

Hospitalization Considerations:

  • Hospitalization may not always be necessary
  • If adherence to treatment is challenging or home environment is not conducive, hospitalization may be required
  • The duration of hospitalization depends on symptom relief and patient understanding of treatment plan

Creating a Supportive Environment

  • Promoting Rest: Ensure the environment supports both mental and physical rest. Nurse the patient in a quiet setting to minimize disturbances and promote relaxation, especially since patients with peptic ulcers experience severe pain.
  • Ventilation: Ensure the environment is well-ventilated to enhance comfort and prevent feelings of stuffiness or discomfort.
  • Stress Reduction: Remove stressful stimuli from the environment as much as possible. Stress can increase vagal activity, exacerbating the symptoms of peptic ulcers. Creating a calm and peaceful environment can help alleviate stress and promote healing.
  • Comfort: Provide amenities that contribute to the patient’s comfort, such as adjusting the room temperature to a comfortable level, providing soft bedding, and ensuring adequate lighting.
  • Safety: Ensure the environment is safe and free from hazards that could potentially harm the patient. Keep walkways clear, and ensure that any equipment or furniture is properly secured to prevent accidents.
  • Privacy: Respect the patient’s privacy by maintaining confidentiality and providing them with a sense of personal space. This can contribute to their overall sense of well-being and comfort during their stay.

Rest

Rest, both mental and physical, plays a crucial role in reducing gastric activity and promoting healing in individuals with peptic ulcers. While a brief period of bed rest is essential, patients may also be encouraged to remain ambulatory with some restrictions on activity and an increase in rest hours. In severe cases, it may be necessary for patients to take time away from work, although for some, the anxiety caused by financial strain or disruption to their routine may outweigh the benefits of rest.

Creating a quiet and pleasant environment is paramount, as is ensuring physical comfort and providing undisturbed rest periods. Visitors who may evoke unpleasant feelings should be avoided, and diversion therapy can help alleviate anxiety. Nurses should listen attentively to patients, encouraging them to develop coping mechanisms for stressful situations that exacerbate symptoms. Providing perspective and offering constructive suggestions can help patients manage their anxiety levels.

In some cases, a sedative or tranquilizer may be prescribed to promote relaxation. It’s important to discourage visitors who may agitate the patient until their condition improves, allowing them the peace and tranquility necessary for healing.

Pain Relief

Assessment of the patient’s pain is essential, involving both verbal communication and observation of non-verbal cues such as grimacing or rubbing the affected area. Administer prescribed medications like Panadol to alleviate pain and enhance comfort, along with other medications aimed at promoting ulcer healing. Additionally, advise the patient to avoid highly spiced foods, as they can exacerbate pain and hinder the healing process. Providing diversional therapy, such as reading books or watching TV, can also help distract the patient from pain and promote relaxation.

Psychological Care

Effective psychological care plays a crucial role in the treatment of peptic ulcers, particularly due to their potential association with emotional factors. Begin by explaining the condition to the patient and their significant others in simple terms, covering aspects such as the disease process, affected parts of the body, associated signs and symptoms, causes, treatment options, and potential complications. This comprehensive explanation serves to impart knowledge and alleviate anxiety.

Encourage the significant others to refrain from alarming the patient with negative news or involving them in serious decision-making processes, as this could exacerbate stress. Instead, create an environment where the patient feels comfortable expressing their fears and concerns openly. Furthermore, involve the patient in developing plans for their care, fostering a sense of cooperation and empowerment in their treatment journey.

Observations

Continuous monitoring of the patient’s general condition is essential to gauging improvement or deterioration. Establish baseline data for vital signs, including pulse and blood pressure, which may indicate hemorrhage, as well as temperature and respirations, which can be affected by severe peptic ulcers.

Observe the patient for pain, noting its location and any exacerbating factors, such as specific foods. Monitor for vomiting episodes and examine the contents of the vomitus, as well as observe stool characteristics. Document and promptly report all findings to the responsible nurse.

Track the patient’s response to treatment and remain vigilant for any potential side effects of prescribed medications. Additionally, monitor for complications such as hemorrhage, which may manifest as dizziness, low blood pressure, a rapid, feeble pulse, or pyloric obstruction, indicated by vomiting of undigested food. Observe the patient’s dietary habits and assist in identifying foods that either alleviate or exacerbate pain, contributing to personalized care and symptom management.

Nutrition and Fluid Management

Nutrition plays a crucial role in the treatment of patients with peptic ulcers, as certain foods can either exacerbate or alleviate symptoms. Identify and avoid foods known to cause pain, as well as those that are highly seasoned or known to produce gas, as they can worsen the patient’s condition. Instead, provide a well-balanced diet rich in proteins to support ulcer healing and roughage to prevent constipation, a common issue.

Offer food in small, frequent portions to promote appetite and reduce the likelihood of vomiting. Encourage fluid intake, either orally or intravenously, depending on the patient’s condition, to prevent dehydration resulting from vomiting and to help neutralize hydrochloric acid in the stomach. This approach supports overall patient comfort and aids in symptom management.

Elimination Management

Monitor intake and output closely, recording measurements to prevent fluid overload. Offer a diet rich in roughage to facilitate bowel movements and prevent constipation, a common concern in patients with peptic ulcers. Regularly inspect stool and vomitus for signs of blood, and promptly inform the physician if any abnormalities are noted. Additionally, provide an emesis bowl to assist with vomiting episodes, ensuring patient comfort and cleanliness. These measures contribute to effective elimination management and overall patient well-being.

Exercises and Hygiene Management

Exercises: Initially, patients with peptic ulcers should be placed on total bed rest to prevent stress and excessive stimulation of the vagus nerve, which can increase hydrochloric acid production. As the patient’s condition improves, introduce gentle exercises gradually to prevent complications such as deep vein thrombosis associated with prolonged bed rest.

Hygiene: Provide assistance to patients with bathing to enhance comfort, promote blood circulation, and maintain cleanliness, thereby reducing the risk of infection. Perform oral care regularly to stimulate appetite, prevent halitosis (bad breath), and maintain oral hygiene. Ensure the timely changing of bed linens as needed to maintain cleanliness and prevent skin irritation. These measures contribute to overall patient comfort and well-being while minimizing the risk of complications associated with immobility and poor hygiene.

Patient Education

  • Educate the patient about avoiding precipitating factors such as caffeinated drinks and alcohol ingestion, which can exacerbate symptoms.
  • Assess the patient’s current knowledge of managing the condition to establish a baseline for further education.
  • Determine the patient’s willingness and ability to learn, ensuring comprehension of the condition and its management.
  • Assist the patient in identifying stressors and making modifications to daily routines to reduce stress-induced hypersecretion of gastric acid and pepsin.
  • Discuss dietary plans and provide guidance on implementation both at home and in the workplace.
  • Teach the patient to recognize warning signs and symptoms of recurrent ulcers or complications, and stress the importance of seeking early treatment.
  • Explain the harmful effects of smoking, which directly irritates the gastric mucosa and can worsen symptoms.
  • Provide a rationale for eliminating alcohol, spicy foods, coffee, tea, and cola from the diet, emphasizing their impact on ulcer symptoms.
  • Offer written materials on the condition to reinforce understanding and provide additional resources for reference.
  • Emphasize the importance of adhering to prescribed medication regimens and educate on the potential side effects of the drugs. Discourage the use of unprescribed drugs such as aspirin.
  • Reinforce the need for regular follow-up appointments to monitor progress and adjust treatment as needed.

Complications

Hemorrhage: This is the most common complication associated with peptic ulcer disease, occurring when the ulcer erodes a blood vessel. Signs of hemorrhage include vomiting blood (hematemesis) and passing black, tarry stools (melena). In cases of massive bleeding, patients may experience weakness, apprehension, dizziness, and faintness, which can progress rapidly to prostration and loss of consciousness. Physical signs include pale, cold, and clammy skin, a rapid and thready pulse, and abnormally low blood pressure. Rapid respirations may indicate air hunger and hypoxemia. If a large blood vessel is eroded, signs and symptoms appear more rapidly, and collapse can occur quickly.

Perforation: Perforation is a serious and potentially life-threatening complication resulting from the progressive erosion of ulcers through the layers of the gastrointestinal wall, including the submucosal, muscular, and serous layers. When the serous membrane is breached, stomach or duodenal contents can leak into the peritoneal cavity, leading to generalized peritonitis due to chemical irritation and infection. Perforation is more common in duodenal ulcers and can occur even in individuals with no previous ulcer history.

Symptoms of perforation include sudden and severe abdominal pain starting in the mid-epigastric region and spreading throughout the abdomen. The patient may exhibit pallor, cold clammy skin, a rapid pulse, shallow, grunting respirations, and may experience nausea and vomiting. Upon examination, the abdomen becomes tender, rigid, and board-like. Patients may adopt a knee-chest position to alleviate tension on the abdominal muscles. Perforation can lead to complications such as bacterial septicemia, hypovolemic shock, and paralytic ileus, further complicating the patient’s condition and requiring prompt medical attention.

Peritonitis -can develop as a consequence of perforation into the peritoneal cavity. Gastric outlet obstruction occurs due to edema, inflammation, and fibrous scar formation. Symptoms include abdominal bloating, nausea, and vomiting. Persistent vomiting can lead to alkalosis due to the loss of acid gastric juice in vomit, resulting in hypokalemia from the loss of chloride ions.

Malignancy -may arise from the chronic ulceration-induced regeneration of epithelium. Penetration occurs when an ulcer on the posterior wall of the duodenum or stomach perforates into adjacent structures such as the pancreas, liver, or biliary tree. Patients may experience intensified and constant pain, possibly radiating to the back, which does not respond to antacids or food.

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Gastritis | Nursing Management

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Introduction

Effective management of patients with stomach and duodenal disorders involves a comprehensive approach aimed at alleviating symptoms, promoting healing, and preventing complications. Below are key aspects of management:

Gastritis

Gastritis refers to inflammation of the lining of the stomach. It can be acute, occurring suddenly and lasting for a short period, or chronic, developing gradually and persisting over time.

Pathophysiology of Gastritis

The gastric mucosa is normally shielded from the corrosive effects of stomach acid by prostaglandins. However, when there is damage to the protective barrier, injury occurs. This injury is exacerbated by the release of histamine and stimulation of the vagal nerve, which allows hydrochloric acid to penetrate back into the mucosa. This acid influx damages small blood vessels, leading to swelling, bleeding, and erosion of the stomach lining.

As gastritis progresses, the walls and lining of the stomach become thinner and may atrophy, reducing the function of parietal cells. This decline in parietal cell function results in a loss of intrinsic factor, essential for the absorption of vitamin B12. Consequently, the absorption of vitamin B12 is impaired, leading to pernicious anemia.

Acute Gastritis

Acute gastritis refers to the acute inflammation of the gastric mucosa or submucosa, characterized by the destruction of superficial epithelial cells. The condition typically lasts for a few hours to a few days (Bloom, 2005).

Causes:

  • Thermal Causes: Consumption of very hot fluids or food can lead to thermal injury to the gastric mucosa.
  • Chemical Causes:
    • Ingestion of corrosive substances.
    • Consumption of irritating foods such as spicy foods and alcohol.
    • Certain drugs, including aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs) in large doses, cytotoxic agents, caffeine, corticosteroids, antimetabolites, phenylbutazone, and indomethacin, can cause mucosal erosion.
  • Bacterial Causes: Endotoxins released from infecting bacteria such as Staphylococci, Escherichia coli, Salmonella, and Helicobacter pylori.
  • Conditions: Uremia, shock, prolonged emotional tension, major burns, hepatic diseases, renal diseases, peptic ulcers, and major surgery can precipitate acute gastritis.
  • Bile Reflux: Backflow of bile into the stomach from the bile tract, which connects to the liver and gallbladder, can irritate the gastric mucosa.
  • Exposure to Procedures: Certain medical procedures such as nasogastric tube insertion and endoscopy can irritate the gastric mucosa.

Signs and Symptoms of Acute Gastritis:

  • Sudden Onset: Symptoms typically appear suddenly.
  • Anorexia: Loss of appetite may occur.
  • Nausea and Vomiting: Patients may experience feelings of nausea and episodes of vomiting.
  • Dyspepsia: discomfort or pain in the upper abdomen, often described as indigestion or an upset stomach.
  • Epigastric Pains: Patients may experience varying degrees of pain or discomfort in the epigastric region (upper abdomen).
  • Gastrointestinal Bleeding: Hematemesis (vomiting of blood) and melena (dark, tarry stools) may occur if gastric bleeding occurs.
  • Water Brash Syndrome: Clear fluid may be present in the mouth due to reflex salivation in response to duodenal ulceration.
  • Signs and Symptoms of Pernicious Anemia: Due to the loss of intrinsic factor, patients may exhibit symptoms associated with pernicious anemia, such as fatigue, weakness, and pallor.
  • Colic Diarrhea: Following intake of contaminated food, patients may experience colicky diarrhea 2-4 hours later if gastritis is due to food poisoning.
  • Fever: Fever may be present in some cases, especially if the gastritis is caused by an infectious agent.

Diagnosis of Acute Gastritis:

  • Endoscopy/Gastroscopy: Visual examination of the stomach using an endoscope will reveal inflamed gastric membranes.
  • Laboratory Tests:
    • Full Blood Count (FBC): Low hemoglobin levels may be detected due to concealed bleeding, indicated by the presence of occult blood in vomitus and stool. Elevated erythrocyte sedimentation rate (ESR) may also be observed, indicating inflammation.
  • Histological Examination: Biopsy specimens obtained during endoscopy can be examined histologically to assess the severity and nature of inflammation.
  • Serologic Testing: Serological tests for antibodies against Helicobacter pylori or a breath test may be performed to detect the presence of H. pylori infection, a common cause of gastritis.
  • Gastric Acid Analysis: Measurement of gastric acid levels can reveal increased hydrochloric acid (HCl) secretion, which may contribute to the development of gastritis.

Medical and Nursing Management:

The gastric mucosa possesses the ability to repair itself following a mild attack of gastritis. Typically, patients recover within a day, although a diminished appetite may persist for an additional 2 or 3 days. Management primarily focuses on symptom relief and supportive care.

  • Fluid and Food Management:
    • During episodes of vomiting, oral fluids and food should be withheld to prevent further irritation to the stomach.
    • Once vomiting subsides, oral fluids and non-irritating foods can be gradually reintroduced based on the patient’s tolerance.
    • The diet can then progress to a normal intake as tolerated by the patient.
  • Intravenous Fluids:
    • If gastritis persists beyond 12–18 hours or if dehydration and electrolyte imbalance are evident, intravenous fluids are administered.
    • Hospitalization may be necessary in such cases, and complete bed rest is recommended to facilitate recovery.

The following medications may be prescribed:

  • Antiemetics: Promethazine can be prescribed to alleviate symptoms of nausea and vomiting. However, it should be avoided if the cause of gastritis is due to corrosive substances.
  • Anticholinergics: Atropine may be administered to decrease gastric secretions and induce relaxation of smooth muscle.
  • Cimetidine: This medication is typically given to reduce gastric acid secretion, especially in cases where there is associated hemorrhage with gastritis.

In cases where gastritis is caused by the ingestion of strong acids or alkalis, emergency treatment involves diluting and neutralizing the offending agent. To neutralize acids, common antacids, such as aluminum hydroxide, are used. For neutralizing an alkali, diluted lemon juice or diluted vinegar can be employed.

Chronic gastritis

Chronic gastritis is a long-term degeneration of the mucous membranes of the stomach, often resulting from prolonged dietary indiscretion or alcohol abuse.

Causes

  • Helicobacter pylori infection (most common cause).
  • Alcohol abuse.
  • Thyroid disease.
  • Diabetes mellitus.
  • Radiation therapy.
  • Repeated episodes of acute gastritis.
  • Autoimmune conditions such as pernicious anemia.
  • Smoking.

Signs and symptoms:

  • Loss of appetite leads to weight loss.
  • Nausea and vomiting (hematemesis), which may provide temporary relief from pain due to irritation of the gastric mucosa.
  • Dyspepsia (indigestion) results from impaired gastric function.
  • Flatulence (excessive gas) due to impaired gastric function.
  • Epigastric pain (heartburn) is caused by the regurgitation of gastric contents.
  • Abdominal pain is due to erosion of the gastric mucosa.
  • Passage of dark, tarry stools (melena) resulting from gastric bleeding.
  • Constipation is followed by diarrhea due to enteritis.
  • Slow progression of symptoms.

Diagnosis:

  • Patient history indicating recurrent episodes of acute gastritis.
  • Barium meal, revealing inflammation of the gastric mucosa.
  • Endoscopy or gastroscopy showing inflammation of the gastric mucosa.
  • Stool testing for occult blood.
  • Complete blood count (CBC) revealing low hemoglobin levels due to bleeding.
  • Gastric acid analysis indicates increased hydrochloric acid (HCl) secretion.

Treatment:

  • Chronic gastritis is managed through dietary modifications, rest promotion, stress reduction, and pharmacotherapy.
  • Encourage the patient to chew food thoroughly before swallowing.
  • Helicobacter pylori infection may be treated with a combination of drugs such as amoxicillin, metronidazole (Flagyl), and omeprazole (triple therapy).
  • Administer antiemetic drugs to alleviate nausea and vomiting, for example, promethazine 25–50 mg either intramuscularly or intravenously for 3 days, or metoclopramide (Plasil) 10–20 mg three times daily for 3 days.
  • Antacids can be given to alleviate pain or discomfort, such as aluminum hydroxide 200–400 mg three times daily for 7 days.
  • Histamine receptor blockers help reduce the production of hydrochloric acid; for instance, cimetidine 200–400 mg three times daily for 14 days.

Nursing Care for Gastritis

Aims

  • Prevent complications.
  • Alleviate signs and symptoms.
  • Assist in the healing process.
  • Reduce anxiety.

Environment

The patient is cared for in a general medical ward where cleanliness and proper ventilation are maintained to promote adequate air circulation and create a calm environment conducive to rest and recovery.

Positioning

The patient is positioned in a comfortable manner, preferably in a semi-fowler’s position, to prevent the regurgitation of gastric juices and to enhance respiratory function. The semi-fowler’s position involves reclining the patient’s upper body at an angle of approximately 30 to 45 degrees, which helps reduce pressure on the abdomen and minimizes reflux while facilitating ease of breathing.

Rest

Ensure a noise-free environment to promote rest and uninterrupted sleep for the patient. Perform nursing activities collectively to minimize disturbances and encourage restful periods. This includes coordinating tasks such as medication administration, assessments, and procedures to avoid unnecessary interruptions to the patient’s rest.

Observations

Regularly assess the patient’s general condition to determine if there are improvements, stability, or worsening of symptoms. Monitor vital signs including temperature, pulse rate, respiratory rate, and blood pressure, and document the findings. Elevated temperature may indicate the presence of infection, while a rapid pulse and low blood pressure could indicate bleeding.

Examine stool and vomitus for characteristics such as color, consistency, volume, and odor. If blood is present in stool or vomitus, provide ice drinks to the patient to help constrict blood vessels and minimize bleeding. Check for abdominal tenderness and observe for any signs of complications such as gastric ulcers.

Patient Weight Monitoring

Perform daily weighing of the patient to monitor for changes in weight, which can indicate fluid retention or loss. This helps in assessing the patient’s hydration status and response to treatment. Document weight measurements accurately to track trends over time.

Psychological Care

It is essential to communicate effectively with the patient and their relatives to alleviate anxiety and foster cooperation. Explain the condition in simple terms, including possible causes, the disease process, treatment options, and reasons for certain restrictions. Encourage the patient to ask questions and provide accurate answers to help them understand their condition better. Involving both the patient and their relatives in the care plan promotes independence and reduces dependency.

Nutrition and Fluids

Provide balanced, nutritious meals containing proteins, vitamins, and carbohydrates to support healing and boost immunity. Serve food in small, frequent amounts to promote appetite and prevent vomiting, especially if the patient experiences anorexia. Avoid spicy foods as they may exacerbate the condition. Ensure adequate fluid intake, either orally or intravenously, to prevent dehydration and flush out toxins. Discourage alcohol consumption as it can worsen the condition and interfere with the healing process.

Elimination

Monitor the patient’s intake and output, including observing stool and vomitus for consistency, color, amount, and odor. Record and report any abnormalities. Additionally, observe the patient’s bowel patterns to identify any changes or irregularities. Encourage the patient to consume foods rich in roughage and increase fluid intake to prevent constipation.

Exercises

Initially, the patient may require total bed rest, but as their condition improves, encourage them to engage in passive exercises. These exercises help prevent complications such as deep vein thrombosis and promote blood circulation. Passive exercises involve gentle movements of the limbs performed by the caregiver while the patient remains in a relaxed position. These exercises can help maintain muscle tone and prevent stiffness during periods of immobility.

Hygiene

If the patient is unable to bathe independently, provide a bed bath to ensure hygiene, comfort, and promote blood circulation. Perform oral care to prevent mouth infections and stimulate appetite. Additionally, provide nail care to prevent the accumulation of dirt. Change bed linens promptly when soiled or dirty to maintain cleanliness and prevent skin irritation.

IEC (Information, Education, Communication)

  1. Explain to the patient the importance of rest in aiding recovery and managing symptoms.
  2. Educate the patient about the disease process, including its causes, symptoms, and potential complications.
  3. Advise the patient to avoid spicy foods and the dangers of consuming unprescribed drugs, which can exacerbate symptoms.
  4. Help the patient identify factors that may worsen their symptoms, such as stress or certain dietary choices.
  5. Stress the importance of medication compliance to ensure effective treatment and symptom management.
  6. Emphasize the significance of attending scheduled review appointments with healthcare providers.
  7. Teach the patient to recognize signs and symptoms of potential complications and when to seek medical attention.
  8. Discuss the necessity of making lifestyle changes, such as abstaining from alcohol consumption, to improve overall health and manage the condition effectively.

Complications

Complications of gastritis can vary in severity and may include:

  1. Gastric ulcers: Prolonged inflammation of the gastric mucosa can lead to the formation of ulcers in the stomach lining, which may cause pain, discomfort, and bleeding.
  2. Haemorrhage: Severe inflammation and erosion of the stomach lining can result in significant bleeding, leading to haemorrhage. This can manifest as vomiting of blood (haematemesis) or passing of black, tarry stools (melena).
  3. Anaemia: Chronic bleeding from gastric ulcers or erosion of blood vessels in the stomach can lead to iron deficiency anaemia due to the loss of red blood cells and decreased iron stores.
  4. Obstruction: Inflammation and scarring of the stomach lining may cause narrowing of the stomach’s passageway, leading to obstruction of food flow. This can result in symptoms such as nausea, vomiting, and abdominal pain.
  5. Perforation: Severe inflammation and erosion of the stomach wall can lead to the formation of a hole or perforation, allowing gastric contents to leak into the abdominal cavity. This is a medical emergency and requires immediate intervention to prevent peritonitis.
  6. Peritonitis: Perforation of the stomach wall can lead to contamination of the peritoneal cavity with gastric contents, resulting in peritonitis—an inflammation of the peritoneum. Peritonitis is a life-threatening condition that requires prompt medical attention and treatment with antibiotics.
  7. Stomach cancer: Chronic gastritis, especially when caused by infection with Helicobacter pylori or long-term exposure to irritants such as alcohol or tobacco, can increase the risk of developing stomach (gastric) cancer over time. Regular monitoring and appropriate management of gastritis are essential for reducing this risk.

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Oral and esophageal disorders | Nursing Management

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Introduction

Oral and esophageal disorders refer to a range of medical conditions that affect the mouth (oral cavity) and the esophagus (the tube connecting the throat to the stomach). These disorders can encompass various conditions such as infections, inflammation, structural abnormalities, tumors, and functional disorders affecting the normal functioning of these areas.

Oral disorders

1. Stomatitis

Stomatitis is defined as inflammation of the mucosa inside the mouth. It can arise from various oral conditions or may be associated with other diseases.

Types of stomatitis:

  1. Simple Catarrhal Stomatitis: Simple catarrhal stomatitis involves inflammation of the mucous membranes within the mouth, accompanied by an increased flow of mucus and exudates. This type of stomatitis is more commonly observed in children compared to adults.

Causes:

  1. Microorganisms such as bacteria can contribute to the development of stomatitis, leading to inflammation of the mouth mucosa.
  2. Poor oral hygiene or neglect of oral care can create an environment conducive to stomatitis.
  3. Consumption of hot foods or drinks may irritate the mouth lining, exacerbating stomatitis symptoms.
  4. Wounds caused by foreign bodies in the mouth can introduce infection and inflammation, triggering stomatitis.
  5. Exposure to strong acids or alkalis can lead to corrosion of the oral tissues, potentially causing stomatitis.
  6. Systemic infections, such as viral or fungal infections, can manifest as stomatitis.

Signs and symptoms:

  1. A low-grade fever may accompany stomatitis as the body responds to inflammation.
  2. Dry mucous membranes in the mouth can cause discomfort and contribute to the development of sores.
  3. The presence of sores or ulcers in the mouth is a common symptom of stomatitis.
  4. Pain in the mouth, especially while eating or drinking, is a characteristic symptom of stomatitis.
  5. Redness of the mucous membranes may indicate inflammation associated with stomatitis.
  6. Loss of appetite and a preference for cold drinks may occur due to discomfort associated with stomatitis.

Treatment:

  1. Administration of antipyretics such as paracetamol, taken at a dose of 1 gram three times a day, can help alleviate the fever and discomfort associated with stomatitis.
  2. Mouthwashes containing antiseptic agents can help reduce the microbial load and promote the healing of oral lesions.
  3. Consumption of a soft diet can minimize irritation to the mouth and facilitate the healing of ulcers.
  4. Treatment of any underlying systemic conditions contributing to stomatitis is essential for comprehensive management of the condition.

2. Vincent’s Stomatitis

Vincent’s stomatitis, also known as acute necrotizing ulcerative gingivitis (ANUG), is a severe inflammation of the mouth and gums primarily caused by bacterial infection, often associated with poor oral hygiene and immunosuppression.

Causes:

  1. Bacterial infection: Vincent’s stomatitis is primarily caused by bacterial overgrowth, particularly species such as Fusobacterium and Prevotella.
  2. Poor oral hygiene: Inadequate dental care and hygiene practices can create an environment conducive to bacterial proliferation and subsequent stomatitis.
  3. Immunosuppression: Weakened immune system function, whether due to underlying medical conditions or medications, can increase susceptibility to bacterial infections and exacerbate the severity of stomatitis.

Signs and symptoms:

  1. Pain in the mouth: Patients with Vincent’s stomatitis often experience significant discomfort and pain, particularly in the affected areas of the mouth and gums.
  2. Swelling of the affected parts: Inflammation and swelling of the gums and surrounding tissues are common manifestations of Vincent’s stomatitis.
  3. Bleeding from the gums: Gingival bleeding, especially during brushing or eating, may occur due to tissue inflammation and breakdown.
  4. Redness of the mucous membrane: The oral mucosa may appear red and inflamed, indicative of the underlying inflammatory process.
  5. Bad taste: Patients may report a foul or unpleasant taste in the mouth, often due to bacterial overgrowth and tissue breakdown.
  6. Halitosis: Persistent bad breath may result from bacterial infection and tissue necrosis characteristic of Vincent’s stomatitis.
  7. Fever due to infection: Systemic symptoms such as fever may accompany severe cases of Vincent’s stomatitis, reflecting the body’s immune response to bacterial invasion.

Diagnosis:

  • Physical examination: Clinical evaluation may reveal characteristic features such as mouth and gum swelling, inflamed and red gums, and ulceration.
  • Dental x-rays: Radiographic imaging may be used to assess the extent of dental and periodontal involvement.
  • History-taking: Gathering information about the patient’s dental and medical history can aid in diagnosis and treatment planning.

Treatment:

  • Oral antibiotics: Antibiotics such as penicillin or erythromycin are commonly prescribed to combat bacterial infection and reduce inflammation.
  • Antiseptic mouthwash: Antimicrobial mouth rinses containing chlorhexidine or hydrogen peroxide can help control bacterial growth and promote oral hygiene.
  • Hydrogen peroxide rinses: Rinsing with a diluted hydrogen peroxide solution can aid in cleaning and disinfecting oral wounds and ulcers.
  • Regular brushing: Maintaining good oral hygiene through regular brushing and flossing is essential for preventing bacterial buildup and promoting healing.
  • Professional dental cleaning: Professional dental cleanings may be necessary to remove plaque, tartar, and debris contributing to bacterial proliferation and inflammation.

3. Moniliasis

Oral thrush, also known as moniliasis or candidiasis, is a mouth infection caused by a yeast-like fungus called Candida albicans.

Predisposing Factors: Oral thrush commonly occurs in individuals with:

  • Lowered immunity: Conditions such as HIV/AIDS, diabetes, or undergoing chemotherapy or immunosuppressive therapy can weaken the immune system, making individuals more susceptible to fungal infections.
  • Prolonged use of antibiotics: Antibiotics, particularly broad-spectrum ones like tetracycline and chloramphenicol, can disrupt the normal flora of the mouth, which usually keeps fungal overgrowth in check. This disruption creates an environment conducive to Candida albicans proliferation.

Signs and symptoms:

  • Lesions on the mucous membrane and gums: Oral thrush manifests as white, creamy patches or plaques on the tongue, inner cheeks, roof of the mouth, and gums. These lesions may be painful and bleed easily when disturbed.
  • Discomfort and pain: Patients may experience discomfort or pain while eating or swallowing, especially if the lesions are located in sensitive areas of the mouth.
  • Soreness or burning sensation: The affected areas may feel sore or have a burning sensation, particularly during eating or drinking acidic or spicy foods.

Treatment:

  • Hydrogen peroxide and normal saline mouthwashes: Rinsing the mouth with a solution of hydrogen peroxide or normal saline can help reduce the fungal load and promote the healing of oral lesions.
  • Antifungal medications:
    • Clotrimazole tablets dissolved in the mouth: Clotrimazole is an antifungal medication available in tablet form which can be dissolved in the mouth and used several times a day to combat oral thrush.
    • Nystatin suspension, pastilles or amphotericin lozenges: These antifungal agents are commonly prescribed to treat oral thrush. They work by directly targeting and killing Candida albicans.
    • Fluconazole for oropharyngeal candidiasis: In severe cases or when other treatments fail, oral fluconazole, a systemic antifungal medication, may be prescribed to eliminate the fungal infection.
  • Oral hygiene: Maintaining good oral hygiene practices, such as regular brushing and flossing, can help prevent the recurrence of oral thrush. Additionally, using a soft-bristled toothbrush and avoiding irritating or abrasive mouthwashes can prevent further irritation of oral lesions.

4. Hepatic stomatitis

Hepatic stomatitis, also known as herpetic stomatitis, is a contagious viral infection of the mouth characterized by the development of ulcers and inflammation. It is commonly observed in children.

Causes:

  • Herpes virus hominis: Hepatic stomatitis is often caused by infection with herpes simplex virus type 1 (HSV-1), which is highly contagious and can be transmitted through close contact with an infected individual or by sharing utensils, towels, or personal items.
  • Epstein-Barr virus (EBV): In some cases, Epstein-Barr virus, the causative agent of infectious mononucleosis, may also contribute to the development of hepatic stomatitis.
  • Varicella zoster virus: This virus, which causes chickenpox and shingles, has also been implicated as a potential cause of stomatitis, particularly in individuals with compromised immune systems.

Signs and symptoms:

  • Blisters in the mouth: The initial presentation of hepatic stomatitis often involves the development of fluid-filled blisters or vesicles on the mucous membranes of the mouth, commonly on the tongue or inner cheeks.
  • Decrease in food intake: Patients may experience a decrease in appetite and food intake, even when they feel hungry, due to pain and discomfort associated with eating.
  • Dysphagia: Difficulty swallowing, known as dysphagia, may occur due to the presence of painful ulcers in the mouth, making it uncomfortable to swallow food or liquids.
  • Drooling: Young children with hepatic stomatitis may exhibit increased drooling due to difficulty swallowing and oral discomfort.
  • Fever: A fever may precede the appearance of blisters and ulcers in the mouth, typically occurring 1 to 2 days before the onset of visible lesions.
  • Irritability: Patients, especially children, may become irritable or fussy due to the discomfort and pain caused by oral ulcers.
  • Pain in the mouth: Oral ulcers can cause significant pain and discomfort, making it painful to eat, drink, or speak.
  • Swollen gums: Inflammation of the gums, or gingivitis, may accompany hepatic stomatitis, leading to swollen and tender gum tissue.
  • Ulcers in the mouth: After the blisters rupture, shallow, painful ulcers may develop on the tongue, inner cheeks, or other areas of the oral mucosa.

Diagnosis:

  • History-taking: A thorough medical history, including symptoms and recent exposure to individuals with viral infections, can help in diagnosing hepatic stomatitis.
  • Physical examination: Healthcare providers may perform a physical examination to assess the appearance of oral lesions and other signs associated with hepatic stomatitis.

Treatment:

  • Antiviral therapy: Medications such as acyclovir, an antiviral agent, may be prescribed to reduce viral replication and alleviate symptoms of hepatic stomatitis.
  • Liquid diet: cool-to-cold, nonacidic drinks or soft foods may be recommended to minimize discomfort while eating and drinking.
  • Oral topical anesthetic: For severe pain, oral topical anesthetics like lidocaine may be used to numb the oral mucosa and provide temporary relief. However, caution should be exercised to avoid interference with swallowing and the potential for burns in the mouth or throat.

5. Parotitis

Parotitis refers to the inflammation of one or both parotid glands, which are the largest salivary glands located near the jaw angle.

Causes:

  • Bacterial infection: Parotitis can be caused by bacterial pathogens such as Staphylococcus aureus or Mycobacterium tuberculosis, which may enter the glandular tissue and trigger inflammation.
  • Viral infection: The mumps virus is a common viral cause of parotitis, leading to the characteristic swelling of the parotid glands seen in mumps infection.
  • HIV: Individuals with the human immunodeficiency virus (HIV) may develop parotitis as a result of impaired immune function.
  • Blockage of the parotid duct: Blockage of the main parotid duct or its branches can prevent the normal flow of saliva, leading to glandular inflammation.
  • Systemic infection: Parotitis may occur as a manifestation of a systemic infection affecting the entire body.

Signs and symptoms:

  • Swollen and painful gland: Patients may experience swelling and tenderness in the affected parotid gland, typically observed at the angle of the jaw.
  • Dry mouth: Reduced saliva production due to glandular inflammation can result in dryness of the mouth, leading to discomfort.
  • Severe pain when swallowing: Inflammation of the parotid gland can cause significant pain, particularly during swallowing or chewing.
  • Purulent exudates: In cases of bacterial infection, purulent discharge or pus may be present from the affected gland.
  • Erythema: The skin overlying the inflamed parotid gland may appear red or erythematous.
  • Ulcers: In severe cases, ulceration of the oral mucosa may occur due to inflammation and tissue damage.
  • Fever: Systemic symptoms such as fever may accompany parotitis, especially in cases of infectious etiology.

Diagnosis:

  • History-taking: A thorough medical history, including recent infections, exposure to pathogens, and symptoms, can provide valuable diagnostic information.
  • Physical examination: Enlargement and tenderness of the parotid gland can be observed and palpated during a physical examination.

Treatment:

  • Antibiotics: If a bacterial infection is suspected or confirmed, antibiotic therapy may be prescribed to target the causative pathogens.
  • Mouth washes: Antiseptic or saline mouthwashes may help reduce oral bacteria and promote healing of the inflamed gland.
  • Warm compresses: Application of warm compresses to the affected area can help alleviate pain and reduce swelling.
  • Increased fluid intake: Adequate hydration is important to maintain saliva production and prevent dehydration.
  • Abscess drainage: In cases where an abscess forms within the parotid gland, surgical drainage may be necessary to remove pus and relieve pressure.

Once we have discussed parotitis, let’s now shift our focus to disorders of the esophagus.

Disorders of the esophagus

1. Achalasia 

Achalasia is a neuromuscular disorder of the gastrointestinal tract characterized by the absence of propulsive peristalsis in the esophagus and inadequate relaxation of the lower esophageal sphincter (LES). This condition leads to the accumulation and stagnation of food and fluids in the esophagus, causing irritation and inflammation.

Cause

The exact cause of achalasia is unknown, but it has been associated with degenerative changes or dysfunction in the nerve plexus that innervates the esophageal muscle tissue.

Signs and symptoms:

  • Progressive dysphagia: difficulty swallowing, particularly with solid foods, which worsens over time.
  • Regurgitation of undigested food: Food that is unable to pass through the LES may be regurgitated back into the mouth.
  • Weight loss: due to inadequate intake of nutrients as a result of swallowing difficulties.
  • Halitosis: a foul breath odor caused by the regurgitation of previously ingested food.
  • Coughing when lying down: Irritation of the esophagus may lead to coughing, especially in a horizontal position.
  • Chest pains: Patients may experience chest discomfort or pain, which may worsen after eating.

Diagnosis:

  • Barium swallow: radiographic imaging showing dilatation of the esophagus and lack of peristalsis.
  • Esophagoscopy: endoscopic examination revealing dilatation of the lower esophageal sphincter, as well as potential complications such as esophageal cancer or candida infection.
  • Esophageal manometry: measurement of muscle contractions in the esophagus during swallowing, indicating failure of LES relaxation and lack of peristalsis.
  • Biopsy: Tissue sampling during endoscopy may show hypertrophied muscles and absence of certain nerve cells in the mesenteric plexus, which controls esophageal peristalsis.

Treatment:

  • Pneumatic dilation is a non-surgical procedure involving the insertion of a balloon into the esophagus to stretch the narrowed area and improve swallowing function.
  • Medication: Calcium channel blockers (e.g., nifedipine) and nitrates (e.g., nitroglycerin) may be prescribed to relax the LES.
  • Balloon (pneumatic) dilatation: Similar to pneumatic dilation, this procedure aims to dilate the esophagus at the point of narrowing using a balloon inserted inside the LES.
  • Surgery: Heller myotomy or cardiomyotomy involves surgical division of the muscles at the lower end of the esophagus to relieve the pressure and improve swallowing function.

2. Gastroesophageal reflux (GER)

Gastroesophageal reflux (GER) is a condition characterized by the backward flow of gastric or duodenal contents into the esophagus, occurring independently of vomiting or belching. It results from abnormalities in the barrier between the stomach and the esophagus, often involving abnormal relaxation of the lower esophageal sphincter (LES) and anatomical abnormalities such as hiatus  hernia, where the upper part of the stomach and the LES move above the diaphragm.

Predisposing factors 

Various predisposing factors contribute to GER, including obesity, Zollinger-Ellison syndrome, pregnancy, smoking, hypocalcemia, certain foods (e.g., caffeine-containing beverages, chocolates, spicy and acidic foods), alcohol consumption, large meals, certain medications (e.g., anticholinergics, calcium channel blockers, nitrates), systemic sclerosis, and prolonged nasogastric tube placement.

Signs and symptoms

Common signs and symptoms of GER include heartburn (a burning sensation behind the breastbone, typically occurring after meals), chest pain radiating to the neck and throat, dysphagia (difficulty swallowing), odynophagia (painful swallowing), excessive salivation (water brash), nausea, nighttime coughing, hoarseness, wheezing, belching, and flatulence.

The diagnosis of GER

Diagnosis of GER often involves esophagoscopy to examine the esophagus for damage, barium swallow to evaluate esophageal damage, continuous esophageal pH monitoring to assess acid reflux severity, esophageal manometry, and stool occult blood test to detect bleeding from esophageal irritation.

Treatment strategies

Treatment strategies for GER include lifestyle modifications such as avoiding trigger foods, losing weight if obese, elevating the head of the bed, avoiding lying down after meals, and quitting smoking. Antacid medications like magnesium trisilicate help neutralize stomach acid, while proton pump inhibitors (PPIs) and H2 antagonists like omeprazole and cimetidine, respectively, reduce acid production. Surgical interventions such as Nissen fundoplication (to repair the LES)  and vagotomy (to remove vagus nerve branches innervating the stomach lining) may be considered in severe cases or when conservative measures fail to provide relief.

3. HICCUP

Hiccup, also known as hiccough, is an involuntary contraction of the diaphragm that occurs repeatedly, resulting in a sudden closure of the glottis and a distinct sound.

Causes

  • Hiccups can be caused by various central and peripheral nervous system disorders, often due to injury or irritation to the phrenic and vagus nerves, as well as toxic or metabolic disorders.
  • Triggers include chemotherapy, ingestion of carbonated beverages, alcohol, or spicy foods, prolonged laughter, and eating too fast.

Treatment

  • Ordinary hiccups typically resolve on their own without medical intervention.
  • Anecdotal remedies include startling the affected person, consuming peanut butter or vinegar, drinking water, holding one’s breath, or altering breathing patterns.
  • In severe and persistent cases (“intractable” hiccups), medical treatment may be necessary, including the use of sedatives such as diazepam and chlorpromazine.

Conclusion

With the discussion on hiccups concluded, we will now proceed to explore conditions affecting the stomach. Before we delve into that, let’s review the common manifestations of gastrointestinal tract (GIT) disorders and their management.

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Health assessment | Nursing

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Introduction

Health assessment involves gathering comprehensive data or information from the patient. It is essential that the information collected is thorough and complete. Within this topic, we will explore:

  • History taking
  • Physical examination

History taking

History-taking, also known as a “clinical interview,” is a fundamental aspect of health assessment. It serves as the initial step in understanding the reason for the patient’s visit to the healthcare facility. This structured conversation is designed to uncover the client’s health needs and issues. Typically, it is conducted prior to the physical examination.

During history-taking, it is important to gather the following information:

  • Demographic data, including age, sex, address, and marital status.
  • Presenting complaints.
  • History of presenting illnesses and previous illnesses.
  • Treatment history.
  • Family history.
  • Social and occupational history.

Now, let’s delve into each piece of information that should be collected during history in detail. Demographic data, also referred to as biographical data, encompasses the following information that needs to be collected and documented:

When collecting demographic data or biographical information, it is essential to gather and record the following details:

  • Full name of the client.
  • Age of the client.
  • Gender or sex of the client.
  • Residential address of the client.
  • Marital status of the client.
  • Next of kin, including their relationship to the client and their contact information.
  • Religion of the client.
  • Denomination (if applicable) within their religious affiliation.
  • Nationality of the client.
  • Tribe or ethnic group to which the client belongs.
  • Occupation or employment status of the client, including details about their job role or profession.

The presenting complaint

The presenting complaint is the primary issue that prompted the patient to seek medical assistance. It involves defining the main problem and its duration. Understanding the timing and duration of symptomatic events is crucial because the sequence of the illness can offer valuable insights into its underlying pathological process.

It’s common for some patients, particularly the elderly, to have difficulty recalling the exact duration of their illness. In such cases, they may use significant events as reference points for timing. It can be helpful to inquire about when the patient last felt completely well, as this may jog their memory regarding earlier symptoms that they might have initially dismissed as insignificant.

Obtaining the history of the present illness

When obtaining the history of the present illness, encourage the patient to narrate the sequence of events from the onset of the illness. Ideally, allow the patient to recount their experience without interruption. Offer gentle encouragement if the patient appears anxious or hesitant. For patients who tend to be verbose, gently guide the conversation to focus on relevant details.

Some patients may use medical terms without understanding their significance. Encourage these patients to express their symptoms in their own words. If friends or relatives accompany the patient, always address the patient directly. Once the patient has provided an initial overview of their symptoms, inquire about specific aspects to clarify the onset and duration of the main symptoms. Explore whether any symptoms fluctuate or are linked to specific times, seasons, or events in the patient’s life. After comprehending the patient’s narrative, delve into each symptom in detail to gain a thorough understanding of the illness.

Symptom Analysis

Symptoms, such as pain, serve as valuable indicators guiding clinical examination and subsequent investigations to diagnose and treat underlying conditions. In symptom analysis, it is crucial to consider the course of the illness, the reason for presentation, and conduct a thorough review of systems. For instance, when analyzing pain, it is essential to explore the following aspects and ask the client relevant questions:

  • Onset: When did the pain initially manifest?
  • Location: Where is the pain localized within the body?
  • Duration: How long have you been experiencing this pain? When did it first occur?
  • Characteristics: How would you describe the pain? Is it sharp, burning, or tingling? Is it localized, or does it radiate from one area to another?
  • Aggravating Factors: What exacerbates the pain? Does coughing or breathing intensify it?
  • Relieving Factors: Are there any actions or treatments that alleviate or reduce the pain?
  • Treatment: What medications or treatments are currently being administered for the pain?

By thoroughly analyzing each symptom, healthcare providers can gain valuable insights into the nature of the condition, allowing for targeted interventions and effective management strategies.

To aid in recalling the components of symptom analysis, the mnemonic OLDCART can be used:

  • O: Onset of symptoms: When did the symptoms first appear?
  • L: Location: Where is the symptom localized within the body?
  • D: Duration: How long have the symptoms been present? When did they start?
  • C: Characteristics: How would you describe the symptom? Is it sharp, dull, intermittent, or constant?
  • A. Aggravating factors: What worsens or exacerbates the symptom? Are there specific triggers or activities that make it worse?
  • R: Relieving factors: What alleviates or reduces the symptom? Are there any actions or treatments that provide relief?
  • T: Treatment: What medications or interventions are currently being used to manage the symptom?
  • S: Severity: How intense or severe is the symptom? Can it be rated on a scale from mild to severe?

By systematically considering each aspect represented by the mnemonic OLDCART, healthcare providers can conduct a thorough analysis of symptoms, aiding in accurate diagnosis and appropriate management of the patient’s condition.

History of previous illnesses

Reviewing the history of previous illnesses provides valuable insights into the patient’s overall health status. It is essential to document all significant illnesses, surgeries, and injuries from infancy onwards. During this assessment:

  • Inquire about the nature of each illness to assess the likelihood of accurate diagnosis.
  • Ask about the treatments received for previous illnesses to understand the management approach.
  • Explore any prior hospital admissions to gain further understanding of the patient’s medical history.

Additionally, consider the following points when evaluating the history of previous illnesses:

  • Duration and severity of each illness.
  • Any recurring or chronic conditions.
  • Complications or side effects experienced during treatment.
  • Impact of previous illnesses on the patient’s daily life and functioning.
  • Any family history of similar illnesses or medical conditions.

Assessing the family history

Assessing the family history of your client is crucial for understanding the health status of immediate family members and identifying potential genetic risks. By evaluating family history, healthcare providers can:

  • Determine if the client is predisposed to certain conditions that run in families.
  • Note the client’s position in the family and the ages of siblings or children, if applicable.
  • Document the health status, significant illnesses, and causes of death of immediate relatives.
  • Inquire about hereditary disorders within the family.
  • Ask if any family members have experienced similar symptoms.

The social history of the patient

The social history of the patient encompasses their physical and emotional environment, including their home and work surroundings, as well as their habits and attitudes toward life and work. These factors are crucial in assessing the impact of illness on the patient and their family. During the assessment, inquire about the patient’s leisure activities, alcohol consumption, smoking habits, and exercise routine. Understanding these aspects can provide valuable insights into the patient’s lifestyle and potential factors contributing to their health status.

Occupational history

Occupational history is important, as certain occupations may increase the risk of specific health conditions. During the assessment, inquire about the following aspects of the patient’s occupation:

  • Exposure to hazardous substances at work.
  • Number of hours worked per week.
  • Nature of work, including specific job titles such as secretary, director, underground mine worker, street vendor, bartender, shop assistant, or nursery nurse.

Assessing menstrual history

When assessing menstrual history in women, it is important to inquire about various aspects related to menstruation:

  • Last normal menstrual period: Determine the date of the patient’s most recent menstrual period to assess regularity and identify any abnormalities.
  • Menstrual regularity: Ask about the regularity of menstrual cycles, including the usual duration between periods.
  • Amount of flow: Inquire about the typical amount of menstrual flow, such as light, moderate, or heavy bleeding.
  • Dysmenorrhea: Assess whether the patient experiences any menstrual pain or cramping (dysmenorrhea) and its severity.
  • Menstrual tension: Explore whether the patient experiences any emotional or physical symptoms, such as mood changes or bloating, before or during menstruation.
  • History of taking oral contraception: Determine whether the patient has a history of using oral contraceptives or other hormonal contraceptives and inquire about any associated side effects or complications.

Obstetric History

When obtaining an obstetric history from a woman, gather information about her childbirth experiences, including:

  • Number of pregnancies.
  • Types of deliveries (normal or complicated).
  • Health during pregnancy.
  • History of abortions or miscarriages.
  • Status of children (alive or deceased).

Physical Examination

Following the patient’s history, it is essential to conduct a routine physical examination. This process may cause discomfort for the patient due to the necessary undressing. Thus, it’s crucial to reassure and comfort the patient.

During the examination, ensure gentleness and minimize unnecessary exposure and fatigue for the patient. In cases of acute illness, it may be prudent to delay routine examinations and only perform those necessary for initial diagnosis and treatment. Both history-taking and physical examinations are integral components of patient assessment, with each complementing the other in providing comprehensive care.

History and physical examinations

History and physical examinations work together to provide a comprehensive understanding of a patient’s health. A thorough physical examination necessitates a cooperative patient and a serene, warm, and well-illuminated environment. Natural daylight is preferable over artificial light, as it allows for accurate observation of subtle changes in skin color, such as the faint yellow hue of mild jaundice.

Efforts should be made to help the patient relax, irrespective of the circumstances. For a comprehensive examination, the patient may be asked to undress, but they should be draped with a bed sheet or blanket for modesty and comfort. Patients may be permitted to retain their underwear, but it is essential to ensure examination of the buttocks and genitalia as well.

Having a chaperone present is essential during examinations involving male nurses and female patients, as well as during rectal and vaginal examinations. This presence provides reassurance to the patient and safeguards the nurse against potential allegations of misconduct.

Four primary techniques are employed during physical examinations:

  • Inspection
  • Palpation
  • Percussion
  • Auscultation

Let’s delve deeper into each technique, starting with inspection.

Inspection

Inspection involves visually examining a specific part or area of the body to evaluate its normal state or any deviations from the norm. It’s important to note that inspection goes beyond mere observation; it is a deliberate, systematic, and focused process.

During inspection, you must compare what you see with the known, typical characteristics of the body parts being examined. Ensure adequate lighting is available, and position and expose the body parts in a manner that allows for viewing of all surfaces. Additional lighting may be required to inspect cavities accurately.

Palpation

Palpation involves examining the body through touch. Both light and deep palpation techniques provide valuable information regarding various aspects such as masses, pulsations, organ enlargement, tenderness or pain, swelling, muscular spasm or rigidity, elasticity, vibration of voice sounds, crepitus, moisture, and differences in texture.

During practical training, you will discover that different parts of the hand are more sensitive to specific assessments. For instance:

  • The fingertips are used to palpate lymph nodes and assess pulse rate.
  • The backs of the hands and fingers are employed to evaluate temperatures.
  • The palm surface is best suited for detecting vibrations, while the abdomen is ideal for assessing tenderness or detecting masses.

Percussion

Percussion is a diagnostic technique used to produce sounds and gather information about underlying body structures. This technique can be performed directly or indirectly. Direct percussion involves tapping the body with one or two fingers to produce a sound. However, indirect percussion is more commonly used.

In indirect percussion, the middle finger of the non-dominant hand (known as the pleximeter) is placed firmly against the body surface. The tip of the middle finger of the dominant hand (known as the plexor) strikes the distal phalanx or the distal interphalangeal joint of the pleximeter finger. To produce optimal sounds, it’s important to maintain a relaxed wrist and deliver rapid strikes.

The sounds and vibrations produced during percussion are evaluated relative to the underlying structures. Any deviation from expected sounds may indicate an underlying problem. For instance, the typical percussion sound in the right lower quadrant of the abdomen is tympany. Dullness in this area may suggest a potential issue that requires further investigation. Specific percussion sounds of various body parts and regions are discussed in corresponding assessment notes.

Auscultation

Auscultation involves listening to sounds produced by the body to evaluate both normal and abnormal conditions. This technique is typically performed indirectly, using a stethoscope to enhance clarity by blocking out background noise.

The bell of the stethoscope is more adept at capturing low-pitched sounds, while the diaphragm is better suited for high-pitched sounds. Auscultation is particularly valuable for assessing sounds originating from the heart, lungs, abdomen, and vascular system.

Screening Physical Examination Outline

General Assessment:
  • Evaluate the patient’s overall appearance to determine if they appear healthy, unwell, or ill, as well as whether they are well cared for or neglected.
  • Assess your intelligence and educational level.
  • Evaluate the mental state, including cognitive function and mood.
  • Observe facial expressions and emotional states.

Build and posture:

  • Evaluate the body’s build and posture for any abnormalities or deviations from the norm.

Nutritional Status and Body Composition:

  • Assess for signs of malnutrition, obesity, or edema (fluid retention).

Skin Examination:

  • Evaluate skin color for signs of cyanosis (bluish discoloration), pallor (paleness), jaundice (yellowing), or abnormal pigmentation.
  • Note the presence of body hair and any abnormalities.
  • Look for deformities, swellings, or growths on the body.

Vital Signs:

  • Measure temperature, pulse rate, and respiratory rate to assess physiological function.
  • Look for features indicative of endocrine diseases such as hyperlipidemia, acromegaly, or Cushing’s syndrome.

Hair:

  • Note the distribution and texture of hair, as well as grooming practices.

Eyes:

  • Conduct simple tests of visual acuity by comparing one eye against the other.
  • Check for exophthalmos or enophthalmos.
  • Assess for eyelid edema.
  • Observe the conjunctivae for signs of anemia, jaundice, or inflammation.
  • Evaluate the pupils for size, equality, regularity, reaction to light, and accommodation.
  • Assess eye movement for nystagmus or strabismus.
  • Perform an ophthalmoscopic examination of the fundi and ocular chambers.

Face:

  • Check for facial symmetry or asymmetry.
  • Assess jaw movements.
  • Look for rash or features suggestive of endocrine disease or hyperlipidemia.

Nose/Sinuses:

  • Inspect the external nose, nasal mucosa, and septum.
  • Palpate the frontal and maxillary sinuses for tenderness.

Mouth and Pharynx:

  • Assess for breath odors.
  • Inspect the lips for color and eruptions.
  • Check for tongue protrusion and appearance.
  • Examine the teeth and gums, noting the fit of dentures and their usage.
  • Inspect the buccal mucous membrane for color and pigmentation.
  • Evaluate the pharynx for movement of the soft palate and the state of the tonsils.

Neck:

  • Palpate the thyroid gland and cervical lymph nodes.
  • Auscultate the carotid arteries for a pulse.
  • Note the presence of jugular venous distension and the angle of distension.
  • Assess the range of neck movements and neck rigidity.

Upper Limbs:

  • Conduct a general examination of the hands and arms.
  • Inspect the fingernails for clubbing or koilonychia.
  • Assess pulse rate, rhythm, volume, and character.
  • Evaluate the arterial walls of the radial and brachial arteries.
  • Check the axillae for lymph node enlargement.
  • Measure your blood pressure.
  • Assess muscles for wasting and fasciculations.
  • Perform tests for muscle power, tone, reflexes, and coordination.
  • Check cutaneous sensation to exclude root or nerve lesions.
  • Evaluate joint movement, pain, and swelling.

Thorax: anteriorly and laterally

  • Note the chest type and any asymmetry.
  • Inspect the breasts and nipples for size, shape, inversion, rashes, ulceration, and discharge.
  • Observe respiratory movement, rate, depth, and character.
  • Check for dilated vessels.
  • Palpate for the position of the trachea.
  • Palpate for the apex beat and pericardial thrills.
  • Estimate tactile vocal fremitus.
  • Percuss the lungs.
  • Auscultate heart sounds.
  • Estimate vocal resonance and check cervical and axillary lymph nodes.

Posteriorly (patient sitting):

  • Inspect and palpate respiratory movements.
  • Estimate tactile vocal fremitus.
  • Percuss lung resonance.
  • Auscultate breath sounds.
  • Estimate vocal resonance.
  • Note spine movements and deformities.
  • Palpate the cervical glands and thyroid.
  • Look for sacral edema.
  • Note any kyphosis or scoliosis, and assess for tenderness and range of motion of the back.

Abdomen:

  • Inspect for size, distension, and symmetry.
  • Check for movement, scars, and dilated vessels on the abdominal wall.
  • Look for visible peristalsis or pulsation.
  • Observe pubic hair and hernial orifices.
  • Palpate the abdomen for tenderness, rigidity, hyperesthesia, splashing, masses, and organs such as the liver, gallbladder, spleen, kidneys, and bladder.
  • Assess abdominal reflexes.

Rectal Examination:

  • Examine the anus and rectal wall for lesions, inflammation, and sphincter muscles.
  • Note any nodules or abnormalities.
  • Check for occult blood in fecal matter.
  • In males, palpate the prostate gland.

Lower Limbs:

  • Conduct a general examination of the legs and feet.
  • Assess stance, balance, and gait.
  • Look for pedal edema and varicose veins.
  • Evaluate muscles for wasting and fasciculations.
  • Perform tests for power, tone, reflexes (including plantar response), and coordination.
  • Check joints for movement, pain, and swelling.
  • Palpate peripheral pulses and assess the temperature of the feet.

We have now reached the conclusion of this unit. Let’s review what you have learned.

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11 Principles of Medicine And Medical Nursing

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Introduction

Principles serve as established guidelines for action in specific situations, providing guidance and direction. In order to effectively learn this course, one must be provided with guidance. Below are the principles of medicine and medical nursing.

Let’s delve into each principle, starting with autonomy.

  • Autonomy: It emphasizes the recognition of individual rights, privacy, and the freedom to make choices. As such, it is imperative for nurses to uphold the patient’s autonomy, including respecting their right to refuse therapy. Additionally, nurses should actively empower patients by providing them with comprehensive information (Young Medicine, 2014).
  • Confidentiality stands as a cornerstone in the management of patient-specific information, crucial for fostering and preserving trust within the nurse-patient relationship. This principle is closely tied to the notion of privacy, emphasizing that information obtained from individuals should not be divulged to others without the patient’s explicit consent.
  • Fidelity symbolizes the obligation to remain steadfast in one’s commitments and promises. It highlights the importance of nurses adhering to their duties and responsibilities towards their patients, ensuring reliability and trustworthiness in their actions.
  • Justice: pertains to the equitable distribution of healthcare services and allocation of resources. It emphasizes fairness and impartiality, advocating for all patients to be treated equally and without discrimination. This principle underscores the importance of ensuring fairness in healthcare delivery and resource allocation processes.
  • Respect: For Persons emphasizes the importance of treating clients with dignity and honor, irrespective of their gender or societal status. It underscores the need for healthcare professionals to recognize and value the intrinsic worth and autonomy of every individual they encounter.
  • The sanctity of life principle asserts that life should be revered and prioritized above all else in healthcare practice. It underscores the fundamental value of preserving and protecting life in all medical decisions and interventions.
  • Veracity : states the obligation to uphold truthfulness and avoid deception or dishonesty in interactions with others. It underscores the importance of transparent communication and maintaining trust through honesty in healthcare relationships.
  • Beneficence: embodies the ethical principle of doing good and acting in the best interests of others. Within the medical realm, beneficence entails taking actions that promote the well-being and welfare of patients, ensuring that interventions and treatments serve their best interests.
  • Informed consent pertains to the active involvement of patients in decisions regarding their healthcare. It underscores the importance of patients being fully informed and understanding the potential benefits and risks of treatment options before making decisions about their care.
  • Cultural concerns: highlight the complexities that arise from cultural differences in medical ethics. It acknowledges that diverse cultural beliefs and practices can present challenges in reconciling spiritual or magical theories about disease origins with Western medical principles. Healthcare professionals must navigate these cultural differences sensitively and respectfully in their practice.
  • Sexual relationships between healthcare providers and patients raise significant ethical conflicts due to the inherent power dynamics and fiduciary responsibilities involved. Such relationships can compromise patient trust and autonomy, leading to professional repercussions for healthcare providers, including deregistration and legal prosecution. Therefore, maintaining clear boundaries and upholding professional ethics are essential to safeguarding patient welfare and maintaining the integrity of healthcare practice.

Nature and Causes of Disease

The term “disease” refers to any condition that disrupts normal bodily function, leading to a departure from health. This departure from normal function can vary in severity, ranging from incapacitating conditions to milder disruptions that allow individuals to remain active but may affect their sense of well-being. Diseases can arise naturally or be acquired artificially. They can be caused by external factors such as waterborne pathogens like cholera or by internal factors such as hypertension.

Individuals with a disease may exhibit specific signs and symptoms, or they may not, depending on factors like the presence of normal cells maintaining some level of function or compensatory mechanisms like tissue hypertrophy (an increase in cell size leading to increased tissue or organ size). Disruptions in the function of one part of the body can impact the functioning of other systems due to their interdependence for essential resources like oxygen, nutrients, and waste elimination.

Causes of Diseases

Diseases can result from various factors, including those originating from within the body (internal) and those stemming from external sources. The following are identified causes of diseases:.

Let’s examine each cause of disease in detail, starting with hereditary factors:

  • Hereditary: These are diseases that are passed from parent to child. Hereditary diseases can be transmitted from one generation to another due to genetic or chromosomal disorders in one or both gametes, such as sickle cell disease.
  • Developmental Defects: Failures or abnormalities in the developmental process during the embryonic or fetal stage lead to developmental defects. In most cases, the exact cause is unknown. Developmental defects may occur in infants born to mothers who had viral infections during the first trimester of pregnancy (the first three months). Toxic chemicals taken during pregnancy can disrupt normal fetal development. Radiation exposure is also believed to cause developmental defects, examples include spina bifida and cleft palate.
  • Biological Agents: One of the most common causes of disease is the invasion of the body by bacteria, viruses, fungi, or parasites. These agents harm and destroy tissues either directly through their action on cells or by the toxins they produce. Diseases caused by biological agents are referred to as infections.
  • Physical Agents: Tissues can be injured or destroyed by external forces in the environment. These forces include pressure, blows, falls, lacerations, and the entry of foreign bodies such as bullets. Cells may be destroyed when exposed to extreme heat or cold. Exposure to excessive sunlight or radiation from x-rays or radioactive material can alter cell structure and activity or cause cell destruction.
  • Chemicals: The introduction of certain chemicals into the body can have harmful effects on tissue cells. These chemicals may disrupt normal cellular chemical reactions by forming incompatible compounds or by interfering with normal enzymatic action within the cells.
  • Deficiencies and Excesses: An inadequate supply of essential materials necessary for normal tissue structure and function can lead to various diseases. This deficiency may stem from insufficient intake of nutritional substances or specific elements, a lack of absorption from the intestine, or impediments in the delivery of essential substances to cells by the circulatory system.
  • Insufficient oxygen supply to any tissue significantly impairs its function, and complete deprivation leads to rapid cell death. Local hypoxia can result from vessel blockages in the affected area, while general oxygen deprivation may arise from respiratory insufficiency or disturbances in oxygen-carrying or delivery mechanisms.
  • Excessive nutrient intake can also pose problems, such as increased demands on bodily functions and the storage of excess fat. Diseases resulting from nutrient excess include hypertension, certain cardiovascular conditions, and diabetes in obese individuals.
  • Emotions: Psychological reactions to stressful situations can influence a person’s autonomic nervous system, altering its control of visceral activities. Changes in autonomic innervations may enhance or diminish the function of certain structures, thereby impacting overall body functioning significantly.
  • Tissue Responses: Diseases can arise from the reactions or responses of tissues to injury or irritation. Examples of these responses include inflammation and allergic reactions.
  • Unknown/idiopathic: The cause of certain diseases remains unknown, such as cancer, rheumatoid arthritis, leukemia, and psychosis. While predisposing and perpetuating factors may be recognized in some cases, the primary causative factor remains unidentified. Despite this uncertainty, understanding predisposing and perpetuating factors can aid in preventive care. In cases where the cause is unknown, treatment and therapy primarily rely on managing the signs and symptoms.

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