Gastrointestinal Disease

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Esophageal Disorders
With increased age, esophegeal motility is altered by degenerative changes in the smooth muscle. Actually, degeneration in the nervous system affects movement along the entire gastrointestinal tract. If the older person has symptoms of change in esophageal contractions, there will be difficulty in swallowing and substernal pressure. Dietary changes and smaller meals may be helpful.
Hiatal Hernia
A hiatal or diaphragmatic hernia is protrusion of the stomach through an opening in the diaphragm and into the thoracic age. The protrusion may occur because of degenerative changes. The incidence of hiatal hernia is extremely high in the elderly population. Signs and symptoms vary. Heartburn or sour stomach may be caused by some kinds of food and tends to me most evident when the person is lying down. Treatment is dietary alteration and antacids, and the patient should keep the head elevated on a number of pillows when lying down.
Chronic Atrophic Gastritis
This is an inflammatory stomach condition, the cause of which is unknown. Symptoms are vague and include loss of appetive, belching, nausea, vomiting, a feeling of fullness, and some discomfort. Antispasmodic drugs and a bland diet of small meals may help relieve symptoms.
An ulcer is an open sore. In older people, both gastric and duodenal ulcers are fairly common. They may be caused by stress, drugs, and chronic gastritis. Pain may be less acute than in younger people. The main symptoms are usually decreased appetite, listlessness, weight loss, black, tarry stools (indicating bleeding), and anemia. Conservative treatment consists of antacids and frequent drinks of low-fat or skim milk. Acid-producing substances such as alcohol, caffeine, and spices should be avoided.
Diverticulosis is the presense of tiny hernias or sacs in the mucosa of the large bowel. The most frequent site is the sigmoid portion of the left colon. Contributing factors may be constipation, obesity, emotional tension, or any eating habits that cause sustained muscular contractions. Most people are asymptomatic. Pain in the lower abdomen is the most common symptom and is often relieved by defacation. The condition is treated with diet and with management of constipation. Weight reduction is desirable in cases of obesity. Diverticulitis is inflammation and perforation of a diverticulum with pain and cramping and blood in the stool. This condition requires analgesics, rest, restriction of oral intake, intravenous therapy, and antibiotics.
Hemorrhoids are dilated or swollen veins in the anal area. They can be internal, under the mucous membrane, or external and covered by skin. Hemorrhoids result from the pressure of straining to defecate when one is constipated. The symptoms are itching, bleeding, and pain, especially with bowel movements. Surgery is the least likely treatment option because hemorrhoids do recur. Stool softeners and bulk-forming, agents will help reduce constipation. Anesthetic, emollient, or cortisone ointments and suppositories relieve itching and discomfort.
Patients who are constipated will not respond well to treatment or nursing care until this very basic problem receives attention.
The following factors contribute to causing constipation :
- Lack of intestinal motility, with soft stool remaining in the rectum
- Increased absorption of fluid and altered muscle contractions in the intestine that produce hard, dry, stool that is difficult to expel and may become impacted.
- Loss of abdominal muscle tone
- Neglecting the urge of defecate
- Poor dentition that makes it difficult to eat high-fiber food
Bad eating habits and poor fluid intake
Chronic use of enemas or laxatives
Environmental factors such as lack of privacy and changes or disruptions in routines
- Degenerative changes in the nervous system
- The vicious cycle of anal lesions (hemorrhoids and fissures) being caused by and then causing further constipation
- Mental stress or disorder
- Drugs

Reference :
Farrell J : Nursing Care of the Older Person, J.B. Lippincott Company, Philadelphia, 1990.

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