11.16 Other Gastrointestinal Disorders

Overviews of other common gastrointestinal disorders are discussed in this section.

Liver Cirrhosis

Liver cirrhosis occurs due to chronic liver damage and is characterized by the development of liver nodules and liver fibrosis (stiffening/scarring of the liver). This chronic liver damage can be related to viruses like hepatitis C, toxic substances like drugs or alcohol, or autoimmune conditions. There is also a hereditary link.^[1],[2]

When exposed to injurious substances, cells in the liver react by depositing excess collagen, which leads to fibrosis. Initially, this fibrosis does not result in loss of liver function. However, as the exposure is repeated over time, the majority of the liver will become fibrosed, and loss of function results. Ultimately, this leads to portal hypertension or elevated pressures in the blood vessels of the liver. Due to the elevated pressure, the body compensates by diverting blood to other veins. This increase in blood flow weakens these vessels and makes them prone to injury and bleeding.^[3],[4]

Clients with liver cirrhosis may be asymptomatic, and the disorder may only be discovered incidentally. Clinical manifestations of cirrhosis may include nonspecific symptoms such as anorexia, weight loss, weakness, fatigue, or signs and symptoms of hepatic decompensation (jaundice, pruritus, signs of upper gastrointestinal bleeding, abdominal distension from ascites, and confusion due to hepatic encephalopathy). Physical examination findings may include jaundice, spider angiomas, gynecomastia, ascites, splenomegaly, palmar erythema, digital clubbing, and asterixis.^[5] Clients with cirrhosis may experience bleeding from enlarged veins in the esophagus caused by portal hypertension called varices. As cirrhosis and portal hypertension continue to progress, the effects are widespread and affect multiple organs of the body. Clients with cirrhosis are also at an increased risk for liver cancer.^[6],[7]

Lab results typically indicate elevated liver enzymes and prothrombin time. Albumin levels are typically decreased because this protein is produced in the liver. Decreased red blood cells, white blood cells, and platelets may also occur. Diagnostic tests include an ultrasound, CT scan, or MRI, but the best diagnostic tool is a liver biopsy. Additional tests may be performed to evaluate for the specific cause of liver cirrhosis.^[8],[9]

Cirrhosis can not be reversed, so treatment is focused on preventing further injury to the liver. Liver transplantation may be an option for some clients.^[10],[11]

Pancreatitis

Pancreatitis is inflammation of the pancreas, and it can be an acute or chronic condition. Although there are a variety of causes of acute pancreatitis, the most common causes are the presence of gallstones and excess alcohol use. Chronic pancreatitis is most commonly caused by alcohol abuse.^[12]

In acute pancreatitis caused by gallstones, the pancreatic duct is obstructed and cannot release digestive enzymes. This leads to autodigestion, a process in which the enzymes of the pancreas digest pancreatic tissue, as well as inflammation. Alcohol use can lead to acute pancreatitis due to the toxic effect of alcohol on pancreatic tissues. Chronic pancreatitis occurs when the pancreas is repeatedly attacked, leading to scarring and pancreatic hypofunctioning.^[13]

Common signs of acute pancreatitis are epigastric abdominal pain that spreads to the back, nausea, and vomiting. Jaundice may be present if the pancreatitis is caused by gallstones, and severe pancreatitis may lead to changes in mental status. Those with chronic pancreatitis may have nausea, vomiting, abdominal pain, weight loss, and steatorrhea. There is also the potential for the development of diabetes due to pancreatic damage.^[14]

Acute pancreatitis can be diagnosed by the presence of elevated serum amylase and lipase levels. These levels may be increased or normal in those with chronic pancreatitis. Imaging, such as a CT scan, MRI or MRCP, may also be done.^[15]

Treatment of acute pancreatitis consists of IV fluids, analgesics, and diet modification. The client typically has an NPO diet order because this stops the activity of the pancreas, but their diet is progressed and they can take food by mouth when their pain is well managed.^[16] In severe cases, parenteral nutrition may be required. If acute pancreatitis is caused by the presence of gallstones, an ERCP and/or a cholecystectomy may be performed. Clients with chronic pancreatitis will require pain management, a low-fat diet, and education on alcohol abstinence and potentially exogenous pancreatic enzymes.^[17]

Colon Cancer

Colon cancer is cancer of the colon or rectum and is one of the top causes of death in the United States. Risk factors for colon cancer are a family history, the presence of colon polyps, a history of inflammatory bowel disease, prior radiation to the abdomen, obesity, tobacco or alcohol use, and the intake of red or processed meat.^[19],[20]

Colon cancer forms after a number of genetic mutations result in cellular changes in the colon. Once colon cancer develops, it can be staged using the TNM system.^[21],[22] For more information on this system of staging, please visit the “Malignancy and Autoimmune Alterations” chapter of this textbook.

Sometimes colon cancer is found incidentally during a colonoscopy or at-home colon cancer screening. A popular at-home screening is Cologuard, which looks for abnormal DNA and blood in a stool sample. Others may have symptoms such as blood in the stool, abdominal pain, anemia, and changes in bowel movements that prompt them to seek medical care. Colon cancer commonly spreads to the liver, lungs, and/or lymph nodes. Clients with metastasis may have additional signs and symptoms.^[23],[24]

A definitive diagnosis of colon cancer requires a colonoscopy with a biopsy, but it could also be detected with a barium enema, CT scan, or MRI. A CEA test, a tumor marker blood test, may also be elevated with colon cancer. However, this test is used to monitor treatment response, not to diagnose.^[25],[26]

Colon cancer can be treated with surgical removal of the cancerous area and affected lymph nodes, chemotherapy, immunotherapy, or other biologic agents. If the entire colon must be removed, the client will end up with a colostomy.^[27],[28] For more information on nursing care of clients with cancer, please visit the “Malignancy and Autoimmune Alterations” chapter.