Pathophysiologic and Psychological
Considerations
Abnormalities of the GI tract are numerous
and represent every type of major pathology that can affect other organ
systems, in-cluding bleeding, perforation, obstruction, inflammation, and
cancer. Congenital, inflammatory, infectious, traumatic, and neoplastic lesions
have been encountered in every portion, and at every site, along the length of
the GI tract. As with all other organ systems, the GI tract is subject to
circulatory disturbances, faulty nervous system control, and aging.
Apart
from the many organic diseases to which the GI tract is susceptible, there are
many extrinsic factors that can interfere with its normal function and produce
symptoms. Stress and anxiety, for example, often find their chief expression in
indigestion, anorexia, or motor disturbances of the intestines, sometimes
pro-ducing constipation or diarrhea. In addition to the state of men-tal
health, physical factors such as fatigue and an inadequate or abruptly changed
dietary intake can markedly affect the GI tract. When assessing and instructing
the patient, the nurse should con-sider the variety of mental and physical
factors that affect the func-tion of the GI tract.
Normal
physiologic changes of the GI system that occur with aging are identified in
the accompanying Gerontologic Consid-erations box. The nurse should carefully
assess and monitor signs and symptoms related to these changes. Age-related
changes in the mouth include loss of teeth, diminished number of taste buds,
decreased production of saliva, and atrophy of gingival tissue. These changes
cause difficulty in chewing and swallowing. Changes in the esophagus include
decreased muscle tone and weakness in the lower esophageal sphincter, leading
to reflux and heartburn.
Decreased
gastric motility leads to delayed gastric emptying. Atrophy of the mucosa
causes a decrease in HCl production, and this can lead to food intolerances,
malabsorption, or decrease in vitamin B12 absorption. Changes in the small and large
intestine are evidenced largely by decreased motility and decreased transit
time, which lead to complaints of indigestion and constipation. Other changes
lead to decreased absorption of nutrients (dextrose, fats, calcium, and iron)
in the large intestine. The nerve supply to the anal sphincter is sometimes
impaired, causing fecal incon-tinence (Luekenotte, 2000).
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