Care of patients with digestive organs disorders

The basic manifestations of gastrointestinal tract diseases are abdominal pains, dyspepsia, a gastrointestinal bleeding.

PAINS

For stomach and duodenum diseases (ulcer, gastritis) pains connected with food intake (on an empty stomach, 30 minutes or 2 h after the meal), night pains are typical. Pains can be reduced by food intake, soda.

The pains caused byintestinal diseasesare not connected with food intake. By their character painsare more often dull, nagging, cutting. They are localised mainly in central area of abdomen. Pains are reduced after defecation, release of gases.

Before the visit of a doctor it is necessary to put the patient to bed, and apply an ice bag on the abdomen. Application of hot-water bottleor anaesthetics without prescriptionfrom the doctor is strictly forbidden.

DYSPEPTIC PHENOMENA

Manifestations include eructation,pyrosis, nausea, vomiting, appetitedisorders.

Eructation - spontaneousreleaseof gases or small amounts of gastric contents from the stomach into the oral cavity. It can be caused by swallowing of excessive quantity of air (aerophagia) during fast eating, neuroses.

Pyrosis - burning sensation behind the breast bone or in the epigastric region, quite often spreading upwards to the pharynx. Most frequent ingastric diseases that are characterized byperacidityof gastric juice. Toreduce pyrosis it is recommendedfor patients to drink half a cup of alkaline mineral water or baking soda with dead-burned magnesia.

Vomiting - uncontrolledejection of the contents of digestive tract, mainly stomach, through the mouth, and sometimes through the nose. Frequently recurrent vomiting resultsin exhaustion of the patient, dehydration, loss of microelements, especially potassium

First aid at vomiting: If vomiting occurs it is necessary to inform the doctor immediately. If the condition of the patient allows it, he should be sitting. The chest and knees are covered with an oil-cloth apron which its bottom overhanging into basin or bucket. The medical worker holds the patient by his shoulders andlowers him forward a little. If gravity of the condition does not allow the patient to sit, he should be turned on one sideand his head be overhanging from the bed a little. Near the mouth a basin is placed, under the head of the patient an oilcloth is put. During vomiting it is necessary to be constantly present near the bed of the patient, helping to rinse mouth or wiping his oral cavity (if the patient is conscious) with 2% solution of sodium bicarbonate, 0,01% solution of potassium permanganate. For termination of vomiting the patient can be given to drink mint drops, cold water with citric acid, 0,5% Novocaine solution, swallow small ice cubes. It is important to remember that the most serious complication of vomiting is aspiration of the gastric contents. It can lead to reflex apnoea, development of aspirational pneumonia.

GASTROINTESTINAL BLEEDING

The source of bleeding in case of ulcer is erosion (ulceration) of vessels inthe bottom of ulcer. Symptoms of this complication are various and depend on its massiveness. In case ofnon-evident manifestations of bleedings patient feels short-term weakness, some time later porridge-like, black, tarry feces (melena) are excreted. Black colour of feces indicates high localization of the bleeding source.

In case of manifested bleeding there can be vertigo, skin paleness, cooling of extremities, thirst, visiondisorders, quite often partial or full loss of consciousness. Sphygmus becomes weak, rapid. Hematemesis does not start at once, but after some hours from the start of the bleeding. In 24 h there appears melena. However, if massive bleeding is accompanied by intensified intestinal peristalsis then the colour of fecal masses can be not black, but dark-cherry.

The hematemesis is observed in gastric ulcer bleeding more frequently than in duodenum. Significant reduction or total elimination of pains after bleeding is very characteristic.

First aid: Patient with bleeding should be provided with full physical and mental rest: strict bed rest is advised, as much as possible all psychological irritants are eliminated. The patient is transported very carefully,providing maximum rest. During transportation the head part of stretcher should be loweredto improve circulation to CNS. At the same time an ice bag is put on the epigastric area, haemostatic agents are given.

Remember! In abdominal pains it is forbidden to apply hot-water bottle, use anaesthetics.

First aid for vomiting includes convenient sittingposition of the patient, preventive measures against aspiration of vomit masses, application of antiemetic drugs.

GASTRIC LAVAGE

It can be done with or without tube. The tubeless wayimplies that the patient is given 2-3 glasses of warm water to drink (it can also be soda solution, mineral water, salty water) with the subsequent forcing to vomiting by pressing on the tongue root. This method is contraindicated forintoxications by corrosive poisons (acids, alkalis), benzine, and unconsciouspatients. Gastric lavage with a thick tube is much more often. The thick tubeis a rubber tube with one blind end, it is 1,5m long, andits external diameter is 10 mm, one end of the tube hasperforations on the walls. Apart from the tube itself, a glass funnel, an apron, a basin, a container with liquid for gastric lavage, tongue forceps, a mouth-gag are also needed.

The technique of gastric lavage: Before the procedure a sets of false teeth is taken out. The patient is sitting or, if it is impossible, lying on the left side with his head below the level of the torso to reducethe risk of aspiration of washing waters. After disinfection the gastric tube is watered or lubricated withvaseline oil. The patient puts on an oil-cloth apron,at his feet is a basin. The doctor stands to the right of the patient. The patient opens his mouth, the tube is introducedto the root of the tongue, then the patient swallows and at this momentthe tube is quickly pushed forward. In case of vomiting reflexthe introduction is paused and the patient is asked to make several deep breaths.

After introduction of the tube into stomach and removal of gastric contents a special glass tube is attachedto the external end of the tube, then to this glass tube by means of one more rubber tube a 500 ml funnel is attached. After lowering theempty funnel below stomach level, it is filled with warm boiled water (37-38°С). After that the funnel is lifted above the head of the patient and water gradually entersthe stomach. When there is still some water left in the funnel it is quickly lowered to the basinand water from stomach with admixtures of slime, nutrition residuals, etc. pours out into the basin. This procedure is repeatedseveral times. It is not recommended to introduce into stomach more than 1 l of fluid at once. It is also necessary to introduce water into stomach slowly, that is why the funnel should be lifted slowly. The whole procedure involves 7- 10 l of water. Stomach can be washed with boiled water with addition of sodium bicarbonate (10 grpero 1 lof water), mineral water, citric acid solution (alkaline poisonings).

If gastric lavage is done 2-3 h after intoxication it should end with introduction through the tube of a saline laxative. It is very important to check for absenceof any liquids in stomach after the process, because it can lead to aspiration of these liquids in case ofspontaneous vomiting.

Gastric lavage is contraindicated to patients suffering from hypertensia, stenocardia, liver cirrhosis, gastric and duodenum ulcer, especially with predisposition for gastrointestinal bleedings, etc.