DIGESTIVE PATHOLOGIES

CONSTIPATION

Evacuation of dry, limited and infrequent feces (less than 2 depositions per week). Causes of the constipation:

  - Obstructive, cancer, hernias…

  - Diet poor in fiber, anal fissure, hemorrhoids, irritable colon.

  - Laxative, antidepressant, antacid, opiate.

  - Diabetes, uremia, hypothyroidism.

  - Trauma, Parkinson, dementia, depression.

Complications:

“Fecaloma”: fecal impaction in rectum or colon. The patients have colic pains and diarrheas. To remove the fecal impact we have to do the next instructions:

  1. Relax the patient and say his/her to breathe deeply.

  2. Introduce the finger in the rectum 5 – 10 cm with a lubricant.

Anal fissure: as a consequence the effort to defecate, has been produced a passive congestion of the mucosa near the anus.

FECAL RETENTION

There are 3 fields we can actuate:

- Consume vegetable fiber 10 – 60 g/day and more liquids. The consume of fiber increase the fecal mass, as consequence the peristalsis.

- Educate to the patient to evacuate regularity every day. Sit down in the toilet between 10 and 15 minutes after the breakfast.

- The physical exercise promotes the abdominal press.

Food that contains fibre:

The photo on right is about food rich in fibre. Its preferable intake insoluble fibre.

Javier Martínez Peromingo, María Rodríguez Couso , M.ª Paz Jiménez Jiménez, Guillermo Yela Martínez. Tratado de Geriatría para residentes. Estreñimiento e incontinencia fecal

BLOW OUT

Surgical creation of a temporal or permanent orifice that join the digestive tube with the exterior in abdominal wall.

Nutritional recommendations to patients with blows out. 

FECAL INCONTINENCE

Is one of the principal geriatrics syndromes that affects in quality of life and overloading to the principal career.  The impact isn’t only physical, also economic and psychosocial.

Types of fecal incontinence:

Minor:

• Soiling (get dirty the underwear): hemorrhoids, diarrhea, immobility, dementia and depression.
• Gas incontinence: avoid flatulent food and carbonic drinks.
• Urgency to defecate: they feel the feces in the rectum but they aren’t able to maintain the incontinence until go to the toilet.

Greater:

• Lesion in the pelvic floor.
• Drugs: laxatives and antibiotics.
• Rectum cancer.
• Neurologic alterations: central, spinal cord, and peripheral.

Risk factors:

  - Urinary incontinence.

  - Immobility.

  - Previous neurologic diseases.

  - Cognitive alteration.

  - More than 70 years.

Parks classification

Rank 1: normal continence.

Rank 2: difficulty to the control of gases and liquids.

Rank 3: total incontinence to liquids.

Rank 4: incontinence to solids feces.

Nursing cares

• Programmed the defecation, increase the hydric ingest and fiber, physical exercise…
• Avoid the soap, toilet paper, rag and towels, realize a soft washing with tepid temperature…
• Treatment the fecal impaction.
• Accessible toilet.
• Using of absorbents.

DYSPHAGIA

The dysphagia is the difficulty to swallow the liquids or solids elements because one or more stages of swallowing are affected. Video.

Causes

Treatment

• Present the food in little quantity.    
• Not mix solids with liquids consistency.
• Avoid the contact the spoon with the teeth.
• Relax ambient, not force.
• Flavor the food with nutrients, proteins…