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LUPUS ERYTHROMATOSUS A TO Z
SOURCE: National Institutes of Health, U.S.Department of Health and Human Services: Link to NIH
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Gastrointestinal Manifestations

Overview

Gastrointestinal (GI) problems are common and range from vague complaints of anorexia to life-threatening bowel perforation secondary to mesenteric arteritis. Anorexia, nausea, vomiting, and diarrhea may be related to the use of salicylates, NSAIDs, antimalarials, corticosteroids, and cytotoxic drugs.

SLE patients who present with acute abdominal pain, esophageal dysmotility, and tenderness need immediate, aggressive, and comprehensive evaluation to rule out an intra-abdominal crisis. Ascites, an abnormal accumulation of fluid in the peritoneal cavity, is rare. Pancreatitis is a serious complication occurring in approximately 5 percent of SLE patients and is usually secondary to vasculitis.

Mesenteric or intestinal vasculitis is a life-threatening condition that may have complications of obstruction, perforation, or infarction. It is rare. Abnormal liver enzyme levels are also found in about one-third of SLE patients, and can be from lupus, infection, or medication.


Potential GI Manifestations

General manifestations
  • dry mouth (characteristic of patients with coexisting Sjogrenís syndrome)
  • anorexia
  • nausea and vomiting
  • diarrhea
  • dysphagia (especially in association with Raynaudís phenomenon)
Pancreatitis
  • mild nonspecific abdominal pain to severe epigastric pain radiating to the back
  • nausea
  • vomiting
  • elevated serum amylase level
  • dehydration
Ascites
  • abdominal distention
  • bulging flanks
  • downward protruding umbilicus
Mesenteric and intestinal vasculitis
  • cramping or constant abdominal pain
  • vomiting
  • fever
  • diffuse direct and rebound abdominal tenderness
Nutritional Deficiencies


Potential Problems

1. alteration in GI function related to drug therapy or disease process

2. nutritional deficiencies

Nursing Interventions

Objective: Minimize GI side effects caused by medications.

1. See the chapter on Medications Used to Treat Lupus and the Patient Information Sheets in on Nonsteroidal Anti-Inflammatory Drugs, Antimalarials, Corticosteroids, Azathioprine, Cyclophosphamide, Methotrexate, Cyclosporine, Mycophenolate Mofetil, and Intravenous Immunoglobulins.

Objective: Minimize complications from GI manifestations.

1. Assess the patient for GI problems at each visit.

2. Monitor laboratory results.

3. Suggest measures that may increase comfort, such as throat lozenges, saline rinses, or small, frequent meals.

4. Instruct the patient to report immediately any sudden or severe abdominal pain, shortness of breath, or epigastric pain to physician.

5. Refer the patient to dietitian.

Objective: Maintain nutritional status.

1. See the nursing interventions under the nutrition section and the Patient Information Sheet on Nutrition and Lupus





Source: National Institutes of Health, U.S.Dept of Health and Human Services



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