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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.
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Potential GI Manifestations
General manifestations
- dry mouth (characteristic
of patients with coexisting
Sjogren's syndrome)
- anorexia
- nausea and vomiting
- diarrhea
- dysphagia (especially in
association with Raynaud's
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
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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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