• Physiology
- Important for the mechanical digestion of food
- The saliva contains SALIVARY AMYLASE or PTYALIN that
starts the INITIAL digestion of carbohydrates
The Esophagus
• Anatomy
- A hollow muscular tube
- Length- 25 cm
- Made up of stratified squamos epithelium
- Located in the mediastinum, anterior to the
spine,posterior to the trachea and heart
- The upper third contains skeletal muscles, contains the
upper esophageal or hypopharyngeal sphincter
- The middle third contains mixed skeletal and smooth
muscles
- The lower third contains smooth muscles and the
esophago-gastric/ cardiac sphincter is found here
• Physiology
- Functions to carry or propel foods from the oropharynx
to the stomach
- Swallowing or deglutition is composed of three phases:
Upper 3rd
Miidle 3rd
Lower 3rd
The stomach
• Anatomy
- J-shaped organ in the LUQ
- Contains four parts- the fundus, the cardia, the body and
the pylorus
- The cardiac sphincter prevents the reflux of the contents
into the esophagus(entrance)
- The pyloric sphincter regulates the rate of gastric
emptying into the duodenum(exit)
- Capacity is 1,500 ml!
Medical Surgical Nursing
The GASTRO-INTESTINAL system
By: Maricel S. Jose MD,RN
- Parasympathetic
Generally EXCITATORY!
• Physiology Increased gastric secretions
Increased gastric motility
- The functions of the stomach are generally to digest the Sphincters relax
food (proteins) and to propel the digested materials into Terms
the SI for final digestion
- The Glands and cells in the stomach secrete digestive • Digestion: phase of the digestive process that occurs when
enzymes: enzymes mix with ingested food and when proteins, fats,
1. Parietal cells- HCl acid and Intrinsic factor and sugars are broken down into their component molecules
2. Chief cells- pepsin digestion of PROTEINS! • Absorption: phase of the digestive process that occurs when
3. Antral G-cells- gastrin small molecules, vitamins, and minerals pass through the
4. Argentaffin cells- serotonin walls of the small and large intestine and into the
5. Mucus neck cells- mucus bloodstream
• Elimination: phase of the digestive process that occurs after
The Small intestine digestion and absorption, when waste products are
eliminated from the body
• Anatomy
- Longest segment, about 2/3 of the total length Functions of the GIT
- Grossly divided into the Duodenum (proximal),
Jejunum(middle) and Ileum(distal) • The breakdown of food particles into the molecular form for
- Duodenum w/ampulla of vater-common bile duct empties, digestion
passage of bile and pancreatic secretions • The absorption into the bloodsteam of small nutrient
- The ileum is the longest part (about 12 feet) molecules produced by digestion
• The elimination of undigested unabsorbed foodstuffs and
other waste products
• Physiology
- The intestinal glands secrete digestive enzymes that
finalize the digestion of all foodstuffs Digestive Processes
- Enzymes for carbohydrates disaccharidases
• Chewing
- Enzymes for proteins dipeptidases and aminopeptidases
- 1.5ml of saliva is secreted daily from the parotid,
- Enzyme for lipids intestinal lipase submaxillary and sublingual glands
- PTYALIN or SALIVARY AMYLASE is an enzyme that begins
the digestion of starches
The Large intestine
• Swallowing begins as a voluntary act, w/c is regulated by
• Anatomy the swallowing center in the medulla oblongata of the CNS
- Approximately 5 feet long, with parts:
1. The cecum widest diameter, prone to rupture • Gastric Function
2. The appendix - stomach-secretes a highly acidic fluid in response to the
3. The ascending colon presence of ingested food
4. The transverse colon - fluid can total as 2.4L/day can have a ph as low as 1 and
5. The descending colon derives its acidity from hydrochloric acid (HCl)
a. to breakdown food into more absorbable components
6. The sigmoid most mobile, prone to twisting
b. to aid in the destruction of ingested bacteria
7. The rectum
8. The Anus Gastric Enzymes
Secreted by zymogens or chief cells
BLOOD SUPPLY Amylase=for starch digestion
- GIT recieves blood from arteries that originate along the Lipase=for fat digestion
entire length of the thoracic and abdominal aorta Pepsin=for protein digestion
- The portal venous system is composed of 5 large veins: Rennin=for milk and protein digestion
superior mesenteric, inferior mesenteric, gastric, splenic,
and cystic veins w/c form the vena portae that enters the Secreted by parietal cells
liver HCl - maintains acidity 1.0 pH destroy some bacteria
- Oxygen and nutrients are supplied to the stomach by the ingested aids also in digestion of food
gastric artery and to the intestines by the mesenteric Intrinsic factor - aids in absorption of vit B12
arteries. * pernicious anemia
• Colonic Function
- bacteria make up a major component of the contents of
the large intestine, assist in completing the breakdown of
waste material esp undigested and unabsorbed proteins
and bile salts
Gastrointestinal Assessment
Laboratory Procedures
• FECALYSIS
- Examination of stool consistency, color and the presence
of occult blood.
- Special tests for fat, nitrogen, parasites, ova, pathogens
and others
• Gastric analysis
- Aspiration of gastric juice to measure pH, appearance,
volume and contents
- Pre-test: NPO 8 hours, avoidance of stimulants, drugs and
smoking
- Post-test: resume normal activities
• EGD - esophagogastroduodenoscopy
- Visualization of the upper GIT by endoscope
- Pre-test: ensure consent, NPO 8 hours, pre-medications
like atropine and anxiolytics
Gastroscopy
• Paracentesis
- Removal of peritoneal fluid for analysis
- Pre-test: ensure consent, instruct to VOID and empty
bladder, measure abdominal girth
- Intra-test: Upright on the edge of the bed, back supported
and feet resting on a foot stool
• Liver biopsy
- Pretest
Consent
NPO
Check for the bleeding parameters
- Intratest
Position: Semi fowler’s LEFT lateral to expose right side of
abdomen
- Post-test: position on RIGHT lateral with pillow
underneath, monitor VS and complications like bleeding,
perforation. Instruct to avoid lifting objects for 1 week Quadrants of the Abdomen
The NURSING PROCESS in GIT Disorders
Assessment
- Health history Nursing History
- PE
- Laboratory procedures
Assessment: History
• Constipation
An abnormal infrequency and irregularity of defecation
Multiple causations
Pathophysiology
Interference with three functions of the colon
1. Mucosal transport
2. Myoelectric activity
3. Process of defecation
The ABDOMINAL examination
The sequence to follow is:
Nursing Interventions
- Inspection
1. Assist physician in treating the underlying cause of
- Auscultation
constipation
- Percussion
2. Encourage to eat HIGH fiber diet to increase the bulk
- Palpation
3. Increase fluid intake
4. Administer prescribed laxatives, stool softeners
5. Assist in relieving stress
Examination of the Abdomen
Medical Surgical Nursing
The GASTRO-INTESTINAL system
By: Maricel S. Jose MD,RN
- Assessment
Severe pallor 3. Malocclusion
Fatigue - Misalignment of the teeth of the upper and lower dental arcs
Weight loss when the jaws are closed
Smooth BEEFY-red tongue - Inherited or acquired
Mild jaundice - Makes the teeth difficult to clean and can lead to decay, gum
Paresthesia of extremities disease
Balance disturbance - Corrections requires an orthodontist, treatments begins when
the pt has shed the last primary tooth and the last permanent
- Nursing Intervention successor has erupted
Lifetime injection of Vitamin B 12 weekly initially, then
MONTHLY
Disorders Of The Jaw
Conditions of the GIT Categorized as follows:
a. myofascial pain- discomfort in the muscle
• UPPER GI system controlling jaw function and neck and shoulder
Conditions of the Oral Cavity muscles
Disorders Of The Teeth b. internal derangement of the joint- dislocated jaw,
1. Dental Plaque and Caries displaced disc, or injured condyle
- tooth decay is an erosive process that begins w/ the c. degenerative joint disease- rheumatoid arthritis or
action of bacteria on fermentable CHO in the osteoarthritis of the jaw
mouth, w/c produces acid that dissolve tooth
enamel Clinical Manifestations - dull, throbbing, debilitating pain
- the extent of damage to the teeth depends on the ff: that can radiate to the ears, teeth, neck muscle, facial
presence of dental plaque- gluey, gelatin like sinuses, restricted jaw motion, locking of the jaw, difficult
substance that adheres to the teeth chewing and swallowing
strength of the acid and ability of the saliva to
neutrlize Assessment and Diagnostic Findings- diagnosis is based on
the length of time the acids are in contact the pt’s report of pain, limitation of motion, dysphagia,
susceptibility of the teeth to decay difficulty in chewing, difficulty w/ speech, hearing
- Prevention difficulties.
Mouth Care- brushing and flossing, normal Management- stress reduction, range of motion exercises,
mastication (chewing), normal flow of saliva pain management w/ NSAIDS, muscle relaxants, if
Diet- ↓ the amount of sugar & starch irreversible- surgery
Fluoridation
Pit and Fissure Sealants- special coating to fill and
Disorders of The Salivary Glands
seal pits and fissures, can last to 5-10 years
1. PAROTITIS- inflammation of the parotid gland
2. Dentoalveolar abscess or Periapical Abscess MUMPS- epidemic parotitis, a communicable disease
- Collection of pus in the apical dental periosteum caused by a viral infection mostly affect children
(fibrous membrane supporting the tooth structure) - elderly, acutely ill, debilitated people w/ decreased
and the tissue surrounding the apex (in the jaw bone) salivary flow from dehydration or medications are at
- May be acute or chronic higher risk
Acute - secondary to a suppurative pulpitis that arises - organism is usually staphylococcus aureus
from an infection from a dental caries
Medical Surgical Nursing
The GASTRO-INTESTINAL system
By: Maricel S. Jose MD,RN
Aphthous Stomatitis
- Canker Sore
- Shallow ulcer w/ white or yellow center and red border; seen
on the inner side of the lip, cheek or on the tongue
- Begins w/ burning or tingling sensation and slight swelling;
painful
- Lasts 7-10 days and heals w/o a scar
- Assoc w/ emotional or mental stress, fatigue, hormonal
factors, minor trauma, allergies, acidic foods and juices,
dietary deficiencies
- Assoc w/ HIV infection
- Instruct pt on comfort measures, soft or bland diet
CANCER OF THE ORAL CAVITY
- Give prescribed antibiotics or corticosteroids
- Often assoc w/ use of alcohol and tobacco
- 95% occur among 40 y/o and older affecting more men
Stomatitis
than women
- Regardless of the stage of cancer at diagnosis, the 5 yr
survival rate is 56% and the 10 yr survival rate is 41%
- Usually squamous cell cancers, affects lips, lateral
aspects of the tongue, floor of the mouth
- S/SX- painless sore or mass that does not heal,
difficulty in chewing, swallowing and speaking
- DX- assessment of oral cavity, biopsy,
- MX- chemotx, radiationTx, surgical resection
- Assessment Findings
1. Heartburn
2. Regurgitation
3. Dysphagia
4. 50%- without symptoms
implicated in reflux
hemorrhage, obstruction, strangulation
3. Ascites
4. jaundice
5. hepatomegaly/splenomegaly
Signs of Shock- tachycardia, hypotension, tachypnea, cold
clammy skin, narrowed pulse pressure
DIAGNOSTIC PROCEDURE
Esophagoscopy
NURSING INTERVENTIONS FOR EV
1. Monitor VS strictly. Note for signs of shock
2. Monitor for LOC
3. Maintain NPO
4. Monitor blood studies
5. Administer O2
- Diagnostic Test 6. Prepare for blood transfusion
Barium swallow and fluoroscopy 7. Prepare to administer Vasopressin and Nitroglycerin
8. Assist in NGT and Sengstaken-Blakemore tube insertion
for balloon tamponade
9. Prepare to assist in surgical management:
Endoscopic sclerotherapy
Variceal ligation
Shunt procedures
Gastro-esophageal reflux
- Backflow of gastric contents into the esophagus
- Usually due to incompetent lower esophageal sphincter ,
pyloric stenosis or motility disorder
- Symptoms may mimic ANGINA or MI
- Incidence increase w/ aging
- Nursing Interventions
1. Instruct the patient to AVOID stimulus that increases
stomach pressure and decreases LES pressure
Nursing Interventions 2. Instruct to avoid spices, coffee, tobacco and carbonated
1. Provide small frequent feedings drinks
3. Instruct to eat LOW-FAT, HIGH-FIBER diet
2. AVOID supine position for 1 hour after eating
4. Avoid foods and drinks TWO hours before bedtime
3. Elevate the head of the bed on 8-inch block 5. Elevate the head of the bed with an approximately 8-
4. Provide pre-op and post-op care inch block
6. Administer prescribed H2-blockers, PPI and prokinetic
Esophageal Varices meds like cisapride, metochlopromide
Dilation and tortuosity of the submucosal veins in the distal 7. Advise proper weight reduction
esophagus
ETIOLOGY: commonly caused by PORTAL hypertension
secondary to liver cirrhosis
This is an Emergency condition!
Conditions of the Stomach
Gastritis
ASSESSMENT findings for EV
1. Hematemesis
- Inflammation of the gastric mucosa
2. Melena
Medical Surgical Nursing
The GASTRO-INTESTINAL system
By: Maricel S. Jose MD,RN
- Etiology:
Acute - irritating foods, highly seasoned or contaminated
w/ disease causing microorganism, NSAIDS, alcohol, bile
reflux and radiationTx
Chronic- Ulceration, bacteria (Helicobacter pylori),
Autoimmune disease (pernicious anemia), diet
(caffeine),alcohol, smoking, bile reflux
- Pathophysiology of Gastritis
Insults cause gastric mucosal damage inflammation,
hyperemia and edema superficial erosions decreased
gastric secretions of gastric juice (very little acid more
mucus), ulcerations and bleeding
- ASSESSMENT
(Acute)
Abdominal discomfort
Headache
Anorexia
Nausea/Vomiting
(Chronic)
Pyrosis
Singultus
Sour taste in the mouth
Dyspepsia
N/V/anorexia
Pernicious anemia
- Diagnostic Procedure
EGD- to visualize the gastric mucosa for inflammation
Absent (Achlorhydria) or Low levels of HCl - NURSING INTERVENTIONS
(hypochlorhydria) or High Levels of HCl
(hyperchlorhydria)
Biopsy to establish correct diagnosis whether acute or
1. Give BLAND diet
chronic 2. Monitor for signs of complications like bleeding,
obstruction and pernicious anemia
Erosive Gastritis 3. Instruct to avoid spicy foods, irritating foods, alcohol
and caffeine, NSAIDS,
4. Conditions of the Stomach
5. Administer prescribed medications- H2 blockers,
antibiotics, mucosal protectants
6. Inform the need for Vitamin B12 injection if deficiency
is present
- PATHOPHYSIOLOGY of PUD
Disturbance in acid secretion and mucosal protection
Increased acidity or decreased mucosal resistance
erosion and ulceration
Zollinger-Ellison Syndrome- severe peptic ulcer,
extreme gastric hyperacidity, and gastrin secreting benign or
Medical Surgical Nursing
The GASTRO-INTESTINAL system
By: Maricel S. Jose MD,RN
- Gastric Ulcer
Usually 50 and over
Male:Female = 1:1
Weight Loss
Pain occurs ½ to 1 hour after meal
Ingestion of food does not help, causes pain
Vomiting common
Hemorrhages more likely
Hematamesis more common than melena
Possibility of Malignancy: occasional
Risk Factors: H.pylori, alcohol, smoking, NSAID
- Diagnostic Tests
EGD and Biopsy
- Medical Management
Pharmacologic therapy- combination of antibiotics,
proton pump inhibitors and bismuth salt to
eradicate H.pylori for 10-14 days, Histamine-2 (H2)
receptor antagonist and PPI are used to treat
NSAID induced ulcers
Stress reduction and rest
Smoking cessation
Dietary modification
Medical Surgical Nursing
The GASTRO-INTESTINAL system
By: Maricel S. Jose MD,RN
Surgical Management
Pharmacotherapy
Histamine-2 (H2) receptor antagonists (PO/IV)
Action: ↓ HCl production
taken with meals or at H.S., cigarettes reduces
its action
SE: headache, dizziness, nausea/vomiting &
urticaria
8 weeks medication (if s/sx does not improve,
start antibiotics)
Cimetidine (Tagamet)
Ranitidine (Zantac)
Famotidine (Pepcid)
Nizatidine (Axid)
Antibiotics
Action: antibacterial to eradicate H. pylori
Amoxicillin (Amoxil)
Clarithromycin (Biaxin)
Metronidazole (Flagyl)
Tetracycline
Can be combined with other drugs Vagotomy
Mucosal Barrier
Action: forms protective barrier, adheres to ulcer
surface
30 min interval before taking antacids
SE: constipation, and nausea/vomiting
Give 1-2 hour after meal or during bedtime on an
empty stomach
5 hours duration
Sucralfate (Carafate)
Pharmacotherapy
Antacids (non absorbable)
Action: ↓ gastric acidity
Chew then swallow, taken 1 hr after meals or at
H.S.
Aluminum Hydroxide SE: constipation
Don’t give other drugs w/in 1-2 hrs after the
antacids
Pyloroplasty
Magnesium Oxide SE: diarrhea
Taken in between meals or at bedtime
May increase serum Magnesium level in RF client
Chew follow with water
Calcium Carbonate SE: ↑ uric acid
Taken in between meals or at bedtime with milk
NaHCO3 SE: metabolic alkalosis and tetany
Proton Pump Inhibitor
Action: ↓ gastric acid secretion of the parietal
cells
4-8 weeks medications
Esomeprazole (Nexium)
Omeprazole (Prilosec)
Lansoprazole (Prevacid)
Pantoprazole (Protonix)
Pathophysiology
- Foods high in CHO and electrolytes must be diluted in
- Vagotomy – severing of the vagus nerve the jejunum before absorption takes place.
- Decreases gastric acid
- Diminishing cholinergic stimulation to the parietal - The rapid influx of stomach contents will
cells- less responsive to gastrin - cause distention of the jejunum early
- Billroth I – Gastroduodenostomy
- symptoms
- Removal of the lower portion of the antrum
- Antrum contains the cells that secretes gastrin
- The hypertonic chyme will draw fluid from the blood
- Small portion of duodenum and pylorus
vessels to dilute the high concentrations of CHO and
- Remaining portion is anastomosed to the duodenum
electrolytes
- Billroth II – Gastrojejunostomy
- Remaining portion is anastomosed to the jejunum
- Later, there is increased blood glucose
- Billroth I
- stimulating the increased secretion of insulin
Feeling of fullness
Dumping syndrome
Diarrhea
- Then, blood glucose will fall causing reactive
Recurrence rate is <1% hypoglycemia
− Billroth II
Dumping syndrome Assessment Findings:
Anemia - Early symptoms
Malabsorption 1. Nausea and Vomiting
Weight loss 2. Abdominal fullness
Recurrence rate of ulcer is 10-15% 3. Abdominal cramping
4. Palpitation
5. Diaphoresis
Medical Surgical Nursing
The GASTRO-INTESTINAL system
By: Maricel S. Jose MD,RN
Clinical Manifestations
- Asymptomatic in the early stage
- Pain relieved with antacids
- Anorexia, dyspepsia, weight loss Assessment and Diagnostic Findings
- Constipation, anemia - CBC count
- Nausea and vomiting - Chemical profile
- Urinalysis
Assessment and Diagnostic Findings - Stool exam
- Advanced Gastric Ca- palpable mass Medical Management
- Ascites and Hepatomegaly- if cancer cells metastasized - Control symptoms
to the liver - Treat the underlying disease
- Sister Mary Joseph’s Nodule- palpable nodules around
the umbilicus Fecal Incontinence
- EGD/Endoscopy w/ biopsy and cytology - Involuntary passage of stool from the rectum
- Barium x-ray exam - Inability of the rectum to sense and accommodate stool
- CT Scan, Bone Scan, Liver Scan - Amount and consistency of the stool
- Medical Management - Integrity of the anal spinchter
- Removal of the tumor - Rectal motility
- Chemotherapy
Clinical Manifestation
Soiling
Conditions of the Lower Tract Occasional urgency and loss of control
Small and Large Intestine Complete incontinence
Poor control of flatus
CONDITIONS OF THE SMALL INTESTINE
Medical Management
Abnormalities of Fecal Elimination Biofeedback therapy
Constipation Bowel training programs
Medical Surgical Nursing
The GASTRO-INTESTINAL system
By: Maricel S. Jose MD,RN
Complications
- intestinal obstruction,strictures, perianal dse, fluid and
electrolyte imbalances, malnutrition
Ulcerative Colitis
- Recurrent ulcerative and inflammatory condition of the
mucosal and submucosal layers of the colon and rectum
- The colon becomes edematous and develops bleeding
ulcerations
- Scarring develops overtime with impaired water
absorption and loss of elasticity
Clinical Manifestations
SEVERE diarrhea (10-20 liquid stools/day) with Rectal
bleeding
1. Weight loss
2. Fever Etiology: usually fecalith, lymphoid hyperplasia, foreign body
3. Anorexia and helminthic obstruction
4. Anemia and Hypocalcemia
5. Dehydration Pathophysiology
6. LLQ Abdominal pain and cramping
- Obstruction of lumen increased pressure decreased
7. Tenesmus
blood supply bacterial proliferation and mucosal
inflammation ischemia necrosis rupture
Assessment and Diagnostic Findings
- assess for tachycardia, tachypnea, hypotension, fever Assessment Findings
and pallor, level of hydration and nutritional status 1. Abdominal pain: begins in the umbilicus then localizes in
- stool exam- (+) for blood the RLQ (Mc Burney’s point)
- ↓ hematocrit and hemoglobin and albumin 2. Anorexia
- ↑ WBC 3. Nausea and Vomiting
4. Fever
- Sigmoidoscopy, colonoscopy
Medical Surgical Nursing
The GASTRO-INTESTINAL system
By: Maricel S. Jose MD,RN
Diagnostic Test
- Anoscopy
- Digital rectal examination
Trearments
- Nonsurgical treatments
Infrared photocoagulation
Laser therapy
- Conservative surgical treatment
Diagnostic Tests rubberband ligation procedure
- CBC- reveals increased WBC count cryosurgical hemorrhoidectomy
- Ultrasound - Hemorrhoidectomy
- Abdominal X-ray For advance thrombosed vein
NURSING INTERVENTIONS
1. Maintain NPO during acute phase
2. Provide bed rest
3. Administer antibiotics, analgesics like meperidine (morphine is
not used) and anti-spasmodics
4. Monitor for potential complications like perforation,
hemorrhage and fistula
5. Increase fluid intake
6. Avoid gas-forming foods or HIGH-roughage foods containing
seeds, nuts to avoid trapping
7. introduce soft, high fiber foods ONLY after the inflammation
subsides
8. Instruct to avoid activities that increase intra-abdominal
pressure
Intestinal Obstruction
- Partial or complete blockage prevents the flow of intestinal
contents thru the intestinal tract
- Hernia (Inguinal)
Mechanical Obstruction
- Intraluminal obstruction or mural obstruction from
pressure on the intestinal wall occurs
Stenosis, adhesions, hernias
Functional obstruction
- The intestinal musculature cannot propel the contents
along the bowel
Muscular dystrophy, endocrine disorders or
neurologic disorders
Mechanical
- Adhesions – fibrous band of scar tissue from surgery
- Hernias – incarcerated or strangulated
- Volvulus – twisting of bowel
- Intussusception – telescoping of the bowel upon itself
- Tumors
- Hematoma
- Fecal impaction
- Intraluminal obstruction
- Intussusception
Medical Surgical Nursing
The GASTRO-INTESTINAL system
By: Maricel S. Jose MD,RN
Neurogenic
- Paralytic ileus
- Adynamic ileus Nursing Management
- intestinal tube insertion (miller abott, cantor tube) for
Vascular decompression
- Occlusion of arterial blood supply - fluid and electrolyte replacement
- Mesenteric thrombosis - prophylactic antibiotic
- Abdominal angina - v/s, I&O
- Small Bowel Obstruction - stool exam
- Intestinal contents, fluids and gas accumulate above the - surgery
intestinal obstruction
- Reduce the absorption of fluids and stimulate more gastric Conditions of the GIT accessory organs
secretion
- Pressure within the intestinal lumen increases
Liver
- Decrease in venous and arteriolar capillary pressure
- Edema, congestion, necrosis, and rupture or perforation of Anatomy
intestinal wall → peritonitis - The largest internal organ
- Reflux vomiting leads to ↓K+, ↓Clˉ in blood, with fluid - Located in the right upper quadrant
losses resulting to shock - Contains two lobes- the right and the left, covered w/
- Clinical Manifestations connective tissue
- Crampy pain, wavelike and colicky - The hepatic ducts join together with the cystic duct to
- May pass blood and mucous, but no fecal matter and become the common bile duct
flatus; vomiting occurs Liver and Biliary System
- If obstruction is complete, vigorous peristalsis, and
assume a reverse direction with the intestinal content
propelled toward the mouth
- If obstruction is in the ileum, fecal vomiting takes place
- Dehydration: thirst, drowsiness, malaise, and a parched
tongue and mucous membranes
- The lower the GI obstruction, the more marked the
abdominal distention
- Uncorrected obstruction leads to shock
- Diagnostics and Management
- Abdominal X-ray and CT Scan
- Electrolyte studies and CBC
- Medical Management
- Decompression of the bowel through a nasogatric or small
bowel tube
- Surgical treatment, if completely obstructed
Removal, repair, and anastomosis
s/sx:
- deep orange, foamy urine
- dark tea colored urine
- clay colored stool
- severe itchiness
- steatorrhea
Hepatocellular Jaundice
due to:
- Diseased liver (hepatitis or cirrhosis)
- Inability of the liver to clear normal amount of bilirubin
from the blood
- Increased bilirubin and albumin
Medical Surgical Nursing
The GASTRO-INTESTINAL system
By: Maricel S. Jose MD,RN
Hepatitis E
- Transmitted by fecal-oral route
- Incubation period 15-65 days
- Resembles hepatitis A and is self-limited, with an abrupt
onset. No chronic form.
- Other Liver Disorders
- Nonviral hepatitis
- Toxic hepatitis
- Drug-induced hepatitis
- Fulminant hepatic failure
Liver Cirrhosis
- A chronic, progressive disease characterized by a diffuse
damage to the hepatic cells
- The liver heals with scarring, fibrosis and nodular
regeneration
Assessment Findings
ETIOLOGY: 1. Anorexia and weight loss
2. Jaundice
Post-infection, Alcohol, Cardiac diseases, 3. Fatigue
Schisostoma, Biliary obstruction
- Types:
• Laennec’s Cirrhosis
most common
alcoholic cirrhosis
scar tissue surrounds the portal areas
chronic disease
• Postnecrotic Cirrhosis
a sequelae of viral hepatitis
Biliary Cirrhosis
due to chronic biliary obstruction and infection
- Pathogenesis:
• repeated destruction of hepatic cell
→ scar tissue formation (fibrotic) → regeneration of liver cell
follows → another destruction will occur → cycle (scarring and 4. Early morning nausea and vomiting
regeneration) will be repeated until hepatocytes becomes 5. RUQ abdominal pain
fibrotic and liver function is compromised 6. Ascites
7. Signs of Portal hypertension
Medical Surgical Nursing
The GASTRO-INTESTINAL system
By: Maricel S. Jose MD,RN
Manifestations
- Pain, dull continuous ache in RUQ, epigastrium, or back
- Weight loss, loss of strength, anorexia, anemia may
occur.
- Jaundice if bile ducts occluded, ascites if obstructed
portal veins
NURSING INTERVENTIONS
1. Maintain NPO in the active phase
2. Maintain NGT decompression
3. Administer prescribed medications to relieve
pain. Usually Demerol (MEPERIDINE)
4. Codeine and Morphine may cause spasm of
the Sphincter increased pain. Morphine cause
MOREPAIN
5. Instruct patient to AVOID HIGH- fat diet and
GAS-forming foods
6. Assist in surgical and non-surgical measures
7. Surgical procedures- Cholecystectomy,
Choledochotomy, laparoscopy
PHARMACOLOGIC THERAPY
1. Analgesic- Meperidine
2. Chenodeoxycholic acid= to dissolve the gallstones
3. Antacids
4. Anti-emetics
- Formation of GALLSTONES in the biliary apparatus
Predisposing FACTORS
- “F”
Female
Fat
Forty
Fertile
Fair
- Pathophysiology
Supersaturated bile, Biliary stasis
↓
- Stone formation
↓
- Blockage of Gallbladder
↓
- Inflammation, Mucosal Damage and WBC infiltration
Medical Surgical Nursing
The GASTRO-INTESTINAL system
By: Maricel S. Jose MD,RN
Physiology
- The exocrine function of the pancreas is the secretion
of digestive enzymes for carbohydrates, fats and
proteins
- Pancreatic amylase carbohydrates
- Pancreatic lipase (steapsin) fats
- Trypsin, Chymotrypsin and Peptidases proteins
- Bicarbonate to neutralize the acidic chyme.
Stimulated by SECRETIN!
Pancreatitis
- Inflammation of the pancreas
- Can be acute or chronic
- Pancreatitis
- A severe disorder that can lead to death. Acute
pancreatitis does not usually lead to chronic
pancreatitis.
- Acute pancreatitis: pancreatic duct becomes
obstructed and enzymes back up into the pancreatic
duct, causing autodigestion and inflammation of the
pancreas
- Chronic pancreatitis: a progressive inflammatory
disorder with destruction of the pancreas. Cells are
replaced by fibrous tissue, and pressure within the
pancreas increases. Mechanical obstruction of the
pancreatic and common bile ducts and destruction of
- Cholesterol Gallstones and Pigment Gallstones the secreting cells of the pancreas occur.
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Etiology and predisposing factors
- Alcoholism
- Hypercalcemia
- Trauma
- Hyperlipidemia
- Biliary tract disease - cholelithiasis
- Bacterial disease
- PUD
- Mumps
Quick Summary
Manifestations • Peptic Ulcer
• Acute - Ulceration of mucosa; In the stomach or duodenum
- Severe abdominal pain - Outstanding Symptom: PAIN
- Patient appears acutely ill. - Nursing Goal: Allow ulcer to heal, prevent complication
- Abdominal guarding - Rest: physical and Mental
- Nausea and vomiting - Eliminate certain foods
- Fever, jaundice, confusion, and agitation may occur. - Medications: antacid, H2 blockers, Proton Pump
- Ecchymosis in the flank or umbilical area may occur. inhibitors, antibiotics, mucosal protectants
- Patient may develop respiratory distress, hypoxia, renal - Surgery: Vagotomy, Billroth 1 and 2
failure, hypovolemia, and shock. - Quick Summary
- Liver Cirrhosis
• Chronic - Destruction of liver with replacement by scars
- Recurrent attacks of severe upper abdominal and back pain - Common causes: alcoholism, post-hepatitic
accompanied by vomiting - Manifestations related to liver derangements
- Weight loss - Jaundice, Ascites, splenomegaly, bleeding, enceph
- Steatorrhea - Nursing goal: Control manifestations and maximize liver
function