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GASTROINTESTINAL DISORDERS

Stomach and Intestine

Assessment
From mouth to Anus
From ingestion to excretion

MEDICAL PROCEDURES

Endoscopy

Position
Mouth- Right lateral (easy access)
Rectum- Left lateral (easier visualization)

Pre:
● NPO 8-12 hrs (especially sa mouth-to prevent vomiting, rectum-prevent stool
formation)
● Consent (invasive)
● Remove dentures (to prevent aspiration)
● Conscious sedation (local anesthetics)
● Anticholinergics (to reduce salivation-Atropine sulfate, to prevent aspiration)
● Local anesthetics (Lidocaine)
Post:
● NPO 2-4 hrs (to prevent aspiration, prevent pneumonia)
● Check for gag reflex using tongue depressor
● WOF fall back of tongue (blocked the airway)
● Monitor for bradycardia and dysrhythmias (vagal nerve stimulation can cause
bradycardia lead to dysrhythmias

Occult blood test

AKA Hidden blood test, Guaiac test

Indication- looking for blood in the stool
Melena- presence of dry blood (upper GI)
Hematochezia- presence of fresh blood (lower GI)

Pre:
● High fiber diet for 2-3 days (stimulate peristalsis)
● N0 red meat, poultry, fish, melon, broccoli, cauliflower (dark colored food yield to
false positive result
● NO iron- side effects is black tarry stool leads to false positive
● NO vitamin C- yield to false negative result

HOW: 3 stool specimen for 3 consecutives days

Using hydrogen peroxide if blue ring (positive bleeding)

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Nasogastric Tube (NGT) Insertion

Indication (FIDME) If Resistance:

Feeding
Irrigation Withdraw
Decompression Relubricate
Medications Reinsert

Position:
During insertion- Hyperextended (para diretso pasok yung NGT) instruction while inserting
is to swallow to in hasten insertion
After insertion- flexed

WOF:
(-) Talking, DOB- means dislodged sa lungs (withdraw, lubricate, reinsert)
Placement:
● X Ray- confirms
● Aspirate- test for acidity if acidic nasa stomach, if alkalinic nasa lungs cause 02 is
alkalinic
● Auscultate-most Convenient- borborygmi (gurgling sounds of the stomach content
using bulb syringe

PHARMACOTHERAPY

ANTACIDS
Action- neutralizes the gastric acid
Taken: 1-3 hrs after meals or HS (at bedtime)
Taken with water- increase the effectivity
NO fruit juice or Vitamin C- Antagonistic effect (kontra)
NO other MEDS- problem in absorptions/drug to drug interactions
Example:
NaHCO3 (sodium bicarbonate) buffer
Al hydroxide (aluminum hydroxide) side effects CONSTIPATION (Alang tae)
Mg hydroxide (Magnesium hydroxide) side effects DIARRHEA (Mgtae)

H2 BLOCKERS
Action- block the HCI production
Taken with meals or HS
NO rapid IVP- can cause Hypotension
Side effects
- Headache, Dizziness, Constipation
Example: “tidine” Ranitidine, cimetidine, nizatidine, famotidine

PROTON PUMP INHIBITORS (PPI)

Action- inhibits HCI production, difference sa H2 blockers nag iiwan ng protective coating
Taken- Before meals or HS (30 mins before meals)
Example: “prazole” omeprazole, pantoprazole, esomeprazole, lansoprazole

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GASTROESOPHAGEAL REFLUX DISEASES AND HIATAL HERNIA

GERD (Chalasia) HIATAL HERNIA (luslos)

Main problem Incompetent LES- incompetent cardiac Portion of stomach protruded in the
sphincter diaphragm- inc intraabdominal
pressure

Manifestations ● Forceful vomiting ● Asymptomatic (initially)

● Heartburn (chest pain because of ● Heartburn (bec HCI reflux
reflux of HCI) damage the lining)
● Bitter taste in mouth (HCI acid is ● Regurgitation
naturally bitter) ● Nocturnal dyspnea
● Dysphagia (difficulty swallowing bec (difficulty of breathing at
of damage esophageal lining) night, flat prevents
● Odynophagia (painful swallowing bec diaphragmatic expansion
of damage esophageal lining)
● Hoarseness (laryngeal damage bec
of regurgitation)

Diagnostics Barium swallow (upper GI series)- 2 days Endoscopy (direct visualization)

lang dapat maexcrete na if beyond 2 days
it could lead to obstruction
NR: excretion, inc OFI, laxatives to
evacuate the barium

Nursing management ● Low fat, high fiber ● SFF

● Small frequent feeding- to not ● Avoid inc abdominal pressure
trigger reflux activity for ex. Laughing so
● AVOID spicy foods (gastric hard & lifting objects
irritants, tobacco, caffeine, ● Upright position
alcohol-stimulate regurgitation ● Herniorrhaphy (surgical
● H2 blockers, Antacids, PPI repair hernia)
● HOB 6-8 inches during sleeping- to
prevent regurgitation

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PEPTIC ULCER DISEASE

Causes:
● Bacteria- Helicobacter pylori or H. pylori
● Excessive HCI secretion
● Decreased mucosal barrier
● Curling’s ulcer (burn patients)

GASTRIC DUODENAL (common)

Main problem Weak gastric mucosa Increased HCI

Normal-alkalinic
Abnormal-high HCI

AKA “Poor man’s or “laborer’s ulcer” “Executive ulcer”

Rich man’s ulcer, Sir archie’s ulcer

Incidence 20% 80%

Malnutrition Well-nourished

Age 50 yrs old above 25-50 yrs old

Precipitating factor Food Gastric emptying

(sumasakit pag kumakain) (Pag walang laman ang tiyan masakit,
kaya kain sila ng kain)

Relieving factor Vomiting Food

(nawawala yung pain)

Quality Dull, aching, gnawing Dull, aching, gnawing

Region/Radiation Radiates to Left Radiates to Right

(left kasi stomach) (right kasi ang duodenum)

Time Pain 30 mins-2 hrs 3-4 hrs (average gastric emptying

-period of the food in the stomach time)

Complications Hematemesis- vomiting of blood Melena- dry blood

Perforation- from ulceration Perforation- dahil sa ulceration

Nursing Management ● High carbohydrates (CHO) for ● High fat diet, goal is tumagal
easier digestion, goal is mawala ang food)
agad ang food sa stomach ● Avoid stimulants
● Avoid stimulants ● Stress reduction
● Antacids- dec HCI ● Bland diet (low flavored food)
● Bland diet- attacks attacks (excessive seasoning can
cause gastric irritants)

Surgical Management Pyloroplasty- adjust gastric emptying

Antrectomies
● Billroth I (gastroduodenostomy)- stomach to duodenum
● Billroth II (gastrojejunostomy)- remove large portion of stomach and
remaining portion is connected to jejunum

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DUMPING SYNDROME
Complication
Sign and symptoms: 5-30 minutes after eating
4 D’s of Dumping Syndrome
● Dizziness
● Diaphoresis
● Diarrhea
● Dehydration
Nursing Managements:
● Diet- SFF high protein, high fat, low CHO- dapat matagal idigest yung food
● Dry food is a must- bawal sabaw
● Direct to a lying down after meals, should be left side lying para hindi agad
bumaba kinain
● Don’t take large fluid with meals- para hindi agad mabusog

APPENDICITIS

Inflammation of the vermiform appendix

-caused by fecaliths/neoplasms
Lymphatic system

Considerations
P-soas signs- flex knee sumasakit ang appendix
R-ovsing’s sign- reverse pag pinindot left side sasakit right
O-bturator sign- iikot ang paa ng letter O sasakit
B-lumberg’s sign- rebound tenderness, pain upon removal of pressure
L-axative, heat, enema- inc intraluminal pressure > rupture of appendix > peritonitis >
septic/hemorrhagic/hypovolemic shock
E-pigastric pain- start with epigastric pain shift to (right side) mcburney’s point
M- cburney’s point- right side
S-ide lying position>fetal (position of comfort)

Unruptured: position of comfort

Ruptured: high fowler-to prevent upward spread of infection

Nursing management:
● NPO
● AVOID: HELP (Heat, Enema, Laxative, Palpations)
● Pain relievers- DO NOT give until the diagnosis is final because it will mask the
symptoms
● Solution surgery- Appendectomy

PERITONITIS

-Rigid board like abdomen

Severe infection, emergency, life threatening
Manifestations:
● Fluid shifting- 300-500 ml/hr
● Rigid board like abdomen

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● Abdominal pain, guarding

● Distention
● Hypoactive bowel sound - tumitigas abdomen
● Shallow breathing
● Fever - from severe infection
● Wbc 20,000- normal is 10, 000
● Paralytic ileus- nawawala peristalsis > stool retention > aggravate board like
abdomen
● Signs of shock- hypovolemic shock (hypotension tachycardia tachypnea)

Nursing Management:
● Fluid balance monitoring
● NGT insertion- decompression
● Semi-Fowler's- to relax the abdominals muscles
● DBE- to minimize pain
● Drainage tubes – Penrose drain- to drain excess fluid
● Colloid replacement- ex. Albumin > pulls water to normal spaces to
prevent/minimize fluid shifting

PANCREATITIS

Inflammation of pancreas
Leakage of pancreatic enzyme
amylase-carbohydrates (first to elevate)
Lipase- fats
Trypsin- protein (most damaging)
Common cause:
● Autodigestion of the pancreas
● Cause: alcohol, biliary obstruction
● Acute and chronic
● Amylase, lipase, trypsin
Manifestations:
● Pain
● Nausea and vomiting
● Anorexia
● Abdominal tenderness
● Steatorrhea- foul fatty feces
● Hyperglycemia- location ng islet of langerhans is pancreas> insulin production
● Increased serum amylase- first to elevate kasi ang amylase
● Hemorrhage
o Grey-Turner’s sign- discoloration in the flank area (back)
o Cullen’s sign- discoloration in the periumbilical area (front)

Management:
● DOC: Meperidine
● DO NOT use MORPHINE it cause more pain cause spasm of sphincter of oddis
● NPO
● NGT – remove gastrin and secretin- because gastrin and secretin inc HCI and
pancreatic enzymes

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● Pancreatic enzymes – given with meals

● ADEK- fat soluble vitamins
● H2 blockers, antacids, anticholinergics- to dec HCI, inhibits HCI production
● Avoid alcohol- main cause of this condition

GASTRIC CANCER
Abnormal production of cells
Cell mutation-causes of destruction of normal cells/tumor

● Common in men than women- due to lifestyle

● History or presence of Pernicious Anemia
● Often develops with the occurrence of atrophic gastritis
● Low-socioeconomic status; live in urban area> stressful environment> inc HCI>
ulceration of the area
● Exposure to radiation or trace metals in soil
Cause: Helicobacter Pylori

Clinical Manifestations:
● Palpable mass- development of tumor
● Ascites- fluid shifting
● Weight loss- di makakain ng maayos
● Dysphagia
● Indigestion and anorexia- no appetite
● (+) high lactate dehydrogenase level in gastric juice- due to abnormal cell
production
Diagnosis: GIT x-ray, gastroscopy- direct visualization of stomach lining
Treatment: Chemotherapy (kill normal cells and cancer cells SE: Alopecia,mouth), radiation
therapy, gastric resection

Nursing Intervention: Same as with patients with ulcer, emotional support, pre and
post-operative health teaching, lifestyle modification, activities, diet, lesser stressful

DIVERTICULUM

● Diverticulum – an outpouching of intestinal mucosa through the muscular coat of

the large intestine (most commonly the sigmoid colon)
● Diverticulosis – refers to the presence of non-inflamed outpouchings of the
intestine
● Diverticulitis – inflammation of a diverticulum
Incidence: > 45 yrs. old ; Male & Female
Etiology:
Lower fiber diet which causes bulk in stools which may cause intraluminal pressure in the
bowel causing diverticula
Risk factors: Chronic Constipation
S/Sx:
● Left Quadrant Pain
● Anorexia
● Increased flatus
● Low grade fever

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● (+) rectal mass on digital rectal examination NR: prepare gloves/lubricant

Medical Intervention:
● High-fiber diet and laxatives
--Diverticulosis-High fiber
-Diverticulitis-low fiber (puputok ang outpouching)
● NGT insertion to relieve pressure
● Control inflammation through antibiotics and advise patient to:
-Avoid activities that may increase abdominal pressure (bending, lifting, etc).
-Intake of 6-8 glasses of water a day- soften stools
-Reduce weight if obese- can aggravate if obese

Surgical Intervention: Indicated for those who developed complications as manifested by

hemorrhage, abscess, perforation and obstruction.
o Colon resection with colostomy (stoma in the intestine)

Ascending colon
Liquid
Without odor
Irrigation not needed
Continuous appliance of the ostomy bag

Transverse colon
Mushy
Slight odor (depends sa assessment)

Descending colon
Solid with odor
Need irrigation
No continuous appliance of the bag
Patient can control and feel na matatae sya

MORALLOS, MARIBEL S.