GI SYSTEMS

DISORDERS
ESOPHAGEAL DISORDERS

GERD GASTRITIS PEPTIC ULCER DISEASE

Acid backflow from the stomach Ulcer formation In the lining of Gi

Inflammation of the stomach
into esophagus tract
lining

Symptoms:
Symptoms: Symptoms:
Gastric Ulcer:
• Heartburn • Indigestion
• Abd pain 30mlns - 1 hr PC eating
• Epigastric pain • Nausea/vomiting
• Eating make it worse
• Regurgitation while supine • Bloating
• Bloody Emesis
• Bitter taste • Abdominal pain
• Dry cough • Decreased appetite
Duodenal Ulcer:
• Abd pain 2-3 hrs PC meals
• Eating makes it better
• Bloody stool

Risk Factors: Risk factors: Risk Factors:

• Weak LES • H. Pylori • H. Pylori
• Obesity • Long term NSAID use • Long term NSAID Use
• Pregnancy • Stress • Stress
• Hiatal Hernia • Smoking • Smoking
• Smoking • Alcohol use • Alcohol use
• Aspirin

Diagnostics:
Diagnostics: Diagnostics:
Urea breath test: assess for presence of H. pylorl
• EGD • EGD
• Manometry, assess ability of • CBC: If actively bleeding
esophagus to squeeze food down • Urea Breath Test
Treatment:
IV fluids
Treatment: Medication:
Elevate head when in bed • H2 Antagonist
Medication:
• Proton pump Inhibitors
• H2 Antagonist
Medication: • Antacids
• Proton pump Inhibitors
• H2 Antagonist • Antiblotic for H. Pylori
• Antacids
• Proton pump inhibltors • Sucralfate to coats stomach lining
• Antibiotic for H. Pylori
• Antacids
• Antiemetics for nausea

Procedure:
Nissen fundoplication: wrapping fundus
around lower esophagus
 Management:
EDUCATION
• Lie down after meals
• Avoid sugar, salt, and milk
/ Smoking cessation x Alcohol
• Take anti-spasmodic medications as prescribed to delay gastric
/ Weight management x Spicy & fried foods
emptying
/ Stress management x Red meat
• Fluid Intake with meals is discouraged, instead fluids may be consumed
/ Small, frequent meals x Dairy
up to 1 hour after mealtime
/ Adequate hydration x Coffee & tea
• Meals shouls contain more dry items than liquid items
/ Probiotics x Citrus
• The patient can eat fat as tolerated but should keep carbohydrate intake
x Peppermint
low and avoid concentrated sources of carbohydrate
x Overeating
x Carbonated drinks
x NSAIDS ABDOMINAL HERNIAS

• Proportion of an organ, tissue or structure through the wall of the cavity in

BARRETTS ESOPHAGUS which it is normally contained, that is often called rupture.
• Cause from congenital or acquired weakness (traumatic injury, aging) of the
• A condition in which the lining of the esophageal mucosa is altered. abdominal wall or Increase Intreabdominal pressure due to heavy lifting,
• Associated with GERD obesity, pregnancy etc.
• Reflux causes changes in the lining of the lower esophagus.
• The cells that are laid to cover the exposed area are no longer squamous in Clinical manifestation:
origin • Bulging area appears when standing and disappears when supine.
• Precursor to esophageal cancer • Hernia tend to Increase in size
• Strangulated hernia present with pain, vomiting, swelling of hernial sac, lower
abd sign peritoneal irritation, fever
Clinical Manifestation:
• Burning sensation in the esophagus (Pyrosis)
Diagnostic evaluation:..
• Dyspepsia (indigestion)
Abdominal x-ray, CT scan
• Dysphagia
Laboratory studies may show hemoconcentration, high or low sodium and elevated
• Hypersalivation
WBC
• Esophagitis

Management:
Management: • Mechanical "Truss" a belt that provides external compression (should be remove
• Photodynamic therapy at night and reapply in the morning)
Laser thermal ablation; destroy the metaplastic cells • Surgical: Herniorrhaphy removal of hernial sac, Hernioplasty reinforcement of
• Esophagectomy suturing often with a mesh.
Total resection of the esophagus with removal of the tumor plus a wide tumor-free
margin of the esophagus and the lymph nodes the area. Nursing Interventions:
• Assess bowel sound and determine bowel pattern
• Fit the patient with truss or belt when hernia is reduced, if
ordered
DUMPING SYNDROME
• Trendelenburg's position to reduced pressure on hernia
• Give stool softening as directed
it is partially the result of rapid gastric emptying, which prevents adequate mixing
with pancreatic and biliary secretions. It is an unpleasant set of and GI symptoms
that sometimes occur in patients who have had gastric surgery or a form of HIATAL HERNIA
vagotomy.
upper stomach tends to move up into the lower portion of the thorax.
Clinical Manifestations: 2 Types: Silding-Upper stomach and the gastroesophageal junction are slide
• Occurring 30 minutes after eating displaced upward and out of the thorax.
• Nausea and vomiting Paradesophageal- All or part of the stomach pushes through the diaphragm
• Feelings of abdominal fullness and abdominal cramping beside the esophagus
• Diarrhea
Clinical Manifestation:
• Palpitations and tachycardia
• Heartburn
• Perspiration
• Regurgitation
• Weakness and dizziness
• Dysphagia
• Borborygmi sound
• Sense of fullness after eating or
• Steatorrhea- fats in the stool
chest pain

Diagnostic procedure:
• Xray studies
• Barium swallow
• Fluoroscopy
 Management: Clinical Manifestation:
• Same pharmacological management with GERD • Fever and leukocytosis
• Small frequent feedings • Cramp-like and colicky pain after meals
• Patient is advised not to recline for 1 hour after eating • Diarrhea (semi solid), which may contain mucus or pus
• Elevate head of bed • Abdominal Distention
• Surgery is indicated in about 15% of patients. • Anorexia, nausea, and vomiting
• Welght loss
• Anemia
• Dehydration
DIVERTICULAR DISEASE
• Electrolyte Imbalances

A sac-like herniation of the lining that of the bowel that extends through a defect in
Diagnostic:
the muscle layer, Most commonly occur in the sigmold colon.
• Endoscopic procedure
• CBC may show mild leukocytosis anemia
Diverticulosis
• Elevated ESR
• Multiple diverticula are present w/o inflammation or symptoms
• Bariums studies shows classic "String sign"
Diverticulitis
• Diverticulosis with inflammation
Management:
• Results when food and bacteria retalned in a diverticulum produce infection.
• Medical management the goal is reduce symptoms and complication,
weight loss and nutrition.
Clinical Manifestations:
• There is no known cure for this disease
• Bowel irregularity with intervals of diarrhea
• Surgery; 70% of patient may requires one or more operation to relleve
• Nausea and anorexia
obstruction, close fistulae, drain abscesses etc.
• Bloating or abdominal distention
• Narrow stools
Nursing Interventions:
• Increased constipation or at times intestinal obstruction
• Assess frequency and consistency of stool to evaluate volume.
• Have patient describe location, severity and onset of abd cramping and
Diagnostic Procedure:
pain
• Colonoscopy
• Ask patient for weight loss and anorexia (weigh dally to monitor changes)
• Barium enema
• Achieving adequate nutritional balance
• CT Scan (test of choice for diverticulitis, and can also reveal fiber abscesses)
• Maintain Fluid and electrolyte
• Abdominal x-rays
• Control pain

Management:
• Antibiotics, analgesics and anticholinergics to reduce bowel spams and
cramping
• An opiold ( Meperidine ,Demerol] is prescribed for patients with severe pain
• Morphine is contraindicated because it can increase intraluminal pressure in
colon, exacerbating symptoms.
• Instruct the client to refrain from lifting, straining, coughing to avoid
increased intra-abdominal pressure

Diet:
• For diverticulosis, soft, high Fiber foods are indicated
• For diverticulitis, a low fiber diet may be necessary until bowel irritation
ULCERATIVE COLITIS
decrease.
• Monitor for perforation, hemorrhage, fistulas, and abscess formation
Recurrent ulcerative and inflammatory disease of the mucosal and submucosal
• Avold gas forming foods
layers of the colon and rectum may be called ulcerative proctitis

Surgical Interventions:
Risk Factors:
• Colon resection with primary anastomosis
• Prevalence is highest in Caucasians and Jewish
• Temporary or permanent colostomy may be required for increased bowel
• NSAIDs exacerbate IBD
inflammation

Clinical Manifestations:
• Anorexia
CROHN'S DISEASE (REGIONAL ENTERITIS) • Weight loss
• Diarrhea (10 to 20 liquid stools per
Sub-acute and chronic inflammation of the GI tract wall that extends through all day)
layers, (transmural lesion), Most common in ileum and colon but can occur • Malaise
• Dehydration and electrolyte imbalance
anywhere along the GI tract, Leads to thickening and scarring, a narrowed lumen, • Left lower quadrant abdominal
• Anemia, hypocalcemia and vit k
fistulas, ulcerations, and abscesses (Classic cobblestone appearance) tenderness and cramping
deficiency
• Rectal Bleeding
 Diagnostic Procedures: Causes:
• Colonoscopy • Kinked or occluded by a fecalith
• Sigmoidoscopy • Tumor
• Barium Enema • Foreign body
• CBC (hemoglobin and hematocrit maybe low, WBC may increase)
• Abdominal X-ray
Clinical Manifestations:
• Stool Examination
• Vague epigastric or perlumbilical pain
Management: • Right lower quadrant pain ( parietal pain that is sharp, discrete, and well
• (Priority: Relieve Inflammation.) localized)
-Salicylate Compounds • Low-grade fever
-Effective for mild or moderate inflammation and are used to prevent or • Nausea and Vomiting
reduce recurrences in long-term maintenance regimens • Loss of appetite
• Corticosteroids • Rebound tenderness or Blumberg's sign (production or intensification of
-Are used to treat severe and fulminant disease and can be administered pain when pressure is released)
orally in outpatient treatment or parenterally in hospitalized patients • Rovsing's sign may be elicited by palpating the left lower quadrant; this
• Immunosuppressants paradoxically causes pain to be felt in the right lower quadrant
-Have been used to alter the immune response. The exact mechanism of
action of these medications in treating IBD is unknown Diagnostic Procedures:
• Anti-diarrheal drugs • Complete blood cell count- increase WBC
-Are used to minimize peristalsis to rest the inflamed bowel. They are • Abdominal x-ray films
continued until the patient's stools approach normal frequency and • Ultrasound studies
consistency • CT scans- right lower quadrant density
• Pregnancy test-to rule out ectopic pregnancy
Nursing Interventions:
• NPO status and administer fluids and electrolytes for acute episodes Complications:
• Diet • Perforation of the appendix
-Low residue • Peritonitis
-High protein • Abscess formation (collection of purulent material)
-High calorie diet • Portal pylephlebitis- septic thrombosis of the portal vein caused by
-Supplemental vitamin therapy vegetative emboli that arise from septic intestines
-Iron replacement
• IV or via parenteral nutrition as prescribed
• Monitor for bowel perforation, peritonitis, and hemorrhage Pharmacologic Management:
• Avoid gas-forming food • IV Fluids are administered
• Antiblotic therapy to prevent infection
Surgical Interventions: • Morphine sulfate: prescribed to relieve pain.
• Proctocolectomy with permanent ileostomy
-An ileostomy, the surgical creation of an opening into the ileum or small Surgical Management:
intestine (usually by means of an ileal stoma on the abdominal wall), is • Appendectomy (surgical removal of the appendix) is performed as soon as possible
commonly performed after a total colectomy ( excision of the entire colon). to decrease the risk of perforation
• Continent lleostomy (Kock Ileostomy) -Low abdominal incision (laparotomy)
-Creation of a continent ileal reservoir (Kock pouch) by diverting a portion -Laparoscopy
of the distal lleum to the abdominal wall and creating a stoma • Perforation- place a drain in the abscess

• Restorative Proctocolectomy
-Surgical procedure of choice In cases where the rectum can be preserved in
Nursing Management:
that it eliminates the need for a permanent lleostomy, It establishes an ileal
• Post-operatively, the nurse places patient in a high-Fowler's position.
reservoir that functions as a "new" rectum, and anal sphincter control of
-Reduces the tension on the incision and abdominal organs, helping to reduce pain.
elimination is retained.
• lleoanal Anastomosis (lleorectostomy)
Discharge teachings:
-Involves connecting the lleum to the anal pouch (made from a small intestine
• Have the surgeon remove the sutures between the 5th and 7th days after surgery.
segment), and the surgeon connects the pouch to the anus in conjunction with
• Incision care
removing the colon and the rectal mucosa
• Heavy lifting is to be avoided postoperatively
• Normal activity can usually be resumed within 2 to 4 weeks

APPENDICITIS
• Inflammation of the appendix

Risk factors:
• Between the ages of 10 and 30 years
 DISORDER OF THE LIVER,
GALLBLADDER AND PANCREAS

HEMORRHOIDS HEPATITIS

• Dilated portions of veins in the anal canal. • Inflammatory disorder of the liver parenchyma, Occurring in Hepatitis A, B,
C. D, E, and toxic or drug-induced hepatitis, Hepatocellular damage results
Causes: from the body's immune response to the virus or toxin and is characterized
. 50 years of age by diffuse inflammatory infiltration with local necrosis.
- Shearing of the mucosa during defecation
- Increased pressure in the hemorrholdal tissue due to pregnancy Clinical Manifestation:
Pre-Icteric Stage Icteric Stage
Types: • Earlest symptoms are not specific • Few days to weeks after pre-
• Internal hemorrholds • Flu-like symptoms icteric stage
• Above the internal sphincter • Malaise • Jaundice
• External hemorrholds • Fatigue • Dark-colored urine
• Appearing outside the external sphincter • Headache • Light-colored stool
• Myalgias • Steatorrhea
• Anorexia • Enlarged liver
Clinical manifestations:
• Nausea & vomiting
• Itching
• Dlarrhea
• Pain
• Bright red bleeding Post- Icteric Stage
• External hemorrholds severe pain from the inflammation and edema caused by • Convalescent stage lasting a few
thrombosis weeks
• Internal hemorrholds are not usually painful until they bleed or prolapse when • Fatigue decreases
they become enlarged. • Appetite returns

Pharmacologic Management:
• Hydrophilic bulk-forming agents (Psyllium)
• Analgesic ointments and suppositories
• Astringents (witch hazel)

Non-Surgical & Surgical Management:

• Infrared photocoagulation
• Bipolar diathermy
• Laser therapy
• Injection of sclerosing agents
• Rubber-band ligation procedure
• Cryosurgical hemorrhoidectomy
• Hemorrholdectomy

Nursing Management:
• Good personal hygiene
• Avoiding excessive straining during defecation
• High-residue diet that contains fruit and bran
• Increase fluid intake
• Warm compresses/Sitz baths
• Bed rest

Diagnostic Procedures:
• Liver function test results are elevated
• Serum billrubin level is increased
• Urinalysis reveals increased billrubin levels

Management:
• Administer prescribed medications, which may include:
-Immunoglobulins
-Immunizations
-Antiviral
• Prevent transmission of infection
• Promote adequate rest without complications
• Encourage proper nutrition
LIVER CIRRHOSIS Clinical Manifestation:
• Ascites
Chronic liver disease marked by diffuse destruction and Fibrotic regeneration • Rapid weight gain
of hepatic cells • Shortness of breathing
• Fluid wave on abdominal percussion
Classifications: • Liver dullness
• Laennec's Cirrhosis • Dilated abdominal vessels radiating from umbilicus (caput medusa)
-Commonly caused by alcoholism and chronic nutritional deficiencies • Enlarged, palpable spleen
• Billary cirrhosis • Fluid and electrolyte imbalance
-Caused by bile duct disorders that suppress bile flow
• Post- hepatic cirrhosis Management:
-Caused by various types of hepatitis • Administering medications which may include diuretics
• Measure & record abdominal girth & body weight daily
• Promote measures to prevent or reduce edema
Clinical Manifestation:
• Assist the health care provider with paracentesis
• Enlarged, Firm liver
• Monitor serum ammonia and electrolyte levels.
• Chronic dyspepsia
• Constipation or diarrhea
• Gradual weight loss
• Ascites PERITONITIS
• Splenomegaly
• Spider telanglectasis Inflammation of the peritoneum, the serous membrane lining the abdominal
• Caput Medusae (Dilated abdominal blood vessels) cavity and covering the viscera
• Portal Hypertension
• Mental deterioration Cause:
• Bacterial infection
Laboratory and Diagnostic Findings: • Injury of trauma
• Liver biopsy • Inflammation that extends from an organ outside the peritoneal area
• Liver Scan • Appendicitis
• Liver function test (ALT, AST) • Perforated ulcer
• Serum protein levels • Diverticulitis
• Prothrombin time • Bowel perforation
• Abdominal surgical procedures
Management: • Peritoneal dialysis
• Administer diuretics to decrease ascites.
• Promote adequate nutrition (Vitamins and nutritional supplements promote Clinical manifestations:

healing of damaged liver cells.) • Diffuse pain, becomes constant localized and more intense on the site of

• Prevent threats to skin integrity maximal peritoneal irritation

• Minimize risk of bleeding • Muscles become rigid and tender

- Antacid/ H2 antagonist to minimize possibility of Gl bleeding • Rebound tenderness

• Limit visitors, and orient the cllent to date, time, and place • Paralytic ileus

• Avoid drinking alcoholic beverages, institute safety measures, such as raising • Anorexia

side ralls and assisting with ambulation • Nausea and vomiting

• Pyrexia

Diet: • Increased pulse rate

• Early Phase: High protein diet- to promote healing of the liver

• Late Phase: Low protein diet-to decrease ammonia levels in the blood Diagnostic Findings:
• Increase WBC
• Altered levels of Potassium, Sodium and Chloride
• Abdominal xray- distended bowel loops

PORTAL HYPERTENSION Management:

• Fluid, colloid, replacement
Elevated pressure in the portal vein associated with increased resistance to blood • Analgesics are prescribed for pain
flow through the portal venous system. • Antiemetics
• Intestinal intubation and suction
Obstruction of portal venous flow through the liver lead to: -Relieves abdominal distention and promotes intestinal function
• Formation of esophageal, and hemorrhoidal varicosities due to • Oxygen therapy by nasal cannula or mask
-Increased venous pressure • Antibiotic therapy
-Accumulation of fluld in the abdominal cavity
 Surgical Management: Gall stone are formed due to impaired metabolism of bile and gets stock in the bile
• Removing the infected area causing inflammation
-Excision (appendix)
-Resection (intestine) TREATMENT:
• Correcting the cause • Antibiotics for infection
-Repair (perforation) • Antiemetics for nausea
-Drainage (abscess) • Cholecystectomy: removal of gall bladder
• ERCP: Diagnostic & remove gall stones
• T-tube: placed in common bile duct to drain bile
Nursing Management:
• Lithotripsy: non-surgical procedure to break up stones
• Positioning the patient for comfort are helpful in decreasing pain
• Patient is placed on the side with knees flexed- decreases tension on the
abdominal organs Nursing Interventions:
• Drains are frequently inserted during the surgical procedure. • NPO preoperatively
• NGT insertion (for gastric decompression)
• IV Fluids for hydration
• Monitor VS & electrolytes
CHOLECYSTITIS
• Monitor T-tube site & drainage
Bile Membranous Inflammation
sac • NO FATTY FOODS

If gallbladder becomes inflamed or blocked and bile cannot exit properly, if

inflammation becomes severe enough can lead to HEPATITIS (Liver Inflammation)
or perforation that can lead to SEPSIS
PANCREATITIS
• Digest fatty foods
• Absorb fat soluble vitamins Inflammation of Pancreas, occurs due to autodigestion of pancreas
• Carry waste out of liver
Factors:
• Alcohol abuse
Risk factors (5 F's):
• Gallstones
• Family History
• Cystic Fibrosis
• Female
• ERCP (can cause trauma to pancreatic duct)
• Fat (Obesity)
• Smoking
• Forty or Older
• Hyperlipidemia
• Fertile (Pregnant)

SYMPTOMS: Two main function:

• Severe RUQ/epigastric pain 1. Secrete insulin and glucagon to regulate blood sugar level
• Nausea and Vomiting 2. Secrete digestive enzymes
• Bloating - Lipase: Digest fats
• Fever - Amylase: Digest carbs
• Steatorrhea (fatty Stool) - Protease: Digest protein
• Tachycardia
• Positive Murphy's Sign Diagnostics:
Laboratory
• Increase Lipase & Amylase
Diagnostics:
• Increase Billrubin
• HIDA Scan: assess for abnormal flow in gall bladder
• Increase WBC
• Abdominal UZ: will show thickening in gall bladder wall
• Decrease Calcium
• CT scan/ MRI
• Increase Glucose
• ERCP (Endoscopic Retrograde Cholangiopancreatography):
• Decrease Platelets
-Diagnostic/ treatment procedure to visualize gall bladder with endoscopic xrays
CT scan: Enlarge Pancreas
after administration of dye
ERCP: (Endoscopic Retrograde Cholangiopancreatography)
Visualize gall bladder & pancreatic duct

BILIARY OBSTRUCTION

If the bile gets blocked, bile cannot leave the gall bladder, causing to backup into the liver

Symptoms:
• Jaundice
• Clay colored stool • Pruritus
• Dark colored urine • Elevated AST/ALT and Bilirubun
 Acute Pancreatitis
• Abrupt onset & recovery within a few days

Symptoms:
• Epigastric LUQ pain that radiates to back
• Fever
• Tetany (from hypocalcemia)
• Nausea/ vomiting
• Turner sign (bruising on flank)
• Cullen sign (bruising around navel)

Complications:
• ARDS (Acute respiratory stress syndrome) inflammatory chemicals leak
into blood stream causing widespread inflammation & alveoli to fill with fluid
-Shortness of breath
-Restlessness
-Tachycardia

Chronic Pancreatitis
Persistent for months & may get worse overtime

Symptoms:
• Chronic, persistent abdominal pain (worse after consuming fatty meals)
• Steatorrhea (fatty stool)
• Unintended weight loss (no enzymes to digest food)

Complications:
• Peritonitis: Bile or bacteria from the pancreas can leak into abdominal
cavity causing inflammation of stomach lining
-Rigid board-like abdomen
-Rebound tenderness
-Fever
This can lead to sepsis if not treated promptly

Treatment:
• Antibiotics for infection
• Antiemetics for nausea
• Antacids: decrease acid production
• ERCP: Diagnostic a remove gall stones

Nursing Interventions:
• NOO at least 24 hrs (eating stimulates enzymes)
• NGT insertion (For gastric decompression
• IV fluids for hydration
• Opiold analgesics for pain
• Monitor for hyperglycemia
• Monitor VS & electrolytes
• Give pascreatic enzymes before meals

Diet:
• Low Fat
• Low Sugar
• No alcohol