Gastrointestinal disorders

Absolutely! Before diving into gastrointestinal (GIT) disorders, it's helpful to understand key
foundational terms. Here's an expanded list of important terms you should be familiar with, especially
for nursing and medical studies:

Basic Terminologies in Gastrointestinal (GIT) Nursing

1. Atresia – Absence or closure of a normal body opening or tubular structure (e.g., esophageal atresia).

2. Endoscope – An instrument used to visualize internal parts of the gastrointestinal tract.

3. Hemorrhoids – Swollen veins in the rectal or anal area, causing discomfort, bleeding, or prolapse.

4. Melena – Black, tarry stool due to upper gastrointestinal bleeding.

5. Constipation – Infrequent or difficult bowel movements with hard stools.

6. Enema – Fluid introduced into the rectum to stimulate bowel movements or cleanse the bowel.

7. Obstruction – A blockage that hinders the normal movement of food or feces through the intestines.

8. Malabsorption – Inadequate absorption of nutrients from the gastrointestinal tract.

9. Peristalsis – Involuntary wave-like muscle contractions that move food through the digestive tract.

10. Dyspepsia – Indigestion; a general term for discomfort or pain in the upper abdomen.

11. Dysphagia – Difficulty swallowing, often indicating a problem in the esophagus or throat.

12. Ascites – Accumulation of fluid in the peritoneal cavity, usually due to liver disease.

13. Flatulence – Accumulation or passage of gas in the gastrointestinal tract.

14. Steatorrhea – Fatty, foul-smelling stools indicating fat malabsorption.

15. Tenesmus – A constant feeling of needing to pass stool, even when the bowel is empty.

16. Hematemesis – Vomiting of blood, indicating upper GI bleeding.

17. Occult blood – Hidden blood in stool, usually detected through lab tests like fecal occult blood test
(FOBT).

18. Gastroesophageal reflux – Backward flow of stomach acid into the esophagus, causing heartburn.

19. Ileus – Temporary lack of movement in the intestines that leads to obstruction symptoms.

20. Proctoscopy – Examination of the rectum using a specialized instrument called a proctoscope.
ANATOMY OF THE GASTROINTESTINAL TRACT
The GI tract is a 23- to 26-foot-long pathway that extends from
the mouth through the esophagus, stomach, and intestines to the
anus . The esophagus is located in the mediastinumin the thoracic cavity, anterior to the spine and
posterior to the trachea and heart. This collapsible tube, which is about 25 cm
(10 inches) in length, becomes distended when food passes through it. It passes through the diaphragm
at an opening called the diaphragmatic hiatus.
The remaining portion of the GI tract is located within the peritoneal cavity. The stomach is situated in
the upper portion of the abdomen to the left of the midline, just under the left diaphragm.

It is a distensible pouch with a capacity of approximately 1500 mL. The inlet to the stomach is called the
esophagogastric junction; it is surrounded by a ring of smooth muscle called theria into the small
intestine. The vermiform appendix is located near this junction.

The large intestine consists of an ascending segment on the right side of the abdomen, a transverse
segment that extends from right to left in the upper abdomen, and a descending segment on the left
side of the abdomen. The terminal portion of the large intestine consists of two parts: the sigmoid colon
and the rectum. The rectum is continuous with the anus. A network of striated muscle that forms both
the internal and the external anal sphincters regulates the anal outlet.

The GI tract receives blood from arteries that originate along the entire length of the thoracic and
abdominal aorta. Of particular importance are the gastric artery and the superior and inferior
mesenteric arteries. Oxygen and nutrients are supplied to the stomach by the gastric artery and to the
intestine by the mesenteric arteries (Fig. 34-2). Blood is drained from these organs by veins that merge
with others in the abdomen to form a large vessel called the portal vein. Nutrient-rich blood is then
carried to the liver. The blood flow to the GI tract is about 20% of the total cardiac output and increases
significantly after eating.
Both the sympathetic and parasympathetic portions of the autonomic nervous system innervate the GI
tract. In general, sympathetic nerves exert an inhibitory effect on the GI tract, decreasing gastric
secretion and motility and causing the sphincters and blood

vessels to constrict. Parasympathetic nerve stimulation causes peristalsis and increases secretory
activities. The sphincters relax under the influence of parasympathetic stimulation. The only portions of
the tract that are under voluntary control are the upper esophagus
and the external anal sphincter.

lower esophageal sphincter (or cardiac sphincter), which, on contraction, closes off the stomach from
the esophagus. The stomach can be divided into four anatomic regions: the cardia (entrance), fundus,
body, and pylorus (outlet). Circular smooth muscle in the
wall of the pylorus forms the pyloric sphincter and controls the opening between the stomach and the
small intestine.

The small intestine is the longest segment of the GI tract, accounting for about two thirds of the total
length. It folds back and forth on itself, providing approximately 7000 cm of surface area for secretion
and absorption, the process by which nutrients enter the bloodstream through the intestinal walls. The
small intestine is divided into three anatomic parts: the upper
part, called the duodenum; the middle part, called the jejunum; and the lower part, called the ileum.
The common bile duct, which allows for the passage of both bile and pancreatic secretions, empties into
the duodenum at the ampulla of Vater. The junction between the small and large intestine, the cecum,
is located in the right lower portion of the abdomen. The ileocecal valve is located at this junction. It
controls the passage of intestinal contents into the large intestine and prevents reflux of bacteria into
the small intestine. The vermiform appendix is located near this junction.

The large intestine consists of an ascending segment on the right side of the abdomen, a transverse
segment that extends from right to left in the upper abdomen, and a descending segment on the left
side of the abdomen. The terminal portion of the large intestine consists of two parts: the sigmoid colon
and the rectum. The rectum is continuous with the anus. A network of striated muscle that forms both
the internal and the external anal sphincters regulates the anal outlet.

The GI tract receives blood from arteries that originate along the entire length of the thoracic and
abdominal aorta. Of particular importance are the gastric artery and the superior and inferior
mesenteric arteries. Oxygen and nutrients are supplied to the

stomach by the gastric artery and to the intestine by the mesenteric arteries . Blood is drained from
these organs by veins that merge with others in the abdomen to form a large vessel called the portal
vein. Nutrient-rich blood is then carried to the liver. The blood flow to the GI tract is about 20% of the
total cardiac output and increases significantly after eating.

Both the sympathetic and parasympathetic portions of the autonomic nervous system innervate the GI
tract. In general, sympathetic nerves exert an inhibitory effect on the GI tract, decreasing gastric
secretion and motility and causing the sphincters and blood
vessels to constrict. Parasympathetic nerve stimulation causes peristalsis and increases secretory
activities. The sphincters relax under the influence of parasympathetic stimulation.

The only portions of the tract that are under voluntary control are the upper esophagus and the external
anal sphincter.

Functions
The Gastrointestinal Tract (GIT), also known as the digestive tract, plays a central role in digestion,
absorption, and elimination.

1. Ingestion

The process of taking food into the mouth.

Involves chewing (mastication) and mixing food with saliva to form a bolus.

2. Propulsion

Moves food through the digestive tract.

Includes swallowing (voluntary) and peristalsis (involuntary muscular contractions that push food
forward).

3. Secretion

Digestive glands secrete enzymes, hormones, mucus, and fluids:

Salivary glands – secrete amylase.

Stomach – secretes hydrochloric acid and pepsin.

Pancreas – secretes digestive enzymes and bicarbonate.

Liver – produces bile.

4. Digestion

Breakdown of food into smaller components:

Mechanical digestion – chewing, churning in the stomach.

Chemical digestion – enzymatic breakdown of macromolecules (carbohydrates, proteins, fats).

5. Absorption

Nutrients, water, and electrolytes are absorbed primarily in the small intestine into the bloodstream and
lymphatic system.

The large intestine absorbs water and electrolytes.

6. Motility

Muscle contractions mix and move contents through the GIT.

Types: segmentation (mixing) and peristalsis (propelling).

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7. Excretion (Elimination)

Undigested food, waste products, and bacteria are formed into feces and expelled via the rectum and
anus.

8. Protection

The GIT acts as a barrier to harmful microorganisms.

Gut-associated lymphoid tissue (GALT) provides immune defense.

9. Hormonal Regulation

Hormones like gastrin, secretin, and cholecystokinin (CCK) regulate digestive activities and secretion of
enzymes.

10. Fluid and Electrolyte Balance

The GIT maintains internal fluid homeostasis by regulating the secretion and absorption of water and
electrolytes.

ASSESSMENT

HEALTH HISTORY AND CLINICAL MANIFESTATIONS

The nurse begins by taking a complete history, focusing on symptoms common to GI dysfunction. These
symptoms include pain, indigestion, intestinal gas, nausea and vomiting, hematemesis, and changes in
bowel habits and stool characteristics. Information about any previous GI disease is important. The
nurse notes past and current medication use and any previous treatment or surgery. Information
pertaining to medications is of particular interest because medications are a frequent cause of GI
symptoms.
The nurse takes a dietary history to assess nutritional status. Questioning about the use of tobacco and
alcohol includes details about type and amount. The nurse and patient discuss changes in appetite or
eating patterns and any examples of unexplained weight gain or loss over the past year.

The nurse also assesses the stool characteristics. The nurse records all abnormal findings and
reports them to the physician. It is important to include in the history questions about psychosocial,
spiritual, or cultural factors that may be affecting the patient.

or from a disorder in the GI tract or elsewhere in the body. Fatty foods tend to cause the most
discomfort, because they remain in the stomach longer than proteins or carbohydrates do. Coarse

vegetables and highly seasoned foods can also cause considerable distress.

Introduction

The gastrointestinal (GI) tract includes the mouth, esophagus, stomach, intestines, liver, pancreas, and
other related organs. The GI tract is responsible for digestion, absorption of nutrients, and elimination of
waste. Assessing this system helps identify problems such as indigestion, infections, ulcers, or bowel
issues.

2. Health History

Ask the patient about:

Appetite: Any loss or increase in appetite?

Weight changes: Unintentional weight gain or loss?

Chewing or swallowing: Difficulty or pain while swallowing?

Nausea or vomiting: Frequency, triggers, appearance of vomit (especially any blood)?

Stool pattern: Changes in bowel habits, color, consistency, presence of blood or mucus?
Abdominal pain: Location, type (sharp, dull, cramping), timing, and what worsens or relieves it?

Past medical history: Ulcers, hepatitis, gallstones, surgeries, etc.?

Medications: Use of painkillers, antibiotics, laxatives, antacids, etc.?

Lifestyle factors: Diet, alcohol use, smoking, stress levels.

3. Physical Examination

A. Inspection (Looking)

Observe the abdomen for: Shape (flat, rounded, bloated)

Visible lumps or masses Scars or stretch marks

Color changes or rashes

Movement (visible pulsations or waves)

B. Auscultation (Listening)

Using a stethoscope:

Listen for bowel sounds in all four abdominal areas

Normal sounds: gurgling or clicking

Absent sounds may indicate blockage

Loud or high-pitched sounds may suggest irritation or obstruction

C. Percussion (Tapping)

Gently tap the abdomen:

Normal: hollow sound over most of the abdomen

Dull sound may indicate fluid, a mass, or a full organ

D. Palpation (Feeling)

Gently press the abdomen:

Check for tenderness, pain, swelling, or hard areas

Light and deep palpation used to assess different layers

Guarding or tight muscles may indicate inflammation or pain

Certainly! Here's a comprehensive nursing explanation of the laboratory and diagnostic tests used in
gastrointestinal (GI) assessment, covering their purposes, nursing roles, and implications:

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. Laboratory and Diagnostic Tests in GI Assessment (Comprehensive Nursing Explanation)

1. Blood Tests

These tests are essential for detecting systemic responses to GI diseases.

Purpose:

Complete Blood Count (CBC): Detects anemia (from chronic bleeding or malabsorption), infection
(elevated WBC), and inflammation.

Liver Function Tests (LFTs): ALT, AST, ALP, bilirubin – assess liver cell damage and bile duct function.

Pancreatic Enzymes: Amylase and lipase levels indicate acute or chronic pancreatitis.

Electrolytes: Help evaluate fluid imbalances from vomiting or diarrhea.

Coagulation Profile: Liver disease can impair clotting factor production.

Nursing Responsibilities:

Explain the purpose of each test to the patient.

Verify fasting status if required (e.g., LFTs or glucose).

Monitor for signs of bleeding or hematoma post-venipuncture.

Report critical values promptly (e.g., low hemoglobin or elevated liver enzymes).
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2. Stool Tests

Non-invasive and provide valuable insights into lower GI pathology.

Purpose:

Occult Blood Test (FOBT): Screens for hidden blood, suggestive of colorectal cancer, ulcers, or polyps.

Stool Culture: Detects bacterial, viral, or parasitic infections.

Fecal Fat Test: Indicates fat malabsorption (e.g., in pancreatitis or celiac disease).

Ova and Parasite (O&P): Identifies parasitic infections.

Nursing Responsibilities:

Provide clear instructions on specimen collection (use a clean, dry container, avoid contamination with
urine or water).

Ensure timely transport of fresh samples to the lab.

Use appropriate specimen containers (e.g., with preservatives if needed).

Educate the patient on diet or medication restrictions (e.g., avoid red meat before FOBT).

3. Imaging Studies

Used to visualize anatomical and sometimes functional abnormalities.

Purpose:

X-ray (Abdominal/KUB): Detects obstruction, perforation (free air), or calcifications.

Ultrasound: Non-invasive; evaluates liver, gallbladder (gallstones), pancreas, and ascites.

CT Scan: Cross-sectional imaging for detailed views of organs and detecting tumors, abscesses, or
inflammation.

MRI: Superior soft tissue contrast; helpful in liver lesions or bile duct imaging (MRCP).

Nursing Responsibilities:

Confirm patient identity and consent.

Assess for allergies to contrast (especially iodine or shellfish for CT).

Ensure NPO status if required (often 4–8 hours before).

Monitor renal function before contrast-enhanced CT.

Educate about procedure duration and sensations (e.g., warmth with contrast).

4. Endoscopy (Upper GI Endoscopy, Colonoscopy, Sigmoidoscopy)

A flexible scope visualizes the GI mucosa and allows biopsy or treatment.

Purpose:

Diagnose ulcers, tumors, bleeding, inflammation, or infections.

Remove polyps (colonoscopy) or dilate strictures.

Biopsy for histopathology (e.g., H. pylori, cancer).

Nursing Responsibilities:

Pre-procedure:

Obtain informed consent.

Ensure NPO status (usually 6–8 hours before).

Explain procedure and sedation.

Administer bowel prep for colonoscopy (e.g., PEG).

Intra-procedure:

Assist with monitoring vital signs and patient safety.

Post-procedure:

Monitor for complications (bleeding, perforation).

Keep NPO until gag reflex returns (after upper GI scope).

Educate on post-sedation safety (no driving).

5. Barium Studies (Barium Swallow or Barium Enema)

Contrast radiographic tests to outline GI tract anatomy.

Purpose:

Barium Swallow: Visualizes esophagus and stomach – useful for detecting strictures, reflux, ulcers.

Barium Enema: Evaluates the colon – detects diverticula, polyps, or tumors.

Nursing Responsibilities:

Pre-procedure:

Explain the need to drink barium (chalky taste).

Ensure fasting or bowel preparation as ordered.

Assess for constipation history or bowel obstruction.

Post-procedure:

Encourage fluid intake to eliminate barium.

Monitor for constipation or white stools (expected temporarily).

Educate the patient to report abdominal pain or signs of bowel obstruction.

Summary

Be knowledgeable about test indications and nursing care before, during, and after procedures.

Ensure patient education and comfort.

Be alert to potential complications like bleeding, infection, or allergic reactions.

Coordinate with multidisciplinary teams for proper test execution and timely follow-up.

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