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Nursing
The GASTRO-INTESTINAL
System
Nurse Licensure Examination
Review
The Gastro-Intestinal
System
Review of the GIT Anatomy and
Physiology
Review of Common laboratory
procedures
Review of Common Symptoms
and their nursing interventions
Review of common disorders of
the:
Esophagus -gallbladder
Stomach -exocrine
pancreas
The GIT System: Anatomy and
Physiology
The GIT is composed of two
general parts
The main GIT starts from the
mouth Esophagus Stomach
SI LI
The accessory organs are the
Salivary glands
Liver
Gallbladder
Pancreas
The GIT ANATOMY
The Mouth
Contains the lips, cheeks, palate,
tongue, teeth, salivary glands,
masticatory/facial muscles and
bones
Anteriorly bounded by the lips
Pre-test:
ensure
consent, instruct to
VOID and empty
bladder, measure
abdominal girth
COMMON LABORATORY
PROCEDURES
Paracentesis
Intra-test: Upright
on the edge of the
bed, back
supported and feet
resting on a foot
COMMON LABORATORY
PROCEDURES
Liver biopsy
Pretest
Consent
NPO
Laboratory procedures
The ABDOMINAL
examination
The sequence to follow
is:
Inspection
Auscultation
Percussion
Palpation
COMMON GIT SYMPTOMS
AND MANAGEMENT
CONSTIPATION
DIARRHEA
DUMPING SYNDROME
COMMON GIT SYMPTOMS
AND MANAGEMENT
CONSTIPATION
An abnormal
infrequency and
irregularity of
defecation
Multiple causations
COMMON GIT SYMPTOMS
AND MANAGEMENT
CONSTIPATION:
Pathophysiology
Interference with three
functions of the colon
1. Mucosal transport
2. Myoelectric activity
3. Process of defecation
COMMON GIT SYMPTOMS
AND MANAGEMENT
NURSING INTERVENTIONS
1. Assist physician in treating
the underlying cause of
constipation
2. Encourage to eat HIGH fiber
diet to increase the bulk
3. Increase fluid intake
4. Administer prescribed
laxatives, stool softeners
COMMON GIT SYMPTOMS
AND MANAGEMENT
Diarrhea
Abnormal fluidity of the stool
Multiple causes
GastrointestinalDiseases
Hyperthyroidism
Food poisoning
COMMON GIT SYMPTOMS
AND MANAGEMENT
Diarrhea
Nursing Interventions
1. Increase fluid intake-
ORESOL is the most important
treatment!
2. Determine and manage the
cause
3. Anti-diarrheal drugs
COMMON GIT SYMPTOMS
AND MANAGEMENT
DUMPING SYNDROME
A condition of rapid
emptying of the gastric
contents into the small
intestine usually after a
gastric surgery
Symptoms occur 30
COMMON GIT SYMPTOMS
AND MANAGEMENT
PATHOPHYSIOLOGY
Foods high in CHO and
electrolytes must be
diluted in the jejunum
before absorption
takes place.
COMMON GIT SYMPTOMS
AND MANAGEMENT
PATHOPHYSIOLOGY
The rapid influx of
stomach contents will
cause distention of the
jejunum
early symptoms
COMMON GIT SYMPTOMS
AND MANAGEMENT
PATHOPHYSIOLOGY
The hypertonic food bolus
stimulating the
increased secretion of
insulin
COMMON GIT SYMPTOMS
AND MANAGEMENT
Then, blood glucose will
fall
causing reactive
hypoglycemia
COMMON GIT SYMPTOMS
AND MANAGEMENT
DUMPING SYNDROME
ASSESSMENT FINDINGS: early
symptoms
1. Nausea and Vomiting
2. Abdominal fullness
3. Abdominal cramping
4. Palpitation
5. Diaphoresis
COMMON GIT SYMPTOMS
AND MANAGEMENT
DUMPING SYNDROME
ASSESSMENT FINDINGS:
LATE symptoms:
6. Drowsiness
7. Weakness and
Dizziness
8. Hypoglycemia
COMMON GIT SYMPTOMS
AND MANAGEMENT
DS NURSING INTERVENTIONS
1. Advise patient to eat
LOW-carbohydrate HIGH-fat
and HIGH-protein diet
2. Instruct to eat SMALL
frequent meals, include
MORE dry items.
3. Instruct to AVOID
consuming FLUIDS with
COMMON GIT SYMPTOMS
AND MANAGEMENT
DS NURSING INTERVENTIONS
4. Instruct to LIE DOWN
after meals
5. Administer anti-
spasmodic medications
to delay gastric
emptying
GIT SYMPTOMS AND
MANAGEMENT
PERNICIOUS ANEMIA
Results from Deficiency of
vitamin B12 due to
autoimmune destruction
of the parietal cells, lack
of INTRINSIC FACTOR or
total removal of the
stomach
GIT SYMPTOMS AND
MANAGEMENT
PERNICIOUS ANEMIA
ASSESSMENT
Severe pallor
Fatigue
Weight loss
SMOOTH BEEFY-RED TONGUE
Mild jaundice
Paresthesia of extremities
Balance disturbance
GIT SYMPTOMS AND
MANAGEMENT
NURSING INTERVENTION
for Pernicious Anemia
Lifetime injection of
Vitamin B 12 weekly
initially, then MONTHLY
Conditions of the
GIT
UPPER GI system
CONDITION OF THE
ESOPHAGUS
HIATAL HERNIA
Protrusion of the
esophagus into the
diaphragm thru an
opening
Two types- Sliding hiatal
hernia
( most common) and Axial
CONDITION OF THE
ESOPHAGUS
ASSESSMENT Findings in
Hiatal hernia
1. Heartburn
2. Regurgitation
3. Dysphagia
DIAGNOSTIC TEST
Barium swallow and
fluoroscopy
CONDITION OF THE
ESOPHAGUS
NURSING INTERVENTIONS
1. Provide small frequent
feedings
2. AVOID supine position for
1 hour after eating
3. Elevate the head of the
bed on 8-inch block
4. Provide pre-op and post-
CONDITION OF THE
ESOPHAGUS
Esophageal Varices
Dilation and tortuosity of the
submucosal veins in the distal
esophagus
ETIOLOGY: commonly caused
by PORTAL hypertension
secondary to liver cirrhosis
This is an Emergency
condition!
CONDITION OF THE
ESOPHAGUS
ASSESSMENT findings for EV
1. Hematemesis
2. Melena
3. Ascites
4. jaundice
5.
hepatomegaly/splenomegal
y
CONDITION OF THE
ESOPHAGUS
ASSESSMENT findings
for EV
Signs of Shock-
tachycardia,
hypotension,
tachypnea, cold
clammy skin, narrowed
CONDITION OF THE
ESOPHAGUS
DIAGNOSTIC
PROCEDURE
Esophagoscopy
CONDITION OF THE
ESOPHAGUS
NURSING
INTERVENTIONS FOR
EV
1. Monitor VS strictly.
Note for signs of shock
2. Monitor for LOC
3. Maintain NPO
CONDITION OF THE
ESOPHAGUS
NURSING INTERVENTIONS FOR EV
4. Monitor blood
studies
5. Administer O2
Shunt procedures
Conditions of the
Stomach
Gastro-esophageal reflux
Backflow of gastric
contents into the
esophagus
Usually due to incompetent
lower esophageal sphincter
, pyloric stenosis or motility
disorder
Conditions of the
Stomach
ASSESSMENT ( for GERD)
Heartburn
Dyspepsia
Regurgitation
Epigastric pain
Difficulty swallowing
Ptyalism
Conditions of the
Stomach
Diagnostic test
Endoscopy or barium swallow
Gastric ambulatory pH analysis
Note for the pH of the
esophagus, usually done for
24 hours
The pH probe is located 5
inches above the lower
esophageal sphincter
The machine registers the
different pH of the refluxed
Conditions of the
Stomach
NURSING INTERVENTIONS
1. Instruct the patient to
AVOID stimulus that
increases stomach pressure
and decreases GES pressure
2. Instruct to avoid spices,
coffee, tobacco and
carbonated drinks
3. Instruct to eat LOW-FAT,
Conditions of the
Stomach
NURSING
INTERVENTIONS
4. Avoid foods and
drinks TWO hours
before bedtime
5. Elevate the head of
the bed with an
approximately 8-inch
Conditions of the
Stomach
NURSING
INTERVENTIONS
6. Administer
prescribed H2-blockers,
PPI and prokinetic
meds like cisapride,
metochlopromide
7. Advise proper
Conditions of the
Stomach
GASTRITIS
Inflammation of the gastric
mucosa
May be Acute or Chronic
ing N/V/anorexia
Pernicious
anemia
Conditions of the
Stomach
DIAGNOSTIC PROCEDURE
EGD- to visualize the
gastric mucosa for
inflammation
Low levels of HCl
Characteristic: Gnawing,
sharp pain in the mid-
epigastrium 1-2 hours
AFTER eating, often NOT
RELIEVED by food intake,
sometimes AGGRAVATING
Conditions of the
Stomach
ASSESSMENT (Gastric
Ulcer)
Nausea
Hematemesis
Weight loss
Conditions of the
Stomach
DIAGNOSTIC PROCEDURES
1. EGD to visualize the
ulceration
2. Urea breath test for H.
pylori infection
3. Biopsy- to rule out
gastric cancer
Conditions of the
Stomach
NURSING INTERVENTIONS
1. Give BLAND diet, small
frequent meals during the
active phase of the disease
2. Administer prescribed
medications- H2 blockers,
PPI, mucosal barrier
protectants and antacids
Conditions of the
Stomach
NURSING INTERVENTIONS
3. Monitor for
complications of bleeding,
perforation and
intractable pain
4. provide teaching about
stress reduction and
relaxation techniques
Conditions of the
Stomach
NURSING INTERVENTIONS
FOR BLEEDING
1. Maintain on NPO
7. Maintain NGT
CONDITIONS OF THE LARGE
INTESTINE
ASSESSMENT FINDINGS for
Appendicitis
4. Fever
5. Rebound tenderness
and abdominal rigidity (if
perforated)
6. Constipation or
CONDITIONS OF THE LARGE
INTESTINE
DIAGNOSTIC TESTS
1. CBC- reveals
increased WBC count
2. Ultrasound
3. Abdominal X-ray
CONDITIONS OF THE LARGE
INTESTINE
NURSING
INTERVENTIONS
1. Preoperative care
NPO
Consent
5. Rectal itching
6. Skin tags
CONDITIONS OF THE LARGE
INTESTINE
DIAGNOSTIC TEST
1. Anoscopy
2. Flatulence
5. Fever
Liver Cirrhosis
ETIOLOGY:
Post-infection,
Alcohol, Cardiac
diseases,
Schisostoma, Biliary
Liver physiology and
Pathophysiology
Normal Function Abnormality in
1. Stores glycogen function
= Hypoglycemia
2. Synthesizes = Hypoproteinemia
proteins
3. Synthesizes =Decreased Antibody
globulins
4. Synthesizes Clotting formation
= Bleeding
factors tendencies
5. Secreting bile = Jaundice and
6. Converts ammonia to pruritus
=Hyperammonemia
urea
7. Stores Vit and =Deficiencies of Vit
minerals and min
8. Metabolizes = Gynecomastia, testes
estrogen atrophy
CONDITION OF THE LIVER
ASSESSMENT FINDINGS
1. Anorexia and weight
loss
2. Jaundice
3. Fatigue
CONDITION OF THE LIVER
ASSESSMENT FINDINGS
4. Early morning nausea
and vomiting
5. RUQ abdominal pain
6. Ascites
7. Signs of Portal
hypertension
CONDITION OF THE LIVER
NURSING INTERVENTIONS
1. Monitor VS, I and O,
Abdominal girth, weight,
LOC and Bleeding
2. Promote rest.
Elevated the head of
the bed to minimize
dyspnea
CONDITION OF THE LIVER
NURSING INTERVENTIONS
3. Provide Moderate
to LOW-protein (1
g/kg/day) and LOW-
sodium diet
4. Provide
supplemental
vitamins (especially
CONDITION OF THE LIVER
NURSING INTERVENTIONS
5.Administer
prescribed
Diuretics= to reduce ascites
and edema
NURSING INTERVENTIONS
6.Avoid hepatotoxic
drugs
Paracetamol
Anti-tubercular drugs
CONDITION OF THE LIVER
NURSING
INTERVENTIONS
7. Reduce the risk of
injury
Side rails
reorientation
Assistance in
CONDITION OF THE LIVER
NURSING
INTERVENTIONS
8. Keep equipments
ready including
Sengstaken-Blakemore
tube, IV fluids,
Medications to treat
CONDITION OF THE LIVER
Nursing Rationale
Interventions
1. Low sodium Diet To reduce edema
2. Low protein diet To reduce NH
3. Benadryl and production
To relieve pruritus
mild soap onto
4. Pressure To prevent bleeding
injection site Done to relieve abdominal
5. Assist in
pressure
paracentesis
6. Administer
Medications:
Diuretics,
Neomycin, Lactulose
Albumin, Amino
acid
Vitamin K
Conditions of the
Accessory organs
The
Gallbladder
CONDITION OF THE
GALLBLADDER
Cholecystitis
Inflammation of the
gallbladder
Can be acute or chronic
CONDITION OF THE
GALLBLADDER
Cholecystitis
Acute cholecystitis
usually is due to
gallbladder stones
CONDITION OF THE
GALLBLADDER
Cholecystitis
Chronic cholecystitis
is usually due to long
standing gall bladder
inflammation
Cholelithiasis
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
6. Jaundice
3. Cholecystography
CONDITION OF THE
GALLBLADDER
DIAGNOSTIC PROCEDURES
4. WBC count increased
5. Oral cholecystography
cannot visualize the
gallbladder
6. ERCP: revels inflamed
gallbladder with gallstone
CONDITION OF THE
GALLBLADDER
NURSING INTERVENTIONS
1. Maintain NPO in the
active phase
2. Maintain NGT
decompression
CONDITION OF THE
GALLBLADDER
NURSING INTERVENTIONS
3. Administer prescribed
medications to relieve
pain. Usually Demerol
(MEPERIDINE)
Codeine and Morphine
may cause spasm of the
Sphincter increased
CONDITION OF THE
GALLBLADDER
4. Instruct patient to
AVOID HIGH- fat diet and
GAS-forming foods
5. Assist in surgical and
non-surgical measures
6. Surgical procedures-
Cholecystectomy,
Choledochotomy,
CONDITION OF THE
GALLBLADDER
PHARMACOLOGIC
THERAPY
2. Analgesic- Meperidine
3. Chenodeoxycholic acid=
to dissolve the gallstones
4. Antacids
5. Anti-emetics
CONDITION OF THE
GALLBLADDER
Post-operative nursing interventions
1. Monitor for surgical
complications
2. Post-operative
position after recovery
from anesthesia- LOW
FOWLER’s
CONDITION OF THE
GALLBLADDER
Post-operative nursing
interventions
3. Encourage early
ambulation
4. Administer medication
before coughing and deep
breathing exercises
5. Advise client to splint
the abdomen to prevent
discomfort during
CONDITION OF THE
GALLBLADDER
Post-operative nursing interventions
6. Administer
analgesics, antiemetics,
antacids
7. Care of the biliary
drainageor T-tube
drainage
8. Fat restriction is only
limited to 4-6 weeks.
Conditions of the
accessory organs
The pancreas:
Exocrine
function
CONDITION OF THE
PANCREAS
Pancreatitis
Inflammation of
the pancreas
Can be acute or
chronic
CONDITION OF THE
PANCREAS
Pancreatitis
Etiology and
predisposing factors
Alcoholism
Hypercalcemia
Trauma
Hyperlipidemia
CONDITION OF THE
PANCREAS
Pancreatitis
Etiology and predisposing
factors
Biliary tract disease -
cholelithiasis
Bacterial disease
PUD
CONDITION OF THE
PANCREAS
PATHOPHYSIOLOGY of
acute pancreatitis
Self-digestion of the
pancreas by its own
digestive enzymes
principally TRYPSIN
CONDITION OF THE
PANCREAS
PATHOPHYSIOLOGY of
acute pancreatitis
Spasm, edema or block
in the Ampulla of Vater
reflux of proteolytic
enzymes auto
digestion of the
CONDITION OF THE PANCREAS
PATHOPHYSIOLOGY of acute
pancreatitis
Autodigestion of pancreatic tissue
3. WBC
4. Serum calcium
5. CT scan
CONDITION OF THE
PANCREAS
NURSING
INTERVENTIONS
1. Assist in pain
management. Usually,
Demerol is given.
Morphine is AVOIDED
2. Assist in correction
CONDITION OF THE
PANCREAS
NURSING INTERVENTIONS
3. Place patient on NPO
to inhibit pancreatic
stimulation
4. NGT insertion to
decompress distention
and remove gastric
CONDITION OF THE
PANCREAS
NURSING INTERVENTIONS
7. Position patient in
SEMI-FOWLER’s to
decrease pressure on the
diaphragm
8. Deep breathing and
coughing exercises
9. Provide parenteral
CONDITION OF THE
PANCREAS
NURSING INTERVENTIONS
10. Introduce oral
feedings gradually-
HIGH carbo, LOW FAT
11. Maintain skin
integrity
12. Manage shock and
Quick Summary
Peptic Ulcer
Ulceration of mucosa; In the stomach
or duodenum
Outstanding Symptom: PAIN
Nursing Goal: Allow ulcer to heal,
prevent complication
Rest: physical and Mental
Eliminate certain foods
Medications: antacid, H2 blockers,
Proton Pump inhibitors, antibiotics,
mucosal protectants
Surgery: Vagotomy, Billroth 1 and 2
Quick Summary
Liver Cirrhosis
Destruction of liver with replacement
by scars
Common causes: alcoholism, post-
hepatitic
Manifestations related to liver
derangements
Jaundice, Ascites, splenomegaly,
bleeding, enceph
Nursing goal: Control manifestations
and maximize liver function
Quick Summary
Liver Cirrhosis
Encourage rest
Avoid hepatotoxic drugs
Semi-fowler’s position
Assist in surgery