GI

notb 11/7/26

gastroesophageal reflux disease (GERD)

disorder in which stomach acid travels up to the esophagus, causing irritation to the esophageal lining. clients may report burning sensation, irritation, dysphagia, or chest pain. occurs via a failure of the lower esophageal sphincter. treatment involves lifestyle modifications that include adopting a low-fat diet, eating smaller meals, and having fluids in-between meals to avoid full feeling. client should avoid alcohol, caffeine, smoking, dairy, and tight clothing at the waist; they should also avoid fried or spicy foods (that cause reflux) and chocolate; bending over after eating and eating before bed should also be avoided. HOB should be elevated about 30º using extra pillows or bed blocks. weight reduction and dental hygiene are also important. client should stay in an upright position for 2-3 hours PC.

barrett’s esophagus

complication of chronic GERD that shows a change in the cells that line the esophagus due to acid exposure. tissue similar to the lining of the SI replaces the tissue in the esophagus. puts a client at high risk for esophageal cancer.

hiatal hernia

condition caused by increased intra-abdominal pressure that results in pushing of the stomach and other organs up through the diaphragm. client can show s/s similar to GERD (heartburn, regurgitation of contents into esophagus or mouth, chest pain, and nausea). other s/s include dysphagia, painful swallowing, belching, hoarseness, chronic cough, bloating, early satiety, and postprandial fullness. can be sliding or paraesophageal. expanding forms of this can give rise to esophageal compression, intestinal obstructions, GI bleeds, ulcerations, esophageal stenosis, aspiration/pulmonary manifestations, esophagitis, and gastric strangulation due to abnormal rotation of the stomach. can be surgically fixed with nissen fundoplication

sliding hiatal hernia

most common form; involves the upper section of the stomach occasionally sliding up or protruding into the chest area through the diaphragm

paraesophageal hiatal hernia

more advanced and concerning form; occurs when a greater portion of the stomach, part of the esophagus, or perhaps the intestines have migrated up into the chest cavity.

peptic ulcer disease (PUD)

open sores that occur in the inner lining of the stomach and/or the duodenum that occur due to a defect in the protective gastric mucosa and destructive factors such as an h.pylori infection. can also be caused by long term ingestion of NSAIDs, smoking, alcohol consumption, and conditions that produce a hypersecretory environment. spicy foods can aggravate an ulcer that is already present, but does not cause ulcers. gastric ulcers can show epigastric pain 1-2 hours PC, burning or gaseous pain in upper abdomen that worsens with food, and possible perforation (causing bleeding or infection). duodenal ulcers show burning or cramp like pain in midepigastric region or back 2-5 hours PC. other s/s include early satiety, bloating, n/v, and anorexia. bleeding in upper GI can cause coffee ground emesis and black tarry stools. can also be asymptomatic, which is usually in older clients who have these due to NSAID use.

PUD interventions

an endoscopy can help provide direct visualization of ulcers and obtain specimens of h.pylori, while also allowing for progress monitoring during healing. client should avoid alcohol, caffeine, spicy foods, and other foods/beverages that intensify manifestations. avoiding smoking, stress management, dietary modifications, and avoiding NSAIDs unless medically necessary for 4-6 weeks are also important. PPIs, antibiotics (bismuth, tetracycline, and metronidazole), and sucralfate can all be used as drug therapy. clients should intake magnesium rich foods such as leafy greens, nuts, and yogurt if PPIs are prescribed. can take 3-6 months to heal.

stomach cancer

adenocarcinomas that stem from the mucosal cells of the inner lining of the stomach. often caused by h.pylori infections or dietary choices (smoked foods, salted fish/meats, pickled vegetables). can also be from minimal intake of fruits and veggies, gastritis, pernicious anemia, polyps, smoking, obesity, and genetic factors. s/s include unexplained weight loss, indigestion, abdominal discomfort/pain, early satiety, and s/s of anemia. late signs include lymph node enlargement and ascites. can be diagnosed via upper GI endoscopy with biopsy. surgical therapy is the best treatment and can include billroth I (removal of lower portion of the stomach), billroth II (removal of 75% of the stomach), and/or a total gastrectomy (removal of stomach, lymph nodes, and omentum. esophagus is reattached to the SI).

dumping syndrome

complication of bariatric surgery due to pyloric sphincter damage or bypass that involves gastric chyme entering the SI as a large hypertonic bolus, which pulls fluid from the blood into the bowel lumen in an attempt to dilute food. this causes decreased blood plasma volumes (s/s of hypovolemia), bloating, distention of the bowel lumen, and a rapid transit of food within 15-30 min of eating (diarrhea). lasts about 1 hour; clients may report weakness, sweating, palpitations (compensation), cramping, borborygmi, and a defacation urge. is reduced with smaller meals and diet changes, drinking after PC, and rest PC.

anastomosis leak

a complication of gastric surgery that involves a newly created connection between two organs failing to seal completely, allowing for the leak of contents on the inside. an #emergency that can lead to sepsis or death. client may report increasing back, shoulder, and abdominal pain, restlessness, tachycardia, oliguria, dyspnea, fever, and anxiety. requires immediate treatment.

hemorrhage

a complication of gastric surgery; bloody drainage is expected initially for 2-3 hours, but this becomes an issue in excess (greater than 75mL/hr). nurse should monitor for clots/obstruction and irrigate with NS to avoid the rupture of sutures, leakage into peritoneal cavity, and abscess formation.

gastric surgery post-op care

monitoring fluid and electrolyte balance is very important. diet progression may vary based on the type of surgery, but the goal is to promote healing, weight loss, and decrease the risk of complications. client will start with clear liquids, to full liquids on day 2 w/ multivitamin, soft diet 2-3 weeks after surgery, and solid foods 4-6 weeks after. monitor Is and Os and weigh client daily. respiratory status should be assessed frequently, client should splint incision when coughing or deep breathing. analgesia, early ambulation, maintaining comfort, n/v management, and frequent repositioning are also indicated.

c-diff infection

a heath-care associated infection that has spores that can survive up to 70 days. clients with this infection should be placed on strict contact precautions (must wash hands). those at risk include those who are receiving antimicrobial or chemo therapy, gastric acid suppressing meds, or immunosuppressive agents. these clients can be treated with oral vancomycin or fidaxomicin for 10 days, along with metronidazole. they should cease taking nonessential antibiotics, stool softeners, laxatives, and antidiarrheals. fecal microbiota transplants (poop transplants) can also help, with donor feces being administered via enema, nasoenteral tube (yuck), or colonoscopy.

irritable bowel syndrome (IBS)

a common disorder that involves chronic abdominal pain or discomfort and an alteration of bowel patterns showing diarrhea or constipation. can be classified as -C if constipation is the main manifestation, -D if diarrhea is the main manifestation, or -M if the presentation is mixed. cause is not entirely understood, but it can relate to psychological stressors, GI infections, adverse reactions to food/dietary intolerances, or a dysfunction of nerves in the GI tract. men are more likely to have -D and are less likely to seek help. females are affected 2-2.5x more than men with most having -C. s/s include changes in bowel habits, abdominal pain, cramping, bloating, flatulence, and mucous or bloody stools without any indication of damage in the intestine.

IBS treatment

can involve psychologic support (stress management), dietary changes (FODMAP diet), and drugs to regulate stool and reduce pain (opioid agonists, antispasmodics, antidepressants, antidiarrheals, or laxatives).

gastroenteritis

inflammation of mucosa of the stomach and SI. s/s include sudden diarrhea, n/v, fevers, and abdominal cramping. common cause is foodborne norovirus. treatment is self limiting and can involve oral or IV fluids and avoiding alcohol.

inflammatory bowel disease (IBD)

a group of disorders characterized by chronic inflammation of the GI tract that shows periods of remission and exacerbation. is most commonly either crohn’s disease or ulcerative colitis. begins in the teens or early adulthood, with a second peak being possible in a client’s 60s. risks factors include poor diet (high intake of refined sugar, fat, polyunsaturated fatty acids, omega-6 fatty acids; low intake of raw fruit, veggies, omega-3s, and dietary fiber), smoking, and stress, all of which alter the microbial flora. can also be due to NSAIDs, antibiotics, or oral contraceptives. there is a strong genetic link with this disease. can lead to complications of SBOs, hemorrhaging, abscess and/or fistula formation, and toxic megacolon. albumin, WBCs, electrolyte levels, and CBC are all important labs to assess.

crohn’s disease (CD)

a more severe subtype of IBD that can affect any area of the GI tract from the mouth to the anus. most commonly manifests in the SI and LI. chronic inflammation due to this can lead to skip lesions (normal tissue between areas of inflammation), cobblestoning (due to deep ulcerations), strictures/tightening that can lead to obstructions, leaks of intestinal contents, and fistulas or abscesses. s/s include diarrhea that can be bloody depending on where inflammation is taking place, cramping, obstructions, weight loss, abdominal/RLQ pain, fevers, fatigue, and anorexia. treatment usually involves surgery due to complications.

ulcerative colitis (UC)

a subtype of IBD that can affect the colon/inner lining of the large intestine and is characterized by the formation of ulcers. typically begins in the rectum and spreads to neighboring regions of the colon. has an autoimmune link, as this can occur when the immune system mistakenly targets substances and cells in the LI, causing inflammation and ulcers to form. shows bloody diarrhea (mild is <4 stools/day, moderate is up to 10 stools/day, and severe is 10-20 stools/day), malabsorption (electrolyte and protein loss), weight loss, abdominal pain, fevers, and fatigue. surgery can be curative. shows a high risk of toxic megacolon (shows abdominal distention and fever) and bleeding. nurse should assess for dehydration w/ bleeding by monitoring Is and Os. client should alert HCP if bleeding or the urge to pass stool becomes more frequent.

IBD treatment

drug therapy can involve 5-ASAs (sulfasalazine), antimicrobials, corticosteroids, immunosuppressants, and bioloigcal and targeted therapy with the goal of inducing and maintaining remission. during acute exacerbations, a client may have to switch their diet as the regular diet may not be tolerated. liquid enteral feedings that are high in calories and nutrients, lactose free, and easily absorbed are preferred in order to help achieve remission and improve nutrition. regular foods can be reintroduced gradually. important to keep a diary to help identify foods to avoid.

colorectal cancer

cancer of the rectum or colon. mostly adenocarcinomas that occur in the epithelial layer of the colon that begin as benign polyps in the early stages. if untreated, the polyps will grow and the risk of malignancy increases. shows prominent genetic risk factors, with those who have first degree relatives with this having very high risk, along with those who have forms of IBD. other risk factors include obesity, smoking, more than 7 servings of red meat/week, more than 4 alcohol drinks/week, and DM. s/s usually do not appear until the disease is in its late stages, with early s/s being nonspecific (fatigue, wt loss) or absent. commonly shows iron-deficiency anemia, rectal bleeding, abdominal pain, and changes in bowel habits. late s/s show abdominal tenderness, palpable masses, hepatomegaly, and ascites.

colorectal cancer treatment

surgery is the only cure; chemo can be used along side surgery in clients who have stage 2 or 3 cancer. surgical therapy can include colectomy (removal of portion of the colon; can be paired with a temporary colostomy or ileostomy) and AP resection (removal of tumor, sigmoid colon, rectum, and anal sphincter with he placement of a permanent sigmoidostomy). radiation can be used as palliative care. regular screenings for polyps should be done from age 45 to 75. flexible sigmoidoscopies/double contrast barium enemas/CT colonographies can be done q5 years, colonoscopies are the gold standard and should be q10 years. clients can decrease their risk of this by maintaining a healthy weight, being physically active, limiting alcohol and smoking, and having a diet high in fruits, veggies, and grains.

colostomy

opening between the bowel and the skin in the colon. shows effluent semi-formed to formed output that is consistent with regular bowel habits. clients with the sigmoid version of this may be able to regulate their own bowel movements and irrigate their site. important that the client maintains a regular diet. client has options when it comes to barrier and pouching systems.

ileostomy

opening between the bowel and the skin that is in the small bowel. shows effluent liquid to pasty consistency with a high output. client is unable to regulate bowel movements. irrigation is contraindicated and client must increase fluids and make dietary modifications. a barrier and pouch are needed at all times as skin irritations are common. pouch should be emptied when 1/3rd full to prevent leaks. appliance should be changed every 5 to 7 days or sooner if leakage or skin irritation occurs. skin and stoma assessment are imperative.

diverticulosis

formation of diverticula/outward facing sacs along the intestinal tract due to areas of weakness. can be caused by fiber deficiencies and weakened bowels. clients are mostly asymptomatic, but may show bloating. a high fiber diet, oral fluids, stool softeners, physical activity, and weight loss can help with this.

diverticulitis

occurs when the diverticula/outward facing sacs along the intestinal tract become inflammed. can present with persistent abdominal pain, n/v, elevated temps, abdominal tenderness, and palpable mass, and constipation or diarrhea. complications can include abscess formation, bowel blockages, fistula development, and/or peritonitis. client should be NPO to rest bowels and be on a low fiber diet. IV fluids and antibiotics can help.

hernias

the protrusion of intestine through an opening or weakened area in the cavity wall. mostly occurs in men and in the abdomen. s/s can include pain that increases with activities that raise intraabdominal pressure, visible profusion, severe pain, vomiting, cramping, and distention in cases of strangulation. imaging studies such as CTs and MRIs can be used to diagnose. strangulation requires emergency surgery and a temporary colostomy. herniorrhaphy (surgical repair) or hernioplasty (reinforcement of weak area) can be used as surgical treatment. post-op, nurse should monitor voiding/Is and Os, scrotal edema, and educate client to not engage in heavy lifting (greater than 10 pounds) for 6-8 weeks. deep breathing, splinting, and coughing or sneezing with an open mouth is encouraged.

cirrhosis

late stage condition of liver failure that presents with a advanced fibrosis or scarring of the liver and a small nodular liver. can be caused by chronic hepatitis C, obesity, IV drug use/sharing needles, unprotected s3x, DM, and alcohol consumption. there is no cure, and this can advance to full blown liver failure. s/s include bruising, lower extremity edema, spider angiomas, weight loss, itchy skin, and jaundice due to bilirubin buildup. can lead to esophageal or gastric varices (tortuous and enlarged veins that are fragile and bleed easily), portal HTN (increased venous pressure in portal circulation), hepatic encephalopathy, and ascites. can be dx by liver enzyme tests (AST, ALT, GGT, alkaline phosphatase), serum bilirubin levels, and liver biopsies. nurse should assess for jaundice, educate on drug therapy, monitor color of urine and stools, perform daily weights, and practice strict I and O monitoring. cholestyramine or hydroxyzine can be used to relive itching.

hepatic encephalopathy

neurological condition that causes changes in level of consciousness such as confusion or lethargy and develops when the liver is unable to remove toxins from the blood. neurotoxic effects of ammonia occur as this waste product crosses the blood brain barrier. can cause alterations in LOC that may progress to a coma. nurse should assess changes in neurologic and mental responsiveness, along with the presence of asterixis (abnormal movement of hands and arms). limiting protein, checking ammonia serum levels, and administering lactulose to reduce levels can help. lactulose can cause more frequent and soft stools and therepeutic effect is displayed when the client shows improved alertness and orientation.

ascites

the accumulation of serous fluid in the peritoneal or abdominal cavity, showing abdomen distention. client should be placed on diuretics and a sodium restriction. abdominal girth measurements and decimation should take place. paracentesis can help remove fluid. client should void immediately before this procedure (to reduce risk of bladder puncture) and be in the high fowler’s position or be sitting on the side of the bed. nurse should monitor for hypovolemia, electrolyte imbalances, bowel perforation, and BP and HR fluctuations during the procedure, and for bleeding/leakage from the dressing post-op.