NURS 370 Final Exam Study Guide: GI

Intestinal (Bowel) Perforation: Background

• Definition: Rupture in the wall of the gastrointestinal tract, allowing enteric contents to leak into the peritoneal cavity.

• Also referred to as intestinal or bowel perforation.

• It is a life-threatening condition.

Intestinal (Bowel) Perforation: S/SX

• Sudden onset

• Acute abdominal pain or cramping

• Nausea

• Vomiting

• Chills

• Fever

• Shoulder pain

• Abdominal bloating

GI Bleed Classification: Overt (Visible) Bleeding

• Blood is visible in vomitus (emesis) or stool.

  • Hematemesis: Vomiting bright red blood or "coffee ground" material.

  • Melena: Black, tarry stool from digested blood—classically from an upper GI source (e.g., esophagus, stomach, duodenum).

  • Hematochezia: Bright red blood per rectum, commonly from a lower GI source (e.g., colon, rectum).

• Nursing implication: Easily detectable; always demands immediate assessment and stabilization.

GI Bleed Classification: Occult (Hidden) Bleeding

• Blood loss is not visible to the naked eye—detected only by laboratory testing (e.g., stool guaiac, occult blood testing).

• Often stems from slow, small-volume bleeding (ulcers, malignancies, inflammation).

• Subtle clinical signs: Fatigue, pallor, iron-deficiency anemia, or a positive stool blood test.

• Nursing implication: Requires vigilance for subtle/anemic symptoms; often detected during routine labs or workup for anemia.

Small Bowel Bleeds

These bleeds originate in your:

• jejunum (middle section of your small intestine).

• Ileum (last section of your small intestine).

Peptic Ulcer Disease

Upper GI Bleed Cause

• Most common cause; ulcers in stomach or duodenum may erode blood vessels.

Gastric/Duodenal ulcer & erosion

Upper GI Bleed Cause

Due to H. pylori, NSAIDs, drugs, stress

Esophageal Varices

Upper GI Bleed Cause

• Dilated veins in the esophagus, commonly from portal hypertension due to liver cirrhosis; often life-threatening when ruptured.

Neoplasms or Vascular Lesions (rare)

Upper GI Bleed Cause

Tumors or tangled blood vessels that rupture

Mallory-Weiss Tear

Upper GI Bleed Cause

• Linear mucosal laceration at the gastroesophageal junction; typically follows vomiting or retching.

• Laceration of distal esophagus from forceful vomiting/coughing

Gastritis/Erosive Esophagitis

Upper GI Bleed Cause

• Inflammation or erosion from infection (e.g., H. pylori), NSAIDs, alcohol, or severe GERD.

• Tissue inflammation from severe reflux or alcohol/irritants can erode and bleed

Diverticulosis/Diverticulitis

Lower GI Bleed Cause

• Outpouchings (diverticula) in the colon wall can bleed, or become inflamed/infected (diverticulitis).

Colorectal Cancer or Polyps

Lower GI Bleed Cause

• Benign or malignant growths in the colon or rectum; bleeding may be chronic and occult or brisk and visible.

Infectious Colitis

Lower GI Bleed Cause

Fever, tenesmus, abdominal pain, loose/bloody stools; often C. difficile post-antibiotics

Intestinal Ischemia (acute/chronic)

Lower GI Bleed Cause

Decreased blood flow to bowel → pain, nausea, bleeding

Diverticular Hemorrhage

Lower GI Bleed Cause

Top cause of brisk hematochezia (massive bright red bleeding); not always with diverticulitis

Inflammatory Bowel Disease (IBD)

Lower GI Bleed Cause

• Includes ulcerative colitis and Crohn’s disease; inflammation damages the intestinal lining, leading to bleeding.

• Especially ulcerative colitis—chronic mucosal inflammation, sunken ulcers, bleeding

Hemorrhoids or Anal Fissures

Lower GI Bleed Cause

• Hemorrhoids: swollen rectal veins causing painless bright red bleeding

• Anal fissures: tears in anal canal leading to painful, bright red blood per rectum

• Swollen rectal veins; painless bright red bleeding

Inflammatory Bowel Disease (IBD)

is an umbrella term for two chronic, relapsing inflammatory diseases:

• Ulcerative colitis (UC): Recurrent, inflammatory, ulcerative disorder affecting the colon and rectum.

• Crohn’s disease (regional enteritis): Acute or chronic inflammatory disorder that can affect any GI segment (mouth to anus), characterized by "skip lesions."

Takeaway

• IBD is chronic and relapsing.

• Nursing priorities: Manage inflammation, maintain nutrition and hydration, and provide psychosocial support for lifelong adaptation and coping.

IBD: Epidemiology & Risk Factors

• More common in industrialized countries.

• Incidence is higher among teenagers.

• May have a hereditary (genetic) tendency.

• Strong positive correlation: Smoking and oral contraceptive use increase risk.

Pathology & Colonoscopy Findings

• IBD = Inflammation + Damage: This means IBD causes visible, structural changes seen on colonoscopy.

• IBS = Irritation + Sensitivity: In contrast, IBS is functional, with normal-appearing tissue on colonoscopy.

Key Distinction:
Both IBD and IBS cause chronic bowel symptoms, but only IBD results in tissue injury and systemic effects (fever, weight loss, anemia).

Nursing Care Focus: UC and Chron’s

1. Managing inflammation and pain

2. Preventing dehydration and malnutrition

3. Supporting coping and quality of life

   • Help patients adapt to a lifelong condition

   • Address body image, anxiety, and social impacts

Postoperative and Procedural Considerations for GI Patients

• General GI Surgery: Early ambulation, pain control, monitor for return of bowel function, wound/drain checks, prevent pneumonia/DVT. Alert for signs of peritonitis/obstruction.​

• Ostomy: Check stoma color/size/moisture, protect skin, fit pouch properly, empty at 1/3–1/2 full, teach patient. Report abnormal stoma findings (dusky, black, active bleeding).​

• Endoscopic/Radiologic Procedures: NPO 8 hrs, bowel prep for lower GI imaging, monitor for perforation, patient teaching about stool changes or contrast.​

• Tube Placement (PEG/PEJ/G-tube): External bolster slightly loose, confirm placement before feeding, flush tube routinely, skin/peristomal care, monitor for infection, leakage, granulation/fungal rash.​