101A: The GI System

Anabolism vs Catabolism

1. builds complex molecules from simpler ones, requiring energy

2. breaks down complex substances into simple compounds

Ascites

a condition where excess fluid accumulates into the abdominal cavity between the peritoneum (lining of the abdomen) and the abdominal organs

Peristalsis

the series of wave- like, involuntary muscle contraction that move substances, such as food and urine, through a hollow tub like the digestive tract or ureter

Excoriation

absence of the skin

Gastrocolic reflex

increase in intestinal and colonic peristaltic activity following the arrival of food into the empty stomach

Ileostomy

opening surgically created at the ileum to divert intestinal contents after lower portions of the bowl have been surgically removed 

Melena

blood that has changed into a dark, tarry substance as it moves through the stomach or small intestine 

Occult

hidden or concealed

Paralytic ileus 

obstruction of the intestines from the inhibition of bowel motility

Valsalva maneuver

closure of glottis and tightening of abdominal muscles after intra abdominal pressure increases when one holds one’s breathe; may result in involuntary  defecation 

GI assessment

-Subjective and Objective data

-general health and nutrition

-oral and swallowing health

-symptoms, lifestyle factors and risk factor/ exposures (HEP immunizations, blood transfusion)

Effects of aging on the GI system 

-weakened swallowing muscles and atrophy of taste buds 

-less efficient esophageal sphincter (increase risk of aspiration) 

-reduced stomach secretions after age 70 (can lead to pernicious anemia) 

-decreased absorption in small intestine (nutrients aren’t absorbed well)

Abnormal stool characteristics

-blood in stool → fresh blood = bleeding in colon (brighter to blood, the lower the source) 

-occult = upper GI bleed 

-pale white/ light gray stock = absence of bile in intestine

-large amounts of mucus, fat, pus 

Rectal suppositories

-glycerin & bisacodyl suppositories

-given 1 hour before meals but pt can choose what time of the day to keep their schedule

-how quickly it works depends on pt and their absorption  

Enemas

-stimulates peristalsis or wash out waste products

-often given before colonoscopy or x ray.  

-volume of typical cleansing enema is 500 to 1000 mL (adults) 

Fecal impaction 

-rectum & sigmoid colon become filled with hardened fecal material 

-most obvious sign → absence of BM> 3 days in pt with regular BM pattern and occurs in pt. who are very ill/ on bedrest/ or are confused

Bowel training for incontinence

-adequate diet & exercise, sufficient fluids & rest → regular bowel elimination

-provide pt. with environment conducive to evacuation 

-set a regular time for evacuation should be established 

Fecal incontinence 

-lack of voluntary control of fecal evacuation  

-causes a lot of dignity

causes → cerebral vascular accident (CVA), illness, traumatic injury

nursing management → offer toileting after each meal, identify cause and institute bowl training program

Specialized test of bowel

-paracentesis (removes fluid from abdominal )

-liver biopsy, capsule endoscopy, gastric analysis

Paracentesis

-relieves pressure d/t acute liver failure or infection

-must be down in an upright position with feet supported high fever 

-there can be a change in LOC, dizziness, cool campy skin, low BP & hypovolemia

Endoscopy 

-used for GI bleed, ulcers, obstructions 

-direct visualization of the body cavity 

Endoscopy: Considerations and Pt. education

considerations: consent, age, health status, meds. and a support system d/t sedation

pt. education → prescription for meds and bowel prep

Colonoscopy

-optic scope

-monitor for over-sedation and respirations 

-have pt. lay on L side and then monitor for pain, bleeding, V/S

Fecal occult blood

-used to deter blood in stool and is an indication of an acute GI bleed

-there needs to be 3 samples from 3 separated days 

Barium swallow and barium enema

-barium sulfate to determine latency & size of esophagus (determines structural problems)

-increase fluids to flush out barium sulfate

prep: NPO, avoid opioids and anticholinergics 

posttest: encourage fluids, laxative to prevent constipation

Nursing implications: Diagnostic test

-check pts allergies (iodine or shellfish)

-a pregnancy test might be ordered (radiation)

-pt teaching  and psychological care

-diet, including NPO status and dehydration

Cause of GI disordered 

-infection, inflammation, physical/chemical trauma, structural defects 

-surgery problems or even immune disorders

-psychological & emotional stress

-genetic predisposition, familial tendency & ethnic correlation

Prevention of GI disorders

-eat normal, well balance diet and maintain a good oral health 

-drink 8 glasses of fluid/day and (pay attention to) Heed need to defecatate promptly 

Anorexia: symptoms/ interventions 

-mouth care

-monitor lab results and document % of each meal eaten

-psychosocial/ cultural factors 

N/V → smells that exacerbate nausea like ginger 

Accumulation of flatus: S/sx and interventions

-surgical intervention, mechanical obstruction and accidental injury

-exercise to decrease gas and bloating 

What are common upper GI conditions 

-stomatitis

-gastritis 

- Gastroesophageal reflux disease (GERD)

-peptic ulcers 

Stomatitis

-inflammation/ redness of oral mucous → causes painful mouth ulcers and white lesions 

s/sx → pain and swelling, increased salivation, excessive dryness, severe halitosis, fever 

tx → symptomatic (alleviated/ manages symptoms) 

nursing measures → control s/x by mouth care, artificial salvia and diet

Acute gastritis (inflammation of stomach lining): s/sx and risk factors

s/sx → anorexia, N/V/D, stomach tenderness, hiccups, indigestion

r/f → H. Pylori, alcohol, smoking, caffeine, stress, older age 

Acute gastritis: Promotion and prevention

-help decreasing anxiety r/t gastritis, diet, monition for Gl bleed, take meds

-eat small frequent meals, avoid irritants 

-report constipation, N/V, or blood stool, stop smoking

Acute gastritis: Diagnostic test and complications 

-upper endoscopy

meds → H2 antagonists, antacids, PPI’s ATBS

complications → gastric bleeding, gastric outlet obstruction, dehydration 

Gastroesophageal Reflux Disease (GERD): Promotion and Prevention

-avoid eat/drinking 2 hr before bed

-avoid tight fitting clothes

-elevate HOB, healthy wt. and low fat diet 

Gastroesophageal Reflux Disease (GERD): Data collection

r/f → obesity, older age, sleep apnea

s/sx → dyspepsia (discomfort in upper abd), pyrosis (heartburn) 

dx → esophageal pH monitoring, esophageal manometer, barium swallow

GERD: medications and complications

medications → PPI’s, antacids, H2 receptors antagonists, prokinetics (improve motility and promotes digestion)

 complications → aspiration of gastric secretions, Barrett’s epithelium

Peptic ulcers

-most common in duodenum

-spread through water, salvia, kissing

-developed during severe stress (like burns or organ failure)

-bleeding is the 1st sign

Peptic ulcers: Promotion and prevention

-drink alcohol in moderation and stop smoking

-exercise regularly and decrease caffeine, balance diet

-avoid NSAID’s

Peptic ulcer: Data collection 

r/f → H. pylori infection, NSAID’s, corticosteroids, sever stress 

s/sx → dyspepsia, full gnawing pain or burning sensation 

lab testing → H. pylori, are breath, stool, Hgb

dx → EGD

peptic ulcers: treatment

medications → ATB’s, H2 receptor antagonist, PPI’s, mucosal protectants

surgical interventions → Vegus nerve will be cut up to decrease gastric acid production

Appendicitis: data collection and dx

-periumbilical abd pain shift to RLQ 

-localized tenderness, muscle guarding

dx → differential CBC and WBC (elevated) 

Appendicitis: Implementations

-no heating pads (increase blood flow, could rupture and inflammation won’t decrease w/ heat)

-no enema (will increase movement) 

-NPO, IV fluids, ice bag to abd (helps w/ pain) 

Peritonitis (inflammation of the peritoneum)

s/sx → severe abd pain and distention

dx → Hx, physical exam, CBC and CT scan 

tx → broad spectrum IV ATB’s, gastric or intestinal decompression, surgery 

LIFE THREATENING AND CAN LEAD TO SEPSIS 

Causes of accessory organ disorders

-risk factors associated with/ gallbladder disease

-liver disorders and viral infections, toxins, & trauma

-liver cancer , pancreatitis, pancreatic cancer 

(Hep A & B decrees risk of infection)

Hepatitis: signs and symptoms

-viral replication phase = no symptoms

-prodromal phase = nausea and fatigue 

-icteric phage = jaundice 

-convalescent phase = jaundice begins to disappear, malaise & fatigue

Hepatitis: Dx

-Hep A & E  route is oral to fecal (bowel with vowels)

-Hep B & C, sexually and parental 

-immunizations for A & B 

Hepatitis: Treatment

Hep A → rest, avoid substance that can damage the liver, well balanced diet, immune globulin

Hep B → drug therapy is used to decrease the viral load, immune globulin

Hep C → antiviral medications

Cholecystitis (inflammation of gallbladder) & Cholelithiasis (gall stones)

s/sx → pain (none severe or unbreakable), biliary colic

dx → US, CT, MRI, and increased WBC’s

tx → diet, shock wave lithotripsy, ATB’s, cholecystectomy

complications → obstruction, peritonitis, pancreatitis

nursing management → pre and post op care, bile acid

Acute pancreatitis: s/sx, dx, tx

s/sx → LUQ pain, N/V, sweating, jaundice (blue/ grey discoloration) 

dx → labs, CT

tx→ rest, pain control, eliminated alcohol intake, small low fat meals, adequate hydration and pancreatic enzymes

Hypoactive bowl and constipation: Causes 

-indicated decrease in peristalsis and usually results in constipation 

-immobility, injury to the bowel, drug (anti- cholinergic), surgery 

Drugs contributing to constipation

-narcotic analgesics (opioids)

-general anesthetics, diuretics, sedatives, anti- cholingergics and Ca channel blocks (slows motility) 

Hyperactive bowel and diarrhea

-increase in peristalsis and may be self limiting

causes → inflammation of GI tract, infectious disease

drugs → many ATBs kill normal bowel bacteria causing diarrhea and some pt Neds ATBs to replace normal flora 

EXAMPLES: lomotil, Imodium

Diverticulitis (inflammation and infection of bowel lining)

s/sx → acute onset abd pain in LLQ, N/V

physical finding → fever, diarrhea or constipation, abd distention

nursing care → supportive care, decreasing stressors, med

FOOD GETS LODGE, MONITOR FOR BLEEDING, FLUID IMBALANCE, PERITONITIS 

Hernias

-bowel herniation → pushes through weak spot in abd muscle

-common sites → groin, umbilicus, surgical incisions

types → incisional, reducible, irreducible, and strangulated 

Hernias: R/F and S/sx

r/f → males, advanced age, obesity or pregnancy, genetics/ family

s/sx → visible bulge/lump site, more noticeable when standing/ coughing/ straining 

nursing care → avoid heavy lifting or twisting, apply ice as prescribes and prevent constipation 

Hiatal hernias: Promotion and prevention

-avoid eating right before bed

-limit triggering foods → chocolate, fatty, spicy acidic, alcohol

-avoid trading or excessive vigorous exercise

-avoid wearing tights clothing around abd

Hiatal hernias: S/sx, dx, tx, and complications

s/sx → heartburn, reflux, chest pain, sense of breathlessness

dx → barium swallow, CT

meds → PPI’s, antacids 

complications → volvulus, obstruction, iron deficiency anemia 

Intestinal obstruction 

s/sx: upper intestine tract; sharp, pains in upper abd, vomiting, dehydration slight abd distention 

tx : NG tube or surgery 

nursing care: fowler position, monitor fluids, measure abd grit, pain control