Module 6: Problems of the Gastrointestinal System

11-12 Questions

What is a tumor in the upper GI diagnosed using?

Barium swallow

What is a tumor in the lower GI diagnosed using?

Barium enema

How do you prepare a patient for a barium swalllow/enema?

• Check kidney function

• Check for iodine/shellfish allergy

• The patient should be NPO

• Stay hydrated!

What important nursing considerations are there post-barium swallow/enema?

• Check kidney function

• Hydrate to flush the dye

What should stool look like post-barium swallow/enema?

White/gray (same color as the dye that went in) because it passes through the colon quickly and doesn’t go through digestion

What are the assessment indications of oral cancer?

• Oral bleeding

• Initial painless lesions that eventually turn painful with growth

• Unexplained weight loss because of difficulty eating

What is the most important consideration with oral cancer?

Oral cancer can impact the patient’s communication, so it is important to establish other methods of communication

What are risk factors of oral cancer?

• Oral hygiene (does the patient use dentures?)

• Alcohol, smoking, and chewing tobacco

• Sun exposure

• HPV

What position should patients with oral cancer be placed in?

High- or semi-Fowler’s

What is the most common upper GI disorder?

Gastroesophageal reflux disease (GERD)

How can we prevent GERD?

• Stay sitting up after eating

• Limit carbonation/caffeine

• Limit spicy/greasy foods

• Wear loose/non-restrictive clothing

• Eat dinner earlier in the day

• No heavy lifting/straining

Who is GERD usually seen in?

Middle aged/older adults

What are the risk factors of GERD?

• Poor diet (caffeine, fatty/greasy foods, chocolate, spicy foods)

• Obesity

• H. pylori

(No single cause)

What are the manifestations of GERD?

• Heartburn

• Indigestion

• Reflux

• LUQ pain

• Chest pain that spreads to the back (the patient may mistake it for a heart attack)

• N/V

• Dysphagia (trouble swallowing)

What are the long-term effects of GERD?

A cough and potentially cancer (gastric content is not meant for esophageal tissue)

What medication is given for GERD, PUD, and gastritis?

PPIs (proton pump inhibitors)

How should PPIs be taken?

PO, on an empty stomach, 30 minutes before breakfast

What is the mechanism of PPIs?

Coats the GI lining

What are risk factors of esophageal cancer?

• UNTREATED GERD!

• Smoking and alcohol use

• H. pylori

• Obesity

• Diets high in nitrates (fermented/processed foods)

What is the main symptom of esophageal cancer?

Dysphagia —> weight loss

• Painful swallowing

• Feeling that food is stuck

(It is usually asymptomatic until the tumor is large)

How is esophageal cancer diagnosed?

A biopsy to see how advanced the tumor is (very rapid/aggressive)

What position should a patient with esophageal cancer be sitting in?

High Fowler’s

What is the quality of life for esophageal cancer?

It is terminal - the life expectancy is short once diagnosed

What is peptic ulcer disease (PUD)?

Bleeding ulcers in the GI tract, when GI mucosal defenses become impaired and are no longer able to protect the epithelium

What is the main causes of PUD?

1. H. pylori

2. Smoking

What is the biggest complication of PUD?

Bleeding + perforation —> peritonitis

What are the manifestations of PUD?

• RUQ and LUQ epigastric pain 2-4 hours after eating

• Burning of the esophagus

What are the different types of ulcers?

• Duodenal

• Gastric

• Stress

How is H. pylori diagnosed?

Breath test, stool test, or tissue biopsy

What are nutrition education points for patients with PUD and gastritis?

• Eat small, frequent meals

• Bland meals are not good long-term because they can lead to rebound symptoms

• Track diet to find specific triggers, and decrease those foods

Is an upper GI bleed an emergency?

Yes!

What are signs of an upper GI bleed?

• Bright red blood in stool

• Coffee-ground emesis

• Decreased H&H

• Hypotension

• Tachycardia

• Dizziness

What are the goals in managing an upper GI bleed?

• Control the bleeding

• Use an NG tube to pump blood out

• Watch for peritonitis (blood leaks into the thoracic cavity and stomach, causing a rigid, board-like abdomen)

What is gastritis?

Inflammation of the gastric mucosa

What are the risk factors of gastritis?

1. Medications (NSAIDs and steroids)

2. Smoking

• Alcohol use

• Stress

• Poor diet (coffee, spicy foods, etc.)

What are the manifestations of gastritis?

• Epigastric pain/discomfort

• Dyspepsia (heartburn)

• Hematemesis (vomiting coffee-grounds)

• Melena (dark/black “tarry” stools)

• N/V

What is the greatest complication of gastritis?

Bleeding

What is given to patients with gastritis caused by alcohol consumption?

Vitamin B12

What is given to patients with gastritis caused by H. pylori (more rare)?

Triple therapy (antibiotics + PPIs)

What is the most common digestive disorder?

Irritable bowel syndrome (IBS)

Why is IBS a syndrome?

Because the cause is unknown (combination of environmental, immunologic, genetic, hormonal, and stress factors)

Who are more likely to have IBS, women or men?

Women

What are the manifestations of IBS?

• Fatigue and malaise

• Abdominal pain

• Changes in bowel pattern

• GI infections

• Bloating and flatulence

• Diarrhea/constipation

What are mechanical intestinal obstructions caused by?

• Hernias

• Adhesions (bowels stick together)

What are non-mechanical intestinal obstructions caused by?

• Paralytic ileus (collapsed bowel)

• No parastasis (no movement in the GI tract)

• Nerve disorders, such as Parkinson’s

• After surgery, when a patient’s bowels do not “wake up” the way they should

What are the risk factors of an intestinal obstruction?

• A past bowel obstruction

• IBS

• Crohn’s disease

• Bowel surgery

What are the manifestations of a bowel obstruction?

• No movement of intestinal content/blockage

• Pain, discomfort, constipation, N/V

• Distended abdomen on inspection

• Hypoactive bowel sounds

• Absent bowel sounds

Which electrolyte imbalance does an intestinal obstruction cause?

Hypokalemia (with vomiting)

How can we diagnose an intestinal obstruction?

A CAT scan with dye

How do we treat an intestinal obstruction?

1. Place an NG tube ASAP to decompress

2. Make sure the patient is NPO and receiving IV fluids to hydrate and address electrolyte imbalances

3. Treat pain

4. Surgical: colon resection —> temporary/permanent ostomy/colostomy