Nursing Management of Gastrointestinal Disorders

Assessment & History

  • Collect full GI history: abdominal pain, nausea/vomiting, appetite changes, weight patterns, bowel habits, stool characteristics, jaundice, prior surgeries, allergies, family history
  • Include psychosocial, cultural, spiritual factors; assess knowledge & education needs

Common GI Signs & Symptoms

  • Pain (acute, chronic, spasmodic, referred)
  • Nausea, vomiting
  • Altered bowel function: constipation, diarrhoea
  • Red-flag findings: guarding, rigid abdomen, haematemesis (bright red / “coffee grounds”), melena, steatorrhoea

Diagnostic Studies

  • Stool tests, breath tests
  • Imaging: ultrasound, CT, PET, MRI
  • Contrast studies of upper / lower GI tract
  • Motility tests
  • Endoscopy (gastroscopy, colonoscopy) with sedation & specific prep
  • 24-h oesophageal pH monitoring & manometry for reflux assessment

Endoscopic Patient Care

  • Gastroscopy: fast 6 h; post-procedure sore throat, bloating, drowsiness
  • Colonoscopy: bowel prep (laxatives, clear fluids), fasting; cramps / minor bleeding possible
  • Monitor: vital signs, pain, fever, breathing, intake/output; watch for rare perforation, bleeding, infection

Upper GI Disorders

Gastro-Oesophageal Reflux Disease (GORD)

  • S/S: heartburn, regurgitation, water-brash, epigastric pain, dysphagia, nocturnal cough, laryngitis
  • Tests: endoscopy with biopsy, pH monitoring, manometry
  • Complications: oesophagitis, ulceration, metaplasia, respiratory issues
  • Management: lifestyle (avoid caffeine, alcohol, chocolate, fatty/spicy foods, late meals; elevate head; weight control); drugs—PPIs, H2 blockers, antacids, prokinetics; fundoplication surgery if refractory

Hiatus Hernia

  • Types: sliding (common), para-oesophageal (emergency)
  • Features: post-meal fullness, heartburn, chest/epigastric pain, belching, dysphagia; risk of volvulus
  • Care parallels GORD; surgery (fundoplication) if severe; teach positioning & meal timing

Oesophageal Varices

  • Result of portal hypertension; high‐mortality bleeding
  • Acute care: resuscitate, endoscopic banding/sclerotherapy, vasoactive drugs (vasopressin, somatostatin), TIPS, balloon tamponade (temporary)

Gastritis

  • Acute: self-limiting hours–days; epigastric discomfort, N/V, haemorrhage (alcohol)
  • Chronic: may be asymptomatic; risk of B12 malabsorption → anaemia & neuro issues
  • Dx: history, endoscopy, H. pylori / anaemia tests
  • Tx: remove cause, NBM & IV fluids if vomiting, antiemetics, PPIs/H2 blockers; patient education on alcohol, smoking, meds

Peptic Ulcer Disease (PUD)

  • Gastric: H. pylori 50–70\%, NSAIDs, steroids, smoking; pain 1–2 h after meal
  • Duodenal: H. pylori 90–95\%; pain fasting/night, relieved by food/antacids
  • Complications: bleeding, perforation, gastric outlet obstruction, penetration, malnutrition
  • Therapy: H. pylori triple therapy (PPI + amoxycillin + clarithromycin for 7 days), PPIs, H2 blockers (NSAID-related), cytoprotectives (sucralfate, misoprostol), antacids
  • Nursing: vitals, pain, NBM, IV fluids/blood, NG suction, fluid balance, oral care, diet & education

Lower GI Disorders

Obstruction & Structural Issues

  • Causes: adhesions, diverticulitis, hernias, tumours, intussusception, volvulus, foreign bodies
  • Investigations: abdominal imaging, sigmoidoscopy/colonoscopy after bowel prep, FOBT for occult blood

Inflammatory Bowel Disease (IBD)

  • Crohn’s: diarrhoea, colicky pain, weight loss, bleeding, fever
  • Ulcerative colitis: bloody mucous diarrhoea (up to 10-20/day), pain, fever, anaemia, tachycardia, dehydration
  • Dx: stools, bloods (FBC, ESR, albumin), endoscopy with biopsy, barium studies, capsule endoscopy
  • Management: induce/maintain remission (aminosalicylates, steroids, immunomodulators, biologics), nutrition (high-calorie enteral/parenteral, food diary), rest, psychosocial support, no smoking, surgery if refractory or emergency

Colorectal Cancer

  • Risk: age, male, family history, IBD, obesity, smoking, high red/processed meat, alcohol
  • Right colon: weight loss, anaemia, occult bleed; Left colon: pain, obstruction, rectal bleeding, change in habit
  • Dx: DRE, FOBT, colonoscopy, imaging (CT/MRI), labs
  • Tx: surgery (polypectomy, resection with anastomosis or colostomy, laparoscopic, APR), chemo, radiotherapy, biologics; surveillance colonoscopies & tumour markers post-treatment

Stoma Care

  • Types: ileostomy, colostomy (sigmoid, transverse, ascending/descending), urostomy; may be temporary loop
  • Pre-op: site marking, body-image counselling, bowel prep, antibiotics
  • Post-op: assess stoma (colour, output), choose pouch, protect skin, chart drainage, teach patient independence & pouch changes
  • Ongoing: stomal therapy referral, supplies list, psychosocial support, community resources

Pharmacologic Overview

  • Acid suppression: PPIs (e.g., esomeprazole, rabeprazole), H2 blockers (ranitidine, famotidine)
  • Motility: prokinetics (metoclopramide, domperidone)
  • Cytoprotectives: sucralfate, misoprostol
  • Vasoactive agents: vasopressin, somatostatin analogues for varices
  • IBD drugs: aminosalicylates, corticosteroids, immunosuppressants, biologics (anti-TNF, etc.)

Nursing Management Essentials

  • Monitor vitals, pain, bleeding, hydration, labs
  • Maintain NBM & NG if ordered; administer IV fluids/blood
  • Educate on diet, lifestyle, medication adherence, symptom reporting
  • Positioning: elevate HOB 30° for reflux / hernia; avoid supine post-meal
  • Psychosocial support: body image, chronic disease coping, smoking & alcohol cessation