GI

Gastrointestinal System Overview

The GI system comprises various components and functions essential for digestion and nutrient absorption.

Alimentary Canal

  • Length: Approximately 30 feet long

  • Components:

    • Mouth

    • Pharynx

    • Esophagus

    • Small intestine

    • Large intestine

    • Anus

  • Function: Peristalsis facilitates the movement of food through the canal.

  • Accessory organs:

    • Teeth

    • Tongue

    • Liver

    • Gallbladder

    • Pancreas

    • Salivary glands

Accessory Digestive Organs

  • Salivary Glands:

    • Parotid salivary gland

    • Sublingual salivary gland

    • Submandibular salivary gland

  • Digestive Organs:

    • Oral cavity

    • Pharynx

    • Esophagus

    • Stomach

    • Small intestine (including the duodenum)

    • Large intestine (including the ascending, transverse, descending colon, cecum, sigmoid colon, appendix, rectum, anal canal, anus)

Normal Gastrointestinal Data Collection

  • Diagnostic Exams:

    • Gastric content analysis

    • Occult blood tests

    • Cultures

    • Barium swallow

    • Upper GI test

    • Endoscopy

    • EGD (Esophagogastroduodenoscopy)

    • Colonoscopy

    • Barium enema study

  • Nursing Interventions Pre and Post Procedures: Focus on patient education and preparation for exams, monitoring vital signs, and post-procedural care.

Conditions and Disorders

Candidiasis (Thrush)

  • Etiology: Fungal infection affecting the mucus membranes, including the GI tract, vagina, and mouth.

  • Risk Factors:

    • Antibiotic use

    • Long-term steroid use

    • Compromised immune systems (e.g., due to chemotherapy, radiation, leukemia)

  • Medical Management: Nystatin mouthwash (swish and swallow).

  • Nursing Interventions: Focus on hygiene and education about the condition.

Gastroesophageal Reflux Disease (GERD)

  • Etiology: Stomach acid backs up into the esophagus due to the lower esophageal sphincter’s inability to close fully.

  • Clinical Manifestations:

    • Dyspepsia (burning sensation in chest)

    • Postprandial pain (20 minutes to 2 hours after eating)

    • Regurgitation of food

    • Aggravating foods: chocolate, caffeine, spearmint, peppermint, fatty foods, cola, milk, citrus juices.

    • Risk factors: obesity, pregnancy, smoking, alcohol use.

  • Medical Management:

    • Dietary changes

    • Antacids

    • H2 antagonists (e.g., Pepcid, Tagamet, Zantac)

    • Proton pump inhibitors (e.g., Protonix, Prilosec, Nexium)

    • Possible surgical intervention for sphincter reinforcement.

    • Potential development into Barrett’s esophagus, increasing risk for carcinoma.

  • Nursing Interventions:

    • Eat 4-6 small meals

    • Low-fat, adequate protein diet

    • Avoid trigger foods

    • Sit upright post meals

    • Weight loss strategies

    • Avoid sleeping flat.

Gastritis

  • Definition: Inflammation of the stomach lining, can be acute or chronic.

  • Causes:

    • Dietary factors

    • Use of NSAIDs

    • Caffeine

    • Smoking

    • Stress response leading to GI irritation.

Peptic Ulcers

  • Definition: Ulcerations anywhere from the lower esophagus to the duodenum.

  • Etiology:

    • Infection by Helicobacter pylori

    • Tobacco use

    • Excessive intake of salicylates

    • Increased acid secretion

    • Psychological stress.

  • Clinical Manifestations:

    • Dull burning, gnawing pain in the epigastric region

    • Abdominal distention, nausea

    • GI bleeding, risk of possible perforation

  • Diagnosis: Based on client symptoms, EGD (esophagogastroduodenoscopy), and testing for H. pylori.

  • Treatment:

    • H. pylori treatment with antibiotics

    • Antacids (calcium-based)

    • H2 blockers (e.g., Famotidine, Ranitidine)

    • Proton pump inhibitors (e.g., Omeprazole, Pantoprazole)

    • Cytoprotective agents (e.g., Sucralfate)

  • Surgical Options:

    • Partial or total gastrectomy

    • Vagotomy to decrease acid production.

  • Patient Education:

    • Understand the role of stress on ulcer formation.

    • Dietary modifications and smoking cessation.

Dumping Syndrome

  • Etiology: Altered gastric size, often following Billroth procedures (50% incidence post-gastric resection surgeries).

  • Clinical Manifestations:

    • Rapid intestinal emptying

    • Symptoms: diaphoresis, nausea/vomiting, abdominal pain, diarrhea.

  • Nursing Interventions: Educate patients on small meal frequency, avoidance of fluids during meals, and reclining post-meals.

Altered Elimination

Conditions include nausea/vomiting, constipation, and diarrhea.

  • Types of Diarrhea:

    • Related to GI infection, self-limiting, oral transmissions often through poor hygiene.

  • Caution: Nurse must culture stool prior to antidiarrheal administration.

Antidiarrheal Medications

  • Examples:

    • Adsorbents: Bismuth subsalicylate (Pepto-Bismol), Attapulgite (Kaopectate)

    • Opioids: Diphenoxylate (Lomotil), Loperamide (Imodium)

Laxatives

  • Types:

    • Saline laxatives: Magnesium citrate

    • Stimulant laxatives: Senna (Sennakot)

    • Bulk-forming: Psyllium (Metamucil)

    • Fecal softeners: Docusate sodium (Colace)

    • Lubricants: Mineral oil

    • Hyperosmotic: GoLytely

Irritable Bowel Syndrome (IBS)

  • Etiology: A combination of chronic and recurrent GI symptoms.

  • Clinical Manifestations:

    • Intestinal pain, abdominal pain during or after defecation

    • Symptoms include gas, diarrhea, constipation, and distention

    • Some association with anxiety.

  • Management:

    • Increased fiber intake

    • Low-residue diet

    • Anti-anxiety medications

    • Relaxation techniques.

Crohn’s Disease

  • Etiology: Inflammatory condition affecting segments of the GI tract, from the mouth to the anus, often autoimmune in nature.

  • Clinical Manifestations:

    • Symptoms: diarrhea, abdominal pain, weight loss, fever, malnutrition, dehydration

    • Fistulas can develop between bowel and other organs (e.g., urinary tract).

  • Diagnosis: Barium enema shows inflammation and cobblestone pattern.

  • Medical Management: Involves anti-inflammatory medications, corticosteroids, dietary changes to promote high protein intake, and monitoring for complications.

Ulcerative Colitis

  • Etiology: Inflammation primarily of the mucosal layers of the colon and rectum.

  • Clinical Manifestations:

    • Symptoms: frequent bowel movements (15-20 stools/day) containing blood and mucus

    • Abdominal pain and cramping.

  • Treatment: Anti-inflammatory medications, corticosteroids, dietary changes, surgery if needed (e.g., ileostomy).

Appendicitis

  • Etiology: Inflammation of the vermiform appendix.

  • Clinical Manifestations: Acute pain in the right lower quadrant (RLQ), may perforate leading to peritonitis.

  • Diagnosis: Elevated WBC count, CT scan. Treatment includes surgical removal.

Peritonitis

  • Etiology: Inflammation of the abdominal cavity's peritoneum due to ruptures (e.g., appendix, ulcers).

  • Clinical Manifestations: Severe abdominal pain, increased pain post-relief, tachycardia, fever, rapid sepsis risk.

  • Diagnosis: X-ray to visualize free air, CBC to assess infection. Treatment often requires surgery and aggressive antibiotic therapy.

Intestinal Obstruction

  • Etiology: Blockage preventing GI content passage. Requires prompt treatment due to risks of perforation or ischemia.

  • Types:

    • Mechanical obstructions (e.g., volvulus, adhesions)

    • Non-mechanical obstructions (loss of peristalsis).

  • Treatment: Remove gas and fluids, restore electrolyte balance, potential NG tube insertion.

Diverticulosis and Diverticulitis

  • Definition: Pouch-like herniations through the muscular layer of the colon, prevalent over age 50.

  • Clinical Manifestations: LLQ pain, fever, elevated WBC, blood in stool.

  • Diagnosis and Treatment: CT scans, colonoscopy; treatment includes low-residue diets and antibiotics.

Hernias

  • Definition: Protrusion of an internal organ through a weakened area in the abdominal wall.

  • Types: Ventral, inguinal, umbilical, femoral.

  • Nursing considerations: Diet adjustments based on type of hernia and risks of obstruction.

Cirrhosis

  • Etiology: Chronic liver disease causing scar tissue formation, decrement in blood flow, and progressive liver cell destruction.

  • Types: Alcoholic, postnecrotic, biliary, secondary biliary, cardiac cirrhosis.

  • Manifestations: Early signs include abdominal pain; later complications include ascites, jaundice, portal hypertension, hepatic encephalopathy.

  • Management: Involves avoiding alcohol, diuretics for ascites, vitamin supplementation, and monitoring for complications.

Hepatitis

  • Definition: Inflammation of the liver due to viral infections or toxic exposure.

  • Types: Hepatitis A, B, C, with transmission routes varying from fecal-oral to bloodborne.

  • Potential Treatments: Supportive therapies, immunosuppressants post-transplant, lifestyle modifications, and vaccination.

Cholecystitis and Cholelithiasis

  • Etiology: Inflammation of the gallbladder, often caused by gallstones or tumors.

  • Clinical manifestations: Acute onset of nausea, vomiting, right upper quadrant pain, possible jaundice.

  • Diagnosis and Management: Ultrasound, HIDA scan for assessment; dietary modifications, cholecystectomy for treatment.

Pancreatitis

  • Etiology: Acute or chronic inflammation due to various factors leading to blockage of digestive enzyme flow.

  • Clinical Manifestations: Severe abdominal pain, nausea, potential jaundicing, diagnostic elevation of amylase and lipase.

  • Management: Includes NPO, IV fluids, NG tube placement, pain management, diet education focused on low-fat foods.

Pancreatic Cancer

  • Etiology: Increasing incidence often diagnosed late, associated with chronic pancreatitis and lifestyle risks (smoking, toxins).

  • Diagnostic Tests: Tumor markers (CEA), ERCP.

  • Medical Management: Seldom operable, management includes Whipple procedure if applicable, radiation, and chemotherapy.