Digestive & Gastrointestinal Function (med surg)

Q: Where is the esophagus located, how long is it, and what is its main function?
A: The esophagus is located in the mediastinum, is approximately 25 cm (10 inches) long, and passes through the diaphragmatic hiatus. Its main function is to transport ingested food into the GI tract.
Q: What is the location, capacity, and structure of the stomach?
A: The stomach is situated in the left upper quadrant (LUQ) and has a capacity of about 1500 mL. It consists of four regions: the cardia, fundus, body, and pylorus. It functions to break down food using digestive juices.
Q: What are the physical characteristics and major functions of the small intestine?
A: It is the longest segment of the GI tract, measuring approximately 70 m (230 feet). Its major function is absorbing small molecules, vitamins, and minerals into the bloodstream.
Q: What is the function of the large intestine, rectum, and anus?
A: They are responsible for the elimination of undigested, unabsorbed food stuffs and waste products.
Q: What are the metabolic and storage functions of the liver?
A: The liver performs glucose (gluconeogenesis), protein, and fat metabolism; converts ammonia; stores vitamins and iron; forms bile; excretes bilirubin; and metabolizes drugs.
Q: What is the function of the gallbladder?
A: The gallbladder functions to store bile.
Q: What are the exocrine and endocrine functions of the pancreas?
A: The exocrine functions involve secreting amylase, trypsin, and lipase. The endocrine functions involve beta cells producing insulin, alpha cells secreting glucagon, and delta cells secreting somatostatin.
Q: How is the abdomen divided for a physical assessment, and what is the proper sequence of examination?
A: The abdomen is divided into four quadrants: RUQ, RLQ, LUQ, and LLQ. Auscultation must precede percussion and palpation to avoid altering bowel sounds.
Q: What are the normal findings for bowel sounds and abdominal percussion?
A: Normal bowel sounds occur at a frequency of 5 to 30 per minute. Percussion normally yields tympany over the stomach/intestines due to air, and dullness over solid organs or masses.
Q: How are abnormal bowel sounds and palpation findings documented?
A: Bowel sounds may be hyperactive, hypoactive, or absent, and you must listen for a minimum of 5 minutes per quadrant before charting them as absent. Abnormal light palpation may reveal tenderness, muscular resistance, or a rigid "board-like" abdomen indicating peritonitis.
Q: Which blood studies are commonly assessed for GI and hepatobiliary issues?
A: The CBC assesses hemoglobin/hematocrit to detect bleeding/anemia; PT/PTT assesses clotting times related to liver function; and Liver Function Tests evaluate AST and ALT. Complete Metabolic Panels (CMP) and triglycerides are also checked, while elevated amylase and lipase specifically indicate pancreatic issues.
Q: What do stool and breath tests evaluate in GI diagnostics?
A: Stool tests, such as the Guaiac test, check for occult blood and must be sent promptly to the lab. Urea breath tests are used to detect Helicobacter pylori (H. pylori).
Q: What is the nursing role prior to and during endoscopic exams like an EGD or colonoscopy?
A: Keep the patient NPO for at least 8 hours prior. Administer Midazolam for anxiety and atropine to decrease secretions and reduce aspiration risk as prescribed. The patient should be positioned laterally.
Q: What is the nursing role following an endoscopic exam?
A: Assess vital signs and pain, and monitor for perforation, which is indicated by pain, bleeding, a rapidly elevating temperature, or difficulty swallowing. Ensure the patient has an escort to go home.
Q: What is the nursing role for radiologic exams and biopsies (CT, MRI, Ultrasound)?
A: Assess for contrast dye allergies and premedicate with corticosteroids or antihistamines if needed. Maintain hydration, and provide post-procedure monitoring and education.
Q: How does referred pain present in the case of a perforated peptic ulcer?
A: A perforated peptic ulcer may cause sharp abdominal pain that is referred to the shoulder.
Q: What does a rigid, "board-like" abdomen signify?
A: It is a medical emergency indicating conditions such as peritonitis, an appendicitis rupture, or a peptic ulcer perforation.
Q: What is the initial nursing management for a patient presenting with active abdominal pain?
A: Keep the patient NPO, initiate IV fluids, monitor bowel sounds, and assess for hypovolemia by monitoring for a trending down blood pressure, dizziness, and dropping Hgb/Hct. Administer analgesics and position the patient for comfort.
Q: What are the clinical manifestations of malabsorption?
A: Diarrhea, frequent, loose, bulky, foul-smelling grayish stools with high fat content (steatorrhea), weight loss, and vitamin and mineral deficiencies.
Q: What is the collaborative care and nursing management for malabsorption?
A: Collaborative care includes dietary therapy, vitamin replacement, and probiotics. Nursing management requires monitoring for fluid and electrolyte imbalances and assessing the patient's risk for osteoporosis.
Q: What are the clinical manifestations of Celiac Disease?
A: Diarrhea, steatorrhea, abdominal pain/distention, flatulence, and weight loss.
Q: What is the treatment and nursing management for Celiac Disease?
A: Celiac disease is noncurable and lifelong; there are no medications to treat it. Nurses must educate the patient to strictly refrain from gluten exposure in foods and consult a dietician.
Q: What are the clinical manifestations and risks of Gastroesophageal Reflux Disease (GERD)?
A: GERD causes a backflow of gastric contents leading to dyspepsia (heartburn), regurgitation, dysphagia, and chest pain that often worsens when lying down. Chronic untreated GERD can lead to Barrett's esophagus, which is a precursor to cancer.
Q: What is the medical and nursing management for GERD?
A: Collaborative care involves the administration of proton pump inhibitors (PPIs). Nurses should advise a low-fat diet and avoidance of fried/fatty foods, caffeine, alcohol, tobacco, citrus, dairy, and peppermint. Patients should eat small meals, avoid eating 3 hours before lying down, and elevate the head of the bed (HOB) at night or sit up after meals.
Q: What is a hiatal hernia and how does it manifest?
A: It is the protrusion of the stomach through the diaphragm. It can be asymptomatic or cause dysphagia, pyrosis, regurgitation, chest pain, and shortness of breath.
Q: What is the collaborative and nursing care for a hiatal hernia?
A: Collaborative care involves laparoscopic or open surgical hernia repair. Nurses should instruct the patient to avoid lifting heavy objects, straining, and wearing tight clothing, while recommending small, frequent, low-fat meals. Postoperatively, nurses must monitor for indications of surgical revision like persistent belching, vomiting, or epigastric pain.
Q: What is the difference between acute and chronic gastritis?
A: Acute gastritis has a rapid onset from dietary indiscretion, medications, or alcohol. Chronic gastritis is prolonged inflammation leading to atrophy and an inability to absorb vitamin B12, which causes pernicious anemia, numbness, and tingling.
Q: What are the overall manifestations and nursing management for gastritis?
A: Symptoms include anorexia, hiccups, nausea/vomiting, hematemesis, and melena. Nurses should keep the patient NPO until symptoms subside, advance to clear liquids/solids, promote rest, reduce stress, monitor I&O, and educate the patient to avoid alcohol and NSAIDs. Medical care includes IV fluids, NG intubation, antacids, H2 blockers, PPIs, and treating H. pylori if positive.
Q: What are the clinical manifestations of Peptic Ulcer Disease (PUD)?
A: It causes erosion of the mucous membrane in the stomach, pylorus, or duodenum, leading to a dull, gnawing, burning pain in the mid-epigastrium or back. Gastric ulcer pain increases 30-60 minutes after meals and presents with weight loss and hematemesis. Duodenal ulcer pain decreases with food but worsens 2-3 hours after meals and at night, often presenting with melena.
Q: What is the collaborative care and nursing management for PUD?
A: Care involves antibiotics for H. pylori (Amoxicillin, Clarithromycin, Tetracycline, Metronidazole, Bismuth), acid reducers, and mucosal protectants. Nurses educate patients to avoid spicy, fatty, acidic foods, caffeine, alcohol, tobacco, and NSAIDs.
Q: What severe complications of PUD must a nurse monitor heavily for?
A: Hemorrhage, gastric outlet obstruction, and perforation. Perforation is characterized by a rigid board-like abdomen and fever, requiring immediate HCP notification.
Q: What are the clinical manifestations of appendicitis?
A: Inflammation of the appendix causes vague periumbilical pain that moves to the RLQ, rebound tenderness, anorexia, low-grade fever, and Rovsing's sign, which is pain in the RLQ when the LLQ is palpated.
Q: What is the collaborative and nursing management for appendicitis, including critical contraindications?
A: Collaborative care includes immediate surgery for complicated cases and antibiotics with IV fluids for uncomplicated cases. The nurse must keep the patient NPO, administer IV normal saline or Lactated Ringers, and control pain. CRITICALLY: Never use heat pads, laxatives, or enemas, as they increase the risk of perforation.
Q: What are the clinical manifestations of peritonitis?
A: Early diffuse pain that becomes constant, localized, and aggravated by movement. Patients present with an extremely tender, distended, rigid "board-like" abdomen, diminished peristalsis (paralytic ileus), fever, and tachycardia.
Q: How is peritonitis managed medically and by nursing staff?
A: Collaborative care focuses on fluid, colloid, and electrolyte replacement, broad-spectrum antibiotics, analgesics, and potential surgical intervention. Nursing management involves maintaining IV/electrolyte balance, monitoring for infection/shock, implementing strict I&O, and managing pain and GI distention.
Q: Differentiate between the clinical manifestations of diverticulosis and diverticulitis.
A: Diverticulosis involves multiple pouches in the bowel wall that are mostly asymptomatic or cause alternating constipation/diarrhea. Diverticulitis is the inflammation of those pouches, causing acute mild-to-severe LLQ cramping pain, fever, and leukocytosis.
Q: How is diverticular disease managed?
A: Uncomplicated cases are managed with diet and medication, while severe cases may require hospitalization or surgery. During a diverticulitis flare, keep the patient NPO or on clear liquids, give IV normal saline and pain meds, and strictly avoid barium enemas or colonoscopies. For diverticulosis, recommend a high-fiber diet, avoid nuts/seeds, and ensure at least 2L of daily fluid intake.
Q: What are the clinical manifestations of an intestinal obstruction?
A: Blockage causes crampy, colicky, wavelike pain, an absence of feces or flatus, vomiting that can smell fecal if complete, and abdominal distention. Worsening signs include a rapid onset of tachycardia, tachypnea, and high fever.
Q: What is the nursing management for an intestinal obstruction?
A: Keep the patient NPO, assess and measure NGT output, administer IV fluids, avoid opioid analgesics, and place the patient in a semi-Fowler's position. Collaborative care includes NGT placement for decompression, maintaining fluid balances, and potential surgery.
Q: What are hernias and hemorrhoids, and what is the nursing management for each?
A: Hernias are the protrusion of an organ through a cavity wall that can cause pain or bowel obstructions; nurses should advise against lifting or straining. Hemorrhoids are dilated veins in the anal canal causing itching, pain, and bright red bleeding; nursing management heavily involves assessing and treating postoperative pain following rubber band ligation or hemorrhoidopexy.
Q: What are the potential complications and common collaborative care medications for Inflammatory Bowel Disease (IBD)?
A: Complications include electrolyte imbalances, cardiac dysrhythmias, GI bleeding with fluid loss, and bowel perforation. Collaborative care utilizes Sulfasalazine (immunosuppressant), Corticosteroids (Prednisone), and antidiarrheals (Loperamide).
Q: What is the nursing management regarding diet and monitoring for IBD?
A: Recommend a high protein, high fiber (unless in flare), low-calorie diet. Nurses must closely monitor I&O, monitor potassium levels, and assess stoma health if surgical resection occurred.
Q: How do the location and pathophysiology differ between Ulcerative Colitis and Crohn's Disease?
A: Ulcerative Colitis primarily affects the descending and sigmoid colon and rectum, causing inflammation and bleeding ulcers in the mucosal and submucosal layers. Crohn's Disease can affect the tract from mouth to anus (mainly small intestines) and involves transmural (all layers) inflammation granulomas that can lead to fistulas.
Q: Compare the stool characteristics and typical symptoms of Ulcerative Colitis and Crohn's Disease.
A: Ulcerative Colitis produces 15 to 20 bloody, liquid stools per day, abdominal pain, and decreased hemoglobin/hematocrit. Crohn's Disease produces 5 loose stools per day containing mucus or pus, steatorrhea (fatty stools), prominent right lower quadrant pain unrelieved by defecation, and is associated with joint, skin, ocular, and oral ulcer disorders.
Q: What are the clinical manifestations of cirrhosis?
A: It causes chronic liver damage and enlargement leading to jaundice, portal hypertension, ascites, gastrointestinal varices, vitamin deficiency, and mental deterioration known as Hepatic Encephalopathy. Manifestations of encephalopathy include mental status changes, asterixis (involuntary hand flapping), and fetor hepaticus (sweet/fecal breath odor).
Q: What is the collaborative and nursing management for cirrhosis?
A: Care includes potassium-sparing diuretics for ascites, lactulose to reduce serum ammonia, antifibrotics, and TIPS procedures. Nurses should promote rest, improve nutrition using a high-protein and low-sodium diet with vitamin supplements, perform frequent neurologic assessments, implement fall precautions, and take daily weights.
Q: What are the manifestations and management strategies for cholecystitis and cholelithiasis?
A: Manifestations include epigastric distress, RUQ pain, biliary colic, jaundice, and changes in urine/stool color. Collaborative care involves pharmacologic therapy, antibiotics, and laparoscopic cholecystectomy. Nursing management includes managing the diet by decreasing sugar, fast foods, and low-fiber foods, monitoring intake and output, and managing postoperative pain and nausea.
Q: What are the clinical manifestations and phases of acute viral hepatitis?
A: Manifestations include jaundice, liver enlargement, and elevated bilirubin due to systemic viral infection producing necrosis and inflammation of liver cells. The four phases are Phase 1 (Viral replication), Phase 2 (Preicteric or prodromal phase), Phase 3 (Icteric phase involving worsening symptoms and jaundice), and Phase 4 (Convalescence, where symptoms resolve but the disease may still progress).
Q: What is the nursing management for viral hepatitis?
A: Promote rest, improve nutritional status with a high-protein/low-sodium diet, provide skin care, and help the patient avoid alcohol and hepatotoxic medications.