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Anatomy covered in class

Location

Accessory Organ
Liver

Right Upper Quadrant (RUQ)

Function

Pancreas

Body - Right Upper


Quadrant (RUQ)
Tail Left Upper Quadrant
(LUQ)
Tail touches the spleen

Metabolize carbs, fats, and


proteins
Convert ammonia to urea for
excretion
Synthesize fat soluble vitamins
(A, D, K) and B12
Secretes bile, cholesterol, and
other lipids.
Releases insulin and glycogen
Releases pancreatic enzymes
into the duodenum for
digestion

Diagnostic and Lab Test Associated with Gastrointestinal Disorders


Diagnostic Exam/ Lab Test
Nursing Considerations
Upper GI
Esophagogastroduodenoscopy
Upper GI Series

Identifies abnormalities of the


esophagus, stomach, and
small intestine
During endoscopy, biopsies
may be taken to detect the
presence of H. pylori

24-hour pH testing

MRI

CT scan

Detects reflux disease


Incompetent sphincter, the
recurrent of backflow of acidic
juices
Outpatient basis, 24 hours of
continuous acidity data
Patient keeps diary of
activities and s/s.
Used to evaluate liver disease
to help characterize tumors,
masses, or cysts found on
previous studies.
Distinguish between
obstructive and nonobstructive jaundice
Can evaluate cause of weight
loss

Requires patient consent


Barium swallow
NPO up to 8 hrs before
procedure to show blockage or
fluid leaking
No opioids or anticholinergic
drugs before procedure
Anesthetic sprayed on throat.
CHECK GAG REFLEX BEFORE
GIVING FOOD OR DRINKS!
Monitor q30min
Sedated, cant drive
Push fluids to remove barium
Chalky white stools (passing
barium)
NOTIFY YOUR DOCTOR IF PAIN
CONTINUES
No antacids, gum, lozenges,
or hard candy during study.
Encouragement of usual
routine
Ice chips for throat comfort

No metal or implanted devices


Lie for 30-90 mins.
Mild sedation optional for
claustrophobic
Food/fluid restriction after
midnight prior to procedure
Distinguish seafood/shell fish
allergy for contrast
Report rare adverse reactions

Help diagnose and evaluate


pancreatitis

Drug Therapy
Antacids
Histamine-2 (H2) receptor antagonist
Proton pump inhibitors (PPIs)
Anticholinergics
Antidiarrheal agents
Laxatives
Emetics
antiemetics

Lab Values Patient Assessment


Decreased Value = PROBLEM!
RBC
Calcium (total) 9.0-10.5 mg/Dl
Potassium 3.5-5.0 mEq/L or
mmol/L
Albumin 3.5-5.0 g/Dl
Cholesterol - <200 mg/dL

Increased Value = PROBLEM!


WBC 5000-10000
Could indicate infection
Ammonia 15-110 mg/dL
Could indicate liver problem
PT 2.5-3.5 seconds
Could indicate liver problem

(nausea, vomiting, dizziness,


headache, hives)
Resume normal diet after test

UPPER GI
PROBLEM
Ulcers, Peptic
A mucosal
lesion of the
stomach or
duodenum.

CLINICAL
MANIFESTATION
Gastric ulcer
Regurgitation

Gastritis
Inflammation
of the gastric
mucosa

Duodenal ulcer
Chronic
high gastric acid
secretions
most common type
of peptic ulcer
Stress ulcer
Acute and chronic
Bleeding from
gastric erosion
(principal
manifestation)
Lesions

Edema, hemorrhage,
and erosion of gastric
lining.
Acute
Epigastric
discomfort, pain,
cramping
Anorexia,
dyspepsia, nausea
and vomiting
Hematemesis,
melena
Gastric Hemorrhage
Gastric infection, H.
pylori
Chronic
Nausea, vomiting,
upper GI discomfort
Anorexia
Intolerance of
fatty/spicy foods
Pernicious anemia
(Type A)
H. pylori (Type B)

DIAGNOSTIC
TEST/EXAMS

Hemoglobin
and
hematocrit
levels
H. pylori test
Upper GI
series if no
perforation is
suspected
CT scan if
perforation is
suspected
EGD (major
diagnostic
test for PUD
and the most
accurate
means of
establishing a
diagnosis)

DRUG
THERAPY

PPI or H2
receptor
blockers to
inhibit gastric
acid secretion
Antacids
(buffering
agents)
decrease
pain, given
q2h after
meals
Mucosal
barrier
fortifiers
provide
protective
coating
Antibiotics for
H. pylori
include
metronidazole
, amoxicillin,
ciprofloxacin
or
tetracycline.
Blood
transfusion
and fluids for
GI bleeding
may be
needed.
H2 receptor
antagonist
famotidine
(Pepcid) to
block gastric
secretions
PPIs
omeprazole
(Prilosec) or
Protonix to
suppress
gastric acid
secretion
Antacids
(buffering
agents)
Antibiotic with
PPI and
bismuth
subsalicylates
if bacterial

NURSING
INTERVENTIONS
Acute of Chronic Pain
Teach patient to
avoid caffeine,
alcohol and tobacco
and NSAIDs
Monitor for gastric
outflow or pyloric
obstruction
manifested by a
feeling of fullness,
nausea after eating,
vomiting
undigested food,
distention,
tenderness, and
reduced bowel
sounds.
Take vitamin B12
injections as
appropriate.
Risk For GI Bleeding
Manage
hypovolemia,
hemorrhage and
perforation

Teach patient to
avoid steroids,
chemotherapeutic
agents, NSAIDs
Avoid OTC drugs
with other
medication.
Avoid heavy meals
Reduce discomfort
with progressive
relaxation,
cutaneous
stimulation, guided
imagery, and
distraction.

infection
Stomatitis

Refers to
inflammation
within the oral
cavity

Gastroesopha
geal Reflux
Disease
(GERD)

Inflammation
Dyspepsia
(heartburn or
pyrosis) is the
primary symptom,
and can resemble
angina. Severe
heartburn may
radiate to neck, jaw
or back.
Water brash (reflex
salivary
hypersecretions)
Dysphagia or
odynophagia
Chronic cough
Belching and
flatulence after
eating
Regurgitating of
warm, bitter fluids
not associated with
belching or nausea.

Sliding Hernia
Heartburn
Regurgitation
Chest pain
Dysphagia
Belching
Paraesophageal/Rolling
Hernia
Feeling of fullness
after eating
Feeling
breathlessness or
suffocation
Chest pain that
mimic agina
Worsening of
manifestations in a
recumbent position

Protrusion of
the stomach
through the
esophageal
hiatus of the
diaphragm
into the
throrax

Oral Cancer

Backflow
(reflux) of GI
contents into
the
esophagus

Hernia, Hiatal

Painful single or
multiple ulcerations
of the oral mucosa

Bleeding from the

24 hour pH
monitoring
Esophageal
manometry
(motility
testing)
Scintigraphy
(measure of
reflux of
radioisotope)

Antimicrobials
Immune
modulators
Symptomatic
topical agents

Proton pump
inhibitors
(PPIs) are the
main
treatment
H2 histamine
receptor
blockers
Antacids
Prokinetic
drugs

Barium
swallow study
with
fluoroscopy is
the most
specific
diagnostic
test

Biopsy

Drug therapy
controls reflux
and its
symptoms
PPIs
Antacids
Histamine
receptor
antagonists
Lapra
Nissen
Fundoplicati
on (LNF)

Radiation

Use soft bristled


toothbrush
Rinse with sodium
bicarbonate
solution, warm
saline, or hydrogen
peroxide solution
Avoid chocolate,
peppermint, fatty
foods and
carbonated
beverages.
Avoid eating 3 hrs
before bed
Remain upright 1 2 hrs after meal
Weight reduction
Elevate head of bed
6 inches to prevent
nighttime reflux
Sleep in right lateral
decubitus (sidelaying) position
Avoid tight clothing

Avoid chewing gum,


foods that are spicy,
fatty, acid, and
caffeinated
beverages and
drinking from a
straw.
Avoid lying after
eating and vigorous
activity.
Surgical Teaching
Patient will have NG
tube after surgery.
Early ambulation &
use of incentive
spirometry while
providing pain relief.
Elevate head of bed
Support incision
during coughing
and deep breathing
Stool softeners to
avoid straining and
prevent
constipation.
Maintaining an open

mouth
Poor appetite
Difficulty chewing
and/or swallowing
Thick/absent saliva
Painless oral lesions
that is red, raised,
or eroded
Thickening or lump
in cheek

Chemotherap
y treatment
with other
drugs
Steroids for
edema
Antibiotics for
infections
Cool mist
supplied via
face tent to
assist with O2
transport and
control of
edema.

airway is the
nurses priority for
care of patients
with copious,
tenacious (thick &
stringy) secretions.
Establish oral
hygiene care