Gastro Intestinal System

Functions:
• Digestion
• Absorption
• Elimination of waste

Liver Function:
• Synthesis of glucose, fats and amino acid
• Conjugation of bilirubin and sex hormones
• Stores Vit. A, B12, D

GASTROESOPHAGEAL REFLUX DISEASE

(GERD)
• Back flow of gastric contents secondary to incompetent esophageal
sphincter
• Clinical manifestation:
• Pyrosis ( burning sensation of the esophagus)
• Dyspepsia (indigestion)
• Regurgitation
• Dysphagia or odyynophagia ( pain in swallowing )
• Hypersalivation
• Esophagitis

NOTE: symptoms mimic those of a heart attack so patients history

plays a major role in obtaining an accurate diagnosis

Diagnostic test:
Barium swallowing
- as the patient swallows the barium suspension, it coats the
esophagus with a thin layer of barium.
- This enables the hallow structure to be imaged via x-ray
pH Probe Test
- esophageal monitoring to evaluate degree of acid reflux
DRUG OF CHOICE:
Ranitidine ( zantac )
- inhibits stomach acid (HCl) production
- H2 receptor antagonist
Antacids ( amphojel, chooz, milk of magnesia )
- neutralized or reduce the acidity of stomach
SURGERY
FUNDOPLICATION
- the gastric fundus ( upper part ) of the stomach is wrapped
around the lower end of the esophagus and stitched in place

NURSING CONSIDERATION:
- small frequent feeding and weight loss program
- limit gastric irritant ( spicy foods, acidic, etc )
- avoid smoking
- lie with head elevated
- discuss stress reduction strategies
GASTRITIS
- inflammation of the gastric mucousa
CAUSES:
1. Acute Gastritis
- food and chemical causes
( Spicy, NSAIDs, aspirin, steroids, alcohol, bile refux,
ingestion of contaminated food)
2. Chronic Gastritis
- due to H. pylori
- Cronic Type A – auto immune, ulcers, pernicious anemia, anal
cancer
- Chronic Type B – due to H.pylori ( G (-), microaerophillic
bacterium )
DRUG OF CHOICE
• H2 Receptor Antagonist
o Cimetidine ( Tagamet)
o Inhibits stomach acid (HCl) production
o NOTE: Do not give too fast it causes Bradycardia
• Antacids
- Chooz, amphojel, milk of magnesia
- Simethicone ( Maalox ) - given frequently due to short duration
of action
- Neutralized or reduce acidity of stomach
- Goal is to maintain gastric pH level @ 3.0-3.5
- Give with H2O
- Do not give with ranitidine
• Proton Pump Inhibitors
o Omeprazole ( omepron ), Esomeprazole (nexium)
o They block the final step in the production of gastric acid by the
“acid secreting cells” in the gastric mucousa
• Cytoprotective Agentrs or Anti Aeptic Agents
- bismuth subsalicylate, sucralfate,misoprostol
- help protect the tissues that line the stomach and small
intestines
• penicillin
o -amoxicillin (amox)
o inhibits synthesis of bacterial cell wall
• Tetracycline
- doxycycline, tetracycline
- inhibit protein synthesis by binding to chromosomes leading to
inability of bacteria to multiply
• Anti protozoal
- metronidazole (Flagyl)
- it is selectively absorbed by anaerobic bacteria and sensitive to
protozoa. Once taken up by anaerobes, it is non-enzymatically
reduced by reacting with reduced ferredoxin. This reduction
causes the production of toxic products to anaerobic cells, and
allows for selective accumulation in anaerobes
 taken up into bacterial DNA and form unstable molecules. And
-
since because this reduction usually happens to anaerobic cells,
I t has relatively little effect upon human cells or aerobic
bacterias
NURSING CONSIDERATION
- monitor for GI Bleeding

PEPTIC ULCER DISEASE

• An erosion of the mucus membrane of the stomach or duodenum
CAUSES:
• Excessive acid production
• Decreased mucus production
DIAGNOSTIC TEST
• Blood serum
• Endoscopy – visualization of stomach
• Barium studies
• Stool exam –presence of blood indicates bleeding
CARDINAL SIGNS:
• Pyrosis ( or heart burn )
• Hematamesis (vomiting of blood)
• Melena (blood in stool)
DRUGS:
• H2 receptor antagonist
• Antacids
• Proton pump inhibitors
SURGERY:
• Antrectomy
- removal of lower 50 % of stomach
- Billroth 1 (gastro duodenal)
- Billroth 2 (gastro jejunal)
Nursing Considerations:
• Avoid anything that increased HCl production

Table of comparison of Gastric Ulcer and

Duodenal Ulcer

GASTRIC ULCER DUODENAL ULCER

PAIN 30 mins. – 1 hr after 2-3 hours

eating
RELIEF Not by food By food
 BLEEDING common Not common

PERFORATION Not common common

Ca CELLS Occasional rare

PHYSICAL FEATURES Weight loss Weight gain due to

increased food intake

SLEEP Doesn’t wake up Wakes up at midnight

APPENDICITIS
- Obstruction of the vermiform appendix leading to inflammation,
gangrene, perforation and peritonitis.
AT RISK:
• Fecal impaction
• Parasites
• Infection

CARDINAL SIGNS
Right lower quadrant pain ( mc Burney’s area)
Rebound tenderness
SURGERY:
• Appendectomy
• Exploratory laparotomy (if ruptured)
Alvorado’s scoring system for diagnosis of appendicitis
“MANTRELS”
Migratory pain (1)
Anorexia (2)
Nausea (1)
Tenderness (2)
Rebound tenderness (1)
Elevated temp. (1)
Leucocytosis (2)
Shift to left (pain) (1)

SCORE DEFINITION
3.4 no AP
5.6 doubtful
7.9 confirmed AP

NURSING CONSIDERATION
• Avoid W.E.L – may cause rupture of V.A
W arm compress
Enema
Laxatives
• Provide comfort
o side lying position
o if ruptured, semi fowler’s to prevent peritonitis
 • Do not give pain meds cause it may mask the symptom

DIVERTICULAR DISEASE
- Outpouching or herniation of the intestinal mucousa through weakness of
muscle layers in the colon wall.

CAUSE:
- Dietary deficiency of fiber
RISK FACTORS:
- Elderly
- Constipation
- IBD
- Obesity

Gallbladder Pancreas
Liver

R Pain L pain

Appendicitis (intestine)
Diverticulitis

DRUGS OF CHOICE
Laxatives
- methyl cellulose
- propantheline bromide ( pro-banthine )
– anti muscorinic agent used for treatment of excessive
sweating, cramps & spasms of stomach, intestines.
Involuntary urination
– Givem @ HS & 30 mins before meal
 - bulk forming laxatives

NURSING CONSIDERATION
• Hydration
• Assess stool characteristic
• High dietary roughage
• Avoid valsalva maneuver

CHRONIC INFLAMMATORY BOWEL DISEASE (CIBD)

2 TYPES:
1. Ulcerative colitis
2. Chron’s disease or regional enteritis

CHRON’S DISEASE
• Patchy lesion in GI tract, decending ( from ileum to rectum) resulting to
excessive diarrhea, FIE imbalance, dehydration and fistula
• Develops slowly with remissions and exacerbations from emotional
factors in family and work
• Cobblestoning of mucousa
CARDINAL SIGNS
• 3-5 semisolid, foul smelling stools/day ( with mucus and pus); RLQ pain
DRUGS:
• Steroids
Corticosteroids ( hydrocortisone, betametasone, prednisone)
Decreased inflammation
• NSAIDs
Salicylates
Decreased inflammation
• Immuno modulators
Azathioprine, methotrexate, natalizumab
Decreased WBC activity
• Sulfonamides
Sulfasalazine (azulfidine)
Blocks PABA to prevent synthesis of folic acid
CHRON’S DISEASE (MORPHOLOGY AND SYMPTOMS)
Cobblestones
High temp
Reduced lumen
Intestinal lumen
Skip lesions
Transmural (all layers may ulcerate)
Malabsorption
Abdominal pain
Submucosal fibrosis

ULCERATIVE COLITIS
• Inflammatory continous lesions in GI tract, ascending (anorectal to
descending colon) leading to intestinal obstruction, malabsorption and
dehydration
• With pseudopolyps in mucousa
RISK FACTOR:
• Genetic
• Stress
• Autoimmune
• 10 – 40 y/o
DIAGNOSTIC TEST
• CBC
• Sigmoidoscopy
CARDINAL SIGNS
• Chronic
• Bloody mucoidal diarrhea

DRUGS:
• Sulfasalazine
• Anti protozoal (metronidazole)
NURSING CONSIDERATION:
• Bulk free diet
• Monitor s/s of dehydration
• Monitor I & O
• Pshychologic support
ULCERATIVE COLITIS : definition of a severe attack
Anemia ( less than 10 g/dl)
Stool frequency (greater than 6 stool/day)
Temperature (above 37.5 oC)
Albumin ( below 30 g/l)
Tachycardia (above 90 bpm)
ESR (above mm/hr)

ULCERATIVE CHRON’S

SITE Recto-sigmoid area Terminal, ileum,

ceccum, ascending
colon
TYPE OF LESION Ascending lesion Skipping lesion

DIARRHEA Prone Little

BLEEDING Prone Little

FISTULA Not common Common

PERIANAL Not common Common

INVOLVEMENT
 RECTAL 100% 20 %

SURGERY:
• Ileostomy / colonoscopy
- if stoma site is dusky, blood supply has been interrupted

CHOLECYSTITIS
- Cholesterol and calcium precipitate as solid crystals with in mucous lining of
gallbladder obstruction cystic duct.
RISK FACTORS:
• 4 F ( female, fat, 40 y/o, fertile)
• High fat diet
• Aging
• Genetics
• Cirrhosis
• Chron’s
• Sickle cell anemia
• Rapid wt. loss
• DM
• Obesity
• Oral contraceptives
DIAGNOSTIC TEST
• Cholangiography
-imaging of the bile duct by x-rays
• Serum bilirubin
o an increase indicates disease
• Alkaline Phosphatase
Normal range of 20 – 14 iu/L
High ALP indicates bile ducts are blocked
CARDINAL SIGNS
• RUQ pain (may radiate to subscapular area)
• Nausea and vomiting
• Intolerance to fat
• Clay colored stool
DRUGS
• Opioids agonists or opioid analgesics
o Meperidine (Demerol)
o Reduce pain binding to opiate receptor sites in the PNS and CNS
o Do not give with MAO inhibitors
• Bile acid sequestrants
Ursodeoxycholic Acid (actigall)
Reduces cholesterol absorption and is used to dissolve gallstones
Cholestyramine (questran)
Binds to bile acids to form an insoluble substance that cannot be
absorbed by the intestine
CHARCOT’S TRIAD
• Fever
• Epigastric RUQ pain
• Emesis and nausea
Murphy’s sign- upon inspiration palpate RUQ and if it painful, pt can’t
continue inspiration.

NURSING CONSIDERATION
• Avoid high fat diet

PANCREATITIS
- injured or disrupted pancreas leaks phospholipase H, lipase,
elastase and trypsin initiating auto digestion resulting to edema,
vascular damage, hemorrhage and necrosis or replacement of
fibrous tissue.

CAUSES: TREATMENT:
Gallstones Monitor V/S
Ethanol
Analgesia/antibiotics
Trauma Calcium
gluconate ( if necessary)
Steroids H2 receptor
antagonist
Mumps IV access/ IV
fluids
Autoimmune NPO
Scorpion/snake bite Empty Gastric
contents
Hyperlipidemia Surgery (if
necessary)
ERCP – Endoscopic retrograde Chologiopancreatography
- combines endoscopy and fluoroscopy
Drugs