Gastrointestinal system

 It has the task for retrieving and supplying essential nutrients for the physiologic function of the
body. It also has the impact on how a person is able to function on a daily basis.

Assessment for history of the patient

 Include food and fluids intake for a certain amount of time as well as recent stressful events or
activities. Past medical history or diagnosis focused on the GI tract as well as stool exams for
laboratory assessment.

Gastritis

 Inflammation of the Gastric mucosa and common in population with more men affected than
women. Not very harmful and maybe acute or chronic.
 Acute Gastritis last a few hours to a few days and may result as a catalyst to other opportunistic
infections that may arise.
 Chronic Gastritis are repeated exposures to the irritating agents and may progress to being
benign or malignant with H. pylori bacteria being a common factor in the case of it being chronic
 Treatment include assessing for cause of underlying condition and providing anti-bacterial
therapy if certain infectious bacteria is present or providing surgery needed for ulcers present
which causes gastritis

Peptic Ulcers

 Is the erosion of the mucous membranes and forms and excavation in certain areas of the
stomach
 H. Pylori has been linked to a large percentage of cases with PUD and should be the focus of
treatment to reduce bacterial infections in the stomach.
 Stool exams as well as endoscopy are able to help in the diagnosis of PUD and able to improve
treatment for patients.

Zollinger Ellison Syndrome

 Gastrinomas that are usually malignant and where H. Pylori is not a risk factor.

Stress Ulcer
  Acute mucosal ulceration of duodenal or gastric area which is primarily triggered by stressful
events which can decrease mucosal blood flow and result in reflux of duodenal contents where
ulceration occurs
 Two main types of stress ulcers are Cushings and Curlings stress ulcer
 Cushings ulcer progresses from head and brain trauma and is deeper in ulceration compared to
Curlings ulcer where primarily happens after burns and observed for 72 hours
 Promote stomach rest and continue pharmacologic therapy for underlying conditions

Food as a causative factor to gastric pain

 Gastric- Does Not Help Sometimes Worsen

 Duodenal- Relieves Pain

Surgical Management for Gastric Disorders

 Pyloroplasty A surgical procedure in which a longitudinal incision is made into the pylorus and
transversely sutured closed to enlarge the outlet and improve digestive mechanisms
 Billroth 1 which involves the removal of the lower portion of the stomach and anastomosed to
the duodenum
 Billroth 2 involves removal of the lower portion of the stomach and anastomosed to the jejunum

Nursing Responsibilities

 Main positive feelings regarding improvement for outcome of patient

 Explain all possible procedures and treatments as well as questions asked by the patient
 Procure relaxation methods for irritated clients.

Complications for Gastric disorders

 Massive Hemorrhage within stomach, colon and rectal areas

 Scarring of gastric tissue which can lead to pain and vomiting of patients
 Hypovolemia and Increased occurrence in stools and reduction of optimal absorption of the
intestines.
Intestinal Disorders

Constipation

 A subjective illness where a patients elimination pattern is not consistent and what he/she may
believe to be normal is poorly understood
 Where mechanisms for elimination which are mucosal transport, myoelectric activity, and
defecation are blocked to eliminate and are not able to activate the stimulation of the inhibitory
recto-anal reflex, relaxation of the internal sphincter muscle, then external sphincter muscle
&muscles in the pelvic region.
 Common complications from constipation include Hypertension, Fecal impaction, Hemorrhoids,
fissures, and megacolon.
 Pharmacologic and dietary therapy are primary treatments for constipation with unprocessed
bran being consumed to improve gastric outcome and laxatives, stimulants and fecal softeners
being used to aid the process of defecation.
 Instruct on bowel routine, exercise and proper position in defecating to maximize use of
muscles.

Diarrhea

 An illness being associated with Usually associated with urgency, perianal discomfort,
incontinence, or a combination of these factors Any condition that causes increased intestinal
secretions, decreased mucosal absorption, or altered motility can produce diarrhea.
 Includes IBS, IBD, Crohns disease, Secratory Diarrhea, and Osmotic Diarrhea
 Manifestations include borborygmus sounds in gastric area and painful straining to eliminate
 Promotion of healing includes proper fluid intake and avoidance of irritating foods and intake of
pharmacologic therapy

Appendicitis

 Appendix inefficiently empties as well as it is prone to obstruction and leads to common

infections where it becomes inflamed and localizes pain to the lower quadrant.
 Diagnostic procedures include IAPP with rebound tenderness a major sign as well as multiple
Palpation procedures (Rovsings, Psoas, Obturator)
  Immediate surgical intervention is necessary or may lead to bursting of the appendix where the
patient will report for absence of pain in the area which can lead to septic shock as well as
hemorrhage.
 Nursing managements include relieving pain, proper fluid control, and maintain skin integrity of
patient.

Diverticular disease

 Areas in the lining of the bowel are sac-like herniations that extend from a defect in the muscle
layer.
 Bowel contents can seep into perforations and accumulate leading to inflammation, obstruction
and infection which can result into hemorrhage.
 Chronic constipation as a causative factor is a predecessor to the development if diverticulosis
and leads to pain in lower left quadrant which left untreated lead to septicemia.
 Illness can be treated with diet and pharmacologic therapy as well as exercise program and if
illness progresses which needs to be intervened surgically. (Hartmann procedure)

Herniations

 Is protrusion of an organ, tissue or structure through the cavity where it is supposed to be

contained.
 Common areas include Umbilical Hernia (obese women and children), Direct and indirect
inguinal hernia, and incisional hernia.
 Severity of hernias are classified by Reducible (can be placed back into abdominal cavity),
Irreducible (cannot be moved back into abdomen), Incarcerated (irreducible in which the
intestinal flow is completely obstructed), Strangulated (irreducible in which blood and
intestinal flow are obstructed; develops when the loop of intestine in the sac becomes
twisted or swollen).
 Therapeutic procedures include lifestyle changes as well as surgical management
(Herniorrhaphy) where removal of the hernial sac and contents are replaced back into the
abdomen with nursing care being focused on comfort and decreased chances of infections
Irritable Bowel Syndrome

 Is a common functional disorder of GI motility not associated with anatomic changes. It is also
known as spastic colon or irritable colon. With common causative factors on heredity, diet and
alcohol/smoking.
 Results form a functional disorder of the intestinal motility and transit time of elimination.
 Clinical manifestations include pain and tenderness as well as changes in bowel patters of the
patients and consistent with diarrhea and constipation.
 Therapeutics include pharmacologic therapy and lifestyle changes to diet and exercise

Inflammatory Bowel Disease

 Inflammatory bowel disease (IBD) is a term for two conditions (Crohn’s disease and ulcerative
colitis) that are characterized by chronic inflammation of the gastrointestinal (GI) tract.
Prolonged inflammation results in damage to the GI tract.
 Proper assessment to health history and Diagnosis are crucial in determining which course of
treatment to approach

Cronhs Disease

 can affect any part of the GI tract (from the mouth to the anus)—Most often it affects the
portion of the small intestine before the large intestine/colon.
 Damaged areas appear in patches that are next to areas of healthy tissue
 Inflammation may reach through the multiple layers of the walls of the GI tract

Ulcerative colitis

 Occurs in the large intestine (colon) and the rectum

 Damaged areas are continuous (not patchy) – usually starting at the rectum and spreading
further into the colon
 Inflammation is present only in the innermost layer of the lining of the colon

 Common symptoms for both include diarrhea, pain, hemorrhage, weight loss and fatigue
  Causative factors have been linked to an autoimmune disease and incorrectly responds to
environmental factors and lead to inflammation.

 As surgical management is applied or both with high recurrence rate of the disease.

 Crohn’s disease is treated with Partial/Complete colectomy (the colon and rectum are removed
and anus is closed) with ileostomy removal/ resection of the affected area (Kock Pouch is
constructed 45cm distal of the ileum and where stool is stored and intraabdominally drained
through a nipple valve of ileum

 Ulcerative Colitis being treated with proctocolectomy with Ileostomy

 Nursing management for both diseases include adherence to pharmacologic therapy and
enhancement of nutritional status as well as minimization of pain

Paralytic Ileus

 is the occurrence of intestinal blockage in the absence of an actual physical obstruction. This
type of blockage is caused by a malfunction in the nerves and muscles in the intestine that
impairs digestive movement.
 Causative factors include gastroenteritis, appendicitis, pancreatitis and surgical complications
can produce a variety of symptoms, such as a distended abdomen, fullness, gas, abdominal
spasms, constipation, diarrhea, nausea with or without vomiting, and foul-smelling breath.
 Treatment options include surgical placement of a tube through the stomach or nose to
alleviate the distension and remove the obstruction.