GASTROINTESTINAL SYSTEM

Jayvee Eduardson A. Avisa, RN

GASTROINTESTINAL SYSTEM
The gastrointestinal tract is a muscular tube lined by a special layer of cells, called
epithelium. The contents of the tube are considered external to the body and are in continuity
with the outside world at the mouth and anus. Although each section of the tract has specialized
functions, the entire tract has a similar basic structure with regional variations.

The primary purpose of the gastrointestinal tract is to break food down into nutrients,
which can be absorbed into the body to provide energy. First, food must be ingested into the
mouth to be mechanically processed and moistened. Secondly, digestion occurs mainly in the
stomach and small intestine where proteins, fats, and carbohydrates are chemically broken down
into their basic building blocks. Smaller molecules are then absorbed across the epithelium of the
small intestine and subsequently enter the circulation. The large intestine plays a key role in
reabsorbing excess water. Finally, undigested material and secreted waste products are excreted
from the body via defecation.

ASSESSMENT OF CLIENT WITH GASTROINTESTINAL DISORDERS

1. History
A. Demographic data, religion, personal and family history
a. general health status
b. previous GI disorders and surgery
c. change in bowel habits
d. any medications taken routinely
e. long term use of laxatives
f. family history of GI disorders

B. Diet history
a. usual foods and fluids that are typically consumed
b. quality and quantity of food ingested
c. relationship of food intake and GI symptoms
d. usual and current appetite
e. symptoms such as nausea and vomiting, difficulty swallowing

C. Chief complaint
Ask for onset, duration, quality, characteristics, severity, location, precipitating
factors, relieving factors, associated symptoms

D. Medical History
a. major illnesses and hospitalization
b. use of medications
c. allergies to foods and other substances
 E. Family history
a. history of cancer, ulcers, colitis, hepatitis, obesity

2. Physical Examination
Assess with this sequence: Inspection, Auscultation, Percussion, and Palpation

DIAGNOSTIC TESTS

1. Carcinoembryonic Antigen (CEA)

- positive in colorectal cancer

2. Guaiac Stool Examination

- done to detect GI bleeding.
- avoid foods such as red meats, turnips, horseradish, cauliflower, broccoli, poultry,
melon, and vitamin C.

3. Gastric Analysis
- measures secretion of HCl and pepsin.

4. Bernstein Test
- to assess if chest pain is related to gastroesophageal reflux

5. Upper GI Series or Barium Swallow

- to visualize the esophagus, stomach, duodenum, and jejunum

6. Lower GI Series or Barium Enema

- to visualize the colon

7. Computed Tomography
- uses beam of radiation to assess cross sections of the body

8. Upper Gi Endoscopy
- direct visualization of esophagus, stomach, and duodenum

9. Proctosigmoidoscopy
-internal examination of the lower large bowel, using a sigmoidoscope.

10. Colonoscopy
- an exam used to detect changes or abnormalities in the large intestine and rectum

NURSING PROCEDURES FOR GASTROINTESTINAL SYSTEM

1. Gastric and Intestinal Decompression

- removal of fluid and gas, to prevent gastric and intestinal distention. NGT and
nasoenteric tubes are used for gastric and intestinal decompression.
2. Esophageal Balloon Tamponade
- done to control bleeding of ruptured esophageal varices in client with liver cirrhosis

3. Enteral Feeding
- NGT feeding, Gastrostomy feeding, Total Parenteral Nutrition

4. Enema
- to relieve constipation, flatulence, administer medications, lower body temperature, and
to evacuate feces in preparation for diagnostic procedure or surgery.

ALTERATIONS OF THE GASTROINTESTINAL TRACT

1. Kwashiorkor
- inadequate protein intake with adequate calorie intake
- body weight at or above ideal weight
- edema sometimes present

2. Marasmus
- Inadequate calorie and protein intake
- cachectic appearance

3.Gastritis
-an inflammation of the gastric mucosa, classified as either acute or chronic.

Signs and Symptoms:

a. epigastric discomfort
b. abdominal tenderness
c. cramping
d. belching
e. reflux
f. severe nausea and vomiting
g. hematemesis
h. diarrhea (within 5 hours of ingestion of contaminated food)

Collaborative Management:
a. antiemetics for vomiting
b. Antacids or histamine receptor antagonists for pain
c. NPO until nausea and vomiting subside

4. Gastric Cancer
- more common among middle aged males

Signs and Symptoms:

a. progressive loss of appetite
b. gastric fullness
c. dyspepsia or indigestion
 d. positive Guaiac stool exam
e. hematemesis
f. weight loss
g. anemia
h. fatigue
i. pain induced by eating
j. palpable abdominal mass

Collaborative Management:
a. Total gastrectomy – esophagus is anastamosed to the jejunum
b. chemotherapy and radiation therapy

5. Peptic Ulcer Disease

- an impairment of the mucosa and deeper structures of the esophagus, stomach,
duodenum. The jejunum may be affected if it is surgically anastamosed to the stomach. The
cause of peptic ulcer is Helicobacter pylori infection.
- also called “poor man’s” or “laborer’s” ulcer because the stomach is usually empty.

Signs and Symptoms:

a. Pain that radiates to left side of the abdomen, experienced ½ to 2 hours after eating or
even during meals. Pain is not relieved by food intake.
b. nausea and vomiting
c. hematemesis

Collaborative Management:
a. Medications
- Antacids – to neutralize HCl
- Histamine H2 Receptor Antagonists – to reduce HCl secretions
- Cytoprotective drug – to coat the ulcers
- Prostaglandin analogue – replaces gastric prostaglandin
- Proton pump inhibitors – suppress gastric acid secretion
- Anticholinergics – reduce gastric motility
- Helicobacter pylori drug treatment
b. Surgical Interventions
- Vagotomy – resection of vagal nerves
- Pyloroplasty – surgical dilatation of the pyloric sphincter
- Billroth I – anastomosis of the gastric stump with the duodenum
- Billroth II – anastomosis of the gastric stump with the jejunum.
6. Dumping Syndrome
- group of unpleasant vasomotor and GI symptoms caused by rapid emptying of gastric
content into the jejunum. Rapid emptying of hypertonic food from the stomach causes fluid shift
from the bloodstream into the jejunum.

Early Signs and Symptoms (occurs 5-30 minutes after eating):

a. weakness
b. tachycardia
c. dizziness
d. diaphoresis
e. pallor
f. feeling of fullness or discomfort
g. nausea
h. abdominal cramps
i. diarrhea

Late Signs and Synptoms (occurs 2 to 3 hours after eating):

Initially hyperglycemia which stimulates increase insulin secretion which ultimately
leads to hypoglycemia.

Collaborative Management:
a. The client should eat in lying/recumbent position
b. Anticholinergics and Antispasmodics
c. Place the client in left side-lying position after meal
d. High-protein diet
e. Limit carbohydrates, no simple sugars
f. Avoid very hot and very cold foods and beverages

7. Gastroenteritis
- an inflammation of the stomach and intestinal tract that primarily affects the small
bowel.

Signs and Symptoms:

a. diarrhea
b. abdominal pain and cramping
c. nausea and vomiting
d. fever
e. anorexia
f. abdominal distention
g. tenesmus
h. borborygmi
i. stool tests positive for leukocytes and may contain the causative organism, mucus and
blood
8. Appendicitis
- inflammation of the vermiform appendix. The most common cause of appendicitis is
obstruction of the appendix by fecalith, foreign bodies, or infection.

Signs and Symptoms:

a. acute abdominal pain that usually starts in the epigastric or umbilical region
b. anorexia
c. nausea and vomiting
d. rigid abdomen, guarding
e. rebound tenderness (Blumberg’s sign)
f. Psoas sign
g. Obturator sign
h. Rovsing’s sign
i. Dunphy’s sign
j. fever and leukocytosis
k. decreased or absent bowel sounds

Collaborative Management:
a. bed rest
b. maintain NPO
c. cold application over the abdomen
d. IV therapy
e. Antibiotic therapy
f. Appendectomy

9. Peritonitis
- inflammation of the peritoneum caused by ruptured appendicitis, perforated peptic
ulcer, diverticulitis, PID, UTI, or trauma, bowel obstruction, and bacterial invasion.

Signs and Symptoms:

a. abdominal pain and tenderness
b. abdominal guarding and rigidity
c. abdominal distention
d. paralytic ileus
e. fever, evlevated WBC
f. nausea and vomiting

Collaborative management
a. NGT insertion
b. bed rest in semi-fowler position
c. peritoneal lavage
d. insertion of drainage tubes
e. fluids, electrolytes, and colloid replacement
f. antibiotics
g. Total Parenteral nutrition
10. Diverticulitis
- acute inflammation and infection caused by trapped fecal material and bacteria in an
outpouching of the mucosal lining of the colon.

Signs and Symptoms:

a. crampy abdominal pain in the left, lower quadrant worsens with movement, coughing
and straining.
b. chronic constipation with episodes of diarrhea
c. low grade fever
d. nausea and vomiting
e. abdominal distention and tenderness
f. occult bleeding

Collaborative Management:
a. high fiber diet
b. liberal fluid intake of 2500 to 3000 ml per day
c. avoid nuts and seeds
d. bulk-forming laxatives (Metamucil, Fiberall, Konsyl)

11. Chronic Inflammatory Bowel Disorders (CIBDs)

A. Chron’s disease
- affects ileum and ascending column

Signs and Symptoms:

a. diarrhea
b. transmural inflammation
c. stool with pus and mucus
d. fistula formation

Collaborative Management:
a. low fiber diet
b. TPN
c. Steroids
d. Azulfidine
e. Flagyl, Ciprofloxacin

B. Ulcerative Colitis
- affects the lining of the large intestine

Signs and Symptoms:

a. diarrhea
b. mucus ulceration of the intestines
c. inflammation starting at rectum
d. stool is with pus, mucus and blood
 Collaborative Management
a. low fiber diet
b. TPN
c. Hydrocortisone
d. Azulfidine
e. Ileostomy, Proctocolectomy

12. Abdominal Hernia

- protrusion of an organ or structure through a weakened abdominal muscle. It may be
congenital or acquired defect.

Types:
a. Reducible hernia – can be returned by manipulation
b. Irreducible hernia – requires surgery
c. Inguinal hernia
d. Umbilical hernia – protrusion through congenital defect in muscles
e. Femoral hernia – protrusion is through femoral canal
f. Incisional hernia – protrusion is through inadequately healed surgical repair
g. Incarcerated hernia
h. Strangulated hernia

Signs and Symptoms:

a. lump in the groin, around umbilicus, or from an old surgical incision
b. sensation of heaviness in the area, with vague discomfort
c. nausea, vomiting, distention, and pain

Collaborative Management
a. herniorrhaphy, hernioplasty

13. Hemorrhoids
- dilated blood vessels of the anal canal

Types:
a. External – below anal sphincter
b. Internal – above anal sphincter
c. Prolapsed – can become thrombosed or inflamed

Signs and Symptoms:

a. constipation
b. anal pain
c. rectal bleeding with defecation
d. anal itchiness

Collaborative management
a. high fiber diet
b. cold packs to the anal area
 c. witch hazel soaks and topical anesthesia
d. hemorrhoidectomy, sclerotherapy, Cryosurgery, Endoscopic rubber band ligation

14. Intussusception
- telescoping of one portion of bowel into another portion which results in an obstruction
to the passage of intestinal contents.

Signs and Symptoms:

a. currant jelly stools
b. colicky abdominal pain
c. vomiting of gastric contents
d. bile-stained fecal emesis
e. hypoactive or hyperactive bowel sounds
f. palpable sausage-shaped mass

Collaborative Management:
a. monitor signs of perforation and shock
b. Barium enema as prescribed
c. Antibiotics
d. IV therapy
e. decompression via NGT