GASTROINTESTINAL TRACT

PURPOSE:
 Digest/Breakdown
 Begins in the mouth.
 Compose of teeth, muscle and tongue  Mechanical Digestion  Mastication
 Saliva  For lubrication  Ptyalin (Salivary Amylase)  Starch  Chemical digestion
CHEMICAL (Enzyme) MECHANICAL (Movement)
 HCl  Chewing
 Pepsin  Pepsinogen when combined to HCl  Tongue movement
the product is Pepsin  HCl and Pepsin’s  Churning  squeezing of stomach to move
purpose is to digest protein the food downwards
 Bile  for emulsification of fats.  Peristalsis  downward movement of food
 Amylase  Pancreatic juice further  Segmentation  dancing of stomach
digestion starch
 Lipase  Pancreatic Juice  further
digestion of fats

ESOPHAGUS STOMACH
 “Bridge”  “Pouch”
 Communicates food from mouth to stomach.  Fundus, cardia, body, pylorus
 Soft tissues  Chief cells  produce pepsinogen
 10 inches  Parietal cells  produce HCl, intrinsic Factor
( absorb Vitamin B12)

DUODENUM
JEJUNUM  Maximum absorption happens
ILEUM
 Absorb
 Excrete
A. GERD  Backflow
 Regurgitation  vomiting
 Difficulty swallowing  dysphagia
 Indigestion  Dyspepsia
 Heart Burn  pyrosis
 Hypersalivation

 DIAGNOSIS
 Upper endoscopy  Esophagogastroduodenoscopy
 To visualize the esophagus
 Local Anesthesia/ Sedation( to prevent gagging) + Atropine (to decrease GI activity and decrease
salivation/secretion to prevent aspiration)
 NPO for 6-8 hours
 Monitor for airway patency
 NPO 1-2 hours after the procedure  sedation is still there and still no gag reflex, and when you
feed the patient right after the procedure aspiration may occur.
 Analgesic and lozenges to prevent irritation.
 INTERVENTIONS
 Small frequent feeding
 Elevate the head of the bed  by virtue of gravity to move the food downward.
 Avoid gas forming food  it increase stomach pressure and churning
 Avoid eating 2 hours before hours of sleep
 Avoid restrictive clothing
 Administration of:
 Antacids
 H2- receptor antagonist
 Proton Pump Inhibitor
 Prokinetics  Motilium
 Avoid  Pirenzepine  Anticholinergic  decreases GI activity especially peristaltic movement
 SURGERY
 Fundoplication  Fundus is folded and sewn around the LES.

B. HIATAL HERNIA  Protrusion

 Manifestation and Interventions are same as GERD.

 DIAGNOSIS
 Upper GI study
 “Barium Swallow”
 Examination of upper GI tract  barium sulfate
 NPO  midnight before procedure
 Laxatives as prescribed after procedure
 Monitor for “chalky white” substance in feces
 ACUTE CHRONIC
CAUSES CAUSES
 Alcoholism  Alcoholism
 Microorganism  H. Pylori
 NSAID’s, ASA  Ulcers
 Highly seasoned food  Autoimmune
C. GASTRITIS  Inflammation

 INTERVENTIONS
 Avoid:
 Highly seasoned food
 Spicy food
 Alcohol
 Smoking
 Caffein
 WOF
 Hemorrhagic gastritis
o Hypotension, tachycardia, tachypnea, hematemesis, melena
 Administer
 H2-receptor Antagonist
 Antacids . Pepto-Bismol “ pink bismuth”
 Antibiotics  to prevent infection.

 DIAGNOSIS
 Endoscopy
 Barium swallow
 Fecalysis
 Avoid dark colored food  it will give positive false result
 Avoid ASA  it will counteract platelet and gives negative false result.
 Send Specimen to the laboratory stat.
 Test for fecal:
o Pathogens
o Parasites
o Nitrogen
o Fat

D. PUD  Varices
 Enterochromaffin cells Histamin 2  Stimulates Parietal cells to produce HCl
 Slightly reduce HCl
 G cells  Gastrin  stimulates Parietal cells to produce HCl
 D cells  Produce somatostatin  Balance
 Vagus Nerve  Stimulates Parietal cells to produce HCl
 Proton Pump  serves as guard for the HCl to go the stomach.
 It greatly reduces HCl production
 Prostaglandin  Lines and protect the mucosa to protect the stomach from HCl
 NSAID’s Prostaglandin inhibitors
 RISK FACTORS
 Family History
 Alcohol Smoking
 NSAID’s and ASA
 Infection (H. Pylori)
 Stress

 MANIFESTATIONS
 Burning stomach pain
 Intolerance in fatty food and chocolates
 Feeling of fullness  termed as satiety
 Fever

GASTRIC DUODENAL
 Less common  HCl is the only  More common  it has more aggressions
aggressor. (amylase, lipase(pancreatic juices), biles,
chyme with HCL

 Late pain  2-4 hours
 Immediate pain  30-60 minutes
 Relieved by eating
 Relieved by sleep  or by vomiting
 Melena  more common
 Hematemesis  more common
 hematemesis
 Melena

 INTERVENTIONS
 Avoid:
 Alcohol and smoking
 NSAID’s
 Aspirin
 Chocolates/fatty foods
 Caffein
 Small frequent feeding
 Reduce stress  identify stressors
 Promote rest
 Administer medication as ordered
 H2 receptor antagonist
 Prostaglandins
 Mucosal Barrier protectants (carafate)
 Antacids
 Anticholinergic  to decrease HCl production
  Bleeding precautions
 Monitor V/S
 Monitor HemHem ( Hematocrit and Hemoglobin)
 NPO  if bleeding is present
 IVF
 Blood transfusion
 NGT  lavage
 Vasopressin  to promote vasoconstriction to lessen the bleeding.

 SURGERY
 Vagotomy  Separation of vagus nerve to the GI tract to decrease production of HCl.
 Total Gastrectomy  Total removal of stomach.
 Billroth I  Gastroduodenostomy  lower part of stomach is removed and connected to
duodenum
 Billroth II  gastrojejunostomy  lower part of stomach is removed and connected to jejunum
 Pyloroplasty  widening of Pyloric sphincter.
 POST-OP INTERVENTIONS
o NPO 1-3 days depending on peristalsis.
o Advance from NPO to sips of water.
o Monitor for electrolyte imbalances.
o Administer IVF and electrolytes as ordered.
o Administer TPN as ordered.

 DUMPING’S SYNDROME
 Increased gastric motility.
 Increased peristalsis.
 Hyperactive bowel sounds
 Diarrhea
 Abdominal cramping
 Palpitations and tachycardia
 Diaphoresis and dizziness

 GOAL  Delay Gastric emptying

o Low fiber/residue diet
o Fluids after meals (PC  post cebum)
o Lie flat on bed after meal
o Antipasmodics to delay gastric emptying

E. VITAMIN B12 DEFICIENCY

 Due to lack of Intrinsic factor from the parietal cells.
 Lack of intrinsic also leads to pernicious anemia.
 Weight loss
 Severe pallor
 Red beefy tongue
 Paresthesia of hands and feet
 Fatigue
 Increase Vitamin B12 in the diet (citrus fruit, organ meat, GLV)
 Vitamin B12 injectables  if total gastrectomy
  SAMPLE MEDICATIONS
 Antacids
 Pepto Bismol
 Na Bicarbonate
 Milk of magnesia
 PPI  -prazole
 H2 receptor antagonist  -tidine
 NSAID’s  not allowed to give
 Diclofenac
 Aspirin
 Naproxen
 Celecoxib
 Eterocoxib

F. INFLAMMATORY BOWEL DISEASE

 Chronic Inflammation of the colon.

 Ulceration may occur.
 Risk Factors:
 Smoking
 Microorganisms
 Stress
 Cytokines  autoimmune  kills the cells that has been infected.
 MANIFESTATIONS
 Abdominal pain
 Abdominal cramping
 Vomiting
 Diarrhea
 Weight loss
 Bleeding
 Fever

ULCERATIVE COLITIS CROHN’S

 Sigmoid, rectum  Cecum, Ileum
 Distal to proximal  Proximal to distal
 Continuous  Patchy
 Superficial  Transmural
 Male and female  More on females
 15-40 y/o  15-40 y/o
 Bleeding  Bleeding and abscess
 Cancer  Cancer  higher chance
  DIAGNOSIS
 “Scopy”
 Anoscopy  Rigid scope to visualize the anal area.
 Protoscopy  Flexible scope to visualize the rectum.
 Sigmoidoscopy  Flexible scope to visualize the sigmoid area.
 Colonoscopy  Flexible scope to visualize the entire colon.
 Biopsies and polypectomies may be performed.
 Enemas are given until returns are clear.
 Left side lying  best position.
 For colonoscopy, put client on NPO midnight before the procedure.

 INTERVENTIONS
 Acute phase  Maintain NPO  administer IVF and electrolytes.
 After acute phase, process diet from liquid to low residue.
 Increase protein in the diet to increase healing process in the colon.
 Avoid gas forming foods.
 Avoid smoking.
 Administer medications:
 Immunosuppressants
 Corticosteroids

 SURGERY
 Total Protocolectomy  Permanent ileostomy
 Koch’s Ileostomy 

G. APPENDICITIS
 Inflammation of the appendix.
 Rupture may occur.
 Pain  RLQ
 Pain intensifies in McBurney’s point. 

 Rebound Tenderness  when you put pressure there is no pain, and when you release the pressure pain will occur.
 Rovsing’s sign  When you put pressure on left side pain will occur in right side.
 Psoa’s sign  When you lift the right leg and apply a bit of pressure on knee while lifting pain will occur.
 Obturator’s sign  Right leg will be positioned 90 degrees. Knees will the turn inward will the foot is rotated out

  Vomiting
 Fever
 Abdominal Tenderness
 Board-like/rigid abdomen.
 NPO status
 IVF as ordered
 Semi-fowler’s  No high fowlers because it can increase pressure.
 Avoid heat application  it can lead to vasodilation blood will gush and can increase pressure that can lead to
pressure.
 Avoid laxatives.
 Avoid enemas.
 Apply ice.
 WOF: Rupture  Abdominal tenderness, board-like/rigid abdomen, high grade fever.
 SURGERY  Appendectomy.

H. DIVERTICULAR DISEASE
 Outpouching of the colon.

False Diverticula True Diverticula

 Can occur in any part of the colon.

 Common in the sigmoid area.
 Diverticulum  1 out pouch
 Diverticula  Plural
 Diverticulosis  presence of diverticula without symptoms.
 Diverticular disease  presence of diverticula with or without symptoms.  an umbrella term.

 MANIFESTATIONS
 Asymptomatic at first.
 Painful diverticular disease
 Pain at the lower ileac fossa.
 Co-exist with IBD
 Bleeding diverticular disease  Dark blood in feces
 Diverticulitis
 Acute ileac pain
 Tachycardia
 Fever.
 PATHOPHYSIOLOGY

 INTERVENTIONS
 NPO or clear liquids as ordered.
 As diet resumes, avoid fiber rich food.
 Introduce fiber once inflammation is resolved.
 Increase OFI.
 Avoid gas forming foods.
 Avoid lifting, straining, coughing, bending.
 Administer medications as ordered:
 Antibiotics
 Analgesics
 Anticholinergics

 Surgery:
 Colon resection
 Anastomosis
 Colostomy

 Hepatobiliary Tree:
 Liver
 Largest gland.
 Stores and filters blood
 Kopffer’s cells.
 Produces albumin  maintains oncotic pressure
 Produces bile.
 Gallbladder
 Stores bile  around 500-1000/day

 Pancreas
 Endocrine Gland  ductless  direct to the blood
 Exocrine Gland  with ducts
  Cholecystokinin
 Contracts the gallbladder.
 Opens the Sphincter of Oddi.

Bile problem

Fats in the stool

 ERCP  Endoscopic retrograde cholagiopancreatography

 NPO 8 hours prior to procedure
 Sedation
 After procedure, WOF return of gag
 WOF perforation

I. LIVER CIRRHOSIS
 Degeneration of hepatocytes
 Hepatotoxicity
 Viral exposure
Post-necrotic Cirrhosis
 Obstruction of ducts  Biliary cirrhosis  If the common bile duct is obstructed, bile and bilirubin will backflow
to the liver and it will destroy the liver.
 Congestive heart failure  Cardiac Cirrhosis  if the heart is congested it can’t accommodate the blood.
Therefore, blood is going to accumulate in the inferior vena cava, liver then stops the circulation that can lead to
decrease tissue perfusion and liver will further damage.
 Alcohol induced  Laennec’s Cirrhosis more common
 “Cirrhosis cause scarring that increases pressure in the liver.”

 MANIFESTATION
 Anorexia
 Generalized edema
 Malnutrition
 Steatorrhea
 Abdominal pain
 Bleeding tendencies
 Increased susceptibility to infection.
 Hepatobiliary problem
 Jaundice
 Clay colored stools
 Dark & foamy urine
 Pruritus
 Splenomegaly
 Esophageal Varices
o Painless hematemesis
o Melena
o Signs of shock
  Hemorrhoids
o Hematochezia  fresh blood in the anus
o Rectal Pain
o Rectal Itching
 Ascites
o Abdominal distension
 Hepatorenal Syndrome
o Edema
o Swelling of the hands
o Swelling of the ankles and feet
 Spider Angiomas  spider like in the abdomen.
 Hepatic encephalopathy  occur due to accumulation of ammonia.
o Loss of memory
o Confusion
o Asterixis  flapping hand tremors.

 INTERVENTIONS
 Semi-fowler’s position.
 High protein if no encephalopathy  Protein in a good source of ammonia.
This prevents protein caloric malnutrition (PCM) and tissue wasting.
Restrict fluids if patient has hepatic encephalopathy and ascites.
 Low sodium and fluid intake as ordered.
 Administer diuretics for ascites and edema.
 WOF signs of bleeding.
 Administer vitamin K as ordered.
 WOF for hepatic encephalopathy
 Administer neomycin and metronidazole  prevent protein synthesis in bacteria.
 Administer Lactulose to decrease pH and ammonia in GIT.
 Avoid opioids, sedatives and barbiturates  these drugs are hepatotoxic.
 Prepare the client for paracentesis.
o Ensure empty bladder before the procedure to prevent accidental puncture of the bladder.

 WOF for esophageal varices

 Apply pressure by inserting Sengstaken Blakemore tube.
o Pair of scissors should be available in bedside in case the tube dislodge.
 WOF for Hemorrhoids
 Hot sitz bath.

J. CHOLECYSTITIS
 Inflammation of the gallbladder
 Acute cholecystitis  Formation of gallstones.
 Chronic cholecystitis  Fibrosis in gallbladder walls.
 Acalculous cholecystitis  Absence of gallstones due to viral infections.
 TERMS
 Inflammation  Cholecystitis
 Formation of stones  Cholelithiasis
 Removal of gallbladder  Cholecystectomy
 Removal of gallstones  Choledocholithotomy

 DIAGNOSTIC:
 Cholecystography
 Used only for the detection of cholelithiasis.
 Asses for allergies.
 Eat fatty foods the night before the procedure.
 NPO midnight before the procedure.
  Inform the client that dysuria is normal after the procedure.

 MANIFESTATIONS:
 Indigestion
 Frequent belching.
 Flatulence
 Nausea and vomiting
 Pain  RUQ  radiate in right shoulder and right scapula.
 Tachycardia due to pain.
 Mass palpated in the RUQ.
 Murphy’s sign  Pressing the RUQ and instruct the patient to breathe deeply.
 Inability to deep breathe deeply while pressing the RUQ is a (+) Murphy’s sign.
 Elevated temperature
 Hepatobiliary problem
 Jaundice
 Dark foamy urine
 Clay colored stools
 Pruritus

 INTEVENTIONS
 NPO  If nausea and vomiting is present  If no Nausea and vomiting low fat and avoid gas forming
food.
 Administer antiemetics as ordered for vomiting.
 Administer anticholinergic to slow down GI activity.
 Administer analgesics as ordered.

 Surgery
 Cholecystectomy
o T-tube  Connected to the site where the gallbladder is removed.
 Should be clamped 2-4 hours after eating in order for the bile to go to the
duodenum once the sphincter of oddi opens.
 Choledocholithotomy
 POST-OP:
o Administer anti-emetic as ordered.
o Administer analgesic as ordered.
o Splint the abdomen when coughing/sneezing.
o Monito drainage from T-tube
 Semi-fowler’s
 Drainage bag is lower.
 Monitor drainage.
 WOF for bleeding.
 WOF for purulent drainage.
 Clamp and unclamp as ordered.

K. PANCREATITIS
 Inflammation of the pancreas.
 Scar tissue replaces normal tissues.
 Causes:
 Stones
 Trauma
 Bacterial infection
 Viral infection
 Alcohol abuse
 MANIFESTATIONS
 Pain  radiates in mid-epigastric region to LUQ to the back.
 Pain aggravated by fatty meal.
 Abdominal guarding.
 Weight loss.
 (+) Cullen’s  bluish discoloration in umbilical area.
 (+) Turner’s  Bluish discoloration in the flank area.
 Significant increase in:
 Amylase
 Lipase Serum  in the blood.

 INTERVENTIONS
 NPO  unconditional
 IVF as ordered.
 Administer analgesics as ordered.
 Administer anticholinergic as ordered to decrease the contractility of the pancreas.
 Avoid alcohol.
 Note that chronic pancreatitis may have sign and symptoms of DM  3 P’s  Polyuria, Polyphagia,
polydipsia.