gastrointestinal system

Medical Surgical Medical Surgical NursingNursing

The GASTRO-INTESTINAL The GASTRO-INTESTINAL SystemSystem

Nurse Licensure Examination Nurse Licensure Examination ReviewReview

The Gastro-Intestinal The Gastro-Intestinal SystemSystem

Review of the GIT Anatomy and Review of the GIT Anatomy and PhysiologyPhysiology

Review of Common laboratory Review of Common laboratory proceduresprocedures

Review of Common Symptoms and Review of Common Symptoms and their nursing interventionstheir nursing interventions

Review of common disorders of the:Review of common disorders of the: EsophagusEsophagus -gallbladder-gallbladder StomachStomach -exocrine pancreas-exocrine pancreas Small intestineSmall intestine -liver-liver Large IntestineLarge Intestine

The GIT System: Anatomy and The GIT System: Anatomy and PhysiologyPhysiology

The GIT is composed of two general The GIT is composed of two general partsparts

The main GIT starts from the The main GIT starts from the mouthmouthEsophagusEsophagusStomachStomachSISILILI

The accessory organs are the The accessory organs are the Salivary glandsSalivary glands LiverLiver GallbladderGallbladder PancreasPancreas

The GIT ANATOMYThe GIT ANATOMY

The MouthThe Mouth Contains the lips, cheeks, palate, Contains the lips, cheeks, palate,

tongue, teeth, salivary glands, tongue, teeth, salivary glands, masticatory/facial muscles and masticatory/facial muscles and bonesbones

Anteriorly bounded by the lipsAnteriorly bounded by the lips Posteriorly bounded by the Posteriorly bounded by the

oropharynxoropharynx

The GIT PhysiologyThe GIT Physiology

The MouthThe Mouth Important for the mechanical Important for the mechanical

digestion of fooddigestion of food The saliva contains SALIVARY The saliva contains SALIVARY

AMYLASE or PTYALIN that starts AMYLASE or PTYALIN that starts the INITIAL digestion of the INITIAL digestion of carbohydrates carbohydrates


The EsophagusThe Esophagus A hollow collapsible tubeA hollow collapsible tube Length- 10 inchesLength- 10 inches Made up of stratified Made up of stratified

squamos epitheliumsquamos epithelium


The EsophagusThe Esophagus The upper third contains The upper third contains

skeletal musclesskeletal muscles The middle third contains mixed The middle third contains mixed

skeletal and smooth musclesskeletal and smooth muscles The lower third contains smooth The lower third contains smooth

muscles and the esophago-muscles and the esophago-gastric/ cardiac sphincter is gastric/ cardiac sphincter is found herefound here

The GIT PHYSIOLOGYThe GIT PHYSIOLOGY

The EsophagusThe Esophagus Functions to carry or propel Functions to carry or propel

foods from the oropharynx to the foods from the oropharynx to the stomachstomach

Swallowing or deglutition is Swallowing or deglutition is composed of three phases:composed of three phases:


The stomachThe stomach J-shaped organ in the epigastriumJ-shaped organ in the epigastrium Contains four parts- the fundus, the Contains four parts- the fundus, the

cardia, the body and the pyloruscardia, the body and the pylorus The cardiac sphincter prevents the The cardiac sphincter prevents the

reflux of the contents into the reflux of the contents into the esophagusesophagus

The pyloric sphincter regulates the The pyloric sphincter regulates the rate of gastric emptying into the rate of gastric emptying into the duodenumduodenum

Capacity is 1,500 ml!Capacity is 1,500 ml!


The functions of the stomach The functions of the stomach are generally to digest the are generally to digest the food (proteins) and to propel food (proteins) and to propel the digested materials into the digested materials into the SI for final digestionthe SI for final digestion

The Glands and cells in the The Glands and cells in the stomach secrete digestive stomach secrete digestive enzymes:enzymes:


Stomach:Stomach: 1. Parietal cells- HCl acid and 1. Parietal cells- HCl acid and

Intrinsic factorIntrinsic factor 2. Chief cells- pepsin2. Chief cells- pepsin

digestion of PROTEINS!digestion of PROTEINS! 3. Antral G-cells- gastrin3. Antral G-cells- gastrin 4. Argentaffin cells- serotonin4. Argentaffin cells- serotonin 5. Mucus neck cells- mucus5. Mucus neck cells- mucus


The Small intestineThe Small intestine Grossly divided into the Grossly divided into the

Duodenum, Jejunum and IleumDuodenum, Jejunum and Ileum The duodenum contains the two The duodenum contains the two

openings for the bile and openings for the bile and pancreatic ductspancreatic ducts

The ileum is the longest part The ileum is the longest part (about 12 feet)(about 12 feet)

The GIT physiologyThe GIT physiology

The intestinal glands secrete The intestinal glands secrete digestive enzymes that finalize the digestive enzymes that finalize the digestion of all foodstuffdigestion of all foodstuff

Enzymes for carbohydratesEnzymes for carbohydrates disaccharidasesdisaccharidases

Enzymes for proteinsEnzymes for proteins dipeptidases and aminopeptidasesdipeptidases and aminopeptidases

Enzyme for lipidsEnzyme for lipids intestinal intestinal lipaselipase

The GIT ANATOMYThe GIT ANATOMYThe Large intestineThe Large intestine Approximately 5 feet long, with parts:Approximately 5 feet long, with parts: 1. The cecum1. The cecum widest diameter, prone to widest diameter, prone to

rupturerupture 2. The appendix2. The appendix 3. The ascending colon3. The ascending colon 4. The transverse colon4. The transverse colon 5. The descending colon5. The descending colon 6. The sigmoid6. The sigmoid most mobile, prone to most mobile, prone to

twistingtwisting 7. The rectum7. The rectum


Absorbs waterAbsorbs water Eliminates wastesEliminates wastes Bacteria in the colon synthesize Bacteria in the colon synthesize

Vitamin KVitamin K Appendix participates in the Appendix participates in the

immune systemimmune system


SYMPATHETICSYMPATHETIC Generally Generally

INHIBITORY!INHIBITORY! Decreased gastric Decreased gastric

secretionssecretions Decreased GIT Decreased GIT

motilitymotility

But: Increased But: Increased sphincteric tone and sphincteric tone and constriction of blood constriction of blood vesselsvessels

PARASYMPATHETICPARASYMPATHETIC Generally Generally

EXCITATORY!EXCITATORY! Increased gastric Increased gastric

secretionssecretions Increased gastric Increased gastric

motilitymotility

But: Decreased But: Decreased sphincteric tone and sphincteric tone and dilation of blood dilation of blood vesselsvessels


The LiverThe Liver The largest internal organThe largest internal organ Located in the right upper Located in the right upper

quadrantquadrant Contains two lobes- the right and Contains two lobes- the right and

the leftthe left The hepatic ducts join together The hepatic ducts join together

with the cystic duct to become the with the cystic duct to become the common bile ductcommon bile duct

The GIT Physiology: The GIT Physiology: LIVERLIVER

Functions to store excess glucose, fats Functions to store excess glucose, fats and amino acidsand amino acids

Also stores the fat soluble vitamins- A, Also stores the fat soluble vitamins- A, D and the water soluble- Vitamin B12D and the water soluble- Vitamin B12

Produces the BILE for normal fat Produces the BILE for normal fat digestiondigestion

The Von Kupffer cells remove bacteria The Von Kupffer cells remove bacteria in the portal bloodin the portal blood

Detoxifies ammonia into ureaDetoxifies ammonia into urea

The GIT anatomyThe GIT anatomy

The gallbladderThe gallbladder Located below the liver Located below the liver The cystic duct joins the hepatic The cystic duct joins the hepatic

duct to become the bile ductduct to become the bile duct The common bile duct joins the The common bile duct joins the

pancreatic duct in the sphincter pancreatic duct in the sphincter of Oddi in the first part of the of Oddi in the first part of the duodenumduodenum


Stores and concentrates bileStores and concentrates bile Contracts during the digestion of Contracts during the digestion of

fats to deliver the bilefats to deliver the bile CholecystokininCholecystokinin is released by is released by

the duodenal cells, causing the the duodenal cells, causing the contraction of the gallbladder contraction of the gallbladder and relaxation of the sphincter of and relaxation of the sphincter of OddiOddi

The GIT anatomyThe GIT anatomy

The pancreasThe pancreas A retroperitoneal glandA retroperitoneal gland Functions as an endocrine and Functions as an endocrine and

exocrine glandexocrine gland The pancreatic duct (major) joins The pancreatic duct (major) joins

the common bile duct in the the common bile duct in the sphincter of Oddisphincter of Oddi

The GIT PhysiologyThe GIT Physiology The exocrine function of the pancreas The exocrine function of the pancreas

is the secretion of digestive enzymes is the secretion of digestive enzymes for carbohydrates, fats and proteinsfor carbohydrates, fats and proteins

Pancreatic amylasePancreatic amylase carbohydrates carbohydrates Pancreatic lipase (steapsin)Pancreatic lipase (steapsin) fats fats Trypsin, Chymotrypsin and Trypsin, Chymotrypsin and

PeptidasesPeptidases proteins proteins BicarbonateBicarbonate to neutralize the acidic to neutralize the acidic

chyme. Stimulated by SECRETIN!chyme. Stimulated by SECRETIN!

Gastrointestinal Gastrointestinal AssessmentAssessmentLaboratory ProceduresLaboratory Procedures

COMMON LABORATORY COMMON LABORATORY PROCEDURESPROCEDURES

FECALYSISFECALYSIS Examination of stool Examination of stool

consistency, color and the consistency, color and the presence of occult blood.presence of occult blood.

Special tests for fat, Special tests for fat, nitrogen, parasites, ova, nitrogen, parasites, ova, pathogens and otherspathogens and others


FECALYSIS: Occult Blood FECALYSIS: Occult Blood TestingTesting

Instruct the patient to adhere Instruct the patient to adhere to a 3-day meatless dietto a 3-day meatless diet

No intake of NSAIDS, aspirin No intake of NSAIDS, aspirin and anti-coagulantand anti-coagulant

Screening test for colonic Screening test for colonic cancercancer


Upper GIT study: barium Upper GIT study: barium swallowswallow

Examines the upper GI Examines the upper GI tracttract

Barium sulfate is Barium sulfate is usually used as contrastusually used as contrast


Upper GIT study: barium Upper GIT study: barium swallowswallow

Pre-testPre-test: NPO post-midnight: NPO post-midnight Post-testPost-test: Laxative is ordered, : Laxative is ordered,

increase pt fluid intake, increase pt fluid intake, instruct that stools will turn instruct that stools will turn white, monitor for obstructionwhite, monitor for obstruction


Lower GIT study: barium Lower GIT study: barium enemaenema

Examines the lower GI tractExamines the lower GI tract Pre-testPre-test: Clear liquid diet : Clear liquid diet

and laxatives, NPO post-and laxatives, NPO post-midnight, cleansing enema midnight, cleansing enema prior to the testprior to the test


Lower GIT study: barium Lower GIT study: barium enemaenema

Post-test:Post-test: Laxative is Laxative is ordered, increase patient ordered, increase patient fluid intake, instruct that fluid intake, instruct that stools will turn white, stools will turn white, monitor for obstructionmonitor for obstruction


Gastric analysisGastric analysis Aspiration of gastric juice to Aspiration of gastric juice to

measure pH, appearance, volume measure pH, appearance, volume and contentsand contents

Pre-test:Pre-test: NPO 8 hours, avoidance NPO 8 hours, avoidance of stimulants, drugs and smokingof stimulants, drugs and smoking

Post-test:Post-test: resume normal resume normal activitiesactivities


EGDEGD(esophagogastroduodenoscopy(esophagogastroduodenoscopy))

Visualization of the upper GIT Visualization of the upper GIT by endoscopeby endoscope

Pre-testPre-test: ensure consent, NPO : ensure consent, NPO 8 hours, pre-medications like 8 hours, pre-medications like atropine and anxiolyticsatropine and anxiolytics


EGDEGDesophagogastroduodenoscoesophagogastroduodenosco

pypy Intra-test:Intra-test: position : position : LEFTLEFT

lateral to facilitate lateral to facilitate salivary drainage and easy salivary drainage and easy accessaccess


EGD EGD (esophagogastroduodenoscopy(esophagogastroduodenoscopy))

Post-testPost-test: NPO until gag reflex : NPO until gag reflex returns, place patient in returns, place patient in SIMS SIMS position until he awakensposition until he awakens, , monitor for complications, monitor for complications, saline gargles for mild oral saline gargles for mild oral discomfortdiscomfort


Lower GI- scopyLower GI- scopy Use of endoscope to Use of endoscope to

visualize the anus, rectum, visualize the anus, rectum, sigmoid and colonsigmoid and colon

Pre-test:Pre-test: consent, NPO 8 consent, NPO 8 hours, cleansing enema hours, cleansing enema until return is clearuntil return is clear


Lower GI- scopyLower GI- scopyIntra-test:Intra-test: position is position is LEFTLEFT lateral, right leg is bent lateral, right leg is bent and placed anteriorlyand placed anteriorly

Post-test:Post-test: bed rest, bed rest, monitor for complications monitor for complications like bleeding and like bleeding and perforationperforation


CholecystographyCholecystography Examination of the gallbladder Examination of the gallbladder

to detect stones, its ability to to detect stones, its ability to concentrate, store and release concentrate, store and release the bilethe bile

Pre-test:Pre-test: ensure consent, ask ensure consent, ask allergies to iodine, seafood and allergies to iodine, seafood and dyes; dyes; contrast medium is contrast medium is administered the night prioradministered the night prior, , NPO after contrast NPO after contrast administrationadministration


CholecystographyCholecystographyPost-test:Post-test: Advise that Advise that dysuria is common as dysuria is common as the dye is excreted in the dye is excreted in the urine, resume the urine, resume normal activitiesnormal activities


ParacentesisParacentesisRemoval of Removal of peritoneal fluid peritoneal fluid for analysisfor analysis


ParacentesisParacentesis

Pre-test:Pre-test: ensure ensure consent, instruct to consent, instruct to VOID and empty VOID and empty bladder, measure bladder, measure abdominal girthabdominal girth


ParacentesisParacentesisIntra-test:Intra-test: Upright Upright on the edge of the on the edge of the bed, back supported bed, back supported and feet resting on a and feet resting on a foot stoolfoot stool


Liver biopsyLiver biopsyPretestPretestConsentConsentNPONPOCheck for the bleeding Check for the bleeding parametersparameters


Liver biopsyLiver biopsy IntratestIntratest

Position: Semi fowler’s Position: Semi fowler’s LEFT lateral to expose LEFT lateral to expose right side of abdomenright side of abdomen


Liver biopsyLiver biopsyPost-testPost-test: position on : position on RIGHT RIGHT lateral with pillow lateral with pillow underneath,underneath, monitor VS and monitor VS and complications like bleeding, complications like bleeding, perforation. Instruct to avoid perforation. Instruct to avoid lifting objects for 1 weeklifting objects for 1 week

The NURSING PROCESS in The NURSING PROCESS in GIT DisordersGIT Disorders

AssessmentAssessmentHealth history Nursing Health history Nursing HistoryHistory

PEPELaboratory proceduresLaboratory procedures

The ABDOMINAL The ABDOMINAL examinationexamination

The sequence to follow The sequence to follow is:is:

InspectionInspectionAuscultationAuscultationPercussionPercussionPalpationPalpation

CONSTIPATIONCONSTIPATION

DIARRHEADIARRHEA

DUMPING SYNDROMEDUMPING SYNDROME

COMMON GIT SYMPTOMS COMMON GIT SYMPTOMS AND MANAGEMENTAND MANAGEMENT

CONSTIPATIONCONSTIPATIONAn abnormal An abnormal infrequency and infrequency and irregularity of irregularity of defecationdefecation

Multiple causationsMultiple causations


CONSTIPATION: CONSTIPATION: PathophysiologyPathophysiology

Interference with three Interference with three functions of the colonfunctions of the colon

1. Mucosal transport1. Mucosal transport 2. Myoelectric activity2. Myoelectric activity 3. Process of defecation3. Process of defecation



NURSING INTERVENTIONSNURSING INTERVENTIONS 1. Assist physician in treating the 1. Assist physician in treating the

underlying cause of constipationunderlying cause of constipation 2. Encourage to eat HIGH fiber 2. Encourage to eat HIGH fiber

diet to increase the bulkdiet to increase the bulk 3. Increase fluid intake3. Increase fluid intake 4. Administer prescribed 4. Administer prescribed

laxatives, stool softenerslaxatives, stool softeners 5. Assist in relieving stress5. Assist in relieving stress


DiarrheaDiarrhea Abnormal fluidity of the stoolAbnormal fluidity of the stool

Multiple causesMultiple causes Gastrointestinal DiseasesGastrointestinal Diseases HyperthyroidismHyperthyroidism Food poisoningFood poisoning


DiarrheaDiarrheaNursing InterventionsNursing Interventions

1. Increase fluid intake- 1. Increase fluid intake- ORESOL is the most important ORESOL is the most important treatment!treatment!2. Determine and manage the 2. Determine and manage the causecause3. Anti-diarrheal drugs3. Anti-diarrheal drugs


DUMPING SYNDROMEDUMPING SYNDROMEA condition of rapid emptying A condition of rapid emptying of the gastric contents into of the gastric contents into the small intestine usually the small intestine usually after a gastric surgery after a gastric surgery

Symptoms occur 30 minutes Symptoms occur 30 minutes after eatingafter eating


PATHOPHYSIOLOGYPATHOPHYSIOLOGYFoods high in CHO and Foods high in CHO and electrolytes must be electrolytes must be diluted in the jejunum diluted in the jejunum before absorption takes before absorption takes place.place.


PATHOPHYSIOLOGYPATHOPHYSIOLOGYThe rapid influx of The rapid influx of

stomach contents will stomach contents will cause distention of the cause distention of the

jejunumjejunum

early symptomsearly symptoms


PATHOPHYSIOLOGYPATHOPHYSIOLOGYThe hypertonic food bolusThe hypertonic food bolus

will draw fluid from the will draw fluid from the blood vessels to dilute the blood vessels to dilute the

high concentrations of CHO high concentrations of CHO and electrolytes in the food and electrolytes in the food

bolusbolus


Later, there is increased Later, there is increased blood glucoseblood glucose

stimulating the stimulating the increased secretion of increased secretion of

insulininsulin


Then, blood glucose will Then, blood glucose will fallfall

causing reactive causing reactive hypoglycemiahypoglycemia


DUMPING SYNDROMEDUMPING SYNDROME

ASSESSMENT FINDINGS: early ASSESSMENT FINDINGS: early symptomssymptoms

1. Nausea and Vomiting1. Nausea and Vomiting 2. Abdominal fullness2. Abdominal fullness 3. Abdominal cramping3. Abdominal cramping 4. Palpitation4. Palpitation 5. Diaphoresis5. Diaphoresis


DUMPING SYNDROMEDUMPING SYNDROMEASSESSMENT FINDINGS: ASSESSMENT FINDINGS: LATE symptoms: LATE symptoms:

6. Drowsiness 6. Drowsiness 7. Weakness and 7. Weakness and DizzinessDizziness

8. 8. HypoglycemiaHypoglycemia


DS NURSING INTERVENTIONSDS NURSING INTERVENTIONS 1. Advise patient to eat1. Advise patient to eat LOW- LOW-

carbohydratecarbohydrate HIGH-fat and HIGH-fat and HIGH-protein dietHIGH-protein diet

2. Instruct to eat 2. Instruct to eat SMALL SMALL frequentfrequent meals, include meals, include MORE MORE dry itemsdry items..

3. Instruct to 3. Instruct to AVOID consuming AVOID consuming FLUIDS with mealsFLUIDS with meals


DS NURSING INTERVENTIONSDS NURSING INTERVENTIONS

4. Instruct to 4. Instruct to LIE LIE DOWN after mealsDOWN after meals

5. Administer anti-5. Administer anti-spasmodic medications spasmodic medications to delay gastric to delay gastric emptyingemptying

GIT SYMPTOMS AND GIT SYMPTOMS AND MANAGEMENTMANAGEMENT

PERNICIOUS ANEMIAPERNICIOUS ANEMIA Results from Deficiency of Results from Deficiency of

vitamin B12 due to vitamin B12 due to autoimmune destruction of autoimmune destruction of the parietal cellsthe parietal cells, , lack of lack of INTRINSIC FACTORINTRINSIC FACTOR or or total removal of the stomachtotal removal of the stomach


PERNICIOUS ANEMIA PERNICIOUS ANEMIA ASSESSMENTASSESSMENT

Severe pallorSevere pallor FatigueFatigue Weight lossWeight loss SMOOTH BEEFY-RED TONGUESMOOTH BEEFY-RED TONGUE Mild jaundiceMild jaundice Paresthesia of extremitiesParesthesia of extremities Balance disturbanceBalance disturbance


NURSING NURSING INTERVENTION for INTERVENTION for Pernicious AnemiaPernicious Anemia

Lifetime injection of Lifetime injection of Vitamin B 12 weekly Vitamin B 12 weekly initially, then MONTHLYinitially, then MONTHLY

Conditions of the Conditions of the GITGIT

UPPER GI UPPER GI systemsystem

CONDITION OF THE CONDITION OF THE ESOPHAGUSESOPHAGUS

HIATAL HERNIAHIATAL HERNIA Protrusion of the esophagus Protrusion of the esophagus

into the diaphragm thru an into the diaphragm thru an openingopening

Two types- Sliding hiatal Two types- Sliding hiatal hernia hernia

( most common) and Axial ( most common) and Axial hiatal herniahiatal hernia


ASSESSMENT Findings in ASSESSMENT Findings in Hiatal herniaHiatal hernia

1. Heartburn1. Heartburn 2. Regurgitation2. Regurgitation 3. Dysphagia3. Dysphagia 4. 50%- without symptoms4. 50%- without symptoms


DIAGNOSTIC TESTDIAGNOSTIC TESTBarium swallow and Barium swallow and fluoroscopyfluoroscopy


NURSING INTERVENTIONSNURSING INTERVENTIONS 1. Provide 1. Provide small frequent feedingssmall frequent feedings 2. 2. AVOID supine positionAVOID supine position for 1 hour for 1 hour

after eatingafter eating 3. 3. Elevate the headElevate the head of the bed on 8- of the bed on 8-

inch blockinch block 4. Provide pre-op and post-op care4. Provide pre-op and post-op care


Esophageal VaricesEsophageal Varices Dilation and tortuosity of the Dilation and tortuosity of the

submucosal veins in the distal submucosal veins in the distal esophagus esophagus

ETIOLOGY: commonly caused ETIOLOGY: commonly caused by PORTAL hypertension by PORTAL hypertension secondary to liver cirrhosissecondary to liver cirrhosis

This is an Emergency condition!This is an Emergency condition!


ASSESSMENT findings for EVASSESSMENT findings for EV 1. Hematemesis1. Hematemesis 2. Melena2. Melena 3. Ascites3. Ascites 4. jaundice4. jaundice 5. hepatomegaly/splenomegaly5. hepatomegaly/splenomegaly


ASSESSMENT findings for ASSESSMENT findings for EVEV

Signs of Shock- Signs of Shock- tachycardia, hypotension, tachycardia, hypotension, tachypnea, cold clammy tachypnea, cold clammy skin, narrowed pulse skin, narrowed pulse pressurepressure


DIAGNOSTIC DIAGNOSTIC PROCEDUREPROCEDURE

EsophagoscopyEsophagoscopy


NURSING NURSING INTERVENTIONS FOR EVINTERVENTIONS FOR EV

1. Monitor VS strictly. 1. Monitor VS strictly. Note for signs of shockNote for signs of shock

2. Monitor for LOC2. Monitor for LOC3. Maintain NPO3. Maintain NPO


NURSING INTERVENTIONS FOR EVNURSING INTERVENTIONS FOR EV

4. Monitor blood 4. Monitor blood studiesstudies

5. Administer O25. Administer O26. prepare for blood 6. prepare for blood transfusiontransfusion


INTERVENTIONS FOR EVINTERVENTIONS FOR EV 7. prepare to administer 7. prepare to administer Vasopressin and Vasopressin and NitroglycerinNitroglycerin

8. Assist in NGT and 8. Assist in NGT and Sengstaken-Blakemore tube Sengstaken-Blakemore tube insertion for balloon insertion for balloon tamponade tamponade


NURSING INTERVENTIONS NURSING INTERVENTIONS FOR EVFOR EV

9. Prepare to assist in 9. Prepare to assist in surgical management:surgical management:Endoscopic sclerotherapyEndoscopic sclerotherapyVariceal ligationVariceal ligationShunt proceduresShunt procedures

Conditions of the Conditions of the StomachStomach

Gastro-esophageal refluxGastro-esophageal reflux Backflow of gastric contents into Backflow of gastric contents into

the esophagusthe esophagus Usually due to incompetent lower Usually due to incompetent lower

esophageal sphincter , pyloric esophageal sphincter , pyloric stenosis or motility disorderstenosis or motility disorder

Symptoms may mimic ANGINA or Symptoms may mimic ANGINA or MIMI


ASSESSMENT ( for GERD)ASSESSMENT ( for GERD) HeartburnHeartburn DyspepsiaDyspepsia RegurgitationRegurgitation Epigastric painEpigastric pain Difficulty swallowingDifficulty swallowing PtyalismPtyalism

Conditions of the Conditions of the StomachStomachDiagnostic testDiagnostic test

Endoscopy or barium swallowEndoscopy or barium swallow Gastric ambulatory pH analysisGastric ambulatory pH analysis

Note for the pH of the esophagus, Note for the pH of the esophagus, usually done for 24 hoursusually done for 24 hours

The pH probe is located 5 inches The pH probe is located 5 inches above the lower esophageal sphincterabove the lower esophageal sphincter

The machine registers the different The machine registers the different pH of the refluxed material into the pH of the refluxed material into the esophagusesophagus


NURSING INTERVENTIONSNURSING INTERVENTIONS 1. Instruct the patient to AVOID 1. Instruct the patient to AVOID

stimulus that increases stomach stimulus that increases stomach pressure and decreases GES pressure and decreases GES pressurepressure

2. Instruct to avoid spices, coffee, 2. Instruct to avoid spices, coffee, tobacco and carbonated drinkstobacco and carbonated drinks

3. Instruct to eat LOW-FAT, 3. Instruct to eat LOW-FAT, HIGH-FIBER dietHIGH-FIBER diet


NURSING INTERVENTIONSNURSING INTERVENTIONS4. Avoid foods and drinks 4. Avoid foods and drinks TWO hours before bedtimeTWO hours before bedtime

5. Elevate the head of the 5. Elevate the head of the bed with an approximately bed with an approximately 8-inch block8-inch block


NURSING INTERVENTIONSNURSING INTERVENTIONS6. Administer prescribed 6. Administer prescribed H2-blockers, PPI and H2-blockers, PPI and prokinetic meds like prokinetic meds like cisapride, cisapride, metochlopromidemetochlopromide

7. Advise proper weight 7. Advise proper weight reductionreduction


GASTRITISGASTRITIS Inflammation of the gastric mucosaInflammation of the gastric mucosa May be Acute or ChronicMay be Acute or Chronic Etiology: Acute- bacteria, irritating Etiology: Acute- bacteria, irritating

foods, NSAIDS, alcohol, bile and foods, NSAIDS, alcohol, bile and radiationradiation

Etiology: Chronic- Ulceration, Etiology: Chronic- Ulceration, bacteria, Autoimmune disease, diet, bacteria, Autoimmune disease, diet, alcohol, smokingalcohol, smoking


PATHOPHYSIOLOGY OF PATHOPHYSIOLOGY OF GastritisGastritis

InsultsInsults cause gastric cause gastric mucosal damagemucosal damage inflammation, hyperemia and inflammation, hyperemia and edemaedema superficial erosions superficial erosions decreased gastric secretions, decreased gastric secretions, ulcerations and bleedingulcerations and bleeding


ASSESSMENT ASSESSMENT

(Acute)(Acute) DyspepsiaDyspepsia HeadacheHeadache AnorexiaAnorexia Nausea/Nausea/

VomitingVomiting

ASSESSMENT ASSESSMENT (Chronic)(Chronic)

PyrosisPyrosis SingultusSingultus Sour taste in the Sour taste in the

mouthmouth DyspepsiaDyspepsia N/V/anorexiaN/V/anorexia Pernicious Pernicious

anemiaanemia


DIAGNOSTIC PROCEDUREDIAGNOSTIC PROCEDURE EGD- to visualize the gastric EGD- to visualize the gastric

mucosa for inflammationmucosa for inflammation Low levels of HClLow levels of HCl Biopsy to establish correct Biopsy to establish correct

diagnosis whether acute or diagnosis whether acute or chronicchronic


NURSING INTERVENTIONSNURSING INTERVENTIONS 1. Give 1. Give BLANDBLAND diet diet 2. Monitor for signs of 2. Monitor for signs of

complications like bleeding, complications like bleeding, obstruction and pernicious obstruction and pernicious anemiaanemia

3. Instruct to avoid spicy foods, 3. Instruct to avoid spicy foods, irritating foods, alcohol and irritating foods, alcohol and caffeinecaffeine


NURSING INTERVENTIONSNURSING INTERVENTIONS 4. Administer prescribed 4. Administer prescribed

medications- H2 blockers, medications- H2 blockers, antibiotics, mucosal antibiotics, mucosal protectantsprotectants

5. Inform the need for 5. Inform the need for Vitamin B12 injection if Vitamin B12 injection if deficiency is presentdeficiency is present


PEPTIC ULCER DISEASEPEPTIC ULCER DISEASE An ulceration of the gastric and An ulceration of the gastric and

duodenal liningduodenal lining May be referred as to location as May be referred as to location as

Gastric ulcer in the stomach, or Gastric ulcer in the stomach, or Duodenal ulcer in the duodenumDuodenal ulcer in the duodenum

Most common Peptic ulceration: Most common Peptic ulceration: anterior part of the upper anterior part of the upper duodenumduodenum


PATHOPHYSIOLOGY of PUDPATHOPHYSIOLOGY of PUD Disturbance in acid secretion Disturbance in acid secretion

and mucosal protectionand mucosal protection Increased acidity or decreased Increased acidity or decreased

mucosal resistancemucosal resistance erosion erosion and ulcerationand ulceration


GASTRIC ULCERGASTRIC ULCERUlceration of the Ulceration of the gastric mucosa, gastric mucosa, submucosa and submucosa and rarely the muscularisrarely the muscularis


GASTRIC ULCERGASTRIC ULCER Risk factors: Stress, smoking, Risk factors: Stress, smoking,

NSAIDS abuse, Alcohol, NSAIDS abuse, Alcohol, Helicobacter pylori infection, Helicobacter pylori infection, type A personality and History type A personality and History of gastritis of gastritis

Incidence is high in older adultsIncidence is high in older adults Acid secretion is NORMALAcid secretion is NORMAL


ASSESSMENT (Gastric Ulcer)ASSESSMENT (Gastric Ulcer) Epigastric painEpigastric pain

Characteristic: Gnawing, Characteristic: Gnawing, sharp pain in the mid-sharp pain in the mid-epigastrium 1-2 hours epigastrium 1-2 hours AFTERAFTER eating, often eating, often NOT RELIEVEDNOT RELIEVED by food intake, sometimes by food intake, sometimes AGGRAVATING the pain!AGGRAVATING the pain!


ASSESSMENT (Gastric ASSESSMENT (Gastric Ulcer)Ulcer)

Nausea Nausea Vomiting is more commonVomiting is more common HematemesisHematemesis Weight lossWeight loss


DIAGNOSTIC PROCEDURESDIAGNOSTIC PROCEDURES 1. EGD to visualize the 1. EGD to visualize the

ulcerationulceration 2. Urea breath test for H. 2. Urea breath test for H.

pylori infectionpylori infection 3. Biopsy- to rule out 3. Biopsy- to rule out

gastric cancergastric cancer


NURSING INTERVENTIONSNURSING INTERVENTIONS 1. Give BLAND diet, small 1. Give BLAND diet, small

frequent meals during the frequent meals during the active phase of the diseaseactive phase of the disease

2. Administer prescribed 2. Administer prescribed medications- H2 blockers, medications- H2 blockers, PPI, mucosal barrier PPI, mucosal barrier protectants and antacidsprotectants and antacids


NURSING INTERVENTIONSNURSING INTERVENTIONS 3. Monitor for 3. Monitor for

complications of bleeding, complications of bleeding, perforation and intractable perforation and intractable painpain

4. provide teaching about 4. provide teaching about stress reduction and stress reduction and relaxation techniquesrelaxation techniques


NURSING INTERVENTIONS NURSING INTERVENTIONS FOR BLEEDINGFOR BLEEDING

1. Maintain on NPO 1. Maintain on NPO 2. Administer IVF and 2. Administer IVF and

medicationsmedications 3. Monitor hydration status, 3. Monitor hydration status,

hematocrit and hemoglobinhematocrit and hemoglobin


NURSING INTERVENTIONS NURSING INTERVENTIONS FOR BLEEDINGFOR BLEEDING

4. Assist with SALINE 4. Assist with SALINE lavagelavage

5. Insert NGT for 5. Insert NGT for decompression and lavagedecompression and lavage


NURSING INTERVENTIONS FOR NURSING INTERVENTIONS FOR BLEEDINGBLEEDING

6. Prepare to administer blood 6. Prepare to administer blood transfusiontransfusion

7. Prepare to give VASOPRESSIN 7. Prepare to give VASOPRESSIN to induce vasoconstriction to to induce vasoconstriction to reduce bleedingreduce bleeding

8. Prepare patient for SURGERY if 8. Prepare patient for SURGERY if warrantedwarranted


SURGICAL SURGICAL PROCEDURES FOR PUDPROCEDURES FOR PUD

Total gastrectomy, Total gastrectomy, vagotomy, gastric vagotomy, gastric resection, Billroth I and resection, Billroth I and II, pyloroplastyII, pyloroplasty


SURGICAL PROCEDURES FOR PUDSURGICAL PROCEDURES FOR PUD

Post-operative Nursing managementPost-operative Nursing management 1. Monitor VS1. Monitor VS 2. Post-op position: FOWLER’S2. Post-op position: FOWLER’S 3. NPO until peristalsis returns3. NPO until peristalsis returns 4. Monitor for bowel sounds4. Monitor for bowel sounds 5. Monitor for complications of 5. Monitor for complications of

surgery surgery


Post-operative Nursing Post-operative Nursing managementmanagement

6. Monitor I and O, IVF6. Monitor I and O, IVF 7. Maintain NGT7. Maintain NGT 8. Diet progress: clear liquid8. Diet progress: clear liquid

full liquidfull liquid six bland meals six bland meals 9. Manage DUMPING 9. Manage DUMPING

SYNDROMESYNDROME

Condition of the Condition of the DuodenumDuodenum

DUODENAL ULCERDUODENAL ULCERUlceration of duodenal Ulceration of duodenal mucosa and submucosamucosa and submucosa

Usually due to Usually due to increased gastric increased gastric acidityacidity


DUODENAL ULCER DUODENAL ULCER ASSESSMENTASSESSMENT

PAIN characteristic:PAIN characteristic:Burning pain in the mid-Burning pain in the mid-epigastrium 2-4 HOURS after epigastrium 2-4 HOURS after eating or during the night, eating or during the night, RELIEVEDRELIEVED by food intake by food intake


DIAGNOSTIC TESTSDIAGNOSTIC TESTSEGD and BiopsyEGD and Biopsy


NURSING INTERVENTIONSNURSING INTERVENTIONS 1. Same as for gastric ulceration1. Same as for gastric ulceration 2. Patient teaching-avoid alcohol, 2. Patient teaching-avoid alcohol,

smoking, caffeine and smoking, caffeine and carbonated drinkscarbonated drinks

Take NSAIDS with mealsTake NSAIDS with meals

Adhere to medication regimenAdhere to medication regimen

UlcersUlcersGASTRICGASTRIC DUODENALDUODENAL

OlderOlder YoungerYounger

Normal AcidityNormal Acidity INCREASED acidityINCREASED acidity

Pain early after Pain early after eatingeating

Pain late after eating Pain late after eating (2-4 hours)(2-4 hours)

WORSENS by food, WORSENS by food, RELIEVED by RELIEVED by VOMITINGVOMITING

RELIEVES by foodRELIEVES by food

Bleeding, weight Bleeding, weight loss and vomitingloss and vomiting

Less likely bleeding Less likely bleeding and vomitingand vomiting

(+) cancer(+) cancer (-) cancer(-) cancer

Conditions of the Conditions of the Lower TractLower Tract

Small and Large IntestineSmall and Large Intestine

CONDITIONS OF THE CONDITIONS OF THE SMALL INTESTINESMALL INTESTINE

CROHN’S DISEASECROHN’S DISEASEAlso called Regional Also called Regional EnteritisEnteritis

An inflammatory disease An inflammatory disease of the GIT affecting of the GIT affecting usually the small intestineusually the small intestine


CROHN’S DISEASECROHN’S DISEASE ETIOLOGY: unknownETIOLOGY: unknown The terminal ileum The terminal ileum

thickens, with scarring, thickens, with scarring, ulcerations, abscess ulcerations, abscess formation and narrowing formation and narrowing of the lumenof the lumen


ASSESSMENT findings for CDASSESSMENT findings for CD 1. Fever1. Fever 2. Abdominal distention2. Abdominal distention 3. Diarrhea3. Diarrhea 4. Colicky abdominal pain 4. Colicky abdominal pain 5. Anorexia/N/V5. Anorexia/N/V 6. Weight loss6. Weight loss 7. Anemia7. Anemia

CONDITIONS OF THE CONDITIONS OF THE LARGE INTESTINELARGE INTESTINE

ULCERATIVE COLITISULCERATIVE COLITIS Ulcerative and inflammatory Ulcerative and inflammatory

condition of the GIT usually affecting condition of the GIT usually affecting the large intestinethe large intestine

The colon becomes edematous and The colon becomes edematous and develops bleeding ulcerationsdevelops bleeding ulcerations

Scarring develops overtime with Scarring develops overtime with impaired water absorption and loss of impaired water absorption and loss of elasticityelasticity


ASSESSMENT findings for UCASSESSMENT findings for UC 1. Anorexia1. Anorexia 2. Weight loss2. Weight loss 3. Fever3. Fever 4. SEVERE diarrhea with Rectal 4. SEVERE diarrhea with Rectal

bleedingbleeding 5. Anemia5. Anemia 6. Dehydration6. Dehydration 7. Abdominal pain and cramping7. Abdominal pain and cramping

NURSING INTERVENTIONS NURSING INTERVENTIONS for CD and UCfor CD and UC

1. Maintain NPO during the active phase1. Maintain NPO during the active phase 2. Monitor for complications like severe 2. Monitor for complications like severe

bleeding, dehydration, electrolyte bleeding, dehydration, electrolyte imbalanceimbalance

3. Monitor bowel sounds, stool and 3. Monitor bowel sounds, stool and blood studiesblood studies

4. Restrict activities4. Restrict activities 5. Administer IVF, electrolytes and TPN 5. Administer IVF, electrolytes and TPN

if prescribedif prescribed

NURSING INTERVENTIONS NURSING INTERVENTIONS for CD and UCfor CD and UC

6. Instruct the patient to AVOID gas-6. Instruct the patient to AVOID gas-forming foods, MILK products and forming foods, MILK products and foods such as whole grains, nuts, RAW foods such as whole grains, nuts, RAW fruits and vegetables especially fruits and vegetables especially SPINACH, pepper, alcohol and caffeineSPINACH, pepper, alcohol and caffeine

7. Diet progression- clear liquid7. Diet progression- clear liquid LOW LOW residue, high protein dietresidue, high protein diet

8. Administer drugsanti-inflammatory, 8. Administer drugsanti-inflammatory, antibiotics, steroids, bulk-forming antibiotics, steroids, bulk-forming agents and vitamin/iron supplementsagents and vitamin/iron supplements


APPENDICITISAPPENDICITISInflammation of Inflammation of the vermiform the vermiform appendixappendix


APPENDICITISAPPENDICITISETIOLOGY: usually ETIOLOGY: usually fecalith, lymphoid fecalith, lymphoid hyperplasia, foreign hyperplasia, foreign body and helminthic body and helminthic obstructionobstruction


APPENDICITISAPPENDICITIS

PATHOPHYSIOLOGYPATHOPHYSIOLOGY Obstruction of lumenObstruction of lumen

increased pressureincreased pressure decreased blood supplydecreased blood supply bacterial proliferation and bacterial proliferation and mucosal inflammationmucosal inflammation ischemiaischemia necrosis necrosis rupture rupture


ASSESSMENT FINDINGS for ASSESSMENT FINDINGS for AppendicitisAppendicitis

1. Abdominal pain: begins in 1. Abdominal pain: begins in the umbilicus then localizes in the umbilicus then localizes in the RLQ (Mc Burney’s point)the RLQ (Mc Burney’s point)

2. Anorexia2. Anorexia 3. Nausea and Vomiting3. Nausea and Vomiting


ASSESSMENT FINDINGS for ASSESSMENT FINDINGS for AppendicitisAppendicitis

4. Fever4. Fever 5. Rebound tenderness and 5. Rebound tenderness and

abdominal rigidity (if abdominal rigidity (if perforated)perforated)

6. Constipation or diarrhea6. Constipation or diarrhea


DIAGNOSTIC TESTSDIAGNOSTIC TESTS1. CBC- reveals 1. CBC- reveals increased WBC countincreased WBC count

2. Ultrasound2. Ultrasound3. Abdominal X-ray3. Abdominal X-ray


NURSING INTERVENTIONSNURSING INTERVENTIONS

1. Preoperative care1. Preoperative careNPONPOConsentConsentMonitor for perforation and Monitor for perforation and signs of shocksigns of shock


NURSING INTERVENTIONSNURSING INTERVENTIONS1. Preoperative care1. Preoperative care Monitor bowel sounds, fever Monitor bowel sounds, fever

and hydration statusand hydration status POSITION of Comfort: RIGHT POSITION of Comfort: RIGHT

SIDELYING in a low FOWLER’SSIDELYING in a low FOWLER’S Avoid Laxatives, enemas & HEAT Avoid Laxatives, enemas & HEAT

APPLICATIONAPPLICATION


2. Post-operative care2. Post-operative care Monitor VS and signs of Monitor VS and signs of

surgical complicationssurgical complications Maintain NPO until bowel Maintain NPO until bowel

function returnsfunction returns If rupture occurred, expect If rupture occurred, expect

drains and IV antibioticsdrains and IV antibiotics


2. Post-operative care2. Post-operative care POSITION post-op: POSITION post-op: RIGHT RIGHT side-lying, semi- fowler’s to side-lying, semi- fowler’s to decrease tension on incision, decrease tension on incision, and legs flexed to promote and legs flexed to promote drainagedrainage

Administer prescribed pain Administer prescribed pain medicationsmedications


HemorrhoidsHemorrhoidsAbnormal dilation and Abnormal dilation and weakness of the veins of weakness of the veins of the anal canalthe anal canal

Variously classified as Variously classified as Internal or External, Internal or External, Prolapsed, Thrombosed Prolapsed, Thrombosed and Reducibleand Reducible


HemorrhoidsHemorrhoidsPATHOPHYSIOLOGYPATHOPHYSIOLOGYIncreased pressure in Increased pressure in the hemorrhoidal the hemorrhoidal tissue due to straining, tissue due to straining, pregnancy, etcpregnancy, etc dilatation of veinsdilatation of veins


Internal hemorrhoidsInternal hemorrhoidsThese dilated veins lie These dilated veins lie above the internal anal above the internal anal sphinctersphincter

Usually, the condition Usually, the condition is PAINLESSis PAINLESS


External hemorrhoidsExternal hemorrhoidsThese dilated veins lie These dilated veins lie below the internal anal below the internal anal sphinctersphincter

Usually, the condition Usually, the condition is PAINFULis PAINFUL


ASSESSMENT findings for ASSESSMENT findings for HemorrhoidsHemorrhoids

1. Internal hemorrhoids- cannot 1. Internal hemorrhoids- cannot be seen on the peri-anal areabe seen on the peri-anal area

2. External hemorrhoids- can be 2. External hemorrhoids- can be seenseen

3. Bright red bleeding with each 3. Bright red bleeding with each defecationdefecation


ASSESSMENT findings ASSESSMENT findings for Hemorrhoidsfor Hemorrhoids

4. Rectal/ perianal pain4. Rectal/ perianal pain5. Rectal itching5. Rectal itching6. Skin tags6. Skin tags


DIAGNOSTIC TESTDIAGNOSTIC TEST1. Anoscopy1. Anoscopy2. Digital rectal 2. Digital rectal examinationexamination


NURSING INTERVENTIONSNURSING INTERVENTIONS1. Advise patient to apply 1. Advise patient to apply cold packs to the cold packs to the anal/rectal area followed anal/rectal area followed by a SITZ bathby a SITZ bath

2. Apply astringent like 2. Apply astringent like witch hazel soakswitch hazel soaks


NURSING NURSING INTERVENTIONSINTERVENTIONS

3. Encourage HIGH-3. Encourage HIGH-fiber diet and fluidsfiber diet and fluids

4. Administer stool 4. Administer stool softener as prescribed softener as prescribed


Post-operative care for Post-operative care for hemorrhoidectomyhemorrhoidectomy

1. Position: 1. Position: Prone or Prone or Side-lyingSide-lying

2. Maintain dressing 2. Maintain dressing over the surgical siteover the surgical site


Post-operative care for Post-operative care for hemorrhoidectomyhemorrhoidectomy

3. Monitor for bleeding3. Monitor for bleeding 4. Administer analgesics and 4. Administer analgesics and

stool softenersstool softeners 5. Advise the use of SITZ bath 5. Advise the use of SITZ bath

3-4 times a day3-4 times a day

CONDITIONS OF THE LARGE CONDITIONS OF THE LARGE INTESTINEINTESTINE

DIVERTICULOSIS AND DIVERTICULOSIS AND DIVERTICULITISDIVERTICULITIS

DiverticulosisDiverticulosis Abnormal out-pouching of the Abnormal out-pouching of the

intestinal mucosa occurring in any intestinal mucosa occurring in any part of the LI most commonly in the part of the LI most commonly in the sigmoidsigmoid

DiverticulitisDiverticulitis Inflammation of the diverticulosisInflammation of the diverticulosis


PATHOPHYSIOLOGYPATHOPHYSIOLOGY Increased intraluminal pressure, Increased intraluminal pressure,

LOW volume in the lumen and LOW volume in the lumen and Decreased muscle strength in the Decreased muscle strength in the colon wallcolon wall herniation of the herniation of the colonic mucosa colonic mucosa


ASSESSMENT findings for D/DASSESSMENT findings for D/D 1. Left lower Quadrant pain1. Left lower Quadrant pain 2. Flatulence2. Flatulence 3. Bleeding per rectum3. Bleeding per rectum 4. nausea and vomiting4. nausea and vomiting 5. Fever5. Fever 6. Palpable, tender rectal mass 6. Palpable, tender rectal mass


DIAGNOSTIC STUDIESDIAGNOSTIC STUDIES 1. If no active inflammation, 1. If no active inflammation,

COLONOSCOPY and Barium COLONOSCOPY and Barium EnemaEnema

2. CT scan is the procedure of 2. CT scan is the procedure of choice!choice!

3. Abdominal X-ray3. Abdominal X-ray


NURSING INTERVENTIONSNURSING INTERVENTIONS 1. Maintain NPO during acute phase1. Maintain NPO during acute phase 2. Provide bed rest2. Provide bed rest 3. Administer antibiotics, analgesics 3. Administer antibiotics, analgesics

like meperidine (morphine is not like meperidine (morphine is not used) and anti-spasmodicsused) and anti-spasmodics

4. Monitor for potential 4. Monitor for potential complications like perforation, complications like perforation, hemorrhage and fistulahemorrhage and fistula

5. Increase fluid intake5. Increase fluid intake


NURSING INTERVENTIONSNURSING INTERVENTIONS 6. Avoid gas-forming foods or 6. Avoid gas-forming foods or

HIGH-roughage foods containing HIGH-roughage foods containing seeds, nuts to avoid trappingseeds, nuts to avoid trapping

7. introduce soft, high fiber foods 7. introduce soft, high fiber foods ONLY after the inflammation ONLY after the inflammation subsidessubsides

8. Instruct to avoid activities that 8. Instruct to avoid activities that increase intra-abdominal pressureincrease intra-abdominal pressure

Conditions of the Conditions of the GIT accessory GIT accessory

organsorgansThe liverThe liver

CONDITION OF THE CONDITION OF THE LIVERLIVER

Liver CirrhosisLiver Cirrhosis A chronic, progressive disease A chronic, progressive disease characterized by a diffuse characterized by a diffuse damage to the hepatic cellsdamage to the hepatic cells

The liver heals with scarring, The liver heals with scarring, fibrosis and nodular fibrosis and nodular regenerationregeneration


Liver CirrhosisLiver Cirrhosis

ETIOLOGY: ETIOLOGY:

Post-infection, Alcohol, Post-infection, Alcohol, Cardiac diseases, Cardiac diseases, Schisostoma, Biliary Schisostoma, Biliary obstructionobstruction

Liver physiology and Liver physiology and PathophysiologyPathophysiology

Normal Function Normal Function Abnormality in Abnormality in functionfunction

1. Stores glycogen1. Stores glycogen = Hypoglycemia= Hypoglycemia

2. Synthesizes 2. Synthesizes proteinsproteins

= Hypoproteinemia= Hypoproteinemia

3. Synthesizes 3. Synthesizes globulinsglobulins

==Decreased Antibody Decreased Antibody formationformation

4. Synthesizes Clotting 4. Synthesizes Clotting factorsfactors

= Bleeding = Bleeding tendenciestendencies

5. Secreting bile5. Secreting bile = Jaundice and = Jaundice and prurituspruritus

6. Converts ammonia to 6. Converts ammonia to ureaurea

=Hyperammonemia=Hyperammonemia

7. Stores Vit and 7. Stores Vit and mineralsminerals

==Deficiencies of Vit Deficiencies of Vit and minand min

8. Metabolizes 8. Metabolizes estrogenestrogen

= = Gynecomastia, testes Gynecomastia, testes atrophyatrophy


ASSESSMENT FINDINGSASSESSMENT FINDINGS1. Anorexia and weight 1. Anorexia and weight lossloss

2. Jaundice2. Jaundice3. Fatigue3. Fatigue


ASSESSMENT FINDINGSASSESSMENT FINDINGS4. Early morning nausea and 4. Early morning nausea and vomitingvomiting

5. RUQ abdominal pain5. RUQ abdominal pain6. Ascites6. Ascites7. Signs of Portal 7. Signs of Portal hypertensionhypertension


NURSING INTERVENTIONSNURSING INTERVENTIONS1. Monitor VS, I and O, 1. Monitor VS, I and O, Abdominal girth, weight, Abdominal girth, weight, LOC and BleedingLOC and Bleeding

2. Promote rest. 2. Promote rest. Elevated the head of the Elevated the head of the bed to minimize dyspneabed to minimize dyspnea


NURSING INTERVENTIONSNURSING INTERVENTIONS3. Provide Moderate to 3. Provide Moderate to LOW-protein (1 LOW-protein (1 g/kg/day) and LOW-g/kg/day) and LOW-sodium dietsodium diet

4. Provide supplemental 4. Provide supplemental vitamins (especially K) vitamins (especially K) and mineralsand minerals



5. Administer prescribed5. Administer prescribedDiuretics= Diuretics= to reduce ascites and edemato reduce ascites and edema

Lactulose= Lactulose= to reduce NH4 in the bowelto reduce NH4 in the bowel

Antacids and Antacids and NeomycinNeomycin= = to kill to kill bacterial flora that cause NH productionbacterial flora that cause NH production



6. Avoid hepatotoxic 6. Avoid hepatotoxic drugsdrugs

ParacetamolParacetamolAnti-tubercular drugsAnti-tubercular drugs


NURSING INTERVENTIONSNURSING INTERVENTIONS7. Reduce the risk of injury 7. Reduce the risk of injury

Side rails reorientationSide rails reorientationAssistance in ambulationAssistance in ambulationUse of electric razor and Use of electric razor and soft-bristled toothbrushsoft-bristled toothbrush


NURSING INTERVENTIONSNURSING INTERVENTIONS8. Keep equipments ready 8. Keep equipments ready including Sengstaken-including Sengstaken-Blakemore tube, IV fluids, Blakemore tube, IV fluids, Medications to treat Medications to treat hemorrhagehemorrhage


Nursing Nursing InterventionsInterventions

RationaleRationale

1. Low sodium Diet1. Low sodium Diet To reduce edemaTo reduce edema

2. Low protein diet2. Low protein diet To reduce NH To reduce NH productionproduction

3. Benadryl and 3. Benadryl and mild soapmild soap

To relieve pruritusTo relieve pruritus

4. Pressure onto 4. Pressure onto injection siteinjection site

To prevent bleedingTo prevent bleeding

5. Assist in 5. Assist in paracentesisparacentesis

Done to relieve abdominal Done to relieve abdominal pressurepressure

6. Administer 6. Administer Medications:Medications:

Diuretics, Diuretics, Neomycin, LactuloseNeomycin, LactuloseAlbumin, Amino Albumin, Amino acidacidVitamin K Vitamin K (menadione)(menadione)

Conditions of the Conditions of the Accessory organsAccessory organs

The The GallbladderGallbladder

CONDITION OF THE CONDITION OF THE GALLBLADDERGALLBLADDER

CholecystitisCholecystitisInflammation of the Inflammation of the gallbladdergallbladder

Can be acute or chronicCan be acute or chronic


CholecystitisCholecystitis

Acute cholecystitis Acute cholecystitis usually is due to usually is due to gallbladder stonesgallbladder stones


CholecystitisCholecystitisChronic cholecystitis Chronic cholecystitis is usually due to long is usually due to long standing gall bladder standing gall bladder inflammationinflammation

CholelithiasisCholelithiasis

Formation of Formation of GALLSTONES in the GALLSTONES in the biliary apparatusbiliary apparatus

Predisposing FACTORSPredisposing FACTORS

““F”F”FemaleFemaleFatFatFortyFortyFertileFertileFairFair

PathophysiologyPathophysiology

Supersaturated bile, Biliary Supersaturated bile, Biliary stasisstasis

Stone formationStone formation

Blockage of GallbladderBlockage of Gallbladder

Inflammation, Mucosal Damage Inflammation, Mucosal Damage and WBC infiltration and WBC infiltration

PathophysiologyPathophysiologyLess bile in the duodenumLess bile in the duodenum

Impaired fat digestion and Impaired fat digestion and absorptionabsorption

Vitamin ADEK mal-absorption, Vitamin ADEK mal-absorption, STEATORHEA with increased gas STEATORHEA with increased gas

formationformation

JaundiceJaundice

ACHOLIC stoolsACHOLIC stools


ASSESSMENT findings ASSESSMENT findings for cholecystitisfor cholecystitis

1. Indigestion, belching 1. Indigestion, belching and flatulenceand flatulence

2. Fatty food 2. Fatty food intolerance, steatorrheaintolerance, steatorrhea



3. Epigastric pain that 3. Epigastric pain that radiates to the scapula radiates to the scapula or localized at the RUQor localized at the RUQ

4. Mass at the RUQ4. Mass at the RUQ



5. Murphy’s sign5. Murphy’s sign6. Jaundice6. Jaundice7. dark orange and 7. dark orange and foamy urinefoamy urine


DIAGNOSTIC PROCEDURESDIAGNOSTIC PROCEDURES

1. Ultrasonography- 1. Ultrasonography- can detect the stones can detect the stones

2. Abdominal X-ray2. Abdominal X-ray3. Cholecystography3. Cholecystography


DIAGNOSTIC PROCEDURESDIAGNOSTIC PROCEDURES

4. WBC count increased4. WBC count increased 5. Oral cholecystography 5. Oral cholecystography

cannot visualize the cannot visualize the gallbladdergallbladder

6. ERCP: revels inflamed 6. ERCP: revels inflamed gallbladder with gallstonegallbladder with gallstone


NURSING NURSING INTERVENTIONSINTERVENTIONS

1. Maintain NPO in the 1. Maintain NPO in the active phaseactive phase

2. Maintain NGT 2. Maintain NGT decompressiondecompression


NURSING INTERVENTIONSNURSING INTERVENTIONS 3. Administer prescribed 3. Administer prescribed

medications to relieve pain. medications to relieve pain. Usually Demerol Usually Demerol (MEPERIDINE)(MEPERIDINE)

Codeine and Morphine may Codeine and Morphine may cause spasm of the Sphinctercause spasm of the Sphincter increased pain. Morphine cause increased pain. Morphine cause MOREPAINMOREPAIN


4. Instruct patient to 4. Instruct patient to AVOID AVOID HIGH- fat diet and GAS-HIGH- fat diet and GAS-forming foodsforming foods

5. Assist in surgical and non-5. Assist in surgical and non-surgical measuressurgical measures

6. Surgical procedures- 6. Surgical procedures- Cholecystectomy, Cholecystectomy, Choledochotomy, laparoscopyCholedochotomy, laparoscopy


PHARMACOLOGIC PHARMACOLOGIC THERAPYTHERAPY

1.1. Analgesic- MeperidineAnalgesic- Meperidine

2.2. Chenodeoxycholic acid= to Chenodeoxycholic acid= to dissolve the gallstonesdissolve the gallstones

3.3. AntacidsAntacids

4.4. Anti-emeticsAnti-emetics


Post-operative nursing interventionsPost-operative nursing interventions

1. Monitor for surgical 1. Monitor for surgical complicationscomplications

2. Post-operative 2. Post-operative position after recovery position after recovery from anesthesia- from anesthesia- LOW LOW FOWLER’sFOWLER’s


Post-operative nursing Post-operative nursing interventionsinterventions

3. Encourage early ambulation 3. Encourage early ambulation 4. 4. Administer medication Administer medication

before coughing and deep before coughing and deep breathing exercisesbreathing exercises

5. Advise client to splint the 5. Advise client to splint the abdomen to prevent abdomen to prevent discomfort during coughingdiscomfort during coughing


Post-operative nursing interventionsPost-operative nursing interventions6. Administer analgesics, 6. Administer analgesics, antiemetics, antacidsantiemetics, antacids

7. Care of the biliary 7. Care of the biliary drainageor T-tube drainageor T-tube drainagedrainage

8. Fat restriction is only 8. Fat restriction is only limited to 4-6 weeks. limited to 4-6 weeks. Normal diet is resumedNormal diet is resumed

Conditions of the Conditions of the accessory organsaccessory organs

The pancreas: The pancreas: Exocrine Exocrine functionfunction

CONDITION OF THE CONDITION OF THE PANCREASPANCREAS

PancreatitisPancreatitisInflammation of Inflammation of the pancreasthe pancreas

Can be acute or Can be acute or chronicchronic


PancreatitisPancreatitis Etiology and predisposing Etiology and predisposing factorsfactorsAlcoholismAlcoholismHypercalcemiaHypercalcemiaTraumaTraumaHyperlipidemiaHyperlipidemia


PancreatitisPancreatitis Etiology and predisposing Etiology and predisposing factorsfactorsBiliary tract diseaseBiliary tract disease - - cholelithiasischolelithiasis

Bacterial diseaseBacterial diseasePUDPUDMumpsMumps


PATHOPHYSIOLOGY of PATHOPHYSIOLOGY of acute pancreatitisacute pancreatitis

Self-digestion of the Self-digestion of the pancreas by its own pancreas by its own digestive enzymes digestive enzymes principally TRYPSINprincipally TRYPSIN


PATHOPHYSIOLOGY of acute PATHOPHYSIOLOGY of acute pancreatitispancreatitis

Spasm, edema or block in Spasm, edema or block in the Ampulla of Vaterthe Ampulla of Vater reflux reflux of proteolytic enzymesof proteolytic enzymes auto digestion of the auto digestion of the pancreaspancreas inflammation inflammation


PATHOPHYSIOLOGY of acute pancreatitisPATHOPHYSIOLOGY of acute pancreatitis

Autodigestion of pancreatic tissueAutodigestion of pancreatic tissue

Hemorrhage, Necrosis and InflammationHemorrhage, Necrosis and Inflammation

KININ ACTIVATION will result to increased KININ ACTIVATION will result to increased permeabilitypermeability

Loss of Protein-rich fluid into the Loss of Protein-rich fluid into the peritoneumperitoneum

HYPOVOLEMIAHYPOVOLEMIA


ASSESSMENT findingsASSESSMENT findings1. Abdominal pain- 1. Abdominal pain- acute onset, occurring acute onset, occurring after a heavy meal or after a heavy meal or alcohol intakealcohol intake

2. Abdominal guarding2. Abdominal guarding


ASSESSMENT findingsASSESSMENT findings 3. Bruising on the flanks and 3. Bruising on the flanks and

umbilicusumbilicus 4. N/V, jaundice4. N/V, jaundice 5. Hypotension and 5. Hypotension and

hypovolemiahypovolemia 6. 6. HYPERGLYCEMIA, HYPERGLYCEMIA,

HYPOCALCEMIAHYPOCALCEMIA 7. Signs of shock7. Signs of shock


DIAGNOSTIC TESTSDIAGNOSTIC TESTS 1. Serum amylase and serum 1. Serum amylase and serum

lipaselipase 2. Ultrasound2. Ultrasound 3. WBC3. WBC 4. Serum calcium4. Serum calcium 5. CT scan5. CT scan 6. Hemoglobin and hematocrit6. Hemoglobin and hematocrit


NURSING INTERVENTIONSNURSING INTERVENTIONS1. Assist in pain 1. Assist in pain management. Usually, management. Usually, Demerol is givenDemerol is given. . Morphine is AVOIDEDMorphine is AVOIDED

2. Assist in correction of 2. Assist in correction of Fluid and Blood lossFluid and Blood loss



3. 3. Place patient on NPOPlace patient on NPO to to inhibit pancreatic stimulationinhibit pancreatic stimulation

4. 4. NGT insertion to NGT insertion to decompress distention and decompress distention and remove gastric secretionsremove gastric secretions

5. Maintain on bed rest5. Maintain on bed rest


NURSING INTERVENTIONSNURSING INTERVENTIONS 7. Position patient in 7. Position patient in SEMI-SEMI-

FOWLER’s to decrease FOWLER’s to decrease pressure on the diaphragm pressure on the diaphragm

8. Deep breathing and 8. Deep breathing and coughing exercisescoughing exercises

9. Provide parenteral nutrition9. Provide parenteral nutrition



10. Introduce oral feedings 10. Introduce oral feedings gradually- HIGH carbo, gradually- HIGH carbo, LOW FATLOW FAT

11. Maintain skin integrity11. Maintain skin integrity12. Manage shock and 12. Manage shock and other complicationsother complications

Quick SummaryQuick Summary

Peptic UlcerPeptic Ulcer Ulceration of mucosa; In the stomach Ulceration of mucosa; In the stomach

or duodenumor duodenum Outstanding Symptom: PAINOutstanding Symptom: PAIN Nursing Goal: Allow ulcer to heal, Nursing Goal: Allow ulcer to heal,

prevent complicationprevent complication Rest: physical and MentalRest: physical and Mental Eliminate certain foodsEliminate certain foods Medications: antacid, H2 blockers, Medications: antacid, H2 blockers,

Proton Pump inhibitors, antibiotics, Proton Pump inhibitors, antibiotics, mucosal protectantsmucosal protectants

Surgery: Vagotomy, Billroth 1 and 2Surgery: Vagotomy, Billroth 1 and 2


Liver CirrhosisLiver Cirrhosis Destruction of liver with replacement Destruction of liver with replacement

by scarsby scars Common causes: alcoholism, post-Common causes: alcoholism, post-

hepatitichepatitic Manifestations related to liver Manifestations related to liver

derangementsderangements Jaundice, Ascites, splenomegaly, Jaundice, Ascites, splenomegaly,

bleeding, encephbleeding, enceph Nursing goal: Control manifestations Nursing goal: Control manifestations

and maximize liver functionand maximize liver function


Liver CirrhosisLiver Cirrhosis Encourage restEncourage rest Avoid hepatotoxic drugsAvoid hepatotoxic drugs Diet: HIGH calorie, Restricted protein, LOW Diet: HIGH calorie, Restricted protein, LOW

NaNa Weight client and measure abdominal girth Weight client and measure abdominal girth

dailydaily Provide skin care for jaundice and edemaProvide skin care for jaundice and edema Assess for bleeding: esophageal, rectal, Assess for bleeding: esophageal, rectal,

cutaneouscutaneous DRUGS: Antacids, Diuretics, Albumin, DRUGS: Antacids, Diuretics, Albumin,

Neomycin and LactuloseNeomycin and Lactulose


CholecystitisCholecystitis Inflammation of the gallbladder Inflammation of the gallbladder

commonly caused by cholelithiasis commonly caused by cholelithiasis (Female, Fat, Forty, Fertile, Fair)(Female, Fat, Forty, Fertile, Fair)

Manifestations: Fat intolerance, RUQ Manifestations: Fat intolerance, RUQ pain, Nausea and vomiting, Jaundice, pain, Nausea and vomiting, Jaundice, Murphy’s signMurphy’s sign

Nursing Goal: Relieve symptoms and Nursing Goal: Relieve symptoms and assist in stone removalassist in stone removal


CholecystitisCholecystitis Administer MEPERIDINE, avoid Administer MEPERIDINE, avoid

morphinemorphine Maintain Fluid and electrolyte balanceMaintain Fluid and electrolyte balance Maintain a LOW fat dietMaintain a LOW fat diet Semi-fowler’s positionSemi-fowler’s position Assist in surgeryAssist in surgery Care of the T-tubeCare of the T-tube


PancreatitisPancreatitis Inflammation of the pancreas brought Inflammation of the pancreas brought

about by the digestion of the organ by about by the digestion of the organ by the enzyme it producesthe enzyme it produces

Common causes: Alcoholism, stoneCommon causes: Alcoholism, stone Manifestations: Extreme upper Manifestations: Extreme upper

abdominal pain radiating into the back, abdominal pain radiating into the back, vomiting, nausea, Abdominal vomiting, nausea, Abdominal distention, Steatorrhea and weight lossdistention, Steatorrhea and weight loss

Laboratory: ELEVATED lipase and Laboratory: ELEVATED lipase and amylaseamylase


PancreatitisPancreatitis Nursing Goal : relieve symptoms, Nursing Goal : relieve symptoms,

maintain blood volume and GIT restmaintain blood volume and GIT rest NPONPO Provide IVF and Parenteral nutritionProvide IVF and Parenteral nutrition Drugs: MEPERIDINE, never morphine, Drugs: MEPERIDINE, never morphine,

Antacids, anticholinergicsAntacids, anticholinergics After Acute phase: LOW fat diet, avoid After Acute phase: LOW fat diet, avoid

alcohol, fat and vitamin replacementsalcohol, fat and vitamin replacements

gastrointestinal system

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