GI Notes
Assessment Slide
 Pain, where is it located, aggravated with eating?
 Auscultating bowel sounds in all four quadrants (hypoactive, hyperactive, normal bowel
sounds) (Normal: Every 5 to 20 seconds)
 Abdomen
 Masses
 Peristalic waves
 Symmetry
 Skin color
 Distention
Gastritis
 Inflammation of gastric lining of the stomach
 Acute or chronic (acute: takes 1 to 3 days to overcome) (Chronic: Does not go away/
find an irritant that causes it to be recurrent)
o Erosive (ulcerations occurred in lining of the stomach/ can bleed) (strong
acid/alkaline substance/ acute onset/ seen with traumatic injury) (more
associated with agents like NSAIDs and aspirin) (Elderly/ GI bleeding issues) (Can
cause pyloric stenosis [can cause gastric outlet obstruction]-Food can’t get
through)
o Non-erosive (Usually due to H. pylori/ main thing that is associated with PUD and
can cause gastric cancer/ HAS TO BE TREATED/ transmitted through kissing,
liquids, etc.)
o See these two with acute diseases
 Manifestations: Acute
o Rapid onset of symptoms
o Epigastric pain, dyspepsia, nausea, vomiting, “can’t eat”, hiccupping, can last
days, hours, weeks (typically 3 days)
 Manifestations: Chronic
o Due to H. pylori
o Long-term drug therapy (NSAIDs, aspirin, etc.)
o Autoimmune disorder (thyroiditis, Hoschimotos)
o More fatigued, pyrosis (kind of like acid reflux), belching, getting full quicker,
anorexia “can’t eat”, nausea, vomiting
 Diagnostic: Both
o EGD with biopsy (sedated) (conscious sedation- spray) (checking for ulcers, H.
pylori- can inject bleeding ulcers to stop bleeding)
o CBC (bleeding [drop in H & H], blood in vomit, “coffee grounds”, dark, tarry
stools)
 Medical management
o Mucosa can repair itself past acute episode
o Generally one day (decrease in appetite 2 to 3 days)
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Patient teaching
Refrain from alcohol and food until symptoms subside
Non-irritating diet (not spicy foods)
May have to have IV fluids (if it is severe) (promote fluid balance)
NG (if there is gastric outlet obstruction/ pyloric stenosis)
Meds: Antacids, Histamine 2 receptor antagonist, Proton pump inhibitors,
sometimes used in conjunction with antibiotics (for H. pylori) or Pepto bismol p.
1299 (Just remember combination of drugs)
o Extreme cases (sx may be required to remove gangrenous/ perforated tissue)
o Chronic
 Diet, rest, decreasing stress, avoid NSAID, ETOH, Antacids, H2 blockers
(look at just these) (A lot are OTC) p. 1295
o Gastric Obstruction: May see vomiting (food cannot get out) Treat with NPO all
together and may need NG tube to decompress the stomach
Nurse Management
o Reduce anxiety and stress (can increase gastric acid production)
o Optimal nutrition
o Physical/ emotional support
o Manage symptoms
o Monitor I & O (at least 30mL/ hr) (need 3 L of fluid/ day unless contraindicated)
o Monitor electrolytes (hypokalemia/ potassium)
o Modify diet to avoid caffeinated beverages (even caffeinated coffee)
o Discourage alcohol use
o Stop smoking
o Symptoms with gastritis/ hemorrhaging (drop in bp, tachycardia)
o Patients will complain of pain (avoid spicy foods, caffeine, anything acidic) more
on alkaline side of foods
o Advancing diet (NPO to ice chips, to clear liquids, to liquids, to full diet)
o Know priority assessment with hemorrhage
o Know with pain meds to AVOID (NSAIDs)
o Pepto Bismol can turn tongue black
o Take antibiotics ALL THE WAY THROUGH
Peptic Ulcer Disease
 Umbrella segment
 Patho: There has been disruption in mucosa and cannot withstand hydrochloric acid
acidity
o Cannot secret enough mucus to protect the lining
 Can be duodenal or gastric ulcer
 Will diagnose based on presentation
 Type O blood more susceptible
 Duodenal ulcer
o More common
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o Pain will be AFTER eating (2-3H)
Gastric ulcer
o Pain WITH meals
Stress ulcers
o Patients who have undergone surgery or are sick or are burn patients can get
this
o Ulceration in duodenal and gastric areas
o Thought to be caused by ischemia to lining of the stomach
Risk
o NSAIDs
o Alcohol
o Zollinger-Ellinger syndrome (Hereditary, rare, malignant tumors in pancreas and
duodenum/ excess acid that create ulcers that spread FATTY STOOLS) (if person
has multiple peptic ulcers that do NOT respond to treatment)
Manifestations
o Last for a few days, weeks, months, come and go
o Complain of dull, gnawing pain
o Burning pain mid-epigastric or the back
o Gastric immediately after eating
o 30-40% wake with pain (gastric)
o 50-80% wake with pain (duodenal)
o Pyrosis (heartburn)
o KILL AN ELDERLY PATIENT: GI bleeding from chronic NSAID use
o Epigastric tenderness
o Abdominal distention
o Transmission: Person-to-person contact
o Peritonitis (rigid abdomen)
Diagnostic
o Endoscopy
o EGD (sedated-> NURSING watch for aspiration, NPO, maintain airway, SWALLOW
o Bx
o Can check blood and stool for H. pylori
o Breath test for H. Pylori
 Urea breath test
 Serum for antigen (draw lab work)
 Can get re-infected
Medical management
o Irradiate H. pylori, manage gastric acidity
o Pharmacological (PPI, antibiotics, bismuth salts 10-14 days) p. 1299 Table 46-3
o Smoking cessation
o Dietary modification
o Sx management
 Intractable (Do not heal) -> bilrof 1 or 2
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Dumping syndrome (look at article)
o F/U
o Eat 3 regular meals a day (small, frequent feedings aren’t necessary if on antacid)
Nursing process
o Assess
 Pain
 Vomiting (can even faint and fall out)
 72-hour diet recall
 Lifestyle (drinking, smoking)
 Make sure after sx that intestines are waking back up (paralytic ileus)
 NG tube (>400mL- sign of obstruction) p. 1303
 Barium swallow
o Diagnosis
 Acute pain
 Deficient nutrition
 Anxiety
Complications
o Hemorrhage
o Perforation
o Penetration
o Gastric Outlet Obstruction
Gastric Outlet Obstruction
 Area distal to the pyloric sphincter becomes scarred and stenosed from spasm or edema
or scar tissue
 First consideration of NG tube (decompress stomach)
 Residual of 400 or greater suggests obstruction
 Upper GI or Endoscopy to confirm
 Balloon dilation may be helpful (open area back up)
GERD
 P. 1283
 Backflow of gastric or duodenal contents into esophagus
 Risk factors
o Incompetent lower esophageal sphincter
o Pyloric stenosis
o Hiatal hernia
o Motility disorder
o Increases with age
 Symptoms
o Pyrosis
o Dyspepsia
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o Regurgitation
o Dysphagia
o Hypersalivation
o Esophagitis
Diagnosis
o Endoscopy
o Barium swallow (x-ray)
o 12-36H capsule monitoring
o Management
o Avoid situations that decrease lower esophageal sphincter pressure or cause
esophageal irritation
o Low fat diet
o Avoid caffeine
Management
o Avoid tobacco, beer, milk, foods with mint, carbonated beverages
o Avoid eating/ drinking 2 hours before bedtime
o Maintain normal body weight
o Elevate HOB 6-8In
o Elevate upper body on pillows
o Avoid wearing tight clothes
Medical management
o Medications
 Antacids, H2 antagonist/blockers
 Pepcid
 Axid
 Zantac
 PPI
 Prevacid
 Nexium
 Prilosec
 Protonix
 Increased motility
 Urecholine
 Motilium
o May need sx correction
Alteration in Bowel (look back over constipation and diarrhea)
 Constipation
o Infrequent bowel movements less than 3 times/week
o Difficulty passing stools
o Excessive straining
o Hard feces
o Can’t defecate at will
o Causes
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Medications (CNS depressants, anticholinergics, diuretics, opioids),
Hemorrhoids, neurologic disorder, obstruction), immobility, certain foods
o Educate on MEDICATION OTC
o Complications: Hemorrhoids, fissures (tears), Valsalva (Trying to force -> drop in
bp), rupture an artery (NO HEART DISEASE STRAINING), impaction etc.
o Look at fiber requirements
o Do abdominal exercises
o P. 1315
o Decalux, cholase
Diarrhea
o Increase in number of stools, more than 3/day
o Passage of liquid unformed feces
o Acute (often with infection) C. Diff (Contact precautions) (WASH HANDS)
o Chronic (more than 2-3 weeks)
o LOOK AT TYPES
o Manifestations: Abdominal cramps, distention, borborygmus (gas), anorexia,
thirst, tenesmus (straining)
o Oil, blood/pus, etc.
o Blood chemistry, biochem
o MONITOR POTASSIUM (hypokalemia) (Digitalis)
o What is the underlying cause? (stool samples)
o Put on bland diet (look at different diets)
o Cardiac dysrhythmias, metabolic acidosis (s/s hypokalemia)
o Skin assessment (may need barrier cream after having diarrhea/ skin integrity is
affected)
IBS (different from IBD) (Irritable Bowel Syndrome) (Functional disorder)
 Chronic functional disorder characterized by recurrent abdominal pain associated with
disordered bowel movements, which may include diarrhea or both
 Manifestations
o Pain, bloating, and abdominal distention (IBS-C or IBS-D)
 Assessment/ Diagnostic
o Recurrent abdominal pain for at least 1 day weekly associated with two or more
 Abdominal pain r/t defecation
 Abdominal pain associated with change in frequency of stool
 Abdominal pain associated with change in form/ appearance of stool
 Management
o Soluble fiber
o Lopreamide (Diarrhea)
o Dicyclomine (Bentyl) (Abdominal pain)
o Probiotics (Lactobacillus)
 Nursing management
o Keep 1-2wk food diary
o Adequate fluid (but fluid not with meals)
o Avoid alcohol and smoking
o Encourage STRESS MANAGEMENT
 Associated with anxiety, more with women, patients younger than 45 diagnose
IBD (Umbrella statement)
 Diverticulitis
o IBD, Chron’s, Ulcerative Colitis
Diverticulosis
 Outpouching in colon (congenital or acquired)
 Usually in sigmoid
 Diverticulitis inflammation of diverticulum could occur
 Risk
o Low fiber
o Constipation
o Obesity
o Weakening of bowel wall (intraluminal pressure)
o Common in both women and men >45
o 80% of those >85
 Usually acute on onset
 Manifestations
o Abdominal pain in LLQ
o Low grade temp
o Diverticular bleed
o Leukocytosis, fever, abscess formed
o Can get peritonitis (from perforation)
o Distention
o Tenderness
o Palpable mass (from abscess)
o V/S
o Can erode and cause massive rectal disease
o Can SMELL bleed in poop
 Assessment/ Diagnosis
o Won’t do colonscopy with diverticulitis (risk for perforation)
 Clear liquid diet 24H before colonoscopy (you can see through liquid, no
red stuff) (have to have bowel prep) (Maxitrate: No those with kidney
disease due to magnesium/ have to drink this/ nausea) (have to inject
air/ will have gas and maybe gas pain)
o CT with contrast
o Elevated WBC, decreased H&H, FOBT
 Management
o Medical management
o Symptomatic treatment
o Rest
o Medications: Analgesics, antispasmodics, antibiotics, initial diet liquid, when
inflammation subsides: High fiber, low fat diet
o Prevention of constipation
o Bran
o Bulk laxatives
o Instruct patient to notify MD of any bowel changes
o Bowel rest
o NPO
o ? NG
o IVs, meds
ACUTE phase of diverticulitis: Low fiber, then adjust to high-fiber after episode (Look at
stages of diverticulitis)
Ulcerative colitis
 Etiology: Unknown
o Genetic basis maybe?
o Seen in families, twins, and ethnic
 Females more affected than males
 Associated with colon cancer
 Autoimmune dysfunction
 Jewish origin (4-5X more likely)
 Affects superficial lining of ONLY COLON (usually starts in rectum and goes up)
 Chronic disease: Remission and exacerbations