GIT part 1

Ruby Ruth Roces, R.N., M.D.

Common laboratory
Procedures
COMMON LABORATORY
PROCEDURES
FECALYSIS
 Examination of stool
consistency, color and the
presence of occult blood.
 Special tests for fat, nitrogen,
parasites, ova, pathogens and
others
COMMON LABORATORY
PROCEDURES
FECALYSIS: Occult Blood
Testing
 3-day meatless diet
 No intake of NSAIDS, aspirin,
iron,steroids & anti-coagulant
48 Hrs prior
 3 stool specimen

 Screening test for colonic

 Test for ova- fresh stool
 Test for lipids- inc fat diet, no
alcohol 3 days prior
72 hr stool specimen- store in ice
no mineral oil, no neomycin SO4
COMMON
LABORATORY
PROCEDURES
Upper GIT study: barium
swallow
 Pre-test: NPO post-midnight
 Post-test: Laxative is ordered,
increase pt fluid intake,
instruct that stools will turn
white, monitor for obstruction
COMMON
LABORATORY
PROCEDURES
Lower GIT study: barium
enema
 Pre-test: low residue diet x 1-
2 days, Clear liquid diet and
laxatives, NPO post-midnight,
cleansing enema prior to the
test
 Post-test: Laxative is ordered,
increase patient fluid intake,
COMMON
LABORATORY
PROCEDURES
Gastric analysis
 Aspiration of gastric juice to
measure pH, appearance, volume
and contents- NGT is inserted,
connected to suction & contents
collected q 15 mins to 1 hr.
 Pre-test: NPO 8-12 hours,
avoidance of stimulants& drugs
for 24-48 hrs, cigarette and
chewing gum for 6 hrs before test
COMMON
LABORATORY
PROCEDURES
Lower GI- scopy
(anoscopy, proctoscopy,
sigmoidoscopy,
colonoscopy)
 Pre-test: consent, clear
liquids 24 hrs,NPO 8 hours,
cleansing enema until return
is clear
 Intra-test: position is LEFT
lateral, right leg is bent and
placed anteriorly
 Post-test: supine for few
minutes to prevent
orthostatic hypotensionbed
rest, monitor for
complications like bleeding
and perforation
COMMON
LABORATORY
PROCEDURES
Paracentesis
 Pre-test: ensure consent,
instruct to VOID and empty
bladder, measure abdominal
girth
 Intra-test: Upright on the
edge of the bed, back
supported and feet resting on
a foot stool
 postprocedure:
 monitor vs, hypovolemia,
elecstrolyte loss, hematuria
 instruct to notify if urine become s
bloody, pink, red
 apply a dry sterile dressing
 measure fluid collected, describe
and record
Conditions of the GIT

UPPER GI system
CONDITION OF THE
ESOPHAGUS
HIATAL HERNIA
 Protrusion of the esophagus
into the diaphragm thru an
opening
CONDITION OF THE
ESOPHAGUS
ASSESSMENT
 1. Heartburn

 2. Regurgitation

 3. Dysphagia

 4. 50%- without
symptoms
CONDITION OF THE
ESOPHAGUS

DIAGNOSTIC TEST
Barium swallow and
fluoroscopy
 CONDITION OF THE
ESOPHAGUS
NURSING INTERVENTIONS
 small frequent feedings
 AVOID supine position for 1 hour
after eating
 Elevate the head of the bed on 8-
inch block
 avoid anticholinergic wch delays
emptying
CONDITION OF THE
ESOPHAGUS
Esophageal Varices
 Dilation and tortuosity of the
submucosal veins in the distal
esophagus
 ETIOLOGY: commonly caused
by PORTAL hypertension
secondary to liver cirrhosis
 This is an Emergency
condition!
CONDITION OF THE
ESOPHAGUS
ASSESSMENT
 Hematemesis
 Melena
 Ascites
 jaundice

hepatomegaly/splenomegaly
 Signs of Shock
 CONDITION OF THE
ESOPHAGUS
DIAGNOSTIC
PROCEDURE
Esophagoscopy
COMMON
LABORATORY
PROCEDURES
EGD
(esophagogastroduodenosco
py)
 Pre-test: ensure consent, NPO
8 hours, pre-medications like
atropine and anxiolytics,
remove dentures, local spray
to post. Pharynx-advise not to
swallow
 COMMON
LABORATORY
PROCEDURES
EGD
 Intra-test: position : LEFT lateral to
facilitate salivary drainage and
easy access
 Post-test: NPO until gag reflex
returns, place patient in SIMS
position until he awakens, monitor
for complications, saline gargles
for mild oral discomfort
CONDITION OF THE
ESOPHAGUS
NURSING INTERVENTIONS
 1. Monitor VS strictly.
 2. Monitor for LOC

 3. Maintain NPO

 4. Monitor blood studies

 5. Administer O2

 6. prepare for blood

transfusion
 CONDITION OF THE
ESOPHAGUS
 7. prepare to administer Vasopressin
and Nitroglycerin
 8. Assist in NGT and Sengstaken-
Blakemore tube insertion for balloon
tamponade
 9. Prepare to assist in surgical
management:
– Endoscopic sclerotherapy
– Variceal ligation
– Shunt procedures
Conditions of the
Stomach
Gastro-esophageal reflux
 due to incompetent lower
esophageal sphincter , pyloric
stenosis or motility disorder
 Symptoms may mimic ANGINA
or MI
Conditions of the
Stomach
ASSESSMENT ( for GERD)
 Heartburn

 Dyspepsia

 Regurgitation

 Epigastric pain

 Difficulty swallowing

 Ptyalism
Diagnostic test
 Endoscopy or barium swallow
 Gastric ambulatory pH analysis

– Note for the pH of the

esophagus, usually done for 24
hours
– The pH probe is located 5
inches above the lower
esophageal sphincter
– The machine registers the
different pH of the refluxed
Conditions of the
Stomach
NURSING INTERVENTIONS
 AVOID stimulus that
increases stomach
pressure and decreases
LES pressure
( spices, coffee, tobacco
and carbonated drinks)
 LOW-FAT, HIGH-FIBER diet
Conditions of the
Stomach
NURSING INTERVENTIONS
 Avoid foods and drinks TWO
hours before bedtime
 Elevate the head of the bed
with an approximately 8-inch
block
 Administer prescribed meds
 Advise proper weight
reduction
Conditions of the
Stomach
GASTRITIS
 Inflammation of the gastric
mucosa
 May be Acute or Chronic

 Etiology: Acute- bacteria,

irritating foods, NSAIDS,
alcohol, bile and radiation,
Autoimmune disease, diet,
smoking
Conditions of the
Stomach
DIAGNOSTIC PROCEDURE
 EGD- to visualize the gastric
mucosa for inflammation
 Low levels of HCl

 Biopsy to establish correct

diagnosis whether acute or
chronic
Conditions of the
Stomach
NURSING INTERVENTIONS
 Give BLAND diet
 Monitor for signs of
complications like bleeding,
obstruction and pernicious
anemia
 Instruct to avoid spicy foods,
irritating foods, alcohol and
caffeine
Conditions of the
Stomach
NURSING
INTERVENTIONS
 Administer prescribed
medications- H2 blockers,
antibiotics, mucosal
protectants
 Inform the need for Vitamin
B12 injection if deficiency is
present
Conditions of the
Stomach
PEPTIC ULCER DISEASE
 An ulceration of the gastric
and duodenal linin
 Most common Peptic
ulceration: anterior part of
the upper duodenumg
Condition of the
Duodenum

DIAGNOSTIC
TESTS
EGD and Biopsy
 Drugs:
 Histamine H2 receptors antagonists (po/iv)
 Axn: ↓ HCl production
 Taken with meals or at h.s., cigarettes
reduces the axn.
 SE: headache, skin rash, bleeding and
dizziness
 8 weeks medication (if s/sx will not
improve start antibiotics)
 Cimetidine (Tagamet)
 Ranitidine (Zantac)
 Famotidine (Pepcid)
 Drugs:
 Antibiotics
 Amoxil

 Tetracycline

 Can be combined with other drugs

Drugs:
 Mucosal Barrier
 Axn: adheres to ulcer surface
 30 min interval before taking
antacids
 SE: constipation, diarrhea and n/v
 Give 1-2 hour after meal or during
bedtime on an empty stomach
 5 hours duration
 Sucralfate (Carafate)
 Drugs:
 Antacids (non absorbable)
 Axn: ↓ gastric acidity
 Chew thoroughly then swallow
 Taken 1 hour after meals or at bedtime
 Aluminum Hydroxide SE: constipation
 Don’t give other drugs within 1-2 hour after
taking antacids
 Magnesium Oxide SE: diarrhea
 Taken in between meals or at bedtime
 May increase serum Magnesium level in RF client
 Chew follow with water
 Calcium Carbonate SE: ↑ uric acid
 Taken in between meals or at bedtime with milk
 NaHCO3 SE: metabolic alkalosis and tetani
Drugs:
 Proton Pump Inhibitor
 Axn: block HCl release from
parietal cell
 4-8 weeks medications

 Omeprazole (Prilosec)

 Lansoprazole (Prevacid)
Surgery

 Vagotomy
(complication is diarrhea) give
KAOPECTATE
 Antrectomy
Complications:

 Hemorrhage
(anemia, hematemesis,
hematochezia, melena)
 Perforation

 Pyloric obstruction
Nursing Considerations:

 Avoid spicy foods

 Milk stimulates HCl secretion

 Avoid coffee, chocolate, cola,

caffeine
 No snacks at bedtime (↑ HCL
secretions)
Gastric Cancer

 Most common
 Key Test GASTROSCOPY
 Surgery:
 Billroth I gastroduodenostomy
 Billroth II gastrojejunostomy
Post op

 Observe NGT drainage:

 -NaCl irrigating solution
 -bloody for the first 12 hours
 -attached to continuous suction
machine
 -don’t give cold give warm weak tea
 -color, amount and consistency
 IVF with KCl
 Early ambulation
 Listen for bowel sounds (1
Post op
 Observe for dumping syndrome
 -subsides in 6 months

 -s/sx are related to FVD

 -palpitations

 -perspirations

 -faintness

 -weakness
Dumping Syndrome
 avoid CHO
 ↑ CHON, ↓ CHO

 no fluids after meal

 lie supine after meal

 avoid fowlers position after meal

Inflammatory Bowel
Diseases
 Crohns Disease
 Ulcerative Colitis
Assessment
 chronic diarrhea
 cramplike pain after meals

 fever

 mucus bloody stool

 dehydration and anemia ( more

sever in ulcerative colitis) 15-20x
BM
 Management:
 ↑calories and CHON, ↓ residue
 bland diet with iron
 All foods must be cooked
 rehydrate
 vitamin B12( crohn”s)
 steroids and antibiotics
 antidiarrheal (lomotil)
 sedatives and narcotics to decrease
apprehension and pain
 immunosuppressive drugs to prevent another
attack
 TPN
Appendicitis

 Inflammation of the appendix due

to obstruction from fecalith,
lymphoid hyperplasia, helminth,
foreign body
 Assessment:
 Key Test – IPPA, Lab results (↑
WBC)pain- epigastric----
periumbilical---RLQ
 Rovsings

 Psoas

 Obturator

 Mcburneys

 CBC- inc WBC

 Urinalysis- +/-RBC
 Management:
 Semi fowler’s to relieve pain and
discomfort
 NPO til bowel sounds present
(postop)
 No laxatives and enemas as it may
rupture
 No warm compress or heat
application
 NGT insertion
CONDITIONS OF THE
LARGE INTESTINE
Post-operative care
 POSITION post-op: RIGHT side-
lying, SEMI- FOWLER’S to
decrease tension on incision,
and legs flexed to promote
drainage
Intestinal Obstructions

 Partial or complete stoppage of

forward flow of intestinal contents
 Key Test – UTZ, don’t use contrast
media if obstruction is suspected
Abdominal UTZ
 Mechanical Type:
 Adhesions-fibrous band of scar tissue from
surgery
 Hernias-incarcerated or strangulated
 Volvulus-twisting of bowel
 Intussusception-telescoping of the bowel upon
itself
 Tumors
 Hematoma
 Fecal impaction
 Intraluminal obstruction

Neurogenic Type:

 Paralytic ileus
 Adynamic ileus
Vascular Type:

 Occlusion of arterial blood supply

 Mesenteric thrombosis

 Abdominal angina
 What will happen?
 Fluids and air are collected proximal
to the obstruction
 peristalsis ↑’s as the bowel attempts
to force-out the collected material
 peristalsis ends and the bowel
becomes blocked
 pressure increases and the
absorption ability is decreased
 this will lead to vomiting and
decreased absorption resulting to
shock
Assessment:
 Constipation
 vomiting
 Cramplike or diffused pain in the abdomen
 gaseous distention
 no flatus
Management:

 intestinal tube insertion (miller

abott, cantor tube) for
decompression
 fluid and electrolyte replacement

 prophylactic antibiotic

 v/s, I&O

 stool exam

 surgery
Hemorrhoids

 Dilated varicose veins of the anal canal

(internal and external may be
affected)
 Due to:
 Portal HPN
 Straining from constipation
 Irritation and diarrhea,
 CHF
 Increased abdominal pressure,
pregnancy
 Assessment:
 Itchiness
 Pain ( external)
 Bleeding
 Complications:
 Hemorrhage
 Strangulation
 Prolapse and Thrombosis
 Management:
 Stool softeners
 Laxative for constipation
 Analgesic
 Hot sitz bath
 Infrared photocoagulation and laser
therapy
 Surgery:
 Hemorrhoidectomy
 Cryosurgery
CONDITIONS OF THE
LARGE INTESTINE
Post-operative care for
hemorrhoidectomy
 1. Position: Prone or Side-
lying
 2. Maintain dressing &
Monitor for bleeding
 4. Administer analgesics and
stool softeners
 5. Advise SITZ bath 3-4x a day