2ND SEM TOPIC 1

GASTROINTESTINAL DISORDERS FLOW

GI tract
ASSESSMENT & DIAGNOSIS - 7 to 7.9m in length
METABOLISM ORAL CAVITY
- Is the sum of all physical processes by - Food then called bolus
which a living substance is formed and
ESOPHAGUS
maintained and by which energy is made
available for use by the organism. DIAPHRAGMATIC HIATUS
DIGESTION - Opening through which your food tube
passes before connecting to your stomach.
- A phase of digestive process that occurs
when digestive enzymes and secretions STOMACH
mix with ingested food and when proteins,
fats, sugars are broken down into smaller - Left upper quadrant
molecules. - Stores 1500 mL of food
- Pancreatic juices; neutralizes acidic chyme
ABSORPTION - Chyme; acidic partially digested food
- Small molecules, vitamins, and minerals SMALL INTESTINE
pass through the walls of the small
intestine and large intestine and into the - Absorption of nutrients
bloodstream. Duodenum
ANATOMY &PHYSIOLOGY - Release pancreatic juices by oddi of
sphincter
Jejunum
Ileum
Ileocecal valve
- Controls the digested materials from the
ileum to the cecum
- One way flow, to avoid backflow.
LARGE INTESTINE
- Absorption of water and electrolytes
RECTUM
- Fecal chambers
ANUS
- Opening for elimination.
FACTS!
1. GI TRACT receives blood from the
arteries
Mainly from the abdominal aorta
  Superior mesenteric artery
 Inferior mesenteric artery
MESENTERY
- A fold of membrane that attaches the
intestine to the abdominal wall and holds it
in place
- Allows the blood vessels to supply blood
to the abdominal organs.
FUNCTION OF THE DIGESTIVE SYSTEM
1. Breakdown of food particles into the
molecular form for digestion
2. Absorption into the bloodstream of small
nutrient molecules produced by digestion
3. Elimination of undigested, unabsorbed
food stuffs and waste.
ORAL CAVITY – mechanical digestion
 Chewing and
swallowing/MASTICATION
 1.5 L of saliva secreted daily from parotid,
submaxillary, and sublingual glands.
 Ptyalin/ salivary amylase
- Digest carbohydrates
 Swallowing is a voluntary act
 Esophageal peristalsis
GASTRIC FUNCTION
 Stomach produces 2.4L/day of fluid that
aid in digestion.
 Gastric secretion function: to further
breakdown food into more absorbable
components and to aid in the destruction of
ingested bacteria.
 Pepsin for protein digestion
 Intrinsic factor is released by the gastric
mucosa and combines with vitamin B12
and is absorbed in the ileum.
 Pernicious anemia is the absence of
intrinsic factor resulting in vitamin B12
deficiency.
 Churning is the process by which large
food particles is churned back into the
stomach for further breakdown.
 Chyme is partially digested food mixed
with gastric secretions.
 Food remains in the stomach for 30 mins
to several hours depending on the amount
of food and the type of food ingested.
SMALL INTESTINE FUNCTION
 The digestive process continues in the
duodenum
 Digestive enzymes (amylase, lipase, bile)
 Bile is produces by the liver and stored in
the gallbladder.
 Bile emulsifies ingested fats
 Pancreatic enzymes (trypsin for proteins
and lipase for fats)
 Sphincter of oddi refers to the smooth
muscle that surrounds the end portion of
the common bile duct and pancreatic duct.
This muscle relaxes during a meal to allow
bile and pancreatic juice to flow into the
intestine.
 Segmentation contraction is the mixing of
intestinal contents back and forth in a
churning motion.
 Intestinal peristalsis is the one-way
movement of intestinal contents.
COLONIC FUNCTION
 Bacteria is a major component of the
contents of the large intestine
 Normal flora/good bacteria; assist in
complete breakdown of waste materials.
 Slow, weak peristalsis moves the colonic
contents along the tract. Slow in nature.
 Large intestine is for water and electrolyte
absorption
  Waste reach the rectum usually in 12 hrs
but ¼ of waste stays for 3 days before
elimination.
WASTE PRODUCTS OF DIGESTION
 Feces consist of undigested foodstuffs,
inorganic materials, water, and bacteria.
 Fecal matter is about 75% fluid and 25%
solid material (Grossman & Porth, 2014).
 Fecal odor- chemicals formed by intestinal
bacteria.
 Gases/flatus formed contain methane,
hydrogen sulfide and ammonia, among
others.
COMMON SYMPTOMS
PAIN
- MAJOR SYMPTOM OF GI DISEASE
- COLDSPA (character, onset, location,
duration, severity, pattern, and associative
factors)
DYSPEPSIA
- MOST COMMON SYMPTOM of patients
with GI dysfunction
- Upper abdominal discomfort associated
with eating (INDIGESTION)
- FATTY FOOD causes the most discomfort
COMMON LOCATIONS
INTESTINAL GAS
- Belching is the expulsion of gas from the
stomach through the mouth.
- Flatulence is the expulsion of gas from the
rectum
- Feeling bloated = food intolerance or
gallbladder problem
NAUSEA AND VOMITING
- Nausea- a vague, uncomfortable sensation
of sickness or “queasiness” that may or
may not be followed by vomiting.
- Emesis/vomitus- may vary in color and
content, may contain undigested food
particles, blood (hematemesis, or bilious.
CHANGE OF BOWEL HABITS AND STOOL
CHARACTERISTICS
- May signal colonic dysfunction or disease
- DIARRHEA may occur with abdominal
pain and cramping and nausea or vomiting.
- Abnormal increase in frequency and
liquidity of stool. Occurs when contents
move rapidly through the intestine.
- The colon/large intestine looses control of
peristalsis, causing colon dysfunction
resulting in watery stools because the
colon has no time for absorption.
- Constipation is a decrease in frequency of
stool or stools that are hard, dry, and of
smaller volume than typical. The colon has
absorbed all the water causing to have dry
and hard stools.
- Tenesmus is the feeling that you need to
pass stool even when your bowel are
already empty.
- Stool is normally light brown to dark
brown
- Melena or black tarry stool indicates upper
GI bleeding
- Bright/dark red stool indicates lower GI
bleeding
- Streak of blood in stool indicates lower
rectal or anus bleeding
- CFACS (color, frequency, amount,
characteristic, and smell)
- Stercobilin is a tetrapyrrolic bile pigment
and is one end product of heme
catabolism. It is the chemical responsible
for the brown color of human fecal
material.
- Urobilin is a colorless pigment produced
from the breakdown of bilirubin by gut
bacteria. Most of this compound is
excreted in feces, and a small amount is
reabsorbed and excreted in the urine.
- Bulky, greasy, foamy stools that are foul in
odor and may or may not float
 - Light-gray or clay-colored stool, caused by - Bruising ; pulsations
a decrease or absence of conjugated
AUSCULTATION
bilirubin
- Stool with mucus threads or pus that may - Bowel tones
be visible on gross inspection of the stool - hypoactive every min. (normal every 15-
- Small, dry, rock-hard masses occasionally 20 seconds)
streaked with blood - hyperactive (about every 3 seconds)
- Loose, watery stool that may or may not
be streaked with blood. PERCUSSION
- Dullness – solid organ such as liver
- Tympany – hollow organs such as the
bowels Resonance – air-filled organs
- Flatness – dense tissue such as muscle and
bone.
PALPATION
- Pulsations
- Tenderness
- Masses
- Rigidity

PHYSICAL ASSESSMENT
LIPS
- moisture, hydration, color, texture,
symmetry, and the presence of ulcerations
or fissures.
- The lips should be moist, pink, smooth,
and symmetric.
GUMS
- The gums are inspected for inflammation,
bleeding, retraction, and discoloration.
- The odor of the breath is also noted.
- The hard palate is examined for color and
shape.
TONGUE
- The dorsum (back) of the tongue is
inspected for texture, color, and lesions.
- The patient is instructed to protrude the
tongue and move it laterally.
- Asking the patient to touch the roof of the
mouth with the tip of the tongue.
ASSESSMENT RECTAL INSPECTION AND PALPATION
INSPECTION
- Skin; distention; scars; obesity; herniations
 - Gloves, water-soluble lubrication, a
penlight, and drapes are necessary tools for
the evaluation.
- Knee-chest, left lateral with hips and knees
flexed, or standing with hips flexed and
upper body supported by the examination
PREPARATION OF CLIENT FOR GASTRIC
table
ANALYSIS
DIAGNOSTIC TESTS
1. SERUM LAB STUDIES
- CEA/carcinoembryonic antigen
- Colorectal cancer marker
- CA19-9; pancreatic cancer marker
- Alpha-fetoprotein; liver cancer marker
- Cancer is present if cancer marker is
present in the blood.
2. STOOL TEST
NURSING INTERVENTION
- Inspecting the specimen for consistency,
color, and occult blood (which is not
visible in the naked eye)
- Fecal urobilinogen, fecal fat, nitrogen,
clostridium difficile, fecal leukocytes,
calculation of stool osmolar gap, parasites,
pathogens, food residue, and other
substances require lab evaluation.
- FOBT or fecal occult blood test is one of
the most commonly performed stool test
- BEFORE- patients have restrictions on
what to eat/take before having the FOBT
since it was believed that it is associated
with false-negative results.
- NOW- These restrictions are no longer
advised since the actual effects have not
been established.
3. BREATH TEST
- Hydrogen breath test to evaluate
carbohydrate absorption. Determines the
amount of hydrogen expelled in the breath
after it has been produced in the colon.
- Urea breath test to detect the presence of H
pylori.
- Peptic ulcer disease is usually caused by
H. pylori bacteria
4. GASTRIC ANALYSIS
- yields information about secretory activity
of the gastric mucosa and the presence or
degree of gastric retention.
 NPO 8 to 12 hrs before the test
 Any medications that affect gastric
secretions are withheld 24 to 48 hrs before
the test.
 Smoking is not allowed on the morning
before the test.
5. ABDOMINAL ULTRASONOGRAPHY
- A noninvasive diagnostic technique in
which high frequency sound waves are
passed into internal body structures and the
ultrasonic echoes are recorded on an
oscilloscope as they strike tissues of
different densities.
- Endoscopic ultrasonography (EUS) is a
direct imaging of the GI tract.
 The patient is instructed to fast for 8 to 12
hours before ultrasound testing to decrease
the amount of gas in the bowel.
 Gallbladder studies- fat-free meal the
evening before the test.
 Barium studies- should be scheduled
before UTZ because it can interfere with
soundwaves.
6. GASTRIC ACID STIMULATION TEST
- histamine/pentagastrin is administered
subcutaneously.
- gastric specimens are collected every 15
minutes for 1 hour.
- Stomach contents are aspired.
7. PERNICIOUS ANEMIA
- Patients with this disease secrete no acid
under basal conditions or after stimulation.
8. SEVERE CHRONIC ATROPHIC
GASTRITIS/GASTRIC CANCER
- Patients with these diseases secrete little or
no acid.
9. GASTRIC ULCER
 - Patients with this disease secrete some
acid.
10. DUODENAL ULCERS
- Patients with this disease usually secrete
an excess amount of acid.
GI SERIES
UPPER GASTRIC SERIES/BARIUM
SWALLOW
- Upper GI tract studies
- Contrast agent is barium sulfate
- Upper GI fluoroscopy delineates the entire
GI tract after the introduction of a contrast
agent.
- It also aids in the diagnosis of ulcers,
varices, tumors, regional enteritis, and
malabsorption syndromes.
- Introduce barium in the body through the
mouth.
NURSING INTERVENTION
 Clear liquid diet to NPO from midnight the
night before the study.
 Not to smoke or chew gum during the
NPO→ increase gastric secretions and
salivation
 Polyethylene glycol (PEG)-based solutions
are considered the most effective bowel
cleansing preparatory agent.
 Increase fluids to facilitate evaluation of
stool and barium.
LOWER GI SERIES/BARIUM ENEMA
 The barium enema can be used to detect
the presence of polyps, tumors, or other
lesions of the large intestine.
 Demonstrate any anatomic abnormalities
or malfunctioning of the bowel.
 Introduce barium through the anus.
 15 to 30 mins examination
NURSING INTERVENTION
 Preparation of the patient includes
emptying and cleansing the lower bowel.
 Low-residue diet 1 to 2 days before the
test.
 A clear liquid diet and a laxative the
evening before. NPO after midnight.
 Cleansing enemas until returns are clear
the following morning.
 Barium enemas are scheduled before any
upper GI studies.
CT SCAN
- Provides cross-sectional images of
abdominal organs and structures.
- A CT scan may be performed with or
without oral or intravenous (IV) contrast,
but the enhancement of the study is greater
with the use of a contrast agent.
NURSING INTERVENTION
 Common risks from IV contrast agents
include allergic reactions and acute kidney
injury; therefore, patients must be screened
for these risks.
 Administration of IV sodium bicarbonate 1
hour before and 6 hours after IV contrast.
 Oral N-acetylcysteine (Mucomyst) before
or after the study.
MRI
- MRI is used in gastroenterology to
supplement ultrasonography and CT.
- This noninvasive technique uses magnetic
fields and radio waves to produce images
of the area being studied.
NURSING INTERVENTION
 NPO 6 to 8 hours before the study.
 Remove jewelry and other metals.
 Inform that the procedure may take 60 to
90 minutes.
POSITRON EMISSION TOMOGRAPHY/PET
SCAN
 - Produce images of the body by detecting
the radiation emitted from radioactive
substances.
- The radioactive substances are injected
into the body IV and are usually tagged
with radioactive isotopes of oxygen,
nitrogen, carbon, or fluorine.
ENDOSCOPIC PROCEDURES
1. UPPER GASTROINTESTINAL
FIBROSCOPY/ESOPHAGOGASTRODU
ODENOSCOPY
- Allows direct visualization of the
NURSING INTERVENTION
esophageal, gastric, and duodenal mucosa
through a lighted endoscope.  Colon cleansing
ENDOSCOPIC RETROGRADE  enema until return flow is clear
CHOLANGIOPANCREATOGRAPHY/ERCP  laxative for 2 days
 intestinal lavage – administration of
- Uses the endoscope in combination with x- polyethylene glycol electrolyte lavage
rays to view the bile ducts, pancreatic solution orally at interval of 3 to 4 hours
ducts, and gallbladder. (intestinal lavage is contraindicated in
clients with IBD and intestinal
NURSING INTERVENTION (GASTROSCOPY) obstruction).

BEFORE:
 NPO for 8 hours before the examination
 Midazolam(sedative) – relieves anxiety
 Atropine – reduce secretions.
 Position client – left lateral to promote
smooth entry of the scope.
AFTER:
 Assess LOC, vital signs, oxygen saturation
 Pain level and signs of perforation
(bleeding, unusual difficulty in
swallowing.
2. FIBEROPTIC COLONOSCOPY
- Virtual colonoscopy provides a
computer-simulated view of the air-
filled distended colon using
conventional CT scanning.
- This procedure is used commonly as a
diagnostic aid and screening device.
- The procedure can be used to remove
all visible polyps with a special snare
and cautery through the colonoscope.
- Before it is called CT colonography
- IBD/INFAMMATORY BOWEL
DISEASE
GI TREATMENT MODALITIES
1. GI INTUBATION
- is the insertion of a flexible tube into
the stomach, or beyond the pylorus
into the duodenum (the first section of
the small intestine) or the jejunum (the
second section of the small intestine).
- Can be inserted through the mouth,
nose, and abdominal wall.
PURPOSE:
 Decompress the stomach and remove gas
and fluid; can be used in patients
undergoing colonic surgery and can
remove excess gasses and contents to
relieve gastric distention
 Lavage (flush with water or other fluids)
the stomach and remove ingested toxins or
other harmful materials
 Diagnose GI disorders
 Administer tube feedings, fluids, and
medications Compress a bleeding site
 Aspirate GI contents for analysis
TYPE TUBES
 A. LEVIN TUBE 3. GASTROSTOMY
- Single lumen (channel within a tube or - is a procedure in which an opening is
catheter) and is made of plastic or created into the stomach.
rubber. - Bolus of feeding by gravity
- Connected into low intermittent - Feeding is usually divided into 3 to 4
suction feedings daily.
- 30 to 40 mmHg to avoid erosion in the - A gastrostomy is preferred over a
gastric lining nasally inserted tube to deliver enteral
B. SALEM SUMP nutrition support longer than 4 weeks.
- Is a radiopaque (easily seen in x-ray), - Balloon and non-balloon gastrostomy
clear plastic double-lumen gastric tube. tubes (G tubes) may be placed
- Large lumen surgically, endoscopically, or
- Air vent fluoroscopically.

FACTS!
 Lavage = flush away/remove from
 Gavage = introduce in PURPOSE:
- Administer medication
- Introduce feeding, fluids
- For gastric decompression
- For coma patients; it makes the
gastroesophageal sphincter intact
resulting in less risk of aspiration and
regurgitation.
2. DUMPING SYNDROME PERCUTANEOUS ENDOSCOPIC
- Caused by fast gastric emptying GASTROSTOMY
- The patient may have feelings of
fullness, nausea, cramping, dizziness,
diaphoresis, and osmotic diarrhea.
- This can lead to dehydration,
hypotension, and tachycardia.
- Common in patients who undergone
gastric surgeries.
- Osmolality is important in feeding
JEJUNOSTOMY
- High concentration feeding = water
will move in the intestinal lumen - It is a surgically placed opening into
rapidly. the jejunum for the purpose of
 administering nutrition, fluids, and
medications.
- A jejunostomy tube (J tube) is
indicated when the gastric route is not
accessible, or to decrease aspiration
risk when the stomach is not
functioning adequately to process and
empty food and fluids.

FORMULAS:
 A total of 1 to 3 L of solution is given over
a 24-hour period.
INITIATING THERAPY
 PN solutions are initiated slowly and
advanced gradually each day to the desired
rate as the patient’s fluid and dextrose
tolerance permits.
 Update lab results frequently to monitor
patient’s response to TPN, daily.
 Standing orders: weight the patient
 Also monitor: I&O, blood glucose, CBC,
and 24 hr urine nitrogen test
ADMINISTRATION METHOD
- PN may be given through either peripheral
or central IV lines, depending on the
patient’s condition and the anticipated
PARENTERAL NUTRITION length of therapy.
- It is a method of providing nutrients to the - An infusion pump is always used for
body by an IV route. administration of PN.
- The nutrients are a complex admixture
containing proteins, carbohydrates, fats,
electrolytes, vitamins, trace minerals, and
sterile water in a single container.
- To maintain muscle mass
- Promote weight maintenance/gain
- Enhance the healing process
PERPHERAL METHOD
- is given through a peripheral vein; this is
possible because the solution is less
hypertonic than a full-calorie PN solution.
- PPN/PARTIAL PARENTERAL
NUTRITION
- Low dextrose content
CENTRAL METHOD
 - they are given into the vascular system the catheter is threaded to the superior
through a catheter inserted into a high- vena cava/right atriocaval junction.
flow, large blood vessel. - Can be done at bedside or outpatient
- TPN - Should be done by specially trained Doctor
or RN’s.
PERCUTANEOUS (NONTUNNELED)
CENTRAL CATHETERS
- Are used for short-term (less than 6 weeks)
IV therapy in acute care settings.
- The subclavian vein is the most common
vessel accessed.
- The second most common access sites
include the basilic, brachial, or cephalic
veins in the arm followed by the jugular
vein.
- Subclavian vein is a stable site for
insertion
- Catheter is anchored easily SURGICALLY PLACED (TUNNELED)
- Easy compress to facilitate hemorrhage CENTRAL CATHETERS
- Also allow freedom of movements
- Are for long-term use and may remain in
- Easy access to dressing
place for many years.
- However; the subclavian site should be
- They are threaded (or tunneled) under the
avoided in patient’s with kidney disease
skin (reducing the risk of ascending
and who are underdoing hemodialysis.
infection) to the subclavian vein and
advanced into the superior vena cava.
- PERMCATH; can be used with single or
double luman
IMPLANTED VASCULAR ACCESS PORTS
- Are also used for long-term IV therapy;
examples include the Power injectable
Port-A-Cath, Mediport, Hickman Port, and
P.A.S. Port.
- The end of the catheter is attached to a
small chamber in the subcutaneous portion
either anterior chest wall or the patient’s
forearm.
- Most expensive

PERIPHERALLY INSERTED CENTRAL

CATHETER
- Are used for intermediate-term (several DISCONTINUING PARENTERAL
days to months) IV therapy in the hospital, NUTRITION
long-term care, or home setting.
- The PN solution is discontinued gradually
- The basilic, brachial, or cephalic vein is
to allow the patient to adjust to decreased
accessed above the antecubital space, and
levels of glucose.
- If the PN solution is abruptly terminated,
isotonic dextrose can be given at the same
rate the PN solution was infusing for 1 to 2
hours to prevent rebound hypoglycemia.
- Symptoms of rebound hypoglycemia
include weakness, faintness, sweating,
shakiness, feeling cold, confusion, and
increased heart rate.