Anatomy of GI tract
What is the digestive system?
- The digestive system is made up of the
digestive tract and other organs that help
the body break down and absorb food. It
is a long, twisting tube that starts at the
mouth and goes through the
oesophagus, stomach, small intestine,
large intestine and anus.
- The digestive system breaks down food
into nutrients such as carbohydrates, fats
and proteins. They can then be absorbed
into the bloodstream so the body can use
them for energy, growth and repair.
Unused materials are discarded as
faeces (poo).
- Other organs that form part of the
digestive system are the pancreas, liver
and gallbladder
Mouth
- When someone eats, the teeth chew
food into very small pieces. Glands in the
cheeks and under the tongue produce
saliva that coats the food, making it
easier to be chewed and swallowed.
Saliva also contains enzymes that start to
digest the carbohydrates in food.
Salivary glands
- Play an important role in digestion
because they make saliva. Saliva helps
moisten food so we can swallow it more
easily. It also has an enzyme called
amylase that makes it easier for the
stomach to break down starches in food.
Pharynx
- Is the portion of the digestive
tract that receives the food from your
mouth. Branching off the pharynx is the
 esophagus, which carries food to the
stomach, and the trachea or windpipe,
which carries air to the lungs
Oesophagus
- The oesophagus is the muscular tube
that carries food from the mouth to the
stomach after it is swallowed. A ring of
muscle at the end of the oesophagus
relaxes to let food into the stomach and
Rectum
contracts to prevent stomach contents
from escaping back up the oesophagus.
Liver
- Your liver makes a digestive juice called
bile that helps digest fats and some
Large intestine and anus
vitamins. Bile ducts carry bile from your
liver to your gallbladder for storage, or to
the small intestine for use.
Stomach
- The stomach wall produces gastric juice
(hydrochloric acid and enzymes) that
digests proteins. The stomach acts like a
concrete mixer, churning and mixing food
with gastric juice to form chyme — a
thick, soupy liquid.
absorbed into the bloodstream through
the wall of the small intestine.
- It is called small because it is about
3.5cm in diameter, but it is about 5m long
to provide lots of area for absorption.
Most of the chemical digestion of
proteins, fats and carbohydrates is
completed in the small intestine.
- The lower end of your large intestine, the
rectum, and stores stool until it pushes
stool out of your anus during a bowel
movement.
- The lining of the large intestine absorbs
water, mineral salts and vitamins.
Undigested fibre is mixed with mucus
and bacteria — which partly break down
the fibre — to nourish the cells of the
large intestine wall and so help keep the
large intestine healthy. Faeces are
formed and stored in the last part of the
large intestine (the rectum) before being
passed out of the body through the anus.

Pancreas

- Your pancreas makes pancreatic

juices called enzymes. These enzymes
break down sugars, fats, and starches.
Your pancreas also helps your digestive
system by making hormones. These are
chemical messengers that travel through
your blood.

Small intestine
- Bile from the gallbladder and enzymes in
digestive juices from the pancreas empty
into the upper section of the small
intestine and help to break down protein
into amino acids and fat into fatty acids.
These smaller particles, along
with sugars, vitamins and minerals, are
COMMON TERMINOLOGIES
TERM DEFINITION
absorption Process of taking nutrients from
our digestive system into the
blood that can be used by the
body, occurs when the small
intestine breaks down nutrients.
anus Opening at the end of the
alimentary canal through which
solid waste matter leaves the
body.
digestion Process of making food
absorbable by mechanically and
enzymatically breaking it down
into simpler chemical compounds
in our digestive tract.
elimination Excreting waste products or
foreign substances from our body.
hydrochloric Strong corrosive irritating acid can
acid be seen in the dilute form of
gastric juice, also called muriatic
acid.
intrinsic factor Glycoprotein secreted by humans
(parietal) or rodents (chief) cells
of gastric mucosa. Important role
in the absorption of vitamin B12 in
our intestine.
lipase An enzyme used by the body to
break down fats in food to be
absorbed in the intestines.
small intestine Organ in our gastrointestinal tract
where the absorption of nutrients
from the food happens.
trypsin Digestive enzyme that breaks
down proteins in the small
intestine, secreted by our
pancreas in inactive form
(trypsinogen).
amylase Enzyme, found chiefly in saliva
and pancreatic fluid, which
converts starch and glycogen into
sugar,
chyme Acidic fluid (pulpy) which passes
from our stomach to the small
intestine, consisting of gastric
juices and some digested food.
dyspepsia Also called Indigestion, happens
when the body has trouble
digesting food that occurs in the
GI tract.
esophagus Part of the alimentary canal which A small rounded mass of a

connects our throat to the substance, especially of chewed

stomach. food at the moment of swallowing

ingestion A process of taking food, drink or catabolism Breakdown of complex molecules

another substance into our body in living organisms to form simpler

by absorbing or swallowing it. ones, also with the release of

large intestine A long, tube-like organ that is energy.

connected to the small intestine at colostomy Opening into the colon from the

one end and our anus at the outside of the body.

other. constipation Condition in which you may have

pepsin A chief digestive enzyme in our fewer than 3 bowel movements a

stomach that breaks down week.

proteins into polypeptides. diarrhea A loose, watery stool 3 or more

stomach An internal organ which is the times a day.

major part of the digestion of food enema Liquid injected into our rectum, to

occurs, linking the esophagus to stimulate evacuation of the bowel

our small intestine (pear-shaped). or heal inflammation of colon or

anabolism A synthesis of complex molecules for diagnostic purposes.

in living organisms from simpler Fecal impaction A mass of dry, hard stool that

ones together with the storage cannot pass out of the colon or in

energy. the rectum.

bolus A single dose of drug or other Fecal Also called accidental bowel

substance given over a short incontinence leakage, accidental passing of

period of time. bowel movements, including solid

 stools, liquid stools or mucus from hydrolysis A chemical breakdown of a

our anus. compound due to reaction with

flatulence Passing gas from our digestive water.

system out of the back passage. ileostomy Surgical operation in which a

flatus Air that moves from the digestive piece of the ileum is diverted to

tract through the mouth an artificial opening in the

(belching). abdominal wall.

gluconeogenesis Process of making glucose from mastication Or chewing, in which food is

its own breakdown products or crushed and mixed with our saliva

from the breakdown of lipids or to form a bolus for swallowing.

proteins. Occurs in kidney or liver. obstipation Severe or complete constipation.

glycogenolysis A process by which the glycogen,

the primary carbohydrate stored

in the liver and muscle cell of

animals, breaks down into

glucose to use as energy and to

maintain blood glucose levels

during fasting.

glycogenesis Formation of glycogen from

sugar.

hemorrhoid Also called piles, a swollen and

inflamed veins around your anus

or in our rectum.
NCM 116 (GERD to IBD) A. Nutritional-metabolic Patterns /
• Digestion Responses to Altered Nutrition
o Mechanical - physical movement 1. Disturbances in Ingestion
to make foods smaller
o Chemical - uses enzymes to Gastroesophageal reflux
break down food - Backflow of duodenal contents
• Absorption - AKA “Reflux Esophagitis”
• Metabolism - Patient with obstructed area disorder
• Elimination (incidence that can lead to GERD)

• Gluconeogenesis - when liver glycogen Risk Factors

stores start to deplete and alternative • Cigarette smoking
source of glucose • Hiatal hernia
• Mastication - chewing • Chronic belching
• Peristalsis - wave-like muscle • Obesity
contractions • Aging
• Cholecystokinin - digestive hormone • Pregnancy
released with secretin when food from • Excessive ingestion of fatty foods, cola
the stomach reaches the duodenum. drinks, coffee, tea, milk, peppermint,
spicy foods/fluids, citrus fruits, and
Gastrointestinal Assessment alcohol
• Incompetent lower esophageal,
Nursing history sphincter, pyloric stenosis, or a motility
• Chief complaint (pain, diarrhea, disorder
vomiting,etc…)
• Present illness (Pain scale, when did it Clinical Manifestation
start, etc…) • Pyrosis (heartburn/burning sensation on
• Medical history esophagus)
• Family history • Dyspepsia (indigestion)
• Regurgitation (backward flowing)
Physical assessment • Dysphagia (difficulty in swallowing) or
• Inspection odynophagia (painful swallowing)
• Auscultation • Hypersalivation
• Percussion • Esophagitis
• Palpation
Diagnostic
Note: Inspect skin for turgor, texture, • Upper gastrointestinal endoscopy
stretchmarks o To evaluate reflux esophagitis
o 1st choice of investigation
A rapid assessment of the gastrointestinal (GI) • Barium swallow
system includes evaluation of: o Evaluate damage to esophageal
• Appetite, intake, and tolerance of foods mucosa
and fluids • Ambulatory 12- to 36- hours esophageal
• Swallowing. pH monitoring
• Abdominal pain, distention, bowel o Degree of acid reflux
sounds. • Esophageal pH monitoring
• Nausea and vomiting.
• Frequency and character of bowel
movements (constipation or diarrhea).
Management Hiatal Hernia
1. Patient education
• Low fat diet - Top of stomach bulges through opening
• Avoid containing in the diaphragm
peppermint/carbonated Main Types:
beverages • Sliding- reflux, regurgitation, and
• Avoid drinking/eating before dysphagia
bedtime • Para esophageal
• Maintain body weight - Chest pain
• Avoid tight fitting clothes - Reflux / regurgitation of undigested food
• Elevate bed head (elevate upper - Gurgling noises after eating
body with pillows) - Halitosis
- Regurgitation of sour materials in the
2. Pharmacologic: mouth
• Antacids (ex: Maalox)
• Histamine 2 receptors
antagonists/blockers (cimetidine,
ranitidine)
• Proton pump inhibitors
(omeprazole, lansoprazole)
• Promotility agent
(metoclopramide)
Note: Histamine and Proton pump inhibitors are
the DRUG OF CHOICE

Surgical Management
1. Fundoplication Risk Factors
Complications: esophageal stricture 1. More in women than men
2. Injury or other damage may weaken
muscle
3. Obesity
4. Aging
5. Smoking
6. Putting too much pressure (repeatedly)
on the muscles around your stomach

Assessment and Diagnostic Tests

1. X-ray studies
2. Barium swallow
• to determine why a person is
having difficulty or pain while
swallowing, weight loss, vomiting
with blood, and other abdominal
issues
3. Fluoroscopy
• take real-time footage of tissues
inside your body
Management
• Determine an eating pattern (small,
frequent feeding)
• Teaching plan for client and family
- Elevate head from 4-8 inches
- Avoid eating 3 hrs before bedtime
- Teach patient to drink prescribed
medication
- Differentiate symptoms of hernia
Management
• Eat slowly and to drink fluids with meals
• Oral calcium channel blockers and
nitrates
• Injection of botulinum toxin (Botox)
• Pneumatic dilation to stretch the
narrowed area of the esophagus
SUMMARY:

Surgery GERD - open sphincter

• Hernia Repair HIATAL HERNIA - opening of diaphragm
ACHALASIA - dilation of esophagus

TERMS:
• Absorption
• Amylase
• Anus
• Chyme
• Digestion
• Dyspepsia
• Elimination
• Esophagus
• Hydrochloric Acid
• Ingestion
Achalasia • Intrinsic Factor
• Large Intestine
- Patient’s esophagus dilates • Lipase
- Absent/ineffective peristalsis • Pepsin
- Person 40 years old and above • Small Intestine
- Difficulty of swallowing foods due to
• Stomach
damage of nerves in esophagus
• Trypsin
Clinical Manifestations
• Dysphagia
• Non-Cardiac chest or epigastric pain
• Pyrosis
• Secondary pulmonary complication:
Aspiration of gastric contents

Assessment and Diagnostic Findings

• X-ray studies (to know if there are
dilations)
• Barium swallow
• Computed tomography (CT) scan of the
chest
• Endoscopy
• Manometry
 - Red/maroon
• Melena is black, tarry stool that
represents digested blood.
- 50 mL GI blood loss/day
- Has an odor
- Loose
- Dark black
- Oily
- Can be upper GI bleeding
Signs of bleeding in the upper digestive
tract: (from MOUTH – DUODENUM)
2. Disturbances in Digestion
• Bright red blood in vomit
Nausea & Vomiting
• Vomit that looks like coffee grounds –
Can be from enzyme (hematin)
• Black or tarry stool
- Food intake
- Odors • Dark blood mixed with stool
- Medications Signs of bleeding in the lower digestive
- Activity tract: (JEJUNUM – SMALL INTESTINE)
Emesis • Black or tarry stool
- After hemorrhage (bright red) • Dark blood mixed with stool
- Blood retains in the body (coffee ground) • Stool mixed or coated with bright red
blood
Causes:
Symptoms
1. Visceral afferent Stimulation
- Infection Overt bleeding: term used when blood is visible
- Pancreatic disorders • Vomiting blood (red, dark brown, coffee
- Peritoneal Irritation ground)
- Dismotility
• Black, tarry stool
- Mechanical Obstruction
• Rectal bleeding, usually in or with stool
2. CNS disorders
3. Irritation of the chemoreceptor trigger Occult bleeding: gastrointestinal bleeding that
zone from radiation therapy, systemic is not visible to the patient or physician, resulting
disorders and anti-tumor chemotherapy in either a positive fecal occult blood test, or iron
medications. deficiency anemia with or without a positive
fecal occult blood test
Gastrointestinal (GI) bleeding
• Lightheadedness
- Stool (black tarry)
• Difficulty breathing
- Vomit
- Not always visible • Fainting
- Esophagus to anus • Chest pain
• Hematemesis is vomitus which contains • Abdominal pain
blood. (coffee ground)
• Hematochezia is red or maroon-colored
blood in the stool. (might be from
upper/lower GI)
Symptoms of shock • Radiation proctitis
- Following radiation therapy
• Drop in blood pressure
- Prostate for male
• Not urinating or urinating infrequently, in - Cervix/Uterus for female
small amounts
• Arteriovenous malformations
• Rapid pulse - In older adults
• Unconsciousness
• Ischemia
Causes of Gastrointestinal Bleeding - Ischemic Colitis (left colon) (left lower
quadrant pain)
Upper GI source: - Acute/Chronic blood loss
• Gastritis • Inflammatory bowel disease
- Stress - Diarrhea and r. massive bleeding
- Alcohol • Infectious colitis
- Diarrhea and massive bleeding
Medication: • Neoplasms
- NSAID - Chronic blood loss
• Ulcers Approach to the Patient
- H. pylori
a. Patient history
Medication: 1. Number of episodes
- NSAID - Time started and ended
• Mallory-Weiss tear 2. Most recent episode
• Biliary 3. Use of NSAIDs, aspirin, or other
- trauma antiplatelet agents
• Large varices 4. Use of anticoagulants
Portal hypertension: an increase in 5. Use of proton pump inhibitors
the pressure within the portal 6. Cirrhosis
vein (the vein that carries blood from 7. Alcohol abuse
the digestive organs to the liver). The 8. Vomiting before hematemesis
increase in pressure is caused by a 9. Presence and location of abdominal pain
blockage in the blood flow through the 10. Prior aortic surgery
liver. 11. Previous history of GI bleeding, if any
• Esophagitis or Esophageal ulcer Physical examination
• Entero-aortic fistula
• Vital signs
• Duodenitis or Dieulafoy’s lesion
• Inflammatory bowel disease Orthostatic Hypotension: also called postural
• Neovascularization hypotension — is a form of low blood pressure
• Gastric cancer that happens when you stand up from sitting or
lying down. Orthostatic hypotension can make
NOTE:
you feel dizzy or lightheaded, and maybe even
• Gastritis, Ulcers, Mallory-Weiss Tear cause you to faint.
- Most common in upper GI bleeding.
• HEENT (Head, Eyes, Ears, Nose, and
Lower GI source: (DRAIIIN) Throat)
• Lungs and heart
• Diverticulosis - Left ventricular dysfunction
- Painless - Murmur sounds
 • Abdomen - (bolus 500 mL water and withdraw
- Nature of blood until there is no blood
- Bowel sounds - Below NGT (duodenal ulcer lavage)
- Rigidity
Lavage: washing out of a body cavity, such as
- Guarding the colon or stomach, with water or a medicated
- Rebound tenderness (might be solution.
peritonitis) D. Hold antihypertensive or diuretic therapy
Peritonitis: is a redness and swelling E. Decide whether to admit the patient to
(inflammation) of the tissue that lines your belly the intensive care unit (ICU).
or abdomen. This tissue is called the Criteria:
peritoneum. It can be a serious, deadly disease.
• Variceal bleeding (suspected or
• Rectum confirmed)
- Palpate rectal masses • Instability of vital signs
• Neurologic examination • Serious comorbid conditions
- Liver diseases • Active GI bleeding or Advanced age
- LOC
• Skin Medical Management
- Yellowish 1. Transfusion
- Palmar erythema - Whole blood
Diagnostic tests: - Packed RBC
- (4 hours, 1 unit of blood, Hgb should
• Blood typing and cross-matching increase and if not there is still blood
• Complete blood count (CBC) with loss)
platelets 2. Intravenous proton pump inhibitors
• Electrolyte panel (Upper GI bleeding)
Blood urea nitrogen (BUN) and creatinine 3. Octreotide (Upper GI bleeding)
levels 4. Vitamin K (Not normal PTT)
Diagnostic test:
• Liver tests
• Prothrombin time (PT) and partial 1. Upper endoscopy
• Thromboplastin time (PTT) - When “urgent”
• Chest and abdominal radiographs - 12-24 Upper GI
• Electrocardiogram (EKG) 2. Colonoscopy
3. Technetium-99m (99mTc)- labeled red
General guidelines for the management of a blood cell scan
patient with GI bleeding 4. Visceral angiogram
- Do not delay the management. 5. Capsule endoscopy
- Small bowel
A. Always begin by evaluating the ABCs
and assessing the patient’s clinical
status.
B. Begin fluid replacement. (IV, big needles
like g18)
C. Insert a nasogastric tube (NGT) if there is
any possibility an upper GI bleed exists.
 Gastritis Diagnostic Tests (UBS)
Risk Factors/Causes 1. Upper GI X-ray series or Endoscopy
2. Biopsy
Acute Gastritis Chronic Gastritis
3. Serologic testing to detect antibodies
a. Food that is a. Helicobacter
against H. pylori
irritating, spicy, pylori (H.
too highly pylori) Management
seasoned, or b. Autoimmune
contaminated diseases 1. Refrain from alcohol and food until
with disease- c. Caffeine symptoms subside.
causing intake 2. After the patient can take nourishment by
microorganisms d. NSAIDS mouth, a nonirritating diet is
b. Overuse of e. Alcohol recommended
aspirin and f. Smoking 3. If the symptoms persist, fluids may need
other NSAIDS g. Chronic reflux to be administered parenterally.
c. Excessive of pancreatic 4. If gastritis is caused by ingestion of
alcohol intake secretions
strong acids or alkalis, treatment consists
d. Bile reflux and bile into
of diluting and neutralizing are the
e. Radiation the stomach
therapy offending agent.
f. Ingestion of 5. Supportive Therapy
strong acid or - NGT
alkali - Analgesic
- Antacid (Maalox, Aluminum
Hydroxide)
Pathophysiology 6. Emergency surgery may be required to
1. In gastritis, the gastric mucous remove gangrenous or perforated tissue
membrane becomes edematous and - For perforated tissues
hyperemic (congested with fluid and Gastrojejunostomy: remove perforated
blood) and undergoes superficial tissues, gangrenous. A surgical procedure in
erosion. which an anastomosis is created between the
2. It secretes a scanty amount of gastric stomach and the proximal loop of the jejunum.
juice, containing very little acid but much This is usually done either for the purpose of
mucus. draining the contents of the stomach or to
3. Superficial ulceration may occur and can provide a bypass for the gastric contents.
lead to hemorrhage.
7. Chronic gastritis is managed by
Clinical Manifestations modifying the patient’s diet, promoting
1. Acute: abdominal discomfort; nausea, rest, reducing stress, and initiating
anorexia; vomiting; and hiccupping. pharmacotherapy.
- Some patients, however, have no 8. H. pylori may be treated with antibiotics
symptoms - Tetracycline
2. Chronic: anorexia; heartburn after eating; - Amoxicillin
belching; a sour taste in the mouth, or - Clarithromycin
nausea and vomiting; mild epigastric
discomfort or report intolerance to spicy
or fatty foods or slight pain that is relieved
by eating; vitamin B12 deficiency
Nursing Management Duodenal ulcer Gastric Ulcer
1. Reduce Anxiety
2. Promote Optimal Nutrition
3. Promote Fluid Balance
4. Relieve Pain
- Foods
- Meds
- Level of pain
5. I and O monitor
6. Serum electrolyte bolus check
7. Ice chips, solid foods if symptoms
subside
8. If smoker educate about counselling
9. If there is hemorrhage
- record hematemesis in output
PEPTIC ULCER DISEASE (GASTRIC
AND DUODENAL ULCERS)
- Esophageal
Risk Factors/Causes
1. Ages between 40- 60 Clinical Manifestations
2. Menopause 1. Dull gnawing pain or a burning sensation
3. Stress/anxiety in the mid epigastrium or in the back
4. Excessive secretion of HCl in the 2. Pyrosis (heartburn)
stomach 3. Hunger
5. Familial tendency 4. Vomiting
6. H. pylori infection 5. Constipation or diarrhea
7. Chronic use of NSAIDs 6. Belching and bloating
Stress ulcer - are multiple, superficial erosions 7. Bleeding (15%)
which occur mainly in the fundus and body of the Complications
stomach. They develop after shock, sepsis, and
trauma and are often found in patients with 1. Hemorrhage
peritonitis and other chronic medical illness. - Frequent in older
- Dizziness
- Observe 72 hours after burn - Anemia in blood test, pale
Cushing ulcer - is a gastro-duodenal ulcer - O. Hypotension
produced by elevated intracranial pressure - H. shock if severe
caused by an intracranial tumor, head injury or - Hematemesis
other space-occupying lesion. - Melena
- Fatigue
- Brain injury 2. Obstruction
- Brain trauma - Edema blocks GI tract
- Occurs in esophagus - Muscle spasm / scar
- Patient feels nauseous / epigastric
fullness
3. Perforation
 - Gastric contents (peritonitis) goes to 12. Advancing age
peritoneum
Clinical Manifestations
Medical Management 1. Minor soiling
2. Occasional urgency
• Triple therapy (10-14days) (MACPPI)
3. Loss of control or complete incontinence
- Metronidazole
- Can be diarrhea and constipation
- Amoxicillin 4. Poor control of flatus
- Clarithromycin 5. Diarrhea or constipation
- PPI
Assessment and Diagnostic Tests
NOTE: Combine amocx, clar, ppi
• Rectal examination and Flexible
• Quadruple Therapy (MTPD) sigmoidoscopy
- Metronidazole - Rule out tumor, inflammation, fissures
- Tetracyline • Barium enema
- PPI • Computed tomography (CT)
Bismuth Salt • Anorectal manometry
1. Pharmacologic Therapy NOTE: b. enema, ct, anorectal mano – used
2. Stress Reduction and Rest to identify alteration in intestinal mucosa,
muscle tone, detecting other structure or
3. Smoking Cessation
functional problems.
- Acidity increases in duodenum
- Bicarbonate balance Medical Management
4. Dietary Modification 1. Impaction is removed and the rectum is
Surgical Management cleansed.
- Cause is impaction
1. Gastric Surgeries 2. Biofeedback therapy with pelvic floor
muscle training.
3. Disturbances in Absorption & Elimination - Decreased sensory
• Disorders of Intestinal Mobility awareness/sphincter control
• Malabsorption Syndromes 3. Bowel training programs
• Structural and Obstructive Bowel
Disorder Surgical management
• Surgical reconstruction,
FECAL INCONTINENCE • Artificial sphincter
• Implantation sphincter repair
Risk Factors/Causes • Fecal diversion
1. Trauma
- After surgical procedure that involves Nursing Management
rectum 1. Obtain thorough health history,
2. Neurologic disorders including information about previous
- Dementia surgical procedure, chronic illness,
- Stroke dietary patterns, bowel habits, and
3. Inflammation problems and current medication
4. Infection regimen.
5. Diarrhea - To know the causes
6. Chemotherapy - Most important/priority
7. Radiation treatment 2. Initiate a bowel-training program that
8. Fecal impaction involves setting a schedule to
9. Pelvic floor relaxation establish bowel regularity.
10. Laxative abuse - Consistent time
11. Medications
 3. Therapeutic use of diet and fiber:
foods that thicken stool (applesauce)
and fiber products (psyllium) help
improve continence.
4. Maintain perineal skin integrity:
incontinence briefs/adult diaper are to
be used only for brief periods of time;
encourage and teach meticulous skin
hygiene and use perineal skin
cleansers and skin protection
products to protect perineal skin.
- To prevent infection
5. Fecal incontinence devices may be
used.
CONSTIPATION
Clinical Manifestations
ADD: bloating, flatulence
1. Abdominal distention
2. Borborygmus
- Gurgling, rumbling sound cause by
passage of gas through the intestine.
3. Pain and pressure
4. Decreased appetite
5. Headache
6. Fatigue
7. Indigestion
8. A sensation of incomplete emptying
9. Straining at stool,
10. Elimination of small-volume, lumpy, hard,
dry stools

- Abnormal infrequency of defecation Pathophysiology

- Hardening because it is absorb by 1. Constipation includes interference with
water one of three major functions of the colon:
- Painful sometimes mucosal transport, myoelectric activity,
- Decreased stool volume or the processes of defecation.
2. The urge to defecate is stimulated
Risk Factors normaly by rectal distention that initiates
1. Medications a series of four actions: stimulation of the
- Antacid inhibitory rectoanal reflex, relaxation of
- Anticholinergics the internal sphincter muscle, relaxation
- Antihypertensive of the external sphincter muscle and
- Antidepressant muscles in the pelvic region, and
- Tranquilizer increased intra- abdominal pressure.
- Diuretic 3. If all organic causes are eliminated,
- Iron idiopathic constipation is diagnosed.
2. Rectal or anal disorders 4. When the urge to defecate is ignored, the
- Hemorrhoids/fissure rectal mucous membrane and
3. Obstruction musculature become insensitive to the
4. Neuromuscular conditions presence of fecal masses, and
- Hirschsprung’s disease consequently a stronger stimulus is
5. Endocrine disorders required
- Hypothyrodism 5. The initial effect of fecal retention is to
6. Irritable bowel syndrome (IBS), produce irritability of the colon, which at
diverticular disease, appendicitis this stage frequently goes into spasm,
- Dehydration especially after meals, giving rise to
7. Weakness, immobility, debility, fatigue, colicky mid abdominal or low abdominal
and an inability to increase intra- pains.
abdominal pressure 6. After several years of this process, the
- Injury on anal sphincter colon loses muscular tone and becomes
8. Delaying or ignoring the urge to defecate essentially unresponsive to normal
9. Dietary habits stimuli.
10. Lack of reqular exercise, and a stress- 7. Atony or decreased muscle tone occurs
filled life with aging. This also leads to
11. Chronic laxative use constipation because the stool is retained
12. Aging for longer periods.
Complications
1. Hypertension
2. Fecal impaction
3. Hemorrhoids
4. Megacolon
Assessment and Diagnostic Tests
1. Barium enema or Sigmoidoscopy
- To determine spasm/narrowing or
bowel movements
2. Stool testing for occult blood
3. Anorectal manometry
- To assess malfunction of sphincter
4. Defecography and colonic transit studies.
- To assess active anorectal sphincter
Medical Management
- Assess full minute bowel sounds
- If bowel sounds are not visible,
laxative is not allowed
- Assess abdominal distention
- Pain
- Last bowel movement
- Dietary intake
- Medications
- 4 doctor’s order of laxative / check
time of effectiveness
- Meds are given usually at night
- Reassess abdomen every time
- Assess effectiveness of laxative to px
1. Bowel habit training
2. Increase fiber and fluid intake
3. Discontinuing laxative abuse
4. Routine exercises to strengthen
abdominal muscles
5. Daily addition to the diet of 6 to 12
teaspoonfuls of unprocessed bran
6. laxative: bulk-forming agents, saline and
osmotic agents, lubricants, stimulants, or
fecal softeners
7. longterm laxative: a bulk-forming agent in
combination with an osmotic laxative
Nursing Management
1. Assess on the following: onset and
duration of constipation, current and past
elimination patterns, the patient's
expectation of normal bowel elimination,
and lifestyle information (exercise and
activity level, occupation, food and fluid
intake, and stress level), past medical
and surgical history, current medications,
and laxative and enema use are
important, as is information about the
sensation of rectal pressure or fullness,
abdominal pain, excessive straining at
defecation, and flatulence.
- Ask the pattern (every what day or
time)
2. Patient education and health promotion.
- Program
3. Restore or maintain a regular pattern of
elimination, ensure adequate intake of
fluids and high-fiber foods, learn about
methods to avoid constipation, relieve
anxiety about bowel elimination patterns,
and avoid complications
Prevention
1. Emphasize the importance of responding
2. Teach how to establish a bowel routine
3. Provide dietary information
- Eat high residue/high fiber
- Fruits/vegetables
- Increase fluid intake (Except for
edema px)
4. Exercise regimen, increased ambulation,
and abdominal muscle toning.
- Explain increase muscle treatment
5. Describe abdominal toning exercises
- Contraction of abdominal muscles 4
times a day
- Sit ups
6. Explain that the normal position
- Semi-squatting
- Maximize abdominal muscle
- Force of gravity
7. Avoid overuse or long-term use of
stimulant laxatives
DIARRHEA
- Watery stool
- Might have odor/fishy
- Color
- Increased frequency of bowel
movements (more than 3 times per
day)
- Infection: if acute it is self-limiting
- If chronic persist longer period
Types
1. Secretory diarrhea
- Bacterial toxins
- Increased production of water and
electrolyte in intestinal mucosa,
Intestinal lumen
2. Osmotic diarrhea
- Occurs when water hold in intestine
by osmotic pressure (unabsorb
particle)
- Slowing reabsorption of water
- Deficiency of lactase
- Pancreatic dysfunction
- Intestinal hemorrhage
3. Malabsorptive diarrhea
- Inhibits absorption of nutrients
4. Infectious diarrhea
- From infectious agents that invades
intestinal mucosa (clostridium
deficile)
5. Exudative diarrhea
- Change in mucosal integrity
- Tissue distraction by radiation /
chemotherapy
6. Thirst
7. Painful spasmodic contractions of the
anus and ineffectual straining (tenesmus)
8. Watery stools
Complications
1. Fluid and electrolyte loss
2. Dehydration
3. Cardiac dysrhythmias
4. Urinary output of less than 30 mL per
hour for 2 to 3 consecutive hours
5. Hypokalemia (less than 3.5 mEq/L
6. Muscle weakness, paresthesia,
hypotension, anorexia, and drowsiness,
(due to hypokalemia)
Assessment and Diagnostic Tests
1. Complete blood cell count
2. Urinalysis
3. Routine stool examination, and stool
examinations
- Ask to describe stool
4. Endoscopy or barium
- For Identifying/assisting care

Risk Factors Medical Management

1. Irritable bowel syndrome (IBS), • controlling symptoms
2. Inflammatory bowel disease (IBD) - Medication: antibiotics, anti-
3. Lactose intolerance inflammatory agent to reduce severity
4. Medications of diarrhea
- Antacid • preventing complications
- Laxative • eliminating or treating the underlying
- Antidiuretics disease
- Stool softener
- Thyroid hormone replacement Nursing Management
- Chemotherapy ADD: stool sample, assess patient IV access if
5. Tube feeding formulas diarrhea is severe.
6. Metabolic and endocrine disorder 1. Assess and monitor the
- Diabetes characteristics and pattern of
- Addison’s disease diarrhea, patient's medication
7. Viral or bacterial infectious processes therapy, medical and surgical history,
- Food poison and dietary patterns and intake.
8. Nutritional and malabsorptive disorders 2. Auscultate abdomen and palpate for
- Celiac disease abdominal tenderness.
3. Assess hydration status
Clinical Manifestations 4. Encourages bed rest and intake of
1. Increased frequency and fluid content of liquids and foods low in bulk until the
stools acute attack subsides.
2. Abdominal cramps 5. When food intake is tolerated: bland
3. Abdominal distention diet of semisolid and solid foods.
4. Intestinal rumbling (borborygmus)
5. Anorexia
 6. Patient should avoid caffeine, - 3 months in a 1 month
carbonated beverages, and very hot - Past 3 months
and very cold foods a. improvement with defecation
7. Restrict milk products, fat, whole- b. Onset associated with change in
grain products, fresh fruits, and frequency of stool
vegetables c. Onset associated with change in
- Monitor I and O appearance (form) of stool
- Antibiotics on schedule 2. To rule out other colon diseases: Stool
- Antimolity should avoid studies; Contrast x-ray studies;
- Document patient status Proctoscopy
- Implement contact precaution (if 3. Barium enema and Colonoscopy
infectious) - Reveal spasm, distention, and
8. Administer antidiarrheal medications muscle accumulation in the intestines
as prescribed 4. Manometry and electromyography
9. Intravenous fluid therapy (EMG)
10. Closely monitor serum electrolyte - To study intraluminal pressure
levels. changes generated by spasticity
11. Report evidence of dysrhythmias or a
change in the level of consciousness. Management
12. The patient should follow a perineal 1. Restriction and then gradual
skin care routine reintroduction of foods that are possibly
NOTE: irritating
- For elderly: can be dehydrated - Observe food that causes irritation
quickly, assess signs of hypokalemia 2. High-fiber diet
for low vitamin K. - Depends if diarrhea/constipation is
the symptoms
3. Exercise
IRRITABLE BOWEL SYNDROME (IBS) - It increases intestinal motility
4. Fluids should not be taken with meals
- A common intestinal disorder that 5. Discourage alcohol use and cigarette
affects the colon (the large intestine) smoking
- Common GI problem 6. Participate in a stress reduction or
- Cause: unknown behavior
7. Pharmacologic:
Risk Factors a. Antidiarrheal agents (loperamide)
1. Women - Most common
2. Heredity b. Antidepressants
3. Psychological stress or conditions - Treating underlying
4. Diet high in fat and stimulating or irritating anxiety/depression and cramping
foods 8. C. Anticholinergics or Antispasmodics
5. Alcohol consumption - To decrease gas in the abdomen
6. Smoking 9. Probiotics
10. Artichoke leaf extract, peppermint oil,
Clinical Manifestations and caraway oil
1. Primary symptoms -constipation,
diarrhea, or a combination of both CONDITIONS OF MALABSORPTION
2. Pain, bloating, and abdominal distention Risk factors/Causes
- Pain removes when pooping 1. Mucosal (transport) disorders causing
generalized malabsorption
Assessment and Diagnostic Findings - Regional enteritis
1. Diagnostic criteria: Recurrent abdominal 2. Infectious diseases causing generalized
pain or discomfort malabsorption
 -Small bowel bacterial overgrowth - Results in destruction in absorbing
-Whipple disease: is a rare bacterial surface of intestine
infection that most often affects your - Weight loss
joints and digestive system. Whipple - Diairrhea
disease interferes with normal 8. Tropical sprue
digestion by impairing the breakdown - Climate change
of foods, and hampering your body's - Low VB12 absorption
ability to absorb nutrients, such as 9. Whipple's disease
fats and carbohydrates - Bacterial invasion in intestinal
3. Luminal problems causing mucosa
malabsorption - Weight loss
- Pancreatic insufficiency - Fever
4. Postoperative malabsorption 10. Certain parasitic diseases
- After gastric/intestinal resection - There is damage in surface of
5. Disorders that cause malabsorption of mucosa
specific nutrients - See in biopsy/stool exam
- Ex: Lactose Intolerance: disaccharide
that leads to L.I Clinical Manifestations
1. Hallmarks: diarrhea
Characteristics of Diseases of - Steatorrhea: when a person has a
Malabsorption loose but bulky stool with globs of fat
1. Gastric resection with gastrojejunostomy and noticeable oil separation (gray
- There is a decrease stimulation by color stool, sometimes)
duodenal bypass or poor mixing of 2. Abdominal pain, abdominal distention
food 3. Increased flatus
- Weight loss 4. Weakness,
- Anemia (combination of iron deficieny 5. Weight loss
and malabsorption
- Folate deficiency Complications
2. Pancreatic insufficiency 1. Malnutrition
- A chronic pancreatitis - Most common
- Reduce intraluminal pancreatic 2. Dehydration
enzyme activity 3. Avitaminosis
- Proteins/Lipids (malabsorption) 4. Osteoporosis
- Abdomindal pain
- Weight loss Assessment and Diagnostic Findings
- 70% has P.I. 1. Stool studies
3. Ileal dysfunction - For qualitative fat analysis
- There is a loss of ileal absorption 2. Hydrogen breath test
surface, decrease VB12 absorption - If there is carbohydrates
4. Stasis syndromes malabsorption (suspected)
- Surgical stricture (ex: blind loops - 3. Endoscopy with biopsy of the mucosa
occurs when food doesn't follow the - Best diagnostic tool
normal digestion route and bypasses 4. Ultrasound studies, CT scans, and x-ray
a section of your intestine.) - To reveal pancreatic/intestinal tumor
5. Zollinger-Ellison syndrome 5. Complete blood cell count
- Has hyperactivity in duodenum that - To detect anemia
makes pancreatic enzyme inactive 6. Pancreatic function tests
6. Lactose intolerance - To assist in specific diagnostic
- Deficiency in intestinal lactase disorders
7. Celiac disease (gluten-sensitive
enteropathy)
Medical Management commonly occurs in the distal ileum and,
1. Avoid dietary substances that aggravate to a lesser degree, the ascending colon.
malabsorption 3. It is characterized by periods of remission
2. Vitamin supplements are water-soluble and exacerbation.
vitamins, fat-soluble vitamins, and 4. The disease process begins with edema
minerals and thickening of the mucosa.
- VB12 and folic acid (water soluble) 5. Ulcers begin to appear on the inflamed
- ADEK (fat soluble) mucosa. These lesions are not in
- Calcium and iron (minerals) continuous contact with one another and
- Give to the patient ^ are separated by normal tissue. Hence,
3. Reduce gluten intake these clusters of ulcers tend to take on a
4. Folic acid supplements classic "cobblestone" appearance.
5. Antibiotics 6. Fistulas, fissures, and abscesses form as
- Treatment of bacterial overgrowth the inflammation extends into the
6. Antidiarrheal peritoneum.
- Decrease intestinal spasm 7. Granulomas occur in 50% of patients.
7. Parenteral fluids 8. As the disease advances, the bowel wall
thickens and becomes fibrotic, and the
INFLAMMATORY BOWEL DISEASE intestinal lumen narrows.
9. Diseased bowel loops sometimes adhere
- Refers to 2 chronic inflammation to other loops surrounding them.
(Cronh’s disease – Ulcerative Colitis)
- Cause: unkown Ulcerative Colitis
Risk Factors
1. Age: 1. Ulcerative colitis affects the superficial
- 10-30 mucosa of the colon and is characterized
- 50-70 by multiple ulcerations, diffuse
2. Men and women inflammations, and desquamation or
3. Family history shedding of the colonic epithelium.
4. Environmental agents 2. Bleeding occurs as a result of the
- Pesticides ulcerations.
- Food additives 3. The mucosa becomes edematous and
- Radiation inflamed.
- Tobacco smoking 4. The lesions are contiguous, occurring
5. NSAIDs have been found to exacerbate one after the other.
IBD 5. Abscesses form, and infiltrate is seen in
6. Allergies and immune disorders the mucosa and submucosa, with
7. Abnormal response to dietary or bacterial clumps of neutrophils found in the
antigens lumens of the crypts (crypt abscesses)
8. Genetic factors that line the intestinal mucosa.
6. The disease process usually begins in
Pathophysiology the rectum and spreads proximally to
involve the entire colon.
Cronh's Disease 7. Eventually, the bowel narrows, shortens,
1. Crohn's disease is a subacute and and thickens because of muscular
chronic inflammation of the Gl tract wall hypertrophy and fat deposits.
that extends through all layers 8. Because the inflammatory process is not
(transmural lesion). transmural (it affects the inner lining
2. Although its characteristic only), fistulas, obstruction, and fissures
histopathological changes can occur are uncommon.
anywhere in the Gl tract, it most
Medical Managements - Opening of ileum
Goal: - Allows drainage of fecal matter from
- Reduce inflammation ileum (occurs in frequent interval)
- S. Appropriate immune response
- Rest in disease bowel Total Colectomy with lleoanal Anastomosis
- Minimize complications - Close for 3 months
1. IV therapy or oral fluids - Temporary diverting loop
- To correct fluid electrolyte imbalance
2. Bland, low-residue, high-protein, high- Complications:
calorie diet, with supplemental vitamin - Irritation of the perianal skin from
therapy and iron replacement leakage of fecal contents, stricture
- Milk formation at the anastomosis site,
- Hot/cold food and small bowel obstruction.
- Beverages
- Alcohol Nursing Diagnoses
- High fat 1. Diarrhea related to the inflammatory
- Smoking process
3. Avoid foods that exacerbate diarrhea 2. Acute pain related to increased
4. Promote rest periods peristalsis and Gl inflammation
3. Deficient fluid volume deficit related to
Medical Management anorexia, nausea, and diarrhea
5. Pharmacologic: 4. Imbalanced nutrition, less than body
a. Corticosteroids requirements, related to dietary
- For severe diseases restrictions, nausea, and malabsorption
b. Antibiotics 5. Activity intolerance related to fatigue
c. Aminosalicylates: Sulfasalazine 6. Anxiety related to impending surgery
- Treats mild/moderate inflammation 7. Ineffective coping related to repeated
- Reduce recurrence (long term episodes of diarrhea
maintenance) 8. Risk for impaired skin integrity related to
d. Sedatives, and Antidiarrheal and malnutrition and diarrhea
Antiperistlatic medications 9. Risk for ineffective therapeutic regimen
- Minimize peristalsis (to rest inflamed management related to insufficient
bowel) knowledge concerning the process and
e. Immunomodulators management of the disease
- For non-responding patients Nursing Interventions
f. Monoclonal Antibodies: 1. Maintaining Normal Elimination Patterns
Natalizumab (Tysabri) – for - Provide ready access restroom (bed
Cronh’s disases pad/commode)
Infliximab (Remicade) - for - Free from odor/clean restroom
ulcerative colitis - As prescribed: antidiarrheal
- Record frequency of stool
Surgical Management - Bed rest for intestines
• Crohn's Disease: Partial or 2. Relieving Pain
Complete Colectomy with lleostomy - Analgesics (30 mins before meals)
or Anastomosis Rectum - Anticholinergics
- Positioning
• Ulcerative Colitis: Total Colectomy - Heat compress as prescribed
with lleostomy Proctocolectomy with - Diversional activities
lleostomy 3. Maintaining Fluid Intake
- IV
Total Colectomy with Ileostomy - I and O
lleostomy - Turgor
 - Skin color
- Dry/moist skin
- Daily weight monitoring
- VS
- Encourage fluid intake
- Regulate IV
4. Maintaining Optimal Nutrition
- Daily weight (same time/clothes)
- .5 weight gain because of parenteral
nutrition (monitor blood glucose every
6 hours
5. Promoting Rest
- Limit activity
6. Reducing Anxiety
- Touch (tap)
- Communication with px
7. Enhancing Coping Measures
- Financial (DSWD/Philhealth)
8. Preventing Skin Breakdown
- Petroleum jelly every poop
- Stoma also if not allergic
- Bag of stoma (lotion as indicated)
9. Monitoring and Managing Potential
Complications
- Monitor serum electrolyte daily
- Electrolyte replacement
- Report evidence of LOC changes
- BT: whole blood (mix to prevent
clamping), packed RBC (red and
white content)
- VS monitoring
- Coagulation profile (CBC etc.)
 INTESTINAL OBSTRUCTION
- There is blockage in the GI tract
- Can be in small or large intestine
- Large intestine (15% chance): mostly
in sigmoid colon (ex: carcinoma, IBD,
benign tumor)
- Mostly in small intestine
Types (MF)
1. Mechanical obstruction
- Blockage in intestinal wall (intestinal
intussusception)
- Cause: abscess, adhesions, tumor,
hernia
2. Functional obstruction
- Ex: muscular dystrophy. Endocrine
disorders
- Just temporary
- Or manipulation due to surgery
Mechanical Causes of Intestinal Obstruction
1. Adhesions – in small intestine, mostly in
GI tract
2. Intussusception - a serious condition in
which part of the intestine slides into an
adjacent part of the intestine. This
telescoping action often blocks food or
fluid from passing through.
Intussusception also cuts off the blood
supply to the part of the intestine that's
affected
3. Volvulus - a condition in which the bowel
twists on itself, causing obstruction to the
flow of material through the bowel. It can
also lead to obstruction of the blood
supply to the intestine itself, which can
result in tissue death within the bowel.
4. Hernia - a tear in your muscle or tissue
that allows part of your insides to bulge
out. It can be a bulge of an internal organ
or your intestines. Sometimes you can
see the hernia, depending on its location
and size. Certain activities can worsen
the condition, like bending over or lifting
heavy objects.
5. Tumor – extends in intestinal lumen.
SMALL BOWEL OBSTRUCTION:
Pathophysiology
1. Intestinal contents, fluid, and gas
accumulate above the intestinal
obstruction.
2. The abdominal distention and retention
of fluid reduce the absorption of fluids
and stimulate more gastric secretion.
3. With increasing distention, pressure
within the intestinal lumen increases,
causing a decrease in venous and
arteriolar capillary pressure. This causes
edema, congestion, necrosis, and
eventual rupture or perforation of the
intestinal wall, with resultant peritonitis.
4. Reflux vomiting may be caused by
abdominal distention. Vomiting results in
loss of hydrogen ions and potassium
from the stomach, leading to reduction of
chlorides and potassium in the blood and
to metabolic
1. Alkalosis.
5. Dehydration and acidosis develop from
loss of water and sodium. With acute fluid
losses, hypovolemic shock may occur.
Clinical Manifestations
1. Initial symptom is usually crampy pain
that is wavelike and colicky
- 1st symptom
2. Passage of blood and mucus, but no
fecal matter and no flatus
- No visible poop
3. Vomiting
- 2nd sign
4. Abdominal distention
- Percuss 2 check (hollow sound)
Complications
1. Dehydration become evident
- Thirst
- Drowsiness
- Generalized weakness
- Dry skin
- Turgor
- Tongue (dry)
- Dry mucus membrane
 2. Edema, congestion, necrosis, and
rupture or perforation of the intestinal wall
3. Peritonitis
- Is a redness and swelling
(inflammation) of the tissue that lines
your belly or abdomen. This tissue is
called the peritoneum. It can be a
serious, deadly disease. Fluid and
electrolyte imbalances.
- This occurs when a portion of your
intestine has ruptured. It leads to
fever and increasing abdominal pain.
This condition is a life threatening
emergency requiring surgery.
4. Hypovolemic shock
- Increasing intraluminal pressure can
result in reduced venous and arterial
blood flow and severe fluid
loss, dehydration (which can lead to
hypovolemic shock and death), and
electrolyte imbalance.
Assessment and Diagnostic Findings
1. Abdominal x-ray and CT findings
Medical Management
1. Decompression of the bowel through a
nasogastric or small bowel tube
- Iba sa ngt feeding, dito winiwithdaw
yung contents
2. IV infusion
- To prevent dehydration
Surgical Management
1. repair of hernia or dividing the adhesion
2. affected bowel may be removed and an
anastomosis performed
- Anastomosis: a surgical connection
between two structures. It usually
means a connection that is created
between tubular structures, such as
blood vessels or loops of intestine.
For example, when part of an
intestine is surgically removed, the
two remaining ends are sewn or
stapled together (anastomosed).
Nursing Management
1. Maintain the function of the nasogastric
tube, assess and measure the
nasogastric output.
- Record I and O
2. Assess for fluid and electrolyte
imbalance.
- Monitor every day or every other day
3. Monitor nutritional status.
- Include dehydration
4. Assess improvement
- Based on clinical findings before the
interventions
- Assess for bowel movement if sound
returns
- If there is flatus, peristalsis,
decreased abdominal distention by
measuring in navel, passage of stool
5. Monitor intake and output
- Output: poop
LARGE BOWEL OBSTRUCTION:
Pathophysiology
1. Results in an accumulation of intestinal
contents, fluid, and gas proximal to the
obstruction.
2. It can lead to severe distention and
perforation unless some gas and fluid
can flow back through the ileal valve.
3. Large bowel obstruction, even if
complete, may be undramatic if the blood
supply to the colon is not disturbed.
However, if the blood supply is cut off,
intestinal strangulation and necrosis
occur; this condition is life-threatening.
4. In the large intestine, dehydration occurs
more slowly than in the small intestine
because the colon can absorb its fluid
contents and can distend to a size
considerably beyond its normal full
capacity.
5. Adenocarcinoid tumors account for the
majority of large bowel obstructions.
Most tumors occur beyond the splenic
flexure, making them accessible with a
flexible sigmoidoscope.
Clinical Manifestations
 1. Constipation may be the only symptom
for days
- Ask how many days ng may
constipation
2. Eventually, the abdomen becomes
markedly distended, loops of large bowel
become visibly outlined through the
abdominal wall
3. Crampy lower abdominal pain
4. Finally, fecal vomiting develops.
5. Alteration in shape of the stool
6. Blood in the stool
7. Weakness, weight loss, anemia
8. Shock may occur
Diagnostic Findings
▪ Abdominal x-ray and CT or MRI
- To know size of obstruction
- Contraindicated in bowel studies
Medical Management
1. Colonoscopy
2. Rectal tube
3. IV infusion
Surgical Management
1. Surgical resection; a temporary or
permanent colostomy; or an ileoanal
anastomosis
- To remove obstructing lesions, then
anastomosis will follow
2. Cecostomy
3. Colostomy
- Opening, stoma
- Temporary fecal diversion
- Consistency of poop is r/t placement
of colostomy
Complications:
▪ Prolapse of the stoma
▪ Perforation
▪ Stoma retraction
▪ Fecal impaction
▪ Skin irritation
▪ Peritonitis
Quiz no. 1 A: Sum of all the chemical reactions in
the body
1. Which disorder describes a backflow of
8. Which of the choices should not be
gastric or duodenal contents into the
asked when assessing a patient with GI
esophagus?
problems?
A: GERD
A: ask about stress, support systems,
2. Which diagnostic procedure is used to
and coping mechanisms
evaluate the degree of acid reflux?
9. A patient with GERD is instructed to,
A: Ambulatory 12- to 36-hour esophageal
except:
pH monitoring
A: avoid tight-fitting clothes; and elevate
3. Narrowing of the esophagus just above
the head of the bed by at least 20
the stomach results in a gradually
degrees (di ko sure if ayan yung sagot)
increasing dilation of the esophagus in
10. A patient came to ER because of
the upper chest is
recurrent heartburn and regurgitation is
A: Achalasia
subsequently the doctor diagnosed the
4. A nurse is providing health promotion
patient with hiatal hernia. Which of the
education to a patient diagnosed with an
following should the ER nurse include in
esophageal reflux disorder. What
health education?
practice should the nurse encourage the
A: Instead of eating three meals a day,
patient to implement?
try eating smaller amounts more often.
A: Avoid carbonated drinks
5. Which drugs help to decrease acid
production?
A: Histamine2 receptor
antagonists/blockers
Feedback
a. Antacids- mild to mod. symptoms(e.g.
Maalox, Mylanta, Gaviscon)
b. Histamine2 receptor antagonists/blockers-
decreases acid production(e.g. Cimetidine,
Ranitidine)
c. Proton pump inhibitors- reduces gastric
secretions; promote healing of esophageal
erosions and relieve
symptoms(e.g. Omeprazole, Lansoprazole)
d. Promotility agent- enhances esophageal
clearance and gastric emptying(e.g.
Domperidone, Metoclopramide)

6. The patient in room 001 is diagnosed

with achalasia based on the history and
diagnostic imaging results. Which
nursing diagnosis when planning the
patient's care should be prioritized?
A: Risk for Aspiration Related to
Inhalation of Gastric Contents
7. Which of the following is not a
description of absorption?