MS-GI LECTURE e.
Pepsin is the chief coenzyme of gastric
GASTRONTESTINAL SYSTEM
FUNCTION:
 DIGESTION, ABSORPTION, ELIMINATION
 Digestion is chemical and mechanical
process on the ingested food to prepare
it for assimilation by the body.
COMPOSITION:
 ALIMENTARY CANAL, ACCESSORY
ORGANS
 PERISTALSIS – wavelike motion that
propels substances within the GIT
 SPHINCTERS / VALVES – controls rate of
peristalsis / prevents regurgitation
GASTROINTESTINAL TRACT
LOWER GIT
 consists of the small and large intestines
 digestion is completed in the small
intestine, and most nutrients are
absorbed in this part of the GIT
 the large intestine serves primarily to
absorb water and electrolytes and to
eliminate the waste products of
digestion through the feces
ANATOMY & PHYSIOLOGY
MOUTH
 The mouth contains the lips, cheeks,
palate, tongue, teeth, salivary glands,
muscles, and maxillary bones.
 Saliva contains the amylase enzyme
(ptyalin) that aids in digestion.
ESOPHAGUS
 is a hollow tube, the upper 1/3 is
composed of skeletal muscles, the rest is
smooth muscle
 lined with mucous membrane - secretes
mucoid substance for protection
 the bolus of food arrives at the cardiac
sphincter of the stomach w/in 5-10 secs
after ingestion
 the lower esophageal sphincter (LES)
prevents reflux of food in the stomach
back into the lower esophagus
STOMACH: Contains the cardia, fundus, the
body, and the pylorus
a. Mucous glands
 mucous glands are located in the
mucosa
 mucous glands prevent
autodigestion by providing an
alkaline protective covering.
b. lower esophageal (cardiac) sphincter
prevents reflux of gastric contents into
the esophagus
c. pyloric sphincter regulates the rate of
stomach emptying into the small
intestine
d. Hydrochloric acid kills microorganisms,
breaks food into small particles, and
provides a chemical environment that is
required by the gastric enzymes.
juice, which converts proteins into
proteases and peptones
f. Intrinsic factor is necessary for the
absorption of vitamin B12.
g. Gastrin controls gastric acidity
Stomach made up of 5 layers of smooth muscle
2 types of contractions:
1. tonus contractions - continuous
contractions
2. rhythmic contractions - may be slow (q2-
3 mins) or fast responsible for the mixing
of food and peristaltic movement
 Vagus nerve - supplies the nervous
stimulation for the stomach. Has both
sympathetic and parasympathetic fibers
 movement of food through the stomach
and intestines is by PERISTALSIS  the
alternate contraction and relaxation of
the muscle fibers that propels the food in
a wave-like motion
Gastric Secretion
 The stomach secretes 1500 to 3000 ml of
gastric juice per day. Major secretions
are HCL, pepsin and mucus
 HCL and pepsin provide the corrosive
power of gastric secretion
 Pepsin is the most active factor in the
digestive processes of the stomach,
acting to break proteins into
polypeptides
 Mucus has a neutralizing effect which
protects the stomach mucosa
PHASES OF GASTRIC SECRETION
A. Cephalic Phase is stimulated by hunger,
food odors, sight and smell, taste
- it begins before food enters the
stomach
- is mediated by the vagus nerve,
releasing acetylcholine which
stimulates the parietal
cells and chief cells to secrete
acid, pepsin and mucus
B. Gastric phase begins with the arrival of
food in the stomach
- distention of the stomach and
presence of digested proteins
stimulate gastrin hormone
secretion
- Gastrin stimulates the parietal
cells of the stomach to secrete
HCL
- this phase continues for several
hours, until the acidity of gastric
contents reaches pH of 1.5
C. Intestinal Phase is stimulated by food
entering the duodenum
- a substance similar to gastrin is
released from the intestines it
stimulates gastric secretion of
pepsin and mucus
 - when the pH in the duodenum
decreases (increase acidity) this
results to release of Secretin
hormone - w/c inhibit gastric
acid secretion and slows gastric
motility and gastric emptying
SMALL INTESTINE
2.5 cm (1 inch) wide and 6 meters (20 feet) long
– fills most of the abdomen
3 parts:
a. Duodenum - First (10 inches) of small
intestine which connects to the stomach
 Receives chyme from the stomach
through the pyloric sphincter
 Fluids from the pancreas and gall
bladder via the common bile duct
 Manufactures intestinal juice
 Susceptible to inflammatory
processes
 Neutralizes the acidic rhyme from
the stomach
b. Jejunum - middle portion (8 feet long)
 Absorption of Magnesium,
Calcium, Iron
c. Ileum - with connects to the large
intestine (12 feet long)
 Chyme moves slowly towards the
ileocecal valve (3 - 10 hours)
LARGE INTESTINE
1. The large intestine is about 5 feet long
2. The large intestine absorbs water and
eliminates wastes
3. Intestinal bacteria play a vital role in the
synthesis of some B vitamins and vitamin
K.
3 parts:
a. cecum - which connects to the small
intestines
b. colon - 4 parts (ascending, transverse,
descending, sigmoid colon)
c. rectum - 17-20 cm. (7-8 inches) long, 
anal canal
4. The ileocecal valve prevents contents of
large intestine from entering ileum
5. The anal sphincters guard the anal canal
Defecation reflex
 Feces enter the rectum and cause
distention of wall of the rectum > send
impulses to the sacral segment of the
spinal cord - then back to the colon,
sigmoid and rectum > initiate relaxation
of the internal anal sphincter > relaxation
or contraction of external anal sphincter
(voluntary control)
PANCREATIC INTESTINAL JUICE ENZYMES
1. Amylase digests starch to Maltose
2. Maltase reduces maltose to
monosaccharides glucose
3. Lactase splits lactose into galactose and
glucose
4. Sucrase reduces sucrose to fructose and
glucose
5. Nucleuses split nucleic acids to
nucleotides
6. Enterokinase activates trypsinogen to
trypsin
Secretion and digestion – major portion of
digestion occurs in the small intestines by the
action of pancreatic and intestinal secretions
(enzymes) and bile
a. Carbohydrate digestion start in the
mouth  Ptyalin — breakdown
polysaccharides to disaccharides
- intestinal enzymes (maltase, lactase,
sucrase)
 Breakdown disaccharides to
monosaccharides (glucose, galactose
fructose)
b. Protein digestion
- start in the stomach  pepsin –
breakdown of proteins to polypeptides
- small intestines  trypsin – breakdown
of polypeptides into peptides and amino
acids
c. Fat digestion
- fats require emulsification into small
droplets before it can be broken down
into glycerol and fatty acids
Bile - from liver; emulsify fats so that it
could be broken down
PERITONEUM
1. The peritoneum lines the abdominal
cavity
2. The peritoneum forms the mesentery
that supports the intestines and blood
supply.
LIVER
1. The liver is the largest gland in the body,
weighing 3 to 4 lbs.
2. The liver contains Kupffer's cells, which
remove bacteria in the portal venous
blood.
3. The liver removes excess glucose and
amino acids from the portal blood
4. The liver synthesizes glucose, amine
acids and fats
5. The liver aids in the digestion of fats,
carbohydrates and proteins
6. The liver stores and filters blood (200 to
400 ml of blood stored)
7. The liver stores vitamins A, D and B and
iron.
 8. The liver secretes bile to emulsify fats
(500 to 1000 ml of bile a day)
9. Hepatic Duct
 The hepatic duct delivers bile to
the gallbladder via the cystic duct
 the hepatic ducts deliver bile to
the duodenum via the common
bile duct
 the common bile duct opens into
the duodenum, with the
pancreatic duct at the ampulla of
Vater
 the sphincter prevents the reflux
of intestinal contents into the
common bile duct and pancreatic
duct.
 Detoxifies ammonia into urea
GALLBLADDER
 The gallbladder stores and
concentrates bile
 The gallbladder contracts to force
bile into the duodenum during the
digestion of fats
 The cystic duct joins the hepatic
duct to form the common bile duct
 The sphincter of Oddi guards the
entrance into the duodenum
 The presence of fatty materials in
the duodenum stimulates the
liberation of cholecystokinin,
which causes contraction of the
gallbladder and relaxation of the
sphincter of Oddi
PANCREAS
EXOCRINE GLAND
a. the pancreas secretes sodium
bicarbonate to neutralize the acidity of
the stomach contents that enter the
duodenum. b. Pancreatic juices contain
enzymes for digesting carbohydrates,
fats, and proteins.
ENDOCRINE GLAND
a. the islets of Langerhans secrete insulin.
b. insulin secreted into the bloodstream
and is important for carbohydrate
metabolism
c. the pancreas secretes glucagon to raise
blood glucose levels
d. the pancreas secretes somatostatin to
exert a hypoglycemic effect
ABSORPTION
 the intestinal wall has many folds which
are covered by fingerlike projections
called (villi)  increase the absorptive
area of the small intestines
 in the center of the Villi are capillaries,
veins, small arteries for absorption of
nutrients into the blood vessel system
 90% of absorption occurs within the
small intestines by active transport or
diffusion
 amino acids, monosaccharides, Na+, Ca+
+ are transported by active transport w/
the expenditure or use of energy
GIT role in Fluid and Electrolyte Balance
 GIT secretions contain electrolytes
 severe fluid and electrolyte imbalance
may occur with excessive losses of
gastrointestinal fluids
Example:
 Na+ and K+ deficits: vomiting, diarrhea,
gastric suctioning, intestinal fistula
 Ca++ & M9++ deficits: malnutrition, mal-
absorption, intestinal fistula
 Metabolic alkalosis: loss of gastric acid by
suctioning or persistent vomiting
 Metabolic acidosis: loss of bicarbonate-
rich intestinal secretions by severe
diarrhea or fistula
Other functions of the GIT
 the GIT supports bacterial growth and
has a role in antibody formation
 intestinal bacteria synthesize Vit. K 
required for production of clotting
factors 11 (Prothrombin), VII, IX, X
ASSESSMENT OF GIT
Nursing History: Subjective Data
General Data
a. presence of dental prosthesis, comfort of
usage
b. difficulty eating or digesting food
c. nausea or vomiting
d. weight loss
e. pain - may be caused by distention or
sudden contraction of any part of the GIT
- specify the area,
describe the pain
Specific data if symptoms are Present
a. situations or events that effect
symptoms
b. onset, possible cause, location, duration,
character of symptoms
c. relationship of specific foods, smoking or
alcohol to severity of symptoms
d. how the symptoms were managed
before seeking medical help
Normal pattern of bowel elimination
a. frequency and character of stool
b. use of laxatives, enemas
Recent changes in normal patterns
a. changes in character of stool
(constipation, diarrhea, or alternating
constipation and diarrhea)
b. changes in color of stool melena - black
tarry stool (upper GI bleeding) bleeding)
 hematochezia - fresh blood in the
stool (lower GI
c. drugs being taken
d. measures taken to relieve symptoms
MOUTH AND PHARYNX
1. lips color, moisture, swelling, cracks or
lesions
2. teeth completeness (20 in children, 32 in
adults), caries, loose teeth, absence of
teeth impair adequate chewing
3. gums color, redness, swelling, bleeding,
pain (gingivitis)
4. mucosa color (light pink)
> examine for moisture, white spots or patches,
areas of bleeding, or ulcers
 Hypoactive - 1 or 2 sounds in 2 mins.
 Absent - no sounds in 3-5 mins. →
peritonitis, paralytic ileus,
 Hyperactive → diarrhea, gastroenteritis,
early intestinal obstruction
Percussion
 done to confirm the size of various
organs
 to determine presence of excessive
amounts of air or fluid
 Normal - tympany
 dullness or flatness - area of liver and
spleen, solid structure
 tumor
Palpation

> white patches - due to candidiasis (oral thrush)
> white plaques w/in red patches may be
malignant lesions
5. tongue- color, mobility, symmetry,
ulcerations / lesions or nodules 6.
pharynx - observe the uvula, soft palate,
tonsils, posterior pharynx
- signs of inflammation (redness,
edema, ulceration, thick yellowish
secretions), assess also for
symmetry of uvula and palate
ABDOMEN
- assess for the presence or absence of
tenderness, organ enlargement, masses, spasm
or rigidity of the abdominal muscles, fluid or air
in the abdominal cavity
Anatomic Location of Organs
RUQ liver, gallbladder, duodenum, right kidney,
hepatic flexure of colon
RLQ cecum, appendix, right ovary and fallopian
tube
 to determine size of liver, spleen, uterus,
kidneys - if enlarged\
 determine presence and character. of
abdominal masses determine degree of
tenderness and muscle rigidity (rebound
or direct
RECTUM
 perineal skin and perianal skin
 assess for presence of pruritus, fissures,
external hemorrhoids, rectal prolapse
3 Phases of Diagnostic testing
Pretest: Client preparation
Intra-test: specimen collection and VS monitoring
Post-test: Monitoring and follow-up nursing care
Related Nursing Diagnoses
 Anxiety
 Fear
 Impaired physical mobility
 Deficient knowledge
Stool Analysis

LUQ-stomach, spleen, left kidney, pancreas, 1. Occult Blood→ GUAIAC test

splenic flexure of colon 2. Steatorrhea
3. Ova/Parasites
LLQ-sigmoid colon, left ovary and tube
4. Bacteria
Inspection 5. Viruses

- assess the skin for color, texture, scars, striae, FECAL ANALYSIS
engorged veins, visible peristalsis (intestinal
Fecal Occult Blood Test (FOBT)
obstruction), visible pulsations (abdominal
aorta), visible masses (hernia)  Detects GI bleeding
 ↑ Fiber diet 48-72 hours
- assess contour (flat, protuberant, globular)

- abdominal distension, measure abdominal girth

or circumference at the level of umbilicus or 2-5 HEMOCCULT GUAIAC TESTS: NURSING AND
cm. below PATIENT CARE CONSIDERATION:

Auscultation Common practices are the following: for 3 days

before the test and during the stool collection
 presence or absence of peristalsis or
period:
bowel sounds
 Normoactive 1. Diet should have a high fiber content.
 2. Avoid red meat in the diet.
Avoid food with a high peroxide content, such as
turnips, cauliflower, broccoli, horseradish, and
melon.
Avoid enemas or laxatives before the stool
specimen collection. Avoid iron preparations,
iodides, bromides, aspirin, no steroidal anti-
inflammatory drugs (NSAIDs), or vitamin C
supplements greater than 250 mg/day.
Fecal Analysis
Stool for Ova and Parasites
Stool Culture
Stool for Lipids
 ↑fat diet, no alcohol(3days)
 72-hour stool specimen
HYDROGEN BREATH TEST
1. It is used to evaluate carbohydrate
absorption.
2. A radioactive substance is ingested, and
after a certain time period, exhaled gases
are measured.
3. The test measures the amount of
hydrogen produced in the colon
absorbed in the blood and then exhaled
in the breath.
4. This test is used as a diagnostic test for
short bowel syndrome, lactose
intolerance, and bacterial overgrowth of
the intestine (blind loop syndrome
Crohn's disease distal ilea disease).
NURSING CONSIDERATIONS:
1. The patient should be NPO 12 hours
before the procedure.
2. The patient should not smoke after
midnight before the test.
3. Antibiotics and laxative/enemas should
not be used for 1 week before the test.
These products may alter the laboratory
results.
Laboratory Test
CEA (Carcinoembryonic antigen)
(+) colon cancer and other forms of cancer
CEA - recurrence or spread of tumor
effectiveness of therapy
> A blood sample is withdrawn or sent to
laboratory
Avoid Heparin
Exfoliative Cytology
Detect malignant cells
Liquid diet
UGI: NGT insertion - saline lavage
LGI: laxative, enema, proctoscope
GASTRIC ANALYSIS
Gastric analysis requires the passage of a
nasogastric tube into the stomach to aspirate
gastric contents for the analysis of acidity (pH),
appearance and volume; the entire gastric
content are aspirated and then specimens are
collected every 15 minutes for 1 hour.
Histamine or pent gastrin may be administered
subcutaneously to stimulate gastric secretions
and may produce a flushed feeling.
Esophageal reflux of gastric acid may be
performed by ambulatory pH monitoring: a
probe is placed just above the lower esophageal
sphincter, is connected to an external recording
device, and provides a computer analysis and
graphic display of results.
 to quantify gastric acidity Normal 1-5
mEq/L
NPO for 12 hours
an NGT is inserted and gastric contents are
aspirated,
connected to suction
gastric content collected every 15 minutes to 1
hour
Result:
HCL: Gastric Ca & Pernicious Anemia
1HCL: Zollinger-Ellison Syndrome & Duodenal
Ulcer
*Check pH
Nursing Intervention
1. Fasting for 8 to 12 hours is required
before the test.
2. Avoid tobacco and chewing gum for 6
hours before the test.
3. Medication that stimulates gastric
secretions are withheld for 24 to 48
hours.
Post-procedure
 Client may resume normal activities.
 Refrigerate gastric samples if not tested
within 4 hours.
GI TRACT VISUALIZATION
RADIOLOGY AND IMAGING STUDIES
UPPER GASTROINTESTINAL SERIES AND SMALL
BOWEL SERIES (Barium swallow)
 1. Upper GI series and small-bowel series
are fluoroscopic x-ray examinations of
the esophagus, stomach, and small
intestine after the patient ingests barium
sulfate.
2. As the barium passes through the GI
tract, fluoroscopy outlines the GI mucus
and organs.
3. Spot films record significant findings.
4. Double-contrast studies administer
barium first followed by a radio lucent
substance, such as air, to produce a thin
layer of barium to coat the mucosa.
This allows for better visualization of any type of
lesion.
Nursing and patient care considerations
1. Explain procedure to patient.
2. Instruct patient to maintain low-residue
diet for 2 to 3 days before test and a
clear liquid dinner the night before the
procedure.
3. Emphasize NPO after midnight before
the test.
4. Encourage patient to avoid smoking,
alcohol, caffeine before the test.
5. Explain that the health care provider may
prescribe all narcotics and
anticholinergics to be held 24 hours
before the test.
6. Tell the patient that he or she will be
instructed at various times throughout
the procedure to drink the barium (480
to 600 mL).
7. Explain that a cathartic will be prescribed
after the procedure.
8. Instruct the patient that stool will be
light in color for the next 2 to 3 days
from the barium.
9. Instruct patient to notify health care
provider if he or she has not passed the
barium in 2 to 3 days
10. Note that water-soluble iodinated
contrast agent (such as Gastrografin)
may be used for a patient with a
suspected perforation or colonic
obstruction.
GIT Visualization
Barium Swallow-UGIS
Pretest: written consent, NPO the night
Intratest: administer barium orally, then followed
by X-ray
Post-test: Laxative for constipation, increased
fluids, assess for intestinal obstruction, warn that
stool is light colored!
BARIUM ENEMA (Lower GI series)
1. Fluoroscopic x-ray examination
visualizing the entire large intestine is
administered after the patient is given an
enema of barium sulfate.
2. Can visualize structural changes, such as
tumors, polyps, diverticula, fistulas,
obstructions, and ulcerative colitis.
3. Air may be introduced after the barium
to provide a double-contrast study.
Nursing and patient care considerations
1. Explain to the patient:
A. What the x-ray procedure
involves.
B. That proper preparation
provides a more accurate view
of the tract and that
preparations may vary.
C. That it is important to retain the
barium so all surfaces of the
tract are coated with opaque
solution.
2. Instruct the patient on the objective of
having the large intestine as clear of fecal
material as possible:
A. The patient may be given a low-
residue, low-fat diet, 1 to 3 days
before the examination.
B. The day before the examination,
intake may be limited to clear
liquids (no drinks with red dye).
C. The day before the examination,
an oral laxative, suppository,
and/or cleansing enema may be
prescribed
3. The patient will be on NPO after
midnight the day of procedure.
4. An enema or cathartic may be ordered
after the barium enema.
5. Inform the patient that barium may
cause light-colored stools for several
days after the procedure.
Git Visualization
Barium Enema- LGIS
Pretest: Informed consent, NPO the night, enema
the morning
Intratest: position on left side, administer enema,
then X-ray follow
Post-test: cleaning enema, laxative for
constipation, assess for intestinal obstruction.
ULTRASONOGRAPHY
1. A noninvasive test focuses high-
frequency sound waves over an
abdominal organ to obtain an image of
the structure.
2. Ultrasound can detect small abdominal
masses, fluid-filled cysts, gallstones,
dilated bile ducts, ascites, and vascular
abnormalities.
3. Ultrasound with Doppler may be ordered
for vascular assessment.
Nursing and patient care considerations
1. If indicated, prepare the patient before
the procedure with a special diet,
laxative, or other medication to cleanse
the bowel and decrease gas.
2. Abdominal ultrasound usually requires
the patient to be NPO for at least 6 hours
before the procedure.
3. Change position of patient, as indicated,
for better visualization of certain organs.
COMPUTED TOMOGRAPHY (CT) SCAN
1. This is an x-ray technique that provides
excellent I anatomic definition and is
used to detect tumors, cysts, and
abscesses.
2. The CT can also detect dilated bile ducts,
pancreatic inflammation, and some
gallstones.
3. It identifies changes in intestinal wall
thickness and mesenteric abnormalities.
4. Ultrasound and CT can be used to
perform guided needle aspiration of fluid
or cells from lesions anywhere in the
abdomen. The fluid or cells are then sent
for laboratory tests (such as cytology or
culture).
Nursing and patient care considerations
1. Instruct the patient that fasting for 4
hours before the procedure and an
enema or cathartic may be necessary.
This is to cleanse the bowel for better
visualization.
2. Ask the patient if she is pregnant. If yes,
do not proceed with scan and notify
health care provider.
3. Ask if there are known allergies to iodine
or contrast media. A contrast medium
may be given intravenously (IV) to
provide better visualization of body
parts. If allergic, notify the technician
and health care provider immediately.
4. Instruct the patient to report symptoms
of itching or shortness of breath if
receiving contrast media, and observe
patient closely.
ENDOSCOPIC PROCEDURES
Endoscopy is the use of a flexible tube (the
fiberoptic endoscope) to visualize the GI tract
and to perform certain diagnostic and
therapeutic procedures. Images are produced
through a video screen or telescopic eyepiece.
The tip of the endoscope moves in four
directions, allowing for wide-angle visualization.
The endoscope can be inserted through the
rectum or mouth, depending on which portion of
the GI tract is to be viewed.
Endoscopes contain multipurpose channels that
allow for air insufflation, irrigation, fluid
aspiration, and the passage of special
instruments. These instruments include biopsy
forceps, cytology brushes, needles, wire baskets,
laser probes, and electrocautery snares.
Endoscopic functions other than visualization
include biopsy or cytology of lesions, removal of
foreign objects or polyps, control of internal
bleeding, and opening of strictures.
ESOPHAGOGASTRODUODENOSCOPY (EGD)
1. This allows for visualization of the
esophagus, stomach, and duodenum.
2. EGD can be used to diagnose acute or
chronic upper GI bleeding, esophageal or
gastric varices, polyps, malignancy, and
gastroesophageal reflux.
3. Instruments passed through the scope
can be used to perform a biopsy or
cytologic study, remove polyps or foreign
bodies, control bleeding, or open
strictures.
Nursing and patient care considerations
1. Explain the following to the patient:
A. The type of procedure to be performed
on the patient. As an outpatient, advise
that someone must accompany the
patient to drive home due to the patient
being sedated.
B. NPO for 8 to 12 hours before the
procedure to prevent aspiration and
allow for complete visualization of the
stomach.
C. Remove dentures and partial plates to
facilitate passing the scope and
preventing injury.
2. Inform the health care provider of any
known allergies and current medications.
Medications may be held until the test is
completed.
3. Obtain prior x-rays, and send with the
patient.
4. Describe what will occur during and after
the procedure:
A. The throat will be anesthetized with a
spray or gargle.
B. An IV sedative will be administered.
C. The patient will be positioned on the left
side with a towel or basin at the mouth
to catch secretions.
D. A plastic mouthpiece will be used to help
relax the jaw and protect the endoscope.
Emphasize that this will not interfere
with breathing.
E. The patient may be asked to swallow
once in a while as the endoscope is being
advanced. The patient should not
swallow, talk, or move tongue.
Secretions should drain from the side of
the mouth, and the mouth may be
suctioned.
F. Air is inserted during the procedure to
permit better visualization of the GI
 tract. Most of the air is removed at the
end of the procedure. The patient may
feel bloated, burp, or pass flatus from
remaining air.
G. Keep patient NPO according to protocol
until patient is alert and gag reflex has
returned.
H. May resume regular diet after gag reflex
returns and tolerating fluids.
I. May experience a sore throat for 24 to
36 hours after the procedure. When the
gag reflex has returned, throat lozenges
or warm saline gargles may be
prescribed for comfort.
J. Monitor vital signs every 30 minutes for
3 to 4 hours, and keep the side rails up
until the patient is fully alert.
K. Monitor the patient for abdominal or
chest pain, cervical pain, dyspnea, fever,
hematemesis, melena, dysphagia,
lightheadedness, or a firm distended
abdomen. These may indicate
complications.
L. Instruct the patient on the above listed
signs and symptoms, and advise to
report immediately should any occur,
even after discharge.
M. Possible complications include
perforation of the esophagus or
stomach, pulmonary aspiration,
hemorrhage, respiratory depression or
arrest, infection, cardiac arrhythmias or
arrest.
GIT Visualization
Esophagogastroscopy
Pretest: Informed consent, NPO for 8 hours,
warn that gag reflex is abolished
Intratest: Position on LEFT side during scope
insertion
Post-test: NPO until gag returns. Monitor for
complications
PROCTOSIGMOIDOSCOPY AND COLONOSCOPY
1. Proctosigmoidoscopy
(rectosigmoidoscopy) is the visualization
of the anal canal, rectum, and sigmoid
colon through a fiberoptic
sigmoidoscope.
2. Colonoscopy is the visualization of the
entire large intestine, sigmoid colon,
rectum, and anal canal.
3. Sigmoidoscopy or colonoscopy can be
used to diagnose malignancy, polyps,
inflammation, or strictures.
4. Colonoscopy is used for surveillance in
patients with a history of chronic
ulcerative colitis, previous colon cancer,
or colon polyps.
5. Lower GI endoscopy can be used to
perform biopsy, remove foreign objects,
or obtain specimen for culture or
cytology.
6. Colonoscopy, a more extensive
procedure than proctosigmoidoscopy,
requires several days of bowel
preparation and use of conscious
sedation during the procedure. The
bowel preparation includes
approximately 1 gallon or less iso-
osmolar electrolyte solution to consume
over a 3- to 4-hour period the day before
the procedure, clear liquid diet the day
before the procedure, and an oral
laxative the night before the procedure.
Protocols may vary.
Nursing Care:
1. Verify the patient's compliance with the
pretest bowel preparation the day
before the procedure, usually an oral
laxative (such as magnesium citrate) and
a clear liquid diet.
2. The patient must be NPO after midnight.
3. Explain to the patient that a feeling of
fullness will occur when water is
introduced into the GI tract. This
eliminates air space and provides for
high resolution.
4. Observe the patient for a change in vital
signs, bleeding, pain, vomiting,
abdominal distention or rigidity.
5. Ensure that patients who have had
endoscopic procedures requiring
sedation have a caregiver to drive home
after the procedure.
GIT Visualization
Anoscopy, proctoscopy, I proctosigmoidoscopy,
colonoscopy
Pretest: Consent, NPO, and enema
administration the morning
Intratest: Position on the LEFT side during scope
insertion
Post-test: Monitor for complications
CHOLECYSTOGRAPHY
Performed to detect gallstones and to assess the
ability of the gallbladder to fill, concentrate its
contents, contract and empty.
Nursing Intervention
1. Assess allergies to iodine or seafood.
2. Contrast agents such as iopanoic acid
(telepaque), iodipamide meglumine
(cholografin), or sodium ipodate
(oragrafin) may be administered to 10 to
12 hours (evening before) before the
test.
3. Client is NPO after the contrast agent is
administered
4. Instruct the client that if a rash, itching
hives or difficulty in breathing occurs
after taking the contrast agent, to report
to the emergency room
Post-procedure:
 1. Inform the client that dysuria is common
because the contrast agent is excreted in
the urine
2. A normal diet may be resumed (a fatty
meal may enhance excretion of the
contrast agent)
IV Cholecystogram
- X-ray visualization of the gallbladder after
administration of contrast media intravenously
Pre-test: Allergy to iodine and sea- foods
Intra-test: ensure patent IV line
Post-test: increase fluid intake to flush out the
dye, Assess for delayed hypersensitivity reaction
to the dye like chills and N/V
ORAL CHOLECYSTOGRAM
 X-ray visualization of the gallbladder
after administration of contrast media
 Done 10 hours after ingestion of contrast
tablets
 Done to determine the patency of biliary
duct
 6 tablets (1 at a time) are swallowed that
contain the contrast medium.
ENDOSCOPIC RETROGRADE
CHOLOANGIOPANCREATOGRAPHY (ERCP)
 Examination of the hepato-bilairy system
is performed via a flexible endoscope
inserted into the esophagus to the
descending duodenum; multiple
positions are required during the
procedure to pass the endoscope.
 If medication is administered before the
procedure, the client is closely
monitored for signs of respiratory and
central nervous system depression,
hypotension, over and vomiting.
Nursing Intervention
 A client is NPO for several hours before
the procedure. • Sedation is
administered before the procedure.
Post-procedure
 Monitor vital signs
 Monitor for the return of gag reflex
 Monitor for signs of perforation or
infection
Examination where a flexible endoscope is
inserted into the mouth and via the common bile
duct and pancreatic duct to visualize the
structures
lodinated dye can also be injected after for the x-
ray procedure
Pre-test: consent, NPO for 12 hours, Allergy to
sea-foods, Atropine sulfate
Intra-test: Gag reflex is abolished, Position on
LEFT side
Post-test: NPO until gag reflex returns, Position
side lying and monitor for perforation and
hemorrhage
PERCUTANEOUS TRANSHEPATIC
CHOLANGIOGRAM
 Under fluoroscopy, the bile duct is
entered percutaneously and injected
with a dye to observe filling of hepatic
and biliary ducts
Paracentesis
 Transabdominal removal of fluid from
the peritoneal cavity for analysis.
Nursing Intervention
1. Obtain informed consent
2. Have the client void before the start of
the procedure to empty bladder and to
move bladder out of the way of the
paracentesis needle.
3. Measure abdominal girth, weight,
baseline vital signs.
4. Note that the client is position upright on
the edge of the bed with the back
supported and the feet resting on a stool
(Fowler's position is used to the client
confined to bed.)
Post-procedure
1. Monitor vital signs
2. Measure fluid collected, describe, and
record.
3. Label fluid samples and send it to the
laboratory for analysis.
4. Apply a dry sterile dressing to the
insertion site; monitor site for bleeding.
5. Measure abdominal girth and weight.
6. Monitor for hypovolemia, electrolyte
loss, mental status changes or
encephalopathy.
7. Monitor for hematuria caused by bladder
trauma.
8. Instruct the client to notify physician if
the urine becomes bloody, pink or red.
LIVER BIOPSY
 A needle is inserted through the
abdominal wall to the liver to obtain
tissue sample for biopsy and microscopic
examination.
Nursing Intervention
1. Obtained informed consent
2. Assess results of coagulation test
(prothrombin time, partial
thromboplastin time, platelet count.).
3. Administer a sedative as prescribe.
4. Note that the client is placed in the
supine or left lateral position during the
procedure to expose the right side of the
upper abdomen.
Post-procedure

1. Assess vital signs

2. Assess biopsy site for bleeding.
3. Monitor for peritonitis.
4. Maintain bed rest for several hours.
5. Place the client on the right side with a
pillow under the costal margin to
decrease the risk of hemorrhage, and
instruct the client to avoid coughing and
straining.
6. Instruct the client to avoid heavy lifting
and strenuous activities for 1 week.

Risk Factors

1. Family history of gastrointestinal

disorders
2. Chronic laxative use
3. Tobacco use
4. Chronic alcohol use
5. Chronic high stress levels
6. Allergic reaction to food or medication
7. Chronic use of aspirin or non-steroidal
anti-inflammatory drugs
8. Long-term gastrointestinal conditions
such as ulcerative colitis that may
predispose to colorectal cancer
9. Previous abdominal surgery or trauma
which can lead to adhesions.
10. Neurological disorders that can impair
movement particularly with chewing and
swallowing.
11. Cardiac, respiratory, and endocrine
disorders that may lead to constipation
12. Diabetes mellitus, which may predispose
to oral candida infections

Alternative Feeding:

1. Enteral hyperalimentation- delivery of

nutrients directly to the GI tract.
a. Short-term- esophagostomy; nasogastric
tube
b. Long-term- gastrostomy: jejunostomy

Indications of NGT:

a. Gavage- to deliver nutrients; for feeding

purposes
b. Lavage- to irrigate the stomach
c. Decompression- to remove stomach
contents or air

NG TUBE

NEVER GIVE WITHOUT CHECKING

GIVE WARM (room temperature)

TURN TO RIGHT SIDE

USE GRAVITY

BE SURE TO ASPIRATE

END WITH WATER AND CHART