Gastrointestinal & Hepatobiliary System
Objectives
Briefly discuss the structure and function of the GI system
Describe in brief the aetiology, underlying pathophysiology and
clinical manifestations of common acute gastrointestinal disease
like;
o Colorectal cancer
o Crohn's disease
o Diverticular disease
o Duodenal ulcers & gastric ulcers
Describe in brief the aetiology, underlying pathophysiology and
clinical manifestations of disorders of the gallbladder
Structure and Function
Main digestive processes
Ingestion of food
Propulsion of food and wastes from the mouth to the anus
Secretion of mucus, water and enzymes
Mechanical digestion of food particles
Chemical digestion of food particles
Absorption of digested food
Elimination of waste products by defecation
Cancers of the Gastrointestinal System
Stomach/Gastric
o Associated with bacterial infection- Helicobacter Pylori.
o High salt diet, use of tobacco and alcohol, low intake of fruit &
veggies
Colorectal/bowel
o Associated with diet high in fats and red meat and low in
vegetables
o Caecum, colon and through to rectum
o 4th most diagnosed cancer in Australia
Upper parts of digestive system- Oesophageal cancer
o Alcohol intake, smoking, chronic reflux & obesity
o High death rate (45%)
Inflammatory Disorders of GI Tract
Also known as Inflammatory Bowel Diseases (IBD)
o Ulcerative Colitis
o Crohn’s Disease
o Diverticular Disease
o Ulcers- Peptic, Gastric & Duodenal
o Starvation
o Malnutrition
Ulcerative Colitis
Chronic inflammatory disease that causes ulceration of the colonic
mucosa
Most severe in sigmoid colon and rectum
Suggested causes:
o Infectious, immunologic (anticolon antibodies), dietary,
genetic (supported by family studies and identical twin
studies)
Clinical manifestations:
o Intermittent periods of remission and exacerbation
o Fever, elevated pulse, frequent diarrhoea (10 to 20/day),
bloody stools, cramping
Treatment:
o Antibiotics and steroids
o Immunosuppressive agents
o Surgery
o Increased colon cancer risk
Crohn’s Disease
Granulomatous colitis or regional enteritis
Idiopathic inflammatory disorder; affects any part of the digestive
tract, from mouth to anus
Difficult to differentiate from ulcerative colitis
Similar risk factors and theories of causation as ulcerative colitis
Creates ‘skip lesions’
Ulcerations can produce longitudinal and transverse inflammatory
fissures that extend into the lymphatics
Anaemia may result from malabsorption of vitamin B12 and folic
acid
Treatment is similar to ulcerative colitis- immunosuppressives,
antibiotics & steroids
Diverticular Disease
Diverticula: Herniations of mucosa through the muscle layers of the
colon wall, especially the sigmoid colon
Diverticulosis: Asymptomatic diverticular disease
Diverticulitis: The inflammatory stage of diverticulosis, may include
infection
Factors contributing to the formation of diverticula:
o Commonly caused by low-fibre diet and excess growth of the
muscle of the gut wall
Ulcers
Cause and Progression of ulcers:
o A combination of acid penetrating the mucosa and increased
acid production contribute to the formation of ulcers
Peptic Ulcers
A break or ulceration in the protective mucosal lining of the stomach
or duodenum
Acute and chronic ulcers
Superficial: Erosions
Deep: True ulcers
Gastric Ulcers
Stomach ulcers that tend to develop in the antral region of the
stomach, adjacent to the acid-secreting mucosa of the body
Pathophysiology:
o The primary defect is an increased mucosal permeability to
hydrogen ions
o Gastric secretion tends to be normal or less than normal
Clinical Manifestations:
o Intermittent pain in epigastric region, relieved by eating
o Pain immediately after eating, loss of appetite, vomiting &
weight loss
Duodenal Ulcers
Occur in younger persons
Caused by H. pylori infection and NSAIDs; hypersecretion of acid
and pepsin; inadequate secretion of bicarbonate by duodenal
mucosa; greater than usual number of parietal cells in gastric
mucosa; high serum gastrin levels
Clinical manifestations similar to gastric ulcers
Complications include bleeding and perforation
Faculty of Health Sciences | School of Nursing
Hepatobiliary System
Liver
Gallbladder
Bile ducts (cystic, hepatic, common & pancreatic)
The biliary organs and duct system that creates, transports, stores,
and releases bile into the duodenum for digestion
Liver is the largest organ in the abdomen and plays important roles
in homeostasis, including metabolism, glycogen storage, drug
detoxification, production of various serum proteins, and bile
secretion
Disorders of the Hepatobiliary System
Cholelithiasis – gallstone formation
Types: Cholesterol (most common) and pigmented
Risk factors: Obesity, middle age, female, rapid weight loss;
gallbladder stasis
Gallstones
Cholecystitis
Inflammation of gall bladder
Usually associated with gallstones
Acute or chronic
Pancreatitis
Inflammation of the pancreas
Acute pancreatitis:
o Usually mild
o Associated with excessive alcohol intake and biliary tract
obstruction which impairs outflow of pancreatic enzymes
o These enzymes cause autodigestion of pancreatic tissue and
leak into the bloodstream to cause injury to blood vessels and
other organs
Clinical manifestations and evaluation:
o Epigastric or mid-abdominal pain
o Fever and leucocytosis
o Hypotension and hypovolaemia
o Enzymes increase vascular permeability
o Characterised by an increase in a patient’s serum amylase
level
Chronic pancreatitis:
o Most common cause is chronic alcohol abuse
Some General Nursing Points to Remember
Document Bowel Actions- checking stools for blood (old/fresh)
Ensure patients are receiving appropriate diet for the condition
FBC
Check for Bowel Sounds, monitor & treat nausea
Blood profile: Clotting factors, LFTs, BGL
Jaundice- obstruction to the biliary tract. Causes excessively dry and
scaly skin
VTE prevention
Vital sign monitoring
