Care of Clients with

Gastrointestinal Disorders

Michael D. Manglapus, BSN-RN, RM, MAN, PhD(In Progress)

The Gastrointestinal Tract
 Functions of
Gastrointestinal System
• Ingestion and propulsion of food
• Digestion
• Absorption
• Elimination
Mouth/ Oral Cavity/
Buccal Cavity
Mouth/ Oral Cavity/
Buccal Cavity
Mouth/ Oral Cavity/
Buccal Cavity
Mouth/ Oral Cavity/
Buccal Cavity
Esophagus
Esophagus
Propulsion of Food
Propulsion of Food
Stomach
Stomach
Stomach
4 Anatomic Regions of
Stomach
Small Intestine
Small Intestine
Small Intestine
Small Intestine

Figure 14.7a
Large Intestine/ Colon
Large Intestine/ Colon
Blood Supply
 Assessment
of the
Gastrointestinal
System:
• Health history/ Family history = Information
about abdominal pain, dyspepsia, gas, nausea and
vomiting, diarrhea, constipation, fecal
incontinence, and GI diseases.
• Abdominal pain = assess for the character,
duration, pattern, frequency, location, distribution
of referred pain, and time of the occurrence of
pain
o Referred pain = pain felt in an area distant from the site of
the stimulus. (e.g., pain in the shoulder may indicate
pancreatitis, perforated duodenal ulcer.
• Dyspepsia = commonly called indigestion, is the
most common symptom of patients with GI
dysfunction.
o Commonly caused by fatty foods, because they remain in
the stomach for digestion longer than proteins or
carbohydrates.
• Intestinal gas = may result to
o Belching = expulsion of gas from the stomach
through the mouth
o Flatulence = expulsion of gas from the rectum
o Cause: food intolerance and gallbladder disease
o Symptoms: bloating, distension, or feeling “full of
gas” with excessive flatulence
• Nausea and vomiting
o Nausea = is a vague, uncomfortable sensation of sickness
or “queasiness” that may or may not be followed by
vomiting.
• Emesis or vomitus = contents of the stomach thrown up
• Causes:
o Visceral afferent stimulation: dysmotility, peritoneal
irritation, infections, hepatobiliary or pancreatic disorders,
mechanical obstruction
o CNS disorders: vestibular disorders, increased ICP,
infections, psychogenic disorders
o Irritation of the chemoreceptor trigger zone from radiation
therapy, systemic disorders, and antitumor chemotherapy
medications.
• Hematemesis = bloody emesis/ vomitus
• Heartburn (Pyrosis) = is a substernal burning
sensation that often radiates to the neck and is
experienced within one hour of eating or one to two
hours after reclining.
o Described as a burning in the throat, neck, and suprasternal
or substernal area.
o Causes: activities that increase intraabdominal pressure
(e.g., bending, lifting, exercise, straining during bowel
movement, or Valsalva maneuver); ingesting irritating
foods (spicy foods).
• Painful swallowing (Odynophagia) = pain
experienced when a person swallows, is associated
with erosion of the esophagus.
o Causes: medication-induced esophagitis (antibiotics
[tetracycline, doxycycline] and some antiviral agents),
esophageal erosion, immunocompromised patients with
Candida, herpes, and cytomegalovirus infections (often
found in patients undergoing chemotherapy), or with HIV
or AIDS
• Difficulty swallowing (Dysphagia)
• Causes: Schatzki’s ring (which is mucosal ring at the
lower esophagus), ethyl alcohol, scleroderma,
achalasia (failure of the LES to relax).
• Change in bowel habits and stool characteristics:
o Diarrhea = an abnormal increase in frequency and
liquidity of the stool or in daily stool weight or
volume, commonly occurs when the contents move so
rapidly through the intestine and colon that there is
inadequate time for the GI secretions and oral contents
to be absorbed.
o Constipation = a decrease in the frequency of stool, or
stools that are hard, dry, and of smaller volume than
typical.
• Normal stool: light to dark brown
• Melena = a tarry-black colored stool, a blood shed in
sufficient quantities into the upper GI tract
• Hematochezia = a bright or dark red stool, a blood
shed in the lower portion of the GIT
 Physical Assessment
• Lips = should be moist, pink, smooth, and symmetric
• Gums = should be red/pink, no inflammation, bleeding,
retraction, and discoloration
• Tongue
o Normal: no signs of infection or inflammation
o CN 12 (hypoglossal nerve) assessment
• Instruct the patient to protrude the tongue and move
it laterally
• Normal: symmetric and has strength
o Assess the frenulum or superficial veins on the
undersurface of the tongue, the common area for oral
cancer, which presents as a white or red plaque, an
indurated ulcer, or a warty growth.
• CN 10 (vagus nerve) assessment
o The patient is told to tip the head back, open the
mouth wide, take a deep breath, and say “ah”.
o Normal: the uvula and soft palate rise
symmetrically with a deep inspiration upon saying
“ah”.
Abdominal Assessment
• Patient lies supine
with knees flexed
slightly.
• Abdomen should be
exposed, patient’s
head should be
resting on a pillow
• Use warm hands to
avoid eliciting muscle
guarding.
• The room should be
warm, with suitable
lighting.
• Sequence: Inspection,
Auscultation,
Percussion, and
Palpation
Four-quadrant method = involves the use of an imaginary line drawn
vertically from the sternum to the pubis through the umbilicus, and a
horizontal line drawn across the abdomen through the umbilicus.
• Inspection:
o Cutaneous angiomas = spider angiomas occur with portal hypertension
o Cullen’s sign = is a faint bluish color around the umbilicus secondary to
hemoperitoneum (intraabdominal bleeding)
o Marked pulsations in epigastric area = highly suggestive of abdominal aortic
aneurysm (AAA)
 Auscultation:
• Auscultation always precedes percussion and palpation
because they may alter sounds.
• Use the diaphragm of the stethoscope for high-pitched and
gurgling sounds.
• Sequence: RLQ, RUQ, LUQ, and LLQ
• Listen at least 5 minutes for abdominal sounds
o Normal: sounds heard every 5-20 sec (5-35 gurgles
per min)
• Hypoactive: 1 or 2 sounds in 2 min (normal the
first few hours after general anesthesia)
• Hyperactive: 5-6 sounds heard in less than 30
sec
• Absent: none heard for at least 5 min (may
signal paralytic ileus, peritonitis, or an
obstruction)
• Use the bell of the stethoscope to note the:
o Bruit = a swishing or buzzing sound and indicates
turbulent blood-flow suggestive of aortic aneurysm
o Friction rubs = are high-pitched sound heard over
the liver and spleen during inspiration.
o Borborygmi = “stomach growling”, is heard as a
loud prolonged gurgle.
 Percussion
• is used to assess the size and density of the abdominal organs
and to detect the presence of air-filled, fluid-filled, or solid
masses.
o The purpose of percussion is to elicit either of two sounds:
• Tympani (drum-like) = is produced over air-filled
structures
• Dullness = is produced over solid structures (mass),
ascites (excessive accumulation of fluid in the
abdominal cavity), or a full bladder
o Sequence: RLQ, RUQ, LUQ, and LLQ
• Normal: tympani is the predominant sound that
results from the presence of air in the stomach and
small intestines.
o Liver cannot be percussed (although it may be 1-
2cm below the costal region)
o Spleen is not normally percussed.
Palpation
o Sequence: RLQ,
RUQ, LUQ, and LLQ
o Light palpation = is
used to detect
tenderness or
cutaneous
hypersensitivity,
muscular resistance,
masses, and swelling.
Keep fingers together
and press gently with
the pads of fingertips
depressing about 1
cm.
Palpation
o Deep palpation = is
used to delineate
abdominal organs
and masses
(tumors).
• Two-hand
method = one
hand is placed
on the top of
the other.
Fingers of the
top hand apply
pressure to the
bottom hand.
Fingers of the
bottom hand
feel for organs
and masses.
Palpation
o Never palpate
over areas
where bruits
are
auscultated.
o Spleen is
never
palpable. If it
is palpable, do
not continue.
o Gallbladder is
unusually
palpable.
 Palpation
• Murphy’s sign = patient is asked to breathe in while the examiner’s fingers
are held under the liver border. Patient guards the movement by an
Inspiratory arrest secondary to painful contact with the fingers. (+)
murphy’s sign confirms cholecystitis.
• Rovsing’s sign = is elicited by palpating the LLQ and paradoxically causes
pain felt in the RLQ. (+) rovsing’s sign indicated appendicitis.
• Rebound tenderness = is elicited when pain is felt in RLQ.
 Rectal Exam
• The final part of the examination is evaluation of the
terminal portion of the GIT, the rectum, perianal
region, and anus.
• For female:
o Rectal examination may be part of gynecological
exam.
o Position the patient in knee-chest, left lateral with
hips and knees flexed.
 Rectal Exam
• For male:
o Digital rectal examination = used to assess
nodules, tenderness, BPH and external
hemorrhoids.
• Gloved and lubricated index finger is placed
against the anus while the patient strains. The
finger is inserted into the rectum as far as
possible.
 Age-Related Changes in the
Gastrointestinal System:
Structural changes Implications
Oral cavity and pharynx: Difficulty chewing and
Injury/loss or decay of teeth swallowing
Atrophy of taste buds
↓ saliva production
Reduced ptyalin and
amylase in saliva
Esophagus Reflux and heartburn
↓ motility and emptying
Weakened gag reflex
↓ resting pressure of lower
esophageal sphincter
 Age-Related Changes in the
Gastrointestinal System:
Structural changes Implications
Stomach Food intolerances,
Degeneration and atrophy of malabsorption, or ↓ vitamin
gastric mucosal surfaces B12 absorption
with ↓ production of HCl
↓ secretion of gastric acids
and most digestive enzymes
↓ gastric motility and
emptying
 Age-Related Changes in the
Gastrointestinal System:
Structural changes Implications
Small intestine ↓ motility and transit time,
Atrophy of muscle and which lead to complaints of
mucosal surfaces indigestion and constipation
Thinning of villi and
epithelial cells
Large intestine ↓ motility which leads to
↓ mucus secretion indigestion and constipation
↓ elasticity of rectal wall
↓ tone of internal anal
sphincter
Slower and duller nerve
impulses in rectal area