DISORDERS OF THE

GASTROINTESTINAL
SYSTEM

Jeo Thomas
M.Sc nursing ,Sarvodaya college of nursing
DIGESTIVE SYSTEM
 FUNCTIONS: ingest food
 DIGESTION:break it down into small
molecules
 ABSORPTION:absorb nutrient molecules

 ELIMINATION:eliminate nondigested
wastes
 ASSESSORY ORGANS :
 pancreas, liver, gallbladder
 Disorders of the upper GI
system
Disorders affecting Ingestion
 ANOREXIA: lack of appetite, could be from
emotional or physical factors
 lab tests may be done to assess nutritional
status
 Medical treatment: supplements may be
ordered, TPN or enteral feedings
 Nursing Interventions:
 oral hygiene, clean room, determine
cause of nausea and treat, include
family and friends(socialization),
respect likes and dislikes, education
STOMATITIS

 Inflammation of the oral mucosa (mouth)

 Causes: trauma, organisms, irritants,
nutritional deficiency, diseases, chemotherapy
 S/S: swelling, pain, ulcerations, excessive
salivation, halitosis, sore mouth
 Treatment:
 pain relief, removal of causative factor, oral
hygiene, medications, soft bland diet
GINGIVITIS
 Inflammation of the gums
 Causes: poor oral hygiene, poorly fitting
dentures, nutritional deficiency
 S/S: red, swollen, bleeding gums,
painful
 Treatment: dental hygiene, prevention
of complications
Nursing Interventions:
Stomatitis and Gingivitis
 Assess mouth condition
 Administer medications
 Mouth care
 Soft bland diet, no spicy foods
 Observe for complications
 Teach importance of mouth and gum
care
HERPES SIMPLEX TYPE 1
 Infection affecting the lips and mucous
membranes of the mouth
 Causes: Herpes simplex virus
 S/S: Vesicles on the mouth, nose or lips,
malaise, edema of surrounding area
 Treatment: Antiviral medication(Zovirax),
analgesics, symptomatic relief
 Nsg Interventions: Administer meds, keep
lesions dry, provide symptomatic relief
LEUKOPLAKIA
 Abnormal thickening and whitening of
the epithelium of the mucous
membranes of the cheeks and tongue
 Causes: Chronic irritation
 S/S: Thickened white or reddish lesions
on the mucous membrane, lesions can
not be rubbed off
 Treatment: May be surgically
removed or treated with
chemotherapy, meticulous oral
hygiene
 Interventions: Assess mouth
frequently, assist with oral hygiene,
discuss removal of sources of irritation
ORAL CANCER
 Malignant lesions may develop on the
lips, oral cavity, tongue and pharynx.
Generally squamous cell carcinomas
 Causes: high alcohol consumption,
tobacco use, external irritants
 S/S: Leukoplakia, swelling, edema,
numbness, pain
 Diagnosis: biopsy
 Treatment:
 Surgery

 Radiation or chemotherapy

 depends on the size and location and the lesion

 Interventions: consult MD for special mouth care, monitor
respiratory status, keep HOB elevated, administer pain med, assess
ability to swallow and talk, assess for infection at incision site,
education
ESOPHAGITIS
 Inflammation or irritation of the esophagus
 Causes: Reflux of stomach contents,
irritants, fungal infections, trauma,
malignancy, intubation
 S/S: heartburn, pain, dysphagia
 Treatment: treat underlying cause
 Interventions: soft bland diet, administer
meds, elevate HOB, observe for
complications
ESOPHAGEAL VARICIES
 Tortuous, distended vessels of the
esophagus
 may rupture and bleed
 causes: Portal hypertension caused by
cirrhosis of the liver
 S/S Hematemesis, hemorrhage from
UGI, black tarry stools, pain, shock
 Treatment:
 Sengstaken-Blakemore tube to controll bleeding

 Iced saline lavage

 Medications( Vasopressin, antibiotics, analgesics)

 Surgeries: ligation, injection sclerotherapy

 Blood transfusions
 Interventions:

 administer meds

 provide pre/post op care

 administer blood transfusions

 monitor tube placement

 assess vital signs, bleeding

CANCER OF THE
ESOPHAGUS
 Prognosis is very poor, diagnosed at late
stages
 Causes- no known cause, predisposing
factors; irritation, poor oral hygiene
 S/S- progressive dysphagia, painful
swallowing, weight loss, vomiting,
hoarseness, coughing, iron deficiency,
anemia, occult bleeding or hemmorage
Treatment of CA of
Esophagus
 Palliative treatment is common
 Radiation, chemotherapy
 surgery:
 Esophagectomy

 Esophagogastrostomy

 Esophagoenterostomy

 Gastrostomy
Interventions
 Maintain NG tube after surgery
 Assess for signs of hemorrahage
 Monitor respiratory status
 monitor adequacy of nutritional intake
( high protein, high calorie diet)
 assess ability to swallow
 allow patient to ventilate feelings
DISORDERS OF DIGESTION
AND ABSORPTION
 N/V
 Hiatal Hernia
 Gastritis
 Peptic Ulcer
 Stomach Cancer
 Obesity
NAUSEA AND VOMITING
 Nausea: unpleasant sensation usually
preceding vomiting, may have
abdominal pain, pallor, sweating,
clammy skin

 Causes: irritating food, infection,

radiation, drugs, hormonal changes,
surgery, inner ear disorders, distention
of the GI tract
 Vomiting: forceful expulsions of
stomach contents through the mouth.
Occurs when vomiting reflex in the brain
is stimulated.
 Projectile vomiting- is forceful ejection of
stomach contents.
 Regurgitation- gentle ejection of
stomach contents without nausea or
retching
Complications and
Treatment
May lead to dehydration, metabolic
alkalosis, aspiration
 Treatment: Antiemetics( Phenergan,
Dramamine, Scopolamine patch Reglan),
IV fluids, NG tube, TPN
 Nursing care: through assessment,
keep patient comfortable, offer liquids,
position on side, suction setup in the
room
 HIATAL HERNIA
 Protrusion of the lower esophagus and stomach
upward through the diaphragm into the chest
 SLIDING-gastroesophageal junction above the
hiatus
 ROLLING( paraesophageal)-junction in place
portion of stomach rolls up through diaphram
 Causes; weakness in the lower esophageal
sphincter, related to increased abdominal pressure,
long term bedrest, trauma
Signs and Symptoms

 Feelings of fullness
 dysphagia
 eruption
 regurgitation
 heartburn
 Complications: Ulcerations, bleeding,
aspiration
 seen in 50% of people over 60.
Treatment for Hiatal Hernia
 Drug therapy
 H2 receptor antagonists:Tagamet,Zantac,
Pepsid- reduce stomach secretions
 Urecholine- increase LES tone

 Antacids- neutralize stomach acids

 Reglan, Propulsid- increase stomach emptying

 diet therapy- decrease caffeine fatty foods,

alcohol( reduce LES tone), acidic and spicy foods
 SURGERY
 Nissen Fundoplication
 Angelclik prothesis
 NURSING CARE: assessment, pain
relief, watch for aspiration, nutrition,
education
GASTRITIS
 Inflammation of the lining of the
stomach
 ACUTE: excessive intake of food or
alcohol. Food poisoning, chemical
irritation
 CHRONIC: repeated episodes of acute, H
Pylori
Signs/Symptoms and
Complications
 Nausea, vomiting, feeling of fullness,
pain in stomach, indigestion. With
chronic may have only mild indigestion
 changes in stomach lining with decrease

in acid and intrinsic factor

( high risk for pernicious anemia)
Treatment
 Treat symptoms, and fluid replacement
 Medications: antacids, H2 receptor
blockers, B 12 injections, corticosteroids
analgesics, antibiotics if H Pylori
 bland diet, frequent meals
 Eliminate the cause
 surgical intervention
 BEST DIAGNOSIS IS GASTROSOPY &
BIOPSY
NURSING CARE
 Good HX and review of present S/S
 pain relief, adequate nutrition, hydration,
stress management, education
PEPTIC ULCER
 Loss of tissue from the lining of the
digestive tract. May be acute or chronic.
 Classified as gastric or duodental (stress-
develop 24-48hr. After event)
 CAUSES: drugs, stress, heavy alcohol
and tobacco use, infection (H .pylori
bacteria) Conditions that cause high
gastric acid concentration
Peptic Ulcer comparison
 Gastric Ulcers  Duodenal Ulcers
 burning pain 1-2 hrs.  burning/ cramping pain
after meals, upper 2-4hrs. P meal, beneath
left abd/back,relieved xiphoid and back,
by food relieved by antacids/food
 N/V, anorexia, wt loss
 increased gastric acid
 Young men, all social
 Shallow/ gastric
classes, bld type O,
secretions deceased chronic illnesses
 Older men, working
class, bld type A,
under stress
PEPTIC ULCER
COMPLICATIONS
 HEMORRHAGE

 PERFORATION

 PYLORIC OBSTRUCTION
TREATMENT
 Drug therapy
 Antacids

 H2 RECEPTOR BLOCKERS
 ANTICHOLINERGICS-Pro-Banthine, Robinul,
Bentyl
 SUCRALFATE- Carafate

 Antibiotics –Flagyl, tetracycline, Biaxin

 treatment goals- relieve symptoms,

promote healing, prevent complications
and recurrence
Nursing Interventions
 Three meals a day – decreases acid
production
 decrease foods that stimulate acid
secretions and cause discomfort
 treat pain with rest, diet and drug
therapy
 educate on stress management and
relaxation
 Surgical options for gastric

ulcers
To decrease acid secretion:
 vagotomy
 pyloroplasty

 gastroenterostomy

 antrectomy

 subtotal gastrectomy
 Billroth I
 Billroth II
Nursing care after gastric
surgery
 No signs of complications
 Gastric dilation

 Obstruction

 Perforation

 Maintenance of NG tube:
 Suction

 do not irrigate or reposition tube

 type of drainage
 Adequate nutrition:

 NPO gradually advance from clear liquids to

full liquids then solid foods
 Assess for N/V, abdominal distention

 Size of meals changes depending on type of

surgery
 Gastric surgeries can have serious effects on
absorption of vit. B12, folic acid, iron, calcium,
vit, D
 Decreased cardiac output
 Dumping syndrome common after gastric surgery:

 small stomach size causes chyme to move rapidly into intestine (15-
30min.), draws fluid from the blood. Results- drop in bld volume,
weakness, dizziness, sweating. ^ in fluid in intestine causes
cramping, loud BS abd urge to defecate . Later ^ bld sugar
 Treatment: 6 small meals qd, low in carbs and refined sugars, mod.
Fat/high protein
 fluids between and not with meals

 lie down for 30 min. after meal

education
 Reinforce diet
 teach signs of complicatons
 Avoid risk factors
STOMACH CANCER
 Rare(25,000/yr.), common in males,
African American, over 70 and low
socioeconomic status. 60% decrease in
past 40 yrs.
 No S/S in early stages
 Late stages S/S: N/V, ascities, liver
enlargement, abd. Mass
 Mets to bone and lung
 10% survival rate after 5 yrs.
 Risk factors: pernicious anemia,
chronic gastritis, cigarette smoking,
diet high in starch, salt, salted meat,
pickled foods, nitrates
 Treatment: surgery/ chemotherapy/
radiation
 subtotal gastrectomy, total gastrectomy
OBESITY
 Increase in body weight, 20% over ideal,
caused by excessive fat. Morbid obesity
twice ideal
 Causes: heredity, body build,
metabolism, psychosocial factors.
Calorie intake exceeds demands.

 Treatment and nursing care

 Weight reduction diet

 drug therapy, mainly Amphetamines
 Surgical procedures:
 Liposuction

 Lipectomy

 Jaw wiring

 Intragastric balloon

 Gastric bypass

 gastroplasty

 jejunoileal bypass

 Nursing care-assessment, diet monitoring, education

DISORDERS
AFFECTING
ABSORPTION AND
ELIMINATION
MALABSORPTION
 CONDITION WHEN ONE OR MORE NUTRIENTS ARE NOT
DIGESTED OR ABSORBED
 multiple causes

 lactase deficiency

 sprue: celiac/tropical

 treatment/care: depends on type

 lactase- hold milk products

 celiac sprue- hold gluten products

 tropical sprue- antibiotics, folic acid

DIRRHEA

 The passage of loose liquid stools with

increased frequency, associated with
cramping, abd, pain
 Causes; (many), foods, allergies,
infections, stress, fecal impaction, tube
feedings, medications
 Complications- usually temporary/ can
be dehydration, malnutrition
Treatment/Nursing care
 Treatment; GI rest, antidiarrheal
drugs(Lomotil, Imodium, Kaolin,
Aluminum hydroxide)

 Nursing Care: help determine cause,

assessVS, weight, skin turgor, abdominal
destention, perianal irritation, skin
integrity
CONSTIPATION
 HARD DRY INFREQUENT STOOLS PASSED
WITH DIFFICULTY
 Causes: (many),inactivity, ignored urge,
drugs,age related changes
 Complications: straining (Valsalva
maneuver) and fecal impaction
Treatment/Nursing care
 Laxatives, suppositorys, enemas for
prompt results
 stool softeners, increase fluids,dietary
fiber
 Nursing care: assessment, monitor fluids
and diet, education, check for impaction
INTESTINAL
OBSTRUCTION
 Exists when there is obstruction in the
normal flow of intestinal contents
through the intestinal tract
 Mechanical- Pressure on the intestinal wall
 Paralytic- Intestinal musculature unable to
propel contents along the bowel
 May be partial or complete
Intestinal obstruction
causes
 SMALL BOWEL:

 adhesions most common

 intussusception

 volvulus

 paralytic ilieus

 abdominal hernia
 LARGE BOWEL:
 carcinoma

 diverticulitis

 inflammatory bowel disorders

 volvulus
Small Bowel vs Large Bowel
 Small:  Large:
 abdominal pain  symptoms develop
 vomiting slowly
 pass  constipation
blood and
mucous, no stool,  distended
no gas abdomen
 over time signs of  crampy lower
dehydration abdominal pain
 fecal vomiting
Management of bowel
obstruction
 Small
 decompression

 is strangulated then surgery

 Large
 surgicalresection with formation of
colostomy
 Nursing care: same as gastric surgery,
management of NG tube
APPENDICITIS
 Inflammation of the appendix

 appendix has no known function in the

body
 opening becomes obstructed

 obstruction interferes with the drainage of

secretions from the appendix
Signs and symptoms

 Generalized epigastric pain at first that

shifts to the RLQ
 pain at McBurney’s point
 elevated temp, N/V, elevated
WBC’s( over 10,000)
Treatment/nursing care
 NPO
 surgical removal
 IV’s and antibiotics
 ice pack to the abd.
 LAXATIVES AND HEAT ARE CONTRAINDICATED
 Nursing Care:
 pain relief, fluid balance

 absence of infection, effective breathing

PERITONITIS

 Inflammation of the peritoneum

 Causes;
 chemical

 bacterial contamination
 S/S pain, rebound tenderness,
rigidity, distention, fever, tachcardia,
tachypnea,N/V
Treatment/Nursing care
 NG tube, IV fluids, antibiotics, analgisics,
surgery if indicated
 Nursing care;
 Assessment- VS, pain, abd distention, BS,
I/O, monitor cardiac output
ABDOMINAL HERNIA
 A protrusion of the intestine through a
weakness in the abdominal wall
 reducible

 irreducible

 Inguinal, umbilical, femoral, incisional

 S/S: smooth lump in the abdomen,
usually not painful. If incarcerated,
severe pain present
Treatment/nursing care

 Treatment: Herniorrhaphy,
Hernioplasty
 Nursing care;
 absence of strangulation, monitor activity
 general surgery interventions with
surgery