MEDICAL SURGICAL NURSING THE UGIT ANATOMY

THE GASTRO-INTESTINAL SYSTEM THE STOMACH

 Contains three parts- the fundus, the body, and

the antrum pylorus.
 Sphincters are located, to control the rate of food
passage.

THE UGIT PHYSIOLOGY

Stomach also aids for gastric secretions:
1. HCl acid
2. Intrinsic factor
3. Pepsinogen
4. Mucoid secretions

THE GIT ANATOMY

THE SMALL INTESTINE
Divided into three parts:
1. Duodenum
THE GIT SYSTEM: ANATOMY AND
PHYSIOLOGY 2. Jejunum

The GI system is composed of two general parts. 3. Ileum

1. GI Tract
Mouth → Esophagus → Stomach → SI → LI THE LARGE INTESTINE

2. Accessory Organs: Divided into four parts.

 Salivary glands 1. Cecum (appendix is located)

 Liver
2. Colon (ascending, transverse, descending and
 Gallbladder
sigmoid)
 Pancreas
3. Rectum
4. Anus
THE UGIT PHYSIOLOGY
THE LIVER
THE MOUTH
Functions:
 Mechanical digestion of food
 The saliva contains SALIVARY AMYLASE or 1. Store excess glucose, fats, and amino acids
PTYALIN
2. Storage of vitamins A, D and B12
THE ESOPHAGUS
3. Production of BILE
 Functions to carry or propel foods from the
oropharynx to the stomach. 4. Synthesis of coagulation factor
5. Detoxifies ammonia into urea.
  Barium sulfate is usually used as contrast.
THE GIT PHYSIOLOGY
THE GALLBLADDER GASTRIC ANALYSIS
1. Stores and concentrates bile.  Aspiration of gastric juice to measure pH,
appearance, volume, and contents.
2. Contracts during the digestion of fats to deliver the
bile.
EGD (ESOPHAGOGASTRODUODENOSCOPY)
THE GIT ANATOMY  Visualization of the upper GIT by insertion of
lighted fiberscope
THE PANCREAS
 A retroperitoneal gland
 Functions as an endocrine and exocrine gland LOWER GI- SCOPY
 The pancreatic duct (major) joins the common
 Use of endoscope to visualize the large intestine.
bile duct in the sphincter of Oddi.

CHOLECYSTOGRAPHY
THE GIT PHYSIOLOGY
 Injection of a dye and an x-ray examination to
THE PANCREAS
visualize the gallbladder.
EXOCRINE FUNCTION
PARACENTESIS
1. Secretion of digestive enzymes
 Removal of peritoneal fluid for analysis
 Amylase
 Lipase (steapsin)
LIVER BIOPSY
 Trypsin, Chymotrypsin
 Gastrointestinal Assessment  Invasive procedure where needle is inserted into
the liver to remove a small piece of tissue for
study.

LABORATORY PROCEDURES
GIT DRUGS
COMMON LABORATORY PROCEDURES
General time of administration of the drugs affecting
gastric acid secretion.
FECALYSIS Best time to
Anti-ulcer drugs Prototype
give
 Examination of stool consistency, color, and the Histamine (H2) With FOOD
presence of occult blood. receptor or ONE
Cimetidine
antagonist/ hour after
blockers ANTACID
UPPER GIT STUDY: BARIUM SWALLOW AlOH and Usually after
Antacids
MgOH meals
 Examines the upper GI tract. Proton pump BEFORE
 Barium sulfate is usually used as contrast. Omeprazole
inhibitors MEALS
Mucosal BEFORE
Sucralfate
protectants MEALS
LOWER GIT STUDY: BARIUM ENEMA
Prostaglandin WITH
Misoprostol
 Examines the lower GI tract. analog MEALS
 2. Instruct to eat SMALL frequent meals, include MORE
dry items.
LAXATIVES
3. Instruct to AVOID consuming FLUIDS with meals.
Type Prototype Action
Direct stimulation 4. Instruct to LIE DOWN after meals
Chemical
Prototype of the GIT nerves
stimulants
Irritant laxatives
Increased fluid PERNICIOUS ANEMIA
Mechanical content of the fecal
(bulk) Lactulose material causing  Results from Deficiency of vitamin B12 due to
stimulants stimulation of the autoimmune destruction of the parietal cells,
local reflex lack of INTRINSIC FACTOR or total removal
Lubricating the of the stomach.
intestinal material to
Lubricants Mineral oil
promote passage
through the GIT
Increases the PERNICIOUS ANEMIA ASSESSMENT
admixture of fat and  Severe pallor
Stool softeners Docusate
water producing a
 Fatigue
softer stool
 Weight loss
 SMOOTH BEEFY-RED TONGUE
CONDITIONS OF THE GIT  Paresthesia of extremities

COMPLICATIONS OF GASTRIC SURGERY AND

CHRONIC GASTRITIS
NURSING INTERVENTION FOR PERNICIOUS
ANEMIA

COMMON GIT SYMPTOMS AND  Lifetime injection of Vitamin B 12 weekly

MANAGEMENT initially, then MONTHLY

DUMPING SYNDROME
 A condition of rapid emptying of the gastric CONDITIONS OF THE GIT
contents into the small intestine usually after a
UPPER GI SYSTEM
gastric surgery
 Symptoms occur 30 minutes after eating.

CONDITION OF THE ESOPHAGUS

DUMPING SYNDROME HIATAL HERNIA
ASSESSMENT FINDINGS: EARLY SYMPTOMS  Protrusion of the esophagus into the diaphragm
may be caused by congenital weakening of the
1. Nausea and Vomiting
muscle in the diaphragm around the
2. Abdominal fullness esophagogastric opening.

3. Abdominal cramping
4. Diaphoresis and tachycardia – Initial Sign ASSESSMENT FINDINGS IN HIATAL HERNIA
1. Heartburn - PS

DS NURSING INTERVENTIONS 2. Regurgitation

1. Advise patient to eat LOW-carbohydrate HIGH-fat 3. Dysphagia

and HIGH-protein diet.
DIAGNOSTIC TEST
 Barium swallow CONDITIONS OF THE STOMACH
ASSESSMENT (FOR GERD)
NURSING INTERVENTIONS  Heartburn
 Dyspepsia
1. Provide small frequent feedings.
 Regurgitation
2. AVOID supine position for 1 hour after eating.  Epigastric pain
 Difficulty swallowing
3. Elevate the head of the bed on 8-inch block.
4. Avoid activities that increases intra-abdominal
pressure. DIAGNOSTIC TEST
 EGD
 Barium Swallow
ESOPHAGEAL VARICES  Bilitec (measure bile reflux)
 Dilation and tortuosity of the submucosal veins
in the distal esophagus
 ETIOLOGY: commonly caused by PORTAL NURSING INTERVENTIONS
hypertension secondary to liver cirrhosis
1. Instruct the patient to AVOID stimulus that increases
 This is an Emergency condition!
stomach pressure and decreases GES pressure.
2. Instruct to avoid spices, coffee, tobacco, and
ASSESSMENT findings for EV carbonated drinks.

1. Hematemesis 3. Instruct to eat LOW-FAT, HIGH-FIBER diet

2. Melena 4. Avoid foods and drinks TWO hours before bedtime.

3. Signs of shock if bleeding is severe. 5. Elevate the head of the bed with an approximately 8-
inch block.
4. Ascites

MEDICATION
DIAGNOSTIC PROCEDURE
 Antacid/H2 blocker- if reflux persist
 Esophagoscopy  Proton-pump inhibitors-decrease release of
NURSING INTERVENTIONS FOR EV gastric acid

1. Monitor VS strictly. Note for signs of shock.

2. Prepare for blood transfusion. GASTRITIS

3. Assist with Sengstaken-Blakemore tube  Inflammation of the gastric mucosa

 May be Acute or Chronic.
4. Assist in iced saline irrigation  Etiology: Acute- bacteria, irritating foods,
NSAIDS, alcohol, bile, and radiation
 Etiology: Chronic- Ulceration, bacteria,
CONDITIONS OF THE STOMACH Autoimmune disease, diet, alcohol, smoking

GASTRO-ESOPHAGEAL REFLUX
ASSESSMENT (ACUTE)
 Backflow of gastric contents into the esophagus
 Usually due to incompetent lower esophageal  Dyspepsia
sphincter, pyloric stenosis, or motility disorder  Headache
  Anorexia
 Nausea/Vomiting

ASSESSMENT (CHRONIC)
ASSESSMENT (Gastric Ulcer)
 Pyrosis
 Dyspepsia 1. Nausea
 N/V/anorexia
 Pernicious anemia 2. Vomiting (more common)
3. Hematemesis
DIAGNOSTIC PROCEDURE 4. Weight loss
 EGD

DIAGNOSTIC PROCEDURES
NURSING INTERVENTIONS
1. EGD to visualize the ulceration.
1. Give BLAND diet
2. Gastric analysis
2. Monitor for signs of complications like bleeding,
obstruction, and pernicious anemia 3. Upper GI series

3. Instruct to avoid spicy foods, irritating foods, alcohol,

and caffeine.
NURSING INTERVENTIONS
4. Administer prescribed medications- H2 blockers,
1. Give BLAND diet, small frequent meals and avoid
antibiotics, mucosal protectants.
acid-producing substances.
5. Inform the need for Vitamin B12 injection if
2. Administer prescribed medications- H2 blockers, PPI,
deficiency is present.
mucosal barrier protectants and antacids.
3. Monitor for complications of bleeding, perforation,
PEPTIC ULCER DISEASE and intractable pain

 An ulceration of the gastric and duodenal lining 4. Provide teaching about stress reduction and relaxation
 May be referred as to location as Gastric ulcer in techniques.
the stomach, or Duodenal ulcer in the
duodenum.
CONDITION OF THE DUODENUM
DUODENAL ULCER
GASTRIC ULCER
 Ulceration of duodenal mucosa and submucosa
 Risk factors: Stress, smoking, NSAIDS abuse,
 Usually due to increased gastric acidity.
Alcohol, Helicobacter pylori infection, and
History of gastritis
 Incidence is high in older adults.
 Acid secretion is NORMAL. DUODENAL ULCER ASSESSMENT
 PAIN characteristic:
ASSESSMENT (Gastric Ulcer)  Burning pain in the mid-epigastrium 2-4
HOURS after eating or during the night,
 Epigastric pain RELIEVED by food intake
 Characteristic: Gnawing, sharp pain in the mid-
epigastrium 1-2 hours AFTER eating, often DIAGNOSTIC TESTS
NOT RELIEVED by food intake, sometimes  EGD
AGGRAVATING the pain!
 4. Colicky abdominal pain
NURSING INTERVENTIONS 5. Anorexia/N/V
1. Same as for gastric ulceration 6. Weight loss
2. Patient teaching-avoid alcohol, smoking, caffeine, and 7. Anemia
carbonated drinks.
 Take NSAIDS with meals
CONDITIONS OF THE LARGE INTESTINE
 Adhere to medication regimen.
ULCERATIVE COLITIS
 Ulcerative and inflammatory condition of the
ULCERS
GIT usually affecting the large intestine.
GASTRIC DUODENAL  The colon becomes edematous and develops
Older Younger bleeding ulcerations.
Normal Acidity INCREASED acidity  Cause: Unknown, contributing factors include
Pain early after eating Pain late after eating (2-4 allergies, autoimmune reaction
hours)
WORSENS by food, RELIEVES by food
RELIEVED by
ASSESSMENT FINDINGS FOR UC
VOMITING
Bleeding, weight loss and Less likely bleeding and 1. Anorexia
vomiting vomiting
(+) cancer (-) cancer 2. Weight loss
3. Fever
CONDITIONS OF THE STOMACH
4. SEVERE diarrhea with Rectal bleeding
SURGICAL PROCEDURES FOR PUD
5. Anemia
 Total gastrectomy, vagotomy, gastric resection,
6. Dehydration
Billroth I and II, esophagogastrojejunostomy
7. Abdominal pain and cramping
CONDITIONS OF THE LOWER TRACT NURSING INTERVENTIONS FOR CD AND UC
SMALL AND LARGE INTESTINE 1. Maintain NPO during the active phase.
2. Monitor for complications like severe bleeding,
dehydration, electrolyte imbalance
CONDITIONS OF THE SMALL INTESTINE
3. Monitor bowel sounds, stool, and blood studies
CROHN’S DISEASE
4. Restrict activities.
 Also called Regional Enteritis
 An inflammatory disease of the GIT usually 5. Administer IVF, electrolytes and TPN if prescribed.
affecting the small intestine.
 Cause: Unknown, contributing factors include 6. Instruct the patient to AVOID gas-forming foods,
allergies, autoimmune reaction MILK products and foods such as whole grains, nuts,
RAW fruits, and vegetables especially SPINACH,
pepper, alcohol, and caffeine.
ASSESSMENT FINDINGS FOR CD 7. Diet progression- clear liquid → LOW residue, high
protein diet
1. Fever
8. Administer drugs- anti-inflammatory, antibiotics,
2. Abdominal distention
steroids, bulk-forming agents, and vitamin/iron
3. Diarrhea supplements.
 1. PREOPERATIVE CARE
APPENDICITIS  POSITION of Comfort: RIGHT SIDELYING in
a low FOWLER’S
 Inflammation of the vermiform appendix
 Avoid Laxatives, enemas & HEAT
 ETIOLOGY: usually fecalith, lymphoid
APPLICATION
hyperplasia, foreign body, and helminthic
obstruction
2. POST-OPERATIVE CARE
PATHOPHYSIOLOGY  Monitor VS and signs of surgical complications.
 Maintain NPO until bowel function returns.
Obstruction of lumen → increased pressure → decreased
blood supply bacterial → proliferation and mucosal 2. POST-OPERATIVE CARE
inflammation → ischemia → necrosis → rupture.
 POSITION post-op: RIGHT side-lying, semi-
fowlers to decrease tension on incision, and legs
flexed to promote drainage.
 Administer prescribed pain medications.

ASSESSMENT FINDINGS FOR APPENDICITIS

HEMORRHOIDS
1. Abdominal pain: begins in the umbilicus then
 Abnormal dilation and weakness of the veins of
localizes in the RLQ (Mc Burney’s point)
the anal canal
2. Anorexia  Variously classified as Internal or External

3. Nausea and Vomiting

4. Fever PATHOPHYSIOLOGY

5. Rebound tenderness and abdominal rigidity (if Increased pressure in the hemorrhoidal tissue due to
perforated) straining, pregnancy, obesity, heavy lifting, etc.
dilatation of veins
6. Constipation or diarrhea

INTERNAL HEMORRHOIDS
DIAGNOSTIC TESTS
 These dilated veins lie above the internal anal
1. CBC- reveals increased WBC count. sphincter.
2. Ultrasound  Usually, the condition is PAINLESS.

3. Abdominal X-ray
EXTERNAL HEMORRHOIDS

NURSING INTERVENTIONS  These dilated veins lie below the internal anal
sphincter.
1. PREOPERATIVE CARE  Usually, the condition is PAINFUL.
 NPO
 Consent
 Monitor for perforation and signs of shock. ASSESSMENT FINDINGS FOR HEMORRHOIDS
1. Internal hemorrhoids- cannot be seen on the peri-anal
area.
NURSING INTERVENTIONS
2. External hemorrhoids- can be seen.
3. Bright red bleeding with each defecation 2. Congenital weakening of the muscular fibers of the
intestine
4. Rectal/ perianal pain
3. Dietary deficiency of fiber
5. Rectal itching
ASSESSMENT findings for D/D
1. Left lower Quadrant pain.
DIAGNOSTIC TEST
2. Bowel irregularities
1. Anoscopy
3. Rectal bleeding
2. Digital rectal examination
4. nausea and vomiting.
5. Fever
NURSING INTERVENTIONS
1. Advise patient to apply cold packs to the anal/rectal
area followed by a SITZ bath. DIAGNOSTIC STUDIES
2. Apply astringent like witch hazel soaks. 1. If no active inflammation, COLONOSCOPY and
Barium Enema
3. Encourage HIGH-fiber diet and fluids.
2. CT scan is the procedure of choice!
4. Administer stool softener as prescribed.
3. Abdominal X-ray

POST-OPERATIVE CARE FOR

HEMORRHOIDECTOMY NURSING INTERVENTIONS
1. Position: Prone or Side-lying 1. Maintain NPO during acute phase.
2. Maintain dressing over the surgical site. 2. Provide bed rest.
3. Monitor for bleeding 3. Administer antibiotics, analgesics like meperidine
(morphine is not used) and anti-spasmodic.
4. Administer analgesics and stool softeners.
4. Monitor for potential complications like perforation
5. Advise the use of SITZ bath 3-4 times a day.
and hemorrhage
5. Increase fluid intake
DIVERTICULOSIS AND DIVERTICULITIS
6. Avoid gas-forming foods or HIGH-roughage foods
DIVERTICULOSIS containing seeds, nuts to avoid trapping.

 Abnormal out-pouching of the intestinal mucosa 7. introduce soft, high fiber foods ONLY after the
occurring in any part of the LI most commonly inflammation subsides.
in the sigmoid
8. Instruct to avoid activities that increase intra-
abdominal pressure.
DIVERTICULITIS
 Inflammation of the diverticulosis
CONDITIONS OF THE GIT ACCESSORY
ORGANS

DIVERTICULOSIS AND DIVERTICULITIS THE LIVER

ETIOLOGY:
1. Stress CONDITION OF THE LIVER
LIVER CIRRHOSIS 3. Provide Moderate to LOW-protein (1 g/kg/day) and
LOW-sodium diet.
 A chronic, progressive disease characterized by
a diffuse damage to the hepatic cells. 4. Provide supplemental vitamins (especially K) and
 The liver heals with scarring, fibrosis, and minerals.
nodular regeneration.
5. Administer prescribed.
 Diuretics= to reduce ascites and edema
ETIOLOGY:  Lactulose= to reduce NH4 in the bowel
 Antacids and Neomycin= to kill bacterial flora
 Post-infection, Alcohol, Cardiac diseases,
that cause NH production
Biliary obstruction
6. Avoid hepatotoxic drugs.
LIVER PHYSIOLOGY AND  Paracetamol
PATHOPHYSIOLOGY  Anti-tubercular drugs

Normal Function Abnormality in function 7. Reduce the risk of injury.

1. Stores glycogen = Hypoglycemia
2. Synthesizes proteins = Hypoproteinemia  Side rails reorientation
=Decreased Antibody  Assistance in ambulation
3. Synthesizes globulins  Use of electric razor and soft-bristled
formation
4. Synthesizes Clotting toothbrush.
= Bleeding tendencies
factors
8. Keep equipment’s ready including Sengstaken-
5. Secreting bile = Jaundice and pruritus
Blakemore tube, IV fluids, Medications to treat
6. Converts ammonia to
=Hyperammonemia hemorrhage.
urea
7. Stores Vit and =Deficiencies of Vit and
minerals min
= Gynecomastia, testes Nursing Interventions Rationale
8. Metabolizes estrogen
atrophy 1. Low sodium Diet To reduce edema
2. Low protein diet To reduce NH production
3. Benadryl and mild
ASSESSMENT FINDINGS To relieve pruritus
soap
1. Anorexia and weight loss 4. Pressure onto injection
To prevent bleeding
site
2. Jaundice Done to relieve
5. Assist in paracentesis
abdominal pressure
3. Fatigue 6. Administer
Medications:
4. Easy bruising
5. RUQ abdominal pain  Diuretics,
Neomycin,
6. Changes in mood, alertness, and mental ability Lactulose
 Albumin, Amino
7. Signs of Portal hypertension acid
 Vitamin K
(menadione)
NURSING INTERVENTIONS
1. Monitor VS, I and O, Abdominal girth, weight, LOC, CONDITIONS OF THE ACCESSORY ORGANS
and Bleeding
THE GALLBLADDER
2. Promote rest. Elevated the head of the bed to
minimize dyspnea.
CONDITION OF THE GALLBLADDER
CHOLECYSTITIS  Codeine and Morphine may cause spasm of the
Sphincter → increased pain. Morphine cause
 Inflammation of the gallbladder
MOREPAIN.
 Can be acute or chronic.
 Acute cholecystitis usually is due to gallbladder 4. Instruct patient to AVOID HIGH- fat diet and GAS-
stones. forming foods.
 Chronic cholecystitis is usually due to long
5. Surgical procedures- Cholecystectomy,
standing gall bladder inflammation.
Choledochotomy, laparoscopy

CHOLELITHIASIS
POST-OPERATIVE NURSING INTERVENTIONS
 Formation of GALLSTONES in the biliary
1. Monitor for surgical complications
apparatus
2. Position client in semi-fowlers or side lying.
3. Encourage early ambulation.
PREDISPOSING FACTORS
4. Administer medication before coughing and deep
“F”
breathing exercises.
 Female
5. Advise client to splint the abdomen to prevent
 Fat
discomfort during coughing.
 Forty
 Fertile
 Fair
CONDITIONS OF THE ACCESSORY ORGANS
THE PANCREAS: EXOCRINE FUNCTION
ASSESSMENT FINDINGS FOR CHOLECYSTITIS
1. Indigestion, belching and flatulence.
CONDITION OF THE PANCREAS
2. Fatty food intolerance, steatorrhea
PANCREATITIS
3. Epigastric pain that radiates to the scapula or localized
at the RUQ after heavy meal.  Inflammation of the pancreas
 Can be acute or chronic.
4. Mass at the RUQ
5. Murphy’s sign ETIOLOGY AND PREDISPOSING FACTORS
6. Jaundice, pruritus, dark amber urine  Alcoholism
 Hypercalcemia
 Trauma
DIAGNOSTIC PROCEDURES  Hyperlipidemia
 Cholecystography PATHOPHYSIOLOGY OF ACUTE
PANCREATITIS
 Self-digestion of the pancreas by its own
NURSING INTERVENTIONS
digestive enzymes principally TRYPSIN
1. Maintain NPO in the active phase.
2. Maintain NGT decompression
ASSESSMENT FINDINGS
3. Administer prescribed medications to relieve pain.
1. Left upper quadrant pain that radiates to the back,
Usually Demerol (MEPERIDINE)
flank, or substernal area.
2. Abdominal guarding
3. Bruising on the flanks and umbilicus 2. In taking Ms. Anne’s medical history, the nurse
should also determine if Mrs. Anderson had any.
4. N/V, jaundice
a. Melena
5. Hypotension and hypovolemia
b. Hyperemia
6. HYPERGLYCEMIA, HYPOCALCEMIA c. Hematemesis
d. Hematinemia
7. Signs of shock

3. Ms. Annie complains of gnawing stomach pain. It is

DIAGNOSTIC TESTS important to determine if this pain.
1. Serum amylase and serum lipase  Occurs while eating.
2. CT scan/Ultrasound  Is relieved by food.
 Occurs upon awakening.
3. WBC  Is relieved by coffee.
4. Serum calcium decreased.
NURSING INTERVENTIONS 4. Ms. Annie reports having difficulty in swallowing.
The appropriate term to charted would be.
1. Assist in pain management. Usually, Demerol is
given. Morphine is AVOIDED.  Anorexia
 Dyspepsia
2. NGT insertion to decompress distention and remove
 Dysphagia
gastric secretions.
 Eructation
3. Place patient on NPO to inhibit pancreatic stimulation.
4. Maintain on bed rest.
5. The term pyrosis refers to.
5. Position patient in SEMI-FOWLER’s or knee chest
 Fever
position to decrease pressure on the diaphragm.
 Esophageal burning
6. Avoid caffeine products and alcohol.  Excessive vomiting
 Air swallowing
7. Provide parenteral nutrition.
8. Introduce oral feedings gradually - HIGH carbo, LOW 6. Subsequently Ms. Annie is admitted to the hospital
FAT with a tentative diagnosis of peptic ulcer, the physician
orders a GI series.

Situation: Ms. Annie is a 50 y/o executive who has come To prepare Ms. Annie for the GI series, the nurse must
to the emergency room w/ a chief complain of a. Give enema until clear.
“vomiting” of 2 days duration. b. Keep the patient NPO after midnight.
Situation: Ms. Annie is a 50 y/o executive who has come c. Insert a levine tube.
to the emergency room w/ a chief complain of d. Administer a laxative at bedtime.
“vomiting” of 2 days duration.
1. Ms. Annie vomited blood several times. The vomiting 7. The GI series confirms the diagnosis of peptic ulcer
of blood is knowing as and Ms. Annie is out on a controlled diet. Which of the
a. Melena following foods are permitted on a liberal diet?
b. Hyperemesis a. Beer and wine
c. Hematemesis b. Tacos
d. Dyspepsia
c. Coffee and Cola beverages
d. Raw fruits and vegetables