DISORDERS OF THE

GASTROINTESTINAL
SYSTEM

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 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
burning pain 1-2 hrs.
after meals, upper
left
abd/back,relieved by
food
N/V, anorexia, wt
loss
Shallow/ gastric
secretions deceased
Older men, working
class, bld type A,
under stress

Duodenal Ulcers
burning/ cramping
pain 2-4hrs. P meal,
beneath xiphoid and
back, relieved by
antacids/food
increased gastric
acid
Young men, all social
classes, bld type O,
chronic illnesses

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:
abdominal pain
vomiting
pass blood and
mucous, no stool,
no gas
over time signs of
dehydration

Large:
symptoms develop
slowly
constipation
distended abdomen
crampy lower
abdominal pain
fecal vomiting

Management of bowel
obstruction
Small
decompression
is strangulated then surgery

Large
surgical resection 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 McBurneys point
elevated temp, N/V, elevated WBCs(
over 10,000)

Treatment/nursing care

NPO
surgical removal
IVs 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