MEDICAL-SURGICAL NURSING II

Care of Clients with Problems in Nutrition and GI Metabolism and Endocrine,

Perception and Coordination (Acute and Chronic)
GASTROINTESTINAL DISORDERS

Owned by:
Jersey Royce Campus
Nursing student
DISORDERS OF THE
ESOPHAGUS
MEDICAL-SURGICAL NURSING I
GASTROINTESTINAL DISORDERS
 GASTROESOPHAGEAL REFLUX DISEASE (GERD)
disorders of the esophagus

DEFINITION OTHER DETAILS SIGNS & SYMPTOMS

Backflow of stomach Causes: Heartburn

acid/gastric juices into Weak or relaxed lower esophageal Chest/back pain
the esophagus, mouth, or sphincter (LES) Dysphagia (difficulty
lungs. Increased pressure in the abdomen swallowing)
Complications: Cough, hoarseness, sore
Temporary LES relaxation

E
Esophageal strictures throat
Risk Factors:

C
(narrowing) Belching, vomiting
Obesity

Y
Ulcers Worse after meals or lying
Barrett’s Esophagus Pregnancy down

O
(precancerous cell Smoking / Alcohol Relieved by antacids

R
changes) Hiatal hernia

Y
Esophageal cancer Caffeine / Chocolate / Fatty foods

ERSE
DIAGNOSTIC TESTS DRUG/MEDICATIONS NURSING

J
MANAGEMENT
BARIUM SWALLOW H2 BLOCKERS
↓

M
ENDOSCOPY (EGD) Ranitidine, Famotidine – acid Health Teaching

A
PH MONITORING Lifestyle:

I
PPIS
ESOPHAGEAL Omeprazole, Pantoprazole – block acid Avoid

@
MANOMETRY PROKINETICS large/fatty/spicy
CHEST X-RAY Metoclopramide – improve motility
ANTACIDS meals
Maalox, Kremil-S – neutralize acid No eating 3 hrs
before bedtime
Stay upright 2 hrs
SURGICAL MANAGEMENT after meals
FUNDOPLICATION Stop smoking and
If pharmacological treatments are ineffective, we will proceed with this surgery.
Wrapping a portion of the gastric fundus around the sphincter area of the alcohol
esophagus.
Nissen – 360° wrap
Toupet – 270° wrap
Wear loose clothes
Complications: Bleeding, infection, gas-bloat syndrome, respiratory issues
NURSING RESPONSIBILITIES:
PRE-OP:
Teach: breathing exercises, NGT use, risks
Consent, NPO after midnight
POST-OP:
Pain management
Semi-Fowler’s position
Monitor NGT, diet advancement
Watch for complications
Encourage ambulation

GASTROINTESTINAL DISORDERS
 HIATAL HERNIA
disorders of the esophagus

DEFINITION OTHER DETAILS SIGNS & SYMPTOMS

Protrusion of the stomach TYPES:

SLIDING HIATAL HERNIA:
into the chest through the Sliding Hernia (90%)
Part of a stomach slides up into the chest. Heartburn
esophageal opening in the
diaphragm. ↑ Risk for GERD.
Rolling (Paraesophageal) Hernia
Regurgitation
Belching
COMPLICATIONS: Dysphagia
Fundus and possibly portions of stomach’s great

E
GERD curvature, rolls up beside the esophagus. Fullness/breathlessness after
Esophagitis

C
No reflux symptoms, but higher risk for strangulation. eating
Ulceration Chest or back pain

Y
Causes & Risk Factors:
Strangulation Increased abdominal pressure (obesity, pregnancy, Feeling of suffocation

O
Anemia/bleeding straining, lifting, coughing) Worse when lying down
Aspiration

R
Muscle weakness (aging) Rolling hernia may have no
Stenosis reflux

Y
Stress

ERSE
DIAGNOSTIC TESTS DRUG/MEDICATIONS NURSING

J
MANAGEMENT
BARIUM SWALLOW H2 BLOCKERS

M
Ranitidine, Famotidine
ENDOSCOPY (EGD) PPIS Health teaching:

A
CHEST X-RAY

I
Omeprazole, Pantoprazole Lifestyle Changes
CBC (CHECK PROKINETICS Small frequent meals

@
Metoclopramide
ANEMIA) ANTACIDS Avoid high-fat/spicy
GUAIAC TEST Maalox, Kremil-S foods
(OCCULT BLOOD) No eating 3 hrs before
SURGICAL MANAGEMENT bedtime
Maintain normal
FUNDOPLICATION
Wrap stomach around esophagus weight
HILL OPERATION Avoid tight clothes,
tighten hiatus + optional wrap
ANGELCHIK PROSTHESIS bending, and lying
silicone band supports LES
PRE-OP: down after meals
Teach: breathing, coughing, incentive spirometry, ambulation
Consent, NPO after midnight
Explain NGT/chest tube
POST-OP:
Pain control
Semi-Fowler’s position
NGT care
Gradual diet advancement
Watch for complications
ONGOING:
Administer meds
Provide referrals (dietary, surgical follow-up)

GASTROINTESTINAL DISORDERS
 DIVERTICULOSIS
disorders of the esophagus

DEFINITION OTHER DETAILS SIGNS & SYMPTOMS

TYPES:
Pouch-like sacs Zenker’s Diverticulum – above upper esophageal sphincter
(UES); most common
Dysphagia (difficulty
(diverticula) form Midesophageal Diverticulum – middle esophagus (rare) swallowing)
Regurgitation (especially when
Epiphrenic Diverticulum – above lower esophageal sphincter
in the esophageal (LES) lying down)
Halitosis (bad breath)
wall. CAUSES:

E
Esophageal wall weakness Coughing
Aspiration

C
Pulsion: pressure from inside (e.g., straining)
Traction: pulling from outside (e.g., scar tissue or inflammation)

Y
Risk Factors:

O
Congenital issues
Esophageal trauma

R
Scar tissue

Y
Chronic inflammation

E
Achalasia

ERS
DIAGNOSTIC TESTS DRUG/MEDICATIONS NURSING

J
MANAGEMENT
BARIUM SWALLOW BOTULINUM TOXIN INJECTED INTO LES (LOWERS PRESSURE)

M
ESOPHAGEAL Health teaching:

A
MANOMETRY Lifestyle Modifications

I
CHEST X-RAY (CXR) Semi-soft diet

@
SURGICAL MANAGEMENT
ENDOSCOPY IS Stay upright for 2
USUALLY AVOIDED DIVERTICULECTOMY
hours after meals
(DUE TO RISK OF Removal of the pouch with reconnection of esophagus Sleep with head of
PERFORATION) Pre-op: bed elevated
Teach deep breathing, coughing, incentive
spirometry
Educate on NGT/chest tube, possible complications
Ensure NPO after midnight
Get consent
Post-op:
Pain management
Semi-Fowler’s position
NGT care
Gradual diet progression
Watch for complications
Ongoing:
Perform regular assessments
Administer medications
Coordinate referrals as needed

GASTROINTESTINAL DISORDERS
 ACHALASIA
disorders of the esophagus

DEFINITION OTHER DETAILS SIGNS & SYMPTOMS

A rare esophageal motility About Achalasia: Dysphagia (for both solids

disorder where the lower LES does not relax during swallowing and liquids)
esophageal sphincter Esophagus above LES becomes dilated due Feeling of food stuck in lower
(LES) fails to relax, and to food backup esophagus
peristalsis is absent or Regurgitation of undigested
Common in adults over 40

E
ineffective, causing food
difficulty in moving food

C
from the esophagus into Chest pain
→
Pyrosis (heartburn)

Y
the stomach. Aspiration risk possible

O
respiratory complications

SEYR
ER
DIAGNOSTIC TESTS DRUG/MEDICATIONS NURSING

J
MANAGEMENT
CALCIUM CHANNEL BLOCKERS OR NITRATES
BARIUM SWALLOW –

M
lower LES pressure HEALTH TEACHING:
"bird’s beak" BOTOX INJECTION

A
Instruct to eat slowly

I
into LES via endoscopy to relax muscles (temporary
appearance effect) Encourage fluids with
X-RAY

@
meals
shows Monitor for aspiration
esophageal SURGICAL MANAGEMENT
and chest discomfort
dilation above
narrowing PNEUMATIC DILATION
CT SCAN Balloon stretches LES
ENDOSCOPY Moderate sedation needed
ESOPHAGEAL
MANOMETRY
Risk: esophageal perforation
monitor closely
→
confirms ESOPHAGOMYOTOMY
diagnosis Laparoscopic cutting of LES muscles
Often paired with antireflux
procedure

GASTROINTESTINAL DISORDERS
 DISTURBANCES IN
DIGESTION
MEDICAL-SURGICAL NURSING I
GASTROINTESTINAL-METABOLISM DISORDERS
 PEPTIC ULCERS
disturbances in digestion

DEFINITION OTHER DETAILS SIGNS & SYMPTOMS

It is a sore or mucosal Two types:

COMPLICATIONS
lesion that forms in the GASTRIC ULCER
lining of the stomach or of
Poorman’s ulcer Hemorrhage
50 years old and above are affected Fibrosis
the duodenum. Malnourished
Perforation
Pain radiates to the left (Gnawing pain)
Aching, dull Carcinoma

E
Not relieved by food. Pag kumain, mas lalong sasakit. repetitive trauma

C
Nausea and vomiting
Hematemesis - blood in the vomitus

Y
Complication: perforation
Prone to students because they skip meals.

O
DUODENAL ULCER SURGICAL MANAGEMENT

R
Executive
20-50 years old are affected. VAGOTOMY

Y
→
Well-nourished resecting vagus nerve
↓↓

E
Duodenal stressful cholinergic stimulation

S
Pain radiates in the right (Epigastric pain) HCl secretions
Relieved by food ↓

R
Must be bland diet para hindi spicy or malasa yung Gastric motility
PYROPLASTY

E
DIAGNOSTIC TESTS kinakain since it may stimulate acid production which
surgical dilation of the pyloric

J
worsens pain.
Melena - palabas sa anus; black starry stool sphincter.
Goal: improvement of gastric
ENDOSCOPY ETIOLOGIES:

M
emptying in the small intestine.
BARIUM SWALLOW →
Excessive hydrochloric acid production

A
Diet hyperacidity (spices, maanghang) ANTRECTOMY

I
Bacteria: helicobacter pylori (h. pylori) removal of the portion of the
chalky white Nagkaroon ng overgrowth stomach
substance

@
BIOPSY
Stress
→
Drugs NSAIDS (too much intake) - prone to gastric ulcer.
Smoking induces hyperacidity.
Need tapyasin ang buong stomach
to reduce production of HCl acid.
PHOTOCOAGULATION
RISK FACTORS:
to analyze cell GASTRITIS - inflammation of the gastric mucosa
laser; direct
ELECTROCOAGULATION
H. PYLORI [Link] - bumaba ang immune system
HURRIED MEALS - must be consumed 30 mins to 1 hour heat; involves faster healing by
culture (urea STIMULANTS / IRRITANTS - caffeine; matatabang pagkain using electric current
GASTRODUODENOSTOMY
breath test, elisa TYPE A PERSONALITY - perfectionist, busy
GENETICS ididikit ang duodenum sa stomach
- produce BILLROTH 1: gastroduodenostomy
BILLROTH 2: gastrojejunostomy
antibodies)
DRUG/MEDICATIONS

H. pylori: Antibiotics NURSING

1st choice (better): amoxicillin and clarithromycin MANAGEMENT
2 weeks to take
PPI: Omeprazole, esomeprazole
2nd choice (most popular): Bismuth + metronidazole + tetracycline BLAND DIET:
Proton pump inhibitor to neutralize acidity
ANTACIDS LICORICE! - not recommended for
H2 BLOCKERS
→
ranitidine, cimetidine
CYTOPROTECTIVES
most popular people with hypertension, kidney
disease, or heart conditions.
coats the ulcer and increases prostaglandin synthesis
Example: carafate (sucral fate)

GASTROINTESTINAL DISORDERS
 GASTRITIS
disturbances in digestion

DEFINITION OTHER DETAILS SIGNS & SYMPTOMS

Inflammation of the Causes:

gastric mucosa. Infectious agents (e.g., Helicobacter pylori) Systemic Manifestations
Autoimmune and hypersensitivity reactions Anemia
Most common in male clients aged 50–60 years
Types of Gastritis Fatigue
Acute: Short-term inflammation Possible signs of

E
Chronic: Long-standing inflammation
Pathophysiology shock

C
Disruption of the mucosal barrier
Contact of mucosa with irritating agents

Y
Inflammatory response

O
Development of gastritis

YR
NURSING

E
MEDICAL MANAGEMENT
MANAGEMENT

RS
Avoid alcohol and spicy foods
REDUCE ANXIETY

E
Non-irritating diet Provide emotional support

J
IV fluids Explain procedures and
Control of bleeding

M
treatment
Nasogastric tube (NGT) insertion if needed PROMOTE OPTIMAL NUTRITION

A
Administer anticoagulants and iron supplements

I
Maintain NPO status initially
Monitor intake and output (I&O)

@
Monitor IV fluids and electrolytes
Offer ice chips, then clear liquids
DRUG/MEDICATIONS
Introduce solid foods gradually
Avoid caffeinated drinks and
ANTACIDS alcohol
H2 RECEPTOR BLOCKERS Discourage smoking
PROMOTE FLUID BALANCE
e.g., ranitidine Monitor hydration status
PROTON PUMP INHIBITORS Ensure adequate fluid
e.g., omeprazole replacement
RELIEVE PAIN
IV fluids Administer prescribed
Fiberoptic endoscopy medications
Emergency surgery (if complications Provide comfort measures
Monitor for recurrence and
arise) report repeat episodes
Gastric resection (in severe cases)
Rest
Avoid NSAIDs
Treatment of H. pylori (e.g., antibiotics)

GASTROINTESTINAL DISORDERS
 ACUTE GASTRITIS
disturbances in digestion

DEFINITION OTHER DETAILS SIGNS & SYMPTOMS

A sudden and Types of Acute Gastritis:

temporary Epigastric pain
A. Erosive Acute Gastritis Discomfort
inflammation or Caused by local irritants,
swelling of the Dyspepsia
including:

E
gastric lining (indigestion)
Aspirin

C
(stomach Anorexia (loss of

Y
NSAIDs appetite)
mucosa).

O
Corticosteroids Hiccups

R
Alcohol consumption

Y
Nausea and
Gastric radiation therapy

E
vomiting

S
B. Non-Erosive Acute Gastritis Hematemesis

R
Commonly caused by

E
(blood in vomit)

J
Helicobacter pylori (H. Melena (black, tarry
pylori) infection

M
stools due to upper

A
C. Severe Acute Gastritis:

I
GI bleeding)
Caused by ingestion of Hematochezia

@
strong acid or alkali (passage of fresh
May result in pyloric blood, usually from
stenosis (narrowing of the the lower GI tract,
pylorus due to scarring and but can occur if
inflammation) rapid upper GI
bleeding)

GASTROINTESTINAL DISORDERS
 CHRONIC GASTRITIS
disturbances in digestion

DEFINITION OTHER DETAILS SIGNS & SYMPTOMS

A long-term Unlike acute gastritis, it usually does not cause

condition where the pain or indigestion, but severe cases may lead to Fatigue (from fluid
stomach lining is vitamin B12 deficiency anemia. and oxygen loss)
damaged, often due Causes and Risk Factors
→
Infection with H. pylori may lead to: Pyrosis (heartburn)

E
to chronic infection Peptic ulcers Belching

C
with Helicobacter Gastric adenocarcinoma Sour taste in the

Y
pylori. MALT lymphoma (gastric mucosa-
mouth

O
associated lymphoid tissue lymphoma)
Halitosis (bad

R
Chemical gastric injury (gastropathy)
Due to long-term drug use (e.g., NSAIDs,

Y
breath)

E
corticosteroids)
Early satiety

S
Duodenogastric reflux
(feeling full quickly)

R
Reflux of duodenal contents into the

E
stomach Anorexia (loss of

J
Common after gastric surgery
Autoimmune disorders appetite)

M
Hashimoto thyroiditis Nausea and

IA
Addison's disease
Graves' disease vomiting
Vague epigastric

@
Types of Chronic Gastritis:
A. Superficial Gastritis
Inflammation limited to surface mucosa
discomfort relieved
Mucosa appears erythematous and by eating
edematous
May present with small erosions and
hemorrhage
Gastric glands remain intact
B. Atrophic Gastritis
Inflammation extends deeper into mucosa
Leads to progressive glandular destruction
Associated with pernicious anemia
Reduced number of parietal and chief cells
C. Hypergastritis / Gastric Atrophy
Characterized by frequent hemorrhages
Gastric glands undergo transformation
Metaplastic changes increase risk for
gastric cancer

GASTROINTESTINAL DISORDERS
 FOOD POISONING
disturbances in digestion

DEFINITION OTHER DETAILS SIGNS & SYMPTOMS

A sudden, serious Since the patient ate Nausea and vomiting

illness caused by contaminated food with Diarrhea
ingestion of food clostridium botulinum, the patient
contaminated with
may experience the following:

E
Clostridium
respiratory arrest

C
botulinum toxin.

Y
Ataxia - lack of muscle

O
coordination

R
Ingestion of mussel (tahong)

Y
Red tide poisoning: shells

SE
Cause: contaminated

R
food/drinks

E
DIAGNOSTIC TESTS

J
If you’re not certain to eat the
GASTRIC ANALYSIS

M
food, do not eat!
CHECK SERUM

IA
ELECTROLYTES
dahil bagsak na

@
kaka-diarrhea MEDICAL MANAGEMENT
NURSING
MANAGEMENT

Determine the cause (food) MONITOR BP, RR, SENSORIUM

Check signs and symptoms of dehydration: give Sensorium: consciousness
IV fluids (NSS) is affected!
Check signs of hypovolemic shock: Check muscular activity
Check blood pressure! MILD NAUSEA
Pag mababa, it may lead to circulatory
→
collapse shock!
Control nausea and vomiting
pwede painumin ng tea,
carbonated drink, tap water
DIET:
Antiemetic medications = plasil
Low residue (low-fiber) /
bland diet
Bananas, rice, apple sauce,
toast, and clear broths

GASTROINTESTINAL DISORDERS
 DISORDERS OF
INTESTINAL MOTILITY
MEDICAL-SURGICAL NURSING I
GASTROINTESTINAL-METABOLISM DISORDERS
 DIARRHEA
disorders of intestinal motility

DEFINITION OTHER DETAILS SIGNS & SYMPTOMS

An increase in frequency, Causes: Frequent, watery stools

fluidity, and volume of Infections: Bacterial (e.g., Shigella, Salmonella), Viral Abdominal cramping
stool, often accompanied (e.g., norovirus) Bloating, gas
by urgency, cramping, Medications: Laxatives/Stool softeners, antibiotics, Tenesmus (feeling of incomplete
and discomfort. It can be antacids, chemotherapy evacuation)
Endocrine/Metabolic disorders: Diabetes, Addison’s Dehydration signs: thirst, dry mouth,

E
acute or chronic. weakness
Chronic disease, hyperthyroidism/thyrotoxicosis

C
Irritable bowel Malabsorption disorders: Celiac disease, lactose

Y
syndrome intolerance
Others: Food poisoning, intestinal obstruction

O
Acute MEDICAL MANAGEMENT
Nutritional disorders
Recent intake ng panis →

R
na pagkain Celiac disease pedia!

Y
Types: Treat the underlying

E
Secretory – excessive fluid secretion into the intestine cause

S
Osmotic – fluid pulled into bowel due to malabsorption
Mixed – combination of both Replace fluids and

R
Complications: electrolytes

E
DIAGNOSTIC TESTS
Dehydration

J
Electrolyte imbalances
CBC, URINALYSIS

M
Cardiac arrhythmias (due to potassium loss)
STOOL EXAM

IA
for pathogens,
blood, or

@
parasites DRUG/MEDICATIONS NURSING
pea-sized! MANAGEMENT

ELECTROLYTES Use of antidiarrheals

BARIUM ENEMA OR (e.g., loperamide) Monitor stool frequency and
ENDOSCOPY if not infectious appearance
for chronic cases ANTIBIOTICS if bacterial infection Ensure hydration – oral or IV
fluids
confirmed Encourage bed rest
If cramps occur: BUSCOPAN Provide bland, low-residue
diet
Maintain skin integrity –
perianal care
Monitor for signs of
electrolyte imbalance

GASTROINTESTINAL DISORDERS
 CONSTIPATION
disorders of intestinal motility

DEFINITION OTHER DETAILS SIGNS & SYMPTOMS

Infrequent, difficult, Causes:

Hard, dry stools
or painful bowel Medications: Opioids, antacids
(aluminum/iron), antidepressants, Straining during
movements often anticholinergics defecation
with hard, dry stools. Anal/Rectal disorders: Hemorrhoids, anal Abdominal distention &

E
It may involve a fissures bloating

C
sense of incomplete Obstructions: Tumors, strictures Sensation of incomplete

Y
evacuation. Neurological disorders: Parkinson’s disease, MS, evacuation

O
spinal cord injury Headache, fatigue,

R
Metabolic/Endocrine: Diabetes, hypothyroidism indigestion

Y
Toxins: Lead poisoning Decreased appetite

E
Connective tissue diseases: Scleroderma, lupus Borborygmus (bowel

S
Complications: sounds)

R
Fecal impaction Severe dehydration

E
Hemorrhoids or anal fissures
hiwa-hiwalay ang tae

J
Hypertension (due to straining)
Megacolon since walang water

M
na nag-bind.

@IA
DIAGNOSTIC TESTS

BARIUM ENEMA
SIGMOIDOSCOPY
FOBT (FECAL OCCULT
BLOOD TEST)
DRUG/MEDICATIONS

CHOLINERGIC AGENTS
e.g., bethanechol
CHOLINESTERASE INHIBITORS
e.g., neostigmine
NURSING
MANAGEMENT

Teach healthy bowel habits

Encourage a high-fiber diet and
adequate hydration
Relieve anxiety related to elimination
Prevent complications like impaction
ANORECTAL PROKINETIC AGENTS and hemorrhoids
MANOMETRY e.g., metoclopramide Stool softener
DEFECOGRAPHY AND Avoid routine use of enemas or Laxatives
Mineral oil
BOWEL TRANSIT suppositories Digital Rectal Examination
STUDIES Use CLEAN GLOVES (double
gloving)
Usually elderly
Dahan-dahan baka masundot ang
vagus nerve which will lead to
bradycardia

GASTROINTESTINAL DISORDERS
 IRRITABLE BOWEL SYNDROME
disorders of intestinal motility

DEFINITION OTHER DETAILS SIGNS & SYMPTOMS

AKA: Spastic colon, Types:

intestinal neurosis, IBS-D – Diarrhea-predominant Abdominal
irritable colon IBS-C – Constipation-predominant pain/cramping
A functional bowel IBS-M (Mixed) – Alternating constipation and Bloating and gas
disorder characterized by diarrhea
↔
Alternating bowel habits

E
abnormal intestinal Etiology: (diarrhea

C
motility without structural Dysfunction between enteric and central nervous constipation)

Y
or biochemical systems Mucus in stool (but
abnormalities. Exaggerated response to GI stimuli

O
Serotonin imbalance in the gut (affects motility,
usually no blood)
Symptoms are chronic

R
and recurrent. sensation, secretion) Weight usually remains

Y
stable

ERSE
DIAGNOSTIC TESTS DRUG/MEDICATIONS NURSING

J
MANAGEMENT

STOOL CULTURE

M
FOBT ANTISPASMODICS / GOALS OF TREATMENT:

A
Relieve GI symptoms

I
ENDOSCOPY ANTICHOLINERGICS Alleviate psychological distress
BARIUM ENEMA,

@
Improve quality of life
SCAN
relieve cramps LIFESTYLE CHANGES:

RULE OUT OTHER TRICYCLIC ANTIDEPRESSANTS Manage

relaxation)
stress (e.g., CBT,

CONDITIONS e.g., Amitriptyline DIETARY MODIFICATIONS:

(E.G., IBD, reduce pain
Avoid caffeine, chocolate,
dairy
CANCER)
ANXIOLYTICS Increase fiber (esp. in IBS-C)
Small frequent meals
e.g., Diazepam, Alprazolam ASSESS
Symptoms, hydration, perianal
for stress skin, stool pattern, triggers
LAXATIVES Administer meds as prescribed
Encourage fluid intake
with caution (only in IBS-C) Perform/teach perianal care
Provide health teaching:
ANTIDIARRHEALS Diet, stress reduction, symptom
for IBS-D tracking
Refer for counseling or GI
specialist as needed

GASTROINTESTINAL DISORDERS
 FECAL INCONTINENCE
disorders of intestinal motility

DEFINITION OTHER DETAILS SIGNS & SYMPTOMS

Involuntary Causes / Risk Factors:

Trauma (e.g., childbirth injury) Urgency and loss of
passage of stool Neurologic disorders (e.g., stroke, spinal cord injury, MS) bowel control
due to dysfunction Inflammation / Infection
Pelvic floor dysfunction or relaxation Inability to retain gas
in bowel control Fecal impaction (flatus)

E
Laxative abuse
mechanisms. Complete

C
Radiation therapy

Y
Medications
Advancing age incontinence in

O
Fecal incontinence results when one or more of the severe cases

R
following is impaired:
Rectal sensation and accommodation

Y
Stool consistency and volume

E
Integrity of anal sphincter muscles

S
Rectal motility

JER
DIAGNOSTIC TESTS

M
SURGICAL MANAGEMENT NURSING
MANAGEMENT

A
SPHINCTEROPLASTY

I
RECTAL EXAM Develop predictable bowel
FLEXIBLE sphincter repair

@
elimination pattern
SIGMOIDOSCOPY RECTAL RECONSTRUCTION Provide perineal care to prevent
BARIUM ENEMA FECAL DIVERSION
skin breakdown
Encourage patient participation
CT SCAN
ANORECTAL colostomy in severe cases in bowel training
Maintain privacy and dignity
MANOMETRY Support coping and reduce
assesses embarrassment
pressure and Medical Management:
sphincter Improve quality of life
control Bowel training program
scheduled toileting, diet
TRANSIT STUDIES regulation
measures Diet modification
bowel control stool consistency
movement (e.g., fiber, avoid triggers)
timing

GASTROINTESTINAL DISORDERS
MALABSORPTION
DISORDERS
MEDICAL-SURGICAL NURSING I
GASTROINTESTINAL DISORDERS
 SPRUE
malabsorption syndrome

DEFINITION OTHER DETAILS SIGNS & SYMPTOMS

Also called short gut Etiology (Causes):

syndrome Infants/Children:
Severe diarrhea
Results from extensive Necrotizing enterocolitis Greasy, foul-
resection or Congenital defects: gastroschisis, smelling stools

E
dysfunction of the omphalocele, midgut volvulus, (steatorrhea)
small intestine

C
Leads to
jejunoileal atresia, meconium ileus Fatigue

Y
malabsorption of Intussusception Weight loss

O
nutrients, fluids, Internal hernia Edema (due to

R
electrolytes, and Adults:
protein loss)

Y
vitamins Crohn’s disease

E
Bowel trauma/injury Malnutrition

S
Cancer requiring bowel resection

MJER
DIAGNOSTIC TESTS MEDICAL MANAGEMENT NURSING
MANAGEMENT

IA
CBC
to check for anemia 1. Nutritional Support Monitor for

@
or infection Oral Rehydration Solutions (ORS) fluid/electrolyte
SERUM ALBUMIN Small frequent feedings (SFF) imbalances
assess nutritional High-calorie, high-protein diet
status Assess for malnutrition
FECAL FAT TEST Vitamin and mineral
supplementation Educate on dietary
detect steatorrhea management
SMALL INTESTINE X-RAY Anti-diarrheal medications (e.g.
VITAMIN LEVELS (B12, A, loperamide) Prevent complications
D, E, K) 2. Depending on Severity (e.g., dehydration,
Mild Cases: Oral nutrition + infection, liver
medications dysfunction from long-
Moderate Cases: Oral nutrition + IV term TPN)
fluids & electrolytes Coordinate with dietitian
Severe Cases: Parenteral Nutrition and multidisciplinary
(TPN) + ORS + gradual intro of enteral team
feeds

GASTROINTESTINAL DISORDERS
 INFLAMMATORY BOWEL DISEASES (IBDs)
malabsorption syndrome

DEFINITION NURSING
GENERAL MANAGEMENT
MANAGEMENT
Chronic inflammatory
disorders primarily Nutritional Therapy ASSESSMENT INCLUDES:
involving the colon Low-residue diet – minimizes bowel Onset, duration,
stimulation
and small intestine, High-protein diet – supports tissue healing characteristics of

E
including conditions High-calorie diet – prevents malnutrition and abdominal pain
such as Crohn’s Presence of diarrhea, fecal

C
weight loss
disease and urgency, tenesmus

Y
Supplemental vitamins – correct nutritional
ulcerative colitis. deficiencies Nausea, anorexia, weight

O
Surgical Management loss, family history of IBD

R
Brooke’s Ileostomy Bowel elimination patterns,

Y
Total proctocolectomy: removal of colon food intolerances, allergies

E
and rectum; anus is closed Sleep disturbances, activity

S
External pouch required intolerance

R
Kock Pouch Ileostomy

E
Skin integrity issues due to
Internal reservoir/pouch from distal ileum

J
diarrhea and malnutrition
No external appliance
Knowledge and

M
Ileal Pouch-Anal Anastomosis (IPAA)
Pelvic pouch created from ileum understanding of disease

IA
Sutured to anal canal and its management
Most common variant: J-pouch GOALS OF CARE:

@
Establish normal bowel
elimination patterns
DRUG/MEDICATIONS
Relieve abdominal pain and
cramping
Aminosalicylates Prevent fluid volume deficit
Maintain optimal nutrition
anti-inflammatory agents (e.g.,
and weight
mesalamine) Reduce fatigue and anxiety
Sulfa-free Aminosalicylates Promote effective coping
alternative for those allergic to sulfa strategies
Antibiotics Prevent skin breakdown
metronidazole, ciprofloxacin (especially Enhance patient knowledge
for abscess or fistula) and self-management
Corticosteroids Monitor for and manage
to control acute inflammation potential complications
Immunomodulators
Suppress immune response (e.g.,
azathioprine, methotrexate)

GASTROINTESTINAL DISORDERS
 CROHN’S DISEASE
malabsorption syndrome

DEFINITION OTHER DETAILS SIGNS & SYMPTOMS

Chronic relapsing Most common location: terminal ileum

disease and colon
Diarrhea
Can develop Any part of the GI tract may be affected Prominent right
segmentally in the Rectum is frequently not involved lower quadrant
abdominal pain

E
alimentary tract Liver and pancreas may be affected

C
Only a segment of the colon is affected unrelieved by

Y
Fat in stool is present defecation

O
Pathophysiology: Abdominal

R
Inflammation and abscess of GI tract tenderness and

Y
wall spasm

E
Development of small focal ulcers

S
Lesions deepen, producing a Crampy pains after

R
meals

E
cobblestone appearance

J
Fistula, fissures, abscess formation Steatorrhea (fatty
that extends to the peritoneum stools)

M
Fats in stool

@IA

GASTROINTESTINAL DISORDERS
 ULCERATIVE COLITIS
malabsorption syndrome

DEFINITION OTHER DETAILS SIGNS & SYMPTOMS

Disease spans the Usually starts in the rectum and distal

entire length of the colon Diarrhea with
colon Spreads upward beyond the rectosigmoid passage of mucus,
Involves only the valve pus, and blood

E
mucosa and Involves most of the sigmoid and
submucosa of the Left quadrant

C
descending colon abdominal pain
large intestine

Y
Intermittent

O
tenesmus

R
GENERAL MANAGEMENT

Y
Bleeding

E
DECREASE DIARRHEA Anorexia, weight

S
Decrease physical activity
loss, fever, vomiting,

R
Reduce inflammation

E
Antidiarrheal medications given sparingly dehydration

J
Fluid and electrolyte replacement Cramping

M
DIET AND SUPPLEMENT
Passage of stool 6

A
Increased in protein and calories

I
Vitamin and mineral supplement or more times a day
Liquid supplements

@
TPN (an elemental diet)
Non-responsive to medication
Preparation for surgery
Post-intestinal resection

DRUG/MEDICATIONS

ANTI-INFLAMMATORY
ANTIDIARRHEAL
ANTICHOLINERGIC
ANTISPASMODIC
ANTIBIOTICS

GASTROINTESTINAL DISORDERS
 SHORT BOWEL SYNDROME
malabsorption syndrome

DEFINITION OTHER DETAILS SIGNS & SYMPTOMS

A condition resulting Etiology / Causes Chronic diarrhea

from the loss or Neonatal/Infant: Fatigue
dysfunction of a large Necrotizing enterocolitis Pale, greasy, foul-smelling
Congenital defects:
portion of the small Midgut volvulus stools (steatorrhea)

E
intestine, leading to Omphalocele Edema (esp. lower
malabsorption of Gastroschisis extremities)

C
nutrients, water, and Jejunoileal atresia Weight loss

Y
Meconium ileus Signs of malnutrition
electrolytes.

O
Internal hernia

R
Intussusception
Children/Adults:

Y
Crohn’s disease

E
Bowel injury/trauma

S
Bowel cancer

JER
DIAGNOSTIC TESTS

M
MEDICAL MANAGEMENT NURSING
MANAGEMENT

IA
CBC
to detect anemia or Nutritional Support Monitor:

@
infection SFF (Small, Frequent Feedings) I&O, weight, hydration
ALBUMIN LEVEL High-calorie, high-protein diet status
for nutritional status Oral Rehydration Solutions (ORS) Electrolyte imbalances
FECAL FAT TEST Vitamin & mineral supplements Assess for:
detects fat Anti-diarrheals as prescribed Malnutrition
malabsorption Severity-Based Management Skin integrity (from
SMALL INTESTINE X-RAY diarrhea)
structural Mild
SFF + fluids + meds for diarrhea Educate:
assessment Diet and fluid
VITAMIN LEVELS Moderate
Oral nutrition + IV fluids/electrolytes management
especially B12, A, D, E,
Importance of compliance
K Severe with supplements and TPN
Parenteral nutrition (TPN) + ORS + if needed
gradual enteral feeding trial Collaborate:
With dietitian, GI team,
pharmacist

GASTROINTESTINAL DISORDERS
 STRUCTURAL AND
OBSTRUCTIVE BOWEL DISORDERS
MEDICAL-SURGICAL NURSING I
GASTROINTESTINAL DISORDERS
 HERNIA
structural and obstructive bowel disorders

DEFINITION OTHER DETAILS SIGNS & SYMPTOMS

Abnormal Hernial sac Visible bulge, especially

Formed by the peritoneum.
protrusion of an Contents when straining or
organ or structure Small/large intestine or omentum may protrude. coughing
through a Types of Hernia Bulge may disappear

E
Inguinal when lying down
weakness or tear Most common. In groin area, where spermatic cord

C
(males) or round ligament (females) exits. More Pain or discomfort at site
in the muscle wall,

Y
common in males. Usually indirect. If strangulated:
typically in the Umbilical Severe pain

O
At the umbilicus. Common in obese women and
abdominal wall.

R
children. Caused by failure of umbilical orifice to Vomiting

Y
close. Signs of bowel

E
Ventral (Incisional)
↑ obstruction

S
Occurs at sites of previous surgery. Risk with
obesity, poor healing, malnutrition, or use of drains

R
Classification by Reducibility

E
Reducible: Hernia can be pushed back into place.

J
Irreducible (Incarcerated): Cannot be reduced; risk of
DIAGNOSTIC TESTS strangulation. NURSING

M
MANAGEMENT

IA
PHYSICAL EXAM
Pre-op:
palpation while

@
THERAPEUTIC MANAGEMENT Educate on avoiding
coughing or straining/lifting
bearing down NON-SURGICAL: Monitor for signs of
IMAGING (IF Truss (supportive belt for reducible hernia) strangulation (pain,
NEEDED) – temporary vomiting, absence of
Ultrasound, CT Surgical: bowel sounds)
scan HERNIORRHAPHY Post-op:
Incision, contents pushed back, defect Pain management
sewn closed. Prevent infection: wound
HERNIOPLASTY care
Contents pushed back + reinforcement Encourage early
of wall with mesh/fascia. ambulation
BOWEL RESECTION OR COLOSTOMY Avoid heavy lifting for 4–6
For strangulated hernia with necrosis. weeks
Monitor for recurrence

GASTROINTESTINAL DISORDERS
 SMALL BOWEL OBSTRUCTION
structural and obstructive bowel disorders (intestinal obstruction)

DEFINITION OTHER DETAILS SIGNS & SYMPTOMS

A blockage in the Wavelike, cramping abdominal

→→↑
Pathophysiology pain
small intestine
causing
Obstruction
Distention gastric secretion, ↓
Proximal buildup of fluid/gas. Nausea and vomiting (may
become fecal in later stages)
accumulation of absorption.
Prolonged pressure →↓ blood flow → Abdominal distention (greater if
obstruction is lower)

E
intestinal contents, Inability to pass flatus or stool
ischemia, edema, necrosis, then
gas, and fluids above
→

C
Visible peristaltic waves
the obstruction perforation.

Y
(especially in thin individuals)
leading to distention, Etiology High-pitched, tinkling bowel

O
Post-surgical adhesions sounds (mechanical obstruction)
decreased

R
Trauma Absent bowel sounds (non-
absorption, and risk of mechanical obstruction)

Y
Pneumonia Dehydration (dry mucous
necrosis and

E
Spinal cord injury membranes, low BP, high HR)

S
perforation. Hypokalemia Blood and mucus may be passed

R
Myocardial infarction rectally (in partial obstruction)

E
Peritonitis Sharp, sustained pain (may

J
Vascular insufficiency indicate perforation)
Signs of shock if left untreated

M
(hypotension, tachycardia)

@IA
DIAGNOSTIC TESTS NURSING
MEDICAL MANAGEMENT
MANAGEMENT

X-RAY / CT SCAN NPO:

Shows dilated bowel MONITOR:
loops Rest the bowel Vital signs (signs of shock)
CBC: NGT insertion:
↑ WBC if
strangulation/perfora
For decompression
I&O, daily weights
Electrolyte levels
IV fluids: NGT patency and drainage
tion
↑ HEMOGLOBIN
HEMATOCRIT
&
Replace fluids/electrolytes
IV antibiotics:
Bowel sounds
PROVIDE:
If infection or perforation suspected Mouth care for NPO status
Due to Pain management
hemoconcentration Surgery:
↓ SERUM ELECTROLYTES
Loss via
If complete mechanical obstruction
Patient education pre-
and post-op
or signs of strangulation REPORT:
vomiting/NPO status
Sudden severe pain →
possible perforation

GASTROINTESTINAL DISORDERS
 LARGE BOWEL OBSTRUCTION
structural and obstructive bowel disorders (intestinal obstruction)

DEFINITION OTHER DETAILS SIGNS & SYMPTOMS

A blockage in the Etiology:

large intestine, less Constipation
acute than small Colorectal cancer Crampy lower
bowel obstruction, but Inflammatory bowel disease abdominal pain
(IBD)

E
can become life- Abdominal distention
threatening if blood Diverticulitis

C
supply is
Late-onset fecal
Benign tumors

Y
compromised. vomiting
Fecal impaction

O
High-pitched tinkling

R
bowel sounds

Y
Palpable abdominal

SE
mass

R
Risk of gangrene,

E
perforation, and

J
peritonitis if

M
untreated

@IA
DIAGNOSTIC TESTS MEDICAL AND NURSING MANAGEMENT

Abdominal Enemas/manual disimpaction (if

radiographs impaction present)
showing distended Surgery for mechanical causes
colon (resection, colostomy)
ILEONAL ANASTOMOSIS
sometimes done
CECOSTOMY
for high-risk patients

GASTROINTESTINAL DISORDERS
 DIVERTICULOSIS (HERNIA)
structural and obstructive bowel disorders (intestinal obstruction)

DEFINITION OTHER DETAILS SIGNS & SYMPTOMS

It is the formation of Cause:

small pouches Low-fiber diet leading to constipation and high Asymptomatic
(diverticula) in the intraluminal pressure Mild cramps
colon wall, often due Complications (when it progresses to diverticulitis): Bloating
Abdominal pain Constipation

E
to increased pressure
from constipation. Bleeding (rare)

C
Abscess, perforation, peritonitis
Common with aging.

Y
Fistula (e.g., colon to bladder)

O
Intestinal obstruction due to scarring

SEYR
MJER
DIAGNOSTIC TESTS NURSING
MANAGEMENT

IA
Medical history and
bowel habits High-fiber diet

@
Physical exam Daily fiber supplements
(including rectal exam)
Stool tests, X-ray, and (e.g., Citrucel,
possibly CT scan Metamucil)
Regular exercise
Avoid seeds, nuts,
popcorn (controversial
but sometimes advised)
Mild pain meds for
cramps/bloating

GASTROINTESTINAL DISORDERS
 ANORECTAL
DISORDERS
MEDICAL-SURGICAL NURSING I
GASTROINTESTINAL DISORDERS
 HEMORRHOIDS
anorectal disorders

DEFINITION OTHER DETAILS SIGNS & SYMPTOMS

Swollen and inflamed Causes/Risk Factors:

veins around the anus Straining during bowel movements Bright red blood on stool,
or lower rectum; may Chronic constipation or diarrhea toilet paper, or in toilet
be internal (inside Pregnancy Pain and irritation
Aging around anus

E
anus) or external
(under skin around Anal intercourse Painful swelling or hard

C
anus). lump (thrombosed

Y
external hemorrhoid)

EYRO
JERS SURGICAL MANAGEMENT

M
DIAGNOSTIC TESTS NURSING
MANAGEMENT

A
RUBBER BAND LIGATION

I
Physical exam
Use of anoscope or Cuts blood flow to internal

@
proctoscope for internal Warm tub
evaluation hemorrhoid baths/Sitz baths
SCLEROTHERAPY Hemorrhoidal
Injection of chemical to shrink creams or
hemorrhoid suppositories
INFRARED COAGULATION Increased dietary
Burns hemorrhoidal tissue fiber and fluids
HEMORRHOIDECTOMY
Surgical removal for severe Stool softeners
cases

GASTROINTESTINAL DISORDERS
 ANAL FISSURES
anorectal disorders

DEFINITION OTHER DETAILS SIGNS & SYMPTOMS

Cracks or ulcers in the Causes/Risk Factors:

lining of the anal Bright red rectal bleeding
canal. Constipation and passage of hard Severe pain during or
stool after defecation
Stretching of the anus Fear of defecation

E
Crohn’s disease leading to stool retention

C
and worsening
Other inflammatory conditions

Y
constipation

EYRO
JERS
M
NURSING
MANAGEMENT

@IA Stool softeners and

high-fiber diet
Increased fluid intake
Sitz baths to promote
circulation
healing
and

Topical anesthetics or
ointments (as
prescribed)

GASTROINTESTINAL DISORDERS
 APPENDICITIS
anorectal disorders

DEFINITION OTHER DETAILS SIGNS & SYMPTOMS

Inflammation of the Causes/Risk Factors:

appendix due to Fever and elevated WBC
obstruction and Constipation and passage of hard Generalized abdominal
subsequent infection. stool pain, later localizing to
Stretching of the anus McBurney’s point (RLQ)

E
Crohn’s disease Nausea, vomiting,

C
anorexia
Other inflammatory conditions

Y
Rebound tenderness,

O
guarding

R
Rovsing’s sign: Pain in

Y
RLQ when LLQ is palpated

ERSE
MJ
DIAGNOSTIC TESTS NURSING
MANAGEMENT

IA
CBC
Elevated leukocytes NPO status; surgical removal

@
and neutrophils (appendectomy) unless
Ultrasound or CT scan perforated
Appendix Ice pack to site and semi-
enlargement Fowler’s position to reduce
pain pre-op
IV fluids and antibiotics if
ruptured; surgery may be
delayed
NGT may be inserted if
perforation occurred
Post-op: NPO until bowel
sounds return, then clear
→
fluids advance diet
Monitor for peritonitis
Pain control, early
ambulation, and pulmonary
hygiene (CDB exercises)

GASTROINTESTINAL DISORDERS