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GI disorders
• Dysphagia Difficulty swallowing
o Causes Nero disease: Parkinson’s, dementias, muscular dystrophy, Huntington’s, ALS, MN,
Guillain Barre Syndrome. Other: Congenital issues/cerebral palsy, Esophageal stenosis,
esophageal diverticula, tumors, stroke, achalasia
• Vomiting – why and consequences Why: protect against substance, reverse peristalsis, increase
intracranial pressure, severe pain. Consequences: lead to fluid, electrolyte, pH imbalance,
aspiration
o Emesis types and why the emesis would be a problem Hematemesis: blood in vomit (protein),
Yellow/green: presence of bile. Deep brown: fecal matter. Undigested food
o Treatment of vomiting disorders Antiemetic med., fluid replacement, correct
electrolyte imbalance, restore acid-base
• Esophageal disorders
o Hiatal hernia Stomach section protrudes through diaphragm
▪ Causes: Weakening of diaphragm muscle, trauma, congenital defects. Manifestation:
Indigestion; heartburn; frequent belching; nausea; chest pain; strictures; dysphagia;
and soft abdominal mass. diagnosis: H & P; barium swallow; upper GI Xrays; EGD,
treatment: eat small meals, sleep elevated, antacid
o GERD
▪ Causes: Certain foods: chocolate, caffeine, carbonated beverages, citrus fruit, tomatoes,
spicy or fatty foods, peppermint , Alcohol consumption; nicotine, Hiatal hernia, Obesity;
pregnancy, Certain medications – such as corticosteroids; beta blockers; calcium-
channel blockers; anticholinergics, NG intubation, Delayed gastric emptying
▪ Manifestations: Heartburn, Epigastric pain, Dysphagia, Dry cough,
Laryngitis Pharyngitis, Food regurgitation, Sensation of lump in throat
▪ Diagnosis: H & P; barium swallow; EGD; esophageal pH monitoring
▪ Treatments: Avoid triggers; avoid restrictive clothing, Eat small frequent meals;
high Fowler’s positioning, Weight loss; stress reduction; Antacids; acid reducing
agent;
mucosal barrier agents, Herbal therapies (licorice, chamomile), Surgery
▪ Complications: Esophagitis; strictures; ulcerations; esophageal cancer;
chronic pulmonary disease
o Gastritis/gastroenteritis
▪ Acute: Can be mild, transient irritation or can be severe ulceration with
hemorrhage, Usually develops suddenly, Likely to also have nausea & epigastric
pain
▪ Chronic: Develops gradually
▪ May be asymptomatic but usually accompanied by dull epigastric pain and a sensation of
fullness after minimal intake
▪ Complications: peptic ulcer; gastric cancer; hemorrhage
▪ H. pylori: Most common cause of chronic gastritis
▪ Bacteria embeds in mucous layer; activates toxins & enzymes that cause inflammation
▪ Genetic vulnerability & lifestyle behaviors (smoking, stress) may increase susceptible
▪ Other causes: Organisms through food/water contamination, LT NSAID use,
Excess alcohol use, Severe stress, Autoimmune conditions
▪ Manifestations of GI bleeding: Indigestion; heart burn, Epigastric pain; abdominal
cramping, N/V; anorexia, Fever; malaise, Hematemesis, Dark, tarry stools = ulceration
& bleeding
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• GI tract disorders
o Peptic ulcer disease
▪ Duodenal: Most commonly associated with excess acid or H.pylori infections,
Typically present with epigastric pain relieved by food
▪ Gastric: Less frequent; more deadly, typically associated with malignancy and
NSAIDs, Pain worsens with food
▪ Symptoms:
▪ Curling’s ulcer from what: associated with burns
▪ Cushing’s ulcer from what: associated with head injuries
▪ Complications of ulcers: GI hemorrhage; obstruction; perforation; peritonitis
▪ Manifestations: Epigastric or abdominal pain, Abdominal cramping,
Heartburn; indigestion, N/V
▪ Diagnosis: same as gastritis
▪ Treatment: Same as for gastritis, Surgical repair may be necessary for perforated
or bleeding ulcers, Prevention is crucial – may need prophylactic medications (ex:
acid-
reducers) for at-risk clients
o Gallbladder disorders
▪ Cholelithiasis: Gallbladder stones
▪ Cholecystitis: Inflammation or infection in the biliary system caused by calculi
▪ Manifestations: Biliary colic; abdominal distension; N/V; jaundice; fever; leukocytosis
▪ Diagnosis: H & P; abdominal Xray; gallbladder US; laparoscopy
▪ Treatments: Low-fat diet, medications to dissolve calculi, Antibiotic therapy, NG
tube with intermittent sxn, Lithotripsy, Choledochostomy, Laparoscopic surgery
o Liver disorders
▪ Hepatitis – infectious: A, B, C, D, E vs. noninfectious: Giant cell hepatitis, Ischemic
hepatitis, Non-alcoholic fatty liver hepatitis, Autoimmune hepatitis, Toxic & drug-
induced hepatitis, Alcoholic hepatitis
▪ Transmission of viral hepatitis: If it’s a Vowel, it comes from the Bowel. All others
are blood
▪ Define: acute: Proceeds through 4 stages—asymptomatic stage then 3 symptomatic
stages chronic: Characterized by continued liver disease > 6 months, Symptom severity
and disease progression vary by degree of liver damage, Can quickly deteriorate with
declining liver integrity fulminant: Uncommon, rapidly progressing form that can
quickly
lead to
▪ Liver failure, hepatic encephalopathy, or death within 3 wks
• Diagnosis: H & P, Serum hepatitis profile, Liver enzymes, Clotting studies,
Liver biopsy, Abdominal US
• treatment for viral hepatitis: treat with interferon & antiviral mediations
▪ Cirrhosis
• Common causes: Hep C and chronic alcohol abuse most common cause in
U.S. Hepatitis and all factors that can lead to hepatitis
• What happens to liver: Leads to fibrosis, nodule formation, impaired blood
flow, and bile obstruction liver failure
• Manifestations: Portal hypertension, Varicosities, Bleeding –slow or severe,
Muscle wasting, Bile accumulation, Clay-colored stools, Dark urine, Ulcers/GI
bleeding, Encephalopathy, Spontaneous bacterial peritonitis
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• Diagnosis & treatments: H & P; liver biopsy; abdominal Xray; liver enzymes;
EGD; clotting studies; stool exam for occult blood
• Hepatic encephalopathy:
o Pancreatitis
▪ Causes: Cholelithiasis, Alcohol abuse, Biliary dysfunction, Hepatotoxic drugs,
Metabolic disorders, Trauma, Renal failure, Endocrine disorders, Pancreatic tumors,
Penetrating peptic ulcer
▪ What happens to the pancreas in the disorder? pancreatic enzymes to leak into
the pancreatic tissue and initiate autodigestion - -results in edema, vascular
damage, hemorrhage & necrosis
▪ Acute pancreatitis importance & complications: Acute respiratory distress
syndrome (ARDS), DM, Infection, Septic or hypovolemic shock, Disseminated
intravascular coagulation (DIC), Renal failure, Malnutrition, Pancreatic cancer
Pseudocyst – pancreatic fluids & necrotic debris accumulate & eventually rupture,
Abscess
• Manifestations: Upper abdominal pain that radiates to the back, worsens
after eating, somewhat relieved by leaning forward or pulling knees to chest,
N/V
Mild jaundice, Low-grade fever, BP and pulse changes
▪ Chronic pancreatitis manifestations: Upper abdominal pain, Indigestion, Losing
weight without trying, Steatorrhea, Constipation, Flatulence
▪ Pancreatitis diagnosis: H & P, Serum amylase & lipase, Serum calcium level, CBC, Liver
enzymes, Serum bilirubin level, ABG, Stool analysis (lipid & trypsin levels), Abdominal
Xray, CT/MRI, Abdominal US, ERCP (endoscopic retrograde
cholangiopancreatography)
▪ treatment: Rest pancreas by fasting; administer IV nutrition; gradually advance diet
from clears as tolerated to low fat, Pancreatic enzyme supplements when diet resumed
Maintain hydration with IVF, NG to intermittent suction, Antiemetic agents, Pain
management, Antacids/acid-reducing agents, Anticholinergic meds, Antibiotics, Insulin
• Bowel disorders
o Diarrhea – acute: Often d/t bacterial or viral infections, Certain medications such as antibiotics,
antacids, laxatives, usually self-limiting depending on cause
o Chronic: Lasts longer than 4 weeks
o Causes: Inflammatory bowel diseases, Malabsorption syndromes, Endocrine
disorders, Chemo/radiation
▪ Manifestations: If small bowel: Large and loose, provoked by eating, Usually
accompanied with pain in right lower quadrant, If large bowel: Stools are small
and
frequent, Frequently accompanied by pain and cramping in the left lower quadrant,
Acute diarrhea is generally infectious, Accompanied by cramping, fever, chills, N/V
Blood (may be frank, occult, or melena), pus, or mucus may be present
Bowel sounds may be hyperactive, Fluid, electrolyte and pH imbalances, Metabolic
alkalosis
▪ Diagnosis/Bristol stool chart: H & P, include usual bowel habits and complete
Bristol Stool chart, Stool analysis –include cultures & occult blood, CBC, Blood
chemistry
ABG, Abdominal US
▪ Treatment: Fasting for acute diarrhea with infection, Antidiarrheal agents maybe or not
Antibiotics may be needed, Anticholinergics, Antispasmodic agents, Clear liquid diet
until diarrhea subsides, then advance diet as tolerated. Dietary fiber to manage chronic
diarrhea, maintain hydration and correct electrolyte and pH imbalance, Meticulous skin
care in presence of incontinence
