GI System Flashcards
Cirrhosis
Extensive scaring(hard)of the liver.Normal liver tissue is replaced with fibrotic tissue that lacks function. Affect liver ability to handle the flow of bile. jaundice is the often the result. Health promotion and disease prevention.
How many types of in cirrhosis
postnecrotic -caused by viral hepatitis or certain medication or toxins.
Laeneecs-Caused by chronic alcoholism.
biliary:caused by chronic biliary obstruction or auto immune disease.
What is the risk factor for cirrhosis?
Alcohol abuse, hepatitis –auto immune/hepatitis BCD/Biliary
steatohepatitis-(fatty liver disease causing chronic inflammation)
Damage to the liver caused by drugs, toxins, and other infections
cardiac cirrhosis:severe right heart failure, inducing necrosis and fibrosis due to lack of blood flow.
Cirrhosis subjective data And assessment findings
Fatigue , weight loss, abdominal pain, distention,
pruritus (Sever itching of skin),
confusion or difficulty thinking -hepatic and encephalopathy
personality and a mentation changes: emotional lability, euphoria(suddenly become happy or so sad),sometimes depression.
Altered sleep/wake pattern.Gastrointestinal bleeding-varices.
Other bleeding signs: patachiae, Ekhymosis, nosebleed.
What is the physical assessment findings of cirrhosis?
Dependent peripheral edema of extremities and sacrum. Asterix(Liver flapping tremor-getting Neuro effect) course tremor characterized by rapid, non-rhythmic extension and flexion of the wrists and fingers. Assess by having client extend arms(continuously not)and dorsiflexion the wrist * Correlates with progression into hepatic and encephalopathy. Fetor hepaticus(liver breath)- fruity or musty order.
What will give Cirrhosis for nursing care?
Respiratory status-Monitor oxygen saturation and distress
Position:sit in a chair or elevated the head of the bed 30° with feet elevated.
Skin integrity- monitor for skin breakdown. Prevent pressure ulcer.
Puritas:wash with cold water, apply lotion
fluid balance-monitor for signs of fluid volume excess. Keep strict intake and output
obtain daily weights, Assess Asities and peripheral edema.
restrict fluids and the Sodium if prescribe.1Lfluid=1kg (fluid collection)
cirrhosis nursing care
vital signs-monitor vital signs and pain level.
Neurological status: hepatic encephalopathy: lactulose( take out ammonia from the body and because of that lactose excreted from the body diarrhea)
Nutritional status: give diet education.
high carbohydrate,low protein, moderate fat, Low sodium diet with vitamins supplements such, thiamine,folate,and multivitamins
Gastrointestinal status
Asities:measures abdominal girth over the largest part of the abdomen
Observe the potential complications 
Medication for cirrhosis
avoid opioids,sedatives and barbiturates.
Give diuretics: excessive fluid in the body.
beta blocking agent: to prevent bleeding varies.
lactulose: used to promote excretion of ammonia from the body through the stool.
Non absorbable antibiotic:rifaximin can be used in place of lactulose.
What is the procedures for Cirrhosis
Surgery:Liver Transplant,
procedure: parasynthesis
complications: Encephalopathy,varices.
client education for cirrhosis
Encourage the client abstain from alcohol and engage in alcohol recovery program.
Helps to prevent further getting on the fibrosis of the liver.
prevents irritation of the stomach,and esophagus’s lining.
Helps decrease the risk of bleeding.
Helps to prevent other life-threatening complications.
Consult with provider prior to taking any over counter medication or herbal supplement.
vitamin B 12 deficiency (pernicious anemia)
Results from inadequate intake of vitamin B 12 are lack of absorption of ingested vitamin from intestinal track.
What are the assessment of vitamin B 12 deficiency (pernicious anemia)
Assessment:smooth, beefy red tongue, paraesthesia of hands and feet, disturbance in gait and balance.
Vitamin B 12 interventions
Administer vitamin B 12 injection says prescribed for life.
Haietal Hernia:portion of the stomach herniates through diaphragm and into thorax .
Heartburn; regurgitation or vomiting; dysphasia; feeling of fullness.
Vitamin B 12 interventions
Provides frequent meals.
Limit amount of liquid taken with meals.
Advise client not to recline for 1hour after feeding.
Appendicitis
Abdominal pain most intense at McBurney‘s point.
Client inside-lying position, with abdominal gardening.
Constipation or diarrhea, peritonitis.
Increased fever;chills; pallor, abdominal distention,; abdominal pain; restlessness; right gardening of abdomen; tachycardia; tachypnea.
What all the Signs
in appendicitis
Rovsing sign(RLQ pain with palpitation of the LLQ):suggested peritoneal irritation obturator sign (RLQ pain with internal and external rotation of the flexed right hip). Suggest the inflamed appendix is located deep in the right hemipelvis.
two more appendicitis
Posas sign (RLQ pain with extension of the right hip or with the flexion of the right hip against resistance). suggests that an inflamed appendix is located along the course of the right posas muscle. Dunphy sign(sharp pain RLQ elicited by a voluntary cough):Suggests localized peritonitis.
Preoperative interventions appendix
Monitor for signs of ruptured appendix, peritonitis,.
Position client in right side- laying or low-to Semi Fowlers position
* avoid application of heat to abdomen, avoid laxatives, enemas
Postoperative interventions, maintaining NPO status until bowl function returns.
with rupture, expect Penrose drain to be in place or incision left open.
Drainage from Penrose may be profuse. 
position the client in right side lying or low to semi fowlers position, legs flexion to facilitate drainage.
Raptured appendix: Peritonitis
Acute inflammation of the peritoneum- the endothelial lining of the abdominal cavity.
clinical manifestation of peritonitis.
Distended abdomen,; , rigid, board like abdomain diminished bowel sounds; inability to pass flatus Abdominal pain (localized poorly localized or referred to the shoulder And thorax). Anorexia, nausea, vomiting; rebound tenderness in the abdomen; high fever; tachycardia; dehydration from the high fever; decreased urinary output; hiccups,possible compromise respiratory status.
lactase intolerance
Due to not enough lactase from small intestine.
Lactase:the enzyme that digests the milk,sugar,lactose.
signs and symptoms: pain, abdominal cramps, bloating,diarrhea and vomiting.
Diagnostics for lactose
Text to diagnose:hydrogen breath test.
more hydrogen produced due to fermentation of lactose in colon (which is not observed in small intestine).
peptic ulcer
It is an erosion of the mucosal lining of the stomach or Duodenum.
There are gastric acid ulcer and Duodenum Ulcer
Pain:Gastric ulcer:30 to60min after a meal.Rarely occurs at night. Pain exacerbated by ingestion of food .
Pain: duodenal ulcer: 1.5 to 3 hours after a meal.often occurs at night.
Pain may be relieved by ingestion of food or antacids.
assessment findings peptic ulcer disease
Epigastric pain upon palpation.
*Pain that radiates to the back may indicate perforation is imminent
Sudden, severe abdominal pain is a sign of perforation.
Maybe left upper epigastrium (gastric),or right epigastrium(Duodenal)
Bloody bloody Emesis(hematemesis) or stools (melena),Weight loss.
risk factors for Peptic ulcer Disease
causes peptic ulcer: Helicobacter (H-pylori) Iinfection.
Nonsteroidal anti-inflammatory drug and corticosteroids-use severe stress,
excess alcohol ingestion, chronic pulmonary or kidney disease,
Zollinger Ellison syndrome (combination of peptic ulcer,and hypersecretion of gastric acid, and gastrin secreting tumors).
diagnostic procedure for peptic ulcer Disease
esophagogastroduodenoscopy (EGD): provide definitive diagnosis.
gastric samples are obtained to test for H. pylori.
Medication for peptic ulcer
Bismuth,misoprostol, sucralfate, histamine2 antagonists can interfere with the testing for H. pylori (false negatives). Therefore a complete medication history should be reviewed prior to testing. 
Nursing care for peptic ulcer 
Avoid foods that cause a distress.
Monitor for orthostatic changes in vital signs and tachycardia as these findings are suggestive of gastrointestinal bleeding.
Administer medication as prescribed.decreased environmental stress.
Encourage rest periods. Increase smoking cessation and avoiding alcohol consumption. medication: antibiotics:eliminate H. pylori infection.
Histamine 2 receptor antagonist:ranitidine hydrochloride (Zantac), famotidine (Pepcid),Suppress the secretion of gastric acid by selectively blocking H2 receptor in parietal cells lining the stomach.
nursing consideration of Peptic ulcer
ranitidine and famotidine can be administered by I/V in acute situation.
Ranitidine can be taken with or without food.
Treatment of peptic ulcer disease is usually started-as oral dose twice a day until the ulcer is healed,followed by a maintenance dose usually taken once a day at bedtime.
*proton pump inhibitor:pantoprazole (proton),Esmoprazole(Nexium)
Reduce gastric acid secretion by is irreversibly inhibiting the enzyme that produces gastric acid.
Reduce basal stimulated acid production.
client education peptic ulcer
not to crash, Chew,or break sustained-release capsules
instruct the client to take med once a day prior to eating in the morning.
Encourage the client to avoid alcohol and irritating medication NSAIDs.
Mucosal protectant: sucralfate Carafate.
Give an 1hour before and ate it bedtime. Monitor for adverse effects of constipation constipation. Antacids: aluminum carbonate, magnesium hydroxide (milk of magnesia).
Antacid are given 1 to 3 hrs after meals to neutralize gastric acid, which occurs with fully ingestion and it’s bedtime.
Gastric surgeries: gastrectomy
All or part of the stomach is removed with Laparoscopic or open approach.
Antrectomy 
the antrum part of the stomach is removed.
And gastroduodenal reconstruction: Billroth 1
Partially undigested.
Gastrojejunostomy:Billroth 2 procedure
The lower portion of the stomach is excised, the remaining stomach is anastomosed to the jejunum, and the remaining deodenum is surgically closed.
Vagotomy
Highly selective Vagotomy severs only the nerve fibers that disrupt acid production
Pyloroplasty
The opening between the stomach and small intestine is enlarged to increases the rate of gastric emptying
Nursing action: gastric surgeries
Monitor incision for evidence of infection.
Position semi fowlers position and to facilitate lung expansion.
NG tube: scant blood may be seen in first 12 to 24 hours
Notify the provider,before repositioning or irritating the Naso gastric tube.
(Disruption of switches).*monitor bowel sounds. advanced diet as tolerated.
Administer medication as prescribed (analgesics, stool softener),(Avoid stool softener)
Vitamins and minerals supplements :vitamin B12,vitamin D,Calcium,Iron,and folate.
Consume small,frequent meals while avoiding large quantities of carbohydrates as directed-no concentrated sweets.
Complications GI surgeries 
perforation/hemorrhage: it is an emergency situation. Severe epigastric pain spreading across the abdomen.
The abdomen is rigid, board-like, hyperactive to diminished bowel sounds, and there is a rebound tenderness.
shock (hypotension, tachycardia, dizziness, confusion), and decreased hemoglobin.
Nursing actions for GI surgeries 
frequent assessment. Report findings. Prepare the client for endoscopic are surgical interventions. Replace the fluid and blood loss is to remain maintain blood pressure. Insert nasogastric tube and provide saline. pernicious anemia occurs due to the deficiency of the intrinsic factor normally secreted by the gastric mucosa.
Manifestations include pallor, glossitis, Fatigue , paresthesias.
client edication monthly lifelong vitamin B12 injections will be necessary.
Dumping syndrome
After Gastric surgery -occur following eating,Rapid gastric emptying.
Assist/instruct the client to lie down vasomotor manifestations-of occur.
Early manifestations for dumping syndrome
Onset: within 30 minutes after eating.
Cause: rapid Emptying
Symptoms: nausea ,vomiting ,dizziness, tachycardia and palpitation
Late manifestation for dumping syndrome
Onset:1.5 to 3hrs after eating
Cause: excessive insulin release
Symptoms: hunger, dizziness, and sweating
tachycardia and palpitation
shakiness and feeling of anxiety (Hypoglycemia episode)
confusion 
Education for client to dumping syndrome
- laying down after a meal slows the movement of food within the intestines.
Limit (reduce)the amount of fluid ingested at one time.
Eliminate liquids with meals for 1hour prior to following Amy and following a meal.
Consume a high protein, high-fat? Low fiber (insoluble), and low to -moderate carbohydrate diet.
Avoid milk, sweets, or sugars produce fruit juice, sweeten fruit, milkshakes, honey, syrup, jelly.
Consumes small, frequent meals rather than large meals.
Hemorrhoids
hemorrhoid are distended or edematous intestinal veins resulting from increased intra-abdominal pressure straining ,obesity
risk for hemorrhoids
Pregnancy increases risk of hemorrhoids.
Hard stool, constipation, obesity, bright red bleeding, swelling, dilated varicose veins in the rectum,, torcher bladder pain, Diet.
Surgery for hemorrhoids
Hemorrhoidectomy. Pain is the priority as patient will dreading having BM
Postoperative interventions:manage pain, assist client to prone or side line position.
Maintain ice packs (on and off )over dressing as prescribed,
monitor for urinary retention. Client to limit sitting too short Period.
Instructed client to use siz baths 3 to 4 times a day.
Bariatric surgery
Size stomach reduced using various procedures.
obese clients increased postoperative risk for pulmonary,thromboembolic complication and, death.
 bariatric surgery postoperative intervention 
Client teaching points about diet.Instruct client to eat small frequent meals, low in calories.
Instruct client to eat, drink fluids at separate times during meal.
Instructed client to take chewable are liquid multivitamin daily as prescribed.
Gastritis
gastritis is an inflammation in the lining of the stomach.
acute , chronic,Erosive gastritis
Acute Gastritis:Sudden onset gastric bleeding if severe.
Chronic Gastritis: slow onset-perinicious Anemia (low vit B12)
erosive gastritis: black, Tarry stools; coffee ground emesis.
irritable bowel syndrome IBS
 IBS causes change in bowel function (chronic diarrhea, constipation or abdominal pain). IBS is difficult to diagnose with a specific tests.
Client dedication:avoid foods that contain dairy, eggs and wheat products.
AvoidClient alcoholic and caffeinated beverages and other fluids containing fructose (fruits )and sorbitol (bakery product).
cholecystitis
Inflammation of the gallbladder that may occur as an acute or chronic process.
Assessment: epigastric pain radiating to scapula 2 to 4 hours after eating fatty foods.
Feeling of abdominal fullness, dyspepsia, pain localized in right upper quadrant.
Gardening, rigidity, rebound tenderness, Mass palpated in right upper quadrant.
Murphy’s sign cessation of breathing while palpating liver.
Biliary obstruction: jaundice; dark orange and foamy urine; steatorrhea;clay colored stools; purities.
pruritus management
Apply cool wet clothes to skin. Apply lotion-calamine ,lanolin Use gloves(cotton), Long sleeved shirt , no hot shower, cut nails short, mild-soup.
What is Ulcerative colitis
Ulcerative and inflammatory disease of bowel (large intestine) results for adoption of nutrients.
ulcerative colitis Assessment
severe diarrhea may contain blood, mucus,dehydration, electrolyte imbalance, anemia from blood loss
Non-surgical interventions ulcerative colitis
administer intravenous IV fluids, total parenteral nutrition as prescribed.
restrict activity level as prescribed.
Monitor bowl function, abdominal distention. Low residue diet(high fiber diet)as prescribed administer bulk forming agents as prescribed
Postoperative colostomy 
colectomy:: monitor for color changes in stoma (pink to bright red),shiny is normal.
Except liquids stool in immediate postoperative period, depending on area of colostomy. Instructed to client avoid foods that causes excess gas formation, odor (Broccoli,brussels sprouts, cabbage, Callie flower, cucumber, mushrooms, and peas, should be avoided).
Foods that help eliminate odor with a colostomy include yogurt, buttermilk, cranberry juice and parsley.
Increased for dehydration, electrolyte imbalance when they have water is not absorbing the Collins IV medication best way. No suppositories.
Postoperative ileostomy
Normal stool is liquid. Monitor for dehydration, electrolyte imbalance.no suppositories administered through ileostomy.
Peristomal skin care in ulcerative colitis
Cleansing peristomal skin with mild soap and water.
Ensuring that the ostomy appliance fits well so that Skin is protected from liquid stool drainage. Trimming the appliance opening to1/8 inch (0.32 cm )larger than the stoma so that it “hugs” the stoma without touching stoma tissue.same bag they can use4/7days.
don’t touch peristomal skin,around the stoma.bag empty as needed
Ileostomy diet
Diet: immediately post op period-low fiber-to prevent obstruction of the narrow lumen of small intestine and stoma.
Low fiber-white rice, refined grains, pasta, most canned or well cooked vegetables and fruits without skin or seeds.
After ileostomy heals, introduce fibrous foods one at a time.
patient should chew thoroughly, and Use cooked vegetables.
Avoid-high paper- popcorn, coconut, brown rice, multigrain bread, dried fruits and prune juice, Raw fruits,Raw or undercooked vegetables, including corn, dried beans, peas and lentils.
Avoid stringy vegetables- celery, broccoli, asparagus.
Avoid seeds/pits-strawberry raspberry, olives .
Crohn’s disease
 inflammatory disease; can occur anywhere in G.I. track, but most often affects terminal ileum. cramp-like,colicky pain after meals,diarrhea (semisolid); may contain mucus,dehydration, electrolyte imbalance.
interventions interventions: similar to ulcerated colitis.
Diverticulosis and Diverticulitis
Out pouching or herniation of intestinal information.
Diverticulosis becomes diverticulitis with inflammation of one or more diverticula; result when diverticulum perforate.
Colostomy irrigation
Daily irrigation to help to gain more control over passages of stool.
Do not use an enema set. Use cone tipped applicator .
fill chamber with 500-1000ML lukewarm water, flush tubing,Hang the container in IV pole.
Client sit on toilet, place irrigation Sleeve over stoma.place irrigation
container18-24inch above stoma.
Lubricate cone tipped irrigator and insert gently into stoma, hold in place
slowly open clamp, clamp if cramping occurs.
pancreatitis pancreatitis
 acute or acute acute or chronic inflammation of pancreas with the associate escape of pancreatic enzymes. 
pancreatitis is an autodigestion of the pancreas by the pancreatic digestive, enzymes.
Risk factors-gallbladder stones, alcohol, smoking, high triglycerides.
The islets and Langerhans in the pancreas secrete insulin and glucagon
The pancreatic tissues secrete digestive enzymes that break down carbohydrates proteins and fats.
pancreatitis
acute attack sign:severe , constant, knife like pain (left upper quadrant,mid epigastric, and/or radiating to the back)that is undelivered by nausea and vomiting.
Inflammation can vary from mild edema to severe necrosis.
pancreatic abscess:report immediately any sign of sudden fever (leads to peritonitis)
The abscess must be treated promptly to prevent sepsis.
Assess for sudden abdominal pain,mid epigastric region,radiating to back, pain aggravated by fatty meal Or alcohol.
Is
Assess for CUllen’S signs, Turner’s sign seepage of blood-stained exudates into tissue as a result of pancreatic enzyme actions.
chronic pancreatitis
 assess for abdominal pain, tenderness, left upper quadrant mass.
assess for steatorrhea, sign signs and symptoms of diabetes mellitus.
Instruct client in prescribed dietary measures.
Administer pancreatic enzyme as prescribed; fat and protein intake may be limited.
Have bland diet. Administering hypoglycemia administer insulin or oral hypoglycemic as prescribed.
Instruct client to notify physician if increase steatorrhea, abdominal distention, cramping for a fever occur. Monitor for respiratory infections.
Hepatitis
Inflammation of the liver caused by virus,bacteria, exposure to medication or hepato-toxins.
what are all the types of hepatitis?
Types of viral hepatitis:hepatitis A BCDE.
Stages of viral hepatitis:
Preicteric stage:flu like symptoms precedes jaundice.
Icteric stage:appearance of jaundice: elevated bilirubin levels; dark or tea colored urine,clay colored stools. Posticteric stage: jaundice decreases; color of stool, urine returns to normal.
laboratory assessment hepatitis
Elevated levels of alanine aminotransferase ,aspirate aminotransferase, alkaline phosphate, bilirubin. 
Pediatric G.I:Esophageal Atresia and Tracheoesophageal Fistula 
*Esophagus terminates before it reaches the stomach and/or
Fistula present that forms a unnatural connection with trachea.  assessment: 3CS3CS: coughing choking cynosis report HCP. Drooling-cannot swallow-aspiration Reported to Hcp.
Preoperative interventions esophageal Atresia

NPO , IV fluids as prescribed.
Suction mouth, pharynx PRN,maintain upright position at all time
maintenance esophageal catheter to slow suction as described
maintain gastrotomy tube as prescribed.
Administer antibiotics as prescribed.
What’s the temperature postoperative esophageal atresia and trachoesophageal fistula
Monitor respiratory status, intake output, daily weight daily weight daily weights, surgical site, pain, sign of dehydration. baby sunken, concave, fontanelles.
Maintain IV fluids, total parenteral nutrition, suction PRN.
Begin oral feeding with sterile water as prescribed.
Hypertrophic pyloric stenosis.
Narrowing of pyloric Canal between stomach and duodenum 
Assessment: visual peristaltic waves from left to right across epigastrium during and immediately following feeding.
Olive shaped Mass in epigastrium, Just right of umbilicus. Projectile vomiting.
Hypertrophic pyloric stenosis interventions
Monitor vital sign, I&O,signs of dehydration, signs of electro imbalances.
pyloromyotomy:incision through muscle fibers of pylorus
postoperatively, feed infant slowly, but frequently, handle minimally following feeding.
Celiac disease
Intolerance to gluten, protein component of barely, rye, oats, wheat. BROW
Assessment:Acute or insidious diarrhea(gradually );anorexia; abdominal pain, distention; muscle wasting,especially in buttocks and extremities ;vomiting; anemia.
Celiac crisis: Precipitated by fever, infection, gluten ingestion.
Electrolyte imbalances; rapid dehydration rapid dehydration; severe acidosis; profuse watery diarrhea; vomiting.
interventions celiac disease 
Maintening gluten free date, substituting corn,rice,millet as sources.instruct in lifelong elimination of gluten sources: beer, pasta, crackers, cereals and many more substances contain gluten.
abdominal wall Defects:omphalocele:-

protrude through an abnormal body opening.
Herniation of abdominal contents through umbilical Ring.
Immediately after birth, sac covered with gauze soaked in normal Saline
preoperatively: maintain NPO status,administrative IV fluids,
monitors signs of infection, handle infant carefully.
Gastroschisis
herniation of intestine,lateral to umbilical ring.
exposed but will cover loosely in saline soaked pads,with abdomen wrapped plastic drape.
Postoperatively ,care similar to that omphalocele, within several hours after birth.
postoperatively:, perform measures to control pain, infection,fluid and electrolyte imbalance; provide nutrition as prescribed.
Hirschsprung disease:
Congenital anomaly; Aganglionic megacolon. presents with fever, gastrointestinal bleeding, explosive (pleasure in sigmoid colon), watery diarrhea.
Hirschsprung’s disease Assessment
Newborn:delayed passage or absence of meconium stool.
Abdominal distention, bilious vomiting,tight under sprinter
children:Ribbon like, Foul-smelling stool.
Hirschsprungs disease Interventions
dietary management; administers stool softener as prescribed; perform daily rectal irrigations with the normal Saline is prescribed
Preoperative interventions: assess bowel function, I&O,abdominal girth,weight;administer antibiotics as prescribed; no rectal temperatures.
postoperative interventions: monitor vital signs, with no rectal temperatures, measure abdominal girth.
Assess surgical site and stoma.
Maintain NPO until bowel sounds return.
Maintain NG tube suction as prescribed.
Monitor for fluids and electrolyte imbalance.
