Adult Nursing Care Unit 6 Review: Gastrointestinal Disorders

What's This Unit All About?

• Focuses on the gastrointestinal (GI) system and its associated disorders commonly encountered in adult nursing care
• Covers the anatomy and physiology of the GI tract from the mouth to the anus
• Explores various GI disorders, their causes, symptoms, and management strategies
• Emphasizes the role of nurses in assessing, diagnosing, treating, and educating patients with GI disorders
• Highlights the importance of early detection and intervention to prevent complications and improve patient outcomes
• Discusses the impact of GI disorders on patients' quality of life and the need for holistic nursing care
• Stresses the significance of interprofessional collaboration in managing GI disorders effectively

Key Anatomy and Physiology Recap

• The GI tract consists of the mouth, esophagus, stomach, small intestine (duodenum, jejunum, ileum), large intestine (cecum, colon, rectum), and anus
• The accessory organs include the liver, gallbladder, and pancreas, which secrete enzymes and bile for digestion
• The GI tract is lined with mucosa, submucosa, muscularis, and serosa layers, each serving specific functions
• Peristalsis, a series of coordinated muscle contractions, propels food through the GI tract
• The small intestine is the primary site of nutrient absorption, with villi and microvilli increasing the surface area
• The large intestine absorbs water and electrolytes, forming and storing feces until elimination
• The liver performs various functions, including bile production, detoxification, and protein synthesis
• The pancreas secretes digestive enzymes and hormones (insulin and glucagon) for glucose regulation

Common GI Disorders We'll Cover

• Gastroesophageal reflux disease (GERD): chronic backflow of stomach acid into the esophagus, causing heartburn and potential esophageal damage
• Peptic ulcer disease (PUD): open sores in the lining of the stomach or duodenum, often caused by Helicobacter pylori infection or NSAIDs
• Inflammatory bowel disease (IBD): chronic inflammation of the GI tract, including Crohn's disease and ulcerative colitis
• Irritable bowel syndrome (IBS): a functional disorder characterized by abdominal pain, bloating, and changes in bowel habits
• Diverticular disease: formation of pouches (diverticula) in the colon wall, which can become inflamed (diverticulitis)
• Colorectal cancer: malignant growth in the colon or rectum, often developing from precancerous polyps
• Gallstones: hardened deposits of bile that can cause pain and obstruction in the gallbladder or bile ducts
• Pancreatitis: inflammation of the pancreas, which can be acute or chronic, often caused by gallstones or alcohol abuse

Symptoms and Red Flags

• GERD: heartburn, regurgitation, dysphagia, chest pain, chronic cough, and hoarseness
  • Red flags: severe or persistent symptoms, dysphagia, unintentional weight loss, and anemia
• PUD: abdominal pain, burning sensation, nausea, vomiting, and dark or bloody stools
  • Red flags: severe pain, vomiting blood, black tarry stools, and signs of perforation or obstruction
• IBD: abdominal pain, diarrhea (often bloody), weight loss, fatigue, and extraintestinal manifestations (joint pain, skin lesions, eye inflammation)
  • Red flags: severe or persistent symptoms, high fever, severe anemia, and signs of bowel obstruction or perforation
• IBS: abdominal pain, bloating, diarrhea, constipation, and mucus in stools
  • Red flags: onset after age 50, unintentional weight loss, nocturnal symptoms, and family history of IBD or colorectal cancer
• Diverticular disease: abdominal pain (usually left lower quadrant), fever, nausea, vomiting, and changes in bowel habits
  • Red flags: severe or persistent pain, high fever, bloody stools, and signs of perforation or obstruction
• Colorectal cancer: changes in bowel habits, rectal bleeding, abdominal pain, unintentional weight loss, and fatigue
  • Red flags: persistent symptoms, iron-deficiency anemia, and family history of colorectal cancer or polyposis syndromes
• Gallstones: right upper quadrant pain, nausea, vomiting, and jaundice (if bile ducts are obstructed)
  • Red flags: severe or persistent pain, high fever, and signs of cholecystitis or pancreatitis
• Pancreatitis: severe epigastric pain radiating to the back, nausea, vomiting, and abdominal distension
  • Red flags: severe or persistent pain, high fever, tachycardia, hypotension, and signs of organ failure

Diagnostic Tests and Procedures

• Physical examination: assessment of vital signs, abdominal palpation, and digital rectal examination
• Laboratory tests: complete blood count, comprehensive metabolic panel, lipase, amylase, and stool studies (occult blood, culture, ova, and parasites)
• Imaging studies: abdominal X-ray, ultrasound, CT scan, MRI, and barium studies (upper GI series, barium enema)
• Endoscopic procedures: esophagogastroduodenoscopy (EGD), colonoscopy, and endoscopic retrograde cholangiopancreatography (ERCP)
  • EGD: visualizes the upper GI tract and allows for biopsy and therapeutic interventions (e.g., removal of polyps, treatment of bleeding)
  • Colonoscopy: examines the entire colon and rectum, enabling biopsy and removal of polyps
  • ERCP: evaluates the biliary and pancreatic ducts, and allows for therapeutic interventions (e.g., removal of gallstones, stent placement)
• Manometry: measures pressure and motility in the esophagus or anorectal region
• Breath tests: detect Helicobacter pylori infection or small intestinal bacterial overgrowth (SIBO)
• Capsule endoscopy: a pill-sized camera that visualizes the small intestine, which is difficult to access with traditional endoscopy

Treatment Options and Nursing Care

• GERD: lifestyle modifications (weight loss, avoiding trigger foods, elevating head of bed), antacids, H2 receptor antagonists, proton pump inhibitors (PPIs), and fundoplication surgery for severe cases
  • Nursing care: educate patients on lifestyle changes, administer medications as prescribed, and monitor for side effects and complications
• PUD: antibiotics for Helicobacter pylori eradication, PPIs, H2 receptor antagonists, and surgery for complications (perforation, obstruction, or bleeding)
  • Nursing care: administer medications as prescribed, monitor for signs of complications, and provide pain management and wound care as needed
• IBD: anti-inflammatory drugs (aminosalicylates, corticosteroids), immunomodulators, biologic agents (TNF-alpha inhibitors, integrin inhibitors), and surgery for severe or refractory cases
  • Nursing care: administer medications as prescribed, monitor for side effects and complications, provide nutritional support, and educate patients on disease management and self-care
• IBS: dietary modifications (low FODMAP diet), antispasmodics, antidiarrheals, laxatives, and psychological therapies (cognitive-behavioral therapy, hypnotherapy)
  • Nursing care: educate patients on dietary changes and stress management, administer medications as prescribed, and provide emotional support
• Diverticular disease: high-fiber diet, antibiotics for acute diverticulitis, and surgery for complications (abscess, fistula, obstruction, or perforation)
  • Nursing care: encourage high-fiber diet, administer antibiotics as prescribed, monitor for signs of complications, and provide pain management and wound care as needed
• Colorectal cancer: surgery (colectomy, anterior resection), chemotherapy, radiation therapy, and targeted therapy
  • Nursing care: provide pre- and post-operative care, administer chemotherapy and supportive medications, monitor for side effects and complications, and provide emotional support and patient education
• Gallstones: laparoscopic cholecystectomy for symptomatic gallstones, and ERCP with stone extraction for choledocholithiasis
  • Nursing care: provide pre- and post-operative care, monitor for signs of complications, and educate patients on dietary modifications and pain management
• Pancreatitis: supportive care (pain management, fluid resuscitation, nutritional support), endoscopic or surgical interventions for complications (pseudocyst, necrosis, obstruction), and treatment of underlying cause (alcohol cessation, gallstone removal)
  • Nursing care: provide pain management, monitor fluid balance and electrolytes, administer medications as prescribed, and educate patients on lifestyle modifications and disease management

Complications and How to Spot Them

• GERD: esophageal stricture, Barrett's esophagus, and esophageal adenocarcinoma
  • Signs: dysphagia, unintentional weight loss, and anemia
• PUD: perforation, obstruction, and bleeding
  • Signs: severe abdominal pain, vomiting, fever, tachycardia, and signs of peritonitis or shock
• IBD: malnutrition, anemia, toxic megacolon, bowel obstruction, and colorectal cancer
  • Signs: severe abdominal pain, high fever, tachycardia, hypotension, and signs of sepsis or bowel perforation
• IBS: no serious complications, but can significantly impact quality of life
• Diverticular disease: abscess, fistula, obstruction, and perforation
  • Signs: severe abdominal pain, fever, tachycardia, and signs of peritonitis or sepsis
• Colorectal cancer: metastasis to lymph nodes, liver, lungs, and bones
  • Signs: changes in bowel habits, rectal bleeding, abdominal pain, unintentional weight loss, and anemia
• Gallstones: cholecystitis, choledocholithiasis, and pancreatitis
  • Signs: severe abdominal pain, fever, jaundice, and elevated liver enzymes or lipase
• Pancreatitis: pseudocyst, necrosis, infection, and organ failure
  • Signs: persistent or worsening abdominal pain, fever, tachycardia, hypotension, and signs of sepsis or organ dysfunction

Patient Education and Discharge Planning

• GERD: educate on lifestyle modifications (weight loss, avoiding trigger foods, elevating head of bed), medication adherence, and follow-up with gastroenterologist
• PUD: educate on medication adherence, avoiding NSAIDs, smoking cessation, and follow-up with gastroenterologist
• IBD: educate on medication adherence, recognizing signs of flare-ups, maintaining a healthy diet, managing stress, and follow-up with gastroenterologist
• IBS: educate on dietary modifications (low FODMAP diet), stress management techniques, medication adherence, and follow-up with gastroenterologist or primary care provider
• Diverticular disease: educate on high-fiber diet, staying hydrated, recognizing signs of complications, and follow-up with gastroenterologist or surgeon
• Colorectal cancer: educate on post-operative care, chemotherapy or radiation therapy side effects, maintaining a healthy lifestyle, and follow-up with oncologist and surgeon
• Gallstones: educate on post-operative care, low-fat diet, recognizing signs of complications, and follow-up with surgeon
• Pancreatitis: educate on alcohol cessation (if applicable), low-fat diet, medication adherence, recognizing signs of complications, and follow-up with gastroenterologist or surgeon