Gastrointestinal System Disorders medical surgical nursing

           Gastrointestinal System Disorders

Upper Gastrointestinal tract study( Barium swallow) 

•  Examination of upper gastrointestinal tract under fluoroscopy after the patient drinks Barium sulphate.

• NPO is required from midnight of the test

•  Postprocedure:- encourage patient to drink oral fluid to pass barium

•  Monitor stool for passage of Barium stool will be chalky white .

 Upper Gastrointestinal Endoscopy 

•  Patient should be kept NPO for 6 to 12 hour before test

• Local anaesthetic or sedation is required

•  Position:- patient is positioned on the left side to facilitate saliva drainage and to provide easy access to endoscope.

•  Airway patency should be monitored during test and emergency equipment should be available

• Postprocedure :- patient should be kept NPO and till the gag reflex Returns.

      Fiberoptic colonoscopy 

•  In this procedure lining of large intestine is visually examined and biopsy and polypectomy can be performed.

• Cardiac and respiratory function are monitored continuously during the test.

•  Position :-  the patient should be on left side with the knees drawn up to the chest.

•  Post-procedure  monitor signs  of bowel perforation and peritonitis

   ERCP ( Endoscopic retrograde   cholangiopancreatography) 

•  Examination of hepatobiliary system is performed by a flexible endoscope.

•  Postprocedure :- monitor for return of gag reflex

Signs of peritonitis and perforation:-

•  Guarding of abdomen

• Increase the fever and chills

• Pallor

• ** progressive abdominal distention and abdominal pain

• Tachycardia and dyspnea

• Restlessness.

Paracentesis 

• It is transabdominal removal of fluid from peritoneal cavity for analysis

• **preprocedure:- 

•  Instruct the patient to void before start of procedure to empty the bladder and move bladder out of way of the paracentesis needle

• Measure  abdominal girth, weight and baseline vital sign

•  Position :- patient is positioned  upright on edge of bed and feet resting on stool (or fowler position)

• *** if fluid drainage output is more than 5 litre then patient should receive IV albumin to prevent shock or hypovolemia.

 Liver Biopsy 

• Preprocedure :- assess results of coagulation test  . Prothrombin time (9.6 to 11.8 sec) and partial prothrombin time ( 20 to 36 sec)

•  Position :- patient is placed in supine or left lateral position during procedure to expose right side of upper abdomen.

•  Postprocedure:- Asses biopsy site for bleeding.

•  Maintain bed rest for several hours

• Instant the patient to avoid coughing and straining.

 Urea Breath Test 

• Urea breath test detects the presence of helicobacter pylori , the bacteria that causes peptic ulcer disease.

•  The patient consumes a capsule of carbon labelled urea and provides a breath  sample for 20 to 30 minutes later.

• H. Pylori can also be detected by assessing serum antibody level.

      ** Abdominal assessment  order ***

medical surgical nursing gastrointestinal disorders

•  Peptic ulcer is an ulceration in the mucosal of the stomach, pylorus , duodenum .

• Administer small frequent blend feeding during that active phase

• Administer H2  receptor antagonist or Proton pump inhibitor as prescribed.
•  Administer mucosal barrier protectants 1 hr before meal

Surgical intervention:-

2  . Vagomy :- surgical division of vagus nerve to eliminate vagus impulses that stimulate HCL in the stomach

3 .  Biliroth 1^st :-  partial gastractomy with remaining segment attached to duodenum

4 . Biliroth 2^nd  :- partial gastractomy with remaining segment attached to jejunum.

5 . Pyloroplasty :- enlargement of pylorus to prevent or decrease pylorus obstruction thereby enhancing gastric empty

• Postoperative  :  ** place patient in fowler position for comfort and drainage

• Maintain NPO status as prescribed for one two three days or until peristalsis (bowel sound) returns.

• Rapid emptying of of gastric content into small intestine that occurs following gastric resection.

•  Symptoms occurs 30 minute after eating 

• Nausea vomiting feeling of abdominal fullness and abdominal cramp

• Perspiration or sweating

• weakness and dizziness, palpitation and tachycardia
•  Borborygmi (Loud gurgles indicating hyperperistalsis)
•  Intervention :- avoid sugar, salt and milk
•  Eat high protein, high fat and low carbohydrate diet.
• Lie down after meals

Vitamin B12 ( cobalamine) Deficiency

• Pernicious anaemia results from deficiency of intrinsic factor(by parietal cells) , necessary for intestinal absorption of vitamin B12

• Assessment :–  severe pallor, fatigue, weight loss

•  ***Smooth, beefy red tongue

•  Paresthasis of hand and feet

•  Intervention :-

• Dietry intake of vit. B12  food like citrus fruits, green leafy vegetables, nuts organ meats.

•  Admitted vitamin B12 injection describe initially weekly and then  monthly for lifelong maintenance.

 Bariatric surgery  weight loss surgery

•  It is surgical reduction of gastric capacity that may be performed on patient with morbid obesity to reduce long-term weight loss

•  Obese patients are at increased post operative risk for pulmonary and thromboembolic complication and death.

•  Postoperative 6 week liquid  or puried food is given.

 Cholecystitis 

• Inflammation of gallbladder that may occur  an acute or chronic

•  Acute inflammation is associated with gallstone( cholithiasis)

•  Assessment :-  nausea and vomiting indigestion

•  Epigastric pain that radiates to scapula 2 to 4 hour after eating fatty food

•  Pain localised in right upper quadrant

•  ***Murphy’s sign :- patient cannot take deep breath when the examiner finger are passed below the hepatic margin because of pain.

• Guarding, rigidity and rebound tenderness.

•  Sugrical :-cholecystectomy is done for the removal of gallbladder

• **kocher’s incision is commonly used in cholecystectomy

•  Postoperative :- monitor for respiratory complication

• Encourage coughing and deep breathing

•  Maintain NPO status and nasogastric tube suction as prescribed

• Normal N tube drainage is 500 to 1000 ml

•  Place patient in semi Fowler position to facilitate drainage

• Claim the end you before a male and observe for abdominal discomfort nausea vomiting if it occurs unclamp tube.

Cirrhosis of liver  

•  Chronic progressive disease of liver characterized by diffuse degenerqtion and destructive of hepatcytes .

Types of cirrhosis 

1. Laennec cirrhosis :-  it is alcohol induced, nutritional or portal