MED SURG EXAM 2 - Review of the gastrointestinal disorders
MED SURG EXAM 2 - Review of the gastrointestinal
disorders (including upper and lower GI disorders)
MED SURG EXAM 2
UPPER GI DISORDERS (Ingestion & Digestion Disorders) CH. 46 + 47
GI SERIES
• Radiographic studies done with or without contrast that define anatomic or functional abnormalities
o Upper GI Series an upper fluoroscopy delineates entire GI tract after introduction of a
contrast agent
▪ Enables examiner to detect/exclude anatomic or functional disorders of the upper GI
organs or sphincters
▪ Aids in DX of ulcers, varices, tumors, regional enteritis, and malabsorption syndromes
▪ Procedure could be extended to examine the duodenum and small bowel
o Barium Enema for visualization of the lower GI tract
▪ Can be used to detect presence of polyps, tumors, or other lesions of the large intestine
+ demonstrate any anatomic abnormalities or malfxning of the bowel
▪ Contraindicated if:
• Pt has active inflammatory disease of colon (enemas contra)
• Signs of perforation or obstruction (a water-soluble contrast study would be
done instead)
• Active GI bleeding (prohibits enemas + laxatives)
• Indications
o Gastric ulcers, peristaltic disorders, tumors, varices, and intestinal enlargements or constrictions
o C/O abdominal pain, altered elimination habits, or GI bleeding
• Nursing Actions
o Pre procedure
▪ Upper GI Series:
• Dietary changes prior to study include: clear liquid diet, with NPO from midnight
the night before the study
• Polyethylene glycol = most effective bowel cleansing prep agent
• No smoking, chewing gum, or mints b/c stimulates gastric motility
• Oral meds withheld the morning of the study, resumed that evening
▪ Barium Enema:
• Patient prep includes emptying + cleansing lower bowel
• Low-residue diet 1-2 days before the test
• Clear liquid diet and a laxative the night before the test
• NPO after midnight
• Cleansing enemas until returns are clear the morning of the test
o Post procedure
▪ Upper GI series:
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• Follow up to ensure the patient has eliminated most of the ingested barium
• Fluids may be increased to facilitate the elimination of stool + barium
▪ Barium Enema:
• Pt education increase fluid intake, evaluate BMs for elimination of barium,
note any increase in BMs (b/c barium has high osmolarity that may draw fluid
into bowel, resulting in greater output) ENDOSCOPY
• Allows direct visualization of body cavities, tissues, and organs for diagnostic and therapeutic purposes
• Different Procedures
o Esophagogastroduodenoscopy (EGD) an be used to evaluate esophageal and gastric motility
and to collect secretions and tissue specimens for further analysis
▪ Valuable when esophageal, gastric, or duodenal disorders or inflammatory, neoplastic,
or infectious processes are suspected
o Endoscopic Retrograde Cholangiopancreatography (ERCP) uses the endoscope in
combination with x-rays to view the ductal structures of the biliary tract
▪ Helpful in evaluating jaundice, pancreatitis, pancreatic tumors, common bile duct
stones, and biliary tract disease
o Colonoscopy direct visualization of the large intestine (anus, rectum, sigmoid, transcending +
ascending colon)
▪ Most frequently used for cancer screening + surveillance for those w/ previous colon
cancer or polyps
▪ Also used in evaluation of pts with diarrhea of unknown cause, occult bleeding, or
anemia, further study of abnormalities found w/ barium enemas, and DX/clarification of
extent of inflammatory or other bowel disease
▪ Therapeutically – can be used to remove visible polyps, TX areas of bleeding or stricture
▪ Performed while pt is lying on the left side with legs drawn up toward chest
o Sigmoidoscopy used to evaluate chronic diarrhea, fecal incontinence, ischemic colitis, lower
GI hemorrhage, + to observe for ulceration, fissures, abscesses, polyps, tumors
• Indications
o Potential Diagnoses
o Client Presentation
ENDOSCOPIC NURSING ACTIONS
• Pre procedure
o Verify informed consent is obtained for proper procedure
o Assess vital signs and verify allergies
o Evaluate baseline laboratory values and report unexpected or abnormal results
o Assess history for risks of complications
o Colonoscopy ➔ Pt must cleanse the colon (diff ways):
▪ may prescribe a laxative for 2 nights before exam and a fleet’s or saline enema until the
return is clear the morning of the test, but more commonly: polyethylene glycol
electrolyte lavage solutions for effective bowel cleansing.
▪ Patient maintains clear liquid diet starting @ noon the day before the procedure, then
patient ingests the solution at intervals over 3-4 hours.
▪ Informed consent is obtained before patient is sedated.
o Sigmoidoscopy ➔ only limited bowel prep – including warm tap water or fleet’s enema until
returns are clear.
▪ Dietary restrictions usually not necessary
▪ sedation not required
• Post procedure
o Monitor vital signs
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o Assess for complications
o If biopsy taken, may have food restrictions
o EGD/ERCP
▪ Withhold fluids until gag reflex returns
o Colonoscopy/Sigmoidoscopy
▪ Monitor for rectal bleeding
▪ Instruct that there may be increased flatulence due to air instillation during the
procedure
o After colonoscopy ➔ bed rest until fully alert.
▪ Pt might have abdominal cramps b/c of the air insuffated into the bowel during
procedure.
▪ Immediately after test – pt is monitored for S/S of bowel perforation (e.g. rectal
bleeding, abdominal pain or distention, fever, focal peritoneal signs)
Hiatal hernia = muscle weakness of the diaphragm at the esophageal hiatus … *in this condition, the
opening in the diaphragm through which the esophagus passes becomes enlarged, and part of the upper
stomach tends to move up into the lower portion of the thorax
• Occurs more often in women
• 2 types:
o sliding occurs when the upper stomach + gastro-esophageal junction are displaced upward +
slide in + out of the thorax (most common)
▪ heartburn, regurgitation, dysphagia (but 50% people are asymptomatic)
o paraesophageal occurs when all or part of the stomach pushes through the diaphragm
beside the esophagus
▪ usually feel a sense of fullness or chest pain after eating (or no symptoms)
▪ reflux doesn’t usually occur b/c the gastro-esophageal sphincter is intact
• Diagnostic Testing
• X-rays
• Barium Swallow
• Fluoroscopy
• Medical Management
• Antacids neutralize gastric acid + raise gastric pH
• H2 Blockers reduce at of acid produced by stomach lining cells (ex. Pepcid, Zantac)
• PPI (proton pump inhibitors) medications that decrease the release of gastric acid (ex.
Prilosec, Protonix)
• Fundoplication surgical procedure in which the upper portion of the stomach is
wrapped around the lower end of the esophagus and sutured in place
• Hiatal Hernia - ASSESSMENT
• Heartburn
• Regurgitation
• Pain
• Dysphagia
• Belching
• Worsening of symptoms after eating or when in recumbent position
• COLLABORATIVE CARE
• Monitor:
• Nutritional status
• Aspiration
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