GI Review

Zollinger-Ellison syndrome: Tumors of the pancreas that cause upper GI inflammation. The tumors secrete gastrin causing high levels of stomach acid.
Symptoms: Diarrhea Vomiting Abdominal pain Tests: Abdominal CT + Calcium Infusion Test + Secretin Stimulation Test Elevated gastrin levels Tumors in the pancreas Treatment: Ranitidine Cimetidine Lansoprazole Omeprazole Surgery

Wilsons disease: High levels of copper in various tissues throughout the body. (Genetically linked- Autosomal recessive).
Key organs affected are: Eyes Brain Liver Kidneys Symptoms: Gait disturbances Jaundice Tremors Abdominal pain/distention Dementia Speech problems Muscle weakness Spenomegaly Confusion Dementia Tests: Various lab tests:

Bilirubin/PT/ SGOT increased Albumin/Uric acid production decreased MRI Genetic testing Low levels of serum copper Copper is found in the tissues Kayser-Fleisher Rings in the eye Treatment: Pyridoxine Low copper diet Corticosteroids Penicillamine Monitor the patient for: Cirrhosis Muscle weakness Joint pain/stiffness Anemia Fever Hepatitis

Pancreatitis: Inflammation of the pancreas

Symptoms: Fever Vomiting Nausea Chills Anxiety Jaundice Sweating Tests: X-ray CT scan Various Lab test Nursing Management Assess vital signs for elevated temperature, elevated pulse, and changes in blood pressure. Assess pain level. Monitor intake and output. Assess abdomen for bowel sounds, tenderness, masses, ascites. Monitor fingerstick blood glucose. Assess lung sounds for bilateral equality. Frequent oral care for NPO patients. Teach patient about home care: 1. Avoid alcohol and caffeine. 2. Bland, low-fat, high-protein, high-calorie, small, frequent meals.

3. Use of blood glucose meter. 4. Medication management, schedule, side effects. 5. Plan rest periods until strength returns.

Pancreatic Cancer: cancer of the pancreas. Higher rates in men.

Symptoms: Nausea Jaundice Depression Back pain Indigestion

Abdominal pain Weight loss Tests: CT scan Biopsy Abdominal US Liver function test Treatment: Surgery Chemotherapy Radiation Whipple procedure

Hepatitis
Hepatitis A: Viral infection that causes liver swelling.
Symptoms: Fatigue Nausea Fever Itching Vomiting Tests: Increased liver enzymes Presence of IgG and IgM antibodies Enlarged liver Treatment: Rest Proper diet low in fatty foods

Hepatitis B: Sexually transmitted disease, also transmitted with body fluids and some individual may be symptom free but still be carriers.
Symptoms: Jaundice Dark Urine Malaise Joint pain Fever Fatigue

Tests: Decreased albumin levels + antibodies and antigen Increased levels of transaminase Treatment: Monitor for changes in the liver. Recombinant alpha interferon in some cases. Transplant necessary if liver failure occurs.

Hepatitis C
Symptoms: Fatigue Vomiting Urine color changes (dark) Jaundice Abdominal pain Tests: ELISA assay Increased levels of liver enzymes No Hep. A or B antibodies Treatment: Interferon alpha Ribavirin NURSING INTERVENTION Monitor vital signs. Assess abdomen for bowel sounds, tenderness, ascites. Plan appropriate rest for patient in acute phase. Monitor intake and output. Assess mental status for changes due to encephalopathy. Assist patient to: 6. Plan palatable meals; remember that breakfast is generally the best tolerated meal. 7. Avoid smoking areasintolerance to smoking.

Gastritis: can be caused by various sources (bacteria, viruses, bile

reflux or autoimmune diseases). Inflammation of the stomach lining. Symptoms: Loss of appetite Hiccups Nausea Vomiting blood Abdominal pain Tests: EGC X-Ray

CT scan TREATMENT Administer antacids: 8. Maalox, Mylanta, Tums, Gaviscon Administer sucralfate to protect gastric lining. Administer histamine 2 blockers: 9. ranitidine, famotidine, nizatidine, cimetidine Administer proton pump inhibitors: 10. omeprazole, esomeprazole, pantoprazole, rabeprazole, lansoprazole Eradicate Helicobacter pylori infection if present. Diet modification. Monitor hemoglobin and hematocrit. NURSING INTERVENTION Monitor vital signs. Monitor intake and output. Monitor stool for occult blood. Assess abdomen for bowel sounds, tenderness. Teach patient about: 11. Diet restrictions: avoid alcohol, caffeine, acidic foods. 12. Medications. 13. The need to avoid smoking. 14. The need to avoid NSAIDs.

Ulcers

Peptic Ulcers-ulcer in the duodenum or stomach

Gastric Ulcers- ulcer in the stomach Duodenum Ulcer-ulcer in the duodenum Bacteria: Helicobacter pylori- often associated with ulcer formation. Symptoms: Weight loss Chest pain Heartburn Vomiting Indigestion Fatigue Tests: EGD Stool guaiac GI X-rays Treatment: Bismuth Famotidine Sucralfate Cimetidine Omeprazole Antibiotics NURSING INTERVENTION Monitor vital signs. Monitor intake and output. Assess abdomen for bowel sounds, tenderness, rigidity, rebound pain, guarding. Monitor stool for change in color, consistency, blood. Teach patient about home care: 15. Diet modification to avoid acidic foods, caffeine, peppermint, alcohol. 16. Eat more frequent, small meals. 17. Avoid nonsteroidal anti-inflammatory medication. 18. Stop smoking. 19. Diverticulitis abnormal pouch formation that becomes inflamed in the intestinal wall. Symptoms: Fever Diarrhea Nausea Vomiting Constipation Tests:

Barium enema WBC count Colonoscopy CT Scan Sigmoidoscopy TREATMENT Administer antibiotics: 20. ciprofloxacin 21. metronidazole 22. trimethoprim-sulfamethoxazole Administer adequate intravenous hydration. Manage pain as needed. NPO or clear liquids (depending on order) during acute inflammation to rest intestinal tract. Surgical intervention to correct perforation of diverticula, abscess formaltion, bowel obstruction, fistula formation. NG tube postoperatively. NURSING INTERVENTION Monitor vital signs for fever, increased heart rate, and decreased blood pressure. Assess abdomen for distention, presence of bowel sounds. Monitor intake and output. Postoperatively check: 23. Stoma at colostomy site 24. Wound site for drainage or signs of infection 25. Peripheral circulation, swelling due to increased risk of clot formation Teach patients: 26. Eat low-residue foods during flare-ups. 27. Eat high-fiber diet when asymptomatic, fresh fruits and vegetables, whole 28.wheat breads, bran cereals. 29. Avoid laxatives and enemas due to increased irritation and intraabdominal 30.pressure. 31. Avoid lifting during exacerbation. 32. Avoid eating nuts and seeds. Intestinal obstruction: Can a paralytic ileus/false obstruction (children) or a mechanical obstruction: Types of mechanical obstruction: Tumors Volvulus Impacted condition Hernia

Symptoms: Constipation Vomiting Diarrhea Breath Abdominal swelling Abdominal pain Tests: Barium enema CT scan Upper/Lower GI series Poor bowel sounds TREATMENT NPO to rest intestinal tract. Nasogastric tube attached to suction the contents from stomach. Intravenous fluid replacement with isotonic solution. Correction of electrolyte imbalances. Parenteral nutrition replacement and vitamin supplementation. Administer antiemetics if nausea continues after NG tube in place. Monitor electrolytes. NURSING INTERVENTION Monitor vital signs for changes. Assess abdomen for bowel sounds, tenderness. Monitor intravenous access site for irritation, redness, swelling. Keep patient NPO. Monitor intake and output. Replace fluids lost from all sources

Carcinoid Syndrome: symptoms caused by cardinoid tumors. Linked to increased secretion of Serotonin.
Symptoms: Flush appearance Wheezing Diarrhea Onset of niacin deficiency Abdominal pain Decreased BP Tests: 5-HIAA test Increased levels of Chromogranin A and Serotonin CT scan MRI Treatment: Surgery Sandostatin

Chemotherapy Multivitamins Octreotide Interferon Monitor the patient for: Low BP Right Sided Heart Failure

Hiatal Hernia: Stomach sticks into the chest through the diaphragm.
Can cause reflux symptoms. Symptoms: Chest pain Heartburn Poor swallow Tests: EGD Barium Swallow X-ray. Treatment: Weight loss Surgical repair Medications for reflux NURSING INTERVENTION Monitor vital signs. Assess abdomen for distention, bowel sounds. Teach patient about lifestyle modifications: 33. Medication management. 34. Not to lie down after eating. 35. Elevate head of bed. 36. Avoid wearing clothing that is tight at waist. 37. Avoid acidic foods (citrus, vinegar, tomato), peppermint, caffeine, alcohol. 38. Stop smoking. 39. Lose weight if overweight.

(GERD) -Gastroesophageal reflux disease

Symptoms: Nausea Vomiting Frequent coughing Hoarseness Belching Chest pain Anatacid relief Sore Throat Tests:

Barium swallow Bernstein test Stool guaiac Endoscopy Treatment: Weight loss Antacids Proton pump inhibitors

Limit fat and caffeine Histamine H2 blockers Monitor the patient for: Chronic pulmonary disease Barretts esophagus Esophagus inflammation Bronchospasms NURSING INTERVENTION Monitor vital signs. Assess abdomen for distention, bowel sounds. Teach about medication management. Teach patient about lifestyle modifications: 40. Not to lie down after eating. 41. Elevate head of bed. 42. Avoid wearing clothing that is tight at waist. 43. Avoid acidic foods (citrus, vinegar, tomato), peppermint, caffeine, alcohol. 44. Stop smoking. 45. Lose weight if overweight

Ulcerative colitis: chronic inflammation of the rectum and large

intestine. Symptoms: Weight loss Jaundice Diarrhea Abdominal pain Fever Joint pain GI bleeding Tests: Barium edema ESR CRP Colonoscopy Treatment: Corticosteroids Mesalamine Surgery Ostomy Azathioprine Monitor the patient for: Ankylosing spondylitis Liver disease Carcinoma Pyoderma gangrenosum

Hemorrhage Perforated colon NURSING INTERVENTION Monitor intake and output. Monitor stool output, frequency. Weigh patient regularly. Sitz bath. Vitamin A & D ointment or barrier cream applied to skin. Witch hazel to soothe sensitive skin. Monitor for toxic megacolon (distended and tender abdomen, fever, elevated WBC, elevated pulse, distended colon). Teach home care for new ostomy patients or refer to enterostomal therapist for education: 46. Teach proper skin care of perianal area to avoid skin breakdown. 47. Avoid fragranced products which can be irritating. 48. Teach dietary modification, and which foods to avoid. 49. Teach medication use, schedule, and side effects. 50. Teach importance of follow-up care. 51. Teach wound care for postoperative patients.