• Moistens and cleans mouth, neutralizes acid
• Contains antibodies IgA-so this is an implication for immune system
• Contains ptyalin, which begins digestion of starches 

The stomach secretes:

5

HCL, Intrinsic Factor, Mucous, Gastrin, Pepsin

controls gastric secretion and motility

(G cells in the antrum) 

breaks down proteins (chief cells) 

What are the accessory organs of digestion

secretes sodium bicarbonate and enzymes

(80% function) 

secretes hormones (insulin, glucagon, etc…) 

Secretions empty through the common bile duct into the duodenum:

Trypsin digests protein

Amylase digests starch

Lipase digests fats. 

Produces bile which emulsifies fats,

processes portal blood

provides storage for vitamins and nutrients,

protection with the Kupffer cells which produce phagocytic macrophages,

metabolism by removing ammonia and

synthesizing albumin

Completion of digestion and absorption of most nutrients occurs in duodenum (1st 10 inches),

jejunum (about 8 feet) and ileum (last 8-10 feet).  

Stomach contents neutralized in duodenum by pancreatic and liver enzymes

Absorbs water. Bacterial breakdown of waste and bile salts.

Function: MOVEMENT, ABSORPTION, and ELIMINATION

There is 350-500 cc of blood in the gut

it can distend up to 1500 cc. 

What Arterys feed the Pancreas and stomach

What vain Collects blood from all areas of the digestion tract , processes absorbed nutrients, delivers blood to hepatic vein >> vena cava 

Chemical digestion and absorption of nutrients:

What are Carbohydrates boken down in to?

Chemical digestion and absorption of nutrients:

Proteins: where/ what brakes it down and in to what?

In the stomach (pepsin)

In the intestines (trypsin)

Final product (amino acids)

Chemical digestion and absorption of nutrients:

Fats and Fat-soluble vitamins: 

Lipase emulsifies in the small intestines.

Vitamins absorbed with the fatty Acids and glycerol. 

Jewish people 

What should a nurse look for when doing General Physical GI assessment 

Striae-streaks (like Cushing's),

Cullen’s sign (ecchymosis around the umbilicus)

Grey-Turner’s sign (blue discoloration around the flank or umbilicus), Color (jaundice) 

What should a nurse look for when doing  GI assessment Abdomen: Inspect, auscultate:

What should a nurse look for when doing  GI assessment Abdomen: Percussion:

What should a nurse look for when doing  GI assessment Abdomen: Palpate:

What should a nurse look for when doing  GI assessment Abdomen: Peristalsis:

Bowel sounds

remember to listen 1 minute in each quadrant

Bowel sounds: normal is high pitched

Bruits: swooshing sound over the abdominal aorta

Tympani: normal

Borborygmus: loud gurgling heard over a complete intestinal obstruction

Venous hum: often heard with cirrhosis over the umbilicus 

anemia due to GI bleed, infection in the GI tract

HGB↓ 

liver damage leads to impaired synthesis of clotting proteins, spleenomegaly leads to thrombocytopenia 

What might Liver function tests: Alanine aminotransferase (ALT)

  tell you about someones GI system?

lactate dehydrogenase (LDH)

bilirubin, ammonia, alkaline phosphatase (ALP)

hepatic or biliary 

• Tumor markers: CA 

pancriuos funftion-fecal fat (steatorrhea),

GI bleed- occult blood (melena),

parasites= loos or formrd

Liver function- urobilinogen (clay colored) 

What is a Radiographic examination for the GI?

and what will it reveal 

Flat plate of abdomen-first x-ray study in diagnosing a GI problem.

Reveals masses, tumors, strictures or obstructions

Post procedure: observe for s/s of perforation and bleeding (if polyps removed).

Push PO fluids after procedure. 

Post procedure: push PO fluids.

Possible stool softener or laxative given. 

Invasive so must check coagulation and contraindicated with iodine allergy.

Bowel prep given.

Post procedure: bed rest x 6 hours. Placed on right side. Inspect right lumbar region for bleeding. 

1. how would the nurse prep the pt for a Esophagogastroduodenoscopy/EGD:

2. What meds are given during

3. post care:

NPO after midnight,

conscious sedation used (Versed). Local anesthetic to inactivate gag reflex. 

NPO until the gag reflex returns, assess for perforation, such as pain, bleeding or fever. 

Endoscopic retrograde cholagiopancreatography (ERCP):

1.What is it for

2. What do u do for a pt after?

1. visualization of the liver, gallbladder and pancreas to identify the cause and location of obstruction.

2. Assess for post procedure complications such as cholangitis, perforation, sepsis, and pancreatitis. 

Colonoscopy:

   1. what is it for

     2. preprocedure

3. meds used 

1. endoscopic examination of the entire large bowel.

2. Clear liquids 24 hours prior to procedure. NPO after midnight. Bowel prep such as liquid preparation for bowel cleansing.

3. Conscious sedation. 

Gastric analysis:

1. what it is/used for 

2. preprocedure

measures the hydorchloric acid and pepsin content to evaluate gastric and duodenal ulcers.

NPO x 12 hours before test. Abstain from alcohol, tobacco, and medications avoided 24 hours prior to procedure. 

Ultrasonography 

1. what it is/used for 

2. preprocedure

used to image soft tissues, such as the liver, spleen, pancreas, gallbladder, and biliary system.

NPO 8-12 hours prior to procedure. 

involves swallowing three thin tubes, used to evaluate pressure, swallowing, reflux and acid content. 

Liver biopsy:

1.uses

2. containdications

3.sadation type

4. post care

1.needle aspiration of tissue to diagnose primary liver disease;

2. contraindicated if platelet count<100,000 or coagulation studies are abnormal.

3. Sedation is used.

4. Post procedure includes positioning on the right side with support under the costal margin. Assess for bleeding or pneumothorax. 

GI Elderly Considerations:

• Decline in epithelial cell growth with age (25% less in an elderly person)

• Decreased gastric secretion of intrinsic factor (predisposes the elderly to vitamin B12 deficiency

• Loss of teeth or dentures (poor fitting): predisposes the elderly to nutritional compromise

• Decreased salivation: increased risk of infection and decreased taste

• Abdominal organs easier to palpate due to thinning musculature and redistribution of fat

• Increased risk of cancer: think slowing immune system

• Slowing of all GI processes 

ORAL CAVITY:

History: 

Some of the things you need to ask are: recent infections, history of stomatitis, nutritional compromise, oral hygiene, oral trauma, stress, immunocompromise, smoking. 

what Interventions may a nurse do

for the ORAL CAVITY?

Oral hygiene, soft toothbrush, frequent mouth rinsing, drug therapy, anti-infectives (antibiotics, antifungal, antiviral), analgesics (local anesthetics, codeine and acetaminophen) REMEMBER ALCOHOL BASED PRODUCTS WILL BURN!!!! 

Leukoplakia (thickened, white, firmly attached patches), Erythroplakia (red, velvety mucosal lesions) 

Tumors-Malignant of the oral cavity

3 most common

Tumors history 

high risk groups

S/S

high risk groups (use of large amounts of alcohol, tobacco, over 40 years of age)

Signs and symptoms: hoarseness, dysphagia, and paresthesia-abnormal sensation, as burning, prickling, 

Oral Tumors interventions: 

Oral Tumors Nursing Implications:

Some nursing diagnoses to think about for patients with oral problems:

• Ineffective airway clearance

• Body image

• Pain

• Infection

• Nutrition

• Swallowing 

viscous lidocaine, Benadryl. 

diabetes, obesity, pregnancy, wearing tight clothing, bending over or lifting, certain abd surgeries, alcohol abuse, tobacco use, chocolate, coffee and fatty foods. 

Antacids, H2 antagonists, cholinergics, avoid food after 6 pm, elevate HOB for sleep, WT loss, avoid known irritating foods, monitor OTC meds (NSAIDS, ASA), decrease use of alcohol, tobacco, and caffeine, surgery Nissen fundoplication or angelchik prosthesis. 

 Sliding which is also termed Type 1

Rolling or Type 2

What is a Sliding Type 1 Hernia?

Slight herniation of stomach upward

80% are asymptomatic

Symptoms usually worsen with position

Portions of the stomach herniates alongside the esophagus.

Does not usually include problems with reflux—but can be present

What are the Complications of a Hiatal

 hernia ?

None if patient is asymptomatic, treat as per GERD with S/S GERD,

surgery if not responsive to conservative tx, Nissen Fundoplication, Angelchik. 

How is a Hiatal Hernia diagnosed 

How is Acalasia Diagnosed?

Squamous cell=90%

Adenocarcinoma=6% 

Progressive dysphagia, weight loss,

odynophagia- severe pain on swallowing 

regurgitation, hoarseness, substernal, boring pain,

iron deficiency anemia

Esophagogastrectomy—diseased portion of the esophagus is removed and the cervical portion is connected to the stomach. May include radical neck dissection and laryngectomy.

Esophagectomy—colon interposition, replacing lost sections with colon. 

Curative/palliative radiation, periodic dilation of the esophagus, single or combination chemotherapy, Laser treatment (after endoscopy and debulking), surgery

A pt has a had an esophagial surgery and the air way is mantained what is the nurses next intervention?

4

eating/ hydration:

 dehydration, monitor I&O and WTS

monitor labs (NA, CL),

inspect IV’s, TPN or enteral feedings

Assess skin for breakdown or s/s infection

teach and assist with turning, coughing and deep breathing

viral infection, contaminated foods, meds (NSAIDS) alcohol or tobacco use, stress. 

Eliminate cause if known, diet, NPO—clear liquids—advance as tolerated, antiemetics, antibiotics, H2 blockers, IV’s to prevent dehydration if N/V severe, antacids. 

What groups of people are most at risk of getting 

Chronic Gastritis

Symptomatic and possible cortisone (short term), B12 if indicated. 

Associated with an increase in aggressive factors, increased acid production, pepsin damage, more rapid emptying of stomach contents 

follows food ingestion, not relieved with food 

N/V, more so with gastric ulcers

dyspepsia with both 

hemorrhage - 10-15%, 

can awaken from sleep, is relieved by ingestion of food

antacids, but returns within 1-3 hours 

dyspepsia with both

hemorrhage -more likely to stop spontaneously 

mortality 7-10%, perforation (duodenal > gastric) 

Antacids 1-3 hours pc and at hs, H2 blockers (cimetidine and ranitidine), can interfere with theophyllin, dilantin, and coumadin, mucosal healing agents: sucralfate 30 minutes ac. Antibiotics for H. pylori infection, Tetracycline or amoxicillin.

Management ulcers Diet:

Increase fiber, decrease spices or other aggravating foods, avoid alcohol, caffeine products, and coffee, increased milk or cream not of value, eat small, frequent meals 

What needs ot be done for a pt with Gastric Cancer,

 Pre-op?

What needs ot be done for a pt with Gastric Cancer, Post-op?

maintain nutritional status (B12 and vitamin for life; dumping syndrome).

Maintain optimal respiratory status (chest tubes). Prevent infection (incisional healing).

Provide emotional support (grieving). Pain control 

abd rigidity, pain, temperature elevation, leukocytosis, bile stained drainage from incision

Treatment = another surgery 

small frequent meals. Increase protein, fat, decrease carbohydrates, decrease fluid with meals, eat slowly. Lie down for 30 minutes after meals. 

vagotomy 

Improves with time

no milk or fluids with meals.

Lomotil or immodium. Paregoric or codeine. Cholestyramine (bile acid binding resin) 

WT loss, malabsorption, anemia, early satiety r/t a decrease in reservoir size, reflux, 

Inadequate mixing causing fatty stools

can treat with pancreatic enzymes

avoid milk or dairy products

treat with lactaids. 

B12 levels checked at least yearly. 

Iron deficiency due to impaired absorption is r/t ,

and treated:

rapid gastric emptying, iron absorbed in duodenum and proximal jejunum.

Treat with iron PO or parenteral. 

Hematemesis

hematachezia (the passage of fresh blood per anus,) 

melena (black, "tarry" feces )

• Hyperactive bowel sounds, diarrhea

• Postural BP and pulse changes

• Cool extremities, pallor

• Decreased urine output and thirst

• Anxiety, agitation, then later lethargy

Frequent VSS checks every 15 minutes

• Prepare to administer vasopressor as ordered to maintain systemic perfusion, Vasopressin IV or via bleeding artery to vasoconstrict 

Maintain large bore, patent IV for saline or LR

They may need blood latter

T/F

A pt with a GI bleed should not have an NG tube placed as this could rupture the already bleeding ulcer

False

An NG tube should be placed to prvent the pt from vommiting as vomiting will rupture the ulcer

How should the nurse position the pt with a GI bleed?

WHY?

Position on left lateral with HOB elevated 15 degrees

to support BP and prevent aspiration 

Placing a Foley

• Assess hourly urine output and specific gravity

• Assess lung sounds and peripheral edema

• NG measurments

(large bore)

• Low constant suction and/or lavage 

Monitor pH and administer antacids if ordered 

A pt with a GI bleed.  the nurse should  assess _______ status, that includes: Lethargy, confusion, irritability

Histamine blockers IV 

Healing does not equal cure

(at risk for subsequent bleeds)

Teaching: Medications, follow up, reoccurrence, risk factors, Abdominal problems 

inflammation of the common bile duct. 

there is irritation and reabsorption that may cause ischemic walls and necrosis. 

Indigestion after eating fatty foods

• Pain, tenderness right subcostal and epigastric areas: builds in intensity over 30 minutes, radiates to back (scapular)

• Positive Murphy’s (inspiratory arrest or holding breath due to increased pain when gallbladder palpated):

Peritoneal irritation increases rebound tenderness

• Anorexia, N/V

• Increased HR, temp, RR, diaphoresis and leukocytosis 

What is a Common bile Duct Obstruction?

what does it cause?

bile does not get to the gut

Mild jaundice, steatorrhea, clay colored stools—lack of urobilinogen, dark amber urine. 

oral cystography, ERCP, Ultrasound. You will also see and increase in direct conjugated and indirect unconjucated bilirubin in the labs. 

• Manage pain 

• Laporoscopic/laser cholecystectomy

• Abdominal cholecystectomy

Lithotripsy—not extremely effective, takes an hour and patient must be sedated. Disintegration of gallstones by shock waves 

NPO, NG, IV’s,

JP drain (<50 cc/8 hours), T-tube (<500 cc QD)

yes

but are slow and not always effective. 

What is Acute or chronic inflammation of pancreas.

 Biliary tract disease, elevated pancreatic enzymes (protease, lipase, amylase), pressure builds up in the duct causing rupture. Enzymes auto digest the pancreas, Pseudocyts and abscesses often form 

When a nurse is assessing a pt suspected of having inflammation of pancreas,  what must the nurse check?

Why?

Cullen—blue-grey periumbilical,

Turner—grey-blue flanks

indicate leakage/bleeding into the cutaneous tissue. 

increased serum and urine amylase,

increased serum lipase—specific to pancreas, leukocytosis, elevated blood sugars,

elevated AST and LDH,

elevation of ALT—indicative of biliary obstruction, decreased calcium, Hct, PO2, increased BUN 

Remove precipitating cause

• Prevent and treat complications (shock leading cause of death)

• Treat pain with Demerol vs. Morphine

• NG, foley, IV’s

• Insulin for hyperglycemia 

Why would a nurse give a Anticholinergic to a pt with inflammation of pancreas?

which Anticholinergic can you not give?

to decrease pancreatic activity

atropine 

Pts with inflammation of pancreas may need TPN.

T/F

True

if NPO for extended periods 

bland, low fat, increased protein and carbohydrates

• No alcohol or caffeinated products. 

diabetes, pancreatitis, men>women

5 year survival rate only 3% 

pain varies but can awaken at night. Symptoms of biliary obstruction when tumor invades head of pancreas (jaundice, clay colored stools), malabsorption, weight loss, glucose intolerance.

Jaundice as the first sign is often the only sign before diagnosis

What can they do for the treatment of 

Pancreatic Cancer

Surgery

Most of the interventions are physically or psychologically supportive

Whipple procedure, which involves removal of part of the stomach, duodenum, head of the pancreas, portion of the jejunum. Cure is possible if tumor confined to the head of the pancreas. Survival rate is very low.

Refer to hospice. 

93% of drugs are altered in the liver. This makes treatment of liver disorders difficult since medications may not be altered or may cause more damage. 

Liver cancer

Precipitating factors

Poor prognosis (most die within 6 months), surgical removal can be done, but rarely curative, similar to liver failure, pain control difficult, as liver can’t detoxify drugs, systemic chemotherapy or via hepatic artery, this cancer is unresponsive to radiation therapy. 

icteric (prodromal)

Flu like, RUQ pain, fat/food intolerance, dyspepsia, hepatomegaly, lymphadenopathy, myalgias, photophobia, WT loss, urticaria (Hives). 

Hepatitis

Diagnosis: 

Lab—increased direct bilirubin, AST, ALT, decreased ALP, albumin, serum calcium, hypoglycemia, prolonged protime. 

Hepatitis

Treatment: 

Antiemetic, vitamin supplements, well balance diet (high carb, low fat & small, frequent meals), prevent transmission to others (universal precautions), bedrest initially, abstain from alcohol for at least one year, possible steroids (short term), skin care (cholestyramine/ questran), immune golubulins, heptavax. 

Portal hypertension, ascites, bleeding esophageal varices, coagulation defects, jaundice, portal-systemic encephalopathy,

hepatorenal syndrome-a condition in which there is progressive kidney failure in a person with cirrhosis of the liver

Cirrhosis S/S: 

early

Cirrhosis S/S: 

Late 

RUQ or epigastric discomfort, collateral circulation—esophageal varices, portal hypertension, hemorrhoids, Spider angiomas and palmar erythema. Believed to be r/t increased estrogen levels. 

Cirrhosis S/S: 

Late

Inability to process bilirubin

Cirrhosis S/S: 

Late

respiratory problems r/t: 

Cirrhosis S/S: 

Late

Vitamin deficiencies 

Cirrhosis S/S: 

Late

anemia 

Cirrhosis S/S: 

Late

Infection

Cirrhosis S/S: 

Late

Inability to metabolize hormones

Cirrhosis S/S: 

Late

Hepatorenal failure

decrease or eliminate causes, treat problems (circulatory, hematologic, immunologic, etc),

provide supportive care, rest, abstinence from alcohol, hepatotoxins,

balanced diet with vitamin supplements (avoid fats, sodium), antiemetics (dramamine, can’t detoxify compazine), diuretics, manage ascites

CHF, Pulmonary edema, MI, septicemia, DIC.

Esophageal Varices: 60% will experience bleeding of which 30-60% will die.

Bleeding constitutes a medical emergency. 

Liver unable metabolize substances toxic to brain, such as ammonia.

• Ammonia produced by bacterial degradation of protein in the GI tract 

Portal systemic encephalopathy:

Treatment: 

Decrease protein in diet

• Lactulose (cathartic, excrete ammonia in stool)

• Neomycin (inhibits protein conversion to ammonia) 

Portal systemic encephalopathy:

Transplantation:

What drug will pt need to be on for life, Why?

Cyclosporin A, Azathioprine (Imuran), prednisone (Deltasone), to reduce risk of rejection 

T/F

There is no priority for liver transplants it is first come first served

Fales

Transplantation of livers is highly regulated with protocols and guidelines about who will get a liver and even rate candidates by priority. Often patients on the transplant list will move from high priority to lower depending on their condition. 

What are the types of hernias

(not stomach)

Intestinal Herniation: Abdominal or Inguinal Femoral

what can a pt try before doing surgery for a 

Intestinal Herniation

If a Hernia is Incarcerated what will it lead to?

Indirect: Bowel pokes through an opening

Direct: weak portion of the abdominal wall 

What is a Mechanical obstruction?

What is a Non-mechanical Obstruction

Obstruction  

S/S: 

What lab values will change with  an Obstruction  

NPO with NG, IV’s, foley 

After a nurse has impolmented (NPO with NG, IV’s, foley) 

 what should the nurse do next?

5

• Assess pain and medicate as appropriate

• Provide comfort measures

• Monitor bowel sounds, vomitus

• Measure abdominal girth

• Assess labs 

Umbrella term

• Characterized by periods of reemission and exacerbation 

T/F

IBD has a Familial tendency

Ulcerative Colitis

Location

Begins in the rectum

and proceeds in a continuous manner toward the cecum

Crohn's Disease

Location

Ulcerative Colitis

Peak incidence at age

Crohn's Disease

Peak incidence at age

Ulcerative Colitis

Complications

Crohn's Disease

Complications

Ulcerative Colitis

Number of stools

Crohn's Disease

Number of stools

Ulcerative Colitis or Crohn's Disease

Which one ha s a frequent need for surgery

Ulcerative Colitis and Crohn's Disease are treated similarly.

T/F

What is the treatment for 

Ulcerative colitis and Crohn’s disease

avoid milk, spicy foods, increase protein and calories, decrease fiber to decrease diarrhea, bowel rest,

TPN, NPO if others don't work

Surgery Ulcerative colitis:

3

Protocolectomy permanent ileostomy,

Kock’s continent pouch or

ileoanal pull through with or without pouch. 

Colorectal Cancer

Risk factor: 

Polyps

• Ulcerative colitis and Crohn’s

• Familial hx

• Lack of bulk in diet 

Colorectal Cancer

S/S: 

change in bowel habits, sense of incomplete evacuation, spasms of anal sphincter, rectal bleeding, hypochromic, microcytic anemia, (late) abd pain, N/V, ascites, WT loss, cachexia 

Colorectal Cancer

Diagnosis: 

Digital exam 15% detection, proctosigmoidoscopy 65% detection, fecal occult blood reliable and cost effective (screening begins at age 40), barium enema, CEA can monitor tumor response to treatment 

Colorectal Cancer

Treatments: 

Radiation can decrease size and lymph node involvement, chemotherapy for palliative treatment 

Colorectal Cancer

Surgery:

Colectomy—anterior to posterior resection with colostomy—sexual dysfunction, urinary incontinence. 

Colorectal Cancer

Nursing care: 

Assess knowledge and teach, ostomy care, nutrition, coping and support systems, grieving, altered body image, sexual dysfunction, urinary incontinence, powerlessness and hopelessness.