This document provides information on gastrointestinal disorders including peptic ulcer disease. It begins by outlining the learning objectives which are to review anatomy and physiology of the GI tract, discuss causes and management of various GI disorders, apply nursing process to clients with GI issues, and develop teaching plans. The document then covers specific disorders like hiatal hernia, achalasia, esophageal cancer, gastritis, and peptic ulcer disease. For each disorder it discusses definition, causes, manifestations, diagnostic tests, and treatment including both medical and surgical options. Nursing care focuses on maintaining nutrition, airway clearance, and dealing with anticipatory grieving.

1. Muhammad Yaqoob
RN, BScN, MSN
Lecturer Nursing
Institute of Nursing
Dow University of Health Sciences
February 28, 2022
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2. Objectives
By the end of the session learners will be able to:
1. Review the anatomy and physiology of gastrointestinal system (GIT)
2. Discuss the causes, pathophysiology and manifestation of the
following GIT disorders
3. Discuss the diagnostic, medical and surgical management of the
below mentioned disorders
4. Apply nursing process including assessment, planning,
implementation and evaluation of care provided to the clients with GIT
disorders
5. Develop a teaching plan for a client experiencing disorders of the
GIT
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3. Disorders of mouth and esophagus
Stomatitis
Oral cancer/tumour
Salivary gland disorders
Gastro esophageal reflux disorder
Hiatal hernia
Achalasia
Diverticula
Esophageal cancer/tumor
Disorders of stomach
Gastritis
Ulcer disease
Gastric carcinoma
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4. Disorders of small and large intestine:
Irritable bowel syndrome
Hernias
Intestinal obstruction
Hemorrhoids
Colorectal cancer
Appendicitis
Peritonitis
Ulcerative colitis
Chron’s disease
Anorectal abscess
Anal fissure
Anal fistula
Alteration in hepatobiliary system:
Pancreatitis
Pancreatic pseudocyst/abscess
Pancreatic carcinoma
Hepatic abscess
Cancer of liver
Cirrhosis of liver
Cholecystitis
Cholilithiasis
Cancer of gall bladder
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5. 4 Layers of GIT
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6. Muscularis
externa
Histological Organization
Tube made up of
four layers.
Modifications
along its
length as
needed.
1
2
3
4
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7. Hiatal Hernia
1. Definition
a. Part of stomach protrudes through
the esophageal hiatus of the diaphragm
into thoracic cavity
b. Predisposing factors include:
Increased intra-abdominal pressure
Increased age
Trauma
Congenital weakness
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8. Hiatal Hernia
 c. Most cases are asymptomatic; incidence
increases with age
 d. Sliding hiatal hernia: gastroesophageal
junction and fundus of stomach slide
through the esophageal hiatus
 e. Paraesophageal hiatal hernia: the
gastroesophageal junction is in normal place
but part of stomach herniates through
esophageal hiatus; hernia can become
strangulated; client may develop gastritis
with bleeding
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9. 9/7/2022 9

10. Hiatal Hernia
2. Manifestations: Similar to GERD
3. Diagnostic Tests
 a. Barium swallow
 b. Upper endoscopy
4. Treatment
 a. Similar to GERD: diet and lifestyle changes,
medications
 b. If medical treatment is not effective or hernia
becomes incarcerated then surgery; usually Nissen
fundoplication by thoracic or abdominal approach
Anchoring the lower esophageal sphincter by
wrapping a portion of the stomach around it to
anchor it in place
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11. 9/7/2022 11

12. Impaired Esophageal Motility
1.Types
a. Achalasia: Absent or ineffective peristalsis of the
distal esophagus, accompanied by failure of the
esophageal sphincter to relax in response to
swallowing.
b. Diffuse esophageal spasm: A motor disorder,
nonperistaltic contraction of esophageal smooth
muscle
2.Manifestations: Dysphagia, odynophagia, and/or
chest pain
3.Treatment
a.Endoscopically guided injection of botulinum toxin
Denervates (removal) cholinergic nerves in the distal
esophagus to stop spams
b. Balloon dilation of lower esophageal sphincter
May place stents to keep esophagus open
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13. Balloon Dilation of Lower Esophagus
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15. 9/7/2022 15

16. Esophageal stent
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17. Esophageal Cancer
1. Definition: Relatively uncommon malignancy with
high mortality rate, usually diagnosed late
2. Pathophysiology
 a. Squamous cell carcinoma
1.Most common affecting middle or distal portion
of esophagus
2.More common in African Americans.
3.Risk factors cigarette smoking and chronic
alcohol use
 b. Adenocarcinoma
1.Nearly as common as squamous cell affecting
distal portion of esophagus
2.More common in Caucasians
3.Associated with Barrett’s esophagus,
complication of chronic GERD and achalasia
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18. Esophageal Cancer
3.Manifestations
 a. Progressive dysphagia with pain while
swallowing
 b. Choking, hoarseness, cough
 c. Anorexia, weight loss
4.Collaborative Care: Treatment goals
 a. Controlling dysphagia
 b. Maintaining nutritional status while
treating carcinoma (surgery, radiation
therapy, and/or chemotherapy)
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19. Esophageal Cancer
5.Diagnostic Tests
a. Barium swallow: identify irregular mucosal
patterns or narrowing of lumen
b. Esophagoscopy: allow direct visualization
of tumor and biopsy
c. Chest x-ray, CT scans, MRI: determine
tumor metastases
d. Complete Blood Count: identify anemia
e. Serum albumin: low levels indicate
malnutrition
f. Liver function tests: elevated with liver
metastasis
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20. 9/7/2022 20

21. Esophageal Cancer
6. Treatments: dependent on stage of disease, client’s
condition and preference
 a. Early (curable) stage: surgical resection of
affected portion with anastomosis of stomach to
remaining esophagus; may also include radiation
therapy and chemotherapy prior to surgery
 b. More advanced carcinoma: treatment is palliative
and may include surgery, radiation and chemotherapy
to control dysphagia and pain
 c. Complications of radiation therapy include
perforation, hemorrhage, stricture
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22. Esophageal Cancer
7. Nursing Care: Health promotion; education regarding
risks associated with smoking and excessive alcohol
intake
8. Nursing Diagnoses
 a. Imbalanced Nutrition: Less than body
requirements (may include enteral tube feeding or
parenteral nutrition in hospital and home)
 b. Anticipatory Grieving (dealing with cancer
diagnosis)
 c. Risk for Ineffective Airway Clearance (especially
during postoperative period if surgery was done)
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23. The Stomach
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25. 9/7/2022 25

26. Gastritis
1.Definition: Inflammation of stomach lining
from irritation of gastric mucosa (normally
protected from gastric acid and enzymes by
mucosal barrier)
2.Types
 a. Acute Gastritis
1.Disruption of mucosal barrier allowing
hydrochloric acid and pepsin to have contact
with gastric tissue: leads to irritation,
inflammation, and superficial erosions
2.Gastric mucosa rapidly regenerates
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27. 9/7/2022 27

28. Gastritis
3. Causes of acute gastritis
 a. Irritants include aspirin and other NSAIDS,
corticosteroids, alcohol, caffeine
 b. Ingestion of corrosive substances: alkali or acid
 c. Effects from radiation therapy, certain
chemotherapeutic agents
4. Erosive Gastritis: form of acute gastritis which is stress-
induced, complication of life-threatening condition
(Curling’s ulcer with burns); gastric mucosa becomes
ischemic and tissue is then injured by acid of stomach
5. Manifestations
 a. Mild: anorexia, mild epigastric discomfort, belching
 b. More severe: abdominal pain, nausea, vomiting,
hematemesis, melena
 c. Erosive: not associated with pain; bleeding occurs 2 or
more days post stress event
 d. If perforation occurs, signs of peritonitis
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29. Gastritis
6.Treatment
 a. NPO status to rest GI tract for 6 – 12
hours, reintroduce clear liquids gradually
and progress; intravenous fluid and
electrolytes if indicated
 b. Medications: proton-pump inhibitor or
H2-receptor blocker; sucralfate (carafate)
acts locally; coats and protects gastric
mucosa
 c. If gastritis from corrosive substance:
immediate dilution and removal of substance
by gastric lavage (washing out stomach
contents via nasogastric tube), no vomiting
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30. Chronic Gastritis
 1.Progressive disorder beginning with
superficial inflammation and leads to atrophy
of gastric tissues
 2.Parietal cells normally secrete intrinsic
factor needed for absorption of B12, when
they are destroyed by gastritis. pts. develop
pernicious anemia
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31. Chronic Gastritis
3. Type B: more common and occurs
with aging; caused by chronic infection
of mucosa by Helicobacter pylori;
associated with risk of peptic ulcer
disease and gastric cancer
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32. Chronic Gastritis
4.Manifestations
 a. Vague gastric distress, epigastric
heaviness not relieved by antacids
 b. Fatigue associated with anemia;
symptoms associated with pernicious
anemia: paresthesia
Lack of B12 affects nerve transmission
5.Treatment: Eradicate H. pylori infection with
combination therapy of two antibiotics
(metronidazole (Flagyl) and clarithomycin or
tetracycline) and proton–pump inhibitor
(Prevacid or Prilosec)
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33. Chronic Gastritis
Collaborative Care
 a. Usually managed in community
 b. Teach food safety measures to prevent
acute gastritis from food contaminated with
bacteria
 c. Management of acute gastritis with NPO
state and then gradual reintroduction of
fluids with electrolytes and glucose and
advance to solid foods
 d. Teaching regarding use of prescribed
medications, smoking cessation, treatment
of alcohol abuse
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34. Chronic Gastritis
Diagnostic Tests
 a. Gastric analysis: assess hydrochloric acid
secretion (less with chronic gastritis)
 b. Hemoglobin, hematocrit, red blood cell indices:
anemia including pernicious or iron deficiency
 c. Serum vitamin B12 levels: determine
pernicious anemia
 d. Upper endoscopy: visualize mucosa, identify
areas of bleeding, obtain biopsies; may treat areas
of bleeding with electro or laser coagulation or
sclerosing agent
 5. Nursing Diagnoses:
 a. Deficient Fluid Volume
 b. Imbalanced Nutrition: Less than body
requirements
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35. Peptic Ulcer Disease (PUD)
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36. Peptic Ulcer Disease (PUD)
Definition and Risk factors
 a. The term peptic ulcer applies to mucosal ulceration
near the acid bearing regions of the gastrointestinal
tract.
 b. Duodenal ulcers: most common; affect mostly
males ages 30 – 55; ulcers found near pyloris
 c. Gastric ulcers: affect older persons (ages 55 – 70);
found on lesser curvature and associated with
increased incidence of gastric cancer
 d. Common in smokers, users of NSAIDS; heredity,
alcohol, cigarettes
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37. 9/7/2022 37

38. Peptic Ulcer Disease (PUD)
2.Pathophysiology
a. Ulcers or breaks in mucosa of GI tract occur
with:
1.H. pylori infection (spread by oral to oral,
fecal-oral routes) damages gastric epithelial
cells reducing effectiveness of gastric mucus
2.Use of NSAIDS: interrupts prostaglandin
synthesis which maintains mucous barrier of
gastric mucosa
b. Trauma, infection, physical or psychological
stress
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39. 9/7/2022 39

40. 9/7/2022 40

41. 9/7/2022 41

42. Peptic Ulcer Disease
Diagnosis
Endoscopy with cultures
Looking for H. Pylori
Upper GI barium contrast studies
EGD-esophagogastroduodenoscopy
Serum and stool studies
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43. 9/7/2022 43

44. Peptic Ulcer Disease (PUD)
3.Manifestations
 a. Pain is classic symptom: burning, aching
hungerlike in epigastric region possibly radiating
to back; occurs when stomach is empty and
relieved by food (pain: food: relief pattern)
 b. Symptoms less clear in older adult; may
have poorly localized discomfort, dysphagia,
weight loss; presenting symptom may be
complication: GI hemorrhage or perforation of
stomach or duodenum
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45. Peptic Ulcer Disease
Treatment
Rest and stress reduction
Nutritional management
Pharmacological management
Antacids (Mylanta)
• Neutralizes acids
Proton pump inhibitors (Prilosec,
Prevacid)
• Block gastric acid secretion
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46. Peptic Ulcer Disease
Pharmacological management
Histamine blockers (Tagamet, Zantac, Axid)
Blocks gastric acid secretion
Carafate
Forms protective layer over the site
Mucosal barrier enhancers (colloidal
bismuth, prostoglandins)
Protect mucosa from injury
Antibiotics (PCN, Amoxicillin, Ampicillin)
Treat H. Pylori infection
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47. Peptic Ulcer Disease
 NG suction
 Surgical intervention
Minimally invasive gastrectomy
Partial gastric removal with laproscopic surgery
Bilroth I and II
Removal of portions of the stomach
Vagotomy
Cutting of the vagus nerve to decrease acid secretion
Pyloroplasty
Widens the pyloric sphincter
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48. Billroth I
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49. Billroth II
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50. Peptic Ulcer Disease (PUD)
4. Complications
 a.Hemorrhage: frequent in older adult: hematemesis,
melena, hematochezia (blood in stool); weakness,
fatigue, dizziness and anemia; with significant bleed
loss may develop hypovolemic shock
 b.Obstruction: gastric outlet (pyloric sphincter)
obstruction: edema surrounding ulcer blocks GI tract
from muscle spasm or scar tissue
1.Gradual process
2.Symptoms: feelings of epigastric fullness,
nausea, worsened ulcer symptoms
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51. Peptic Ulcer Disease
 c.Perforation: ulcer erodes through mucosal wall
and gastric or duodenal contents enter
peritoneum leading to peritonitis; chemical at
first (inflammatory) and then bacterial in 6 to 12
hours
1.Time of ulceration: severe upper
abdominal pain radiating throughout abdomen
and possibly to shoulder
2.Abdomen becomes rigid, boardlike with
absent bowel sounds; symptoms of shock
3.Older adults may present with mental
confusion and non-specific symptoms
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52. Upper GI Bleed
Bleeding from a lesion in the esophagus,
stomach or duodenum is called upper GI
bleeding.
Patient may present with hematemesis or
melena.
Mortality approx. 10%
Predisposing factors include: drugs,
esophagitis, PUD, gastritis and carcinoma
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53. Upper GI Bleed
Signs and Symptoms
Coffee ground vomitus
Black, tarry stools
Melena
Decreased B/P
Vertigo
Drop in Hct, Hgb
Confusion
syncope
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54. Upper GI Bleed
Diagnosis
History
Blood, stool, vomitus studies
Endoscopy
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55. Upper GI Bleed
Treatments
Volume replacement
Crystalloids- normal saline
Blood transfusions
NG lavage
EGD
Endoscopic treatment of bleeding ulcer
Sclerotheraphy-injecting bleeding ulcer with
necrotizing agent to stop bleeding
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56. Upper GI Bleed
Treatments
Sengstaken-Blakemore tube
Used with bleeding esophageal varacies
Surgical intervention
Removal of part of the stomach
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57. Sengstaken-Blakemore Tube
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58. Gastric Carcinoma
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59. Cancer of Stomach
1. Incidence
 a. Worldwide common cancer, but less common in US
 b. Incidence highest among Hispanics, African
Americans, Asian Americans, males twice as often as
females
 c. Older adults of lower socioeconomic groups higher
risk
2. Pathophysiology
 a. Adenocarcinoma most common form involving
mucus-producing cells of stomach in distal portion
 b. Begins as localized lesion (in situ) progresses to
mucosa; spreads to lymph nodes and metastasizes early
in disease to liver, lungs, ovaries, peritoneum
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60. Symptoms
Epigastric pain (similar to peptic ulcer
pain, not relieved by antacids, not periodic,
not relived by eating or vomiting.)
Loss of appetite
Weight loss,
Dysphagia
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61. sign
 Pallor
Epigastric tenderness
Palpable Epigastric mass
Metastasis
Peritoneal metastasis produce ascites
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62. Cancer of Stomach
3.Risk Factors
a. H. pylori infection
b. Genetic predisposition
c. Chronic gastritis, pernicious anemia
d. Achlorhydria (lack of hydrochloric acid)
e. Diet high in smoked foods and nitrates
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63. Cancer of Stomach
5.Collaborative Care
a. Support client through testing
b. Assist client to maintain adequate
nutrition
6.Diagnostic Tests
a.CBC indicates anemia
b.Upper GI series, ultrasound identifies a
mass
c.Upper endoscopy: visualization and
tissue biopsy of lesion
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64. Cancer of Stomach
7.Treatment
 a. Surgery, if diagnosis made prior to
metastasis
1.Partial gastrectomy with anastomosis to
duodenum: Bilroth I or gastroduodenostomy
2.Partial gastrectomy with anastomosis to
jejunum: Bilroth II or gastrojejunostomy
3.Total gastrectomy (if cancer diffuse but
limited to stomach) with esophagojejunostomy
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65. Billroth-I
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66. Billroth-II
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67. Gastrectomy
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68. Total Gastrectomy
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69. Total Gastrectomy
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70. 9/7/2022 70

71. Cancer of Stomach
Complications associated with gastric surgery
 1. Dumping Syndrome
a.Occurs with partial gastrectomy; hypertonic,
undigested chyme bolus rapidly enters small intestine
and pulls fluid into intestine causing decrease in
circulating blood volume and increased intestinal
peristalsis and motility
b.Manifestations 5 – 30 minutes after meal: nausea
with possible vomiting, epigastric pain and cramping,
and diarrhea; client becomes tachycardic, hypotensive,
dizzy, flushed, diaphoretic
c.Manifestations 2 – 3 hours after meal: symptoms
of hypoglycemia in response to excessive release of
insulin that occurred from rise in blood glucose when
chyme entered intestine
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72. Cancer of Stomach
d. Treatment: dietary pattern to delay gastric emptying and
allow smaller amounts of chyme to enter intestine
 1. Liquids and solids taken separately
 2. Increased amounts of fat and protein
 3. Carbohydrates, especially simple sugars, reduced
 4. Client to rest semi-recumbent 30 – 60 minutes after
eating
 5. Anticholinergics, sedatives, antispasmodic
medications may be added
 6. Limit amount of food taken at one time
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73. Cancer of the Stomach
 Common post-op complications
Pneumonia
Hemorrhage
aspiration
Sepsis
Reflux gastritis
Paralytic ileus
Bowel obstruction
Wound infection
Dumping syndrome
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74. Paralytic ileus
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75. Cancer of Stomach
 Nutritional problems related to rapid entry of food into the
bowel and the shortage of intrinsic factor
 1 Anemia: iron deficiency and/or pernicious
 2 Folic acid deficiency
 3. Poor absorption of calcium, vitamin D
c. Radiation and/or chemotherapy to control metastatic spread
d. Palliative treatment including surgery, chemotherapy; client
may have gastrostomy or jejunostomy tube inserted
7. Nursing Diagnoses
 a. Imbalanced Nutrition: Less than body requirement:
consult dietician since client at risk for protein-calorie
malnutrition
 b. Anticipatory Grieving
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76. Reference resources
1.https://www.youtube.com/watch?v=o8Y
HxXvCbAo
2.https://www.youtube.com/watch?v=4iUC
sTlnRZc
https://www.youtube.com/watch?v=7_HJ8
VHBNwc
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