The document provides information on disorders of the gastrointestinal system. It begins with an overview of the anatomy and functions of the digestive system. It then discusses specific disorders such as stomatitis, oral cancer, and disorders of the salivary glands that affect the mouth. Disorders of the esophagus are also reviewed, including gastroesophageal reflux disease, hiatal hernia, achalasia, and esophageal cancer. Nursing management of these gastrointestinal disorders focuses on promoting oral hygiene, ensuring adequate nutrition, pain management, preventing infections, and providing patient education.

1. UNIT 1
GASTRO INTESTINAL
DISORDERS

2. Objectives
By the end of the session, participants will be able to:
 Review the anatomy and physiology of gastro intestinal system
(GIT)
 Discuss the causes, pathophysiology and manifestation of the
following disorder
 Apply nursing process including assessment, planning,
implementation and evaluation of care provided to the client with
GIT disorders.
 Develop a teaching plan for a client experiencing disorders of the
GIT

3. Oral
cavi
ty
An
us
Esophagus
Liver
Esophagus
Sphincter Stomach
Small
intestine
Large
intestine
Ileum
(small
Intestine)
Ap
n<t ix
anu
s

4. The Digestive System
 Also known as the gastrointestinal
(GI) tract or the alimentary
system, it is responsible for
breaking down the complex food
into simple nutrients, the body can
absorb and convert into energy.
This process is known as
digestion.

6. Mouth/Esophagus
 Digestion begins in the mouth where the
teeth mechanically break food down into
smaller pieces by chewing and mixing it
with saliva.
 The food is then swallowed and
transported down into the esophagus
through the rhythmic contraction of
muscles known as peristalsis

7. Stomach
 Further, mechanical and chemical
breakdown of the food occurs in
the stomach, which secretes
gastric juices that contain
hydrochloric acid (HCL)and
pepsinogen, a non-active form of
the enzyme pepsin.

8. Small Intestine
 Approximately 20 to 25 feet long and is
responsible for absorbing nutrients from
the chyme (semi-liquid mass of partially
digested food)
 Small intestine divided into: duodenum
(first 10-12 inches); jejunum (the middle
8-10 feet) and the ileum (the distal 12
feet).

9. Large Intestine
 Also known as the colon, the large
intestine is responsible for absorbing
water, electrolytes, and salts
 The last 5 inches of the large intestine
comprise the rectum. The distal end of the
rectum forms the anal canal composed of
muscles that control defecation. The
opening to the anal canal is called the
anus.

10. Accessory Organs
 Pancreas.
 Liver.
 Gallbladder.
The digestive system is also comprised of
organs that help in digestion of food:

11. LIVER…… really works hard….

12. Functions of the Liver
 Produce and secrete bile,
which emulsifies fat.
 Convert glucose into
glycogen for storage.
 Convert glycogen to
glucose when blood
sugar level drops.
 Metabolize hormones.
 Break down nitrogenous
wastes to urea.
 Incorporate amino acids
into proteins.
 Filter blood and destroy
bacteria.
 Produce prothrombin and
fibrinogen, which are
necessary for blood
clotting.
 Manufacture cholesterol.
 Produce heparin.
 Store vitamin B12 and fat
soluble vitamins A,D,E,
and K.
 Detoxify poisonous
substances.

13. The Gallbladder
 A pear-shaped sac attached to the
underside of the liver.
 Stores and concentrates the bile until it is
needed in the small intestine.

14. Changes in the Digestive System
with Aging
 Decrease in peristalsis.
 Oral changes.
 Decrease in enzyme secretion.
 Decrease in saliva.

15. Functions of the
gastrointestinal system
structures (summary)

16. Let’s have a small
challenge …..

17. DISORDERS OF MOUTH

18. Objectives
DISORDERS OF MOUTH AND ESOPHAGUS
 Stomatitis
 Oral cancer/tumor
 Salivary glands disorder
 Gastro esophageal reflux disorder (GERD)
 Hiatal hernia
 Achalasia
 Diverticula
 Esophageal cancer /tumor

19. Useful tip…..
Remember!!!!
the suffix “itis” used for
inflammation

20. Disorders of the Oral Tract:
1. Stomatitis
 It is an inflammation and ulcerations in the
oral mucosa or mouth.
 Can be caused by infections, damage to
the mucous membranes by irritants, or
chemotherapy.

21. 2. ORAL CANCER
 Cancers of the oral cavity which occurs in any parts of
mouth or throat.
CAUSES:
 Genetics ,
 alcohol consumption,
 substance abuse,
 sometimes ingestion of smoked food.

22. Highly effected areas….
 Squamous cell area of oral cavity
 Oro-pharynx
 Lateral sides of tongue
 Floor of mouth
 Lips

23. Clinical manifestation
 Initially, painless lesion that does not heal
 Tenderness
 Difficulty in chewing
 Swallowing
 Speaking
 Coughing of blood-tinged sputum
 Enlarged cervical nodes

24. Diagnostic tests
 Oral examination
 Biopsy

25. Salivary glands
2018/03
/15
Compiled by C
Settley

26. Disorders of salivary glands
1. PAROTITIS
Inflammation of parotid glands . In common words, we call is Mumps.
Signs include swelling and tenderness of glands, fever. Treatment is
dehydration, antibiotic and surgery in complicated stage.

28. Parotitis
• MEDICAL management: Antibiotic therapy is
necessary. Drainage by procedure known as
parotidectomy.
• Nursing management: maintaining adequate
nutritional and fluid intake, good oral hygiene,
compliance with prescribed medicine.

29. Disorders of salivary glands
2. SIALADENTITIS
Inflammation of salivary glands. Caused by dehydration,
stress, malnutrition, radiation therapy, salivary glands
calculi.
Signs include pain, fever, swelling, discharge.
Treatment is hydration, antibiotic, surgery

30. Disorders of salivary glands
3. SIALOLITHIASIS
Calculi in salivary glands. Salivary calculi usually formed
by calcium phosphate. It is asymptomatic unless
infection occurs. The calculi is extracted through
lithotripsy

31. Useful tip…..
Remember!!!!
the signs of infection are:
Redness, fever, pain, swelling
The story of
R,F,P,S

32. Nursing process for oral
disorders
 History taking
 Oral hygiene, awareness of lesion in oral cavity, daily food intake,
substance abuse, history of sore or blood in sputum, use of dentures
 Physical examination of lips, gums, tongue
 Lab test or other diagnostic test

33. Evaluation and diagnostic data including laboratory tests
and radiologic and endoscopic examinations
Bowel elimination patterns
Physical examination including inspection
Psychosocial factors
Complete nutritional history
Medication history including medications
History of present complaint regarding specific symptoms

34. Nursing diagnosis
 Impaired oral mucous membrane related to a pathologic condition,
infection, chemical or mechanical trauma
 Imbalance nutrition less than body requirement related to inability to
ingest adequate nutrition secondary to dental and oral conditions.
 Disturbed body image related to physical change in appearance
resulting from disease condition or its treatment
 Fear of pain and social isolation related t disease or change in physical
appearance
 Pain related to oral lesion or treatment
 Impaired verbal communication related to treatment
 Risk of infection related to disease or treatment
 Deficient knowledge about disease process and treatment plan

35. Nursing intervention
 Promoting mouth care by regular brushing, flossing.
 Ensuring adequate food and fluid intake
 Supporting positive self image
 Minimizing pain and discomfort
 Promoting effective communication
 Preventing infection
HOME TEACHING
 Oral care, suctioning, tracheo-stomy care, wound care, diets.

36. DISORDERS OF ESOPHAGUS

37. DISORDERS OF THE ESOPHAGUS:
1. Gastro-esophageal Reflux
Disease
A disease in which the gastric secretions
flow upward into the esophagus due to
incompetent esophageal sphincter and
cause damage the tissue.

38. Sphincters in stomach
2018/03
/15
Compiled by C
Settley
• Two sphincters keep the contents of the stomach
contained;
• the lower oesophageal sphincter (found in the cardiac
region), at the junction of the oesophagus and stomach,
• and the pyloric sphincter at the junction of the stomach
with the duodenum

39. Clinical manifestation
 Pyrosis (burning sensation in esophagus)
 Dyspepsia (indigestion)
 Regurgitation (backflow of food)
 Dysphagia (difficulty in swallowing)
 Hyper-salivation
 Oesophagitis

40. The general GIT system:
Diagnostic studies
• X ray
• Barium swallow
• To determine the cause of painful swallowing,
difficulty with swallowing,
abdominal pain, bloodstained vomit, or unexplained
weight loss.
• To visualize the structures of the oesophagus.
• The patient swallows liquid barium while X-ray
images are obtained.
• The barium fills and then coats the lining of the
oesophagus so that it can diagnose anatomical
abnormalities such as tumours.

41. The general GIT system:
Diagnostic studies
• Barium enema
• Detect changes or abnormalities in the large intestine
(colon).
• The radiologist will insert a small tube into the patient’s
rectum and introduce the barium and water mixture.
• The radiologist may gently push air into the colon after
the barium has been delivered in order to allow for
even more detailed X-ray images.

42. The general GIT system:
Diagnostic studies
2018/03
/15
• Endoscopies
• A procedure in which an instrument is introduced into
the body to give a view of its internal parts.
Compiled by C Settley

43. The general GIT
system:
Diagnostic
studies
• Fibre optic colonoscopy
2018/03
/15
Compiled by C
Settley

44. The general GIT system:
Diagnostic studies
2018/03
/15
Compiled by C
Settley
• Abdominal
ultrasound
• CT scan
• MRI
• Stool tests

45. Management of GERD
 Instruct to eat low fat diet
 Avoid caffeine, tobacco, beer, milk, carbonated
drink
 Avoid eating and drinking 2 hrs before bedtime
 Maintain normal body weight
 Avoid tight fitting clothes
 Elevate head of bed 30 degree
 Antacids
 Surgical intervention.

46. DISORDERS OF THE ESOPHAGUS:
2. Hernias
 Occurs when the wall of a muscle weakens and the intestine
protrudes through the muscle wall.
Hiatus hernia
 The opening in the diaphragm through which
esophagus passes becomes enlarged, and part of
the upper stomach tends to move up into the thorax.

47. Clinical manifestation
 Regurgitaion
 Dysphagia
 Sense of fullness
 Haemmorhage (loss of excessive blood)
 Obstruction
 Strangulation
Is the condition in which circulation of blood to a part of the
body (especially a hernia) is cut off by constriction.
Complication

48. Diagnostic tests
 X- rays
 Barium swallow

49. Management
 Frequent, small foods
 Elevate head of bed
 Instruct client to Stay in relax position for 1 hrs at least after meal

50. Disorders of the Esophagus:
3. Achalasia
 Achalasia is absent or ineffective peristalsis of the
distal esophagus, along with failure of esophageal
sphincter to relax response of swallowing.
Ineffective
peristalsis
Failure of
esophageal
sphincter
Achalasia

51. Clinical manifestation
 Difficulty in swallowing liquid and solid food
 Sensation of food sticking in the lower portion of esophagus
 Pyrosis (chest burning)

52. Diagnostic test
 X-ray studies
 Barium swallow
 CT scan

53. Management
 Instruct client to take food slowly and drink fluid with food
 Surgical intervention might be done i.e. esophagomyotomy
(Lower part of esophagus is cut length wise).

54. The cause are:
 Ingestion alcohol
 Use of tobacco
 Nutritional imbalances
 Heredity
 Environmental influences
Disorders of the GI Tract:
1. Esophageal Cancer

55. Disorders of the Esophagus:
4. Diverticulosis & Diverticulitis
 The diverticula are sac like protrusions of the weak portions of the
esophgeal wall.
 Diverticulosis is a condition of the colon in which multiple
diverticula are present.
 Diverticulitis refers to the inflammation of one or more of the
diverticula generally in the sigmoid colon.

56. Match the following
Disease Definition
Diverticulosis An inflammation
Diverticula A condition
Diverticulitis
A sac like
protrusion

57. Clinical manifestation
 Difficulty in swallowing
 Fullness in the neck
 Belching
 Regurgitation
 Gurgling noises after eating

58. Diagnostic tests
 Barium swallow
Management
 Surgical intervention is required for the removal of
diverticula

59. Disorders of the esophagus:
5. ESOPHAGEAL CANCER
Cancer of esophagus
CAUSES : tobacco use, alcohol consumption, dietary
habits, environmental influences, excessive heat,
genetic formation

60. Clinical manifestation
 Ulcerated lesion of esophagus
 Dysphagia (initially, with solid then liquid)
 Sensation of mass on the throat
 Painful swallowing
 Sub-sternal fullness and pain
 Regurgitation
 Persistent hiccups
 Respiratory difficulty
 Fowl smell

61. Diagnostic test
 Gastroscopy
 Bronchoscopy
 Endoscopic ultrasound

62. Useful tip…..
Remember!!!!
the suffix “otomy” used for
resection or surgical removal

63. Management
 Early stage = the treatment is easy and prognosis is
good
 Later stage = symptomatic treatment include surgery,
radiation, chemotherapy and combination
 Surgical management = esophagectomy
Esophago= esophagus
Otomy = removal of

64. Nursing process for
esophagus disorder
ASSESSMENT
 History taking
 Physical examination
 Respiratory signs (distress, SOB)
 Inquired about dysphagia, dietary patterns, weight
loss, pain and tenderness

65. NURSING DIAGNOSIS
 Imbalanced nutrition less than body requirement
related to difficulty in swallowing
 Risk for aspiration related to difficulty in swallowing or
tube feeding
 Acute pain related to difficulty swallowing, ingestion of
an abrasive agent, tumor or frequent episodes of
gastric reflux
 Deficient knowledge about esophageal disorder,
diagnostic test, treatment and rehabilitation

66. Nursing intervention
 Encourage adequate nutrition
 Decrease risk of aspiration
 Relieving pain
 Provide patient education
HOME TEACHING
 Suctioning
 Tube feeding or parental feeding
 Medication
 Dietary needs of patient and plan

67. DISORDERS OF
STOMACH

68. DISORDERS OF STOMACH
 Gastritis
 Ulcer disease
 Gastric carcinoma
Objectives

69. 1. Gastritis
An inflammation of the stomach mucosa
Causes: medications, smoke, food allergens, or toxic chemicals.
Two types
 Acute gastritis
 Chronic gastritis

70. Acute Gastritis
 Short term
 Related to chemical ingestion, spices, alcohol, drugs, NSAIDS,
Aspirin, Iron, chemotherapy, radiation

71. Chronic Gastritis
 Type A = Autoimmune disease.
 Type B = associate with infection i.e. Helicobacter
Pylori. Infection damage stomach mucosa
Gastric
cells
Pernicious
Anemia

72. Medical Management
 Mild acute gastritis
 Symptomatically, bland diet, antacid
 Type A
 Management of underline systemic disease. Vit B12
 Type B
 Symptomatic control and medication for H. Pylori

73. Nursing Management
 Preventive health teaching
 Monitoring
 Supportive care
 Relieving pain
 Adequate fluid balance

74. Home Teaching
 Don’t leave food out of refrigerator over 2 hrs
 Wash cutting boards, utensils with soaps after cutting raw meat and
poultry
 Avoid slow cooking of meat and poultry
 Freeze or refrigerate leftovers promptly

75. 2. Peptic Ulcer Disease
 Peptic ulcers are erosions that form in the
esophagus, stomach, or duodenum resulting
from acid/pepsin imbalance.
 Two types: gastric and duodenal
 CAUSES:
Genetic factors
Environmental factors such as smoking,
alcohol, stress, coffee
Infection

76. Duodenal Ulcers versus Gastric
Ulcers
DUODENAL ULCERS GASTRIC ULCERS
Age : 30 -60 yrs Usually 50 and over
Hyper-secretion of stomach acid
(HCL)
Normal or hyposecretion of stomach
acid (HCL)
May have weight gain Weight loss
Pain occur: 2 – 3 hr after a meal;
ingestion of food relieves pain
Pain occur ½ hr to 1 hr after meal;
rarely occur at night; may be relieved
by vomiting; ingestion of food doesn’t
help, sometimes increase pain
Vomiting uncommon Vomiting common
Hemorrhage less likely to occur Hemorrhage more likely to occur
Risk factor: H.pylori, alcohol, smoking,
stress
Risk factor: H.pylori, alcohol, use of
NSAIDS, gastritis, smoking, stress

77. Diagnostic Tests
 Classic symptoms
 Endoscopy
 Biopsy
 Barium swallow

78. Medical Management
 Antacids
 Histamine receptor Antagonists
 Vagotomy
 Bilroth I
 Bilroth II
 Total Gastrectomy
 Vagotomy is a surgical operation in which one or more
branches of the vagus nerve are cut, typically to reduce
the rate of gastric secretion (e.g. in treating peptic ulcers).

80. Post Surgical Care
 Promote pulmonary ventilation – deep breathing &
coughing
 Provide comfort
 Measure N/G drainage, Look for COCA
 Monitor for bowel distention
 Monitor weight
 Avoid stress
 Elevate head when lying
 Add food in small quantity

81. Complication of Gastric
Surgery
 Bleeding
 Duodenal leakage
 Later: anemia, fat mal-absorption
 (For more reading: refer BOOKS)

82. 3. Gastric Carcinoma
 Cancer of stomach
 Causes: unknown, dietary habits, lifestyle, environment influences,
excessive heat, genetic factors

83. Sign & Symptoms
 Vague and persistent symptoms of gastric disorders
 Flatulence
 Loss of appetite, dyspepsia, bloating
 Gradual weight loss,
 Bowel habit changes

84. Treatment
 Only curative method : Surgical removal
 Diagnostic test: Biopsy
 Medication: No role except chemotherapy
 Radiation : Not effective
 Diet: no dietary consideration only symptomatic

85. TERMINOLOGY DESCRIPTION
Gastrectomy Removal of stomach
Gastro-duedenostomy
Partial gastrectomty with anastomosis to
the duodenum, same as Billroth I
Billroth I
The surgical removal of the pylorus in
the treatment of gastric cancer or peptic
ulcers. The proximal end of the
duodenum is anatomosed to the
stomach
Billroth II
The surgical removal of the pylorus and
duodenum. The cut end of the stomach
is anastomosed to the jejunum through
the transverse mesocolon.

86. TERMINOLOGY DESCRIPTION
Total gastrectomy
Removal of the entire stomach;
anastomosis of the esophagus to the
jejunum
Esophagojejunostomy
Total gastrectomy with anastomosis of the
esophagus to the jejunum

87. References
 Smeltzer S. C., & Bare B. G., (2004), “Medical Surgical
Nursing”, Lippincott Williams & Wilkins, Philadelphia