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Upper Gastrointestinal Disorders – Diagnostic Evaluation & Management

(High-Yield Notes for Competitive Nursing Exams)

A) Diagnostic Evaluation of Upper GI Disorders

1. Laboratory Tests

  • Complete Blood Count (CBC): Detects anemia (low Hb in ulcers, cancer).
  • Serum Electrolytes: Monitors dehydration, metabolic imbalances.
  • Liver Function Tests (LFTs): Rule out liver-related GI issues.
  • Amylase & Lipase: Evaluates pancreatic involvement.
  • Helicobacter pylori Tests: Urea breath test, stool antigen, biopsy (for ulcers, gastritis).
  • Fecal Occult Blood Test (FOBT): Detects hidden GI bleeding.

2. Imaging Studies

  • X-ray (Barium Swallow): Identifies esophageal strictures, achalasia, GERD.
  • Upper GI Endoscopy (Esophagogastroduodenoscopy – EGD): Direct visualization of esophagus, stomach, duodenum.
  • CT Scan/MRI: Used for tumors, abscesses, perforation detection.

3. Functional Tests

  • Manometry: Measures esophageal motility (achalasia, dysphagia).
  • pH Monitoring: Detects acid reflux (GERD diagnosis).

B) Management of Upper Gastrointestinal Disorders

1. Parotitis (Inflammation of parotid gland)

  • Causes: Viral infections (mumps), dehydration, poor oral hygiene.
  • Symptoms: Painful swelling near jaw, dry mouth, fever.
  • Management:
    • Hydration, warm compresses, sialogogues (sour candy to increase saliva).
    • Antibiotics if bacterial; analgesics for pain.

2. Stomatitis (Inflammation of oral mucosa)

  • Causes: Viral (HSV), fungal (candida), vitamin deficiency (B12).
  • Symptoms: Painful ulcers, difficulty eating, swollen gums.
  • Management:
    • Topical anesthetics (lidocaine gel), antifungals (nystatin for candida).
    • Good oral hygiene, avoid spicy foods.

3. Glossitis (Inflammation of tongue)

  • Causes: Nutritional deficiencies (B12, iron), infections.
  • Symptoms: Swollen, red tongue, pain, difficulty swallowing.
  • Management:
    • Treat nutritional deficiencies, antiseptic mouthwash, hydration.

4. Gingivitis (Inflammation of gums)

  • Causes: Poor oral hygiene, plaque buildup, smoking.
  • Symptoms: Swollen, bleeding gums, bad breath.
  • Management:
    • Professional dental cleaning, antiseptic mouthwash, good oral hygiene.

5. Pyorrhea (Advanced gum disease with pus formation)

  • Symptoms: Pus discharge, loose teeth, foul odor.
  • Management:
    • Antibiotics, deep cleaning (scaling), gum surgery if severe.

6. Dental Caries (Cavities)

  • Causes: Bacterial infection, poor diet, poor hygiene.
  • Symptoms: Toothache, sensitivity, decay.
  • Management:
    • Fillings, fluoride treatment, root canal in severe cases.

7. Halitosis (Bad Breath)

  • Causes: Poor oral hygiene, infections, GERD.
  • Management:
    • Good oral hygiene, mouthwash, tongue cleaning, treating underlying cause.

8. Dysphagia (Difficulty Swallowing)

  • Causes: Stroke, GERD, esophageal strictures.
  • Management:
    • Soft diet, thickened liquids, speech therapy, treating underlying cause.

9. Achalasia Cardia (Failure of lower esophageal sphincter to relax)

  • Symptoms: Regurgitation, weight loss, chest pain.
  • Management:
    • Balloon dilation, botulinum toxin injection, esophageal surgery.

10. Gastroesophageal Reflux Disease (GERD)

  • Causes: Weak lower esophageal sphincter, obesity, smoking.
  • Symptoms: Heartburn, regurgitation, chest pain.
  • Management:
    • Lifestyle changes (avoid spicy foods, elevate head at night).
    • Medications (PPIs, H2 blockers).
    • Surgery (fundoplication in severe cases).

11. Cancer of the Esophagus

  • Risk Factors: Smoking, alcohol, GERD, Barrett’s esophagus.
  • Symptoms: Dysphagia, weight loss, chest pain.
  • Management:
    • Surgery, chemotherapy, radiation therapy.

12. Hiatal Hernia (Stomach bulging into chest through diaphragm)

  • Symptoms: GERD-like symptoms, chest pain.
  • Management:
    • Weight loss, avoid lying down after eating.
    • Surgical repair if severe.

13. Gastritis (Stomach lining inflammation)

  • Causes: H. pylori infection, NSAIDs, alcohol.
  • Symptoms: Epigastric pain, nausea, vomiting.
  • Management:
    • Avoid irritants, PPIs, antibiotics for H. pylori.

14. Gastric & Duodenal Ulcers (Peptic ulcer disease – PUD)

  • Causes: H. pylori, NSAIDs.
  • Symptoms: Epigastric pain, relieved by food (duodenal), worsened by food (gastric).
  • Management:
    • Triple therapy for H. pylori (PPI + clarithromycin + amoxicillin).
    • Avoid NSAIDs, alcohol.

15. Gastric Cancer

  • Risk Factors: H. pylori, smoking, diet high in smoked foods.
  • Symptoms: Weight loss, anorexia, anemia.
  • Management:
    • Gastrectomy, chemotherapy.

16. Gastroenteritis (Inflammation of stomach & intestines – food poisoning)

  • Causes: Bacterial, viral, or parasitic infection.
  • Symptoms: Vomiting, diarrhea, dehydration.
  • Management:
    • Oral rehydration therapy (ORT), IV fluids if severe.

17. Esophageal Fistula (Abnormal connection between esophagus & other structures)

  • Causes: Trauma, cancer, congenital defects.
  • Symptoms: Coughing while eating, aspiration pneumonia.
  • Management:
    • Surgical repair, feeding tube for nutrition.

18. Peritonitis (Inflammation of peritoneum – life-threatening)

  • Causes: Perforated ulcer, ruptured appendix, trauma.
  • Symptoms: Severe abdominal pain, guarding, fever.
  • Management:
    • Emergency surgery, IV antibiotics, IV fluids.

🚨 High-Yield Quick Revision Points:

  • GERD → PPIs + Lifestyle changes
  • Peptic ulcer → H. pylori triple therapy
  • Achalasia → Balloon dilation or surgery
  • Esophageal cancer → Risk = Smoking, Alcohol
  • Gastric cancer → Risk = H. pylori
  • Peritonitis = Surgical Emergency

Care of Patient with Gastrointestinal Intubation and Special Nutritional Management

(High-Yield Notes for Competitive Nursing Exams)

A) Care of Patient with Gastrointestinal Intubation

1. Types of GI Tubes:

  • Nasogastric (NG) Tube: For decompression, feeding, or medication administration.
  • Orogastric Tube: For short-term use (common in infants or unconscious patients).
  • Gastrostomy/Jejunostomy Tubes: Long-term nutritional support.

2. Indications:

  • Decompression (e.g., bowel obstruction).
  • Enteral feeding (dysphagia, unconscious patients).
  • Medication administration.
  • Lavage (poisoning cases).

3. Nursing Care:

  • Tube Placement Verification: Check placement via X-ray, pH of aspirate, or air insufflation method.
  • Secure the Tube: To prevent displacement.
  • Patency Maintenance: Regular flushing with sterile water.
  • Monitor for Complications:
    • Aspiration risk: Keep head elevated (30–45°).
    • Blockage: Flush regularly.
    • Infection: Monitor insertion site for signs of infection in gastrostomy tubes.
  • Oral and Nasal Care: Prevent mucosal dryness and ulcers.

B) Special Nutritional Management

1. Enteral Nutrition (Tube Feeding):

  • Types: NG, PEG (percutaneous endoscopic gastrostomy), or jejunostomy feeding.
  • Formulas: Standard, high-protein, fiber-enriched, disease-specific (renal, diabetic formulas).
  • Nursing Care:
    • Ensure proper formula temperature.
    • Monitor for aspiration, diarrhea, bloating.
    • Check residual volume before feeding.

2. Parenteral Nutrition (IV Nutrition):

  • Indications: Non-functional GI tract (e.g., bowel obstruction, severe IBD).
  • Types:
    • TPN (Total Parenteral Nutrition): Central line.
    • PPN (Peripheral Parenteral Nutrition): Short-term via peripheral vein.
  • Nursing Care:
    • Monitor for infection at IV site.
    • Monitor blood glucose regularly.
    • Strict aseptic technique to prevent sepsis.

C) Management of Patient with Lower Gastrointestinal Disorders

1. Helminthiasis (Worm Infestation):

  • Causes: Roundworms, hookworms, tapeworms.
  • Symptoms: Abdominal pain, anemia, malnutrition, diarrhea.
  • Management:
    • Anthelmintic drugs (albendazole, mebendazole).
    • Hygiene promotion to prevent reinfection.

2. Constipation:

  • Causes: Low fiber diet, dehydration, immobility, medications.
  • Symptoms: Hard stools, straining, infrequent bowel movements.
  • Management:
    • High-fiber diet, adequate fluids, regular exercise.
    • Laxatives (if needed): Bulk-forming, osmotic, stimulant laxatives.

3. Diarrhea:

  • Causes: Infections, IBS, IBD, medications.
  • Symptoms: Frequent loose stools, dehydration, electrolyte imbalance.
  • Management:
    • Rehydration (oral or IV fluids).
    • Antidiarrheal drugs (loperamide).
    • Treat underlying cause.

4. Fecal Incontinence:

  • Causes: Neurological disorders, rectal surgery, chronic constipation.
  • Management:
    • Bowel training, pelvic floor exercises.
    • Dietary changes (fiber).
    • In severe cases, surgical intervention.

5. Irritable Bowel Syndrome (IBS):

  • Symptoms: Abdominal pain, bloating, alternating constipation and diarrhea.
  • Management:
    • High-fiber diet, stress management.
    • Antispasmodics (dicyclomine), antidiarrheals, laxatives as needed.

6. Appendicitis:

  • Symptoms: Right lower quadrant pain (McBurney’s point), fever, nausea.
  • Management:
    • Emergency appendectomy.
    • Pre-op: NPO, IV fluids, antibiotics.

7. Diverticular Disease:

  • Symptoms: Left lower quadrant pain, bloating, constipation.
  • Management:
    • High-fiber diet (except during acute diverticulitis).
    • Antibiotics for infection.
    • Surgery if complications occur.

8. Crohn’s Disease: (Chronic Inflammatory Bowel Disease)

  • Symptoms: Abdominal pain, diarrhea, weight loss, fistula formation.
  • Management:
    • Anti-inflammatory drugs (mesalamine), corticosteroids, immunosuppressants.
    • Nutritional support.
    • Surgery for complications.

9. Ulcerative Colitis: (Chronic Inflammation of Colon)

  • Symptoms: Bloody diarrhea, abdominal cramps, urgency.
  • Management:
    • Same as Crohn’s (anti-inflammatories, corticosteroids).
    • Surgery (colectomy) in severe cases.

10. Intestinal Obstruction:

  • Causes: Adhesions, hernias, tumors.
  • Symptoms: Abdominal distension, vomiting, constipation, absent bowel sounds.
  • Management:
    • NPO, NG tube for decompression.
    • IV fluids, electrolyte correction.
    • Surgery if strangulation or perforation.

11. Colitis:

  • Types: Infectious, ischemic, microscopic.
  • Symptoms: Diarrhea, abdominal pain, fever.
  • Management:
    • Treat underlying cause (antibiotics for infection, anti-inflammatories for IBD).

12. Abdominal Tuberculosis (TB Abdomen):

  • Symptoms: Abdominal pain, weight loss, fever, ascites.
  • Management:
    • Anti-TB therapy (ATT): 6–9 months.
    • Nutritional support.

13. Colorectal Cancer:

  • Symptoms: Change in bowel habits, rectal bleeding, weight loss.
  • Management:
    • Surgical resection (colectomy), chemotherapy, radiation.
    • Colostomy care if needed.

14. Polyps of Colon and Rectum:

  • Symptoms: Often asymptomatic, may cause bleeding.
  • Management:
    • Polypectomy via colonoscopy.
    • Surveillance for cancer risk.

15. Anorectal Abscess:

  • Symptoms: Painful swelling near anus, fever.
  • Management:
    • Incision and drainage.
    • Antibiotics if systemic infection.

16. Anal Fistula and Fissure:

  • Symptoms: Pain, discharge, bleeding.
  • Management:
    • Fistulotomy for fistula.
    • Stool softeners, sitz baths, topical anesthetics for fissures.

17. Hemorrhoids:

  • Symptoms: Rectal bleeding, itching, pain.
  • Management:
    • High-fiber diet, sitz baths, topical creams.
    • Surgical options (ligation, hemorrhoidectomy) for severe cases.

🚨 Quick Revision Points (High-Yield):

  • Appendicitis → McBurney’s point tenderness → Appendectomy
  • Crohn’s = Transmural inflammation; Ulcerative Colitis = Mucosal inflammation
  • Colorectal Cancer → Change in bowel habits + rectal bleeding
  • Hemorrhoids = Painless bleeding (internal), painful (external)
  • TB Abdomen = Anti-TB therapy for 6–9 months
  • Bowel Obstruction = NPO, NG tube, surgery if needed

E) Alternate Therapies for Gastrointestinal (GI) Disorders

(High-Yield Notes for Competitive Nursing Exams)

1. Dietary Modifications:

  • High-fiber diet: For constipation, diverticular disease, IBS with constipation.
  • Low-residue diet: For Crohn’s disease, ulcerative colitis during flare-ups.
  • Gluten-free diet: For celiac disease.
  • Lactose-free diet: For lactose intolerance.
  • Bland diet: For gastritis, GERD.

2. Herbal and Natural Remedies:

  • Peppermint oil: Relieves symptoms of IBS (antispasmodic effect).
  • Ginger: Reduces nausea and improves digestion.
  • Chamomile tea: Soothes gastric irritation.
  • Aloe vera juice: For mild gastric discomfort.

3. Probiotics:

  • Lactobacillus, Bifidobacterium: Help restore normal gut flora in diarrhea, IBS, and antibiotic-associated diarrhea.

4. Acupuncture and Acupressure:

  • Effective in reducing nausea and vomiting (postoperative, chemotherapy-induced).

5. Stress Management Techniques:

  • Yoga, meditation, relaxation therapy: Helpful in IBS, GERD, and functional dyspepsia.

6. Physical Activity:

  • Regular exercise improves bowel motility and reduces stress-related GI symptoms.

7. Cognitive-Behavioral Therapy (CBT):

  • Beneficial for IBS and functional GI disorders linked with stress and anxiety.

F) Drugs Used in the Treatment of GI Disorders

1. Antacids:

  • Examples: Aluminum hydroxide, magnesium hydroxide, calcium carbonate.
  • Uses: Neutralize gastric acid in GERD, gastritis, peptic ulcers.
  • Side Effects: Constipation (aluminum), diarrhea (magnesium).

2. Proton Pump Inhibitors (PPIs):

  • Examples: Omeprazole, pantoprazole, esomeprazole.
  • Uses: GERD, peptic ulcer disease, Zollinger-Ellison syndrome.
  • Side Effects: Risk of fractures, vitamin B12 deficiency with long-term use.

3. H2 Receptor Blockers:

  • Examples: Ranitidine, famotidine (ranitidine use reduced due to safety concerns).
  • Uses: GERD, peptic ulcers, gastritis.
  • Side Effects: Headache, dizziness.

4. Antiemetics:

  • Examples:
    • Metoclopramide: Increases GI motility.
    • Ondansetron: Effective for chemotherapy-induced nausea.
    • Domperidone: For gastroparesis.
  • Side Effects: Drowsiness, extrapyramidal symptoms (with metoclopramide).

5. Laxatives:

  • Types:
    • Bulk-forming: Psyllium (for chronic constipation).
    • Osmotic: Lactulose, polyethylene glycol.
    • Stimulant: Bisacodyl, senna.
    • Stool softeners: Docusate sodium.
  • Uses: Constipation, bowel preparation.
  • Side Effects: Dependence with overuse.

6. Antidiarrheals:

  • Examples: Loperamide, diphenoxylate-atropine.
  • Uses: Acute and chronic diarrhea.
  • Contraindications: Avoid in bloody diarrhea or infectious diarrhea (risk of worsening condition).

7. Antibiotics:

  • Examples: Metronidazole, ciprofloxacin.
  • Uses: H. pylori infection (triple therapy with PPI), infectious diarrhea, diverticulitis.
  • Side Effects: GI upset, risk of Clostridioides difficile infection.

8. Antispasmodics:

  • Examples: Dicyclomine, hyoscine.
  • Uses: IBS, biliary colic.
  • Side Effects: Dry mouth, blurred vision.

9. Anti-Helminthics:

  • Examples: Albendazole, mebendazole.
  • Uses: Helminthiasis (worm infestations).
  • Side Effects: Abdominal pain, dizziness.

10. Immunosuppressants and Biologics:

  • Examples: Azathioprine, infliximab.
  • Uses: Crohn’s disease, ulcerative colitis (severe cases).
  • Side Effects: Risk of infections, liver toxicity.

11. 5-ASA (Aminosalicylates):

  • Examples: Mesalamine, sulfasalazine.
  • Uses: Inflammatory Bowel Disease (IBD) – Crohn’s disease, ulcerative colitis.
  • Side Effects: Nausea, headache.

12. Prokinetic Agents:

  • Examples: Metoclopramide, domperidone.
  • Uses: Gastroparesis, GERD.
  • Side Effects: Tardive dyskinesia (long-term metoclopramide use).

🚨 Quick Revision Points (High-Yield):

  • PPIs → Drug of choice for GERD and peptic ulcers.
  • Metronidazole + Clarithromycin → Part of H. pylori triple therapy.
  • Loperamide → Antidiarrheal (avoid in bloody diarrhea).
  • Albendazole → Anti-helminthic (for worm infestations).
  • Mesalamine → First-line for IBD (Crohn’s, ulcerative colitis).
  • Metoclopramide → Increases GI motility (watch for extrapyramidal side effects).
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Categorized as COH-MSN, Uncategorised