disturbances in digestion

• Nausea


  Feeling that you might vomit but not actually vomiting
• Vomiting


  An uncontrollable reflex that expels the contents of the stomach through the mouth
• Causes of nausea and vomiting

  • Motion sickness
  • Emotional stress
  • Ingestion
  • Food poisoning
  • Viruses
  • Bacteria
  • Chemical toxins
  • Medications
  • Coughing and other diseases
  • Exposure to other chemicals/ sensitive sense of smell
  • Hormonal
• Assessment of nausea and vomiting

  • Feeling you are about to vomit
  • Signs of dehydration
  • Teary eyed
  • Sweating
  • Lightheadedness
  • Abdominal cramps/ pain
  • Restless
  • Fatigue
• Medical management of nausea and vomiting

  • GI stimulant – metoclopramide (Reglan)
  • Antiemetics- Promethazine (Phenergan)
  • Antimotion sickness- (Dimenhydrinate)
  • Hydroxyzine (Atarax, Iterax)
  • Odansetron (Zofran)
  • Oral Rehydration
  • Tube feeding
  • Suction
  • NPO
• Nursing management of nausea and vomiting

  • Turn to sides
  • Provide basin
  • Provide cool/ comfy environment
  • Elevate the head
  • Offer ice chips
  • Carry -out doctor's order
• Gastrointestinal bleeding


  Swollen or tear in the GI tract usually found in colon, small intestine. A presentation of a disorder in the digestive tract. Passage of blood in the vomit or stool.
• Assessment of gastrointestinal bleeding

  • May be asymptomatic
  • Abdominal pain
  • Melena (dark-black tarry-sticky stools)
  • Bright red-bloody stools (hematochezia)
  • Pale
  • Anemia
  • Difficulty of breathing
  • Lightheadedness
  • Weak
  • Palpable mass
• Medical management of gastrointestinal bleeding

  • Diagnostics: PE, CBC, Endoscopy, Colonoscopy, Stool examination, Lavage, Sigmoidoscopy, Scans
  • Medication: Proton pump inhibitor (PPI), Antibiotics, Prokinetic Agents- metoclopramide, H pylori Agents- PPI, Metronidazole, Maalox, NSAID, H2 Antagonist- cimetidine, ranitidine, nizatidine, Iron, Tranexamic Acid (TXA)
  • Oral Rehydration/IV therapy, Tube feeding, Suction/Lavage, NPO, Blood transfusion, Surgical ligation
• Nursing management of gastrointestinal bleeding

  • Assessment & monitoring
  • Identify the source
  • Health Education in terms of: food, medications, rest
  • Prepare patient for labs and transfusion
• Gastritis


  Inflammation of the gastric or stomach mucosa; a common GI problem. Common in both men and women.
• Types of gastritis


  • Acute gastritis- Erosive (caused by local irritants such as aspirin, NSAIDs and alcohol consumptions), Nonerosive (caused b infection with Halicobacter Pylori/ H. pylori), Severe form of acute gastritis- "stress-related gastritis" (caused by stress, burns, other sever infections)
  • Chronic gastritis- classified according to the underlying causative mechanism which is often of H. pylori. Development of PUD, gastric adenocarcinoma and gastric mucosa-associated lymphoid tissue lymphoma. may be caused by long-term use of NSAIDS, or an autoimmune disorders
• Assessment of acute gastritis

  • Epigastric pain, Discomfort, Dyspepsia (indigestion), Anorexia, Hiccups, Nausea &vomiting, Melena, Hematochezia, May complain fatigue, pyrosis
• Assessment of chronic gastritis

  • Epigastric pain, Discomfort, Dyspepsia (indigestion), Anorexia, Hiccups, Nausea &vomiting, Melena, Hematochezia, May complain fatigue, Pyrosis, Anemia, Intolerance of spicy foods
• Medical management of gastritis

  • Diagnostics: Endoscopy & Histologic exam, CBC, H.pylori test
  • Treatments: Refrain from alcohol, Non-irritating diet is recommended, IV, NGT, Surgery in extreme cases
• Medications for gastritis


  • Antibiotics: Amoxicillin, Clarithromycin, Metronidazole, Tetracycline
  • H2 receptor antagonists
  • Proton Pump Inhibitors
  • Antidiarrheal
• Nursing management of gastritis

  • Reducing anxiety, Promote nutrition, Provide physical and emotional support, I&O, Health teachings in terms of food, medications, rest, Promoting fluid balance, Reduce or quit smoking, drinking alcohol and caffeinated beverages
• Peptic Ulcer Disease (PUD)

  An excavation (hollowed-out area) that forms in the mucosa of the stomach. More likely to be in the duodenum than in the stomach.
• Men and women have equal risk in developing peptic ulcers. NSAIDs, stress and infections can also be the cause of PUD. Familial history may also be a predisposing factor and no direct evidence for ingestion of milk, caffeinated beverages and spicy foods are associated with PUD.
• Zollinger-Ellison Syndrome (ZES)


  A rare condition in which benign or malignant tumor from pancreas and duodenum that secretes excessive amount of Gastrin.
• Causative Agent of Peptic Ulcer Disease

  Helicobacter Pylori (H. Pylori)
• Pathophysiology of Peptic Ulcer Disease

  1. Feco-oral transmission of H. Pylori, increase HCl, medications

  (+ decrease mucosal resistance to digestive enzymes or increase enzymatic activity)

  2. Damage to gastroduodenal mucosal lining
• Types of Peptic Ulcer Disease

  • Gastric Ulcer
  • Duodenal Ulcer
• Characteristics of Gastric Ulcer

  • HCl Levels: Either normal or low
  • Weight: Loss
  • Pain and Related Factors: Occurs 1- 1 ½ hours after meals, usually relieved by vomiting; food intake aggravates pain
  • Vomiting: Common
  • Bleeding: Likely, with hematemesis more common than melena
  • Perforation: Less likely
  • Malignancy: Occasionally
  • Occurrence: Less Likely
• Characteristics of Duodenal Ulcer

  • HCl Levels: High
  • Weight: Gain
  • Pain and Related Factors: Occurs 2-3 hours after meal, when gastric emptying occurs; pain relieved by food intake
  • Vomiting: Uncommon
  • Bleeding: Less likely, but occurs with melena
  • Perforation: More likely
  • Malignancy: Rare
  • Occurrence: More likely
• Assessment of Peptic Ulcer Disease

  • May be asymptomatic
  • Dull, gnawing pain at epigastric area or back
  • Pyrosis
  • Constipation
  • Awake with pain during night
  • Abdominal cramps
  • Abdominal distention
  • Nausea & vomiting
  • Hypotension
  • Tachycardia
  • Shock
  • Anemia (Bleeding PUD)
  • Fatigue
• Diagnostics for PUD

  Endoscopy & Histologic exam, CBC, H.pylori test
• Medications for Peptic Ulcer Disease

  • Antibiotics: Amoxicillin, Clarithromycin, Metronidazole, Tetracycline
  • H2 receptor antagonists
  • Proton Pump Inhibitors
  • Antidiarrheal
  • Combination of antibiotics and PPIs (4-8 wks therapy)
• Surgical procedures for Peptic Ulcer Disease

  • Vagotomy, Truncal vagotomy, Selective Vagotomy, Proximal Vagotomy, Pyloroplasty, Gastroduodenostomy (Billroth I), Gastrojejunostomy (Billroth II)
• Nursing management of Peptic Ulcer Disease

  • Reducing anxiety, Monitoring and managing complications, Promote nutrition, Provide physical and emotional support, I&O, Health teachings in terms of food, medications, rest, Promoting fluid balance, Reduce or quit smoking, drinking alcohol and caffeinated beverages, Pre-operative, intraoperative and post-operative care
• diagnostic for nausea and vomiting

  PE
• GI stimulant; an example is reglan

  metoclopramide
• an antiemetics (phenergan)

  promethazine
• an antimotion sickness

  • dimenhydinate
  • hydroxyzine (atarax, iterax)
  • odansetron (zofran)
• dark-black tarry-sticky stools

  melena
• bright red-bloody stools

  hematochezia
• diagnostic test for GI bleeding

  • PE
  • CBC
  • endoscopy
  • colonoscopy
  • stool exam
  • lavage
  • sigmoidoscopy
  • scans
• medications for GI bleeding

  • proton pump inhibitors
  • antibiotics
  • prokinetic agents
  • H pylori agents
  • NSAID
  • H2 Antagonists
  • iron
  • tranexamic acid
• prokinetic agents

  metoclopramide
• H pylori agents

  PPI, metronidazole, Maalox