PROB IN DIGESTION AND ABSORPTION

• Gastrointestinal bleeding


  A bleeding symptom either in upper or lower GI
• Obvious bleeding


  Emesis or stool
• Occult or hidden bleeding


  Not obvious
• Types of GI bleeding (location)

  • Upper GI bleeding
  • Lower GI Bleeding
• Upper GI bleeding


  Bleeding in the upper gastrointestinal tract arising from the esophagus, stomach or duodenum
• Upper GI bleeding appearance

  Coffee ground or black
• Lower GI Bleeding


  Bleeding occurs in the colon, rectum, or anus
• Lower GI Bleeding appearance

  Hematochezia or melena
• Causes of GI bleeding

  • Trauma in the GI tract
  • Erosions or ulcers
  • Ruptured of an enlarged vein such as varicosity (esophageal or gastric varices
  • Inflammation such as esophagitis (cause by acid), gastritis
  • Inflammatory bowel disease (ulcerative colitis and Crohn's
  • Alcohol and drugs ( aspirin, NSAIDS and cortecosteroids)
  • Diverticular disease
  • Hemorrhoids or fissures
• Bright red blood


  Vomited from high esophagus (hematemesis), rectum or distal colon
• Mixed dark red blood

  Higher up in colon and small intestine, mixed with stool
• Coffee ground blood


  Esophagus, stomach, and duodenum
• Melena


  Black tarry stool, excessive blood in the stomach
• Signs and symptoms of bleeding

  • Massive bleeding
  • Subacute bleeding
  • Chronic Bleeding
• Massive bleeding


  Acute, bright red hematemesis or large amount of black tarry stool, Rapid pulse, hypotension, hypovolemia and shock
• Subacute bleeding


  Intermittent/alternate melena or coffee ground emesis, Weakness, dizziness
• Chronic Bleeding


  Intermittent appearance of blood, Increased weakness, paleness or SOB, Occult blood
• Diagnostic tests


  • History
  • CBC
  • Endoscopy and MRI or CT
  • Stool test- for occult blood
• History


  Change in bowel pattern, Presence of pain or tenderness, Recent intake of food and what kind(red beef), Alcohol consumption and medications taken (aspirin or steroids, NSAIDS)
• CBC


  Low hemoglobin, high hematocrit, low platelet, High PT( 10-12 sec ) and aPTT( 30-45sec); NV
• Endoscopy and MRI or CT


  Identifies the source and cause of bleeding
• Emergency intervention


  1. Patient remains on NPO

  2. IV lines and oxygen therapy

  3. Administer vasopressin and blood replacement

  4. Intra arterial vasopressin- to slow or stop bleeding from diverticulum

  5. Surgical if indicated

  6. Nasogastric tube Intubation
• Nasogastric tube Intubation


  1. An NG tube should be in place for most patients with acute or upper GI bleeding

  2. 2-3 L of tap water lavage and if the aspirate continues to be bloody, this indicate that the patient is in active bleeding that requires emergent intervention
• Nursing interventions


  1. Attaining Normal Fluid Volume

  2. Attaining Balance Nutritional Status
• Attaining Normal Fluid Volume

  Maintain NG tube and NPO status to rest GI tract and evaluate bleeding, Monitor I and O to evaluate fluid status and hydration, Monitor VS, Administer IV fluids, Assess signs of shock such as hypotension, tachycardia, tachypnea (increase RR), decrease urine output, change in mental status
• Attaining Balance Nutritional Status

  Weigh daily to monitor caloric status', TPN, to promote hydration and nutrition while on NPO restriction, Begin liquids if patient is no longer on NPO, then DAT. DAT should be high in calorie, high CHON. Frequent small feedings if indicated
• Patient education


  Instruct the patient to report signs of GI bleeding such as melena, emesis that is bright red or coffee ground color, rectal bleeding, weakness, fatigue and SOB
• Evaluation: Fluid volume is maintained, hypovolemic shock is prevented, Patient verbalized no signs of bleeding, Nutritional and body weight status is maintained
• Complications

  • Hemorrhage
  • Shock
  • Death
• Gastritis


  Inflammation of the gastric or stomach mucosa
• Types of gastritis


  • Acute
  • Chronic
• Acute gastritis


  Lasting several hours to few days
• Causes of acute gastritis


  • Severe form caused by ingestion of strong acid or alkali
  • Acute illnesses or major traumatic injuries (Burns, severe infection, hepatic,kidney or respiratory failure and major surgery)
• Classification of acute gastritis

  • Erosive Acute Gastritis
  • Non-Erosive Acute Gastritis
• Erosive Acute Gastritis


  Most often caused by local irritants such as aspirin and other NSAIDS (Naproxen, Voltaren, Ibuprofen), alcohol consumption and gastric radiation therapy
• Non-Erosive Acute Gastritis

  Most often caused by an infection with Helicobacter Pylori (H. Pylori)
• Chronic gastritis


  Results from repeated exposure to irritating agents or recurrent episodes of acute gastritis
• Causes of chronic gastritis

  • H. Pylori infection
  • Chemical gastric injury (Gastropathy)- long term use of NSAIDS and aspirin
  • Autoimmune disease- Hashimoto thyroiditis, Addison's disease, Grave's disease
• Pathophysiology of gastritis


  Disruption of the mucosal barrier that normally protects the stomach from digestive juices (Hcl and pepsin) are irritating agents (Aspirin, NSAID and H. Pylori) comes in contact with the gastric mucosa that resulted to inflammation. In acute gastritis, the inflammation is usually transient and self-limiting in nature. In chronic gastritis, persistent and repeated insults lead to chronic inflammation that leads to atrophy or thinning of the gastric tissue.
• Clinical manifestations of acute gastritis

  • Hiccups
  • Anorexia
  • Epigastric pain (rapid onset
  • Dyspepsia (Indigestion)
  • Nausea and vomiting
  • Melena (black, tarry stools,) hematemesis (blood in vomitus), hematochezia (bright red, bloody stools)
  • Possible sign of shock