gi disorders

• Family history


  • Very important, ask patient regarding family history that patient may have
  • Some disorders are hereditary
• Personal health history


  • History of GI disorders
  • Bowel pattern
  • Appetite
  • Weight
  • Stool
  • Prescription meds
  • OTC meds
  • Aspirin or NSAIDs (important because of GI bleeding, PUD)
  • Laxative/enema use (important because patient becomes used to them and dependent, can cause electrolyte imbalance and constipation)
  • Diarrhea causes loss of K+
  • Smoking/chewing tobacco (predisposes to oral cancer)
  • Travel history (reason for diarrhea)
• Physical assessment


  1. Begin right side in a systematic manner

  2. Intestinal activity and bowel sounds will increase if not in this order

  3. Avoid palpation and percussion of appendicitis or abdominal aneurysm as it becomes life threatening

  4. Report findings immediately
• Inspection


  • Look for symmetry, distension, hardness, color (ecchymotic area, lumps, bumps, lesions)
• Auscultation


  1. Start RLQ - RUQ -LUQ - LLL

  2. Listen for bowel sounds over abdominal aorta, renal and iliac arteries

  3. If bruit (swooshing), thrill - report stat
• Percussion


  1. Determine size of organs or masses, fluid, and air

  2. Tympanic (high pitched, musical (air filled in intestines), dull/medium pitched (soft/dull organs such as liver)
• Palpation


  1. Deep for APN; determine size and location

  2. Mass, tenderness, light and deep palpation

  3. Rebound tenderness - notify HCP
• Daily behaviors of a client with GI problems requiring further nursing assessment


  • Smokes a pack of cigarettes
  • Uses Fleet enemas frequently to assist with bowel movements
  • Practices intentional relaxation
  • Eats multiple servings of fruit
  • Takes 325 mg of aspirin at night for arthritic pain
  • Exercises for 30 min. three times weekly
  • Travels extensively across the world
• Nurse notes a bruit over the aorta while performing an abdominal assessment


  Notify the healthcare provider of the findings (possibly AAA)
• Diagnostic lab tests


  • CBC (anemia from GI bleed or peptic ulcer disease, inflammation of the bowel)
  • PT (clotting, coagulation time, amount of time for prothrombin to convert to thrombin, depends on how much Vit K patient has)
  • Electrolytes (calcium absorbed in GI tract to detect malabsorption, diarrhea causes loss of sodium and potassium)
  • AST/ALT (liver function, indicates peptides or cirrhosis)
  • Amylase/lipase (acute pancreatitis, serious inflammation of the pancreas)
  • CEA & CA 19-9 (blood antigens, diagnose cancer, monitor treatment success and cancer recurrence)
  • Urine tests (see if any amylase which is present in acute pancreatitis)
  • Stool tests (fecal occult blood test, GI bleed, Cologuard - stool specimen in lab if positive needs colonoscopy)
  • Bilirubin (primary pigment in bile, excreted by liver, occurs before patient becomes jaundiced)
  • Ammonia (indicates elevated liver enzymes, if liver not functioning this is high)
  • Gastric analysis (pepsin, HCl to detect gastritis and duodenal disorders)
  • Urobillinogen (form of bilirubin, excreted in urine and created by intestinal mucosa, important for hepatic and biliary obstruction)
  • DNA gene to detect colon cancer, can look at ova parasites and C.diff
• Diagnostic imaging tests


  • Abdominal X-ray (looks for bowel obstructions or masses, tumors, or strictures)
  • CT scan (tissue density and abnormalities with or without contrast, patient needs IV contrast for 4 hrs)
  • MRI
  • Endoscopy (direct visualization of GI tract, allows viewing and manipulation of internal body areas, see if bleeding, ulceration, inflammation, cancer of esophagus, stomach, biliary, bowel)
  • Esophagogastroduodenoscopy (EGD) (visualize esophagus, stomach and duodenum, if GI bleed is found, physician can clip and inject therapy, thermal coagulation and topical)
  • Barium swallow (patient drinks barium and fluoroscopy, X-ray pictures to trace barium throughout esophagus and stomach)
  • Small bowel follow through (SBFT) (similar to barium swallow, no barium, thin tube passes through stomach and into first part of small intestine, barium liquid then poured into tube to look at esophagus, stomach and small intestine)
  • Barium enema (used to examine GI tract)
  • Colonoscopy (endoscopic exam that looks at entire large bowel, recommended at age 45 all healthy men and women have this every 10 years, can have biopsy obtained)
  • Ultrasound (high frequency sound waves passed through body transformed into pictures and used for analysis)
  • Endoscopic retrograde cholangiopancreatography (ERCP) (provides visual of radiographic exam of liver, gallbladder, bile ducts, and pancreas to identify cause and location of obstruction, biopsy can be obtained)
  • Small bowel capsule endoscopy (provides view of small intestine, video capsule, small bowel to visual entire small bowel, location of GI bleed)
  • Sigmoidoscopy (exams rectum and sigmoid colon, purpose for colon cancer, source of GI bleed or Irritable bowel)
• Client statement regarding intake

  I take ibuprofen three times daily for arthritis