NUR 406 Gastrointestinal Alteration Notes

Unit 8: Gastrointestinal Alterations
Acute GI Bleed
 Bleeding in the upper or lower gastrointestinal tract which accounts for 100.000 inpatient deaths
annually
 Causes
o Upper
 Duodenal Ulcer
 Esophageal Varices
 Gastric ulcer
 Mallory-Weiss tear
o Lower
 Cancer
 Diverticulitis
 Inflammatory disease

Peptic Ulcer Disease
 Pathophysiology Timeline
o Acid
 Secretion of Acetylcholine, gastrin, and secretion is elevated for an unknown cause
 Secreted by the chief cells in the stomach
o Damage
 Excess acid breaks down the mucosal lining and causes a break and damage to the
mucosal wall
o Mucosa
 Break in the mucosal lining extends through the mucosa down to the muscular layer
o Vasculature
 As the damage extends to the muscular layer, which involves blood vessels, this leads
to hemorrhage and GI perforation
 Perforation is dangerous because of the natural flora within the GI tract
o Though this flora is normal and healthy in the GI tract, when a
perforation occurs, the bacteria begins to invade the peritoneal cavity
and can cause the patient to go into sepsis

Esophageal Varices  Venous Blood
 Portal hypertension
o Damage to liver cells places increased pressure on the portal venous system  portal
hypertension
o Collateral circulation forms in order to divert blood from the liver to the systemic circulation
in order to relieve pressure
 Collateral channels
o Develop in the submucosa of the esophagus and rectum, anterior abdominal wall, and the
peritoneum
o Normal venous pressure of collateral circulation  2-6 mmHg
 The varices/channels enlarge and bulge when portal pressure exceeds 6 mmHg

,  Bleeding occurs when the pressure exceeds 10 mmHg
 Normally present in the esophagus, but can be present in the upper GI tract

Mallory-Weiss Tears  Arterial Blood
 Patho
o Arterial bleed from a tear in the gastrointestinal mucosa
 The bleeding will be rapid and in large amounts due to the blood coming from the
arterial system
 Frequency
o 10-15% of all GI bleeds
o Lacerations critical due to arterial nature
 Cause
o Forceful retching creates increased pressure
 Risk factors
o Alcoholics/binge drinkers
o Pregnant women
 If they are having a very hard time with morning sickness and vomiting, they can be
at risk for Mallory-Weiss tears when dry heaving begins to occur
o Those with eating disorders

Lower Bleeds
 Clinical Presentation of Lower GI Bleeds
o Bright, red blood in the stool
 Cancer
o Primary tumors
o Mucosal metastatic tumors
o Malignant or benign neoplasms
o ***do not need to know why, but just need to know that cancer can cause
 Diverticulitis
o History of diverticulosis
 Diverticulosis  the bulging of the normal
o Patho
 Pressure exerted on the intestinal wall breaks open, causing damage to the
surrounding vessels
 Can occur when patients eat seeds, nuts, or anything that is small enough to get stuc
 As the inflammatory response continues, the pouches will continue to bulge and
begin to bleed
 Inflammatory diseases of the colon
o Chron’s disease
o Ulcerative Colitis
 Hemorrhoids and Polyps
o Hemorrhoids
 Veins within the anal tract bulge due to increases in pressure and then tear
 #1 cause  constipation due to excessive straining that occurs when the individual is
trying to release stool