Med Surg Study guide on GI chapter.
1. Describe intestinal obstruction: types (mechanical vs. non-mechanical),
pathophysiology, expected findings (small vs. large bowel), treatment, complications
● Types:
○ Mechanical- bowel blocked by something outside or inside the intestines
(adhesions, fecal impactions) complete mechanical should have surgery
○ Nonmechanical- diminished peristalsis within the bowel (paralytic ileus)- can be
postoperative due to mishandling intestines during surgery
● Patho:
○ Mechanical: compressed intestine by adhesions, tumors, fibrosis (endometriosis),
strictures (Crohn’s, radiation)
■ Postsurgical adhesions- small bowel obstruction
■ Carcinomas- large intestine obstruction
○ Nonmechanical: neurogenic disorders (manipulation during surgery and spinal
fracture)
■ Vascular (insufficiency and mesenteric emboli)
■ Electrolyte imbalance (hypokalemia)
■ Inflammatory (peritonitis or sepsis)
● EF:
Small Small + Large Large
● Severe fl and ● Obstipation-can’t pass ● Minor fl and elect
electrolyte imbalance stool/flatus >8hrs imbalance
● Metabolic alkalosis despite the urge ● Metabolic acidosis
● Visible peristaltic ● Abd distention (possible)
waves (possible) ● High-pitched bowel ● Significant lower abd
● Epigastric or upper sound above site of distention
● Intermittent abd
abd distention obstruction
cramping
● Profuse, sudden (borbogymi), ● Infrequent vomiting
projectile vomiting w/ hypoactive below site; ● Diarrhea or ribbon-
fecal odor overall hypoactive like stools around
then absent later impaction
● Tx:
○ Focused on fl and electrolyte balance, decompressing bowel, relief/removal of
obstruction
○ NGT w/ a vent- to prevent damage to stomach mucosa during cont. Suctioning-
decompression
■ Intermittent
■ Ensure patency, irrigate w/ 30 mL sodium chloride every 4 hours
■ Semi-fowler’s, fasten NG to gown
, ■ Assess output, nasal area
■ Oral hygiene every 2 hrs
■ VS, skin integrity, weight, I&O
● Complications:
○ Dehydration from persistent vomiting
○ Electrolyte imbalance (SBO) from persistent vomiting
■ Monitor electrolytes (potassium), give IVF
○ Metabolic alkalosis (SBO) from persist vomit, leading to a loss of gastric
hydrochloride
■ Monitor hypoventilation (confusion, hypercarbia), ABG, noreplace fl and
elect, oral hygiene to alleviate increased thirst response
○ Metabolic acidosis (LBO)
■ Monitor for deep, rapid respirations (confusion, hypotension, flushed
skin), ABG
2. Differentiate Cholelithiasis/Cholecystitis: pathophysiology, biliary colic with chronic
cholecystitis, clinical manifestations, complications, risk factors, diagnostic and lab
studies, treatment (bile acids and therapeutic procedures, surgery), post-op nursing
interventions and discharge instructions.
● Patho
○ Cholelithiasis- stones in the gallbladder, made up of bile/cholesterol
○ Cholecystitis- inflammation of gallbladder, often caused by gallstones
● Biliary colic w/ chronic cholecystitis
○ Indigestion of high-fat diet→causes biliary colic
○ Pattern of periodic abd pain→caused by obstruction in biliary tract
■ ↑pressure in any hollow organ
● Clinical manifestations
○ Sharp pain in the RIGHT upper quadrant, may radiate to right shoulder
○ Indigestion- rule out heart attack first, flatulence, eructation (belching)
○ ↑HR, pallor, diaphoresis w/ n/v after eating a high-fat meal caused by biliary colic
● Complications
○ Obstruction of Bile Duct- ischemia, gangrene, gallbladder rupture
■ Peritonitis (rigid abd; surgery, broad-spectrum abx)
○ Bile peritonitis- rare, potentially fatal→if bile is not drained from surgical site,
report
○ Postcholecystectomy Syndrome- manifestations of gallbladder disease continue
after surgery, can occur immediately or months later, assess for pain
● Risk factors
○ Rapid weight loss (↑cholesterol)
○ Native American, Mexican American, genetics
○ Females, estrogen therapy, and oral contraceptives (alters bile
composition+motility→ gallstone formation)
○ Obesity
1. Describe intestinal obstruction: types (mechanical vs. non-mechanical),
pathophysiology, expected findings (small vs. large bowel), treatment, complications
● Types:
○ Mechanical- bowel blocked by something outside or inside the intestines
(adhesions, fecal impactions) complete mechanical should have surgery
○ Nonmechanical- diminished peristalsis within the bowel (paralytic ileus)- can be
postoperative due to mishandling intestines during surgery
● Patho:
○ Mechanical: compressed intestine by adhesions, tumors, fibrosis (endometriosis),
strictures (Crohn’s, radiation)
■ Postsurgical adhesions- small bowel obstruction
■ Carcinomas- large intestine obstruction
○ Nonmechanical: neurogenic disorders (manipulation during surgery and spinal
fracture)
■ Vascular (insufficiency and mesenteric emboli)
■ Electrolyte imbalance (hypokalemia)
■ Inflammatory (peritonitis or sepsis)
● EF:
Small Small + Large Large
● Severe fl and ● Obstipation-can’t pass ● Minor fl and elect
electrolyte imbalance stool/flatus >8hrs imbalance
● Metabolic alkalosis despite the urge ● Metabolic acidosis
● Visible peristaltic ● Abd distention (possible)
waves (possible) ● High-pitched bowel ● Significant lower abd
● Epigastric or upper sound above site of distention
● Intermittent abd
abd distention obstruction
cramping
● Profuse, sudden (borbogymi), ● Infrequent vomiting
projectile vomiting w/ hypoactive below site; ● Diarrhea or ribbon-
fecal odor overall hypoactive like stools around
then absent later impaction
● Tx:
○ Focused on fl and electrolyte balance, decompressing bowel, relief/removal of
obstruction
○ NGT w/ a vent- to prevent damage to stomach mucosa during cont. Suctioning-
decompression
■ Intermittent
■ Ensure patency, irrigate w/ 30 mL sodium chloride every 4 hours
■ Semi-fowler’s, fasten NG to gown
, ■ Assess output, nasal area
■ Oral hygiene every 2 hrs
■ VS, skin integrity, weight, I&O
● Complications:
○ Dehydration from persistent vomiting
○ Electrolyte imbalance (SBO) from persistent vomiting
■ Monitor electrolytes (potassium), give IVF
○ Metabolic alkalosis (SBO) from persist vomit, leading to a loss of gastric
hydrochloride
■ Monitor hypoventilation (confusion, hypercarbia), ABG, noreplace fl and
elect, oral hygiene to alleviate increased thirst response
○ Metabolic acidosis (LBO)
■ Monitor for deep, rapid respirations (confusion, hypotension, flushed
skin), ABG
2. Differentiate Cholelithiasis/Cholecystitis: pathophysiology, biliary colic with chronic
cholecystitis, clinical manifestations, complications, risk factors, diagnostic and lab
studies, treatment (bile acids and therapeutic procedures, surgery), post-op nursing
interventions and discharge instructions.
● Patho
○ Cholelithiasis- stones in the gallbladder, made up of bile/cholesterol
○ Cholecystitis- inflammation of gallbladder, often caused by gallstones
● Biliary colic w/ chronic cholecystitis
○ Indigestion of high-fat diet→causes biliary colic
○ Pattern of periodic abd pain→caused by obstruction in biliary tract
■ ↑pressure in any hollow organ
● Clinical manifestations
○ Sharp pain in the RIGHT upper quadrant, may radiate to right shoulder
○ Indigestion- rule out heart attack first, flatulence, eructation (belching)
○ ↑HR, pallor, diaphoresis w/ n/v after eating a high-fat meal caused by biliary colic
● Complications
○ Obstruction of Bile Duct- ischemia, gangrene, gallbladder rupture
■ Peritonitis (rigid abd; surgery, broad-spectrum abx)
○ Bile peritonitis- rare, potentially fatal→if bile is not drained from surgical site,
report
○ Postcholecystectomy Syndrome- manifestations of gallbladder disease continue
after surgery, can occur immediately or months later, assess for pain
● Risk factors
○ Rapid weight loss (↑cholesterol)
○ Native American, Mexican American, genetics
○ Females, estrogen therapy, and oral contraceptives (alters bile
composition+motility→ gallstone formation)
○ Obesity
