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Gastrointestinal

Gastrointestinal System Review

Educational Use Only. This app is not intended to replace instructor guidance, institutional policies, clinical judgment, or professional medical training.

Overview

The GI system handles digestion and absorption. NCLEX covers GI bleeding, inflammatory bowel disease, liver disease, pancreatitis, and ostomy care. Key areas include nutrition, fluid balance, and recognizing complications.

Key Concepts

  • 1

    Upper GI bleed: hematemesis (coffee-ground emesis), melena (black tarry stools); Lower GI bleed: hematochezia (bright red blood)

  • 2

    Liver cirrhosis: portal hypertension leads to ascites, esophageal varices, splenomegaly; impaired clotting from decreased vitamin K absorption

  • 3

    Pancreatitis: elevated amylase and lipase; caused by gallstones and alcohol; NPO, NG tube, IV fluids

  • 4

    Inflammatory bowel disease: Crohn's (any part of GI, transmural, skip lesions) vs Ulcerative colitis (colon only, mucosal, continuous)

  • 5

    Bowel obstruction: distention, vomiting, absent bowel sounds, colicky pain; risk factors: adhesions, hernias, tumors

  • 6

    GERD: retrosternal burning, worse after meals and lying down; managed with PPIs, H2 blockers, lifestyle changes

  • 7

    Ostomy types: colostomy (stool varies by location), ileostomy (liquid output), urostomy (urine)

Nursing Interventions

  • Assess abdomen: inspect, auscultate, percuss, palpate (in that order to avoid altering bowel sounds)

  • Monitor stool for blood, mucus, consistency, and frequency; test for occult blood if indicated

  • For GI bleeding: monitor vital signs, hemoglobin/hematocrit, IV access, type and cross-match blood

  • Maintain NPO status for bowel obstruction, pancreatitis, and pre-procedure; monitor hydration

  • For ascites: measure abdominal girth, daily weights, monitor intake/output, low-sodium diet

  • Ostomy care: assess stoma color (healthy = pink-red), skin integrity, pouch fit, and output characteristics

  • Administer proton pump inhibitors, antacids, and antiemetics as ordered; monitor effectiveness

Critical Red Flags

  • Hematemesis or melena — active GI bleeding

  • Rigid, board-like abdomen with severe pain — peritonitis or perforation

  • Sudden onset severe epigastric pain radiating to back — acute pancreatitis

  • Coffee-ground emesis or bright red blood per rectum — hemorrhage

  • Absent bowel sounds with distention and vomiting — bowel obstruction

  • Confusion, asterixis (flapping tremor) — hepatic encephalopathy

Key Lab Values

Serum amylase: 30-122 U/L (elevated in pancreatitis)

Serum lipase: 0-160 U/L (more specific for pancreatitis)

Albumin: 3.5-5.0 g/dL (low in liver disease and malnutrition)

Total bilirubin: 0.1-1.2 mg/dL (elevated in liver/gallbladder disease)

ALT/AST: 10-40 U/L (elevated in liver damage)

Hemoglobin: 13.5-17.5 men, 12.0-15.5 women (monitor for bleeding)

Patient Teaching

  • Eat small, frequent meals; avoid trigger foods (spicy, fatty, caffeine, alcohol for GERD)

  • For ostomy: change pouch when 1/3 to 1/2 full; clean skin with warm water, avoid harsh soaps

  • Maintain adequate hydration, especially with ileostomy (risk of dehydration from liquid output)

  • Report signs of obstruction: persistent vomiting, severe pain, no stool or gas output

  • Avoid alcohol and NSAIDs with liver disease and GI bleeding risk

  • Follow prescribed diet restrictions (low-sodium for ascites, low-fat for pancreatitis)

Educational Use Only — Not a substitute for professional training.