Chapter 49: Adult Gastrointestinal Problems

The gastrointestinal system functions to break down food, facilitate nutrient absorption, and eliminate waste through coordinated activities of the stomach, liver, gallbladder, and pancreas, each secreting critical substances including hydrochloric acid, pepsin, intrinsic factor, bile, digestive enzymes, and glucose-regulating hormones. Diagnostic procedures such as upper endoscopy, colonoscopy, endoscopic retrograde cholangiopancreatography, paracentesis, and liver biopsy require specialized nursing protocols including preprocedural fasting, aspiration prevention through gag reflex assessment, and careful monitoring for complications such as bowel perforation and hemorrhage. Laboratory markers including transaminases, bilirubin, amylase, lipase, and ammonia levels guide diagnosis of liver and pancreatic pathology. Upper gastrointestinal disorders encompass gastroesophageal reflux disease and hiatal hernia managed through dietary modification and lower esophageal sphincter protection, peptic ulcer disease differentiated by pain characteristics related to food intake, and dumping syndrome following gastric surgery requiring frequent small meals and postprandial positioning. Intestinal pathologies including inflammatory bowel disease present with varying distributions and severity of inflammation, appendicitis manifesting as characteristic pain migration to McBurney's point, and diverticular disease requiring nutritional management adjusted to inflammatory status. Hepatobiliary and pancreatic disorders include cholecystitis with typical radiation patterns and positive Murphy's sign, cirrhosis with life-threatening complications including portal hypertension, ascites, esophageal varices, and hepatic encephalopathy managed through sodium restriction and ammonia reduction, viral hepatitis requiring transmission-specific prevention strategies, and acute pancreatitis demanding pancreatic rest and aggressive fluid resuscitation. Critical nursing safety considerations include heat avoidance in appendicitis, timing of oral intake resumption after endoscopy, positioning protocols following liver biopsy, and recognition of hemorrhage indicators in hepatic disease.