Gastrointestinal Disorders Overview for BSN Students

Upper GI Overview and Complications

Karen Whitaker: Welcome back to NSG3046 Adult Med-Surg 2. I'm Karen Whitaker, and today Derek and I are going to walk you through some of the big gastrointestinal disorders you'll see on the floor and on your exams.

Derek Mendoza: Hey everyone, it's Derek. GI can feel like alphabet soup, but once you connect the patterns, it really does start to make sense. We’re going to stay very close to the script you’ve been studying, just shaping it into a conversation so you can hear the flow in your head.

Karen Whitaker: We’ll start up top with upper GI, then move down, and finish with liver, biliary, and pancreas. Let’s begin with some quick oral conditions you’ll definitely see in practice—oral herpes simplex virus type 1 and aphthous ulcers.

Derek Mendoza: Right, so HSV-1 is what patients usually call cold sores or fever blisters. They typically show up on or around the lip. They’re contagious, so as the nurse, you’re drilling home hand hygiene and simple things like, “Hey, once the illness is over, change that toothbrush so you don’t reinfect yourself.” Treatment is antiviral meds such as valacyclovir.

Karen Whitaker: And then oral aphthous ulcers—canker sores—those are inside the mouth on the inner lip or cheek. You’ll see that yellow-gray wound base and they last about a week. We’re mostly managing discomfort: NSAIDs or topical steroids can help.

Karen Whitaker: Now let’s slide down to nausea and vomiting, because this is a huge nursing priority no matter where the problem starts. With excessive vomiting, I want you immediately thinking fluid and electrolyte imbalances and aspiration risk—especially in older adults or anyone with a decreased gag reflex.

Karen Whitaker: I had a patient in her late seventies with persistent vomiting from a bowel obstruction. She was drowsy from opioids. Our priorities were strict NPO, side-lying positioning, suction at the bedside, and IV fluids while we corrected her electrolytes. That’s the pattern you should hear in your head for exams: airway protection, positioning, and volume.

Derek Mendoza: Alright, let’s talk reflux and ulcers. Gastroesophageal reflux disease—GERD—is not one single disease. It’s a syndrome where gastric contents reflux into the lower esophagus and cause symptoms or mucosal damage.

Karen Whitaker: Risk factors you’ll see over and over: a weak lower esophageal sphincter, hiatal hernia, impaired esophageal motility, and delayed gastric emptying. On the NCLEX, they love linking GERD to obesity, large fatty meals, lying flat after eating, and smoking.

Derek Mendoza: The classic symptom is heartburn, especially after meals or when lying down. Some patients just call it indigestion. Over time, chronic reflux can lead to Barrett’s esophagus—cell changes in the lower esophagus that are precancerous and increase the risk for esophageal cancer. That’s a big test point.

Karen Whitaker: Management starts with lifestyle changes: avoid large, fatty meals and trigger foods, don’t lie down right after eating, elevate the head of the bed about six to eight inches, lose weight if needed, avoid tobacco, and manage stress. Medications focus on decreasing acid and protecting the mucosa—proton pump inhibitors, H₂ blockers, and sometimes antacids or prokinetic agents.

Derek Mendoza: Hiatal hernia often goes hand-in-hand with GERD. That’s when part of the stomach herniates through the diaphragm into the esophagus. Anything that raises intraabdominal pressure—obesity, pregnancy, heavy lifting—can contribute. Complications include reflux, esophagitis, bleeding, ulceration, or even strangulation of the herniated portion.

Karen Whitaker: Conservative treatment for hiatal hernia basically mirrors GERD management: lifestyle changes and acid suppression. Surgery, usually laparoscopic, is reserved for complications or severe, refractory symptoms. From a nursing standpoint, you’re reinforcing teaching and monitoring for bleeding or respiratory compromise post-op.

Derek Mendoza: Now let’s get into peptic ulcer disease. PUD is erosion of the GI mucosa from the action of hydrochloric acid and pepsin. You can have gastric ulcers or duodenal ulcers. Most patients have H. pylori infection, and the other big risk factors are NSAIDs and aspirin, smoking, alcohol, and stress. H. pylori may come from undercooked meats or raw vegetables, so a diet history can be helpful.

Karen Whitaker: Clinically, the timing of pain helps you differentiate. Gastric ulcer pain often occurs one to two hours after meals and may be aggravated by food. Duodenal ulcer pain tends to show up two to five hours after meals and may actually improve temporarily with food or antacids. Endoscopy is the most common diagnostic tool, and we test for H. pylori.

Derek Mendoza: Major complications you need to recognize quickly are GI bleeding, perforation, and gastric outlet obstruction. Perforation is an emergency. The patient suddenly has severe, sharp abdominal pain, a rigid, board-like abdomen, tachycardia, and maybe shallow, rapid respirations. Your priorities: stop oral intake, notify the provider, prepare for surgery, and support blood volume.

Karen Whitaker: Treatment for PUD includes eradicating H. pylori with antibiotics plus a proton pump inhibitor, stopping or reducing drugs that can irritate ulcers, and teaching about smoking cessation, limiting alcohol, and avoiding NSAIDs if possible. Long term, nurses are key in reinforcing adherence and monitoring for signs of bleeding like melena or coffee-ground emesis.

Derek Mendoza: We should also touch on gastritis and stomach cancer. Gastritis is inflammation of the gastric mucosa. It can be acute—from NSAIDs, alcohol, or a spicy-food binge—or chronic from H. pylori, autoimmune disease, or long-term irritant exposure. Symptoms are anorexia, nausea, vomiting, epigastric tenderness, and a feeling of fullness.

Karen Whitaker: Acute gastritis treatment is mostly supportive: NPO if needed, IV fluids, antiemetics, and removing the cause, like stopping the NSAID. Chronic gastritis focuses on eliminating the underlying cause and treating H. pylori if it’s present. This is another pattern: remove the irritant, support perfusion, protect the mucosa.

Derek Mendoza: Stomach cancer often develops after chronic mucosal injury—H. pylori, autoimmune gastritis, or irritants like tobacco. The problem is the symptoms are vague at first: weight loss, anorexia, indigestion, abdominal discomfort, and anemia. By the time it’s obvious, it may have spread.

Karen Whitaker: Treatment usually involves surgery, sometimes combined with chemo, radiation, or targeted therapy. Our nursing focus is pain control, nutritional support, and helping patients maintain the best possible quality of life for their disease stage.

Derek Mendoza: Finally for this section, upper GI bleeding. Severity depends on whether the source is venous, capillary, or arterial, and whether it’s acute or slow and insidious. Peptic ulcers, especially with H. pylori and NSAID use, are a major cause.

Karen Whitaker: Your assessment needs to be systematic: airway, breathing, circulation; vital signs; level of consciousness; skin color and perfusion; and a focused abdominal exam for distention, guarding, or changes in bowel sounds. We also monitor intake and output closely and track hemoglobin, hematocrit, and coagulation labs.

Derek Mendoza: Endoscopy with endotherapy is first-line to identify and control the bleeding. Drug therapy, like PPIs, helps decrease acid and support hemostasis. Once stabilized, we do a lot of teaching about avoiding future bleeding—being cautious with aspirin, NSAIDs, or corticosteroids, and using protective medications when needed.

Lower GI Disorders and Cancer Risk

Karen Whitaker: Alright, let’s move down the GI tract and talk about lower GI disorders. We’ll start with some bread-and-butter issues: diarrhea, constipation, and abdominal pain.

Derek Mendoza: Diarrhea is defined as at least three loose or liquid stools per day. It can be acute, persistent, or chronic. Causes include changes in motility, increased secretion, or decreased absorption, but in practice, the big one you’ll see is infection from ingested organisms.

Karen Whitaker: On exams and in real life, treat all acute diarrhea as infectious until proven otherwise. Use strict infection control, especially hand hygiene. Patients on antibiotics are at risk for C. difficile, a serious bacterial infection. We manage that with specific antibiotic therapy and sometimes fecal microbiota transplant for recurrent cases.

Derek Mendoza: Your goals with diarrhea are to normalize bowel patterns, maintain fluid, electrolyte, and acid-base balance, protect the skin, and preserve nutrition. I remember a patient with relentless C. diff diarrhea—our routine was frequent skin checks, barrier creams, meticulous perianal care, and encouraging fluids within his ordered limits.

Karen Whitaker: Constipation is the flip side. It’s fewer than three stools per week plus hard stools, straining, a feeling of incomplete emptying, maybe bloating. Causes range from low fiber and low fluid intake to medications and immobility. We lean heavily on nonpharmacologic measures first: increasing fiber, fluids, and physical activity, and then add laxatives if needed.

Karen Whitaker: Chronic abdominal pain is often from conditions like irritable bowel syndrome, diverticulitis, peptic ulcer disease, chronic pancreatitis, hepatitis, or cholecystitis. Treatment depends on the cause, but as nurses, we assess patterns over time and support long-term management, including stress and diet changes.

Derek Mendoza: Speaking of IBS—irritable bowel syndrome is chronic abdominal pain with altered bowel habits: diarrhea, constipation, or both. The cause is unknown and it’s diagnosed based on symptoms. Management targets lifestyle, diet, stress, and symptom control with medications. Think symptom cluster and ruling out red flags.

Karen Whitaker: Let’s hit some key inflammatory and acute conditions. Appendicitis usually starts with periumbilical pain, then anorexia, nausea, and vomiting. The pain localizes to the right lower quadrant at McBurney’s point. Treatment is usually prompt surgical removal, with fluids and antibiotics as needed beforehand.

Derek Mendoza: Peritonitis is inflammation of the peritoneum, usually from contamination with bacteria or irritating chemicals after an organ perforates. Patients have severe abdominal pain, a hard, rigid abdomen, and marked tenderness. Major concerns are fluid and electrolyte imbalance and septic shock. Surgery is typically needed to repair the cause and drain fluid, along with antibiotics, analgesics, NG suction, and IV fluids.

Karen Whitaker: Inflammatory bowel disease includes ulcerative colitis and Crohn’s disease. Both are autoimmune-type conditions with an overactive, inappropriate immune response, leading to periods of remission and unpredictable exacerbations.

Derek Mendoza: Ulcerative colitis affects the mucosal layer of the rectum and colon in a continuous pattern. Hallmark symptoms are bloody diarrhea and abdominal pain. Crohn’s disease can occur anywhere from mouth to anus but often hits the terminal ileum and colon with skip lesions—normal segments between diseased areas giving a patchwork, quilt-like appearance. Diarrhea and crampy abdominal pain are common, and if the small intestine is involved, you’ll see weight loss and malnutrition due to malabsorption.

Karen Whitaker: Goals of IBD treatment include bowel rest, controlling inflammation, improving nutrition, relieving symptoms, and improving quality of life. Drug classes include aminosalicylates, antimicrobials, corticosteroids, immunosuppressants, and biologic therapy. Ulcerative colitis can be cured with total colectomy; surgery for Crohn’s is more limited because of recurrence and the risk of short bowel syndrome.

Derek Mendoza: Bowel obstruction is another big one. It can occur in the small or large intestine and be partial or complete, simple or strangulated. A simple obstruction has an intact blood supply; a strangulated one doesn’t, which is an emergency.

Karen Whitaker: Clinical signs depend on location but often include nausea, vomiting, abdominal pain and distention, inability to pass flatus, and signs of hypovolemia. The higher the obstruction, the earlier the vomiting. We’re tracking vitals, pain, abdominal girth, and urine output very closely.

Derek Mendoza: If the obstruction is strangulated, tissue death, necrosis, and sepsis can follow, so surgery is urgent. Nursing care centers on pain control, fluid volume management, NG decompression when ordered, and close monitoring for signs of shock or peritonitis.

Karen Whitaker: Now, zooming out to cancer risk. Polyps in the colon show neoplastic changes and are closely linked to colorectal cancer. They’re often discovered and removed during colonoscopy, which is why screening is so important. Starting at age forty-five, average-risk adults should have regular screening.

Derek Mendoza: Colorectal cancer risk increases with age, family or personal history, polyps, and IBD. Lifestyle factors include obesity, smoking, alcohol use, and diet. Symptoms often don’t appear until late and can include rectal bleeding, abdominal pain, or a change in bowel habits. The patient may need surgery and end up with a colostomy or ileostomy.

Karen Whitaker: Nursing care is huge here: emotional support for the body image change, teaching stoma care, choosing an appropriate pouching system, and monitoring for fluid and electrolyte imbalances, especially with ileostomies. We want patients to be able to change their pouch, protect their skin, control odor, and recognize complications so they can stay independent.

Karen Whitaker: We also see diverticulosis and diverticulitis. Diverticula are outpouchings in the colon. Diverticulitis is when they become inflamed, which can lead to perforation, abscess, fistula, or bleeding. Many patients are asymptomatic, but symptomatic ones may have abdominal pain, bloating, flatulence, or changes in bowel habits.

Derek Mendoza: Teaching focuses on a high-fiber diet mainly from fruits and vegetables, and reducing fat and red meat to prevent exacerbations. Nuts and seeds may also irritate inflamed areas. That’s a very testable patient teaching point—high fiber, avoid triggers, and know when to seek care for fever or worsening pain.

Liver, Biliary, and Pancreatic Disorders

Karen Whitaker: Let’s finish by talking about liver, biliary tract, and pancreas problems. These can look intimidating, but the patterns are pretty consistent once you get used to them.

Derek Mendoza: Starting with viral hepatitis. We have types A, B, C, D, and E. Hepatitis A and E are RNA viruses transmitted by the fecal–oral route, usually through contaminated food or water. Poor hygiene and sanitation are big risk factors, and the highest transmission risk with HAV is actually before symptoms appear. A classic memory cue is, if hepatitis comes with a vowel, it comes from the bowel.

Karen Whitaker: Hepatitis B is a DNA virus transmitted by blood and body fluids—perinatal from an infected mother, percutaneous exposure like IV drug use, or mucosal exposure from sexual contact or saliva. Hepatitis C is an RNA virus primarily spread percutaneously, especially through shared needles among IV drug users. Other risks include transfusions before 1992, high-risk sexual behavior, occupational exposure, hemodialysis, and being born between 1945 and 1965.

Derek Mendoza: Most patients with acute viral hepatitis recover fully, but some develop chronic disease, especially with hepatitis C and some hepatitis B. Chronic hepatitis may be asymptomatic or present with ongoing fatigue, malaise, joint pain, and hepatomegaly. Complications include acute liver failure, chronic hepatitis, cirrhosis, and liver cancer.

Karen Whitaker: Nonalcoholic fatty liver disease and nonalcoholic steatohepatitis are increasingly common. NAFLD is fat accumulation in the liver not due to alcohol or viral hepatitis; NASH adds inflammation and scarring. They’re often tied to metabolic syndrome—obesity, diabetes, hyperlipidemia. There’s no single approved drug; we focus on reducing risk factors through weight loss, lipid control, and good diabetes management.

Derek Mendoza: Cirrhosis is a chronic progressive disease with degeneration and destruction of liver cells and fibrosis. Common causes include chronic alcohol use, viral hepatitis, NAFLD, malnutrition, biliary obstruction, and right-sided heart failure. Manifestations can include jaundice, fatigue, hepatomegaly, spider angiomas, thrombocytopenia, anemia, coagulation problems, endocrine changes, and peripheral neuropathy.

Karen Whitaker: Patients with cirrhosis can be compensated or decompensated. Major complications you should know are portal hypertension, esophageal and gastric varices, ascites, hepatic encephalopathy, and hepatorenal syndrome. Portal hypertension leads to splenomegaly, collateral veins, ascites, and varices. Bleeding esophageal varices are life-threatening and demand rapid response.

Derek Mendoza: Ascites is fluid accumulation in the peritoneal cavity, often with peripheral edema, dehydration, and hypokalemia. Hepatic encephalopathy is a terminal complication with neurologic manifestations, especially confusion and changes in mental status. Both of these issues put patients at high risk for falls, so safety is huge.

Derek Mendoza: Typically the blood ammonia levels will be elevated. So management of hepatic encephalopathy focuses on reducing ammonia formation and treating precipitating causes, like GI bleeding or infection. Nursing care is all about a safe environment, sustaining life, and helping with measures that decrease ammonia, including medications like lactulose as ordered.

Karen Whitaker: Diet for patients with cirrhosis without complications is usually high calorie with high carbohydrates and moderate to low fat. Sodium restriction comes in when they have ascites or peripheral edema. Prevention and early treatment of complications are central nursing responsibilities—you’re watching weight, girth, mentation, and bleeding risk closely.

Derek Mendoza: Acute liver failure, or fulminant hepatic failure, is sudden severe liver dysfunction with encephalopathy, often due to drugs like acetaminophen, especially combined with alcohol. Manifestations include jaundice, coagulation abnormalities, and encephalopathy. Liver transplant is the definitive treatment, and nurses are critical in recognizing deterioration early.

Karen Whitaker: Hepatocellular carcinoma is the most common primary liver cancer. Its symptoms overlap with cirrhosis, so it’s hard to catch early. Prevention really means preventing and treating chronic hepatitis B and C and chronic alcohol misuse. Treatment depends on stage and liver function and can include surgery, ablation, or systemic therapies. Many of these patients, along with those with end-stage liver disease, are candidates for liver transplantation.

Derek Mendoza: Let’s bring in the pancreas. Acute pancreatitis is an acute inflammatory process. In women, biliary tract disease is the most common cause; in men, it’s usually alcohol. Hypertriglyceridemia is another risk factor. We describe it as mild, edematous pancreatitis or severe, necrotizing pancreatitis.

Karen Whitaker: Classic symptoms are left upper quadrant abdominal pain, often radiating to the back, plus nausea, vomiting, low-grade fever, elevated white blood cell count, hypotension, tachycardia, and possibly jaundice. Two key local complications are pancreatic pseudocyst—fluid collection near the pancreas—and pancreatic abscess, which is an infected fluid collection with pus that often arises from a pseudocyst.

Derek Mendoza: We diagnose acute pancreatitis mainly with elevated serum amylase and lipase. Goals of care are pain relief, preventing or managing shock, reducing pancreatic secretions, correcting fluid and electrolyte imbalances, preventing or treating infections, and addressing the cause. Treatment is mostly supportive—aggressive IV hydration, pain management, managing metabolic complications, and minimizing pancreatic stimulation with NPO status when indicated.

Karen Whitaker: Chronic pancreatitis is a prolonged process. The pancreas gets progressively destroyed and replaced with fibrotic tissue, with strictures and calcifications. Patients can have chronic abdominal pain, malabsorption and weight loss, constipation, mild jaundice with dark urine, steatorrhea—fat in the feces—and diabetes from endocrine insufficiency.

Derek Mendoza: During acute flares of chronic pancreatitis, we treat them similarly to acute pancreatitis. Otherwise, nursing management is more palliative and focused on health promotion—dietary changes, pancreatic enzyme replacement, and diabetes management. You’re supporting nutrition and pain control while watching for complications.

Karen Whitaker: Pancreatic cancer is often diagnosed late, after it has metastasized. Signs and symptoms mimic chronic pancreatitis—abdominal pain, weight loss, maybe jaundice. CT scanning is the main diagnostic tool. Surgery is the most effective option, but only a minority of tumors are resectable. Radiation and chemotherapy may be used before or after surgery.

Derek Mendoza: Our nursing role is largely supportive: managing pain, supporting nutrition, and providing strong psychosocial support, because these patients often face significant anxiety and depression. Small, consistent acts—good pain control, listening, clear explanations—go a long way.

Karen Whitaker: Finally, disorders of the biliary tract. Cholelithiasis is gallstones in the gallbladder, and cholecystitis is inflammation of the gallbladder, usually from stones or biliary sludge. Stones form when the balance of cholesterol, bile salts, and calcium is disrupted, causing precipitation.

Derek Mendoza: Manifestations of cholecystitis can range from indigestion to moderate or severe right upper quadrant pain, fever, and jaundice. Initial symptoms usually include indigestion and pain and tenderness in the right upper quadrant. Gallstones themselves may be silent or cause severe pain if they obstruct ducts. During acute episodes, treatment is supportive—pain control, antibiotics to control infection, and maintaining fluid and electrolyte balance.

Karen Whitaker: Ultrasound is frequently used to diagnose gallstones. Treatment depends on the patient and disease stage. Laparoscopic cholecystectomy is the treatment of choice for symptomatic gallstones. For patients who are poor surgical candidates with small radiolucent stones, medical dissolution therapy may be considered.

Karen Whitaker: Post-op nursing care after laparoscopic cholecystectomy includes monitoring for complications, controlling pain, encouraging early ambulation, and preparing the patient for discharge with instructions about activity, diet, and watching for signs of infection or bile leak.

Derek Mendoza: Primary gallbladder cancer is rare and usually presents like chronic gallbladder disease, so it’s often advanced by the time we diagnose it. Prognosis is usually poor, so nursing care is mainly palliative—nutrition, skin care, pain control, and psychosocial support for patients and families.

Karen Whitaker: That was a whirlwind tour of upper and lower GI, plus liver, biliary, and pancreatic disorders. As you’re studying, focus on patterns: typical symptoms, major complications, and your nursing priorities—especially fluid balance, bleeding risk, infection, and patient teaching.

Karen Whitaker: Derek, thanks for breaking this down with me, and thanks to all of you for listening. Keep reviewing your key points and connecting them back to assessment and interventions.

Derek Mendoza: Absolutely. You’ve got a lot of content here, but it really does come down to recognizing patterns and acting early. We’ll see you in a future episode with more Med-Surg content. Take care, everyone.