Gastrointestinal Nursing.pdf

Gastrointestinal Emergencies 151Chapter 11Gastrointestinal EmergenciesChapter objectivesAfter reading this chapter you should be able to:• Describe the underlying pathophysiology of common gastrointestinalemergencies.• Understand the cause and risk factors of gastrointestinal emergencies.• Identify the main symptoms of complications.• Relate the measures that are required to treat gastrointestinal emergencies,and the relevant nursing practice.Perforation of the gastrointestinal tractPerforation of the gastrointestinal tract can occur in the oesophagus, stomachor duodenum. It can be the result of trauma, underlying pathology, ingestionof a foreign body, increased intraoesophageal pressure or mechanical traumaduring upper endoscopy. Oesophageal perforation during therapeutic upperendoscopy most commonly occurs during dilatation of oesophageal strictures.It can also be the result of instrument trauma during an endoscopic procedure,caused by the instrument, dilators or biopsy forceps. Gastric perforation is lesscommon than oesophageal perforation and is usually related to peptic ulcerdisease.Clinical presentation of gastrointestinal perforationThe most common presenting symptom is pain. This pain and other presentingsigns and symptoms are dictated by the site and severity of the perforation.Oesophageal perforationIf the perforation is in the upper third of the oesophagus the patient will havedysphagia, stiffness of the neck and tenderness in the region affected. Perforationin the thoracic oesophagus can result in sub-sternal or epigastric pain that151