Adult Medical-Surgical Nursing

GI & hepatobiliary nursing: bleeding, IBD, cirrhosis & GI tubes

Peptic ulcers and GI bleeding, IBD, obstruction, cirrhosis, hepatitis, pancreatitis and gallbladder disease — plus safe care of NG and GI tubes.

Must-know for the exam

Coffee-ground emesis or melaena (black, tarry stool) signals upper GI bleeding; frank haematemesis or bright rectal bleeding needs urgent assessment for hypovolaemic shock.
Ruptured oesophageal varices are a medical emergency — the priorities are airway protection and haemodynamic stabilisation, with vasoactive drugs and endoscopic banding.
Hepatic encephalopathy is treated with lactulose to lower ammonia; rising confusion and asterixis (flapping tremor) are key markers.
Confirm NG tube placement before every feed or medication using aspirate pH (about 5.5 or below) or X-ray — never rely on the auscultation whoosh test alone.
Acute pancreatitis presents with severe epigastric pain radiating to the back and raised amylase/lipase; keep the patient NPO to rest the gut and give aggressive IV fluids and pain relief.
Hepatitis A and E spread faecal-orally (hand hygiene, food); B, C and D spread by blood and body fluids — match precautions to the route.

In this note

1.How the exam frames GI & hepatobiliary questions
2.Upper GI: peptic ulcer disease, GERD & upper GI bleeding
3.Lower GI: IBD, IBS, diverticular disease & bowel obstructionPremium
4.Liver: cirrhosis, portal hypertension, ascites & varicesPremium
5.Hepatic encephalopathy & viral hepatitisPremium
6.Gallbladder & biliary: cholelithiasis & cholecystitisPremium
7.Acute pancreatitisPremium
8.NG tubes, enteral/parenteral nutrition & stoma carePremium
9.Rapid revision — traps & report-immediately findingsPremium

How the exam frames GI & hepatobiliary questions

These items usually hand you a symptom cluster, a lab value or a procedure and ask you to name the problem, choose the FIRST nursing action, pick the finding to report, protect the patient from a complication, or teach safely about diet, drugs or a tube. The gastrointestinal tract is long, but the exam keeps returning to a short list of high-stakes events: BLEEDING (upper or lower), OBSTRUCTION, PERFORATION/peritonitis, ASPIRATION, and the liver failing to do its jobs.

A reliable frame for any GI or hepatobiliary scenario:

•Look for bleeding first — haematemesis or 'coffee-ground' vomit and black tarry stools (melaena) point to an UPPER GI bleed; bright red rectal blood points LOWER. A GI bleed is a circulation problem, so airway, breathing and circulation and shock recognition come before anything else.
•Protect the airway. Vomiting, a depressed conscious level (hepatic encephalopathy), and NG/enteral feeding all carry ASPIRATION risk — positioning and airway protection are frequent right answers.
•Ask what the organ normally does. The liver detoxifies (ammonia), makes clotting factors and albumin, and stores glucose; when it fails, bleeding, encephalopathy, oedema/ascites and hypoglycaemia follow. The pancreas digests and controls glucose; when it is inflamed, autodigestion causes severe pain and enzyme leakage.
•For any drug or tube (PPIs, lactulose, TPN, NG tubes, stomas), safe administration, placement checking and monitoring are common correct answers.

Reference values quoted below are widely used adult figures (serum amylase and lipase rise markedly in acute pancreatitis; serum ammonia is often raised in hepatic encephalopathy but is NOT used to titrate treatment; INR rises as the failing liver makes fewer clotting factors); laboratories differ, so always read against your own local range and protocol.

Upper GI: peptic ulcer disease, GERD & upper GI bleeding

PEPTIC ULCER DISEASE (PUD) is a breach in the mucosa of the stomach or duodenum, driven mainly by Helicobacter pylori infection and by NSAIDs/aspirin (which strip the protective prostaglandins); smoking, alcohol and stress worsen it. A GASTRIC ulcer classically hurts SOON after eating (food can worsen pain, so patients may lose weight); a DUODENAL ulcer classically hurts 2–3 hours after meals and at night, and is often RELIEVED by food. The two feared complications are BLEEDING and PERFORATION.

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Traps that cost marks

Confirming NG tube position by injecting air and listening (the whoosh test) instead of checking aspirate pH or X-ray.
Giving opioids or antiemetics that mask a deteriorating GI bleed or obstruction before assessing perfusion and vital signs.
Mistaking melaena (black, tarry stool) for the effect of iron or diet and failing to escalate a GI bleed.
Offering a high-protein diet to a patient in hepatic encephalopathy, worsening the ammonia load, rather than following prescribed protein limits and lactulose.
Overlooking early hypovolaemic shock in GI bleeding because the blood pressure is still normal — watch tachycardia and a rising respiratory rate.

GI & hepatobiliary nursing: bleeding, IBD, cirrhosis & GI tubes

Peptic ulcers and GI bleeding, IBD, obstruction, cirrhosis, hepatitis, pancreatitis and gallbladder disease — plus safe care of NG and GI tubes.

Must-know for the exam

Coffee-ground emesis or melaena (black, tarry stool) signals upper GI bleeding; frank haematemesis or bright rectal bleeding needs urgent assessment for hypovolaemic shock.
Ruptured oesophageal varices are a medical emergency — the priorities are airway protection and haemodynamic stabilisation, with vasoactive drugs and endoscopic banding.
Hepatic encephalopathy is treated with lactulose to lower ammonia; rising confusion and asterixis (flapping tremor) are key markers.
Confirm NG tube placement before every feed or medication using aspirate pH (about 5.5 or below) or X-ray — never rely on the auscultation whoosh test alone.
Acute pancreatitis presents with severe epigastric pain radiating to the back and raised amylase/lipase; keep the patient NPO to rest the gut and give aggressive IV fluids and pain relief.
Hepatitis A and E spread faecal-orally (hand hygiene, food); B, C and D spread by blood and body fluids — match precautions to the route.

In this note

1.How the exam frames GI & hepatobiliary questions

2.Upper GI: peptic ulcer disease, GERD & upper GI bleeding

3.Lower GI: IBD, IBS, diverticular disease & bowel obstructionPremium

4.Liver: cirrhosis, portal hypertension, ascites & varicesPremium

5.Hepatic encephalopathy & viral hepatitisPremium

6.Gallbladder & biliary: cholelithiasis & cholecystitisPremium

7.Acute pancreatitisPremium

8.NG tubes, enteral/parenteral nutrition & stoma carePremium

9.Rapid revision — traps & report-immediately findingsPremium