Gastrointestinal Surgery

Lesson Objectives

By the end of this topic, learners should be able to:

1. Identify common gastrointestinal surgical conditions.

2. Understand pathophysiology, clinical features, and complications.

3. Describe diagnostic approaches and imaging modalities.

4. Recognize surgical interventions and post-operative care requirements.

5. Apply nursing and medical perspectives for optimal patient outcomes.

 Key Glossary Terms

1. Appendicitis

• Definition: Inflammation of the vermiform appendix, often due to obstruction (fecalith, lymphoid hyperplasia).

• Clinical Features:

  • Early: Periumbilical pain, nausea, anorexia

  • Later: Right lower quadrant pain, tenderness at McBurney’s point, fever

• Complications: Perforation, abscess, peritonitis

• Management: Appendectomy (open or laparoscopic), antibiotics pre- and post-op

2. Cholecystitis

• Definition: Inflammation of the gallbladder, often due to gallstones.

• Clinical Features: RUQ pain, Murphy’s sign, fever, nausea/vomiting

• Complications: Empyema, gangrene, perforation

• Management:

  • Supportive: IV fluids, analgesics, antibiotics

  • Definitive: Cholecystectomy (laparoscopic preferred)

3. Bowel Obstruction

• Definition: Partial or complete blockage of intestinal contents.

• Causes: Adhesions, hernia, tumors, volvulus

• Clinical Features: Colicky abdominal pain, vomiting, abdominal distension, constipation

• Management:

  • Stabilization: IV fluids, electrolytes, nasogastric decompression

  • Surgery: If strangulation or failure of conservative management

4. Perforated Viscus

• Definition: Full-thickness defect of the gastrointestinal tract, leading to spillage into the peritoneal cavity.

• Clinical Features: Sudden severe abdominal pain, peritonitis, rigid abdomen, hypotension

• Management: Emergency laparotomy, IV antibiotics, resuscitation

5. Hernias

• Definition: Protrusion of an organ or tissue through a defect in the abdominal wall.

• Types:

  • Inguinal (direct, indirect)

  • Femoral

  • Umbilical

  • Incisional

• Complications: Incarceration, strangulation

• Management: Elective or emergency surgical repair (open or laparoscopic)

6. Diverticulitis

• Definition: Inflammation of colonic diverticula

• Clinical Features: LLQ pain, fever, change in bowel habits

• Management: Mild: antibiotics, dietary modification; Severe/complicated: surgery (resection)

7. Colorectal Surgery Principles

• Bowel Preparation: Mechanical + antibiotic prophylaxis

• Anastomosis: Surgical joining of bowel segments

• Post-op Care: Monitor for leakage, infection, ileus, bleeding

8. Nursing & Medical Student Focus

• Nursing: Pain assessment, wound care, NG tube management, monitoring vital signs, early mobilization, patient education

• Medical Students: Recognize indications for surgery, perform focused history/exam, interpret labs and imaging, manage post-op complications

9. GI Surgery Mnemonics

• “APB H” for common GI surgical emergencies:

  • Appendicitis

  • Perforated viscus

  • Bowel obstruction

  • Hernia

• “5 Fs” risk factors for gallstones: Female, Fat, Fertile, Forty, Family history

 Tables

Table 1: Common GI Surgical Conditions

Table 2: Post-Operative Nursing Care in GI Surgery