Mouth The mouth is the starting point in the digestive system. Both mechanical and chemical digestion can occur here. The teeth grind food for mechanical digestions while the salivary gland break down for chemically for chemical digestion. Salivary Glands The salivary glands release saliva. The saliva breaks down food chemically. You have three major salivary glands. One on the top of your mouth, one on the bottom and one that covers both sides. Saliva breaks up food using the enzyme salivary amylas Esophagus (also Oesophagus) The esophagus, a muscular tube through which partially digested food travels, connects the mouth and the stomach. Food goes down the esophagus using peristalsis, a pattern of muscular movements, contracting and expanding. Stomach The stomach's job is to break down large food molecules into smaller pieces, so that they are more easily absorbed into the blood. The stomach can give off two or three liters of gastric juices per day. This juice can even destroy the inner liner of the stomach. This is why the inner lining of the stomach is replaced every two to three days. Liver, Pancreas, and Gallbladder The liver puts bile into the small intestine through the biliary system, using the gallbladder as a container to hold the extra bile. The pancreas puts off a fluid containing bicarbonate and several juices, including trypsin, chymotrypsin, lipase, and pancreatic amylase, as well as nucleolytic juices, into the small intestine. Both these organs help in the process of digestion. Small Intestine The small intestine connects the stomach and the colon or large intestine. It has three parts. They are the duodenum, jejunum, and the ileum. The walls of the small intestine are lined with villi. Villi help absorb nutrients and put them into the blood. This is the main purpose of the small intestine.

It also absorbs some vitamins such as vitamin k. Food is partly broken down by the process of chewing and by the chemical action of salivary enzymes (these enzymes are produces by the salivary glands and break down starches into smaller molecules). In the small intestine .Large Intestine (Colon) The large intestine is used to remove water from solid waste. food enters the duodenum. it also has to excrete waste. The digestive system is essentially a long. our body has to break the food down into smaller molecules that it can process. and other digestive enzymes produced by the inner wall of the small intestine help in the breakdown of food. plus a few other organs (like the liver and pancreas) that produce or store digestive chemicals. . wave-like muscle movements (called peristalsis) to force food from the throat into the stomach. twisting tube that runs from the mouth to the anus. This muscle movement gives us the ability to eat or drink even when we're upside-down. In the small intestine. bile (produced in the liver and stored in the gall bladder).After being chewed and swallowed. It uses rhythmic.the mouth: The digestive process begins in the mouth. sack-like organ that churns the food and bathes it in a very strong acid (gastric acid). Most of the digestive organs (like the stomach and intestines) are tube-like and contain the food as it makes its way through the body. the first part of the small intestine. It then enters the jejunum and then the ileum (the final part of the small intestine).After being in the stomach. The Digestive Process: The start of the process .5 meters in length. On the way to the stomach: the esophagus . In the stomach . pancreatic enzymes. The esophagus is a long tube that runs from the mouth to the stomach.The stomach is a large. In order to use the food we eat. Food in the stomach that is partly digested and mixed with stomach acids is called chyme. Human Digestive System The human digestive system is a complex series of organs and glands that processes food. It is 1. the food enters the esophagus.

appendix . The food travels across the abdomen in the transverse colon. bile .Solid waste is then stored in the rectum until it is excreted via the anus. Lactobacillus acidophilus. descending colon .the first part of the small intestine. food passes into the large intestine. Digestive System Glossary: anus . it is C-shaped and runs from the stomach to the jejunum.the first part of the large intestine. ascending colon . cecum . The end of the process .the part of the large intestine that run downwards after the transverse colon and before the sigmoid colon.the flap at the back of the tongue that keeps chewed food from going down .a digestive chemical that is produced in the in the stomach that is partly digested and mixed with stomach acids. Many microbes (bacteria like Bacteroides. it is located after the cecum. duodenum . and secreted into the small intestine.the opening at the end of the digestive system from which feces (waste) exits the body. Food then travels upward in the ascending colon.In the large intestine .a small sac located on the cecum. Escherichia coli. the appendix is connected to the cecum. In the large intestine. Chyme goes on to the small intestine for further digestion. some of the water and electrolytes (chemicals like sodium) are removed from the food. and then through the sigmoid colon. and Klebsiella) in the large intestine help in the digestion process. stored in the gall bladder. epiglottis . chyme . The first part of the large intestine is called the cecum (the appendix is connected to the cecum).After passing through the small intestine. goes back down the other side of the body in the descending colon.the part of the large intestine that run upwards.

an enzyme-producing gland located below the stomach and above the intestines. sigmoid colon . gall bladder . It filters toxins from the blood.the first part of the digestive system. liver .a large organ located above and in front of the stomach.rhythmic muscle movements that force food in the esophagus from the throat into the stomach. mouth . where food enters the body. When you swallow. It uses rhythmic muscle movements (called peristalsis) to force food from the throat into the stomach. Saliva contains enzymes that break down carbohydrates (starch) into smaller molecules. When you breathe. the epiglottis opens so that air can go in and out of the windpipe.the part of the large intestine between the descending colon and the rectum. salivary glands . Chewing and salivary enzymes in the mouth are the beginning of the digestive process (breaking down the food). Enzymes from the pancreas help in the digestion of carbohydrates.the windpipe to the lungs.glands located in the mouth that produce saliva.the long. sac-like organ located by the duodenum. and makes bile (which breaks down fats) and some blood proteins. jejunum .a small. peristalsis . It is also what allows you to eat and drink while upside-down. ileum . Peristalsis is involuntary . rectum .the long tube between the mouth and the stomach.the last part of the small intestine before the large intestine begins.the lower part of the large intestine. where feces are stored before they are excreted. . pancreas . the epiglottis automatically closes. fats and proteins in the small intestine. it is between the duodenum and the ileum. It stores and releases bile (a digestive chemical which is produced in the liver) into the small intestine. esophagus .you cannot control it. coiled mid-section of the small intestine.

Digestion has two parts. mechanical and chemical. it is churned in a bath of acids and enzymes. lipid.the part of the large intestine that runs horizontally across the abdomen. while chemical digestion is the work the enzymes do when breaking large carbohydrate. Both chemical and mechanical digestion takes place in the stomach. transverse colon .5 quarts) of water. .a sack-like. and enzymes each day to lubricate the canal and aid in the process of digestion. The cells lining the GI tract secrete about 9 liters (9. protein and nucleic acid molecules down into their subcomponents -these and others are the nutrients-. muscular organ that is attached to the esophagus.stomach . Secretion is the act of expelling a liquid. When food enters the stomach. Mechanical digestion is chewing up the food and your stomach and smooth intestine churning the food. acid. The digestive system carries out six basic processes: ingestion secretion propulsion digestion absorption defecation Ingestion is taking food into the mouth. Absorption occurs in the digestive system when the nutrients move from the gastrointestinal tract to the blood or lymph. buffers. Propulsion consists of alternating contraction and relaxation of smooth muscle in the walls of the GI tract to squeeze food downwards. Defecation is the process of expelling what the body couldn't use.

Decreased blood flow. Increased neutrophils. heat-shock protein enzymes. etc. Decreased cell restitution Bleedin g Melena Hemateme sis Abdominal Pain . lymphocytes.) Non-Steroidal AntiInflammatory Hydrogen ions and pepsin Mucosal damage and ulceration Topical and systemic effects Decreased mucus production. neutrophils. etc.PATHOPHYSIOLOGY OF BLEEDING PEPTIC ULCER DISEASE Helicobacter Pylori Release of cytokines. Decreased bicarbonate. Inflammatory cascade initiated (cytokines. lipopolysaccharides.


.monitor patient for .Name of drug Metronidazole Pharmacodynamic s Direct-acting trichomonacide and amebicide that works inside and outside the intestines. causing cell death. It is thought to enter the cells of microorganisms that contain nitroreductase. take as soon as remembered if not almost time for the next dose. dry mouth. Do not skip doses or double up on missed doses. nausea.advise patient to consult .caution patient that medication may cause an unpleasant metallic taste. improvement after a few days or if signs such as black furry overgrowth in tongue. dizziness. Id a dose is missed. . . unpleasant taste vomiting Skin: rashes.patients with hypersensitivity to metronidazole or other nitroimidazoles. Nursing Responsibilities . diarrhea. Rationale . forming unstable compounds that bind to DNA and inhibit synthesis. Dosage Adverse effects CNS: headache. .drug may cause . . .administer with food or milk.caution patient about dizziness or lightactivities that may be minimize gastric irritation. Tablets may be crushed for patients with difficulty swallowing.use cautiously in patients who take hepatotoxic drugs or have hepatic disease or alcoholism.instruct patient to take medication exactly as directed evenly spaced times between dose. anorezia. Patients . . glossitis. requiring mental awareness until response to medication is known. or foul-smelling stools develop. furry tongue. even if feeling better.this may indicate occurrence of a health care professional if there is no superinfection. . urticaria Hematologic: leucopenia Local: phlebitis at IV site Neuro: peripheral neuropathy Other: superinfection Contraindications . or retinal or visual changes.altering the dosage of the medication may cause untoward effects. CNS disorder.use cautiously in patients with history of blood dyscrasia. seizures GI: abdominal pain.inform patient that medication may cause urine to turn dark.


recurrent bleeding on medical therapy. o o o o . H pylori eradication.MEDICAL MANAGEMENT • Given the current understanding of the pathogenesis of PUD. symptomatic peptic ulcers. Obstruction may persist or recur despite endoscopic balloon dilation. though rare with the cure of H pylori infection and the appropriate use of antisecretory therapy. • Perform endoscopy early in patients older than 45-50 years and in patients with associated so-called alarm symptoms. such as dysphagia. particularly in patients with massive hemorrhage and hemodynamic instability. are a potential complication of PUD. Complications of PUD include the following: o Refractory. Penetration. weight loss. however. Bleeding can complicate PUD. along with the appropriate use of antisecretory therapy. • Computer models have suggested that obtaining H pylori serology followed by triple therapy for patients who are infected is the most cost-effective approach. no direct evidence from clinical trials provides confirmation. • A number of treatment options exist for patients presenting with symptoms suggestive of PUD or ulcerlike dyspepsia. particularly if not walled off or if a gastrocolic fistula develops. • Potential indications for surgery include refractory disease. or avoidance of NSAIDs. or bleeding. However. Obstruction can complicate PUD. particularly if PUD is refractory to aggressive antisecretory therapy. most patients with PUD are treated successfully with cure of H pylori infection and/or avoidance of NSAIDs. including empiric antisecretory therapy. is a potential complication of PUD. empiric triple therapy for H pylori infection. surgery has a very limited role in the management of PUD. recurrent vomiting. and failure of therapeutic endoscopy to control bleeding. this is not mandatory for all patients. and H pylori serology followed by triple therapy for patients who are infected. Perforation usually is managed emergently with surgical repair. endoscopy followed by appropriate therapy based on findings. Breath testing for active H pylori infection may be used. SURGICAL TREATMENT With the success of medical therapy.

o Many authorities recommend simple oversewing of the ulcer with treatment of the underlying H pylori infection or cessation of NSAIDs for bleeding PUD. Additional surgical options for refractory or complicated PUD include vagotomy and pyloroplasty. o . or a highly selective vagotomy. vagotomy and antrectomy with gastroduodenal reconstruction (Billroth I) or gastrojejunal reconstruction (Billroth II).• The appropriate surgical procedure depends on the location and nature of the ulcer.

IF NOT TREATED Complications of Bleeding Peptic Ulcer Disease Bleeding from granulation tissue Erosion of ulcer into an artery or vein HEMORRH AGE Sudden onset of weakness Dizziness Thirst Cold and moist skin Desire to defecate Passage of loose. tarry. or even red stools and coffee-ground emesis Excessive blood loss Circulatory shock .

spasm or contraction of scar tissue OBSTRUCTION Interference with the free passage of gastric contents through the pylorus or adjacent areas Feeling of epigastric fullness And heaviness after meals SEVERE OBSTRUCTION Vomiting of undigested food .Edema.

Ulcer erodes through all the layers of the stomach or duodenum PERFORATIO N Gastrointestinal contents enter the peritoneum Symptoms: Radiation of pain into the lower back Severe night distress PERITONIT IS Bowel obstruction Penetrate adjacent Inadequate pain relief from eating food or taking antacids Nausea and vomiting Translocation of fluid into peritoneal cavity and into bowel Further losses of fluid Hypovolemia and shock .

it leads to toxemia and shock. . and eventually death.PERITONITIS Reflex muscle guarding Vomiting Fever Elevated WBC count Irritation of phrenic nerve Abdomen is rigid. often described as board-like Tachycardia Hypotension Hiccups Breathing is shallow PARALYTIC ILEUS ABDOMINAL DISTENTION Note: if peritonitis progresses and is left untreated.

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