Gastro Intestinal System

Functions: • Digestion • Absorption • Elimination of waste Liver • • •

Function: Synthesis of glucose, fats and amino acid Conjugation of bilirubin and sex hormones Stores Vit. A, B12, D

GASTROESOPHAGEAL REFLUX DISEASE (GERD)
• • Back flow of gastric contents secondary to incompetent esophageal sphincter Clinical manifestation: • Pyrosis ( burning sensation of the esophagus) • Dyspepsia (indigestion) • Regurgitation • Dysphagia or odyynophagia ( pain in swallowing ) • Hypersalivation • Esophagitis

NOTE: symptoms mimic those of a heart attack so patients history plays a major role in obtaining an accurate diagnosis Diagnostic test: Barium swallowing - as the patient swallows the barium suspension, it coats the esophagus with a thin layer of barium. - This enables the hallow structure to be imaged via x-ray pH Probe Test - esophageal monitoring to evaluate degree of acid reflux DRUG OF CHOICE: Ranitidine ( zantac ) - inhibits stomach acid (HCl) production - H2 receptor antagonist Antacids ( amphojel, chooz, milk of magnesia ) - neutralized or reduce the acidity of stomach SURGERY FUNDOPLICATION - the gastric fundus ( upper part ) of the stomach is wrapped around the lower end of the esophagus and stitched in place NURSING CONSIDERATION: - small frequent feeding and weight loss program - limit gastric irritant ( spicy foods, acidic, etc ) - avoid smoking - lie with head elevated - discuss stress reduction strategies

and allows for selective accumulation in anaerobes . anal cancer .it is selectively absorbed by anaerobic bacteria and sensitive to protozoa. sucralfate. tetracycline . NSAIDs.Neutralized or reduce acidity of stomach .food and chemical causes ( Spicy.Do not give with ranitidine • Proton Pump Inhibitors o Omeprazole ( omepron ). steroids.given frequently due to short duration of action .Chooz. pylori . milk of magnesia . Chronic Gastritis .inhibit protein synthesis by binding to chromosomes leading to inability of bacteria to multiply • Anti protozoal . This reduction causes the production of toxic products to anaerobic cells. amphojel. Once taken up by anaerobes. Acute Gastritis . aspirin.due to H.GASTRITIS .5 . it is non-enzymatically reduced by reacting with reduced ferredoxin. pernicious anemia. alcohol. ulcers.Give with H2O .Cronic Type A – auto immune.Chronic Type B – due to H.misoprostol .0-3. microaerophillic bacterium ) DRUG OF CHOICE • H2 Receptor Antagonist o Cimetidine ( Tagamet) o Inhibits stomach acid (HCl) production o NOTE: Do not give too fast it causes Bradycardia • Antacids .doxycycline.inflammation of the gastric mucousa CAUSES: 1.metronidazole (Flagyl) .help protect the tissues that line the stomach and small intestines • penicillin o -amoxicillin (amox) o inhibits synthesis of bacterial cell wall • Tetracycline . ingestion of contaminated food) 2.Goal is to maintain gastric pH level @ 3.bismuth subsalicylate.Simethicone ( Maalox ) . bile refux. Esomeprazole (nexium) o They block the final step in the production of gastric acid by the “acid secreting cells” in the gastric mucousa • Cytoprotective Agentrs or Anti Aeptic Agents .pylori ( G (-).

taken up into bacterial DNA and form unstable molecules. And since because this reduction usually happens to anaerobic cells. I t has relatively little effect upon human cells or aerobic bacterias NURSING CONSIDERATION .monitor for GI Bleeding - PEPTIC ULCER DISEASE • An erosion of the mucus membrane of the stomach or duodenum CAUSES: • Excessive acid production • Decreased mucus production DIAGNOSTIC TEST • Blood serum • Endoscopy – visualization of stomach • Barium studies • Stool exam –presence of blood indicates bleeding CARDINAL SIGNS: • Pyrosis ( or heart burn ) • Hematamesis (vomiting of blood) • Melena (blood in stool) DRUGS: • H2 receptor antagonist • Antacids • Proton pump inhibitors SURGERY: • Antrectomy .Billroth 1 (gastro duodenal) .Billroth 2 (gastro jejunal) Nursing Considerations: • Avoid anything that increased HCl production Table of comparison of Gastric Ulcer and Duodenal Ulcer GASTRIC ULCER PAIN RELIEF 30 mins.removal of lower 50 % of stomach . – 1 hr after eating Not by food DUODENAL ULCER 2-3 hours By food .

A W arm compress Enema Laxatives • Provide comfort o side lying position o if ruptured. (1) Leucocytosis (2) Shift to left (pain) (1) SCORE 3.E. gangrene. perforation and peritonitis. semi fowler’s to prevent peritonitis .9 DEFINITION no AP doubtful confirmed AP NURSING CONSIDERATION • Avoid W.L – may cause rupture of V.4 5.BLEEDING PERFORATION Ca CELLS PHYSICAL FEATURES common Not common Occasional Weight loss Not common common rare Weight gain due to increased food intake SLEEP Doesn’t wake up Wakes up at midnight APPENDICITIS Obstruction of the vermiform appendix leading to inflammation.6 7. AT RISK: • Fecal impaction • Parasites • Infection CARDINAL SIGNS Right lower quadrant pain ( mc Burney’s area) Rebound tenderness SURGERY: • Appendectomy • Exploratory laparotomy (if ruptured) Alvorado’s scoring system for diagnosis of appendicitis “MANTRELS” Migratory pain (1) Anorexia (2) Nausea (1) Tenderness (2) Rebound tenderness (1) Elevated temp.

Constipation .Elderly .IBD .• Do not give pain meds cause it may mask the symptom DIVERTICULAR DISEASE CAUSE: .Obesity .methyl cellulose . intestines.Outpouching or herniation of the intestinal mucousa through weakness of muscle layers in the colon wall. Involuntary urination – Givem @ HS & 30 mins before meal .propantheline bromide ( pro-banthine ) – anti muscorinic agent used for treatment of excessive sweating.Dietary deficiency of fiber RISK FACTORS: . cramps & spasms of stomach. Gallbladder Liver R Pain Pancreas L pain Appendicitis (intestine) Diverticulitis DRUGS OF CHOICE Laxatives .

- bulk forming laxatives NURSING CONSIDERATION • Hydration • Assess stool characteristic • High dietary roughage • Avoid valsalva maneuver CHRONIC INFLAMMATORY BOWEL DISEASE (CIBD) 2 TYPES: 1. FIE imbalance. Chron’s disease or regional enteritis CHRON’S DISEASE Patchy lesion in GI tract. foul smelling stools/day ( with mucus and pus). prednisone) Decreased inflammation • NSAIDs Salicylates Decreased inflammation • Immuno modulators Azathioprine. RLQ pain DRUGS: • Steroids Corticosteroids ( hydrocortisone. methotrexate. decending ( from ileum to rectum) resulting to excessive diarrhea. dehydration and fistula • Develops slowly with remissions and exacerbations from emotional factors in family and work • Cobblestoning of mucousa CARDINAL SIGNS • 3-5 semisolid. natalizumab Decreased WBC activity • Sulfonamides Sulfasalazine (azulfidine) Blocks PABA to prevent synthesis of folic acid CHRON’S DISEASE (MORPHOLOGY AND SYMPTOMS) Cobblestones High temp Reduced lumen Intestinal lumen Skip lesions Transmural (all layers may ulcerate) Malabsorption • . betametasone. Ulcerative colitis 2.

5 oC) Albumin ( below 30 g/l) Tachycardia (above 90 bpm) ESR (above mm/hr) ULCERATIVE SITE Recto-sigmoid area CHRON’S Terminal. ceccum. ileum. ascending colon Skipping lesion Little Little Common Common • TYPE OF LESION DIARRHEA BLEEDING FISTULA PERIANAL INVOLVEMENT Ascending lesion Prone Prone Not common Not common . ascending (anorectal to descending colon) leading to intestinal obstruction. malabsorption and dehydration • With pseudopolyps in mucousa RISK FACTOR: • Genetic • Stress • Autoimmune • 10 – 40 y/o DIAGNOSTIC TEST • CBC • Sigmoidoscopy CARDINAL SIGNS • Chronic • Bloody mucoidal diarrhea DRUGS: • Sulfasalazine • Anti protozoal (metronidazole) NURSING CONSIDERATION: • Bulk free diet • Monitor s/s of dehydration • Monitor I & O • Pshychologic support ULCERATIVE COLITIS : definition of a severe attack Anemia ( less than 10 g/dl) Stool frequency (greater than 6 stool/day) Temperature (above 37.Abdominal pain Submucosal fibrosis ULCERATIVE COLITIS Inflammatory continous lesions in GI tract.

fat. fertile) • High fat diet • Aging • Genetics • Cirrhosis • Chron’s • Sickle cell anemia • Rapid wt. loss • DM • Obesity • Oral contraceptives DIAGNOSTIC TEST • Cholangiography -imaging of the bile duct by x-rays • Serum bilirubin o an increase indicates disease • Alkaline Phosphatase Normal range of 20 – 14 iu/L High ALP indicates bile ducts are blocked CARDINAL SIGNS • RUQ pain (may radiate to subscapular area) • Nausea and vomiting • Intolerance to fat • Clay colored stool DRUGS • Opioids agonists or opioid analgesics o Meperidine (Demerol) o Reduce pain binding to opiate receptor sites in the PNS and CNS o Do not give with MAO inhibitors • Bile acid sequestrants Ursodeoxycholic Acid (actigall) Reduces cholesterol absorption and is used to dissolve gallstones Cholestyramine (questran) Binds to bile acids to form an insoluble substance that cannot be absorbed by the intestine CHARCOT’S TRIAD • Fever • Epigastric RUQ pain • Emesis and nausea .if stoma site is dusky. RISK FACTORS: • 4 F ( female. blood supply has been interrupted CHOLECYSTITIS .Cholesterol and calcium precipitate as solid crystals with in mucous lining of gallbladder obstruction cystic duct. 40 y/o.RECTAL 100% 20 % SURGERY: • Ileostomy / colonoscopy .

Murphy’s sign.combines endoscopy and fluoroscopy Drugs TREATMENT: Monitor V/S Calcium H2 receptor IV access/ IV NPO Empty Gastric Surgery (if . hemorrhage and necrosis or replacement of fibrous tissue. lipase. elastase and trypsin initiating auto digestion resulting to edema. NURSING CONSIDERATION • Avoid high fat diet PANCREATITIS . CAUSES: Gallstones Ethanol Analgesia/antibiotics Trauma gluconate ( if necessary) Steroids antagonist Mumps fluids Autoimmune Scorpion/snake bite contents Hyperlipidemia necessary) ERCP – Endoscopic retrograde Chologiopancreatography . pt can’t continue inspiration. vascular damage.injured or disrupted pancreas leaks phospholipase H.upon inspiration palpate RUQ and if it painful.

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