Nursing Profession — CASH
18 sign of dehydration — thirst
C Caring, Client — Centered,
A Art, “TUOS’ / “Therapeutic Use Of Self
Encourage Catharsis
S Science: Theoretical body of knowledge
H Holistic, Holism : “as a whole’, Helping
Profession, Health Promotion
CBQ — Common Board Question
- most important activity : Health teachings
o Most effective (visual) — give
pictures, illustrations,
Functions of the GI System
Pp Process of food substances
A Absorb the products of digestion into the
blood
Pp Provides environments for synthesis of
nutrients / Vitamin K — in newborns,into v.
lateralis bc stomach is sterile, no bacteria
for synthesizing vit k
Excretion of undigested material
Stercobilin - color to stool
Urobilinogen — color to urine
Processin the Digestive System
(I-PM Mo Si Adlawan)
Ingestion -
O;f/VU—
Propulsion — movementfrom one organ to
the next organ “Peristalsis”
Mechanical Digestion (Mastication) —
physical process
Chemical Digestion (Pancreatic Enzymes)
— metabolism of proteins, lipids, carbs —
broken down by enzymes
Absorption -— active or passive, transfer
>|
from GI to blood or lymph.
Water absorption — large intestine
Nut/vit/min absorption — small intestine
Defecation — elimination of undigested
O
substance via anus
1% sign of bleeding — tachycardia (>100bpm)
18 sign of hypoxia/hypoxemia — restlessness
Physical Exam
Teenager, RLQ — appendicitis (commonly in boys)
Normal — IPPA
Abd. Pain —| A Per Pa (change in order for
abdominal pain)
- Auscultate before palpating to avoid altering
bowel motility and bowel sounds
(borborygmi)
| Inspection — contour, symmetry, skin
changes, scars, localized bulging,
distention, peristaltic waves
A Auscultation — bowel sounds
(borborygmi), 4 quadrants (use
diaphragm), BP (use bell), normal bowel
sound (5 — 30 / min)
CBQ
Hypoactive (1 -2 in 2 mins. 122), opiates,
anticholinergic, antipsychotic drugs
(phenothiazines), general anesthesia,
radiation to abdomen. “constipated”
hypoactive @ sleep
Hyperactive (5 — 6 in 0.5 mins 5630)
Crohn’s Disease, Diarrhea, Foodallergy,
Gl bleeding, infectious enteritis (Small
intestine), ulcerative colitis
Absent (NO SOUNDS in 3-5 mins)
“paralytic ileus” post abdominal surgery
Pp Percussion
&" Tympany — gas in stomach
Dull — Solid massesor fluid
Pp Palpation
4 Light — determine swelling / tenderness
Deep — massesin quadrant(?)
CBQ
Palpate the affected area (+) pain, if there
is pain, we should palpate LAST
Sequence: LLQ — LUQ —-RUQ—RLQ
L
—
Hea LLG
 LLQ
-Lower Lobeof L. Kidney

era
-Sigmoid Colon
-Section pf Descending Colon
-L. Ovary
-L. Fallopian Tube
-L. Ureter
-L. Spermatic cord
-Part of uterus

O} MF vgI
CBQ: Whatare the diseases:
Diverticulitis
Colonic Volvulus (twisted bowel)
Colonic perforation

Mnemonicsfor - - -
GI Primary Hormones
RUQ
Liver, Gallbladder, duodenum, head of pancreas, CCK: Cholecystokinase
right adrenal glands, upper lobe of right kidney,
hepatic flexure of colon, Section of transverse colon Secretal: DJl: Duodenum, Jejunum, lleum
Releasing Cells: | cells
CBQ: Whatare the diseases: Acting on: Exocrine Pancreas,Gallbladder,
Acute Cholecystitis, Stomach
Cholangitis (inflammation of bile duct system), Primary Function:
Hepatitis. -Increases enzymesecretion
-Contracts Gallbladder
RLQ, -Decreases Gastric Emptying
Lower lobe of R kidney, Cecum, appendix, section R. Constriction of Pyloric Sphincter Tube
of ascending colon, Right ovary, right fallopian
tube, right ureter, Right spermatic cord, part of CBQ:
uterus. Exocrine Pancreas (outside)
Secretes:
CBQ: Whatare the diseases: Sodium Bicarbonate
Appendicitis Pancreatic Enzymes & Juices
Ovarian torsion/ cyst
Pelvic Inflammatory Disease (DIF) CHO : Carbs (Amylase) Breakdown of carbs
CHON : Proteins (Trypsin)
LUQ FATS: (Lipase)
Left lobe of Liver
Stomach Endocrine Pancreas
Spleen Secretes:
Upper lobe of L kidney Glucagon- increases blood glucose level (I: 70-
Pancreas 110 midl)
L. Adrenal Gland Somatostatin — If release it causes hypoglycemic
Splenic Flexure of Colon effect
Section of Transverse colon
Descending Colon Insulin: secreted @ Islets of Langerhans
NPO: Nil Per Os
CBQ: Whatare the diseases:
Peptic Ulcer
Pancreatitis/Kidney (stones)
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 “High Na Diet”
“Full Liquids Diet” - Addisons Dse
-Foods that turned into liquid @ body temp - Cystic Fibrosis
Eq: Ice Cream “High Protein Diet“
-Usually it contains Milk (Source of Cholesterol) - Anemia — Pernicious
¥ Low in Fe, Proteins, Calories - Burn
- Cretinism (Severe Hypothyroidism)
-GI disturbances -Crohns Dse
-Cant tolerate solid or semi-solid Foods - Decubitus Ulcer ( Bedsores, Pressure
sores)
Ex: all food on clear liquids (;8); Common cause of Decubitus Ulcer is
-Milk & milk drinks Pressure
-Pudding & Custard iyymainity: Risk for Decubitis Ulcer
-lce cream - Hepatitis
-Cream, Butter - Hyperthyroidism
-Peanut butter -Hirschprung Dse (Congenital condition in
-Yogurt pediatrics

“Low Protrein Diet”

-Liver cirrhosis
-Relievesthirst -Hepatic encephalopathy
-Prevents {SN (dehydration) -Phenylketonuria (PKU)
-Minimize stimulation of GI tract - Acute Renal Failure
-ADHD (Diagnosed under 4 yrs old)
(Attention Deficit Hyperactivity Disorder)
“Soft Diet” -Finger Foods
-Easily Chewed (modified or pureed diet)

SR eo Ls S8 ‘ £ FR PY PRE
-withdifficulties in chewing & swallowing side Nofes (CA)
Sina Neston (CNS \\

-Autism (Diagnosed under 3 yrs old)

Ex: All food on clear & full liquids - Mentally Retarded (diagnosed 18 yearsold)
-Meat “ chopped, shredded
-meat alternatives Sickle Cell Anemia
“Eggs’
- Increase Fluids
- Scrambled, omelet, Poached eggs Angina Pectoris
-Vegetables: Mashed, crushed -Low CHolesterol
-Fruits: Cooked/ canned fruits Arthritis
Apple Sauce -Purine Restriction
-Bread & Cereals Bipolar
-Desserts: Soft Cake/ Puddings -Finger Foods

Celiac — Tropical Sprue

Avaid foods that is high in gluten
“Regular Diet” Barley
-Contains all essential nutrients Rye
“Ideal” : Cho, Chon, FAT
OATS
-Vits/ minerals
Wheats
-fluids& electrolytes
Malt
Avoid for life or pt might die from dehydration
Low Na
- Acute Glomerulonephritis (AGN)
- Menieres Dse
- CHF
- Renal
- Renal Colic
Choletithiasis -Nuts
— Increase protein, Carb, Lowfat -Mayonnaise

DM Giordano Giovannetti
- Well Balanced Diet - Low CHON
- Fro patients suffering Renal Problem
Diverticulitis Butter Ball
- Low Fiber - Low CHON
- Low residue - High Carb
-For clients Suffering Liver cirrhosis
Diverticulosis (Pouching) Furstenberg
- High Residue (No Seeds) - Low Na Diet
- Meniere’s Dse
Hypertension
- DASH Graham Cole
- High Fat
Hyperthyroidism - Excretes Dye
-increase Ca Ex. Banana
-increase Protein
Sippy
Hypothyroidism - Six Glasses of Milk “cream”
-Increase Ca - For clients with peptic Ulcer Disease
-Low Phosphorus
Karell — 4 glasses of milk
Myocardial infarction - Low Sodium
-Low Fat - Advance Cardiac Failure w/ Edema
-Low Sodium
-Low CHolesterol
Side notes
Sg

Intraocular pressure 10-21 mmhg

Peptic Ulcer Dse
-High Fat
GI Upper and Lower are separated by Ligamentof
-High Carb
Treitz ( 4" portion of duodenum)
-High Protein
Upper
Renal Failure
Melena — Blacktarry stool
-Low protein
Hematemesis — vomity of blood
-Low Sodium
-Potassium
Lower: Bright Red Stool (Hematochezia)
CHO:
“2802: a brisk upper GI bleeding: Hematochezia
-Bread
-Cereals
“Upper GI Bleeding”
-Crackers
-Potato
GIbleeding
-corn
Ulcer
H. Pylori (Tetracycline best drug of choice)
CHON
Diverticulitis
- Beef
Hemorrhoids
-Pork
IBD
-Fish
-Cheese
:;: NSAIDS, Anticoagulants, Iron Supp.
(Aspinn Clopidogrel)
FAT
vg: Smoking, Heavy alcohol use
-Margarine
- Cirrhosis, Renal DisO, Malignancy
-Avocado
ASSO “: dysphagia, wtloss, Preceding emesis,
-Olives
change in bowel habits
 OOWDD:.

he
Gastric/ Duodenal INR —“O. 3.—4.1
Erosive Esophagitis, Gastritis, duodenitis PT: 10-12 - Evaluate Ability to clot
Esophageal or Gastric Varices PTT: 30-45 - Determine Effectivity of
Portal Hypertensive Gastropathy Drugs:(Blood Thinners)
oo
C&D signs of Liver Problems Lacteta~ Elevated
Bes
oa

E. Arteriovenous malformation AVM (problem - End organ Dysfunction

in artery and vein) 30: Guaiac test (FOBT)
F. Mallory Weiss Tear — located @ Lower -‘Determines microscopic Blood in stool
esophageal sphincter -Specimen: Stool
-Violent coughing & vomiting Note: Not A screening for Active Bleeding
G. Malignancy - Low Sensitivity (poor)
Painful Swallowing — Odynophagia - Best for Colorectal Cancer

Lower chronic constipation Preparations —

Diverticulitis — Gl Bleeding - Increase Fiber (1-2 days)
Q@*-o9200®

Hemorrhoids — GI bleeding -Avoid Red meat

IBD - Bloody Diarrhea -Avoid NSAIDS
Ischemic Colitis — Abdl pain/ bleeding -Avoid Aspirin
AVM - -A. Indomethacin
Infections Colitis
Malignancy

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WAsk Toast
(bread)
(Crackers)

Management:
a. Establish / Vaccess
(Good / Patent)
ae)
3

L. Brachial vein
L. Metacarpal vein
sk SY SY So weer cept
2 8
Ssce
RS ox are tice
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EY eas
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PIPL ESSE Sk
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yas iAV
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a at ot
Shue - Adults
MISSEse
RB Re eh

24 — Yes eoy . Pediatric

\Vfigiat - Neonates/ newborns

*Rapid Infusion of Blood & Fluids

B. Fluid Rescucitation
A. ORS ~
- Decrease in platelet (PNSS/PLR)
- Dec Hbg (Delayed) -lsotonic Crystalloids — Same concentration
mS, Easic Nietainoic Pare: ~
- 730: Gl bled SLR: Battles/ Prevents Acidosis (in dengue)
- Best for Trauma
- Low Albumin
 Meds:
Harttmanns (PLR) A. Proton Pump Inhibitors (PPI) — Best Txt for
PANCAKE Gastric Ulcers
- Stomach
C. Transfuse - Duodenum
Blood
Packed RBC: if Hgb<7g/dl Taken: 30-60mins b4 breakfast/dinner
Common:
CBQ -Prilosec - Omeprazole
<8g/dl : unstable coronary artery dseof active -Protonix - Pantoprazole
bleeding ao -Preracid - Lansoprazole
-Nexium - Esomeprazole

Cu
Vasoactive Drugs

OO
Reversal Agents for Anticoagulants
awa CA OE Consult a GI specialist
CBQ:
Best Dx & Therapy
-Upper Endoscopy
“it -Colonoscopy
Cel| Yen
Barium Swallow
- Aka: Upper GI series
- Check: Upper GI obstruction
-Take Barium Sulfate (chalky liquid)
*SE: Constipation
Pre: NPO (6-8hrs)
Post:
a. Inc OFI
b. B. check appearance of stool
-expect for chalky color stool(white)

c. Offer Laxatives

Barium Enema
-aka: Lower GI series
-check for lower GI Obstruction
Prep:
Low residue Diet (fiber) 1-2 days b4
Clear liquids A day b4
NPO Post midnight
Cleansing Enema Early morning
a. High Cleansing -Usually performed b4
enema surgery
-18inches
b. Low cleansing
-12inches

Enema:
-Length of tube: 3-4in
Technique: Clean Technique
Position: Instruct to inhale slowly
Insertion: @ Left Sims Position
Retention: Left side lying position
MGH - May Go Home A. Hyperextend the neck (checkfor signs of
Ngt — Nasogastric Tubule obstruction
*Obstruction: choanal atresia — Obstruction
Purpose
of nasopharynx
G Garage (primary
B. Nasopharynx: Teary eyed (offer tissue)
reason)
Oropharynx: there is gagging —
Give feeding
mgt Tilt the
L Lavage (Cleanse)
Head and offer cup and
-poisoning, toxicity
straw instruct to sip slowly
(irrigate)
Nurse: Advancethe tube 2-
A Admin of Meds
Ainches.
-Crushed Meds
Feeding
D Decompression F - osition High fowlers position
(relieve pressure E —ssess residual volume
-Post abdl surgery E-
-Active Pancreatitis D — ht of feeding(Dose) 12in 1 foot
Best Position: High Fowlers/sitting position >12in — rapid feeding _
Technique: Sterile Tech
Length of tube: — ire ets
Adult: NEX method
NEX: Nose — Earlobe — Xiphoid process

Pedia: NEB
NEB: Nose — Earlobe — Between umbilicus and
Xiphoid Process
Determine Location/Placement:
-Gold Standard: Xray (abdominal)
-Ph: N:acidic (stomach)
ABN: >6(intestine, bile)
-Swooshing Test (LUQ)
-Gurgling
-Instill 5-20ml of air
Use Diapraghm
-Encourage the Pt. to talk

Types of tube:
Plastic: Soften it (coil, immerse in hot h20 in
30mins)

Rubber: Stiffen (Immerse in ice cold water for 30

mins) 42n’
I — Irrigate the tube 30-60ml of H20
N — No to cold feedings (OF) Cold feeding may
Single: Levin tube (common) Garage/lavage
lead to abdl cramps, Diarrhea,
Double: Salem Sump tube
G — Go and change the tube (q24hrs)
Portable suction machine
(Low pressure) not more than
25mmhg

Triple: Triple Lumen tube

Sengstaken Blakemore tube
Best equipment in bedside is Scissors
Primary Concern
Aspiration pneumonia — Chemical pneumonia
Lubricant: Water Based
Insertion: H. Fowlers
RLE METABOLISM

Digestive system
Functions are
-Digestion Stomach
-Metabolism
Stomach Anatomy
2 Main groups = C-shaped
- Alimentary Canal — Continuous, coiled hollow muscular
Tube = Located ontheleft side of the abdominal
- Accessory Digestive Organs
cavity
-Liver " Food enters at the cardioesophageal sphincter
-Gallbladder
- Pancreas Stomach Anatomy
= Regions of the stomach
Alimentary canal includes:
= Cardial region — nearthe heart
e mouth
= Fundus — expanded part
e pharynx salivary glands 3
= Body- midportion
e esophagus
e stomach = Pylorus — funnel-shaped terminal end
e small intestine liver:
= Food empties into the small intestine at the
gallbladder
e large intestine pyloric sphincter
e rectum
Pyloric Sphincter — Gatekeeper of food from sphincter
® anus
Stomach Anatomy
= Whenit is empty, it collapses inward on
Processes of the mouth
itself, and its mucosais throwninto large
- Mastication
folds called rugae
- Mixing food with saliva
-Initiation ofswallowing by tongue = Rugae — wrinkled, fold
- Allowing fro the senseof taste = External regions
Pharynx
= Lesser curvature-concave medial surface
= Serves as a passagewayfor air and food
= Greater curvature —convexlateral surface
= Foodis propelled to the esophagus by two
muscle layers
Stomach Anatomy
= Whenit is empty, it collapses inward on
" Longitudinal- inner layer itself, and its mucosais throwninto large
folds called rugae
" Circular fashion - outer layer
= Rugae — wrinkled, fold
= Food movementis by alternating contractions
= External regions
of the muscle layers (peristalsis)
= Lesser curvature-concave medial surface
Esophagus = Greater curvature —convexlateral surface
Esophagus
= Runs from pharynx to stomach through the
diaphragm
= Conducts food byperistalsis
(slow rhythmic squeezing)
« Passagewayfor food only
 Stomach Anatomy
" Layers of peritoneum attached to the stomach
= Lesser omentum — a double layer, extends
from the liver to the lesser curvature
= Greater omentum — drapes downward and
covers abdominal organs
-Containsfat to insulate, cushion, and protect
abdominal organs
Stomach Anatomy
Small Intestine
= The body’s major digestive organ
= Site of nutrient absorption into the blood
= Muscular tube extending form the pyloric
sphincter to the ileocecal valve
= longest section of the GI tract
= Suspended from the posterior abdominal wall
by the fan-shaped mesentery

Esophagus
Muscularis
externa .
Longitudinallayer.
Circular layer
Oblique layer

Subdivisions
Subdivisions of the Small Intestine
= Duodenum
Pyloric
sphincter
Pyloric
antrum
= Attached to the stomach

Stomach Functions = Curves around the head of the pancreas

Stomach Functions * Jejunum
= Acts as a temporary storage tank for food = Attaches anteriorly to the duodenum
= Site of food breakdown = Tleum (twisted intestine)
= Chemical breakdown ofprotein begins = Extends from jejunumto large intestine
(ileocecal valve)
= Delivers chyme(processed food)to the small
intestine Duodenum - shortest
Cells Chemical Digestion in the Small Intestine
= Small amountof food at a time
Specialized Mucosa of the Stomach
= Pyloric sphincter — "gate keeper”
= Simple columnar epithelium
= Source of enzymesthat are mixed with chyme
= Mucouscells — producea sticky alkaline = Intestinal cells — mostinteresting features
mucus = Pancreas

= Gastric glands ~ secret gastric juice = pancreatic ducts — complete breakdownof food
* Bile (liver) enters from the duodenum through bile duct
* Chief cells — produce protein-digesting
enzymes(ex. pepsinogens)
= Parietal cells — produce corrosive
hydrochloric acid
= Endocrinecells — produce gastrin
7 comritgLA
QOSHME-AGHVIES,purines
Small Intestine
 Chemical Digestion in the Small Intestine Structuresoflarge intestine
Structures of the Large Intestine
= Saclike cecum first part of the large intestine
= Appendix — worm-like
= Accumulation of lymphatic tissue that
sometimes becomes inflamed
(appendicitis)
= Hangs from the cecum

= A potential trouble spot

ESGey ea ; 7 Usually twisted, an ideal location for
, ; : bacteria to accumulate and multiply
= Called circular folds or plicae circulares
Structures of Large Intestine
= Deep folds of the mucosa and submucosa as
= Do not disappear whenfilled with food

= Peyer’s patches-found in the submucosa = Colon

(collections of lymphatic tissue) = Regions:
= -increase towards the end ofthe SI
us : ps = Ascending
= -remaining (undigested) food residue in the
intestine contains huge numbersofbacteria, = Transverse
which must be prevented from entering the are
: ‘ = Descending
cobloedsiream-ifat-all-pessible
= S-shaped sigmoidal

‘Right cotie
—e
Transverse = Rectum
(hepatic) flexure
Transverse colon = Anus — external body opening

— Accessory Digestive
eaten Accessory Digestive Organs
ener * Salivary glands
= Teeth

= Pancreas
Figure 14.8
pe .© 2006 Pearson Education, inc., publishing as Benjamin Cummi
= Liver
—
= Gall bladder
Functions of Large Intestine
Functions of the Large Intestine
= Absorption of water
= Eliminates indigestible food from the body as .
feces Salivary Glands
= Doesnotparticipate in digestion of food * 3 pairs of Saliva-producing glands
= Large Parotid glands — located anterior to
= Goblet cells produce mucusto act as a ears
lubricant
« Submandibular glands
* Small Sublingual glands
Saliva
= Mixture of mucus and serous fluids
" Helps to form a food bolus
= Contains salivary amylase to begin starch
digestion
= Dissolves chemicals so they can be tasted
= The role is to masticate (chew) food
= Humanshavetwosets of teeth
= Deciduous (baby or milk) teeth
= 20 teeth are fully formed by age two
Classification of Teeth
= Incisors
= Canines
= Premolars
= Molars
Pancreas
= Produces a wide spectrum ofdigestive
enzymesthat break down all categories of
food
= P. Enzymesare secreted into the duodenum
= Alkaline fluid introduced with enzymes
neutralizes acidic chyme
= Endocrine products of pancreas
" Insulin
= Glucagons
Ze)6
= Largest gland in the body
= Located on the right side of the body under
the diaphragm
= Consists of four lobes suspended from the
diaphragm and abdominal wall by the
falciform ligament
= Connectedto the gall bladder via the common
hepatic duct
»
= Produced bycellsin the liver
= Composition:
" Bile salts
" Bile pigment (mostly bilirubin from the
breakdown of hemoglobin)
" Cholesterol ‘
" Phospholipids
Electrolytes
aa 7 Coprriete MO.ENZYMES Benjamin Cummings
Gall Bladder
= Sac found in hollow fossa ofliver
= Stores bile from the liver by way ofthe cystic
duct
= Bile is introduced into the duodenum in the
presenceoffatty food
= Gallstones can cause blockages
Processesof the Digestive System
Ingestion — getting food into the mouth
= An active voluntary process
* Propulsion — moving foods from one region
of the digestive system to another
= Ex: Swallowing — food movementthat
dependsonperistalsis
eleeeORESun Schematic summary ofGI tract activities
" Peristalsis — alternating Food

wavesof contraction \ ,

= Segmentation — moving
materials back and forth
to aid in mixing *
Feces

Developmental Aspects of the Digestive

(o) System
Processesof the Digestive System = The alimentary canal is a continuous tube by
the fifth week of development
= Mechanicaldigestion
= Digestive glands bud from the mucosaofthe
= Mixing of food in the mouth by the tongue alimentary, tube

= Churning of food in the stomach = The developing fetus receivesall nutrients

throughthe placenta
= Segmentation in the small intestine
= In newborns, feeding mustbe frequent,
Processesof the Digestive System peristalsis is inefficient, and vomiting is
. ee common
= Chemical Digestion
«5 Pamminht © 2006 Paarann Eduestion ine miblishinn a8 Raniamin Cumminas
®E k f lecules int 2 :
nzyimesbrealc down food.
their building blocks
molecules into DAdiculcCecnchoman Pleciice
System
= Each major food groupuses different = Teething begins around age six months
enzymes
- . .
" Carbohydrates are broken to simple sugars Metabolism decresses willvold age

= Proteins are broken to aminoacids * Middle age digestive problems

" Fats are brokento fatty acids and alcohols = Ulcers

" Gall bladder problems
Processesof the Digestive System
= Absorption

= End products of digestion are absorbed in

the blood or lymph

= Food must enter mucosalcells and then

into blood or lymphcapillaries
= Defecation

= Elimination of indigestible substances as

feces
Process of Metabolism

¥ SIX (6) BASIC PROCESSESIN DIGESTIVE

SYSTEM
.
e

DEFECATION
1.| INGESTION 3.| MECHANICAL 5.| ABSORPTION Elimination of indigestible substances form the
DIGESTION body via the anus in the form of feces.

2.| PROPULSION 4.| CHEMICAL 6.| DEFECATION

DIGESTION
SUPPLEMENTAL VIDEO:
https:/!youtu be/6ColDScAzog

: produced by G cells in the ston

INGESTION S fi : Stomach di
Food must be placedinto the mouth before it can
be acted upon. This is an active, voluntary process

~ stimulation of gastric secretion

i/oCee)
/ stion of gastroesophagelsphi
SUPPLEMENTAL VIDEO:
httns://voutu be/VnEHcn6QB41 o IN of ileocecal sphincter
* O14
tility of stomach
-
OY
A) o

PROPULSION \
Since food are to be processed by more than one
digestive organ, they must be propelled from.
‘oneorgan to the next

—_< \_
secreted by the | cells in the intes

Fatin the duod

=: Gallbladder, pancreas

Of bile into duodenum

oduction pancreatic enz\
DIGESTION e! ( control of meal Size
Physical processes ike mixing offod in the mouth
the tongue, chumingof food in the ion Secretion of 7
stomach, and segmentation in the small
intestine.

SUPPLEMENTALVIDEO:
hitps://youtu be/PuEVWwP_KM
 SY

secreted byScells in the

duodenum and jejunum
imulusof p)
- pH of chyme in duodenumb
+E: Stomach, pancreas

Gastric gland, gastric

muscle
Increase gastric
» Generally ine
sphincterto

: sights, smell,
stomach dist
‘S-:) Gastric gland, gastric ai
muscle
Increase gastric cic
Generally incre
 ABDOMINAL ASSESSMENT ABDOMINAL ASSESSMENT
a |
.\ = : Percussion

aby eieeetre)
Tympany
DTU atest
mtr] or iite) 0
Light Palpation is appropriate for identifying areas
of tenderness or swelling; the nurse may use
Deep Palpation to identify massesin any of the
four quadrants
ial a
ey Nal 44d \ P

ABDOMINAL ASSESSMENT QUADRANTS OF THE ABDOMEN

NN Sy >
Quadrants
i PO
Sy eh
~ powelsounds in all‘four quadrants Right Lower _ ey, cecum, appendix,
using the diaphragm of the Stethoscope right ovary, right
ik spermiatic cord,

———
Right“Upper

Auscultation
Of The Abdomen mach, See upperlobe of
Peel gland, splenic
erly oo

Aorta ET moid colon, section of

eMule)amet)
rn ue Roar] ayla3 4 Ti
rae le } , ala

Right Femoral Left Femoral

 Cerny ened Nsg rier)
RBC - Lfe span 120 days ComerCecnan
” Bilirubin
Reticuloendothelial Bloodstream Liver Gut 8.PTT (Partial -checks the 25-35 seconds none - bleeding disorder
Thromboplastin function of Or 30-45 seconds (hemophilia)
albumin widne excreted in feces Time) specific -liver disease
RBCs glucourony| transferase gutbacteria _ (stercobilin) coagulation -APAS (Antiphospholipid
(factorVIILX.X1 Antibody Syndrome) or
inte & Xil) lupus anticoagulant
heme Roccreaeted
bilirubin- eres
bilirubin eon
uroblinagen=2%—sexcretedin; urine syndrome
albumin (direct bilirubin) 2 = -Vit. K deficiency
unconjugated complex 18% 9. Fasting Blood -to determine 80-120 mg/dL. NPO post used in screening for any
bairubin (indirect bilirubin) a enterohepatic Sugar (FBS) the amount of Or 4-6 mmol/L midnight except _prediabetes or diabetes
circulation glucosein the water
blood
Da
beea 10.GTT to check how the !40mg/dl (78 mmov. Dink 75 grams or hyperglycemia
(Glucose body breaks Bereees. ogare of
|.Total Bilirubin Yellowish 0.1 = 1.2 mg/dl; 1.9 -Askthe client -to investigate Tolerance test) down Seon clearee Nt glucose dissolved in
pigmentfor mg/dl (1.71-20.5 for any foods or —_jaundice (metabolizes) Above 200mg/dL(I1.1 mmout)- Water aoe ;
normal mmol/L) (adults) meds taken and —-_liver, blood sugar. dabeces Lie
breakdown of mg/dl (below 18 activity on same gallbladder, bil
RBC yrs old) dy. R: duct blockage Cen errrneta eer
Results may be - detect liver
affected by disease
certain foods,
medications or 11. Hbatc -amountof blood 45.6%
strenuous (Giycosylated sugar(glucose) 57-64% -
exercise
hemoglobin) attached to borderline
hemoglobin 6.5% - diabetes
1.1 Unconjugated -molecule is not _0.2-0.8 mg/dL -} hemolysis of
Bilirubin water soluble RBC 12. Serum -awaste product 15-45 wdL. (I1- Fasting for 12-14 hours. _- liver disease;kidney failure
Ammonia (NH3) madeby your body 32 umol/L Youshould not smoke
-indirect (hepatocellular during the digestion prior to collection.
bilirubin damage) ofprotein

13.Urea breath rapid diagnostic 14 days after stopping acid -H- pylori is present
procedure used to reducing medication
1.2 Conjugated -water soluble _Less than 0.3 mg/dl biliary identify infections by (proton pump inhibitors,
Helicobacter pylori PPI) or 28 days after
peers [eee iran stopping antibiotic
Comerned treatment.
2ALTISGPT most specific 29 to 33 units per No special ~ Liver problem UREA BREATH TEST:
indicator offiver liter (IU/L) for _preparation
function males and 19 to 13C-Urea Breath Test — How to collect breath
25 1UIL for
females Cole Cy RSS i CO
* 7-561, ‘new ar mee op te
3.ASTISGOT present inliver & 5-40 IU/L 1 -hepatitis, cirrhosis, or other liver
heart problems: pancreatitis, heart problems

4 Liver function to 44-147 1U/Lor —_Fasting 6 hrs before ‘-biliary obstruction, bone dse., healing
ALKALINE detect damage or 0.73-245 the test(drinking fracture, hyperpara
PHOSPHATASE bone disorder: microkatal/L minimal water only Osteoblastic bone tumors, osteomalacia,
Detect GB disease (ikat/L) permitted) rickets, Paget disease, Sarcoidosis
| -malnutrition, CHON deficiency
(Sight to moderateelevaton
Ceo
roe
Indicates hepetocelluar disease
> severeelevation
L Indicates obstructive biiary disease)
4. NPO 24hrs
eee

14.H.pylori Antibody To detect levels of H. Negative (+)indicates Peptic

5.GGT (Gamma- transport 9-48 U/L, -NPO at least 8 -liver damage orbile ducts pylori in the blood ulcer caused by H.
Glutamy! molecules hours ‘obstruction Pylori
‘Transpeptidase) helps liver in -stop drinking
metabolism’ alcoholor certain
prescription meds
6.Total CHON —-measures total 6-8 g/dL. -no special 4 = hepatocellular or kidney damage ULTRASONOGRAPHY
aka (A/G ratio) amount ofalbumin preparation;
and globulin estrogen and } = inflammationor infections(viral
birth control pills Hepa Bor C, or HIV) ; bone
may decrease marrow disorders (multiple focuses high-frequency sound wavesover an
blood CHON myeloma)
levels abdominal organ to obtain an imageofthe structure
7. PT Clotting time of 10-14 seconds none t+ bleeding or clotting disorder
(Prothrombin plasma ~ Lack of vitamin K,lack of clotting
Time) factors detect small abdominal masses, fluid-filled cysts,
~ Liver disease
gallstones, dilated bile ducts, ascites, and vascular
If lower — could be taking
abnormalities
~y Ultrasound with Doppler may be ordered for vascular
assessment
 CHOLESCINTIGRAPHY OR HEPATOBILIARY
NSG. RESPONSIBILITIES: SCINTIGRAPHY

+ an imaging test used to view theliver, gallbladder, bile ducts, and smallintestine,
Diet modification, laxative, or other medication eeeratecodechneee
to cleanse the bowel and decrease gas eeeears retwensome corpre

¥NPOfor at least 6 hours before the procedure

Changeposition of patient

COMPUTED TOMOGRAPHYSCAN(CT-
ean) PREPARATION:
‘Y Detect tumors, cysts, and + NPO 4-12 hoursbefore the scan
abscesses + Special precaution: Pregnant & breastieeding mothers
¥ Detectsdilated bile ducts, + remove any jewelry and metal accessories.
pancreatic inflammation, and some
+ Avoid drugs thataffect gastric motility, including diarrhea meds within the dayof procedure
gallstones
Identifies changes in intestinal wall
After the procedure:
thickness and mesenteric
abnormalities ~ drink plenty of water to help speed up theradioactive tracer’s movementoutofthe body
through urination and bowel movements.
hetps://www.youtube.com/watch?v=yFl_-fghWSs&t=70s

NSG RESPONSIBILITIES: RESULTS WITH HIDA SCAN:

+ Normal The radioactive tracer moved freely with the bile from yourliver into your
‘gallbladder and small intestine’
¥ Askthepatientif she is pregnant. + Slow movementof radioactive tracer: Slow movementofthe tracer mightindicate
¥ Explain procedure a blockage orobstruction,or a problem in liver function
¥ Clear liquid dietin a.m. + Mo radioactive tracer seen in the gallbladder.Inability to see the radioactive tracer
Fvinicontast: in your gallbladder might indicate acute inflammation (acute cholecystitis).
a . i + Abnormally low gallbladder ejection fraction. The amount of tracerleaving your
¥ NPOfor2 - 4 hoursbefore the procedure and an enemaorcathartic gallbladderis low after you've been given a drug to makeit empty, which might indicate
may be necessary chronic inflammation (chronic cholecystitis).
Y Assessforhistory of allergies to iodine and seafoods + Radioactive tracer detected in other areas. Radioactive tracer found outside of
¥ Report symptomsofitching or shortnessof breath during yourbiliary system mightindicate a leak.
administration of or after receiving contrast media, and observe
patient closely
MAGNETIC RESONANCE IMAGING(MRI) UPPER GASTROINTESTINALSERIES (UGIS)
BARIUM SWALLOW
vFluoroscopic x-ray examinationsof the esophagus,
‘a type of noninvasive test that uses magnets and radio waves to create images of the
inside of the body. The magnets andradio waves create cross-sectional images ofthe stomach, and smallintestine after the patient ingests
abdomen, which allows doctors to check for abnormalitiesin the tissues and organs barium sulfate
without making an incision.
a Barium passesthrough theGl tract, fluoroscopy
outlines the GI mucus and organs

Ventrodorsal View
Abdo
barium swallow
PREPARATION:
+ Ask the patientfor any metal implants(artificial heart valves,clips, pins, or screws,plates,
Staples, stents) and pacemaker. B. Ascending Colon
Cc. Tran: Colon
* If visualization of colon needed: NPO 4-6 hrs before the exam, uselaxatives or enema.
* Alert for any allergic to dye(gladolinium) Peabecendingicoot
E. Site of lleocolic &
* entire process takes 30 to 90 minutes.
Cecocolic Orifices
+ Instruct the patientto stay still inside the machine.
Cecum
- —————— | Gas in Stomach
ABDOMINALX-RAY OR FLAT PLATE ABDOMEN
RADIOGRAPHY NSG. CONSIDERATIONS:
Int

DESCRIPTION:
Detect and evaluate tumors, abnormalgas v Explain procedure
collection, other abdominal disorder
Testcontains twoplates: vLow-residue diet
taken whenthe patientis supine and when
Patient stands YNPOafter midnight before the test
IMPLEMENTATION yy Avoid smoking, alcohol, caffeine before the test
Doesnotrequire any specialpre-test
Explain procedure Barium (480 to 600 mL)
 BARIUM ENEMA Z. 3 ah
(LOWER GASTROINTESTINAL TRACT STUDY) Camera-equipped Endoscope takes video Tool attachment can also

J gh P
flexible tube(endoscope) of esophagus, stomach, _take tissue samples for
is passed down throat upper small intestine biopsy or make repairs
‘YFluoroscopic x-ray examination visualizing
the large intestine after rectal instillation of
barium SO,
Detects structural changes, such as tumors,
polyps, diverticula, fistulas, obstructions, and
ulcerative colitis
NSG. RESPONSIBILITIES:
a:
"NSG. RESPONSIBILITIES:
vy low-residue, low-fatdiet, 1 to 3 days before the
examination. wv Explain the procedure/obtain consent
y clearliquid diet and laxative in the evening
YNPOfor8 to 12 hours before the procedure
+ NPO post midnightbefore the test
y orallaxative, suppository, and/or cleansing enema may ‘y Remove dentures and partial plates
be prescribed
knownallergies and current medications. Medications
Care after the procedure: same with UGIS
may be held until the test is completed

LIVER BIOPSY Local anesthesia is administeredd

BA liver bi , ; f YY Keep patient NPO
theliver so it can be examined with a microscope for
signs of damageor disease.
Mayresumeregulardiet after gag reflex returns
~Mayexperience a sore throat
Anticholinergic drugs as ordered
~¥Sidelying position after the procedure
~vAsessfor bleeding, dysphagia, fever, dyspnea
Avoid driving for 12 hrs if sedative was used.
PREPARATION:
Written consent
POSSIBLE COMPLICATIONS:
* NPO2-4hrs
* Vit K injection
* Monitor protime;initial VS
Position in theleft side orsupineposition with pillow under theright shoulder ~Y perforation of the esophagus or stomach
* Instruct to exhale deeply; hold breath for 5-10 secs, during needleinsertion to
prevent traumato the diaphragm ‘Y pulmonary aspiration
Theprocedure takes about 5 minutes.
* Observefor signs of peritonitis ~y hemorrhage
CARE AFTERLIVER BIOPSY ‘YY respiratory depressionorarrest
Y infection
Turntorightside for 4 hrs to apply pressure and prevent bleeding
Bedrestfor 24 hrs YY cardiac arrhythmiasorarrest
Monitor VS every 30 mins-every hourforthefirst 24 hrs ENDOSCOPIC RETROGRADE
Avoid taking aspirin, or anti-inflammatory drugs (such as ibuprofen, CHOLANGIOPANCREATOGRAPHY(ERCP)
Advil, Naprosyn, Indocin, or Motrin) for one weekafter the
procedure. You may take acetaminophen (Tylenol) if needed.
INDICATION:
* Donotperform vigorousphysicalactivity for at least 24 hours after Examination of hepatobiliary system via flexible endoscope inserted
the biopsy.
in the esophagusto the descending duodenum.

ESOPHAGOGASTRODUODENOSCOPY (EGD)

‘¥ Visualization of the esophagus,

stomach, and duodenum
‘¥ Diagnosesacute or chronic
upperGI bleeding, esophageal
or gastric varices, polyps,
malignancy, and
gastroesophagealreflux 1
 Routine Fecalysis:
SPECIAL CONSIDERATIONS:
-Asses gross appearance of the stool
-Detects presence of OVA
Normal findings are negative gallstones, No Technique: Sterile Technique
obstruction in the pancreatic duct, commonbile Best time: Early in the morning
duct, gallbladder Amount: 1tbsp (inch)
Abnormalresults mayinclude stones, stenosis, - Tongue depressor
malignancy Bristol stool chart
Bristol Stool Chart
PROCTOSCOPY- is acommon
medical procedure in which an
@ © @ Separate hard lumps, like nuts
Te © © © (tard to pass)
instrument called a proctoscopeis
used to examine the anal cavity,
rectum or sigmoid colon. This Type2 osap Sausage-shaped but lumpy
procedureis normally done to
inspect for hemorrhoids or rectal
polyps and might be mildly Tee) Ee Like
iace a sausage but with cracks on

uncomfortable as the proctoscope is

inserted further into the rectum. Uke a sausage or snake, smooth
Tee 4 Rm ic
O Useofrigid scope to examine anal — » =
canal a P&H Soft blobs with clear-cut edges
0 Direct visualization of mucosa of Tees eae os (passed easily)
distal segment of the colon and /
Type 6 gE Fluffy pieces with ragged edges, a
mushy stool
RECTAL EXAM (DRE)
ae <=> Watery,no solid pieces

* Positioning
Stool Culture & Sensitivity
A. Sims for weak patients
- Detects spsecific
B. Standing and then bending over
-Bacteria
-Viruses
* During the procedureinstruct the patient to relax the Technique: Sterile
anal muscles by doing conscious breathing ( breathing Uses: Sterile cotton tip applicable
through the mouth)

*Fecal fat Test — checks presence/lvl of fat

Stool Exam -Done usually 24-72hrs
-Normal Indications:
-color: Brown/ Yellow -Chronic Fibrosis
- Odor: Aromatic in Nature -Celiac Dse
- Amount : 150-300g -Chronic Hepatitis
- Shape: Cylidrical in Nature follows shape of -Crohns Dse
rectum -Pancreatitis
- Consisting: Formed/ Soft
- Frequency of FOBT: Aka Guaiactest
CBQ: Detect Microscopic Blood In stool
Upper GI Bleeding: Melena (black,tarry stool) Technique: Strile
Lower GI: Hematochezia (Bright red bleeding) Specimen: Stool
Bile Duct Obstruction: Acholic Stool Preparations:
- High Fiber Diet
HirschprungsDse: Ribbon like Stool (pellet, goat like) - Avoid Red meat(causes false positive result)
After Barrium Swallow: Chalky white stool (normal -Avoid gastric irritant medicaitons)
after barium swallow) -Nsaids
Intussesception (combination of mucous): Mucus + -Aspirin
blood “Red currant jelly like stool”
Celiac Dse / Cystic Fibrosis: Fat Bulky ful smelling stool
(steatorrhea)
Colonoscopy
Paracentesis
Enema