- Intensive: Gastrointestinal disorders

- mouth
1. Mechanical digestion - chewing
2. Chemical digestion - amylase
- esophagus
- lower esophageal sphincter
- stomach
1. Fundus
2. Stomach - chemical digestion HCL (acid) and pepsin - digestion - dilution of food
- pH: 1.5 - 3.5
- chewing and HCL is inversely proportional
3. Antrum
4. Pyloric sphincter - open 2-3 hrs after meal
- small intestine - absorption of nutrients
- Duodenum - connected to the hepatobilliary tract
- liver: production of bile
- gallbladder: storage of bile (emulsification of fats)
- pancreas - amylase (carbohydrates), lipase (fats), proteases/strepsin (protein)
- Jejunum - absorption of nutrients
- Ileum - absorption of bile and vitamin B12
- colon (large intestine) - absorption of water
1. Ascending colon
- cecum
- appendix
2. Transverse
3. Descending colon
4. Sigmoid colon
5. Rectum (highly vascular)
- hemorrhoids
6. Anus
- peristalsis is inversely proportional with H20
- increased peristalsis = decrease absorption of water - diarrhea
- decreased peristalsis = increase absorption of water - constipation

1. gastroesophageal reflux disease

- weak lower esophageal sphincter - back flow of gastric contents - esophagus - leading to signs and symptoms of
GERD: heartburn (pyrosis), indigestion (dyspepsia), nausea and vomiting, dysphagia (dysphagia), odynophagia
(painful upon swallowing)
- causes:
- anything that increases HCL/decrease LES
1. Coffee
2. Citrus
3. Cigarette smoking
4. Chocolate
5. Carbonated beverages
6. Alcohol
7. Fatty foods (fried foods)
8. Peppermint
9. Spicy foods
- management: (foods should go down)
1. High carbs
2. High fiber (increase satiety)
3. Small frequent feedings
4. HOB elevated and turned to left
5. Medications
- antacids
- H2 blockers
- proton pump inhibitor
- prokinetics

2. Peptic ulcer disease

- factors:
1. Stress - increases acetyclcholine
2. Cigarette smoking -
3. Alcohol
4. Caffeine
5. Aspirin and NSAIDS - increases HCL
- management
- rupture/perforation - peritonitis - rigid/board-like abdomen
1. Monitor for signs of bleeding.
2. Diet:
- milk: avoid
- feeding: SFF
- chew: increase
- foods: as tolerated
3. Avoid factors
4. Stress reduction (rest/relaxation)
- medications
1. Antacids
- neutralizes acid
- 1-2 hrs after meal
2. Histamine 2 receptor blockers - ranitidine
- bedtime: decreases HCL
3. Proton-pump inhibitors - omeprazole
- before meals (decreases HCL)
Gastrointestinal
4. Cryoprotective drugs - sucralfate
Sunday, August 28, 2022 3:26 PM
- before meals
5. Prostaglandins - misoprostol
- decreases HCL, increases mucus, inflammation, uterine contraction (cytotec)
6. Hormone - octreotide
- mimics - somatostatin - decrease HCL
- PUD caused by NSAIDS - prostaglandin analog
- surgery
1. Vagotomy - decreases stimulus for the production of HCL
2. Gastrectomy - severe or to decrease parietal cells
- total
- subtotal/antrectomy - remove of distal portion of stomach
3. Anastomosis
- billroth I - gastroduodenostomy
- billroth II - gastrojejunostomy (dumping syndrome)

- dumping syndrome - rapid gastric emptying

- management
- food should stay in the stomach
1. Diet:
- protein: high
- fat: high
- carbohydrates: low
- meals: small frequent feeding
- fluids: avoid fluids in between meals
- salt, sugar and milk - avoid
2. Position
- lie down after eating
- turn to left side

3. diverticulosis
- outpouching of intestinal mucosa
- common site: sigmoid
- cause: low fiber diet (constipation)

- diverticulitis
- inflammation of 1 or more diverticula
- cause: accumulation of fecal material
1. Inflammation - abdominal pain (left lower quadrant - crampy)
2. Infection - fever
3. Injury - blood in the stool
4. Obstruction (increased GAS)

- bloating and flatulence

- chronic constipation with episodes of diarrhea
- management
1. Fiber diet: high
2. Fluid intake: high
3. Medication: laxatives
- acute phase - painful episodes - rest the bowel - decrease the peristalsis
- fiber: low
- oral intake: NPO
- activity: bed rest
- medication: antispasmodics/anticholinergics
- monitor for perforation: peritonitis

4. Appendicitis
- Fecalith - appendix - obstruction - injury - infection and inflammation
- Increased peristalsis - at risk for rupture (sudden disappearance of pain) - peritonitis
- Management
- Decrease the peristalsis
- Nothing per orem
- Bed rest
- IV fluids
- Avoid anything that will increase peristalsis
- No enema
- Laxatives
- Hot application
- Appendectomy
- Clinical manifestation
- Mcburney’s point (right lower quadrant)
- Rovsing sign - palpate at the left lower quadrant - pain at the right lower quadrant pain (referred pain)
- Dunphy’s sign - coughing (straining and increases intraabdominal pressure) - pain
- Blumberg’s sign - rebound tenderness (pain upon release)
- WBC - high WBC
- Bowel sound - decreased/absent
- Psoas (muscle) sign - place patient at left side lying and flex legs backwards - pain
- Obturator (muscle) sign - patient on supine and then right knees flexed at 90 degrees - pain

5. Liver cirrhosis - repeated injury on the liver causes fibrosis after healing, leading to loss of function
- Types:
1. Laennec’s cirrhosis - alcoholism
2. Post necrotic - hepatitis b and c (hepatotoxins - analgesics)
3. Biliary cirrhosis - obstruction (gallstone)
4. Cardiac cirrhosis - right sided heart failure
- Clinical manifestations
1. Kupffer cell - phagocytosis - decrease immunity - high risk for infection
2. No excretion of “GMA”
i. Increased glucocorticoids - increased cortisol - increased glucose
ii. Mineralocorticoids - aldosterone (sodium and water retention) (potassium excretion)
iii. Androgens - increase testosterone (female - hirsutism), increase estrogen (male - gynecomastia)
(vasodilator - spider angioma)
3. No excretion of ammonia- increases ammonia - neurotoxic - hepatic encephalopathy- asterixis (decreased
LOC) - fetor hepaticus (bad breath), constructional apraxia (cannot mimic the shapes when drawn)

4. Increased bilirubin causes skin discoloration (jaundice/icterus) - pruritus. The bilirubin will also go to the
kidney, leading to a dark colored urine. Absence of bile will causes fat inabsorption - large intestine -
steatorrhea

5. Absence of albumin causes low oncotic pressure, leading to shifting of fluid to the interstitial space (edema)

6. Hepato-renal syndrome

- Laboratory tests

- Management

- Medications

6. Cholecystitis

- Clinical manifestations

- Management

7. Acute pancreatitis

- Laboratory findings

- Management:

8. Chronic pancreatitis

- Post-test
1. C - lying down after esting
2. C - ask the client to extend the wrist and fingers
3. C - administration of antispasmodics
4. D - it is important that I eat slowly and chew my food thoroughly
5. A - lay down after eating
6. A - pallor (sign of shock + hypoglycemia - sign of dumping syndrome)
7. D - dyspnea
8. C - pain relieved by food intake
9. A - cramping type pain
10. A - fetor hepaticus
11. B - administering a lactulose as ordered
12. C - serum amylase and lipase
13. D - high fiber diet….
14. D - stools are less fatty (steatorrhea)
15. A - meats and beans
16. D - gastric acid pH
17. C - misoprostol (prostaglandin analog)
18. a - a fecalith
19. D - question the physician about the order
20. D - demerol for pain (causes seizures)
21. C - jaundice produces pruritus…
22. A - passage of 2 or 3 soft stools daily
23. D - (+) cullen’s sign
24. C - (+) murphy’s sign (place in the hepatic margin and let client inhale
25. D - pain relieved by vomiting