Simmons Nursing Advanced Pathophysiology MASTERY GUIDE: Gastrointestinal, Hepatobiliary & Pancreatic Disorders – Expert Visuals, Clinical Correlations & Diagnostic Pathways (GUARANTEED SUCCESS )

What is GI system responsible for?

*breakdown food=molecules/absorption

*digestion

*secretion

*absorption

*motility

*coordination

Carbs, proteins, lipids

How are carbs digested?

*starch to maltose AMYLASE

*disaccharide digestion-sucrase, lactase, maltase

*absorbed to blood

*malabsorption-LACTOSE INTOLERANCE

How are proteins digested?

*denature- happens in stomach HCL+pepsin

*peptides to amino acids

*aborbed to blood

*malabsopriton

HARNUP DISEASE/PANCREATIC DISEASE

How are lipids digested?

*emulsifcation BILE SALTS/PHOSPHOLIPDS

*Micelle formation - Lipase

*diffusion/reformation exocytosis

*aborbed to lympth

*insufficientLIPASE OR BILE

Other digestion

*fat soluble ADEK

*vitamin B-12

How are digestion and absorption connected?

*NEURAL & HORMONAL

ENTERIC- short-in the NERVOUS system tract

*LONG-connect to the CNS

What are the 3 major digestive hormones?

*gastrin-HCL stomach - protein /parasympathetic

*secretin-bicarb release- LIVER/pancrease acid in SI

*CCK-digestive enzyme release-pancreas- lipids/proteins in SI

What are the disorders of the ESOPHAGUS?

*CARRIES GI to mouth to stomach

*CC is CP and back pain & heartburn

*CC GERD

disorders r

*dysphagia

*esphagitis

*hiatal hernia

*GERd

*exophageal cancer

*esohphageal diverticula

*esophageal laceration

MALLORY-WEISS SYNDROM

WHAT are the differences in dysphagia?

*difficulty swallowing

*ACHALASIA- incomplete relation of the lower esophageal sphincter (LES)

*narrow/ obstruction

*intrinisic obstruction-tumors inside and extrinsic are the outside tumors

*lack of spit

*Impaired esophageal motility

Hiatal Hernia what is it?

*protrusion UPPER PART OF THE STOMACH into the thorax-tear, weakness in the diaphram

*SS generally none, but when it happen cp sob hr palp, food swallow discomfort, acid reflux

Cause-smoke, obesity, pregancy, constipation

age-50 older

tx-underlying, surgery if danger of constriciton or strangulated.

What is esophagitis?

*inflammation of esophagus caused by GERD/INFECTIONS/IMMUNOCOMPROMISED

*eosinophilic-esophagus is filled w eosinophils

*infection-immunocompromised

*MAIN CAUSE/ CANDIDA ALBICANS/ HERPES/CYTOMEGLAVIRUS

*erosive- chronic acid reflux=inflammation and ulceration

What is GERD

*backflow gastric/duodenal contents past the LES

wo belching or vomiting

*CC epigastric pain

heartburn

radiates to chest and arms

Cause-changes in barrier between the stomach and exophagus including abnormal relaxation o LES

*pregant, obest, lying down after a meal

food alchohol smoke HH, obesity, pregnancy medication ng tube and weal LES

TX-lifestyle mods, meds PPI, H2 receptors, antacids

Esophageal CAncer what is it?

*cancer develops in the cells lining the esophagus

*squamous cell UPPER/ adenocarcinoma LOWER

*smoke, alcohol, HPV

SS difficulty swallowing wt loss pain

*MOST adenocarcinomas-Barrett's esophagus/cells are replaced with intestine cells instead of esophageal cells

NVA

urge

forceful/ increase in intra abdominal- relaxation of LES return of stomach into

Anorexia- no desire of food, N, abd pain, diarrhea.

What are the disorders of intestinal motility?

ANS and PS= increase SN=slow down

Diarrhea-fluidity or volume feces and frequency

ACUTE or CHRONIC

ACUTE=2 weeks or less inflam or non inflam

CHRONIC=3-4 weeks

irritable or inflammator bowel conditions- malabsopriton

WHat are infections of the GI tract?

SS-d, n, v, abd pain, fever or chills

VIRAL=rotavirus, norwalk virus, adenoviruses

bacteria-salmonella, shigella, escherichia coli, camplybacter clostridium

Parasite-giadia lamblia, cryptopsoridium, entamoeba histolytic

Hygene=fecal to oral food and water contamination = most common

What is acute diarrhea?

inflammatory-small volume or noninflammatory lg volume

fever/blood dysentary

*bacteria-shigella, salmonella, e coli

NONinflammatory LARGE WATER AND NONBLOODY STOOLS

8MORE toxin producing bacteria staph or other parsitic or viral agents

What is chronic diarrhea?

*osmotic/lactose intolerance

*SECRETORY-12/Zollinger-Ellison syndrodrome

*inflammatory is w acute. or chronic Crohn or ulcerative

What is constipation?

3 types

normal-transit-difficulty defecation increased fluid and fiber intake

_slow-infrequentBM alteration in intestinal innervatin

REason_defecation due to dysfunction of the pelvic floor or anal sphincter

What are intestinal obstructions?

*partial or complete blockage of the lumen

*Small bowel 90% COMMin AND serious

*complete=death shock and vascular collapse

Chief cause-adhesions/stragulated hernias small BO

carcinomas=large BO

Obstructions-mechanical fruit pits gallstones or works

NON mechanical-parlytic ileus, electroyte imablance, toxicity

There is more INTESTINAL OBSCTRUCTION blockage

*simple-blocakge

*strangulated-no blood

*closed loop-both ends BS isolating it

Fluid air gas near the site

*peristalis increase TEMPORARILY TO FORCE

*Distension

Bowel wall becomes edematous and begins to secrete water, NA and K

*alkalosis-dehyrdration. loss of gastric HCl in SMALL BOWEL

****ULTIMATELY

ISCHEMIA, NECROSIS, DEATH

WHAT ARE THE 3 TYPES OF INTESTINAL OBSTRUCTION?

*intussusception w invagination or SHORTENING of the bowel

*volvulus of the sigmoid colon

*hernia

What is diverticulosis?

*inflammation of the diverticula. or herniation within the wall of the intestinal tract

*MUCOSAL layer of colon herniate through the muscularis layer, accompanied by an inflammatory response, usually in the sigmoid colon

*INTERLUMAINAL PRESSURE/chronic constipatin, obesity, causes foramtin of diverticula -pocketing or herniation through muscular weakness in the wall.

*inflammation bacterial infection/undigested food, wall thickening obstruction, abscess formation perforation

*complications

perforation, peritonitis, sepsis and shock

What is peritonitis?

inflammatory response SEROUS membrane lining lines the abd cavity

covers visceral organs

*bacterial invasion or chemical irritation

*perforation of bowel causes exposure to enteric bacteria

Common CAUSE-perforated peptic ulcer

ruptured appendix

perforated diverticulm

gangrenous bowel or gallbladder

PID

SS-PAIN fever v, tachy, hypot,

TRANSLOCATION OF FLUID EXTRACELLULAR = peritoneal cavity, bowel obstruct, loss of fluid V/D

HYPOVOLEMIA

SHOCK

What is malabsorption syndrome?

Alteration INTESTINE to absorb nutrients

*gut wall abnormality

*enzyme bile deficiency

*abonormalities of gut flora

*impaired digestion

*absorption of nutrients

CAUSES-congenital defects

*disease of pancreas/liver/gallbaldder

*inflammation

*infection

*injury

*surgical removal

COMMON disorders-

*cystic fibrosis

*chronic pancreatitis

celiac disease

*IBS

Inflammatory BS

SS-

*anemia

decreased v B12

diarrhea/streatorrhea

edema

malnutrition

wt loss

What is celiac disease?

*immune disorder-gluten

*1%

*innapropriate T CELL gliadin fraction of gluten

*HLA class II

*other autoimmune disorders diabetes or addisions

1st or 2nd degree relatives GREATER risk

*increased risk of head and neck cancer

adenocarcinoma

non hodgkin lymphoma

SS

*infants young-diarrhea/ftt/malnutriton

*older-anemia, short, constipation

*adults-75% women-d/abd pain discomfort

DX-based on clinical manifestations, serological test, intestinal biopsy

IGA TTG

IGA EMA

TX-remove gluten rapid and complete healing of intestinal mucosa

What is GI bleeding?

Upper GI

*esophagus

stomach

duodenum

bleeding varices

PUD

esophageal tear

Hematemesis- blood in vomit

MELENA-dark tarry stools

LOWER GI-

jejunum

ileum

colon

recturm

HEMATOCHEZIA-frank bleed from recturm

OCCULT-slow chronic blood loss

What is a colorectal neoplasm?

*adenomatous polys are benign neoplasms-adenomas- arise from the MUCOSAL layer of the intestine

*colorectal cancer=adenocarcinoma of the colon and is extremely common

ETIOLOGY-20% inherit,

80% sporadic- predisposing factors including chronic ulcerative colitis or Chrohn's disease

diet/ low in fiver

high in fanimal protein

fat refined carbs

carcinogen exposure

SS-blood in stool or changes in bowel habits

SCREENING- fecal occult blood testing DX COLONOCSCOPY

TX surgical resection

chemotherapy

What is jaundice?

Icterus-yellow green eyes

*excessive BILIrubin in blood-goes to extracellular fluid

*SIGN

Liver enzymes!

pale stool

*dark urine

severe itching

pruritis in skin

What are the 3 major causes of Jaundice?

*prehaptic

*hepatic

*posthepatic

Prehaptic / hemolyitic jaundice

genetic-sickle cell, thalassemia

phosphate dehydrogenase

hemolytic uremic syndrome

Hepatic/hepatocellurar jaundice

Liver can't conjegate bilirubin to eliminate

CAUSES:hepatitis or cirrhosis

NEONatal-impaired uptake of conjugated bili-those enzymes are not present at birth

Postheptaic/cholestatic jaundice

*passage through bile ducts/obstructive

GALLSTONES-obstruct the bile duct or by disorders of the pancreas

What is malabsorption

LIVER is CRITICIAL

*BILE and PHospholipids NEED digest FATS

*NO fat digest-fat absorb is compromised

LIVER dysfunction = fat malabsorption

ADEK

K-clotting and caog problems

What are the disorders of the HEPATIC metabolism?

SS

Fluid edema-ALBUMIN (colloid, osmotic agent)

ENcephalophy-nitrogen=amino acids=ammonia=needs to excrete to "UREA for renal excretion

*gynecomastia-biotransforms LIPID soluable=estrogen to water soluble accumulation = boobs