chapter 9 pathos

Upper GI tract path

• Mouth → Pharynx → Esophagus → Stomach

What does the LES (lower esophageal sphincter)

Prevents reflux

Function of the stomach

• converts food to chyme; pyloric sphincter controls emptying.

Liver function

• Metabolizes nutrients, detoxifies blood, stores glycogen/fats, produces bile, synthesizes proteins/clotting factors.

• Removes old RBCs, regulates glucose, and maintains fluid balance.

Gallbladder & Pancreas Function

• Gallbladder: stores/releases bile.

• Pancreas: exocrine (enzymes for digestion), endocrine (insulin, glucagon).

Components of lower GI tract

• Small intestine: absorbs nutrients.

• Large intestine: reabsorbs water/electrolytes.

• Rectum/anus: eliminate waste.

What happens to function of GI tract with age

• ↓ peristalsis, ↓ absorption (iron, calcium, B12), ↓ liver function → slower drug clearance.

What is vomiting (emesis)

• Reflex center: medulla.

• Sequence: deep breath → glottis closes → diaphragm/abdominal contraction → LES relaxes → chyme expelled.

• Causes: infection, increased ICP, severe pain, toxins.

• Complications: dehydration, electrolyte imbalance, metabolic alkalosis, aspiration pneumonia.

• Treatment: antiemetics, fluid replacement, treat cause.

What is GERD (gastroesophageal reflux disease)

• Patho: Weak LES → acid/bile reflux into esophagus → mucosal irritation.

• Causes: caffeine, chocolate, citrus, fatty foods, alcohol, smoking, pregnancy, obesity, hiatal hernia, certain meds.

• Symptoms: heartburn, regurgitation, dysphagia, dry cough, sore throat, chest pain (can mimic angina).

• Complications: esophagitis, strictures, Barrett’s esophagus (metaplasia → cancer risk).

• Treatment: avoid triggers, small meals, elevate HOB, weight loss, antacids, PPIs, surgery if severe.

Peptic ulcer disease (PUD)

• Lesions: in stomach or duodenum.

• Etiology: H. pylori infection, NSAIDs, stress, alcohol, smoking.

• Duodenal ulcers: pain relieved by food.

• Gastric ulcers: pain worsens with food, may signal malignancy.

• Stress ulcers: due to burns (Curling’s) or head injury (Cushing’s).

• Complications: bleeding (hematemesis, melena), perforation, peritonitis.

• Diagnosis: endoscopy, H. pylori testing (breath, stool, antibodies).

• Treatment: antibiotics (if H. pylori), acid suppression, surgery if perforated.

Liver disorder hepatitis

• Causes: viral (A–E), alcohol, drugs (acetaminophen), autoimmune.

• Transmission:
  

  • A & E → fecal-oral.

  • B, C, D → blood/body fluids.

• Phases:
  

  • Prodromal (fatigue, anorexia, fever)

  • Icteric (jaundice, dark urine, clay stools)

  • Recovery.

• Chronic hepatitis: lasts >6 months.

• Diagnosis: serum hepatitis panel, liver enzymes, biopsy.

• Treatment: antivirals, interferon, rest, vaccines (A & B).

Cirrhosis liver disease

• Chronic, irreversible liver scarring.

• Causes: hepatitis C, alcohol, toxins.

• Manifestations: jaundice, ascites, varices, portal hypertension, bleeding, pruritus, clay stools, dark urine, hormonal changes.

• Treatment: treat cause, avoid hepatotoxins, diuretics, paracentesis, low-sodium diet, TPN, antivirals, lactulose for ammonia.

Lower GI disorder diarrhea

• ↑ stool frequency, volume, or fluidity.

• Causes: infection, medications, IBD, malabsorption.

• Small intestine: large, watery stool (RLQ pain).

• Large intestine: frequent, small stool (LLQ pain).

• Complications: dehydration, electrolyte imbalance, skin breakdown.

• Treatment: fluids, electrolytes, antidiarrheals, antibiotics, skin care.

Lower GI disorder constipation

• ↓ stool frequency, hard stool.

• Causes: low fiber, dehydration, inactivity, delaying urge, meds.

• Complications: hemorrhoids, fissures, diverticulitis.

• Treatment: hydration, fiber, activity, stool softeners, enemas.

Lower GI tract disease diveticular disease

• Diverticulosis: asymptomatic pouches in colon.

• Diverticulitis: inflamed/infected diverticula due to retained feces.

• Symptoms: LLQ pain, fever, constipation, blood in stool.

• Complications: abscess, perforation, peritonitis, shock.

• Treatment: high-fiber diet (prevention), antibiotics, fluids, colon resection if severe.

1. The primary cause of GERD is:
   A. Weak LES
   B. Excess bile production
   C. Increased gastric pH
   D. Pancreatic enzyme deficiency

A

2. Which hepatitis type is transmitted via fecal-oral route?
   A. Hepatitis A
   B. Hepatitis B
   C. Hepatitis C
   D. Hepatitis D

A

3. Pain relieved by food is characteristic of:
   A. Gastric ulcer
   B. Duodenal ulcer
   C. Stress ulcer
   D. GERD

B

4. The first sign of stress ulcer may be:
   A. Vomiting
   B. Hemorrhage
   C. Abdominal cramping
   D. Fever

B

5. A patient with ascites, jaundice, and spider angiomas most likely has:
   A. GERD
   B. Cirrhosis
   C. Hepatitis A
   D. Diverticulitis

B

1. Scenario: A 45-year-old male reports burning chest pain after eating spicy food and lying down.
   

   • Likely condition? →

   • What diagnostic test? →

   • Nursing teaching? →

• Likely condition? → GERD

• What diagnostic test? → EGD or esophageal pH monitoring

• Nursing teaching? → Avoid spicy/fatty foods, small meals, elevate HOB.

2. Scenario: A 60-year-old female has black, tarry stools and positive occult blood test.
   

   • Likely diagnosis?

   • Immediate nursing concern?

• Likely diagnosis? → Peptic ulcer with GI bleed

• Immediate nursing concern? → Hemorrhage → monitor for hypovolemic shock.

3. Scenario: Patient with chronic alcoholism presents with jaundice, ascites, and confusion.
   

   • Likely disorder? →

   • Nursing priority? →

• Likely disorder? → Cirrhosis with hepatic encephalopathy

• Nursing priority? → Lactulose administration to reduce ammonia; fluid restriction; monitor neuro status.

4. Scenario: Older adult with LLQ pain, fever, and constipation.
   

   • Likely diagnosis? →

   • What dietary change after recovery? →

• Likely diagnosis? → Diverticulitis

• What dietary change after recovery? → High-fiber diet, avoid seeds/popcorn.

5. Scenario: A nurse notes watery stools after antibiotic use.
   

   • Likely cause? →

   • Nursing action? →

• Likely cause? → C. difficile infection

• Nursing action? → Contact precautions, stool culture, rehydration, probiotics.

• Pharynx:

passage for food and air; coordinated by the swallowing center in the medulla.

• Epiglottis:

covers trachea during swallowing to prevent aspiration.

• Esophagus:

muscular tube that moves food to the stomach by peristalsis.

• Lower Esophageal Sphincter (LES):

• prevents reflux of stomach contents into esophagus.

• Stomach:

muscular sac that stores food, mixes it with gastric acid to form chyme.

• Gallbladder:

stores and releases bile into the duodenum to aid fat digestion.

1. What is the function of the LES?
   →

→ It prevents stomach acid and contents from refluxing into the esophagus.

2. How does the epiglottis prevent aspiration?
   →

→ It closes over the trachea during swallowing so food enters the esophagus instead of the airway.

3. What is chyme and where is it produced?
   →

→ Chyme is a semi-liquid mixture of food and gastric juices produced in the stomach.

• The lower esophageal sphincter primarily functions to:
  A. Mix chyme with digestive enzymes
  B. Prevent regurgitation of gastric contents
  C. Control bile flow into the intestine
  D. Absorb nutrients

B

1. Where is the vomiting reflex located?

1. Where is the vomiting reflex located?

2. Why does hematemesis appear like “coffee grounds”?

2. Because the blood has been partially digested by stomach acid.

• Which is the main risk associated with vomiting in an unconscious patient?
  A. Electrolyte imbalance
  B. Aspiration
  C. Hypoglycemia
  D. Fever

B

A postoperative patient is vomiting while drowsy. What is your priority nursing action?

→

→ Place the patient on their side to prevent aspiration and ensure airway protection.

1. What cellular adaptation occurs in GERD and why?
   →

→ Metaplasia (Barrett’s esophagus), where squamous epithelium changes to columnar epithelium due to chronic acid exposure.

2. Name three risk factors that weaken the LES.
   →

→ Alcohol use, obesity, pregnancy, caffeine, and nicotine. (Any three)

• A hallmark symptom of GERD is:
  A. Nausea and vomiting
  B. Heartburn after eating
  C. Weight gain
  D. Pale stools

B

A 50-year-old reports chest burning after meals and when lying flat. What should you teach?

→

→ Avoid trigger foods, eat small meals, avoid lying down after meals, elevate head of bed 6 inches, lose weight if overweight.

1. How does H. pylori contribute to ulcer formation?
   →

→ It breaks down the mucosal barrier, allowing acid to damage the stomach and duodenal lining.

2. What differentiates gastric vs duodenal ulcers?
   →

→ Gastric ulcer pain worsens with food; duodenal ulcer pain is relieved by food.

1. Which symptom is most typical of a duodenal ulcer?
   A. Pain after eating
   B. Pain relieved by eating
   C. Pain unrelated to food
   D. Hematemesis only

B

2. Stress ulcers related to burns are called:
   A. Cushing’s ulcers
   B. Curling’s ulcers
   C. Zollinger ulcers
   D. Peptic ulcers

B

A patient with a history of NSAID use develops epigastric pain and black stools.

→ Diagnosis:

→ Nursing priority:

→ Diagnosis: Peptic ulcer with GI bleed.

→ Nursing priority: Monitor for hypovolemia (low BP, high HR) and notify provider.

1. What are the two main blood sources to the liver?
   →

→ Hepatic artery and portal vein.

2. What is bile’s main function?
   

→ Emulsifies fats for digestion and absorption.

• Which of the following is produced by the liver?
  A. Insulin
  B. Bile
  C. Gastrin
  D. Secretin

B

1. What is the main transmission route of Hepatitis B?
   →

→ Through blood and body fluids

2. Name three manifestations of cirrhosis.
   

→ Jaundice, ascites, easy bruising, varices, pruritus.

• Which hepatitis type can be prevented by vaccination?
  A. A and B
  B. B and C
  C. C and D
  D. D and E

A

A patient presents with jaundice, ascites, and confusion. What condition is this?

→

Priority:

→ Cirrhosis with hepatic encephalopathy.

Priority: administer lactulose to remove ammonia, restrict protein, monitor LOC.

1. What is the main function of the large intestine?
   →

→ Absorption of water and electrolytes, and storage/elimination of feces.

• The primary site for nutrient absorption is:
  A. Stomach
  B. Small intestine
  C. Large intestine
  D. Gallbladder

B

1. What is the most serious complication of chronic diarrhea?
   →

→ Dehydration and electrolyte imbalance.

2. Name three causes of constipation.
   →

→ Low fiber intake, inadequate fluids, physical inactivity, delaying urge, certain medications.

• Which finding suggests constipation?
  A. Hyperactive bowel sounds
  B. Frequent watery stool
  C. Pain with defecation and hypoactive bowel sounds
  D. Yellow stool

C

A patient reports 3 days without a bowel movement and straining.

→

→ Encourage fluids, fiber, ambulation, and administer stool softener if ordered.

1. What causes diverticulitis to develop from diverticulosis?
   

→ Retention of fecal matter in diverticula leading to infection and inflammation.

2. What dietary recommendation helps prevent recurrence?
   →

→ High-fiber diet, adequate fluids, avoid seeds/popcorn if advised.

• Diverticulitis most commonly affects which area?
  A. Right upper quadrant
  B. Left lower quadrant
  C. Right lower quadrant
  D. Epigastric region

B

A 70-year-old with LLQ pain, fever, and leukocytosis is diagnosed with diverticulitis.

→ Treatment:

→ Treatment: NPO, IV fluids, antibiotics, analgesics, and surgery if perforation occurs.