wk1-wk5 ms

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23 to 26 feet (7 - 7.9m)

23 to 26 feet (7 - 7.9m)

length of gastrointestinal (GI) tract in the human body.

1.5 liters of saliva

liters of saliva are produced per day.

salivary amylase or ptyalin

enzyme that begins digestion.

esophagus location

mediastinum anterior to the spine, posterior to the brachial and heart. (25 cm to 10 inches)

stomach location

upper left portion of the abdomen and under the left lobe of the liver and diaphragm, overlays most of the pancreas.

stomach characteristics

hollow, muscular and has a capacity of approx. 1.5L

stomach functions

storage of food, secretion of digestive fluid and propels chyme into the small intestine

small intestine

longest segment of the gi tract, approx. 70 m or 230 ft, secrets gastric fluid and is responsible for the absorption of nutrients.

duodenum

the proximal section, and it has common bile duct and is where the hepatic duct empties

jejunum

middle section of the small intestine

ileum

distal section and it terminates into the ileocecal valve

ileocecal valve

this controls the flow of digestive material and prevents reflux of the bacteria into the small intestine, also the location of the vermiform appendix

large intestine

to dry out indigestible food residue by absorbing water

functions of the gi tract

breakdown of food particles into molecular form of digestion, absorption of nutrients into the bloodstream which is produced by digestion, elimination of undigested unabsorbed food and waste products

assessment of gi tract

nutritional problems, abdominal pain, dyspepsia / indigestion, n&v, diarrhea, constipation, dysphagia, fecal incontinence, jaundice and previous gi disease

undigested food particles in vomitus

may indicate or suggest tumor, ulcers, obstructions

hematemesis

may be due to hemorrhage, bright red — arterial bleeding, dark red — venous bleeding

bilious material in vomitus

cause a bitter taste

gastric contents in vomitus

sour acid taste

bright red in vomitus

mallory-weiss tear, laceration of gastroesophageal junction, indicating upper gi bleeding

coffee ground in vomitus

digested blood from slow bleeding

yellowish vomitus

bile leakage or medication that is used remove bowel contents prior to surgery

fecal contents in vomitus

may indicate intestinal obstruction

Order of physical examination

1. inspection

2. auscultation

3. percussion

4. palpation

supine with knees flexed slightly

position of physical examination

diaphragm

for soft clicks and gurgling sounds (for high pitched)

bell

for bruits (for low pitched)

friction rubs

high pitched sound which is usually heard over liver and spleen during respiration

borborygmus

the loud, prolonged gurgle, this is produced when the stomach gurgles or parang growling

tympany

sound of air in the stomach or intestine

dullness

sound produced or heard over solid masses

light percussion

identify for tenderness or muscular resistance

deep palpation

to identify masses

tenting of the skin

may suggest dehydration

weight loss and nutritional deficiency

manifested by mouth lesions, missing teeth, swollen or bleeding gums

palpable mass

indicate enlarged organ, inflammation, malignancy or hernia

rebound tenderness, guarding and rigidity

this may indicate appendicitis, cholecystitis, peritonitis, pancreatitis, duodenal ulcer

ascitis

(shifting dullness or fluid wave) may be presented with abdominal protuberant or bulging abdomen, flanks

abdominal distention and absence of bowel sounds

may indicate intestinal obstruction

normal stool

light to dark brown

situations can change the color of

(1) abnormalities or diseases in the body, (2) medications (3) food

green stools

indicate green leafy vegetables

red stools

meat, food colouring

black stools

iron supplement

milky white stools

barium solution

melena

black tarry stools that indicate upper gi bleeding

hematochezia

indicate lower gi bleeding

anal bleeding

blood streaks on the surface of the stool or blood on toilet paper

steatorrhea

bulky, greasy, foamy, foul smelling, stool may or may not float

light gray or clay coloured stools

decreased or absence of conjugated bilirubin

chronic ulcerative colitis shigellosis

presence of mucus threads or pus

bloody mucoid stools

infection from shigella dysenteriae

constipation stools

small, dry, rock hard masses with occasional blood streaks in the stool

spastic colon syndrome

marble sized stool pellets

purpose of stool examinations

determine fecal urobilinogen which may suggest an obstructive jaundice, measures fecal fat, determines bacteria, parasites and other pathogens, identify fecal leukocytes.

hemoccult guaiac test (fobt)

most commonly performed stool tests

avoid vitamin c

to avoid false negative in fobt

avoid red meat

‘heme’ may result in false positive result

avoid aspirin and NSAIDs

causes microscopic gi tract bleeding. resulting in false positive

hydrogen breath test

help diagnose SIBO and IBD by evaluating carbohydrate absorption,

urea breath test

help diagnose peptic ulcer disease, by detecting presence of h. pylori

hydrogen

tested in a hydrogen breath test

h. pylori

detected in urea breath test

avoid proton pump inhibitors

for 2 weeks because it can kill H. Pylori

avoid cimetidine, famotidine

for 24 hours because it depresses production of hydrochloric acid and can kill H. Pylori

barium swallow

x-ray examination of esophagus, stomach, small intestine after introduction of a contrast agent

barium enema

detect polyps, tumors, lesions of the LGIT, determine anatomic abnormalities and functional disorders of the LGIT

abdominal ultrasonography

non-invasive test focuses high frequency sound waves that will pass on the internal structures to obtain an image of the structure

endoscopic procedures

use of fiberoptic endoscope to visualize the GIT, this is for dx and tx procedures, may be inserted through the mouth or rectum

fibroscopy / EGD

direct visualization of the esophagus, stomach, duodenum, evaluate GI motility, collect secretions and tissue specimen

endoscopic retrograde cholangiopancreatography (ercp)

endoscopic combination with X-ray, uses contrast dye and x ray,

midazolam (ercp)

used as a sedative to prevent gag reflex and to lessen anxiety

atropine (ercp)

administered prior and during the procedure to reduce secretion

glucagon (ercp)

administered prior the procedure which helps in relaxing smooth muscles

position during ercp

left lateral to faciliate clearance of pulmonary secretion to avoid aspiration and to promote smooth entry of the scope

anoscopy, proctoscopy and sigmoidoscopy

endoscopy of the lower git

proctoscopy

fiberoptic colonoscopy

direct visualization of the LGIT or the anus to secum

laparoscopy / peritoneoscopy

minimally invasive procedure, allows visualization of the organs and structures within the abdomen w/ the use of fiber optic laparoscope

gastroesophageal reflux disease

characterized by backflow/ reflux of stomach or duodenal contents into the esophagus resulting to esophageal mucosal injury

causes of gerd

incompetent lower esophageal sphincter, pyloric stenosis, hiatal hernia, motility disorder

risk factors of gerd

increased in aging, irritable bowel syndrome, obstructive airway disorders, Barrett Esophagus, PUD, angina, irritants (tobacco, coffee, alcohol, h. pylori)

hallmark sx of gerd

regurgitation

manifestations of gerd

• pyrosis

• dyspepsia

• dysphagia or odynophagia

• hypersalivation

• esophagitis

• mimic heart attack

• dental erosions, ulcerations

dx of gerd

• pt’s hex

• ambulatory pH monitoring

• endoscopy or barium swallow

gold standard of gerd dx

ambulatory pH monitoring, involves placement of trans nasal catheter, quantifies and measures the reflex.

types of meds for gerd

• antacids

• h2 blockers

• proton pump inhibitors

• prokinetic agents

cimetidine

h2 blockers, by decreasing gastric acid production

metoclopramide or flacil

prokinetic agents accelerate gastric emptying which promotes passage of gastric contents into the intestine

open laparoscopic nissen fundoplication

fundus of the stomach is wrapped around the sphincter so that it will tighten the junction between the esophagus and stomach to prevent the reflux

esophageal diverticulum

out-pouching of mucosa and submucosa that protrudes through a weak portion of the muscles of the esophagus

pharyngoesophageal

upper

midesophageal

middle

epiphrenic

lower

zenker diverticulum

most common type of diverticulum, located in pharyngoesophageal area

pulsion diverticulum

posterior to the pharynx and middle of the neck

manifestations of diverticulum

• dysphagia

• fullness in neck

• belching, regurgitation of undigested food

• coughing

• gurgling noises after eating

• halitosis

• sour taste in mouth

halitosis

foul odor of the mouth caused by decomposed food in the diverticulum

dx for diverticulum

barium swallow — to measure and locate the diverticulum

endoscopic septotomy

dissection of the pouch