Exam 2

effect of sympathetic on digestion

inhibitory effect (decreased gastric secretions, decreased motility, blood constriction

effect of parasympathetic on digestion

increased secretory activities, peristalsis, sphincter relaxation

functions of digestive system

-breakdown of food particles into molecular form
-absorption of particles into bloodstream
-elimination of undigested and unabsorbed food

amylase

breaks down carbohydrates

maltase

breaks down maltose to form glucose

sucrase

hydrolyzes sucrose into fructose and glucose

trypsin

hydrolysis of proteins

chewing and swallowing enzymes + secretions

saliva, salivary amylase

gastric function enzymes + secretions

hydrochloric acid, pepsin, intrinsic factor

small intestine enzymes + secretions

amylase, lipase, trypsin, bile

HCl

breaks down proteins in the stomach

bile

aids in digestion of fats

dyspepsia

most common symptoms of patients with GI dysfunction

intestinal gas

bloating, distension, or feeling "full of gas" with excessive flatulence as a symptom of food intolerance or gallbladder disease

nausea and vomiting

nausea is vague, uncomfortable sensation of sickness or queasiness that may or may not be followed by vomiting

CBC

-complete blood count
-high WBC count→infection
-low hemoglobin→GI bleed

CMP

-comprehensive metabolic panel
-provides information on your blood sugar (glucose) levels, the balance of electrolytes and fluid as well as the health of your kidneys and liver

coags (INR)

-test used to see how fast the blood clots

lipid panel

-finds abnormalities in lipids, such as cholesterol and triglycerides.

LFTs

-liver function tests
-blood tests that provide information about the state of a patient's liver

CEA

-carcinoembryonic antigen
-type of tumor marker
-A high level of CEA can be a sign of certain types of cancers

c-diff

-bacterium that causes infection in large intestine
-detected with stool test

leukocytes

-if results show leukocytes in stool, it means there is some kind of inflammation in the digestive tract

FOBT

-fecal occult blood test
-positive if there is bleeding in the GI tract

breath tests

detects bacterial overgrowth such as H. Pylori

what does H. Pylori cause?

PUD (peptic ulcer disease)

what can detect an enlarged gallbladder, stones, enlarged ovaries, appendicitis

US (ultrasound)

what can be used for cancer detection

CEA, CT/MRI, PET

CT

-computed tomography
-cross-sectional images of organs and structures.
-inflammatory conditions
→appendicitis, diverticulitis, ulcerative colitis, pancreatic and renal issues

MRI

-magnetic resonance imaging
-uses magnetic fields to produce images of the area
→abdominal soft tissues, vessels, abscesses, fistulas, neoplasms

PET

-positron emission tomography
-detects radiation being emitted from RA substances (administered IV)
-tagged with radioactive hotspots (oncology)

when would a feeding tube possibly be indicated?

-motor vehicle accident
-CVA (after stroke)
-mechanical ventilation in use
-ALS
-HEENT malignancy (head, eyes, ears, neck, throat issue)
-partial/total gastrectomy
-aspiration risk

GI tube uses

-decompression
-lavage
-feedings
-aspiration

enteral feeding

feedings infused directly from tube to GI tract

osmolality

ionic concentration of fluid

normal body osmolality

300 osm/kg

what can occur when feeding is administered with high osmolality too quickly or in large amounts?

-water moves rapidly into the intestines
-causes fullness, bloating, cramping, diaphoresis, osmotic diarrhea

what syndrome is caused by high osmolality feeding is given too quickly or in large amounts?

dumping syndrome

dumping syndrome leads to

-dehydration
-hypotension
-tachycardia

bowel elimination abnormalities

-malnutrition
-c. diff
-zinc deficiency
-dumping syndrome
-constipation

who is at risk for c. diff

someone recently on antibiotics

where will you feel gallstone pain

right upper quadrant

TPN

-total parenteral nutrition
-a method of feeding that bypasses the gastrointestinal tract.
-special formula given through a vein provides most of the nutrients the body needs.
-used when someone can't or shouldn't receive feedings or fluids by mouth.

parenteral nutrition

-nutrition by IV
-very complex mixture
-can provide enough calories and nitrogen to meet nutritional needs whereas IV fluids cannot
-given if pt is unable to ingest food for 7-10 days

indications for parenteral nutrition

-intake insufficient to maintain anabolic state
-ability to ingest food orally or by tube is impaired
-pt not interested or unwilling to ingest nutrients
-medical conditions precludes oral or tube feeding
-preoperative or postoperative nutritional needs are prolonged

GI bleed causes

gastritis and hemorrhage

xerostomia

dry mouth

oral cancer risk factors

-tobacco use
-alcohol
-HPV
-history of head and neck cancer
-increased incidence in men 2x as often as women
-may occur in any area but lips, lateral tongue, and floor most frequently affected

manifestations of early stage oral cancer

-few or no symptoms
-painless sore or mass that doesn't heal
-indurated ulcer with raised edges
-may bleed easily, present with red or white patch

manifestations of late oral cancer

-complaints of tenderness
-difficulty chewing, swallowing, or speaking
-coughing up blood-tinged sputum
-enlarged cervical lymph nodes

achalasia

makes it difficult for food and liquid to pass from the esophagus to the stomach

hiatal hernias

upper part of your stomach bulges through your diaphragm into your chest cavity.

diverticula

small, bulging pouches develop in the digestive tract.

perforation

a hole in digestive tract

GERD

-gastroesophageal reflux disease
-back flow of gastric or duodenal contents into the esophagus that causes troublesome symptoms and/or mucosal injury to the esophagus
-poor diet, acidic foods, eating late, obesity, smoking, alcohol, coffee, stress, anxiety, H. pylori, tobacco use

management of GERD

-low-fat diet
-avoid caffeine, tobacco, beer, milk, minty foods, and carbonated drinks
-elevate head of bed at least 30 degrees

gastritis

-inflammation of the stomach
-common GI problem

acute gastritis

-rapid onset of symptoms usually caused by dietary indiscretion, medications, alcohol, bile reflux, radiation therapy
-ingestion of strong acid or alkali may cause serious complications

chronic gastritis

-prolonged inflammation due to benign or malignant ulcers of the stomach by H. pylori
-may also be associated with some autoimmune diseases, dietary factors, medications, alcohol, smoking, chronic reflux of pancreatic secretions or bile

erosive gastritis

inflammation characterized by multiple lesions in the mucous lining caused by ulcer-like symptoms

acute gastritis symptoms

-anorexia
-epigastric pain (rapid onset)
-hematemesis (bloody vomit)
-hiccups
-melena or hematochezia (blood from anus)
-nausea and vomiting
-signs of shock

chronic gastritis

-belching
-early satiety
-spicy + fatty food intolerance
-nausea + vomiting
-pyrosis
-sour taste in mouth
-vague epigastric discomfort relieved by eating
-anemia
-fatigue

peptic ulcer

-erosion of a mucous membrane forms an excavation in the stomach, pylorus, duodenum, or esophagus
-associated with infection of H. pylori

peptic ulcer risk factors

-excessive stomach acid secretion
-dietary factors
-chronic NSAID use (inhibit prostaglandin synthesis)
-alcohol
-smoking
-familial tendency

peptic ulcer clinical manifestations

-dull gnawing pain
-burning in midepigastrium
-heartburn
-vomiting

peptic ulcer treatment

-medications
-lifestyle changes
-surgery

peptic ulcer pathophysiology

-erosion caused by increased concentration of acid (pepsin) or decreased resistant normal protective barrier
-mucosa exposed to HCl (and other irritating agents)
-inflammation → injury → erosion
-NSAIDs inhibit prostaglandin synthesis which is associated with disruption of normal protective barrier

45

gastric cancer screenings should start at __ according to ACS

stress ulcer

-acute mucosal ulceration of duodenal or gastric area that occurs after physiologically stressful events (burns, shock, sepsis, multiple organ dysfunction syndrome-most common in ventilator-dependent patients)

gastric cancer

-incidence is decreasing but accounts for more than 10,000 deaths in U.S. annually
-greater incidence in men, native americans, hispanic americans, and african americans

gastric cancer risk factors

-diet
-chronic inflammation of stomach
-H. pylori infection
-pernicious anemia
-smoking
-achlorydria (stomach does not produce hydrochloric acid)
-gastric ulcers
-previous subtotal gastrectomy
-genetics

gastric cancer clinical manifestations

-pain relieved by antacids
-dyspepsia
-early satiety
-weight loss
-abdominal pain
-loss or decrease in appetite
-bloating after meals
-nausea
-vomiting
-diagnosis of disease often late

gastric cancer treatment

-surgical removal of tumor
-palliative care

coffee ground emesis

blood in upper GI would produce

lipase

catalyzes the breakdown of fats into individual fatty acids that can be absorbed into the bloodstream

gastric cancer pathophysiology

-90-95% are adenocarcinomas
-40% develop in lower stomach
-40% develop in middle stomach
-15% develop in the upper stomach
-10% involve more than one area

-lesion involving cells on top layer of stomach mucosa, submucosa, and stomach wall
-lesion will infiltrate stomach wall and start extending (metastasizing) to nearby structures and organs near the stomach
-lymph node involvement tends to occur quickly due to abundant lymphatic vascular networks of stomach

most common metastatic sites of gastric cancer

-liver (most common one)
-peritoneum
-lungs
-brain

gastric cancer gerontologic considerations

-6/10 pts diagnosed are 65 or older
-66.4% of deaths from gastric cancer are in patients 65+
-geriatrics have atypical presentation
-surgery often hazardous

rebound constipation

result of getting addicted to laxatives

constipation

-fewer than 3 bowel movements weekly
-bowel movements that are hard, dry, small, or difficult to pass

constipation causes

-inadequate water intake
-fiber free tube feeds
-opioid use
-chronic laxative use
-weakness
-immobility
-inability to increase abdominal pressure
-ignoring urge to defecate
-lack of regular exercise

perceived constipation

subjective problem in which person's elimination pattern isn't consistent with what they believe to be normal

constipation clinical manifestations

-fewer than 3 bowel movements a week
-abdominal distension
-pain
-bloating
-sensation of incomplete evacuation
-straining at stool (can lead to hemorrhoids)
-elimination of small-volume, hard, dry stools

constipation complications

-decreased cardiac output
-fecal impaction
-hemorrhoids
-fissures
-rectal prolapse
-megacolon

irritable bowel syndrome (IBS)

-chronic functional disorder characterized by recurrent abdominal pain associated with disordered bowl movements, which may include diarrhea, constipation, or both
-15% of U.S. adults report symptoms of IBS
-more common in women

IBS triggers

-chronic stress
-sleep deprivation
-surgery infections
-diverticulitis
-some foods

IBS clinical manifestations

-alteration in bowel patterns
-pain
-bloating
-abdominal distension

malabsorption

-inability of digestive system to absorb one or more of the major vitamins, minerals, or nutrients
-conditions:
-mucosal disorders
-infectious disease
-luminal disorders
-postoperative malabsorption
-hallmark finding is diarrhea or frequent loose, bulky, foul-smelling, grayish stool

malabsorption clinical manifestations

-diarrhea or frequent loose, bulky, foul smelling grayish stool
-weight loss
-vitamin and mineral deficiency

celiac disease

-disorder of malabsorption caused by autoimmune response to consumption of the protein gluten
-has become more common in the past decade, with prevalence of 1% in the U.S.
-women affected 2x as often as men
-Type I diabetes, Down Syndrome, Tuner Syndrome

celiac disease clinical manifestations

-diarrhea
-steatorrhea (oily/fatty stool)
-abdominal pain
-abdominal distension
-flatulence
-weight loss

appendicitis

-most frequent cause of acute abdominal pain in US
-most common reason for emergency abdominal surgery
-appendix becomes inflamed and edematous as a result of becoming kinked or occluded by a fecalith or lymphoid hyperplasia
-inflammatory process increases intraluminal pressure causing edema and obstruction of orifice
-once obstructed, the appendix becomes ischemic, bacterial overgrowth occurs, and eventual gangrene or perforation occurs

diverticulum

-sac-like herniation of the lining of the bowel that extends through defect in the muscle layer (due to increased pressure)
-may occur anywhere in intestine but most common in sigmoid colon
-diverticular disease increases with age and is associated with a low fiber diet
-avoid popcorn, seeds, nuts, berries

diverticulosis

multiple diverticula without inflammation

diverticulitis

infection and inflammation of the diverticula

intestinal obstruction

exists when blockage prevents the normal flow of intestinal contents through the intestinal tract

mechanical obstruction

intraluminal obstruction or mural obstruction from pressure on intestinal wall

functional or paralytic obstruction

intestinal musculature can't propel contents along bowel

inflammatory bowel disease

-chron's disease
-ulcerative colitis

chron's disease

-chronic inflammation of the gastrointestinal tract.
-Persistent diarrhea.
-Rectal bleeding.
-Urgent need to move bowels.
-Abdominal cramps and pain.
-Sensation of incomplete bowel evacuation.
-Constipation, which can lead to bowel obstruction.