1) Patho digestive and gi

enteral feeding

feedings infused directly from tube to GI tract

enteral feeding is inserted into the

mouth, nose, abdominal wall

reasons to get enteral feeding

-decompress stomach
-lavage
-administer tube feedings, fluids, meds
-aspirate GI contents

lavage

flush with water to remove toxins and materials

reasons to aspirate GI contents

-bleeding
-alc poisoning

parenteral feeding

nutrition by IV

parenteral feeding can only go through ______ ____

central line

parenteral feeding mixture is composed of

lipids
carbs
fats
vitamins
sterile water

parenteral feeding goals

-provide enough calories and nitrogen
-maintain muscle mass
-promote weight maintenance/gain
-enhance healing process

parenteral feeding indications

-inability to digest foods/liquids for 7-10 days
-intake insufficient to maintain anabolic state
-pt unwilling to ingest adequate nutrients
-pre-op and post-op nutritional needs are prolonged

total parenteral nutrition (TPN)

pt unable to tolerate oral food or feeding tube; only fed through IV
(not sustainable for long term)

peptic ulcer disease (PUD)

erosion of a mucous membrane forms an excavation in stomach, pylorus, duodenum, or esophagus

organism associated with PUD

H. pylori

PUD patho

-inc concentration of acid (pepsin) leads to dec resistant normal protective barrier
-mucosa cant secrete enough mucous to act as barrier
-mucosa exposed to HCl leads to inflammation leads to injury leads to erosion

stress ulcer

acute mucosal ulceration of duodenal/gastric area
-occurs after stressful events (burn, shock, sepsis, MO DS)

stress ulcer is _________ ________ from peptic ulcers

clinically different

stress ulcer is most common in

ventilator-dependent pt after trauma/surgery

PUD risk factors

-excessive excretion of stomach acid
-dietary factors
-alc
-smoking
-familial tendency
-chronic use of NSAIDs

major risk of PUD

NSAIDs

PUD diet recommendations

-dec mixing temp
-no caffeine
-neutralize acid
-small frequent feedings if not on an antacid or H2 blocker

PUD clinical manifestations

-dull gnawing pain
-burning in back
-heartburn
-vomiting
-constipation or diarrhea
-bleeding

PUD most common clinical manifestations

-dull gnawing pain
-burning in back

PUD NSAIDs

inhibits prostaglandin synthesis
associated with disruption of normal protective mucosal barrier

gastric cancer risk factors

-most acquired gene mutations
-5-10% familial genetics
-diet, chronic inflammation of stomach, H. pylori, pernicious anemia, smoking, achlorhydria, gastric ulcers, previous subtotal gastrectomy

beginning gastric cancer clinical manifestations

few/no symptoms

early gastric cancer clinical manifestations

gastric pain relieved with antacids

advanced gastric cancer clinical manifestations

-dyspepsia
-early satiety
-unintentional weight loss
-abdominal pain above umbilicus
-dec/loss of appetite
-bloating, fatigue
-nausea/vomiting
-blood loss

metastasis for gastric cancer

lymph node involvement and Mets occur quickly due to abundant lymphatic and vascular networks for stomach

gastric cancer common metastastic sites

liver
peritoneum
lungs
brain