N216 Elimination Unit

Elimination is the ___ of waste products. The passage of stool through the ______ and dispelling of the still by means of ________. it usually occurs under _______

Excretion. Intestinal tract. Intestinal smooth muscle contraction. Voluntary control

Common clinical presentations of elimination 4 types:

Acidity, transition time, nausea and vomiting, liver disease

Too slow excretion means;

An increased re-absorption of water ie. constipation or obstruction

Too fast excretion means;

Decreased absorption of nutrients and water. Such as diarrhea

2 parts of excretion:

Gi tract (alimentary canal) and accessory organs such as salivary glands, liver, gallbladder

Digestion fxs: 3

Transport (peristalsis
absorption (villi in small intestine + water reabsorption in small intestine
Enzymes for digestion; stomach HCL + enzymes ; pancreatic juice; bile

Gastric pits: are ___ ___. Lined with _____ cells and _____ cells

Indented depression. Mucous, specialized gastric

HCL acid made from _____. Pepsinogen found in _____. _____ cells cause Gastrin and Histamine release. The pH is ___ to ___.

Parietal cells. Gastric chief cells. Enteroendocrine. 1.5-3.5

Protection from gastric juice; Foveolar cells; ____ and ____. Lower GI protection; gallbladder secretion of _____ and _____ ____

Mucous and bicarbonate. Bile and pancreatic bicarbonate

6 levels of endogenous protection form stomach:

Mucous layer
Bicarbonate layer
Epithelium,
Vascular layer
Smooth muscle
Serosa

G cells secrete ___. Which stimulates ___ cells and___ ___. Parietal cells produce ____. Proton pump releases ____ into the ____ which is mdiated by enzyme ____

Gastrin. Parietal. Gastric histamine, HCL, HCL, stomach, H+K+-ATPase

Histamine released from ____ cells. Binds to ____ receptors on ____ cells. it Increases ____ production by parietal cells.

Enteroendocrine (G). H2, parietal, HCL.

HCL acid control needed for 2 reasons;

1. Reflux and GERD
2. peptic ulcer disease (gastric and duodenal ulcers)

Reflex and gastroEsophageal reflux disease is the reflux of ____ into the ____. Burning sensations known as ____. If persistent, label as ____.

Gastric contents. Esophagus. Heartburn. GERD.

Reflux and GERD are the transient relaxations of weak or incompetent ____ __ sphincter that allows reflux to occur. Also could be a delayed ___ ___. It causes ____ injury.

Lower esophageal. Gastric emptying. Mucosal.

4 Gerd complications

-esophageal erosion of mucosa, ulcerations.
-pain
-inflammation
-decreased appetite

Treatment for GERD 3 ways

-decrease acidity
-avoid irritants
-surgery; Fundoplication

peptic ulcer disease PUD is the ____ of endogenous protection. (Tight mucosal-cell ____ and ____/____ layer

Failure, junctions and mucous/bicarbonate layer

PUD causes ____ erosion and may extend into the deep layers of the ___ ___ as well as the underlying layers

Mucosal, mucosal wall

Gastric Ulcer is pain _____ with ___. It causes ____. usually causes weight ___ and ______

Increased, eating, anorexia, hematemesis

Duodenal Ulcer is pain ____ by eating. Pain re-occurs every ___ hours after eating. usually causes ____ pain. The appetite is ____. It may cause weight ____. Characteristic is _____ stool.

Relieved. 3-5 hrs. Nocturnal pain, nprmal, weight gain, Melena stool.

Most common PUD causes

-H-Pylory infection
-NSAIDS
-Stress

Helicobacter pylori infection (H-Pylori) is Gram ____. Present in ____% of duodenal and ____% of gastric ulcers

G-, 90%, 75%

NSAIDS cause PUD because they inhibit____ in the __ __ which leads to a reduction in ___ ____ and its cytoprotective effects in___ ___.

COX-1, GI tract, prostaglandin secretion, gastric mucosa

Treatment for PUD involves 3 things:

-decreased acidity
-treat the infection, (antibodies treatment according to sensitivity)
- Stop NSAIDS as required.

3 options to help treat PUD: failure of _____ protection (tight ____-____ junctions & _____/_____ layer. Causes _____ erosion. May extend into the deep layers of the _____ ____ as well as the underlying layers.

Endogenous, mucousal-cell, mucous/bicarbonate. Mucosal. Mucosal wall.

H. Pylori is a common precursor of ____ and ___ ___. Risk factor for ____ ____.

Gastritis. Peptic ulcers. gastric Carcinoma

H. Pylori is a curved Gram _____ rod. Organisms synthesize ____ which produces ____ that damages the ___ ____. Ammonia also neutralizes ___ ___. Which allows the organism to live in the ____. Treatment for H.Pylori is ___, ____, and ___.

Negative. Urease. Ammonia. Gastric Mucosa. Acid pH. Stomach.

Omeprazole, Clarithromycin, Amoxicllin.

3 options to treat NSAID damage by PUD. ____ receptor antagonism. (___ ___ receptor). ____ ____ inhibitors. ________.

H2. Parietal cell. Protein pump. antacids.

Antacids neutralize existing ___. Work quickly but produce only ___ ___ relief in the ____.

Acid. Short term. Stomach.

Protein Pump inhibitors irreversibly bind to ___ producing ____ ___ and inhibit ___ production regardless of pathway.

Acid. Protein pumps. Acid.

Upper GI products/mechanisms: ____, ____, and ___, all activate ____ which secrete ____ which enter the ____.

Acetylcholine, histamine, gastrin. Protein pumps. Acid (HCL). Stomach.

H2 receptor antagonists block 1 of 3 ____-_____ pathways (acetylcholine, histamine, gastrin)

Acid stimulating.

Histamine 2 receptor antagonism has ____ blockade. (H2 specific). It causes a decrease in ___- ____. Meds for this are (3 drugs). They provide ___- relief and target ___- tx.

Selective. HCL production.

-ine suffix from histamINE.
Ranitidine (zantac, does not cross BBB)
Cimetidine (tegamet)
famotidine (pepcid)

Quick, acute.

Proton Pump Inhibitors: Binds to ___+, K___+, _____ enzymes to inhibit the proton pump. Meds for treatment; ole suffix (3 drugs). Efficacy ; _____ than H2 receptor blockers. Half life is _____ than H2 recptor blockers. And provide ___- relief.

h+, k+, ATPase.

Omeperazole, (Losec)
lansoprazole, (prevacid)
Pantoprazole (pantoloc)

Higher. Longer. Chronic.

Antacids: alkaline agents. ____ stomach pH (do not ____ HCL secretion) Not recommende as only tx for ___ or ___ acidity conditions. ____ relief only. Unscheduled. 2hrs pre/post other ____ meds.

Increase. Decrease. High or chronic. Symptom. PO.

4 medications based on mineral elements.

Aluminum magnesium, calcium, sodium

Aluminum hydroxide (______). Magnesium hydroxide (____ of _____). Calcium carbonate (____, ____). Pepto-bismol ( _____ _____). Rolaids, Maalox; ____ ___ (alka-_____); Eno; ______

Amphojel.
milk of Magnesia
Tums, Caltrate
bismuth Subsalicylate
Sodium carbonate (alka-seltzer); Eno Diovol

Aluminum medication causes _____

Constipation

Magnesium meds cause ____

Diarrhea

H2 blockers can cause 5 things:

Headaches, dizzy, diarrhea, drowsiness, constipation

Malabsorbed nutrients

iron, calcium, magnesium

PUD 1st line therapy; 3 _____ x2 weeks. They are ___, ___, ___, plus ___ (losec, Omeperazole)

Antibiotics. Amoxicillin, Clarithromycin (tetracycline if allergy). metronizadole (Flagyl)

PPI.

Bismuth Therapy; antibiotics + ____ ____ (pepto-bismol) inhibits ____ growth and ____ adhesion.

Bismuth subsalicylate. Bacteria. Mucosal

Digestion small intestine is ___ feet long or __m. It is __ inches in diameter. 3 parts are the _____. The longest is the ___. Major function is the ___- of nutrients.

20 feet. 6m. 1 inch. Duodenum, jejunum, ileum. Illeum. Absorption

Large intestine is __ feet long and __ inches in diameter. 4 parts are the ___. major functions are the ______ of water ( using ___ ___ cells.) the host flora = Vit __ and ___ synth.

5 feet. 3 inches. Ascending colon, transverse colon, descending colon, sigmoid colon. Reabsorption. (Simple columnar cells). Vit B and K.

Gastric pepsin : ___ enymes. Amino acid chains (___)

Pancreatic. (Peptides)

Carboydrates (4 kinds). Amylase; ____ enymes + ___ ___ enzymes. = 3 kinds are ____

Sucrose maltose, lactose, fructose

Pancreatic. Brush border

Glucose, galactose, fructose

Fat

____ lipase; ____; pancreatic _____

= ___ acids

Lingual. Bile. Lipase.

Fatty acids

Intestinal motility is affected by the ___ system. ANS innervation: either ___ or ___. Enteric Nervous system input from ____: GI stretch. ____: food. presence/ _____/ and ____. Innervated by the ___.

Nervous. Sympathetic or parasympathtic. Mechanoreceptors. Chemoreceptors. Osmolarity. ANS

Diarrhea causes increased ___ and ___. Excessively frequent passage of ___ or ____ stool. Caused by infectious ___, food ____, intestinal ___. Drugs. Can be acute or chronic. Complications are ___ imbalance, ____, and ____

Frequency and fluidity. Loose or unformed. Organisms. Intolerances. Disease. Electrolyte. Dehydration. Malabsorption

Acute diarrhea is less than __ weeks.

2

Noninflammatory: causes ___ and ____ stools. Disruption of normal ___ or ___ process. ___ cramps, ____, nausea, ____. Can result in ____.

Watery and unbloody. Absorption. Secretory. Periumbilical. Bloating. Vomiting. Dehydration

Inflammatory infectious acute diarrhea caused by ___ invasion of ____ cells. (4 kinds____). Predominantly affects the ___.

Pathogenic. Intestinal.

Shigella, salmonella, C. Diff, E.coli

colon

Fever Inflammatory acute diarrhea: Fever and blood diarrhea (____). Left lower quadrant ____, urgency and ____ (feeling of incomplete defecation). Can result in ___.

Dysentry. Cramps. Tenesmus. Dehydraion.

Treavelers diarrhea is infectious and mostly _____. Treat infection _____ using ___ (PO, IV). Manage diarrhea symptoms as needed.

Bacterial. First. Ciproflaxin.

PO for travellers diarrhea: __% bioavailability. little 1st pass metabolism losses. Site of action; directly binds to ____ in GI.

70%. Bacteria.

travllers diarrhea Phase 1 metabolism has ____ metabolites. It is __- potent than the original drug. It has a ___ inhibitor.

Renal excretion and some ___. Half life is ___ hours

Active. Less. CYP. 2-4 hours.

C diff is gram __ bacteria. It multipies ___. Requires hand ____. hand sanitizer does not remove ___. Releases a toxin enterotoxin (C diff. Toxin __). And cytotoxin (C diff Toxin __). It destroys the ____ lining. it causes diarrhea that is ___. It causes blood or pus in the ___. It causes ___. And abdominal ___.

Positiv. Quickly. Washing. Spores. A. B. Intestinal. Severe. Stool. Fever. Pain.

C diff caused by ___ or long term ___ treatment. Common in the ___. Tx 1st line is ____ PO. 2nd line is ____ PO.

Nosocomial. Antibiotic. Elderly. Flagyl PO. Vancomycin PO.

lactobacillus acidophilus destroys other ___ like E.coli by secreting toxic ___ ___. It restores and protects ___ ___. Best choice is ____ plus (refrigerated) that contains 25-50 million ___ per tablet. Added to food like ___ (low dose)

Bacteria. Hydrogen peroxide. Normal flora. BioK. Bacteria.

Antidiarrheals; ___ most effecting by targeting the ___ receptors. Which causes decreased ___. Side effects include ___ depression in high doses. Caution use during ___ and ___ ___.

opioids. Mu2. Peristalsis. CNS. Pregnancy. Drug abuse.

Mu2 causes ____ (spinal). And depression of ___ physical dependence. Helps in ___.

Analgesia. Ventilation. Constipation.

Antidiarrheals meds are ___ + ___. Such as ____ (dyphenoxylate). _____ (Loperamide HCL). ____ (Demerol) + ____

Opioid and atropine.
Lomotil
Imodium
Meperidine + atropine

atropine is an ___. Which blocks the ____ and stimulates the ___ drive.

Antimuscarinic
PNS the Sympathetic drive

Antidiarrheals are in low doses ____ and high doses in ___.

OTC
Rx

Rehydration in hospital using a ____ IV solution (NS or D5.2 NaCl). Check serum ___ and serum ____. At home use ___ or ___. Or make it yourself using __ liters of water __ml of glucose, and __ml of NaCl.

isotontic. Sodium. Electrolytes.

Rehydration solutions such as Gastrolyte Pedialyte.

1L of water. 80mL of glucose. 7mL NaCl

Chronic Diarrhea lasts over __ weeks. Often associated with complex chronic ____ diseases. IBD and ___. Mal-____ syndrome, ____ disorders, or radiation ___.

4. GI. IBS. Absorption. Endocrine. Colitis.

Osmotic diarrhea is when water is pulled into the ___ by the ___ nature of its contents and the colon is unable to reabsorbs excess ___. Example is ___ deficiency.

Bowel. Hyperosmotic. Fluid. Lactase

Secretory Diarrhea occures when the ___ processes of the bowel are ___ and when excess bile ___ remain in the ____ contents as they enter the colon.

Secretory. Increased. Acids. Intestinal.

Inflammatory diarrhea associated with ___ or ___ inflammation or ___ disease of the colon.

Acute or chronic. Intrinsic.

IBS as a cause of diarrhea: causes ____ pain/discomfort, ____, ___ and ___/constipation. Has unknown ____ markers, the CNS dysrgulation of normal ___. Triggers are (4 things)

Abdominal. Cramping, bloating, diarrhea. Physical. Motility.

Stress, menstruation, diet, food intolerances.

Constipation usually responds to decreased ___ and ___ intake. Alterations in ____ or intestinal __ impacting ___ motor function. Ex. Inactivity/ bedrest; ___; meds; pain (____), _____ disease; trauma.

Fluid and fiber. Peristalsis. Innervation. Colonic. Surgery. Hemorrhoids. Hirschsprung disease.

Fecal impaction is the retention of ___ or putty-like ___ in the rectum and ___. If not removed, it can cause partial or complete ____ obstruction.

Hardened. Stool. Colon. Bowel.

Hirschsprung disease is caused when parasympathetic ____ cells in the wall of the large ____ (colon) do not develop before ___. The affected segment of the colon lacks the ability to relax and move ___ ___ along.

ganglion. Intestine. Birth. bowel contents.

Treatment Laxative (5 types)

Bulk forming, softeners, saline and osmotic pull water into stool, stimulants. Miscellaneous-lubricating.

Bulk forming laxatives pull __ into the stool and add ___ to the stool. ____ (psyllium). Fiber increases __ and pulls __. Is it a ___ best. __ to ___days to take effect. Water intake a must. Used long term in ___ homes. Most given by ___ and ___ (suppository). Most avaiable unscheduled.

Water. Fiber. Metamucil. Bulk. Water. Prophylactic. 1-2 days. Nursing. PO PR.

Laxative Softeners pull __ and __ into the stool. Drugs are ___ (docusate sodium). It is a __ best. Decreases ___. Good renal __ for __. Main use is Post ___ __ and post ___.

Water and fat. Colace. Prophylactic. Straining. Function for excretion. MI and surgery.

Saline and osmotic laxatives pull __ into the stool. Eg. is ___ of ___, ___, and ___. ____ best. Very ___ and acts fast; takes __ to __ hours. Milk of Magnesia excreted ___. ___ not absorbed (contra in ___ intolerance.

Water. Milk of Magnesia. Lactulose, GoLytely. Pre-procedural, potent. 1-3 hrs. Renally. Lactulose. Lactose.

Stimulants Laxatives- ___ - increase ___. Eg. are ___, ___ (Exlax and Sonokot), and ___ oil. Cramping. If obstruction possible, do not use because of ___. Not first choice for ___ or pre-____.

Irritants. Peristalsis. Dulcolax, Senna, Castor. Perforation. Constipation. Pre-surgery.

Laxatives Miscellaneous lubcricating such as ___ oil, glycerine. Adjunct treatment with constipation

Mineral.

Cathartics: are pre-procedure ___ preparation. Cathartic = _____. It causes fast ___. PR administration with patient lying on ____ side. water and ____ combination.

Bowel. Enema. Evacuation. Left. Electrolyte.

Bloating Tx; are ___ to increase ____ digestion. meds is ___ and ___ choices.

Enzymes. Carbohydrate. Gasex. Dietary.

PathoPhysiology; vomiting centre in the ___ (neuronal network.)Outside of the ___. Receives ___ pathway signals from ___ pathways.

Medulla. BBB. Sensory. Emetic.

vagal nerve in the ____ tract triggers the ___ centre in the ___ cortex which causes the ____ muscles to contract. (Vomiting)

GI tract. Emetic. Cerebral. Abdominal.

Drugs, metabolic found in the chemoreceptor trigger zone activate the __ and ___ receptors.

Serotonin and dopamine.

motion, position found in the vstibular area triggers ___ and ___ receptors.

Muscarinic, Histamine.

Visceral found in the Organs area triggers ___ and ____ receptors.

Dopamine, serotonin.

Non-specific found in the CNS area triggers the ___ receptors.

Cannabinoid.

Increased cranial pressure found in the cerebral cortex area triggers ___ receptors.

Histamine.

Vomiting centre affects the effector organs using the ___, ___, and ___ receptors.

Histamine, Muscarinic, serotonin.

Tx of nausea and Vomiting target most ___ receptors. s/e: ____ (drowsiness, sedation)

Appropriate. CNS

Tx of the of the underlying cause: pain or _____ poisoning.

Tx the effects of perfuse vomiting: If dehydrated: drink ___. If electrolytes imbalanced, correct with ___ solutions.

Water. Rehydration.

Stimulus: morning sickness, motion induced, acticipatory nausea target ___ antagonism (antihistamines). Reduce ___ excitation. Meds are ___ (gravol); dihenhydramine + chlorotheophyline. _____ (Dramamine). ____ (doxylamine + pyridoxine hydrochloride( Vit B6)).

H1. Vestibular. dimenhydrinate. Meclizine. Diclectin.

Ginger as a medication. Med: Ginger Gravol used for ___ (herbal therapy). It increases intestinal ____. It is safe in ____ doses. Overdoses can cause ____ and ___ depression.

NHP. Peristalsis. Moderate. Bleeding. CNS

Target: antimuscarinic anticholinergics. Reduce ___ excitation. Some affinity to ___ recptors. Meds used are ___ (Hyoscine) and can be taken via ____, ___, ___.

Vestibular. H1. Scopolamine. Transdermal patch. IV. PO.

Stimulus: drug-induced and Chemotherapy for ____ pain. Target: 5HT3 (_____) antagonists. Meds are _____ (zofran) which is ____ only, administered in ___ or ___.

Visceral. Serotonin. Ondansetron. prescription only, PO, IV.

Stimulus GI pain: Target D2 receptor antagonism stimulates ___ motility. CLinical use in __ placement. Med class is ____. Meds are _____ (Maxeran, Reglan). And ___ (Stermetil). Prescription only and and administered ___ or ___. Side effect is ___.

GI. NJ. Phenothiazines. Metoclopramide. Prochlorperazine. PO or IV. Sedation.