Professional Documents
Culture Documents
Functions:
• Digestion
• Absorption
• Elimination of waste
Liver Function:
• Synthesis of glucose, fats and amino acid
• Conjugation of bilirubin and sex hormones
• Stores Vit. A, B12, D
Diagnostic test:
Barium swallowing
- as the patient swallows the barium suspension, it coats the
esophagus with a thin layer of barium.
- This enables the hallow structure to be imaged via x-ray
pH Probe Test
- esophageal monitoring to evaluate degree of acid reflux
DRUG OF CHOICE:
Ranitidine ( zantac )
- inhibits stomach acid (HCl) production
- H2 receptor antagonist
Antacids ( amphojel, chooz, milk of magnesia )
- neutralized or reduce the acidity of stomach
SURGERY
FUNDOPLICATION
- the gastric fundus ( upper part ) of the stomach is wrapped
around the lower end of the esophagus and stitched in place
NURSING CONSIDERATION:
- small frequent feeding and weight loss program
- limit gastric irritant ( spicy foods, acidic, etc )
- avoid smoking
- lie with head elevated
- discuss stress reduction strategies
GASTRITIS
- inflammation of the gastric mucousa
CAUSES:
1. Acute Gastritis
- food and chemical causes
( Spicy, NSAIDs, aspirin, steroids, alcohol, bile refux,
ingestion of contaminated food)
2. Chronic Gastritis
- due to H. pylori
- Cronic Type A – auto immune, ulcers, pernicious anemia, anal
cancer
- Chronic Type B – due to H.pylori ( G (-), microaerophillic
bacterium )
DRUG OF CHOICE
• H2 Receptor Antagonist
o Cimetidine ( Tagamet)
o Inhibits stomach acid (HCl) production
o NOTE: Do not give too fast it causes Bradycardia
• Antacids
- Chooz, amphojel, milk of magnesia
- Simethicone ( Maalox ) - given frequently due to short duration
of action
- Neutralized or reduce acidity of stomach
- Goal is to maintain gastric pH level @ 3.0-3.5
- Give with H2O
- Do not give with ranitidine
• Proton Pump Inhibitors
o Omeprazole ( omepron ), Esomeprazole (nexium)
o They block the final step in the production of gastric acid by the
“acid secreting cells” in the gastric mucousa
• Cytoprotective Agentrs or Anti Aeptic Agents
- bismuth subsalicylate, sucralfate,misoprostol
- help protect the tissues that line the stomach and small
intestines
• penicillin
o -amoxicillin (amox)
o inhibits synthesis of bacterial cell wall
• Tetracycline
- doxycycline, tetracycline
- inhibit protein synthesis by binding to chromosomes leading to
inability of bacteria to multiply
• Anti protozoal
- metronidazole (Flagyl)
- it is selectively absorbed by anaerobic bacteria and sensitive to
protozoa. Once taken up by anaerobes, it is non-enzymatically
reduced by reacting with reduced ferredoxin. This reduction
causes the production of toxic products to anaerobic cells, and
allows for selective accumulation in anaerobes
taken up into bacterial DNA and form unstable molecules. And
-
since because this reduction usually happens to anaerobic cells,
I t has relatively little effect upon human cells or aerobic
bacterias
NURSING CONSIDERATION
- monitor for GI Bleeding
APPENDICITIS
- Obstruction of the vermiform appendix leading to inflammation,
gangrene, perforation and peritonitis.
AT RISK:
• Fecal impaction
• Parasites
• Infection
CARDINAL SIGNS
Right lower quadrant pain ( mc Burney’s area)
Rebound tenderness
SURGERY:
• Appendectomy
• Exploratory laparotomy (if ruptured)
Alvorado’s scoring system for diagnosis of appendicitis
“MANTRELS”
Migratory pain (1)
Anorexia (2)
Nausea (1)
Tenderness (2)
Rebound tenderness (1)
Elevated temp. (1)
Leucocytosis (2)
Shift to left (pain) (1)
SCORE DEFINITION
3.4 no AP
5.6 doubtful
7.9 confirmed AP
NURSING CONSIDERATION
• Avoid W.E.L – may cause rupture of V.A
W arm compress
Enema
Laxatives
• Provide comfort
o side lying position
o if ruptured, semi fowler’s to prevent peritonitis
• Do not give pain meds cause it may mask the symptom
DIVERTICULAR DISEASE
- Outpouching or herniation of the intestinal mucousa through weakness of
muscle layers in the colon wall.
CAUSE:
- Dietary deficiency of fiber
RISK FACTORS:
- Elderly
- Constipation
- IBD
- Obesity
Gallbladder Pancreas
Liver
R Pain L pain
Appendicitis (intestine)
Diverticulitis
DRUGS OF CHOICE
Laxatives
- methyl cellulose
- propantheline bromide ( pro-banthine )
– anti muscorinic agent used for treatment of excessive
sweating, cramps & spasms of stomach, intestines.
Involuntary urination
– Givem @ HS & 30 mins before meal
- bulk forming laxatives
NURSING CONSIDERATION
• Hydration
• Assess stool characteristic
• High dietary roughage
• Avoid valsalva maneuver
2 TYPES:
1. Ulcerative colitis
2. Chron’s disease or regional enteritis
CHRON’S DISEASE
• Patchy lesion in GI tract, decending ( from ileum to rectum) resulting to
excessive diarrhea, FIE imbalance, dehydration and fistula
• Develops slowly with remissions and exacerbations from emotional
factors in family and work
• Cobblestoning of mucousa
CARDINAL SIGNS
• 3-5 semisolid, foul smelling stools/day ( with mucus and pus); RLQ pain
DRUGS:
• Steroids
Corticosteroids ( hydrocortisone, betametasone, prednisone)
Decreased inflammation
• NSAIDs
Salicylates
Decreased inflammation
• Immuno modulators
Azathioprine, methotrexate, natalizumab
Decreased WBC activity
• Sulfonamides
Sulfasalazine (azulfidine)
Blocks PABA to prevent synthesis of folic acid
CHRON’S DISEASE (MORPHOLOGY AND SYMPTOMS)
Cobblestones
High temp
Reduced lumen
Intestinal lumen
Skip lesions
Transmural (all layers may ulcerate)
Malabsorption
Abdominal pain
Submucosal fibrosis
ULCERATIVE COLITIS
• Inflammatory continous lesions in GI tract, ascending (anorectal to
descending colon) leading to intestinal obstruction, malabsorption and
dehydration
• With pseudopolyps in mucousa
RISK FACTOR:
• Genetic
• Stress
• Autoimmune
• 10 – 40 y/o
DIAGNOSTIC TEST
• CBC
• Sigmoidoscopy
CARDINAL SIGNS
• Chronic
• Bloody mucoidal diarrhea
DRUGS:
• Sulfasalazine
• Anti protozoal (metronidazole)
NURSING CONSIDERATION:
• Bulk free diet
• Monitor s/s of dehydration
• Monitor I & O
• Pshychologic support
ULCERATIVE COLITIS : definition of a severe attack
Anemia ( less than 10 g/dl)
Stool frequency (greater than 6 stool/day)
Temperature (above 37.5 oC)
Albumin ( below 30 g/l)
Tachycardia (above 90 bpm)
ESR (above mm/hr)
ULCERATIVE CHRON’S
SURGERY:
• Ileostomy / colonoscopy
- if stoma site is dusky, blood supply has been interrupted
CHOLECYSTITIS
- Cholesterol and calcium precipitate as solid crystals with in mucous lining of
gallbladder obstruction cystic duct.
RISK FACTORS:
• 4 F ( female, fat, 40 y/o, fertile)
• High fat diet
• Aging
• Genetics
• Cirrhosis
• Chron’s
• Sickle cell anemia
• Rapid wt. loss
• DM
• Obesity
• Oral contraceptives
DIAGNOSTIC TEST
• Cholangiography
-imaging of the bile duct by x-rays
• Serum bilirubin
o an increase indicates disease
• Alkaline Phosphatase
Normal range of 20 – 14 iu/L
High ALP indicates bile ducts are blocked
CARDINAL SIGNS
• RUQ pain (may radiate to subscapular area)
• Nausea and vomiting
• Intolerance to fat
• Clay colored stool
DRUGS
• Opioids agonists or opioid analgesics
o Meperidine (Demerol)
o Reduce pain binding to opiate receptor sites in the PNS and CNS
o Do not give with MAO inhibitors
• Bile acid sequestrants
Ursodeoxycholic Acid (actigall)
Reduces cholesterol absorption and is used to dissolve gallstones
Cholestyramine (questran)
Binds to bile acids to form an insoluble substance that cannot be
absorbed by the intestine
CHARCOT’S TRIAD
• Fever
• Epigastric RUQ pain
• Emesis and nausea
Murphy’s sign- upon inspiration palpate RUQ and if it painful, pt can’t
continue inspiration.
NURSING CONSIDERATION
• Avoid high fat diet
PANCREATITIS
- injured or disrupted pancreas leaks phospholipase H, lipase,
elastase and trypsin initiating auto digestion resulting to edema,
vascular damage, hemorrhage and necrosis or replacement of
fibrous tissue.
CAUSES: TREATMENT:
Gallstones Monitor V/S
Ethanol
Analgesia/antibiotics
Trauma Calcium
gluconate ( if necessary)
Steroids H2 receptor
antagonist
Mumps IV access/ IV
fluids
Autoimmune NPO
Scorpion/snake bite Empty Gastric
contents
Hyperlipidemia Surgery (if
necessary)
ERCP – Endoscopic retrograde Chologiopancreatography
- combines endoscopy and fluoroscopy
Drugs