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What are the 3 phases of digestion? Cephalic, Gastric, Intestinal.
What occurs in the the Cephalic phase of digestion? Sight/smell of food stimulates the Vagus nerve to send impulses to the GI tract, which causes an increase in secretions and an increase in motility.
What happens in the Gastric phase of digestion? Distention, decreased acidity, and peptides cause hormonal (gastrin & nerve (vagus) stimulation.
What does Gastrin do? Activates parietal cells to increase secretion and increase motility.
What occurs in the Intestinal phase of digestion? Distention, increased acidity, increased osmolarity of chyme stimulates 5 cells to release Secretin.
What does Secretin do? Decreases acid production and decreases motility.
What is the purpose of saliva? To: lubricate/moisten, neutralize acid, antibacterial properties, release Amylase.
What do proteins do in the GI system? Buffer acid. Stimulate gastrin secretion, which increases acid secretion by parietal cells.
What does the esophagus do? Transport food. Prevent reflux.
How does food move through the esophagus? Via peristaltic waves.
UES innervation. By excitatory impulses. Receives 0 inhibitory impulses.
Esophageal sphincters remain: Closed between swallows. (In a state of tonic contraction)
LES innervation. Receives both inhibitory & excitatory impulses.
LES inhibitory factors. Hormones, chemicals (nicotine, peppermint, tea, coffee, fatty acids), & gastric distension.
What effect do peppermint, nicotine, hormones and gastric distension have on the LES? They cause the LES to open, causing reflux.
LES is comprised of: 1. Internal LES2. External LES3. Oblique muscles of stomach (form flap d/t 90 degree angle).
Functions of the stomach. Store food. Form chyme. Meter food out slowly.
Pacemaker area. Body of stomach. Action potentials generate movement through gap junctions. Frequency stays the same, force changes with neural & hormonal stimuli.
Body of stomach contains: 75% of gastric glands. A billion parietal cells. Chief cells. Mucus
What do parietal cells secrete? HCl & intrinsic factor.
What do chief cells secrete? Pepsinogen.
Pepsinogen is converted to? Pepsin, in the presence of HCL.
What causes Pepsin to be inactivate? pH of 7.
What is the residual volume of the stomach? 50 mL.
How much can the stomach hold? Up to 1000 mL.
Secretions of the antrum. Gastrin. Mucus. Pepsinogen.
What causes the pylori sphincter to close? Muscle contraction of antrum.
Where does starch digestion begin? In the mouth.
What destroys Amylase? Acid in the stomach.
What is the digestive result of protein? Peptide fragments.
What is the only essential element? Intrinsic factor.
Why does B12 need Intrinsic Factor? B12 is large and charged. It needs to be bound to Intrinsic Factor in order to be absorbed in the ileum.
What are the 3 lines of defense in the Gastric Mucosal Barrier? Mucus. Epithelial tight junctions. Microvascular system.
What action does the mucus take in the gastric mucosal barrier? A bicarbonate layer of gel that impedes ion diffusion.
What is the purpose of the epithelial tight junctions in the gastric mucosal layer? To secrete mucus. Also capable of fast repair.
What is the purpose of the microvascular system in the gastric mucosal layer? Contribution of HCO3 and prostaglandins.
Basal acid secretion follows a circadian rhythm. When is it highest? It is highest in the night and lowest in the morning.
Where are Brunner's glands? In the Duodenum.
What is the importance of the pyloric sphincter? Regurgitation of bile salts could damage the stomach. Leakage of gastric acid could damage the duodenum.
_____ is 10" long, a portal for chyme, bile, and pancreatic enzymes. The duodenum.
This is activated by amino acids and fatty acids. Cholecystokinin (CCK).
What does CCK do? Regulates gallbladder contraction. Relaxes the Sphincter of Oddi. Regulates pancreatic secretions. Potentiates Secretin.
Prosecretin is activated to? Secretin, by acid chyme.
What does secretin do? Stimulates the pancreas to secrete HCO3.
For optimal absorption in the SI, how does movement occur? Chyme is moved back and forth over short distances.
What does intestinal mucosa produce from the crypts of Lieberkuhn? 2000 mL of serous fluid that acts as a vehicle for absorption.
A disruption in motility, or damage to the surface area of the SI affects... absorption of nutrients.
Motility is increased by ______ . Inflammatory processes
Motilitly is decreased by _______ . Surgical manipulation.
How much fluid is absorbed from the SI? 80%
How often do enteroctyes turn over? Q 72h.
Enterocytes: Are capable of repairing damage. Little cancer in SI. Are susceptible to damage by chemo/radiation.
What do Brush Border's enzymes do? Complete carbohydrate digestion. Complete protein digestion.
What does the colon do? Secretes mucus. Stores & concentrates chyme by absorbing Na and H2O.
What is the purpose of bacteria in the colon? To synthesize Vit K, and aid in synthesis of some B vitamins. Break down undigested carbs. Deanimate amino acids to form ammonia.
How is urea formed? Ammonia is converted in the liver to form urea.
What controls GI function? The enteric nervous system in the GI tract.
Does the parasympathetic system decrease/increase motility and secretion? Increase.
Does the sympathetic system decrease/increase motility and secretion? Decrease.
What type of muscle is in the esophagus? Smooth and skeletal.
What does Gastrin do? Causes the parietal cells to secrete HCl and intrinsic factor.
What is the purpose of gastric mucus? Protect the stomach lining and lubricate.
What is produced for every hydrogen ion that is secreted into the lumen? HCO3, which serves to maintain a neutral pH along the epithelial membrane.
What does it mean when you say that NSAIDS, ETOH, and bile salts are lipid soluble? It means they can penetrate the lipid soluble layer and damage the gastric mucosa.
What do prostaglandins do in the GI system? Improve blood flow. Increase HCO3 secretion. Enhance mucus production.
What effect do NSAIDS have on prostaglandins? Decrease.
What digestive enzymes in the pancrease are stimulated by CCK? Amylase. Lipase. Trypsin.
Contraction of the gallbladder causes the secretion of? Bile.
Teniae coli are what? Three bands of longitudinal muscle in the colon.
When the teniae coli constrict, the colon gathers into pouches called _______ . Haustra.
This is probably the most common GI disorder. GERD
What causes GERD? Improper closure of the LES.
What are contributing factors to GERD? Obesity, Fat, Peppermint, Peppers, Tomato Sauce, ETOH, Nicotine, Caffeine
What causes the painful burning sensation associated with GERD? Acid that refluxes and touches the lining of the esophagus.
Is nausea common or uncommon with GERD? Uncommon.
The most important factor in GERD? An incompetent LES.
What are symptoms of GERD? Pyrosis, Regurgitation, Strictures, Barrett's esophagus, Extra-esophageal effects
What is Barret's esophagus? The growth of stomach lining into the esophagus. It is a precancerous condition.
Which test needs to be done last in a series of GI tests? Barium swallow.
What diagnostic tests are used for GERD? Barium swallow, EGD, 24h pH
What lifestyle changes are indicated for GERD? Remain upright for 3h after eating. Eat 6 small meals per day.
Medications used to treat GERD. Antacids, Foaming agents, H2 blockers, PPIs
What surgery may be used to treat GERD if medications fail? Nissan Fundoplication.
What is a hiatal hernia? Herniation of part of stomach into the thoracic cavity through the esophageal hiatus in the diaphragm.
What is Gastritis? Inflammation of the gastric mucosa.
Name two types of gastritis. Acute Chronic
What causes acute gastritis? Dietary toxins, ETOH, ASA
What are symptoms of acute gastritis? N/V
How is acute gastritis diagnosed? GI series, Endoscopy
What causes chronic gastritis? Autoimmune disorders, H. Pylori, Chemical agents
What happens in chronic gastritis? Atrophy of gastric mucosa results in a loss of function, diminished acid secretion, and pernicious anemia.
Peptic ulcers, varices, and gastritis occur in this type of GI bleed. Upper GI bleed.
Malignancy and diverticulitis occur in this type of GI bleed. Lower GI bleed.
Often, GI bleeds are this. Intermittent
75-80% of these stop spontaneously. GI bleeds.
How does a GIB present? Suddenly, with s/sx of hypovolemic shock.
What are symptoms of a GIB? Hematemesis, Coffee ground emesis, Hematochezia, Melena, Occult bleed
What color indicates a positive guiaic? Blue.
Nursing actions for a GIB. VS, Stabilize or call a code. Monitor: H&H, PT, PTT, BUN. Insert NGT. Prep for colon/endoscopy. Give IV fluids. Instruct patient to lay down.
How will the H&H appear with a GIB? Normal, patients bleed whole blood.
Peptic ulcer disease (PUD) is characterized by? Exacerbations & remission.
What causes most ulcers? H. Pylori
How does H. Pylori cause an ulcer? By secreting urease, and producing toxins.
Gastric ulcers Higher mortality, Occur in older people, 50-70% from H. Pylori, NSAIDs and ETOH the remainder
Duodenal ulcers 80% of ulcers, Lower mortality, Age 35-45, Male, H. Pylori causes 90%, Remainder NSAIDs and stress
How does stress contribute to an ulcer? By increasing HCl and decreasing HCO3.
Food aggravates this type of ulcer. Gastric
No food aggravates this type of ulcer. Duodenal
What are 3 major complications of an ulcer? Hemorrhage, Perforation, Obstruction
What is Zollinger-Ellison syndrome? It is rare and is caused by a gastrin-secreting tumor.
Peptic Ulcer Disease diagnosis. History, Labs, Radiologic Imaging, ENDOSCOPY
Treatments for PUD. Dual antibiotics, PPI, H2 receptor antagonists, Bismuth, Sucralfate, Antacids
These decrease acid. PPIs, H2 receptor antagonists
These heal & protect. Bismuth, Sucralfate
When is Sucralfate given? Before food.
In PUD what is the goal of surgery? To decrease acid-secreting ability.
Why is there an NGT during Post-op of PUD surgery? To decompress the stomach, To prevent stress to suture lines
What is important to remember when caring for a patient with an NGT? Never reposition or irrigate unless specifically ordered by a surgeon.
What color will the drainage be from an NGT? Initially dark brown, Within 8h yellowish-green
How often should you check for proper tube placement of an NGT? Q 4-8h
How should an NGT be anchored? To nose and gown.
What type of suction is used with an NGT? LIS (low intermittent suction)
How much saline is used to irrigate an NGT? 10-20 mL
What complications may result from PUD surgery? Dumping syndrome, Malabsorption, B12 deficiency
Early Dumping Syndrome. 15-30 min after meals, Fluid shift into gut lumen-plasma V decrease-intestinal distention
Late Dumping Syndrome. 90min- 3h after meals, Hypoglycemia d/t excess insulin
To avoid dumping syndrome & postprandial hypoglycemia: Eat six small meals, No fluids with meals, Avoid concentrated sweets, Increase protein and fat. Short rest period after meals
Inflammatory Bowel Disease is characterized by: Chronic, recurrent inflammation, Diarrhea, Weight loss
Where does Crohn's usually begin? The ileum.
Where does Ulcerative colitis usually begin? The rectum.
Which has skip lesions, Crohn's or Ulcerative colitis? Crohn's.
Which has a cobblestone appearance, Crohns or Ulcerative colitis? Crohn's.
What are the symptoms of Crohn's? Nutritional deficiencies, Electrolyte disorders, Weight loss, Pain, Diarrhea, Low grade fever
Diagnosis of Crohn's disease. Sigmoidoscopy, Stool Cultures, Radiologic contrast studies, CT scan
Treatment of Crohn's. Corticosteroids, 5-ASA, Flagyl, Infliximab (Remicaid), Nutritional therapy, Surgery, Anti-immune drugs
Continuous erythema and ulceration occurs in? Ulcerative colitis.
What are the symptoms of Ulcerative Colitis? Profuse diarrhea with blood and mucus, Weakness Fatigue, Anemia, Dehydration
Diagnosis of Ulcerative colitis. CBC, WBC, lytes, stool culture, colonoscopy, sigmoidoscopy, double contrast barium enema
Treatment of Ulcerative colitis DietCrohn's medsSurgery
This bacteria is anaerobic, gram positive, and spore forming. C. Difficile
What are two types of C. Diff colitis? Hospital acquired Opportunistic
What do broad spectrum antibiotics do to the GI system? Alter normal bowel flora.
How is C. Diff transmitted? Antibiotic use, Low resistance, Fecal-oral route
C. Diff diagnosis Diarrhea longer than 48h-stool culture-microscopic exam
Pseudomembranous colitis Severe C. Diff infection, Adherent inflammatory membrane overlying areas of injury.
C. Diff treatment Stop antibiotics (some patients)Vancomycin, Flagyl, Probiotics
Why do we avoid antidiarrheals with C. Diff? They delay the clearance of the toxin.
Does alcohol gel kill C. diff spores? No.
How do we prevent transmission of C. Diff? Good hand-washingIsolation
Diverticulosis Mucosal layer herniates thruough teniae coli from increase in intraluminal P d/t V of colonic contents.
Symptoms of diverticulosis. Asymptomatic to lower abdominal discomfort.Change in bowel habits.BloatingGas
The Wonder Bread Disease. Diverticulosis.
Diagnosis of diverticulosis. Barium Enemax-rayCT scanUS
Treatment of diverticulosis. High fiber diet.
Diverticulitis Inflamed diverticulum.
Symptoms of diverticulitis. LLQ cramping pain, N/V, F, Increased WBC, stool changes
Diagnosis of diverticulitis. x-ray, ct scan, US
Why is barium enema avoided with diverticulitis? Risk of peritonitis.
Treatment of diverticulitis. Antibiotics,NPO-CL,Heat,Surgery.
Two types of bowel obstruction are.... Mechanical and Paralytic.
Hernias and adhesions are examples of? Mechanical bowel obstruction.
Medications, infections, and surgery are examples of? Paralytic bowel obstruction.
What is the #1 cause of bowel obstruction? Adhesions
What is the #2 cause of bowel obstruction? Hernia
Obstruction leads to... Abdominal distension. Loss of fluid and electrolytes. Atony.
Symptoms of bowel obstruction. Pain, constipation, distention, vomiting.
Diagnosis of bowel obstruction. H&P, x-ray (reveals air-fille bowel).
Treatment of bowel obstruction. Decompression with NGT to suction. Correct electrolyte imbalances. Surgery.
When do s/sx of colon cancer appear? Not until late in the disease.
Diagnosis of colon cancer. H&P, colonoscopy, digital rectal exam, CT, US, barium enema.
Treatment of colon cancer. Surgery, radiation, chemotherapy.
Prevention of colon cancer? Age 40+, annual rectal examAge 50+, add annual guiac, flexible sigmoidoscopy every 3-5 years.
Positive guiac? Get a colonoscopy.
What is a bowel resection? An excision of colon containing tumor, leaving an area of clean margins.
What type of line is used for TPN? A central line with filter to catch precipitates.
How to prep for a bowel resection. CL for 1-2 days prior. NPO after midnight. Antibiotics, enemas, laxatives, and GoLytely.
What to watch a stoma for. Necrotic tissue. Unusual bleeding. Dull color.
What you want to see in a stoma. Beefy red color, edema.
How soon will bowel function return after a bowel resection? In 72 hours.
Where will rebound tenderness be with appendicitis? RLQ (McBurney's point)
What are symptoms of appendicitis? RLQ pain, low-grade F, high WBC (>10,000), N/V
What complications can occur from appendicitis? Peritonitis, abscess formation, and septicemia.
What causes peritonitis? Bacteria or chemical irritant.
Symptoms of peritonitis. N/V, pain, rigid board-like abdomen.
Treatment of peritonitis. Antibiotics, fluid and electrolytes, NGT to suction, NPO, Surgery to correct cause.
What rate does TPN run at? 60-80 mL/h
Where do you put meds in, when running TPN? Below the filter.
Why is TPN given via a central line? Hypertonicity.
What to monitor for while giving TPN. Blood glucose, electrolytes, BUN (high amino acid content), infection d/t central line.
What does bile do? Emulsifies fats. ADEK.
Bilirubin is a waste product of this. RBC
Bilirubin is not soluble in this. Fluid
Bilirubin needs to be bound to this. Albumin
Bilirubin goes here for conjugation. The liver.
This gives feces and urine it's color. Bilirubin.
Total Bilirubin 0.1 - 1.2
Prehepatic jaundice Hemolytic reaction, disorder of RBC
Intrahepatic jaundice Liver damage, drugs.
Posthepatic jaundice Disorders of bile duct, cholelithiasis.
Which LFT is specific to the liver? ALT
Hepatitis is the inflammation of? Liver cells, from infection of hepatitis viruses.
Symptoms of hepatitis. RUQ pain, jaundice, malaise, anorexia, nausea, chills, F, elevated AST & ALT.
How are Hepatitis A&E transmitted? Oral-fecal route.
How are Hepatitis B,C,D transmitted? Bodily fluids.
Which hepatitis can product a carrier state? B or C.
Hepatitis treatment. Bedrest, nutritional support, gradual progressive ambulation.
How long can there be shedding of the hepatitis virus before a serologic marker is present? 2 weeks
Hepatitis A Don't usually die.
Hepatitis B Can be fatal.
Hepatitis C 75% are healthy carriers. Can cause liver cancer and cirrhosis.
Cholelithiasis Gallstones
Gallstones are more common in.... Women d/t estrogen
Gallstones form d/t.... Abnormal bile, stasis of bile, cholecystitis.
Symptoms of cholelithiasis. Indigestion, biliary colic, jaundice.
Why is morphine not given for biliary colic? Causes spasms at sphincter of oddi.
What is used to visualize the biliary tree? ERCP
Diagnosis of cholelithiasis. ERCP, US, cholescintigraphy.
Treatment of cholelithiasis. Gallbladder removal.
Which patients need an open cholecystectomy? Those who have undergone extensive abdominal surgery. Those with severe, acute, cholecystitis. Obese patients.
What is the purpose of a T tube? To ensure patency of bile duct.
Post op care of T tube. Keep below gallbladder. output 400 mL + a day. Never irrigate, aspirate, clamp tube without physician order.
Cholecystitis Gallbladder edema
Cholecystitis manifestations. Biliary colic, increased WBCs, increased LFTs,increased bilirubin, jaundice (if stone in CBD)
Cholecystitis diagnosis. CBC, LFT, US.
Increased Alkaline phosphatase indicates? Inflammation in biliary tree.
What happens if activated pancreatic enzymes leak into body of pancreas? They can autodigest it.
What causes most cases of acute pancreatitis? Alcohol abuse or a gallstone lodged in duct.
Symptoms of acute pancreatitis. SEVERE epigastric & abdominal PAIN radiating to back, abdominal distension/hypoactive bowel, F, shock symptoms, mild jaundice.
Diagnosis of acute pancreatitis. Elevated amylase, elevated lipase, elevated WBCs, hyperglycemia, hypocalcemia, x-ray, CT SCAN.
Amylase level 53 - 123
BUN level 8 - 25
ALT level 8 - 20
AST level 5 - 40
Treatment of acute pancratitis. Put the pancreas to rest! Antibiotics, pain meds, NPO, NGT to suction, fluid and electrolytes.
Complications of pancreatitis. ARDS, pseudocyst.
Chronic pancreatitis Episodic pancreatitis characterized by progressive destruction of pancreas usually r/t alcoholism.
Symptoms of chronic pancreatitis. Pain, N/V, gas, anorexia, deficiencies of endocrine and exocrine function leading to malabsorption.
Treatment of chronic pancreatitis. Pancreatic enzymes, insulin, low-fat diet, pain meds, pain may necessitat surgery.
UGI with SBFT NPO for 8h before. Hold anticholinergics or narcotics for 24h before. Drink a lot of fluid to expel barium. Stools will be chalky white for 24-72h
Barium enema CL 12-24h before. NPO after midnight. GoLytely. Hold barium.
FOBT Save all stool. Guiac blue = positive.
EGD NPO after midnight. Conscious sedation. Remove dentures. IV access. Lying on left side. NPO until gag reflex returns.
ERCP NPO after midnight. IV access. Ask if allergic to iodine, dye or shellfish. NPO until gag returns. ASSESS FOR PANCREATITIS.
Colonoscopy CL 24h before. NPO after midnight. GoLytely the evening before. Conscious sedation on left side, knees up.
How is GoLytely administered? 8oz q 15 minutes until gone. DO NOT DILUTE.
Atropine is to be ready during a colonoscopy, why? In the event the patient becomes bradycardic from vasovagal response.
What antibiotics are used to treat H. Pylori? Clarithromycin and Flagyl (Metronidazole).
Considerations while taking Flagyl (Metronidazole). D/C if CNS s/sx develop. NO ETOH.
Clarithromycin is what type of antibiotic? Broad spectrum.
Sulfasalazine (Azulfidine) Anti-inflammatory GI agent. Used in Crohn's and Ulcerative Colitis.
How does Sulfasalazine (Azulfidine) work? It is converted by intestinal flora into 5-ASA compound. Acts locally to produce an anti-inflammatory effect. May inhibit prostaglandins & suppress migration of inflammatory cells.
Infliximab (Remicade) is what type of drug? Tumor necrosis factor modifier.
What is Infliximab (Remicade) used for? Crohn's
How does Infliximab (Remicade) work? Monoclonal antibody binds to TNF cytokine, prevent it's action. Reduce infiltration of inflammatory cells to damaged area of intestine.
When hanging an IV with Infliximab (Remicade) it is important to remember... It is incompatible with PVC tubing & bags.
Why should you stop Infliximab (Remicade)? For hemodynamic instability/fever/chills/SOB.
Sucralfate (Carafate) Anti-ulcer agent.
How does Sucralfate (Carafate) work? It reacts with gastric acid to form a paste that sticks to and protects damages mucosa.
What is a side effect of Sucralfate (carafate)? It causes dose dependent diarrhea.
When should Sucralfate (carafate) be administered? 1h AC & HS.
H2 Receptor antagonists Famotidine (pepcid), Ranitidine (zantac), Cimetidine (tagamet).
Antacids can be given with? Famotidine (pepcid).
Antacids must be given 2h before/after administration of? Ranitidine (zantac), Cimetidine (tagamet).
How do H2 receptor antagonists work? They inhibit hitamine action at H2 receptor site on parietal cell, blocking gastric acid secretion. By raising stomach pH, indirectly reduces pepsin secretion.
Pancrelipase Pancreatic enzyme replacement. (protease, lipase, amylase)
Important to remember with Pancrelipase. Take with meals & snacks. Enteric coated (do not crush/chew).
Proton Pump Inhibitors (PPIs) Pantoprazole (protonix), Omeprazole (prilosec).
How do PPIs work? They decrease acid secretion by inhibiting the H, K, ATPase pump in parietal cells.
When should PPIs be administered. Before breakfast.
Antiemetics Metoclopramide (reglan), Promethazine (phenergan).
Metoclopramide (reglan) Also a GI stimulant. Accelerates gastric emptying & intestinal transit time. Extrapyramidal side effects.
Promethazine (phenergan) Depresses CTZ in medulla. IV dilute with 10 mL NS, give slowly. Monitor for excess sedation.
Which antiemetic needs to be diluted? Promethazine (phenergan). IV dilute with 10mL NS and give slowly.
What can patients with a gastric ulcer eat? Most foods, as long as it doesn't bother their stomach.
Why is an NGT inserted for a possible bowel obstruction? It removes fluid and air from the stomach.
What is the primary initial symptom of a perforated duodenal ulcer? Pain.
After a laproscopic cholecystectomy a patient is instructed to eat a low fat diet, what is importatn to know? The patient may not need to remain on the low fat diet for long.
Pernicious anemia results from a lack of B12, which organ absorbs B12? The ileum.
What food is good for breakfast with a GERD patient? NON-FAT milk.
Pancrelipase should decrease the amount of what in the stool? Fat.
Is gastric mucosa resistant to HCL? Yes
What is the first consideration of a newly diagnosed C. Diff patient? Are they taking any antibiotics?
Pain in GERD is expected to radiate to... the throat.
Acute pancreatitis nursing actions. Patient may need drain/stent. Closely monitor pulse ox and ABGs. NGT to suction to relieve N/V.
What is typically seen with both ulcerative colitis and crohn's? Weight loss.
Symptoms of a rolling/paraesophageal hernia. Feel really full. SOB.
When inserting an NGT, instruct the patient to: Swallow, tuck their chin.
What should you do with the NGT when inserting? Rotate 180 degrees.
EGD is used to visualize the: Stomach and duodenum.
How soon will a patient have a bowel movement after their first dose of GoLytely? Within 1h.
Why is the incidence of cancer in the SI so low? Cells are turned over q 4 days.
The lower esophageal sphincter relaxes with ingestion of: Caffeine, ETOH, fat.
Where is Vitamin K synthesized? Large intestine.
What kind of diet is given do a person with dieverticulosis? High fiber diet.
What is a classic sign of perforation? Shoulder tip pain & abdominal pain.
Stomach contraction is inhibited by: Secretin
Ascending colostomy Done for right-sided tumors.
Transverse (double-barreled) colostomy Often used in emergencies such as intestinal obstruction or perforation. 2 stomas.
Metamucil 1-2 T q morning
MOM 30 mL HS, hold if creatinine > 3.0
Docusate 250 mg BID
Bisacodyl 1-2 tabs q morning, or suppository HS.
Lovenox SQ DVT prevention
How is blood supplied to the GI tract? Abdominal aorta.
How do nutrients get to the liver? Via drainage from the gastric and splenic veins.
GI function is controlled by: The enteric nervous system in the GI tract.
Myenteric plexus controls: Motility.
Submucosal plexus controls: Motility, secretion, absorption.
Prostaglandins do this to blood flow. Improve it.
Sliding hiatal hernia. The most common. D/t weak anchors of esophageal junction to diaphragm.
Rolling hiatal hernia. Pouch of stomach herniated beside junction through hiatus. These can strangulate. Feel full after eating. SOB.
Albumin 3.1 - 4.3
Protein 6.0 - 8.0
Glucose 80 - 120
Alkaline Phosphatase 42 - 128 units/L to 30 - 85 IU/L
Created by: NataschAnn