Applied Digestive System Flashcards
Stages of digestion
1) ingestion
2) propulsion
3) mechanical/physical digestion
4) chemical digestion
5) absorption
6) defecation
Faecal formation
Stomach»_space;> small intestine»_space;> large intestine
Key players in the large intestine:
- fermentation
- gut bacteria
- water and cellulose
Faeces is moved from the large intestine into the rectum - muscular chamber filled with nerves.
It is felt as an urge to defecate. The rectum is able to detect the type of material in the rectum.
Parasympathetic activity leads to mass action contraction. The increase in abdominal pressure assists the process if the time is right.
Malodorous wind or bowel movements are an indication of stomach upset.
The viscous circle of constipation
- your patient will present with low appetite
- overloaded rectum affects colon mobility
- transverse colon lies beneath the stomach which once overloaded it compresses the stomach
- displaced stomach affects appetite
- reluctance to eat slows general mobility
- eating triggers peristalsis
- increases constipation
- patients with mobility issues more likely to have reluctance to drink to avoid needing to pass urine
- increases constipation
- results in more urgent need to pass urine or open bowels»_space;> potential UTI
Stool assessment
Frequency
Odour
Volume
Colour
Presence of blood or mucous
Pain
Effort
Abdominal tenderness or distension
Weight loss or loss of appetite
Nausea and vomiting
Associated urinary symptoms
Stool culture
Capacity
Previous illness
Allergies or food intolerances
Any sudden changed
»> child specific:
Any early difficulties
Time frame of constipation
Was meconium passed appropriately
Anal canal present at birth
Describe potty training experience
Current toilet habits
Childs behaviour when passing stool
Awareness and response to urge
Common causes of constipation
- obstruction
- conditions e.g. Ehlers Danlos syndrome
- poor diet»_space;> lack of fibre
- medications»_space;> antidepressants or hypotension medications can cause constipation as a side effect
Other reasons for being more susceptible to constipation
- being an older adult
- being female
- being dehydrated
- eating a low fibre diet
- little or no physical activity
- taking certain medications e.g. sedatives, opioids pain meds, antidepressants, hypotension meds
- mental health conditions e.g. depression, eating disorders
Patient presentation of constipation
- abdominal bloating
- BO less than 3 times a week or more than 3 per day of type 1 or 2
- pain upon defecation
- rectal bleeding
- spurious diarrhoea - overflow
- lower back pain
- headaches
What can we do to prevent (recurrence)?
- important to treat constipation before considering prevention or recurrence
- high enough doses of medications for long enough
- consider damage to the rectum and the time required for full recovery»_space;> in childhood it will take as long as the condition has existed to recover
- encourage a high fibre diet
- reduce processed foods
- encourage fluids
- encourage regular exercise
- manage stress
- do not ignore the urge to pass stool
- encourage a regular schedule for bowel movements
- manage medications
- stool assessment
- administer laxatives e.g. stool softeners, osmotic and stimulant laxatives
- assess mental health stressors
- in children consider structural congenital and genetic causes as well as obese
Diarrhoea
> > > At least 3 loose, liquid or watery bowel movements each day
Secretory diarrhoea
- sodium is prevented from being absorbed into the blood stream
- draws water into the bowel
- may be caused by bacterial infection
Osmotic diarrhoea
- unabsorbed nutrients draw water into the bowel
Causes of diarrhoea
- viruses
- bacteria and parasites
- medications
- lactose intolerance
- digestive disorders
- artificial sweeteners/foods
- surgery
Patient presentation with diarrhoea
- abdominal pain or cramping
- bloating
- nausea and vomiting
- fever
- blood or mucous in the stool
- urgent need to have a bowel movement
Irritable bowel syndrome
- it is important to differentiate IBS, in which no pathological process of the GI tract has been identified, from IB, in which a well defined pathological process is identifiable
- IBS is a complex entity that remains incompletely understood
- presents with alternating diarrhoea and constipation accompanied by abdominal cramping pain in the absence of any identifiable pathological process in the GI tract
- the quantity of symptoms is not as important as their effect of the normal lifestyle of an individual
- those with IBS may miss work, curtail their social life and avoid sexual intercourse
- primarily a disorder of bowel motility
- the Moyo wave activity of the colon, which usually occurs at a rate of six times per minute, it markedly increased in IBS
- the sensory response to distension and stimulation seems to be heightened
- could be genetic pastors of environmental
- episodic infection, psychological stressors or dietary patterns
Obstruction
- most common obstruction in adults is cancer
- in children tumours are much less common
- more common obstructions in infants is intussusception
- most tumours of the large bowel are adenocarcinomas
- these tend to grow slowly and remain asymptomatic for long periods
- tumours in the rectum and sigmoid and descending colon grow circumferentially and constrict the intestinal lumen
- tumours in the ascending colon are usually large and palpable
GI disease
> > > Reduced saliva = xerostomia
Symptoms
- dry mouth
- dental caries
- difficulty swallowing
Causes
- caused by drugs»_space;> radiation therapy
Dysphasia
Difficulty swallowing»_space;> CNS disease - stroke
Physical blockage»_space;> oesophageal cancer
