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NURS 2514 > Chapter 1 Digestive System > Flashcards

Chapter 1 Digestive System Flashcards

1
Q

What concepts connect to the digestive system?

A
  1. Nutrition
  2. Elimination
  3. Inflammation
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2
Q

Finish the process:

Food is consumed, (a) __________ , (b) __________ , Elimination

A

(a) food enters GI tract

(b) food moves along until broken down and enters blood stream to be used as energy

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3
Q

What forms of elimination relating to the digestive system does the body excrete?

A

(a) Urine

(b) feces

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4
Q

What is the digestive tract?

A

The digestive tract consists of a long hollow tube that runs from the mouth to the anus. At various points is connected to gland and organs which all work together to aid in the process of digestion

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5
Q

What are the major functions of the GI tract?(7)

A
  1. Ingestion of food (chewing and swallowing)
  2. Absorption of digested food
  3. Elimination of waste products by defecation
  4. Propulsion of food and waste from mouth to anus
  5. Secretions of mucous, water, and enzymes
  6. Immune and microbial protection against infection
  7. Mechanical digestion of food particles
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6
Q

Which of the two are involuntary and voluntary?

(a) Swallowing
(b) Peristalsis

A

(a) Voluntary

(b) Involuntary

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7
Q

The digestive tract consists of 4 layers. From the outside in, what are the layers called?

A
  1. Mucosa
  2. Submucosa
  3. Muscularis
  4. Serosa
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8
Q

In the digestive tract what is and does the mucosa layers do?

A

It is a epithelial layer that produces mucus, digestive enzymes, and absorbs nutrients

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9
Q

In the digestive tract what is and does the submucosa layer do?

A

It is a connective tissue layer containing nerves, blood and lymph vessels

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10
Q

In the digestive system what is and does the muscularis layer do?

A

It is a smooth muscle layer that allows proportion of food through GI tract (peristalsis)

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11
Q

In the digestive system what is and does the serosa layer do?

A
  • It is an outer connective tissue layer forms the visceral peritoneum.
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12
Q

What other names does the serosa layer of the digestive system have?

A

Serous membrane also known as peritoneum has additional labelling depending on which part you are referring to.

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13
Q

What is the serosa layer called if it wraps around the bowel?

A

Visceral peritoneum

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14
Q

What is the serosa layer called if it wraps around the abdominal wall?

A

Parietal peritoneum (has a large surface area)

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15
Q

What does it mean when the GI tract surface changes related to function? Think of the 4 layers.

A
  1. The mucosa neck cells of the stomach protects gastric mucosa from digestive actions of acid and pepsin by creating a mucosal barrier
  2. Chief cells secrete pepsinogen a proteolytic enzyme that breaks down protein
  3. Parietal cells secrete hydrochloric acid and intrinsic factor
  4. Endocrine cells produce histamine and hematostatin
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16
Q

How is the surface layer of the S. intestine different than the L. intestine?

A

The S. intestine has a larger surface (villi) area for allowing more absorption of water and electrolytes.
L. intestine has deep crypts, have no villi, is smooth, and secretes mucous to lubricate the intestinal contents to transport through the bowel

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17
Q

What is intrinsic factor?

A

Vitamin B12 binds to it to form a complex

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18
Q

What is entering the GI tract and what is leaving the GI tract?

A

7L of fluid a day (saliva, bile, and stomach, intestinal, and pancreatic secretions)
+
2L of fluid/day consumed by average adult
= 9 Litres/day

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19
Q

How much fluid is reabsorbed in the GI tract and why does our body do that?

A

8.8L is reabsorbed and the purpose is that we cannot manage to replace a full 9L of water per day.

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20
Q

What are the common problems of the GI tract?

A
  1. Acid issues (occurs in upper GI tract)
  2. Inflammation/Erosion (affect GI functioning)
  3. Motility Issues (structural and neural) –> Increase/decrease or stop of movement

*Each can interrupt normal processes of nutrition and elimination

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21
Q

How does the 4 layers change in different parts of the GI tract?

A

You didn’t answer this in your notes

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22
Q

What do the gastric glands produce and what are their roles in the stomach

A

Gastric juice and protective mucous

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23
Q

How do secretions play a important role in our overall fluid balance?

A

Not sure where this is in your notes

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24
Q

What consists of the upper GI tract?

A

Mouth. esophagus, stomach

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25
Q

What are some mouth issues?

A

Easy to inspect for problems

Think about what you need.to properly chew food

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26
Q

What are some throat issues?

A

Swallowing is a voluntary act controlled by skeletal motor neurons.
Dysphagia can occur from mechanical obstruction or functional impairment (nerve or muscle problem)

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27
Q

What are the 3 common symptoms associated with GI disorders?

A
  1. Anorexia
  2. Nausea
  3. Vomiting
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28
Q

What is the definition, symptom, what condition it is associated with anorexia

A

Definition: Lack of desire to eat, loss of appetite
Symptom: Non specific
Often associated with: Nausea, abdominal pain, diarrhea, and psychological stress

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29
Q

What diseases does anorexia accompany?

A

Cancer, heart disease, and kidney disease

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30
Q

Anorexia can be a side effect of medication. TRUE or FALSE?

A

True

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31
Q

Define Nausea

A

Subjective feeling of discomfort in epigastrium with conscious desire to vomit

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32
Q

Define vomitting

A

Forceful ejection of partially digested food and secretions (emesis) from the upper GI tract

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33
Q

Which types of patients would we seethe symptoms of nausea and vomiting in?

A

Patients with GI diseases, pregnancy, infectious diseases, CNS disease, cardiovascular problem, metabolic disorders, allergies, fear/stress

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34
Q

What causes the sensation of nausea and vomiting and what part of the brain controls/allows for that?

A
  1. Chemoreceptor trigger zone (lies outside of BBB) uses receptors for dopamine, serotonin, opiate, acetylcholine
  2. Vestibular system sends info. to brain via cranial nerve VIII (plays role in motion sickness) and is rich in muscarinic receptors
  3. Enteric and Vagus nervous system in puts info. about state of GI. Once irritated it activates serotonin receptors
  4. CNS mediates vomiting that arises from psychiatric disorders and stress from higher brain centers

Part of brain: Emetic centre in the medulla

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35
Q

GI irritation can be caused by?

A
  1. Chemotherapy
  2. Radiation
  3. Distention (enlarged from pressure)
  4. acute infectious gastroenteritis
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36
Q

What are the 3 main causes of nausea and vomiting?

A
  1. Inflammation in any part of the GI tract
  2. Irritation/injury to the CNS
  3. Reaction to drug
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37
Q

Examples of inflammation in the GI tract causing nausea and vomiting include:

A
  1. Gastritis
  2. Gastroenteritis of food poisoning
  3. Gastroesophageal reflux disease
  4. Pyloric stenosis, bowel obstruction, peritonitis, ileus
  5. Overeating
  6. Food allergies
  7. Cholesytitis, pancreatitus, appendicitis, depatitis
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38
Q

Examples of irritation/injury to the CNS that causes nausea and vomiting include:

A
  1. Motion sickness
  2. Concussion
  3. Cerebral haemorrhage
  4. Migraine
  5. Brain tumors and ICP (increased intracranial pressure)
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39
Q

Examples of reaction to drugs causing nausea and vomiting include:

A
  1. Alcohol
  2. Opioids
  3. Selective serotonin re-uptake inhibitors (SSRIs for depression)
  4. Many chemotherapy drugs
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40
Q

What pathway does the neurotransmitter serotonin use?

A

Afferent pathway

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41
Q

Why are nurses concerned about nausea and vomiting?

A
  1. Aspiration: Passage of gastric contents into the lungs (infection)
  2. Mallory-Weiss tear: Tear in esophageal lining (bleeding)
  3. Fluid and electrolyte imbalance: Occurs with prolonged vomiting due to loss of HCL, K+, and increase of HCO 3- (metabolic acidosis)
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42
Q

If a patient has nausea and vomiting that results in vomiting why does an infection occur and why is it a concern?

A

Patient has aspiration.

  1. Stomach acid is highly acidic and contains bacteria which can irritate the lungs.
  2. The patient is most at risk are unconscious and have an absent gag reflex.
  3. Patients that just had sedation or had a stroke
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43
Q

If a patient has nausea and vomiting that results in a Mallory-Weiss tear why should a nurse be concerned about the bleeding?

A

Depending on the location, it can be difficult to stop the bleeding

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44
Q

What happens when vomiting is prolonged?

A
  1. The risk for dehydration increases

2. A patient can develop metabolic acidosis

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45
Q

What are the 3 mechanisms that explain vomiting complication

A

a) Physical loss of HCO 3- as duodenal secretions (which are alkaline) are lost in the vomit
b) Consumption of HCO 3- through lactic acid production (caused by hypovolemia and increased muscle activity)
c) Depletion of liver stores of glucose causes ketoacidosis

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46
Q

What are the roles of the emetic centre in nausea and vomiting?

A
  1. Once stimulated it will cause nausea and if stimulated, a lot can cause vomiting
  2. Transmits info about state of GI tract
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47
Q

Which pathway would control the nausea/vomiting response in a patient who has motion sickness?

A

Vestibular system to the brain via cranial nerve VIII

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48
Q

Which pathway would control nausea/vomiting response in a person who had food poisoning?

A

Enteric and Vagus nerve system

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49
Q

Why does a person with prolonged vomiting develop hypokalemia?

A

Fluid and electrolyte imbalances

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50
Q

How does prolonged vomiting affect acid/base balance?

A

Person can get metabolic alkalosis to metabolic acidosis if prolonged

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51
Q

What can go wrong in the upper GI tract? List 6 examples.

A
  1. Gastroesophageal reflux disease (GERD)
  2. Hiatal Hernia
  3. Peptic Ulcer Disease (PUD)
  4. Gastritis
  5. GI Bleeding
    6 Esophageal cancer
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52
Q

Define GERD (Gastroesophageal Reflux Disease)

A

A condition where gastric contents move into the esophagus creating the sensation of heartburn and/or esophagitis

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53
Q

Why do people get GERD?

A

GERD can be caused by:

  1. Weak or incompetent LES (lower esophageal sphincter)
  2. Hiatal Hernia
  3. Impaired esophageal motility
  4. Decreased saliva function
  5. Delayed gastric emptying
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54
Q

What are 3 examples that can cause a weak or incompetent LES?

A
  1. Caffeine
  2. Eating larger frequent meals
  3. Anti-cholingerics, BB, CCB, and morphine
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55
Q

How does a patient who has impaired esophageal motility relate to GERD?

A

Esophagus does not push down properly. Can be due to viral infection.

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56
Q

How does a patient who has decreased saliva function relate to GERD?

A

Can be caused by medication(s)

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57
Q

How does a patient who has delayed gastric emptying relate to GERD?

A

Pressure in the stomach is too great that it overwhelms LES causing stomach contents to reflux back to the esophagus.
High pressure cause by increase in acid production or delayed gastric emptying (due to tumour or ulcer)

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58
Q

What are the common symptoms of GERD?

A
  1. Heartburn (Pyrosis)
  2. Respiratory Symptoms
  3. Regurgitation
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59
Q

Explain common symptoms of GERD for heartburn

A

Burning/tight sensation felt intermittently beneath lower sternum and spread to throat/jaw.
Occurs 30-60 mins after meal and worse when bending at the waist.

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60
Q

Explain common symptoms of GERD for respiratory symptoms

A

Aspirations of stomach content can cause wheezing, coughing. and dyspnea.
Stomach acid irritates respiratory tract.

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61
Q

Explain common symptoms of GERD for regurgitation

A

Effortless return of food or gastric contents into mouth. Often described as hot, bitter, sour liquid coming into mouth.
Due to regurgitation (food contents come back to the mouth).

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62
Q

What are the 3 chronic GERD complications with ongoing esophagitis?

A
  1. Esophageal Stricture
  2. Barrett’s Esophagus
  3. Ulceration and bleeding
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63
Q

Define esophageal stricture

A

Narrowing of esophagus caused by scar tissue formation (leads to dysphagia).
Summary: Scar tissue formed

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64
Q

Define Barrett’s Esophagus

A

Replacement of esophageal stratified squamous epithelium with simple columnar epithelial (like stomach/intestine).
10% of patients with Barrett’s will develop esophageal cancer.
Summary: Cellular changes

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65
Q

Define ulceration and bleeding

A

There’s too much acid or not enough mucus, the acid erodes the surface of the stomach or small intestine resulting in a open sore that can bleed.

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66
Q

Define Hiatal Hernia

A

Herniation of a portion of the stomach into the esophagus through an opening in the diaphragm

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67
Q

What are the contributing factors to hiatal hernia?

A

Weakening of muscles in the diaphragm around the esophogastric opening, increase in intra-abdominal pressure (obesity - extra fat , pregnancy, ascites, tumours, and heavy lifting - external)

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68
Q

What are the symptoms of hiatal hernia?

A

Similar to GERD and often occur when supine, after a large meal, with smoking/alcohol

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69
Q

What are two examples of hiatal hernia?

A
  1. Sliding hiatal hernia

2. Para-esophageal (rolling) hiatal hernia

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70
Q

What are 5 symptoms would a patient experience if they have esophageal cancer?

A
  1. Asymptomatic (early)
  2. Dysphagia - Meat (difficult ((first)) –> soft food –> liquids
  3. Neck pain
  4. Weight loss
  5. Bleeding (complication)
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71
Q

What does (a) LES stand for and what (b) is its main function?

A

(a) Lower esophageal sphincter

(b) Prevents stomach contents from moving up

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72
Q

Why can GERD cause respiratory symptoms?

A

Acid/stomach contents can cause aspiration

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73
Q

What is Barrett’s esophagus and why is it a significant?

A

Changes in cell structures. Can further into esophageal cancer.

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74
Q

What types of patients might be at increased risk for a hiatal hernia?

A

Obese, pregnant, weight lift, and ascites

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75
Q

Why does esophageal cancer cause dysphagia?

A

The tumour can cause blockage to the esophagus

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76
Q

How does peptic ulcer disease occur?

A

Occurs when ulcerative lesions are caused by exposure of the stomach or duodenal mucosa to HCL acid-pepsin secretions

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77
Q

What are 5 aggressive factors that cause PUD?

A
  1. H. Pylori
  2. NSAIDS
  3. Acid
  4. Pepsin
  5. Smoking
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78
Q

What are the 5 Defensive factors for PUD?

A
  1. Mucus
  2. Bicarbonate
  3. Blood flow
  4. Prostaglandins
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79
Q

The GI mucosa is normally protected by what?

A

Mucus containing HCO 3- (bicarb) and mucin (coating action)

80
Q

How do ulcer’s develop?

A

Develops when there is excess acid or diminish mucosal defense

81
Q

What are the most common causes of PUD (peptic ulcer disease)?

A
  1. H. Pylori infection - gram (-) colonize on the stomach & duodenum. It degrades protective layer by injuring mucosal cells
  2. NSAID Use - Adverse effect. Inhibits prostaglandins (stimulates blood flow & mucous production)
82
Q

(a) What percentage of people with PUD are infected with H. Pylori? (b) Do they develop ulcers?

A

(a) 90%

(b) Many people that are infected don’t develop ulcers

83
Q

What percentage of NSAID users will develop ulcers?

A

20%

84
Q

What are the 4 risk factors of PUD?

A
  1. Diet
  2. Smoking
  3. Alcohol
  4. Stress
85
Q

What are the 3 examples of the diet risk factor for PUD?

A
  1. High salt
  2. animal products
  3. spicy
86
Q

What does PUD disease look like?

A
  1. Erosion (eroded submucosa - base looks like cooked meat, eroded muscularis
  2. Scarring
  3. Perforated ulcer - when the hole is out to the serosa, up to the duodenum
87
Q

What are the symptoms of PUD?

A
  1. Can be asymptomatic - stomach + duodenum don’t have a lot of sensory pain fibres
  2. Pain
    (a) Gastric ulcer: ‘Gaseous’ in epigastric area, 1-2 hours after eating
    (b) Duodenal ulcer: ‘Cramp-like’ in mid-epigastric or back pain, 2-4 hours after eating
88
Q

What are the 3 complications and their symptoms for PUD?

A
  1. Hemorrhage: Due to erosion of granulation tissue at base of ulcer (more common peritoneal cavity), Hematemesis, Melena (blood stool), or Occult Bleeding (small amounts of blood on stool)
  2. Perforation: Ulcer penetrates serosal surface and gastric/duodenal contents enters peritoneal cavity, Peritonitis (inflammation of peritoneam)
  3. Gastric Outlet Obstruction: On going inflammation can cause obstruction of gastric outlet, Belching (burping), Projectile Vomiting
89
Q

Define gastric outlet obstruction

A

Obstruction of flow from stomach to duodenum due to the sphincter being inflamed

90
Q

(a) Define gastritis.

A

(a) Inflamed stomach mucosa with significant risk of GI bleeding.
Summary: Mucosal inflammation of stomach lining

91
Q

What causes gastritis? (5)

A 
Alcohol
NSAIDS
H. Pylori
Crohn's disease
Stress
92
Q

Gastritis commonly occurs in who?

A

Hospitalized patients with trauma, burns, sepsis, shock, mechanical ventilation (5-10% have significant bleeding)

93
Q

What are the clinical manifestations of gastritis? (6)

A

Often asymptomatic but can have anorexia, nausea and vomiting, epigastric tenderness, and feeling of fullness

94
Q

What is the difference between (a) gastritis and (b) PUD in the mucosal layer?

A

(a) Mucosal layer is intact

(b) Mucosal layer is eroded

95
Q

How do the (a) aggressive factors and (b) defensive factors effect the development of PUD?

A

(a) Where theres too much aggressive factors it can cause PUD
(b) Where theres too little it can cause PUD

96
Q

YES or NO, does a person with H. Pylori infection usually develop peptic ulcers?

A

No

97
Q

How does the timing of symptoms help identify where an ulcer might be located?

A

Due to mucosal movement of food contents with acid

98
Q

Why would a nurse be concerned if a patient with gastric ulcer suddenly started belching and vomiting?

A

The patient might have developed a complication such as gastric outlet obstruction

99
Q

(a) What type of patient would most likely develop gastritis? (b) Why would we want to prevent gastritis in hospitalized patients?

A

(a) Hospital patients with trauma, burns, sepsis, shock, mechanical ventilation
(b) Because it can cause risk for bleeding

100
Q

What are the common lower GI symptoms? (2)

A

Diarrhea and constipation

101
Q

What are the common lower GI disorders? (4)

A
  1. Appendicitis
  2. IBDs - Intestinal obstruction
  3. Malabsorption Syndrome
  4. Colon Cancer
102
Q

What is a normal bowel pattern?

A
  1. Variation in BM - consistency/frequency is normal

2. Consistent look of normal stool

103
Q

What are some terms for the word ‘poop’?

A

Stool, feces, BM (bowel movement), defecation, diarrhea, melena, stool with Frank Blood

104
Q

Define diarrhea

A

Frequent passage of watery stools

105
Q

GI secretions are rich in what electrolytes?

A

HCO 3- and K+

106
Q

TRUE or FALSE? GI contents are basic when in the stomach

A

False. GI contents are ACIDIC when in the stomach

107
Q

TRUE or FALSE? GI contents are basic in the intestines

A

TRUE. As GI contents move from the stomach to the intestine, the GI secretions becomes more basic

108
Q

What are some of the common causes of diarrhea? (3)

A
  1. Decreased fluid absorption
  2. Increased fluid secretion
  3. Motility disturbances
109
Q

What are some examples that cause decreased fluid absorption that causes diarrhea? (3)

A

Drugs, malabsorption, and mucosal damage

110
Q

What are some examples of increased fluid secretion that causes diarrhea? (4)

A

Infections, drugs, food, and hormones

111
Q

What are some examples of motility disturbances that causes diarrhea? (3)

A

IBS (irritable bowel syndrome), diabetic enteropathy, and gastrectomy

112
Q

How does mucosal damage relate to decreased fluid absorption in causing diarrhea?

A

Mucosal damage will result in decrease of absorption capabilities

113
Q

How does motility disturbances relate to causing diarrhea?

A

Due to fast chyme movement, there is a decreased time for absorption

114
Q

What are the complications of prolonged diarrhea? (4)

A
  1. Metabolic acidosis
  2. Kussmaul’s respirations
  3. Hypovolemia –> shock
  4. Dehydration
115
Q

If a patient as prolonged diarrhea, how do they develop metabolic acidosis?

A

Due to the loss of HCO 3- in the GI secretions and pancreatic juice

116
Q

If a patient has prolonged diarrhea. how does the patient develop Kussmaul’s respirations?

A

The body will compensate by increasing the respiratory rate to decrease CO2

117
Q

(a) If a patient has prolonged diarrhea, how does the patient develop hypokalemia? (b) If the patient has hypokalemia, this imbalance can lead to what?

A

When the patient develops severe diarrhea. (b) This imbalance can lead to cardiac arrhythmias.

118
Q

If a patient has prolonged diarrhea, how does the patient develop dehydration?

A

Diarrhea causes fluid loss (water and electrolytes) which will eventually cause hypovolemic shock

119
Q

What are the risk population for prolonged diarrhea? (2)

A

Children and older adults

120
Q

Define constipation

A

Infrequent or hard to pass bowel movements (BM)

121
Q

How does someone who have constipation feel when trying to defecate?

A

Painful

122
Q

Severe constipation can lead to _______ ?

A

Fecal impaction (stool is stuck) —> Obstruction (nothing is getting passed)

123
Q

What causes constipation? (5)

A
  1. Diet
  2. Medications
  3. Metabolic and muscular disorders
  4. Structural and functional abnormalities
  5. Psychologic reasons
124
Q

What are some examples of diet relative to constipation? (2)

A

Low fibre and lower liquid intake

125
Q

What are some examples of medications relative to constipation? (7)

A
  1. Opioids (slows GI motility)
  2. Diuretics (dehydrating)
  3. Antidepressents
  4. Anticonvulsants (slow digestive tract)
  5. Antihistamines (drying effect)
  6. Aluminum/calcium antacids
  7. Calcium channel blockers
126
Q

What are some examples of metabolic and muscular disorders relative to constipation? (6)

A
  1. Hypercalcemia
  2. Hypothyroidism (decrease metabolism)
  3. Diabetes mellitus (affect on nerves cause damage)
  4. Cystic fibrosis (thickens secretions, interferes with bowel)
  5. Celiac disease (malabsorption disorder)
  6. Muscular dystrophy (weak muscles)
127
Q

What are some examples of structural and functional abnormalities relative to constipation? (5)
Hint: Acronym C.A.P.P.S

A
  1. Spinal cord lesions
  2. Parkinson’s disease
  3. Colon cancer ( growth in bowel)
  4. Anal fissures (erosion of tissue around anus)
  5. Paralytic ileus (functional obstruction, bowel stops working)
128
Q

What is an examples of psychologic reasons relative to constipation?

A

Voluntary withholding of stool

129
Q

How are (a) melena and (b) frank rectal bleeding different?

A

(a) Is a dark stool

(b) Is a fresh blood stool

130
Q

If my patient has prolonged diarrhea why should I worry about their heart?

A

Hypokalemia can occur with severe diarrhea, this imbalance can lead to cardiac arrhythmias

131
Q

Why does my patient with diarrhea look like they are hyperventilating?

A

Kussmaul’s respirations. The body is compensating due to low PH. This is the body’s way to get of CO2.

132
Q

Why is it important for nurses to assess/treat constipation?

A

It can cause obstruction leading to painful defecation/elimination

133
Q

List several types of patients who would be at increased risk for developing constipation (5)

A

Patients who have:

  1. Low Fibre diet
  2. Medication
  3. Metabolic and muscular disorders
  4. Structural and function abnormalities
  5. Psychologic reasons
134
Q

Define appendicitis

A

Inflammation on the appendix due to obstruction by fecalith (hard piece of feces) or if bowel becomes twisted

135
Q

(a) Obstruction while appendicitis can cause what in the appendix? (b) Leading to what conditions within the appendix? (2)

A

(a) Increased pressure

(b) Ischemia and necrosis

136
Q

In Appendicitis, inflammation can (a) ______ (increased/decreased) permeability of appendix, causing (b) localized __________.

A

(a) Increased

(b) Peritonitis

137
Q

As pressure (a) ________ (increases/decreases), the appendix can rupture leading to generalized (b) __________ which is (c) ______________ (life threatening/non threatening)

A

(a) Increases
(b) Peritonitis
(c) Life threatening

138
Q

What are the clinical manifestations of appendicitis: What does it fee like?

(a) Initially what you see
(b) Eventually
(c) What you are looking for (7)

A

(a) Periumbilical pain (persistent and continuous)
(b) Pain will localize to the McBurney point
(c) Anorexia, nausea and vomiting, localized tenderness, rebound tenderness, muscle guarding (tightening abdomen muscles), low grade fever

139
Q

Where is the McBurney Point located?

A

Halfway between the umbilicus and right iliac crest

140
Q

Define peritonitis

A

Inflammation of the peritoneum

141
Q

Define peritoneum

A

Connective tissue that surrounds the abdominal organs and keeps the system anchored to the abdominal wall

142
Q

The inflammation of the peritoneal membrane when when having peritonitis is caused from what? (2) (b) Name the examples from the causes of inflammation.

A
  1. Chemical irritation - (b) perforated ulcer (stomach acid) or bile
  2. Bacterial infection - (b) burst of appendix or bowel obstruction
143
Q

Inflammation from chemical irritation when having peritonitis can (a) _______ (increase/decrease) permeability of the intestinal wall and can lead to (b) ______________ (which can occur within hours).

A

(a) Increase

(b) Bacterial peritonitis

144
Q

What are the common causes of peritonitis? (8)

A
  1. Perforated ulcer
  2. Ruptured gallbladder
  3. Pancreatitus
  4. Ruptured spleen
  5. Hemorrhage
  6. Perforated appendix
  7. IBD (inflammatory bowel disease)
  8. Intestinal obstruction
145
Q

What are the clinical manifestations of peritonitis? (8)

A
  1. Severe generalized abdominal pain
  2. Tenderness over involved area
  3. Rebound tenderness
  4. Rigid abdomen
  5. Septicemia (blood born infection)
  6. Hypovolemic shock
  7. Paralytic ileusl
  8. Fever/leukocytosis (systemic infection)
146
Q

Define rebound tenderness

A

Pain or tenderness that occurs upon sudden release of pressure, especially abdominal pressure

147
Q

TRUE or FALSE. Paralytic ileus has bowel sounds

A

FALSE

148
Q

What happens to the appendix to cause it to become inflamed?

A

Twisted –> Becomes gangrenous due to fecalith (hard piece of stool) obstruction

149
Q

What happens to the appendix to cause it to become inflamed?

A

Twisted –> Becomes gangrenous due to fecalith (hard piece of stool) obstruction

150
Q

How do patients describe the pain associated with appendicitis?

A

Periumbilical pain (continuous and persistent)

151
Q

What would a nurse feel if they touched a patients abdomen who had appendicitis?

A

Localized tenderness, rebound tenderness, and muscle guarding

152
Q

(a) How can appendicitis turn into peritonitis? (b) If this happened, how would a patient’s symptoms change?

A

(a) Perforated appendix

(b) Symptoms would be generalized pain instead of localized

153
Q

Why is peritonitis a serious condition? (2)

A

Can lead to septic shock (life threatening) and hypovolemic shock

154
Q

What are the types of inflammatory bowel disease? (2)

A
  1. Crohn’s disease

2. Ulcerative Colitis

155
Q

Define IBD (inflammatory bowel disease)

A

Chronic inflammatory bowel diseases which are autoimmune in nature

156
Q

What are the characteristics of IBD? (4)

A
  1. Disease trajectory follows pattern of periods of exacerbations and remissions
  2. Diarrhea and abdominal pain are common
  3. Increased risk of colon cancer
  4. Can develop associated autoimmune diseases
157
Q

What are some examples of developed associated autoimmune disease in IBD? (4)

A
  1. Iritis (inflammation of iris)
  2. Dermatitis
  3. Vasculitis with thromboembolism
158
Q

Crohn’s disease effects what part of the body?

A

Most often effects ilium (in the S. intestine) but can be anywhere in the GI tract

159
Q

What are the characteristics of Crohn’s disease? (3)

A
  1. Inflammatory ulcerative ‘skip’ lesions that involve the entire thickness of GI wall and create cobble stone appearance
  2. Genetic component (1/2 receive diagnoses have genetic history but 1/2 do not) - defect in genes can lead to the disease
  3. Onset is teens to mid-30s
160
Q

Ulcerative colitis affects what part of the body?

A

Begins in the rectum and progresses proximally through the large intestine

161
Q

What are the characteristics of ulcerative colitis? (2)

A
  1. Inflammation affects only muscosa and submucosa (bleeding) - when stool passes it is likely to bleed which results in bloody diarrhea which is a common symptom
  2. Onset is 18-30s y.o
162
Q

How are the two types (Crohn’s disease and ulcerative colitis) of IBD different? (List unique symptom and complication)

A

(a) Crohn’s disease
- Unique symptoms: Weight loss, malabsorption and nutrient deficiency
- Complication: Fistulas, strictures

(b) Ulcerative Colitis
- Unique symptom: Rectal bleeding, tenesmus
- Complication: Toxic Megacolon

163
Q

Define tenesmus

A

A painful rectal spasm and feeling the need to deficate

164
Q

Define megacolon

A

Abnormal dilation of the colon that is not caused by mechanical obstruction. Once inflamed, it can lead to bowel obstruction

165
Q

Define fistula

A

Abnormal opening that has a risk for infection

166
Q

Define strictures

A

Scar tissue that can increase the risk of bowel obstruction

167
Q

How are the type types of IBD (Crohn’s disease and ulcerative colitis similar?

A

They both have bowel obstruction

168
Q

How can the types of IBD (Crohn’s disease and ulcerative colitis) be managed?

A

Pharmacotherapy

169
Q

Define intestinal obstruction

A

Anytime there is an impaired movement of the intestinal contents.

170
Q

Where does intestinal obstruction occur?

A

Commonly in the S. intestine but can occur in L. intestine, where symptoms develop slowly

171
Q

What are the two different causes of intestinal obstruction?

A
  1. Mechanical obstruction

2. Non-mechanical obstruction

172
Q

Define mechanical obstruction an provide examples (4)

A

Definition: Occurs there is a physical obstruction in the intestine

Examples:

  1. Adhesions from surgery (S. intestine)
  2. Tumour (L. intestine), inguinal hernia (bulge that occurs in groin area due to weakening of the muscle in lower abdomen)
  3. Volvulus (intestine loops around)
  4. Intussusception (S. intestine goes to L. intestine)
173
Q

Define non-mechanical obstruction (functional) and provide examples (5)

A

Definition: Occurs from neurological impairment or failure of propulsion of the intestine. Often called ‘paralytic ileus’

Examples:

  1. Peritonitis
  2. Pancreatitis
  3. Crohn’s disease
  4. Ulcerative colitis
  5. Spinal cord injuries or electrolyte imbalances
174
Q

What should a nurse be looking for in a patient with a possible small intestinal obstruction?

A

Onset will be rapid and include frequent vomiting (might be orange or brown in colour due to bacterial overgrowth due to obstruction) with colicky (exp. severe pain in abdomen), cramp like-abdominal pain.
Patient may continue to have bowel movements for a period of time.

175
Q

What should a nurse be looking for in a patient with a possible large intestinal obstruction?

A

Onset is gradual and include low-grade cramping abdominal pain, significant abdominal distension (stomach gets larger due to filling of gas and fluid), and absolute constipation (no BMs).
Not likely to vomit or no bowel movement.

176
Q

Define Borborygmi

A

Loud and audible bowel sounds. Reflects increase in peristalsis

177
Q

What is IBD?

A

Chronic inflammatory bowel diseases which are autoimmune in nature

178
Q

What is an exacerbation in the context of IBD?

A

An exacerbation of IBD is the reoccurrence or worsening in the absence of secondary causes.

Example: Nonsteroidal anti-inflammatory medications: Ibuprofen (Advil, Mortin IB, others), naproxen sodium (Aleve), diclofenac sodium and others. These increase risk of IBD and worsening for people who already have it.

179
Q

(a) Which type of IBD would likely cause the patient to present with weight loss and (b) why?

A

(a) Crohn’s disease

(b) Happens in S. intestine which affects absorption due to damaged mucosa

180
Q

Would a patient with IBD be likely to develop a mechanical or a functional obstruction?

A

Nonmechanical (functional)

181
Q

How can a patient with an intestinal obstruction become hypotensive?

A

As fluid shifts (3rd spacing) into intestine continuously

182
Q

Malabsorption syndrome results from impaired absorption of what? (5)

A
  1. Fats
  2. Carbohydrates
  3. Proteins
  4. Minerals
  5. Vitamins
183
Q

What are the possible causes of Malabsorption syndrome? (5)

Hint: B.ED.D.S

A
  1. Enzyme deficiency (need for absorption)
  2. Bacterial proliferation (prevent reabsorption)
  3. Disruption of S. intestinal mucosa
  4. Disturbed lymphatic and vascular circulation
  5. Surface area loss (result from surgery)
184
Q

What are some examples of malabsorption syndrome? (4)

A

Lactase deficiency is the most common malabsorption disorder followed by IBD, celiac disease, and cystic fibrosis

185
Q

Define lactase deficiency

A

A condition in which lactase enzyme is deficient or absent

186
Q

What are the clinical manifestations of malabsorption syndrome? (7)

A
  1. Abdominal bloating
  2. Cramps
  3. Flatulence
  4. Diarrhea
  5. Nausea
  6. Borborygmi
  7. vomiting
187
Q

How do you manage malabsorption syndrome?

A

Lactaose avoidence and/or lactase supplementation

188
Q

TRUE or FALSE. Colorectal cancer is the third most common cause of cancer death in Canada.

A

FALSE. The second most common cause of cancer death in Canada

189
Q

Where does colorectal cancer occur?

A

20% of tumours are within reach of examining finger and 50% are within reach of a sigmoidoscope.
Most are found distal part of bowel.

190
Q

What are the risk factors of colorectal cancer? (6)

A
  1. Diet high in red/processed meat
  2. Obesity
  3. Physical inactivity
  4. Alcohol
  5. Smoking
  6. Low intake of fruit and veg
191
Q

What are the manifestations of colorectal cancer? (9)

A
  1. Nonspecific (early)
  2. Rectal bleeding (occult)
  3. Changing bowel patterns
  4. Abdominal cramps
  5. Gas
  6. Bloating
  7. Narrow ribbon-like stool
  8. Loss of appetite
  9. Weight loss
192
Q

Why can IBD lead to malabsorption syndrome from a patho perspective? Explain.

A

IBD (chrones) can lead to a mal-absorption dur to inflammations on parts of ileum and S. intestine. GI thickness

193
Q

Where is the most common place for colorectal cancer to occur?

A

Distal part of bowel and sigmoid

194
Q

Why are stool samples taken in people over 50 to screen for colorectal cancer?

A

High chance of risk factor

195
Q

What types of food should be avoided to reduce risk for colorectal cancer?

A

Red processed meat, alcohol, and low fibre foods

196
Q

What types of GI symptoms might alert the nurse that the patient should be assessed for colorectal cancer? (9)

A

Manisfestations: Nonspecific (early), rectal bleeding (occult), changin bowel patterns, abdominal cramps, gas, bloating, narrow ribbon-like stool, loss of appetite, and weight loss

NURS 2514 (11 decks)

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