Chapter 18 Gastrointestinal Alterations Flashcards
1
Q
Anatomy and Physiology
- Alimentary canal
- Accessory organs
- Gut wall
A
- Gut wall
1) Mucosa
2) Gastric mucosal barrier
3) Submucosa
2
Q
Anatomy and Physiology
- Oropharyngeal cavity
A
- Oropharyngeal cavity
- Mouth
- Salivary glands
- Pharynx
- Esophagus
3
Q
- Anatomy and Physiology
- Stomach
- Small intestine
A
- Stomach
- Cardia, fundus, body, and antrum
- Gastric glands and pyloric glands
- Hydrochloric acid (pH 0.8)
- Small intestine
- Duodenum, jejunum, and ileum
- Digestion and absorption of foodstuff
- Water, electrolyte, and vitamin absorption
4
Q
Anatomy and Physiology
- Large intestine
- Pancreas
- Gallbladder
A
- Large intestine
- Ascending, transverse, descending, and rectum
- Absorption of water and electrolytes
- Pancreas
- Exocrine = digestive enzymes
- Endocrine = insulin and glucagon
- Gallbladder
- Bile
5
Q
- Liver: 400 different functions
-Liver vascular functions
-Liver secretory function
-Liver metabolic functions
-
A
- Receives 25% of cardiac output
- Liver vascular functions
- Blood storage
- Filtration
- Liver secretory function
- Bile production
- Bilirubin metabolism
- Liver metabolic functions
- Carbohydrate, fat, and protein
- Clotting factors
- Detoxification
- Vitamin and mineral storage
6
Q
Blood Supply of the Gastrointestinal System
A
- Splanchnic circulation
- Superior and inferior mesenteric and celiac arteries
7
Q
GI History
A
- History of swallowing, digestive, and elimination problems
- Nonspecific symptoms, such as anorexia and fatigue
- Weight changes and diet
- Pain assessment
- Surgical procedures
- Medications—prescription and over-the- counter
8
Q
GI Assessment
- Inspection
A
- Skin color and texture
- Symmetry and contour of abdomen
- Masses and pulsation
- Peristalsis and movement
9
Q
- Auscultate before?
- Percussion
- Palpation
A
- Auscultate before percussion and palpation
- Auscultate for 5 minutes before determiningnabsence of bowel sounds
- Percussion
- Palpation
- Last
- Assess rebound tenderness, rigidity, and guarding
10
Q
Which assessment component is done last when assessing the abdomen? A. Auscultation B. Inspection C. Palpation D. Percussion
A
Palpation
11
Q
Acute Upper GI Bleeding
- Etiology
- Potential for?

A
- Etiology
- Peptic ulcer disease
- Stress ulcer
- Mallory-Weiss tear
- Esophageal varices
- Potential for hypovolemic shock

12
Q
Peptic Ulcer Disease
- Duodenal versus?
- Risk factors
A
- Duodenal versus peptic
- Risk factors
- Smoking
- Helicobacter pylori bacteria
- Drugs: Nonsteroidal antiinflammatory drugs (NSAIDs), aminosalicylic acid (ASA), steroids
- Alcohol
13
Q
Stress Ulcer
- Ischemic—decreased blood flow
- Cushing’s—
- Prevention part of ICU “bundle” of care
A
- Ischemic—decreased blood flow
- Hemorrhage
- Trauma
- Burns (Curling’s ulcer)
- Cushing’s—decreased blood flow and hypersecretion of acid
- Head trauma
- Prevention part of ICU “bundle” of care
- Antacids or H2-receptor blocker medications
14
Q
Mallory-Weiss Tear
A
- Arterial hemorrhage
- Longitudinal tear
- Forceful retching
- Long-term NSAIDs or aspirin
- Excessive alcohol
15
Q
Esophageal Varices
A
- Portal hypertension
- Veins become distended and varices develop
- Esophagus
- Upper portion of stomach
- Tend to bleed easily
16
Q
Varices—Assessment
- Blood loss
- Symptoms of hypovolemia
- Pain or discomfort
A
- Blood loss
- Color, amount, and consistency of emesis and stool
- Symptoms of hypovolemia
- Hypotension
- Tachycardia
- Dizziness
- Pain or discomfort
17
Q
Nursing Assessment - First priority is to assess blood loss Vital signs Level of consciousness Urine output - Hyperactive bowel sounds
A
Nursing Assessment First priority is to assess blood loss Vital signs Level of consciousness Urine output Hyperactive bowel sounds A B C D, then focused, then head to toe
18
Q
Nursing Assessment
- First priority is to assess blood loss
- Hyperactive bowel sounds
A
- First priority is to assess blood loss
- Vital signs
- Level of consciousness
- Urine output
- Hyperactive bowel sounds
- A B C D, then focused, then head to toe
19
Q
Laboratory Studies
- Complete blood count (CBC)
- Electrolyte imbalance
- Increased blood urea nitrogen (BUN) and creatinine
A
- Complete blood count (CBC)
- Hemoglobin and hematocrit
- White blood cell (WBC) count
- Platelets
- Electrolyte imbalance
- Increased blood urea nitrogen (BUN) and creatinine
20
Q
Laboratory Studies
A
- Liver function
- Clotting profile
- Ammonia levels
21
Q
Diagnostic Tests
- Endoscopy
- Barium studies
A
- Endoscopy
- Procedure of choice
- Diagnosis and treatment of upper GI bleeding
- Barium studies
- Ulcers/bleeding, tumors
22
Q
Priority Treatment
- Hemodynamic stabilization
- Gastric lavage
A
- Hemodynamic stabilization
- Oxygen administration
- Arterial pressure monitoring
- Administration of fluids and/or blood products
- Hematocrit may not reflect actual blood loss
- Gastric lavage
- Upper GI bleeding
- May be done prior to endoscopy to provide better visualization of gastric fundus
23
Q
Pharmacological Therapy

A
- Proton pump inhibitors
- Antacids
- H2-receptor blockers
- Mucosal barrier enhancers
- Antibiotics (Helicobacter pylori)