Chapter 18 Gastrointestinal Alterations

Question 1

Anatomy and Physiology

• Alimentary canal
• Accessory organs
• Gut wall

Answer 1

• Gut wall
  1) Mucosa
  2) Gastric mucosal barrier
  3) Submucosa

Question 2

Anatomy and Physiology

- Oropharyngeal cavity

Answer 2

• Oropharyngeal cavity
  
  • Mouth
  • Salivary glands
  • Pharynx
• Esophagus

Question 3

• Anatomy and Physiology
• Stomach
• Small intestine

Answer 3

• 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

Question 4

Anatomy and Physiology

• Large intestine
• Pancreas
• Gallbladder

Answer 4

• Large intestine
  
  • Ascending, transverse, descending, and rectum
  • Absorption of water and electrolytes
• Pancreas
  
  • Exocrine = digestive enzymes
  • Endocrine = insulin and glucagon
• Gallbladder
  
  • Bile

Question 5

• Liver: 400 different functions
  -Liver vascular functions
  -Liver secretory function
  -Liver metabolic functions
  -

Answer 5

• 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

Question 6

Blood Supply of the Gastrointestinal System

Answer 6

• Splanchnic circulation

- Superior and inferior mesenteric and celiac arteries

Question 7

GI History

Answer 7

• 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

Question 8

GI Assessment

- Inspection

Answer 8

• Skin color and texture
• Symmetry and contour of abdomen
• Masses and pulsation
• Peristalsis and movement

Question 9

• Auscultate before?
• Percussion
• Palpation

Answer 9

• Auscultate before percussion and palpation
  
  • Auscultate for 5 minutes before determiningnabsence of bowel sounds
• Percussion
• Palpation
  
  • Last
  • Assess rebound tenderness, rigidity, and guarding

Question 10

Which assessment component is done last when assessing the abdomen?
A. Auscultation 
B. Inspection 
C. Palpation
D. Percussion

Answer 10

Palpation

Question 11

Acute Upper GI Bleeding
- Etiology
- Potential for?


Answer 11

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

Question 12

Peptic Ulcer Disease

• Duodenal versus?
• Risk factors

Answer 12

• Duodenal versus peptic
• Risk factors
  
  • Smoking
  • Helicobacter pylori bacteria
  • Drugs: Nonsteroidal antiinflammatory drugs (NSAIDs), aminosalicylic acid (ASA), steroids
  • Alcohol

Question 13

Stress Ulcer

• Ischemic—decreased blood flow
• Cushing’s—
• Prevention part of ICU “bundle” of care

Answer 13

• 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

Question 14

Mallory-Weiss Tear

Answer 14

• Arterial hemorrhage
  
  • Longitudinal tear
• Forceful retching
• Long-term NSAIDs or aspirin
• Excessive alcohol

Question 15

Esophageal Varices

Answer 15

• Portal hypertension
• Veins become distended and varices develop
  
  • Esophagus
  • Upper portion of stomach
• Tend to bleed easily

Question 16

Varices—Assessment

• Blood loss
• Symptoms of hypovolemia
• Pain or discomfort

Answer 16

• Blood loss
  
  • Color, amount, and consistency of emesis and stool
• Symptoms of hypovolemia
  
  • Hypotension
  • Tachycardia
  • Dizziness
• Pain or discomfort

Question 17

Nursing Assessment
- First priority is to assess blood loss 
 Vital signs
 Level of consciousness  Urine output
- Hyperactive bowel sounds

Answer 17

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

Question 18

Nursing Assessment

• First priority is to assess blood loss
• Hyperactive bowel sounds

Answer 18

• 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

Question 19

Laboratory Studies

• Complete blood count (CBC)
• Electrolyte imbalance
• Increased blood urea nitrogen (BUN) and creatinine

Answer 19

• Complete blood count (CBC)
  
  • Hemoglobin and hematocrit
  • White blood cell (WBC) count
  • Platelets
• Electrolyte imbalance
• Increased blood urea nitrogen (BUN) and creatinine

Question 20

Laboratory Studies

Answer 20

• Liver function
• Clotting profile
• Ammonia levels

Question 21

Diagnostic Tests

• Endoscopy
• Barium studies

Answer 21

• Endoscopy
  
  • Procedure of choice
  • Diagnosis and treatment of upper GI bleeding
• Barium studies
  
  • Ulcers/bleeding, tumors

Question 22

Priority Treatment

• Hemodynamic stabilization
• Gastric lavage

Answer 22

• 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

Question 23

Pharmacological Therapy



Answer 23

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