Gastrointestinal - CCRN Flashcards
What is intrinsic factor?
Where is it produced?
Required for absorption of B12
Secreted by parietal cells of the stomach
What type of food slows gastric emptying?
High fat
What gets absorbed in the small intestine?
Fats Amino acids Vitamins Proteins Sugars Carbs
What gets absorbed in the duodenum?
Iron
Trace elements
Water soluble vitamins
What is absorbed in the Jejunum?
Protein
Sugar carbs
What is absorbed in the ileum?
Bile salts
Vitamin B12
What is absorbed in the descending colon?
Water
Electrolytes
What prevents air from entering the esophagus during respiration?
Upper esophageal sphincter
List the functions of the liver:
Forms clotting factors
Synthesizes plasma protein and bile
Stores glycogen, fat and fat soluble vitamins
Breaks down fat, carbs, protein, bilirubin, toxins
When does the liver mature?
During the first year of life
What is GERD?
Gastroesophageal Reflux Disease
Reflux of gastric contents into esophagus
Relaxation of lower esophageal sphincter
More common in preemies
List s/sx of GERD:
Failure to Thrive
Aspiration
Apnea
How is GERD dx?
Hx, presenting sx
pH probe placed for 24 hours (+ for GERD if pH s <4 for >15 seconds)
Record feedings
List tx for GERD. (Meds and Surgery)
Nissan Fundoplication= severe cases = fundus of stomach is wrapped around esophagus
MEDS:
Tagamet, Zantac, Pepcid = decrease acid secretion, lead to H/A, bradycardia or tachycardia
Proton Pump Inhibitors:
Omeprazole (Prilosec), Pantoprazole (Protonix), Lansoprazole
More for short term use
Cause diarrhea, increased liver enzymes
Prokinetics
Metaclopromide (Reglan), erythromycin
Slow gastric emptying
What are common causes of acute GI hemorrhages in kids?
Bacterial enteritis Milk/soy allergy Mucosal erosion from gastric acid Intussesseption Meds: NSAIDs, Indomethacin
Rare in kids, usually self-limiting
Can be life threatening
What physiologic “landmark” is used to define upper vs lower GI bleeds?
Ligament of Treitz
Give examples of causes of upper GI bleeds:
Gastritis
Irritating ingestion
Varies
Give examples of causes of lower GI Bleeds:
NEC
Volvulus
Milk allergy
What is bright or Dark blood from the rectum called?
Hematochezia
List s/sx of GI bleed:
Vomiting blood
Bloody/tarry stools
S/sx of hypovolemic shock
List management techniques for GI bleeds.
Fluid replacement Transfusion Tx underlying cause Saline lavage until bleeding stops Monitor s/sx of abd perforation (fever, abd rigidity, severe pain) Monitor gastric pH
What are esophageal varices?
Dilated veins in the lower esophagus d/t portal hypertension
What are possible tx for esophageal varices?
Vasopressin (short acting, vasoconstricts = decreased blood flow to spleen = decreased portal HTN)
Octreotide (decreases blood flow to spleen, inhibits synthesis of gastric, gastric acid)
Endoscopic variceal sclerosis - shrinks varices
