Gastrointestinal Problems Flashcards
Functions of the GI system
- process food substances
- absorb the products of digestion into the blood
- excrete unabsorbed materials
- provide an environment for microorganisms to synthesize nutrients, such as vit K.
Stomach
- contains the cardia, fundus, body, and pylorus.
- hydrochloric acid kills microorganisms, breaks food into small particles, and provides a chemical environment that facilitates gastric enzyme activation.
- pepsin is the chief coenzyme of gastric juice, which converts proteins into proteoses and peptones,
- intrinsic factor comes from parietal cells and is necessary for the absorption of vit B12.
- gastrin controls gastric acidity.
Small and large intestine
- the duodenum contains the openings of the bile and pancreatic ducts; small intestine terminates in the cecum.
- large: absorbs water and eliminates wastes; intestinal bacteria play a vital role in the synthesis of some B vitamins and vit K; the ileocecal valve prevents contents of the large intestine from entering the ileum.
Pancreatic intestinal juice enzymes
- amylase digests starch to maltose.
- maltase reduces maltose to monosaccharide glucose.
- lactase splits lactose into galactose and glucose.
- sucrase reduces sucrose to fructose and glucose.
- nucleases split nucleic acids to nucleotides.
- enterokinase activates trypsinogen to trypsin.
Liver
- largest gland in the body.
- contains Kupffer cells, which remove bacteria in the portal blood.
- synthesizes glucose, amino acids, and fats.
- aids in the digestion of fats, carbohydrates, and proteins.
- stores and filters blood (200-400ml of blood)
- secretes bile to emulsify fats (500-1000ml of bile/day).
- hepatic ducts: deliver bile to the gallbladder via the cystic duct and to the duodenum via the common bile duct.
Gallbladder
- stores and concentrates bile and contracts to force bile into the duodenum during the digestion of fats,
- the sphincter of Oddi is located at the entrance to the duodenum.
- the presence of fatty materials in the duodenum stimulates the liberation of cholecystokinin, which causes contraction of the gallbladder and relaxation of the sphincter of Oddi.
Pancreas
- exocrine gland: secretes sodium bicarbonate to neutralize the acidity of the stomach contents that enter the duodenum; pancreatic juices contain enzymes for digesting carbohydrates, fats, and proteins.
- endocrine gland: secretes glucagon to raise blood glucose levels and secretes somatostatin to exert a hypoglycemic effect; the islets of Langerhans secrete insulin; insulin is secreted into the bloodstream and is important for carbohydrate metabolism.
Diagnostic Procedures: Upper GI Tract Study
- examination of the upper GI tract under fluoroscopy after the client drinks barium sulfate.
- preprocedure: withhold foods and fluid for 8h prior to the test.
- postprocedure: a laxative may be prescribed; increase oral fluid intake to help pass the barium; monitor stools for the passage of barium (appear chalky white for 24 to 72h) because barium can cause a bowel obstruction.
Diagnostic Procedures: Capsule Endoscopy
- a procedure that uses a small wireless camera shaped like a med capsule that the client swallows; the test will detect bleeding or changes in the lining of the small intestine.
- the camera travels through the entire digestive tract and sends pictures to a small box that the client wears like a belt.
- preprocedure: a bowel preparation will be prescribed; the client will need to maintain a clear liquid diet on the evening before the exam; additionally, NPO status is maintained for 3h before and after swallowing the capsule.
Diagnostic Procedures: Gastric Analysis
- requires the passage of a NG tube into the stomach to aspirate gastric contents for the analysis of acidity (pH), appearance, and volume.
- the entire gastric contents are aspirated, and then specimens are collected every 15 min for 1h.
- histamine or pentagastrin may be adm SC to stimulate gastric secretions.
- esophageal reflux may be diagnosed; a probe is placed just above the the lower esophageal sphincter and connected to an external recording device, which provides a computer analysis and graphic display of results.
- preprocedure: fasting for at least 12h, use of tabacco and chewing gun is avoided for 24-48h.
- postprocedure: may resume normal activities; refrigerate gastric samples if not tested within 4h.
Diagnostic Procedures: Upper GI endoscopy
- following sedation, an endoscope is passed down the esophagus to view the gastric wall, sphincters, and duodenum; tissue specimens can be obtained.
- prepro: NPO for 6-8h; local anesthetic (spray or gargle) is adm along with med that provides moderate sedation.
- client is positioned on the left side to facilitate saliva drainage and to provide easy access of the endoscope.
- airway patency is monitored and emergency equipment should be readily available.
- postpro: NPO until gag reflex returns (1-2h); monitor for signs of perforation and maintain bed rest for the sedated client until alert.
Diagnostic Procedures: Fiberoptic Colonoscopy
- study in which the linning of the intestine is visually examined; biopsies and polypectomies can be performed.
- client is positioned on the left side with knees drawn up to the chest.
- prepro: cleansing of the colon is necessary; a clear liquid diet is started ont he day before and NPO should start 4-6h prior the test (avoid red, orange and purple liquids).
Diagnostic Procedures: Endoscopic retrograde cholangiopancreatography (ERCP)
- examination of the hepatobiliary system is performed via a flexible endoscope inserted into the esophagus to the descending duodenum.
- prepro: NPO 6-8h and moderate sedation during.
- postpro: monitor VS, return of gag reflex, and signs of perforation or peritonitis.
Diagnostic Procedures: Magnetic resonance cholangiopancreatography (MRCP)
- uses magnetic resonance to visualize the biliary and pancreatic ducts in a noninvasive way.
- pre and postprocedure: same as ERCP.
Diagnostic Procedures: Computed tomography (CT) Scan
- noninvasive cross-sectional view that can detect tissue densities in the abd, including in the liver, spleen, pancreas, and biliary tree.
- can be performed with or without contrast medium.
- prepro: NPO for at least 4h.
- postpro: no specific care.
Diagnostic Procedures: Paracentesis
- prepro: informed consent; obtain VS and weight; void; position upright.
- during: assist PHCP; monitor VS; and provide comfort.
- postpro: weigh the client maintain bed rest; measure fluid collected, describe, and record; label and send to lab; apply a dry sterile dressing to the insertion site and monitor for bleeding; monitor for hypovolemia, electrolyte loss, mental status changes, or encephalopathy, and hematuria.
- the rapid removal of fluid from the abd cavity during paracentesis leads to decreased abd presure, which can cause vasodilation and resultant shock; therefore, HR and BP must be monitored closely.
Diagnostic Procedures: Liver Biopsy
- a needle is inserted through the abd wall to the liver to obtain a tissue sample for biopsy and microscopic examination.
- prepro: assess results of coagulation tests; adm sedative; place client in the supine or left lateral position during the procedure to expose the right side of the upper abd.
- postpro: assess VS and site for bleeding; monitor for peritonitis; maintain bed rest for several hours; place the client on the right side with a pillow under the costal margin for 2h to decrease the risk of bleeding, and instruct the client to avoid coughing and straining; avoid heavy lifting and strenuous exercise for 1 week.
Diagnostic Procedures: Stool specimens
- includes inspecting the specimen for consistency, color, and occult blood.
- tests for fecal urobilinogen, fat, nitrogen, parasites, pathogens, food substances, and other substances may be performed.
- quantitative 24-72h collections must be kept refrigerated until taken to the lab.
- some specimens require that a certain diet be followed or that certain meds be withheld.
Diagnostic Procedures: Urea breath test
- detects the presence of Heliobacter pylori, the bacteria that cause peptic ulcer disease.
- client consumes a capsule of carbon-labeled urea and provides a breath sample 10-20 min later.
- certain meds may need to be avoided:
= antibiotics and bismuth subsalicylate for 1 month before the test;
= sucralfate and omeprazole for 1 week before;
= cimetidine, famotidine, ranitidine, and nizatidine for 24h before. - H.pylori can also be detected by assessing serum antibody levels.
Diagnostic Procedures: Esophageal pH testing for gastroesophageal reflux disease
- used to diagnose or evaluate the treatment for heartburn or reflux disease.
- a probe is inserted into the nostril and is situated in the esophagus.
- pH is tested over a period of 24-48h.
Diagnostic Procedures: Liver and pancreas lab studies
- liver enzyme levels are elevated with liver damage or bilary obstruction.
= ALP 38-126 U/L
= AST 0-35 U/L
= ALT 4-36 U/L - prothrombin time is prolonged with liver damage.
= normal: 11-12.5 seconds - serum ammonia level assesses the ability of the liver to deaminate protein byproducts.
= normal: 10-80 mcg/dL - an increase in cholesterol level indicates pancreatitis or biliary obstruction.
= normal: < 200mg/dL - an increase in bilirubin level indicates liver damage or biliary obstruction.
= total 0.3-1.0 mg/dL
= indirect 0.2-0.8 mg/dL
= direct 0.1-0.3 mg/dL - increased values for amylase and lipase levels indicate pancreatitis.
= amylase 60-120 su/dL
= lipase 0-160 U/L
Gastroesophageal Reflux Disease
- backflow of gastric and duodenal contents into the esophagus; caused by an incompetent lower esophageal sphincter (LES), pyloric stenosis, or motility disorder.
- assessment: heartburn, epigastric pain, dyspepsia, nausea, regurgitation, pain, difficulty with swallowing, hypersalivation.
- interventions: avoid factors that decrease LES pressure or cause esophageal irritation, such as peppermint, chocolate, coffee, fried or fatty foods, carbonated beverages, alcoholic beverages, and cigarette smoking; eat a low-fat, high-fiber diet and to avoid eating or drinking 2h before bedtime (also elevate head of bed 15-30cm); avoid the use of anticholinergics, which delay sstomach emptying; also NSAIDs and other meds that contain AAS need to be avoided; instruct client regarding prescribed meds such as antacids, H2-receptor antagonists, proton pump inhibitors, and prokinetic meds (which accelerate gastric emptying).
- surgery may be required in extreme cases.
Gastritis: description and assessment
- inflammation of the stomach or gastric mucosa.
- acute gastritis is caused by the ingestion of food contaminated with disease-causing microorganisms or food that is irritating or too highly seasoned, the overuse of aspirin or other NSAIDs, excessive alcohol intake, bile-reflux, or radiation therapy.
- chronic gastritis is caused by benign or malignant ulcers or by the bacteria H.pylori, and also may be caused by autoimmune diseases, dietary factors, meds alcohol, smoking, or reflux.
Assessment: - acute: abd discomfort, anorexia, nausea, vomiting, headche, hiccupping, reflux.
- chronic: anorexia, nausea, vomiting, belching, heartburn after eating, sour taste in the mouth, vit B12 deficiency.
Gastritis: interventions
- acute: food and fluids may be withheld until symptoms subside; afterward, ice chips can be given, followed by clear liquids, and then solid food.
- monitor for signs of hemorrhagic gastritis.
- avoid irritating foods, fluids, and other substances, such as spicy and highly seasoned foods, caffeine, alcohol, and nicotine.
- instruct the use of ATB for H.pylori and information about vit B12 injections if a deficiency is present.