Gastrointestinal System Flashcards
Functions of the pancreas
Exocrine: acinar cells secrete inactivated enzymes that travel to the small intestine and become activated to help digest carbohydrates, fats, and proteins
Endocrine: Islets of Langerhans cells regulate blood glucose levels through hormones like glucagon and insulin
Functions of the liver
Storage of minerals and fat soluble vitamins, bile production and secretion, Bilirubin metabolism and secretion, detoxification of harmful drugs and substances, plasma protein synthesis (albumin and clotting factors), fat metabolism including cholesterol synthesis and elimination, carbohydrate metabolism (ex: glycogenolysis is the breakdown of glycogen which is stored carbohydrate energy in the liver)
Function of gallbladder
Storage and concentration of bile from the liver
Esophagogastroduodenoscopy (EGD)
Done under moderate sedation, scope, inserted down the throat and esophagus, stomach, and the duodenum are visualized, patient must be NPO 6 to 8 hours prior to the procedure, no bowel prep needed for procedure
Sigmoidoscopy
Visualizes the anus, rectum, and sigmoid colon; no anesthesia required, patient will need to be NPO after midnight before the procedure, patient will need to drink polyethylene glycol to clean out bowels (bowel prep)
Colonoscopy
Performed under moderate sedation, visualizes the anus, rectum, Sigmoid colon, descending colon, transverse colon, and ascending colon; patient will need to be NPO after midnight and will need to consume polyethylene glycol for bowel prep
GI series
used to identify GI abnormalities, such as an ulcer, tumor or obstruction; patient will drink barium and x-rays are taken as barium moves through GI tract; patient will need to be NPO for eight hours prior to the procedure, educate patients not to smoke or chew gum for eight hours prior to the procedure, after the procedure encourage patient to increase fluid intake to flush out barium, inform patient that stools will be white in color for several days until barium is cleared out
Level one Dysphagia diet
All food puréed and thickened liquids
Level two and three Dysphagia diet
Soft and moist foods
Dysphagia nursing care
Sit the HOB up when eating, teach patient to tuck their chin against their chest when swallowing
Backflow of gastric contents into the esophagus due to relaxation or weakening of lower esophageal sphincter, causing pain and mucosal damage leading to esophagitis and Barrett’s esophagus (high risk for esophageal cancer)
GERD
GERD risk factors
Obesity, smoking, alcohol use, older age, pregnancy, ascites, hiatal hernia
S/S of GERD
Dyspepsia (indigestion), throat irritation, bitter taste, burning pain in esophagus that is better when sitting up and worse when sitting down, chronic cough
GERD treatment
Antacids, H2 receptor antagonists, PPIs, prokinetic agents
Surgical intervention for GERD
Nissen fundoplication — invasive, fundus wrapped around esophagus
GERD patient education
Avoid fatty, fried, and spicy foods, citrus fruits, caffeine; eat 5 smaller meals as opposed to 3 large meals, remain upright after meals, avoid eating before bedtime, avoid tight clothing, lose weight, smoking cessation, reduce alcohol intake, elevate HOB at home
Protrusion of the stomach through the diaphragm into the thoracic cavity
Hiatal hernia
S/S of hiatal hernia
Heartburn, Dysphagia, chest pain after meals
Hiatal hernia treatment and education
Same as GERD
Inflammation of the gastric mucosa
Gastritis
Gastritis risk factors
H Pylori, long-term NSAID use, smoking, stress, heavy alcohol use
S/S of gastritis
Dyspepsia, N/V, stomach pain, bloating, lack of appetite, formation of ulcers when can bleed and cause anemia in severe cases
Erosion of the mucosa of the stomach, esophagus, or the duodenum
Peptic ulcer disease (PUD)
Key risk factor for PUD
H pylori infection; Other: chronic NSAIDs use, corticosteroid use
S/S of PUD
Epigastric pain (upper abdominal pain), N/V, bloating, hematemesis (coffee-ground), melena (bloody stool), pain differs based on type of PUD
Pain related to gastric ulcer
Pain 15-30 min after consuming meal, worse during day, worse with eating
Pain related to duodenal ulcer
Pain 2-3 hours after meal, pain worse at night, may be a little better with eating
PUD patient education
Avoid NSAIDs, caffeine, smoking, and alcohol
Complications of PUD
- Hypovolemic shock (d/t bleeding ulcers) — hypotension, tachycardia, tachypnea, low UOP; treat with administration of blood products and IV fluids
- Perforation (ulcer erodes through entire mucosa causing contamination of peritoneal cavity with gastric contents) — severe pain, fever, rigid board-like abdomen (peritonitis); treat this with emergency surgery (peritoneal lavage)
Foods that can trigger IBS symptoms
Milk, alcohol, caffeine, wheat, eggs
Key medications used in the treatment of IBS
Alosetron — IBS w/ diarrhea
Lubiprostone — IBS w/ constipation
IBS patient education
Keep symptom/food journal, increase fiber intake, increase physical activity, avoid gluten, reduce stress
Abdominal hernia risk factors
Obesity, pregnancy, lifting of heavy objects
Abdominal hernia S/S
Lump or protrusion at the affected site, severe pain and decreased bowel sounds (w/ strangulation and obstruction)
Abdominal hernia treatment
Truss (belt holds protruding tissue in place), surgical repair, bowel resection (if resulted in strangulation)
Patient education following hernia repair
Avoid coughing, if they need to cough or sneeze splint the area, avoid heavy lifting and straining
Risk factors for paralytic ileus
Abdominal surgery, electrolyte imbalances, abdominal infections, decreased blood supply to intestines
S/S of intestinal obstruction
Abdominal distention and pain, constipation, N/V, absent bowel sounds distal to obstruction
S/S of small bowel obstruction
Profuse vomiting, severe fluid and electrolyte imbalances, metabolic alkalosis
intestinal obstruction nursing care
NPO, NG tube, administer fluids and electrolytes as ordered, maintain strict I&Os monitor electrolytes and acid-base balance
Surgical repair of intestinal obstruction
Colon resection, colostomy
Surgical repair of intestinal obstruction
Colon resection, colostomy
Output from ileostomy
Loose, watery
Output from colostomy
Ascending: more liquid
Descending/sigmoid: more formed
Ostomy patient education
Assess stoma regularly (should be pink or red, moist; pale or blue indicates ischemia), empty ostomy when it is 1/3 to 1/2 full, if leaking then change whole appliance immediately, cut opening in barrier no more than 1/8 in bigger than stoma, chew food thoroughly, consume low-fiber diet for first 6-8 weeks, avoid foods that cause gas or odor
S/S of appendicitis
RLQ pain at McBurney’s point, rebound tenderness, loss of appetite, N/V, fever
Appendicitis treatment
NPO, IV fluids, antibiotics, appendectomy
Complications of ruptured appendix
perforation and peritonitis (ruptured appendix indicated by sudden relief of pain, followed by severe pain)
Peritonitis treatment
NPO, NG tube, IV fluids, antibiotics, analgesics
Key complication of peritonitis
Sepsis
S/S of ulcerative colitis
Diarrhea w/ blood or pus, 10-20 liquid stools per day, fever, abdominal pain, fecal urgency, weight loss, weakness, possible anemia and dehydration
Labs associated with ulcerative colitis
Increased WBC, ESR, CRP
Meds for treatment of UC
Sulfasalazine, prednisone, cyclosporine, anti-diarrheal
UC nursing care
Monitor I&Os, electrolytes, and CBC levels
UC patient education
NPO during exacerbations, ongoing — consume high-calorie low-fiber diet, avoid caffeine, alcohol, and lactose, eat smaller more frequent meals throughout the day
Crohn’s Disease
Affects entire GI tract, formation of patchy/sporadic ulcerations, ulcerations can affect all layers of bowel wall and can lead to fistulas (abnormal tunnel between two organs)
S/S of Crohn’s disease
Diarrhea, 5-6 loose stools/day, steatorrhea, RLQ pain, weight loss, anemia, fever, fatigue
Labs associated with Crohn’s disease
Elevated WBC, ESR, CRP
T or F: UC and Crohn’s disease are autoimmune disease
True
Crohn’s disease nursing care
Monitor I&Os, electrolytes, and CBC, monitor for complications such as fistulas, malnutrition, and intestinal obstruction
Meds, treatment, and education for Crohn’s disease
Same as UC
Formation of pouches off of the intestine due to high intraluminal pressure caused by obesity, low fiber diet, and genetics
Diverticulosis; presence of undigested food and bacteria in pouches can cause diverticula to get inflamed leading to diverticulitis
S/S of diverticulitis
LLQ pain, bloating, fever, N/V
Labs associated with diverticulitis
Elevated WBC, ESR
Decreased blood levels if bleeding
Complications of diverticulitis
Perforation, peritonitis, bleeding, fistulas
Diverticulitis patient education
NPO or clear liquid diet during exacerbations then progress to low-fiber diet, ongoin — high fiber diet
Pancreatitis risk factors
Alcohol abuse, bile tract disease, GI surgery, gallstones, trauma, medication toxicity
S/S of pancreatitis
Several LUQ or epigastric pain that can radiate to left shoulder or back, N/V, Cullen’s sign (blue/gray discoloration around umbilicus), turner’s sign (ecchymosis of flank), jaundice, tetany (hypocalcemia)
Labs associated with pancreatitis
Elevated lipase, amylase, WBC, bilirubin, glucose
Decreased calcium, magnesium, platelets
Nursing care pancreatitis
NPO, gradually increase to bland low-fay diet over time, provide IV fluids, opioid analgesics, provide antibiotics, antiemetics, insulin, pancreatic enzymes with all meals and snacks
Pancreatitis patient education
Do NOT consume alcohol, consume low-fat diet, no smoking
Main causes and types of cirrhosis
Postnecrotic cirrhosis: caused by viral hepatitis or toxins/drugs
Biliary cirrhosis: damage to bile ducts causing bile to back up into liver
Laennec’s cirrhosis: chronic alcoholism
Early signs of cirrhosis
Fatigue, hepatomegaly, N/V, abdominal pain
Late S/S of cirrhosis
Bleeding and bruising (d/t absence of clotting factors), jaundice, ascites, esophageal varices, portal hypertension, peripheral edema, fetor hepaticus, hepatic encephalopathy (build up of ammonia in brain causing confusion), pruritis, petechiae, spider angiomas, palmar erythema, dark urine, clay-colored stools
Labs associated with cirrhosis
Elevated AST, ALT, bilirubin, ammonia
Decreased serum protein and albumin
Laxative that helps to bring down ammonia levels
Lactulose
Cirrhosis nursing care
Monitor I&Os, restrict fluid and sodium as ordered, measure abdominal girth daily, monitor for complications such as encephalopathy, portal hypertension, esophageal varices, hemorrhage
Cirrhosis patient education
Consume low-sodium diet, eat small frequent meals, encourage alcohol recovery program if alcohol abuse
Abdominal paracentesis pre-procedure nursing care
Have patient empty bladder to prevent perforation, measure vital signs, weight, and abdominal girth
Abdominal Paracentesis post-procedure nursing care
Measure vitals, weight, abdominal girth, monitor for hypovolemia, administer albumin if ordered
Key risk factor for esophageal varices
Portal hypertension
Which types of hepatitis are spread through the fecal-oral route?
HAV and HEV
Which types of hepatitis are spread through blood and bodily fluids?
HBV, HVC, HDV
Which types of hepatitis have vaccines?
HAV and HBV
HDV can only occur if also infected with
HBV
Risk factors for viral hepatitis
IV drug use, body piercings, tattoos, high-risk sexual practices, travel to underdeveloped countries
S/S of hepatitis
Fever, lethargy, N/V, jaundice, clay-colored stools, dark urine, abdominal pain, arthralgia
Labs associated with hepatitis
Elevated ALT, AST, bilirubin
Hepatitis treatment
HAV and HEV: self-resolving, supportive care
Chronic HBV and HCV: antivirals
Cholecystitis risk factors
Cholelithiasis, high-fat diet, obesity, genetics, older age, females
S/S of cholecystitis
RUQ pain that radiates to right shoulder, pain upon ingestion of high-fat food, N/V, dyspepsia, gas and bloating, if liver involvement — jaundice, dark-colored urine, clay-colored stools
Cholecystitis treatment
Analgesics, lithotripsy (for cholithiasis), cholecystectomy
Cholecystitis nursing care
Monitor for complications such as pancreatitis, peritonitis
Cholecystitis patient education
Advise patient to consume low-fat diet, avoid gas-causing foods, lose weight if applicable
Surgical intervention aimed at reducing an individual’s gastric capacity or absorption indicated for morbidly obese patients
Bariatric surgery
Bariatric surgery post-op nursing care
Monitor for dumping syndrome (abdominal cramping, tachycardia, nausea, diarrhea, diaphoresis), educate patient to chew food slowly and thoroughly, eat 6 smalls meals/day, do NOT consume liquids with meals, recline after meals to slow gastric emptying, avoid foods high in sugar, fat, and carbs
