GI Flashcards
Pavel is an 18-year-old nursing student who has had an enjoyable night out at Jesters. The following morning, he is woken up by the need to vomit; and runs to the bathroom. Describe the physiological process Pavel’s body uses to complete the process of vomiting (17 marks)
Award up to 4 marks for naming each stage of vomiting physiology:
* Noxious stimuli (1 mark)
* Nerve system pathways (1 mark) - give 1 mark if all three are individually named rather than summarised
* Pre-ejection (1 mark)
* Ejection (1 mark)
Award remaining marks as follows:
* Identification of alcohol as a toxic substance (1 mark)
* Phrenic (motor) nerve stimulates diaphragm (1 mark) to reduce thorax/chest pressure (1 mark)
* Spinal nerve stimulates abdominal muscles (1 mark) to increase abdominal pressure (1 mark)
* Parasympathetic activation causes salivation (1 mark) to protect the teeth/mouth (1 mark)
* Sympathetic activation causes sweating and high heart rate (1 mark)
* Gastric muscles relax (1 mark)
* Reverse peristalsis forces intestinal content through the pyloric sphincter into the stomach (1 mark)
* Stomach contents are pushed into the oesophagus (1 mark)
* Abdominal, intercostal and diaphragm contraction causes retching (1 mark)
* Upper oesophageal sphincter opens and vomiting occurs (1 mark)
Ashti is a 45-year-old female who had been admitted to hospital following 2 weeks of diarrhoea and vomiting secondary to food poisoning. What sequelae should the registered nurse observe for? (5 marks)
Award marks as follows:
* Dehydration / hypovolemia (1 mark)
* Electrolyte imbalance / hyperkalaemia / any acceptable named electrolyte imbalance associated with D&V (1 mark)
* Mallory-Weiss Tear / tissue damage / oesophageal tear (1 mark)
* Metabolic alkalosis (1 mark)
* Transmission of infection (1 mark)
* Malnutrition (1 mark)
Constipation is a common presentation across the lifespan, particularly in children. Name the three types of constipation and describe the pathophysiology of each of them. (6 marks)
1 Mark for each type; and 1 mark for an accurate description
Normal transit constipation (1 mark) – regular passing of stools but evacuation is difficult normally associated with lack of exercise, low fibre and/or dehydration (1 mark)
Slow transit constipation (1 mark) – infrequent bowel movement, straining to pass stool, abdominal distention by impaired colon activity (1 mark)
Pelvic floor (outlet) dysfunction (1 mark) – Poor action of the pelvic floor muscles or anal sphincter leading to difficulty/inability to defecate (1 mark)
NAme and describe the 4 types of Diarrhoea
Osmotic- fluid drawn into the intestine
Secretory – increased fluid into intestine
Motility – increased rate of transit reduces absorption
Inflammatory – decreased absorbtion of water, electroyles and nutrients
Name and describe the 4 types of diarrhoea.
Osmotic- fluid drawn into the intestine
Secretory – increased fluid into intestine
Motility – increased rate of transit reduces absorption
Inflammatory – decreased absorbtion of water, electroyles and nutrients
What is Osmotic diarrhoea?
fluid drawn into the intestine
What type of diarrhoea this description?
increased fluid into the intestine
Secretory
What type of diarrhoea is this description?
Decreased absorption of water, electroyles and nutrients
Inflamatory
Describe Motility diarrhoea
Motility – increased rate of transit reduces absorption
Name and describe the types of constipation
normal transit – normal bowel movement
slow transit – infrequent bowel movements
pelvic floor dysfunction – poor coordination of the pelvic floor
Name the secondary types of constipation
Secondary Constipation
dehydration
metabolic disturbances
medications
neurological disorders
myopathic disorders
structural abnormalities
Define constipation
hard or less frequent stools
Define Diarrhoea
Diarrhoea: loose or more frequent stools
What are the consequences of vomiting?
Lose water and salts quickly
Dehydrated
Define Regurgitation
The return of undigested food to the oesophagus and mouth
What is Anticipatory?
nausea and vomiting: has been referred to as conditioned, learned, or psychological nausea and vomiting.
What is retching?
vomit like with no substance
what is Emetogenesis?
a substance that causes vomiting
What is emesis?
Vomiting- involuntary forceful expulsion
What is Nausea and the triggers?
non-specific. Can be triggered by many stimuli – pregnancy, dizziness, motion sickness, anxiety and depression
What are the Neurochemical causes of emesis/vomiting?
Vomiting is controlled by the medulla oblongata of the brainstem
Different signals trigger vomit centre
1. Chemoreceptors and mechanoreceptors in the GI tract
2. Pharyngeal input eg. infection
3. Labyrinthine Input eg. motion sickness
what are the consequences of vomiting?
- Lose water and salts quickly
- Dehydrated
- Electrolyte disturbances
- Malnutrition
Define constipation and diarrhoea
- Constipation: hard or less frequent stools
- Diarrhoea: loose or more frequent stools
Explain and describe the 3 types of primary constipation
- normal transit – regular passing of stools but evacuation is difficult eg. lack of exercise, low fibre, dehydrated
- slow transit – infrequent bowel movements and straining to pass stool
- pelvic floor dysfunction – poor activation of pelvic floor muscles
What are the causes of secondary constipation?
- dehydration
- metabolic disturbances
- medications
- neurological disorders
- myopathic disorders
- structural abnormalities
Explain the D + V Sequelae
- Dehydration
- Electrolyte imbalance
- Tissue damage
- Malnutrition
- Metabolic alkalosis
- Transmission of infection
