GI Flashcards
process by which ingested food is broken down into small moelcules
DIgestion
• GI system is controlled by ___ ____
nerves plexus
maintains electrical rhythm
Responds to local stimuli to increase of decrease activity
o Sympathetic = decreases motility & hunger
o Parasympathetic = increases motility & hunger (relaxes sphincter to allow food to pass)
_____ is released by stomach in anticipation of food
gastrin
What does gastrin trigger?
stomach muscles to contract
causes release of HCL and pepsinogen
What effect does fiber have on the stomach? Metamucil on drugs?
decreases acid concentration
decreases absorption
What protects the stomachs mucosal layer?
bicarbonate, thick mucous layer
In the digestive process, liver and pancreatic enzymes are released. What are the enzymes and what do they do?
protein, carbs, fat breakdown
trypsin = protein break down
(memory: trypsin - trysin = tyrosine = amino acid = protein)
amylase = breaks down sugar (bread tastes sweet in your mouth because of this)
Lipase = breaks down fat (Lipase = lipo = fat)
what does bile do during digestion?
further breakdown of fat
What are the endocrine hormones released during digestion?
insulin, glucagon, somatostatin.
Once removed from the GI tract, nurtients and drugs are delivered back to the blood through the _____ ______.
Portal system
Found in the Liver.
Nutrients absorbed from Small intestine -> portal vein -> Liver-> broken down -> hepatic vein -> venae cavae
Good anatomy video
https://www.youtube.com/watch?v=O71niTozP-o
For motility, the SI uses the process of _______; whereas, the LI uses a process of ____ _____
segmentation; mass movement
Initiation of activity depends on local reflexes
_____ reflex: Stimulates stomach by stretching (response to smelling, seeing, tasting or thinking about food).
______ reflex: stimulates stomach, increase activity in colon to prepare for space for new chyme.
____ _____ reflex: Stimulates colon activity/mas movement by presence of food or a stretch in duodenum; making room for new chyme.
_____ - ______ reflex: irritation in small intestine in one area can cause Paralytic ileus.
Gastroenteric Reflex
Gastrocolic Reflex
Duodenal colic reflex
Intestinal-Intestinal reflex
What is a paralytic ileus? What causes it?
Paralytic ileus.
o Paralytic ileus: entire intestinal system ceases activity = constipation
Common after abdominal surgery, post op
• No bowel sounds
• Pt to walk, start w/ fluids
The Vomiting Reflex protects the system from unwanted irritants. It is stimulated by two centers in the _______:
o Emetic zone
o CTZ zone (Chemoreceptor Trigger Zone) = vomiting
medulla
VR Caused by: tactile projection, increased intracranial pressure, stimulation of vestibular receptors in inner ear (I’m on a boat!), chemical (drugs)
before vomiting –> sweating, HR increases, deeper respiration, and nausea
TPN may lead to _______
hyperglycemia
When would you use gastrostomy or jejunostomy tubes over nasogastric?
Long term use
Vitamins are (ORGANIC/INORGANIC)
Minerals are (ORGANIC/INORGANIC)
Organic
inorganic; supplied by food/supplements
A D E K are (WATER/LIPID) soluble.
fat
can be toxic from build up in fat.
A = eyes (too much and you will turn orange. Who needs spray tans?) D = calcium E = antioxidant K = clotting
Which B vitamin is found only in animal protein?
B12 (meat, seafood, eggs)
Ma+ enteres cells through fast channels during depolarization which is the …
start of the muscle’s contraction
Potassium is found in…
potatoes, bananas… fresh fruit and veggies…
Hypocalcemia is less than ____ mEq/L
4.5
What is the order of abdomen assessment?
Inspect
Auscultate
Percuss
Palpate
Causes of PUD (Peptic Ulcer disease)
H. Pylori
Stress
Drugs - NSAIDs, ccorticosteroids, ASA
T or F: BUrning and gnawing abdomen pain of ulcers disappears after eating.
True, but will return in 1-3 hours post meal
Signs of PUD?
bright red blood in vomit
black tarry stool
Parietal cells secrete stomach acid. Parietal cells have H2 receptors (histamine 2). Blocking H2 = no stomach acid production. Some H2 blockers are zantac, pepcid. What is the prototype for this group?
Cimetidine (Tagamet)
Memorization:
https://www.youtube.com/watch?v=IR-iEOpDmDM
From commercial:
“Dual action liquid” = DUal = 2 = H2 blocker
He presses the number 2 to control acid
It creates a barrier = blocker
This drug is an anTAGonist.
Indication: if it blocks acid, it can be used to fight hypersecretory state, ulcers.
Smoking can increase ____ ____ ____ and may decrease effectiveness of histamine 2 receptor antagonist (it antagonizes and antagonist)
gastric acid secretion
Don’t give ______ within one hour of giving an H2 blocker (tagamet)
antacid
Omperazole (Prilosec) memorization tool:
https://www.youtube.com/watch?v=g3XtH_M6EXg
Larry the cable guy hates heart burn
Priolsec Purple Pil is a Proton Pump inhibitor
works like an H2 receptor but last longer. Larry says once a day pill.
For PUD and GERD
If a drug needs stomach acid for absorption, what might happen if you take an antacid?
may interfere with medication that depends on acid
Can a pill like Prilosec be chewed?
no. 24-hour pill means time released means must be swallowed whole.
_____ _______ is an antacid that neutralizes stomach acid.
sodium bicarbonate (Bell/Ans)
(Bell/Ans = Bell / NAs = NA / B = sodium bicarbonate)
remember that bicarbonate is alkaline and that will help you remember that it neutralizes antacid
Antacids with a high dose of aluminum can cause …
constipation
magneisum can cause the reverse, milk of magnesia is used to relive constipation and too much will cause diarrhea…
Administer antacids 1 hour, or ideally 2 hours after other oral medications. Why?
They inhibit H2 receptors and interfere with other oral medications.
Too much can cause alkalosis (too much alkalinity)
If a person has ulcers caused by H. Pylori, what can you give them in conjunction with antacids to treat the infection?
Antibiotics (amoxicillin, clarithromycin, tetracycline, the usuals)
elimination of the organism can cause ulcers to heal more rapidly
Antacids, H2 antagonists, proton pump inhibitors, and antipeptic agents, prostoglaninds and digestive enzymes like pancrelipase are all drugs that affect gastrointestinal _______.
secretions
Either blocking secretions, producing secretions
Antipeptic agent (also known as GI PROTECTANT) protects the ulcer crater by creatin an ulcer-adherent complex to protect the site from acid, ____, and bile salts.
pepsin
Remember we are made of protein. Pepsin digests protein. If we do not have an ANTI pepsin (or antipeptic) when we have an open sore in our stomach, pepsin will eat away at our body’s own protein.
Prostaglandins such as misoprostol (Cytolec) inhibit acid secretion and increase bicarbonate and mucus production in the stomach. Why shouldn’t pregnant women use it?
(Cytolec = Cyto - cell = protects stomach cells from acid)
It can cause miscarriage. It can also cause excessive bleeding, spotting, hypermenorrhea, dysmenorrhea and other menstrual disorders.
Memory for name and what it does:
MisoPROStol = PROStaglandin (gland - glands secrete - related to secretion)
MEMORY for adverse effect:
misoprostol = MIS o P = MIss your period
MisoProStol = MPS = PMS
Pancrelipase tells you what it does in the name…
Pancre = Pancreas Lipase = Lipo + ase = fat enzyme (Enzymes break down)
Strong enough to break down fat, strong enough to break down protein and carbs too.
Pancreas cannot produce the digestive enzyme, so we administer a replacement.
Pancrelipase is a replacement for pancreatic digestive enzyme. How does it work? Downside of using?
It helps digests and absorb fats, proteins and carbohydrate when the pancreas is unable to produce enough pancreatic juice. Can cause contact dermatitis (a form of eczema). Irritating to the skin.
It can also be used as a saliva substitute in the case of dry mouth. Cause abnormal electrolyte balance
Which of the following would a nurse include when describing the action of a histamine2 antagonists to a patient?
a. The block release of gastrin and pepsin leading to a decrease in protein digestion.
b. they selectively block histamine receptors, reducing swelling and inflammation at numerous sites.
c. the selectively block specific histamine receptor sites leading to a reduction in gastric acid secretion.
C.
The nurse would monitor a patient receiving intravenous cimedtidine (Tagamet) for an acute ulcer problem for
a. GI upset
b. gynecomastia
c. cardia arrhtyhmias
d. constipation
C.
A nurse taking care of a patient who is receiving a proton pump inhibitor should teachthe patient to:
a. take the drug after every meal
b. chew or cursh tablets to increase their absorption
c. swallow tablets or capsuls whole
C.
A. one - two hours before or after meals
B. if you chew a time released capsule, you will get a toxic dose because the entire day amount will be in your gut.
_____ are agents that block the hyperactive response of the CTZ (Chemoreceptor trigger zone) to various stimuli, the response that produces non beneficial nausea and vomiting
antiemetics
Definition of MIDEPIGASTRIC?
. : of, relating to, or located in the middle of the epigastric region of the abdomen … (Under xyphoid process above belly button)
Where nause is usually felt
Why are there different antiemetics to choose from?
DIfferent drugs are used for different causes of the nausea/vomiting
Medicines that are used to treat nausea and vomiting include the list below.
- Phenothiazines (prochloraperazine/Compazine)
- nonphenothiazines (metoclopramide/Reglan)**
* *can also be used as an gastrointestinal stimulant - Antihistamine/Anticholinergic
(meclizine/Antivert) - serotonin 5-HT3 Receptor Blockers
(ondanstetron/Zofran) - Substance P/Neurokinin 1 receptor ANTagonists (aprepitant/Emend)
(aprepitant/Emend)
1-4 are related to CTZ (chemoreceptor trigger zone) in the medulla.
- blocks CNS nausea receptors
Common adverse effects of antiemetics?
ANTICHOLINERGIC EFFECTS
dry eyes and mouth
constipation
also drowsiness and photosensitivity
Which antiemetics is the drug of choice for children?
compazine
Physiology of vomiting
https://www.youtube.com/watch?v=LTjbp5xdwf4
breaks down the CTZ and what/how makes you want to vomit
_________ is an ANTIcholinergic ANTIhistamine that treats nausea by blocking the impulses to the CTZ. Used for vertigo, motion sickness.
ANTIvert or meclizine (izine = izzy = dizzy)
Zohan had a cancerous tumor removed and is being treated with chemotherapy. He becomes nauseous and feel like vomiting. His nurse ask the dr to prescribe ______ or ______.
Zofran (seratonin 5-HT) receptor blocker
(generic name:
ondansetron - ONdanSETron - onset of nausea after chemo)
or
aprepitant (Emend)
a-prep-itant = prep your pt about nausea after chemo.
E-mend = Mend the patient after chemo.
blocks receptors
T or F: Ipecac is widely used.
False.
No longer used. can cause cardiotoxicity, throat issues (throwing up bleach), etc.
If child is conscious, drink water, administer activated charcoal.
All of the following are drugs that relate to gastrointestinal ______.
castor oil / Neoloid magnesium citrate / Citrate of Magnesia mineral oil/ Agoral plain metoclopramide (Reglan) loperamide (Immodium)
motility
making the poo go
making the poo stop
a common laxative that is not the prototype but is listed throughout the power points…
Dulcolax…
or as my grandma calls it Dookilax.
How do laxatives work?
Examples of chemical stimulant laxatives: Dulcolax, castor oil (Neoloid)
promote emptying of the large intestine by stimulating peristalsis and lubricating the fecal mass
or
by adding bulk to the colon contents
What are common adverse effects of laxatives
Diarrhea, cramping, nausea
FYI:
If we have too much diarrhea, we lose electrolyes, which leads to dehydration, which leads to issues with the heart.
Mineral oil (Agoral plain) is used to prevent ______. Colace is another med used for this.
Mineral oil is the e oldest of lubricating laxatives. It is not absorbed after taken and forms a slippery coat on the contents of the intestinal tract. the oil protects the bolus from water removal so it slips right out.
straining (valsalva’s maneuver aka pushing so hard to poop that you pass out).
can cause vitamin deficiency because it blocks absorption of fat soluble vitamins
Bulk stimulants such as magnesium citrate work by …
increasing the fluid in the intestinal contents, which enlarges bulk, stimulates stretch receptors and activates local activity.
Before giving a laxative, offer the patient…
prune juice/prunes
