GI exam #1 Flashcards
Purpose of the GI tract
to supply nutrients for use at the cellular level
- meet nutritional needs
- and eliminate waste
Process of the GI tract
1) ingestion
2) digestion
3) absorption
4) elimination
Ingestion
taking in food
-intake, chewing anddeglutition
digestion
molecules for absorption (into chyme)
absorption
transfer from GI tract to circulation
elimination
excretion of waste products of digestion
Components of GI tract
mouth, pharynx, esophagus, stomach, small intestine, large intestine, rectum, anus,
Accessory organs to GI tract
teeth, tongue, salivary glands, liver, gallbladder, pancreas
Mucosa
innermost layer of GI tract
- -Protects, secretes, absorbs
- —lumen/ small intestines: form folds “villi” and increase absortive capacity (surface area)
Submucosa
contains blood and lymph vessles
—transports nutrients
(connective tissue)
Muscularis (muscular) layer
Smooth muscle fibers arranged in circular and longitudinal groups.
—-motility
Serosa (serous) layer
outer covering
—protection
Peritoneum
lines walls of entire abdominal cavity. Forms the peritoneal cavity
Two folds of peritoneum
Mesentary and Omentum
Mesentary
blood and lymph
Omentum
fat covering for protection
Blood supply of GI tract
aorta–>celiac artery–> superior and inferior mesenteric arteries
–superior and inferior mesenteric arteries supply small and large intestine
—venous blood draiing GI tract empties into portal vein - carries nutrient rich blood to liver
(25-30% total caridac output is going directly to GI tract. increases after eating. more blood to transport nutrients)
Mucous
- from mouth to anus.
- protects and lubricates (only secretion in esophagus)
Digestive secretions
- enzymes, hormones, digestive juices, bile, pancreatic juices
- produced throughout GI w/ very specific functions
Peristalsis
wavelike movements
-stimulus is expansion of lumen of tract by food
Gastrocolic and duodenocolic reflex
leads to urge to poop after eating
particularly strong in the morning
Bacteria
normal component of GI tract. Essential for function. Major component of colon
-aids digestion (proteins) 10% of stool
Sympathetic
inhibits or decreases digestive actions. “slows down” S-S
Pararsympathetic impules
-increase GI activities “picks up”
P-P
Vagus nerve
cranial that innervates GI tract
Mouth
Oral or buccal cavity Functions: where digestion begins 1)mastication: mechanically reduces size of food particles and mixes with saliva. protects esphagus from trauma by decreasing size of particles 2) speech 3) expression 4) taste
Salivary Glands
parotid, submaxillary, sublingual
Salivary secretions
1000-1500 ml saliva produced daily
Amylase
begins digestion of starches
Pharynx
Nasopharynx, Oropharynx, laryngopharynx
- -pharyngeal muscles regulate swallowing
- -involuntary control
Act of swallowing (deglutition)
1) initiated voluntary (force food into pahrynx)
2) Involuntary (swallowing reflex)
3) transported by peristalsis to stomach
Esophagus
transports food to stomach
penetrates diaphragm thru esphageal hiatus
–no digestion, only mucous
Pharyngo-esophageal orn upper esophageal sphincter
allows food into esophagus
Gastro-esophageal or lower esophageal sphincter
allows food into the stomach
- -prevents acid reflux
- -between esophagus and stomach
How many seconds for food to pass into the stomach?
10 seconds
Stomach
- mixes food with gastric secretions
- -stores food until it can pass into small intestines
- empties content at rate which digestion can occur
Gastric secretions
chemical liquification of ingested food
Gastrin
stimulates secretions of parietal and chief cells
Parietal cells
secrete HCL and intrinsic factor
decrease HCL?
Chief cells
produce pepsinogen–>pepsin–>protein digestion
Mucous neck cells
secrete alkaline mucous to lubricate and protect stomach from self-digestion
pyloric glands
secretes mucous
pyloric sphincter
between stomach and duodenum
Gastric emptying
- controlled by nerve impulses, chyme, and hormonal effects
- fats and duodenal chyme (high acid)= activate the enterogastric reflex= inhibits gastric motility and secretion
- allows pancreatic juices time to neutralize in duodenum
Vagal stimulation….
increases emptying
Small intestine
- major site for digestion and absorption
- major nutrients absorbed
Villi
increase surface area and enhance absorption of nutrients
Duodenum and jejunum absorb….
carbohydrates, amino acids, lipids, iron, and calcium
Ileum absorbs…
water, electrolytes, bile salts, vitamins
How much water does the ileum absorb per day?
8 Liters
Large intestines
absorb water and electrolytes
and store feces until elimination
Mass movements
strong peristaltic actions occur when colon becomes filled
Haustra
when peristalsis breaks chyme into large pockets
–extracts water and chyme becomes solid feces
Rectum
storage and expulsion of food
–connects sigmoid colon and anus
Internal sphincter
- involuntary control.
- autonomic nerves makes area insensitive
External sphincter
- voluntary control
- somatic nerves make area very sensitive
Defecation reflex
feces move into rectum–>stretches and causes distention–> activates parasympathetic nervous system–> relaxes sphincters–> constricts muscles –> forces feces out
Chronic constipation
Occurs when defecation reflex is ignored or inhibited regularly
Major functions of the liver
- storage, protection, metabolism
- bile production and secretion
- carb metabolism
- protein metabolism
- formation of clotting factors
- fat metabolism
- vitamin and mineral storage
- filtration/detoxification
- blood storage
Kupffer cells
reticuloendothilial cells provide crucial filtering system
(part of the immune system)
—-phagocytically destroy old RBCs and remove bacteria from nlood
what supplies blood to the liver?
portal vein and hepatic artery
Portal vein supplies how much blood to the liver?
75%
Hepatic artery supplies…?
other 25% as oxygenated blood
Pancreas
- neutralizes acid chyme (lipase and amylase)
- –enters the duodenum via the pancreatic duct to the common bile duct
Acini cells
secrete pancreatic juices
Cholecystokinin-pancreozymin
food ingestion stimulates secretion stored bile in GB
Gallbladder
stores and concentrates bile made in the liver
Bile
emulsifies fats
Common bile duct
carries bile and empties into duodenum at ampulla of vater
Bilirubin
pigment derived from breakdown of hemoglobin
*main component of bile
Urobilinogen
converted from bilirubin by bacteria
- excreted in feces, giving brown color
- reabsorbed and excreted via kidneys giving yellow color
GI assessment
- establish baselines ht, wt, stool patterns
- chief complaint/present illness
- age, gender, culture
- PMH
- family history
- eating habits
1st sign of GI problem
abdominal pain
Abdominal assessment (4)
inspection, auscultation, percussion, palpation
Inspection of abdomen
- at eye level
- note contour
- note any pulsations
- cullen’s sign
- measure abdominal girth
Cullen’s sign
bluish around umbilicus
-indication internal bleed
Ausculation
- listen in each quadrant 5-15 seonds
- turn NG tube off before listening
Palpation
- light palpation
- muscle guarding
- blumbergs sign
- Mcburney’s point
- DO NOT palpate any pulsations
Blumberg’s sign
- rebound tenderness
- classic sign of peritonitis
McBurney’s point
- between umbilicus and iliac crest
- pain = appendicitis
Most specific indicator of liver damage
ALT
Paracentesis
- *void prior to procedure
- may accidentally puncture bladder
- removing fluid from the abdomen
GI cocktail
- determine difference between GERD and heart
- lidocaine, donatal, and , malox
- if pain goes away after cocktail = GERD
Barium swallow/enema
upper and lower GI series
-lots of water and laxatives to pass through
Liver biopsy
-needle inserted through abdominal wall into liver, sample removed for microscopic exam
Potential complications of liver biopsy
- hemorrhage (check PTT prior to)
- chemical peritonitis from bile leak into abdomen
- pneumothorax
What MUST be done after liver biopsy?
- ***place patient on right side for 2 hours after procedure
- monitor for hemorrhage
What is an important nursing responsibility for nutritional problems
-providing education on a well balanced diet with nutritional supplementation and support
Nutritional status is influenced by…
- age/gender
- health
- religion/culture preferences
- attitudes about food
- financial staus
- availability of food sources
Hunger
uneasy or painful sensation cause by lack of food
Hidden hunger
subclinical deficiencies but no obvious signs of undernutrition
Food insecurity
lack of access to food to meet dietary needs
Malnutrition is caused by…
- insufficient diet
- unbalanced diet
- excessive diet
- impaired absorption of nutrients
- upper GI disorders (dysphagia, anorexia
Malnutrition effects on the body…
-**weakens the immune system and causes delayed wound healing
- impairs mental and physical health
- slows thinking
- stunts growth
- vision problems
Malnutrition
deficiency or excess of nutrients
Under nutrition
state of poor nutrition from inadequate diet or diseases that affect appetite and utilization of food (chemo)
Over nutrition
ingestion of more food than required for body needs
Protein calorie malnutrition
- most common form of malnutrition
- from chronic or prolonged inadequate protein and or calorie intake
- or from high metabolic protein and energy requirements
Primary protein-calorie malnutrition
nutritional needs are not met
Secondary protein calorie malnutrition
- physiological cause unable to meet nutrition
- alteration or defect in ingestion, digestion, absorption or metabolism
Catabolism
without needed proteins and calories, body fills its energy needs by breaking down stored proteins and fats
- loss of muscle mass
- weakness and fatigue
- poor wound healing
- death
Kwashiokor
lack of protein quality and quantity. adequate calories.
-ascites due to lack of protein
Marasmus
low protein and calories. leads to starvation and death
-calorie malnutrition in which body fat and proteins are wasted.
(muscle wasting)
Starvation
-initially the body uses carbohydrates to meet metabolic needs, glycogen found in liver and muscles - totally depleted in 18 hours
-next proteins are converted to glucose (gluconeo)
within 5-9 days body fat is mobilized to supply energy
-once fat stores gone (4-6wks), body proteins (internal organs) become only source of energy
Main signs of starvation
- edema
- skin becomes dry and wrinkled (cells not getting fluid)
Obvious signs of protein/calorie deficiency
- skin = dry
- eyes = sunken in
- muscle wasting
- CNS = slowed thinking and reflexes
- decreased wound healing and delay in recovery
- anemia
Nutritional assessment: subjective data
- dietary intake in last 24 hrs
- food diary for at least 2 weeks
- psychosocial factors
- alcohol intake
- medications
Nutritional assessment: objective data
- physical exam
- ht and wt
- body frame size
- mid-arm circumference
- skin fold thinkness
- BMI
Labs for nutritional assessment
- serum vitamins
- nitrogen balance
- H&H
- total lymphocyte count
- serum iron
- total protein
- albumin (visceral protein depletion)
Most specific indicator of malnutrition
pre-albumin
Normal range for pre-albumin
anything above 20
Expected outcomes for malnourished client
- achieve wt gain (1-2 pounds a wk)
- consumes specified number of calories/day
- selects good food choices
- eat 75% of food on tray
- take rest periods of 30 mins
- no evidence of infection
Goal of treatment for malnourished patients
restore nutrition with diet high in calories and protein
prevents fatigue and infection
Nursing interventions for malnourished patients
-**good mouth care
*-small frequent meals
-supplemental feedings
-vitamin supplements
- pain relief
if severe: correct fluid and electrolyte balance, treat infections, enteral feedings, TPN
what may cause or exacerbate malnutrition?
hospitalization
- -NPO, changed diet, bad food, stress and anxiety
- prevention is important
- identify patients at risk.
Bariatric medicine
branch of medicine that deals with prevention, control, and treatment of obesity
- excess fat or adipose tissue relative to lean body mass
- 20% above normal body weight
Pathophysiology of obesity
obesity results when calorie intake exceeds energy demands for a prolonged period of time and the body stores excess calories as fat
Primary obesity
caused by excess calorie intake for metabolic demands
Secondary obesity
congenital, chromosomal, or metabolic problems
Hypertrophic obesity
- increase in size of adipose cells.
- seen in adult onset obesity
Hyperplastic obesity
- increase in size and number of fat cells
- seen in younger age
Android obesity
- fat distributed over abdomen and upper body
- apple shape
- **greater risk for CV issues
Gynecoid Obesity
- fat distributed over the hips
- pear body shape
- better health prognosis but more difficult to lose weight
Normal BMI
18.5-24.9
Morbid obese BMI
41-45
Super obese
> 50
major complications of obesity
-cardiovascular, respiratory and musculoskeletal
susceptible to infections
Major assessment question for obese patients
previous attempts at weight reduction
-what they tried and why they failed. find out what triggered them to fail
Important objective assessment for obese patients
skin assessment –increase in infection. make sure clean and dry
Plan for obese patients
- modify eating patterns
- participate in regular exercise (aquatherapy)
- achieve weight loss at specified level
- maintain wt loss ( 1-2 lbs/wk)
- minimize or prevent health problems
Treatment for obese patients
prevention is the best treatment.
- educate on proper diet and eating habits
- diet, nutrition therapy, drug therapy, behavioral management
Best diet for obese patient
nutritionally balanced diet
two categories of drugs approved by the FDA for obese patients
- appetite suppressants
- decrease nutrient absorption (usually fat so fat soluble vits no absorbed- no clotting factor)
Gastroplasty
- gastric partitioning
- stomach divided by surgery, stapling, or banding into small upper portion and large distal portion
- -must modify dietary habits. easier than bypass
Important post-op care after surgery for obese peeps
airway priority
complication: anastomotic leak is the most common (leak at the connection)
Most common cause affecting teeth
tooth decay
Primary cause of tooth decay
plaque
poor dental hygiene can lead to…
heart disease, stroke, and cancer
Risk factors for tooth decay
- diet high in simple sugars
- poor oral hygiene
- poor health
- familial tendency
Best treatment for tooth decay
prevention!
frequent brushing and daily flossing
Treatment once tooth decay has occurred
- removal of decayed tooth
- replacement with restorative barrier devices
- tooth extraction
Periodontal disease
- inflammation of tissue that supports and surrounds tooth caused by bacterial plaque
- many adults have some degree of periodontal disease= other health problems
- most common cause on tooth loss in adults
Periodontal disease is caused by
bacterial plaque
Gingivitis
inflammation of gums causing separation from tooth surface
- pockets form, collects bacteria, pus forms
- gums recede, bone destruction, tooth loosens
First sign of gingivitis
painless bleeding of gums with normal brushing
Nursing responsibility for gingivitis
provide and teach meticulous mouth care
Halitosis
bad breath
- caused by dental caries, periodontal disease, other upper GI pathology
- food particles between teeth or in esophagus decay and create odor
what to treat with halitosis
underlying cause
stomatitis
inflammation of the mouth
-sore mouth, decreased appetite problems - very painful
glossitis
inflammation of the tongue
Nursing interventions for stomatitis, glossitis, and gingivitis
- *remove underlying cause
- soft bland diet
- avoid harsh substances
- topical or systemic antibiotics
Apthous ulcers
(canker sores) small painful ulcers on mouth and lips
tx: topical or systemic steroids (lidex,bland diet, soothing oral care). can go away on own.
Herpes simplex (cold sores, fever blisters)
viral lesions appear as small vesicles or shallow ulcers on mouth, lips, edge of nose, or gums
tx: treat symptoms
steroids, antiseptic mouthwash, antiviral agent
Vincent’s Gingivitis
(trench mouth)
acute necrotizing ulcerative gingivitis caused by bacteria present in mouth
-hourly mouthwashes (peroxide and water)
-antibiotics and analgesics
Candidiasis
(yeast or thrush)
fungal infection by candida albicans
-pearly white, curdlike patches in mouth which reveal raw bleeding surface when rubbed
-causes: steroid use, antibiotics, suppressed immune system (ca or hiv), debilitated patients
Nursing interventions for Cadidiasis
- *good oral hygiene
- bland diet
- Nystatin suspension or troches or clotrimazole (teach patients to keep in mouth as long as possible)
Acute Sialadenitis
inflammation of salivary glands caused by inactivity of gland
-most common is parotid gland
Anyone that is NPO for a long time is at risk for…
developing acute sialadenitis
Treatment for Acute Sialadenitis
- good oral hygiene to decrease bacteria
- keep patient well hydrated
- stimulate secretions of glands (candy & gum)
Calculi or Sialolithiasis
stones in salivary glands
- most common in submaxillary, pain w/ chewing
- tx by excision
Salivary gland tumors
- parotid gland: usually benign
- submaxillary gland: usually malignant
spreads by lymphatic system, pain as tumor enlarges
tx: local excision
Oral cancer
- may occur anywhere in mouth
- RFs: poor oral hygiene, tobacco, alcohol, chronic irriation, over exposure to wind/sun
Cancer of the tongue
- **poor prognosis r/t extensive vascular and lymphatic supply
- metastasizes early to cervical lymph nodes
- usually already mets when diagnosed
Kaposi’s sarcoma
- HIV infection related
- red, purple or blue lesion on oral mucosa
Treatment for oral cancer
- mandibulectomy, glossectomy, resections of buccual mucosa and floor of mouth
- speech therapy necessary
- radical neck dissection
Radical neck dissection
done to relieve pressure on trachea, esophagus, blood vessels and nerves
-removal of tissue from jaw bone to clavical
Complications of RND
- high rate of complications
- airway obstruction
- hemorrhage
- aspiration
- infection
- skin flap necrosis
Post-op care for RND
1-maintain airway
- *emotional support and pre-op teaching is essential
- oral hygiene, saliva management -oral suction
- pain management
- nutrition, wound care, communication
GERD
gastroesophageal reflux disease
-syndrome that causes reflux of gastric and duodenal contents into espophagus = irritation and inflammation = esophagitis
Etilology of GERD
- increased abdominal pressure (obesity, ascites, preggo)
- incompetent LES
- Hiatal hernia is most common
Most common cause of GERD
hiatal hernia
Symptoms of GERD
- dyspepsia
- regurgitation
- eructation and flatulence
- bloating
- dysphagia/odynophagia
- chronic cough
Treatment for GERD
- **small frequent meals
- **don’t lay down after eating
- avoid triggering substances
- No CATS
Barrett’s esophagus
(precancerous)
cells change and tend to be malignant
-can cause regurgitation
most common symptom of hiatal hernia
pyrosis and indigestion
