GI Part 1 Flashcards by Christina Stafstrom

innermost, thin layer of smooth muscle and exocrine cell

mucosa

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connective tissue in GI tract

submucosa

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smooth muscle in GI tract

muscularis

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outermost, connective tissue in GI tract

serosa

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Hollow muscular tube, lumen surrounded by 4 major tissue layers

GI tract

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function of the GI tract

secretion, digestion, absorption, motility, elimination

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function of GI tract in order of how food goes into body

ingestion, mechanical digestion, propulsion, chemical digestion, absorption, defecation

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by myenteric plexus in smooth muscle and submucosa plexus in inner layer nerve plexuses runs length of GI tract

intrinsic stimulation

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Parasympathetic stimulation by vagus nerve, connects with intrinsic system

autonomic system

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stimulates motor and secretory activity and relaxes sphincters (CN X)

vagus

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thoracic and lumbar splanchnic nerves slows movement, inhibits secretions and contracts sphincters

sympathetic system

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function of mouth

Mastication, taste, begin movement
Glands produce 1 L of saliva/day
Saliva contains mucin and salivary amylase with begins to break down CHO

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food is softened, made into a “bolus” and tongue moves to the back of the mouth

Oral preparatory phase

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tongue presses bolus against hard palate, elevates the larynx and forces the food bolus to the pharynx, triggering swallowing

oral phase

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soft palate elevates and seals nasal cavity, inhibits respirations and allows esophagus to open

pharyngeal phase

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is when bolus enter at cricopharyngeal juncture, peristalsis now takes food to the stomach

esophageal phase

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how long do all the mouth phases together take

10 seconds

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what is the order of the oral stages

oral preparatory phase, oral phase, pharyngeal phase, esophageal phase

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Canal about 10 in long, passes through the center of the diaphragm

esophagus

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at rest it is closed to prevent air from entering the esophagus

upper esophageal sphincter

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it sits at the gastroesophageal junction, at rest it is closed to prevent reflux of gastric contents, this is where GERD occurs

lower esophageal sphincter

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function of esophagus

to propel food and fluids and prevent reflux

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Digestive and endocrine organ, in midline and LUQ

stomach

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what are the regions of the stomach

cardia, fundus, body, antrum

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narrow part that is distal to the gastroesophageal junction (stomach)

cardia

left above the GE junction (stomach)

fundus

corpus- largest area (stomach)

body

pylorus, is the distal portion and is separated from the duodenum by the pyloric sphincter, prevents backflow from the duodenum (stomach)

antrum

what is the surface of the stomach covered by

is covered in rugae or folds and have smooth muscle for motility

what type of nerves does the stomach have

extrinsic and intrinsic

function of parietal cells in stomach

secrete HCL acid and intrinsic factor, which absorbs B 12, without it, what anemia can occur?

function of chief cells in stomach

secrete Pepsinogenpepsin

sight, smell and taste of food, regulated by vagus, begin secretory and contractile activity

Cephalic phase

G cells in the antrum secrete gastrin, which causes HCL and pepsinogen to be released. HCL changes pepsinogen to pepsin, which digest proteins. Mucous and Bicarb are secreted to protect the stomach wall

Gastric phase

chyme produced empties into the duodenum and causes distention, this produces secretin, which stops the acid production and gastric motility

intestinal phase

Longest portion of the GI tract, 16-19 ft.. | Made up of 3 sections

small intestine

what are the 3 parts of the small intestine

duodenum, jejunum, ileum

first 12” and is attached to the pylorus. The CBD and pancreatic duct join to form the ampulla of Vater (hepatopancreatic ampulla) and empty into the duodenum at the duodenal papilla. This surrounded by a muscle, called the Sphincter of Oddi

duodenum

middle 8 ft. portion

jejunum

last 8-12 ft..

ileum

what is the inner lining of the small intestine made up of

is made up of intestinal villi and folds of mucosa and submucosa for digestion.

what are the main functions of the small intestine

movement, digestion, absorption

describe movement of small intestine

mixing and peristalsis | Moves chyme by segmental contractions and mixes with enzymes

describe digestion of small intestine

enzymes produced by the intestinal cells make: Enterokinase, peptidases, lactase, maltase and sucrose Help to digest, CHO, proteins and lipids

describe absorption

absorbs most of the nutrients from food, takes 3-10 hours for the contents to pass through

what is the major organ for absorption

small intestine

describe the cross section of the small intestine

Velvety appearance Due to mucous fingerlike projections-intestinal Villi Folds of mucosa and submucosa

what are the three sections of the large intestine

cecum, colon, rectum

is the beginning, dilated pouch like structure, appendix is attached to the base (large intestine)

cecum

what are the 4 sections of the colon

Ascending, transverse, descending and sigmoid

last 6-8” to the sphincter muscles and anus

rectum

what is the function of the large intestine

movement, absorption, elimination

segmental contractions, to allow time for the water and electrolytes to be absorbed

movement

possible cause of bowel retention

Ignoring the “urge to go” or decreased peristalsis

Leads to retention of stool in the rectum

Stool dries and hardens Constipation Impaction

how do you prevent bowel retention

Hydration, Adequate dietary fiber, Regular toileting practices, Regular exercise, Avoidance of environmental contamination

what to look for in family history of GI

GI disorders, cancer

what to look for in personal history of GI

G I surgeries, RX & OTC meds, travel

what to look for in diet history of GI

anorexia, dyspepsia, Food allergies, eating habits, alcohol, caffeine

what to look for in health history of GI

N/V, diarrhea, constipation, # and color of stools, change in wt. or appetite

how to assess abdominal pain

``` P- precipitating Q-quality- how intense, severe, type R-region or radiation S- severity scale- 0-10 T-timing- when did it first occur, duration and frequency ```

what is decreased in malabsorption

decreased with vomiting, diarrhea

decreased indicates possible malabsorption in the small intestine

D-Xylose absorption

increased with Crohn’s disease and malabsorption

stool for fecal fat

used to monitor for cancer in the GI tract

Oncofetal antigens- CA19-9 and CEA

increased with Crohn’s disease and malabsorption

stool for fecal fat

pharynx to duodenojejunal junction, barium swallow and SBFT

Upper GI and small bowel-

how do barium swallows in upper GI and SBFT work

NPO 8 hours before, drink barium, then lie, stand and turn in multiple directions to view movement of barium SBFT- drink more barium and view passage After drink fluids to pass barium

Large intestine, done for obstructions, masses, not done is perforated colon or fistulas

barium enema

how do you prepare for a barium enema

Only clear liquids for 12-24 hours prior, NPO, given bowel prep like Golytely

large bowel, take biopsies and remove polyps, have a bowel prep prior, given versed and fentanyl prior

colonoscopy

now done to visualize, apply a data recorder to the abdomen and the patient swallows the capsule

capsule enteroscopy

like colonoscopy, only a rigid tube, less invasive and does not require the cleansing of the colonoscopy

Proctosigmoidoscopy

what does GERD cause

causes esophageal mucosa to be irritated by the effects of gastric and duodenal contents, results in inflammation

what does GERD stand for

gastroesophageal reflux disease

what can lead to GERD

Inappropriate relaxation of the LES, sphincter tone is decreased Irritation from refluxed material Delayed gastric emptying, gastric volume or intra-abdominal pressure is increased Abnormal esophageal clearance

Factors contributing to decreased lower esophageal sphincter pressure

Fatty foods, Caffeinated beverages, Chocolate, Nicotine, Calcium channel blockers, Nitrates, Peppermint, Alcohol, Anticholinergic drugs, High levels of estrogen and progesterone, NG tube placement

Refluxed material has a pH of

1.5-2

esophagus normally has a pH of

6-8

what cause tissue injury in the esophagus

gastric acid and pepsin

thicker, but can be cancerous, can also cause hemorrhage, aspiration pneumonia, asthma, laryngitis and dental deterioration.

Barrett’s epithelium-

heartburn, substernal or retrosternal burning that moves up and down in wavelike fashion, pain may radiate to neck or jaw or back, worsens when bends over, strains or lies on their back, occurs after meals and last 1-2 hours, helped by fluids and staying upright

dyspepsia

food entering throat without nausea, watch for cough, hoarseness or wheezing

regurgitation

water brash in response to reflux, fluid without sour or bitter taste

hypersalivation

physical manifestations of GERD

dyspepsia, regurgitation, hypersalivation, dysphagia

difficulty or painful swallowing, esophagus may be narrowed by inflammation or tumor, odynophagia-

dysphagia

24 hour ambulatory pH monitoring- pass a small tube into esophagus and monitor pH levels

endoscopy

foods that decrease LES pressure

chocolate, fat and mints. Also, smoking and alcohol decrease

foods that increase gastric pressure

Carbonated foods

what are the three nursing diagnoses with GERD

Impaired Nutrition, Acute Pain r/t irritation of the esophagus, Risk for aspiration r/t reflux of gastric contents

what is the goal of drug therapy with GERD

Goal is to inhibit gastric acid secretion, accelerate gastric emptying and protect the gastric mucosa

Elevate the pH and deactivate pepsin, good for heartburn, take 1 hour before and 2-3 hr after a meal

antacids

name two antacids

maalox, mylanta

Decrease acid, help promote healing of the esophagus

histamine receptor antagonists

common histamine receptor antagonists

pepcid, zantic, tagment

Main treatment for GERD, long acting inhibition of gastric acid secretions by inhibiting proton pump of parietal cell, can reduce by 90%/ day

proton pump inhibitor

common proton pump inhibitors

prilosec, prevacid, aciphex, nexium, protonix

other medications that lower LES pressure

oral contraceptives, anticholinergics, sedative, tranquilizers, B-adrenergic agonists, nitrates and Ca channel blockers

for emptying and peristalsis- metoclopramide (Reglan)

prokinetic drugs