lecture 3- GI Flashcards
mouth does what
chew food, food mixes with saliva and turns into bolus
what occurs in mouth
some carb b/d
after mouth, food is moved thru what
pharynx
pharynx
peristaltic waves initiate swallow reflex
what is swallow reflex
as bolus goes in, innervation in pharynx senses food is there and needs it to start sm muscle pushing food down
impairment of sensing food there
in neuro disease- parkinsons, CVA
impaired sense of food there means what
inc risk of dysphagia/aspiration
what interventions for risk of dysphagia/aspiration?
HOB up while eating, high fowlers, keep up at least 20 mins after eating. HOB up 30 degrees at all times.
esophagus does what
peristalsis, sm muscle innervation, helps move bolus into stomach
what happens in stomach
bolus/stomach contents mix with hydrochloric acid & pepsin.
what does pepsin do
starts protein b/d then controls propelling of chyme into sm intestine
sm intesting
large amount of absorption. chyme mixes w/ other enzymes.. absorbs protein, lipids, CHO, vit, H2O, elytes; controls propelling of chyme to lg intestine
lg intestine
lots of absorption of most fluids. bolus propelling to colon then into rectum
what does lg intestine do if dehydrated
pulls fluid from stool, makes stool drier/harder
sphincters
prevent bolus from being pushed back up. keeps it flowing thru intestinal tract
liver/gallbladder
produce various enzymes
bile synthesis/secretion/storage/concentration/expulsion
pancreas
synthesis/secretion of enzymes and alkaline fluid
oropharynx (mouth/throat) changes
bone atrophy, gum recession, worn dentin/enamel, tooth loss/damage, oral mucosa thinning, dec saliva alkalinity, dec taste buds, inc salty/sweet threshold,
esophagus changes
dec upper esophageal pressure, dec secondary peristalsis, hypertrophy upper 1/3 of sk muscle, thickening of lowe 2/3 sm muscle, dec # ganglion cells coordinating peristalsis
esophageal changes can lead to what
GERD, med-induced esophaheal injury
stomach changes
dec gastric mucosal cytoprotection, dec response to injury, dec gastric mucosal proliferation/regeneration
stomach “little changes”
gastric acid secretion, intrinsic factor secretion, blood flow
stomach changes effect
inc susceptibility to GI infx
sm intestine changes
dec uptake of vitD, folic acid, VitB12, Ca, Cu, Zn, fatty acids, cholesterol. dec sm muscle, strenght, tone. impaired response to bolus. villus atrophy. dec neurons in myenteric plexis. dec immune “f”.
sm intestine changes effects
prone to bact overgrowth and malabsorption
lg intestine changes
dec anorectal distention sensitivity. inc transit time. dec coordination of contractions. dec mech integrity. inc collagen in colon wall. dec ability to resist inc intraluminal pressure
lg intestine changes effect
prone to diverticulosis/itis, constipation
accessory organ changes
dec liver size, bf, perfusion; dec # hepatocytes, remainder enlarge; inc bile lithogenesis; dec pancreas wt, inc fibrosis and cell degranulation
accessory organ changes effect
prone to cholelithiasis
GI assessment
look flat/distended/obese?
listen to all 4 quads
feel soft/firm/tender?
last BM, INO, N/V, diet, meds
constipation definition
none.
small/dry/hard that are difficult to pass, < 2-3/week, incomplete passage of stool.
associated with pain, inc straining, inc flatus/bloating
epidemiology of constipation
inc w/ age, most common elder GI complaint.
risk factors of constipation
poor nutrition/hydration, sedentary, cranial injury
patho of constipation
dec rectal tone, impaired rectal sensation, inc rectal distention needed for int. anal sphincter relaxation.
failure to relax puborectalis & external anal sphincter w/ attempted defaction.
med causes of constipation
analgesics, anesthetics, antacids, anticholinergic, anticonvulsants, antiHTN, antiparkinsons, calcium, diuretics, iron, phenothiazines
conditions that cause constipation
intestinal, metabolic, neuro, dec cals/fiber/fluids, fever, immobility
assess for constipation
usual pattern, last BM, impaction
labs for constipation
abd xray, barium studies
meds for constipation
bulk (fibercon), stimulant (dulcolax), softener (colace), osmotic (MOM)
nsg implication for constipation
inc fiber/fluids/exercise, monitor INO, privacy, access to BR (bedpan, commode, toilet)
complications of constipation
fecal impaction, intestinal obstruction, urinary retention, UTI, hemorrhoids, rectal bleeds
DM
metabolic syndrome characterized by hyperglycemia and sometimes ketoacidosis
epidemiology of DM
7th leading cause of death in US. 23.6 mil persons dx in US. incidence inc w/age.
what % of people </= 40 yo dx DM
<5%
what % of people >/= 60 yo dx DM
23%
what race/gender/age highest incidence of DM
African Am Women over 65 yo
2nd highest incidence of DM
hispanic men/women over 65 yo
y DM undiagnosed in elder
sometimes symptoms are vague, aging changes resemble other disease processes
annual cost of DM
$174 mil/year
type 2 DM
90-95% of all elders have this type
patho of DM type 2
hyperglycemia caused by insulin resistance to glucose transport into cells r/t dec receptors & cell metab changes. then dec insulin secretion.
