Midterm

Question 1

What if the function of the GI system

Answer 1

1. process food substances
2. Absorb the products of digestion into the blood
3. Excrete unabsorbed materials
4. Provide an environment for microorganisms to synthesize nutrients such as vitamin K.

Question 2

What is the role of the mouth in the GI system

Answer 2

Contains lips, cheeks, palate, tongue, teeth, salivary glands, muscles, and maxillary bones

saliva contains the enzyme amylase which aids in digestion

Question 3

What is the role of the esophagus in the GI system

Answer 3

The esophagus is a collapsible muscular tube about 10 inches long

Carries food from the pharynx to the stomach.

Question 4

What is the role of the stomach in the GI system?

Answer 4

Contains the cardia, fundus, body and pylorus of the stomach

Mucous glands are located in the mucosa and prevent autodigestion by providing an alkaline protective covering

The lower esophageal (cardiac) sphincter prevents the reflux of gastric contents into the esophagus

The pyloric sphincter regulates the rate of stomach emptying into the small intestine.

Hydrochloric acid kills microorganisms, breaks food into small particles, and provides a chemical environment that facilitates gastric enzyme activation.

Pepsin is the chief coenzyme of gastric juice, which breakdown proteins

Intrinsic factor comes from parietal cells and is necessary for absorption of B12,

Gastrin controls gastric acidity

Question 5

What is the role of the small intestine in the GI

Answer 5

duodenum contains the opening of the bile and pancreatic ducts

The jejunum is about 8 feet long
The ileum is about 12 feet

The small intestine terminates in the cecum

Question 6

What is the role of the large intestine in the GI

Answer 6

about 5 feet long
Absorbs water and eliminates wastes
Intestinal bacteria play a vital role in the synthesis of some B vitamins and vitamin K

Colon: Includes the ascending, transverse, descending, and sigmoid colons and rectum

The ileocecal valve prevents the contents of the large intestine from entering the ileum.

The internal and external anal sphincters control the anal canal.

Question 7

What is the peritoneum?

Answer 7

It lines the abdominal cavity and forms the mesentary that supports the intestines and blood supply

Question 8

What is the role of the liver?

Answer 8

The largest gland in the body, weighing 3-4 lbs
Contains Kupffer cells which remove bacteria in the portal venous blood.
Removes excess glucose and amino acids from portal blood.
Synthesizes glucose, amino acids, and fats
Aids in the digestion of fats, carbohydrates, and proteins

Stores and filters blood (200-400 ml of blood stored)
Stores Vit. A, D, B and Iron
The Liver secretes bile to emulsify fats (500-1000ml of bile/day)

Hepatic ducts deliver bile to the gallbladder via the cystic duct and to the duodenum via the common bile duct

The common bile duct opens into the duodenum, with the pancreatic duct at the ampulla of Vater.
The sphincter prevents the reflux of intestinal contents into the common bile duct and pancreatic duct.

Question 9

What is the role of the gallbladder in the GI system

Answer 9

Stores and concentrates bile and contracts to force bile into the duodenum during the digestion of fats
The cystic duct joins the hepatic duct to form the common bile duct
The sphincter of Oddi is located at the entrance to the duodenum

presence of fatty materials in the duodenum stimulates the liberation of CCK which causes the gallbladder to contract and the sphincter of oddi to relax

Question 10

What is the role of the pancreas in the GI system

Answer 10

Exocrine gland - secretes sodium bicarb to neutralize the acidity of the stomach contents that enter the duodenum
Pancreatic juices contain enzymes for digesting carbohydrates, fats, and proteins

Endocrine gland - secretes glucagon to raise blood glucose levels and secretes somatostatin to exert a hypoglycemic effect
the Islets of langerhans secrete insulin
Insulin is secreted into the bloodstream and is important for carbohydrate metabolism

Question 11

What are signs of bowel perforation and peritonitis?

Answer 11

• guarding of the abdomen
• increased temperature and chills
• pallor
• Progressive abdominal distention and abdominal pain
• Restlessness
• Tachycardia and tachypnea

Question 12

What is Laparoscopy?

Answer 12

A procedure performed with a fiberoptic laparoscope that allows direct visualization of organs and structures within the abdomen; biopsies may be obtained

Question 13

Describe GERD and the assessment for it?

Answer 13

Description:
The backflow of gastric and duodenal contents into the esophagus. The reflux is caused by an incompetent lower esophageal sphincter, pyloric stenosis, or motility disorder

Assessment:

• Heartburn, epigastric pain
• Dyspepsia
• Nausea, regurgitation
• Pain and difficulty with swallowing
• Hypersalivation

Question 14

What nursing interventions are applicable for GERD?

Answer 14

1. Instruct the client to avoid factors that decrease LES pressure or cause esophageal irritation, such as peppermint, chocolate, coffee, fried or fatty foods, carbonated beverages, alcoholic beverages, and cigarette smoking
2. Instruct low-fat, high-fiber diet and avoid eating and drinking 2 hours before bedtime and wearing tight clothes, elevate head of the bed on 6 to 8 inch blocks
3. Avoid the use of anticholinergics, which delay stomach emptying, also NSAIDS and other medications containing ASA
4. Educate patient on Antacids, H2-Receptors, and PPI
5. Educate patient on prokinetic medications that accelerate gastric emptying
6. Surgery may be required in extreme cases when medical management is unsuccessful.

Question 15

What is the assessment findings for acute gastritis?

Answer 15

abdominal discomfort
anorexia, N&V
Headache
Hiccuping 
Reflux

Question 16

What is the assessment findings for chronic gastrits?

Answer 16

Anorexia, N&V 
Belching 
Heartburn after eating 
Sour taste in the mouth 
B12 deficiency

Question 17

What is gastritis ?

Answer 17

inflammation of the stomach or gastric mucosa

Acute gastritis is caused by ingestion of food contaminated, highly spiced, or overuse of NSAIDS

Chronic is caused by benign or malignant ulcers or by H. Pylori, may also be caused by autoimmune, dietary, alcohol, smoking or reflux.

Question 18

What are the interventions for gastritis?

Answer 18

1. NPO until symptoms subside, after as prescribed ice chips may be given, followed by clear liquids and then solid food.
2. Monitor for signs of hemorrhagic gastritis such as hematemesis, tachycardia, and hypotension, notify HCP immediately
3. Instruct client to avoid irritating foods, fluids, and other substances
4. Instruct the client in the use of precsibred medications such as antibiotics
5. Provide the client with information about B12 injections if deficiency is present

Question 19

What is peptic ulcer disease?

Answer 19

A peptic ulcer is a ulceration in the mucosal wall of the stomach, pylorus, duodenum, or esophagus in portions accessible to gastric secretions, erosion may extend through the muscle.
The ulcer may be referred to as gastric, duodenal, or esophageal depending on location
The most common peptic ulcer are gastric ulcers and duodenal.

Question 20

What is a gastric ulcer?

Answer 20

a gastric ulcer involves ulceration of the mucosal lining that extends to the submucosal layer of the stomach

Predisposing factors: stress, smoking, corticosteroids, NSAIDS, alcohol, Hx of gastritis, Hx of family gastric ulcers, H. Pylori

Complications include hemorrhage, perforation, and pyloric obstruction

Question 21

What is the difference between gastric and duodenal ulcers presenting symptoms

Answer 21

Gastric
gnawing, sharp pain in or to the left of the mid-epigastric region, 30-60 mins after a meal. (Food ingestion makes pain worse)
Hematemesis more common than melena

Duodenal
burning pain, occurs in mid-epigastric area 1.5-3 hours after a meal and during the night
Melena is more common
Pain relieved by ingestion of food.

Question 22

What is dumping syndrome?

Answer 22

the rapid emptying of the gastric contents into the small intestine that occurs following gastric resection

Question 23

What would present on assesment of dumping syndrome?

Answer 23

symptoms occuring 30 mins after eating 
N&V 
Feelings of abdominal fullness and abdominal cramping 
diarrhea 
palpitations and tachycardia 
Perspiration 
Weakness and dizziness 
Borborygmi

Question 24

What are complications of Cirrhosis?

Answer 24

Portal hypertension
Ascites 
Bleeding of esophageal varices 
coagulation defects 
Jaundice 
Portal systemic encephalopathy 
hepatorenal syndrome

Question 25

What interventions are applicable for the patient with cirrhosis ?

Answer 25

1. Elevate HOB to minimize shortness of breath
2. if ascites and edema are absent and the client does not exhibit signs of impending coma, a high-protein diet supplemented with vitamins is prescribed
3. provide supplemental vitamins (B complex, A, C, K, folic acid, and thiamine)
4. Restrict sodium intake and fluid intake
5. Initiate enteral feedings or parenteral nutrition as prescribed
6. Administer diuretics as prescribed to treat ascites
7. Monitor intake and output, and electrolytes
8. Weigh client and measure abdominal girth daily.
9. Monitor LOC
10. Monitor for asterixis
11. Monitor for fetor hepaticus, fruity, musty, breath odour.
12. Maintain gastric intubation to assess bleeding
13. Administer blood products as prescribed
14. Monitor coagulation
15. Adminster antacids
16. Administer lactulose for ammonia excretion
17. Antiobiotics to decrease production of ammonia
18. avoid opioids
19. Instruct client to avoid alcohol
20. prepare for paracentesis to remove abdominal fluid
21. Prepare for surgical shunting to divert fluid from ascites to venous system.