Wk1 Flashcards
Name the different sphincters
Upper oesophageal Lower oesophageal Pyloric Ileocecal Anal
Layers of gastrointestinal tract
Mucosa: simple columnar, has direct contact with food, scattered goblet cells secrete mucous for lube, lamina propria is connective tissue that provides capillaries for epithelial layer, muscularis mucosa is smooth muscle that provides muscular activity
Submucosa: connective tissue contains large blood vessels, nerves and secretary glands
Muscularis: 2 sub layers, inner layer around GI tract, outer aligned alongside GI tract
Serosa: outer layer of connective tissue, contains and supports GI tract
Enteric nervous system
Controls GI tract and digestive function
Sub mucosal plexus: sub mucosal layer, localised functions - blood flow, absorption and secretion from GIT to blood
Myenteric plexus: located between circular and longitudinal muscular areas
Sphlanchnic blood flow
Provides blood to oesophagus, stomach, intestines, liver, gallbladder, pancreas and spleen
These salivary glands include:
Submandibular
Sublingual
Parotid
Describe the process of deglutition
Swallowing
Saliva contain enzyme (amylase) which breaks down carbohydrates.
Relaxation of the stomach is facilitated by gastrin and cholecystokinin (polypeptide hormones secreted by GI mucosa)
Gastrin
Stimulus: presence of partially digested proteins in stomach
Action: stimulates HCL secretion and pepsinogen
Histamine
Stimulus: gastrin
Action: stimulates acid secretion
Acetylcholine
Stimulus: vagus and nerves in stomach
Action: increase GI motility
Motilin
Stimulus: presence of fat and acid in duodenum
Action: increase GI motility
Secretin
Stimulus: presence of chime in duodenum
Action: stimulates pancreas and liver, decreases motility and decreases gastrin and gastric acid secretion
Cholecystokinin
Stimulus: chime in duodenum
Action: stimulates gall bladder and pancreas, decreases GI motility, inhibits gastrin, constricts pyloric sphincter
Pancreatic polypeptide
Stimulus: protein, fat and glucose in small intestine
Action: decreases pancreatic bicarbonate and enzyme secretion
Vasoactive intestinal peptide
Stimulus: intestinal mucosa and muscle
Action: relaxes intestinal smooth muscle
Glycogenolysis
Breakdown of glycogen
What are parietal cells used for
Release stomach acid
What is Glycogenolysis
Breakdown of glycogen stores to release glucose
What is Gluconeogenosis
Glycogen stores have been used, liver can convert amino acids and glycerol (proteins) to glucose
What is gastro reflux
Backward movement of gastric content to oesophagus
Weak lower oesophageal sphincter
Over production of acid
Inflames and causes cellular damage to oesophagus where acid has burned
Symptoms and nursing management of gastro reflux
Heart burn 30-60mins after a meal Painful to swallow Burning in chest Burping Nausea Mimic angina Causes stricture: scar tissue Oedema, muscular spasm
NC Positioning: sit up, avoid bending Small meals Weight loss Antacids Histamine 2 receptor agonists Proton pump inhibitors PPI
What is gastritis
Inflammation of gastric mucosa, local irritants such as alcohol, drugs, bacterial endotoxins, aspirin
May be severe
What is chronic gastritis
Chronic changes to gastric mucosa
H.pylori
Autoimmune
Chemical: alkaline reflux from duodenum
What is peptic ulcer disease
20% gastric
80% duodenum
Most caused by h.pylori
Aspirin and other NSAIDS
Stress - physiologic - burns
H.pylori produces enzymes and toxins which interfere with the mucosal protection against injury from gastric acid
Can penetrate mucosal lining, smooth muscle or perforate outer wall
Healing results in scarring - predisposes site to another ulcer
Signs and symptoms of PUD and treatment
Burning, cramps, bleeding (coffee ground appearance if vomited), pain when stomach is empty, pain relieved by food or antacids temporarily, malemia: black tar from intestinal tract
Treatment: test: endoscopy, radiological studies (anaemia, faecal occult blood), antibiotics (h.pylori), antacids (relieve symptoms), heal ulcer crater, complications: haemorrhage, obstruction, perforation
What is crohns disease
Recurrent inflammatory disease of sub-mucosal layer of GI tract
Mainly proximal colon and terminal ileum
Cause Unknown
Diagnosed by X-Ray, sigmoidoscopy, colonoscopy, complications include fistula formation, abdominal abscess, bowel obstruction
S&S of crohns and treatment
S&S: colicky pain, weight loss, malaise, low fever, diarrhoea, Perianal skin ulceration
Tx: decrease inflammatory response with an anti inflammatory (corticosteroids), antibiotics for bacterial infection, pain relief, nutritional support, surgical resection of damaged bowel, rest bowel with temporary stoma
What is ulcerative colitis
Inflammatory condition of colon. Mainly rectum and sigmoid colon (large bowel)
Affects continuous layer of bowel
Lesions forms in mucosal layer which may become necrotic or ulcerated
S&S of ulcerative colitis and treatment
S&S: stools contain blood, anorexia, anaemia, cramping, exacerbation and remission, Perianal skin breakdown
Tx: anti inflammatory drugs (corticosteroids), immunosuppressant drugs if severe (cyclosporine), surgery to remove bowel
Nursing management of ulcerative colitis
Obs Pain relief and meds Skin care - stoma site, Perianal care Support and reassurance Education
What is irritable bowel syndrome
Functional GI disorder (no physical changes to gastric wall)
No specific structural alterations as cause of disease
Altered bowel habits
Treatment includes: laxatives, antidiarrhoeals, low dose antidepressants, anti spasmodics
Colorectal cancer
Begin as benign polyps Present for a long time before symptoms Change in bowel habits Foetal occult blood test Barium studies Colonoscopy, sigmoidoscopy
Treatment for colorectal cancer
Polyp removal Surgery Temporary colostomy Permanent colostomy Postop chemo Regular examination Colonoscopy
What is diverticulitis
Diverticula becomes inflamed. Causes lower quadrant abdo pain, fever, increased white cell count, cramping, nausea, diarrhoea
Diverticula: pouches within bowel wall
What is appendicitis
Inflammation and infection of appendix, fever, pain, nausea and vomiting, CT ultrasound to confirm, antibiotics or removal
What is bowel obstruction
Impaired movement of bowel contents
Mechanical: hernias, adhesions, tumours, strictures, volvolus(twisting of bowel), intussusception (bowel fold back)
Paralytic: impaired peristalsis, peritonitis, intestinal ischaemia
S&S and nursing a management of bowel obstruction
Abdo pain and distension, constipation, anorexia,
History and examination, abdo X-ray, CT and ultrasound, NGT, IV hydration, surgery
Signs and symptoms of liver cirrhosis
Impaired protein synthesis Impaired fat metabolism Impaired bile synthesis Impaired carb metabolism Impaired steroid hormone and drug metabolism
What is liver cirrhosis
Liver tissue damage by toxins that is replaced by fibrous tissue. Disrupts flow within vascular and biliary channels
Weight loss, jaundice, pain as liver enlarges, anorexia
Late S&S: splenomegaly, ascites, portal hypertension, liver failure,
What is hepatitis
Inflammation of liver
Caused by viruses (a,b,c,d and e) a.b.d are preventable, auto immune disorder, reaction to drugs and toxins, secondary to other infections
Malaise,joint pain, anorexia, nausea and vomiting, jaundice, right side abdo pain
What is pancreatitis
Inflammation of pancreas
Pain in upper abdo
Fever
Diabetes
