metabolize carbs, proteins, fats, steroids and detox of drugs/toxins
formation of bile and cholesterol/excrete bile
storage of glucose as glycogen, vitamins, fatty acids, minerals and amino acids
breakdown of old RBC's, WBC's, bacteria, Hgb to bilirubin
Function of the gallbladder
to concentrate and store bile
2 functions of pancreas
exocrine-secretion of pancreatic enzymes to aid in the process of digestion
endocrine-secretion of insulin from the beta cells and secrete glucagon from the alpha cells
What can antibiotics do to the digestive tract?
mess with the normal flora causing diarrhea
What causes GERD?
reflux of gastric contents into the esophagus
Predisposing conditions for GERD
Impaired esophageal clearance in to stomach
Impaired gastric emptying (gastric paresis)
With GERD what refluxes into the lower esophagus?
Intestinal proteolytic enzymes
Primary factor in GERD is....
Incompetent Lower Esophageal Sphincter
stomach contents move from high pressure in the stomach to a lower pressure in the esophagus thru a weak sphincter
Who is at high risk for having GERD?
Pt. with DM
they have internal neuropathies which creates a problem with gastric emptying
Clinical Manifestations of GERD
When do you need to get heartburn (pyrosis) evaluated?
when it is happening more than once/week
increase in severity
occurs at night
wakes you up from sleep
How do you relieve indigestion (dyspepsia)?
How do differentiate between angina and GERD?
GERD is relieved by antacids
Complications of GERD
Chronic Esophigitis may lead to...
Barrett's esophagus can lead to....
With GERD the gastric secretions can irritate the upper airways causing....
How do you dx GERD?
*Based on symptoms and symptom relief with medications and behavioral changes
What will a Barium Swallow show?
if you have a HH....
What will an Endoscopy show?
it is a direct visualization showing any incompetency with the LES
You can do a biopsy with Endoscopy. What will it differentiate?
Lifestyle modifications for GERD and HH
avoid triggers that cause reflux
reduce intra-abdominal pressure by decreasing weight
Foods to avoid if you have GERD and HH
If you have GERD....key things to know when eating.
small frequent meals with fluid in between
avoid late meals
don't lay down after eating
Proton Pump Inhibitors (2)
How do they work?
Protonix and Prilosec
blocks production of acid in the stomach
What is the problem with Protonix and Prilosec?
it changes the pH in the GI tract, we are are seeing a high incidence of c-diff
H2R blockers (2)
How do they work?
Pepcid or Zantac
blocks histamine from entering the stomach
How does it work?
increases motility in the GI tract promoting gastric emptying and reducing the risk of gastric acid reflux
GI Protectant (1)
How does it work?
Covers the ulcer to protect from gastric acids with food ingestion
When do you take Carafate and Reglan?
30 minutes prior to eating
How do antacids work?
When should they be taken?
Neutralizes the HCL acid for mild to intermediate heartburn (not effective with severe heartburn)
take 1-3 hours after meals and at bedtime
When do you have surgery when you have GERD?
when you have complications from it like Esophagitis, Barrett's, Strictures
Laparoscopic anti-reflux procedure
wraps the fundus of the stomach around the lower portion of the esophagus, thereby enhancing the integrity of the LES so gastric reflux is reduced.
After a person has fundoplication when can they start eating again?
NPO till peristalsis return and slowly increasing diet, starting with fluids to solids
What's Hiatal Hernia (HH)?
when a portion of the stomach herniates through an opening in the diaphragm
What causes a HH?
weakened muscles in the diaphragm
situations that increase intra-abdominal pressure
What are some situations that increase intra-abdominal pressure?
intense physical exertion
continual heavy lifting-job
Clinical manifestations of HH
When a person has a HH what will irritate it?
ingestion of large meals
Complications of HH
Hemorrhage from erosion
Stenosis (narrowing of the esophagus)
Ulceration in herniated portion of stomach
How do you dx HH?
Surgical Therapy for HH
closure of the HH defect in the diaphragm by pushing the herniated piece below the diaphragm and attaching it to something so it doesn't pop back out (gastropexy)
attaching a piece of intestine to something so it doesn't pop back out and cause another HH
What stimulates us to vomit?
Anorexia usually accompanies....
Vomiting causes Metabolic
Diarrhea causes Metabollic
What is a potential complication of N/V....especially in a person who is elderly or unconscious?
If you have vomit that smells like feces with bile....what is going on?
intestinal obstruction below the pyloric valve.
If you have feces in the vomit without bile what is the problem?
an obstruction below the ampulla of vater
If a person has dark red or coffee ground emesis, this is a sign of....
HCL turns the blood dark brown
What does bright red blood mean?
active bleeding ulcer
Interventions for N/V
IV fluids for hydration and electrolytes
NGT for decompression
Teach ways to prevent N/V
Why do you monitor VS with a person who has N/V?
you are looking for hypotension and hypovolemia
Who shouldn't take Scopolamine transdermal for N/V?
Pt. with glaucoma
pyloric or bladder neck obstruction
cuz they decrease motility of the GI and GU tract=
can't eat, see pee, spit or poop
Who cant have antihistamines?
Persons with glaucoma
cuz of the 3D's
Why would a person with N/V be given Reglan?
cuz it increases GI motility-gastric emptying
thereby decreasing n/v related to distention
If you get n/v from migraines and anxiety what meds would you take (3)
cuz they work on the vomit ctr and enhance gastric emptying and block n/v
What medication for n/v will make you super sedated?
What med is used in the OR to relieve post op nausea?
Common anti nausea meds (4)
If a person has persistent vomiting....what will I probably have to do?
insert a NG tube to decompress the stomach
What do you eat when you have n/v?
room temp uncarbonated drinks
liquid btwn meals
Which sort of gastritis causing bleeding?
acute causes bleeding
chronic causes pernicious anemia
What causes gastritis?
a breakdown in the normal gastric mucosal barrier allowing HCl acid to diffuse back into the mucosa resulting in edema and disruption of capillary walls resulting in bleeding
inflammation in the lining of the stomach
What causes gastritis?
general abdominal discomfort, idegestion
Sign of erosive gastritis
black tarry stools
coffee ground emesis
Symptoms of acute gastritis
sense of fullness
pain high up in the abdomen
How does chronic gastritis cause pernicious anemia?
chronic inflammation causes the result of loss acid secreting cells and intrinsic factors. The loss of intrinsic factors impairs absorption of V. B12 and results in cobalamin deficiency once the liver stores are depleted. Pernicious Anemia
5 Diagnostic studies for gastritis
Hx of drug and alcohol use
Endoscopy for definitive dx
Biopsy for H pylori
CBC if chronic gastritis....anemia
Stool sample for occult blood
Interventions for acute gastritis
Same as n/v
frequent checks of VS
treatment of n/v (npo, clear liquids....)
Why are there VS checks for a person with acute gastritis?
What does trouble look like?
they are likely to hemorrhage
Drug therapy for gastritis is aimed at.....
examples of meds used
reducing gastric acid secretion and provide symptomatic relief
Interventions for chronic gastritis
focuses on eliminating the specific cause (alcohol, drugs, H pylori)
screen for stomach cancer
Drug therapy for gastritis
v. B12 shots
Nutritional therapy for a person with gastritis
six small meals a day
no irritating foods
antacids after each meal
Who's more likely to get a gastric ulcer?
women and old people
Risk factors for getting a gastric ulcer
Who's most likely to get a duodenal ulcer?
person 35-45 years old
Risk factors for getting a duodenal ulcer
H pylori (most common cause)
What causes a peptic ulcer?
erosion of the GI mucosa from HCl and pepsin
Where will you see peptic ulcers?
2 things that increase a persons risk for peptic ulcer disease? PUD
What 3 things will delay the healing of an ulcer?
Clinical manifestations of gastric ulcers
dyspepsia in the epigastric area 1-2 hrs after meals
Clinical manifestations of duodenal ulcers
burning/cramping feeling in the mid epigastric region below the xiphoid process or the posterior aspect of the duodenum
occus 2-5 hours after a meal
these manifest for a few weeks or months...subside and return later
Complications for gastric and duodenal ulcers
Gastric outlet obstruction
Which type of ulcer causes more Upper GI bleeds?
Most common complication for ulcers
What can happen if you have a perforation from an ulcer?
it is lethal....
the ulcer can penetrate the serosal surface, spilling gastric or duodenal contents in to the peritoneal cavity
Interventions for ulcers
take meds with foods
NPO with acute exacerbation
IV fluid replacement
Assess for sudden abdominal pain
Signs of bowel perforation
rigid board abdomen
decreased or absent bowel sounds
What do you do for a person with a perforated bowel?
NG tube for decompression to minimize contents in to peritoneal cavity
How do you treat gastric outlet obstruction?
decompression with an NG tube with suction to allow the stomach to rest and regain normal muscle tone as well as allowing the ulcer to heal.
Sign a person with an NG tube can start eating again
if aspirate is less than 200mL after 8-12 hours
Drug therapy for Ulcers
Nutritional therapy for ulcers
eliminate aggravating foods
small frequent meals
avoid alcohol and smoking
Partial gastrectomy for ulcers
removal of part of the stomach and anastomosis to duodenum
Vagotomy for ulcers
partial or complete severing of vagus nerve
Pyloroplasty for ulcers
enlargement of the pyloric sphincter
Complications for partial gastrectomy
bile reflux gastritis
S/S of dumping syndrome
15-30 min after eating dizzy
audible bowel sounds and sudden urge to defecate
What's postprandial hypoglycemia?
caused by dumping syndrome when a bolus of carbs is dumped into the intestines causing hyperglycemia which results in increased insulin secretion causing a secondary hypoglycemia with symptoms