Notes stolen from Teanu Tamayo NCM MIDTERMS

Metabolism Administer pts for side and adverse effects

Provide health teachings
Sum of an organisms chemical reaction
Property of life DISORDERS OF UPPER GIT
Involve interactions between molecules within cells
1. GERD (gastroesophageal reflux disease)
2 Metabolic Pathways
The backflow or regurgitation of gastric contents into esophagus
1. Catabolism breaking down of complex molecules brought about by inappropriate relaxation or weakening of LES
into simpler substances releasing energy (lower esophageal sphincter) (open sphincter) >esophagitis
Ex. Fatty acids, amino acids, glucose
2. Anabolism synthesis from simpler to complex 2. Achalasia
molecules by consuming energy
Absence of esophageal peristalsis and impaired relaxation of
Hypoxemia -> develop lactic acidosis -> metabolic acidosis LES (does not relax) in response to swallowing which can cause
obstruction and regurgitation > dilates the esophagus and
General functions of Gastrointestinal tract heightens Pressure > bad peristalsis > regurgitation >
esophagitis
1. Motility
Causes
Ingestion
Mastication Esophageal nerve degeneration
Deglution/swallowing Chagas disease (parasitic infection)
Peristalsis & segmentation Esophageal cancer

2. Secretion (endocrine and exocrine) 3. Hiatal Hernia

Exocrine: water hydrochloric acid, Condition in which part of the stomach bulges up above the
bicarbonate(pancreas), digestive juices diaphragm into the chest cavity/thoracic. May weaken the LES
Endocrine: stomach and small intestines Hormones of the esophagus which can lead to regurgitation

Major FXN Causes

3. Digestion High pressure of the stomach

4. Absorption
5. Storage and elimination I sliding II paraethophagyeal hernia III mix (I&II) IV severe
6. Immune barrier
Injury to the area
Layers of GI tract Inborn large hiatus
Intense and persistence pressure muscles (coughing,
-a-*notes from agullana heavy lifting straining on bowel movement, vomiting)

Medical Management 4.*

Medications 5. Esophageal Varix/varices

1. Antibacterial Extremely dilated sub-mucosal veins in the lower third of the

2. Antiviral esophagus of and a consequence of portal hypotension due to
3. Antifungal liver disease. Dilated veins (hypertension) can rupture and lead
4. Corticosteroid (tapering) to bleeding.
5. Mucosal Protective
6. Analgesics Cause by Liver cirrhosis
7. Vitamins (B12, C)
Lot of scar liver (fibrotic)
Maintaining Integrity of the oral Mucosa
6. Mallory-Weiss Syndrome MWS
Instruct the client to brush and floss his teeth and
massage his gums several times daily Condition marked by a tear in the mucous membrane or inner
lining where the esophagus meets the stomach.
Advise the client to use gauze or a sponge toothette to
clean the mucosa when pain prevents the use of a
Causes
toothbrush
Recommend the use of water, saline, or a dilute 1. Forceful vomiting or retching
instead of toothpaste or mouthwash. 2. Intense coughing
Health education on importance of oral hygiene and 3. Heavy lifting
dental check-up 4. trauma to chest/ abdomen
5. Prolonged severe hiccups liver disease
Promote adequate food and fluid intake 6. Liver disease
7. GERD
Advise the client to eat a bland diet
Suggest that the client consume lukewarm or cold food 7. Borehaave syndrome
and fluids
Transmural perforation of the esophagus (spontaneous rupture)
Administer medications as Prescribed
Same causes of Mallory-weiss
Notes stolen from Teanu Tamayo NCM MIDTERMS
Assessment: esophageal Disorders: Gradual progression of diet upon resumption of GI
function
1. Dysphagia Avoid carbonated drinks, gas forming and high fat die
2. Odynophagia chewing gum and drinking using straw post-surgery
3. Hematemesis
4. Chronic sore throat 3. Carryout Psychosocial assessment
5. Chronic cough
6. Sour taste 4. Continuous monitoring for complications
7. Halitosis
8. Chest pressure/pain Document and report
9. Symptoms associated with shock due to bleeding
10. heartburn POST SURGICAL COMPLICATION

Medical and Surgical management 1. Dysphagia due to too tight or too long fundoplication
2. Torsion of abdominal esophagus due to poor spatial
1. Proton pump inhibitors (omeprazole, lansoprazole) positioning of fundoplication
before meals stimulate acid production 3. Gastric volvulus
4. Fibrosis (scar tissue formation)
2. laparoscopic fundoplication 5. Wound infection
6. Tension pneumothorax
A new valve is constructed as the upper portion of the stomach
(fundus) is wrapped around the lower end of the esophagus. 1. Pyloric Stenosis
The wrap is intended to support the sphincter muscle so that it
will open only when it is supposed to and not allow stomach acid Also known as infantile hypertrophic pyloric stenosis (IHPS) is
to push its way up into the esophagus. the most common cause of intestinal obstruction in infancy

3. LINX procedure
A permanent, drug free treatment for GERD that consists of a
small band of magnetized titanium beads wrapped around the
Lower esophagus LES located at the base of
3. endoscopic therapy (to inject botulinum toxin A)
improves esophageal emptying in achalasia
5. pneumatic dilation dilates narrowed esophageal
sphincter in achalasia
A gastric obstruction brought about by any disease process that
produces mechanical impediment to gastric emptying
3ps palpable mass projectile vomiting peristalsis visible
Patho
Obstruction > vomiting as cardinal symptoms > poor calorie
intake and weight loss > malnutrition > fluid and electrolyte
imbalance >gastric dilatation and decreased contractility >
aspiration pneumonia

6. Laparoscopic esophagomyotomy Ex. Hyponatremia shrinking cells, bad cardiac

Surgical disruption of muscles at LES to decrease resting
pressure to release and relax the muscle > opening the LES >
lowering the pressure of achalasia
7. use of Ca blocker and nitrates
To decrease lower esophageal pressure by relaxing LES
Cause hiatal hernia also have to manage pylorus via
pyloryplasty
Nursing Management Esophageal Disorders
1. Teach the client to avoid factors that increase lower
esophageal irritation
Eat a low fat, high fiber diet
Avoid irritants, such as spicy or acidic foods, alcohol,
caffeine and tobacco because they increase gastric
acid production.
Avoid food or drink 2 hours before bedtime or lying
down after eating
Elevate the head of the bead on 6 to 8 bocks
Lose weight if necessary
Administer medications as prescribed and monitor for
side adverse effects
Develop post-operative teaching plan (prioritize
respiratory care; due to anesthesia; hypoxemia)
St segment (t atrial) the time it starts contraction till start of
relaxation (potassium imbalance)
Hypocalcemia hyperirritable, tremors, voxtex trousseau
MEDICAL AND SURGICAL MANAGEMENT
1. Fluid and electrolyte replacement
2. Pyloromyotomy - cutting through the outside later of the
thickened pylorus muscle (preferred)
3. Atropine treatment (causes contraction of smooth
muscles in small doses and in large relaxation)
4. Endoscopic balloon dilatation (balloon could be
displaced)
2. Gastritis
Causes Helicobacter pylori
MEDICAL AND SURGICAL MANAGEMENT
1. Medication to eliminate H. Pylori
2. Medication to block gastric acid production and
promote healing of ulcer (proton pump inhibitors H2
receptor antagonists, antacids)
3. Medication to protect mucosal lining of stomach and
intestine
3. Peptic Ulcer disease

2. Ensure nutritional care A break in the lining of the stomach first part of the small
intestine or occasionally the lower esophagus
When to begin oral intake (TPN-hypertonic; cellular
dehydration) An ulcer in the stomach is known as a gastric ulcer while that in
the first art the intestine is known as a duodenal cancer and
Notes stolen from Teanu Tamayo NCM MIDTERMS
sometimes esophagus Nutritional status
Duodenum relieved by eating Tissue perfusion
Gastric leads to cancer more
If there is inflammation > fluid shifting > lowers circulating
Duodenal hyper acid secretion fluid

Gastric hypo/ normal 3. Medication administration and checking for adverse effects

MEDICAL AND SURGICAL MANAGEMENT 4. Perioperative Nursing consideration

1. Medication to eliminate H. Pylori 5. Assessment of patients concerns

2. Medication to block gastric acid production and
promote healing of ulcer (proton pump inhibitors H2 6. Psychoeducation: stress management
receptor antagonists, antacids)
3. Medication to protect mucosal lining of stomach and 4. Zollinger Ellison Syndrome
intestine
Rare condition in which one or more tumors form in your
SURGERY FOR PUD pancreas of the upper part of your small intestine (duo) these
tumors called gastrinomas secrete large amounts of the
1. Vagatomy cutting one or more of the nerves to hormone gastrin which causes your stomach to produce too
stomach (stops the board by denervate by stopping much acid resulting in peptic ulcer disease.
acid release)
2 categories: truncal vagatomy (complete) stop parietal DISORDER OF THE LOWER GIT
cells to release acid.
INTESTINAL DISORDERS
Selective (total gastric)
Proximal (highly selective parietal cell)
1. Celiac Disease
2. Pyloroplasty widening the gastric outlet (pylorus) goal
to widen pylorus (gluten-sensitive enteropathy)
3. Gastrectomy removing part of the stomach that is
severely uclcerated Sometimes called sprue or coeliac is an immune reaction
Kinds: wedge gastrectomy, central, proximal (inflame) to eating gluten a protein found in wheat barley and
Distal, subtotal, total rye.

Types of Gastric Surgery 1. Celiac disease patho

1. Billroth I gastroduodenostomy 1. autoimmune response

2. Billroth II gastrojejunostomy 2. damage to small intestine
3. diarrhea and fluid and electrolyte loss
Complications of Gastrectomy 4. malabsorption
5. anemia (due to malab)
1. Wound infection
6. weight loss and fatigue
2. Leaking from where the stomach has been closed or
reattached to the small intestine 2. Inflammatory Bowel Disease
3. Stricture where stomach acid leaks up in to your
oesophagus and over time causes causing, leading to 1. Crohns diseases
the oesophagus
4. Becoming narrow and constricted Small intestine, and large intestine; skip lesions
5. Chest infection internal bleeding
6. Blockage of the small intestine Crohns disease affect all the layers of the bowel wall. Affects
7. Malnutrition and anemia any part of the GIT from the mouth to the anus. Usually affects
8. Hepato-biliary injury the end of the small intestine and the beginning of the large
9. Dumping syndrome (rapid gastric emptying) WOF: intestine.
diarrhea, dehydration, hypoglycemia
2. Ulcerative Colitis
NURSING MANAGEMENT
Descending colon to Sigmoid to rectum; lesions are continuous;
1. Health medication: Lifestyle remedies more prone to malignancy

Healthy diet Ulcerative Colitits: affects only the inner lining of the large
Consider food with probiotics intestine and usually the descending, sigmoid colon and rectum.
Control stress
*pathophysio
Smoking cessation (emphasize and find out what
makes them smoke) TREATMENT OF UL CERATIVE COLITIS AND
Avoid alcohol CROHNS
Switch pain killers (dont always change)
Eliminate milk (further stimulates gastric acid C
production) Control diarrhea
Adequate sleep (for recovery of immune system) Control inflammation
R
2. Monitoring and preventing complications relieve pain
Restore fluid
Pain
A
Fluid and electrolyte
Notes stolen from Teanu Tamayo NCM MIDTERMS
Anticholinergics Disorders of the Small intestine
Antibiotics
M 4. Irritable bowel syndrome
Meals correct
A functional disorder causing the nerves and muscles of the
nutritional deficiencies
large intestine to be oversensitive, leading to symptoms such as
P cramps, bloating, flatulence, diarrhea and constipation.
psychological counseling
S Causing/triggers of IBS
support emotionally/coping
1. Food allergens and irritants (caffeine, alcohol, fatty or
diverticulum is a saclike herniation of the lining of the bowel that fried)
extends through a defect in the muscle layer. Diverticula may 2. Psychological stress
occur anywhere in the small intestine or colon but most 3. GIT infection
commonly occur in the sigmoid colon 4. Digestion problems

3. Diverticular Disease MANAGEMENT OF IRRITABLE BOWEL SYNDROME

1. Diverticulosis - Small bulging pouching in the 1.Relief of symptoms:

digestive tract due to high pressure in the colon from
muscle spasm or stool straining Anti-diarrheal (lomotil, loperamid, )
Laxative (lactulose; direct-directly affects peristalisis
Causes chronic constipation; too much strain; bulk forming laxative)
Bile acid binding agents (cholestyramine
2. Diverticulitis - Involves the inflammation and infection
ASSIGNMENT) (helps by removing bile acids which
of diverticula lowers cholesterol level in the blood)
Antispasmodics (buscopan)
Predisposing factors
Anti-depressant (Zoloft)
1. Age - Weaker wall of large intestine and pressure of hard Anti-anxiety (diazepam)
stools passing through intestines
2. Lifestyle Modification
2. Diet and lifestyle low-fiber, smoking obesity chronic
constipation long term use of NSAIDs Fiber supplementation
Avoidance of caffeine
3. Genetics judicious water intake
gluten free diet
What are assessment finding to distinguish diverticulosis form intake of probiotics
diverticulitis
3. Psychological therapy and long term monitoring
SYMPTOMS
psychoeducation on stress management
1. Alternating diarrhea and constipation cognitive behavioral therapy
2. Painful cramps or tenderness on lower abdomen
3. chills and fever causes

Critical thinking: s/s

1. Should a ^fiber diet be considered? nsg problems intervetions

Diver yes litis no (inflam)Assg. Soluble and insol fiber
2. Can laxatives and enemas be given in this case? Same psychoeducation
as above
3. What are complications arising from diverticulitis? OBSTRUCTION care of patients with colonoscopy
Fluid&Electrolyte dec > cardiac problems; neuro
problems Dellusion false belief

Soluble gel-like; absorbs water; for diarrhea; bulk forming Hallucination perceive something in the absence of a stimulus

Read peritonitits > septicemia Illusion stimulus but wrong interpretation

and IBD

MEDICAL AND SURGICAL MANAGEMENT: DIVERTICULAR

DISEASE

1. Antibiotic therapy and clear liquid diet

2. Intravenous fluid therapy
3. Emergency colectomy
4. Resection of affected bowel
5. Percutaneous drainage of abscess
6. Pain management