Week 7 180

Mouth, salivary glands, esophagus, and stomach

Small intestine, large intestine, and rectum

Liver, pancreas, and gall bladder

-Upper sphincter prevents food from entering the airway and air from entering the digestive tract
-Lower sphincter protects esophagus from gastric acids
-Innervated by the vagus nerve (cranial nerve 10)

Longest part of the intestine, where digestion takes place
-Consists of three sections: duodenum, jejunum, ileum

-Section of small intestine immediately after the stomach
-Foods mix with bile from the liver and digestive enzymes from the pancreas (chemical digestion)

-Section of the small intestine after the duodenum
-Highly vascular; food is churned, mucosal lining completes additional digestion, nutrient and water absorption occurs

-Last and longest portion of the small intestine
-Slower movement, less blood flow, waste is moved toward the large intestine

-Remaining water is absorbed as well as electrolytes
-Produces vitamins B and K

Holds feces until defecation

-Makes and secretes bile
-Removes waste and toxins from the blood

-Secretes digestive enzymes (exocrine)
-Produces insulin and glucagon (endocrine)

Stores bile from the liver

Gastroesophageal reflux disease
-AKA heartburn; acid travels from the stomach into the esophagus and damages the esophageal lining
-Can be acute or chronic

-Diet (fat, spice, citrus)
-Excessive caffeine
-Obesity
-Smoking and alcohol use
-NSAIDs or aspirin
-Gastritis
-Pregnancy
-Often seen with patients who also have hiatal hernias and high stress levels

Chronic damage to the esophagus can lead to Barrett's esophagus, esophageal strictures, and cancer

-Manifestations occurring four to five times per week on a consistent basis are considered diagnostic
-Esophagogastroduodenoscopy (EGD)
-Barium swallow

-Diagnostic procedure for GERD
-Allows for visualization of the esophagus and gastric lining with a camera
-Ensure patient's ability to swallow returns following the procedure

-Procedure that allows for visualization of the esophagus with an x-ray
-Ensure patients void all barium post-procedure to avoid impaction

-Diet and lifestyle modification
-Avoid foods that cause reflux
-Avoid large meals, carbonated beverages, eating before bed
-Remain upright after eating
-Consume four to six small meals throughout the day
-Avoid clothing that is tight-fitting around the abdomen
-Lose weight, if applicable
-Elevate the head of the bed (semi to high fowler's)
-Avoid lifting heavy objects
-Walk daily
-Stop smoking

-Used to treat GERD when other treatments fail
-Procedure where the fundus of the stomach is wrapped around and behind the esophagus to create a physical barrier

-Elevate the head of the bed to promote lung expansion after surgery
-Reinforce the abdomen with a pillow during movement and minimize coughing to prevent straining sutures
-Patients should avoid carbonated beverages and heavy lifting
-Patients may experience temporary dysphagia, difficulty burping, and abdominal distention

-Proton-pump inhibitors (PPIs) - pantoprazole, omeprazole
-Antacids
-Histamine 2 receptor antagonists - famotidine (pepcid)
-Prokinetics - metoclopramide (reglan)

Examples: Pantoprazole, omeprazole (end in 'ozole')
-Reduces gastric acid by inhibiting cellular pumps that produce gastric acid

Examples: Pantoprazole, omeprazole (end in 'ozole')
-Safety not established in breastfeeding or children less than one month old
-Administer whole before meals; DO NOT CRUSH; capsules may be opened and sprinkled on applesauce
-Teach patient to monitor for black, tarry stools, diarrhea, and abdominal pain
-Long-term use is related to pneumonia and c.diff infections, increased risk of fractures, and electrolyte imbalances
-Do not treat diarrhea before notifying provider

Examples: aluminum hydroxide (gaviscon), magnesium hydroxide (maalox), calcium carbonate (tums), and sodium bicarbonate (baking soda)
-Neutralizes excess stomach acid

Examples: aluminum hydroxide (gaviscon), magnesium hydroxide (maalox), calcium carbonate (tums), and sodium bicarbonate (baking soda)
-Ensure there are no contraindications with other medications (levothyroxine)
-Evaluate kidney function in clients taking magnesium hydroxide
-Take when acid secretion is highest: 1-3 hours after eating and/or at bedtime
-Separate from other medications by at least one hour

Examples: famotidine (pepcid) (end in 'idine')
-Reduces the secretion of acid by inhibiting histamine at the gastric parietal cells

Examples: famotidine (pepcid) (end in 'idine')
-Onset is longer than antacids, but so is duration
-Increased fetal risk if used during pregnancy
-Take with meals or at bedtime
-Take one hour before or after antacids
-Not suggested for patients with kidney disease

Examples: Metoclopramide (reglan)
-Increases the mobility of the esophagus and stomach

Examples: Metoclopramide (reglan)
-Monitor for restlessness, difficulty speaking or swallowing, involuntary muscle contractures or facial movements (extrapyramidal symptoms)
-Side effects may occur weeks to months after therapy begins
-Side effects are more common in pregnant and lactating people, pediatric and geriatric populations

When the lower esophageal sphincter is above the diaphragm instead of below leading to poor sphincter control

Complaints will vary depending on the type, but all symptoms are typically worse following a meal
-Sliding: Heartburn, reflux, chest pain, dysphagia, belching
-Paraesophageal: fullness after eating, sense of breathlessness/suffocation, chest pain, worsening of manifestations when reclining

-Barium swallow
-Esophagastroduodenoscopy (EGD)
-CT Scan of the chest with contrast

-Check for iodine/shellfish allergy
-Encourage fluids to avoid kidney injury
-Monitor BUN and creatinine

Medications: PPI, antacids
Procedures: fundoplication

-Volvulus: twisting of the esophagus and/or stomach
-Obstruction: blockage of food in the herniated portion of the stomach
-Strangulation: compression of the blood vessels to the herniated portion of the stomach
-Anemia: resulting from bleeding into the gastric mucosa due to obstruction

-Acute illness: pancreatic enzymes activate within the pancreas causing inflammation and autodigestion
-Chronic illness: progressive inflammation and fibrosis of the pancreas
--Chronic calcifying (alcohol use disorder)
--Chronic obstructive (cholelithiasis)
--Autoimmune
--Idiopathic
--Hereditary

-Alcohol use (primary cause)
-Gallstones
-GI surgery and diagnostic procedures
-Hyperlipidemia, hyperparathyroidism, hypercalcemia
-Kidney failure or transplant
-Genetic predispositioin
-Trauma
-Penetrating ulcer (gastric or duodenal
-Medication toxicity
-Coxsackievirus B and HIV
-Smoking

-Pain due to pancreatitis may be intermittent or chronic and is often very severe
-People can experience intense stabbing upper abdominal pain that extends to the back
-Patients with pancreatitis likely to experience upper abdominal pain after food or when lying down
-Nausea, vomiting, anorexia
-Epigastric pain
-Diarrhea, oily stools
-Pyrexia and tachycardia
-Abdominal tenderness and distention
-Grey-turners and cullens and/or bruising on the flanks
-Tetany due to hypocalcemia (Trousseau's and Chvostek's)

-Serum amylase: increases within 24 hours and remains increased for 2 to 3 days (continued elevation can indicate pancreatic abscess or pseudocyst)
-Blood lipase: increases slowly and can remain increased for days longer than amylase
-WBC count: increased due to infection and inflammation
-Platelets: decreased
-Blood calcium and magnesium: decreased due to fat necrosis and pancreatitis
-Blood liver enzymes and bilirubin: increased with associated biliary dysfunction
-Blood glucose: increased due to a decrease in insulin production by the pancreas
-Erythrocyte sedimentation rate: elevated

-Pain medicine
-Pancreatic enzyme supplements with every meal
-Insulin, if diabetes develops
-Vitamin supplements, if needed
-Substance-related support groups
-Avoid high-fat and heavy meals

-NG tube
-Fasting
-IV fluids
-Pain medicines

-Pain relief: NSAIDs, Opioid analgesics
-Decrease gastric acid: Histamine receptor antagonists, proton pump inhibitors
-Pancrelipase

Examples: ketorolac, toradol
-Inhibits prostaglandin synthesis

-Do not take for more than 5 days
-Enters breast milk in small amounts, do not use after 20 weeks gestation
-Increased risk of GI bleed in older adults
-Increased risk of hypersensitivity in patients with asthma

Examples: morphine, hydromorphone
-Binds to opiate receptors in the central nervous system

Examples: morphine, hydromorphone
-High alert medication
-Avoid chronic use during pregnancy and lactation, infants less than three months
-Risk for respiratory depression, constipation
-Increased risk of severe reactions in patients takine MAOIs

Supplies lipolytic, amylolytic, and proteolytic enzymes to increase the digestion of fats, carbohydrates, and proteins in the GI tract

-Low risk in pregnant and lactating patients
-Ensure capsules are swallowed whole; do not crush tablets
-Ensure capsules are taken with a full glass of water to ensure they are thoroughly swallowed
-Administer immediately before or with meals
-Report abdominal pain or distention, vomiting, and constipation to the provider

-No abnormal physical findings on colonoscopy
-Associated with dysbiosis and altered brain-gut communication
-Diagnosis of exclusion
-Abdominal pain and altered bowel habits (constipation, diarrhea)

-Physical changes to colon observed on colonoscopy
-Elevated levels of calprotectin, lactoferrin, CRP
-Blood in stool possible
-Abdominal pain and altered bowel habits (constipation, diarrhea)

-Abdominal pain, cramping or bloating that is related to passing a bowel movement
-Changes in appearance of bowel movement
-Changes in how often you are having bowel movements
-Weight loss
-Diarrhea at night
-Rectal bleeding
-Iron deficiency anemia
-Unexplained vomiting
-Pain that isn't relieved by passing gas or a bowel movement

Ulcerative colitis and Chron's disease
-Diarrhea
-Fatigue
-Abdominal pain and cramping
-Blood in your stool
-Reduced appetite
-Unintended weight loss

Unknown, but issues with muscle contractions and nerve conductivity in the intestine, infection, changes in gut microbiome, and exposure to stress in early life may play a role

-Triggers: food allergy/intolerance or stress
-Risk factors: <50 years old, female, family history, anxiety, depression, mental health disorders

Inflammation and ulcers that can occur along the entire GI tract; 'skip lesions'

Inflammation in the lining and deeper layers of the colon and rectum

-Cause: Unknown; autoimmune condition is suspected, along with heredity
-Risk factors: <30 or 50-60 years old, family history, smoking, use of NSAIDs

-Colonoscopy
-CT scan images of the abdomen and pelvis that might rule out other causes of symptoms, especially belly pain
-Upper endoscopy to visualize esophagus, sampling of tissue and fluid
-Barium enema
-Food intolerance tests
-Breath tests for bacterial overgrowth
-Stool tests

-Crohn's=RLQ pain relieved with defecation
-Colitis=LLQ pain relieved with defecation

-Promote rest
-Decrease stressors (physical stress and food triggers)
-Nutritional support
--High protein and calorie, low fiber diet
--Avoid caffeine, alcohol, lactose
--Monitor for fluid and electrolyte imbalance; hypokalemia
--May require NPO status for TPN
--Weekly weight
-Treat symptoms
--Medications
--Notify provider if manifestations of obstruction or perforation occur

-Anti-inflammatories: sulfasalazine, mesalamine, balsalazide
-Corticosteroids: Prednisone, hydrocortisone, budesonide
-Immunosuppressants and immunomodulators: cyclosporin, methotrexate, adalimumab, infliximab
-Anti-diarrheal: diphenoxylate and atropine (lomotil), loperamide

Anti-inflammatory for IBD
-Acts in the colon, suspected activity inhibition of prostaglandin synthesis
-Contraindicated in patients with allergies to sulfa antibiotids or salycylates, pregnancy, lactation
-Monitor CBC and diff, liver and kidney function before and during therapy
-Patients should consume at least 2 L of fluid daily
-Can cause yellow-orange discoloration of skin and body fluids
-Avoid sun exposure

Anti-inflammatory for IBD
-Monitor for kidney toxicity, side effects less severe
-Contraindicated in patients with allergies to sulfa or salicylates

Examples: prednisone, hydrocortisone, budesonide
-Used to achieve remission for IBD
-Avoid long-term use
-Take oral doses with food
-Monitor patient bp, change doses slowly, monitor blood sugar and electrolytes
-Increased risk of infection; avoid crowds and illness exposures

Examples: cyclosporin, methotrexate
-Exact action is unknown
-Can take 6 months to achieve results
-Used as a last-line treatment due to toxicity
-High risk for acquiring infection

Examples: adalimumab, infliximab
-Suppresses the immune response and inhibits tumor necrosis factor (antibody in crohn's disease)
-Large amount of adverse side effects possible
-Monitor liver enzymes, blood count, coagulation during treatment

Examples: diphenoxylate and atropine (lomotil), loperamide
-Inhibits GI motility
-Decrease risk of fluid volume deficit and increase comfort

Examples: diphenoxylate and atropine (lomotil), loperamide
-Can lead to toxic megacolon (massive dilation of the colon)
-Lomotil is structurally similar to opioids but has no pain-relief properties
-Older adults may be more sensitive to effects, safety not established in pregnancy, lactation, or children under 12

The formation of pouches or pockets in the wall of the colon

When the pouches of diverticulosis become inflamed or infected

-Acute onset of pain in abdominal LLQ
-Nausea and vomiting
-Diarrhea or constipation
-Abdominal distention
-Fever

-Diagnostic imaging and labs are similar to crohn's and ulcerative colitis
-Chronic management is done at home
--take meds as ordered
--low fiber diet, NPO during flares
--Drink plenty of fluids
--Rest frequently
--Avoid laxatives and enemas

Examples: ciprofloxacin, metronidazole, sulfamethoxazole-trimethoprim
-Used to treat infection
-Monitor hepatic and renal function
-Can cause thrush, yeast infections
-Have an awareness of individual function, risks, and associated nursing actions for individual antimicrobial medications

Surgery
-Surgical repair of fistulas
-Surgical widening of strictures
-Colectomy (colon resection) with or without ostomy

-Distended intestinal veins
-Caused by increased intra-abdominal pressure from: straining, increased body weight, or prolonged sitting or standing

-Bright red blood in stool
-Pain, irritation, or itching at the anus
-Swelling or a hard lump around the anus

-Warm water bath soaks
-Ice packs to reduce swelling
-Increased intake of fiber and fluids to soften the stool

Corticosteroid suppositories (hydrocortisone)
-Act topically to reduce inflammation
-Can cause adrenal suppression in long-term therapy
-Do not use on broken skin
-Do not use with occlusive dressings

-Rubber band ligation
-Sclerotherapy
-Electrical coagulation
-Hemorrhoidectomy

Refers to intractable vomiting during pregnancy leading to weight loss and volume depletion, resulting in ketonuria and/or ketonemia

-Increased placental mass in the setting of a molar or multiple gestations
-Women who experience nausea and vomiting outside of pregnancy due to the consumption of estrogen-containing medications, exposure to motion, or having a history of migraines are at a higher risk of experiencing nausea and vomiting during pregnancy

Average onset of symptoms happens approximately 5 to 6 weeks into gestation

Non-pharmacologic interventions such as switching the patient's prenatal vitamins to folic acid supplementation only, ginger supplementation as needed, and applying acupressure wristbands

Combination of vitamin B6 (pyridoxine) and doxylamine

-Antihistamines and dopamine antagonists
-Metoclopramide, odansetron, or promethazine

Group of rare conditions when abnormal cells (tumors) grow in the uterus during the early stages of pregnancy

The onset of nausea and vomiting after nine weeks can be signs of preeclampsia, HELLP, and acute fatty liver of pregnancy

-Severe cases can lead to vitamin deficiency, dehydration, and malnutrition, if not treated appropriately.
-Wernicke's encephalopathy caused by vitamin B1 deficiency, can lead to death and permanent disability if left untreated
-Secondary injuries due to forceful and frequent vomiting (esophageal rupture and pneumothorax)
-Electrolyte abnormalities can also cause significant morbidity and mortality

-No association between hyperemesis and perinatal or neonatal mortality has been found

Daily intake of a multivitamin with folic acid at least one month prior to conception not only reduces the risk of congenital anomalies such as neural tube defects but has also been associated with reduced frequency and severity of nausea and vomiting in pregnancy

An acute inflammatory process involving the appendix

Appendicitis

An obstruction of the appendix, either from inflammation of the wall or a fecalith (hard stools)

Hard stool

Calcified deposits in the appendix

-Retrocecal appendix can present with back pain or flank pain
-Pelvic appendix can present with suprapubic pain
-Long appendix can present as right upper quadrant or left lower quadrant pain
-Rebound tenderness
-Rovsing's, psoas, or obturator signs

Palpation of the left lower quadrant increases pain feld in the right lower quadrant
-A sign of appendicitis

The presence of pain experienced upon extending hip
-Indicative of a retrocaecal appendix

Pain experienced upon internal and external rotation of the flexed hip

Redness and swelling (inflammation) of the lining of the abdomen (peritoneum)
-Often caused by an infection from a hole in the bowel or a burst appendix

-Mild to severe abdominal pain and sensitivity to touch
-Swollen, distended abdomen
-Dehydration
-Paralytic ileus
-Fever
-Nausea and vomiting
-Tachycardia
-Shortness of breath

Fluid collects in the abdominal cavity

-Mild cognitive impairment (from hepatic encephalopathy)
-Fatigue and malaise
-Swollen legs and feet (edema)
-Easy bruising and bleeding (thrombocytopenia)
-Abdominal swelling and rapid weight gain

-WBC: can be elevated or normal
-Urinalysis: can be normal or abnormal

-Ultrasound: thickened, non-compressible appendix greater than 6mm
-CT of abdomen and pelvis
-MRI if ultrasound is inconclusive

-NPO
-IV administration of isotonic crystalloid fluid
-Antibiotic prophylaxis
-Surgery (appendectomy)

-Perforation
-Shock
-Pelvic abscess
-Wound infection
-Bowel obstruction

The process by which food is mechanically and chemically broken down into tiny, simple particles

Chewing

-Acidic substance containing mostly water with tiny amounts of proteins, mucins, enxymes, and electrolytes
-Assists with the digestion process

Amylase, protease, and lipase

-Digestive enzyme found in saliva and the small intestine
-Assists in the destruction of starches, polysaccharides, and complex carbohydrates

-Digestive enzyme that breaks down proteins and polypeptides

-Digestive enzyme that aids in the digestion and absorption of dietary fats

An enzyme that is released in the stomach that is responsible for the breakdown of proteins. It is activated when acid levels are high in the stomach.

Glands in the pancreas that secrete enzymes for digestion and comprise 85% of the composition of the organ

-Breaks down red blood cells
-Regulates the chemical makeup of the blood
-Produces and detoxifies hormones
-Helps absorb vitamins
-Deactivates toxins
-Produces bile
-Produces proteins and cholesterol
-Controls metabolic processes

Cecum, ascending colon, transverse colon, descending colon, and sigmoid colon

Vitamin B12

A fungal infection of the oral cavity that presents as raised, white patches

A circular, reddened lesion that most often presents with a white, gray, or yellowish center, and is commonly known as a canker sore
-Cause is not fully understood, but there is a link between several different bacterial species

Including gingivitis and tooth decay, is a detrimental inflammatory gum condition that is caused by the invasion of harmful pathogens, particularly gram-negative anaerobic bacteria

Characterized by an abnormal change in the tissues that line the distal esophagus demonstrating precancerous changes linked to the chronic inflammation attributed to GERRD

The chronic and underlying destruction of the alveolar bone, causing tooth loss

Reddened or puffy gums that may bleed easily after brushing or flossing
-May experience bad breath that does not go away due to the build-up of plaque

Yes, with aggressive, high-quality oral care hygiene

-Swollen, bleeding gums that cause soreness in the mouth
-Receding gums that can take on a dark red or even purplish appearance
-Tooth sensitivity, persistent bad breath, formation of pus pockets within the gums, and loose or separating teeth can also occur

-Preventing the spread of contagious oral disorders, such as avoidance of oral sexual contact with active mouth lesions from oral HSV-1
-Good oral hygiene: replace toothbrush at least every three months, soft bristled toothbrush, disinfect dentures frequently (clean dentures and soak them overnight); and rinse their mouth with water after using a corticosteroid inhaler or spacer

-Headache
-Diarrhea
-Constipation
-Abdominal pain
-Flatulence
-Risk for hypocalcemia and hypomagnesemia

Reduces the intermittent relaxation of the lower esophageal sphincter that causes GERD manifestations

-May cause drowsiness, dizziness, and constipation
-Alcohol may increase the dizziness and drowsiness
-Increase dietary fiber

Painful swallowing

Epigastric pain

A bacterial infection that attacks the lining of the stomach and duodenum that may cause inflammation, pain, and ulcers to develop

-More advanced and concerning variety that occurs when a greater portion of the stomach, a part of the esophagus, or perhaps the intestines have migrated up into the chest cavity through the hiatus

Hidden or microscopic bleeding that is not visible to the naked eye. Typically detected through laboratory tests such as the fecal occult blood test or urine occult blood tests.

A condition where part or all of a lung collapses, leading to a decrease in gas exchange

-Sometimes referred to as gastropathy
-Affects the movement of the muscles of the stomach due to neurological dysfunction
-Chronic disorder that results in the delay or even absence of gastric emptying

-Often can occur along with a diagnosis of type 2 diabetes and is a potential side effect of long-term use of some anti-depressant medications and overuse of opioids

Inflammation of the inner tissue lining of the stomach that causes the integrity of the gastric mucosal lining to become compromised and exposed to viral, fungal, and bacterial, such as H. pylori infections
-Can be acute or chronic

Open sores that occur in the inner lining of the stomach
-Often referred to as peptic ulcers

-Abdominal pain described as a burning or gnawing sensation noted most frequently after meals or at night
-Weight loss
-Nausea
-Vomiting
-Feeling bloated
-Early satiety
*Monitor for signs of bleeding and infection as they are at high risk for perforation

-Inflammation of the liver

Late-stage condition that presents with advanced fibrosis or scarring of the liver

Neurological condition that causes changes in level of consciousness such as confusion or lethargy and develops when the liver is unable to remove toxins from the blood

-Most common type of hepatitis caused by hepatitis viruses A, B, C, D, and E
-Depending on type, risk factors may include unprotected sex, AUD, and sharing of dirty needles

Metabolic dysfunction-associated steatotic liver disease
-A chronic liver condition characterized by excessive fat accumulation in the liver that can lead to inflammation and damage

-Hep A and E: infected food or water
-Hep C: blood only
-Hep B and D: any bodily fluids

Acute or chronic inflammation of the gallbladder

-Calculous: caused by obstruction that may prevent bile from being expelled (most common)
-Acalculous: sudden inflammation of the gallbladder without the presence of gallstones **LIFE THREATENING due to risk of perforation and necrosis (less common; occurs more often in critically ill clients)

Gallbladder removal surgery

-Occurs when client has not had a bowel movement for over five days or more
-Manifestations include: vomiting, dehydration, malnutrition, pain, diarrhea and/or seepage of liquid stool

Bowel perforation and sepsis

A digital rectal examination to determine the presence of stool in the rectum

Digital removal of stool

Exposure to sunlight or other ultraviolight light

Can cause spiderlike veins or spider angioma

A white or reddish patch on the inside of the mouth

Establish IV access because the client will need urgent hydration and IV pain relief