Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
107 Cards in this Set
- Front
- Back
|
Mouth-chem digestion
|
1)salivary amylase AKA ptyalin
- secreted by salivary glands=(carbs) inactivated by stomach acids 2)lingual lipase -secreted by tongue=(fats) -activated by stomach acids |
|
|
Mastication
|
Chewing= beginning of digestion
|
|
|
Reflux Salivation
|
Triggered by eating, chewing, smell, or taste
|
|
|
Epiglottis
|
Seals off the larynx=swallowing or pharynx=breathing
|
|
|
Pharynx
|
Throat (skeletal muscle)
1) nasopharynx –F only in respiration 2) oropharynx 3) laryngopharynx *second two F w/respiration and digestion |
|
|
Esophagus
|
Between the spine and the trachea
Upper portion is skeletal muscle this transforms into smooth on the way down -UES=upper esophageal sphincter AKA hypopharyngeal sphincter stops/allows food to pass into esophagus -LES=lower esophageal sphincter AKA gastroesophageal or CARDIAC sphincter allows food to pass into stomach -Reglan=increases tone -Nicotine= decreases tone |
|
|
(Diaphragmatic??)
Esophageal hiatus |
where the esophagus passes thru the diaphragm
|
|
|
inlet to stomach
|
Gastroesophageal junction
|
|
|
stomach capacity
|
1500mL takes about an hour to empty
|
|
|
Regions of the stomach
|
1) cardia (entrance)-cardiac sphincter AKA lower esophageal sphincter
2) fundus 3) body 4) pyloris (exit) a) pyloric antrum (top)= contains G cells that secrete gastrin into blood stream b) pyloric canal (bottom) *-pyloric sphincter –controls flow to duodenum |
|
|
Folds within the stomach
|
Rugae
|
|
|
stomach curvatures
|
1)greater curvature =convex side/ 2) lesser curvature =concave
|
|
|
Gastric exocrine glands and the secretions
|
1) mucous neck cells
a) alkaline mucus that coats/protects stomach wall 2) chief cells a) pepsinogen (protein) inactive until converted to pepsin by HCL or pepsin best in pH (2) inactivated by higher ph b) gastric lipase – (fat)-limited role in adults, used for milk fats , best in pH 5-6 3) parietal cells a) intrinsic factor=needed for B12 absorption used for erythropoiesis b) hydrochloric acid= breaks down food and kills bacteria (pH 1-5) *ALL of THESE= gastric juice |
|
|
HCL secretion by parietal cells stimulated by
|
1) acetylcholine (released by parasympathetic neurons) stimulated by………….
Sight, smell, chewing, stomach distention 2) Gastrin (released by G cells in stomach) stimulated by……………… stomach distention (increases gastric juices, constricts upper sphincter, relaxes lower sphincter ) 4) histamine enhances effect of acetylcholine and gastrin on parietal cells =increasing HCL production (works on H2 receptor) |
|
|
Chyme
|
Liquid moved through plyloric sphincter = gastric emptying
|
|
|
Parts of the sm intestine
And secretions *major function is ABSORPTION -magnessium, phosphate, and potassium absorbed throughout |
1) duodenum
-Secretin-secreted by duodenum when pH of chyme in duodenum is <4-5 stomach= inhibits gastric secretion pancreas= increases production of bicarbonate rich juice -cholecystokinin-secreteion stimulated by fat in the duodenum gallbladder= release bile into duodenum pancreas= increased production of enzyme rich pancreatic secretions stomach= kinda inhibits gastric secretion 2) jejunum-ABSORPTION begins here (active transport/diffusion) absorbs-fats, proteins, crabs, Na, and chloride 3) ileum- absorbs- Vitamin B12 and bile salts 4) terminates at ileocecal valve =controls flow to ascending colon |
|
|
Prenicous anemia
|
Intrinsic factor not secreted/combined w/vit B12 to be absorbed by ileum
|
|
|
Accessory organs that make Duodenum secretions
|
1) pancreas
secretions have alkaline pH neutralizes stomach acids when entering duodenum -trypsin= protein - amylase= starch - lipase = fats 2) liver a) bile= fat emulsification 3) gallbladder –stores bile 4) glands in intestinal wall |
|
|
Function of ileocecal valve
|
Controls flow from ileum to cecal portion of lrg intestine and prevents bacteria from lrg intestine moving upward (reflux)
|
|
|
Vermiform appendix
|
Attached to cecum , looks like a little worm , has no function
|
|
|
Common bile duct
|
-empties into duodenum through ampulla of Vater
-for bile and pancreatic juices |
|
|
Parts of large intestines
*major function is absorption of WATER and ELECTROLYTES |
1) ascending colon (right side)
-final absorption takes place but it is only MINOR 2) transverse colon 3) descending (left side) also sigmoid colon 4) rectum 5) anus -internal sphincter (involuntary) autonomic system -external sphincter (voluntary)- cerebral cortex |
|
|
Colon secretions
|
1)electrolyte solution=bicarbonate
-neutralizes the end product of the bacterial breakdown 2) mucus -protects the mucosa and provides adherence for the fecal mass |
|
|
Sympathetic nerves GI
|
Inhibitory effect on GI tract=
-decreases gastric secretion and motility -constriction of sphincters and blood vessels |
|
|
Parasympathetic nerves GI
|
- increases gastric secretion and motility/parastalsis
- dilation of sphincters except those under voluntary control -upper esophagus and external anal sphincter |
|
|
% of blood supply to GI
(% of cardiac output) |
Is 20% but will INCREASE during digestion especially with large meals
this can cause a drop in BP after a large meal |
|
|
Portal Venous system
|
1) superioror mesenteric
2) inferior mesenteric 3) gastric 4) splenic 5) cystic veins *eventually form the vena portae that enters the liver after traveling thru hepatic veins in terminates into INFERIOR VENA CAVA |
|
|
stenssen’s duct
|
( parotid gland)=red dot in buccal mucosa near upper molars
|
|
|
vallate papillae
|
“V” form on distal portion of dorsum of tongue
|
|
|
frenulum
|
superficial veins under tongue for size, color, pain
• common area for oral cancer- as white/red plaque, ulcer, warty growth |
|
|
GI assessment
|
1) empty bladder
2) stenssen’s duct 3) vallate papillae and frenulum 4) pt supine w/knees flexed -inspection, auscultation, palpation, percussion of abdomen *lesions=many GI disorders produce skin changes 6) abdomen contour =flat, round, scaphiod 7) bowel sounds w/diagphragm of scope normal=q5-20 seconds/ hypo 1-2/min/ hyper 5-6/30 seconds/ absent=none 3-5min 8) bell os scope= bruits in aortic, renal, iliac, femoral arteries 9) friction rubs= high-pitched over the liver/spleen 10) Borborygmi = stomach growling 11) light palpation=tenderness, muscular resistance/ deep= masses *rebound tenderness testing is PAINUL so use LIGHT percussion 12) rectal exam -knee-chest/ L lateral w/hips and knees flexed/ standing hips flexed *R side w/knees up to the chest 13) pilondial area 14) bear down =fistulas, fissures, prolapse, polyps, hemorrhoids 15) finger in while bearing down=anal tone |
|
|
Pilondial cyst
|
-rashes, tenderness, inflammation, cysts, hair, dimpling, scars, etc could indicate it
|
|
|
CEA
(serum) |
-carcinoembryonic antigen
-indicates CANCER is present , also for stage and prognosis (esp GI, colorectal) |
|
|
CA19-9 (serum)
|
-tumor marker, “shed” by cancer cells
-often elevated w/advanced pancreatic cancer -also colorectal/lung/bladder cancer, gallstones, pancreatitis, cystic fibrosis, liver dz |
|
|
FOBT
used most often for contraindicated in what to avoid before test |
Fecal Occult Blood Testing
-used most often in early cancer detection -Hemoccult II- is the most common type used -contraindicated if hemorrhoidal bleeding -avoid red meat, aspirin, NSAIDs, turnips, horseradish for 72h B4 to avoid false + -avoid XS vitamin C to avoid a false (-) |
|
|
Hydrogen Breath Test
|
*hydrogen produced by contact of galactose and fermenting bacteria in colon
-evaluates carbohydrate absorption -dx of bacterial overgrowth in intestine -dx of short bowel syndrome |
|
|
Urea breath test
|
*detects presence of Helicobacter pyori AKA H. pylori
(the bacteria can live in mucosal lining os stomach and cause peptic ulcer dz) -pt ingests capsule of carbon-labeled urea -H.pylori metabolizes urea quickly and the carbon is absorbed fast -the carbon can be measured as cardon dioxide in expired breath 10-20 minutes later AVOID -antibiotics or lopermide (Pepto Bismol) for 1 month before test -sucralfate (Carafate) and omeprazole (Prilosec) for 1 week before test -cimetidine (Tagamet), famotidine (Pepcid), ranitidine (Zantac) for 24h before test *H. pylori can also be detected assessing serum antibody levels) |
|
|
Abdominal Ultrasonography
EUS can the pt eat? |
-sound waves transmitted to body and ultrasonic echos are recorded by oscilloscope
-cannot transmit through bone, gas, fluid, or air = USED FOR TISSUES --------------------------------------- Endoscopic Ultrasonography -higher quality resolution BOTH?? -NPO for 8-12 hours before test to decrease gas in bowel -if gallbladder study= pt should eat a fat-free meal the night before the test -barium studies should be performed AFTER as they can interfere w/transmission |
|
|
Stool Color
|
-brown-normal =breakdown of bile
-white/clay= absent/decreased bile -clay= reduced stomach acid -stetarhhea= malabsorption, especially fat/ floats/ greasy -tarry black (melena)= upper GI bleed -red/streaking= lower GI bleed |
|
|
Dyspepsia
s/s what foods seem to be worst |
AKA indigestion-upper abdominal discomfort associated w/ eating
-pain, discomfort, fullness, bloating, early satiety, belching, heartburn, regurgitation -most common symptom w/GI dysfunction -fatty foods cause most problems=hardest to digest/remain in stomach the longest -salads/coarse veggies/ seasoned foods may also cause issues |
|
|
Chancre
early sign of? |
-reddened circumscribed lesion-ulcerates- then crusts
-early sign of syphilis |
|
|
Actinic Cheilitis
|
-on LIPS
-overexposure to UV radiation -scaling, crusty, fissures, hyperkeratosis (overgrowth of horny layer of epidermis) -premalignant squamous cell carcinoma |
|
|
N/V causes
|
1)visceral afferent stimulation
2)CNS disorders 3)Irritation of chemoreceptor zone 4)Odor, activity, medications, food |
|
|
Leukoplakia
Hairy Leukoplakia |
-white patches, usually painless, seen in buccal mucosa
-seen w/tobacco use -------------------------------------------------------------------------------------------- -same patches but w/hair like projection, often seen on side of tongue -viral, tabacoo use, often seen w/HIV * BOTH= seek MD attention if not healed w/n 2 weeks IN MOUTH |
|
|
Candidiasis
causes and tx |
AKA moniliasis/ THRUSH
-cheesy white plaque that comes off leaving an erytheamatous base -caused by Candida Albicans -more common in diabetics, w/use of steroids or antibiotics TX: Antifungal like nystatin (Mycostatin) *if suspension is used=swish for 1min and swallow |
|
|
Aphthous stomatitis
|
AKA Canker Sore
-burning/tingling-ulcer w/white/yellow center and red border -often inner cheek/tongue, lasting 7-10 days w/no scar |
|
|
Gingivitis
Necrotizing gingivitis (trench mouth) Periodontitis |
-redness, swelling, bleeding in response to light pressure
-d/t poor hygiene, puberty, pregnancy -------------------------------------- -gray-white pseudomembranous ulcerations all up in the mouth -nasty breath, painful talking and swallowing d/t poor hygiene, stress, strep. Pneumonia, meningitis, malaria *BOTH=-TX hydrogen peroxide mouthwash/ penicillin --------------------------------------- -may result from untreated gingivitis -no pain at onset then receding/bleeding gums, loose teeth, bone resorption, pus |
|
|
Malocclusion
|
Upper and lower teeth do not come together
-inherited or d/t thumb sucking, trauma, etc TX: braces then a retainer best started after last primary tooth erupts |
|
|
Caries
what causes them? |
-tooth enamel is the hardest substance in body
-acids from fermentable carbs cause erosion -saliva acts to neutralize these acids -if you can’t brush pt teeth then wipe w/gauze followed by antiseptic mouthwash |
|
|
Cancers of oropharynx
prognosis causes most common type |
-cancers in ANY part of mouth or throat are curable if discovered early
-combination of alcohol and tobacco =synergistic carcinogenic effect -usually squamous cell types -s/s painless sore or mass that does not heal (after 2-3wks) *hemiglossectomy= removal of ½ tongue *total glossectomy= removal of all tongue --------------------------------------- *radial forearm free flap= skin from arm used to repair neck –crazy NR: assess pt ability to communicate in writing b4 sx , Doppler for pulse, TPN |
|
|
Allen Test
|
-tests to see if ulnar artery is patent to supply blood to hand
- radial may be removed or unusable 1) ask pt to make a fist and then manually compress ulnar artery 2) ask pt to open hand in relaxed position =the palm is pale 3) Pressure is released= should flush in 3-5 seconds |
|
|
Xerostomia
|
(radiation, meds, HIV, mouth breathers, etc)
-avoid dry bulky, irritating foods/fluids -humidifier when sleeping -synthetic saliva (moisturizing antibacterial gel) like Oral Balance -saliva production stimulant like Salagen AKA dry mouth |
|
|
Chyle Fistula
dx and tx |
-milk-like drainage from thoracic duct into thoracic cavity
DX: 3% fat content and specific gravity of 1.012 or more TX: 500mL or less=pressure, increased medium chain fatty acids |
|
|
most common symptom of esophageal dz
|
-difficulty swallowing/dysphagia
|
|
|
Odynophagia
|
Acute pain on swallowing
|
|
|
Pyrosis
|
AKA heartburn –faulty UES
|
|
|
Neck dissection-d/t malignancies
Radical neck dissection Modified radical Selective Complications Interventions |
Removal of all nodes, sternocleidomastoid muscle, internal jugular vein, and spinal accessory muscle on 1 side of neck
Complications: shoulder drop, poor cosmesis (visible neck depression) ------------------------------------- Preserves one or more of the nonlymphatic structures-used more often --------------------------------------- Preserves 1+ lymph node groups, sternocleidomastoid muscle, internal jugular vein, and spinal accessory nerve --------------------------------------- -hemorrhage , chyle fistula, nerve injury (dysphagia, facial dropping) -------------------------------------- -Fowler’s position=airway -assess for stridor over trachea frequently -coughing, deep breathing -protect suture lines during suctioning -avoid oral temperature -humidified oxygen -Jackson-Pratt -80-120ml of serosanguineous secretions in 1st 24hrs (more than that may in |
|
|
Waterbrash
|
-regurgitating gastric juices (bitter taste)
-faulty LES if chronic |
|
|
Achalasia
|
-hypoactivity disorder, LES fails to dilate during swallowing
-feels like “it gets stuck”, pain, dysphagia, regurgitation DX: deformed/ballooned esophagus/ manometry is definitive TX: -calcium chanel blockers, antacids, Botox –temporary -pneumatic dilation to stretch narrowed areas –may cause GERD |
|
|
Hiatal Hernia
types |
AKA hiatus or hiatal
-opening in diaphragm where esophagus passes gets enlarged and organ protrudes 1) direct/sliding=stomach slides up thru the ring into thoracic cavity LES compromised=pain and GERD -loose wt, same teaching as w/heartburn 2) paraesophageal/rolling =fundus herniates beside esophagus sense of fullness, chest pain after eating, NO REFLUX may need ER SX d/t strangulation |
|
|
esophageal Diverticulum
s/s and tx |
-outpouching of esophagus
-food may get stuck in it =halitosis and a sour taste -s/s fullness, belching, reflux, gurgling noises after eating TX: sx, must have X-ray BEFORE any fluids/food given |
|
|
Gastroesophageal reflux dz AKA GERD
dx, tx, nursing stuff |
-reflux into esophagus
s/s pyrosis, dyspepsia, reflux, may mimic heart attack symptoms dx: Ambulatory 12-36hr pH monitoring or Bilitec to measure bilirubin tx: antacids/H2 receptor agonists/ proton pump inhibitors –increase bacteria prokinetic agents=accelerate gastric emptying sx:Nissen fundoplication=wraps some of fundus around sphincter -low fat diet -avoid:caffeine, tobacco, alcohol, carbonated drinks, tight clothing -maintain a normal wt -remain elevated 1-2 hrs after ingestion, elevate HOB slightly @ night |
|
|
Barrett’s Esophagus
|
-altered lining of esophagus
-becomes like lining of stomach -HGD (high-grade dysplasia)-sqaumous cells turn into columnar epithelium -EGD= lining is red not pink -d/t untreated GERD, may cause cancer |
|
|
Esophageal cancer
|
1) adenocarcinoma or 2) squamous cell carcinoma
–intermittent and increasing dysphagia, persistant hiccups SX: pieces can be replaced -NG tube placed DO NOT MANIPULATE, often on low intermittent suction -aspiration is a huge concern , avoid chest physiotherapy -NPO until X-ray confirmation, can eat after a barium swallow -drainage from cervical neck wound=early sign of esophageal leak -risk of A-fib d/t vagal= nerve stimulation -avoid BOOST/ENSURE d/t dumping syndrome |
|
|
Dumping Syndrome
|
-vagal nerve disruption causes stomach to empty too fast
s/s stomach crampind, liquid BM, diaphoresis, tachycardia, tachypnea |
|
|
Scleraderma
|
-autoimmune dz –WOMEN MOSTLY
-results in hardening of ALL tissues, death from renal failure -1st s/s is dysphagia -“bird beak”, hard skin |
|
|
Sengstaken-Blakemore
|
NG tube used to tx bleeding esophageal varices
-rubber / x3 lumen |
|
|
How long can an NG tube stay in
|
4 weeks
|
|
|
Levin
|
-NG TUBE
-plastic or rubber/ x1 lumen -attached to low suction (30-40mmHg) -circular markings on tube for guidelines |
|
|
Gastric sump
AKA Salem Moss (NG) |
-rubber/ x2 (gastric) x3 (salem)
-radioopaque -inner lumen AKA blue port allows for low (25mmHg) suction) -maintain blue vent lumen above pt waist -20mL of air into pigtail???? |
|
|
Enteric Tubes
|
-smaller bore = use 30mL syringe or greater
-into intestines to provide nutrition -tungsten-weighted tip, radiopaque, stylet, 24hrs to reach sweet spot |
|
|
NG tube placement assessment
|
-X-ray
-measure length of tube and document, assess qshift -gastric juice=cloudy green, tan, white, brown (1-5) -intestinal juice= yellow or green (6+) -respiratory aspirate= 7+ -asculatate after 20mL push over xiphiod process -tape nose (skin prep) change x3 days, and pin to gown -assess placement qshift if continuous or b4 administering anything -irrigate q 4-6 hrs -flush w/30mL b4 and after medications -HOB at 30-45 degrees -residual gastric volume before feeding or q4-8 hrs (continuous) 200mL or less or ½ of hourly rate -change feeding tubes q24hrs/ hang 4hrs of formula at a time ( avoid temp extremes) -document amount, color, type drainage q 4-8 hrs -label lumens if more than 1 -mouth, nose care -I+O , report negative balance -monitor BUN and creatinine -pause cuction for 30min post medication administration -pause suction/decompression tube for a trail period b4 removal -flush w/10mL of water b4 removal -mark canister with tape @ end of shift (s |
|
|
Parenteral Nutrition
|
-always given by a pump
-in a central line if greater than 10% dextrose (d/t intima irriation) -may switch to isotonic dextrose before d/c completely |
|
|
TPN
|
-stored in light protected container-to prevent amino acid breakdown
-often start w/D10W to acclimate pt to high sugar -pt must then be tx as a DIABETIC ( diuresis= check I+0) -again must use pump -do not stop abruptly=shock -can maintain life forever |
|
|
how fast to administer bolus feedings
|
300-500mL over 10-15 minutes
|
|
|
Caffeine and nicotine effect on stomach secretions
|
Caffeine = CNS stim increases pepsin
Nicotine=reduces pancreatic bicarbonate |
|
|
Gastritis
|
-inflammation of gastric mucosa
-secretes less acid and more mucus -could also be over/under prod. of HCL -scarring can cause pyloric stenosis ACUTE -often foods, bile, NSAIDs, aspirin -ingestion of strong acid or base -will often go away in a day -don't eat or drink alcohol for a min -base tx w/vinegar or lemon juice -acid tx w/antacids CHRONIC- -may also be d/t meds -stomach ulcers or Heliobacter pylori BOTH -avoid caffeine and nicotine -maintain hydration -monitor electrolytes |
|
|
types of peptic ulcers
|
-gastric
-duodenal -esophageal (think GERD) |
|
|
Duodenal Ulcers
|
-often too much acid
-alcohol and tabacco may cause -higher in blood type O -stress/anxiety may cause -obstruction is common -rarely malignant -pain-food-relief pattern -night pain common -often well nourished |
|
|
Gastric ulcers
|
-much more common in men
-disruption of barrier HCL often low/WNL -alcohol, tobacco, bile reflux may cause -obstruction is rare -pain-food-relief or food-pain pattern -night pain NOT common -anorexia, wt loss IS common |
|
|
Stress ulcers
|
-r/t severe stress,trauma,burns, head injury
-head injury=hypersecretion of HCL -alcohol, aspirin -often many diffuse erosions -risk for complications/ DEATH -perforation is common -may NOT have s/s until severe |
|
|
s/s of perforation of ulcer
|
sudden onset pain in upper abdomen w/rigidity
IT IS AN ER |
|
|
Constipation
|
-infrequency or hardening of stool
-fewer than 3 a week -Rome criteria to make it techi -chronic is 12+ wks in last 12 months -can cause HTN, hemmoroids, fissures -straning =Valsalva maneuver -stops venous flow to the chest -A and V get less blood -decreased cardiac output -increased pressure after release -this rebound effect can be fatal -HTN can rupture vessels/arteries |
|
|
Diarrhea
|
-increased frequency 3+/day
-increased amount or loss conc -acute=most often infetion 7-14days -chronic=more than 2 weeks -watery=most often sm bowels -loose=most often lrg bowels -oil droplets=often pancreatic insufficiency -nocturnal=often diabetic neuropathy TYPES: -secretory=high volume d/t infection -osmotic=water pulled into colon -malabsorptive=malnutrition -infectious=most often C.diff -exudative=change in mucosa ALWAYS consider C.diff if pt has or is taking antibiotics MONITOR for hypokalemia -encourage fluids and bed rest -avoid caffeine, carbonated drinks -avoid milk products, fruits/veg -eat bland semi to solid foods |
|
|
tenesmus
|
ineffective straining during BM
|
|
|
IBS
|
-irritable bowel syndrome
-disorder of intestinal motility -segments are affected others not -primary s/s=altered elimination -pain after eating relieved w/BM -may try food restriction/reintroduction |
|
|
Malabsorption
|
hallmarks:
-diarhhea or frequent loose, bulky, foul-smelling stools, with increased fat content, often grayish -also malnutrition, wt loss, etc -hydrogen breath test to evaluate carbohydrate absorption |
|
|
Appendicitis
|
-most common age 10-30
-becomes occluded w/feces/etc -periumbilical pain that becomes localized at RLQ -McBurney's Point=rebound tenderness -Rovsing's sing=pain felt in RLQ when LLQ is palpated -if it suddenly goes away it may have ruptured |
|
|
Rovsing's sign
|
pain felt in RLQ when LLQ is palpated used to help dx appendicitis
|
|
|
Diverticulum
Diverticulosis Diverticulitis |
-herniation/pouching of hallow sac
-multiple diverticulum -they become inflamed |
|
|
Peritonitis
major concern |
-inflammation of the peritoneum
-abdominal organs leak fluid n2 space -diffuse pain worse with movement -abdominal distention -SEPSIS /shock is major concern |
|
|
IBD
|
-Inflammatory Bowel Disease
1) Crohn's disease 2) ulcerative colitis -family hx is biggest risk factor -more common in Jewish -aggravated by NSAIDs |
|
|
Crohn's disease
|
-inflammation of GI tract wall
-through ALL layers -periods of remission and exacerbation -ulcers form in a "cobblestone" -bowel wall thickens/fibrosis -RLQ pain, diarrhea NOT better w/BM -crampy pain worse after meals -pt may not eat to avoid pain -may be thin, malnutrition -STEATORRHEA -barium study of upper GI best dx= "string sign" on terminal ileum -fistulas to skin may occur |
|
|
Ulcerative Colitis
|
-affects superficial mucosa of colon
-lesions are contigous -also desquamation=BLEEDING -often starts at rectum moves proximal -bowel will narrow and thicken -LLQ pain, diarrhea, mucus and pus -rectal bleeding -toxic megacolon may occur= colon stays distended |
|
|
Kock pouch
|
-continent ileal reserve
-ileum used to create a stoma -will have catheter 2-3 wks after sx -low residue diet 1st 6-8 weeks |
|
|
Stoma care
how long to mature how often to change appliance |
-should be pink/red and shiny
-takes 3 months b4 reaches final size -appliance worn 5-10 days -empty q4-6h or prn |
|
|
small bowel obstruction
major causes s/s |
-intussusception
-volvulus -hernia (inguinal) s/s -pain -vomiting -no passage of stool |
|
|
large bowel obstruction
|
-progresses more slowly
-may only have chronic constipation -shape of stool is altered |
|
|
parietal cells
|
-found in stomach
a) intrinsic factor=needed for B12 absorption used for erythropoiesis b) hydrochloric acid= breaks down food and kills bacteria (pH 1-5) |
|
|
chief cells
|
-found in stomach
a) pepsinogen (protein) inactive until converted to pepsin by HCL or pepsin best in pH (2) inactivated by higher ph b) gastric lipase – (fat)-limited role in adults, used for milk fats , best in pH 5-6 |
|
|
mucous neck cells
|
-found in stomach
a) alkaline mucus that coats/protects stomach wall |
|
|
Secretin
|
-secreted by duodenum when pH of chyme in duodenum is <4-5
stomach= inhibits gastric secretion pancreas= increases production of bicarbonate rich juice |
|
|
cholecystokin
|
secreteion by duodenum stimulated by fat duodenum
gallbladder= release bile into duodenum pancreas= increased production of enzyme rich pancreatic secretions stomach= kinda inhibits gastric secretion |
|
|
where does absorption start
what is absorbed there |
jejunum(active transport/diffusion)
absorbs-fats, proteins, carbs, Na, and chloride |
|
|
what does the ileum absorb
|
Vitamin B12 and bile salts
|
|
|
duct of Wirsung
|
* the largest pancreatic duct (duct of Wirsung) joins the common bile duct from the liver and gallbladder forming the Ampulla of Vater AKA (hepatopancreatic ampulla) which empties the secretions into the duodenum*
|
|
|
Valsalva maneuver
who should not do it and why |
-cardiac pt, after eye surgery
-stops venous flow to the chest -A and V get less blood -decreased cardiac output -increased pressure after release -this rebound effect can be fatal -HTN can rupture vessels/arterie |
