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95 Cards in this Set
- Front
- Back
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Inner most layer of the alimentary canal
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Mucosa
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Layers of the alimentary canal
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Mucosa - inner
Submucosa - connective tissue Muscularis - smooth muscle Serosa or adventitis - outer |
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Salivary Glands produce this much fluid each day
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1-1.5 L
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Regions of the stomach
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cardiac, fundus, body, pyloric region
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What are 3 barrier breakers to the cells of the stomach
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aspirin, alcohol, and bile salts (from reflux)
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Amount of gastric secretions per day
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2-3 liters
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Factors that increase gastric fluid production
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pleasant thoughts, smell of food, mod. amounts of alcohol & caffeine, emotions, intrinsic factor (for absorption of B12)
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When there is a blockage in an ileostomy, the pt. will get sick in how many hours
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12
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The small intestine secretes how much fluid per day? And reabsorbs how much fluid
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7-9 liters. Reabsorbs 2 liters/day through the ileocecal valve.
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How long is the small intestine?
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16-22 feet
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Length of the small intestine from birth to adulthood.
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5 feet to 20 feet
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Absorption surface of small intesting from birth to adulthood
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950 cm to 7600 cm
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An ileostomy can put out this much fluid per day
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750-1000 cc
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The colon is how many feet in length
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5-6 feet
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The sigmoid to rectum which is 6-8" long is called the
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anal canal
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The width of the color is
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1-1/2"
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Feces are alkaline with a pH of what which irritates the skin
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6.8-7.8
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Inflammatory Bowel Disease, Diverticulitis, Cancer, IBS, GI Bleed, GERD, Appendicitis, Peritonitis are diseases of the
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GI Tract
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This is reflux of GI acid into the esophagus and causes pain and changes in esophageal mucosa
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GERD
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These are foods that cause dec. lower esphageal pressure (gerd)
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fatty foods, caffeine, chocolate, peppermint, spearmint, alcohol, tomato products
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These foods do not cause decreased lower esophageal pressure (gerd)
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low fat dairy, acidic and spicy foods
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Symptoms of GERD
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heartburn, regurgitation, hypersalivation, dysphagia and painful swallowing (odynophagia) gas
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Diagnostic tests for GERD
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24-hour ambulatory pH monitoring and endoscopy
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A thin, pressure-sensitive tube is passed through your mouth or nose into your stomach. Tube is pulled slowly back into esophagus to test your muscles & sphincters.
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esophageal manometry
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7 Treatments for GERD
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anatacids, prokinetic drugs, histamine blockers (pepcid, zantac) proton pump inhibitors(prilosec), smoking cessation, elevate HOB, don't eat before bed.
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2 types of inflammatory bowel disease
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crohns disease, ulcerative colotis
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who gets IBS more often
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western heritage, whites, jewish, urban.
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Peak occurrence of IBD
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15-25 years of age
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Where in the digestive system does Ulcerative colitis occur and in what layer?
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From the anus to the ileocecal junction. In the mucosal layer only
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What are the clinical manifestations of Ulcerative Colitis?
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diarrhea, rectal bleeding, crampy abdominal pain, weight loss, anemia.
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Complications of Ulcerative Colitis are
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hemorrhage, toxic megacolon (require emergency surgery), colon cancer (deadly)
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Other manifestations of Ulcerative colotis
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arthritis, pyoderma gangremosum, liver dysfunction, ocular lesions
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Diagnosis techniques for Ulcerative Colitis
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Barium enema, colonoscopy, biopsy
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Management of Ulcerative Colitis
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Medical mgmt. first. Corticosteroids, sulfasalazine, then surgical which is curative.
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Clinical Manifestations of Crohn's disease
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fever, abdominal pain, diarrhea, steatorrhea, malaise, anorexia, nausea, vomiting, weight loss, malnutrition, abdominal mass in RLQ, perianal disease - fissure and fistulas, rectal bleeding (rarely)
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What layers of the bowel does Crohn's disease affect?
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All layers - transmural
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Where can Crohn's disease occur?
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Anywhere from mouth to anus
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What are the complications of Crohn's disease?
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Perforation, strictures, abscess, fistula, perianal disease, malnutrition, hemorrhage, toxic megacolon
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How is Crohn's disease diagnosed?
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Colonoscopy, perianal evaluation, small bowel follow through or capsule endoscopy.
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Treatment for Crohn's disease
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Corticosteroids, immunosuppresant agents, antidiarrheals, salicylates, monoclonal antibodies, antibiotics (Flagyl), pain mgmt., surgery
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Nursing considerations for Crohn's disease
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Low residue diet, fistula formation, malnutrition, pain mgmt., risk of dehydration, sepsis, emotional support.
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Crohn's disease is characterized by
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transmural skip lesions
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What surgical treatments are done for Crohn's disease
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Relief of complications (fistulas, perianal disease. total proctocolectomy with end ileostomy if confined to colon, resectioning.
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What complication happens when too much ileum is removed?
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Decreased B12 absorption
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What diet considerations are made for a pt. with an ileostomy?
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low residue, low liquid diet
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People with stomas can still pass this from the anus
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mucous
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Key points to assess ostomy
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ileostomy functions in 3-4 days, colostomy functions in 5-7 days, assess stoma and skin.
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Most important step before getting a stoma
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Make area-below umbilicus, w/in rectus muscle, avoid folds, keeping stoma where it can be seen.
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Nursing care for ostomy
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initial marking, pouch emptying & changing, peristomal skin care, diet instruction, supplies
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When should you irrigate on ileostomy?
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Never. It is done by a trained healthcare provider
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Foods to avoid with ileostomy
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peanuts, popcorn, nondigestable fiber. No enteric coated meds.
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Diet restrictions with colostomy
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None
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Types of stomas
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Loop bowel and end-hartmans
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Ostomy complications
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Dehydration (ileostomy), peristomal irritation, peristomal hernia, peristomal abscess, skin disorders (both)
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Nursing care for mucous fistula
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vaseline gauze
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How do you change a stoma pouch
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Change regularly, use soap & water, opening 1/8" larger than stoma, protective paste around inner opening.
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Why do you avoid ibuprofen with Crohn's disease
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Crohn's is an autoimmune disease and ibuprofen is an antiinflammatory which is contraindicated in autoimmune disease patients.
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Where does diverticular disease occur
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90% in the sigmoid or L color
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What is diverticulosis
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Little hernias in the mucosa of the intestine due to poor diet
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What is diverticulitis
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Infection of the diverticulosa
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Risk factors for diverticular disease
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low fiber diet, age 50 and older, high meat or protein diet, chronic constipation.
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Symptoms of diverticular disease
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abdominal pain, tenderness in LLQ, swollen, hard abdomen, fever, chills, poor appetite, N, V, diarrhea, constipation, cramping, rectal bleeding.
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Diagnosis of diverticular disease
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colonscopy, barium enema, stool analysis, CT scan, blood work, physical exam
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Treatment of diverticular disease
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high fiber diet, bowel rest, antibiotics (flagyl, bactrim, septra, cipro), potential surgery
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Complications of diverticular disease
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perforation and abscess formation, fistula formation, bleeding
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Surgical options for diverticular disease
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Hemicolectomy w/ primary anastomosis, hemicolectomy w/ loop ileostomy, hartmans procedure, lap procedure.
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Risk factors for colon cancer
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50-80 years, low fiber diet, high animal fat and red meat, black men and women, fam. history.
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Screening tests for colon cancer
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Beginning at age 50: fecal occult flood test q year, sigmoidoscopy q 5 years, colonoscopy q 10 years
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Clinical manifestataions of Colon cancer
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rectal bleeding, bright red (lower), tarry (upper), change in bowel habits, fatigue, weight loss, pain, bloating
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Diagnosis of Colon cancer
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Colonoscopy with biopsy, H&H due to bleeding, fecal occult blood test, Carcinoembryonic antigen CEA elevated in 70%
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Staging of Colon cancer
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Duka A-penetrates mucosa
Duke B-penetrates muscular layer B2 penetrates muscular wall C1 penetrates muscular wall and ca in lymph nodes Duke D-Mets to liver, lung, or bone. |
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TNM Staging of Colon cancer
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Tumor, Nodes, Metastastis
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Treatment of Colon cancer
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Surgery, radiation, chemotherapy
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Postop care for colon cancer resections and ostomies
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NG tube, PCA, stoma assessment, wound management (abdominal, perineal)
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Factors contributing to Irritable Bowel Syndrome
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Aspirin, food allergies
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Diagnostics of Irritable Bowel Syndrome
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Blood workup - normal, barium enema, flexible sigmoidoscopy
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Nursing management of irritable bowel syndrome
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Treat symptoms. Constipation-metamucil, diarrhea-lomotil, immodium, pain-anticholinergics or antispasmodics, antidepressants (elavil), stress mgmt.
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Causes of GI bleed
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Hemorrhoids, inflammation, colorectal cancer, colorectal polyps, diverticular disease, duodenal ulcer, varices, mallory-weiss syndrome (tear in lining of esophagus)
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Symptoms of GI bleed
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fatigue, weakness, shortness of breath, abdominal pain, pale, vomiting blood
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Treatment of GI Bleed
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stop bleed, treat hypovolemia, prevent dehydration, maintain fluids and electrolytes
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Name 3 diseases of the liver
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Cirrhosis, portal hypertension, hepatitis
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Symptoms of hepatitis
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anorexia, N,V, fever, fatigue, RUQ pain, dark urine, light stool, joint pain, jaundice, elevation of liver enzymes
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Treatment of Hepatitis
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Hi protein, hi carb, low fat diet. no alcohol or drugs, rest, universal precautions
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Causes of Cirrhosis
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Etoh, hepatitis
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Effects of cirrhosis
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portal hypertension, ascities, esophageal varices (caput medusa), coagulation defects, jaundice, encephalopathy, bacterial peritonitis
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Nursing for cirrhosis encephalopathy
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Lactulose PO or PR, Neomycin PO, NG, PR, Low protein diet.
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Treatment of esophageal varices
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tamponade, mallory-weiss tears - cauterization, embolization, vasopressin
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Treatment of cirrhosis
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paracentesis, Transjugular Intrahepatic portosystemic shunt procedure TIPS, organ transplant
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3 risk factors for cholecystitis
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Post menopausal women, obesity, high cholesterol
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Symptoms of cholycystitis
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RUQ pain, N, V, indigestion, gas, fever, jaundice, pain after fatty foods.
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Where are the enzymes in the pancreas
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In the head
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What happens when the tail of the pancreas is removed
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The patient becomes diabetic
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How much bicarbonate is produced by the pancreas per day
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1500-2000cc
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Treatment of cholecystitis
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Pain mgmt, fluid and electrolytes, percutaneous catheter, lap chole
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Pancreatitis cause
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calcifying from repeated bouts of acute pancreatitis from ETOH or Obstructive - due to cholelithiasis and bilary tract disease
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