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Digest This!
The alimentary canal is a long, muscular tube
Structure – it is 25 to 30 feet in length Includes the mouth, pharynx, esophagus,
stomach, small intestine, large intestine and anus
The mouth or buccal cavity chews food called mastication
Saliva is produced by the parotid, sublingual, and submadibular glands
Food is broken down by an enzyme called salivary amylase
The mouth is not a sterile area
Food is swallowed in a bolus – and enters the pharynx
This triggers the epiglottis to close The bolus continues down the esophagus to
the stomach Esophagus and stomach are not sterile
Once food bolus is in the stomach, the cardiac sphincter closes to prevent food from flowing back into the esophagus
Peristalsis begins to mechanically digest the food, and HCL, pepsin, lipase are chemically breaking down food
HCL – kills bacteria Pepsin – breaks down protein Lipase breaks down fat
Food dumps from the stomach to the small intestine into the duodenum
This section is where bile from the gallbladder and liver and pancreatic juice enter through the ducts
After this point the small intestine produces enzymes; maltase, sucrase, and lactase – these break down sugars into simple forms
Peptidase – for protein Steapsin – digestion of fat
This is where nutrients asborb into the blood stream through the villi of the small intestine
What remains goes into the large intestine – also not sterile
This is where water and nutrients like B complex and Vit K are asborbed
Rectum stores the indigestible food and waste
Waste exits from the anus – also not sterile
GERD – Gastroesophageal reflux disease It is the backwards flow of stomach
contents into the esophagus Etiology – incompetent lower esophageal
sphincter makes the stomach contents dump back into the esophagus
Signs and symptoms of GERD Dyspepsia (heartburn) Coughing AM hoarseness Belching Chest pain Regurgitation Odynophagia – painful swallowing
Teach patient◦Small meals◦Avoid spicy foods◦Elevate HOB 8-12”◦Sleep in left lateral position◦Stop smoking!!!!
Gastritis – inflammation of the gastric mucosa
Two kings◦No. 1 Acute gastritis (erosive) – can be caused by
infection of the helicobacter pylori bacteria. This is normal to have in your stomach, but if you become stressed it can have an overgrowth, and cause an ulcer. It could also be caused by e.coli, or salmonella.
◦ Inflammation can also be “set off” by irritating foods, chronic aspirin use and alcohol.
Signs and symptoms of Acute gastritis:◦Rapid onset of epigastric pain◦Vomiting blood – can look like coffee grounds◦Stomach pain◦anorexia
Treatment:◦EGD (esophagogastroduodenoscopy) is an
examination of the lining of the esophagus, stomach, and upper duodenum with a small camera (flexible endoscope) which is inserted down the throat.
◦Antibiotics to help with h.pylori infection
No. 2 Chronic gastritis (non erosive) – constant irritation without ulcers, develops gradually and is more likely to cause a dull pain and a feeling of fullness or loss of appetite after a few bites of food. For many people, though, chronic gastritis causes no signs or symptoms at all.
Chronic gastritis signs and symptoms – causes few symptoms:◦Vague epigastria pain – usually relieved with food◦ Intolerance of spicy foods◦Anemia – can’t absorb your B12 from food – you
need this for red blood cells to function
Diagnosis is same as the Acute – EGD and antibiotics if needed
Treatment for chronic gastritis:◦Remove the cause – don’t take too much aspirin,
eat too much acidic/fatty/spicy foods, stop smoking
◦Medications – antacids, H2 receptor antagonist, antibiotics, Pepto
PUD – Peptic ulcerative Disease – lesions in the stomach – stress ulcers, h.pylori causes acid increase
Usually located in the lower stomach, upper duodenum
Complications of PUD:◦Bleeding◦Melena – blood in the stool is black and tarry, very
smelly◦ Perforation – ulcer wears through the bowel or
stomach, and leaks into the peritoneal cavity – 2-3% of people perforate, and of this 67% die
◦4% have pyloric obstruction – valve is obstructed and patient has vomiting
Test for PUD:◦EGD◦Blood chemistry (CBC) – checks for anemia◦Check of occult blood◦Urea breath test – check after midnight if h.pylori
is present patient will have an increase in CO2◦Surgery – goes in an stems bleeding
IBS – Irritable Bowel Syndrome – 10-20% of U.S. citizens have this
Chronic recurrent diarrhea, constipation and bloating, abdominal pain, flares up with certain foods or stress
IBS can flare up with stress or anxiety, food allergies like lactose intolerance
Can have exacerbation – flare up Can be in remission – no problems
Teach:◦Avoid precipitating factors◦ Patient may need fiber supplements for
constipation or Lomotil for diarrhea◦Stress management◦May need antidepressants
Hemorrhoids – swollen engorged veins in the anorectic area
Caused by severe straining, childbirth, cancer, liver disease due to portal hypertension
Two types of hemorrhoids◦External – swelling of the anus◦ Internal – inflammation near the anus, and can
swell to the outside – it is possible to have both at the same time
Both cause pain an ditching, sometimes bleeding can occur – will be bright red, unlike melena, which is black
Thrombosed hemorrhoid – Veins in the anus or outside of the rectum can start to swell and become external when they protrude outward from these areas. When blood flow becomes restricted in these veins, the vessels tend to split causing pools of blood to form and clot under the skin. When this happens, you get a thrombosed hemorrhoid.
Treatment of hemorrhoids:◦Topical creams – decreases inflammation, eases
pain◦Diet high in fiber◦Avoid – nuts, spices, coffee, alcohol◦Avoid sitting for prolonged periods◦Avoid valsalva maneuver – no straining, lifting◦ In case of thrombosed hemorrhoid – surgery is
required to release the blood for the swollen vein – follow with cold pack
Crohn’s disease – is a form of IBS because it causes inflammation of the lining of the digestive tract. Crohn’s can extend deep into the layers of the affected bowel tissue.
Common signs and symptoms for Crohns:◦Diarrhea◦Cramping◦Bloody stools◦Ulcers – can be severe and perforate through the
bowel◦Weight loss
Other signs and symptoms People with severe Crohn’s disease may also
experience:◦ Fever◦ Fatigue◦Arthritis◦Eye inflammation◦Skin disorders◦ Inflammation of the liver or bile ducts◦Delayed growth or sexual development, in children◦See handout
Diagnoses with a colonoscopy or barium enema allows an x-ray of the entire colon
Also a form of IBS – Inflammation of the colon
Can be severe and life threatening Difference in the Chrohn’s and ulcerative is
right side Crohn’s left side colitis Signs and symptoms can range from rectal
bleeding, bloody diarrhea, cramps, pain, malnutrition, dehydration, shock and even death
Treatment for both: Crohns and Ulcerative Colitis◦Steroids – reduce inflammation◦Diet◦Stop smoking◦No alcohol◦ For people who do not respond to all of the above,
they might try to suppress the immune system to stop the body’s allergic response