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Gi Nelec

The gastrointestinal system has 4 layers - mucosa, submucosa, muscular, and serosa. GERD is caused by lower esophageal sphincter (LES) tone dysfunction and causes heartburn. Risk factors for GERD include smoking, caffeine, alcohol, and increased intragastric pressure. Treatment includes lifestyle changes and medications like antacids, H2 blockers, and proton pump inhibitors. The liver produces bile and HCl. Liver diseases can cause complications like esophageal varices, ascites, and hepatic encephalopathy. The gallbladder stores and concentrates bile. Cholelithiasis are gallstones which can cause cholecystitis. Surgical treatments include cholecystectomy

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Jordz Placi
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58 views52 pages

Gi Nelec

The gastrointestinal system has 4 layers - mucosa, submucosa, muscular, and serosa. GERD is caused by lower esophageal sphincter (LES) tone dysfunction and causes heartburn. Risk factors for GERD include smoking, caffeine, alcohol, and increased intragastric pressure. Treatment includes lifestyle changes and medications like antacids, H2 blockers, and proton pump inhibitors. The liver produces bile and HCl. Liver diseases can cause complications like esophageal varices, ascites, and hepatic encephalopathy. The gallbladder stores and concentrates bile. Cholelithiasis are gallstones which can cause cholecystitis. Surgical treatments include cholecystectomy

Uploaded by

Jordz Placi
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPT, PDF, TXT or read online on Scribd
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GASTROINTESTINAL SYSTEM

1
4 layers
-Mucosa
-Submucosa
-Muscular
-Serosa

2
Figure 16.10b

3
Esophagus

4
GERD due to LES TONE
Heartburn- PYROSIS
substernal burning pain-
Coughing

5
RISK FACTORS FOR GERD
S MOKING
C AFFEINE
A LCOHOL
N CREASED INTRAGASTRIC PRESSURE
FATTY FOODS

6
GERD
)

7
GERD

Avoid food & meds that LES tone

Elevate HOB for sleeping

8
• Medications
1.Antacids- neutralize stomach
acid- Maalox
gastric acid
2. H2 receptor blocker-
Ranitidine (Zantac)
3.Proton pump inhibitor(PPI)-
Nexium (Esomeprazole)
9
10
Stomach

Parietal cells
HCL
IF- needed for absorption of Vit
B12 in small intestine

11
Gastritis

12
• Medications
1.Antacids- neutralize stomach acid-
Maalox
2.Histamine H2 receptor antagonists-
Decreases gastric acid
Ranitidine (Zantac)
3.Proton pump inhibitors(PPI)-
Nexium (Esomeprazole)
13
PUD

14
Gastric ulcer
• Predisposing Factors:
Stress, smoking
Corticosteroids,
Alcohol, Aspirin
NSAIDS
,
15
• Medications
1.Antacids- neutralize stomach acid-
Maalox
2.Histamine H2 receptor antagonists-
Decreases gastric acid
ex Ranitidine (Zantac)
3.Proton pump inhibitors(PPI)-
Nexium (Esomeprazole)
16
4. Mucosal protectant

• Sucralfate
17
Liver

Liver cirrhosis
Complications
18
19
Esophageal varices

• Dilated & tortous veins in submucosa of esophagus


• Cause: portal HPN,
• Associated w/ liver cirrhosis

20
Esophageal varices
 Esophageal tamponade / balloon tamponade
 Sengstaken- Blakemore or Minnesota tubes
 Monitor - respiratory distress

21
Esophageal varices: INTERVENTIONS:

VS ,LOC, NPO, NGT


O2, Blood Transfusion
• Vasopressin iv- lowers pressure
• Propranolol (Inderal)- reduces portal
pressure

22
Ascites
Accumulation of plasma- rich fluid w/n peritoneal
cavity
oncotic pressure
Cirrhosis – most common cause

23
Ascites
• THERAPEUTICS
• Diuretics
• Measure abdominal girth, weigh pt
• Paracentesis
• Low salt diet

24
Hepatic Encephalopathy

AMMONIA
• Liver cannot convert ammonia to urea
• BEHAVIORAL changes
Asterixis – flapping tremors of the hands
Fetor hepaticus – musty odor breath
Mgt

Assess neuro status, vs, hand writing, wt


Diet: use of vegetable CHON
Meds: Neomycin , metronidazole,
lactulose

26
Gallbladder

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Cholelithiasis

28
Risk Factors : Cholelithiasis
Cystic Fibrosis
Obesity, rapid wt loss
Low dose Estrogen therapy
Ileal resection
29
Cholecystitis: S/S

Bleeding
Clay colored feces
Dark orange urine
Morphine
Preferred analgesic agent for mgt of
acute pain 30
Cholecystectomy

Choledochostomy
incission to common duct for
removal of stones
31
Post-op
Care of T-Tube

Semi-fowlers
Avoid irrigation, clamping of
T- tube
32
Which of the following will you
implement to a client with T- tube ?

A.Place on semi fowlers


B. Monitor serum calcium
C. Prone position
D. increase fat diet
33
Pancreatitis
Causes:

Alcoholism
Biliary tract disease
Unknown

34
Pancreatitis
PAIN
epigastric , radiates to back
Improves - fetal position

35
Pancreatitis

–Grey Turner’s spots


ecchymoses -flanks
–Cullen’s sign
ecchymoses -periumbilical area
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Pancreatitis

37
Lab
Amylase

Lipase
38
Pain relief: Acute Pancreatitis

Parenteral opiod
Morphine
NI
NPO; NGT
Pg1183 column 2 paragraph 4 39
You are caring for a client who has
acute pancreatitis. Which plan of care
will you give the highest priority?

• A. Monitor for hematochezia


• B. Monitor I&O
• C. Increase OFI
• D. Maintain NPO 40
IBD (Inflammatory Bowel Disease)

Crohn’s dse- steatorrhea , diarrhea

Ulcerative Colitis-
bleeding + diarrhea

41
UC
• Meds: Corticosteroids to bowel inflammation

Avoid raw vegetables, fruits,whole grain,nuts,

Low residue diet


Sx: Total colectomy w/ Ileostomy
Continent ileostomy- creation of continent
ileal reservoir ( Kock’s pouch) 42
• COLOSTOMY- fecal diversion
to an external collection
device
Preop
Bowel cleansing
Intestinal antiseptics

43
Post op

• V/S, Bowel sounds, stoma

• Encourage ambulation
-stimulate peristalsis 44
STOMA color

Normal : Pink to bright red


Pale - LOW Hgb, hct
Purple Black- compromised circulation

45
POST- OP Colostomy

Empty pouch when it is 1/3 fulL


AVOID: foods -cause excess gas
formation & odor

46
47
Stoma Care & Irrigation
Instill 500-1000mL
lukewarm tap water
through stoma
Irrigate preferably 1 Hr
AFTER a meal

48
49
Colorectal Ca
Risk Factors:

Cigarrete smoking, alcohol


Obesity, Hx of IBD

Low fiber, High fat, CHON (beef)


Old (increased age)
Ndometrial, ovarian Ca
50
Colorectal Ca
Most common s/s:

Change in bowel habits


Unexplained anemia
Blood in stool
Anorexia
51
Primary tx

Surgery
52

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