Transcript Gastrointestinal

Digest This!
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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
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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
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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
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Once food bolus is in the stomach, the
cardiac sphincter closes to prevent food from
flowing back into the esophagus
Peristalsis(mixing, contracting)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
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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
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What would happen if we had something
wrong with the pancreas, and we could not
produce enzymes to break food down?
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This is where nutrients asborb into the blood
stream through the villi of the small intestine
(duodenum, jejunum, ileum)
What remains goes into the large intestine –
also not sterile
This is where water and nutrients like B
complex and Vit K are asborbed
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If your large intestine became swollen and
irritable, what nutrients could you not absorb,
and how would that effect you?
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Rectum stores the indigestible food and
waste
Waste exits from the anus – also not sterile
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GERD – Gastroesophageal reflux disease
It is the backwards flow of stomach contents
into the esophagus
Etiology – incompetent(weak) lower
esophageal sphincter makes the stomach
contents dump back into the esophagus
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Signs and symptoms of GERD
Dyspepsia (heartburn)
Coughing
AM hoarseness
Belching
Chest pain
Regurgitation
Odynophagia – painful swallowing
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Teach patient
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Small meals
Avoid spicy foods
Elevate HOB 8-12”
Sleep in left lateral position
Stop smoking!!!!
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If you had to explain to a 6 year old how to
treat GERD, how would you do it?
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Gastritis – inflammation of the gastric mucosa
Two kinds
◦ 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.
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Signs and symptoms of Acute gastritis:
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Rapid onset of epigastric pain
Vomiting blood – can look like coffee grounds
Stomach pain
anorexia
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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
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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.
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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
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Diagnosis is same as the Acute – EGD and
antibiotics if needed
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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
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PUD – Peptic ulcerative Disease – lesions in
the stomach – stress ulcers, h.pylori causes
acid increase
Usually located in the lower stomach, upper
duodenum
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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
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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
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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
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IBS can flare up with stress or anxiety, food
allergies like lactose intolerance
Can have exacerbation – flare up
Can be in remission – no problems
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Teach:
◦ Avoid precipitating factors
◦ Patient may need fiber supplements for
constipation or Lomotil for diarrhea
◦ Stress management
◦ May need antidepressants
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Hemorrhoids – swollen engorged veins in the
anorectic area
Caused by severe straining, childbirth,
cancer, liver disease due to portal
hypertension
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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
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Both cause pain and itching, sometimes
bleeding can occur – will be bright red, unlike
melena, which is black
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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.
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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
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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.
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Common signs and symptoms for Crohns:
Diarrhea
Cramping
Bloody stools
Ulcers – can be severe and perforate through the
bowel
◦ Weight loss
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Other signs and symptoms
People with severe Crohn’s disease may also
experience:
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Fever
Fatigue
Arthritis
Eye inflammation
Skin disorders
Inflammation of the liver or bile ducts
Delayed growth or sexual development, in children
See handout
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Diagnoses with a colonoscopy or barium
enema allows an x-ray of the entire colon
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Also a form of IBS – Inflammation of the colon
Can be severe and life threatening
Difference in the Crohn’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
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Treatment for both: Crohn’s and Ulcerative
Colitis
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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