NURS 5315 GI MODULE 9, EXAM 5|2023/24 UPDATE|GRADED A+

Upper GI organs mouth,pharynx, esophagus, stomach, and duodenum Lower GI organs small intestine, large intestine, rectum and anus Hepatoportal circulation hepatic artery receives oxygenated blood from the inferior mesenteric, gastric, and cystic veins. The hepatic portal vein receives deoxygenated blood from the inferior and superior mesenteric vein and splenic vein and delivers nutrients that have been absorbed from the intestinal system Osmotic diarrhea Caused by the presence of a nonabsorbable substance in the intestines. This pulls water by osmosis into the intestinal lumen and results in large volume diarrhea. This is how mag citrate, lactulose and miralax work. Causes include: excessive ingestion of nonabsorbable sugars, tube feedings, dumping syndrome, malabsorption, pancreatic enzyme deficiency, bile salt deficiency, small intestine bacterial overgrowth or celiac disease Secretory diarrhea Results in large volume losses secondary to infectious causes such as rotavirus, bacterial enterotoxins, or c-diff. Motility diarrhea AKA short bowel syndrome. Results from resection of small intestine or surgical bypass of small intestine, IBS, diabetic neuropathy, hyperthyroidism, and laxative abuse. Fatty stools and bloating are common in malabsorption syndrome. Complications include: dehydration, electrolyte imbalance, metabolic acidosis, weight loss and malabsorption. Upper GI bleed bleeding that occurs in the esophagus, stomach or duodenum commonly caused by bleeding varices, peptic ulcers or Mallory-Weiss tear(tearing of esophagus from stomach) Characterized by frank, bright red or coffee ground emesis. Lower GI bleed Bleeding in the jejunum, ileum, colon or rectum from inflammatory bowel disease, cancer, diverticula or hemorrhoids. Hematochezia, or the presence of bright red blood in the stools, suggest what kind of bleed Peptic Ulcer Disease Is a break in the integrity of the mucosa of the esophagus, stomach or duodenum resulting in exposure of the tissue to gastric acid. Risk factors include smoking, advanced age, NSAID use, ETOH, chronic disease, acute pancreatitis, COPD, obesity, socioeconomic status, gastrinoma, and infection with Helicobacter pylori. S&S: Epigastric pain is worse with eating, melena or hematemesis Duodenal ulcers most common and tend to develop in younger patients. S&S: epigastric pain that is relieved by food. Patients may have melena(black and tarry stool) or hematemesis Ulcerative colitis (UC) Inflammatory disease of the large instestine in persons 20-40y/o. Less common in people who smoke. Has periods of remission and exacerbations. Characterized by inflammation and ulcerations that remain superficial and in the small intestine. UC S&S recurrent diarrhea, bloody stools, febrile, polyarthritis, uveitis, sclerosing cholangitis, erythema nodosum and pyoderma gangrenosum UC complications fissures, hemorrhoids, perirectal abscess, toxic megacolon, colon perforation, and colorectal adenocarcinoma. Increased risk of VTE and microthrombi, and colon cancer Crohn's disease Chronic inflammatory disorders that can affect any portion of the GI tract but most often in the ileum and proximal colon. Affects persons in their 20-30s and of jewish decent. CARD15/NOD2 gene mutation commonly associated. Crohn's disease risk factors smoking, family history, Jewish decent, age less than 40, slight predominance in women and altered gut microbiome. Crohn's disease patho includes trasmural involvement of the affected area(entire wall of intestine is affected) and the presence of skip lesions. Disease progression may lead to abscess formation in GI tract. Possible causes include infectious agents, autoimmune, psychosomatic, impaired T-cell immunity Crohn's disease S&S abd pain, diarrhea, dehydration, bloody stools, malabsorption, malnutrition, weight loss, intestinal obstruction from chronic inflammation, fistulas and perforation of the intestine Diverticular disease Characterized as the presence of diverticula in the large intestine. Risk factors include older age, genetic predisposition, obesity, smoking, diet, lack of exercise, ASA and other NSAIDS, altered DI microbiome and abnormal colonic peristalsis Diverticulosis/Diverticulitis outpouchings of mucosa from the muscle layer of the intestine that protrude into the intestinal lumen most commonly in the sigmoid colon. Diverticulosis is the presence of diverticula in an asymptomatic person. Diverticulitis is an inflammation of diverticula and cause LLQ pain. Results in abscess formation, rupture and peritonitis Appendicitis Inflammation of the appendix usually in persons 10-19. S&S: periumbilical pain, RLQ pain, nvd, anorexia. Pain may initially be epigastric or periumbilical then settle in RLQ. Perforation, peritonitis and abscess formation are all potential complications Small bowel obstruction Most commonly caused by postop adhesions, tumors, Crohn's disease, hernias and intussusception. Causes distention 2ndary to impaired absorption and increased secretions which leads to fluid accumulation and gas proximal to the ileus. Distention in the intestines decreases their ability to absorb water and increases secretion of those things.