Alexander Negron

Gastro Intestinal Deficits

Main function of the GI system
Ingestion
Digestion
Absorption
Elimination
Appetite center is the hypothalamus
Stimulated by hypoglycemia
Empty stomach
Increase in body temperature
Hormones
Small intestine
Duodenum --> jejunem --> ilieum
About 1 liter of saliva is made per day
Phaynx is works with the respiratory system. Mucus is also made in to help
with the chewing
The mouth is mechanical and checmical
The stomach stores the food and starts to break it down
Hydrochloric acid is in the stomach
Chyme, pepsin
Once it starts to break down and it dumps into the small intestines
The large intesting is where water and electrolytes are absorbed
The large intestine is not a clean place, it has all kinds of bacteria
The pancreatic enzyme enter at the doudenmon
Pancreatic enzyme is lipase, tripsin, amylase, they help to break down
carbs, fats, and proteins
When making an assessment of the GI... Things to consider
Does he take meds
Do they smoke, drink, caffine? Have they traveled lately.
Diet patterns and preferences, textures in food
How much fluid that they take and how much daily
Remember that caffine acts as a duiretics
Any minirals or supplements
Any changes in appetite or food tolerance
Any weight changes or allergies?
Elimination patterns, pattern, colors, do they need to use a laxitive
Any skin break down related to GI problems
How active are they, are they limited in mobility, what about dentures?
Can they feed themselves and handle their own ADLS

Alexander Negron
Gastro Intestinal Deficits

Do they have urgency?

Is it safe to use the bathroom
Have them been exposed to any chemicals
Do they have trouble swallowing
Can they prepare their own meals, do they have a support system
How to they sleep, do they sleep well
Do they have heartburn when theyre sleeping?
Do they frequently burp or pass gas
Do they have trouble eating cold or hot foods? Some cultures do the hot and
cold (hispanics and chinese)
Are they on any pain medications (narcotics)
Are they on appetite suppressant
Do they have social isolation?
How to they cope with stress
Values and belief patterns, how they treat themselves, holistcally, medically
Changes in weight pattern? How do they feel about themselves?
Check for sores in the mouth, the alteration in the taste make it harder to eat
Do they have orders in the mouth, or swelling of the gums? Tenderness
When listening to each quadrant of the stomach, it is for 1-2
minutes each
Bowel sounds can be hypoactive, hyperactive, or normal
Bowel sounds present x 4? Then describe
If you suspect that there are no bowel sounds, listen for 5
minutes per quadrant
Most occur between 5 and 35 seconds
Start in the right lower quadrant
Most of the problems that accompany no bowel sounds are related to
obstruction, they may be small bowel or large bowl
Inspect, auscultate, palpate, percussion
When looking at the anus
Ask them if theyve had any blood in their stools
When checking the texture..
Any lessions
Dilated viens, is the umbilicus symmetrical, is the abdomen soft or hard
Are theyre any observable masses, has the patient had hernias?
When you palpate, its light palpation
Deep palpation is checked for pain, look at the patients face for the pain
because sometimes they dont express the pain.
As we get older we start to lose our taste and smell

Alexander Negron
Gastro Intestinal Deficits
Decreased mobilty leads to decreased motility
Risk for epigastric discomfort
Delayed absorption
Decreased drug and hormone metabalize, in the live
Remember to use the nursing process!!
Diagnostic Tests
CBC
CMP
PT
PTT
Liver function test, amalyze, cholesterol levels,
Guiac the stool for occult blood
OEP for parasites
Culture and sensitivity to check for c-df
Breath test for pH
Ultrasound helps us find, hernias, lesions or turmors
Check them for fat content, ordor, color, mucus
All invasive procedure require the patient to be invasi
Lower GI study you give them bowel prep
Contrast medium
Meglumine diatrizoate
Upper GI series, you drink the barium, done under fluoroscopy
You want to increase fluid intake
Stool will be a white chalky color for atleast 72 hours, and you want to
give them a laxative to have it removed.
Sometimes they put air ti help vizualize the
Ultrasound, non invasive, no consent is required,
They can diagnose any probles with the live, ascites, appendits,
gallstones and polyps, you usually want the patient to be NPO
Slide 33.
CT scan non invasive, when giving contracts then it becomes invasive.
If theyre allergic to contrast
If theyre on metmorfin, the contrast will increase the level of metformin
in the blood
Too much metformin you increase the risk of lactic acidosis

Alexander Negron
Gastro Intestinal Deficits

MRI
If the patient has a pace maker, or metal clip, they cant go inside
the machine no metal
Virtual colonoscopy
It combines a CT and a MRI with virtual reality software.
Tenesmus**
Endoscopy
Checking for turmors
Mallory- weiss tears -- someone with TB whos constantly vomiting and
coughing, bolemic.
NPO after midnight (8 hours before procudrue) you do not give ice chips
either
Conscious sedation - (moderate sedation)
After the procedure you wanna check the vitals 15 minutes in the first
hour, and 30 minutes in the next
When theres a spike in temp,
Upper endoscopy (EGD) goes down into the stomach.
Colonsocopy
To visualize the entire colon!! The entire thing
Can be used to dilate any strictures
Usually the day before the procedure, theyre on clear liquids
6pm the day prior, they become NPO, they have to take a laxitive
goLYtely, magsitrate, then 4 hours before the procedure
For consious sedation the drug of choice is propofol
Take their temp
Any severe adbinmal pain, or tenesmus they shoudl go to the ER
They are also laying on the left side
Capsule endoscopy
Takes about 57,000 pics in 8 hours
Laparosocopy,
Surgical procure
Looking at the peritoneal cavity

Alexander Negron
Gastro Intestinal Deficits

Done under general anesthesia

They can remove the gallbladder and stones, any tumor and biopsy
ERCP, into the doudoumen, common bile duct and the pancreases
Gastric analysis
Checking the pH of the stomach, obscure gastric pain, usually present
with weight loss and loss of appetite, also used for a suspected peptic ulcer.
Zollinger-Ellison syndrome, high level of gastrin that makes a tumor
Gastric acid stimulation test, measures the amount of
Esophageal pH monitoring
H pylori, gram negative bacteria
Either with a blood test or gastric biopsy, carbin urea breath test. Theyre
usually treated with antibiotics.
GI System
Obesity
Increase in proportion of fat cells
When you have a obese patient, you wanna ask them about dietary
habits
Bariatric Surgery
Restrictive - GASTRIC SLEEVEremove a large portion of the stomach so it
looks like a sleeve. 60 to 150ml. You can feel the food at the top of the
stomach. You usually end up vomiting its also not uncommon. Make sure you
eat protiens first before you eat anyting else, some foods increase in size
inside the stomach.
Usually lose about 60% of body weight
Malabsorptive
People that are morbidly orbese, gastric bypass is better becaue 60% is not
enough.
Lapban, isnt really used anymore because its not , the doctor is inflating and
deflating the cuf.
Gastric bypass
70 percent of the stomach is removed, part of the small intestine is

Alexander Negron
Gastro Intestinal Deficits

redirected. The advantage is that you can eat as much food as you want, less
food tolerance. Weight loss is greater and rapid, but you have dumping
syndrome. You have to live on fat saluable vitamins, also need to be on iron.
Usually have to have BMI of 35or 40, also have proof of other diets and it
didnt work.
Includes behavior modification
Gastrititis
NSAIDS and aspirin because it blocks COX-2 which lines the stomach.
GERD
PPI end in OZOLE
REceptor blockers end in INE (cimetidine)
Nissen Fundoplication -- usually the one thats most often done
Helps to make the LES smaller so that theres less back up of the acid
Treatment of Hiatal hernia
Gastropexy, attach the stomach to the diaphram so that i t cant move
through the opening.
GI bleed - upper or lower
Upper GI is stomach, esphagus, duodemun
Lower is large intestine, jejunum, iliem
Peptic ulcer
Either in the (gastric) stomach of the duedenum (duodenal)

IBD (Inflammatory bowel disease) , chrones and diverticulitis