Day 7 Peptic-Ulcer-Appendicitis

Digestive
System
Digestion
• Phases Include
1. Ingestion
2. Movement
3. Mechanical and Chemical Digestion
4. Absorption
5. Elimination
Digestion
• Types
• Mechanical (physical)
• Chew
• Tear
• Grind
• Mash
• Mix
• Chemical
• Enzymatic reactions to improve digestion of
• Carbohydrates
• Proteins
• Lipids
Digestive System Organization
• Gastrointestinal (Gl) tract
• Tube within a tube
• Direct link/path between organs
• Structures
• Mouth
• Pharynx
• Esophagus
• Stomach
• Small intestine
• Large Intestine
• Rectum
4
Mouth
• Teeth mechanically • Epiglottis is a flap-like
break down food into structure at the back of
small pieces. Tongue the throat that closes
mixes food with saliva over the trachea
(contains amylase, preventing food from
which helps break down entering it. It is located
starch). in the Pharynx.
Esophagus
• Approximately 20 cm long.
• Functions include:
1.Secrete mucus
2.Moves food from the throat to
the stomach using muscle
movement called peristalsis
• If acid from the stomach gets in
here that’s heartburn.
Mouth, Pharynx and Esophagus
Stomach
• J-shaped muscular bag that stores
the food you eat, breaks it down
into tiny pieces.
• Mixes food with Digestive Juices that
contain enzymes to break down
Proteins and Lipids.
Lipids
• Acid (HCl) in the stomach Kills
Bacteria.
• Food found in the stomach is called
Chyme.
7
Small Intestine
• Small intestines are roughly
7 meters long
• Lining of intestine walls has
finger-like projections called
villi, to increase surface area.
• The villi are covered in
microvilli which further
increases surface area for
absorption.
8
Small Intestine
• Nutrients from the food pass into
the bloodstream through the
small intestine walls.
• Absorbs:
• 80% ingested water
• Vitamins
• Minerals
• Carbohydrates
• Proteins
• Lipids
• Secretes digestive enzymes
9
Large Intestine
• About 1.5 meters long

• Accepts what small intestines
don’t absorb
• Rectum (short term storage
which holds feces before it is
expelled).
Large Intestine
• Functions
• Bacterial digestion
• Ferment
carbohydrates
– Absorbs more water

– Concentrate wastes
Accessory Organs The Glands
• Not part of the path of food,

but play a critical role.
• Include: Liver, gall

bladder, and
pancreas
Liver
• Directly affects digestion by

producing bile
• Bile helps digest fat
• filters out toxins and waste including drugs and
alcohol and poisons.
13
Gall Bladder
• Stores bile from the

liver, releases it into the
small intestine.
• Fatty diets can cause
gallstones
Pancreas
• Produces digestive
enzymes to digest fats,
carbohydrates and
proteins
• Regulates blood sugar
by producing insulin
GI Tract Assessment
Common Symptoms:
1. Pain
2. Dyspepsia - caused by excessive fatty/oily food intake
3. Intestinal Gas - Excessive Flatulence - Possible food intolerance or
gallbladder disease
4. Nausea and Vomiting
• Dysmotility, peritoneal irritation, hepatobiliary or pancreatic disorders
• CNS Disorders - Increased ICP, Psychogenic D/O, Vestibulo - cochlear
disorders
• Irritation of chemoreceptor triggers - radiation/chemotherapy
5. Change in Bowel Habits/Stool Characteristics
• Increase/Decrease of Bowel Movement
• Color of Stool - dark, tarry stools (internal bleeding), bright red
(hemorrhoids, lower GI bleeding)
GI Tract Assessment - Lab.Studies
1. Serum Amylase/Lipase
2. Tumor Markers
• CEA
• CA 19-9
• AFP
3. Stool Tests
• Regular Sample Testing for helminthic parasites
• FOBT - Fecal Occult Blood Test
a. No red meat, NSAIDS, aspirin 72 hours prior - False Positive
b. No Vit. C supplements or foods - False Negative
GI Tract Assessment - Imaging
Studies
1. Abdominal Ultrasound - enlarged gallbladder/pancreas, gallstones,
appendicitis
• NPO 8 to 12 Hours
• Fat Free Meal evening before for Gallbladder studies
• Barium studies after the abdominal ultrasound
2. Upper GI Fluoroscopy - use a contrast agent (Barium) - ulcers, tumors,
regional enteritis, anatomic dysfunctions, obstructions, diverticula
• Clear liquid diet then NPO 8 to 12 Hours prior to procedure
• Polyethylene glycol to cleanse the bowel
• No smoking, chewing gums or mint flavored food
• Increased fluids post procedure
GI Tract Assessment - Imaging Studies
3. Barium Enema - tumors, polyps, lesions, diverticula, obstructions
• Low - residue diet 1 - 2 days before procedure
• Clear liquid diet and laxative the night before
• Bowel cleansing 2 - 4 hours before procedure
• No Barium Enema for pt. with active inflammatory dse. - use water soluble
contrast study
• Increase fluid intake post procedure
• Transiet increase in bowel movement post procedure
4. CT Scan/MRI - may or may not use contrast medium
• Assess allergy to iodine or claustrophobia
• NPO 8 hours prior to procedure
• MRI can take 60 - 90 minutes
• Remove metallic objects in the body before procedure
GI Tract Assessment - Imaging Studies
Endoscopy - direct visualization through a camera - esophageal,

gastric or duodenal ulcers, tumors, obstructions, infections
• NPO 8 Hours before procedure
• Anesthetic gargle or spray to reduce gag reflex
• Left lateral position
• Check LOC, V/S, O2 Sat. Pain and Bleeding
• Lozenges, saline gargle, oral analgesic after gag reflex has
returned
Gastritis
• inflammation of the gastric mucosa (achlorhydria - low HCl)
• equal among men and women, more common in the elderly
• Erosive - caused by H.pylori/Non-Erosive - NSAIDS, alcohol abuse,
radiation therapy
• Acute Gastritis - major trauma, burns, severe infection, hepatic,
kidney or respiratory failure
• Chronic Gastritis - autoimmune disease such as pernicious anemia
Clinical Manifestations
1. abdominal discomfort, headache, N&V, anorexia, hiccupping
2. Erosive Gastritis - blood in vomit or stool (tarry or bright red)
3. Chronic Gastritis - anorexia, heartburn, belching, sour taste in the
mouth, N&V
Assessment
1. Endoscopy and Histologic Examination of tissue
Gastritis
Medical Management
1. H2 Receptor Antagonists - Famotidine, Ranitidine
2. Proton Pump Inhibitors - Omeprazole, Lansoprazole
3. IV Fluids
4. Antibiotics for H.pylori infection
4. Chronic Gastritis - diet modification, rest, reduce stress, no alcohol,
NSAIDS
Nursing Management
1. Reduce Anxiety - calm approach to explain the situation, procedures
2. Acute Gastritis - NPO with IV, Monitor electrolytes, Ice Chips, Clear
Liquid Diet, Slowly introduce solid food
3. No caffeinated beverage, alcohol, smoking
4. Monitor for dehydration, Increase IV Fluids, Monitor for
hematemesis, tachycardia, hypotension
5. Pain Management - non irritating food
Peptic Ulcer Disease
• an excavation that forms in the mucosal wall of the stomach, the

pylorus, duodenum or in the esophagus - generally occur alone,
commonly found in the duodenum
• erosion occur in one layer or may extend all the way to the peritoneum
• More common among 65 years old and above - consistent increase
Causes
• Common Cause - H. pylori - gram negative bacteria - ingested through
food or water
• NSAIDS - with H.pylori are synergistic
• Aspirin
• Excess HCl
• Smoking, alcohol, spicy food, caffeinated beverage, milk
Clinical Manifestations - last a few days, weeks or months

1. Dull, gnawing pain or burning sensation in midepigastrium
2. Pain after eating (Gastric ), Pain 2-3 Hours after eating (Duodenal)
3. Heartburn, Vomiting, Constipation/Diarrhea, Eructation (burping)
4. Bleeding - in vomitus or in stool
Assessment
• PE - Pain/Abdominal Distention
• Endoscopy
• CBC - bleeding
• Antibody testing for H. pylori
Medical Management
Medications - Proton Pump Inhibitor, Metronidazole, Amoxicillin,
Nursing Management
1. Smoking Cessation
2. Dietary Modification - alcohol, coffee, too hot, too cold food
3. Pain Relief - using non - NSAIDS
4. Reduce Anxiety - proper explanation/information
5. Assess for weight loss/malnutrition, education on proper diet
6. Monitor/Manage Complications
• Bleeding - either stool (dark) or vomitus (bright red)
• Monitor - hypotension, tachycardia, faintness, dizzynes, tachypnea - IV
fluids, Hemodynamic monitoring, blood transfusion, NGT,
• Perforation/Penetration - erosion from gastric serosa into the peritoneal
cavity without warning - requires emergency surgery - Ex.Lap
S/Sx - sudden, severe upper abdominal pain, fainting, vomiting, hypotension,
tachycardia - monitor F&E balance, absent bowel sounds, temperature,
abdominal distention
Appendicitis
• inflammation of the appendix - small, fingerlike appendage attached to
the cecum (10cm)
• most common cause of acute surgical surgeries, more common from 10-30
year olds.
• appendix becomes inflamed due to occlusion by a fecalith (hardened stool)
or becoming kinked, a tumor or foreign body
• inflamed appendix becomes filled with pus, bacterial overgrowth occurs,
ischemia and gangrene occures eventually
Clinical Manifestations
1. Vague epigastric pain - RLQ pain
2. Low - grade fever, nausea with some vomiting, loss of apetite
3. Local tenderness at the McBurney's point - rebound tenderness
4. Constipation
5. Rovsing Sign - palpate LLQ to generate pain in the RLQ
Appendicitis
Diagnostics
• CBC - elevated WBC - neutrophils
•Abdominal X-ray/CT Scan - densities or distention of the bowel
•U/A - rule out UTI
• Complete history and physical examination
Medical Management
•Surgery - Appendectomy/Perforation - Ex.Lap.
•IV Fluids and Antibiotics - prior to and after surgery
Nursing Management
1. Pain relief - pain medications - opioid analgesics
2. IV Fluids - prevent FVD
3. High Fowler's position - post surgery - relieve pressure on incision
4. Diet after Bowel Sounds are heard
5. Peritonitis - drain is left in place post.op, IV antibiotics, monitor signs of
intestinal obstruction

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Digestive

• About 1.5 meters long

– Absorbs more water

• Not part of the path of food,

• Include: Liver, gall

• Directly affects digestion by

• Stores bile from the

Endoscopy - direct visualization through a camera - esophageal,

• an excavation that forms in the mucosal wall of the stomach, the

Clinical Manifestations - last a few days, weeks or months

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