NURS 5315 GI
Upper GI organs - ANS mouth,pharynx, esophagus, stomach, and duodenum
Lower GI organs - ANS small intestine, large intestine, rectum and anus
Hepatoportal circulation - ANS 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 - ANS 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 non absorbable sugars, tube feedings, dumping syndrome, malabsorption,
pancreatic enzyme deficiency, bile salt deficiency, small intestine bacterial overgrowth or celiac
disease
Secretory diarrhea - ANS Results in large volume losses secondary to infectious causes such
as rotavirus, bacterial enterotoxins, or c-diff.
Motility diarrhea - ANS 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 - ANS 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 - ANS 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 a lower GI bleed usually in the rectum, sigmoid colon or descending colon
Peptic Ulcer Disease - ANS 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 - ANS 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) - ANS Inflammatory disease of the large intestine in persons 20-40 y/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 - ANS recurrent diarrhea, bloody stools, febrile, polyarthritis, uveitis, sclerosing
cholangitis, erythema nodosum and pyoderma gangrenosum
UC complications - ANS fissures, hemorrhoids, perirectal abscess, toxic megacolon, colon
perforation, and colorectal adenocarcinoma. Increased risk of VTE and microthrombi, and colon
cancer
Crohn's disease - ANS 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 descent. CARD15/NOD2 gene mutation commonly associated.
Crohn's disease risk factors - ANS smoking, family history, Jewish descent, age less than 40,
slight predominance in women and altered gut microbiome.
Crohn's disease patho - ANS includes transmural 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 - ANS abd pain, diarrhea, dehydration, bloody stools, malabsorption,
malnutrition, weight loss, intestinal obstruction from chronic inflammation, fistulas and
perforation of the intestine
Diverticular disease - ANS 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 - ANS Diverticula are 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 causes LLQ pain. Results in abscess formation, rupture and
peritonitis
Appendicitis - ANS 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