Normal Operation= Increased

Peristalsis

Emergency Operation= Decreased

Peristalsis

- Venous blood draining GI tract organs empties into the portal vein which then perfuses the liver

- Because these organs get 25-30% of cardiac output, it is a major source from which blood flow can be diverted during exercise and stress

Covers all abdominal organs

Two Layers:

Parietal: Lines cavity wall

Visceral: Covers organs

Like an apron; prevents friction; contains fat and lymph nodes

Greater/Lesser

GI Bacteria

(Very important)

- Microorganisms breakdown that not digested

- Also synthesize Vitamin K (needed for synthesize products for coagulation [clotting]) and some B (breaks down fat and CHO; improves muscle tone of the stomach)

- Produces flatus (important to remove gas in the GI tract)

- Amino Acids: deamminated leaving ammonia which liver converts to urea

Valsalva Maneuver

(takes over when you're trying to deficate)

- Defication facilitates

- Contradicted in patients with: head injury, eye surgery, cardiac problems, hemorrhiods, abdominal surgery, liver cirrhosis, with portal hypertension, TURF( trans urethral resection of the prostate)

- Creates more cranial pressure

- largest internal organ that plays a role in:

- Metabolism

- Bile Synthesis

- Detoxification

- Blood Proteins

- Stores glycogen

- "Romance of the abdomen" because it hugs different organs in abdomen

- Exocrine function (Digestive enzymes)

- Endocrine function (insulin, glucagon)

Consists of:

Gall bladder & CBD (common bladder duct)

CHO

(carbohydrate)

Cholecystokinase stimulates...

(breaksdown fats)

- Colonoscopy

- CT colonography

- Lab tests

Barium Enema/Swallow

- Stool Specimen

- Clostridium

- Salmonella

- C Diff (Clostridium Difficile)

- Gardia (f/ drinking water, treated with meds)

- Antibiotic associated pseudomembranous colitis (AAPMC) [can be from clindamycin, ampicillin, erythromycin, tetracycline, cephalosporins, lincomycin, & aminocyclosides --> associated with taking antibiotics, may take probiotic to prevent]

- Fecal output has increased H2O

- May contain blood & mucus

- Rectal urgency, cramping

- Tenesmus (difficult painful bowel movements)

- Nausea

- Conservative

- Fluid & electrolytes (loss of K+ & Na+)

- No antidiarrheals, antispasmodics (because it slows down passage)

- Kaolin & pectin (increase stool consistency)

- Bismuth subsalicylate (pepto bismal, decrease diarrhea)

- Handwashing (important!!)

Irritable Bowel Syndrome

(diagnosed if you can't diagnose with Crohn's ect.)

- Abdominal pain relieved with BM

- More frequent BM's

- Sense of incomplete evacuation

- Flatulence

- Constipation/diarrhea/both

- Diet and Bulking agents

-Medications:

- Anticholinergics

- MOM, Mineral oil

- Opioids

- Antianxiety

- Antidepressants

- Ulcerative colitis

- Crohn's Disease

- Cause unknown

- Mucose SUbmucosa

- Increased risk for Ca (cancer)

- Symptoms:

- 15-20 bloody, liquid stools/day

- Abdominal pain

May result in: anemias, fatigue

- History

- Colonoscopy/Sigmoidoscopy

- Sulfasalazine (anti-inflammatory)

- Steriods (really severe cases)

- Anti-cholinergics

- Antdiarrheals (immodium)

- Immunosuppressive

- Vitamins/minerals

- Diet:

- NPO - if cannot eat

- High calories

- High Protein

- Low residue

- Exclude milk

- Enteral supplements (if losing weight)

- Surgery is curative

- Poor response

- Poor response to medications

- Complications

- Surgical Procedures:

- Kock Pouch- Continent Ileostomy

- IAAP- Ileoanal Anastamosis Proctocolectomy (ileum taken down to anus, colon removed)

- NG suction

- Monitor stoma

- Check Ostomy output

- Teach ostomy care

- I & O

- Assess electrolytes

- Abdominal drains

- Urinary catheter

- Assess/ Monitor Pt for:

- Hemorrhage

- Abdominal Abscess

- Small Bowel Obstruction

- Dehydration

- Nutrition

- Cause Uknown

- Small intestine, transmural "string effect"

- Thickening of wall cobblestone effect

- Attacks intermittent

- Malabsorption complicaton

- Non-curative

- Can affect anything from your mouth to your anus

- 3-4 semi-solid stools/day

- Depend on site

- Fatigue

- Abdominal Pain

- Weight loss

- Fever

- fatty stools (float)

- non-curative

-symptoms shown in people 15-35 (slightly more in females than males and more in jewish people)

Diagnosis of Crohn's

(Treatment: remicade and humira)

- Physical Assessment

- History

- Extraintestinal Symptoms (effects eyes, mouth, kidney, bowel ect.)

- Steatorrhea

- Endoscopic Exam

- Abscesses

- Fistules:

- Bowel

- Skin

- Bladder

- Rectum

- Vagina

- Malabsorption

Alomental diet

(Crohn's Disease)

- Diet - Elemental Diet

- Medications

- Surgery (not done a lot because of all the places Crohn's may affect & risk of reoccurance):

- Non-curative

- Recurrence high after surgery

- Depends on area

- Post-op Care name as for CUC

- Nutrition

- Fluid Balance

- Medications

- Psychological factors

- Sexuality

- Appendicitis

- Diverticular Disease

- Peritonitis

- Acute Appendix

- Teens, young adults, males

- Inflammation, obstruction

- Rupture= peritonitis

- Pre-op:

- NPO

- Iv-Fluids & electrolytes

- No enemas, narcotics, heat

- Ice for pain

Post-op:

- IV

- NPO (May have NG-ADAT)

- Assess for complications

Pouch like hernias in colon

- Inflammation of hernias

- Perforation, abscess, obstruction, hemorrhage

- Pain

- fever

- Alternating constipation/diarrhea

- Increased WBC

- Bleeding (hematocheziahas: stool looks black but has gelled blood in it)

- Rest Colon (NPO/NG)

- Semi-Fowlers

- Oral Care

- IV Fluids

- Cough & Deep Breathe

- Abdominal Assessment

- Check for Signs/Symptoms Perotinitis

- Congenital por acquired weakness

- Abdominal femoral or inguinal, hiatal, umbilical ventral

- Reducible or irreducible (able to push it in)

- Incarcerated, strangulated

- Ventral/Incisional

- Very difficult to treat

- No repair unless complications

- To reduce- wear truss

- Surgery:

- Herniorrhaphy: sutured

- Hernioplasty: repaired with mesh

- I & O- watch for urinary retention

- Wound infection

- Serotal edema

- NO coughing

- Routine Post-op cares

- Teaching

- Partial or Complete

- Mechanical or nonmechanical

- Usually Ileum

- PROMPT TREATMENT

- Depends on location

- Nausea and Vomiting (bile)

- Abdominal Distention

- No flatus, obstipation

- Colicky pain

- abdomen: really tight and hard

- Medical:

- NPO

- Exvacuation of contents

- Intestinal decompression

- IV fluids/electrolytes

- Non-narcotic analgesics

Surgery:

- Most mechanical obstructions are treated this way

- Resection of area of obstruction

Pre-op:

- Assessment

- Analgesics

- VS

Post-op:

- Fowler's

- Cough & deep breathe

- Abdominal assessment

- Treat pain

- IV fluids & electrolytes

- I & O

- Nutrition

- Bowel Sounds

- Risk w/ CUC/diverticulosis

- Transit time theories

- Adenicarcinoma most common

(sometimes ppl who smoke a lot)

Symptoms:

- Non-specific until disease well advanced (it can look like another disease)

- Symptoms r/t mestastasis (spread to liver --> then goes all throughout body)

Diagnosis:

- Digital Rectal Exam

- Sigmoidoscopy/Colonoscopy

- Radiation

- Chemotherapy

- Surgery:

- Right hemicolectomy

- Left hemicolectomy

(depends where cancer is; then remove 1/2 of colon)

Pre-op:

- Bowel Prep

- Stoma site marking

Post-op:

- IV,NG, Foley, I & O

- Perineal irrigation

- Ostomy teaching

- Routine Post-Op cares

- Jejunostomy

- Ileostomy

- Ileal Pouch and Anastamosis

- Continent Ileostomy

Ostomy Options

(4)

J-Pouch, Temporary Loop ileostomy Stages I and II

- Congenital Disorders

- Obstructive Disorders

- Colon and Rectal Malignancies

- Diverticulitis

- Crohn's

- Radiation

- Trauma

- Ascending

- Transverse

- Descending

- Sigmoid

- Pouching

- Colostomy Irrigations:

- Indications

- Contraindications

- Procedure

- Pro/Con

- End

- Loop

- Double Barrel

Types of Stoma Construction

(3)

- Altered Body Image

- Acceptance

- Management of Cares

- Diet

- Trouble Shooting at home

- Stoma Appearance

- Red, moist, edematous

- No nerve endings in stoma

- Normal to have mucosla bleeding

- Psychosocial issues

- Patient teaching

- Soft diet, bulk, fluids

- Reduce BM anxiety

- Inappropriate Placement

- Necrosis

- Mucocutaneous Separation

- Stenosis

- Retraction

- Prolapse

- Peristomal hernia

- Laceration

- Shearing

- Dermatitis

- Yeast

- Denuded skin-stool or urine

- Folliculitis

- Radiation

- Varicose veins anal sphincter

- Lay terminology

- Ages 20-50:

- Straining, pressure

- CHF, Portal HTN

- Prolonged sitting or standing

- Ulcerations or laceration:

- Due to trauma

- Abnormal opening to surface:

- Repair needed

- form of electromagnetic radiation (like light); they are of higher energy, however, and can penetrate the body to form an image on film. Structures that are dense (such as bone) will appear white, air will be black, and other structures will be shades of gray depending on density.

- can provide information about obstructions, tumors, and other diseases, especially when coupled with the use of barium and air contrast within the bowel.

- In this procedure, a thin X-ray beam is rotated around the area of the body to be visualized. Using very complicated mathematical processes called algorithms, the computer is able to generate a 3-D image of a section through the body.

- very detailed and provide excellent information for the physician.

- scanning technique used to image the interior of the abdomen. Like the X-ray, MRI, and CT scan, it has its place as a diagnostic tool.

- use high frequency sound waves to produce an image and do not expose the individual to radiation. The procedure is painless and safe.

is an endoscopic procedure used to identify the presence of stones, tumors, or narrowing in the biliary and pancreatic ducts. After the endoscope is properly placed, a catheter is advanced which will inject a contrast agent through the ducts. The contrast is visible on X-rays, and allows a physician to evaluate the caliber, length and course of the ducts.

- may be performed if a patient experiences symptoms such as jaundice, abdominal pain, fever, or malabsorption

- It is a relatively new technology that allows imaging of the interior of the body without using X-rays or other types of ionizing radiation.

- scan is capable of showing fine detail of different tissues. Its use is rapidly increasing while the use of standard X-rays is decreasing.