GIT TOPRANK Small Intestine:

 Duodenum
Functions:
 Jejunum- maximum absorption of nutrients
 Digestion happens here
 Absorption  Ileum
 Elimination
4 Disorders of the Upper GI Tract GERD
1.) GERD- backflow  Regurgitation- vomiting
2.) Hiatal Hernia- Protrusion  Difficulty swallowing- dysphagia
3.) Gastritis- Inflammation  Indigestion- dyspepsia
4.) PUD- Varices/Ulcers  Heartburn- pyrosis
GI Tract  Hypersalivation- kasi akala ng stomach mo
 Starts with the mouth  teeth, muscles, nagddigest ka pa
tongue  mechanical digestion  mouth: Diagnosis
saliva, lubrication and ptyalin (salivary  Upper Endoscopy (hanggang esophagus
amylase, different from pancreatic amylase) lang to confirm GERD)
- To visualize the esophagus
- Esophagogastroduodenoscopy
Chemical- enzymes Mechanical-
- Local anesthesia/sedation + atropine to
movement
kill gag reflex and decrease salivation,
HCl Chewing
respectively.
Pepsin Tongue movement
Bile Churning - NPO for 6-8 hours before
Amylase Peristalsis - Monitor for airway patency
Lipase Segmentation- - NPO for 1-2 hrs after the procedure
movement of the - Analgesics and Lozenges
colon Interventions
 Small frequent feeding
 Elevate head of bed
 Avoid gas forming food
 Avoid eating 2hrs before hours of sleep
 Avoid restrictive clothing
 Administration of medications:
o Antacids
o H2-receptor antagonist
o PPI
o Prokinetics
 Gastric sleeve- the curvature of
- Prokinetics
the stomach
o Promotes peristaltic movement,
Physiology:
promotes downward
 Cardiac Sphincter or LES (lower esophageal
movement of food
sphincter)- prevents reflux
 Avoid administering Pirenzipine- anti-
 Pyloric Sphincter- pag di nakasarado, leads
cholinergic drug which dec GI activity.
to dumping
Surgery:
 Digestion: food + HCl = chyme (2-4 hrs)
 Fundoplication
 Manifestations:
HIATAL HERNIA
Manifestations- Same as GERD
Interventions- Same as GERD
- Protrusion in the hiatus

**Vit B12 deficiency because nasira ang parietal

cells at masisira din ang intrinsic factor.
Interventions:
 Avoid- highly seasoned food
- Spicy food
Diagnosis - Alcohol
 Upper GI study - Smoking, increases peristaltic
- Barium swallow- no need to assess movement, GI activity, and HCl
allergy to dye. production
 Examination of upper GI tract- barium - Caffeine- gas forming food
sulfate  WOF- Hemorrhagic gastritis
 NPO- midnight before procedure - Hypotension, tachycardia, tachypnea,
 Laxatives as prescribed after the procedure- hematemesis, melena (black tarry
BaS04 may cause obstruction stools)
 Monitor for “chalky white” substance in  Administer medications as ordered:
feces. - H2 receptor antagonist
- Antacids like Pepto-bismol or Pink
Gastritis- inflammation Bismuth
 Acute- sudden in onset - Antibiotics
- Due to alcoholism Diagnosis:
- Microorganisms  Endoscopy
- NSAID’s, ASA (acetyl salicylate acid, ex  Barium swallow
aspirin), these are gastric irritants,  Fecalysis
prostaglandin inhibitors - Avoid dark colored food, to avoid false
- Highly seasoned foods diagnosis (ex dark meat of beef,
 Chronic- prolonged onset caldereta, adobo which has soy sauce)
- Alcoholism - Avoid aspirin administration, may cause
- H. Pylori kasi di napapatay ng HCl false diagnosis
- Ulcers - Send specimen to laboratory STAT
- Autoimmune - Test for fecal:
 o Pathogens
o Parasites
o Nitrogen
o Fat

PUD

*Hematemesis more common in Gastric

 Proton pump inhibitors greatly reduces HCl *Melena common in Duodenal
 H2 receptor antag- slightly reduces HCl, kasi Interventions:
magpproduce pa din ng HCl thru Gastrin at  Alcohol and smoking
Vagal nerve stimulation - NSAID’s
Types: - Aspirin
 Esophageal - Chocolates
 Gastric- poor man’s ulcer - Caffeine
 Duodenal- rich man’s ulcer  Small frequent feedings
 Reduce stress
Risk Factors:  Promote rest
 Family History  Administer medications as ordered
 Alcohol and smoking - H2 receptor antagonists
 NSAIDs and ASA - Prostaglandins
 Infection (H.Pylori) - Mucosal barrier protectants (Carafate)
 Stress - Antacids
Manifestations: - Anticholinergics
 Burning stomach pain  Bleeding precautions: Monitor V/S
 Intolerance to fatty food - Monitor Hem-hem (hematocrit and
hemoglobin)
 Feeling of fullness
- NPO, pag may ulcer at may signs of
 Fever
bleeding, subject it to NPO
- IVF, as ordered (NSS for possibility of
BT)
- Blood transfusion for heavy bleeding
- NGT- Lavage
- Vasopressin, promotes vasoconstriction
Surgery:
 Vagotomy- separation of vagus nerve
 Total gastrectomy
 Billroth I- Gastroduodenostomy Sample Medications
 Billroth II- Gastrojejunostomy  Antacids- Pepto Bismol
 Pyloroplasty- widens pyloric sphincter - Na Bicarbonate
Post-op: - Milk of Magnesia
 NPO 1-3 days depending on peristalsis (kasi  PPI (prazole)- ome-, panto
yung GIT ang mismong  H2-receptor antagonist (tidine)
 Advance from NPO to sips of water  NSAIDS (avoid)- Diclofenac
 Monitor for electrolyte imbalances kasi ang - Aspirin
tagal ng post-op - Naproxen
 Administer of IVF and electrolytes as - Celecoxib
ordered - Etoricoxib
 Administer TPN as ordered

Dumping’s Syndrome
(Increased gastric motility)
 Increased peristalsis
 Hyperactive bowel sounds
 Diarrhea
 Abdominal cramping
 Palpitations
 Diaphoresis
Goal: delay gastric emptying Inflammatory Bowel Disease
 Low residue diet (low-fiber)  Chronic inflammation of the colon
 Fluids after meals  Ulcerations may occur
 Lie flat on bed post-cebum (PC)  Risk factors:
 Antispasmodics to delay gastric emptying - Smoking
 Give solid foods - Microorganisms
- Stress
Vitamin B12 Deficiency - Cytokines- autoimmune
 Due to lack of intrinsic factor from the
parietal cells Manifestations:
 Lack of intrinsic factor leads to pernicious  Abdominal pain
anemia  Abdominal cramping
 Weight loss  Vomiting, manipis ang outlet
 Severe pallor  Diarrhea, dahil inflamed ang colon ang tubig
 Red beefy tongue ay di naaabsorb
 Paresthesias of hands and feet  Weight loss
 Fatigue  Bleeding dt ulcers
 Increase Vitamin B12 in the diet, pag total  Fever
gastrectomy thru Vitamin B12 injectables
 Sources are citrus fruit, organ meat, GLV Crohn’s vs Ulcerative Colitis
 Vitamin B12 injectables4
Diagnostic: (-scopy)
 Anoscopy- rigid scope to visualize the anal
area
 Proctoscopy- flexible
 Sigmoidoscopy- flexible
 Colonoscopy- flexible
 Biopsies and polypectomies may be
performed
 Enemas are given until returns are clear
 Left-side lying, the position that will open
up the colon
 For colonoscopy, put client on NPO
midnight before procedure
Interventions:
 Acute phase: Maintain NPO (admin IVF and
electrolytes, as ordered)
- Pain, cramping, bleeding
 After acute phase, progress diet from liquid
to low residue
 Increase protein in the diet
 Avoid gas forming food
 Avoid smoking
 Administer medications:
- Immunosuppressants
- Corticosteroids (for long term)
Surgery:
 Total Proctocolectomy (permanent
ileostomy)
 Koch’s ileostomy
Appendicitis
 Inflammation of appendix
 Rupture may occur
 Pain
 Pain intensifies in McBurney’s point