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7/21/2019 Upper GI PPT for Class.ppt
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Chapter 17
Digestive System Disorders
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Digestive System
%ro#esses ingested food and f!uids &rea's them do(n into their units Contro!!ed by en)ymes
*bsorbs ne#essary #omponents +embrane transport me#hanisms +ost!y in sma!! intestine
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Stru#tures and -un#tions of the
.astrointestina! System /Cont$
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*natomy of the Digestive System
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*ppetite #ontro!!ed by hypotha!amus Stimu!ated by hypog!y#emia, empty stoma#h,
de#reased body temperature, brain input
Deg!utition s(a!!o(ing "n#!udes mouth, pharyn5, and esophagus
"ngestion and %ropu!sion of -ood
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Digestion %hysi#a! and #hemi#a! brea'do(nof food into absorbab!e substan#es &egins in mouth Stoma#h fun#tions are to store food, se#rete
digestive ui#es, mi5 the food (ith gastri#se#retions, and empty the resu!ting #ontent
/#hyme into the sma!! intestine
Digestion and *bsorption
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*bsorption o##urs in the sma!! intestine /vi!!i
nd produ#ts of digestion8 transfer a#ross the
intestina! (a!! to #ir#u!ation$
9o digestion or absorption o##urs in theesophagus$
Digestion is #omp!eted in the sma!! intestine$
Digestion and *bsorption
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Digestion and *bsorption
Carbohydrates Digestion starts in mouth -o!!o(ed by digestion in the sma!! intestine
%roteins Digestion starts in stoma#h, #ontinues in sma!!
intestine ipids
mu!sified by bi!e prior to #hemi#a! brea'do(n *#tion of en)ymes form monog!y#erides and free
fatty a#ids -ormation of #hy!omi#rons
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Digestion and *bsorption
-at<so!ub!e vitamins =itamins *, D, , >
• *bsorbed (ith fats
?ater<so!ub!e vitamins =itamins & and C@diffuse into b!ood !e#tro!ytes
*bsorbed by a#tive transport or diffusion
Drugs are primari!y absorbed in the intestine$ =arious transport me#hanisms Some /e$g$, aspirin absorbed in the stoma#h
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Digestion and *bsorption
?ater *bsorbed primari!y by osmosis *bout 700 m of (ater is se#reted into the
digestive tra#t ea#h day$ *bout 200 m is ingested in food and f!uids An!y 30 to 200 m !eaves the body in fe#es$ Severe vomiting or diarrhea (i!! interrupt this
re#y#!ing me#hanism$
• *ffe#ts f!uid and e!e#tro!yte ba!an#e of body
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Cepha!i# /nervous Se#retion of hydrogen #h!oride /BC,
pepsinogen, mu#us .astri# /hormona! and nervous
Se#retion of gastri# hormone from antrum to
stimu!ate gastri# se#retions "ntestina! /hormona!
*#idi# #hyme /pB 2 re!ease of se#retin, gastri#
inhibitory po!ypeptide, #ho!e#ysto'inin Chyme /pB re!ease of duodena! gastrin
.astri# Se#retion %hases
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9eura! and Bormona! Contro!s
%arasympatheti# nervous system /%9S %rimari!y through vagus nerve /#rania! nerve
EC9F G• "n#reased moti!ity
• "n#reased se#retions
Sympatheti# nervous system /S9S Stimu!ated by fa#tors su#h as fear, anger "nhibits gastrointestina! a#tivity
Causes vaso#onstri#tion edu#ed se#retions and regeneration of epithe!ia!
#e!!s
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+aor Contro!s in the Digestive
Hra#t and Hheir ffe#ts
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9eura! and Bormona! Contro!s
-a#ia! /C9 ="" and g!ossopharyngea! /C9 "G
nerves +aintain #ontinuous f!o( of sa!iva in mouth
Distention and stret#hing of stoma#h %9S a#tivation I %erista!sis and gastri# se#retions
Stoma#h empties (ithin 2 to 6 hours after
mea!$ -ood in intestine Stimu!ation of intestina! a#tivity
• nterogastri# ref!e5
"nhibition of gastri# emptying
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Bormona! Contro!s
.astrin Se#reted by mu#osa! #e!!s /stoma#h in response to
distention of stoma#h or partia!!y digested substan#es• "n#reases gastri# moti!ity, re!a5es py!ori# and i!eo#e#a!
sphin#ters@promotes stoma#h emptying Bistamine
"n#reased se#retion of hydro#h!ori# a#id Se#retin
De#reases gastri# se#retions
Cho!e#ysto'inin "nhibits gastri# emptyingJ stimu!ates #ontra#tion of
ga!!b!adder
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"nvo!ves the !arge intestine +ost important fun#tion is absorption of (ater
and e!e#tro!ytes Haustral churning Defe#ation is vo!untary and invo!untary -a#i!itated by appropriate positioning
=a!sa!va manoeuvre
!imination
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!imination /Cont$
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Kpper .astrointestina! Hra#t
Ara! #avity "nitia! phase of me#hani#a! brea'do(n of food
• +asti#ation by teeth
"nitia! #hemi#a! digestion• Sa!ivary amy!ase@starts #hemi#a! brea'do(n of
#arbohydrates
-ormation of bo!us %haryn5
S(a!!o(ing /deg!utition sophagus
C!osed e5#ept during s(a!!o(ing, s'e!eta! mus#!e
at superior end@fo!!o(ed by smooth mus#!e
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Hhe Ara! Cavity
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Bea!thy %eriodontium
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%eriodonta! Disease
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Disorders of the Ara! Cavity
Carries &a#teria brea' do(n sugars and produ#e !arge Luantities of !a#ti# a#id$ a#ti# a#id disso!ves minera! in tooth ename! Hooth erosion and #aries formation Caries is promoted by freLuent inta'e of sugars and a#ids$ -!uoride@anti#aries treatment
.ingivitis "nf!ammation of the gingiva
• Hissue be#omes red, soft, s(o!!en, b!eeds easi!y
• +ay be a resu!t of a##umu!ated p!aLue "nadeLuate ora! hygiene Hoothbrush trauma
• esu!ts from improper or e5#essive brushing
• Creates e5tensive grooving on tooth surfa#e
• "n#rease p!aLue retention and damage to gingivae
%eriodonta! Disease "nfe#tion and damage to the periodonta! !igament and bone
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Stoma#h
5pansib!e mus#u!ar sa# < reservoir for food and f!uid Hhree smooth mus#!e !ayers Constant mi5ing and #hurning of food "nitia! digestion of proteins
&y pepsin• -ormed by #ombination of pepsinogen and BC!
%rodu#tion of intrinsi# fa#tor ssentia! for absorption of vitamin &12 in the i!eum
-ormation of #hyme *bsorption of sma!! and !ipid<so!ub!e mo!e#u!es
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o(er .astrointestina! Hra#t
Sma!! intestine Duodenum, eunum, i!eum =i!!i /fo!ds of the mu#osa M mi#rovi!!i /fo!ds of #e!!
membranes• "n#rease surfa#e area for absorption
+aor site for absorption of nutrients a#tea!@!ymphati# vesse! Site of produ#tion of
• +u#us• ntero'inase, peptidases, nu#!eosidases, !ipase,
su#rase, ma!tase, !a#tase, #ho!e#ysto'inin /hormone
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+aor Digestive n)ymes and
Hheir *#tions
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o(er .astrointestina! Hra#t /Cont$
arge intestine %eyer pat#hes /!ymphati# tissue esident norma! f!ora
• &rea'do(n of #ertain food materia!s
• =itamin > synthesis by ba#teria
-!uid and e!e#tro!yte reabsorption -ormation of so!id fe#es
• +ass movements
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+outh %eriodonta! disease, taste buds de#rease sophagus De#reased tone and moti!ity *bdomina! (a!! Hhinner, de#reased re#eptors Stoma#h, sma!! intestine, !iver, ga!!b!adder, and
pan#reas De#reased synthesis and se#retions arge intestine, anus, and re#tum De#reased tone,
moti!ity and transit time
Consider impa#t of e#onomi# #onstraints
*ge<e!ated Considerations ffe#ts of
*ging on the .astrointestina! System
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f .
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*ssessment of ."
Sube#tive data
• Sores or !esions• Sore throat• &!eeding gums• Hooth a#he• Boarseness• *!tered taste• Smo'ing, a!#oho!
#onsumption• Se!f #are behaviors /denta! #are
pattern, dentures, app!ian#es, diet of high
fibre foods, most re#ent e5aminations
D, o##u!t stoo! test, #o!onos#opy, %S*
• Change in appetite• Dysphagia /s(a!!o(ing
• -ood into!eran#e
• *%• 9N=• &o(e! Babits, freLuen#y,
#o!our • Change in &o(e! Babit
/diarrhea, #onstipation, !a5ative and
enema use
• e#ta! &!eeding• %ast *bd B5 /u!#er, ga!!b!adder,
hepatitis, appendi#itis, "&D, hernia
• +eds /pres#ription, AHC, anta#ids,
!a5atives, stoo! softeners, iron
• *!#oho! M Hoba##o• 9utritiona! *ssessment
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%hysi#a! e5amination• +outh /ips, gums, teeth, tongue, bu##a! mu#oa, pa!ate,
tonsi!s
• *bdomen
"nspe#t Contour, symmetry, umbi!i#us, s'in, pu!sations ormovements, #!ient demeanor • *us#u!tate &o(e!s M vas#u!ar sounds• %a!pate !ight and deep pa!pation in a!! 4 Luadrants, =o!untary
guarding, rebound tenderness,• mass /!o#ation, si)e, shape, #onsisten#y Ehard, firm, softF,
Surfa#e Esmooth, nodu!arF, mobi!ity, pu!sati!ity M
tenderness• %er#uss Costovertebra! *ng!e Henderness
• e#tum M anus
*ssessment of ."
Abe#tive data
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*ssessment of the
.astrointestina! System /Cont$
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*bdomina!%a!pation
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iver %a!pation
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Common +anifestations of
Digestive System Disorders1$ 9ausea and =omiting
2$ *nore5ia
$ Diarrhea
4$ .as3$ &!ood in Stoo!
6$ Constipation
7$ -!uid M !e#tro!yte "mba!an#e
:$ %ain
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9ausea and =omiting
+ay be signs ofdigestive disorder or
other #ondition
e!se(here in the body
Systemi# infe#tion Kremia motiona! responses +otion si#'ness
%ressure in the brain Averindu!gen#e of
food, drugs %ain
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9ausea * fee!ing of dis#omfort in the epigastrium (ith a
#ons#ious desire to vomit Knp!easant sube#tive fee!ing Simu!ated by distention, irritation, inf!ammation of
digestive tra#t *!so stimu!ated by sme!!s, visua! images, pain, and
#hemi#a! to5ins andNor drugs
*nore5ia Aften pre#edes nausea and vomiting
9ausea and =omiting
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9ausea and =omiting
=omiting /emesis Hhe for#efu! ee#tion of partia!!y digested food and
se#retions from the K."H
=omiting #enter !o#ated in the medu!!a• Coordinates a#tivities invo!ved in vomiting
• %rote#ts air(ay during vomiting -or#efu! e5pu!sion of #hyme from stoma#h
•Sometimes in#!udes bi!e from intestine
*nore5ia and vomiting Can #ause serious #omp!i#ations
• Dehydration, a#idosis, ma!nutrition
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9ausea and =omiting
&u!imia@eating disorder Damage to stru#tures of the ." tra#t #aused by
re#urrent vomiting• Ara! mu#osa
• Heeth• sophagus
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=omiting Center *#tivation
Distention or irritation in digestive tra#t Stimu!i from various parts of the brain
esponse to unp!easant sights or sme!!s, is#hemia %ain or stress =estibu!ar apparatus of inner ear /motion "n#reased intra#rania! pressure
Sudden proe#ti!e vomiting (ithout previous nausea Stimu!ation of #hemore#eptor trigger )one
&y drugs, to5ins, #hemi#a!s
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=omiting ef!e5
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Chara#teristi#s of =omitus
%resen#e of b!ood@hematemesis Coffee ground vomitus@bro(n granu!ar materia! indi#ates
a#tion of BC! on hemog!obin Bemorrhage@red b!ood may be in vomitus
Oe!!o(< or green<stained vomitus &i!e from the duodenum
Deeper bro(n #o!or +ay indi#ate #ontent from !o(er intestine
e#urrent vomiting of undigested food %rob!em (ith gastri# emptying or infe#tion
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Carefu! *ssessment M +onitoring < parti#u!ar!y during
periods of f!uid !oss and subseLuent rehydration therapy$
+ore !i'e!y to have #ardia# or rena! insuffi#ien#y
< p!a#es them at greater ris' for !ife<threatening f!uid and e!e#tro!yteimba!an#es
Beart fai!ure or ena! Disease < 5#essive rep!a#ement
of f!uid and e!e#tro!ytes may resu!t in adverse #onseLuen#es
9ausea and =omiting A!der *du!t
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Diarrhea
5#essive freLuen#y of stoo!s oose or (atery #onsisten#y *#ute or #hroni#
-reLuent!y (ith nausea M vomiting (ith infe#tionor inf!ammation
+ay be a##ompanied by #ramping pain %ro!onged may !ead to dehydration,
e!e#tro!yte imba!an#e, a#idosis, ma!nutrition
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Common Hypes of Diarrhea
arge<vo!ume diarrhea /se#retory or osmoti# ?atery stoo! resu!ting from in#reased se#retions into
intestine from the p!asma Aften re!ated to infe#tion
imited reabsorption be#ause of reversa! of norma! #arriersfor sodium andNor g!u#ose
Sma!!<vo!ume diarrhea Aften #aused by inf!ammatory bo(e! disease Stoo! may #ontain b!ood, mu#us, pus
+ay be a##ompanied by abdomina! #ramps and tenesmus
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Common Hypes of Diarrhea
Steatorrhea@fatty diarrhea8 -reLuent bu!'y, greasy, !oose stoo!s -ou! odor Chara#teristi# of ma!absorption syndromes
• Ce!ia# disease, #ysti# fibrosis -at usua!!y the first dietary #omponent affe#ted
• %resen#e interferes (ith digestion of other nutrients$ *bdomen often distended
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&!ood in Stoo!
&!ood may o##ur in norma! stoo!s (ith
diarrhea, #onstipation, tumors, or an
inf!ammatory #ondition$
Frank blood• ed b!ood@usua!!y from !esions in re#tum or ana! #ana!
Occult blood• Sma!! hidden amounts, dete#tab!e (ith stoo! test
• +ay be #aused by sma!! b!eeding u!#ers
Melena• Dar'<#o!ored, tarry stoo!
• +ay resu!t from signifi#ant b!eeding in upper digestive
tra#t
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.as
-rom s(a!!o(ed air < drin'ing from a stra(
&a#teria! a#tion on food -oods or a!terations in moti!ity
5#essive gas #auses ru#tation < be!#hing
&orborygmus P rumb!ing or gurg!ing noise made by movement
of f!dNgass
*bdomina! distention and pain -!atus
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Constipation
ess freLuent bo(e! movements Sma!! hard stoo!s *#ute or #hroni# prob!em
+ay be #aused by de#reased perista!sis "n#reased time for reabsorption of f!uid
%eriods of #onstipation may a!ter (ith periods
of diarrhea$
Chroni# #onstipation may #ause hemorrhoids,ana! fissures, or diverti#u!itis$
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Causes of Constipation
?ea'ness of smooth mus#!e < age or i!!ness
"nadeLuate dietary fiber "nadeLuate f!uid inta'e
-ai!ure to respond to defe#ation ref!e5 "mmobi!ity 9euro!ogi#a! disorders Drugs /i$e$, opiates
Some anta#ids, iron medi#ations Abstru#tions #aused by tumors or stri#tures
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-!uid and !e#tro!yte "mba!an#es
Dehydration and hypovo!emia are #ommon
#omp!i#ations of digestive tra#t disorders$ !e#tro!ytes
ost in vomiting and diarrhea *#id<base imba!an#es
+etabo!i# a!'a!osis• esu!ts from !oss of hydro#h!ori# a#id (ith vomiting
+etabo!i# a#idosis• Severe vomiting #auses a #hange to metabo!i# a#idosis
be#ause of the !oss of bi#arbonate of duodena!
se#retions$
• Diarrhea #auses !oss of bi#arbonate$
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%ain
Bigh!y #omp!e5 and sube#tive e5perien#e$ Knp!easant sensory and emotiona!
e5perien#ed asso#iated (ith a#tua! or
potentia! tissue damage$ %ain is a!(ayssube#tive8 /*%S$
Sube#tive report is most re!iab!e indi#ator$
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%QSH
% R %rovo#ation N %a!!iation Q R Qua!ity N Quantity R egion N adiation S R Severity S#a!e
H R Himing Do#umentation R
%atients understanding of the pain s#a!e %atients satisfa#tion (ith pain !eve! (ith #urrent treatment
moda!ity
Hime!y reassessment fo!!o(ing any intervention and responseto t5
Communi#ation (ith +D %atient edu#ation provided and pts response to !earning$
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%ain eferred %ain /Cont$
Common phenomenon %ain is per#eived at a
site different from origin$ esu!ts (hen vis#era!
and somati# nerves#onverge at one spina!
#ord !eve! Sour#e of vis#era! pain
is per#eived as thesame as that of the
somati# nerve$
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*#ute *bdomina! %ain tio!ogy M %athophysio!ogy
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*#ute *bdomina! %ain tio!ogy M %athophysio!ogy
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%!ease fo!!o( the !in's be!o(
evie( of Septi# Sho#' evie( of Bypovo!emi# Sho#'
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+a!nutrition
+ay be !imited to a spe#ifi# nutrient or genera! Causes of !imited ma!nutrition@spe#ifi#
prob!em =itamin &12 defi#ien#y
"ron defi#ien#y Causes of genera!i)ed ma!nutrition
Chroni# anore5ia, vomiting, diarrhea Ather systemi# #auses
• Chroni# inf!ammatory bo(e! disorders
• Can#er treatments
• ?asting syndrome
• a#' of avai!ab!e nutrients
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&asi# Diagnosti# Hests
adio!ogi#a! studies /Contrast medium may be used Kpper gastrointestina! series /barium s(a!!o( o(er gastrointestina! series /barium enema *bdomina! u!trasonography /+ay sho( unusua! masses Computed tomography /CH +agneti# resonan#e imaging /+"
ndos#opy /&iopsy may be done during pro#edures ndos#opi# u!trasonography Capsu!e endos#opy Sigmoidos#opy and #o!onos#opy
iver biopsy /Apen and #!osed
iver fun#tion serum studies iver fun#tion, pan#reati# fun#tion, #an#er mar'ers
aboratory ana!ysis of stoo! spe#imens Che#' for infe#tion, parasites and ova, b!eeding, tumors, ma!absorption
. !!b! dd K!t d
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.a!!b!adder K!trasound
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i d
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iver ndos#opy
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Common Hherapies and
%revention Dietary modifi#ations
5amp!e@g!uten<free diet /#e!ia# disease edu#ed inta'e of a!#oho! and #offee "n#reased fiber and f!uid inta'e
Stress redu#tion te#hniLues Stress impairs immune fun#tion and tissue
hea!ing$ Drugs
=ariety of medi#ations are avai!ab!e$
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Drugs Ksed in Digestive System
Disorders /Cont$
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Kpper .astrointestina! Hra#t
Disorders
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Dysphagia
Diffi#u!ty s(a!!o(ing Causes
9euro!ogi#a! defi#it +us#u!ar disorder +e#hani#a! obstru#tion
esu!ts and presentation %ain (ith s(a!!o(ing "nabi!ity to s(a!!o( !arger pie#es of so!id materia! Diffi#u!ty s(a!!o(ing !iLuids
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Causes of Dysphagia
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Dysphagia /Cont$
9euro!ogi#a! defi#it "nfe#tion Stro'e &rain damage *#ha!asia
• -ai!ure of the !o(er esophagea! sphin#ter to re!a5
be#ause of !a#' of innervation
+us#u!ar disorder
"mpairment from mus#u!ar dystrophy
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Causes of Dysphagia /Cont$
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Dysphagia /Cont$
+e#hani#a! obstru#tion Congenita! atresia /abnorma! narro(ing
• Deve!opmenta! anoma!y
• Kpper and !o(er esophagea! segments are separated$
Stenosis• 9arro(ing of the esophagus
• +ay be deve!opmenta! or a#Luired
• +ay be se#ondary to fibrosis, #hroni# inf!ammation,
u!#eration, radiation therapy
• Stenosis or stri#ture may a!so resu!t from s#ar tissue• +ay reLuire treatment (ith repeated me#hani#a! di!ation
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Dysphagia /Cont$
+e#hani#a! obstru#tion /Cont$ sophagea! diverti#u!a
• Autpou#hings of the esophagea! (a!!
• Congenita! or a#Luired fo!!o(ing inf!ammation
• Causes irritation, inf!ammation, s#ar tissue• Signs in#!ude dysphagia, fou! breath, #hroni# #ough,
hoarseness
Humors• +ay be interna! or e5terna!
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Biata! Bernia
*'a < Diaphramati# Bernia %rotrusion of the stoma#h through the
esophagea! hiaus of the diaprhragm into the
thro5$ S!iding hernia
+ore #ommon type %ortions of the stoma#h and gastroesophagea!
un#tion s!ide up above the diaphragm$
o!!ing or paraesophagea! hernia %art of the fundus of the stoma#h moves up through
an en!arged or (ea' hiatus in the diaphragm and
may be#ome trapped$
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Hypes of Biata! Bernia
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Biata! Bernia *ssessment
-ood may !odge in pou#h of the hernia Causes inf!ammation of the mu#osa ef!u5 of food up the esophagus /#hroni# esophagitis
Signs
%yrosis /Beartburn -reLuent be!#hing "n#reased dis#omfort (hen !aying do(n Substerna! pain that may radiate to shou!der and
a( -ee!ing fu!!ness after eating or a fee!ing of
breath!essness or suffo#ation Symptoms (orse (hen !ying do(n
. t h ! f!
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.astroesophagea! ef!u5
Disease /.D %eriodi# ref!u5 of gastri#
#ontents into dista!
esophagus #auses erosion
and inf!ammation$
Aften seen in #onun#tion(ith hiata! hernia
Severity depends on
#ompeten#e of the !o(er
esophagea! sphin#ter$
De!ayed gastri# emptying
may be a fa#tor$
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.D *ssessment
Consumption of fatty foods, #affeinated beverages, #ho#o!ate,
ni#otine, a!#oho!, peppermint
Drug history beta<b!o#'ers, #a!#ium #hanne! b!o#'ers, nitrates,
anti#o!inergi# drugs, estrogen M progesterone
"nf!ammation, dis#omfort up to 2 h after ea#hmea!
egurgitation (ith a sensation of (arm f!uid
trave!ing up(ard to the throat, !eaving a bitter,
sour taste in the mouth Dysphagia -!atu!en#e andNor b!oating after eating
. t h ! f!
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Co!!aborative #are ifesty!e modifi#ations
• ?eight !oss and smo'ing #essation
9utritiona! therapy• edu#ing fatty foods, #affeinated beverages, #ho#o!ate, ni#otine,
a!#oho!, peppermint, inta'e of spi#y and a#idi# foods$• at 3 P 6 sma!! mea!s during the day /de#reases pressure
Drug therapy• *nta#ids < neutra!i)es gastri# a#id
• %roton pump inhibitor /%%" P most po(erfu!TT &!o#'s fina! step in
the BUion se#retion by the parieta! #e!!• Cispride and +etro#!opramide P ." stimu!ants P improves gastri#
emptying
Surgi#a! therapy
.astroesophagea! ef!u5
Disease /Cont$
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9ursing +anagement
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Hea#h patients to avoid fa#tors that #ause
ref!u5 Smo'ing #essation !evating BA& to 0 degrees /68 b!o#s under BA&
*void !ying do(n 2< hours after eating *void !ate<night eating / h before s!eep *void restri#tive #!othing, !ifting heavy obe#ts,
straining, (or'ing bend over$ va!uate effe#tiveness and adverse effe#ts of
medi#ations ta'en for heartburn
g g
.astroesophagea! ef!u5
Disease
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.D d Bi t ! B i
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"n#iden#e in#reases (ith age$ &oth are asso#iated (ith (ea'ening of the
diaphragm, obesity, 'yphosis, and use of #orsets or
other fa#tors that in#rease intra<abdomina! pressure$ -irst indi#ations may in#!ude esophagea! b!eeding
se#ondary to esophagitis or respiratory
#omp!i#ations /e$g$, aspiration pneumonia re!ated to
aspiration of gastri# #ontents$
.D and Biata! Bernia *ge<e!ated Considerations
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.astritis *#ute .astritis
"nf!ammatory pro#ess of the mu#osa! !ining of thestoma#h$
+ay be u!#erated, edematous, and b!eeding *#ute
*!#oho! or ingestion of aspirin or 9S*"Ds VV
"nfe#tion by mi#roorganisms "ngestion of e5#essive amounts of tea, #offee, mustard, #!oves,
papri'a or pepper "ngestion of #orrosive or to5i# substan#es adiation or #hemotherapy Severe stress -ood poisoning /staph and infe#tions /#andida, herpesvirus
Chroni# Hype * P autoimmune Hype & P Be!i#oba#ter py!ori
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.astritis +anifestations
Dis#omfort (ith fa#ia! grima#es and
rest!essness *nore5ia, nausea, vomiting may deve!op
Bematemesis #aused by b!eeding pigastri# pain, #ramps or genera! dis#omfort ?ith infe#tion, diarrhea may deve!op$
i
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.astritis Hreatment
Acute gastritis Ksua!!y se!f<!imiting$ Comp!ete regeneration of
gastri# mu#osa
Supportive treatment (ithpro!onged vomiting
+ay reLuire treatment
(ith antimi#robia! drugs +ay reso!ve in 4:h /rapid
#e!! pro!iferation and
restoration of gastri# mu#osa
Chronic Gastritis ong<term -NK gastri# C* %erni#ious anemia
/destru#tion of parieta! #e!!s in
fundus and body !eads to
inadeLuate vitamin &12 absorption B2 e#eptor antagonist P
bo#'s gastri# se#retion and
maintains pB of gastri# #ontents
above 4$0 thus de#reasing
inf!ammation
*ntibioti#s P treat B$ py!ori
% ti K!
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%epti# K!#er.astri# M Duodena! K!#ers
+ost #aused by H. Pylori infe#tion
Ksua!!y o##ur pro5ima! duodenum /duodena! u!#ers
*ntrum of the stoma#h /gastri# u!#ers
K!#er may e5tend through the tissue !ayers of
the mus#!e and serosa into the abd #avity
Deve!opment begins (ith inabi!ity of the
mu#osa to prote#t itse!f from damage by a#id
pepsin in the !umen
%epti# K!#er
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%epti# K!#er
.astri# M Duodena! K!#ers
%epti# K!#er
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.astri# M Duodena! K!#ers
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Hypes of %epti# K!#er Disease
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%epti# K!#er Disease
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%epti# K!#er
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%epti# K!#er+anifestations M Diagnosti# Hests
Signs and symptoms pigastri# sharp, gna(ing or burning !o#a!i)ed
pain,
Duodena! u!#er o##urs ;0m to h after eating,re!ieved (ith food or anta#ids
.astri# u!#er pain is pre#ipitated by foo and not
re!ieved by anta#id
Diagnosti# tests sophagogastroduodenos#opy
&arium 5<ray
%epti# K!#er
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%epti# K!#erHreatment
Hreatment Combination of
• antimicrobial P to eradi#ate B$ %y!ori
• proton pump inhibitor P optimi)es u!#er
hea!tin by binding to the proton pump of parieta!#e!! and inhibiting se#retion of BU ions into
gastri# !umen
• H2 antagonist – reduces acid secretion to
optimize ulcer healing edu#tion of e5a#erbating fa#tors
%epti# K!#er
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%epti# K!#er
Comp!i#ations Comp!i#ations of pepti# u!#er
Bemorrhage• Caused by erosion of b!ood vesse!s
• Common #omp!i#ation
• +ay be the first sign of a pepti# u!#er %erforation
• K!#er erodes #omp!ete!y through the (a!!$
• Chyme #an enter the peritonea! #avity$
• esu!ts in #hemi#a! peritonitis
Abstru#tion• +ay resu!t !ater be#ause of the formation of s#ar tissue$
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%epti# K!#er Disease /Cont$
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%epti# K!#er Disease /Cont$