Cute si dims J

GIT (gastrointes+nal tract)

08/24/23 – sir keith Garino
• GERD (gastroesophageal reflux disease)
o Problem: the food going up
o Priority: food should go down.
o Cause
§ Weak LES
§ Slow mo=lity
§ Pyloric stenosis
o Clinical manifesta7on:
§ Indiges=on burns your throat, larynx, and esophagus.
• Dyspepsia – indiges=on à nausea and vomi=ng (high saliva+on +
bi=er taste)
• Pyrosis – burning sensa=on of the esophagus or LES known as the
heartburn; most common complain.
• Globus – feeling of fullness in the throat.
• Laryngi=s – dry cough + hoarseness of voice
• Dysphagia – difficulty of swallowing
• Odynophagia – painful swallowing caused by ulcera=on.
o Avoid 5CAFPS:
§ Coffee
§ Citrus fruits/citric acid – this includes tomatoes.
§ Carbonated drinks
§ CigareNes
§ Chocolates
§ Alcohol
§ Fried or faNy foods the diges+on of fats and proteins is 2-3 hours related to
gastric emptying.
§ Pepper mint
§ Spicy
o Avoid: interven+on should focus on maintaining the food down
§ High IAP – obese, pregnant, +ght clothing, heavy liHing
§ Drug: decreased Mo=lity and increased HCI
• Aspirin
• NSAIDs
• An=cholinergic/an=spasmodic
• Ca channel blocker (calcium channel blocker)
o Diet
§ High in CHO
§ High in fiber à delays gastric emptying à increased sa+ety à prevents
overea+ng.
§ High protein – SFF (6-10 meals/day)
o Posi7on:
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§ HOB – elevated (30-45)

§ Turned to the le\ side esophagus is posi+oning above the level of stomach.
o Medica7on
§ Antacids
§ H2 receptor blocker
§ Proton pump inhibitor
§ Prokine=cs – increases the mo=lity and it is used for indiges=on such as
domperidone.
• Pep7c ulcer disease
o High HCl and high pepsin
o Decreased mucus produc=on thus lessen the protec=on in the stomach
o Process: when there is burns related to the PUC
§ Burns à increased permeability à fluid shi\ due to the fluid shiHs the
main management of the burns is fluid volume deficient à edema
§ Fluid shi\ à poor blood supply à poor circula=on à stomach –
hypoac=ve à decreased mucus à curling’s ulcers
o Factors:
1. Stress – PNS à acetylcholine à s=mulates the vagus nerve à s=mulates
the produc=on of gastrin à s=mulates the HCl
2. Drinks – caffeinated and decaffeinated. (both)
3. Vices – smoking + alcohol
4. Drugs – aspirin and NSAIDs
5. Infec=on – H.pylori – helicobacter
Gastric ulcer Doudenal ulcer
Poor mans or laborer’s ulcer à Execu=ve ulcer à stress
deceased food intake.

20% incidence 80% incidence

Common in people 50 years old à Common in people 25-50 years old à

decreased food intake cancer stage

Malnourished – weight loss Well nourished

Pain – ½ - 1 hour a\er meal Pain – 2-3 hours a\er meal

Pain is triggered by food intake. Pain is relieved by food intake.
Pain relieved by vomi=ng. Pain is common at night.

Nausea, vomi=ng and hematemesis Melena black and starry stool

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o Interven7on
§ Meal – SFF à decreased food = decreased HCl
§ Diet
• Food – as tolerated.
• Chew – slow + thoroughly increased chew =m
• Milk (-) large amount
• Ac=ve phase à bland
§ Avoid factors
o Medica7on:
§ An=bio=cs à Metronidazole; avoid à alcohol
§ Antacids à neutralize acid “chemical name” / “hydroxide/carbonate”
§ An=cholinergic à decreased GIT ac=vity à decreases HCl + decreased
mo=lity.
§ Cytoprotec=ve – “protect fate” à barrier or coa=ng in the stomach
§ H2 blockers – histamine rhymes with “+dine” à decreased hydrochloric
acid
§ Proton pump inhibitor – “prazole” – decreased hydrochloric acid
§ Prostaglandins analog – “misoprostol” – increase mucus + decreased HCl
• Not allowed for pregnant because it causes abor=on
• NSAIDs reduce PUD
o Surgery for PUD
§ Vagotomy – removal of vagus nerve which will make hydrochloric acid low
à acidity will be low à increased gastric pH
§ Gastrectomy – decreased HCl/to prevent perfora=on.
• Total – esophagus à reconnect at small intes=ne.
• Subtotal/antrectomy – removal of lower half
§ Anastomosis – reconnec+on
• Billroth I – gastroduodenostomy – reconnected to duodenum.
• Billroth II – gastrojejunostomy – reconnected to jejunum.
• Dumping syndrome (Problem at going down)
o Rapid gastric emptying à increased concentra=on of food à small intes=ne and
blood concentra=on fluids sha\ to small intes=ne thus à blood volume decreases
à shock
o Increased concentra=on of food à hyperglycemia à increased insulin à post
prandial hypoglycemia
o Management: main focus is delay gastric
§ Diet food should stay.
• Protein – high
• Fiber – high as tolerated.
• Carbohydrate – low simple
• Meals – small frequent feeding
• Fluids – avoid during meals/ drink in between meals.
• Salt, sugar, milk, and caffeine it will worsen the dumping syndrome.
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§ Posi7on: stay lie down a\er meal because it will delay gastric emptying;
TURN TO THE LEFT
§ Medica7on:
• An=cholinergic/an=spasmodic
• Diver7culosis
o Outpouching of intes=nal mucosa – diver+cula
o Common site: sigmoid
o Cause: low fiber diet à cons=pa=on
o Management:
§ Fiber diet high
§ Fluid intake high
§ Medica=on – laxa=ves
• Diver7culi7s
o Inflamma=on of 1 or more diver=cula
o Cause: accumula=on of fecal material
o Symptoms:
§ Inflamma=on – abdominal pain – crampy +
§ Infec=on – temperature and WBC
§ Injury – stool blood
§ Obstruc=on – bloa=ng and flatulence increase gas
§ Chronic cons=pa=on with episodes of diarrhea when there is irrita+ons. à
paraly+c ileus or absent bowel sound
o Management
§ Fiber diet low
§ Monitor for perfora=on à peritoni=s board like and rigid
o Acute phase: diver+culi+s, appendici+s, diver+culosis or pancrea++s
§ Goal: rest the bowel and decreased GIT ac7vity
• Oral intake – should be NPO.
• Ac=vity – bed rest
• Fluids – IV
• N/V – NGT à lavage or decompression
• Malnutri=on – TPN
• DOC:
o An=cholinergic/an=spasmodic
• Appendici7s
o Found in the ascending colon or at the sedum.
o Cause: fecalith namoong stool à obstruc=on à cause injury à infec=on +
inflamma=on
§ Increase peristalsis.
§ Increase IAP
§ Vasodila=on
• These three causes rapture then peritoni+s
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• Watch out for sudden disappearance of pain it means that it

ruptured
o Clinical manifesta7on: look for the abdominal guarding.
§ McBurney’s point – from the periumbilical at the ischial 1/3 at the right
lower quadrant.
§ Rovsing’s sign – palpated at the leH lower quadrant but it triggers the pain
at the right or known as referred pain.
§ Dunphy’s sign – triggered by. Coughing
§ Blumberg’s sign – rebound tenderness.
§ WAC
§ Bowel sound – low bowel sound
o Management:
§ Refer to acute phase.
§ Hot/cold compress – cold will cause constric+on which will lessen the
rupture.
§ Analgesics – avoid analgesics.
§ Avoid
• High peristalsis.
• high IAP
• vasodila=on
• Live cirrhosis
o Types:
§ Laennec’s cirrhosis – caused by alcoholism; most common/faNy acid
§ Post necro=c – hepa B + C
§ Biliary cirrhosis – caused by obstruc=on/gall stones.
§ Cardiac cirrhosis – RHF
o Process:
§ Repeated injury of the liver à healing à fibrosis (Scar) à loss of func=on
o Clinical manifesta7on
• Hemoglobin – hemo or iron à conversion to bilirubin colored is
brown, yellow and orange à liver à bilirubin (500-1000 ml/day)
or cholesterol à GB à GIT à emulsifying of fats à absorp+on of
vitamin ADER à cloang.
• GIT à conversion of bilirubin
§ Protein
• Amino acid and its waste produce is à ammonia à liver à urea
à BUN à kidneys…
§ Portal circula=on
• Heart provides blood supplies to the à kidneys
• Heart provides blood supplies to the à GIT à liver à back to the
heart.
• If the liver is destroyed it causes fibrosis à obstruc+on à increased
blood à hepatomegaly
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• With the Increased blood it will also cause à portal hypertension

à this may cause backflow to the GIT
o Management.
§ Bile – low
• Diet low fat diet
§ Hepa=c Encephalopathy – increased ammonia
• Asterixis – extend the hand
• Construc=onal apraxia – unable to draw (shapes)
• LOC – monitor and seda+ves should not be given.
• Fetor hepa=cus – assess à breath.
• Diet – low protein + high carbs
• DOC
o Lactulose – laxa=ve thus it promotes defeca=on and
produce so\ stool.
o Neomycin – an=bio=cs it will kill the bacteria inside the GIT.
à low protein à with low ammonia
o Management:
§ Portal hypertension
• DOC: beta blocker – it will decrease the portal pressure which is
lessen risk for rupture and bleeding.
• Procedure: TIPS
o Trans jugular
o Intrahepa=c
o Portal systems
o Shunt
§ Esophageal varices
• Avoid
o Increase in pressure
• Rupture – bleeding
o Procedure: Balloon tamponade – to stop the bleeding
o Readily material: scissors to cut the 2 balloon lumen and
esophageal and gastric to deflate.
• Gallbladder
o Cholecys77s
§ Types:
• Calculous – gall stone (most common)
• Acalculous – injury + surgery
• Cholelithiasis – supa-satura=on à bile (such as (1) cholesterol most
common, (2) bilirubin/pigment or hemoly+c disorder.)
o When there is obstruc+on it causes disten+on and
inflamma+on, and when there is obstruc+on bile is trapped
resul+ng to indiges+on of fats.
§ Classic complica=on: peritoni=s
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§ Clinical manifesta7on
• Inflamma=on
o Biliary colic – severe pain
o Abdominal pain – RUQ
o Rebound tenderness.
o Radia=ng – right shoulder
o Usually a\er a faNy or heavy meal
• Indiges=on of fats à increase of GAS
o N&V
o Belching
o Flatulence
§ Murphy’s sign
• Posi=on of the pa=ent is supine.
• Nurses’ hand’s is in the hepa=c margin.
• Inhale à it will trigger the pain
• Obstruc=on
o Skin – jaundice
o Stool – pale/clay + stretorrhea
o Urine – dark
o Vitamin deficiency – ADEK à increase bleeding
• Infec=on
o Fever
§ Management
• Refer to acute phase.
• Diet
o Fat – low fat diet
o Meal – small frequent feeding
o Gas forming food (-) egg, milk, and vegetables came from
the ground.
• Medica=on for mild cases to dissolve
o Ursodeoxycholic acid (UDCA)
o Chenodeoxycholic acid (Chenodiol or CDCA)
• Pancreas
o Acute pancrea77s
§ Cause: alcohol = gall stone à trapped pancrea=c enzymes which will cause
autodiges+on.
§ Inflamma=on
• Pain – LUQ
• Radia=ng – back
• Aggravated by
o Diet – fats
o Beverage – alcohol
o Posi=on – flat in bed
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• Bowel sound – decreased.

• N&V – indiges=on
§ Bleeding
• Dehydra=on
• Weight loss
• Cullen’s and Grey turner’s sign
o Cullen’s – it is in the umbilical.
o Grey’s turner – turn the pa=ent à flank or side.
o Laboratory findings
§ WBC – high
§ Glucose – high
§ Bilirubin
§ Alkaline phosphate
• Both bilirubin and alkaline phosphate indicator of Obstruc+on à
when its high high
§ Serum and urinary amylase
§ Serum lipase
• Best parameter and both are high.
o Management
§ Refer to acute phase.
§ Medica=on
• H2 receptor blocker – decrease hydrochloric acid.
• Proton inhibitor – decrease hydrochloric acid.
o It alleviates the HCl before the pain.
• Morphine
o It does not alleviate the HCl and directly to the pain.
• Chronic pancrea77s
o Repeated injury à healing (Ca) à fibrosis à loss of func=on à (1) lower insulin
and (2) p. enzyme
o Inflamma7on
§ Abdominal pain – LUQ
o Fibrosis
§ Mass – LUQ
§ Calcium – hypocalcemia
o Loss of func7on
§ Weight – loss
§ Bilirubin – high
§ Stool
§ Glucose – high
o Diet
§ Food – bland
§ Meals – small frequent feeding
§ Fats
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§Protein
• Both protein and fats are low
§ Calorie – high carbs
o Medica=on
§ Pancrea=n
§ pancrealipase
§ Insulin and OHA – to decrease the Blood sugar