Wk1

Question 1

Name the different sphincters

Answer 1

Upper oesophageal
Lower oesophageal
Pyloric
Ileocecal
Anal

Question 2

Layers of gastrointestinal tract

Answer 2

Mucosa: simple columnar, has direct contact with food, scattered goblet cells secrete mucous for lube, lamina propria is connective tissue that provides capillaries for epithelial layer, muscularis mucosa is smooth muscle that provides muscular activity

Submucosa: connective tissue contains large blood vessels, nerves and secretary glands

Muscularis: 2 sub layers, inner layer around GI tract, outer aligned alongside GI tract

Serosa: outer layer of connective tissue, contains and supports GI tract

Question 3

Enteric nervous system

Answer 3

Controls GI tract and digestive function

Sub mucosal plexus: sub mucosal layer, localised functions - blood flow, absorption and secretion from GIT to blood

Myenteric plexus: located between circular and longitudinal muscular areas

Question 4

Sphlanchnic blood flow

Answer 4

Provides blood to oesophagus, stomach, intestines, liver, gallbladder, pancreas and spleen

Question 5

These salivary glands include:

Answer 5

Submandibular
Sublingual
Parotid

Question 6

Describe the process of deglutition

Answer 6

Swallowing
Saliva contain enzyme (amylase) which breaks down carbohydrates.
Relaxation of the stomach is facilitated by gastrin and cholecystokinin (polypeptide hormones secreted by GI mucosa)

Question 7

Gastrin

Answer 7

Stimulus: presence of partially digested proteins in stomach

Action: stimulates HCL secretion and pepsinogen

Question 8

Histamine

Answer 8

Stimulus: gastrin

Action: stimulates acid secretion

Question 9

Acetylcholine

Answer 9

Stimulus: vagus and nerves in stomach

Action: increase GI motility

Question 10

Motilin

Answer 10

Stimulus: presence of fat and acid in duodenum

Action: increase GI motility

Question 11

Secretin

Answer 11

Stimulus: presence of chime in duodenum

Action: stimulates pancreas and liver, decreases motility and decreases gastrin and gastric acid secretion

Question 12

Cholecystokinin

Answer 12

Stimulus: chime in duodenum

Action: stimulates gall bladder and pancreas, decreases GI motility, inhibits gastrin, constricts pyloric sphincter

Question 13

Pancreatic polypeptide

Answer 13

Stimulus: protein, fat and glucose in small intestine

Action: decreases pancreatic bicarbonate and enzyme secretion

Question 14

Vasoactive intestinal peptide

Answer 14

Stimulus: intestinal mucosa and muscle

Action: relaxes intestinal smooth muscle

Question 15

Glycogenolysis

Answer 15

Breakdown of glycogen

Question 16

What are parietal cells used for

Answer 16

Release stomach acid

Question 17

What is Glycogenolysis

Answer 17

Breakdown of glycogen stores to release glucose

Question 18

What is Gluconeogenosis

Answer 18

Glycogen stores have been used, liver can convert amino acids and glycerol (proteins) to glucose

Question 19

What is gastro reflux

Answer 19

Backward movement of gastric content to oesophagus
Weak lower oesophageal sphincter
Over production of acid
Inflames and causes cellular damage to oesophagus where acid has burned

Question 20

Symptoms and nursing management of gastro reflux

Answer 20

Heart burn 30-60mins after a meal
Painful to swallow
Burning in chest
Burping
Nausea
Mimic angina
Causes stricture: scar tissue
Oedema, muscular spasm

NC
Positioning: sit up, avoid bending 
Small meals
Weight loss
Antacids
Histamine 2 receptor agonists
Proton pump inhibitors PPI

Question 21

What is gastritis

Answer 21

Inflammation of gastric mucosa, local irritants such as alcohol, drugs, bacterial endotoxins, aspirin
May be severe

Question 22

What is chronic gastritis

Answer 22

Chronic changes to gastric mucosa
H.pylori
Autoimmune
Chemical: alkaline reflux from duodenum

Question 23

What is peptic ulcer disease

20% gastric
80% duodenum

Answer 23

Most caused by h.pylori
Aspirin and other NSAIDS
Stress - physiologic - burns
H.pylori produces enzymes and toxins which interfere with the mucosal protection against injury from gastric acid
Can penetrate mucosal lining, smooth muscle or perforate outer wall
Healing results in scarring - predisposes site to another ulcer

Question 24

Signs and symptoms of PUD and treatment

Answer 24

Burning, cramps, bleeding (coffee ground appearance if vomited), pain when stomach is empty, pain relieved by food or antacids temporarily, malemia: black tar from intestinal tract

Treatment: test: endoscopy, radiological studies (anaemia, faecal occult blood), antibiotics (h.pylori), antacids (relieve symptoms), heal ulcer crater, complications: haemorrhage, obstruction, perforation

Question 25

What is crohns disease

Answer 25

Recurrent inflammatory disease of sub-mucosal layer of GI tract Mainly proximal colon and terminal ileum Cause Unknown Diagnosed by X-Ray, sigmoidoscopy, colonoscopy, complications include fistula formation, abdominal abscess, bowel obstruction

Question 26

S&S of crohns and treatment

Answer 26

S&S: colicky pain, weight loss, malaise, low fever, diarrhoea, Perianal skin ulceration Tx: decrease inflammatory response with an anti inflammatory (corticosteroids), antibiotics for bacterial infection, pain relief, nutritional support, surgical resection of damaged bowel, rest bowel with temporary stoma

Question 27

What is ulcerative colitis

Answer 27

Inflammatory condition of colon. Mainly rectum and sigmoid colon (large bowel) Affects continuous layer of bowel Lesions forms in mucosal layer which may become necrotic or ulcerated

Question 28

S&S of ulcerative colitis and treatment

Answer 28

S&S: stools contain blood, anorexia, anaemia, cramping, exacerbation and remission, Perianal skin breakdown Tx: anti inflammatory drugs (corticosteroids), immunosuppressant drugs if severe (cyclosporine), surgery to remove bowel

Question 29

Nursing management of ulcerative colitis

Answer 29

``` Obs Pain relief and meds Skin care - stoma site, Perianal care Support and reassurance Education ```

Question 30

What is irritable bowel syndrome

Answer 30

Functional GI disorder (no physical changes to gastric wall) No specific structural alterations as cause of disease Altered bowel habits Treatment includes: laxatives, antidiarrhoeals, low dose antidepressants, anti spasmodics

Question 31

Colorectal cancer

Answer 31

``` Begin as benign polyps Present for a long time before symptoms Change in bowel habits Foetal occult blood test Barium studies Colonoscopy, sigmoidoscopy ```

Question 32

Treatment for colorectal cancer

Answer 32

``` Polyp removal Surgery Temporary colostomy Permanent colostomy Postop chemo Regular examination Colonoscopy ```

Question 33

What is diverticulitis

Answer 33

Diverticula becomes inflamed. Causes lower quadrant abdo pain, fever, increased white cell count, cramping, nausea, diarrhoea Diverticula: pouches within bowel wall

Question 34

What is appendicitis

Answer 34

Inflammation and infection of appendix, fever, pain, nausea and vomiting, CT ultrasound to confirm, antibiotics or removal

Question 35

What is bowel obstruction

Answer 35

Impaired movement of bowel contents Mechanical: hernias, adhesions, tumours, strictures, volvolus(twisting of bowel), intussusception (bowel fold back) Paralytic: impaired peristalsis, peritonitis, intestinal ischaemia

Question 36

S&S and nursing a management of bowel obstruction

Answer 36

Abdo pain and distension, constipation, anorexia, History and examination, abdo X-ray, CT and ultrasound, NGT, IV hydration, surgery

Question 37

Signs and symptoms of liver cirrhosis

Answer 37

``` Impaired protein synthesis Impaired fat metabolism Impaired bile synthesis Impaired carb metabolism Impaired steroid hormone and drug metabolism ```

Question 38

What is liver cirrhosis

Answer 38

Liver tissue damage by toxins that is replaced by fibrous tissue. Disrupts flow within vascular and biliary channels Weight loss, jaundice, pain as liver enlarges, anorexia Late S&S: splenomegaly, ascites, portal hypertension, liver failure,

Question 39

What is hepatitis

Answer 39

Inflammation of liver Caused by viruses (a,b,c,d and e) a.b.d are preventable, auto immune disorder, reaction to drugs and toxins, secondary to other infections Malaise,joint pain, anorexia, nausea and vomiting, jaundice, right side abdo pain

Question 40

What is pancreatitis

Answer 40

Inflammation of pancreas Pain in upper abdo Fever Diabetes