H&I 3

• malnutrition
• obstruction
• pathological conditions

• inflammations,
• decrease blood supply,
• visceral type pain,

• infection
• chemical trauma
• defects
• stress
• Gi bleeding

• lower stress by
•   exercise,
•   relaxation techniques
•   imagry
•  

...heartburn

scarring which causes obstruction if get enough scarring

irritating foods should be avoided

• x-ray
• upper lower gi tract study
• lab  CBC, etc
• breath test (for carbohydrates absorption.)
• stool test
• EGD
• gastric analysis
• abdominal ultrasound
• Barrium
• DNA
• gastric analysis
• •MRI’s.

look for infection, or bleeding

• mechanical
• chemical

• evaluate carbohydrate absorption
• detects presence of helicobacter pylori-bacteria

look for abn stools esp in  loose stools

• Closridium difficile
• fecal leukocytes
• calcultation of stool

• 3 specimen have to go to lab w/in 30min
• can also examine stools for lipids

• -hemorrhidal bleeding
• -re meats
• -aspirin
• -NSAIDS
• =turnips/horesradish

• instruct pt to avoid red meat for 3 days before testing,
•  
• no more than 30minutes must pass n to labs,

• .detect enlareged gallbladder/pancreas
• .presence of gallstones
• .elarged ovary
• .appendicities
• .Dx acute colonic diverticulits

• specialized
• aids in diagnosis of GI disorders

• eval
• barretts esophagus
• portal hypertension
• chronic pancreatitis
• suspected pancreatic neoplasm

• mechanical
• chemical

endoscopic ultrasonography

look for high risk

• x-ray flate plane of abd
• upper & lower barrium

• abn growth
• polyps
• obstructions

• NPO right before & 6-8 hr prior
• clear liquids night prior
• after test want to get rid of barrium
•   -will crystalize

will turn into a rock

• increase liquids to 12 8oz glasses of water for several days prior
• lots of fluid after

turn them white

• w/ lower-emema (get go lightly night before)
• w/upper- drink

w/ lower GI low residu diet up to 2 hrs

• treatment for GI problems
• nutrients given IV

hyperglycemia must be filtered & IV pump

w/ in 1 hr

in pharmacy

dextros/aminos/ fats/lipids/

undernurished

only RN's can give

• no piggy backs
• no interuption unless spec written order
• w/TPN stat slowly- start rate slowly
• when on TPN may be on insulin-has dextrose
• slowly wean off to prevent hypoglycemia
• can be given in central line

• albumin
• CBC
• platlets
• TPP

lack of appetite

• no unless prolonged
• affecting their system

• Eposotic-caused by certain thing
• transient-come and go
• Chronic-when you worry

• GI/liver problems
• inflammatory d/o
• severe pulminary disease
• uremia
• CVA
• poor oral hygine
• distended
• meds-ex amphetamines, antihist

• fear
• anxiety
• depression
• things that are offensive (ex oders, etc, conversations)
• anything unpleasant

• malnutrion
• electrolye imbalance

• treating underlying cause
• may need supplimental feeding or TPN

• really good Hx
•  -when started
•  -cause
•  -general appearance
• check for wt loss
• observe for s/s of malnutrition

• bright eyes
• good muscle tone
• shiney hair
• non brittle hair/skin

eating patterns, relationship to nutrition

albumin  & lymphatics go down

no less than 15,000 cal /day

• talk w/ DR/nutrionialist/famly/pt
• try to find cause
• get DR order & find out what they like & get out sides food
• food should be attractive
• encourage eating when feel hungary
• food is important exp w/ underlying problems

• often peer pressure
• think they are fat when are slim

only when starts to effect body

have morbid obsessioin w/ weight and eating

females 12-18

seen a lot in upper class

• use differant way to stay thin
• perge
• over exercise
• after a while stop eating

• distorted image
• increase use of laxitivs
• binge
• perge

when start purging/binging

• losse electrolytes
• prob w/ starvation

protrusion of portion of stomach through esophogial ring

part of upper stomach move into lower portion of thorax

nesal fundalplication

• GERD
• discomfort
• regergitation
• dysphagia
• 50% + asymptomatic

• x-ray
• barium swallow
• fluoroscopy

• obesity
• pregnancy
• cough
• vomit

• sliding-most common 90%
• rolling (paraesophageal)

• upper stomach and gastroesophageal junction displaced upward
• --slide in and out of thorax

most common

all parts of stomach gets pushed through he diaphram beside the esophagus

• 50% asymptomatic
• heartburn
• acid reflux
• belching
• difficulty swallowing
• lowered motility

• no reflux
• often no s/s

many complain of fullness

• Hx of symptoms
• once prob determained -treat symptoms

• symptoms
• elevate HOB @ least 6in to reduce
• meds-H2 blockers-release hydorchloric acid

• bland
• should eat @ least 1 hr before bed

can occur from any part of GI bleeding

• upper-stomach
• lower-jajunim/ colon/ rectum illium

over wk/mo

how old/ from where

• coffee ground color-old
• bright red recent -outside hemroid

• acute or chronic-depending on underlying problem
• reacurring or
•  intermittent
• persistant

most common cause of chronic

• belching- can be long term few hrs to few days
• heartburn after eating
• sour taste in mout

• upper gi xray series
• endoscopy histologic exam of tissu

• refrain from alcohol & food till symptoms subside- usually few days
• nonirritating diet
• IV fluids

antacids

• NG intubation
• analgesic
• sedatives
• fiberoptic endoscopy

• b/w gum & cheek white
• irritated tongue
• slow sore healing
• pailess leasions w/ raised edges

• males
• highest in af am

• susternal neck/back pain
• late s/s -hiccup

next to bone causes lots of pain

• high risk af am male over 70 yrs
•   also seen in ppl under 40yrs
• starts in mucosa

pain above umbilicus-Dr have to r/o 1st

Crohn's & ulcerative cholitis

both get ulcer saffecting mucosal lining

• unknown cause
• attack usually under stress (phy/Psy)

usually in young adults b/w 15-30 &.70yrs

similar in both differance where occur

• small intest-abd tenderness, pain, cramp
• colon: -inflam , abd cramp, rectal bleeding, diarrhea w/ mucus
• inflamed red eyes
• will loss wt
• fever
• night sweat
• arthritis
• abn liver func

subacute & chronic infalmation of GI tract wall-extends through all layers

• no cure get remmision
• deeper lesions separated by good tissue
• seen more often in smokers
• linked to autoimmune response

• can occur throughout GI tract
• most common occurance in distal ileum & ascending colon

famales

• has periods of remission and exacerbation
• begins w/ edema & thickening of mucosa
• ulcers start to show
• can form ulcer or lesion
• get scarring from tissue break down

• have areas of lesions separated by good tissue
• hyperactive LUQ bowel sounds

• if stomach involve-n/v
• small intestind- abd tender, pain , cramp
• colon-inflamed / abd cramps, rectl
•  bleeding, diarrhea, w/ mucus

• fissure
• absess
• fistula
• be carrful what eat
• high risk of colon CA
• electrolte imbalances
• cause scaration
• protein in blood not absorped

• enoscopy, colonoscopy, intestinal biopsy
• barium enema=show ulcerations/fissure/fistula
• CT-show bowel wall thickening & fistula formation
• H&H -excess bleeding/anemia

• reliev symp-steroids
• iron supp
• surg if indicated-last resort

steroids if severe

• similar to Crohns
• dev ulcers
• high incidence in Euro Jews
• affects superficial mucosa of colon
• multiple ulcers

• shedding of colonic skin
• bleeding from ulcerations
• most will have bloody diarrhea

complication- up colon CA

serum albumin, skin lestion, liver involvement

• surgery last resort
• avoid iritating food
• colonstomy will cure colitis not chrones-w/ crohns lesions alwayscome back

• low residue
• low fat
• high protein

inflimation fo veriform appendis

• pouch fills up
• food ferments->bacteria ->bacteria can sread outside of appendix ->
• opening becomes blocked
• blood becomes blocked -can only stretch so much then rupture
• can dev paritinitus

• LRQ pain
• classic-reffered pain rebound pain
• mimic flue like syp

• b/w naval & illiac crest
• up temp
• n/v legs flexed toward bed
• can't straigten R leg b/c of pain

WBC steadily go up >1500

appendectomy

• more common in duodemum
• in pt 40-60yrs
• loose/destroy mucus layers

• h Pylori-gram neg bact-mostly seen in elderly
• transmitted
• genetics
• oral/fecalshock /burn/trauma

• worse w/ spicy foods
• epigastric burning1-2hr after meal
• n/v
• anorexia
• wt loss
• some pt get cramping 2-4 hr after meal
• pain usualy under xyphoid process

• drugs for H-pylori
• h2 blockers
• antagonists
• proton pump inhibitors
• antibiotics

• bland diet
• freq small feedings , lower stress, no skip meals

subtotal gastroectome remove lower stomach attach to jejunum

for tumor removal

• 50% stomac removed
• lower stomace used spec for duadernal

for dumping syndrom, malabsorptionremove tumore

• w/ gast surgery
• stomach empty's too fast goes into dueodemum
• lasts20-60 min
• can occure after/during meal

• weak
• ,faint,
• tachycardic,
• reactive hypoglycemia (3-4hr after meal)-tx w/orange juice / simple sugar

• diet low carb
• high proteing
• mod fat
• liquid 1hr prior/after meal
• resting high fowlers 20min after meal
• simple sugar than recheck

remove diseased coloncolectomy

for temp - use accending & transvers

colon ostomy becomes functional in  3-5 days

• ascending-liquid
• transvers liq-semi solid
• descending-soft formed stools