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Secreted by parietal cells

HCl- maintains acidity 1.0 pH

- destroy some bacteria ingested

- aids also in digestion of food

Intrinsic factor- aids in absorption of Vit B12

Secreted by entero- endocrine cells

Gastrin, somatostatin ,serotonin, endorphins and histamines.

Gastrin- regulates secretion and motility of the stomach

Assessment

History ( Demographic, Diet, CC, Medical, Family, Psychosocial )

Physical Examination

- position

- sequence

DIAGNOSTIC TESTS

Laboratory tests

CEA ( Carcinoembryonic Antigen)(+) colorectal cancer

specimen by venipuncture

Fecal Analysisstool for occult blood

detect GI bleeding

Prep: increase fiber diet48- 72 hrs no red meat, poultry, fish

withold for 48 hrs iron, steroids,

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Indomethacine, colchicine

Gastric analysis

Measures secretion of HCL and pepsin

NPO for 8-12 hrs

Gastric contents collected q15min for 1 hr

Radiographic Tests

UGIS

-to visualize the esophagus, stomach, doudenum and jejunum.

Prep: NPO 6-8 hrs

Barium sulfate per orem

X-ray taken on standing and lying position

Post-procedure: laxative

increase fluid intake

stool is white for 24-72hrs

observe for barium impaction

LGIS: to visualize the colonPrep: low residue/ clear liquid diet for 2 days

laxative or cleansing bowel

suppository and cleansing enema in AM

barium sulfate per rectum

Post-procedure: same as UGIS

Endoscopy

UGI Endoscopy- direct visualization of esophagus, stomach and duodenum.

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Prep: NPO 6-8 hrs

Anti-cholinergics

sedatives, narcotics, tranquilizers

Remove dentures

Post-procedure: side lying

NPO until gag reflex

LGI Endoscopy

Proctosigmoidoscopy ( sigmoid, rectum)

Prep: clear, liquid diet 24 hrs before test

administer cathartic/laxative as ordered

cleansing enema

kneechest/lateral position

Post- procedure: supine position for few minutes

assess for signs of perforation -

bleeding, pain and fever

Colonoscopy

Prep: sedation

position: left side, knees flexed

Post-procedure: Monitor v/s

Assess for s/s of perforation

Laparoscopy direct visualization of the organs and structures within the abdomen

Laparoscopic surgery, also called minimally invasive surgery (MIS), band aid surgery, or keyhole surgery

It is a modern surgical technique in which

operations in the abdomen are performed

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through small incisions (usually 0.51.5 cm)

Endoscopic retrograde

cholangiopancreatography (ERCP)

examination of the hepatobiliary system

Paracentesis trans-abdominal removal of fluid from the peritoneal cavity for analysis

Liver Biopsy

Post- Procedure:

Place on the right side with pillow under coastal margin.

Avoid heavy lifting and strenuous activities for a week.

Maintain bed rest for several hours.

Urea breath test detects the presence of helicobacter pylori, the bacteria that causes_____

Procedure: patient consumes a capsule of carbon-labeled urea and provides a breath sample 10 to 20

mins later.

Several medications has to be avoided prior to the test: antibiotics (1 month) carafate and omeprazole (

1 week ) and H2 blockers (24 hrs)

Sigmoidoscopy

Colonoscopy

Gastroscopy

Gastroesophageal reflux

DESCRIPTION:

Backflow of gastric contents into the esophagus

Usually due to incompetent lower esophageal sphincter , pyloric stenosis or motility disorder

Symptoms may mimic heart attack

Do you know why I took up nursing? It was in 4th year high school that I saw a vision of a great

woman bearing a light in her right hand wearing a long gown and a headress calling me to serve

her.

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Statue of Liberty

TRY THIS!!!

Is it possible that stomach will digest itself?

No, because of

MUCOUS GLANDS

Mucous glands

prevent autodigestion

by providing

an alkaline protective

covering

LAUGH BREAK

Bakla at Macho nagkasabay sa CR...

Bakla: Ang laki naman nyan sayo...

Macho: Wala na tong silbi kasi iniwan na ako ng GF ko... puputulin ko na

lang at ipapakain ko sa aso!

Bakla: aw! aw! aw!

Gastric Ulcer

-50 y/o and above

-lower socioeconomic class

-20% incidence

-normal to hyposecretion of HCl

-pain at meal

-hematemesis

-with malignancy

-at lesser curvature

-malnourished

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-blood group A

HIATAL HERNIA

Esophageal or diaphragmatic hernia

Portion of the stomach herniates diaphragm thorax

Weakening of the muscles of the diaphragm & aggravated by fx that abdominal pressure

i.e. pregnancy, ascites, obesity, tumors, and heavy lifting

Cx:

ulceration, hemorrhage, regurgitation and aspiration of stomach contents, strangulation, and

incarceration of the stomach in the chest with possible necrosis, peritonitis, and mediastinitis

HIATAL HERNIA

Assessment

Heartburn

Regurgitation or vomiting

Dysphagia

Feeling of fullness

HIATAL HERNIA

Implementation

Medical and surgical management is similar to that for GER

Provide small, frequent meals and minimize the amount of liquids

Advise the client not to recline for 1 hour after eating

Avoid anticholinergics, which delay stomach emptying

LAUGH BREAK

CROHNS DISEASE

ULCERATIVE COLITIS

APPENDICITIS

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Destroys old RBC/blood reservoir

Removes poisons from the blood

Stores and releases glycogen as needed by the body

Manufactures bile

Storage of minerals and fat soluble vitamins

Pancreas

Both exocrine and endocrine gland

Exocrine function is to secrete pancreatic enzymes amylase, lipase and trypsin

Collects worn out RBC

Disorders

Liver Physiology and Pathophysiology

fetor hepaticus (foul smelling breath)

metabolism of nitrogenous waste products

leads to azotemia to hepatic encephalitis (asterixis and decreased LOC)

Predisposing Factors: 5 Fs

Female

Fat

Fair

Forty

Fertile

Colorectal Cancer

Cause: Unknown

Most Common Site: rectosigmoid area

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Types of Colostomies

Ascending colostomy

Stoma is on the right of abdomen

Fecal drainage is watery becomes pasty

Transverse Colostomy-Transverse portion

- middle of the abdomen

- output: liquid initially-semiformed to paste like in 4-6weeks

Descending and Sigmoid Colostomy

Stoma on the left of the abdomen

Fecal drainage is well-formed

Colonic Surgery

Postop Care

Managing the perineal wound

6months to completely heal

Wound irrigations with NSS and absorbent dressings until wound closes.

Drainage is initially copious and serosanguinous, to be drained regularly

Stoma Monitoring

Stoma is red and with slight edema for 5-7 days

Dark, dusky or brown- black stoma indicates ischemia and necrosis

Should protrude by to inches over abdomen Flatus and fecal drainage- begin in 4-7 days, as peristalsis returns Empty the pouch 1/3 full of stool

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- Teaching for self- care Stoma Care

Gently encourage the client to look at the stoma Inform that stoma has no touch or pain sensation

Skin care

Wash the skin with warm water, pat dry when pouch seal leaks, change pouch immediately Use skin barrier to protect the peristomal skin from liquid stool Skin infection caused by Candida Albicans is treated with nystatin (

Mycostatin) powder.

Colostomy Irrigation

Initial Irrigation- stimulate peristalsis; subsequent irrigations-promote evacuation of feces at a regular

and convenient time

Recommended with sigmoid colostomy

Initiated 5-7 days postop

Semi-fowlers position; sitting on a toilet bowl once able

Use warm normal saline solution

How to Irrigate..

Initially, introduce 200ml of NSS then 500- 1000ml subsequently

Dilate stoma with lubricated gloved finger before insertion of catheter

Lubricate catheter before insertion

Insert 2-4 inches of the catheter into the stoma

Height of solution 18 inches above the stoma

Abdominal cramps-temporarily stop the flow of solution until peristalsis relaxes

Allow the catheter to remain in place for 5-10 minutes for better cleansing effect, then remove

catheter to drain for 15-20 minutes.

Clean the stoma, apply new pouch.

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Managing Odor

Avoid gas- forming and foul odor foods

Rinse pouch with tepid water or weak vinegar solution.

Place deodorant tablet or small amount of mouthwash or a piece of charcoal into a pouch.

Colonic Surgery

Postop Care

Supporting a Positive Self- Concept

Encourage to view the stoma

Encourage to verbalize feelings, fears and concern abou the stoma

Encourage to participate in colostomy care

Encourage to gradually resume all usual activities

Preventing Sexual Dysfunctions

Explore positions that minimize stress and pressure on the pouch

Empty and clean the pouch before sexual activity

Use smaller- sized pouch or pouch cover during sexual activity

Use of a binder or special underwear to hold the pouch secure