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Lecture 5

NURS 364 Lecture Notes - Lecture 5: Hiatus Hernia, Vitamin B12, Gastric Mucosa


Department
Nursing
Course Code
NURS 364
Professor
Deborah Van Kuiken
Lecture
5

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Alterations of Digestive Function
Review of the GI tract
Neural Control & Motility
Autonomic nervous system
Parasympathetic- increases actiivity
Innervate the stomach, small intestine, cecum, ascending colon, and transverse
colon occurs by way of the vagus nerve
Sympathetic- slows things down
Controls mucus secretion by the mucosal glands
Reduces motility
Enhances sphincter function
Increases the vascular smooth muscle tone of the blood vessels that supply the
GI tract.
Neural Control & Motility
Enteric nervous system
Over half of the nerve cells in your body are located in the gut.
Your “gut brain” is also able to learn and produce emotion-based feelings.
Governs many GIT functions without external innervations (modulation only)
motility
secretion
growth regulation
collaboration with immune system on defense
Gastrointestinal Hormones
GI tract is the largest endocrine organ in the body.
Gastrin
Stimulation of gastric acid secretion
Growth production of mucosa
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Motilin
Stimulates peristalsis
Intrinsic factor
Absorption of Vitamin B12 (Cyanocobalamin)
Cholecystokinin
Stimulates pancreas
Regulates GB secretion
Gastric emptying
Disorders of Motility
Disorders of Motility
The act of swallowing depends on the coordinated action of the tongue and pharynx.
These structures are innervated by cranial nerves V, IX, X, and XII.
Esophagus
Muscular tube connecting the pharynx to the stomach
Disorders of Motility
Dysphagia (difficulty swallowing)
Mechanical obstructions
Narrowing of the esophagus.
Strictures: do to scarring from inflammatory disorders (GERD)
Cancer of the esophagus
Tumor
Functional obstructions
Neural or muscular
Achalasia - Denervation of smooth muscle in the esophagus and lower
esophageal sphincter relaxation
CVA cranial nerves that control swallowing
Parkinson’s disease
Disorders of Motility
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Clinical Manifestations:
Pain at the level of obstruction
Food and fluid accumulate in esophagus
Dilation of lower esophagus
Risk for aspiration--- try to drink something to wash it down which increases
the risk
One of the complications of GERD is aspiration, which is a possible/likely outcome?
A. Asthma /chronic bronchitis--- asthma and GERD are somewhat linked. It’s inflammation of the
bronchus. If we are aspirating we will see it in bronchus
B. Emphysema--- more with smoking
C. Pleural effusion--- out in pleural space
D. Tamponade --- with heart
Gastro-Esophageal Reflux Disease (GERD)
Refers to the backward movement of gastric contents (chyme, acid,
pepsin) into the esophagus due to defective lower esophageal
sphincter--- only partial reflux of stomach contents into the
esophagus… esophagus pH= 5-7 stomach pH= 2 so stomach has ways
to protect against acid but esophagus does not so problems can
happen
Persistent gastro-esophageal reflux produces mucosal damage & leads to strictures r/t
edema, scarring, and spasm of the esophagus
Gastro-Esophageal Reflux Disease (GERD)
Severity of the esophagitis depends on:
Composition of the chyme
Acidic? pancreatic enzymes? Bile?
Length of contact with the esophageal mucosa
Gastro-Esophageal Reflux Disease (GERD)
Etiology & Risk factors
Lower Esophageal Sphincter (LES): decreased tone and pressure
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