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Final

NURS 20363 Final: Pathophysiology Final


Department
Nursing
Course Code
NURS 20363
Professor
Howington
Study Guide
Final

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Gastrointestinal System Ch. 36 & 37
1. Describe the pathophysiology, risk factors, and clinical manifestations of constipation, diarrhea, and
gastrointestinal (GI) bleeding. (include pediatric diarrhea as well)
pg. 907-909
Constipation:
-INFREQUENT OR DIFFICULT DEFECATION
A DECREASE IN NUMBER OF MOVEMENTS/WEEK
THE NORMAL NUMBER OF MOVEMENTS VARIES PER PERSON.
Patho & Risk Factors:
Primary Constipation is classified into three categories:
-Normal Transit (functional): normal rate of stool passage but there is a difficulty with stool evacuation.
-Functional: associated with sedentary lifestyle, low residual diet and low fluid intake.
-Slow-transit: impaired colonic motor activity. Infrequent poos, straining to poo, mild abdominal distention,
palpable poo in the sigmoid colon.
Secondary Constipation- caused by diet, medications, or neurogenic disorders.
- Neurogenic disorders: STROKE, SPINAL CORD LESIONS, ETC.
neural pathways or neurotransmitters are altered and colon transit time is delayed.
Risk Factors:
FUNCTIONAL OR MECHANICAL CONDITIONSDISORDERS OF THE PELVIC FLOOR IN FEMALES IS
AN EXAMPLE OF THIS--RECTOCELE
LOW-RESIDUE DIETNOT ENOUGH FIBER
SEDENTARY LIFESTYLE---NOT ENOUGH EXERCISE TO MOVE BOWELS
EXCESSIVE USE OF ANTACIDSDECREASED MOTILITY
CHANGES IN BOWEL HABITSAGING, NO ACCESS TO TOILETS, PREGNANCY, IBS
Clinical Manifestations:
INDICATORSMUST LAST FOR 3 MONTHS
STRAINING W/ STOOLING AT LEAST 25% OF THE TIME
LUMPY OR HARD STOOLS AT LEAST 25% OF THE TIME
SENSATION OF NOT EMPTYING AT LEAST 25% OF THE TIME
MANUAL MANEUVERS TO REMOVE STOOL
LESS THAN 3 MOVEMENTS PER WEEK WHEN MORE WAS NORMAL
ALSO POSSIBLE:
HEMORRHOIDS
RECTAL BLEEDING OR TEARS DURING BOWEL MOVEMENTS (ANAL FISSURES)
EXTREME ABDOMINAL PAIN AND CRAMPING
FEELINGS OF FULLNESS AND NOT BEING ABLE TO PASS STOOL
Diarrhea and Pediatric Diarrhea:
- presences of loose, watery stools.
- acute: more than 3 loose stools over 24 hours.
- persistent: lasts longer than 14-30 days.
Patho:
- Generally caused by excessive amounts of water or secretions or both into the intestines.
-Osmotic: non-absorbable substance in the intestine draws excess water into the intestine and increases stool
weight and volume producing large-volume diarrhea.
-Secretory: Excessive muscosal secretion of fluids and electrolytes produces large-volume diarrhea. Infections
causes include viruses, bacterial endotoxins/.
-Motility: Caused by resection of the small intestine, surgical bypass of an area of the intestine or fistula
formation between loops of intestine, utterable bowl syndrome- diarrhea predominant, diabetic neuopathy,
hyperthyroidism, and laxative abuse.
Clinical Manifestations:
INCREASED VOLUME, FLUIDITY, WEIGHT OF THE FECES

Only pages 1-3 are available for preview. Some parts have been intentionally blurred.

MORE WATER IS IN STOOL SO MORE WEIGHTLARGE VOLUME DIARRHEA
EXCESSIVE MOTILITY BUT NOT CHANGE IN VOLUMESMALL VOLUME DIARRHEA
CAN BE RELATED TO A BACTERIA OR VIRUSCHANGE TO THE MUCOSAL LINING
EXCESSIVE SECRETION OF FLUID AND ELECTROLYTES
PROLONGED DIARRHEA IN CHILDREN IS DANGEROUS-
CAN LEAD TO FLUID/ ELECTROLYTE IMBALANCEDEHYDRATION
CHILDREN HAVE LOWER FLUID RESERVES THAN ADULTS
CAN BE ACUTE OR CHRONIC DEPENDING ON THE CAUSE
SYSTEMIC EFFECTS
DEHYDRATION
ELECTROLYTE IMBALANCEHYPONATREMIA, HYPOKALEMIA
WEIGHT LOSS
NEED TO FIND THE CAUSE IN ORDER TO REVERSE THE MANIFESTATIONS
Gastrointestinal Bleeding:
Patho:
UPPER GASTROINTESTINAL BLEEDING
bleeding in ESOPHAGUS, STOMACH, OR DUODENUM
Characterized by frank, bright red bleeding or dark grainy digested blood “coffee grounds” that has
been affected by stomach acids.
Commonly caused by bleeding varicose gains in the esophagus, peptic ulcers, arterovenous
malformations, or a Mallory-Weiss year at the esophageal-gastic junction caused by severe
vomiting/gagging.
LOWER GASTROINTESTINAL BLEEDING
BLEEDING FROM THE JEJUNUM, ILEUM, COLON, OR RECTUM
Caused by polyps, diverticulitis, inflammatory disease, cancer or hemorrhoids.
OCCULT BLEEDING
TRACE AMOUNTS DETECTABLE WITH LAB TESTS (GUIAC TESTING)
Caused by slow, chronic blood loss that is not obvious and results in iron deficiency anemia as iron
stores in the bone marrow re slowly depleted.
Risk Factors:
Clinical Manifestations:
HEMATEMESISBLOODY EMESIS; VARIES FROM RED TO DARK “COFFEE GROUNDS”
APPEARANCE
HEMATOCHEZIABLOOD THAT IS FRESH AND FROM THE RECTUM
MELENABLACK, TARRY, FOUL-SMELLING STOOL CAUSED BY BLOOD IN THE INTESTINAL TRACT
- Changes in BP and HR are the best indicators of massive blood loss in the GI.
- Early stages: arteries constrict and shunt blood to vital organs/
- Signs of large volume loss: Lightheadedness, loss of vision, tachycardia
- Digestion of blood proteins originating from massive upper GI bleeding is reelected by an increase in blood
urea nitrogen (BUN) levels.
- Hematocrit and hemoglobin values are not good indicators of acute GI bleeding bc plasma volume and red
cell volume are lost proportionally.
2. Compare and contrast upper and lower GI bleeding.
pg. 909
UPPER GASTROINTESTINAL BLEEDING
bleeding in ESOPHAGUS, STOMACH, OR DUODENUM
Characterized by frank, bright red bleeding or dark grainy digested blood “coffee grounds” that has
been affected by stomach acids.

Only pages 1-3 are available for preview. Some parts have been intentionally blurred.

Commonly caused by bleeding varicose gains in the esophagus, peptic ulcers, arterovenous
malformations, or a Mallory-Weiss year at the esophageal-gastic junction caused by severe
vomiting/gagging.
LOWER GASTROINTESTINAL BLEEDING
BLEEDING FROM THE JEJUNUM, ILEUM, COLON, OR RECTUM
Caused by polyps, diverticulitis, inflammatory disease, cancer or hemorrhoids.
3. Describe the pathophysiology, risk factors, and clinical manifestations of gastro-esophageal reflux disease
(GERD) in the adult and pediatric population.
pg. 911
GERD- Reflux of acid and pepsin or bile salts from the stomach into the esophagus that causes esophagitis
GERD IS THE REFLUX OF CHYME FROM THE STOMACH TO THE ESOPHAGUS THROUGH THE
ESOPHAGEAL SPHINCTER
IF GERD CAUSES INFLAMMATION OF THE ESOPHAGUS, IT IS CALLED REFLUX ESOPHAGITIS
A NORMAL FUNCTIONING LOWER ESOPHAGEAL SPHINCTER MAINTAINS A ZONE OF HIGH
PRESSURE TO PREVENT CHYME REFLUX
IN REFLUX ESOPHAGITIS THE PRESSURE TENDS TO BE LOWER THAN NORMAL
SEVERITY DEPENDS ON THE COMPOSITION OF THE GASTRIC CONTENTS
- reflux- backwards flow- sphincter not strong
- eventually it could lead to esophageal erodes and it could lead to esophageal bleeding and then to
esophageal cancer
Patho:
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