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 Analysis stool for occult blood detect GI bleeding Prep: increase fiber diet 48- 72 hrs no red meat, poultry, fish withold for 48 hrs iron, steroids,

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 colon

Prep: 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.

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 knee chest/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

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.

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

-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

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

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

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.

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