VI.

ANATOMY AND PHYSIOLOGY:

DIGESTIVE SYSTEM
The digestive system consists of two linked parts: the alimentary canal and
theaccessory digestive organs. The alimentary canal is essentially a tube, some
9meters (30 feet) long, that extends from the mouth to anus, with its longest section-the
intestines- packed into the abdominal cavity. The lining of the alimentary canal
iscontinuous with the skin, so technically its cavity lies outside the body. Thealimentary
‘tube’ consist of linked organs that each play their own part in digestion:mouth, pharynx,
esophagus, stomach, small intestine, and large intestine. Theaccessory digestive
organs consist of the teeth and tongue in the mouth; and the
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salivary glands, liver, gallbladder, and pancreas, which are all linked by ducts to the
alimentary canal.

STOMACH
It is a J- shaped enlargement of the GI tract directly under the diaphragm inthe
epigastric, umbilical and left hypochondriac regions of the abdomen.Whenempty, it is
about the size of a large sausage; the mucosa lies in large folds,
calledRUGAE.Approximately 10 inches long but the diameter depends on how much
foodit contains.When full, it can hold about 4 L ( 1 galloon) of food.Parts of thestomach
includes cardiac region which is defined as a position near the heartsurrounds the
cardioesophageal sphincter through which food enters the stomachfrom the
esophagus;fundus which is the expanded part of the stomach lateral to thecardia
region;bod y is the mid portion; and thepylorus a funnel shaped which is theterminal
part of the stomach.The pylorus is continuous with the small intestinethrough the pyloric
sphincter, or valve.
With the gastric glands lined with several secreting cells the zymogenic(peptic)
cells secrete the principal gastric enzyme precursor, pepsinogen.Theparietal (oxyntic)
cells produce hydrochloric acid, involved in conversion ofpepsinogen to the active
enzyme pepsin, and intrinsic factor, involved in theabsorption of Vitamin B12 for the red
blood cell production. Mucous cells secretemucus.Secretions of the zymogenic, parietal
and mucus cells are collectively calledthe gastric juice.Enteroendocrine cells secrete
stomach gastrin, a hormone thatstimulates secretion of hydrochloric acid and
pepsinogen, contracts the loweresophageal sphincter, mildly increases motility of the GI
tract, and relaxes thepyloricsphincter.Most digestive activity occurs in the pyloric region
of the stomach.After food has been processed in the stomach, it resembles heavy
cream and iscalled CHYME.The chyme enters the small intestine through the pyloric
sphincter

c. Drug study
DRUG NAME
Paracetamol
DOSE/FREQUENCY/ROUTE
500 mg 1 tab q4h PRN for fever
CLASSIFICATION
Analgesic; antipyretic
MECHANISM OF ACTION
May produce analgesic effect by blocking pain impulses,
byinhibiting prostaglandin or pain receptor sensitizers. May relieve fever by
actingonhypothalamic heat-regulating center. Relieves fever.
SPECIFIC INDICATION
For fever.
CONTRAINDICATION
Contraindicated in patients hypersensitive to drug or its
components.
SIDE EFFECTSAnemia, jaundice, rash, urticaria.
NURSING PRECAUTION
Do not administer for fever that’s above 39.5° C, lasts longer than 3
days or recurs.
DRUG NAME
AMBROXOL
DOSE/FREQUENCY/ROUTE
0.75ml TID P.O
CLASSIFICATION
Cough and Cold Preparation
MECHANISM OF ACTION
Ambroxol is a mucolytic agent. It acts by increasing the respiratory
tract secretion of lower viscosity mucus and exerting a positive influence on the
alveolar surfactant system which leads to improved mucus flow and transport.
Expectoration of mucus is thus facilitated.
SPECIFIC INDICATION
Cough
CONTRAINDICATION
Hypersensitivity to ambroxol or any ingredient of Ambrolex.
SIDE EFFECTSMild GI side effects.
NURSING PRECAUTION
Should be taken with food.
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 DRUG NAME
GENTAMYCIN
DOSE/FREQUENCY/ROUTE
IVT q 8 ANST
CLASSIFICATION
Amino glycoside
MECHANISM OF ACTION
Broad-spectrum aminoglycoside antibiotic derived from
Micromonospora purpurea. Action is usually bacteriocidal.
SPECIFIC INDICATION
Parenteral use restricted to treatment of serious infections of GI
CONTRAINDICATION
History of hypersensitivity to or toxic reaction with any
aminoglycoside antibiotic. Safe use during pregnancy (category C) or lactation is
not established
SIDE EFFECTS
a.an allergic reaction (shortness of breath; closing of the throat; hives;
swelling of the lips, face, or tongue; rash; or fainting);
b.little or no urine;
c.decreased hearing or ringing in the ears;
d.dizziness, clumsiness, or unsteadiness;
e.numbness, skin tingling, muscle twitching, or seizures; or
f.severe watery diarrhea and abdominal cramps.
NURSING PRECAUTION
Draw blood specimens for peak serum gentamicin concentration
30 min–1h after IM administration, and 30 min after completion of a 30–60 min IV
infusion. Draw blood specimens for trough levels just before the next IM or IV dose.
Use nonheparinized tubes to collect blood

bacterial gastritis

 Helicobacter gastritis (ex-Campylobacter gastritis)

 Enterococcus gastritis

 mycobacterial gastritis

 disseminated tuberculosis

 Mycobacterium avium-intracellulare (AIDS)

 gastric syphilis (Treponema pallidum-associated gastritis or syphilitic gastritis)

 viral gastritis

 enteroviruses
 cytomegalovirus (CMV gastritis) in children and immunocompromised patients
 fungal gastritis

 Candida species (gastric candidiasis)

 Histoplasma capsulatum (gastric histoplasmosis)

 Mucoraceae (zygomycosis)

 Mucormycosis agents (Phycomycetes class)

 parasitic gastritis

 Cryptosporidium

 giardiasis (Giardia intestinalis)

 Strongyloides stercoralis

 Anisakis larvae