NRS 313 Study Guide - Final Guide: Malabsorption, Jejunum, Tears
27 May 2018
School
Department
Course
Professor
Nutrient Acquisition
• Interal nutrition: feeding tube going into gut
• Parainternal nutrition: need to bypass gut. Right into vascular system because the gut or
intestines are not working.
• Bolus: A Large amount at one time (not dripping slowly) 300ml
• Cannot cram 300 ml in the Jejunum (can only hold 50-60ml) Anything more can cause
ruptures
• Aging and the GI Tract
o Protective mucosal barrier reduced
o Intestinal villa become shorter causing reducing absorption of nutrients
o GI motility slows
▪ Leads to constipation which is frequent with elderly if they arn’t mobile
o Amount of proteolytic enzymes from pancreas decreases
▪ Decreased absorption of Trypsin/ proteins
o Liver function declines
▪ Decreased drug metabolism = risk for toxicity
▪ Decreased bile salts – decreased absorption of fats
o Impaired contributes to decreased GI mobility
o Start to have dry mouth
▪ Decreased in production of amylase cant break down carbs
• Vomiting
o Parasympathetic (Cholenergics) activity is increased leading to:
▪ Hypersalivation, increased gastric motility, UES/LES sphincter relaxation
▪ SLUD – GE salivation, lacrimation, urination, defacation, increased
gatrointestinal motility, emesis (vomiting)
o Decreased tone in esophageal sphincter leads to vomiting
o Overeating, excess alcohol, salmonella, flu
o Peptic ulcer=> ulcers in stomach or duodenum
o Cancer
o Bulemia
• Coffee Ground Emesis
o Bleeding in the stomnach + Duadenum
▪ Pepsin digests RBCs. Bile from duodenum + dead RBCs are in the vomit
• Abdominal Pain
o Pain is diagnostic…don’t try to take it away if you don’t know the cause
o Mechanical Pain
▪ Pain usually due to over-stretching/ rapid distention and adhesions
• Adhesions are a sign of chronic inflammatory process
• Hard + firm scar tissue that causes mechanical pain
o Inflammatory Pain
▪ Mast cell synthesis of prostaglandin
find more resources at oneclass.com
find more resources at oneclass.com
▪ Mast cell activity also leads to edema causing distension pressure
o Murphy’s sign (Gallbladder/liver) look at the RUQ
o Rovsing’s sign (Appendix) look at the RLQ
• Hiatal Hernia
o Sliding hernia
▪ r/t increased abdominal pressure
▪ Less Dangerous
▪ Weakeness in the diaphragm due to increased abdominal pressure
▪ Bronchitis can also cause this
▪ When you relieve the pressure it slides down
▪ Pain at the base of the sternum with non referred pain
o Para-esophageal hernia
▪ R/T weakness on one side of diaphragm
▪ Leading to ulcers and strangulation
▪ 1 sided hernia
▪ Substernal pain
▪ Hernia gets stuck
▪ Constant pain
▪ If no treatment, we can get ischemia=> inflammatory process
• Gastroesophageal Reflux
o Disruption in the normal tone of the LES (lower esophageal sphincter)
▪ High fat meals relax LES
• Distension in the stomach=> you get a change in tone
▪ Increased intra-abdominal pressure stretches LES (obesity)
▪ Delayed gastric emptying out of pyloric sphincter
▪ Alcohol, Chocolate, fatty food, heavy smoking will relax LES
• And increase in HCl production
o Esophageal irritation
▪ Inflammatory response in esophageal mucosa: Chyme contents cause
irritation: highly acidic
▪ Esophagus can’t protect itself due to HCl because of no neck cells
▪ You get erosion
▪ Barrett’s Lining (“intestinal metaplasia” from esophagus to intestinal
cells)
• Barretts lining= growth of stomach cells in esophagus. Metaplasia
that can lead to dysplasia=>carcinoma
▪ Chronic inflammatory response > leads to cancer (esophageal
adenocarcinoma)
▪ Tissue experiences edema, erosion, fibrosis/thickening/scarring
• Ulcer formation
o Stress Ulcers
▪ CHRONIC Stress prolongs sympathetic response
find more resources at oneclass.com
find more resources at oneclass.com
