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Saunders Comprehensive Review For The NCLEX-RN Examination, 8 Ed. | Registered Nurse (RN) School Study Aid

Oral Cavity

Mouth

Mechanical Digestion

Salivary Amylase Begins Carbohydrate Breakdown

Lingual Lipase Begins Lipid Breakdown

Esophagus

Bolus

Peristalsis

1 min

Stomach Digestion

Chief Cells Secrete Pepsinogen

Pepsinogen Turned to Pepsin By H+

Protein Breakdown Begins

Mucous Cells Secrete Mucus and Bicarbonate

G Cells Secrete Gastrin

Gastrin Stimulates Parietal Cell HCl Release

Parietal Cells Secrete Intrinsic Factor

2 mins

Small Intestine Absorption

Carbohydrates Undergo Active Transport

Amino Acids Undergo Active Transport

Small Lipids Undergo Passive Diffusion

Epithelial Cells

Intestinal Capillaries

Hepatic Portal Transports Nutrients

Liver

Large Lipids Transported as Chylomicrons

Lacteals Transport Chylomicrons

2 mins

Small Intestine Digestion

Brush border enzymes

Pancreatic Enzymes are secreted via a Duct

Pancreas secretes bicarbonate

Brush Border activates Pancreatic Trypsin

Trypsin activates Chymotrypsin

Trypsin and Chymotrypsin digest Proteins

Gallbladder Releases Bile

Pancreatic Lipase breaks down Lipids

Goblet cells secrete mucus

Pancreatic Amylase breaks down Carbohydrates

Pancreatic Nucleases breakdown DNA/RNA

Digestion occurs in the Duodenum

2 mins

Large Intestine

Colon

Electrolyte Reabsorption

Water Reabsorption

Microflora Produce Vitamins

Rectum Stores Feces

1 min

Pancreatin, Pancrelipase (Pancreatic Enzymes)

Pancreatic Enzymes

Cystic Fibrosis

Pancreatic Insufficiency

GI Distress

Inactivated by Gastric Acid

24 Hour Fat Excretion

Take with Every Meal and Snack

2 mins

Pancreas

Acinar Cells Release Digestive Enzymes

Ductal Epithelial Cells Release Bicarbonate

Islets of Langerhans

Beta Cells Release Insulin

Alpha Cells Release Glucagon

Delta Cells Release Somatostatin

Somatostatin Inhibits Alpha and Beta Cells

3 mins

Liver Biopsy Procedure

Diagnosis of Liver Disease

Incisional (Open Method)

Needle Biopsy (Closed Method)

Coagulation Status

Type and Crossmatch Blood

Right-Side Lying

Post-Biopsy Monitoring

2 mins

Liver Enzyme Tests: AST and ALT

AST/ALT Ratio

AST: 8-20 U/L

ALT: 8-20 U/L

1 min

Gastroesophageal Reflux Disease (GERD) Assessment

Relaxed Lower Esophageal Sphincter

Dyspepsia (Indigestion)

Belching

Nighttime Coughing

Dysphagia

Epigastric Pain

Regurgitation

Heartburn (Pyrosis)

Globus

2 mins

Acute Gastritis

Erosive

Disruption of Mucosal Barrier

Caused by Stress

NSAIDs (Non-Steroidal Anti-Inflammatory Drugs)

Alcohol

Uremia

Burns

Curling's Ulcer

Brain Injury

Cushing Ulcer

Increase H+ Production

1 min

Chronic Gastritis

Type A

Fundus and Body

Autoimmune

Autoantibodies to Parietal Cells

Pernicious Anemia

Achlorhydria

Type B

Most Common Type

Helicobacter pylori

Antrum

Increased Risk of MALT Lymphoma

HIV/AIDS

Crohn's Disease

3 mins

Peptic Ulcer Disease Assessment

Helicobacter Pylori

NSAIDs

Increased Stomach Acid

Abdominal Pain

Heartburn (Pyrosis)

Melena

Weight Changes

GI Distress

Most Commonly in Duodenum

Duodenal: Pain Relieved by Eating

Gastric: Pain Caused by Eating

2 mins

Peptic Ulcer Disease Interventions

Combination Drug Therapy

Two Antibiotics

Proton Pump Inhibitor (PPI)

Decrease Acid Secretion

Avoid NSAIDs

Diet and Lifestyle Changes

1 min

Cobalamin (Vitamin B12)

Vitamin B12

Vitamin Deficiency

Pernicious Anemia

Hypokalemia

Arthralgia

Dizziness

IM Injection for Pernicious Anemia

Never Give IV

2 mins

Types of Hernias

Hiatal

Gastroesophageal Reflux Disease (GERD)

Inguinal

Men

Femoral

Women

Incisional

Umbilical

Strangulation

1 min

Hernia Interventions

Reduce Intra Abdominal Pressure

Avoid Straining and Lifting

Open Mouth Sneezing

Excision

Herniorrhaphy

Hernioplasty

Scrotal Support

1 min

Cholecystitis Interventions

Supportive Therapy

Antibiotics

Low Fat Diet

NG Tube

Analgesics

Lithotripsy

Cholecystectomy

T Tube

2 mins

Cirrhosis Assessment

Degeneration and Destruction of Liver Cells

Jaundice

Fatigue

Palmar Erythema

Spider Angiomas

Hepatosplenomegaly

Edema

Gynecomastia

Change in LOC

2 mins

Cirrhosis Interventions

Maintain Nutrition

Paracentesis

Drug Therapy

Endoscopic Band Ligation or Sclerotherapy

Balloon Tamponade

Transjugular Intrahepatic Portosystemic Shunt (TIPS)

Lactulose

Antibiotics

2 mins

Complications of Cirrhosis

Portal Hypertension

Ascites

Esophageal Varices

Coagulation Defects

Portal-Systemic Encephalopathy

Hepatorenal Syndrome

1 min

Hepatitis A (HAV) Assessment

Fecal-Oral

Ingestion of Contaminated Food or Water

4 Weeks

Fever

General Malaise

Hepatomegaly

Self-Limiting

Proper Hand Washing

2 mins

Hepatitis B (HBV) Assessment

Bodily Fluids

Blood Transmission

People Who Use IV Drugs

Variable 1-6 Months

Fever

Nausea and Vomiting

Hepatomegaly

Cirrhosis

Hepatocellular Carcinoma

Vaccination

2 mins

Hepatitis C (HCV) Assessment

Blood Transmission

High Risk Sex (rare)

IV Drug Users

7 Weeks

Cirrhosis

Barrier Protection

2 mins

Irritable Bowel Syndrome (IBS) Assessment

Abdominal Pain

Relieved by Defecation

Alternating Diarrhea and Constipation

Fatigue

Excessive Flatulence

Sensation of Incomplete Evacuation

Stressors

Food Intolerances

More Common in Women

Rule Out Other Disorders

2 mins

Irritable Bowel Syndrome (IBS) Interventions

Identify Triggers

Increase Fiber Intake

Probiotics

Anticholinergics

Tricyclic Antidepressants (TCAs)

Loperamide

Linaclotide

Tegaserod (Zelnorm)

Lubiprostone (Amitiza)

Alosetron (Lotronex)

2 mins

Ulcerative Colitis Assessment

Cramping Abdominal Pain

Tenesmus

Bloody Diarrhea

Up to 10-20 / Day

Fever

Hemorrhage

1 min

Crohn's Disease Assessment

Diarrhea

5-6 per day

Cramping Abdominal Pain

Fever

Weight Loss

Malabsorption

Anemia

Obstruction

Fistulas

2 mins

Colostomy Care

Wash with Warm Water

Cut 1/8 inch Around Stoma

Decreases Skin Irritation

Empty When 1/3 to 1/2 Full

Change 3-7 Days

Avoid Odor Causing Foods

Irrigate at Same Time

2 mins

Appendicitis Assessment

Obstruction of Appendix

Periumbilical Pain

RLQ Pain

Nausea/Vomiting/Anorexia

Increased White Blood Cells

Rebound Tenderness

Fever

Peritonitis

Sepsis

2 mins

Appendicitis Interventions

Appendectomy

Antibiotics

IV Fluids

No Enema or Laxative

Semi-Fowler's Position

Nasogastric Tube

Diet as Tolerated

Pain Management

Early Ambulation

2 mins

Diverticulosis and Diverticulitis Assessment

Outpouching

Inflamed Diverticula

Abdominal Pain

Abdominal Distention

Flatulence

Fever

Rectal Bleeding

Alternating Constipation and Diarrhea

Peritonitis

2 mins

Diverticulosis and Diverticulitis Interventions

High Fiber Diet

Reduce Intra-abdominal Pressure

Stool Softeners

Exercise

Anticholinergics

Antibiotics

Bowel Resection

2 mins

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