1
Med Surg II
Exam 1
Structures of the Lower GI tract
❖ Duodenum
➢ High alkaline, breakdown of cholesterol
❖ Pancreas
➢ releases breakdown enzymes
❖ Liver and biliary systems
➢ produce bile, metabolizes protein carbs and fats,
vitamins and cholesterol are stored, detoxification of
bacteria
❖ Jejunum and ileum
➢ absorbs dietary folic acid (jejunum)
➢ Ileum- increase of lymphoid cells
➢ Main areas of obstruction
❖ Cecum and appendix
➢ appendix exits from the cecum, there's no job for the
appendix
❖ Colon
➢ 4.9 ft long, reabsorbs liquid, most bacteria
❖ Rectum and anus
➢ control of feces
Small Intestine
❖ Folic acid
➢ produces RBCs, enhances appetite,
➢ Foods
▪ Beans, banana, dark green leafy, shellfish and liver
❖ Cobalamin
❖ Iron
❖ Fat-soluble vitamins
❖ Hormones and neurotransmitters
❖ Absorption of fat, carbohydrates, and proteins
Diet for swallowing disorders
❖ Mechanical soft
➢ Include bread, hot cereal, ready-to-eat cereal soaked in
milk, canned fruit, soft cooked vegetables, juice, scrambled
eggs, ground meat, cooked beans, cooked peas, cottage
cheese, yogurt without fruit, custards, puddings, cream
soups and noodles.
Acute Abdomen
❖ Epidemiology
➢ Very common with many causes
, 2
➢ Elderly
, 3
❖ Etiology
➢ Medical or surgical
❖ Pathophysiolo
gy
➢ Inflammation
▪ Infectious or chemical
➢ Obstruction
▪ Of the small or large bowel may be due to mechanical
causes or paralysis of intestinal muscles and may be
partial or complete.
➢ Vascular
❖ Assessment with clinical manifestations
➢ Pain assessment
▪ Origins
▪ Location
▪ Radiation
▪ Character of the abdominal pain
➢ Inspection
▪ Cullen’s sign: blush periumbilical discoloration, can occur
with intra- abdominal bleeding
▪ Grey Turner or Fox signs: should be sought in the flank and
inguinal
area, respectively.
▪ Borborygmi: gurgling, slashing sound normally heard
over large intestine.
➢ Vital signs
➢ Abdomen
❖ Diagnostic tests
➢ CT of abdomen and pelvis
➢ CBC, BMP
➢ Liver function test AST, ALT, albumin(low) and
bilirubin will be evaluated to indicate any cirrhosis or
hepatitis
Appendicitis
❖ Pathophysiology
➢ The function of the appendix is not completely known,
but it does regularly fill with and empty digested food. If
untreated, necrosis, gangrene, and perforation follow.
➢ Obstruction of the appendix.
❖ Assessment with clinical manifestations
➢ Periumbilical pain
➢ Nauseous
➢ Low- grade fever
➢ Rovsing’s sign (Rebound tenderness- more pain after
pressure is released)
➢ Pain in the RLQ
Med Surg II
Exam 1
Structures of the Lower GI tract
❖ Duodenum
➢ High alkaline, breakdown of cholesterol
❖ Pancreas
➢ releases breakdown enzymes
❖ Liver and biliary systems
➢ produce bile, metabolizes protein carbs and fats,
vitamins and cholesterol are stored, detoxification of
bacteria
❖ Jejunum and ileum
➢ absorbs dietary folic acid (jejunum)
➢ Ileum- increase of lymphoid cells
➢ Main areas of obstruction
❖ Cecum and appendix
➢ appendix exits from the cecum, there's no job for the
appendix
❖ Colon
➢ 4.9 ft long, reabsorbs liquid, most bacteria
❖ Rectum and anus
➢ control of feces
Small Intestine
❖ Folic acid
➢ produces RBCs, enhances appetite,
➢ Foods
▪ Beans, banana, dark green leafy, shellfish and liver
❖ Cobalamin
❖ Iron
❖ Fat-soluble vitamins
❖ Hormones and neurotransmitters
❖ Absorption of fat, carbohydrates, and proteins
Diet for swallowing disorders
❖ Mechanical soft
➢ Include bread, hot cereal, ready-to-eat cereal soaked in
milk, canned fruit, soft cooked vegetables, juice, scrambled
eggs, ground meat, cooked beans, cooked peas, cottage
cheese, yogurt without fruit, custards, puddings, cream
soups and noodles.
Acute Abdomen
❖ Epidemiology
➢ Very common with many causes
, 2
➢ Elderly
, 3
❖ Etiology
➢ Medical or surgical
❖ Pathophysiolo
gy
➢ Inflammation
▪ Infectious or chemical
➢ Obstruction
▪ Of the small or large bowel may be due to mechanical
causes or paralysis of intestinal muscles and may be
partial or complete.
➢ Vascular
❖ Assessment with clinical manifestations
➢ Pain assessment
▪ Origins
▪ Location
▪ Radiation
▪ Character of the abdominal pain
➢ Inspection
▪ Cullen’s sign: blush periumbilical discoloration, can occur
with intra- abdominal bleeding
▪ Grey Turner or Fox signs: should be sought in the flank and
inguinal
area, respectively.
▪ Borborygmi: gurgling, slashing sound normally heard
over large intestine.
➢ Vital signs
➢ Abdomen
❖ Diagnostic tests
➢ CT of abdomen and pelvis
➢ CBC, BMP
➢ Liver function test AST, ALT, albumin(low) and
bilirubin will be evaluated to indicate any cirrhosis or
hepatitis
Appendicitis
❖ Pathophysiology
➢ The function of the appendix is not completely known,
but it does regularly fill with and empty digested food. If
untreated, necrosis, gangrene, and perforation follow.
➢ Obstruction of the appendix.
❖ Assessment with clinical manifestations
➢ Periumbilical pain
➢ Nauseous
➢ Low- grade fever
➢ Rovsing’s sign (Rebound tenderness- more pain after
pressure is released)
➢ Pain in the RLQ
