PATHOPYSIOLOGY|PHARMACOLOG
Y II (NURS 432) STUDY SHEET FOR
EXAM 2 (a comprehensive and
thorough review of all the material
that will be tested on Exam 2 in this
course) PACE UNIVERSITY.
,NURS 432 – Pathophysiology/Pharmacology II Exam 2 Study Sheet
Module 3
Gastrointestinal System
Upper GI System A&P and DX:
Overview of the GI System: composed of the upper GI, lower GI, & hepatobiliary system (liver, gallbladder, pancreas)
➢ GI walls: 4 layers
• Mucosa: innermost layer
o Mucus production: movement of GI contents, PX vs pH
o High turn-over rate: of food due to acidity
• Submucosa: connective tissue, blood vessels, nerves, lymphatics, secretory glands
• Muscle: contraction (peristalsis)
• Serosa: outer layer
➢ Peritoneum: large serous membrane lining abdominal cavity
• Parietal layer: outer; abdominal, top of bladder & uterus
• Visceral: inner; double-walled membrane which encases abdominal organs
• Peritoneal cavity: space b/w parietal & visceral layers which contains serous fluid; ↓ friction, facilitates movement
• Mesentery: double-layer peritoneum containing blood vessels & nerves supplying intestinal wall; supports
intestines while allowing flexibility for peristalsis & content volumes
➢ GI Changes w/ Aging:
• Stomach lining: shrinkage & inflammation → atrophic gastritis
• ↓ stomach acid production: achlorhydria, B12 deficiency, slowed digestion
• Liver △: ↓ blood flow, delayed drug clearance, ↓ capacity to regenerate damaged cells
• △s in absorption & metabolism: lactose, Ca, Fe
o Small intestine: ↓ Ca abs.
o ↓ lactase: ↓ lactose metabolism
o ↓ Peristalsis: leading to constipation
Upper GI A&P: components include the oral cavity, pharynx, esophagus, stomach
➢ Oral cavity:
• Mechanical digestion: chewing, or mastication
• Salivary glands: enzymes & antibodies kill or neutralize bacteria
o Bicarbonate: moistens food
o Salivary lipase: digests fat
➢ Swallowing: food passing trigeminal & glossopharyngeal nerves trigger
swallowing reflex
• Cranial nerves V, IX, X, and XII: relay info to swallowing center in
medulla → coordinates movement of food from mouth → esophagus →
stomach
o Prevents aspiration: food into trachea & lungs: aspiration
➢ Esophagus: composed of muscular rings which move food downward toward
stomach
• Lower Esophageal Sphincter: (LES)
o Relaxation: allows food → stomach
o Prevents reflux: of stomach contents into esophagus
➢ Stomach: expandable food & liquid reservoir
• Empty: wall shrinks → forming wrinkles (rugae)
• Filling: unfolding rugae, 2-4L capacity
• Digestive juices: chemical digestion turns food into chyme
o Hydrochloric acid: protein digestion, kills bacteria
o Pepsin: protein digestion
o Gastric lipase: fat digestion
o Intrinsic factor: B12 absorption in small intestine
o Mucus: protects stomach lining from acid/enzymes
• Absorption: no nutrients, only prepared for absorption; EtOH
• Pyloric sphincter: site where chyme exits stomach
o Prevents reflux: of bile from the small intestines into the stomach
➢ Duodenum: of the small intestine is considered part of the Upper GI
1
, Dysphagia: aka difficulty swallowing
➢ Patho of Dysphagia: mechanical obstruction of esophagus; impaired esophageal motility
• Preceding mechanical obstructions:
o Congenital atresia: separation of upper & lower esophagus
o Esophageal stenosis or stricture
o Esophageal diverticula: outpouching of esophageal wall
o Tumors: of the esophagus or nearby structures
• Preceding neurologic disorders:
o Cerebral damage: stroke, traumatic brain injury
o Achalasia: loss of innervations → failure of LES relaxation → inability of food bolus to enter stomach
o Other Neurological DX: Parkinson’s disease, Alzheimer’s disease, Huntington’s disease, Cerebral palsy,
MS, ALS, Guillain-Barré syndrome
• Preceding muscular disorders: muscular dystrophy
• Associated psychiatric DX: anxiety, depression, somatoform disorders, hypochondriasis, conversion disorders,
eating disorders
• Iatrogenic causes:
o Head & Neck Surgery/Procedures: laryngectomy, tracheostomy, endotracheal intubation, esophageal
dilatation, radiation
o Medications:
▪ Muscle relaxers
▪ CNS depressants: Sedatives, Narcotics, Antipsychotics
▪ NSAIDs & KCl: may cause drug-induced mucosal damage
➢ Clinical manifestations:
• Sensation of: choking, coughing
• Pocketing: food in the cheeks
• Food Bolus: is difficult to form
• Odynophagia: delayed, painful swallowing
➢ Complications: alterations in nutrition, and risk of aspiration
➢ Management of Dysphagia:
• Diagnostic procedures: focused on underlying cause
o Barium swallow: aka esophagogram; imaging
procedure used to detect problems in the upper GI
o Esophageal measurements: of pH and pressure
o FEESST: (flexible endoscopic evaluation of swallowing
with sensory testing) examines swallowing mechanism
response to stimuli
o VFSS: (video-fluoroscopic swallow study) videotaped
X-ray of entire swallowing process; makes use of mineral barium
o EGD: (Esophagogastroduodenoscopy) visualization of esophagus, stomach, duodenum
• Treatment of causative condition:
o Speech therapy
o Maintain nutritional status & PX aspiration: soft/pureed foods, thickened liquids, small bites, no straws
Emesis: aka vomiting
➢ Patho of Emesis:
• Potentially proceeding:
o Nausea: subjective urge to vomit
o Retching: strong unproductive effort
• Vomiting: the involuntary or voluntary forceful ejection of chyme from stomach → esophagus → mouth
• Coordination: via medulla oblongata
o Vomiting center: (VC) nucleus of neurons
o Direct acting stimuli:
▪ Fear: cerebral cortex
▪ Smell/sight or pain: sensory organs
▪ Motion sickness: vestibular apparatus of inner ear
o Indirect stimuli: activate Chemo-Trigger Zone (CTZ), which acts on VC (drugs, toxins, chemicals)
• Activation of CTZ:
o Vagal afferents: signals from stomach → small intestine
o Emetogenic compounds: travel from the blood to CTZ; cisplatin (anticancer drugs & opioids)
• Protective: drug OD; infection
• Reverse peristalsis: intestinal obstructions; ↑ ICP
• Association w/ severe pain: migraines; renal calculi
2
Y II (NURS 432) STUDY SHEET FOR
EXAM 2 (a comprehensive and
thorough review of all the material
that will be tested on Exam 2 in this
course) PACE UNIVERSITY.
,NURS 432 – Pathophysiology/Pharmacology II Exam 2 Study Sheet
Module 3
Gastrointestinal System
Upper GI System A&P and DX:
Overview of the GI System: composed of the upper GI, lower GI, & hepatobiliary system (liver, gallbladder, pancreas)
➢ GI walls: 4 layers
• Mucosa: innermost layer
o Mucus production: movement of GI contents, PX vs pH
o High turn-over rate: of food due to acidity
• Submucosa: connective tissue, blood vessels, nerves, lymphatics, secretory glands
• Muscle: contraction (peristalsis)
• Serosa: outer layer
➢ Peritoneum: large serous membrane lining abdominal cavity
• Parietal layer: outer; abdominal, top of bladder & uterus
• Visceral: inner; double-walled membrane which encases abdominal organs
• Peritoneal cavity: space b/w parietal & visceral layers which contains serous fluid; ↓ friction, facilitates movement
• Mesentery: double-layer peritoneum containing blood vessels & nerves supplying intestinal wall; supports
intestines while allowing flexibility for peristalsis & content volumes
➢ GI Changes w/ Aging:
• Stomach lining: shrinkage & inflammation → atrophic gastritis
• ↓ stomach acid production: achlorhydria, B12 deficiency, slowed digestion
• Liver △: ↓ blood flow, delayed drug clearance, ↓ capacity to regenerate damaged cells
• △s in absorption & metabolism: lactose, Ca, Fe
o Small intestine: ↓ Ca abs.
o ↓ lactase: ↓ lactose metabolism
o ↓ Peristalsis: leading to constipation
Upper GI A&P: components include the oral cavity, pharynx, esophagus, stomach
➢ Oral cavity:
• Mechanical digestion: chewing, or mastication
• Salivary glands: enzymes & antibodies kill or neutralize bacteria
o Bicarbonate: moistens food
o Salivary lipase: digests fat
➢ Swallowing: food passing trigeminal & glossopharyngeal nerves trigger
swallowing reflex
• Cranial nerves V, IX, X, and XII: relay info to swallowing center in
medulla → coordinates movement of food from mouth → esophagus →
stomach
o Prevents aspiration: food into trachea & lungs: aspiration
➢ Esophagus: composed of muscular rings which move food downward toward
stomach
• Lower Esophageal Sphincter: (LES)
o Relaxation: allows food → stomach
o Prevents reflux: of stomach contents into esophagus
➢ Stomach: expandable food & liquid reservoir
• Empty: wall shrinks → forming wrinkles (rugae)
• Filling: unfolding rugae, 2-4L capacity
• Digestive juices: chemical digestion turns food into chyme
o Hydrochloric acid: protein digestion, kills bacteria
o Pepsin: protein digestion
o Gastric lipase: fat digestion
o Intrinsic factor: B12 absorption in small intestine
o Mucus: protects stomach lining from acid/enzymes
• Absorption: no nutrients, only prepared for absorption; EtOH
• Pyloric sphincter: site where chyme exits stomach
o Prevents reflux: of bile from the small intestines into the stomach
➢ Duodenum: of the small intestine is considered part of the Upper GI
1
, Dysphagia: aka difficulty swallowing
➢ Patho of Dysphagia: mechanical obstruction of esophagus; impaired esophageal motility
• Preceding mechanical obstructions:
o Congenital atresia: separation of upper & lower esophagus
o Esophageal stenosis or stricture
o Esophageal diverticula: outpouching of esophageal wall
o Tumors: of the esophagus or nearby structures
• Preceding neurologic disorders:
o Cerebral damage: stroke, traumatic brain injury
o Achalasia: loss of innervations → failure of LES relaxation → inability of food bolus to enter stomach
o Other Neurological DX: Parkinson’s disease, Alzheimer’s disease, Huntington’s disease, Cerebral palsy,
MS, ALS, Guillain-Barré syndrome
• Preceding muscular disorders: muscular dystrophy
• Associated psychiatric DX: anxiety, depression, somatoform disorders, hypochondriasis, conversion disorders,
eating disorders
• Iatrogenic causes:
o Head & Neck Surgery/Procedures: laryngectomy, tracheostomy, endotracheal intubation, esophageal
dilatation, radiation
o Medications:
▪ Muscle relaxers
▪ CNS depressants: Sedatives, Narcotics, Antipsychotics
▪ NSAIDs & KCl: may cause drug-induced mucosal damage
➢ Clinical manifestations:
• Sensation of: choking, coughing
• Pocketing: food in the cheeks
• Food Bolus: is difficult to form
• Odynophagia: delayed, painful swallowing
➢ Complications: alterations in nutrition, and risk of aspiration
➢ Management of Dysphagia:
• Diagnostic procedures: focused on underlying cause
o Barium swallow: aka esophagogram; imaging
procedure used to detect problems in the upper GI
o Esophageal measurements: of pH and pressure
o FEESST: (flexible endoscopic evaluation of swallowing
with sensory testing) examines swallowing mechanism
response to stimuli
o VFSS: (video-fluoroscopic swallow study) videotaped
X-ray of entire swallowing process; makes use of mineral barium
o EGD: (Esophagogastroduodenoscopy) visualization of esophagus, stomach, duodenum
• Treatment of causative condition:
o Speech therapy
o Maintain nutritional status & PX aspiration: soft/pureed foods, thickened liquids, small bites, no straws
Emesis: aka vomiting
➢ Patho of Emesis:
• Potentially proceeding:
o Nausea: subjective urge to vomit
o Retching: strong unproductive effort
• Vomiting: the involuntary or voluntary forceful ejection of chyme from stomach → esophagus → mouth
• Coordination: via medulla oblongata
o Vomiting center: (VC) nucleus of neurons
o Direct acting stimuli:
▪ Fear: cerebral cortex
▪ Smell/sight or pain: sensory organs
▪ Motion sickness: vestibular apparatus of inner ear
o Indirect stimuli: activate Chemo-Trigger Zone (CTZ), which acts on VC (drugs, toxins, chemicals)
• Activation of CTZ:
o Vagal afferents: signals from stomach → small intestine
o Emetogenic compounds: travel from the blood to CTZ; cisplatin (anticancer drugs & opioids)
• Protective: drug OD; infection
• Reverse peristalsis: intestinal obstructions; ↑ ICP
• Association w/ severe pain: migraines; renal calculi
2
