The Gastrointestinal System | Picmonic Nursing Webinar

so GI gastrointestinal system so first off my name is Kendall Wyatt I am the instructional content strategist and the content director here at pic monic so just a little bit about me I started out as a paramedic then I went to nursing school and now I'm in my third year of medical school doing my rotations here in the Phoenix Valley so we are broadcasting live from pic from their pic monic headquarters and we're actually inside of our audio sound booth where we record all of the pic monix in our system that you particular that you learn and basically a little bit about me what do I do here at pic Manik so I work with all all of our students all of our users and I kind of bring together all their comments and concerns and I also work with our content so I make sure that our content medically accurate I help make sure that it's relevant to you and that what you guys are learning if it's confusing and I'm just kind of the liaison in the in-between to make sure that everything is working and and to give you all those pointers and everything of course in these wonderful webinars on the lever system we have lots of different webinars if you've not seen any of them we have webinars on all of the different systems and we have them recorded on our YouTube channel as well as on our website so you can go and review them after the fact as well let's go and get started what is peak Manik so we if you haven't seen any of our webinars you've not heard anything about is we take pictures we take characters and turn them into all the medical facts that you need to know during nursing school and and basically put them all together so you can memorize everything we're research proven to increase a memory over three hundred and thirty one percent so everything you need to learn so let's say bipolar we talked about a psychiatric webinar recently we will show up by polar bear all the pharmacology drugs you need to know during nursing school so warfarin will show warfarin we're going to show you a war fairy and you know with warfarin you know you need to remember remember pt/inr you need to monitor that and we're going to show you a PTI on our Factory in this story that brings everything together and don't forget yes we have like Hepper and we have a hippie heron which is a hippie type of bird that you'll see and you'll see a PTT hourglass with that so that we can be able to contrast all the differences and keep everything straight in your mind we have over 700 different topics for nursing cover everything you possibly need to know and what we're going to do today is go over the GI system and hit on some brief points so what are we going to talk about and we're going to talk about the GI system as a whole and with everything that we talk about I'd like to just point out important points and a lot of it is understanding the concepts of everything especially with GI it's a big one to just really understand the big picture so then you can put it all together and we're going to talk about kind of I always just you know talk from mouth to anus or mouth the rectum type of way to think about everything if you think about from the mouth all the way down there are different disorders all the way we're going to talk about some of them as we go but the big things we're going to hit heavy hit on the contrasting things you need to know the difference is of knowing one versus the other and what are those key points for you to know that's what we're really going to focus on today we're going to touch on some digestion right in the first at the beginning everything we're going to finish up with some pharmacology just some quick drugs on things that you also need to know as well so in case you have come to our other webinars we got a fancy new light as well so I I feel like I've got a little bit of a pasty-faced today so maybe I need to get some of that time that makeup you know to put on here to get me some instant tan today so I feel a little pale I'm going to compare this to the last week so um when we talk about learning body systems and oh let me just mention one thing first if anytime today you have any questions or you have a concern right away you can go in our questions box in your control panel there and you can type in your question and press Enter and we'll see all those and if I see them we can go right in and you know stop and dress those at the relevant otherwise we do a QA at the end that we kind of go over all the questions in whatnot so if you've seen any of our webinars you've seen how we've built this body systems out on how everything you need to learn during nursing school and I always you know I teach this as this exact same mechanism every way and I just going to quickly briefly quickly and briefly go over it how you need to kind of think of the whole body and everything together and if any of these our problem areas you should definitely check in with this and see our other webinars because we have one for every single one of these systems so first off just the whole body we always I was thinking this whole human body is a fish tank and this fish tank is kind of where that this everything that holds everything together so the skin and the body itself holds all this stuff and it holds if that's the whole body it's the container just like a fish tank would be unlike the actual glass that keeps everything together and inside of a great fish tank you know you have pipes that kind of move everything around and that's a human body's veins and arteries so we've got to move flew it around around round in the system to be able to move things around around the system like through the veins and arteries we need a pump just like any great fish tank needs a good pump and a good pump circulates and that's exactly what the heart does so if there's a port of this problem with the pipes then the pump can compensate to increase and come harder or faster to compensate and then we have entire webinar on heart failure and what not along with all of this no fish tank and no body of course is complete without a good aeration system so an aerator puts oxygen into the fluid and that's exactly what the lungs do which is exactly the same thing that an air pump would do in a fish tank as well as always you need a good fluid to move to have inside of your tank and that's what the body needs blood for and just like every single fish tank and body out there as we build up all these waste products waste products or the kidneys and everything that kind of builds up the kidneys clean it all out and just like a filter does in a great fish tank and if the filter isn't working all this gunk builds up and all these toxins build up from the human body and that's exactly how you should be thinking about renal failure is that toxins build up now the GI system which is what we're going to talk about today is all about you know creating having sustenance and nutrition that our body can consume and then use as energy and fuel and that's exactly what we need we have here anything that's inside of a tank or a fish tank needs some energy or some fish food to keep everything together so this fish food goes into the system and we eat food usually usually through our mouths right we we eat food and we goes through a system and we digest it and turn that into fuel and if you think about a fish tank that's exactly what you need to do and just like everything else we end up in making waste which needs to be removed out of the system based on with some good filters and the last one which is some another webinar we have is just knowing that you need electricity you need something to fire all of this stuff to keep it all all together and that's exactly where we think about the nervous system how these electrical impulses are all firing to keep everything together so just as just as a good graphic example you can see how all of these systems easily build on top of each other and they actually work cohesively just like they do in the human body so that each system works together and here you can see the last one I just added is the GI system inside of this entire other system with the pipes and the pump and the filters to keep you and give you energy and sustenance and of course we have our battery for our nervous system as well inside of here and this is exactly how you need to be thinking about the entire body of how this works we're going to talk about the GI system and all these problems and disorders but if you don't have any energy and nutrition going in or a purser tintin of the nutritional tract is unable and not working the best you can see where the body is not going to be able to get that that type of that energy in there as well and we're going to go over those as well so one of the things you really you really just need to understand is definitely absorption you we have a couple of different pic monix on this we have all the different organs but you really need to know kind of what is absorbed and where and this is a really we have a really good pic monic on this in its entirety but let me just show you these two we have a small here's a small intestine absorption and @gi absorption one just to kind of show you these two quick examples so we use these characters to keep everything in and what you need to know let's just look at the GI here's our GI absorption actual pic monic from just screencap from our our pic monic learning system so you can see that in the GI system if you memorize where everything's absorbed then you should be able to then know if you don't have that particular piece or that piece is not functioning you should see where there's going to be a problem and here's a really big really common one does anybody know the most common vitamin deficiency in the world what the most common vitamin deficiency is kind of a trick question I know what everybody usually thinks in nursing so the most I see lots of different answers here but the most common vitamin deficiency is actually folate and folate we know works in and generation of red blur generation of progenitor cells in to create red blood cells and to create these cells and works within it works with DNA formation we know that just like we always teach anybody who is a woman who might be expecting we always have to tell them to take folate supplements right well that's along the road say reason because pole eight is the most common one but here we can see inside of our pic monic learning system that folate is actually absorbed in the jejunum so if you if you followed along with this we could see stomach well alcohol is absorbed directly in the stomach that's why if you drink alcohol you can get drunk very fast absorbs straight into your stomach it really doesn't you know the stomach wall lining can absorb alcohol right away the duodenum will show it by a character like this dodo dodo dodo and denom this dodo bird in denim and we're going to you need to remember that that's really where iron is absorbed and jejunum of course is foley and the next one is the terminal ileum and the terminal ileum is two important ones and we're going to circle back to this as well as vitamin b12 gets absorbed there and here's an interesting thought over the whole just a concept so I add not good I don't really talk about diarrhea as you know as a GI thing I don't really talk about it specifically today but let's just think about if you had diarrhea so if I increase the motility of everything running through the GI tract or I shorten the GI tract um are we going to absorb as much of all of these nutrients the answer obviously is no I mean that's you I always think that some of these things are rhetorical before I say them but you know then some somebody always gives me a weird answer but if I so if I put give somebody diarrhea I'm essentially evacuating everything out of the tract you know a diarrhea is the body's mechanisms today oh no this is something bad in here and I don't want it let's get rid of it and as everyone who is human has had diarrhea you know that that is exactly what happens and you need to put that in your mind as a concept as well so we're reducing the ability to absorb all these things so any type of any type of diet or anything that causes or a disorder that causes particular type of increased motility also decreases absorption of all of these things so if you know exactly where does anybody know which if I said the terminal ileum immediately which which disorder do you immediately think up for the terminal ileum if I had to pick one if I had to pick one I said terminal ileum vitamin b12 is absorbed there that's great I've got that here bioabsorption reabsorption is there resorption rather is there and that that's true but what what disorder does anybody know you can just type it there in the question box oh that's right Tanya Tanya actually said it's Crohn's disease and that's right we're going to talk about that in a second so terminal ileum is specifically one of the places that's affected with crohn's disease is the terminal ileum it's kind of its favorite spot so we see these people with lots of lots of deficiencies but specifically right away vitamin b12 as well as a decrease of absorption of bile because that's kind of where the problem area is and just another side note just so I don't forget this because this is a really really high yield point that I I didn't put into this webinar today but I want to make sure that I mention it so if I have a patient who has permission emia um there's any pernicious anemia so if I said pernicious anemia what does that really mean what does pernicious and me anemia mean I feel like I'm tongue-tied today pernicious anemia anybody what okay alma and looks like you say b12 deficiency so what happens is the body can absorb b12 and one of the big things that's a really high yield point here with pernicious anemia is I need to give you what should you immediately know if I'm if I have somebody who has b12 deficient and they have pernicious anemia what is that really how do I give them b12 it kind of already loaded the question here loaded the proper answer but this is really important I see this missed all the time I have to get this right you guys immediately several of you jumped right in can I just give you b12 by mouth no I if you have pernicious anemia it's because you can't absorb between b12 what you have to give it intramuscularly as an injection that's a really high a point that you should know because I see a lot of students gets tricked up by that one right away and that's definitely something you don't want to mess up on for sure it's a really high up point so we're going to talk about just some other random kind of fundamentals things you guys should know but I just wanted because I'm gonna mention these all again so here are some other really important points that you just have to know and understand so dysphasia dysphasia is something difficulty swallowing any patient who has trouble difficulty swallowing do we just go ahead and feed them do we do we watch them ourselves the answer is no they have to be evaluated by a speech therapist and a lot of students trick this up because they think speech they think that that somebody is going to teach somebody how to talk but a big part the majority of the part of a speech therapists job especially in a hospital or nursing or medical point is actually evaluating swallowing so it's just the muscles of speech and the neck muscles as well as and they do an entire study to see how people swallow and then like what type of diet that the speech therapist would recommend so somebody with immediately if you think somebody with dysphasia what type of what type of diet do you think that they're immediately going to be on at a minimum what type of diet so this is an interesting this is a really kind of a paradoxical thing then I see students also mess up on a lot I see lots and lots of different all over the place we hear and the big answer is what actually do people choke on the most yes they choke on you know a dry cheeseburger right I mean that's obviously that's possible I actually choked on them on one one once myself thought I was going to die but that's a whole separate corny story for later but the point is actually you don't want to give them regular liquids the answer is that they need to have thickened liquids because thickened liquids are easier to move with your palate and then can you can swallow them easier versus just plain liquids or you know water or whatnot that is where you're going to those that's actually more likely a choke risk on any of those types of patients so don't mess that up somebody was choking or somebody has trouble swallowing would be have an easier time swallowing something with that's thickened liquids at a minimum and then soft mechanical puree and those as well as they move up but thicken liquids at a minimum you'd never give them a liquid diet unless they had clearing from the speech therapist or whatever so just along the same lines and I just some important kind of points I want to put on so dice dysphasia we always show in big Manik of a dice fajita we just thrown one of our characters in here and you can see all the characters that we use a common throughout our pic Manik Manik learning system but inside here as well I've just got some different types of diets and there are some more of course but I threw these in here because if you want to hit some some points I'm regular diet truth truthfully even I can tell you as you know working and doing my rotations right now I just finished in turtle medicine not too long ago you know there's not a lot of patients truly get a regular diet especially there's something wrong with them so let's just talk about some of these high fiber vs. low fiber we're going to talk on this one again but high fiber diet as soon as I say high fiber diet you need to be thinking about what is what do you what should immediately pop your head as soon as I say I need to give this person a high-fiber diet what what is the purpose of giving someone high fiber diet what does fiber do let's that's just thing about that so lots of guys us you guys typing in for constipation so that's that's a acceptable answer fiber essentially creates bulk in the stool so if I have somebody who has if I need to create a let's just call it like a fluffy bulk right I'm not a hard mass because what we know about with stool and we're going to talk about that too in a second is it gets harder more firm as it goes through but if I put a lot of fluff and a lot of fiber in there it's not really a digestible material but instead in essence it holds water and it causes more bulk to form in the stool which makes it easier to go to the bathroom and easier to to actually stool and pass pass stool on a low fiber diet of course would then cause your stool to be become more firm and and this is going to come right back and should circle right back in your mind so that it goes so it ties together cardiac diet is almost always type a low sodium type diet low sodium why low sodium cause of hypertension if we give you a lot of high salt and you can soon lots of salt most definitely it's going to probably cause you to have a higher blood pressure so a low sodium diet for sure and there's a whole obviously you know stages of sodium diets and you should under self with them renal diet usually just pretty much involves no protein because that really protein breaks down into what protein breaks down into urea and if you don't have kidneys working very great do you really want a bunch of urea that you need to excrete to your kidneys no so we would give them a low that's more of a low protein type diet yes there's low purine and whatnot as well diabetic kind of along the same lines and then of course low cholesterol just for somebody who is high cholesterol we put them on a low-fat low-cholesterol type diet as well so I'm gonna just see we got here we got a couple of yeah so um a couple of students said that you know high fiber or fiber itself stimulates bowel movement and just an interesting point what actually stimulates bowel movement well bowel movement actually so if this is my I hope my bowel isn't this big or yours but of about a portion of my bow ISM full of stool and it stretches out that's what actually causes a reaction of peristalsis you know peristaltic movements so if it gets firm it stretches out that's actually what triggers that that peristalsis movements of it moving and squeezing it down through through this stool as well so types of diets not really deep not really something that I want to go over right now but it's telling something if you if you're not understanding the types of diets you should clear liquids obviously are clear and when we say clear why do we why do we indicate clear liquids well I see this all the time you know somebody is on a clear liquid diet versus a liquid diet they're on clear liquid diets probably because of what reason what reason when we put somebody on clear liquid diet versus just liquid diet does anybody have an example of why we would want to submit on clear liquids versus just liquid well there's a couple different a couple different a couple different answers here you know surgery lots you guys are answering yes but you know the big reason clear liquid diet is most likely to indicate whether a patient is bleeding or not if they're on a clear liquid diet and something comes out colored then we know that something discolored that stool so we put somebody on a liquid diet do we want to give them a bunch of red jello and a bunch of red colored things no because it's going to cause colouring in discoloration and I see that all the time not really a high yield point but definitely an important point as you get out and in practice for sure my cure a mechanical soft soft and and the other types as well not so much important for us today and some important points that I want to go over but definitely something you should review we have a pic monic on it to help you review if you if you need to go over the types of diets something that I went to just mention that's a really high yield point I see a lot of them a lot of questions on this and I'm not sure why to be honest but in g-tubes so does anybody know how to measure an NG tube it's if you're not in your fundamental level or you know you took that last year year before you need to remember this is really important and this is really just understanding some basic concepts I know there's more that goes with in G tubes I'm aware of that but I'm trying to pack in the highest yield points here and the big thing is really just a quick and easy way to measure how do I measure an NG tube well I take my patient and I go from my nose I take my NG tube and I go over my nose I got over my ear right from nose to my ear and down to my side process where's my xiphoid process hopefully you know that and that's the base of my sternum in the center and that's going to give me that distance approximate distance all the way down into my stomach so why do we use an NG tube whether nasogastric tubes we can use them for lots of different reasons and there's several different types we could use it just to decrease the acid out of the stomach we could use it to feed we could put food through it we could attach it to suction to decompress the stomach we could use it as lavage we can input something if someone overdosed we could insert like activated charcoal and then it would by I mean we could suck it back out lots of different ways for ng tubes to be used the big point is knowing how to put it in and to know that it swallow it so you curl around your finger just kind of a trick for you to know you curl the end around your finger and then you put it into their nose nasogastric tube nazo to the gastric neighs to the nasal to the stomach and you insert it in their stomach or into their nose weather insert them nose while they're swallowing some water to actually make sure that they swallow and it doesn't go in the lungs definitely a good point and we know that we know that we need to aspirate contents and they should be what what do we expect those contents to be this is hopefully pretty easy and the answer is very acidic right we can aspirate those contents and check that they're acidic or we can also also do a chest x-ray to make sure that it's actually placed in the right place I have a sensitive tooth today I think I have a new cavity must be from oh like candy that I've been eating um so the next thing I want to talk through we're going to talk through some disorders oh hold on me I went one of my they're real I clicked I get a happy clicking I apologize so we're going to talk through some disorders um each one kind of just high-yield points and what you really need to know something that is so important that I see students really struggle with is that they don't really understand they don't really pay attention what's different which eat with each disorder and G is definitely one of those places where a lot of students have a lot of trouble because there's so many different problems and is it oh well what do I really need to know to make sure that I can identify what's going on now let's we're just going to run through them we're going to talk about them one of the first ones and probably the most common when you're gonna see with anybody that's over 30 35 40 years old is gastroesophageal reflux disease or GERD right I mean that's a lot of words and GERD is a lot easier now I've got some signs and symptoms out here but is this the only list absolutely not I just wanted to highlight in here we have a whole pic monic on gastroesophageal reflux talked about some that really clue us into that it's GERD and this is how I want you to really think through what's going on here GERD gastroesophageal reflux disease so you I mean just by the name you know that it's a reflux so what happens is the esophageal sphincter at the end of the esophagus the lower esophageal sphincter relaxes a little bit contract as well and acid actually comes up from the stomach and regurgitates up into the esophagus and when it gets into the esophagus there's no feeling until it gets into the ED esophagus in the esophagus it gets irritated and when it gets irritated you have things like heartburn and essentially is a burning type pain right but specifically when with the acid more easily come out of the stomach is it when you're standing upright or is it when you're suspended from your feet I mean just think about the logical concept there logical concept well if I was hanging by my feet from a tree which is not what humans are designed to do unless you're impersonating a bat or a vampire I guess there's that possibility you you wouldn't have acid naturally going that way with gravity but what happens is we sleep and that's why the very first indication of gastroesophageal reflux disease is when a nighttime coughing or heartburn when they lay down right that's that makes sense you've put that together so if I immediately I don't have the interventions for gas excuse me gastroesophageal reflux disease in here because I want you to just think about what is the easiest thing you could do for somebody who says I have heartburn when I sleep what can I do to fix it what is the answer what do you tell them what's the easiest thing you could tell them as a nurse ah lots of you guys right away got my easy one I got a knot put ice in my drink teeth hurt so you guys everyone looks like lots you guys typed in the right answer and that is exactly that means you're really thinking and maybe maybe I preempted maybe I made it too easy for you I mean I can make it harder but the answer here is that you need to prompt those patients up you need to elevate the head of the bed when they sleep now what I can tell you about esophageal reflux disease or any type of disorder that constantly irritates over time what happens if I constantly irritate any tissue in my body over time for using using these in years becomes cancer any anything if I sunburn my skin over and over and over and over and over and over again because I love tanning beds I'm going to get skin cancer or I'm increasing my risk exponentially so if I lay flat and I have this relaxed lower esophageal sphincter and I don't ever raise my head of bed of my inner radiance a head of my bed then I am going to increase my risk of esophageal cancer exponentially and that's how you need to think about this easiest things first so we're going to elevate the head of the bed what happens if I can't prop myself up on some pillows I can't do that what's the next option the next option was just put the top but the front of their bed under some blocks so their entire bed is essentially elevated just a little bit and Julie says I need a root canal I've had eight root canals and I'm about fourteen fourteen of those um caps caps yeah I have awful teeth so I'm always used to root canals are my that's good friend because they get rid of all this awful tooth anyway so easy things first is what we want to go with so GERD right easy so easy with gastroesophageal reflux disease we saw what this classic signs and symptoms are and we know immediately what we have to do well raise the head of the bed now if I had an answer on there of giving someone and you know something to reduce acid if that's the only answer that's not the best answer per se we always want to think of the easiest and the cheapest first then we move on to medications or what not and and you know those types of things as well so the next thing I'm actually let me hmm yeah oh so this is a side note here so I talked about cancer esophageal cancer so any of these types of cancer GERD is a is definitely something this chronic could be a risk factor for cancer what are some other risk factors for esophageal cancer and I just this is the entire GI tract that will increase your risk of getting cancer this is one of those select all that apply questions that just everyone hates and ends up yeah GERD no I mean if you had GERD that is a risk factor for cancer especially if it's untreated but what else there's some really big ones here looks like Julie is volunteering to give some root canals I think she says she's a dental assistant so that's good uh so what uh so what we're going to what are the other things that are definitely increased the risk factor for esophageal cancer and looks like several of you guys typed in a several the right answers and that's right the answers that I'm going for here are smoking as definitely smoking and alcohol right so alcohol consumption alcohol consumption irritates the gie lining smoking irritates those linings and what happens is sometimes with medications I like to explain so we give oxycodone with acetaminophen right why is oxycodone combined with acetaminophen we take those types of pills because they have a synergistic effect because they work better together right that's why we have percocet which is oxycodone plus acetaminophen they have a synergistic effect they work better together well in the exact same regard if you have gosh gastroesophageal reflux disease and you smoke and you drink alcohol and regular basis you have the trifecta of the synergistic effect of giving yourself esophageal cancer as well as other cancers so you are synergistically combining those effects to give you a worse definitely worst worse or more probability that you're going in up with gastro you know esophageal cancer so deadly not things that you need them you just need to think of those you know string case smoking doesn't mean you're going to get esophageal cancer no but that combined with alcohol combined with GERD causes the synergistic effect together so as we're breaking down the GI lining one of the things that pops up and is so high-yield as knowing peptic ulcer disease so epic peptic ulcer disease is a fun one in the fact that and I just really talked about the risk factors for peptic ulcer disease and you know smoking and alcohol are definitely some big ones what's another big one that's going to cause ulcers what's another big big big cause of ulcers there are two that I'm really going for here that I really want to ah lots of the answer nursing school right of course yes nursing school med school myself stress right I mean stress causes also I mean the first even several we've got a caps lots of stress stress stress right in here and that's right enough but the other one I mean that's definitely a cause stress but before stress you need to think about this and never forget is insets non-steroidal anti-inflammatory drugs is a huge cause for for ulcers at definitely definitely instant cause for ulcers another one good Julie pointed I was H pylori gila gila go back to by pylori as a gram-negative infection that can cause ulcers how do we diagnose h pylori what is a way we could diagnose h pylori this is a just a side note done by something you need to know uh right why right away i wasn't expecting such a immediate answer and that is you can do an h pylori breath test um so we're actually checking you breathe in this device and it checks your breath for for the presence of the byproducts of h pylori because by h pylori creates byproducts that we can measure in your in your in your breath and that's for sure lots of lots of you guys typed in that answer for sure not sure sometimes whether you guys type the answer in after i said the answer or you've typed it in if you're not pushed enter and then ever i say it and everybody pushes enter because it's like six people always pop up right away and i've done tons of these webinars now and it seems like it's always a it's one brave person who pushes inter I don't know something then everybody does or what who knows so that's some interesting things with peptic ulcer disease now the the important thing to know with the peptic ulcer disease here is knowing where the ulcers are this is something is really important so let me just back up so we have different types of ulcers we have a do it in or duodenal ulcer and we have gastric ulcers what is the difference now we know a gastric ulcer is in this stomach and a do it in or duodenal ulcer is in the duodenum or duodenum however you want to pronounce it i what it's one of those i just gave up on how we how it's really typed in what is the difference between those two types of ulcers and this is really important really high your points that you need to know to really kind of know how to treat as well signs and symptoms that's right so let's look at these signs and symptoms so I just I broke them out here for you we have pic Manik to help you characterize all of these to you know characterize these keep them straight and here is what you need to memorize and we have pic Manik for this a dude in order water oil sir you feed you feed or don't do it in a loss or duodenal ulcer and you starve a gastric ulcer well what does that really mean if I just memorize this what does that really mean what's the concept here well this all ties in together so let's just look at a gastric ulcer since it's higher up it's in the stomach so the gastric ulcer if I if I have a gastric ulcer and I eat it's painful right it's painful if I eat right now let's say I'm gonna you know I got some pizza I'm going to eat some pizza I'm lactose intolerant by the way and I eat this pizza delicious pizza lots of cheese extra cheese and I eat it my stomach secretes acid immediately and I have pain I have lots of pain so what are some signs and symptoms I see with gastric ulcers well I see people who don't want to eat because eating is unpleasant right sometimes I tell people you should try to get a gastric ulcer for weight loss because gastric ulcers hurt when you meet I just ate and now it's hurting so bad that is a gastric ulcer we see weight loss with these types of patients because they don't want to eat those are all signs and symptoms those also we starve a gastric ulcer the acid is produced and it causes irritation because it's also in the gastric lining and it's very painful but a duodenal ulcer is different what happens with the duo ulcer is it's painful all the time but it is feels better when you eat why because the acid is neutralized from the stomach comes out as decreased and then it Sue's this this time soothes the do a duodenal ulcer I'll do it in ulcer it soothes it and then essentially so these people have weight gain with a dog do it didn't loss sir and they feel better after eating so they have pain right now I got this pain in my chest and it hurts let me just go eat a couple of candy bars and now it's feeling all better and but then I gain 500 pounds right so that's how you can keep them definitely straight it's definitely something definitely saying the way you need to think about it's a concept then you can tie everything in memorizing all of the signs and symptoms is very important but this is a way to think through the concept of how it's actually working and this is what the whole goal here is I want to UM I want to preempt you on memorizing everything's great pic monic is amazing for memorizing but I want you to really understand the concept of how these things go together why do we starve a gastric ulcer well we starve a gastric ulcer as treatment because we don't tell these people never to eat again but we then if a gastric ulcer it means it's painful when they eat that's because all that acid is produced in the stomach and immediately irritating to that also which is an open sore so just an interesting thing how do we diagnose a gastric ulcer is we would do an EGD is Sappho Safa go gastroduodenal skippy so we would do an EGD and we would go down to the scope and look and see actually visualize the gastric lining as well as it do it in a lining and see where those ulcers are and if they're present for sure so another one I'm I'm sad I didn't keep these texts until last is moving on down the GI tract probably the most high-yield one you really just need to understand the difference of Crohn's disease and all sort of colitis these are such high-yield points that you just have to know as a nurse you've got to know this for your in clicks or for your nursing exams you just have to know the answer but interestingly enough we have pic monix with all of the details for these but there's really just some high yield point so you really have to know to keep them straight and those high yield points are really to know that with crohn's disease what do we see versus all sort of colitis so I've got them kind of spit out for you here already so I'm sad that I can't really quiz you to see how you're doing or if you're paying attention right but Crohn's disease what's characteristic of chronic Crohn's disease what's characteristic of colitis the big things here is Crohn's disease we show you this crown of intestines for Crohn's disease we've got some really comical pic monix for it but the interesting thing about Crohn's disease is it's you a non bloody stool it's because it's not necessarily an inflammatory process it was not really bloody stools with crohn's disease they often have five to six stools per day diarrhea they complain a diary like crazy but how many five to six per day you know that's a lot I mean I will get to this TMI information in a bit but you know I would sometimes I feel like I would love to go to the bathroom five to six times per day but definitely not a blessing because people with clothes Aziz for sure and the major affecting part is of course the terminal ileum so the terminal ileum and these pits always end up with anemia so we have the stools it can be diarrhea it's going to be full steatorrhea you know diarrhea but not bloody stools and five to six per day or so once it differs it all sort of colitis so all sort of colitis it in fact affects the entire small bowel but also the rectum what's different here is it's an inflammatory process so it's inflammatory process in the fact that you have inflammation of that gastric lining so when you get inflammation of it and then you're just constantly having these 10 to 20 stools per day you end up you stew a lot I mean I couldn't even imagine going to the bathroom 10 to 20 times per day but if you had to this is all sort of colitis and they have exacerbations of this right and we know that exacerbations of both of these often are exacerbated by food which we're going to talk about in a second but bloody stool because of the inflammation in that lining and then when you inner ear eight-eight the lining just like you know you rubs your skin and it gets raw like a blister it ends up bleeding if you just keep rubbing it rubbing and that's exactly what happens still stools – eventually you get bloody stool 10 to 20 per day and the big thing here is it's it's an inflammatory process so it causes this more of a you know more stool and something that I like that we have a character I kind of wish I had thrown in here it's called a tennis mousse and definitely a we had a question of the day on it's a tenesmus tenesmus tenesmus is a medical term you need to know tenesmus and it is the sudden urge to defecate as in I got to go and I got to go right now tenesmus and if you had all sort of colitis and you had to go to the bathroom 20 times per day that's tenesmus you got to go you got to go right now and that's really just the differences here so here we have our anemia and M&E we have our bloody toilet over here pick marnik we we actually have entire pick mine except we memorize it this one's bloody with a bloody toilet and this one's just just diarrhea with a regular toilet Dobby keep track of which ones which which is what we're actually great at to help you memorize all these little details and keep everything straight something I want to mention but I'm not going to go into big detail on is diverticulitis and diverticulitis Llosa sorry diverticulosis so here's an interesting point on diverticulitis when i say itís right i just I would just mentioned all sort of colitis itis what is itis itis is an inflammation there is one thing a definitely I had a student reach out to me not too long ago and they you know they said they were doing a abridge course where they were already had their bachelor's degree but they were doing like a high high paced nursing degree on top of it one of those accelerated tracks I'm sure several of you guys are doing that but definitely something that I recommended was understanding medical terminology like this is going to help you so much and itís I mean this one's a simple one yeah I know is inflammation right so diverticulitis is inflammation of the diverticulum water diverticulum well that these little these little pouches right here diverticulum that's a diverticulum diverticulosis OSIS means like an outpouching or in it or an enlargement of and that's diverticulosis so it's a giant outpouching so itis is an inflammation so an irritation of that lining enosis is an outpouching so if I were just to talk about them diverticulitis is an inflammation and diverticulosis is an outpouching diverticulitis happens because of inflammation of the entire tract usually because of diet or an entire in you know systemic process diverticulosis can be episodic but a lot of because of diet so you know something regarding something regarding consuming different types of food that would get stuck in these little out pouches and and become infected or more painful and what is the one type of food more a couple types of food if you have a couple of examples that I would definitely do not recommend to somebody with diverticulitis or diverticulosis somebody who has an ileostomy somebody who has something I don't want you to have aa lot to you know right away good answers immediately pouring in the number one answer that I see most commonly on most exams is popcorn I love popcorn I love to go to the movies I think you know I usually go by myself and sit and cry for the first 15 minutes but after I get over that fact and you know the movie starts I enjoy popcorn and one thing about popcorn is it is awful for diverticulitis diverticulosis because there's little tiny pieces they don't digest that's not fiber that's just pieces that do not digest right I mean those end up causing irritation they get stuck in those out pal chains they irritate the gastric lining and they cause extreme inflammation definitely a big one and lots you guys said nuts and seeds and that's another really common one is some seeds and nuts can be really careful with this but popcorn is the big big one definitely the only one I see the most most often mentioned in questions but definitely seeds and nuts for sure but a most definitely popcorn for sure let's just keep moving on here so we got a little diver diver lumpy here and aren't diverticula Sun fighter diver on fire and you see these little out pouches on our diverticulosis diver lumpy character these are little outpouching usually that's what that's what it is or you know diverticulosis is and that's exactly what it becomes in the bow as well just these little extras so the thing I want to talk about next this is everyone's favorite IBS irritable bowel syndrome and this one's an interesting one I have irritable bowel syndrome and I could talk about irritable bowel syndrome all day long mainly because I think it's fun and it's you know makes everyone cringe right know I'm irritable bowel syndrome is an interesting one because I always get lots of cringe responses in there when when you when I talk about personal bowel experiences but I don't get a lot of time when I can talk to hundreds of people about my personal bowel experiences I just feel like this is the best time really just let it all out there and just let it go right just just relax and just let it flow maybe not the best use of words but I mean you know this is how it goes irritable bowel syndrome it's really classic and one thing that you cannot use to identify it especially as a nurse and that is alternating bouts of diarrhea and constipation and the big thing is they usually they usually have irritating foods there's no way to diagnose irritable bowel syndrome except to rule out everything else so rule out you don't have all sort of Quietus you don't have Crohn's disease because those are things we can diagnose but irritable bowel syndrome what is it what are some witnessin really irritating irritating foods that could flare up irritable bowel syndrome so what are some things you could feed me most likely it's probably gonna flare up irritable bowel syndrome ah oh all of these look delicious and anyone here in the office who knows me knows that I can't eat any of these and they're the first things out of my mouth Heather says spicy foods I would love to eat spicy foods but I can't because if I eat spicy foods they march out of me like a fire right exactly um fatty foods and not so much but sometimes some people are specific to that but the big one and I see here the next one is most definitely dairy products Kalindi says dairy products dairy products yes there's lactose intolerance that's its own thing but what we see with irritable bowel syndrome is it actually really is usually a flare-up of irritable bowel syndrome why because when we consume dairy products what happens when you have dairy you know you've got a carton of milk and you let it sit in the fridge for too long and it expired then you opened it up you realize that the carton is probably a little bit expanded and it's not so nice and it's curdled right what happens is if you eat that it creates gas definitely a very gas producing food which creates expansion if we have expansion in there that expansion then exacerbated peristalsis and in IBS cases extreme peristalsis and a complete bowel evacuation diarrhea what not so here are just our alternating we love regular diarrhea versus constipation or corticon while 'it just to kind of show you the differences um the next topic something that is really important and I this is something the best thing I can really offer you to really make sure as far as a value tool for today's webinar then you're really just going to sink in your mind and like wow that Kendall guy he's really kind of got some smart stuff up asleep and this is just something that I've just taught for years that I just love to teach I don't really love talking about poop in general it just happens to just be a crappy conversation I am talking about a lot so my favorite topic especially if you're a nursing student is to talk about colostomies in ileostomy is right there are some really high yield points you have to know here and one of those is I'm really just understanding the idea that stew is formed more as we go further down the colon right I mean that seems like a logical concept but you know I know that there's that table somewhere in your fundamentals book that you had to memorize as well that really talks about how it's you know it's my CAC I'm and the duodenum and I guess the ileum is a little more formed and it gets down to the gets down to the large you know the cecum and it's essentially like a kind watery 1/2 blah blah or whatever you don't really need to memorize all that per se for your exams long term you need to understand the process so here we have so what I need you to remember is and as you need to try to remember everything we're about to talk about whether we talk about it pendous itis in a second or how the bow is formed I want you to just think about yourself hmm how do I remember what the colon is like on a body well what is that quite what is the answer to that question and the answer that question is a question mark so I want you to draw a question mark right on sorry I see lots of people writing jokes are commenting on my on my awkward statements in our in our question board so I try to read them all but I I get a little distracted there's squirrels all over this sound booth so the question with about knowing the stools and everything is essentially a question mark so if you draw a question mark just look at this question mark I have Ray understand sexy little thing right here I see love this question works great right well this actually outlines the bow so you can actually go in here and imagine the large intestine is drawn exactly like a question mark so you're imagining a human body right in front of you in anatomical position in front of you and you're going to draw a question mark right on that little bugger in your mind just draw here it is here's the question mark here's how it outlines and exactly what you can see here is immediately over here where the large intestine starts is the a semicolon going across transversal and that's pretty simple right transverse is next descending is next so do you need to where is the stool the most formed well oh sorry it's most born in the descending colon and the rectum I mean that's obvious right but now it's obvious maybe you are not able to memorize that right away so it's less formed in the a sending more forming the transverse almost fully formed in the descending and fully formed in the rectum right here at the end but what we do we we've thrown in this Trank triangle here and we're going to talk about the last set for pancreatitis just at that little nugget at the end so let's talk about colostomy versus ileostomy so if I have an ileostomy that's in the ileum so we have this up here in the ileum the ileum touches on here here we've got our ileocecal Junction right here then right about where this eye is gonna be on this beautiful little colon character just a little nugget so that's about where the ileocecal Junction is and in the ileocecal Junction not only do we always remember that's where an intussusception happens in a child but most importantly we know that that's where the the small bow essentially attaches to the large bow right so in here the large bow and if I get it illy ostomy that's in the ileum what do I know about ileostomy versus colostomy what is the most important thing you need to know what is it well it starts with a ly one start to see how you guys are genius no no types of stool okay tell me a little more tell me more about these stools you speak up these magical stools tell me more that's right so you guys not you guys are typing in the answers here and the answers are exactly right so an ileostomy you have to know that immediately you expect to be free-flowing loose fluid from that it's not formed yet at all because what is the function of the large intestine well the large intestine essentially really as a whole all it really does is it absorbs water it really absorbs water its source of nutrients and chylomicrons blah blah yes but the main function is really to absorb water out of it to make it more of a form stool I just realized my nose is really sunburned think that's just so sorry there's lots of squirrels in here I'm very distracted today um so it's very um very sometimes the question the comments that come in the message board really throw me off so I got a step you got a pea to pay attention here so ileostomy yes very loose stool because it colostomy can makes it more form so its own it colostomy I see form stool so what is an important thing here for ileostomy what do I teach somebody with an ileostomy about diet what do I teach them they need to take what types of foods ah a couple excuse me a couple of you typed in oh my to that I'm just gonna I don't pull this out in the webinar one of these days this to that I have definitely definitely need a root canal there so um the the ileostomy and ileostomy is very loose stool so we're okay with that that's fine we're not trying to firm up that stool and the last thing we need to do is get that person to create more bulk in a loose stool right that's not that's not the purpose so an ileostomy gets a low fiber diet very low fiber diet and absolutely at all costs avoid things that are gonna irritate like popcorn nuts seeds all those things you guys were talking about low fiber diet very very very important and a colostomy is likely more formed and more formed is most likely you know that that's somebody that you may potentially increase you okay you can eat a regular diet or maybe a higher fiber diet to keep that stool from becoming very firm and that all depends on where exactly the colostomy is located very often we have people with colon cancer which we talk about just a second that end up with colostomies as well now the most important thing that I can teach you about a colostomy and the most thing you have to memorize we have a whole colostomy Leah ostomy care pick monic as well is to know you have to keep that diameter on a colostomy 1/8 of an inch that diameter which to cut around the colostomy pouch to put over top of that little stoma I was just just I always use it if you've never seen a stoma then you really don't know but once you see when you're never going to forget me doing this with my finger in my little tongue because that's about what a stoma looks like it's an outpouching of actual bow coming out of the skin and sewn in and you need to create your little out pouching 1/8 of an inch diameter around that's very very important why because we want to decrease the irritation especially with an ileostomy because it's it's liquid and very very irritating because if that in sight becomes infected can you just immediately just throw in a new ileostomy no I mean that's definitely traumatic to the patient's not something you can do and not really a very easy very easy place to do and once you guys typed in about nutrients what not for really elastic oil EOS means those things are definitely true Kevin says some colostomy ostomies and colostomies are more red than my tongue and that's probably the case as well so quickly let's talk about colon cancer not really a lot here for us to mention about colon cancer the important thing is it's really common cause of death and we see a lot of diverting colostomies because of colon cancer they have a resection and then they end up getting chemo and treatment and they get a resection but the big most important thing about colon cancer it's completely preventable it is the one another one is it's just like breast cancer as well if you find breast cancer early enough you just remove it and it's fine so this is very important that anybody over the age of 50 gets a colonoscopy and there are specific guidelines about if you have a family member with colonoscopy to get a colonoscopy earlier than they were diagnosed with colon cancer but the most important thing to memorize here is over age 50 you must receive a colonoscopy another thing you can do is a fecal occult blood test which is just a nice poop smear on a little on a little car to see if there's actual occult blood in the stool definitely not my favorite thing to do as a nurse is to you know get a section of stool and get your little knife and cut out your little you know stool sample section not really the favorite thing to do but definitely one of the things that we have to do on prevention of colon cancer this is seems like pretty easy stuff but it's definitely one you're going to get as a high outpoint and it's eating a high fiber diet a low-fat diet maintaining a healthy weight and when they didn't put in here was having nice green leafy green leafy vegetables it's definitely something's going to decrease your risk of getting colon cancer for sure not really a lot I want to put in here with that as well but just some other points um an important point that I do want to make with stool and blood in your stool or blood in your vomit is what are we going to do well as great nurses where they're nursing thinking caps on we want to know everything about it I mean oh you had a you had a bowel movement tell me everything as Marley's favorite words that she likes to explain to me Marley's our newest nurse that's joined us here at our Pig morning team you'll be seeing her later on but she has this really wonderful saying about anything that's going on and I just decided to recreate it but um I just imagined Marley talking to our patients and patient comes in and they say oh I've got some you know blood in my stool when she says tell me everything because as a nurse you want to know everything about what's going on you want to know characteristics when why when how what it smell like what I feel like everything right what do we want to know about stool blood in the stool and that's just a couple simple things the simple things here are is it bright red or dark red if it's bright red blood coming with you if you had a stool and you had bright red blood then you're going to think yeah probably maybe hemorrhoids or a bleed that's lower to that GI to the area so it's lower in the GI tract right it didn't have a lot of time to get digested so it's lower in the GI tract so if I vomit bright red blood I've vomit up bright red blood then I'm going to have maybe a I believe that's a upper GI bleed maybe in my stomach gasps you know gastric ulcer esophageal varices may be esophageal cancer those kind of things I'm vomiting up bright red blood I'm but if it's dark red blood we're happy with dark red blood well if it's from my stool if I'm having these dark red coffee ground stools then that's digested blood it's curdled blood essentially your body has digested it and it's turned out to it's coffee ground dark brown black type substance that's because it's probably from an if it's stooling dark red coffee ground type blood it's probably digested so it's an upper bleed that has worked its way all through if you vomit up dark red then most likely the thing you're going to be thinking about is an obstruction or a bleed or a vomiting up of digestive would be more like a do a dental also some type where the blood is a time to digest as well you know it's definitely definitely not a good sign and we see it a lot with elderly people because of these types of reasons so one thing we want to talk about here really quick is bowel obstructions not really a whole lot here to talk about but the big thing is the number one then your concern post surgically is what there are different types of bowel obstructions there's non mechanical and mechanical yes that's true that's on your test the number one thing you worry about post surgical for any patient is have you pooped yet right have you pooped that's all you care about I love packing nurses but they are obsessed with whether you pooped or not especially the outpatient ones that's all they care about even as a medical student and a nurse speaking to patients in the PACU hey how you doing tell me everything have you pooped or not have you passed gas why because if you have gone under anesthesia your bowels essentially it's the last to wake up so you end up with this neurogenic ileus and we can't send patients home if that isn't important kevin says OB nurses worry about neurogenic ileus as well and that is absolutely true anytime you're under any kind of anesthesia that is the number one thing because the barrels are kind of like this lazy sleepy thing if we need blood flow if we're shocked if you're of a patient who's in shock what's one of the places that your body deprives a blood flow first well that is your boughs it says we don't need to digest we need to run the heck out of here so it shunts blood away from your bowels into it you know your cardiac your peripheral vascular system – same with anesthesia everything just kind of yeah the bowels really not that important we're sleeping so there's going to ignore them for a while so it takes some time for them to be Reaper fused and get get kind of wake back up and that's definitely something we always worry about because we wouldn't send a patient back to their medication wise what medication would we think about what medication what do we think about if I said medication creating an obstruction this is so I yield and you just gotta he says Martin narcotics but which narcotics what are we really worried about and looks like you know Kevin said morphine well that's great but what do we really worry about worried about opioids and that's right morphine is an opioid all of those opioids cause bow-bow decreased motility of the bow because they relax everything else and they just kind of hay battles don't worry about pooping just keep it all in that's kind of wayward other causes include mechanical causes the actual most common cause of a bowel obstruction is actually adhesions and those are adhesions are just typing a bow Huett which is scarred kind of together and created this constricted part or you know it's usually because of previous surgeries or you know congenital problem but adhesions are actually the most common cause of bowel obstruction in general so just definitely just a side note there for you so we have different types of instruction obstructions rather we haven't picked monix for all of these as well oh I don't let me go back thought I had a hiccup but then I thought maybe I need a coffee I don't know what's going on today so let's quickly look at the next topic which is hernias these are picnics on obstruction the types of obstructions just everything I went over to help you memorize everything together now types of hernias this is something I just want to actually run you through the pic monic to show you how we really tie how you can remember everything together which one goes where which one goes which so this is a pic monic I'm just going to guide you through it as if I was teaching you a pic monic like you'd learn in our epic monic system so types of her knees are really important of the types of hernias right what hernias go where and when and kind of how to keep them together I'm in supporting to the types of hernias as shown by our little hermit crab character throughout this entire pic monic thing pic monarch learning system so there's a hiatal hernia this little her knee her knee a hermit crab with a hi-hat and it's usually hiatal is usually seening gastroesophageal reflux disease as you'll see here with our Gertie girl for gastroesophageal reflux disease and a hiatal hernias essentially bowel that comes up through that that finked er where the stomach is so the bow or the stomach Girja Gurjit eights up through above the diaphragm and it causes is hiatal hernia it causes a lot of GERD and is associated with GERD as well another one is in Quino Quino is kind of a we think about those kind of in the groin and general abutting we know is course in that in we know space you know ladies as most nurses are ladies always think about that v-cut that's in Guino in the groin there's kind of a in them ever crab in the groin here the big thing with them in we know horn is is they're most commonly in men and that's one of the reasons why we screen most young boys for inguinal hernias because it's a possible complication with lifting and whatnot you strain and you cause this inguinal hernia um another type of a hernia is umbilical hernia so we have our umbrella hermit crab here so think about the umbilicus this is when I see all the time I see it incidentally these patients you feel their belly and they got this little lump around their belly button and it's a congenital defect just because the belly button fell off and it created a little loose spot because what's important to know is any time that we've had surgery or there's a there's a previous cut in any type of body tissue it creates a wood loose area because scar tissue is not as strong as regular tissue how strong is it well is like two-thirds I think two-thirds right away I think is the the I can remember the exact percentage for moral hernias are femoral bone hernia form or hernia and most common women you can see why we got this woman with her femur and her and her little hemorrhoid hermit crab and then incisional and this is the one that you see very often you see somebody who has an incision so OB patients Kevin talked about how you hate it as OB clinicals I'm right there with you I hated OB my still hey Toby but you end up with a incision and those incisions are if you have a whatever the term is when they take the baby out and it's not I came and think of the word right off definitely not a very good blank to draw at this moment but c-section yes the Sirian section thanks Heather if you have a cesarean section you you have to have cesarean sections after that mainly because the week it weakens the abdominal wall and you have a increased risk of uterine rupture and that's really important because you've scarred it and that's why incisional hernia is a very common that we see any ways any kind of incision is up Nick couldn't simpler than incision incisional hernia is just kind of how we guide you through everything to keep track strangulated is something where you could have just a a Heavin that obstructs things off and creates an obstructed hernia one of those is like with pancreatitis as we're pinna size which we're going to talk about right now so here's appendicitis just a couple more things I just want to touch on because I always end up running right against the time here for the hour that I try to always stay – appendicitis we have this appendix pan here appendicitis is fun the most thing you need to know about Penn aside is cholecystitis which is next is just a couple little things it's so easy um and if I if I just jump back and I here I've got my signs and symptoms rebound tenderest right lower quadrant fever leukocytosis risk for perforation great all those things are in our pic morning let me see if I've got my and here's my question mark again so I went over all that I love this little question mark because this question mark lets me see exactly how I can always remember where the appendix is this is something I struggle with I am dyslexic and I always mix things up that are common every single time but I know how to draw a question mark I don't know if it's just because I'm like to draw question marks maybe I don't know but I draw this question mark and we drew this question mark here for you so here is my question mark on my colon and you know it's just a little nugget right here hello whoop-dee-doo right there that little squiggly that's the appendix right so if we have my ileocecal Junction right here where this is and there's my appendix and I imagine that that's a body and I drew this on to a human body I'm imagining somebody standing right in front of me in anatomical position I draw this question mark on them right well there's the appendix so which side is the appendix on well it's on the right lower quadrant right lower quadrant because if this patient right here with this appendix and this little pupule here was in anatomical position this would be the left side and this would be the right side right it'd be opposite so here I've drawn this wonderful question mark right on my imaginary patient right in front of me and right there it is there's a little appendix poopoo and what do you know appendix right lower quadrant every single time you're not going to miss it it's so easy you got it you're not a draw question mark you have appendicitis and that's almost the most common question you're going to get right lower quadrant versus left lower quadrant right and it's the number one thing students have so much trouble with so it's definitely something you're going to struggle with and this really just helps you get the answer so appendicitis we had a question of the day for appendicitis patient comes in you believe it's appendicitis what do you do first with appendicitis well a really important point here with anybody with abdominal pain just in general it's really important that you do what before you palpate well you always auscultate before you palpate someone's abdomen now yes I understand very often it's taught that you the doctor palpate sore deep palpates and you only like palpate or you don't palpate at all depending on what your school teaches you but the important thing is you must auscultate before you palpate and the other thing with appendicitis is it's rebound tenderness and I can tell you appendicitis patient always appears the same way they have an increased white count they come in with a fever and the hand that's right lower quadrant pain it's almost classic so easy to catch and you do what for it what you do an ultrasound you find out that they have appendicitis and you send them off to surgery what to do good for them we have a big bonnet for this as well and I want to go too much into it but the big thing here for a nurse is to know where it is and it's definitely on that right lower quadrant so the next one that goes right along with it is cholecystitis so gallbladder problems I mean sorry ladies 95% of everyone ever listens to these webinars in nursing is a female well what I got to tell you you probably already know is cholecystitis right so gallbladder issues what are some signs and symptoms of gallbladder well immediately you should be thinking about what types of foods ah the five F Kevin says is right FFF that's right everyone should be think about apps cholecystitis f-f-f-f-f-f-f cholecystitis FFF f this F that that that's right it is F everything cholecystitis but the big thing you always need to think about this characteristic fact and that is cholecystitis they usually have a pain after they eat and what type of food is fatty food because what happens what does it think about the concept here what does the gallbladder do what does it really do yeah you have a you have your diet your body senses about new fad so that you know cholecystokinin gets released which then cause cause cause it's gall bladder contraction and then that decrease increases bile which blah blah know that that always true there's no way you need to think about you need to have the big picture in the concept and the concept here is you eat fatty food and the gallbladder itself releases bile so to make up the hiccups I get every every week I think I get cited I get these hiccups but anyway the gallbladder releases bio and that bio comes down it helps break down these fat emotions into smaller particles amino acids and break everything down so they can be absorbed by collagen by that the intestinal tract that you think absorbs fats so if I ate a fatty food after 80 mm physics severe pain now where's the pain well let's think about where our body is we have the liver on on this right side on top of the liver we have a gallbladder underneath the liver we have the gallbladder so this is a right upper quadrant pain and most importantly it's after eating clay color stools because we could have cholecystitis or cholelithiasis lift ISS means stone lift means stone we could have this stone which could obstruct the bile duct and cause no bio to come down at all and that causes clay-colored stools because we know that the bile actually collars our stool this beautiful brown greenish greenish pigment right the gall bladder essentially just stores bile and concentrates bile from the liver it just concentrates all this pile it just stores it all and then when you eat a fatty meal gall butter goes okay here's a little squeeze a bow for you and it squeezes a little bit of bile out but if there's a stone or inflammation it tries to contracting creates this extreme pain if you ate this fatty meal that it needs to help digest and who's at risk this is my favorite all the F's female patient's we have an entire pic monic for this female fat fair light skin fertile pregnant and usually at around her age 40 and when we talk about body shape you know we talked about that pear shape you can have that pear shape you have an apple shape that's probably something you also talked about in your nursery school and the patient that are more likely the apple-shaped you know the different types you can know with cholecystitis as well there is another important point she's kind of a high-yield little point there I'm going to talk too much about cirrhosis today because this is a definitely something we go in really high in-depth on and types of cirrhosis and hepatitis which we're not going to touch on today but definitely cirrhosis and general liver failure so liver essentially whoever has lots of functions but the Muslim thing with liver cirrhosis what's the most common cause of liver cirrhosis hepatitis yes alcoholism is what everybody always picks but actually things like hepatitis and as far as the world usually is more common but alcoholism is definitely very common for sure and it causes you know chronic alcohol is over time causes cirrhosis and and cirrhosis essentially is you know the liver enlarges and then it becomes cirrhotic and it breaks down it becomes very fibrous and can't repair itself liver is a great organism because it can repair itself and you can beat that thing up all day long but you can only beat it up so much until it finally just starts to give up and can't repair itself that's why we get you know that's why you're able to detox so much but it's essentially just a big giant detoxing engine and one of the things it does is we see with cirrhosis if it backs up and fluid backs up I just went back down to the bottom we see esophageal varices and a pata splenomegaly but why is because we without going too much in detail with the the anatomical structure fluid backs up in the liver it can't go through the liver and past it so you end up with this portal vein hypertension and that causes those those – like – like tail end ectasias I can never say that word – let it tell inject a Xia's it's not a word I've ever been able to pronounce and anything we have a PICC Manik with it I just ask somebody else to do it but a spider angiomas basically is another good word for it but it's this little tiny blood vessels because of increased pressure as well and in this stomach that cap put medusae that we see in the stomach because of this increased pressure because the pressure can go through the liver because it's it's become this hard mass because the liver isn't working liver is very responsible for breaking down urea I didn't and turning Yuri into a product and ammonia metabolizing ammonia so we can get rid of it so we end up with this hepatic encephalopathy and the important thing to memorize is yes we have Pig Minds for always to help you memorize that the fact that estrogen causes this palmar erythema and spider angiomas and gynecomastia those are all important because of breaking down estrogen let me just mention it and explain it since I said it the liver one of the things liver does is break down estrogen estrogen or Estrella all types of estrogen is actually made by fat cells and the liver actually breaks it down and gets rid of it but if your liver isn't working bye-bye liver no more you like the alcohol enjoy the liquor while you're going it up with these manboobs right because you have too much estrogen because your liver can't break it down and you end up with this palmar erythema this redness of the hands went up with spider angiomas and allows it because of this increased estrogen body in your body that your liver cannot break down and get rid of and that's why you end up with gynecomastia and liver failure but you're also going to put hyper M anemia that you so you can't metabolize ammonia and get rid of this toxic ammonia nobody wants ammonia but I'm just an important point that's here is how do we get rid of a high ammonia level this is just really really high yield um no you didn't know Kevin says his instructor says I think of esophageal barely bear ceases hemorrhoids in the esophagus and that's very true so the esophagus veins and your your the gleams around your rectum your anus are actually attached to this portal venous system so if you increase the pressure in there you end up with diverticulosis right this OSIS is outpouching which is hemorrhoids and essentially varices in your esophagus and when you increase the pressure in those sometimes they pop a little bit and then they just bleed and that's why we have to ban them either in your rectum or in your esophagus if you have this liver cirrhosis liver failure is not a not a fun thing cirrhosis is not a fun time so anyway back to it ammonia what do we know about ammonia well monia the big thing ammonia is actually made in the GI tract um it's made mostly in a large intestine with breaking down these beautiful green leafy vegetables especially creates ammonia and we break this down create ammonia and our body usually absorbs it metabolizes and gets rid of it well sometimes it doesn't work so we have to give these resins that bind to it and excrete it so I either need to make it give you diarrhea or I have to give you an enema to bind and then in excreted and the big thing we see is is lactulose um this definitely one you're going to see and the since lactulose is the trade name I'm actually not sure this is an important point I had a student right in was is the NCLEX actually show polystyrene sodium or do they show lactulose and I don't really know I'm going to look that up I miss deadly I my list of things that we need to know but what you guys said lactulose that's important so you can take lactulose by mouth you're going to give them diarrhea it's usually a liquid take 15 MLS of lactulose four times a day and just going to bind to that ammonia binds it your body can absorb it it makes you poop it out usually awful diarrhea or I can give you a lactulose enema what not as well but that's about the only the only fixes for it I can give you antibiotics but those antibiotics essentially what away antibiotics do they give you diarrhea so I could give you prime accent as an antibiotic but it's really just giving you diarrhea binding to it and excreting it out because bacteria are actually in your gut what create create the ammonia that the bacteria breaking down everything so I know I'm over time I don't wanna go too much over today but just really quick GI pharmacology just really fast if we have G up just some two therefore big drugs classes of drugs h2 receptor blockers we have acid right GI acid acid is something we've got a you have to come you know maintain so we have GERD you produce too much acid we can decrease the acid we could decrease the acid with an h2 receptor blocker which is histamine to receptor blocker which decreases acid production or we could give you a proton pump inhibitor which is a PPI which decreases acid production as well just just a big we have a pharmacology lecture next week which I recommend you come to if you haven't seen our pharmacology endings one but this is one here – Dean you're going to so easy to be a remember – Dean is the ending for h2 receptor blockers – Dean rent it to Dean cimetidine because we're going to show a rented Teddy and a cement Teddy inside pic – you know these Teddy's our receptor h2 receptor blockers ppis proton pump inhibitors always end in the ending pres o P Raz Oh Ellie and I always get some student always says well what about asel I mean those are those are antifungals right and the answer is yes but Prez o with a PR azo le are always proton pump inhibitors how do I remember well P proton pump inhibitor Pro so P I remember that poach on pump inhibitor omeprazole panto prison Pinto Brasil um it's not as important that's of students writing do I need to remember Pantera Brazil was only given IV and MEP Rizal was only given by mouth not really so much you can give one by you know a particular route those are the things you're going to get tested on especially when it comes NCLEX time should the vector you can identify it to other drugs that are really important to some important points sucrose eight or trade in Kara fate which is not important you don't need to know trade names but sucrose fate it's an interesting one because it coats actual ulcers so if I have an Austrian in my stomach this gastric ulcer sukh afraid I take the sue Kofi it goes in and it's actually activated by the Aston you know you got too much acid down there making making all those great taeksoo cruel fate and it's going to create this protective layer over top of the ulcer and then it's going to keep it from becoming painful the important point with Sukho fate is of course well it requires that acidic medium to become activated so you need to take it one hour before you would ever eat so then you could have this acidic stomach you need to take it on into the stomach crazy people why can't you understand this sometimes I think patients just need to understand everything of course I know I don't yell at my patients but sometimes I wish I could zofran or onto the set run owned and set Ron zofran is really popular H antiemetic type medication definitely one we use for anti nausea we also use vinaigrette or promethazine as well as Antonacci drug but the big one of choice is ondansetron or the zofran of giving it the big thing with all these anti-nausea meds is they usually work before the patient actually starts vomiting and that's just a side note to have and once they start vomiting I mean they're already vomiting so you need to overcome some more mechanisms as well in addition I'm just a side note here pick monic all these medications we just mentioned for but we have a big whole webinar next week I recommend you join but we cover over 150 different medications just for pharmacology alone so lots of different things in our entire product to memorize all those drugs and there's one thing I guarantee you will get lots of as drugs and you must just memorize a bunch of crazy facts this is what we're really good at for sure so I just want to just put everything together just a quick recap a lot of everything I just said whoops but the thing is them remember what's different for each one so remember what's different wean peptic ulcer disease a gastric ulcer versus a do it in or duodenal ulcer know what's different no it's – between Crohn's disease and ulcerative colitis know what's different between ileostomy a colostomy know the big picture differences of them the fundamental concept and if you know the concept of everything well then you should be able to reason through with your nursing thinking cap how you need to treat it and it's so easy once you really think through and understand the concepts I see so many students who struggle with that which is basic concept putting it all together and it's really just understanding of in the beginning maybe you didn't have a great understanding I don't know but we have all these topics that we mentioned today in our pig monic system so you can go through and read through all of them read the definitions and get all of the information that you have to keep things straight so what we have we have a promo code for you today for PIC monic if you're not a subscriber right now you can sign up for pick monic system and we'll give you a 20% discount code to our fixed nursing subscriptions and our promo code I'm so excited for this one is poo 20p oo xx I love that promo code share friends is a good one it's definitely something should go viral in the next 15 minutes if you have any questions right now now is a good time to type them in the question box so we can quickly answer some of your questions and can get to those for you so that we can go over them and see in case I missed it something or you didn't understand quite something very well so if you have any questions definitely type those in now but if you have them you do not a Pigman a subscriber everything we went over today is sudden the big concept pictures are inside our picnic learning system we have over tons of different pic monix on all of these different disorders which go into great detail explaining all of the nitty-gritty facts you really need to know and all those characters are associated so it makes it so easy to remember peptic ulcers versus do it in ordinal ulcers so easy to keep them straight definitely something you need to know for sure um so I'm just gonna oh so also just really quick before I answer questions we have this promo code itself our fixed subscriptions someone always ends up asking that how we how we do our subscriptions and the big thing is and we have a annual subscription for $99.99 that gives you access to all 750 pick monix we have an in click study guide you can follow along and the big thing we have a mobile mobile apps that you can download and use pick monic on the go to always keep on top of everything we have pathways so whether you're studying brain clicks right now or you're in a particular course maybe you're taking pharmacology we have more organized out for you so you can just go right in and follow along and make sure you're learning things what else let's see what we have for questions today so we just have a couple so that's good Diane asks in Crohn's why are they anemic if they're non bloody stools so this is an interesting point and then we mentioned well early on and I just want to maybe you joined in late um so any time it's just a concept that you really have to understand what does grasp now that you don't understand it now but anybody that has a diarrhea if you're having five stools per day I mean I have two stools per week maybe three because I have IBS alternating diarrhea and constipation but if I had five to six tools per day and I crows disease I mean I'm moving everything I eat I'm moving it out ass I mean it's in and it's out all sort of colitis even worse the fact that it's bloody doesn't matter for the anemia the fact that it's bloody way of or the fact that it's you causes anemia switch you ever think of any time I'm increasing the motility and I'm saying I'm gonna eat this giant cheeseburger and it's going to shoot out the other end very fast is the fact that you're not able to absorb any nutrients so any patient who has a receptive bow or a shortened bow or any patient has a lot of diarrhea is not able to absorb nutrients out of all of that that sustenance it's there they're consuming and then of course excreting so any patient who has a constant diarrhea is at a risk of a decreased absorption now specifically with crohn's disease crows eases specifically targets most preferentially the terminal ileum and at the terminal ileum is where folate and b12 are absorbed and without folate and b12 you can't create red blood cells and you can then you immediately become anemic as and as an early on sign and symptom all sort of colitis blood loss usually doesn't cause enough blood loss to make you anemic per se yes the diarrhea alone causes it but it's definitely something you see anemia early on in the early stages of Crohn's disease before you'd see it in an early stage a very early stage of ulcerative colitis but it definitely doesn't mean it doesn't happen for us so Jeanne asked some are the pig monic just random or when you subscribe or are they by disease process so the great thing about this you can create anybody can create a trial account for free if you're not a subscriber but you can go in and we organized all of the pig monix in multiple different ways you can either follow along with a body system maybe we're doing GI you can follow along by body system we've organized them all so all of the big monix as well by course so maybe you're studying fundamentals maybe you're studying pharmacology maybe you're studying med surg you can follow along with med surg by med surg and topic areas or we also have organized them by book so you can follow along with most popular books that we have index and we are indexing more books every day so you can follow along with your book and see which pack monix are read by chapter by page as well so there are seven or fifty of them in available and definitely cover everything you need to know in nursing school for sure dentally help you give you up on your grade um so Victoria asks about a renal diet does it consist of a low potassium and low phosphorus diet along with a low protein diet and here's kind of the way you need to think about a renal diet um a renal diet really just um it's just awful it's just not fun it's nothing a renal diet is the worst one but the definite the definite thing is you you need to avoid things that break down the big thing is definitely reducing the amount of potassium for sure because potassium that electrolyte the bills up the fastest right so it's definitely potassium and phosphorus because phosphorus builds up as well but it's most definitely just avoiding a lot of bland foods and a lot of things that don't don't create a lot of byproducts I don't know if that's the best answer to give but it limits the buildup of waste products so it's low salt low potassium low phosphorus and and other pretty much all the electrolytes but it does give me definitely not the not the best diet to be on renal diet is if you think about them why are you on a renal diets because you can't excrete things so you don't want to have a high protein diet you're going to create urea which has to be excreted you don't want to have a lot of potassium because you need to excrete potassium so you limit the potassium you limit the phosphorus and you limit all you know all the electrolytes as well but the big thing are fluid restriction potassium sodium phosphorus those are the biggest ones for sure Jhin asks are these available all available with instruction I don't really quite know what your question means but if you wanted to rephrase it I will see if I can answer it lots of lots of love me statements no I'm kidding I always take anything free you have I'll shower me with gifts I love gifts any kind of gifts not gifts gifts like as in presence yeah okay so I'm not seeing too many other questions got a couple that I think we addressed and that's for sure if you have any other questions you can definitely reach out to us Steve in the background I'm here at Peck Monica's giving me some crap because I always try to throw in showering Kendall with gifts as often as possible not gif gif but presents gifts like um you know things worth money ah for sure because I always mention that I you know get 35 cents every time I show this pic monic cup which is almost empty today but we appreciate you coming if you have any other questions you can reach out to us at pick monic our scenic feedback at pick Montcalm I think I think I have that in here so I can show you feedback at pick Montcalm we have a question you're interested in something else that you ever you need help with if you have trouble using our setting up our system to learn you can always reach out to us click help email us right away you're gonna get myself or one of our other amazing team members here at big monic and next week we are having a pharmacology webinar that you can join in it's on the 20th you can see it on the pigmented comm slash webinars oh one question that was so happy to answer Heather asks when will Android app be ready and the answer is tomorrow but if you would like to use the head Android app today you can email us at feedback at pick Monica calm and Steve will set you up with it today but it is coming out in the next couple of days you are welcome Heather it's definitely something that a lot of people ask for but it is out we have our beta version that we are internally testing we are releasing in the next couple of days our entire Android app we're so excited about it but then lots of nursing students definitely requested them for sure but if you have any other questions reach out to us we're students for students is definitely something that we always say it's definitely true reach out to us at feedback pick Montcalm if you have any questions concerns gripes well are here for you as always good luck studying and have a good night you


  1. Pharmacy technician student here … I love the content you present; however, you "chatter" so much … it's too much.

  2. Im currently in Med Surg 2 and we have a GI exam in a week. I am so happy I came across your channel. I just purchased your picmonic system too! Thank you so much, you have already helped me so much to simplify everything. I hope Med School is going well for you 🙂

  3. Video says the UC affects the “small bowel” this is incorrect… it affect the LARGE bowel (intestine). Small intestine is rarely involved

  4. hi kendall tjis vidoe is awesome and even i am also passing through the same path you did.
    i am also an rn and about to apply for medical school
    thank you for this video its really helpful

  5. Currently taking Med-Surg in my 2nd semester of nursing school. Your lessons have helped me so much! Took my 2nd exam and your lesson on the endocrine system helped me so much!! Thank you!!

  6. Where does the speaker go to Med school? That's pretty admirable that he went from years of Nursing as an RN then on to med school.

  7. It seems like everything is a high yield point in nursing…D; haha, thank you for your incredibly informative video!

  8. your video motivates me to study for the test, GI disorder was our lesson but all we did was read the book and complete a sheet with patho, s/s, risk, complication etc of GI disorder. thanks for pointing out just the important one.

  9. awesome i just subscribed to the picmonic website and its the best HIGHLY RECOMMENDED!!!!!!!!! i which i knew about this before. Thanks for the help

  10. Just saw in the Mosby NCLEX text that studies have shown nuts and seeds pop corn does not increase incidence of disease.

  11. OMG!! I really love your teaching!!! when I read the book, I keep forgetting symptoms and things but your explanation is so helpful and makes me retained the learned concept! Thank you so much!

  12. In this webinar, Picmonic's Content Director, Kendall Wyatt, RN, shows you all of the Gastrointestinal Disorders and Pharmacology you need to know for nursing school and the NCLEX®!


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