The Gastrointestinal System | Picmonic Nursing Webinar

so GI gastrointestinal system so um first off my name is kall Wyatt um I am um the instructional content strategist and the content director here at picmonic so um just a little bit about me I started out as a paramedic um then I went to nursing school and now I'm in my third year of medical school doing my rotation here in the Phoenix Valley so uh we are broadcasting live from P from the picmonic headquarters we're actually inside of our audio sound booth where we record all of the picmonics um in our system that you particular that you learn um and um uh basically a little bit about me what do I do here at picmonic so I work with um all all of our students all of our users and I kind of uh bring together all their comments and concerns and I also work with our content so I make sure um that our content is medically accurate I help make sure that um it's relevant to you um and that what you guys are learning if it's confusing and I'm just kind of the liais on and the in between to make sure that everything is working and um and give you all those pointers and everything and of course do these wonderful webinars on all our system um we have lots of different webinars if you've not seen any of them um we have um uh 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 so let's go and get started what is picmonic um so we if you haven't seen any of webinars you've not heard anything about us we take pictures um we take characters and turn them into all the medical facts that you need to know during nursing school and um and basically um put them all together so you can memorize everything um we're research proven to increase memory over 331 per um so everything you need to learn so let's say bipolar we T we had a psychiatric webinar recently um we will show a bipolar bear uh all the pharmacology drugs you need to know during nursing school um so warrin we'll show warrin we're going to show you a war fairy and um you know with Warr you know you need to remember remember PTI INR you need to monitor that and we're going to show you a PTI in our Factory in this story that brings everything together and don't forget yes we have like Hein we have a hippie Heron um which of course is a a hippie type of bird that you'll see and you'll see a PT hourglass with that so that we can you'll be able to contrast all the differences and keep everything uh straight in your mind we have over 700 different topics for nursing cover everything you possibly need to know and um what we're going to do today is go over um the GI system and uh hit on some brief points so what are we going to talk about um 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 um 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 uh I always just you know talk a mouth to anus or mouth to rectum type of uh way to think about everything if you think about from the mouth all the way down there are different disorders all the way and 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 the contrasting things you need to know the differences of um 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 in the beginning and then we're going to finish it up with uh some pharmacology just some quick drugs on things that you also need to know as well um 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 a pasty face today so maybe I need to get some of that um that uh uh makeup you know to put on here to get me some of instant tan uh today so I feel a little pale I'm going to compare this to last week so um when we talk about learning body systems and oh let me just mention one thing first um if anytime today you have any questions or you have a concern right away you can go in our questions box in the 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 um we can go right in and and um you know stop and address those if they're relevant otherwise we do a QA at the end um that we kind of go over all the questions and 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 um during nursing school and um I always you know I teach this as this exact same mechanism every way and I'm just going to quickly briefly um 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 problem or problem areas you should definitely check in with this um and um 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 always like to think of this whole human body is a fish tank and this fish tank um is kind of where the this everything that holds everything together so the scin and the the body itself holds all this stuff and it holds that's the whole body it's the container just like a fish tank would be um like 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 in the human body's veins and arteries so we've got to move uh fluid around around around in the system um to be able to move things around and around in the system like through the veins and arteries we need a pump just like any great fish tank needs a good pump um and a good pump circulates and that's exactly what the heart does so um if there's a PO if there's problem with the pipes then the pump can compensate to increase and pump harder or faster to compensate and then we have an entire webinar on heart failure and whatnot along with all of this no fish tank and no body of course is complete without a good Iration system so an airator 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 um 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 are the kidneys um and everything that kind of builds up the kidneys clean it all out and just like a filter does in a great fish tank um and if a filter isn't working all this Gunk builds up and all these toxins build up in the human body and that's exactly how you should be thinking about renal failure is that toxins build build up now the GI system which is what we're going to talk about today is all about you know creating um having sustenance and nutrition that our body can consume um 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 um we we eat food and um we goes through our 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 then making waste which needs to be removed out of the system based on some with some good filters and the last one which is um another webinar we have is um just knowing that you need electricity you need something to fire all of this stuff to keep it all together and that's exactly where we think about um 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 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 um we're going to talk about the GI system uh and all of these problems uh and disorders but if you don't have any energy and nutrition going in or a certain portion of the nutritional tract is unable 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 um go over those as well so one of the things you really you really just need to understand um is definitely um absorption you we have a couple of different picmonics on this we have all of the different organs um but you really need to know kind of what is absorbed and where um and this is a really we have a really good picmonic on this um in its entirety but um let me just show you these two we have a small here's a small intestin absorption and a GI absorption one um just to kind of show you these two quick examples um 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 picmonic from just screen kept from our um our picmonic Learning System so you can see that um in the GI system um if you memorize where everything's absorbed then you should be able to then know um 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 com really common one um does anybody know the most common vitamin deficiency in the world what the most common vitamin deficiency is kind of a trick question because I know what everybody usually thinks in nursing so the most I see lots of different answers here uh but the most common vitamin deficiency is actually folate um and folate we know Works in um uh in in generation of red uh generation of um progator cells in to create red blood cells and to create these cells and works within he works with DNA formation we know that uh 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 a all the same reason because folate is the most common one but here we can see inside of our picmonic Learning System that P um folate is actually absorbed in the junam 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 uh the doad denim um we'll show it by a character like this dodo uh dodo dodo and denim this dodo bird in Denim and we're going to you need to remember that that's really where iron is absorbed um and uh Jun of course is folate and the next one is the terminal ilium and the terminal ilium is two important ones and we're going to circle back to this as well um is vitamin B12 uh gets absorbed there and here's an interesting thought over the whole just a concept um so I I'm not 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 um 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 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 a body's mechanism to say 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 um 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 um any type of diet or anything that causes or or a disorder that causes a particular type of um increase motility also decreases absorption of all of these things so if you know exactly where does anybody know which if I said the terminal ilium immediately which uh which disorder do you immediately think of for the terminal ilium if I had to pick one if I had to pick one I said terminal ilium vitamin B12 is absorbed there that's great I've got that here bioabsorption reabsorption is there um resorption rather um is there and that that's true but what what disorder does anybody know you can just type it there and question box oh that's right Tanya um Tanya actually said it's Crohn's disease and that's right we're going to talk about that in a second so terminal ilium specifically one of the places that's affected with Cron's disease is the terminal ilium 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 re absorption of bile because that's kind of where the problem area is um and just another uh side note just so I don't forget this because this is a really really high old point that I I didn't put into this webinar today but I want to make sure that I mention it um so if I have a patient who has pernicious anemia um does any put pernicious anemia so if I said pernicious anemia what does that really mean what does pernicious anemia mean I feel like I'm Tongue Tied today pernicious anemia anybody what okay Alma and looks like you say B12 deficiency um so what happens is the body can't absorb B12 12 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 I 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 that's right you guys immediately uh several of you jumped right in can I just give you B12 by mouth no um I if you have pernicious anemia it's because you can't absorb B B12 uh what you you have to give it uh intramuscularly as an injection that's a really high point that you should know um because I see a lot of students gets tricked up by that one um right away and that's definitely something um you don't want to mess up on uh for sure that's a really high point so we're going to talk about just some other random uh kind of fundamentals things you guys should know but I just want to because I'm going to mention these all again so here are some other um really important points that you just have to know and understand um so dysphasia um phasia 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's somebody who's going to teach somebody how to talk but a big part a majority of the part of a speech therapist job especially in a hospital or or nursing home or medical uh point is actually evaluating swallowing um so it's just the muscles of speech and the neck muscles as well is and they do an entire study um to see how people swallow and then like what type of diet that the speech therapist would recommend um so somebody with uh immediately if you think somebody with dysphasia what type of uh 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 really kind of a a paradoxical thing that I see students also mess up on a lot I see lots and lots of different all over the place we hear and the the big answer is what actually do 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 a 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 here is that they need to have thickened liquids um because thick liquids are easier to move with your pallet and then can you can swallow them easier versus just PL plain liquids um or you know water or whatnot um that is where you're going to those that's actually more likely a choke risk than any of those types of patients so don't mess that up somebody who choking um or somebody has trouble swallowing would be have an easier time swallowing something with that's thickened liquids at a minimum um and then soft mechanical puree and those as well as they move up but thicken liquids at a minimum you'd never G them um a liquid diet unless they had a clearing from a speech therapist or whatever so uh just along the same lines um and just some important kind of points I want to put on so dice um dysphasia we always show in picmonic of a dice fajita we just thrown one of our characters in here and you're gonna see all the characters that we use common throughout our picmonic per picmonic 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 I just want to hit some um some points um regular diet truth truthfully um even I can tell you as you know working and doing my rotations right now I just finished Internal Medicine not too long ago um you know there's not a lot of patients truly get a regular diet especially if there's something wrong with them um so let's just talk about some of these high fiber versus 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 to 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 a high fiber diet what does fiber do let's let's just think about that um so lots of guys um lots of you guys typing in um for constipation so that's that's a acceptable answer fiber essentially creates bulk in the stool so um if I have uh somebody who has um if I need to create a let's just call it like a fluffy bulk right um not a hard mask CU what we know about with stool and we're going to talk about that too 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 in 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 a low fiber diet of course would then cause your stool to be become more firm um 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 because of hypertension if we give you a lot of high salt and you consume lots of salt um most definitely um 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 you know refresh yourself with those renal diet usually just pretty much involves no protein um because that really protein breaks down into what protein breaks down into Ura and if you don't have kidneys working very great do you really want a bunch of Dua that you need to excrete through your kidneys no so we would give them a l 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 has high cholesterol we put them on a low fat um or low cholesterol type diet as well so let me just see what we got here got a couple of yeah so um um uh a couple of students said that you know high fiber or Fiber itself stimulates bowel movement and just an interesting point what actually stimulates bow movement well bow movement actually so if this is my bow I hope my bowel isn't this big or yours but if if a bow a portion of my bow is um full of stool and it stretches out that's what actually causes a reaction of peristal you know paralic movements so if it gets firm it stretches out that's actually what triggers um that that peristalsis movements of it moving and squeezing it down through through this stool as well um so types of diets uh not really not really something that I want to go over right now um but it's definitely something if if you're not understanding of the types of diets you should um 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 um somebody's on a clear liquid diet versus a liquid diet they're on clear liquid diets probably because of what reason what reason will we put somebody on clear liquid diet versus um just liquid diet does anybody have an example of why we would want somebody on clear liquids versus just liquid well there's a couple different couple different uh couple different answers here um you know s surgery lots of you guys are answering yes but you know the the big reason clear liquid diet is most likely U to to indicate whether a patient is bleeding or not if there on a clear liquid diet and something comes out colored then we know that something discolored that stool um so we put somebody on a liquid diet do we want to give them a bunch of red Jell-O and uh a bunch of red collared things no because it's going to cause colloring and discoloration and I see that all the time not really a high yield point but definitely an important Point as you get out in practice uh for sure mure mechanical soft soft and and and um the other types as well not so much important for us today and some important points that I want to go over but um definitely something you should review we have a picmonic on it to to help you review if you if you need to go over the types of diets um something that I want to just mentioned that's a really high point I see a lot of um a lot of questions on this and I'm not sure why to be honest but uh in G tubes um so does everybody know how to measure an NG tube it's a 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 um and this is really just understanding uh some basic concepts I know there's more that goes with NG tubes um 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 from my nose I go to my ear right from nose to my ear and down to my zho process where's my zyo 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 um into my stomach so why do we use an NG tube whether n OG gastric tubes um you can use them for lots of different reasons and there's several different types um we could use it just to decrease the acid out of the stomach um we could use it to feed um we could put food through it um we could attach it to suction to decompress the stomach um we could use it as lavage we can input something if someone overdosed we could insert like uh um activated charcoal and then it would bind and 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 you 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 naso to the gastric Nas to the nasal to the stomach and you insert it in their stomach or into their nose rather um insert the nose while they're swallowing some water to actually make sure that they swallow it and doesn't go in the lungs um definitely a good point and we know that um we know that um we need to aspirate uh contents and they should be what what do we expect those contents contents to be this is hopefully pretty easy and the answer is very acidic right and we can aspirate those contents and check that they're acidic or we can also um um 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 all the candy that I've been eating um so the next thing uh I want to talk through we're going to talk through some disorders oh hold on let me I went one of my there we are I clicked I get a happy clicking I apologize so we're going to talk through some disorders um each one um 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 to what's different with with each disorder and GI is definitely one of those places where a lot of students have a lot of trouble because there's just so many different problems and they say oh 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 them we're going to talk about them one of the first ones and probably the most common one you're going to see with anybody that's over 30 35 40 years old is gastroesophageal reflux disease or gird right I mean that's all a lot lot of words and gird is a lot easier now I've got some signs and symptoms on here but is this the only list absolutely not I just wanted to highlight in here we have a whole picmonic on gastro GE gird um assessment and interventions but let's talk about some that really clue us into that it's gir um and this is how I want you to really think through what's going on here GD gastro sophal reflex 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 um the lower esophageal sphincter relaxes a little bit or doesn't 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 um until it gets into the at esophagus and the esophagus and gets irritated and when it gets irritated you have things like heart burn and essentially is a burning type pain right but specifically when would 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 um or a vampire I guess there's that possibility um 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 gastrosoph reflex disease is when a nighttime coughing or a 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 Gast excuse me gastresophageal Reflex 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 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 to not put ice in my drink teeth hurt so you guys everyone looks like lots of 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'm going I can make it harder but the answer here is that you need to prop those patients up you need to elevate the head of the bed when they sleep now what I can tell you about esophageal reflex 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 years and years and years and 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 spincter and I don't ever raise my head of bed of my you know raise the 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 um 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 that I can't do that then what's the next option the next option well is just put the top put the front of their bed under some blocks so that their entire bed is essentially elevated just a little bit um and uh Julie says I need a root canal I've had um eight root canals and um about 14 uh 14 of those um caps caps yeah uh I have awful teeth so I'm always used to root canals are my best good friend because they get rid of all this awful uh tooth pain anyway so easy things first is what we want to go with so G right easy so easy with gastro reflux disease we saw what this classic signs and symptoms are and 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 an 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 whatnot uh and and you know those types of things as well so the next thing um actually let me yeah oh so just as a side note here so I talked about cancer esophageal cancer um so any of these types of cancer gird is a is definitely something that's 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 trct 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 gird well I mean if you had gird 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 me 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 with what are the other things that are definitely increased the risk factor for um esophageal cancer and looks like several of you guys typed in a several the right answers and that's right um the the answer that I'm going for here are um smoking um as definitely smoking and alcohol right so alcohol consumption alcohol consumption irritates the GI lining smoking irritates those Linings and what happens is um sometimes with medications I like to explain um so we give um uh Oxycodone with acetaminophen right why is oxycodone combined with acetaminophen when we take those types of pills because they have a c istic effect because they work better together right that's why we have um peret which is oxycodone plus acetamin they have a synergistic effect and they work better together well in the exact same regard if you have G gastro esophageal reflux disease and you smoke and you drink alcohol on a regular basis you have the trifecta of the synergistic effect of giving yourself esophagal cancer as well as other cancers so you are synergistically um combining those effects to give you a worse definitely a worst uh worse or more probability that you're going to end up with gastro you know sagic cancer so definitely not things that you need to you know you just need to think of those you know is drinking smoking doesn't mean you're going to get esophageal cancer no but that combined with alcohol combined with gird causes this synergistic effect together so as we're breaking down the GI lining one of the things that pops up and is so high yield is knowing peptic ulcer disease um so pepic peptic ulcer disease is a fun one and the fact that um and I just really talked about the risk factors for peptic uler 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 a another big big big cause of ulcers there are two that I'm really going for here um that I really want to ah lots of the answer is nursing school right of course yes nursing school med school myself stress right I mean stress causes all I mean the first uh even several of you got a caps of stress stress stress right in here and that's right but the other one I mean that's definitely a cause stress but before stress you need to think about this and never forget as incets non-steroid anti-inflammatory drugs is a huge cause for um for ulcers a definitely definitely instant cause for ulcers um another one good um Julie pointed out was H pylori hel helicobactor pylori is a gram negative um infection that can cause um ulcers um how do we diagnose um h pylor what is a way we could diagnose H pylor this is a just a side note um definitely something you need to know ah right why right away wasn't expecting such a immediate answer and that is you can do an H py breath test um so we're actually checking you breathe in this device and it checks your breath for um for the presence of uh uh the byproducts of H pylori because H pylori creates uh 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 I'm not sure sometimes whether you guys type the answer in after I said the answer or you've typed it in if you not pushed enter and then every 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 enter I don't know if it's and 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 oh let me just back up so we have different types of ulcers we have a dadal or dual ulcer and we have gastric ulcers what is the difference now we know a gastric ulcer is in the stomach and a dadal or dadal ulcer is in the dadum or dadum however you want to pronounce it I it's one of those I just gave up on how we how it's really typed in um what is the difference between those two types of ulcers and this is really important really high you points um 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 I broke them out here for you we have picmonic to help you car characterize all of these to you know characterize these um keep them straight and here is what you need to memorize and we have picmonic for this um a duodenal or dadal ulcer you feed you feed a d doal ulcer 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 going to 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 eat 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 all so we starve a gastric ulcer the acid is produced and it causes irritation because it's a ulcer in the gastric Lang and it's very painful but a dadino ulcer is different what happens with a doo 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 it's decreased and then it sues this um this uh Kim uh sues the dadino ulcer dueno ulcer it soothe it and then essentially so these people have weight gain with a du dual ler and they um feel better after eating so they have pain right now oh 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 gained 500 lounds right so that's how you can keep them definitely straight it's definitely something um definitely saying uh the way you need to think about it it's a concept um 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 um preempt you on memorizing everything is great picmonic is amazing for memorizing but I want you to really um 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 uh 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 so that's because all that acid is produced in the stomach and immediately irritating to that ulcer which is an open sore so just an interesting thing um how do we diagnose a gastric ulcer is we would do a EGD esopo esophago gastro duodenoscopy so we would do an EGD and we would go down with a scope and look um and see actually visualize the gastric lining as well as do lining and see if where those ulcers are and if they're present for sure so another one um and I I'm I'm sad I didn't keep these um uh text 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 ulcerative colitis um these are such high yield points that you just have to know as a nurse you've got to know this for your inlex or for your nursing exams you just have to know the answer but interestingly enough we have picmonics with all of the details for these but there's really just some high yield points you really to know to keep them straight um and those high yield points are really to know that with crohn's disease what do we see versus aler of colitis so I got them kind of spit out for you here already so I'm I'm sad that I can't really quiz you to see how you're doing or if you're paying attention right but Cron's disease what's characteristic of Crohn's Disease what's characteristic of Al of colitis the big things here is Crohn's disease um we show you this crown of intestines for Crohn's disease we got some really comical picmonics for it but the interesting thing about Crohn's disease is it's usually a non-bloody stool it's because it's not necessarily an inflammatory process so it's not really bloody stools with Cron's disease they often have five to six stools per day diarrhea they complained diarrhea like crazy but how many five to six per day you know that's a lot I mean I we'll get to this TMI information in a bit but um you know I would sometimes I feel like I would love to go to the bathroom five to six times per day but um it's definitely not a blessing for those people with Cron's disease for sure and the the name major affecting part is of course the terminal ilium um so the terminal ilium and these PE patients always end up with anemia so we have the stools it going to be diarrhea it's going to be um uh statera you know diarrhea um but not bloody stools and five to six per day or so what's the difference with ulcer of colitis so ulcer of colitis um it in fact affects the entire small bow but also the rectum what's different here is it's an inflammatory process so it's an inflammatory process in the fact that you have um inflammation of that gastric lining so when you get inflammation of that and then you're just constantly having these 10 to 20 stools per day um you end up you stool a lot I mean I couldn't even imagine going to the bathroom 10 to 20 times per day um but if you had to this is all sort of colitis and they have exacerbations of this right um 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 that inflammation of that lining and then when you irritate the lining just like you know you rub your skin and it gets raw like a blister it ends up bleeding if you just keep rubbing it and rubbing it that's exactly what happens stool stool stool eventually you get bloody stool 10 to 20 per day and the big thing here is it's um it's an inflammatory process so it causes this um more of a uh you know more stool and something that I I like that um we have a character kind of wish I had thrown in here it's called a tennis moose and definitely a a we had a question of the day on it it's a tenesmus um tenesmus tenesmus is a medical term you need to know tenesmus um and it is the sudden urge to defecate as in I got to go and I got to go right now to nesus 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 um anemia anemon um we have our bloody toilet over here pikm monic we we actually have entire picmonics to help you memorize that this one's bloody with a bloody toilet and this one's just just diarrhea with a regular toilet to help you keep track of which one's which um which is what we're actually great at to help you memorize all these little details and keep everything straight um something I want to mention but I'm not going to go into big detail on is diverticulitis and diverticulo losis sorry diverticulosis uh so here's an interesting point on diverticulitis when I say itis right I just I would just mentioned all sort of colitis um itis what is itis itis is an inflammation um there is one thing that that definitely I had a student reach out to me not too long ago and they you know they said they were doing a um a bridge course where they were already had their bachelor's degree but they were doing like a high fa high-paced Nursing degree on top of it U one of those accelerated tracks I'm sure several of you guys are doing that um but definitely something that I recommended um was uh uh understanding medical terminology like this is going to help you so much and itis I mean this one's a simple one yeah I know itis inflammation right so diverticulitis is inflammation of the diverticulum what are diverticulum well they're these little these little pouching right here diverticulum that's a diverticulum diverticulosis osis means like an outpouching or an or enlargement of and that's diverticulosis so it's a giant out pouching so itis is an inflammation so irritation of that lining and osis is an out pouching so I were to talk about them diverticulitis is an inflammation and diverticulosis is an outpouching um diverticulitis happens because of inflammation of the entire tract usually because of diet or an entire um you know systemic process diverticulosis um can be episodic but a lot of because of diet so you know um something regarding um something regarding uh consuming different types of food that would get stuck in these little outpouchings and then become infected or um or painful and what is the one type of food or a couple types of food if you have a couple of examples that I would definitely do not recommend to somebody who diverticulitis or diverticulosis somebody who has um an ostomy somebody who has um something I don't want you to have ah lot of you ah right away good answers immediately pouring in the number one answer that I see most commonly on most exams is popcorn um I Love Popcorn I love to go to the movies I 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 those little tiny pieces they don't digest that's not fiber that's just pieces that do do not digest right um and those end up causing irritation they get stuck in those outpouchings they irritate the gastric lining and they cause extreme inflammation definitely a big one and lots of you guys said nuts and seeds and that's another really common one um is um seeds and nuts you got to be really careful with those but popcorn is the big big one definitely definitely one I see the most most often mentioned in questions but um definitely seeds and nuts for sure but uh most definitely popcorn for sure let's just keep moving on here so uh we got a little diver diver lumpy here in our diver ulous on fighter diver on fire and you see are these little outpouchings on our diverticulosis diver lumpy character these are little outpouchings just show you that's what that's what osis or a you know a 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 uh this one's an interesting one I I have irritable bowel syndrome and I could talk about irritable bowel syndrome all day long um mainly because I think it's fun and it's you know makes everyone cringe right no um irritable bowel syndrome is an interesting one because uh I always get lots of cringe responses in there when when you when I talk about uh personal bowel experiences but I don't get a lot of T time when I can talk to hundreds of people about my personal bow experiences I just feel like this is the best time to 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 is really classic in one thing that you can use to identify especially as a nurse and that is alternating bouts of diarrhea and constipation um and the big thing is they usually um they usually have um irritating Foods um there's no way to diagnose irritable bowel syndrome except to rule out everything else so rule out you don't have aler of citis you don't have Crohn's disease because those are things we can diagnose irritable bowel syndrome what is a what are some what are some really irritating irritating Foods um that could flare up irritable bowel syndrome so what are some things you could feed me most likely that's probably going to 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 yeah not so much but sometimes some people are specific to that but the big one and I see here um the next one is most definitely d dairy products um Kendy says um 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 a flare up of um 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's probably a little bit expanded and it's not so nice and it's curved right what happens is if you eat that it creates gas um and it's definitely a very gas producing food which creates expansion if we have expansion in there um that expansion then ex exacerbates peristalsis and in IBS cases extreme peristalsis and um complete B evacuation diarrhea whatnot so here are um just our alternating wheel of regular diarrhea versus constipation or corticon toilet just to kind of show you the differences um the next topic something that is really important and 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 that you're really just going to sink into your mind and like wow that Kindle guy he's really kind of got some smart stuff up his sleeve and this is just something that I've just taught for years um 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 um so my favorite topic especially if you're a nursing student is to um talk about colostomies and ostomies right there are some really high yield points you have to know here um and one of those is I'm really just understanding the idea that stool 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 m a Kim and the duodenum and then get the ilum is a little more formed and it gets down to the um uh gets down to the large you know the seeum and it's essentially like a a clim watery half blah blah whatever you don't really need to memorize all that per se for your exams um long term but you need to understand the process so um here we have so what I need you to remember is um and as you need to try to remember everything we're about to talk about whether we talk about appendicitis in a second or how the bow is formed I want you to just think about yourself hm how do I remember what the colon is like on a a body well what is that qu what is the answer to that question and the answer to that question is a question mark um so I want you to draw a question mark right on um sorry I see lots of people writing jokes or commenting on my U 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 um the question with um about knowing the stools and everything is is essentially a question mark so draw a question mark just look at this question mark I have right here in this sexy little thing right here I see love this question mark it's great right well this actually outlines the bow um 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 ascending colon going across transverse colon 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 formed in the descending colon and the rectum I mean that's obvious right but now it's obvious maybe you were not able to memorize that right away so it's less formed in the asending more formed in 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 thrown in this TR triangle here and we're going to talk about the last SE for pancreatitis just at that little nugget at the end um so let's talk about colostomy versus ostomy so if I have an ostomy that's in the ilum so we have this up here in the ilum um the ilium attaches on here here we've got our um ilocal Junction right here the right about where this eye is going to be on this beautiful little colon character just little nugget um so that's about where the ilocal junction is and in that ilocal Junction not only do we always remember that's where an Inception happens in a child but most importantly um we know that that's where the the small bow essentially attaches to the large bow right so in here's the large bow and if I had a ostomy that's in the ilum um what do I know about ostomy versus colostomy what is the most important thing you need to know what is it one starts with i one starts with c ha you guys are genius no nah types of stool okay tell me a little more tell me more about these stools you speak of these magical stools tell me more that's right so you guys um lots of you guys are typing in the answers here and the answers are exactly right um so in ostomy 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 it absorbs of nutrients and Chom microns blah blah blah yes but the main function is really to absorb water out of it to make it more of a formed stool um I just realized my nose is really sunburnt I think that's just a sorry there's lots of squirrels in here I'm very distracted today um so it's very um very uh sometimes the quest the comments that come in the message board really throw me off so I gotta stop I gotta pay pay attention here so ilost yes very loose stool because a colostomy can makes a more formed stool so in a ostomy I see form stool so what is an important thing here um for ostomy what do I teach somebody with an ostomy about diet what do I teach them they need to take what types of foods ah excuse me a couple of you typed in oh my tooth I'm just gonna I'm GNA pull this out on the webinar one of these days this tooth that I have definitely definitely need a root canal there so um the the ostomy and ilost is a 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 the that's not the purpose so an ilost get a low fiber diet very low fiber diet and absolutely at all costs avoid things that are going to 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 um is most likely uh you know 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're going to 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 ostomy care picmonic as well um is to know you have to keep that diameter on a colostomy 1/8 of an inch that that diameter what you have to cut around the colostomy pouch to to put over top of that little stom I always just I just I always use a if you've never seen a stom then you really don't know but once you see one you're never going to forget me doing this with my finger and my little tongue because that's about what a stom looks like it's an outpouching of actual bowel coming out of the skin it's sewn in and you need to create your little outpouching 1/8 of an inch diameter around that it's very very important why because we're going to decrease irritation especially with an ilost because it's it's liquid and very very irritating because if that in uh site becomes infected can you just immediately just throw in a new ostomy no I mean that's definitely traumatic to the patient it's not something you can do and not really a very easy uh very easy uh place to do and um lots of you guys typed in about nutrients and whatnot for for Le ostomies those things are definitely true Kevin says um colost ostomies and colostomies are more red than my tongue and that's probably the case um as well so quickly let's talk about colon cancer not really a lot here for us to mention about colon cancer um the important thing is it's really common cause of death um and we see a lot of diverting colostomies because of colon cancer they have a reection and then they end up getting chemo and treatment and then they get a reection but the big most important thing about colon cancer it's completely preventable um 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 um so this is very important that anybody over the age of 50 gets a colonoscopy um and um there are specific guidelines um about if you have a family member with colonoscopy that you get a colonoscopy earlier um then they were diagnosed with colon cancer but the most important thing to memorize here is over age 50 you must receive a colonoscopy um another thing you can do is a feal call blood test which is just a nice poop smear on a little on a little car to see if there's actual ult blood um in um 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 um that we have to do um prevention of colon cancer this is seems like pretty easy stuff but it's it's definitely one you're going to get as a high yield Point um and it's eating a high-fiber diet a lowfat diet maintaining a healthy weight and one thing I didn't put in here was having nice green leafy uh green leafy vegetables it's definitely something that's going to decrease your risk of getting colon cancer for sure um 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 sto um and blood in your stool or blood in your vomit is what are we going to do well as great nurses with our 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 picmonic team um 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 imagine Marley talking to her patients and patient comes in and they say oh I've got some you know blood in my stool and she says tell me everything because as a nurse you want to know everything about what's going on you want to know characteristics you want to know why when how what it smell like what it feel like everything right what do we want to know about stool uh blood in the stool and that's just a couple simple things um the simple things here are is it bright red or dark red if it's bright red blood coming if you if you had a stool and you had bright red blood then you're going to think yeah probably maybe hemorrhoids or a a bleed that's lower to that GI to that 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 vomit up bright red blood then I'm going to have maybe a a bleed that's a a upper GI bleed maybe in my stomach a gast you know gastric ulcer esophageal veraces uh maybe esophageal cancer those kind of things I'm vomiting up bright red blood um but if it's dark red blood what happens with dark red blood well if it's from my stool if I'm having these dark red coffee ground um stools then that's digested blood it's curdled blood essentially your body has digested it and it's turned out to this coffee ground dark brown black type substance that's because it's probably from if it's stooling dark red um coffee ground type blood it's probably digestive so an upper bleed that has worked its way all through um if you vomit up dark red then that's most likely um the thing you're going to be thinking about is uh an obstruction or a bleed or a vomiting up um of digested would be more like a duodenal ulcer some type where the blood is at time to digest um 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 um so one thing we want to talk about here really quick is bow obstructions um not really a whole lot here to talk about uh but the big thing is the number one thing you're concerned postsurgically is what there are different types of bow 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 Pac you 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 PAC you hey how you doing tell me everything have you pooped or not have you pass gas why because if you have gone under anesthesia your bowels essentially are the last to wake up so you end up with this neurogenic ilas and we can't send patients home um if that isn't important Kevin says OB nurses worry about um neurogenic ilas as well and that is absolutely true anytime you're under any kind of anesthesia that is the number one thing because the bowels are kind of like this lazy sleepy thing um if we need blood flow if we're shock um if you're have a patient who's in shock what's one of the places that your body deprives of blood flow first well that is your bowels 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 you know your cardiac your peripheral vascular system it's the same one with anesthesia everything just kind of the bowels really aren't that important we're sleeping so they're just going to ignore them for a while so it takes some time for them to be reused 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 that medication wise what medication would we think about what medication what we think about if I said medication creating obstruction this is so high yield and you just got to Kendy says narcotics but which narcotics what are we really worried about and um looks like you know Kevin said morphine well that's great but what are we really worried about worried about opioids and that's right morphine is an opioid all of those opioids cause bow uh bow uh decrease motility of the bow because they relax everything else and they just kind of hey bows don't worry about pooping just keep it all in that's kind of way it work um other causes include mechanical causes the actual most common cause of a bowel obstruction is actually adhesions um and those are um adhesions are just type you know bow which is scarred kind of together and created this um constricted part or um you know it's usually because of previous surgeries or you know congenital problem but adhesions are actually the most common cause of um bowel obstruction in general so just just a side note there for you so um we have different types of instruction obstructions rather um we have a picmonics for all of these um as well oh hold on let me go back I thought I had a hiccup but then I thought maybe I needed a cough but I don't know what's going on today so let's quickly look at the next topic which is hernas these are our picmonics on obstructions and types of obstructions just everything I went over to help you memorize everything together now types of hernas um this is something I just want to actually run you through the picmonic to show you how we really tie how you can remember everything together of which one goes where or which one goes which um so this is a picmonic I'm just going to guide you through it as if I was teaching you a picmonic like you'd learn in our in our picmonic system so types of hernas are really important you know the types of hernas right what hernas go where and when and kind of how to keep them together um it's important know the types of hernas as shown by our little um hermit crab character throughout this entire picmonic thing picmonic Learning System so there's a hiatal hernia this little Hern hernia hermit crab with a high hat and that's usually Hiatal is usually seen in gastrosoph reflex disease as you'll see here with our Gertie girl for gastro Sagal reflex disease and a hio hernia is essentially um bowel that comes up through that um that sphincter where the stomach is so the bow or the stomach GG regurgitates up through above the diaphragm and it causes hiatal hernia causes a lot of gird and it's associated with gird as well another one is inguino um inguino is kind of a um we think about those kind of in the groin in general but uo of course in that inguino space um you know Ladies as most nurses are ladies always think about that V cut that's inguino in the groin um that's kind of a in we have our crab in the groin here the big thing with um uo horn is is they're most commonly in men and that's one of the reasons why we screen most young boys for uh inguino hernas because it's a possible complication with lifting and what not you strain and you cause this inguino hernia another type of hernia is umbilical hernia so we have our um umbrella hermit crab here so think about the umbilicus and this is one I see all the time I see it incidentally um 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 anytime that we've had surgery or there's a there's a previous cut in any type of body tissue it creates a loose area cuz scar tissue is not as strong as regular tissue how strong is it well was like two3 I think um two-thirds right away I think is the the I can't remember the exact percentage for moral Hern here's our femoral bone hernia femoral hernia are most common in women you can see by we got this woman with her femur and her uh and her little hemoroid hermit grab and then incisional and this is the one that you see very often you see um uh somebody who has a an incision so um OB patients um Kevin talked about how he hated as OB clinicals I'm right there with you I hated OB um I still hate OB but you end up with a an incision and those incisions um are a if you have a um whatever the term is when they take the baby out and it's not I can't even think of the word right off um definitely not a very good blank to draw at this moment but C-section yeah cerian section thanks uh Heather if you have a cerian section um you you have to have cerian sections after that U mainly because the weak 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 hernas are very common that we see anyway any kind of incision ends up with it could ends up with an incision her incisional hernia this is just kind of how we guide you through everything to keep track um strangulated is something where you could have just a um an adhesion that obstructs things off and creates an obstructed hernia one of those is like with pancreatitis as we're or appendicitis 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 um that I try to always stay to appendicies we have this appendix pen here um appendicitis is fun um the most thing you need to know about appendicitis kystis 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 Tess right quadrant fever lucco yosis risk for perforation great all those things are in our picmonic 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's my question mark of my and you notice this little nugget right here see that little Boop ddoo right there that little squiggly that's the appendix right so if we have my ilocal Junction right here where this eye is and there's my appendix and I imagine that that's a body and I drew this onto a human body I'm imagining somebody standing right in front of me in anatomic 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 poo poo here was in anatomical position this would be the left side and this would be the right side right it' 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 poo poo 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 not how to draw a question mark you have appendicitis and that's almost the most common question you're going to get right lower quadrant versus um left lower quadrant right I me that'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 um appendicitis we had a question of the day um for appendicitis a 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 um it's really important that you do what before you palpate well you always osculate before you palpate someone's abdomen now yes I understand um very often it's taught that you the doctor palpates or deep palpates and you only light palpate or you don't palpate at all depending on what your school teaches you but the important thing is you must osculate 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 they have this right lower quadrant pain it's almost classic so easy to catch um and you do what for it well you do an ultrasound you find out that they have a pentis and you send them off to surgery whoopy do good for them we have a bigon for this as as well and I don't 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 cystitis so gallbladder problems I mean sorry ladies 95% of everyone ever listens to these uh webinars in nursing is a female well what I got to tell you you probably already know is ky cystitis right so gallbladder issues what are some signs and symptoms of gallbladder well immediately you should be thinking about what types of foods H the 5f Kevin says that's right um FFF that's right everyone should be thinking about FS kystis f f f f f f chitis f f f f this F that F that that's right it is f everything kystis but the big thing you always need to think about this characteristic fact and that is kystis they usually have a pain after they eat and what type of food is fatty food because what happens what is it think about the concept here what is it all bladder do what does it really do yeah you have a you have fat in your diet your body senses the fact you have fat so the you know um cystic kinen gets released which then cause cause causes Gul batter contraction and then that decrease increases bile which blah blah no that that all is true those are not what you need to think about you need to have the big picture and the concept and the concept here is you eat fatty food and the gallbladder itself releases bile excuse me I got the hiccups um I get every every week I think I get cited and I get these hiccups but anyway the gallbladder releases bio and that bio comes down helps break down um these fat emotions into smaller particles amino acids and break everything down so they can be absorbed by K and by the the intestinal tract think absorbs fats so if I ate a fatty food um after I eat it I'm at this 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 Pane and most importantly it's after eating clay color stools because we could have chitis or cholithiasis lithiasis means Stone lith means Stone um we could have this uh Stone which could obstruct the bile duct and cause no bile to come down at all and that causes clay colored stools because we know that the the bile actually collors our stool this Beautiful Brown greenish uh greenish pigment right um the gallbladder essentially just stores bio and concentrates bile from the liver um it just concentrates all this bile it just stores it all and then when you eat a fatty meal gallbladder goes okay here's a little squeeze of bile for you and it squeezes a little bit of bile out but if there's a stone or inflammation it tries to contract and 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 fs female patients we have an entire picmonic for this female fat Fair light-skinned fertile pregnant and usually at around her age 40 and when we talk about body shape you know we talk about that pear shaped you can have that peir shaped you have apples shaped um and that's probably something you also talked about in your nursing school and the patients that are um more likely the apples shaped um you know the different types uh you can know with colly cystitis as well so there's another important point just kind of a high Yi little point there um I'm not going to talk too much about curosis today because this is um definitely something we can go into really high um in depth on and types of therosis and hepatitis which we're not going to touch on today but um definitely therosis in general liver failure so liver essentially liver has lots of functions um but the most thing with liver ceros what's the most common cause of liver ceros um hepatitis yes um alcoholism is what everybody always picks but um actually um things like hepatitis as far as the war World usually is more common but alcoholism is definitely very common for sure and it causes you know chronic alcohol loose over time causes curosis and and sosis essentially is you know the liver enlarges and then it becomes cerotic and it breaks down and becomes very fibrous and can't repair itself liver is a great organism because it can repair itself I mean 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 um that's why we get um you know that's why you're able to detox uh so much but it's essentially just a big giant detoxing engine and um one of the things it does is we see with therosis um if it backs up and fluid backs up I just want to back down here to the bottom we see esophago veres and a a pen omegal but why is because we without going too much in detail with the the anatomical structure um 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 um those um to like to like tasus I can't never say that word uh T tasus it's not a word I've ever been able to pronounce and anytime we have a picmonic with it I just ask somebody else to do it but um uh Spider angomas basically is another good word for it but it's this little tiny blood vessels because of increased pressure um as well in in the stomach the caput medus um that we see in the stomach because of this increased pressure because the pressure can't go through the liver because it's it's become this hard Mass um because the liver isn't working um liver is very responsible for breaking down Ura right and and turning Ura into a product and ammonia metabolizing ammonia so we can get rid of it so we end up with this hepatic and seil opathy and the important thing to memorize is yes we have pigmon for all these to help you memorize uh that the fact with estrogen causes this pulmer arthema and spider angas and gynecomastia those are all important because of breaking down estrogen um let me just mention it or explain it since I said it um the liver one of the things liver does is break down estrogen um estrogen or estriol types of estrogen is actually made by fat cells and the liver actually breaks it down and gets rid of it um but if your liver isn't working um bye-bye liver no more you like the alcohol enjoy the liquor um well you're going to end up with these man boobs right because you have too much estrogen because your liver can't break it down and you end up with this Palmer Emma um this redness of the hands you end up with spider angomas um and a lot of this is because of this increased estrogen body in your body um that your liver cannot break down and get rid of and um that's why you end up with gynecomastia and liver failure um but you also end up with hyperammonemia um that you so you can't metabolize ammonia and get rid of this toxic ammonia nobody wants ammonia but um 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 that to know Kevin says his instructor says to think of esophagal ver veres as hemorrhoids in the esophagus and that's very true so the esophagus uh veins and your your the glams around your rectum your anus are actually attached to this portal Venus system so if you increase the pressure in there you end up with diverticulosis right this osis this 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 sorosis liver failure is not a not a fun thing sorosis is not a fun time um so anyway back to am ammonia um what do we know about ammonia well ammonia um 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 it creates ammonia um and we break this down we create ammonia and our body usually absorbs and metabolizes and gets rid of it well Sun 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 excrete it and the big thing we see is um is lacos that's definitely the one you're going to see and um uh the since lacos is the trade name I'm actually not sure um this is an important point I had a student right in um was um is the inlex actually show polystyrene sodium or do they show lacal and I don't really know I'm going to look that up I'm it's definitely on my list of things um that we need to know but lots of you guys said lactose and that's important so you can take lactose by mouth you're going to give them diarrhea it's usually a liquid um take 15 MLS of lactose four times a day and she's going to bind to that ammonia binds it your body can absorb it and makes you poop it out gives you awful diarrhea or it can give you elao inema whatnot as well but that's about the only um the only fixes for it I could give you antibiotics but those antibiotics essentially what antibiotics too they give you diarrhea um so I could give you um primaxin as an antibiotic but it's really just giving you diarrhea and binding to it and excreting it out um because bacteria are actually in your gut what create uh create the ammonia the bacteria breaking down everything so um I know I'm over time I don't want to go too much um over today but just really quick GI pharmacology just really fast um if we have gi just some two there four big drugs classes of drugs H2 receptor blockers we have acid right GI acid acid is something we've got to you have to com you know maintain so we have gird you produce too much acid we can decrease the acid we could decrease the acid with an H2 receptor blocker which is um histamine 2 um receptor blocker which decreases acid production or we could give you a proton pump inhibitor um 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 um if you haven't seen our pharmacology endings one but this is one right here tadine you're going to so easily be able to remember tadine is the ending for H2 receptor blockers tadine renit tadine CET tadine because we're going to show a renette Teddy and a cement Teddy um inside picmonic you know these teddies are receptor H2 receptor blockers um ppis proton pump inhibitors always end in the ending prel p r a z o e and I always get some student always says well what about ail I mean those are those are antifungals right and the answer is yes but Pres with a p r a z o e are always proton pump inhibitors how do I remember well P proton pump inhibitor prol p i remember that poon pump andher omisol panto pantozol um it's not as important lots of students write in do I need to remember pantol was only given IV and meol was only given by mouth not really so much um you can give one by you know particular route those aren't the things you're going to get tested on um especially when it comes to inlex time just the fact you can identify it um two other drugs that are really important just some um important points sucral fate um or a trade named carapate which is not important you don't need to know trade names but sucral fate um is an interesting one because it coats actual ulcers so if I have an ulcer in in my stomach this gastric ulcer sucrate I take the sucrate it goes in and it's actually activated by the acid oh you got too much acid down there making making ulcers great take sucral 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 um the important point with suul 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 you can have this acidic stomach you need to take it on an empty stomach crazy people why can't you understand this sometimes I think patients just need to understand everything but uh of course I you know I don't yell at my patients but sometimes I wish I could um Zofran or on deetron onen cetron um Zofran is a really popular um u h u shoot um anti-emetic type medication definitely one we use for antasia we also use figrin or promethazine as well as an antia drug um but the big one of choice is onen cetron or zofen um of giving it the big thing with all these antia meds is um they usually work before the patient actually starts vomiting and that's just a side note to have um once they start vomiting I mean they're already vomiting so you need to overcome some more mechanisms um as well in addition um just as a side note here um picmonic all of these medications we just mentioned four but we have a p whole webinar next week I recommend you join um 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 uh for sure so I just want to just put everything together just a quick recap um a lot of everything I just said whoops uh but uh the thing is um remember what's different for each one so remember what's difference between pipic Ulcer Disease a gastric ulcer versus a duodenal or dadal ulcer know what's different um know what's different between Crohn's disease and Aller of colitis um know what's different between ostomy and 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 read reason through with your nursing thinking cap um how you need to treat it um and it's so easy Once you really think through and understand the concepts I see so many students who um struggle with that just basic concept putting it all together um and it's really just understanding from the beginning U maybe you didn't have a great understanding I don't know but we have all these topics that we mentioned today in our picmonic system so you can go through and read through all of them read the definitions and get all of the information um that you have to keep things straight so um what we have uh we have a promo code for you today um for pmic if you're not a subscriber right now you can sign up for um picmonic system and we'll give you a 20% off uh discount code to our fixed nursing subscriptions and our promo code I'm so excited for this one is poo20 P2 I love that promo code share it with your friends it's a good one um it's definitely something that should go viral in the next 15 minutes um if you have any questions right now um now is a good time to type them in the question box so we can quickly answer some of your questions um and get to those for you so that we can go over them and see in case I missed something or you didn't understand quite something um very well um so if you have any questions definitely um type those in now but if you have um if you're not a picmonic subscriber everything we went over today aside from the big concept pictures um are inside our picmonic Learning System we have over tons of different picmonics and 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 peples versus D or D no elers so easy to keep them straight um definitely something um you need to know for sure um so I'm just G to uh oh so also just really quick before I answer questions uh we have this promo code it's off our F fixed subscriptions um someone always ends up asking uh that how we how we do our subscriptions and um the big thing is um we have a annual subscription for $99.99 um that gives you access to all 750 picmonics um we have an incle study guide you can follow along and the big thing we have a mobile mobile apps um that you can download and use picmonic on the go um to always keep a on top of everything we have Pathways um so whether you're studying brain clex right now or you're in a particular course maybe you're taking pharmacology we have them all organized out for you so you can just go right in and follow along and make sure you're learning things well so let's see what we have for questions today we just have a couple so that's good um Diane asks in Crohn's why are they anemic if they're non-bloody stools so this is an interesting point um and that we mentioned well early on I just want to maybe you uh joined in late um so anytime it's just a concept that you really have to understand or just grasp not that you don't understand it now but um 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 um diarrhea and constipation but um if I had um five to six tools per day and I Crohn's disease I mean I'm moving everything I eat I'm moving it out fast I mean it's in and it's out all sort of citis even worse the fact that it's bloody doesn't matter for the anemia the fact that it's bloody what you have or the fact that it's you causes anemia which you have to think of anytime I'm increasing the motility and I'm saying I'm going to eat this giant cheeseburger and it's going to shoot out the other end very fast is the fact that um you're not able to absorb any nutrients so any patient who has a reected bow or a shortened bow or any patient who has a lot of diarrhea is not able to absorb nutrients out of all of that that sustenance that's there they're consuming and then of course excreting so any patient who um has a constant diarrhea is at a risk of a decreased absorption now specifically with crohn's disease Crohn's disease specifically targets most preferentially the terminal ilium and at the terminal ilium 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 a as an 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 um but it's definitely something you see anemia early on in the early stages of Crohn's Disease before you would see it in an early stage a very early stage of aler of colitis but that definitely doesn't mean it doesn't happen of course so jeie asks um are the picmonics just random or when you subscribe or are they by disease process so um the great thing about this um you can create anybody can create a trial account for free if you're not a subscriber but um you can go in and we organize all of the picmonics in multiple different ways you either follow along with a body system maybe we're doing GI you can follow in Along by body system we've organized them also all of the picmonics as well by course so maybe you're studying fundamentals maybe you're studying pharmacology maybe you're studying Med surge you can follow along with Med surge by med Surge and topic areas or we also have organized them by book so you can follow along with the most popular books that we have indexed and we are indexing more books every day so you can follow along with your book and see which pikem monics are rated by chapter by page as well so there are seven or 50 of them in available and definitely cover everything you need to know in nursing school uh for sure definitely help you give you um an up on your grade um so Victoria asks about a renal diet does it consist of a low pottassium and low phosphorus diet along with a low protein diet um 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 Arenal diet is the worst one um but um the definite the definite thing is you you you need to avoid things that break down the big thing is is definitely um reducing the amount of uh potassium for sure because pottassium is that electrolyte that builds up the fastest right um so it's definitely potassium um and phosphorus because phosphorus builds up as well but it's most definitely just avoiding um a lot of bland Foods um and a lot of things that don't um don't create a lot of byproducts I don't know if that's the best answer to give um but it it limits the buildup of waste products um so it's it's low salt low potassium low phosphorus and and um other pretty much all the electrolytes um but excuse me definitely not the not the best diet to be on um renal diet is if you think about the wire you on Ral diets because you can't excrete things so you don't want to have a high protein diet because you're going to create Ura 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 um and you limit um all you know all the electrolytes as well but the big thing are um fluid restriction potassium sodium phosphorus those are the biggest ones uh for sure um Jen asks um 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 um lots of um lots of love me statements no I'm kidding I always take anything free you have I shower me with gifts I love gifts any kind of gifts not gifts gifts like as in presents okay so I'm um not seeing too many other questions got a couple um that I think we addressed and that's for sure um if you have any other questions um you can definitely reach out to us Steve in the background um here at picmonic is giving me some crap because I always try to throw in showering Kindle with gifts as often as possible um not gift GIF but presents gift like um you know things worth money uh for sure because I always um mention that I you know get cents every time I show this picmonic cup which is almost empty today but um we appreciate you coming if you have any other questions you can reach out to us at picmonic um or excuse me feedback picmonic.com I think I I think I have that in here um so I can show you feedback picmonic.com um you have a question you're interested in something else that you have you 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 going to get myself or one of our other amazing team members here at picmonic and um next week we are having a pharmacology um webinar um that you can um join in it's on the 20th you can see it on picmonic.com webinars oh one question that I would so happy to answer um Heather asks when will Android app be ready and the answer is tomorrow but if you would like to use the Android app today you can email us at feedback picmonic.com and Steve will set you up with it today um but um it is coming out in the next couple of days you are welcome Heather is definitely something that a lot of people ask for but it is out um 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 um but um lots of nursing students definitely requested them um for sure um but if you have any other questions reach out to us um we're students for students is definitely something that uh we always say and it's definitely true reach out to us at feedback picmonic.com if you have any questions concerns gripes um we are here for you as always good luck studying and have a good night

Channel: PicmonicVideo

Views: 271,986

Keywords: Gastrointestinal Perforation (Disease Or Medical Condition), nursing help, nursing videos, picmonic, visual learning, audiovisual, Nursing School (Organization), Nursing (Field Of Study), nclex, ati, hesi, mnemonics, nursing student, nursing mnemonics, The Gastrointestinal System, digestive system, stomach, digestion, esophagus, liver, pancreas, biology, human digestive system, small intestine, rectum, intestine, Gastrointestinal Stromal Tumor, how does the gastrointestinal system work

Id: 2XunDu6Ga2o

Length: 91min 14sec (5474 seconds)

Published: Wed Oct 14 2015