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Elderly patient w/ Stomach cancer has been placed on feeding tube…
Elderly patient w/ Stomach cancer has been placed on feeding tube
Backround Info
Relevant anatomy
physiology
Breakdown of food:
Mouth: saliva aids in chemical breakdown of the ingested material
Teeth: participate in mastication or chewing
Pharynx: funnel shaped passageway for both food and air
oropharynx and laryngopharynx lined with stratified squamous epithelium, protecting against abrasions
Esophagus: ingested material travels through pharynx to the esophagus.
Tubular, directly anterior to vertebral bodies
Superior esophageal sphincter: contracted ring of circular skeletal muscle at the superior end of the esophagus
closed during inhalation so air does not enter the esophagus
Inferior esophageal sphincter: contracted ring of smooth muscle at inferior end of esophagus
Stomach:
food enters through the cardia
Fundus: dome shaped, lateral and superior to esophageal connection
body: largest region
pylorus: narrow, funnel shaped, opening to duodenum of small intestine called the pyloric office.
surrounding Pyloric office is the pyloric sphincter, regulates movement of material into small intestine
Internal lining called gastric folds allow for expansion
Mechanically digests the food with smooth muscle contractions, turns semi-digested bolus into chyme
Chyme is mixed with gastric secretions and moved through pyloric sphinctor into the duodenim
Small intestine: 6 meters in length,involved in absorption of nutrients and movement of chyme
Duodenum: first segment of small intestines
pancreatic duct from pancreas,and common bile duct from gallbladder, empty into
Jujunem: middle region of small intestine
Iluem: last region of small intestine,
circular folds: act as "speed bumps" to sow movement of chyme and ensure digestion of nutrients
Large intestines.. fecal matter exits through:
cecum relaxes to allow movement through the ileum into large intestine
Ascending colon
transverse colon
descending colon
rectum
anal canal
Liver: main function is production of bile. Bile contains mostly water/alkaline fluid transported to duodenum.
Gastric secretions of the stomach
Surface Mucous Cells: line stomach lumen and gastric pits
secrete alkaline product containing mucin, protects against acidity and ulcers
Mucous Neck cells: located deep to the base of gastric pit
acidic mucin, helps maintain acidic conditions resulting from parietal cells
Parietal cells: responsible for addition of intrinsic factor and HCl
Chief cells: most numerous secretory cells. produce pepsinogen and gastric lipase
G-cells: hormone producing cells in gastric glands of the stomach
Upstream
The esophagus, stomach and duodenum are bypassed by feeding tube
The patient's gallbladder removal prevents the draining of bile into duodenum
without the stomach, chemicals such as H+, Cl-, HCl, and The protein digesting enzyme pepsin will not be produced to aid in chemical breakdown
Presence of cancerous cells in the stomach may have spread to the esophagus and duodenum
Downstream
because the esophagus, stomach and duodenum are bypassed, the food will not undergo mechanical breakdown or be turned into chyme
because of this, food given through feeding tube must be chyme-like material, aka liquids.
special liquid food mixture containing protein, carbohydrates (sugar), fats, vitamins and minerals must be given
The patient will be unable to absorb enough nutrients without help of the stomach and duodenum due to lack of digestive enzymes
Patient will be at risk for:
site infection
constipation
perforation
peritonitis