GI system quiz

digests starch to maltose

- Amylase

Exam of stool for occult blood

- tumors of the large intestine grow into the lumenand are subject to repeated trauma by fecal stream -tumor ulcerates and bleeding occurs -bleeding can be slight that gross blood is not seen in stool -If occult blood is detected in stool a benign or malignant GI tumor suspected -tests include stool guaiac test, hemoccult test, hematest -Occult blood in stool may occur in ulceration and inflammation of Upper or lower GI system -Internal hemorrhoids that are bleeding -swallowing blood of oral or nasopharyngeal origin.

Upper GI ( Small Intestine)

-Duodenum contains the openings of the bile and pancreatic ducts -Jejunum is 8 ft long -Ileum feet lon -small intestine terminates into cecum

Pancreas

1. A. Exocrine gland- secretes sodium bicarbonate to neutralize the acidity of the stomach contents that enter the duodenum B. Pancreatic juices contain enzymes for digesting cars, fats and proteins. 2. Endocrine gland A. Secretes glucagon to raise blood glucose levels and secretes somatostatin to exert a hypoglycemic effect B. Islets of Langerhans secrete insulin C. Insulin is secreted into bloodstream and is important for carbohydrate metabolism.

Lower GI tract study ( barium enema) Pre-Procedure:

1. A low residue diet fo r 1-2 days before the test 2. Clear liquid diet and a laxative evening before test 3. NPO after midnight before day of test 4. Cleansing enemas on the morning of the test

Liver Bx Pre-Procedure;

1. Assess results of coagulation tests (prothrombin time, partial prothromboplastin time and platelet count. 2. Administer sedative 3. Client placed in supine or left lateral position during the procedure to expose the right side of the upper abdomen

Liver Bx Post-Procedure

1. Assess vitals 2. Assess bx site for bleeding 3. Monitor peritonitis 4. Maintain bedrest 5. Place client on right side with pillow under the costal margin to decrease the risk bleeding, and instruct the client to avoid coughing, straining. 6. No strenuous activity 1 week

Cholecystography Post- Procedure

1. Inform client that dysuria is common because contrast agent is excreted in urine 2. Normal diet may be resumed ( fatty meal may enhance excretion of contrast

Lower GI Tract study (barium enema) Post-Procedure

1. Instruct client to increase oral fluid intake to help pass barium 2. Administer mild laxative as prescribed to facilite emptying of barium 3. Monitor stools for passage of barium 4. Notify health care provider if bowel movement does not occur within 2 Days

Upper GI (barium swallow) Post-Procedure

1. laxative prescribed 2. Instruct client to increase oral fluid intake to help pass barium 3. Monitor stools for passage of barim ( stools appear chalky white) because barium can cause a bowel obstruction

Cholecystography Pre-Procedure:

1.Assess for allergies to iodine or seafood 2.Contrast agents may be administered 10-12 hours (evening before) test. 3.Client NPO after the contrast agent admin. 4.Instruct pt. to report to ER if rash, itching, hives, difficulty breathing occurs after taking contrast agent

Lower GI tract study ( barium enema)

A fluoroscopic and radiographic examination of the large intestine is perfomred after rectal instillation of barium sulfate -study may be done with or without air

Liver Bx

A needle is inserted through the abdominal wall to the liver to obtain a tissue sample for biopsy and microscopic examination

Achalasia Discuss common medications used for this condition. Discuss the process of dilatation

Also called cardiospasm Inability of a muscle to relax, particularly the cardiac sphincter of the stomach The primary manifestation is dysphagia Treatment Medications Dilatation

Assessment Gastritis

Anorexia Nausea Discomfort eating Pain Vomiting Hematemesis Melena

Chrohns management Discuss effects of malnutrition on laboratory values.

Antiinflammatory medications Corticosteroids Multivitamins Immunosuppressive therapy Dietary modification Surgery

Acute Abdominal Inflammations

Appendicitis Diverticulitis Peritonitis

Large Intestine (colon)

Approximately 5-6 feet long Larger in diameter than the small intestine Main function is the reabsorption of water

Ulcerative Colitis Nursing Interventions Discuss other appropriate nursing interventions students feel would be appropriate for these patients.

Assess elimination pattern Assess and treat pain Assess nutritional status Assess coping abilities Provide patient education Perform preoperative measures Provide postoperative care

Nursing Interventions with patient Stoma Discuss how to change stoma appliance and bag.

Assess skin integrity Assess for allergies to powders or adhesive Provide education on changing pouch Assess peristomal area for infection

Chrons assessment

Assessment Weakness Loss of appetite Abdominal cramps Pain Frequent BMs Diarrhea Fistulas

Large Intestine

absorbs wter and elimnates wastes -syntesises itamins B and K

Sigmoidoscopy ( Lower GI Endoscopy)

Endoscopy of the lower GI tract allowing visualization of inner lining of sigmoid colon and, access to obtain bx of specimens of tumors, polyps, or ulcerations of anus, rectum and sigmoid colon.

activates trypsinogen to trypsin

Enterokinase

Upper GI tract study (barium swallow)

Examination of upper gatrointestinal tract under fluoroscopy after the client drinks (barium sulfate.)

Pancreas Inform students that the role of the pancreas in digestion is an exocrine function. The role it plays in glucose regulation is an endocrine function and is not discussed here.

For digestion, the pancreas produces enzymes that aid in digestion of carbohydrates, fats, and protein Secretes sodium bicarbonate that aids in neutralizing stomach acid

Disorders of stomache

Gastritis Peptic ulcer disease Cancer of the stomach

Gastritis Ask students to name what stressors can lead to this.

Inflammation of the lining of the stomach Associated with alcoholism, smoking, and stressful physical problems Manifestations Nausea Vomiting Fever Diarrhea Headache Loss of appetite

Appendicitis

Inflammation of the vermiform appendix Usually acute Characterized by rebound tenderness in the right lower quadrant of the abdomen Patient may also experience nausea and anorexia WBC count >10,000/mm3 Emergency surgical intervention is the treatment of choice

Peptic Ulcer disease Medical management Discuss the causes of and treatments for H. pylori. Discuss an example of each type of medication category.

Insert an NG tube to monitor gastric content Antacids H2 receptor blockers Proton pump inhibitors (PPIs) Sucralfate Antibiotics for H. pylori

Acessary Organs of Digestive System

Liver Gallbladder Pancreas

Carcinoma of esophagus Ask students to list types of surgeries typically performed for this condition.

Malignant epithelial neoplasm that has invaded the esophagus Risk factors Alcohol Tobacco use Acid reflux Obesity Prevention focuses on eliminating risk factors

Mouth Specific special functions of teeth

Marks the entrance of the digestive system Contains the tongue Involved in chewing and swallowing Contain taste buds Digestion begins in the mouth The teeth, located in the mouth, are an accessory organ of the digestive system

Carcinoma of Oral Cavity

May occur on the lips, oral cavity, tongue, and pharynx Higher incidence of cancers of the mouth and throat with a history of heavy drinking, tobacco use, or exposure to HPV Clinical manifestations Leukoplakia Sore in the mouth Assessment Difficulty chewing, swallowing, or speaking Edema, numbness, or loss of feeling in any part of the mouth Earache, facial pain, and toothache Medical management varies greatly and can include surgery, radiation, and chemotherapy

Ulcerative Colitis Medical Management

Medical Management Inflammatory response modifiers Antibiotics Immune response modifiers Antidiarrheals Nutrition therapy Surgical control

Medical Management Gastritis

Medications/Antacids NG tube Gastric lavage Removal or avoidance of causative factors Nursing interventions Monitor I&O Keep NPO until symptoms subside Administer IV feedings as indicated

Cancer of the stomache Discuss types of surgeries and chemotherapy patients may undergo.

Men more commonly affected than women Rates are highest in Japan, China, Southern and Eastern Europe, and South and Central America The patient may be asymptomatic in early stages of the disease With more advanced disease, the patient may appear pale and lethargic if anemia is present

Nursing Interventions Discuss intermittent suction and why it is important to have intermittent suction, as opposed to continuous. Review Table 442 with students. Review Nursing Care Plan 44-1 with students

NG or intestinal tube placement Intermittent suction Administer medications Assess frequently Monitor vital signs

Upper GI (barium swallow) Pre-Procedure

NPO after midnight

Gastrografin Studies Interventions

NPO after midnight -Food and Fluid prevent barium from accurately outling GI tract -explain importance of rectally expelling all barium -Stools light in color -Absorption of fecal water may cause a hardened barium impaction -increase fluid intake to expell barium preventing consipation/blockage -Laxative may be given

Nursing Interventions EGD, UGI, Gastroscopy

NPO after midnight prior to test informed consent preprocedure IV sedative (midazolam) Versed) Pharynx is anesthetized by spraying with lidocaine hydrochlorixe (Xylocane) Post procedure: -No eating or drinking until gag reflex returns ( -tongue blade to back of pharynx) -Vitals and SaO2 monitored -Assess for signs of perforation including abd. pain and tenderness, -guarding, oral bleeding, melena (tarlike, fetid -smelling stool containing undigested blood, and hypovolemic shoch

Sigmoidoscopy Interventions

NPO status after midnight Informed consent Bowel prep consists of laxatives, enemas, or combination of both After exam ptr. be observed for evidence of bowel perforation, abd pain, tenderness, distention, and bleeding

Tube Gastric analyses Nursing Intervention

No anticholiergic meds for 24 hours before NPO after midnight to avoid altering rate of gastric acid secretion smoking prohibited because nicotine stimulates flow of gastric secretion Nurse or radiology personnel inserts a NG tube into stomach to aspirate gastric content. Pt. may eat or drink w/o restrictions

split nucleic acids to nucleotides

Nucleuses

Cancer of stomach interventions

Nursing Interventions Improve nutritional status Relieve anxiety Improve understanding of drainage tubes Closely monitor I&O Maintain TPN Remain alert for weight loss

nursing intervention Crohns Discuss areas where fistulas may develop. Discuss specific examples of the medications that may be used. Discuss ways these interventions can best be accomplished.

Nursing Interventions Provide nutritional education Monitor I&O closely Assess and treat pain Provide bedside commode Provide emotional support

3 Salivary glands

Parotid, submandibular, and sublingual glands which secrete saliva. Major enzyme is salivary amylase (ptylin) which initiates carbohydrate metabolism. Lysozyme, destroys bacteria and protects the mucous membrane from infections and teeth from decay..

Capsule Endoscopy

Patient swallow capsule containing camera that provides endoscopc evaluation of GI tract. -used to visualize the small intestine and diagnose diseases like Crohns, celiac and malabsorption syndrome -Helps identify sources of GI bleedin in areas not accessible by Upper endoscopy or colonscopy. -takes 10 of thousand pics thru 8 hrs capsule relays images to data recorder the patient wears on belt.

Liver Discuss the role albumin plays in the body. Discuss the significance of the liver in detoxification. Clarify students' understanding of emulsification

Produces bile, which is necessary to digest fat Manages blood coagulation Metabolizes proteins, fats, and carbohydrates Manufactures cholesterol and albumin Detoxifies poisons (alcohol, nicotine, drugs) Converts ammonia to urea

Clinical Manifestation and assessments:

Progressive dysphagia over a six-month period Assessment Dysphagia Chronic cough Vomiting Hoarseness

Gerd Nursing Interventions

Provide patient education concerning diet and medications Encourage patient to stop smoking Patient should avoid clothing that is tight over the abdomen Patient should avoid working in a bent-over position Elevate the head of the bed

Medical Management

Radiation Chemotherapy Surgery

Medical management

Surgery Dumping syndrome is a possible complication Radiation Chemotherapy

Rectum

The last 8 inches of the large intestine Where fecal material is expelled The anus is the sphincter through which feces are passed

Peptic Ulcer disease

Ulcerations of the mucous membrane or deeper structures of the GI tract Most commonly occur in the stomach and duodenum Pain is the characteristic symptom It is described as dull, burning, boring, or gnawing Pain is located in the epigastric region

Inflammatory Bowel Disease Cause is unknown. See Table 44-3 for differentiation

Ulcerative colitis Crohn's disease

Upper Gastrointestinal Series (Upper GI, UGI) Why is water important after exam? Discuss significant findings of this exam with students. Explain why water intake following exam is critical

Upper Gastrointestinal Series (Upper GI, UGI) Consists of a series of radiographs of the lower esophagus, stomach, and duodenum using barium sulfate as the contrast medium Nursing interventions Keep patient NPO prior to exam No smoking prior to exam Explain importance of ensuring all barium is expelled rectally following procedure Instruct patient to increase fluid intake following exam

Cancer of stomach assessment

Vague epigastric discomfort Early satiety Weight loss Blood in stools Vomiting after eating or drinking Anemia

Diverticulites medical management:

diet high fiber, fresh fruits and veges, decreased intake of fat and red meat recommended for prevention physical activity to decrease risk weight reduction for obese pt should avoid increased intraabdominal pressure like straining, vomiting, bending, lifting and wearing tight restrictive clothing -observe for possible peritonitis administer broad spectrum antibiotics as orderd monitor wbc count when acute attack stops oral fluid are given progressing to semisolids -bowel rest and antibiotic therapy

Gastrografin (diatrizoate meglumine and diatrizoate sodium)

is a product used instead of barium for patients who are susceptible to bleeding from the GI tract and who are being considerd for surgery -water soluble and rapidly absorbed -preferred when perforation is suspected -grstrografin facilitates imaging through radiographs -if product escapes GI tract it is absorbed by surrounding tissue -In contrast, if barium leaks from GI tract it is not absorbed and can bring on complictions

Diverticulitis why should these patients not have a colonoscopy

is the presence of pouchlike herniations through the circular smooth muscle of the colon Diverticulitis is the inflammation of one or more of the diverticular sacs Incidence increases after age 40 Inflammation can lead to perforation, abscess, peritonitis, obstruction, and hemorrhage Most common cause of lower GI hemorrhage

splits lactose into galactose and glucose

lactase

Virtual colonoscopy

less invasive CT scanning or MRI with computer software to produce images of colon and rectum bothe procedures a small tube insers throughthe anus and into rectum -CT procedure the colon is expanded by instillation of Co2 gas, to aid in visualization -MRI method a contrast medium is given to expand the colon -sedatives not required and no scope is needed -disadvantage is that it does not allow for biopsies, removal of polhyps or coagulation of velssels -Colonoscopy provides early detection of any primary or secondary tumors

peritoneum

lines the abdominal cavity and forms the mesentery that supports the intestines and blood supply

reduces maltose to monosaccharide glucose

maltase

diverticulitis clinical manifestations and assessment

mild to severe pain in LLQ of abdomen, fever and elevated WBC and erythrocyte sedimentation rate -if untreated can lead to sepsis and shock can develop -hypotensive and tachycardic -intestinal obstruction can occur causing abd. distention, nausea and vomit -constipation and diarrhea -increased flatus and chronic constipation alternating with diarrhea, anorexia, and nausea, -leukocytosis blood in stool, abdomen tenderness on papation, palpable abdoninal mass

Cholecystography

performed to detect gallstones and to assess ability of the gallbladder to fill, concentrate its contents, contract, and empty

Upper GI (Mouth)

salivca contains amylase enzyme (ptyalin) aids in digestion

Tube Gastric analysis

stomache contents are aspirated to determine the amount of acid produced by parietal cells in stomach. The analysis helps determine the completeness of a bagotomy, confirm hypersecretion or achlorhydria( an abnormal condition characterized by absence of hydrochloric acid in the gastric juice) estimate acid secretory capacity, or test for intrinsic factor.

Barium sulfate

works by coating the inside of esophagus, stomach, or intestines which allows them to be seen more clearly on a CT scan or other radiologic exams Xray.

Esophagogastroduodenoscopy (EGD, UGI endoscopy, Gastroscopy)

-Endoscopy enables direct visualization of a particular hollow organ or cavity with fiberoptic scope. -Visualizes esophagus, stomach, and duodenum for routine screening as swell as for examination of tumors, varices (abnormally enlarged veins), mucosal inflammation, hiatal hernias, polyps, ulcers, helicobacter pylori, strictures (narrowings) and obstructions. -It can also remove polyps, coagulate sources of active GI bleeding, perform sclerotherapy (injection of a solution into vein causing it to shrink and disappear of esophageal varices. -Areas of narrowing can be dilated. -Camera equipment can be attached to photograph a pathologic condition Biopsys for H. Pylori

Stool Specimen Interventions

-Enema , only normal saline or tapwater is used -Soapsuds or any other substanc can alter affect if viability or organism -stoll sample for O&P obtained before barium exams. -urine can not be mixed with feces sample -wear glove and take sample to laboratory within 30 min

Colonoscopy Interventions

-Informed consent -Dietary restriction include clear liquid diet for 1-3 days before to decrease the residue in bowel -NPO for 8 hours -Laxatives or enemas and premedications (stool softener are ordered to cleanse the bowel Postprocedure: -Montor for evidence of bowel perforation ( abd. pain, guarding, distention, tenderness, excess rectal bleeding or blood clots and stools should be examined for gross blood -Pt. should be monitored for hypovolemic shock

Nursing Intervention Occult blood Stool

-Keep stool free of urine or toilet paper -Gloves and tongue blades are appropriate for specimen collection to transfer stool to proper recetacle -No organ meat for 24 to 48 hours before guaiac test -Specimen slide and developer are used by the nurse to test stool for occult blood -3 consecutive stools collected

Liver

-Largest gland in body, weighs 3-8 lbs -removes excess glucose and amino acids from the portal blood -synthesizes glucose, amino acids, and fats -aids in digestion of fats, cars, and proteins -receives blood supplyu from the hepatic artery and portal vein 1500 mL of blood flows through the liver every minute -stores vitamins A, B, D and Iron -Secretes bile to emulsify fats (500-1000 mL day)

Esophageal Function Studies (Bernstein Test) Interventions

-NPO for 8 hrs and any meds that interfere with production of acid (antacids and analgesic) witheld -NG tuve inserted and mild hydrochloric acid is instilled followed by saline -Pt. will be asked if he feels any pain or discomfort is felt during instillation of hydrochloric acid

Upper GI ( Stomach )

-The lower esophageal (cardiac) sphincter prevents reflux of gastric contents into the esophagus -cardiac sphincter regulates rate of stomach emptying into small intestine -Hydrochloric acid kills bacteria, breaks food into small particles, and provides a chemical environment that facilitates gastric enzyme activation -Pepsin is chief coenzyme of gastric juis whic converts proteins into proteases and peptones.

Upper GI (Esophagus)

-a collapsible muscular tube about inches long carries frood from pharynx to the stomach

Esophageal Function Studies (Bernstein Test)

-acid perfusion test is attempt to reproduce symptoms of Gastroesophageal reflux -Helps differentiate esophageal pain caused by esophageal reflux from that caused by angina pectoris -If patient suffers pain with instillation of hydrochloric acid into esophagus, test is positive which indicate Reflux Esophagitis

Hepatic ducts

-deliver bile to gallbladder via cystic duct and to the duodenum bia common bile duct -common bile duct opens into the duodenum with the pancreatic duct at the ampulla of Vater -Sphincter prevents reflux of intestinal contents into common bile duct and pancreatic duct

Colonoscopy

-examination of entire colon from anus to cecum detects lesions in proximal colon -benign and malignant neoplams, mucosal inflammation or ulceration and sites of active hemorrhage can also be seen -Bx obtained and small tumors removed through the scope -Actively bleeding vessels can be coagulated

Obstruction Series ( Flat plate of the abdomen)

-group of radiographic studies performed on abdomen of pt.s who have suspected bowel obstruction, paralytic ileus, perforated viscus ( a viscus is any large interior organ in any of the great body cavities, or abdominal abscesses. -series consists of two radio graphic studies -first is an erect abd. radio graphic stud allowing visualization of diaphragm -radio graphs examined for evidence of free air under diaphragm, which is pathognomonic( signs or symptoms specific to a disease condition) of perforated viscus (hollow organ) -radio graphic study used to detect air fluid levels within the intestine as well Interventions: make sure study is scheduled before any barium studies

Large intestine ( Colon )

-includes the ascending, transverse, descending, sigmoid, and rectum -ileocecal valve prevent contents of large intestine from entering the ileum -Anal sphincters control/guard the anal canal

Appendicitis

-inflammation of the vermiform appendix acute can lead to rapid perforation and peritonitis -common causes are obstruction of the lumen by fecalith (accumulated feces), foreign bodies and tumor of the cecum or appendix. -if obstructed and inflamed pathogenic bacteria E. Coli begin to mulitply in appendix causing infection/pus -Distention and infection severe appendix may rupture releasing contents into abdomen Assessment: pain in RLQ abd. Mcburneys point ( halfway between the umbilicus and the crest of the right ileum. nausea, anorexia, FEVER, elevated WBC, rebound tenderness, rigid abdomen, decreased or absent bowel sounds Management: -Emergency surgical intervention is treatment of choice for acute appendicits -Antibiotic therapy is givwen when perforation is likely -complication include: infection, intrabdominl abscess, mechanical small bowel obstruction Interventions: -explain diagnostic tests and surgical procedures -relieving anxiety -bed rest -NPO status -pain relief -replace fluid and electrolytes -vitals monitored every hour because of threat o perforation with pertonititis -Opiods can mask symptoms of acute appendicitis -ic bag to relieve pain can be given no heat ( increases circulation to appendix and could lead to rupture -cleansing enema is not ordered because danger of rupture

Gallbladder

-stores and concentrates bile and contracts to force bile into duodenum during digestion of fats -cystic duct joins the hepatic duct to form common bile duct -sphincter of Oddi is located at entrance into duodenum

Disorders of Esophagus Gastroesophageal Reflux Disease (GERD)

Backward flow of stomach acid up into the esophagus Symptoms typically include Burning and pressure behind the sternum Described by patients as heartburn Dry cough Hoarseness Sore throat

DX test diverticulitis

CT with oral contrast CBC urinalysis fecal occult blood test barium enema to determine narrowing or obstruction of colonic lumen colonscopy to rule out polyps or malignancy -pt with acute diverticulitis should not have barium enema or colonscopy because of the possibility of perforation and peritonits

Chrohns Disease Display pictures of a bowel section affected by Crohn's disease.

Characterized by inflammation of segments of the GI tract Cause is not known Possible immune link Most commonly occurs during adolescence and early adulthood Mucosa develops a cobblestone appearance Malabsorption is a major issue

Crohns disease clinical manifestation

Clinical Manifestations Diarrhea Fatigue Abdominal pain Weight loss Fever Malnutrition

Ulcerative Colitis Assessment

Complaints of rectal bleeding and abdominal cramps Lethargy Frustration Weight loss Fever Tachycardia

Gallbladder Discuss the importance of the gallbladder to digestion.

Connected to the underside of the liver Stores bile Ejects bile into the duodenum to aid in digestion

digestive system List organs that aid in digestion

Consists of the digestive tract A muscular tube that extends from the mouth to the anus Consists of the mouth, pharynx, esophagus, stomach, small intestine, large intestine, and anus Accessory organs aid in digestion

Ulcerative Colitis Clinical Manifestations Discuss electrolyte loss with diarrhea. Discuss megacolon

Diarrhea that may contain blood, mucus, and pus Abdominal cramps Moderate, up to five stools per day Severe, 15-20 stools per day Diagnosed with double barium enema

Small Intestine Discuss how villi serve to aid in digestion

Digestion of protein begins in the stomach The stomach breaks the food down into chyme Chyme passes through the pyloric sphincter into the duodenum for the next phase of digestion

Stomache Discuss the effects diabetes mellitus can have on the stomach. Discuss with students how the stomach works to prevent reflux.

Digestion of protein begins in the stomach The stomach breaks the food down into chyme Chyme passes through the pyloric sphincter into the duodenum for the next phase of digestion

Barium swallow and Gastrografin Studies

barium swalloiw study allows a clear view of esophagus than that provided by most UGI exams -defects in luminal filling and narrowing of the barium column indicate tumor, scarred stricture, or esophageal varices. -allows easy recognition of swallowing difficulties resulting from conditions like: Cerebrovascular accidents (stroke or brain attack) anatomical abnormalities (hiatal hernia) -Cancer of esophagus -GERD -ulcers -muscle disorders

Diverticulitis/osis

diverticulosis is presence of pouchlike herniations through the circular smooth muscle of colon (sigmoid) diverticulitis is inflammation of one or more of the diverticular sacs (most common cause of lower GI hemorrhage) -causes: aging leads to decreased strength and elasticity of colon lack of fiber in diet and increase in refined carbs causing high pressure in lumen of colon lack of exercise, obesity and smoking -penetration of fecal matter through the thin walled diverticula causes inflammation and abscess formation in tissues surrounding colon -repeated inflammation leads to the lumen of colon narrowing and beoming obstructed. -when diverticla inflamed diverticulitis results causing complication of divericulosis -inflammation can lead to perforation, abscess, peritonits, obstruction and hemorrhage

Stool culture

feces can be examined for presence of bacteria, ova, and parasites. -(O&P) -Bacteria like E. Coli are indigenous in bowel -Bacterial cultures are done to detect enteropathoges like Staphylococcus aureus, Salmonella or Shigella organisms, E. coli 0157.H7, or CDiff -3 stool is examined consecutively -culture results are not available for sev. days

Perotinitis -inflammation of the peritoneum, typically caused by bacterial infection either via the blood or after rupture of an abdominal organ.

guarding of the abdomen Increased fever and chills pallor progressive abdominal distention and abdominal pain restlessness tachycardia, tachypnea