{"id":347,"date":"2021-12-11T20:35:51","date_gmt":"2021-12-12T01:35:51","guid":{"rendered":"https:\/\/opentextbc.ca\/nursingpharmacology\/chapter\/7-3-conditions-and-diseases\/"},"modified":"2023-07-18T14:18:40","modified_gmt":"2023-07-18T18:18:40","slug":"7-3-conditions-and-diseases","status":"publish","type":"chapter","link":"https:\/\/opentextbc.ca\/nursingpharmacology\/chapter\/7-3-conditions-and-diseases\/","title":{"raw":"7.3 Conditions and Diseases of the Gastrointestinal System","rendered":"7.3 Conditions and Diseases of the Gastrointestinal System"},"content":{"raw":"In this section, we will review common conditions and diseases related to the gastrointestinal system and elimination including hyperacidity, diarrhea, constipation, nausea, and vomiting.\r\n<h1>Hyperacidity and Ulcers<\/h1>\r\nAcid-related diseases can occur when there is an imbalance of secretions by the surface epithelium cells in the stomach.\r\n\r\nThe most common mild to moderate hyperacidic condition is <strong>[pb_glossary id=\"646\"]gastroesophageal reflux disease (GERD)[\/pb_glossary]<\/strong>, often referred to by clients as heartburn, indigestion, or sour stomach. GERD is caused by excessive hydrochloric acid that tends to back up, or reflux, into the lower esophagus. See Figure 7.3a for an illustration of GERD.[footnote]\"<a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:GERD.png\" rel=\"noopener noreferrer\">GERD.png<\/a>\" by <a href=\"https:\/\/commons.wikimedia.org\/wiki\/User:BruceBlaus\" rel=\"noopener noreferrer\">BruceBlaus<\/a> is licensed under<a class=\"internal\" href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/\" rel=\"noopener noreferrer\"> CC BY-SA 4.0<\/a>[\/footnote]<a id=\"7.3a\"><\/a>\r\n\r\n[caption id=\"\" align=\"aligncenter\" width=\"504\"]<img class=\"\" title=\"&quot;GERD.png&quot; by BruceBlaus is licensed under CC BY-SA 4.0\" src=\"https:\/\/opentextbc.ca\/accessibilitytoolkit\/wp-content\/uploads\/sites\/397\/2021\/12\/image3-2.png\" alt=\"Illustration showing gastroesphageal reflux disease \" width=\"504\" height=\"605\" \/> Figure 7.3a Illustration of GERD <a href=\"#7.3a_desc\">[<em>Image Description<\/em>]<\/a>[\/caption]<strong>[pb_glossary id=\"647\"]Peptic ulcer disease (PUD)[\/pb_glossary]<\/strong> occurs when gastric or duodenal ulcers are caused by the breakdown of GI mucosa by pepsin, in combination with the caustic effects of hydrochloric acid. PUD is the most harmful disease related to hyperacidity because it can result in bleeding ulcers, a life-threatening condition.\r\n\r\n<strong>[pb_glossary id=\"648\"]Stress-related mucosal damage [\/pb_glossary]<\/strong> is another common condition that can occur in hospitalized clients leading to PUD. Thus, many post-operative or critically ill clients receive medication to prevent the formation of a stress ulcer, which is also called\u00a0[pb_glossary id=\"735\"]<strong>stress ulcer prophylaxis<\/strong>[\/pb_glossary].[footnote]Lilley, L., Collins, S., &amp; Snyder, J. (2014). <em>Pharmacology and the Nursing Process<\/em>. pp. 782-862. Elsevier.[\/footnote] See an image of a duodenal ulcer in Figure 7.3b.[footnote]\"\"<a class=\"internal\" href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/\" rel=\"noopener noreferrer\">Duodenal ulcer01.jpg<\/a>\" by <a href=\"https:\/\/commons.wikimedia.org\/wiki\/User:%E3%83%A1%E3%83%AB%E3%83%93%E3%83%AB\" rel=\"noopener noreferrer\">melvil<\/a> is licensed under <a class=\"internal\" href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/\" rel=\"noopener noreferrer\">CC BY-SA 4.0<\/a>[\/footnote]\r\n\r\n[caption id=\"\" align=\"aligncenter\" width=\"360\"]<img title=\"&quot;Duodenal ulcer01.jpg&quot; by melvil is licensed under CC BY-SA 4.0\" src=\"https:\/\/opentextbc.ca\/accessibilitytoolkit\/wp-content\/uploads\/sites\/397\/2022\/05\/image4.png\" alt=\"Photo of peptic ulcer disease\" width=\"360\" height=\"266\" \/> Figure 7.3b Image of a duodenal ulcer[\/caption]\r\n\r\n<span style=\"text-align: initial; font-size: 1em;\">Here are some additional links to supplementary videos illustrating heartburn and gastric ulcers: <\/span>\r\n<ul>\r\n \t<li><a class=\"arrow\" href=\"https:\/\/medlineplus.gov\/ency\/anatomyvideos\/000068.htm\" rel=\"noopener noreferrer\">Heartburn<\/a>[footnote]MedlinePlus. Bethesda (MD): National Library of Medicine (US); [updated 2019 October 23]. Heartburn; [updated 2019 October 2; cited 2019 October 27] <a href=\"https:\/\/medlineplus.gov\/ency\/anatomyvideos\/000068.htm\" rel=\"noopener noreferrer\">https:\/\/medlineplus.gov\/ency\/anatomyvideos\/000068.htm<\/a>[\/footnote]<\/li>\r\n \t<li><a class=\"arrow\" href=\"https:\/\/blausen.com\/en\/video\/gastric-ulcers\/\" rel=\"noopener noreferrer\">Gastric ulcer<\/a>[footnote]Blausen Medical. (2015, November 17). <em>Gastric Ulcers<\/em> [Video].<a href=\"https:\/\/blausen.com\/en\/video\/gastric-ulcers\/\" rel=\"noopener noreferrer\">https:\/\/blausen.com\/en\/video\/gastric-ulcers\/#<\/a>[\/footnote]<\/li>\r\n<\/ul>\r\n<h2>Diarrhea<\/h2>\r\nDiarrhea itself is not a disease but is a sign and symptom of other conditions and disease processes in the body.\r\n\r\n<strong>[pb_glossary id=\"653\"]Diarrhea[\/pb_glossary]<\/strong> is defined as the passage of three or more loose or liquid stools per day (or more frequent passage than is normal for the individual). Frequent passing of formed stools is not considered diarrhea. Diarrhea has multiple causes such as bacteria from contaminated food or water; viruses such as influenza, norovirus, or rotavirus; parasites found in contaminated food or water; medicines such as antibiotics, cancer drugs, and antacids that contain magnesium; food intolerances and sensitivities; and diseases that affect the colon, such as Crohn's disease or irritable bowel syndrome.[footnote]A.D.A.M. Medical Encyclopedia [Internet]. Atlanta (GA): A.D.A.M., Inc.; \u00a92019. Heartburn; [reviewed 2019 May 10; cited 2019 October 27]. <a href=\"https:\/\/medlineplus.gov\/ency\/anatomyvideos\/000068.htm\" rel=\"noopener noreferrer\">https:\/\/medlineplus.gov\/ency\/anatomyvideos\/000068.htm<\/a>[\/footnote]\r\n\r\nThe most severe threat posed by diarrhea is dehydration caused by the loss of water and electrolytes. Diarrheal disease is a leading cause of child mortality and morbidity throughout the world due to dehydration; frail elderly are also at risk. When severe diarrhea occurs, assessment for dehydration and electrolyte imbalances receive top priority and rehydration with oral rehydration solutions or IV fluids may be required.[footnote]World Health Organization. (2017, May 2). <em>Diarrhoeal disease.<\/em><a href=\"https:\/\/www.who.int\/en\/news-room\/fact-sheets\/detail\/diarrhoeal-disease\" rel=\"noopener noreferrer\">https:\/\/www.who.int\/en\/news-room\/fact-sheets\/detail\/diarrhoeal-disease<\/a>.[\/footnote]\r\n<h2 style=\"text-align: left;\">Constipation<\/h2>\r\n[pb_glossary id=\"830\"]<strong>Constipation<\/strong>[\/pb_glossary] is defined as \"three or fewer bowel movements in a week; stools that are hard, dry or lumpy; stools that are difficult or painful to pass; or the feeling that not all stool has passed.\"[footnote]National Institute of Diabetes and Digestive and Kidney Diseases, National Institute of Health. (2018). <em>Symptoms and causes of constipation.<\/em><a href=\"https:\/\/www.niddk.nih.gov\/health-information\/digestive-diseases\/constipation\/symptoms-causes\" rel=\"noopener noreferrer\">https:\/\/www.niddk.nih.gov\/health-information\/digestive-diseases\/constipation\/symptoms-causes<\/a>[\/footnote] If defecation is delayed for an extended time, additional water is absorbed, thus making the feces firmer and potentially leading to constipation. There are several causes of constipation, such as lack of proper fluids or fiber in the diet, lack of ambulation, various disease processes, recovery from surgical anesthesia and opiates, and side effects of many medications. A list of these potential causes can be found in Table 7.3a.[footnote]National Institute of Diabetes and Digestive and Kidney Diseases, National Institute of Health. (2018). <em>Symptoms and causes of constipation.<\/em><a href=\"https:\/\/www.niddk.nih.gov\/health-information\/digestive-diseases\/constipation\/symptoms-causes\" rel=\"noopener noreferrer\">https:\/\/www.niddk.nih.gov\/health-information\/digestive-diseases\/constipation\/symptoms-causes<\/a>[\/footnote] Because there are several potential causes of constipation, treatment should always be individualized to the client. Many times, constipation can be treated with simple changes in diet, exercise, or routine. However, when medications are also needed to resolve constipation, there are several categories of laxative medications that work in different ways. Classes of laxative medications are described below.\r\n<table class=\"alignleft\" style=\"border-collapse: collapse; width: 100%;\" border=\"0\"><caption>Table 7.3a Common Causes of Constipation<\/caption>\r\n<tbody>\r\n<tr style=\"height: 18px;\">\r\n<th style=\"width: 14.3707%;\" scope=\"col\">Cause<\/th>\r\n<th style=\"width: 85.5302%;\" scope=\"col\">Examples<\/th>\r\n<\/tr>\r\n<tr style=\"height: 270px;\">\r\n<th style=\"width: 14.3707%;\" scope=\"row\">Medications<\/th>\r\n<td style=\"width: 85.5302%;\">\r\n<ul>\r\n \t<li>Antacids that contain aluminum and calcium<\/li>\r\n \t<li>Anticholinergics and antispasmodics<\/li>\r\n \t<li>Anticonvulsants\u2014used to prevent seizures<\/li>\r\n \t<li>Calcium channel blockers<\/li>\r\n \t<li>Diuretics<\/li>\r\n \t<li>Iron supplements<\/li>\r\n \t<li>Medicines used to treat Parkinson's disease<\/li>\r\n \t<li>Narcotic pain medicines<\/li>\r\n \t<li>Some medicines used to treat depression<\/li>\r\n<\/ul>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"height: 297px;\">\r\n<th style=\"width: 14.3707%;\" scope=\"row\">Health and Nutrition Problems<\/th>\r\n<td style=\"width: 85.5302%;\">\r\n<ul>\r\n \t<li>Not eating enough fiber<\/li>\r\n \t<li>Not drinking enough liquids or dehydration<\/li>\r\n \t<li>Not getting enough physical activity<\/li>\r\n \t<li>Celiac disease<\/li>\r\n \t<li>Disorders that affect the brain and spine, such as Parkinson's disease<\/li>\r\n \t<li>Spinal cord or brain injuries<\/li>\r\n \t<li>Diabetes<\/li>\r\n \t<li>Hypothyroidism<\/li>\r\n \t<li>Inflammation linked to diverticular disease or proctitis<\/li>\r\n \t<li>Intestinal obstructions, including anorectal blockage and tumors<\/li>\r\n<\/ul>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"height: 189px;\">\r\n<th style=\"width: 14.3707%;\" scope=\"row\">Daily Routine Changes<\/th>\r\n<td style=\"width: 85.5302%;\">\r\n<ul>\r\n \t<li>Pregnancy<\/li>\r\n \t<li>Aging<\/li>\r\n \t<li>Traveling<\/li>\r\n \t<li>Ignoring the urge to have a bowel movement<\/li>\r\n \t<li>Medication changes<\/li>\r\n \t<li>Change in diet<\/li>\r\n<\/ul>\r\n<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n&nbsp;\r\n<h2>Nausea and Vomiting<\/h2>\r\nSimilar to diarrhea and constipation, nausea and vomiting are common conditions that are most often signs and symptoms of other conditions or side effects of medication.\r\n\r\nNausea is the unpleasant sensation of having the urge to vomit, and vomiting (emesis) is the forceful expulsion of gastric contents.[footnote]Bashashati, M. &amp; McCallum, R. (2014). Neurochemical mechanisms and pharmacologic strategies in managing nausea and vomiting related to cyclic vomiting syndrome and other gastrointestinal disorders. <em>European Journal of Pharmacology, 772<\/em>, p 79.[\/footnote]\r\n\r\nThe vomiting center can be activated directly by irritants or indirectly following input from four principal areas: gastrointestinal tract, cerebral cortex and thalamus, vestibular region, and chemoreceptor trigger zone (CRTZ). See Figure 7.3c for an illustration of the pathophysiology of nausea and vomiting.[footnote]Becker D. E. (2010). Nausea, vomiting, and hiccups: a review of mechanisms and treatment. Anesthesia progress, 57(4), 150\u2013157. doi:10.2344\/0003-3006-57.4.150[\/footnote]<a id=\"7.3c\"><\/a>\r\n\r\n[caption id=\"\" align=\"aligncenter\" width=\"407\"]<img title=\"Becker D. E. (2010). Nausea, vomiting, and hiccups: a review of mechanisms and treatment. Anesthesia progress, 57(4), 150\u2013157. doi:10.2344\/0003-3006-57.4.150\" src=\"https:\/\/opentextbc.ca\/accessibilitytoolkit\/wp-content\/uploads\/sites\/397\/2022\/05\/image1-2.png\" alt=\"Chart showing pathophysiology of nausea and vomiting\" width=\"407\" height=\"332\" \/> Figure 7.3c Pathophysiology of nausea and vomiting <a href=\"#7.3c_desc\">[<em>Image Description<\/em>]<\/a>[\/caption]An important part of the emesis circuit is the <strong>[pb_glossary id=\"656\"]chemoreceptor trigger zone (CTZ)[\/pb_glossary]<\/strong>, located in the <strong>[pb_glossary id=\"728\"]area postrema[\/pb_glossary] <\/strong>in the brain. The CTZ is not restricted by the blood\u2013brain barrier, which allows it to respond directly to toxins in the bloodstream such as anesthesia and opioids. The CTZ also receives stimuli from several other locations in the body including the vestibular center; visceral organs such as the GI tract, kidneys, and liver; the thalamus; and the cerebral cortex.\r\n\r\nThe vestibular center and cerebral cortex can stimulate the vomiting center directly or indirectly through the CTZ. The <strong>[pb_glossary id=\"657\"]vestibular system [\/pb_glossary]<\/strong> is located within the inner ear and gives a sense of balance and spatial orientation for the purpose of coordinating movement with balance. The feeling of nausea associated with motion sickness often arises from stimuli from the vestibular center. The gastrointestinal tract sends stimuli to the CTZ via cranial nerves IX and X related to obstruction, distension, inflammation, and infection. The cerebral cortex and other parts of the brain can also stimulate a sense of nausea related to odors, tastes, and images and send these stimuli to the CTZ. The CTZ forwards these signals to the vomiting center in the brain. Pain can also directly stimulate the vomiting center.\r\n\r\nThe <strong>[pb_glossary id=\"658\"] vomiting center[\/pb_glossary]<\/strong> (VC) is located in the medulla in the brain. In response to these stimuli, the vomiting center initiates vomiting by inhibiting peristalsis and producing retro-peristaltic contractions beginning in the small bowel and ascending into the stomach. It also produces simultaneous contractions in the abdominal muscles and diaphragm that generate high pressures to propel the stomach contents upwards. Additionally, autonomic stimulation of the heart, airways, salivary glands, and skin cause other symptoms associated with vomiting such as salivation, palor, sweating, and tachycardia. Several neurotransmitters are involved in the nausea and vomiting process, and antiemetic medications are targeted to specific neuroreceptors.[footnote]Becker D. E. (2010). Nausea, vomiting, and hiccups: a review of mechanisms and treatment. <em>Anesthesia progress, 57<\/em>(4), 150\u2013157. <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3006663\/\" rel=\"noopener noreferrer\">https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3006663\/<\/a>[\/footnote]\r\n\r\nThere are many potential causes of nausea and vomiting, such as:\r\n<ul>\r\n \t<li>Morning sickness during pregnancy<\/li>\r\n \t<li><strong>[pb_glossary id=\"727\"]Gastroenteritis[\/pb_glossary] <\/strong>and other infections<\/li>\r\n \t<li>Migraines<\/li>\r\n \t<li>Motion sickness<\/li>\r\n \t<li>Food poisoning<\/li>\r\n \t<li>Side effects of medicines, including those for cancer chemotherapy<\/li>\r\n \t<li>GERD\u00a0and ulcers<\/li>\r\n \t<li>Intestinal obstruction<\/li>\r\n \t<li>Poisoning or exposure to a toxic substance<\/li>\r\n \t<li>Diseases of other organs (cardiac, renal, or liver)<\/li>\r\n<\/ul>\r\nA health care provider should be contacted immediately if the following conditions occur:\r\n<ul>\r\n \t<li>Vomiting for longer than 24 hours<\/li>\r\n \t<li>Blood in the vomit (also called <strong>[pb_glossary id=\"659\"]hematemesis[\/pb_glossary]<\/strong>)<\/li>\r\n \t<li>Severe abdominal pain<\/li>\r\n \t<li>Severe headache and stiff neck<\/li>\r\n \t<li>Signs of dehydration, such as dry mouth, infrequent urination, or dark urine<\/li>\r\n<\/ul>\r\n<h1>Image Descriptions<\/h1>\r\n<strong><a id=\"7.3a_desc\"><\/a>Figure 7.3a image description:<\/strong> Illustration of GERD.\r\n<p class=\"p1\">The stomach is located in the upper left quadrant of the abdomen and the esophagus comes down from the throat to the stomach.<\/p>\r\n<p class=\"p1\">When it is normal, the lower oesophageal sphincter, which is between the esophagus and stomach, is closed. Stomach acid and stomach contents sit in the stomach.<\/p>\r\n<p class=\"p1\">When a person has GERD, the lower esophageal sphincter is open. This allows a back flow of acid and stomach contents into the esophagus, which causes heartburn. <a href=\"#7.3a\">[Return to figure 7.3a]<\/a><\/p>\r\n&nbsp;\r\n\r\n<strong><a id=\"7.3c_desc\"><\/a>Figure 7.3c image description:<\/strong> The pathophysiology of nausea and vomiting.\r\n<p class=\"p1\">The Vomiting Center sits in the centre. The receptors illustrated in the vomiting center are:<\/p>\r\n\r\n<ul>\r\n \t<li class=\"p1\">H<sub>1<\/sub> histamine<\/li>\r\n \t<li class=\"p1\">M<sub>1<\/sub> acetylcholine<\/li>\r\n \t<li class=\"p1\">NK<sub>1<\/sub> (neurokinin), and 5-HT3 serotonin.<\/li>\r\n<\/ul>\r\n<p class=\"p1\">Four principal areas can activate the vomiting center:<\/p>\r\n\r\n<ul>\r\n \t<li class=\"p1\">GI Tract (5-HT<sub>3<\/sub> serotonin)<\/li>\r\n \t<li class=\"p1\">Cortex Thalamus (Anxiety, Pain)<\/li>\r\n \t<li class=\"p1\">Vestibular (H<sub>1<\/sub>\u00a0histamine, M<sub>1<\/sub>\u00a0acetylcholine)<\/li>\r\n \t<li class=\"p1\">Chemoreceptor trigger zone (mu\/kappa opioids, DA<sub>2<\/sub>\u00a0dopamine, and NK<sub>1<\/sub> (neurokinin)) <a href=\"#7.3c\">[Return to figure 7.3c]<\/a><\/li>\r\n<\/ul>","rendered":"<p>In this section, we will review common conditions and diseases related to the gastrointestinal system and elimination including hyperacidity, diarrhea, constipation, nausea, and vomiting.<\/p>\n<h1>Hyperacidity and Ulcers<\/h1>\n<p>Acid-related diseases can occur when there is an imbalance of secretions by the surface epithelium cells in the stomach.<\/p>\n<p>The most common mild to moderate hyperacidic condition is <strong><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_347_646\">gastroesophageal reflux disease (GERD)<\/a><\/strong>, often referred to by clients as heartburn, indigestion, or sour stomach. GERD is caused by excessive hydrochloric acid that tends to back up, or reflux, into the lower esophagus. See Figure 7.3a for an illustration of GERD.<a class=\"footnote\" title=\"&quot;GERD.png&quot; by BruceBlaus is licensed under CC BY-SA 4.0\" id=\"return-footnote-347-1\" href=\"#footnote-347-1\" aria-label=\"Footnote 1\"><sup class=\"footnote\">[1]<\/sup><\/a><a id=\"7.3a\"><\/a><\/p>\n<figure style=\"width: 504px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" class=\"\" title=\"&quot;GERD.png&quot; by BruceBlaus is licensed under CC BY-SA 4.0\" src=\"https:\/\/opentextbc.ca\/accessibilitytoolkit\/wp-content\/uploads\/sites\/397\/2021\/12\/image3-2.png\" alt=\"Illustration showing gastroesphageal reflux disease\" width=\"504\" height=\"605\" \/><figcaption class=\"wp-caption-text\">Figure 7.3a Illustration of GERD <a href=\"#7.3a_desc\">[<em>Image Description<\/em>]<\/a><\/figcaption><\/figure>\n<p><strong><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_347_647\">Peptic ulcer disease (PUD)<\/a><\/strong> occurs when gastric or duodenal ulcers are caused by the breakdown of GI mucosa by pepsin, in combination with the caustic effects of hydrochloric acid. PUD is the most harmful disease related to hyperacidity because it can result in bleeding ulcers, a life-threatening condition.<\/p>\n<p><strong><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_347_648\">Stress-related mucosal damage <\/a><\/strong> is another common condition that can occur in hospitalized clients leading to PUD. Thus, many post-operative or critically ill clients receive medication to prevent the formation of a stress ulcer, which is also called\u00a0<a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_347_735\"><strong>stress ulcer prophylaxis<\/strong><\/a>.<a class=\"footnote\" title=\"Lilley, L., Collins, S., &amp; Snyder, J. (2014). Pharmacology and the Nursing Process. pp. 782-862. Elsevier.\" id=\"return-footnote-347-2\" href=\"#footnote-347-2\" aria-label=\"Footnote 2\"><sup class=\"footnote\">[2]<\/sup><\/a> See an image of a duodenal ulcer in Figure 7.3b.<a class=\"footnote\" title=\"&quot;&quot;Duodenal ulcer01.jpg&quot; by melvil is licensed under CC BY-SA 4.0\" id=\"return-footnote-347-3\" href=\"#footnote-347-3\" aria-label=\"Footnote 3\"><sup class=\"footnote\">[3]<\/sup><\/a><\/p>\n<figure style=\"width: 360px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" title=\"&quot;Duodenal ulcer01.jpg&quot; by melvil is licensed under CC BY-SA 4.0\" src=\"https:\/\/opentextbc.ca\/accessibilitytoolkit\/wp-content\/uploads\/sites\/397\/2022\/05\/image4.png\" alt=\"Photo of peptic ulcer disease\" width=\"360\" height=\"266\" \/><figcaption class=\"wp-caption-text\">Figure 7.3b Image of a duodenal ulcer<\/figcaption><\/figure>\n<p><span style=\"text-align: initial; font-size: 1em;\">Here are some additional links to supplementary videos illustrating heartburn and gastric ulcers: <\/span><\/p>\n<ul>\n<li><a class=\"arrow\" href=\"https:\/\/medlineplus.gov\/ency\/anatomyvideos\/000068.htm\" rel=\"noopener noreferrer\">Heartburn<\/a><a class=\"footnote\" title=\"MedlinePlus. Bethesda (MD): National Library of Medicine (US); [updated 2019 October 23]. Heartburn; [updated 2019 October 2; cited 2019 October 27] https:\/\/medlineplus.gov\/ency\/anatomyvideos\/000068.htm\" id=\"return-footnote-347-4\" href=\"#footnote-347-4\" aria-label=\"Footnote 4\"><sup class=\"footnote\">[4]<\/sup><\/a><\/li>\n<li><a class=\"arrow\" href=\"https:\/\/blausen.com\/en\/video\/gastric-ulcers\/\" rel=\"noopener noreferrer\">Gastric ulcer<\/a><a class=\"footnote\" title=\"Blausen Medical. (2015, November 17). Gastric Ulcers [Video].https:\/\/blausen.com\/en\/video\/gastric-ulcers\/#\" id=\"return-footnote-347-5\" href=\"#footnote-347-5\" aria-label=\"Footnote 5\"><sup class=\"footnote\">[5]<\/sup><\/a><\/li>\n<\/ul>\n<h2>Diarrhea<\/h2>\n<p>Diarrhea itself is not a disease but is a sign and symptom of other conditions and disease processes in the body.<\/p>\n<p><strong><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_347_653\">Diarrhea<\/a><\/strong> is defined as the passage of three or more loose or liquid stools per day (or more frequent passage than is normal for the individual). Frequent passing of formed stools is not considered diarrhea. Diarrhea has multiple causes such as bacteria from contaminated food or water; viruses such as influenza, norovirus, or rotavirus; parasites found in contaminated food or water; medicines such as antibiotics, cancer drugs, and antacids that contain magnesium; food intolerances and sensitivities; and diseases that affect the colon, such as Crohn&#8217;s disease or irritable bowel syndrome.<a class=\"footnote\" title=\"A.D.A.M. Medical Encyclopedia [Internet]. Atlanta (GA): A.D.A.M., Inc.; \u00a92019. Heartburn; [reviewed 2019 May 10; cited 2019 October 27]. https:\/\/medlineplus.gov\/ency\/anatomyvideos\/000068.htm\" id=\"return-footnote-347-6\" href=\"#footnote-347-6\" aria-label=\"Footnote 6\"><sup class=\"footnote\">[6]<\/sup><\/a><\/p>\n<p>The most severe threat posed by diarrhea is dehydration caused by the loss of water and electrolytes. Diarrheal disease is a leading cause of child mortality and morbidity throughout the world due to dehydration; frail elderly are also at risk. When severe diarrhea occurs, assessment for dehydration and electrolyte imbalances receive top priority and rehydration with oral rehydration solutions or IV fluids may be required.<a class=\"footnote\" title=\"World Health Organization. (2017, May 2). Diarrhoeal disease.https:\/\/www.who.int\/en\/news-room\/fact-sheets\/detail\/diarrhoeal-disease.\" id=\"return-footnote-347-7\" href=\"#footnote-347-7\" aria-label=\"Footnote 7\"><sup class=\"footnote\">[7]<\/sup><\/a><\/p>\n<h2 style=\"text-align: left;\">Constipation<\/h2>\n<p><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_347_830\"><strong>Constipation<\/strong><\/a> is defined as &#8220;three or fewer bowel movements in a week; stools that are hard, dry or lumpy; stools that are difficult or painful to pass; or the feeling that not all stool has passed.&#8221;<a class=\"footnote\" title=\"National Institute of Diabetes and Digestive and Kidney Diseases, National Institute of Health. (2018). Symptoms and causes of constipation.https:\/\/www.niddk.nih.gov\/health-information\/digestive-diseases\/constipation\/symptoms-causes\" id=\"return-footnote-347-8\" href=\"#footnote-347-8\" aria-label=\"Footnote 8\"><sup class=\"footnote\">[8]<\/sup><\/a> If defecation is delayed for an extended time, additional water is absorbed, thus making the feces firmer and potentially leading to constipation. There are several causes of constipation, such as lack of proper fluids or fiber in the diet, lack of ambulation, various disease processes, recovery from surgical anesthesia and opiates, and side effects of many medications. A list of these potential causes can be found in Table 7.3a.<a class=\"footnote\" title=\"National Institute of Diabetes and Digestive and Kidney Diseases, National Institute of Health. (2018). Symptoms and causes of constipation.https:\/\/www.niddk.nih.gov\/health-information\/digestive-diseases\/constipation\/symptoms-causes\" id=\"return-footnote-347-9\" href=\"#footnote-347-9\" aria-label=\"Footnote 9\"><sup class=\"footnote\">[9]<\/sup><\/a> Because there are several potential causes of constipation, treatment should always be individualized to the client. Many times, constipation can be treated with simple changes in diet, exercise, or routine. However, when medications are also needed to resolve constipation, there are several categories of laxative medications that work in different ways. Classes of laxative medications are described below.<\/p>\n<table class=\"alignleft\" style=\"border-collapse: collapse; width: 100%;\">\n<caption>Table 7.3a Common Causes of Constipation<\/caption>\n<tbody>\n<tr style=\"height: 18px;\">\n<th style=\"width: 14.3707%;\" scope=\"col\">Cause<\/th>\n<th style=\"width: 85.5302%;\" scope=\"col\">Examples<\/th>\n<\/tr>\n<tr style=\"height: 270px;\">\n<th style=\"width: 14.3707%;\" scope=\"row\">Medications<\/th>\n<td style=\"width: 85.5302%;\">\n<ul>\n<li>Antacids that contain aluminum and calcium<\/li>\n<li>Anticholinergics and antispasmodics<\/li>\n<li>Anticonvulsants\u2014used to prevent seizures<\/li>\n<li>Calcium channel blockers<\/li>\n<li>Diuretics<\/li>\n<li>Iron supplements<\/li>\n<li>Medicines used to treat Parkinson&#8217;s disease<\/li>\n<li>Narcotic pain medicines<\/li>\n<li>Some medicines used to treat depression<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<tr style=\"height: 297px;\">\n<th style=\"width: 14.3707%;\" scope=\"row\">Health and Nutrition Problems<\/th>\n<td style=\"width: 85.5302%;\">\n<ul>\n<li>Not eating enough fiber<\/li>\n<li>Not drinking enough liquids or dehydration<\/li>\n<li>Not getting enough physical activity<\/li>\n<li>Celiac disease<\/li>\n<li>Disorders that affect the brain and spine, such as Parkinson&#8217;s disease<\/li>\n<li>Spinal cord or brain injuries<\/li>\n<li>Diabetes<\/li>\n<li>Hypothyroidism<\/li>\n<li>Inflammation linked to diverticular disease or proctitis<\/li>\n<li>Intestinal obstructions, including anorectal blockage and tumors<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<tr style=\"height: 189px;\">\n<th style=\"width: 14.3707%;\" scope=\"row\">Daily Routine Changes<\/th>\n<td style=\"width: 85.5302%;\">\n<ul>\n<li>Pregnancy<\/li>\n<li>Aging<\/li>\n<li>Traveling<\/li>\n<li>Ignoring the urge to have a bowel movement<\/li>\n<li>Medication changes<\/li>\n<li>Change in diet<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>&nbsp;<\/p>\n<h2>Nausea and Vomiting<\/h2>\n<p>Similar to diarrhea and constipation, nausea and vomiting are common conditions that are most often signs and symptoms of other conditions or side effects of medication.<\/p>\n<p>Nausea is the unpleasant sensation of having the urge to vomit, and vomiting (emesis) is the forceful expulsion of gastric contents.<a class=\"footnote\" title=\"Bashashati, M. &amp; McCallum, R. (2014). Neurochemical mechanisms and pharmacologic strategies in managing nausea and vomiting related to cyclic vomiting syndrome and other gastrointestinal disorders. European Journal of Pharmacology, 772, p 79.\" id=\"return-footnote-347-10\" href=\"#footnote-347-10\" aria-label=\"Footnote 10\"><sup class=\"footnote\">[10]<\/sup><\/a><\/p>\n<p>The vomiting center can be activated directly by irritants or indirectly following input from four principal areas: gastrointestinal tract, cerebral cortex and thalamus, vestibular region, and chemoreceptor trigger zone (CRTZ). See Figure 7.3c for an illustration of the pathophysiology of nausea and vomiting.<a class=\"footnote\" title=\"Becker D. E. (2010). Nausea, vomiting, and hiccups: a review of mechanisms and treatment. Anesthesia progress, 57(4), 150\u2013157. doi:10.2344\/0003-3006-57.4.150\" id=\"return-footnote-347-11\" href=\"#footnote-347-11\" aria-label=\"Footnote 11\"><sup class=\"footnote\">[11]<\/sup><\/a><a id=\"7.3c\"><\/a><\/p>\n<figure style=\"width: 407px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" title=\"Becker D. E. (2010). Nausea, vomiting, and hiccups: a review of mechanisms and treatment. Anesthesia progress, 57(4), 150\u2013157. doi:10.2344\/0003-3006-57.4.150\" src=\"https:\/\/opentextbc.ca\/accessibilitytoolkit\/wp-content\/uploads\/sites\/397\/2022\/05\/image1-2.png\" alt=\"Chart showing pathophysiology of nausea and vomiting\" width=\"407\" height=\"332\" \/><figcaption class=\"wp-caption-text\">Figure 7.3c Pathophysiology of nausea and vomiting <a href=\"#7.3c_desc\">[<em>Image Description<\/em>]<\/a><\/figcaption><\/figure>\n<p>An important part of the emesis circuit is the <strong><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_347_656\">chemoreceptor trigger zone (CTZ)<\/a><\/strong>, located in the <strong><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_347_728\">area postrema<\/a> <\/strong>in the brain. The CTZ is not restricted by the blood\u2013brain barrier, which allows it to respond directly to toxins in the bloodstream such as anesthesia and opioids. The CTZ also receives stimuli from several other locations in the body including the vestibular center; visceral organs such as the GI tract, kidneys, and liver; the thalamus; and the cerebral cortex.<\/p>\n<p>The vestibular center and cerebral cortex can stimulate the vomiting center directly or indirectly through the CTZ. The <strong><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_347_657\">vestibular system <\/a><\/strong> is located within the inner ear and gives a sense of balance and spatial orientation for the purpose of coordinating movement with balance. The feeling of nausea associated with motion sickness often arises from stimuli from the vestibular center. The gastrointestinal tract sends stimuli to the CTZ via cranial nerves IX and X related to obstruction, distension, inflammation, and infection. The cerebral cortex and other parts of the brain can also stimulate a sense of nausea related to odors, tastes, and images and send these stimuli to the CTZ. The CTZ forwards these signals to the vomiting center in the brain. Pain can also directly stimulate the vomiting center.<\/p>\n<p>The <strong><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_347_658\"> vomiting center<\/a><\/strong> (VC) is located in the medulla in the brain. In response to these stimuli, the vomiting center initiates vomiting by inhibiting peristalsis and producing retro-peristaltic contractions beginning in the small bowel and ascending into the stomach. It also produces simultaneous contractions in the abdominal muscles and diaphragm that generate high pressures to propel the stomach contents upwards. Additionally, autonomic stimulation of the heart, airways, salivary glands, and skin cause other symptoms associated with vomiting such as salivation, palor, sweating, and tachycardia. Several neurotransmitters are involved in the nausea and vomiting process, and antiemetic medications are targeted to specific neuroreceptors.<a class=\"footnote\" title=\"Becker D. E. (2010). Nausea, vomiting, and hiccups: a review of mechanisms and treatment. Anesthesia progress, 57(4), 150\u2013157. https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3006663\/\" id=\"return-footnote-347-12\" href=\"#footnote-347-12\" aria-label=\"Footnote 12\"><sup class=\"footnote\">[12]<\/sup><\/a><\/p>\n<p>There are many potential causes of nausea and vomiting, such as:<\/p>\n<ul>\n<li>Morning sickness during pregnancy<\/li>\n<li><strong><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_347_727\">Gastroenteritis<\/a> <\/strong>and other infections<\/li>\n<li>Migraines<\/li>\n<li>Motion sickness<\/li>\n<li>Food poisoning<\/li>\n<li>Side effects of medicines, including those for cancer chemotherapy<\/li>\n<li>GERD\u00a0and ulcers<\/li>\n<li>Intestinal obstruction<\/li>\n<li>Poisoning or exposure to a toxic substance<\/li>\n<li>Diseases of other organs (cardiac, renal, or liver)<\/li>\n<\/ul>\n<p>A health care provider should be contacted immediately if the following conditions occur:<\/p>\n<ul>\n<li>Vomiting for longer than 24 hours<\/li>\n<li>Blood in the vomit (also called <strong><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_347_659\">hematemesis<\/a><\/strong>)<\/li>\n<li>Severe abdominal pain<\/li>\n<li>Severe headache and stiff neck<\/li>\n<li>Signs of dehydration, such as dry mouth, infrequent urination, or dark urine<\/li>\n<\/ul>\n<h1>Image Descriptions<\/h1>\n<p><strong><a id=\"7.3a_desc\"><\/a>Figure 7.3a image description:<\/strong> Illustration of GERD.<\/p>\n<p class=\"p1\">The stomach is located in the upper left quadrant of the abdomen and the esophagus comes down from the throat to the stomach.<\/p>\n<p class=\"p1\">When it is normal, the lower oesophageal sphincter, which is between the esophagus and stomach, is closed. Stomach acid and stomach contents sit in the stomach.<\/p>\n<p class=\"p1\">When a person has GERD, the lower esophageal sphincter is open. This allows a back flow of acid and stomach contents into the esophagus, which causes heartburn. <a href=\"#7.3a\">[Return to figure 7.3a]<\/a><\/p>\n<p>&nbsp;<\/p>\n<p><strong><a id=\"7.3c_desc\"><\/a>Figure 7.3c image description:<\/strong> The pathophysiology of nausea and vomiting.<\/p>\n<p class=\"p1\">The Vomiting Center sits in the centre. The receptors illustrated in the vomiting center are:<\/p>\n<ul>\n<li class=\"p1\">H<sub>1<\/sub> histamine<\/li>\n<li class=\"p1\">M<sub>1<\/sub> acetylcholine<\/li>\n<li class=\"p1\">NK<sub>1<\/sub> (neurokinin), and 5-HT3 serotonin.<\/li>\n<\/ul>\n<p class=\"p1\">Four principal areas can activate the vomiting center:<\/p>\n<ul>\n<li class=\"p1\">GI Tract (5-HT<sub>3<\/sub> serotonin)<\/li>\n<li class=\"p1\">Cortex Thalamus (Anxiety, Pain)<\/li>\n<li class=\"p1\">Vestibular (H<sub>1<\/sub>\u00a0histamine, M<sub>1<\/sub>\u00a0acetylcholine)<\/li>\n<li class=\"p1\">Chemoreceptor trigger zone (mu\/kappa opioids, DA<sub>2<\/sub>\u00a0dopamine, and NK<sub>1<\/sub> (neurokinin)) <a href=\"#7.3c\">[Return to figure 7.3c]<\/a><\/li>\n<\/ul>\n<hr class=\"before-footnotes clear\" \/><div class=\"footnotes\"><ol><li id=\"footnote-347-1\">\"<a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:GERD.png\" rel=\"noopener noreferrer\">GERD.png<\/a>\" by <a href=\"https:\/\/commons.wikimedia.org\/wiki\/User:BruceBlaus\" rel=\"noopener noreferrer\">BruceBlaus<\/a> is licensed under<a class=\"internal\" href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/\" rel=\"noopener noreferrer\"> CC BY-SA 4.0<\/a> <a href=\"#return-footnote-347-1\" class=\"return-footnote\" aria-label=\"Return to footnote 1\">&crarr;<\/a><\/li><li id=\"footnote-347-2\">Lilley, L., Collins, S., &amp; Snyder, J. (2014). <em>Pharmacology and the Nursing Process<\/em>. pp. 782-862. Elsevier. <a href=\"#return-footnote-347-2\" class=\"return-footnote\" aria-label=\"Return to footnote 2\">&crarr;<\/a><\/li><li id=\"footnote-347-3\">\"\"<a class=\"internal\" href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/\" rel=\"noopener noreferrer\">Duodenal ulcer01.jpg<\/a>\" by <a href=\"https:\/\/commons.wikimedia.org\/wiki\/User:%E3%83%A1%E3%83%AB%E3%83%93%E3%83%AB\" rel=\"noopener noreferrer\">melvil<\/a> is licensed under <a class=\"internal\" href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/\" rel=\"noopener noreferrer\">CC BY-SA 4.0<\/a> <a href=\"#return-footnote-347-3\" class=\"return-footnote\" aria-label=\"Return to footnote 3\">&crarr;<\/a><\/li><li id=\"footnote-347-4\">MedlinePlus. Bethesda (MD): National Library of Medicine (US); [updated 2019 October 23]. Heartburn; [updated 2019 October 2; cited 2019 October 27] <a href=\"https:\/\/medlineplus.gov\/ency\/anatomyvideos\/000068.htm\" rel=\"noopener noreferrer\">https:\/\/medlineplus.gov\/ency\/anatomyvideos\/000068.htm<\/a> <a href=\"#return-footnote-347-4\" class=\"return-footnote\" aria-label=\"Return to footnote 4\">&crarr;<\/a><\/li><li id=\"footnote-347-5\">Blausen Medical. (2015, November 17). <em>Gastric Ulcers<\/em> [Video].<a href=\"https:\/\/blausen.com\/en\/video\/gastric-ulcers\/\" rel=\"noopener noreferrer\">https:\/\/blausen.com\/en\/video\/gastric-ulcers\/#<\/a> <a href=\"#return-footnote-347-5\" class=\"return-footnote\" aria-label=\"Return to footnote 5\">&crarr;<\/a><\/li><li id=\"footnote-347-6\">A.D.A.M. Medical Encyclopedia [Internet]. Atlanta (GA): A.D.A.M., Inc.; \u00a92019. Heartburn; [reviewed 2019 May 10; cited 2019 October 27]. <a href=\"https:\/\/medlineplus.gov\/ency\/anatomyvideos\/000068.htm\" rel=\"noopener noreferrer\">https:\/\/medlineplus.gov\/ency\/anatomyvideos\/000068.htm<\/a> <a href=\"#return-footnote-347-6\" class=\"return-footnote\" aria-label=\"Return to footnote 6\">&crarr;<\/a><\/li><li id=\"footnote-347-7\">World Health Organization. (2017, May 2). <em>Diarrhoeal disease.<\/em><a href=\"https:\/\/www.who.int\/en\/news-room\/fact-sheets\/detail\/diarrhoeal-disease\" rel=\"noopener noreferrer\">https:\/\/www.who.int\/en\/news-room\/fact-sheets\/detail\/diarrhoeal-disease<\/a>. <a href=\"#return-footnote-347-7\" class=\"return-footnote\" aria-label=\"Return to footnote 7\">&crarr;<\/a><\/li><li id=\"footnote-347-8\">National Institute of Diabetes and Digestive and Kidney Diseases, National Institute of Health. (2018). <em>Symptoms and causes of constipation.<\/em><a href=\"https:\/\/www.niddk.nih.gov\/health-information\/digestive-diseases\/constipation\/symptoms-causes\" rel=\"noopener noreferrer\">https:\/\/www.niddk.nih.gov\/health-information\/digestive-diseases\/constipation\/symptoms-causes<\/a> <a href=\"#return-footnote-347-8\" class=\"return-footnote\" aria-label=\"Return to footnote 8\">&crarr;<\/a><\/li><li id=\"footnote-347-9\">National Institute of Diabetes and Digestive and Kidney Diseases, National Institute of Health. (2018). <em>Symptoms and causes of constipation.<\/em><a href=\"https:\/\/www.niddk.nih.gov\/health-information\/digestive-diseases\/constipation\/symptoms-causes\" rel=\"noopener noreferrer\">https:\/\/www.niddk.nih.gov\/health-information\/digestive-diseases\/constipation\/symptoms-causes<\/a> <a href=\"#return-footnote-347-9\" class=\"return-footnote\" aria-label=\"Return to footnote 9\">&crarr;<\/a><\/li><li id=\"footnote-347-10\">Bashashati, M. &amp; McCallum, R. (2014). Neurochemical mechanisms and pharmacologic strategies in managing nausea and vomiting related to cyclic vomiting syndrome and other gastrointestinal disorders. <em>European Journal of Pharmacology, 772<\/em>, p 79. <a href=\"#return-footnote-347-10\" class=\"return-footnote\" aria-label=\"Return to footnote 10\">&crarr;<\/a><\/li><li id=\"footnote-347-11\">Becker D. E. (2010). Nausea, vomiting, and hiccups: a review of mechanisms and treatment. Anesthesia progress, 57(4), 150\u2013157. doi:10.2344\/0003-3006-57.4.150 <a href=\"#return-footnote-347-11\" class=\"return-footnote\" aria-label=\"Return to footnote 11\">&crarr;<\/a><\/li><li id=\"footnote-347-12\">Becker D. E. (2010). Nausea, vomiting, and hiccups: a review of mechanisms and treatment. <em>Anesthesia progress, 57<\/em>(4), 150\u2013157. <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3006663\/\" rel=\"noopener noreferrer\">https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3006663\/<\/a> <a href=\"#return-footnote-347-12\" class=\"return-footnote\" aria-label=\"Return to footnote 12\">&crarr;<\/a><\/li><\/ol><\/div><div class=\"glossary\"><span class=\"screen-reader-text\" id=\"definition\">definition<\/span><template id=\"term_347_646\"><div class=\"glossary__definition\" role=\"dialog\" data-id=\"term_347_646\"><div tabindex=\"-1\"><p>Caused by excessive hydrochloric acid that tends to back up, or reflux, into the lower esophagus.<\/p>\n<\/div><button><span aria-hidden=\"true\">&times;<\/span><span class=\"screen-reader-text\">Close definition<\/span><\/button><\/div><\/template><template id=\"term_347_647\"><div class=\"glossary__definition\" role=\"dialog\" data-id=\"term_347_647\"><div tabindex=\"-1\"><p>Occurs when gastric or duodenal ulcers are caused by the breakdown of GI mucosa by pepsin in combination with the caustic effects of hydrochloric acid.<\/p>\n<\/div><button><span aria-hidden=\"true\">&times;<\/span><span class=\"screen-reader-text\">Close definition<\/span><\/button><\/div><\/template><template id=\"term_347_648\"><div class=\"glossary__definition\" role=\"dialog\" data-id=\"term_347_648\"><div tabindex=\"-1\"><p>A common condition in hospitalized patients that can lead to PUD.<\/p>\n<\/div><button><span aria-hidden=\"true\">&times;<\/span><span class=\"screen-reader-text\">Close definition<\/span><\/button><\/div><\/template><template id=\"term_347_735\"><div class=\"glossary__definition\" role=\"dialog\" data-id=\"term_347_735\"><div tabindex=\"-1\"><p>Medication to prevent the formation of stress ulcers.<\/p>\n<\/div><button><span aria-hidden=\"true\">&times;<\/span><span class=\"screen-reader-text\">Close definition<\/span><\/button><\/div><\/template><template id=\"term_347_653\"><div class=\"glossary__definition\" role=\"dialog\" data-id=\"term_347_653\"><div tabindex=\"-1\"><p>The passage of three or more loose or liquid stools per day (or more frequent passage than is normal for the individual).<\/p>\n<\/div><button><span aria-hidden=\"true\">&times;<\/span><span class=\"screen-reader-text\">Close definition<\/span><\/button><\/div><\/template><template id=\"term_347_830\"><div class=\"glossary__definition\" role=\"dialog\" data-id=\"term_347_830\"><div tabindex=\"-1\"><p>Three or fewer bowel movements in a week; stools that are hard, dry or lumpy; stools that are difficult or painful to pass; or the feeling that not all stool has passed.<\/p>\n<\/div><button><span aria-hidden=\"true\">&times;<\/span><span class=\"screen-reader-text\">Close definition<\/span><\/button><\/div><\/template><template id=\"term_347_656\"><div class=\"glossary__definition\" role=\"dialog\" data-id=\"term_347_656\"><div tabindex=\"-1\"><p>Area in the brain that responds directly to toxins in the bloodstream and stimulates the vomiting center.\u00a0 The CTZ receives stimuli from several other locations in the body.<\/p>\n<\/div><button><span aria-hidden=\"true\">&times;<\/span><span class=\"screen-reader-text\">Close definition<\/span><\/button><\/div><\/template><template id=\"term_347_728\"><div class=\"glossary__definition\" role=\"dialog\" data-id=\"term_347_728\"><div tabindex=\"-1\"><p>A structure in the medulla oblongata in the brainstem that controls vomiting. Its location in the brain also allows it to play a vital role in the control of autonomic functions by the central nervous system.<\/p>\n<\/div><button><span aria-hidden=\"true\">&times;<\/span><span class=\"screen-reader-text\">Close definition<\/span><\/button><\/div><\/template><template id=\"term_347_657\"><div class=\"glossary__definition\" role=\"dialog\" data-id=\"term_347_657\"><div tabindex=\"-1\"><p>An area located within the inner ear that gives a sense of balance and spatial orientation for the purpose of coordinating movement with balance.<\/p>\n<\/div><button><span aria-hidden=\"true\">&times;<\/span><span class=\"screen-reader-text\">Close definition<\/span><\/button><\/div><\/template><template id=\"term_347_658\"><div class=\"glossary__definition\" role=\"dialog\" data-id=\"term_347_658\"><div tabindex=\"-1\"><p>An area in the brain that initiates vomiting by inhibiting peristalsis and producing retro peristaltic contractions beginning in the small bowel and ascending into the stomach. It also produces simultaneous contractions in the abdominal muscles and diaphragm that generate high pressures to propel the stomach contents upwards.<\/p>\n<\/div><button><span aria-hidden=\"true\">&times;<\/span><span class=\"screen-reader-text\">Close definition<\/span><\/button><\/div><\/template><template id=\"term_347_727\"><div class=\"glossary__definition\" role=\"dialog\" data-id=\"term_347_727\"><div tabindex=\"-1\"><p>Infection of the intestines.<\/p>\n<\/div><button><span aria-hidden=\"true\">&times;<\/span><span class=\"screen-reader-text\">Close definition<\/span><\/button><\/div><\/template><template id=\"term_347_659\"><div class=\"glossary__definition\" role=\"dialog\" data-id=\"term_347_659\"><div tabindex=\"-1\"><p>Blood in the vomit.<\/p>\n<\/div><button><span aria-hidden=\"true\">&times;<\/span><span class=\"screen-reader-text\">Close definition<\/span><\/button><\/div><\/template><\/div>","protected":false},"author":90,"menu_order":3,"template":"","meta":{"pb_show_title":"on","pb_short_title":"","pb_subtitle":"","pb_authors":["amanda-egert","kimberly-lee","manu-gill"],"pb_section_license":""},"chapter-type":[],"contributor":[70,71,72],"license":[],"class_list":["post-347","chapter","type-chapter","status-publish","hentry","contributor-amanda-egert","contributor-kimberly-lee","contributor-manu-gill"],"part":334,"_links":{"self":[{"href":"https:\/\/opentextbc.ca\/nursingpharmacology\/wp-json\/pressbooks\/v2\/chapters\/347","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/opentextbc.ca\/nursingpharmacology\/wp-json\/pressbooks\/v2\/chapters"}],"about":[{"href":"https:\/\/opentextbc.ca\/nursingpharmacology\/wp-json\/wp\/v2\/types\/chapter"}],"author":[{"embeddable":true,"href":"https:\/\/opentextbc.ca\/nursingpharmacology\/wp-json\/wp\/v2\/users\/90"}],"version-history":[{"count":9,"href":"https:\/\/opentextbc.ca\/nursingpharmacology\/wp-json\/pressbooks\/v2\/chapters\/347\/revisions"}],"predecessor-version":[{"id":1696,"href":"https:\/\/opentextbc.ca\/nursingpharmacology\/wp-json\/pressbooks\/v2\/chapters\/347\/revisions\/1696"}],"part":[{"href":"https:\/\/opentextbc.ca\/nursingpharmacology\/wp-json\/pressbooks\/v2\/parts\/334"}],"metadata":[{"href":"https:\/\/opentextbc.ca\/nursingpharmacology\/wp-json\/pressbooks\/v2\/chapters\/347\/metadata\/"}],"wp:attachment":[{"href":"https:\/\/opentextbc.ca\/nursingpharmacology\/wp-json\/wp\/v2\/media?parent=347"}],"wp:term":[{"taxonomy":"chapter-type","embeddable":true,"href":"https:\/\/opentextbc.ca\/nursingpharmacology\/wp-json\/pressbooks\/v2\/chapter-type?post=347"},{"taxonomy":"contributor","embeddable":true,"href":"https:\/\/opentextbc.ca\/nursingpharmacology\/wp-json\/wp\/v2\/contributor?post=347"},{"taxonomy":"license","embeddable":true,"href":"https:\/\/opentextbc.ca\/nursingpharmacology\/wp-json\/wp\/v2\/license?post=347"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}