Your Complete GI Factory Foundation

From perfusion to GI diseases � built with the cell-factory model.

Before we begin, what is your name?

What You'll Master:

? Perfusion-first GI thinking
? Cell factory failures ? disease ? drugs ? nursing care
? Visual diagrams, tables, and mnemonics for quick recall
? NGN-style case thinking and safety priorities

Perfusion Problem	Factory Failure	Clinical Signs
Shock	Power loss	Ileus, abdominal pain
Sepsis	Supply chain collapse	Distention, no bowel sounds
Portal HTN	Back pressure	Varices, GI bleed

Cell Part	Factory Job	Failure Result
Nucleus	Control center	Wrong proteins made
Mitochondria	ATP power	Cell fatigue, death
Membrane receptors	Signal input	Drug targets fail

GI Cell Types: The Worker Crew

Enterocyte, hepatocyte, parietal cell, and pancreatic acinar cell.

Enterocyte: Absorption Specialist

Enterocytes line the small intestine villi. They have microvilli (brush border) to maximize surface area and enzymes that finish digestion. Their apical surface faces food, and their basolateral surface ships nutrients into blood or lymph. If enterocytes are damaged, malabsorption, diarrhea, and weight loss follow.

Hepatocyte: Detox and Metabolism

Hepatocytes filter portal blood, detoxify drugs, store glucose as glycogen, and produce bile. When hepatocytes fail, toxins accumulate, clotting drops, and jaundice appears.

Parietal Cell: Acid and Intrinsic Factor

Parietal cells release hydrochloric acid to break down food and intrinsic factor for vitamin B12 absorption. Overactivity leads to ulcers; underactivity can cause B12 deficiency.

Pancreatic Acinar Cell: Enzyme Factory

Acinar cells release digestive enzymes (amylase, lipase, proteases). Premature activation inside the pancreas causes pancreatitis and tissue injury.

Diagram: Villus and Enterocyte

Enterocytes move sugars/proteins into blood and fats into lymph.

Diagram: Gastric Gland Cell Map

Parietal = acid + intrinsic factor. Chief = pepsinogen. G/D cells regulate acid.

Cell	Primary Job	Failure Outcome
Enterocyte	Absorption	Malabsorption, diarrhea
Hepatocyte	Detox + bile	Jaundice, encephalopathy
Parietal cell	Acid + IF	Ulcers or B12 deficiency
Acinar cell	Enzymes	Pancreatitis

Mnemonic

E-H-P-A = Enterocyte, Hepatocyte, Parietal, Acinar.

Region	Main Job	Key Clinical Note
Stomach	Acid + mixing	GERD/PUD risk
Small intestine	Absorption	Malabsorption if damaged
Liver	Detox + bile	Jaundice, clotting issues
Colon	Water absorption	Constipation/diarrhea

Disease Pathophysiology: GI Factory Failures

What breaks, why it breaks, and how we fix it.

Diagram: Acid vs Protection Balance

Ulcers happen when acid overwhelms protection.

Diagram: Portal HTN ? Varices ? Bleed

Back pressure can cause life-threatening bleeding.

?? GERD: Weak Valve, Acid Backflow

?? Cell Factory Failure:

Weak lower esophageal sphincter (LES) ? acid backflow ? esophageal irritation.

?? Why This Happens:

Primary cause: LES weakness, hiatal hernia.
Risk factors: Obesity, caffeine, alcohol, smoking, late meals.
Pathophysiology: Acid damages esophageal lining ? inflammation.

?? Drug Targets & Mechanisms:

PPIs block proton pumps ? ? acid.
H2 blockers reduce histamine-driven acid.
Antacids neutralize existing acid.

??? Signs & Symptoms:

Early: Heartburn, sour taste.
Progressive: Regurgitation, dysphagia.
Late/Severe: Esophagitis, bleeding.

?? LPN Care Tips:

?? Priority #1: Elevate HOB, avoid late meals.
?? Monitor: Pain, swallowing difficulty.
?? Medication safety: Take PPIs before meals.
?? Teaching: Avoid peppermint, caffeine, fatty foods.
?? Critical alert: Report black stools or vomiting blood.

?? When to Notify Provider IMMEDIATELY:

Hematemesis or melena
Severe chest pain with swallowing
Unexplained weight loss

?? Peptic Ulcer Disease: Protective Barrier Failure

?? Cell Factory Failure:

Mucus/bicarb barrier fails ? acid burns mucosa ? ulcer.

?? Why This Happens:

Primary cause: H. pylori, NSAIDs.
Risk factors: Smoking, alcohol, stress.
Pathophysiology: Acid penetrates lining ? bleeding/perforation.

?? Drug Targets & Mechanisms:

PPIs/H2 reduce acid.
Sucralfate coats ulcer.
Antibiotics eradicate H. pylori.

??? Signs & Symptoms:

Early: Gnawing epigastric pain.
Progressive: Nausea, bloating.
Late/Severe: Bleeding, perforation.

?? LPN Care Tips:

?? Priority #1: Monitor for GI bleed.
?? Monitor: Stool color, pain.
?? Medication safety: Avoid NSAIDs.
?? Teaching: Small meals, avoid alcohol.
?? Critical alert: Sudden rigid abdomen = perforation.

?? When to Notify Provider IMMEDIATELY:

Black tarry stools
Sharp, sudden abdominal pain
Vomiting blood

?? Viral Hepatitis: Liver Cell Injury

?? Cell Factory Failure:

Hepatocytes inflamed ? detox and bile processing fail.

?? Why This Happens:

Primary cause: Hepatitis A-E viruses.
Risk factors: Contaminated food/water, blood exposure.
Pathophysiology: Inflammation ? jaundice, enzyme rise.

?? Drug Targets & Mechanisms:

Supportive care for HAV/HEV.
Antivirals for HBV/HCV (provider managed).

??? Signs & Symptoms:

Early: Fatigue, nausea.
Progressive: Jaundice, dark urine.
Late/Severe: Bleeding, encephalopathy.

?? LPN Care Tips:

?? Priority #1: Prevent spread (hand hygiene).
?? Monitor: LFTs, jaundice, mental status.
?? Medication safety: Avoid hepatotoxic meds.
?? Teaching: Rest, no alcohol.
?? Critical alert: Confusion + bleeding = emergency.

?? When to Notify Provider IMMEDIATELY:

Severe jaundice
Altered mental status
Bleeding/bruising

?? Cirrhosis / Portal Hypertension

?? Cell Factory Failure:

Fibrosis replaces hepatocytes ? portal pressure rises ? varices/ascites.

?? Why This Happens:

Primary cause: Chronic liver injury (alcohol, hepatitis).
Risk factors: Long-term alcohol, viral hepatitis.
Pathophysiology: Scar tissue blocks portal flow.

?? Drug Targets & Mechanisms:

Diuretics for ascites (provider managed).
Lactulose lowers ammonia.

??? Signs & Symptoms:

Early: Fatigue, RUQ discomfort.
Progressive: Jaundice, ascites.
Late/Severe: Variceal bleed, encephalopathy.

?? LPN Care Tips:

?? Priority #1: Monitor for GI bleed.
?? Monitor: Abd girth, mental status.
?? Medication safety: Lactulose can cause diarrhea.
?? Teaching: Low-sodium diet, no alcohol.
?? Critical alert: Hematemesis = emergency.

?? When to Notify Provider IMMEDIATELY:

Vomiting blood
Confusion or asterixis
Rapidly rising abdominal girth

?? Pancreatitis: Enzymes Digest the Factory

?? Cell Factory Failure:

Premature enzyme activation ? pancreatic self-digestion.

?? Why This Happens:

Primary cause: Gallstones, alcohol.
Risk factors: Hyperlipidemia, trauma.
Pathophysiology: Enzymes leak ? inflammation.

?? Drug Targets & Mechanisms:

Analgesics for severe pain.
H2/PPIs reduce acid stimulation.

??? Signs & Symptoms:

Early: Severe LUQ/epigastric pain to back.
Progressive: Nausea/vomiting, ? amylase/lipase.
Late/Severe: Shock, Cullen/Turner signs.

?? LPN Care Tips:

?? Priority #1: NPO, IV fluids per orders.
?? Monitor: Pain, vitals, labs.
?? Medication safety: Watch for respiratory depression with opioids.
?? Teaching: No alcohol, low-fat diet.
?? Critical alert: Hypotension + severe pain = emergency.

?? When to Notify Provider IMMEDIATELY:

Sudden hypotension
Severe abdominal distention
Confusion or cyanosis

?? Appendicitis: Blocked Appendix ? Peritonitis Risk

?? Cell Factory Failure:

Appendix obstruction ? swelling ? rupture ? peritonitis.

?? Why This Happens:

Primary cause: Fecalith obstruction.
Risk factors: Young adults, infection.
Pathophysiology: Ischemia ? perforation.

?? Drug Targets & Mechanisms:

Antibiotics pre/post surgery.
Analgesics for pain.

??? Signs & Symptoms:

Early: Periumbilical pain ? RLQ.
Progressive: Rebound tenderness, fever.
Late/Severe: Rigid abdomen, sepsis.

?? LPN Care Tips:

?? Priority #1: Keep NPO, monitor for rupture.
?? Monitor: Pain shift, fever.
?? Medication safety: Avoid laxatives/heat.
?? Teaching: Post-op wound care.
?? Critical alert: Sudden pain relief can mean rupture.

?? When to Notify Provider IMMEDIATELY:

Rigid abdomen
High fever with worsening pain
Signs of sepsis

Diagram: UC vs Crohn

UC is continuous colon disease; Crohn's has skip lesions.

?? IBD: Ulcerative Colitis vs Crohn's

?? Cell Factory Failure:

Immune attack on bowel lining ? chronic inflammation.

?? Why This Happens:

Primary cause: Autoimmune/inflammatory response.
Risk factors: Family history, smoking (Crohn).
Pathophysiology: Ulcers, malabsorption, bleeding.

?? Drug Targets & Mechanisms:

Aminosalicylates reduce inflammation.
Corticosteroids suppress immune response.
Immunosuppressants for severe disease.

??? Signs & Symptoms:

UC: Bloody diarrhea, cramps.
Crohn: Crampy pain, weight loss, fistulas.

?? LPN Care Tips:

?? Priority #1: Monitor stool and hydration.
?? Monitor: Anemia, electrolytes.
?? Medication safety: Watch steroid effects.
?? Teaching: Low-residue diet during flares.
?? Critical alert: Severe pain + fever = perforation risk.

?? When to Notify Provider IMMEDIATELY:

Severe bleeding
High fever with rigid abdomen
Signs of dehydration

?? Diverticulitis: Inflamed Pouches

?? Cell Factory Failure:

Diverticula inflame ? localized infection ? perforation risk.

?? Why This Happens:

Primary cause: Fecal trapping in diverticula.
Risk factors: Low fiber diet, aging.
Pathophysiology: Inflammation ? abscess/perforation.

?? Drug Targets & Mechanisms:

Antibiotics for infection.
Antispasmodics reduce pain.

??? Signs & Symptoms:

Early: LLQ pain, fever.
Progressive: Nausea, bloating.
Late/Severe: Peritonitis.

?? LPN Care Tips:

?? Priority #1: NPO/clear liquids during acute phase.
?? Monitor: Pain, temperature.
?? Medication safety: Watch for antibiotic effects.
?? Teaching: High fiber diet after recovery.
?? Critical alert: Rigid abdomen or sudden severe pain.

?? When to Notify Provider IMMEDIATELY:

Worsening pain with fever
Signs of perforation
Persistent vomiting

Disease	Cell Factory Problem	Drug Strategy	LPN Priority
GERD	Weak LES ? acid reflux	PPI/H2/antacid	Positioning + diet
PUD	Mucosal barrier failure	PPI + sucralfate + abx	Monitor bleed
Hepatitis	Hepatocyte inflammation	Supportive/antivirals	Infection control
Cirrhosis	Fibrosis blocks flow	Diuretics/lactulose	Monitor bleed/AMS
Pancreatitis	Enzyme auto-digestion	Analgesics, NPO	Monitor vitals
Appendicitis	Obstruction ? rupture	Antibiotics	NPO, prep surgery
IBD	Immune attack	Anti-inflammatory	Hydration
Diverticulitis	Inflamed diverticula	Antibiotics	Monitor perforation

Quiz 2: GI Diseases

Score 80% to unlock Nursing Tips.

Question 1

GERD is primarily caused by:

A. Weak LES
B. No bile production
C. Pancreatic enzyme excess
D. Colon spasm

Question 2

PUD risk is highest with:

A. NSAID use + H. pylori
B. Low fiber diet only
C. High potassium
D. Gallstones alone

Question 3

Which hepatitis is fecal-oral?

A. Hepatitis A
B. Hepatitis B
C. Hepatitis C
D. Hepatitis D

Question 4

Portal hypertension can cause:

A. Esophageal varices
B. Hypoglycemia only
C. Kidney stones
D. Gallbladder spasm

Question 5

Key lab rise in pancreatitis:

A. Amylase/lipase
B. Troponin
C. INR only
D. Creatinine only

Question 6

Appendicitis pain usually moves to:

A. Right lower quadrant
B. Left upper quadrant
C. Right shoulder
D. Flank only

Question 7

Ulcerative colitis is best described as:

A. Continuous colon disease
B. Skip lesions anywhere
C. Only stomach ulcers
D. Gallbladder disease

Question 8

Diverticulitis usually presents with:

A. LLQ pain + fever
B. RUQ pain only
C. No pain
D. Shoulder pain only

Question 9

Best first priority in suspected GI bleed:

A. Assess airway/perfusion
B. Give laxatives
C. Encourage walking
D. Offer fluids immediately

Question 10

Lactulose is used in cirrhosis to:

A. Lower ammonia
B. Increase acid
C. Treat GERD only
D. Prevent infection

Scenario	Immediate Action	Notify RN/PHCP
GI bleed	Assess airway, vitals	Yes � STAT
Peritonitis	NPO, vitals, pain	Yes � STAT
Post-endoscopy	Check gag reflex	If pain/fever
Ostomy skin breakdown	Protect skin	If worsening

Final Quiz: Critical GI Nursing

100% required to complete.

Question 1

A client with hematemesis and hypotension needs priority focus on:

A. Airway and perfusion
B. Diet teaching
C. Ambulation
D. Stool softeners

Question 2

After endoscopy, the client may eat when:

A. Gag reflex returns
B. 12 hours pass
C. Pain is gone
D. Bowel sounds absent

Question 3

Purple-black stoma indicates:

A. Compromised circulation
B. Normal healing
C. Mild irritation
D. Good perfusion

Question 4

Lactulose is given to cirrhosis clients to:

A. Lower ammonia
B. Increase bile flow only
C. Treat GERD
D. Prevent appendicitis

Question 5

A rigid abdomen with rebound tenderness suggests:

A. Peritonitis
B. Mild constipation
C. GERD only
D. Dehydration only

Question 6

Low potassium can cause:

A. Ileus
B. Increased motility
C. Hematemesis
D. Jaundice

Question 7

Priority after paracentesis is to monitor:

A. Blood pressure
B. Hair color
C. Vision
D. Appetite only

Question 8

A client with appendicitis should avoid:

A. Heating pad on abdomen
B. NPO status
C. IV fluids
D. Pain assessment

Question 9

Black tarry stools indicate:

A. Upper GI bleed
B. Normal stool
C. Gallstones
D. Constipation only

Question 10

Crohn's disease can occur:

A. Anywhere in GI tract
B. Only in stomach
C. Only in rectum
D. Only in esophagus

Question 11

After liver biopsy, client should lie on:

A. Right side
B. Left side
C. Prone only
D. Sitting upright

Question 12

C. diff risk is highest after:

A. Broad-spectrum antibiotics
B. Antacids only
C. Multivitamins
D. Fiber supplements

Question 13

A priority with ostomy care is:

A. Protect skin from stool
B. Keep pouch overfilled
C. Avoid hydration
D. Remove stoma daily

Question 14

Severe sudden abdominal pain with rigid abdomen suggests:

A. Perforation
B. Mild reflux
C. Constipation only
D. Appetite increase

Question 15

Best diet teaching for diverticulosis after recovery:

A. High-fiber diet
B. Low fluid intake
C. No vegetables ever
D. Only liquid diet forever

Your Complete GI Factory Foundation

Perfusion: Power to the GI Factory

Why Perfusion Comes First

Safety Red Flags

LPN Priority

Cell Factory Basics

The Complete Cell Factory

Mnemonic

Quiz 1: Perfusion + Cell Basics

GI Cell Types: The Worker Crew

Enterocyte: Absorption Specialist

Hepatocyte: Detox and Metabolism

Parietal Cell: Acid and Intrinsic Factor

Pancreatic Acinar Cell: Enzyme Factory

Mnemonic

GI Anatomy: Factory Layout

Factory Flow Overview

Mnemonic

Disease Pathophysiology: GI Factory Failures

?? GERD: Weak Valve, Acid Backflow

?? Cell Factory Failure:

?? Why This Happens:

?? Drug Targets & Mechanisms:

??? Signs & Symptoms:

?? LPN Care Tips:

?? When to Notify Provider IMMEDIATELY:

?? Peptic Ulcer Disease: Protective Barrier Failure

?? Cell Factory Failure:

?? Why This Happens:

?? Drug Targets & Mechanisms:

??? Signs & Symptoms:

?? LPN Care Tips:

?? When to Notify Provider IMMEDIATELY:

?? Viral Hepatitis: Liver Cell Injury

?? Cell Factory Failure:

?? Why This Happens:

?? Drug Targets & Mechanisms:

??? Signs & Symptoms:

?? LPN Care Tips:

?? When to Notify Provider IMMEDIATELY:

?? Cirrhosis / Portal Hypertension

?? Cell Factory Failure:

?? Why This Happens:

?? Drug Targets & Mechanisms:

??? Signs & Symptoms:

?? LPN Care Tips:

?? When to Notify Provider IMMEDIATELY:

?? Pancreatitis: Enzymes Digest the Factory

?? Cell Factory Failure:

?? Why This Happens:

?? Drug Targets & Mechanisms:

??? Signs & Symptoms:

?? LPN Care Tips:

?? When to Notify Provider IMMEDIATELY:

?? Appendicitis: Blocked Appendix ? Peritonitis Risk

?? Cell Factory Failure:

?? Why This Happens:

?? Drug Targets & Mechanisms:

??? Signs & Symptoms:

?? LPN Care Tips:

?? When to Notify Provider IMMEDIATELY:

?? IBD: Ulcerative Colitis vs Crohn's

?? Cell Factory Failure:

?? Why This Happens:

?? Drug Targets & Mechanisms:

??? Signs & Symptoms:

?? LPN Care Tips:

?? When to Notify Provider IMMEDIATELY:

?? Diverticulitis: Inflamed Pouches

?? Cell Factory Failure:

?? Why This Happens:

?? Drug Targets & Mechanisms:

??? Signs & Symptoms:

?? LPN Care Tips:

?? When to Notify Provider IMMEDIATELY:

Quiz 2: GI Diseases

Nursing Tips & Safety

Top 10 LPN Priorities

Final Quiz: Critical GI Nursing