Conclusion

The small intestine receives the contents of the stomach and also, at the duodeum, secretions from the gall bladder and the pancreas. The proximity of the duodenum to the stomach means that this is the prime site for peptic ulcers; the stomach is well protected against the acidity of its contents but the duodenum is less well adapted to this high acidity. The small intestine is the major site of absorption in the gastrointestinal tract and disorders of the small intestine tend to have a deleterious effect on absorption.

One of the first events in the small intestine is the neutralisation of the acid contents of the stomach as they enter the duodenum, by the copious secretion of sodium bicarbonate from the pancreas. Apart from the importance of this process to digestion in the small intestine, which takes place in a neutral to slightly alkaline environment, there is another consequence which can be deleterious to the intestine. Any bacteria, viruses or parasites which have survived the acidic environment of the stomach may have the opportunity to grow in the less hostile environment of the small intestine and this means that the small intestine is the prime site in the gastrointestinal tract for infectious and parasitic diseases. These are all debilitating and, in some cases, life-threatening disorders. The small intestine is also the site where food intolerance and food allergies are manifested.

Nursing care of patients with disorders of the small intestine will involve the usual reinforcement of medical diagnoses. Patients with acute gastrointestinal infections may require intensive care and will require attention to fluid and electrolyte levels as well as nutritional status if they are unable to eat normally. Advice on lifestyle change will be a major feature of nursing care for patients who have intolerant and allergic conditions.

BACKGROUND READING

Additional reading to support the material in this chapter can be found in the relevant sections of the following texts:

Alexander, M., Fawcett, J.N. and Runciman, P. (2000) Nursing Practice: Hospital and Home - the Adult. Churchill Livingstone, Edinburgh (Chapter 4).

Brooker, C. and Nicol, M. (2003) Nursing Adults: the Practice of Caring. Mosby, London (Chapter 22).

Clancy, J. and McVicar, A.J. (2002) Physiology and Anatomy: a Homeostatic Approach, 2nd edition. Arnold, London (Chapter 10).

Clancy, J., McVicar, A.J. and Baird, N. (2002) Perioperative Practice: Fundamentals of Homeostasis. Routledge, London (Chapter 2).

Haslett, C., Chilvers, E.R., Boon, N.A. and Colledge, N.R. (2002) Davidson's Principles and Practice of Medicine, 19th edition. Churchill Livingstone, Edinburgh (Chapter 17).

Hinchliff, S., Montague, S. and Watson, R. (1996) Physiology for Nursing Practice, 2nd edition. Bailliere Tindall, London (Chapter 5.1).

Kindlen, S. (2003) Physiology for Health Care and Nursing. Churchill Livingstone, Edinburgh (Chapter 9).

Kumar, P. and Clark, M. (2002) Clinical Medicine, 4th edition. Saunders, Edinburgh (Chapter 6).

McKenry, L.M. and Salerno, E. (1998) Pharmacology for Nursing, 20th edition. Mosby, St Louis (Unit 11).

Watson, R. (2000) Anatomy and Physiology for Nurses, 11th edition. Bailliere Tindall, London (Chapter 20).

EVIDENCE-BASED GUIDELINES

BSG (2002) Interim Guidelines for the Management of Patients with Coeliac Disease (http:// www.bsg.org.uk/clinical_prac/guidelines/coeliac.htm accessed 8 May 2004).

BSG (2003) Guidelines for the Investigation of Chronic Diarrhoea (Tests for Malabsorption), 2nd edition (http: / / www.bsg.org.uk/clinical_prac / guidelines / chronic_diarr.htm accessed 8 May 2004).

REFERENCES

Clark, M.L., Talbot, I.C., Thomas, H.J.W. and Williams, C.B. (2000) Tumours of the gastrointestinal tract. In: Concise Oxford Textbook of Medicine (Leadingham, J.G.G. and Worrell, D.A., eds), pp. 577-84. Oxford University Press, Oxford.

Heaney, M.R. (2000) Immune disorders of the gastrointestinal tract. In: Concise Oxford Textbook of Medicine (Leadingham, J.G.G. and Worrell, D.A., eds), pp. 591-95. Oxford University Press, Oxford.

Jewell, D.P. (2000) Coeliac disease. In: Concise Oxford Textbook of Medicine (Leadingham, J.G.G. and Worrell, D.A., eds), pp. 577-84. Oxford University Press, Oxford.

Misiewicz, J.J. and Punder, R.E. (2000) Peptic ulceration. In: Concise Oxford Textbook of Medicine (Leadingham, J.G.G. and Worrell, D.A., eds), pp. 530-37. Oxford University Press, Oxford.

Food Allergies

Food Allergies

Peanuts can leave you breathless. Cat dander can lead to itchy eyes, a stuffy nose, coughing and sneezing. And most of us have suffered through those seasonal allergies with horrible pollen counts. Learn more...

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