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Upper Gastrointestinal Disorders Module 4

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Title: Upper Gastrointestinal Disorders Module 4


1
Upper Gastrointestinal DisordersModule 4

2
Nausea and Vomiting
  • Nausea-conscious desire to vomit
  • Vomiting-ejection of emesis from upper GI tract

3
Nausea and VomitingEtiology
  • GI disorders
  • Non GI disorders
  • Pregnancy
  • Infections
  • CNS disorders
  • Cardiovascular disorders
  • Metabolic disorders
  • Stress
  • Medications
  • Motion

4
Nausea and VomitingPathophysiology
  • Vomiting center in brainstem
  • Chemoreceptor zone (CTZ) stimulated
  • Autonomic nervous system is activated
  • Sympathetic
  • Tachycardia
  • Diaphoresis
  • Parasympathetic
  • Relaxation of LES

5
Nausea and VomitingClinical Manifestations
  • Nausea-subjective
  • If vomiting prolonged
  • Dehydration
  • Water, electrolytes lost
  • Loss of extracellular fluid leading to
    circulatory collapse
  • Metabolic alkalosis can occur-gastric loss or
  • Metabolic acidosis if small intestine contents
    lost (less common)

6
Characteristics of Vomiting
  • Regurgitation-Partially digested food
  • Projectile-forceful expulsion without nausea
  • Fecal/intestinal-can be result of obstruction

7
Characteristics of Vomiting
  • Color
  • Coffee grounds-bleeding in stomach
  • Blood changes to dark brown as result of
    interaction with HCL
  • Bright red blood-active bleeding
  • Green-bile

8
Medications to Alleviate Nausea/Vomiting
  • Antimuscarinics
  • Scopolamine-patch
  • Antihistamines
  • Benadryl-can be given IV
  • Phenothiazines
  • Compazine-given IM

9
Medications to Alleviate Nausea/Vomiting
  • Antimuscarinics
  • Antihistamines
  • Phenothiazines
  • These classes have anitcholinergic effects
  • Common contraindications with these classes
  • Do not give to client with glaucoma, BPH (urinary
    retention), pyloric/bladder neck obstruction,
    biliary obstruction
  • Common side effects Dry mouth, constipation,
    hypotension, sedative effects

10
Medications to Alleviate Nausea/Vomiting
  • Metroloperamide (Reglan) and Domperidone
    (Motilium)
  • Antiemetics
  • Act on Dopamine receptors
  • Enhance release of acetylcholine
  • Increased gastric emptying (prokinetics)
  • Side effects of Reglan hallucinations, tremors,
    dyskinesias

11
Medications to Alleviate Nausea/Vomiting
  • 5-HT receptors-antagonists to serotonin receptors
  • Work peripherally and centrally to reduce
    vomiting
  • Used for Chemotherapy/radiation, migraine
    induced vomiting
  • Ondansetron (Zofran), granisetron (Kytril),
    dolasetron (Anzemet)

12
Oral Inflammations and Infections
  • Primary
  • Secondary
  • Chemotherapy
  • Good oral hygiene important

13
Oral Inflammations and Infections
  • Gingivitis
  • Vincents infection (trench mouth)
  • Oral candidiasis (thrush)
  • Herpes Simplex (cold sore)
  • Aphthous stomatitis (canker sore)
  • Parotiditis
  • Stomatitis (inflammation of the mouth)

14
Gingivitis
  • Etiology-
  • Neglected oral hygiene
  • Stress
  • Manifestations
  • Bleeding during tooth brushing
  • Pus
  • Loosening of teeth (peridonitis)
  • Treatment
  • Prevention, Dental care, dental rinses, flossing

15
Vincents Infection (Trench Mouth)
  • Etiology-
  • Bacteria/Neglected oral hygiene
  • Stress
  • Manifestations
  • Ulcerations that bleed
  • Increased saliva with metallic taste
  • Halitosis
  • Treatment
  • Prevention, Dental care, dental rinses H2O2,
    topical antibiotics, stress management

16
Oral Candidiasis (Thrush)
  • Etiology-
  • Candidiasis albicans
  • Immunosuppression
  • Manifestations
  • White patches in oral cavities
  • Treatment
  • Nystatin swish and swallow
  • Amphotericin B

17
Herpes Simplex (Cold Sore)
  • Etiology-
  • Herpes simplex I or II
  • Stress exacerbates
  • Manifestations
  • Vesicle formation
  • Treatment-antivirals
  • Zovirax

18
Aphthous Stomatitis (Canker Sore)
  • Etiology-
  • Chronic form of infection secondary to trauma,
    stress
  • Manifestations
  • Painful ulcers of lips
  • Treatment
  • Topical/systemic corticosteroids
  • Topical antibiotic

19
Parotiditis
  • Etiology-
  • Staph, Strep
  • Manifestations
  • Pain in gland/ear
  • Lack of saliva
  • Purulence
  • Treatment
  • Antibiotics
  • Mouthwashes
  • Lollipops to stimulate saliva production

20
Stomatitis(Inflammation of the Mouth)
  • Etiology-
  • Side effect of chemotherapy
  • Trauma
  • pathogens
  • Manifestations
  • Excessive salivation
  • Halitosis
  • Sore mouth
  • Treatment
  • Remove cause
  • Soothing mouth wash solutions
  • Bland diet

21
Oral Cancer
  • Common sites
  • Lower lip
  • Lateral border of tongue
  • Buccal mucosa
  • Etiology
  • Tobacco use
  • Chronic irritation
  • UV light-Cancer of the lip

22
Manifestations of Oral Cancer
  • LeukoplakiaSmokers patch
  • Erthroplakia
  • Sore that does not heal
  • Late
  • Pain especially moving jaw
  • Dysphagia
  • Cancer of the lip-induration
  • Pain in tongue when eating

23
Diagnostic/Treatment of Oral Cancer
  • Diagnosis
  • History and Physical
  • Biopsy of lesion/cytology
  • Toluidine test-blue dye is taken up by the cancer
  • Treatment
  • Chemo
  • Radiation
  • Surgery

24
Surgery for Oral Cancer
  • Radical Neck dissection
  • Involves removal of lymph nodes
  • Need tracheostomy
  • JP drains

25
Nursing Care of the Radical Neck Dissection Client
  • Airway monitoring
  • Monitor for bleeding
  • Nutritional considerations
  • Parenteral
  • Feeding tube
  • Tracheostomy care
  • Psychosocial
  • Pain management

26
Gastroesophageal Reflux (GERD)
  • Not a disease, but a syndrome
  • Clinically symptomatic condition resulting in
    reflux of gastric contents into lower esophagus

27
Gastroesophageal Reflux (GERD)--Etiology
  • Combination of factors
  • Hiatal hernia
  • Incompetent LES
  • Decreased esophagus clearance
  • Decreased gastric emptying
  • Medications
  • Results in esophageal irritation and inflammation

28
Gastroesophageal Reflux (GERD)Clinical
Manifestations
  • Varies from individual
  • Heartburn (pyrosis)
  • Burning, tight sensation
  • Can spread to jaw
  • May wake person from sleep
  • R/O cardiac causes first
  • Heartburn usually relieved with milk, alkaline
    substances
  • Wheezing, coughing, dyspnea, hoarseness
  • Lump in throat
  • Regurgitation-hot, bitter, sour liquid coming
    from mouth
  • Stomatitis
  • N/V

29
Gastroesophageal Reflux (GERD)Complications
  • Esophagitis
  • Esophageal stricture/scarring
  • Barretts Esophagusprecancerous lesion for
    esophageal cancer/adenocarcinoma
  • Bronchospasm
  • Aspiration pneumonia
  • Dental erosion

30
Gastroesophageal Reflux (GERD)Diagnostic Studies
  • History and Physical
  • Barium swallow
  • EGD
  • Use of Proton pump inhibitors as trial

31
Nursing Considerations for the Client with GERD
  • Smoking cessation
  • Avoid food that decrease LES pressure
  • fatty foods
  • Chocolate
  • Peppermint
  • Coffee
  • Tea
  • Milk
  • Avoid late night snacks
  • Small, frequent meals

32
Nursing Considerations for the Client with GERD
  • HOB 30 degrees
  • IV therapy
  • Weight reduction
  • Medication education
  • Advance diet

33
Pharmacological Intervention for GERD
  • Medications to
  • Improve LES function
  • Increase esophageal clearance
  • Decrease volume and acidity of reflux
  • Protect esophageal mucosa
  • Two approaches
  • Step upfrom antacids, H2blockers, PPI
  • Step down from PPI, H2 blockers, antacids

34
AntacidsMaalox, Mylanta, Milk of Magnesia
  • Partially neutralizes gastric acid
  • Does not coat stomach
  • Usually mixture of aluminum (causes constipation)
    and magnesium (causes diarrhea)
  • Caution magnesium solutions with renal disease
  • Decrease absorption of Digoxin, tetracycline, INH
  • May have to separate medication admin and
    antacids by one hour
  • Give 1 to 3 hours after meals and at bedtime for
    maximum effect

35
H2 Blockers
  • Rantidine (Zantac),Cimetidine (Tagamet),
    Famotidine (Pepcid), Nizatidine (Axid)
  • Decrease secretion of HCl acid by stomach
  • May increase toxicity of Coumadin, Theophylline,
    Dilantin
  • Side effects confusion

36
Proton Pump Inhibitors (PPI)
  • Omeprazole (Protonix), Esomeprazole (Nexium)
  • Inhibit proton pump mechanism responsible for
    secretion of H ion
  • May increase effects of Dilantin, Coumadin
  • Give on empty stomach

37
Antiulcer Medication
  • Sucralfate (Carafate)
  • Cytoprotective agent
  • Adheres to an ulcer site
  • Give 1 hour before meals and at bedtime
  • Do not crush/Liquid form available
  • Side effect constipation, dizziness

38
Prokinetic (Reglan)
  • Facilitates gastric emptying
  • Side effect Hallucinations, anxiety,
    restlessness, insomnia

39
Surgical/Endoscopic Therapy for GERD
  • Surgical
  • Antireflux procedures
  • Nissen fundoplication
  • Endoscopic
  • Stretta procedure-induces collagen formation,
    forms barrier against reflux

40
Hiatal Hernia
  • Herniation of portion of stomach into esophagus
    through opening in diaphragm
  • Types
  • Sliding
  • Paraesophageal/rolling

41
Etiology of Hiatal Hernia
  • Factors
  • Structural changes
  • Obesity
  • Pregnancy
  • Heavy lifting

42
Clinical Manifestations of Hiatal Hernia
  • May be asymptomatic
  • Heartburn
  • Dysphagia
  • Reflux with lying down
  • Pain, burning when bending over

43
Hiatal Hernia
  • Diagnostic studies
  • Barium swallow
  • Endoscopy
  • Surgical intervention
  • Nissen fundoplication

44
Complications of Hiatal Hernia
  • GERD
  • Hemorrhage
  • Stenosis of esophagus
  • Ulcerations
  • Strangulation of hernia
  • Regurgitation
  • Increased risk for respiratory disease

45
Esophageal Cancer
  • Rare malignancy
  • Barretts Esophagus-risk for malignancy
  • Etiology
  • Unknown
  • Risk factors
  • Smoking
  • Excessive ETOH
  • Achalasia (delayed emptying of lower esophagus)
  • Majority of tumors located in middle and lower
    portions of esophagus

46
Clinical Manifestations of Esophageal Cancer
  • Usually late
  • Progressive dysphagia
  • Pain
  • Sore throat
  • Hoarseness
  • Weight loss
  • Regurgitation of blood tinged esophageal contents

47
Complications of Esophageal Cancer
  • Hemorrhage
  • Esophageal perforation
  • Esophageal obstruction

48
Diagnostic Studies Esophageal Cancer
  • Barium swallow with fluoroscopy
  • Endoscopy
  • Bronchoscopy
  • CT
  • MRI

49
Nursing Considerations for the Client with
Esophageal Cancer
  • Poor prognosis
  • Combination of surgery, chemotherapy, radiation
  • Surgery
  • Esophagectomy-
  • Remove esophagus, graft to resect
  • Esophagogastrostomy
  • Resect esophagus to stomach
  • Esophagoenterostomy
  • Resect esophagus to colon
  • Dilation of esophagus
  • Parenteral fluids for nutrition
  • Pain management

50
Post-op Nursing Considerations for the Client
with Esophageal Cancer
  • NGT-bloody drainage 8 to 12 hours then turns to
    greenish
  • Do not reposition NGT
  • Airway assessment-T,C,D,B
  • Semi-Fowlers

51
Esophageal Diverticula
  • Saclike outpouching of one or more layers of the
    esophagus
  • Zenkers diverticulum
  • Most common of esophageal diverticulum
  • Located above the upper esophageal sphincter
  • Symptoms
  • Dysphagia
  • Weight loss
  • Regurgitation
  • Chronic cough
  • Aspiration

52
Esophageal Diverticula
  • Treatment
  • Clients learn to empty esophagus by applying
    pressure
  • Limit foods (blenderize)
  • Endoscopic Surgery

53
Esophageal Stricture
  • Most common-formation of scar tissue from
  • Strong acid/alkaline ingestion
  • Reflux
  • Treatment
  • Dilation via endoscopy using bougies
  • Balloon dilation
  • Calcium Channel blockers can help to relax smooth
    muscle

54
Achalasia
  • Peristalsis of the lower two thirds of the
    esophagus resulting in
  • Dilation of the lower esophagus
  • Symptoms
  • Dysphagia
  • Halitosis
  • Regurgitation of sour foods
  • Symptoms similar to GERD

55
Achalasia
  • Diagnosis
  • Endoscopy
  • Treatment
  • Dilation
  • Surgery
  • Bland diet
  • Esophageal dilation
  • Heller myotomy (reduces LES pressure)
  • Anticholinergics
  • Calcium channel blockers
  • Botox?

56
Disorders of the Stomach and Small Intestine
  • Gastritis
  • Upper GI bleed
  • Peptic Ulcer disease
  • Gastric ulcers
  • Duodenal Ulcer
  • Gastric Cancer
  • Food Poisoning

57
Gastritis
  • Inflammation of gastric mucosa
  • Acute or Chronic
  • Three types of chronic
  • Autoimmune
  • Diffuse antral
  • Multifocal

58
Etiology of Gastritis
  • Breakdown in normal gastric mucosa from
  • Medications i.e. ASA, steroids, NSAIDs
  • Diet i.e. spicy, ETOH
  • Microorganisms i.e.. H. Pylori, Salmonella, Staph
  • Smoking
  • Pathophysiology i.e. burns, stress, renal
    failure, sepsis, shock
  • Trauma i.e. NGT, endoscopy

59
H. Pylori
  • Client may be asymptomatic
  • Believed to be acquired in childhood and survives
  • Can play a major role in gastritis, peptic ulcer,
    duodenal ulcer
  • H. Pylori secretes urease that protects it from
    being destroyed in acid environment

60
Antibiotics Used to Treat H. Pylori
  • Amoxicillin
  • Flagyl (metronidazole)
  • Tetracycline
  • Biaxin (Clarithromycin)

61
Manifestations of Gastritis
  • Acute gastritis
  • Anorexia
  • Nausea
  • Vomiting
  • Epigastric tenderness
  • Feeling of fullness
  • Chronic gastritis
  • May be asymptomatic
  • Loss of intrinsic factor lead to s/s of B 12
    deficiency--anemia

62
Diagnostic Studies of Gastritis
  • History and Physical/ Social history
  • ETOH
  • Smoking
  • Endoscope
  • H. Pylori testing
  • CBC
  • Stool for occult blood
  • Cytology
  • Gastric analysis-decreased or absent HCL
  • Antibodies to parietal cells and intrinsic factor

63
Nursing Care of the Client with Acute Gastritis
  • May be NPO or NGT
  • IV fluids
  • Antiemetics
  • VS, check for bleeding
  • Antacids
  • H2 blockers
  • Proton pump inhibitor
  • Tritec-Proton pump inhibitor plus bismuth

64
Nursing Care of the Client with Chronic Gastritis
  • Eliminate specific cause i.e. ETOH
  • Eradicate H. Pylori
  • Different protocols
  • Antibiotics i.e. Amoxicillin
  • Proton pump inhibitor
  • Antiinfectives i.e. Flagyl
  • Six small meals a day
  • Antacids
  • No Smoking

65
Upper GI BleedPathophysiology
  • Can be sudden or gradual
  • Severity depends on what type of bleed
  • Arterial
  • Bright red (not in contact with stomach)
  • Large amounts
  • Coffee ground-In stomach for some time
  • Longer the passage of blood through intestine,
    the darker the stool

66
Upper GI BleedPathophysiology
  • Massive GI bleed
  • 1500 ml or 25 of intravascular blood volume
  • Hematemesis-bright red blood or coffee grounds
  • Melena-Black, tarry stools, slow bleeding from
    upper GI
  • Occult bleed-small amounts of blood in vomit,
    stool, etc. not detectable by sight

67
Upper GI BleedEtiology
  • Medications-ASA, NSAIDs, steroids
  • Esophagus-Esophageal varicies, Esophagitis,
    Mallory-Weiss tear
  • Gastric Cancer
  • Hemorrhagic gastritis
  • Peptic ulcer disease
  • Polyps
  • Stress ulcer
  • Blood dyscrasias
  • Renal failure

68
Esophageal Bleeding
  • Mallory-Weiss tear
  • Caused by severe retching and vomiting
  • Tear occurs at the junction of the esophagus and
    stomach
  • Esophageal varicies
  • Usually secondary to cirrhosis of the liver
  • Anything that increase pressure i.e. coughing can
    start massive bleed

69
Stomach and Duodenal Bleed
  • Bleeding ulcers-majority of upper GI bleeds
  • Physiological stress ulcers
  • Burns
  • Surgery
  • Medications

70
Emergency Treatment for the Client with an Upper
GI Bleed
  • VS (frequent), cap refill, urinary output
  • Abdominal assessment
  • Presence/absence of bowel sounds
  • Rigid, boardlike abdomen-emergency, can indicate
    perforation
  • HP
  • CBC, BUN, Chemistry, ABGs, coagulation studies,
    liver studies
  • Multiple IV lines with large guage
  • Fluids (LR)

71
Emergency Treatment for the Client With an Upper
GI Bleed
  • Type and cross/transfuse
  • O2
  • Foley
  • CVP line
  • Gastric lavage
  • To OR or Endoscopy

72
Diagnostic Studies/Treatment for Upper GI Bleed
  • Endoscopy
  • Can coagulate/thrombose area
  • Surgery
  • Angiography
  • Medications
  • Proton pump inhibitors
  • H2 blockers
  • Pitressin
  • Sandostatin

73
Pharmacological Intervention for Upper GI Bleed
  • Pitressin
  • Creates vasoconstriction
  • Continuous IV drip
  • Titrate for effectiveness
  • Sandostatin
  • Suppresses secretion of HCL

74
Peptic Ulcer Disease
  • Erosion of the GI mucosa from the digestive
    action of HCL acid and pepsin
  • Types
  • Acute-superficial erosion/minimal inflammation
  • Chronic-Long duration, erosion through muscular
    wall, fibrous tissue formation
  • Both gastric and duodenal ulcer fall into this
    category

75
Peptic Ulcer DiseaseEtiology
  • Peptic ulcers only develop in acid environments
  • Cause of disease same as for upper GI bleed

76
Peptic Ulcer DiseasePathophysiology
  • Pesinogen converts to pepsin in acid environment
  • Mucosal barrier impaired from previously
    mentioned causes
  • H. Pylori can also destroy mucosal barrier
  • As mucosal layer is impaired, increase in
    bloodflow
  • Increased vasodilation
  • Tissue damage occurs
  • Emotions increase secretion of HCL

77
Gastric Ulcers
  • Most commonly found on less curvature of stomach
  • Superficial lesion
  • Gastric secretion normal to low
  • Greater in women 50-60 years old

78
Clinical Manifestations/Complications of Gastric
Ulcers
  • Burning or gastric pressure in high epigastrum
  • Pain 1-2 hours after meals
  • N/V
  • Weight loss
  • Complications
  • Hemorrhage
  • Perforation

79
Duodenal Ulcer
  • Majority of all peptic ulcers
  • More in men 35-45 years
  • High acid secretion
  • Disease that increase risk of developing duodenal
    ulcers
  • COPD
  • Cirrhosis
  • Pancreatitis
  • Renal Failure
  • Hyperparathyroidism
  • Zollinger-Ellison syndrome

80
Duodenal Ulcer
  • Penetrating lesion usually found in first 1-2 cm
    of duodenum
  • Greater in men
  • Associated with stress
  • Increase with ETOH, smoking

81
Zollinger-Ellison Syndrome
  • Severe peptic ulceration
  • Gastric acid hypersecretion
  • Increased serum gastrin levels
  • Gastrinoma of the pancreas/duodenum

82
Clinical Manifestations of Duodenal Ulcers
  • Clinical manifestations
  • Burning, cramping across midepigastrum and upper
    abdomen
  • Back pain
  • Pain 2-4 hr after meals and midmorning, middle of
    night
  • Relief with food antacids
  • N/V

83
Complications of Peptic Ulcer Disease
  • Hemorrhage
  • Perforation-most lethal, severe abdominal pain
    that spreads throughout abdomen, shoulder pain,
    absent bowel sounds
  • Obstruction

84
Diagnostic Studies of Peptic Ulcer Disease
  • Endoscopy
  • Tests for H.Pylori
  • Invasive
  • Tissue specimens
  • Rapid urease test
  • Nonivasive
  • IgG
  • Urea breath test (by product of H.Pylori)
  • Barium swallow/X-rays- not accurate

85
Treatment of Peptic Ulcer Disease
  • Discontinue medications if possible that
    exacerbate condition
  • No smoking/ETOH
  • Avoid spicy/acid foods, black pepper, small
    frequent meals
  • Medications
  • H2 Blockers
  • Cytotec (antisecretory and cytoprotective)
  • Cytoprotective agents (Carafate)
  • Antacids
  • Antibiotics for H. Pylori
  • Treat stress
  • Antidepressants?
  • Surgery

86
Treatment of Peptic Ulcer Disease-Surgery
  • Not usual course of treatment
  • Gastroduodenostomy (Biliroth I)-Partial
    gastrostomy
  • Gastrojejunostomy (Biliroth II) antrum and
    pylorus removed, preferred method for duodenal
    ulcer
  • Vagotomy-sever Vagal nerve
  • Pyroplasty-enlarge pyloric sphincter

87
Peptic Ulcer DiseasePost op Complications
  • Avoid Dumping syndrome by
  • Small meals, no liquids with meal
  • Dry foods, low carbs, moderate protein, fats
  • Avoid Postprandial hypoglycemia by
  • If hypoglycemic occurs, candy
  • Follow diet for dumping syndrome
  • Bile reflux gastritis
  • Notify Health care provider if epigastric
    distress similar to pre op

88
Gastric Cancer
  • Adenocarcinoma of the stomach wall
  • Usually men in advanced stage
  • Etiology
  • Unknown
  • ? High spice, high smoked foods
  • Pathophysiology
  • Nonspecific mucosal injury
  • Predisposing factors
  • Atropic gastritis
  • H.Pylori at early age
  • Gastric Polyps
  • Pernicious anemia
  • Achlorhydria

89
Clinical manifestations of Gastric Cancer
  • Usually late in disease process
  • Signs/symptoms of anemia
  • Pallor
  • SOB
  • Fatigue
  • Signs/symptoms of peptic ulcer disease
  • Burning pain, alleviated by antacids
  • Weight loss
  • Dysphagia
  • Later
  • Papable mass in abdomen
  • Enlarged hard lymph nodes

90
Acute exacerbation of Peptic Ulcer Disease
  • Frequent VS
  • NGT
  • Several IV lines (Large bore)
  • Crystalloid/colloid solutions (LR)
  • CBC, Chemistries, ABGs
  • O2
  • Type and Cross Match
  • Emergency care as per client needs
  • Perforation-OR

91
Diagnostic Studies of Gastric Cancer
  • HP
  • Upper GI barium
  • Endoscopy-biopsy/cytology/US
  • CBC, Chemistries, Stool specimens
  • Tumor markers-CEA, CA 19-9

92
Treatment of Gastric Cancer
  • Surgery removal of tumor
  • Chemo/radiation ? Success
  • Treat symptoms
  • Pain
  • Correct anemia

93
Food Poisoning
  • Types
  • Acute gastroenteritis
  • Neurological symptoms from botulism

94
Responsible Microorganisms of Food Poisoning
  • Staph
  • Onset-30 min-7hr
  • Symptoms-N/V, diarrhea
  • Prevent Refrigerate foods
  • Clostridium
  • Onset-8-24 hr
  • Symptoms-Nausea with no vomiting, diarrhea
  • Prevent Correct preparation of meat

95
Responsible Microorganisms of Food Poisoning
  • Salmonella
  • Onset-8hr-days
  • Symptoms-n/V fever
  • Prevent Proper preparation of poultry, pork,
    beef
  • Botulism
  • Onset 12-36 hr
  • Symptoms GI, CNS symptoms
  • Prevent Correct processing of canned foods

96
Responsible Microorganisms of Food Poisoning
  • E. Coli
  • Onset 8hr-1wk
  • Symptoms Bloody stools, hemolytic uremic
    syndrome, profuse diarrhea
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