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Med Surg Ch. 32
Gastrointestinal, Hepatobiliary, and Pancreatic Systems Function
Question | Answer |
---|---|
The hepatobiliary system consists of | liver, gallbladder and bile duct |
Saliva made of | mostly water; only digestive enzyme in saliva is amylase; lingual lipase |
Esophagus function | Peristalsis of the muscle layer in the wall propels food down to the stomach and through the intestines |
Lower esophageal sphincter | aka cardiac sphincter or esophageal sphincter |
Lower esophageal sphincter: incomplete closure causes what | gastric juice to splash up into the esophagus causes GERD, heartburn |
Stomach characteristics | Upper left abdominal quadrant; Reservoir for food, so digestion can occur gradually; Stomach mucosa has rugae; Mucosa has gastric pits, glands that produce gastric juice |
Gastric Juice made of what | water, mucus, pepsinogen, hydrochloric acid, gastric lipase, intrinsic factor |
Mucus function | helps form a bolus and protect mucosal lining |
Pepsinogen | inactive enzyme that activates to pepsin by hydrochloric acid; Pepsin begins the digestion of proteins to polypeptides |
Hydrochloric acid function | creates the pH of 1-2 that is necessary for pepsin to work and to kill most microorganisms that enter the stomach; it also denatures proteins |
Gastric lipase function | helps digest triglycerides |
Intrinsic factor function | aids in the absorption of vitamin B12 |
The three muscles that provide efficient mechanical digestion to change food into chyme | circular, longitudinal, and oblique |
Where is digestion completed | small intestine |
Where does bile from the liver and enzymes from the pancreas function | small intestine |
What happens when chyme enters the duodenum | intestinal mucosa produces the enzymes sucrose, maltase, lactase, peptidase, nucleosidases and phosphatases |
Function of sucrose, maltase and lactase | complete digestion of disaccharides to monosaccarides |
Function of peptidase | complete the digestion of proteins to amino acids |
Function of nucleosidases and phosphatases | complete the nucleotide digestion |
Function of small intestine’s extensive folds | absorb nutrients |
Where are water-soluble nutrients absorbed | into the blood in the capillary networks |
Where are fat-soluble vitamins (fatty acids and glycerol) absorbed | into the lymph in the lacteals |
What structures comprise the hepatobiliary system | liver, gallbladder, and bile duct |
Function of hepatic portal circulation | allows the liver to regulate blood levels of nutrients or to remove potentially toxic substances before the blood circulates to the rest of the body |
What is the only digestive (function of the liver) | production of bile by the hepatocytes |
Carbohydrate Metabolism (function of liver) | regulates the blood glucose level, stores excess glucose as glycogen and changes it back to glucose when the blood glucose level is low |
Amino Acid (function of liver) | Regulates the blood levels of amino acids; able to synthesize 12 of the 20 amino acids (nonessential amino acids) |
Lipid Metabolism (function of liver) | forms lipoproteins |
Synthesis of plasma proteins (function of liver) | synthesizes albumin, clotting factors, and globulins |
Phaocytosis by Kupffer Cells (function of liver) | These cells phagocytize worn erythrocytes, leukocytes and some bacteria |
Formation of Bilirubin (function of liver) | Form bilirubin from heme portion of worn erythrocytes; Removes bilirubin from the blood collected from the spleen and red bone marrow, excreted in the bile |
Storage function of the liver | Stores the mineral iron and copper and the fat soluble vitamins A,D,E, and K; and the water soluble vitamin B12 |
Detoxification (function of liver) | Liver synthesizes enzymes that alter harmful substances into less harmful ones |
What vitamin does the liver activate | vitamin D |
Aging and the Gastrointestinal System | taste; periodontal disease; less GI secretions; less motility; weak cardiac sphincter; Indigestion, constipation, hemorrhoid and diverticulosis may increase; more risk of colon cancer; Increase gallstones; Poor absorption vitamin B1, B12, calcium and iron |
Physical assessment of the oral cavity | Loose teeth can affect nutrition and obstruct the airway |
Physical Assessment: Auscultation | Bowel sound norm is 5-30 times per minute; hyperactive, hypoactive; absent is no sounds for 2-5 minutes in each quadrant |
Carcinoembryonic Antigen (CEA) | main laboratory work to see if cancer tx is working and for diseases of the liver |
Upper GI Series (Barium Swallow) | Exam of the esophagus, stomach, duodenum, jejunum using oral radiopaque contrast medium and fluoroscope |
Upper GI Series (Barium Swallow) used for what | detect strictures, ulcers, tumors, polyps, hiatal hernias and motility problems |
Upper GI Series (Barium Swallow) pre procedure indications | NPO for 6-8 hours before procedure, clear liquid supper; no smoking |
What is a contraindication for a barium enema | Severe active inflammatory disease of the colon or suspected perforation or obstruction |
Contraindications to use of laxatives and enemas | active GI bleeding |
Proctosigmoidoscopy contraindication for bowel pre | pts with bleeding or severe diarrhea |
Tube feeding nursing care for placement check | essential to preventing complications or death; need xray confirmation prior to using for the first time; subsequent placement checks can be done by pH check of aspirate |
Tube Feeding: what do you do if you find greater than 100 mL residual | stop the feeding and notify the RN or physician |
Therapeutic measures after GI surgery | no advantage to keeping a pt NPO until bowel function returns; nutrition can be provided to pt early postoperatively which may actually improve recovery with fewer complications |
Care of nasogastric, gastric and orogstric tubes | all need to be flushed periodically; use saline to flush to prevent electrolyte imbalance; flush to clear tube to prevent occlusion and to move tube away from gastric or intestinal wall to maintain patency |
Total Parenteral Nutrition | RN is responsible for administering TPN; started slowly for pancreas to adjust to insulin production for high amounts of glucose in the TPN; TPN is increased until the order rate is reached or as tolerated by pt |
What to monitor with TPN | glucose levels and signs of hyperglycemia |
Peripheral Parenteral Nutrition | used for less than 10 days when pt does ot need more than 2000 calories daily |
Indication for TPH/PPN | 10% or more weight loss; decrease of oral intake for more than 3 days; significant signs of protein, serum albumin levels < 3.2 g/dl; muscle wasting; decreased tissue healing; Persistent vomiting |