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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 |
Created by:
laotracuata
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