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Med Surg Ch. 32

Gastrointestinal, Hepatobiliary, and Pancreatic Systems Function

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