Transcript GI 32
Gastrointestinal, Hepatic, and Pancreatic
Systems Function, Assessment, and
Therapeutic Measures
Anterior View of Digestive System
Stomach: Anterior View and Partial
Section
Gastrointestinal Anatomy and
Physiology
Oral Cavity and Pharynx- mechanical digestion begins
in the oral cavity.
Esophagus
Stomach
Small Intestine
Large Intestine
Liver, Gallbladder, Pancreas, and
Duodenum
Liver Functions
Carb metabolism- stores glycogen
Amino acid metabolism- converts excess to urea to
be removed by kidneys.
Lipid metabolism- excretes excess cholestrol
Produces clotting factors prothrombin and
fibrinogen
Form bilirubin
Stores iron, copper, Vitamins A, E, D, K
Detoxification (alcohol, meds, ammonia)
Gallbladder/Pancreas Functions
Stores bile and contracts to secrete bile into
duodenum in response to cholecystokinin
Pancreas secretes digestive enzymes amylase,
lipase, trypsinogen, and bicarbonate juice
Gallbladder stores bile
Pancreas
Amylase- changes Starch to Maltose
Lipase – changes Emulsified Fats to Fatty Acids and
glycerol
Trypsinogen- changes to Trypsin in duodenum and
digests polypeptides to amino acids
Bicarbonate Juice- neutralizes hydrochloric acid as it
enters the deudenum
Aging and Gastrointestinal System
Tooth Enamel Harder/More Brittle
Tongue Atrophy-sweet/sour taste decrease
Saliva Production Decreased 33%
Esophagus Motility Less, Emptying Slower
Weaker Gag Reflex
Faulty absorption of B1, B12, calcium, iron
Aging and Gastrointestinal System
(cont’d)
Decreased Motility of Stomach
Decreased Gastric HCL Production
Fat Absorption Slower
Atrophy of Large/Small Intestine
Decreased Mucous Secretions
Decreased Elasticity of Rectal Wall
Data Collection: Subjective Data
Health History
Travel (Clostridium Difficile)
Elimination
Medications
Nutritional assessment
Family History
Cultural influences “Which foods do you most
commonly consume?”
Objective Data (cont’d)
Inspection- look
Jaundice, N/V, pain, distention
Auscultation- listen, normal BS 5-30 per min
Percussion- detect fluid, air or masses (usually NP
or Dr.)
Palpation- feel for masses, rigidity, pain
RUQ tenderness, distended
Appetite/wt changes, bowel changes, HT, Wt, body mass
Physical Assessment
Inspection
Striae- light silver colored or thin red lines on the
abdomen
Bruising
Caput medusae- bluish purple swollen vein
pattern extended out from navel
Spider angiomas- thin reddish-purple vein lines
close to the skin
Jaundice(icterus) yellowing of skin
Jaundice Pathophysiology
Destruction of old red blood cells yeild bilirubin
Liver converts bilirubin to water-soluble compound for
excretion
Jaundice (icterus) occurs if liver unable to convert
bilierubin and buildup occurs
may also occur if bile drainage obstructed
Abdominal Auscultation
Diagnostic Lab Tests
Laboratory Tests
CBC- reveals anemia or infection
Electrolytes- imbalance occurs from vomiting, diarrhea,
or malabsorption disorders
Carcinoembryonic Antigen (CEA)- monitor
effectiveness of GI cancer tx and reoccurrence
Liver Enzymes- ALT,AST increase indicates liver damage
Stool test-test for occult blood, false + with bleeding
gums and eating red meats
Diagnostic Tests (cont’d)
Radiographic Tests
Flat Plate of the Abdomen
Upper GI Series (Barium Swallow)
Lower GI Series (Barium Enema)
Computed Tomography (CT) Scan
Magnetic Resonance Imaging (MRI)
Nuclear Scan
Diagnostic Tests (cont’d)
Angiography
Liver Scan
Endoscopy
Esophagogastroduodenoscopy [EGD]
Cholangiopancreatography (ERCP)
Lower Gastrointestinal Endoscopy
Proctosigmoidoscopy
Colonoscopy
Gastroscopy
Endoscopic Retrograde
Cholangiopancreatography
Diagnostic Tests
Ultrasonography- will use lubricating gel on abd
with a tranducer that produces sound waves. A
picture of your abd will appear on a screen
Endoscopic Ultrasonography
Percutaneous Liver Biopsy
Oral Cholecystogram- (gallbladder series) if
gallstones. Pt ingests a radiopaque dye that collects
in the bile in the liver. Dye shows up in xray.
Pretest- high-fat diet x2 days, low-fat day before
test. Take tablets evening before test with water
5mins apart. NPO after MN
Therapeutic Measures
Gastrointestinal Intubation
Tube feedings- Gravity, bolus, pump
Gastrointestinal decompression
Total Parenteral Nutrition (intravenous
hyperalimentation
Feeding Tubes
NG Tubes
Purposes
Remove gas or fluids from stomach or intestines.
Obtain gastric secretions fro analysis
Tx obstructions or bleeding in GI tract
Provide means for nutrition (gavage feeding)
hydration, and medications.