Chapter 32 Gastrointestinal Hepatic and Pancreatic Systems Function

Chapter 32 Gastrointestinal, Hepatic, and Pancreatic Systems Function, Assessment, and Therapeutic Measures Copyright © 2015. F. A. Davis F. A. Company Copyright © 2015. Davis Company

Anterior View of the Digestive System Copyright © 2015. F. A. Davis Company

Stomach: Anterior View and Partial Section Copyright © 2015. F. A. Davis Company

Gastrointestinal Anatomy and Physiology · · · · Oral Cavity-mechanical digestion begins Esophagus Stomach Small Intestine Large Intestine Acessory organs of digestion Produce or store digestive secretions Copyright © 2015. F. A. Davis Company

Liver, Gallbladder, Pancreas, and Duodenum Copyright © 2015. F. A. Davis Company

Liver Functions · Carbohydrate Metabolism- stores glycogen · Amino Acid Metabolism- converts excess to urea to be removed by kidneys · Metabolize lipids -excretes excess Cholesterol · Produces prothrombin and Fibrinogen · Formation of Bilirubin · Stores iron, copper, Vitamin A, D, E, K · Detoxification (alcohol, meds, ammonia) Copyright © 2015. F. A. Davis Company

Gallbladder/ Pancreas Functions · Gallbladder stores bile and contracts to secrete bile into duodenum in response to cholecystokinin · Pancreas secretes digestive enzymes amylase(changes starch to maltose), Lipase(Turn emulsified fats to fatty acids), trypsinogen( changes to trypsin in duodenum & digests polypeptides to amino acids), and bicarbonate juice(neutralizes hydrochloric acid as it enters duodenum) Copyright © 2015. F. A. Davis Company

Aging Effects on the Gastrointestinal, Hepatic, and Pancreatic Systems Copyright © 2015. F. A. Davis Company

Aging and the Gastrointestinal System · · · · Tooth Enamel Harder/More Brittle Tongue Atrophy Sweet Taste Sensation Lost Saliva Production Decreased 33% Esophagus Motility Less, Emptying Slower Weaker Gag Reflex Decreased Motility of Stomach Decreased Gastric HCL Production Copyright © 2015. F. A. Davis Company

Aging and the Gastrointestinal System (cont’d) · · · Fat Absorption Slower Atrophy of Large/Small Intestine Decreased Mucous Secretions Decreased Elasticity of Rectal Wall Weakness of Intestinal Wall Faulty Absorption of Vitamins B 1 and B 12, Calcium, Iron Copyright © 2015. F. A. Davis Company

Assessment- Subjective data · Health History ‒ Travel- Clostridium Difficile ‒ Elimination ‒ Medications · Nutritional Assessment · Family History · Cultural Influences- “Which foods do you most commonly consume? ” Copyright © 2015. F. A. Davis Company

Physical Assessment- Objective · Inspection- Look ‒ Jaundice, N/V, pain, distention · Auscultation- Listen normal BS 5 -30 min. · Percussion-detect fluid, air, or masses · Palpation- feel for masses, rigidity, pain ‒ Abdominal Girth ‒ Distention, tenderness, appetite/wt changes, Copyright © 2015. F. A. Davis Company

Physical Assessment (cont’d) · Inspection ‒ Striae- “stretch marks” red or silver colored lines ‒ Caput medusa- bluish purple lines from abdomen ‒ Spider angiomas- thin reddish purple lines close to skin surface ‒ Petechiae ‒ Jaundice- old RBC destroyed, yields bilirubin. Liver converts bilirubin to water-soluable compound for excretion. Jaundice (icterus) occurs if liver unable to convert bilirubin and build up occurs. May occur if bile drainage obstructed. Copyright © 2015. F. A. Davis Company

Diagnostic Tests · Laboratory Tests ‒ CBC ‒ Electrolytes ‒ Carcinoembryonic Antigen (CEA) ‒ Bilirubin ‒ Liver Enzymes ‒ Pancreatic Enzymes ‒ Stool Tests ‒ Gastric Analysis Copyright © 2015. F. A. Davis Company

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 ‒ Nuclear Scan/Liver Scan ‒ Angiography Copyright © 2015. F. A. Davis Company

Diagnostic Tests (cont’d) · Endoscopy ‒ Esophagogastroduodenoscopy (EGD) ‒ Endoscopic Retrograde Cholangiopancreatography (ERCP) ‒ Lower Gastrointestinal Endoscopy § Proctosigmoidoscopy § Colonoscopy § Liver Biopsy Copyright © 2015. F. A. Davis Company

Gastroscopy Copyright © 2015. F. A. Davis Company

Endoscopic Retrograde Cholangiopancreatography Copyright © 2015. F. A. Davis Company

NG Tubes · Decompression- remove gas or fluids from stomach or intestines · Obtain gastric secretions for analysis · Lavage- treat bleeding in GI tract · Provide means for nutrition (gavage feeding), hydration, and medications. Copyright © 2015. F. A. Davis Company

Feeding Tubes Copyright © 2015. F. A. Davis Company

Therapeutic Measures · Enteral Nutrition- Gravity, pump, bolus, intermittent, continuous · Placement Check · Residual · Parenteral Nutrition- Central (TPN) or peripheral IV route (PPN) Copyright © 2015. F. A. Davis Company