Download 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.