Med-Surg: Chapter 27: The Gastrointestinal System

Digestive acids and enzymes can be triggered into a hyper productive response for a number of reasons like:

-stress -poor dietary habits This excessive response can cause erosion of the gastric lining leading to the formation of gastric ulcers and colitis

When should IV fluid therapy be considered?

Only after the patient fails a PO fluid challenge or if they are physically unable to swallow

Antiemetics should be administered before offering:

PO fluids to prevent further exacerbation of vomiting

The gastrocolic reflex initiates elimination; it is stimulated by the ingestion of food. By tightening the voluntary anal sphincter; the reflex emptying of the rectum is:

stopped

Gallbladder:

stores bile. Located attached to the lower portion of the liver

Function of the rectum:

stores feces until eliminated through the anus

If lifestyle and dietary changes do not suffice in relieving gallstones:

surgical removal may be necessary

Pancreatic cancer has been noticed at a higher incidence with smokers, however:

the actual cause is not yet known

If less invasive strategies to relieve constipation are not successful:

the administration of an enema may be necessary

Food moves from the mouth through the pharynx and down the esophagus through ____

Peristalsis

What does getting vaccinated for hepatitis help with?

Preserving liver health

Moderating alcohol as well as surgical removal of a gallbladder with stones has been show to reduce the incidence of:

pancreatitis. Stones block the pancreatic duct and the backflow causes inflammation.

Maintaining a healthy body weight can:

prevent development of hiatal hernias that cause reflux

Age related degradation of the teeth can impede with:

proper mastication of food and lead to eating problems. Consequently, this leads to nutritional deficits

The liver is instrumental in:

protein metabolism, converting certain amino acids into different ones as needed for protein synthesis

What does the liver synthesize that is necessary for blood clotting?

prothrombin

What does the gastroesophageal (cardiac) sphincter prevent?

reflux from the stomach into the esophagus

Secretion of pancreatic enzymes is controlled by:

secretin and cholecystokinin, two substances secreted by the intestinal mucosa

Mild diarrhea is typically not treated and is:

self limiting with resolution of symptoms occurring a few days after the beginning.

Rapid weight loss diets have been linked to:

the development of gallstones

Accessory GI system organs are:

the liver, gallbladder, and pancreas

The organs of the GI system are:

the mouth, pharynx, esophagus, stomach, small intestine, large intestine, rectum, and anus

Portal vein:

transports all venous blood and nutrients absorbed from the small intestine to the liver

The internal anal sphincter at the top of the anal canal is under involuntary control; the external anal sphincter at the end of the anal canal is under:

voluntary control

Large intestine reabsorbs:

water and electrolytes, formulates some vitamin K, and eliminates waste products

The pancreatic acinar cells secrete digestive enzymes into ducts that connect with the....

pancreatic duct

Hepatitis B and C can be contracted through ______ and safe sex practice with barrier protection should be implemented to prevent contraction of these diseases

sexual intercourse

Due to the highly regenerative nature of the liver, prompt intervention can be successful in repairing any damage as long as:

some portion of the liver remains healthy and intact

Gallbladder can store up to:

50mL of bile

How long is the small intestine?

6 meters

Good hygiene practices can stave off:

GI infection

Prevention of GI disorders:

-well balanced diet sufficient in fiber and limited on highly processed foods and foods high in nitrates and nitrites as well as a diet heavy smoked and red meats

Elevated levels of amylase and lipase can signal what?

Pancreatitis

What calls for prophylactic treatment with stool softeners and encouraging fluid intake?

Using opioid analgesia as these can cause constipation

The gallbladder connects to the ______ that leads from the _______ to the ______.

1). common bile duct, 2). liver, 3). duodenum

Villi:

absorb digested food particles into the bloodstream. Located on the walls of the small intestine

Secretion of lipase from the pancreas _____, altering fat digestion, and may contribute to a __________ ___________ _________ in older adults.

1). decreases 2). depressed nutritional state

Chyme:

Partially digested, semiliquid food mixed with digestive enzymes and acids in the stomach.

Why should laxatives be used short term for constipation?

The body can become dependent on them and this will cause rebound constipation

Care of a patient with diarrhea:

-Fluid intake is encourage to replace what is lost -assess for s/s of electrolyte imbalance, especially potassium -introduce probiotics to reduce duration and prevent reoccurrence of diarrhea -Halt caffeine intake since it is a GI stimulant -High fiber foods should be avoided -Peanut butter and bananas should be eaten to thicken the stool -Frequent assessment of an incontinent patient with diarrhea -If diarrhea is infectious, underlying cause is treated

Chronic GI inflammation can trigger:

-GI bleeding -increased peristalsis -inadequate absorption of nutrients

Blockage in the GI system can be caused by:

-adhesions -tumors (benign or malignant) -obstruction of pancreatic and bile ducts

Liver cirrhosis is a disorder that is linked to heavy consumption of liver toxic substances like:

-alcohol -acetaminophen

Pancreatitis has been associated with:

-alcoholism -obesity -DM -cholelithiasis -hyperlipidemia

The major pancreatic enzymes:

-amylase -protease -trypsin -lipase

The liver is a large filter containing phagocytic Kupffer cells that remove:

-bacteria -damaged red blood cells -toxic materials from the blood

Methods to avoid constipation:

-choosing foods high in fiber -moderate exercise -adequate and consistent hydration

The patient should be provided with what supplies for mouth care?

-cups of fresh water -toothbrush -basin to spit into -mild mouthwash

Key points to understand about nausea and vomiting:

-excessive vomiting can exacerbate an already dehydrated patient or increase the chances of becoming dehydrated in those patients already at risk. -nausea can discourage PO intake and limit how much fluid is actually going to be replaced

Prevention of gallbladder disorders begins with:

-healthy dietary practices -maintaining a healthy weight -keeping foods low in fats and fiber -alcohol intake should be moderated while maintaining high calcium intake

The GI tract is susceptible to:

-infection -inflammation -trauma -structural defects (fistulas, torsion, blockage, post op adhesions, etc.)

A common disorder of the gallbladder is the occurrence of gall stones that can cause:

-irritation -inflammation of the gallbladder -obstruction of the bile duct

Effects of aging on the gastrointestinal system:

-muscles used for swallowing become weaker, food particles are retained in the cheek pouches or pharynx -esophageal is less efficient at opening and closing, increasing risk for aspiration -taste buds atrophy -After 70 years, parietal cells in the stomach decrease their secretion of HCl; enzyme and intrinsic factor also decrease. Lack of intrinsic factor may cause pernicious anemia -The mucosa of the small intestine becomes less absorptive, large intestine may develop diminished motility.

Females develop gall stones more frequently than men do and are typically associated with:

-poor dietary habits high in fatty foods -increases with age -obesity -having birthed several children

Causes of constipation:

-slowed gastric motility -dehydration

The islets of Langerhans, which are regions of endocrine tissue in the pancreas, secrete the hormones ______ and ______ into the blood. Insulin is essential to the metabolism of _____ and maintenance of ______.

1).insulin 2).glucagon 3).carbohydrates 4).electrolyte balance

How long is the larger intestine?

1.5 meters long

The liver may store how much blood?

200-400mL

The small intestine receives the chyme from the stomach, adds more digestive enzymes and fluids, receives biles and pancreatic enzymes from the common duct and further digests the chyme into a more liquid state.

FREE KNOWLEDGE CARD

Which virus in particular attacks the liver causing chronic inflammation and damage to the tissue which can result in impaired function?

Hepatitis

Catabolism:

Metabolic pathways that break down molecules, releasing energy.

Anabolism:

Metabolic pathways that construct molecules, requiring energy.

Which sphincter controls the release of food into the small intestine?

The pyloric sphincter

After gallstones have developed:

adopting healthier strategies prevent exacerbation of the disorder.

The liver synthesizes:

albumin, fibrinogen, globulins, and clotting factors

Gallstone incidence is higher in older adults due to:

an increase in biliary cholesterol related to diet and a tendency for dehydration

In situations where diarrhea doesn't resolve itself:

antidiarrheal medications are administered. Caution should be taken for overuse however as constipation may occur

The large intestine is populated with _____ that aid in breakdown of waste products.

bacteria

Adhesions:

bands of scar tissue joining two surfaces that are normally separated

Mucus, hydrochloric acid, intrinsic factor, pepsinogen, and gastrin are secreted into the stomach from cells within its walls and are mixed into the food to:

break down further the particles for absorption

Atrophy of taste buds leads to:

decreased appetite and lack of desire for food when eating further increasing the risk for nutritional deficits

Functions of the liver:

detoxifies and breaks down many compounds and drugs, preparing them for excretion; it alters ammonia, a by-product of protein metabolism, so that it does not harm the body

A more natural approach to constipation is:

drinking warm prune juice throughout the day

Excessive vomiting can rapidly bring along volume depletion quite rapidly, especially in the:

elderly, since the body carries less body water due to age related changes. Patients on diuretic therapy are also at greater risk.

Pancreas:

elongated, flat organ that sits behind the stomach and consists of a "head" and a "tail"

The liver manufactures and secretes bile and bile salts necessary to digest:

fat and fat-soluble vitamins

A natural approach to nausea is:

fresh ginger root brewed in a tea or candied ginger. Ginger has been proven to be effective as an antiemetic in cases of mild nausea and as a prophylactic.

Stress management can also help in the prevention and management of:

gastric ulcers

The liver plays a major role in:

glucose metabolism, removing excess glucose from the blood, converting it to glycogen, and then, as glucose is needed, converting glycogen back to glucose

The liver is a storage area for:

glucose, vitamins A, D, E, K, and B12, and iron

Maintaining sufficient activity, particularly in elderly population, can help promote:

healthy gastric motility while maintaining good abdominal muscle tone which helps maintain control of defecation and stave off bowel incontinence.

The liver receives blood directly from the digestive tract via the:

hepatic portal vein. All nutrients and oral medications pass through the liver before being distributed to other parts of the body.

The liver helps break down and excrete:

hormones, drugs, cholesterol, and hemoglobin from worn-out red blood cells

The liver is responsible for:

how drugs are metabolized

Patients should ambulate as soon as possible as:

immobility is a major contributing factor to constipation

Functions of the teeth and tongue:

instrumental in the chewing process, help break down food into smaller pieces

Moderating alcohol consumption as well as eliminating concurrent use with other liver toxic substances, like medications:

is crucial in preventing liver damage

How do PO fluids compare to IV fluids when treated a nauseated patient:

just as effective as fluids given by IV and should be considered first whenever possible.

Liver:

large organ located in the upper right quadrant of the abdominal cavity under the diaphragm; it is protected by the ribcage

The liver plays key roles in:

lipid metabolism, breaking down fatty acids and synthesizing cholesterol and phospholipids, and in converting excess carbohydrates and proteins into fats.

Traumatic injury to the liver can cause:

massive hemorrhage due to the highly vascular nature of the organ and its ability to store large amounts of blood

The intestine is lined with various receptors that interact with the:

nervous and endocrine systems

Pancreatic enzymes are essential to the digestion and absorption of:

nutrients from the small intestine