CH 17 & 18: digestive and urinary systems Flashcards
Carbohydrate metabolism generates
ATP
lipid metabolism provides
energy storage and release
protein metabolism provides
amino acids
Adequate nutrition relies on
optimal intake
digestion
absorption
transportation of nutrients,
excretion of waste products.
Once the food goes through the process of digestion, the extracted nutrients are made suitable for
absorption and transportation.
process of ingesting and utilizing nutrients for energy.
Nutrition
Metabolism allows chemical
reactions that do three things
(1) produce heat to maintain body temperature
(2) conduct neural impulses
(3) contract muscles.
Nutrition also provides the substances needed for the
growth, repair, and
maintenance of cells.
Water functions to:
- Serve as a solvent promoting the availability of solutes to the cell
- Promote and maintain fluid balance
- Provide a transport medium for nutrients and wastes
- Serve as a lubricant
- Contribute to the regulation of body temperature
- Provide the foundation for metabolic reactions
- Contribute to the structure of cells and the circulatory system
The major macronutrients that are converted to usable sources of energy are:
proteins, lipids, and
carbohydrates.
proteins are broken down into :
amino acids and absorbed into circulation
how many amino acids are essential and required in the diet
9
dietary fats:
support -
stimulate -
supports digestion by decreasing gastric motility and secretions
stimulates pancreatic enzymes and bile secretion to facilitate digestion, absorption, and transportation of fat-soluble vitamins.
Essential fatty acids influence:
plasma membrane fluidity
receptor function
enzyme activity
cytokine production.
considered an essential fatty acid and has been demonstrated to reduce many disease states, including heart disease.
Linoleic acid
digested and converted into glucose
carbohydrates
what are two actions of glucose after digested
- where about 50% is used for oxidation or stored as glycogen
- exits the liver and is circulated throughout the body to be used by cells for energy.
major role of carbohydrates
provide energy
organic substances that the body is unable to manufacture (for the most part) and,
therefore, must be consumed. (
Vitamins
fat soluble vitamins
ADEK
Vitamin K function
coagulation of the blood
Thiamin B1 function
regulation of neural function
Folate functions
DNA RNA synthesis
red blood cells and white blood cells in bone marrow
Cobalamin functions
metabolism of all cells, GI tract, bone marrow, nervous tissue
major roles of vitamins are to help develop
genetic materials, red blood cells, hormones, collagen, and nervous
system tissue.
Minerals constitute
bone, hemoglobin, enzymes, hormones, and chemical mediators.
macrominerals include
sodium, potassium, calcium, phosphorus, magnesium, and sulfur.
microminerals include
iron, zinc, fluoride, and copper.
Hunger and satiety are regulated in the brain by the
hypothalamus, based on feedback from the gastrointestinal tract on the quantity and quality of food in the stomach and intestines
digestion is essential for what 3 functions
(1) digesting and extracting macronutrients
(2) absorbing nutrients
(3) forming a physiologic and chemical barrier against microorganisms and other foreign materials introduced during food ingestion.
stomach acids are a part of which line of defense
first
by destroying many types of microorganisms and other
harmful substances on contact
Four major secretory cells are found in the stomach:
Mucous cells, which secrete alkaline mucus and protect the epithelium from stress and acid
contact (protection from stomach acid)
Parietal cells, secrete both hydrochloric acid, a strong acid needed to activate pepsinogen and
destroy pathogens, and intrinsic factor, a glycoprotein needed for intestinal absorption of
vitamin B12 -INTRINSIC FACTOR
Chief cells, which secrete pepsin, a proteolytic enzyme critical to protein digestion
G cells, which secrete gastrin, a hormone responsible for controlling acid secretion and
stimulating gastric motility
complex process of taking in nutrients and moving these to the circulation to be used by cells.
Absorption
Small intestine contains:
duodenum contains the
openings for the bile and
pancreatic ducts
Jejunum is 8 ft long
Ileum is 12 ft long
Ends in the cecum
Large Intestine includes:
5 feet long
Absorbs water and eliminate
waste
Intestinal bacteria vital role in
the synthesis of some B and K
vitamins
Colon includes the ascending,
transverse, descending
sigmoid and rectum
altered nutrition possible causes
Genetic defects that impact metabolism or absorption of nutrients
Malformation or damage to the gastrointestinal mucosa
Inadequate or excessive dietary intake of required nutrients
Excessive nutrient losses, such as through vomiting, diarrhea, or laxative use
Hypermetabolic states that exert excessive demands, such as with hyperthyroidism, cancer,
burns, fever, or severe infection
Malabsorptive syndromes
Ingestion of unsafe food and water
lack of nutrient intake most often related to inadequate calorie consumption, inadequate intake of essential vitamins and minerals, or problems with digestion, absorption, or
distribution of nutrients in the body.
Undernutrition
most common nutrients that are
inadequately consumed or in great demand in those presenting with undernutrition.
Protein, iron, and vitamins
Protein malnutrition related to:
Marasmus deprivation of all food, a condition of starvation
Kwashiorkor persons consuming adequate carbohydrates
dietary glucose is unavailable for
glucose-dependent tissues, such as the brain and muscle tissue
in marasmus
lack of movement of specific nutrients across the gastrointestinal mucosa.
Malabsorption
Carbohydrate malabsorption is often the result of
pancreatic enzyme deficiencies
absence or reduction of brush border disaccharidases
congenital deficiency of the glucose–galactose transporter
bacterial flora overgrowth in the intestine.
clinical manifestations of altered immunity
weight loss
muscle weakness
muscle wasting
dehydration
fatigue
vitamin and mineral deficiencies
digestive system labs
a complete blood count with red blood cell indices
peripheral smear
sedimentation rate (to detect inflammation)
serum electrolytes
urinalysis
urine culture.
protein status, including serum albumin, transferrin, creatinine, and blood urea nitrogen (BUN) levels.
reduction in the number of circulating blood cells and subsequently reduced hemoglobin levels
anemia
represents a problem of iron demand on red blood cell development that cannot be met with current iron stores.
Iron-deficiency anemia
clinical manifestations of IDA
manifestations include pallor of the skin and mucous membranes
fatigue
weakness
lightheadedness
breathlessness
palpitations
headache
tachycardia
syncope
brittle hair
nails and mouth sores.
craving to chew or eat substances of non-nutritive value, such as chalk, soil, clay, or paper
Pica.
form of pica in which the person chews ice.
Pagophagia
Excessive body fat
Major contributor to morbidity and mortality
Health crisis
Obesity
the primary cell involved in obesity, are highly active metabolic, endocrine, and inflammatory cells.
Adipocytes
clinical manifestations of obesity
excess weight and body fat
comorbidities of obesity
diabetes
heart disease
hypertension
hyperlipidemia
stroke
osteoarthritis
liver disease
gallstones
poor wound healing
sleep apnea
certain cancers
functional units of the kidneys, forming urine through filtration, reabsorption, and secretion.
Nephrons.
2 primary roles of the kidneys
Regulation of body fluid and the balance between acids and bases
waste product produced by the kidneys, stored in the bladder, and excreted via the urethra through a complex interplay between neural, motor, and hormonal mechanisms
urine
basic processes of the renal system
- Regulation of body fluid volume and composition
- Elimination of metabolic wastes
- Synthesis, release, or activation of hormones
- Erythropoietin
- Renin
- Vitamin D
- Regulation of blood pressure
functions of nephrons
Filter water-soluble substances from the blood
Reabsorb filtered nutrients, water, and electrolytes
Secrete waste
functions of the kidneys
Maintain acid-base
Excrete the end products of body metabolism
Control fluid and electrolytes
Excrete bacterial toxins, water-soluble medications, and the metabolites of medications
Secrete renin to regulate blood pressure RAAS
Synthesize Vitamin D so calcium can be absorbed
Secrete erythropoietin to stimulate the bone marrow to make RBCs
homeostasis of water
ADH reabsorption of water stimulated by dehydration, sodium concentration, or decrease in
blood volume
Lack of ADH = Diabetes insipidus
homeostasis of sodium
When sodium increases extra water is retained
This increases blood volume and increases BP
BP increases gfr increases
RAAS controls the reabsorption of sodium and stimulates the release of aldosterone
Aldosterone also increases the amoung of K in the blood
ureters composed of:
Bladder composed of:
Ureters composed of smooth muscle
Bladder composed of detrusor muscle and sphincters
urinalysis components
pH
Specific gravity
Protein
Glucose
Ketones
Nitrite
Leukocyte esterase
Microscopic analysis includes crystals, casts squamous cells, WBCs and RBCs
should not be found in urine:
o Glucose
o Ketones
o Nitrite
o Bacteria
o Leukocyte esterase
o Crystals
o Stones
o protein
possible motility issues of urine
Results in stasis of urine in the bladder and the kidney
Can cause precipitation (solid substances to form from fluid
Blockage
Pyelonephritis and acute tubular necrosis
Inadequate arterial blood supply
ischemia or infarction
The consequences of obstruction are influenced by the:
o Degree of the obstruction (complete or partial)
o Duration of the obstruction
o Acuity or chronicity of the condition
possible complication of a patency issues
Can lead to structural damage impaired function
Can lead to ischemia and necrosis
Can lead to obstruction of urine flow
Can lead to dilation injuries – hydronephrosis – decreased GFR and decreased function
Can developed within 24 hours
Can also lead to infection, sepsis and loss of function
stasis of urine behind the obstruction of renal structures, ureters, or urethra
urinary obstruction
collection of gas and fluid behind the obstruction
intestinal obstruction
signs and symptoms of obstructive disease
Altered volume of urine
Altered urine characteristics
Bleeding
Pain
Distension
Anorexia
Nausea
Vomiting
Fever
patho indications for altered urinary elimination
proteinuria
glucosuria
ketonuria
hematuria
pyuria
bacteriuria
Laboratory analysis of stool
may include:.
microscopic examination or chemical evaluation.
Color, consistency, volume, shape, and odor should be consistent with characteristics described previously.
Increased motility may impair:
nutrition
may enhance loss of water and electrolytes.
Decreased motility prolongs storage time in the large intestine, increasing:
fluid loss from fecal matter, forming hard stools, and potentially promoting the return of waste products to circulation.
factors altering bowel elimination
analgesics
emotional stress
reduced activity
possible causes of bowel obstruction
tumors, polyps, and impacted feces
fluid and gas accumulation, bowel obstruction is manifested by abdominal distension and pain
if obstruction impairs venous return,
o edema develops in the large intestine, leading to reduced absorption.
o Edema promotes continued fluid and gas accumulation because water and gas move
into the bowel lumen.
o Hydrostatic forces may increase so that fluid is forced through the bowel wall into the
peritoneum. Further, bacteria may gain access to the circulation, promoting the
development of sepsis.
o Perforation may result from the pressure that exceeds the ability of the tissue to retain
its structure.
assessment for bowel obstruction
Inspection
Auscultation
Palpation
Characteristics of stool color consistency presence of fat or blood
Watery, hard, stringy, fatty, foul odor
Hemorrhoids
Blood
Pain
alterations in texture of stool that can give cause
watery
hard
stringy
fatty
foul odor
Watery diarrhea can mean:
o Acute onset caused by gastroenteritis or anxiety
o Chronic pattern linked to inflammatory conditions or a high-fiber diet. Also caused by
intolerance to particular foods or the effects of certain medications
hard diarrhea can mean
o Water content low, resulting in a dry stool that is difficult to pass
o May contribute to the development of hemorrhoids. Linked to low-fiber diet, side
effects of certain medications, or voluntary avoidance of stool evacuation
stringy diarrhea can mean
o May be caused by parasitic infections
fatty diarrhea can mean
o Caused by malabsorption of fat
o Likely to float
foul odor in diarrhea can mean
o May be caused by steatorrhea, parasitic infection, or malabsorption syndromes
Characterized as diffuse, radiating and generalized; difficult to determine precise location
Caused by stretching, distension, or inflammation, inducing edema and vascular congestion
Visercal
Described as sharp, intense, and localized to a specific site
Caused by injury to the abdominal wall or parietal peritoneum
Somatic (also known as parietal)
Felt at a location different from origin of pain
Caused by the sharing of a common afferent pathway between origin of pain and referred location
Referred
Individuals at risk for development of kidney stones include those with:
- Obstructive renal calculi (kidney stones) is an emergecy
- Genetic predisposition
- Urinary tract infection
- Cystic kidney disease
- Diabetes
- Obesity
- Gout
- Hyperparathyroidism
- Gastric bypass
fluid-filled cysts in kidney tissue bilaterally, leading to progressive loss of nephrons
may be inherited or acquired.
polycystic kidney disease
Progressive decline in GFR is characteristic of decline in kidney function as follows:
Mild disease, GFR 60 to 89 mL per minute
Moderate disease, GFR 30 to 59 mL per minute
Severe disease, GFR 15 to 29 mL per minute
Renal failure, GFR < 15 mL per minute
rapid loss of kidney function
leads to cell hypoperfusion, cell death, decreased renal function
normal function can return if the cause removed
prerenal, intrarenal and postrenal causes
Acute Kidney Injury AKI
AKI: blood loss, dehydration, shock, infection (outside the kidney)
prerenal
AKI: tubular necrosis, prolonged ischemia, obstruction or nephrotoxicity
intrarenal
AKI: between the kidney and the outside: bladder neck obstruction or infection
postrenal
kidney disease that has Slow progressive and irreversible - Occurs in stages
chronic kidney disease
% loss of function nephrons before patient becomes symptomatic
75%
characteristic of GFR for CKD
GFR <60 ml per min for 3 months or longer
causes of CKD
o Can follow AKI
o DM or other metabolic disorders
o Hypertension
o Urinary obstruction
o Recurrent infections
o Renal artery occlusion
o Autoimmune disorders
labs for kidney disease
GFR best estimate for kidney function
CMP contains electrolytes BUN Creatinine
BUN elevated
Creatinine elevated
Urinalysis abnormal: RBCs, WBCs, casts, proteinuria, bacteria, nitrite, leukocyte esterase if infection
CBC: anemia, leukocyutosis, thrombocytopenia
Renal ultrasound
prevents reflux of gastric contents into the esophagus
lower esophageal sphincter
are critical in producing and secreting digestive enzymes and bile into the gastrointestinal tract.
Ex:
Enyzmes
salivary glands, pancreas, and liver,
secrete alkaline mucus and protect the epithelium from stress and acid contact
mucous cells
secrete both hydrochloric acid, a strong acid needed to activate pepsinogen and destroy pathogens, and intrinsic factor, a glycoprotein needed for intestinal absorption of vitamin B12 -INTRINSIC FACTOR
parietal cells
secrete pepsin, a proteolytic enzyme critical to protein digestion
chief cells
secrete gastrin, a hormone responsible for controlling acid secretion and stimulating gastric motility
G cells
deprivation of all food, a condition of starvation
Marasmus
persons consuming inadequate proteins
Kwashiorkor
Problems with processing or digesting nutrients:
pancreatic dysfunction
enzyme deficiencies
inadequate bile secretion
Problems with moving substances across the mucosa:
inflammatory conditions
gastrointestinal atrophy
excessive ingestion of a nutrient
use of certain medications
protein deficiencies
inhibits transport of nutrients once they have been absorbed across the mucosa and may occur with neoplasms or infectious processes
Lymphatic obstruction
how many exposures to food for allergy to occur
at least two
classes of BMI
*Class 1: BMI of 30 to less than 35
*Class 2: BMI of 35 to less than 40
*Class 3 (extreme or severe obesity): BMI of 40 or higher
diagnosis of obesity
comprehensive evaluation for comorbidities, such as hypertension, hypercholesterolemia, diabetes, hypothyroidism, venous varicosities, osteoarthritis, sleep apnea, depression, reproductive alterations, and infection
kidneys processing of cardiac out
20-25%
1000mL of blood per minute
neuromuscular function alterations of urine
*may involve the neurons of the peripheral and central nervous systems, neurotransmitter production, and availability or coordination of neural impulses from initiation to action
*Result in retention or incontinence
perfusion issues of urine
*Inadequate arterial blood supply – ischemia or infarction
*Damage to the renal structures
*Decrease perfusion due to excessive constriction of arterioles, inadequate vascular volume, or obstructed patency of the arterial supply, as occurs with an embolism
infection causing bowel patentcy issues and patho
appendicitis
– inflammatory response – if not treated and ruptures – infection of the peritonial cavity – septic shock – reduced perfusion to all organs
diagnostics of bowel obstruction
- Guaiac Test occult blood
- Xray
- Barium enema
- Sigmoidoscopy
- colonoscopy
types of urinary incontinence
*involving muscular contraction, neural transmission, hormonal stimulation, or mechanical factors
*stress,
*urge,
*nocturia
*overflow,
*functional – inabilit to get to the toilet
GFR < 60 indicates:
CKD
proteinuria possible etiologies
renal failure
nephrotic syndrome
preeclampsia
renal artery/vein thrombosis
glomerular disease
tubulopathy
glucosuria possible etiologies
diabetes mellitus
ketonuria possible etiologies
DM
ketoacidosis
starvation
hematuria possible etiologies
glomerular damage
tumors
kidney trauma
UTI
acute tubular infection
urinary tract obstruction
pyuria possible etiologies
upper and lower UTI
acute glomerulonephritis
renal calculi
