Chapter 43 Flashcards
What is the length of the GI tract?
30 ft (9 m)
What are the four layers of the GI tract from inside to outside?
- Mucosa lining
- Submucosa connective tissue
- Muscle
- Serosa
What does the submucosa layer of the GI tract contain?
- Glands
- Blood vessels
- Lymph nodes
The GI tract extends
from the mouth to the anus.
What are the three smooth muscle layers in the GI tract?
The oblique (inner) layer, circular (middle) layer, and longitudinal (outer) layer.
What is the main function of the parasympathetic system in the GI tract?
Mainly excitatory, increasing peristalsis.
What is the main function of the sympathetic system in the GI tract?
Mainly inhibitory, decreasing peristalsis.
What does the enteric nervous system (ENS) regulate?
Motility and secretion along the entire GI tract.
What are the two networks that compose the enteric nervous system?
- Meissner plexus in the submucosa
- Auerbach (myenteric) plexus between the muscle layers.
What does the submucosal plexus control?
Secretion and is involved in many sensory functions.
What is the major nerve supply to the GI tract?
The myenteric plexus.
The enteric nervous system (ENS) functions
independently of the brain and spinal cord.
What is unique about the circulation in the GI system?
Venous blood drains into the portal vein, which perfuses the liver.
What arteries supply arterial blood to the GI tract?
- Celiac artery
- Superior mesenteric artery (SMA)
- Inferior mesenteric artery (IMA).
What is the nature of the omentum?
Hangs like an apron from the stomach to the intestines, containing fat and lymph nodes.
the main function of the GI system is to supply the body with nutrients. It does so by.
- Ingestion
- Digestion
- Absorption
- Elimination.
Ingestion is
The intake of food
What hormone released from the stomach mucosa stimulates appetite?
Ghrelin.
What factors stimulate appetite?
- Hypoglycemia
- An empty stomach
- Decrease in body temperature.
What is the role of leptin in appetite regulation?
Inhibits appetite.
What is deglutition?
The mechanical portion of swallowing
Which organs are involved in deglutition?
- Mouth
- Pharynx
- Esophagus
What are the components of the oral cavity?
- Lips
- Hard palate
- Soft palate
- Tongue
What is the primary function of the tongue?
Aids in swallowing and speech
What are the three pairs of salivary glands?
- Parotid
- Submandibular
- Sublingual
What does saliva consist of?
- Water
- Protein
- Mucin
- Inorganic salts
- Salivary amylase
What are the three divisions of the pharynx?
- Nasopharynx
- Oropharynx
- Laryngeal pharynx
What initiates the swallowing reflex?
Food or liquid stimulating receptors in the oropharynx
What is the function of the epiglottis during swallowing?
Closes over the opening to the larynx to prevent food from entering the respiratory tract
What is the esophagus?
A hollow, muscular tube that moves food from the pharynx to the stomach
What are the four layers of the esophagus?
- Inner mucosa
- Submucosa
- Muscularis propria
- Outermost adventitia
What is the role of the upper esophageal sphincter (UES)?
Remains closed between swallows and relaxes during swallowing
What is the function of the lower esophageal sphincter (LES)?
Prevents reflux of acidic gastric contents into the esophagus
What are the primary functions of the stomach?
- Store food
- Mix food with gastric secretions
- Empty contents into the small intestine
What are the three main parts of the stomach?
- Fundus (cardia)
- Body
- Antrum
What is the role of intrinsic factor in the stomach?
Promotes cobalamin (vitamin B12) absorption in the small intestine
What is the length and diameter of the small intestine?
About 23 ft (7 m) in length and 1 to 1.1 in (2.5 to 2.8 cm) in diameter
What are the three segments of the small intestine?
- Duodenum
- Jejunum
- Ileum
What are villi?
Minute, fingerlike projections in the mucous membrane of the small intestine
What is the function of Brunner’s glands?
Secrete an alkaline fluid containing bicarbonate to neutralize acidic fluids
What is the process of digestion?
The physical and chemical breakdown of food into absorbable substances
Where does digestion begin?
In the mouth
What enzyme in saliva breaks down starches?
Amylase
How much saliva does a person produce each day?
About 1 L
What enzyme is secreted by the salivary glands and what is its action?
Salivary amylase
Initiates starch digestion.
What is the daily amount of gastric secretions produced by the stomach?
2500 mL
This includes HCl acid and other components.
What is the function of HCl acid in the stomach?
Activation of pepsinogen to pepsin
This is crucial for protein digestion.
What is the role of intrinsic factor secreted by the stomach?
Essential for cobalamin absorption in ileum
Cobalamin is also known as vitamin B12.
What type of digestion does gastric lipase facilitate?
Fat digestion
It acts on dietary fats.
What enzymes are secreted in the small intestine?
Aminopeptidases, Amylase, Enterokinase, Lactase, Lipase, Maltase, Peptidases, Sucrase
Each has a specific role in digestion.
What is the action of enterokinase in the small intestine?
Activation of trypsinogen to trypsin
This is important for protein digestion.
What does lactase do?
Breaks down Lactose into glucose and galactose
It is crucial for lactose digestion.
What is the daily secretion amount of pancreatic enzymes?
700 mL
This includes amylase, chymotrypsin, lipase, and trypsinogen.
What is the function of bile secreted by the liver and gallbladder?
Emulsifies fats and aids in absorption of fatty acids and fat-soluble vitamins (A, D, E, K)
Bile is essential for fat digestion.
Fill in the blank: The enzyme _______ digests starch to disaccharides.
Amylase
This enzyme is secreted by both the salivary glands and pancreas.
Hcl activates
Pepsinogen into pepsin
Pepsin is an active enzyme that digests proteins.
What is the function of maltase?
Maltose to 2 glucose molecules
It helps in carbohydrate digestion.
What initiates the cephalic phase of gastric secretion?
Sight, smell, taste of food
This phase occurs before food enters the stomach and is mediated by the CNS and the vagus nerve.
What is released during the gastric phase of gastric secretion?
Gastrin
Gastrin is released from the antrum into circulation to stimulate gastric secretions and motility.
What stimulates the intestinal phase of gastric secretion?
Presence of chyme in small intestine
The intestinal phase is characterized by hormonal responses to the chyme.
What happens when acidic chyme (pH <2) is present in the small intestine?
Release of secretin, gastric inhibitory polypeptide, cholecystokinin
These hormones decrease HCl acid secretion.
What occurs when chyme has a pH greater than 3?
Release of gastrin from duodenum
This release increases acid secretion.
What are the three phases of gastric secretion?
- Cephalic phase
- Gastric phase
- Intestinal phase
Each phase has distinct stimuli and hormonal responses.
True or False: The vagus nerve mediates the cephalic phase of gastric secretion.
True
The cephalic phase is initiated in the CNS and mediated by the vagus nerve.
Fill in the blank: The _______ phase of gastric secretion is initiated by the sight, smell, or taste of food.
[cephalic phase]
What type of secretion is stimulated during the gastric phase?
Gastric secretions and motility
This is a response to food in the antrum of the stomach.
What is the daily amount of saliva secreted by salivary glands?
1000-1500 mL
What does salivary amylase initiate?
Starch digestion
What are the main secretions of the stomach?
- HCl acid
- Intrinsic factor
- Lipase
- Pepsinogen
What is the function of intrinsic factor in the stomach?
Essential for cobalamin absorption in ileum
What is the consequence of pepsinogen activation in the stomach?
Activation to pepsin
Where does no digestion or absorption occur in the GI tract?
Esophagus
What controls both GI secretion and motility?
Neural and hormonal control
What are the products absorbed in the digestive process?
- Monosaccharides
- Fatty acids
- Amino acids
- Electrolytes
- Vitamins
- Minerals
What is the length of the large intestine?
5 to 6 feet (1.5 to 1.8 m)
What are the primary functions of the large intestine?
- Water absorption
- Electrolyte absorption
- Formation of feces
- Reservoir for fecal mass until defecation
What percentage of feces is composed of water?
75%
What does the large intestine secrete to protect the mucosa?
Mucus
How do microorganisms in the colon contribute to digestion?
- Producing vitamin K and some B vitamins
- Breaking down proteins into amino acids
What is ammonia converted to in the liver?
Urea
How is urea excreted from the body?
By the kidneys
What causes gas to escape the colon?
Bacteria produce gas that escapes as flatulence or flatus
What triggers peristalsis in the colon?
Food entering the stomach and duodenum
What are the movements of the large intestine usually described as?
Slow
What reflexes result in peristalsis in the colon?
- Gastroclic reflex
- Duodenocolic reflex
When are the gastrocolic and duodenocolic reflexes more active?
After the first daily meal
What is the function of Gastrin?
Stimulates gastric acid secretion and motility. Maintains LES tone.
What activates Cholecystokinin?
Fatty acids and amino acids in the small intestine.
What is the role of Gastric inhibitory peptide?
Inhibits gastric motility and acid secretion. Stimulates pancreatic bicarbonate secretion.
What stimulates the release of Secretin?
Acid entering the small intestine.
What anatomical structures are involved in defecation?
Rectum, internal anal sphincter, external anal sphincter.
What is the reflex center for defecation?
Parasympathetic nerve fibers in the sacral part of the spinal cord.
What can occur if defecation is suppressed for long periods?
Constipation or fecal impaction.
What does the Valsalva maneuver involve?
Inspiring deeply, holding the breath, contracting abdominal muscles, bearing down.
What happens to blood pressure during the Valsalva maneuver?
Transient drop in BP followed by an immediate rise upon relaxation.
What is the largest internal organ in the body?
Liver.
Where is the liver located?
Right epigastric region.
What are the functional units of the liver called?
Lobules.
What cells are found in the sinusoids of the liver?
Kupffer cells.
What do hepatic cells secrete?
Bile.
What are the two main ducts that bile flows into?
Left and right hepatic ducts.
What is the weight of the liver approximately?
Around 3 lb (1.36 kg).
What is the anatomical structure that divides the liver into lobes?
Fibrous capsule.
What is the primary source of blood supply to the liver?
The portal circulatory system and the hepatic artery.
What percentage of the liver’s blood supply comes from the hepatic artery?
About 25%.
What role does the portal vein play in the liver’s function?
It carries absorbed products of digestion directly to the liver.
What are the main functions of the liver?
Metabolic, secretory, vascular, and storage functions.
What components make up bile?
- Water
- Cholesterol
- Bile salts
- Electrolytes
- Fatty acids
- Bilirubin
What is the function of bile salts?
Fat emulsification and digestion.
What is bilirubin and how is it formed?
A pigment derived from the breakdown of hemoglobin.
What is the form of bilirubin that is insoluble in water?
Unconjugated bilirubin.
How does unconjugated bilirubin travel to the liver?
It binds to albumin in the bloodstream.
What happens to unconjugated bilirubin in the liver?
It is conjugated with glucuronic acid and excreted in bile.
What is the significance of conjugated bilirubin?
It is soluble in water.
What does bacterial action in the intestines produce from bilirubin?
- Stercobilinogen
- Urobilinogen
What accounts for the brown color of stool?
Stercobilinogen.
Where does urobilinogen go after being reabsorbed into the blood?
It is returned to the liver through the portal circulation.
What is the function of the biliary tract?
Connects the liver, gallbladder, and duodenum.
What is the structure and function of the gallbladder?
A pear-shaped sac that concentrates and stores bile.
How much bile can the gallbladder hold?
About 45 mL.
What triggers the release of cholecystokinin?
The presence of fat in the upper duodenum.
What effect does cholecystokinin have on the gallbladder?
It causes the gallbladder to contract and release bile.
Where does the hepatic duct receive bile from?
The canaliculi in the liver lobules.
What are the metabolic functions of the liver?
Blood clotting factors, carbohydrate metabolism, fat metabolism, protein metabolism
Includes glycogenesis, glycogenolysis, gluconeogenesis, synthesis of lipoproteins, and synthesis of nonessential amino acids.
What is the role of the liver in blood clotting?
Synthesis of prothrombin (factor I), fibrinogen (factor II), and clotting factors V, VII, IX, and X.
What processes are involved in carbohydrate metabolism in the liver?
Glycogenesis, glycogenolysis, gluconeogenesis.
What is glycogenesis?
Conversion of glucose to glycogen.
What is glycogenolysis?
Process of breaking down glycogen to glucose.
What is gluconeogenesis?
Formation of glucose from amino acids and fatty acids.
What are the primary functions of the liver related to fat metabolism?
Synthesis of lipoproteins, breakdown of triglycerides, formation of ketone bodies, synthesis and breakdown of cholesterol.
What is the function of the liver in protein metabolism?
Synthesis of nonessential amino acids and plasma proteins (except gamma globulin).
What happens to unconjugated bilirubin in the liver?
It combines with glucuronic acid to become conjugated bilirubin (soluble).
What components make up bile produced by the liver?
Contains bile salts, bile pigments (mainly bilirubin), and cholesterol.
What is the role of the pancreas in digestion?
Production and release of digestive enzymes.
What are the exocrine functions of the pancreas?
Production of digestive enzymes.
What are the endocrine functions of the pancreas?
Secretion of insulin, amylin, glucagon, somatostatin, and pancreatic polypeptide.
What changes occur in the GI system due to aging?
Decreased appetite, loss of teeth, decline in taste buds, dry mouth (xerostomia), delayed esophageal emptying.
What is hypochlorhydria?
Decrease in intrinsic acid and HCl acid secretion with age.
What percentage of adults over age 60 are affected by chronic constipation?
30% to 40%.
What factors can increase the risk for constipation in older adults?
Slower peristalsis, anorectal dysfunction, inactivity, decreased fiber intake, inadequate fluid intake, constipating medications.
What happens to liver size after 50 years of age?
Liver size decreases, but liver function tests (LFTs) remain normal.
What structural changes occur in the pancreas with aging?
Fibrosis, fatty acid deposits, atrophy.
What is a risk for older adults regarding nutrition?
Decreased food intake due to inability to obtain food and economic constraints.
What are the expected aging changes in the mouth related to GI assessment?
Atrophy of gingival tissue, decreased number of taste buds, decreased sense of smell, decreased volume of saliva, gingival retraction, poor-fitting dentures, decreased sense of taste (especially salty and sweet), dry oral mucosa, loss of teeth, difficulty chewing
These changes can impact nutrition and overall health.
What changes occur in the esophagus as individuals age?
Decreased lower esophageal sphincter (LES) pressure, decreased motility, potential for epigastric distress, dysphagia, potential for hiatal hernia and aspiration
These changes can lead to swallowing difficulties and increased risk for aspiration.
What are the expected changes in the abdominal wall with aging?
Decreased number and sensitivity of sensory receptors, thinner and less taut abdominal wall, less sensitivity to surface pain
This may affect pain perception and the ability to detect GI issues.
What key health history information should be obtained from a patient during a GI assessment?
History of diarrhea, constipation, melena, rectal bleeding, past gastric issues (gastritis, hepatitis, gallstones, hemorrhoids, peptic ulcer, cancer, diverticulitis, hernias), weight history (unexplained weight loss/gain)
This information helps in understanding the patient’s current GI health status.
What medications should be assessed for their effects on the GI system?
Antacids, laxatives, antibiotics, herbal supplements, NSAIDs, acetaminophen
These can have side effects that impact GI functioning and drug absorption.
What are the expected aging changes in the stomach?
Atrophy of gastric mucosa, decreased blood flow, food intolerances, signs of anemia from cobalamin malabsorption, slower gastric emptying
Aging can lead to decreased digestive efficiency and nutrient absorption.
What changes occur in the small intestines as a person ages?
Slightly decreased motility and secretion of most digestive enzymes, leading to indigestion, slowed intestinal transit, delayed absorption of fat-soluble vitamins
This can affect overall nutrient absorption and digestion.
What are the expected changes in the liver with aging?
Decreased protein synthesis, decreased ability to regenerate, decreased size and lowered position, decreased drug and hormone metabolism
These changes can impact medication metabolism and detoxification processes.
What changes occur in the large intestine, anus, and rectum with aging?
Decreased anal sphincter tone and nerve supply to rectal area, decreased muscular tone, decreased motility, leading to fecal incontinence
These changes can significantly affect bowel control.
What are the expected changes in the pancreas with aging?
Distended pancreatic ducts, decreased lipase production, decreased pancreatic reserve, impaired fat absorption, decreased glucose tolerance
These changes can lead to digestive issues and metabolic problems.
What is an appendectomy?
Removal of appendix
Common surgical procedure for appendicitis.
What is a cholecystectomy?
Removal of gallbladder
Typically performed for gallstones causing pain or infection.
What does choledochojejunostomy involve?
Opening between common bile duct and jejunum
A procedure to bypass obstructions in the bile duct.
What is choledocholithotomy?
Opening into common bile duct for removal of stones
A surgical procedure addressing bile duct stones.
What is a colectomy?
Removal of colon
Often indicated for conditions like colorectal cancer or severe diverticulitis.
What is a colostomy?
Opening into colon
Created to divert waste from the colon to an external bag.
What does esophagoenterostomy entail?
Removal of part of esophagus with segment of colon attached to remaining part
A procedure addressing esophageal cancer or severe esophageal disease.
What is esophagogastrostomy?
Removal of esophagus and anastomosis of remaining part to stomach
Used in cases of esophageal cancer.
What is a gastrectomy?
Removal of stomach
Indicated for stomach cancer or severe ulcers.
What does gastrostomy involve?
Opening into stomach
Typically performed for feeding in patients unable to eat by mouth.
What is a glossectomy?
Removal of tongue
Often necessary due to cancer or severe trauma.
What is a hemiglossectomy?
Removal of half of tongue
Similar to glossectomy but preserves some tongue function.
What is herniorrhaphy?
Repair of a hernia
Surgical procedure to correct hernias, often through mesh placement.
What is an ileostomy?
Opening into ileum
Diverts waste from the small intestine to an external bag.
What is a mandibulectomy?
Removal of mandible
Often performed for oral cancer.
What does pyloroplasty involve?
Enlargement and repair of pyloric sphincter area
A procedure to alleviate gastric outlet obstruction.
What is vagotomy?
Resection of branch of vagus nerve
Aimed at reducing acid secretion in the stomach.
What health behaviors can negatively affect GI function?
- Binge drinking alcohol
- High intake of alcohol
- Cigarette smoking
These behaviors can lead to conditions like fatty liver and cirrhosis.
What are the potential consequences of chronic alcohol exposure on the liver?
- Fatty infiltration of the liver
- Cirrhosis
- Hepatocellular cancer
Chronic alcohol use can severely damage liver tissue.
What should be assessed regarding a patient’s health practices related to the GI system?
- Recent foreign travel
- Exposure to parasites
- Sexual and drug behaviors
Important for evaluating risks for infections like hepatitis.
What vaccinations should be determined for a patient concerning hepatitis?
- Hepatitis A
- Hepatitis B
Vaccination history is crucial for prevention of viral hepatitis.
What is an appendectomy?
Removal of appendix
Common surgical procedure for appendicitis.
What is a cholecystectomy?
Removal of gallbladder
Typically performed for gallstones causing pain or infection.
What does choledochojejunostomy involve?
Opening between common bile duct and jejunum
A procedure to bypass obstructions in the bile duct.
What is choledocholithotomy?
Opening into common bile duct for removal of stones
A surgical procedure addressing bile duct stones.
What is a colectomy?
Removal of colon
Often indicated for conditions like colorectal cancer or severe diverticulitis.
What is a colostomy?
Opening into colon
Created to divert waste from the colon to an external bag.
What does esophagoenterostomy entail?
Removal of part of esophagus with segment of colon attached to remaining part
A procedure addressing esophageal cancer or severe esophageal disease.
What is esophagogastrostomy?
Removal of esophagus and anastomosis of remaining part to stomach
Used in cases of esophageal cancer.
What is a gastrectomy?
Removal of stomach
Indicated for stomach cancer or severe ulcers.
What does gastrostomy involve?
Opening into stomach
Typically performed for feeding in patients unable to eat by mouth.
What is a glossectomy?
Removal of tongue
Often necessary due to cancer or severe trauma.
What is a hemiglossectomy?
Removal of half of tongue
Similar to glossectomy but preserves some tongue function.
What is herniorrhaphy?
Repair of a hernia
Surgical procedure to correct hernias, often through mesh placement.
What is an ileostomy?
Opening into ileum
Diverts waste from the small intestine to an external bag.
What is a mandibulectomy?
Removal of mandible
Often performed for oral cancer.
What does pyloroplasty involve?
Enlargement and repair of pyloric sphincter area
A procedure to alleviate gastric outlet obstruction.
What is vagotomy?
Resection of branch of vagus nerve
Aimed at reducing acid secretion in the stomach.
What health behaviors can negatively affect GI function?
- Binge drinking alcohol
- High intake of alcohol
- Cigarette smoking
These behaviors can lead to conditions like fatty liver and cirrhosis.
What are the potential consequences of chronic alcohol exposure on the liver?
- Fatty infiltration of the liver
- Cirrhosis
- Hepatocellular cancer
Chronic alcohol use can severely damage liver tissue.
What should be assessed regarding a patient’s health practices related to the GI system?
- Recent foreign travel
- Exposure to parasites
- Sexual and drug behaviors
Important for evaluating risks for infections like hepatitis.
What vaccinations should be determined for a patient concerning hepatitis?
- Hepatitis A
- Hepatitis B
Vaccination history is crucial for prevention of viral hepatitis.
What is a significant risk factor for Colorectal Cancer (CRC) related to family history?
CAC may run in families, particularly if first-degree relatives or other family members had CAC diagnosed before age 50
CAC refers to Colorectal Cancer.
What genetic condition is associated with an increased risk for CRC and involves mutations in several different genes?
Hereditary nonpolyposis colorectal cancer (HNPCC)
What characterizes Familial adenomatous polyposis (FAP)?
Multiple polyps that are noncancerous at first but can develop into cancer if not treated
Most cases of FAP are due to mutations of the adenomatous polyposis coli (APC) gene.
What is the increased risk factor for first-degree relatives of individuals with Inflammatory Bowel Disease (IBD)?
5- to 20-fold increased risk for developing IBD
How does smoking affect gastrointestinal (GI) health?
Smoking is related to GI cancers (especially mouth and esophageal cancers), esophagitis, and ulcers; it delays the healing of ulcers.
What is the importance of family history in colorectal cancer cases?
About one third of cases of CRC occur in patients with a family history.
What is essential for a thorough nutritional assessment?
Taking a diet history and asking about both content and portion size.
What method can be used to analyze the adequacy of a patient’s diet?
24-hour diet recall
What should be compared in a nutritional assessment?
Weekday and weekend diet intake patterns in relation to both the quality and quantity of food.
What dietary factors should be assessed during a nutrition evaluation?
- Use of sugar and salt substitutes
- Caffeine intake
- Fluid and fiber intake
What may indicate cancer or inflammation in a patient?
Anorexia and weight loss.
What impact can pain have on a patient’s eating habits?
Pain can influence intake, leading to avoided activity, fatigue, and disrupted eating patterns.
What issues related to self-perception can arise from GI and nutrition problems?
Problems related to self-esteem and body image for overweight and underweight persons.
What challenges may arise for patients needing external devices to manage elimination?
The need for colostomy or ileostomy may be challenging and affect body image and self-esteem.
What are some health conditions related to changes in body image?
Cirrhosis, hepatitis, ostomies, obesity, and relationships.
What gastrointestinal symptoms can stress manifest as?
Nausea, abdominal pain, peptic ulcer disease, irritable bowel syndrome, and inflammatory bowel disease.
What should be assessed in the patient’s value-belief pattern regarding food?
Spiritual, religious, and cultural beliefs about food and food preparation.
What is a key consideration for vegetarians with anemia?
Finding iron-rich foods other than meat.
What is the importance of inspecting the mouth during a physical assessment?
To check for symmetry, color, size, abnormalities, and lesions.
What should be observed when inspecting the pharynx?
The tonsils, uvula, soft palate, and anterior and posterior pillars.
What are the two systems used to anatomically describe the abdomen?
The four quadrants system and the nine regions system.
What position should a patient be in for an abdominal assessment?
Supine position and as relaxed as possible.
What is crucial for avoiding muscle guarding during an abdominal assessment?
Using warm hands and having the patient breathe slowly through the mouth.
What is a common issue to check for in older adults during an oral assessment?
The fit and condition of dentures.
What is a usual finding when examining the abdomen of an older adult?
The abdomen may be thinner and laxer unless the patient is obese.
What should be assessed during the inspection of the abdomen?
Skin changes, umbilicus, symmetry, and contour.
What are the possible contours of the abdomen?
- Flat
- Rounded (convex)
- Concave
- Protuberant
- Distended
Where can a normal aortic pulsation occur during abdominal examination?
A normal aortic pulsation may be seen in the epigastric area.
is peristalsis normally visible?
Peristalsis is not normally visible in adults but may be visible in a thin person.
Why should auscultation be performed before percussion and palpation?
Because percussion and palpation may alter the bowel sounds.
Which part of the stethoscope is used to auscultate high pitched bowel sounds?
The diaphragm is used to auscultate high-pitched bowel sounds.
What should be done to the stethoscope before auscultation?
Warm the stethoscope in your hands.
In which quadrant should bowel sounds be auscultated first?
Start in the right lower quadrant.
How long should bowel sounds be listened for?
Listen for bowel sounds for at least 2 minutes.
What are the three classifications of bowel sounds?
- Normal
- Hypoactive
- Hyperactive
What characterizes normal bowel sounds?
High pitched and gurgling.
What does stomach growling or loud gurgles indicate?
Indicate hyperperistalsis.
What does tympany indicate during percussion?
It indicates the presence of gas in the intestines.
What is the normal range of liver height in the right midclavicular line?
6 to 12.7 cm.
What is the purpose of light palpation during abdominal examination?
To detect tenderness, sensitivity, muscular resistance, masses, and swelling.
What technique is used for deep palpation?
Use the palmar surfaces of the fingers to press more deeply.
What should be noted during palpation of the abdomen?
Location, size, shape of masses, and presence of tenderness.
What nonverbal cues should be observed during abdominal examination?
The patient’s facial expression for discomfort or pain.
Which structures are located in the Right Upper Quadrant?
- Liver and gallbladder
- Pylorus
- Head of pancreas
- Portion of ascending colon
- Right kidney
- Right adrenal gland
- Right ovary and fallopian tube
Which structures are located in the Left Upper Quadrant?
- Left lobe of liver
- Spleen
- Body of pancreas
- Portion of left kidney
- Left adrenal gland
- Bladder (if distended)
- Splenic flexure of colon
- Uterus (if enlarged)
Which structures are located in the Right Lower Quadrant?
- Cecum and appendix
- Lower pole of right kidney
- Portion of ascending and transverse colon
- Right ureter
- Right spermatic cord
Which structures are located in the Left Lower Quadrant?
- Lower pole of left kidney
- Sigmoid flexure
- Part of descending colon
- Left ureter
- Left spermatic cord
What is the method for assessing rebound tenderness in the abdomen?
Press in slowly and firmly over the painful site, then withdraw quickly. Pain on withdrawal indicates peritoneal inflammation.
How far below the right costal margin may the liver be palpated in patients with chronic obstructive pulmonary disease?
0.4 to 0.8 in (1 to 2 cm) below the right costal margin.
What is the normal size range of the spleen?
About 5 in long (12.7 cm), 3 in wide (7.6 cm), and 1.5 in (3.8 cm) thick.
What should be done if the liver is palpable during assessment?
Do not continue palpation, as manual compression of an enlarged liver may cause injury.
What areas should be inspected during the examination of the rectum and anus?
Color, texture, masses, rashes, scars, erythema, fissures, and external hemorrhoids.
What technique is used for the digital examination of the rectum?
Place a gloved, lubricated index finger against the anus, have the patient gently bear down, and insert the finger toward the umbilicus.
What should be assessed during the digital examination of the rectum?
Nodules, tenderness, or irregularities.
What is the appearance of the lips in a normal physical assessment of the Gl system?
Moist and pink lips
What does the buccal mucosa and gingivae look like in a normal physical assessment?
Pink and moist without plaques or lesions
What condition should the teeth be in during a normal physical assessment?
Teeth in good repair
What is the expected position of the tongue during a normal physical assessment?
Protrusion of tongue in midline without deviation or twitches
What should the uvula, soft palate, tonsils, and posterior pharynx look like in a normal assessment?
Pink and in midline
What is a normal swallowing response during a physical assessment?
Swallows smoothly without coughing or gagging
What is the expected shape of the abdomen in a normal physical assessment?
Flat without masses or scars
What is noted about bowel sounds in a normal physical assessment?
Bowel sounds in all quadrants
What indicates a lack of abdominal tenderness during a physical assessment?
No abdominal tenderness; nonpalpable liver and spleen
What is the size of the liver in a normal assessment?
10 cm in right midclavicular line
What is the expected percussion note of the abdomen?
Generalized tympany
What is the condition of the anus in a normal physical assessment?
Absence of lesions, fissures, and hemorrhoids
What indicates good anal sphincter function during a physical assessment?
Good sphincter tone
What should the rectal walls feel like in a normal assessment?
Smooth and soft
What is noted about masses during a normal rectal examination?
No masses
What is the expected appearance of the stool in a normal assessment?
Soft, brown, and heme negative
What is acute marginal gingivitis?
Friable, edematous, painful, bleeding gingivae
Indicates inflammation of the gums, often requiring dental evaluation.
What are the characteristics of candidiasis in the mouth?
White, curdlike lesions surrounded by erythematous mucosa
Commonly caused by Candida albicans.
What is cheilitis?
Inflammation of lips (usually lower) with fissuring, scaling, crusting
Often associated with nutritional deficiencies or irritants.
What is cheilosis?
Softening, fissuring, and cracking of lips at angles of mouth
Also linked to nutritional deficiencies.
What is geographic tongue?
Scattered red, smooth (loss of papillae) areas on dorsum of tongue
A benign condition with unknown etiology.
What is glossitis?
Reddened, ulcerated, swollen tongue
Can indicate nutritional deficiencies, particularly riboflavin or cobalamin.
What are the symptoms of herpes simplex in the mouth?
Vesicular lesion
Often appears as painful blisters in the oral cavity.
What is leukoplakia?
Thickened white patches
May be a premalignant lesion requiring further evaluation.
What is pyorrhea?
Recessed gingivae, purulent pockets
Indicative of periodontal disease.
What is dyspepsia?
Burning or indigestion
Common symptom in gastrointestinal disorders.
What is dysphagia?
Difficulty swallowing, sensation of food sticking in esophagus
Can be caused by various esophageal conditions.
What does eructation refer to?
Belching
A normal physiological process but can indicate gastrointestinal issues.
What is hematemesis?
Vomiting of blood
A sign of serious gastrointestinal conditions, such as bleeding ulcers.
What does nausea and vomiting indicate?
Feeling of impending vomiting, expulsion of gastric contents through mouth
Can result from various gastrointestinal problems and stress.
What are potential etiologies for acute marginal gingivitis?
Candida albicans, calcium deposits on teeth, food impaction
Various factors can lead to gingival inflammation.
What are common causes of glossitis?
Riboflavin deficiency, vitamin B deficiencies, anemia
Nutritional deficiencies are a major contributing factor.
What conditions can cause dyspepsia?
Peptic ulcer disease, gallbladder disease
Dyspepsia is often linked to several gastrointestinal disorders.
What can hematemesis indicate?
Esophageal varices, bleeding peptic ulcer
Both are serious conditions requiring immediate medical attention.
What is odynophagia?
Painful swallowing
What does pyrosis refer to?
Heartburn, burning in epigastric or substernal area
What is borborygmi?
Waves of loud, gurgling sounds
What is a bruit?
Humming or swishing sound heard through stethoscope over vessel
What is a hernia?
Bulge or nodule in abdomen, usually appearing on straining
What is rebound tenderness
Sudden pain when fingers withdrawn quickly
What is a fissure in the rectum?
Ulceration in anal canal
What are hemorrhoids?
Thrombosed veins in rectum and anus (internal or external)
What does melena refer to?
Abnormal, black, tarry stool containing digested blood
What is steatorrhea?
Fatty, frothy, foul-smelling stool
What does tenesmus describe?
Painful and ineffective straining, sense of incomplete evacuation
What is a pilonidal cyst?
cyst in midline just above coccyx
What is required for many GI system diagnostic procedures?
- Measures to prepare the GI tract
- Ingestion or injection of a radiopaque tracer
What should be monitored closely during diagnostic studies?
Adequate hydration and nutrition
What adjustments may be needed for older adults during diagnostic procedures?
Adjustments for pressure points when positioning
What can prolonged fluid restriction lead to in older adults?
Dehydration
What can bowel-cleansing procedures cause?
Diarrhea
What does an upper GI series visualize?
Oropharyngeal area, esophagus, stomach, small intestine
What is the contrast medium used in an upper GI series?
Thick barium solution or gastrografin
What is observed during an upper GI series?
Movement of the contrast medium with fluoroscopy and x-rays
What conditions can an upper GI series help identify?
- Esophageal strictures
- Polyps
- Tumors
- Hiatal hernias
- Foreign bodies
- Ulcers
What is the purpose of a lower GI series or barium enema?
To observe the colon filling with contrast medium and to observe the filled colon
How is the contrast medium administered in a lower GI series?
Through an enema
What is the purpose of adding air contrast after barium in colon imaging?
It provides better visualization of tumors and other lesions in the colon.
What is virtual colonoscopy?
A less invasive imaging technique that combines CI scanning or MRI to produce images of the colon and rectum.
What are the requirements for virtual colonoscopy?
- Radiation
- Prior cleansing of the colon
- No sedation
How does virtual colonoscopy compare to conventional colonoscopy?
It provides a better view inside the colon that is narrow from inflammation or a growth.
What must happen if a polyp is found during virtual colonoscopy?
It will have to be removed by conventional colonoscopy.
What is a limitation of virtual colonoscopy?
It may be less sensitive in detecting small (less than 10 mm) flat polyps.
What is endoscopy?
The direct visualization of a body structure through an endoscope.
What is an endoscope?
A fiberoptic instrument with a light and camera attached.
What structures can be examined using endoscopy?
- Esophagus
- Stomach
- Duodenum
- Colon
What is endoscopic retrograde cholangiopancreatography (ERCP)?
A procedure that visualizes the pancreatic, hepatic, and common bile ducts.
What procedures can be combined with endoscopy?
- Biopsy
- Cytologic studies
- Invasive procedures
- Therapeutic procedures
What are examples of therapeutic procedures performed during endoscopy?
- Polypectomy
- Sclerosis or banding of varices
- Cauterization of bleeding sites
- Common bile duct stone removal
- Balloon dilation
What is the primary purpose of a colonoscopy?
To directly visualize the entire colon up to the ileocecal valve.
What type of scope is used in a colonoscopy?
Flexible fiberoptic scope.
During a colonoscopy, how is the patient’s position managed?
The patient’s position is changed frequently to assist with the advancement of the scope to the cecum.
What conditions can a colonoscopy help diagnose?
- Inflammatory bowel disease
- Polyps
- Tumors
- Diverticulosis
What additional procedures can be performed during a colonoscopy?
- Biopsy
- Removal of polyps
True or False: A colonoscopy requires laparotomy for polyp removal.
False
Fill in the blank: A colonoscopy allows for biopsy and removal of polyps without _______.
[laparotomy]
What is Endoscopic retrograde cholangiopancreatography (ERGP)?
A fiberoptic endoscope using fluoroscopy is orally inserted into the descending duodenum to visualize common bile and pancreatic ducts.
Can retrieve gallstones, dilate strictures, biopsy, and diagnose pseudocysts
What does Esophagogastroduodenoscopy (EGD) directly visualize?
The mucosal lining of the esophagus, stomach, and duodenum with a flexible endoscope.
May detect inflammation, ulcerations, tumors, varices, or Mallory-Weiss tears and allows for biopsies
What is the purpose of laparoscopy?
To visualize the peritoneal cavity and contents with a laparoscope, allowing for biopsy specimen collection.
Double-puncture peritoneoscopy enhances abdominal cavity visualization, especially the liver
What is sigmoidoscopy used for?
To directly visualize the rectum and sigmoid colon with a lighted flexible endoscope.
Detects tumors, polyps, inflammatory and infectious diseases, fissures, and hemorrhoids
What does video capsule endoscopy involve?
The patient swallows a vitamin-sized capsule with a camera that takes over 50,000 images during the test.
Provides visualization of GI tract areas not accessible by upper and lower endoscopy
What is cholangiography?
A radiologic examination of the biliary system.
What does MRCP stand for?
Magnetic resonance cholangiopancreatography.
What is the purpose of a percutaneous transhepatic catheter (PTC)?
To access the biliary system for diagnostic or therapeutic purposes.
What is a surgical cholangiogram?
A procedure where contrast medium is injected into the common bile duct during surgery on biliary structures.
What imaging technology is used in computed tomography (CT) scans?
X-ray technology to create detailed images of the body.
What is the primary use of MR technology in medical imaging?
To obtain images of biliary and pancreatic ducts.
What is defecography?
A procedure that uses fluoroscopy or MRI to assess the shape and position of the rectum during defecation.
Describe the procedure used in defecography.
A lubricated small plastic tip fills the rectum and anus with barium, and images are taken while the person sits on a toilet-like seat.
What does the use of oral and IV contrast medium in imaging do?
Accentuates density differences to enhance visualization.
What abnormalities can defecography detect?
Pelvic floor abnormalities.
What is the role of fluoroscopy in PTC?
To guide the long needle into the liver and bile duct.
What is the purpose of the Gastric emptying breath test (GEBT)?
To diagnose delayed gastric emptying
What special meal is consumed during the Gastric emptying breath test?
A scrambled egg mix and Spirulina platensis
What imaging technique uses a contrast medium given rectally to examine the colon?
Barium enema
What is the test of choice for a barium enema?
Double-contrast or air-contrast barium enema
What does a Magnetic resonance imaging (MRI) use to visualize internal structures?
Radiofrequency waves and a magnetic field
What is the role of gadolinium in MRI?
It is an IV contrast medium that may be used
What does nuclear imaging scans (scintigraphy) help identify?
Functional disorders and structural defects
What is measured in gastric emptying studies?
Ability of stomach to empty solids
What is the common tracer used in hepatobiliary scintigraphy (HIDA)?
99mTc
What procedure assesses gastrointestinal bleeding using a radioactive isotope?
Scintigraphy of GI bleeding
What is the purpose of a small bowel series?
To assess the digestive tract after ingesting a contrast medium
What is the method of recording in nuclear imaging?
A scanning device picks up radioactive emission
What technology is used in ultrasound imaging?
High-frequency ultrasound waves
What does ultrasound help to show?
Size and shape of an organ
What are the time intervals for imaging in gastric emptying studies?
0, 1, 2, and 4 hours later
What is the purpose of injecting 99mTc-labeled sulfur colloid?
To determine the site of active GI blood loss
What is the purpose of an abdominal ultrasound?
Detects abdominal masses (tumors, cysts), gallstones, biliary and liver disease, ascites.
A conductive gel is applied to skin, and a transducer is placed on the area.
How does endoscopic ultrasound (EUS) improve imaging accuracy?
Images obtained are more accurate and detailed than those provided by traditional ultrasound due to the proximity of the EUS transducer to the organ(s).
A small ultrasound transducer is installed on the tip of the endoscope.
What types of tumors and abnormalities can EUS detect?
Esophageal, gastric, rectal, biliary, and pancreatic tumors and abnormalities.
EUS is specifically designed to assess these areas more effectively.
What does ultrasound elastography (Fibroscan) assess?
Level of liver fibrosis.
Transient elastography uses an ultrasound transducer and is used to monitor patients with chronic liver disease.
What is virtual colonoscopy and how is it performed?
Combines CT scanning or MRI with computer virtual reality software; air is introduced via a tube placed in rectum to enlarge the colon for better visualization.
It detects intestine and colon diseases, including polyps, cancer, diverticulosis, and lower GI bleeding.
What preparation is needed for an abdominal ultrasound?
Teach patient to be NPO for 8-12 hours.
Air or gas can reduce the quality of images; food intake can cause gallbladder contraction.
What is the nursing responsibility before performing EUS?
Explain the need to lie in dorsal decubitus position with right arm extreme abduction.
This positioning helps in obtaining clearer images during the procedure.
What bowel preparation is needed before virtual colonoscopy?
Bowel preparation similar to colonoscopy.
Proper bowel preparation is crucial for clear imaging.
What is Amylase?
Enzyme secreted by pancreas. Important in diagnosing acute pancreatitis. Level peaks in 24 hr and then returns to normal in 48-72 hr
Amylase is a digestive enzyme that helps break down carbohydrates.
What is Gastrin?
Hormone secreted by cells of the antrum of the stomach, the duodenum, and the pancreatic islets of Langerhans
Gastrin plays a key role in stimulating the secretion of gastric acid.
What is Lipase?
Enzyme secreted by pancreas. Important in diagnosing pancreatitis. Level stays higher longer than serum amylase in acute pancreatitis
Lipase is essential for the digestion of fats.
What is the reference interval for Amylase?
60-120 U/L (30-220 U/L)
Reference intervals may vary by laboratory.
What is the reference interval for Gastrin?
25-100 pg/mL when fasting
Gastrin levels can be affected by food intake.
What is the reference interval for Lipase?
0-160 U/L
Elevated lipase levels may indicate pancreatitis.
What does Fecal DNA testing detect?
Detects shredded cell debris from polyps, adenomas, and cancers
Fecal DNA testing is a non-invasive method for colorectal cancer screening.
What does Fecal occult blood testing detect?
Detects blood in stool related to the presence of inflammatory bowel disease, diverticulosis, ulcers, cancer, and other GI problems
This test is crucial for early detection of gastrointestinal disorders.
What is the purpose of a Stool culture?
Tests for the presence of bacteria, including Clostridium difficile
Stool cultures are important for diagnosing infections in the gastrointestinal tract.
What is the major complication of GI endoscopy?
Perforation
Perforation can lead to severe complications and requires immediate medical attention.
What is Capsule endoscopy?
A noninvasive approach to visualize a GI tract. Useful in diagnosing small bowel disease and monitoring inflammation in patients with IBD
Capsule endoscopy allows for visualization of areas not easily accessible by traditional endoscopy.
What are Liver Function Studies (LFTs)?
Serologic (blood) studies that reflect hepatic disease
LFTs help assess the overall health and function of the liver.
What is the purpose of a liver biopsy?
To obtain hepatic tissue for diagnosis of cancer or liver disease or to assess and stage fibrosis and cirrhosis
Liver biopsies are crucial for evaluating the extent of liver damage.
What is the normal range for serum bilirubin levels?
0.3-1.0 mg/dL (5.1-17 Hmol/L) for total bilirubin
Includes direct (conjugated) and indirect (unconjugated) bilirubin measurements.
What does a prothrombin time (PT) of 11-12.5 seconds indicate?
Measures liver’s ability to conjugate and excrete bilirubin
Prolonged PT can indicate liver dysfunction.
What is the significance of urinary bilirubin levels?
Should be 0 or negative
Presence of bilirubin in urine can indicate liver disease or bile duct obstruction.
What is the range for serum albumin levels?
3.5-5.0 g/dL (35-50 g/L)
Albumin is a key protein synthesized by the liver.
What does a high alkaline phosphatase (ALP) level indicate?
High in liver damage, inflammation, and biliary obstruction
ALP is an enzyme associated with the liver and bones.
What is the normal range for serum ammonia levels?
<10 ng/mL (<10 mcg/L)
Elevated ammonia levels can lead to hepatic encephalopathy.
What does an elevated level of alpha-fetoprotein (a-FP) signify?
Sign of hepatocellular cancer
a-FP is normally produced in the liver and is usually elevated in liver cancer.
What is the role of Vitamin K in hemostatic function?
Essential cofactor for many clotting factors
Vitamin K deficiency can lead to bleeding disorders.
What is the normal range for total protein levels in serum?
6.4-8.3 g/dL (64-83 g/L)
Total protein includes both albumin and globulin.
What is the primary function of the liver in protein metabolism?
Conversion of ammonia to urea
This process normally occurs in the liver and is crucial for detoxification.
What is the normal range for serum globulin levels?
2.3-3.4 g/dL (23-34 g/L)
Globulins are a group of proteins in the blood, including antibodies.
What is the normal range for aspartate aminotransferase (AST) levels?
0-35 U/L (0.0-0.58 Mkat/L)
AST is an enzyme that indicates liver damage when elevated.
True or False: High levels of y-Glutamyl transpeptidase (GGT) are indicative of liver dysfunction.
True
GGT is more sensitive than ALP for liver dysfunction.
What does a high serum cholesterol level indicate?
High in biliary obstruction
Low levels can indicate cirrhosis and malnutrition.
Fill in the blank: The ileocecal fold is located at the junction of the _______ and the _______.
ileum; cecum
This anatomical structure plays a role in digestion and absorption.
What is the main function of the liver related to bilirubin?
The liver’s ability to conjugate bilirubin, converting it from unconjugated to conjugated bilirubin in plasma.
What are the two types of bilirubin mentioned?
- Unconjugated bilirubin
- Conjugated bilirubin
What is a common complication to monitor for after a liver biopsy?
Internal bleeding
What position should a patient be kept in after a liver biopsy?
Lying on the right side for a minimum of 2 hours
What is the purpose of maintaining bed rest after a liver biopsy?
To splint the puncture site and prevent complications
How often should vital signs be checked post-procedure?
15 minutes for 2 times, then 30 minutes for 4 times
What should a caregiver be taught about discharge care after a liver biopsy?
Signs and symptoms to report to HCP and activity restrictions
True or False: A liver biopsy can only be performed as an open procedure.
False
What is the difference between an open liver biopsy and a closed liver biopsy?
- Open biopsy involves making an incision and removing a wedge of tissue
- Closed biopsy can be done percutaneously
What should patients avoid doing after a liver biopsy to reduce intra-abdominal pressure?
Straining or coughing
What type of anesthesia is often used during an open liver biopsy?
General anesthesia
What is the purpose of a liver biopsy?
To obtain a specimen of hepatic tissue for diagnostic purposes
Liver biopsies are often performed to diagnose liver diseases or conditions.
What imaging techniques are commonly used to guide a liver biopsy?
Ultrasound or CT guidance
These imaging techniques help ensure accurate needle placement.
In a liver biopsy, where is the needle typically inserted?
Between the 6th and 7th or 8th and 9th intercostal spaces on the right side
This specific location is chosen to access the liver safely.
What is administered to the patient before the needle insertion in a liver biopsy?
A local anesthetic
This helps minimize discomfort during the procedure.
What alternative approach can be used for a liver biopsy?
Transjugular approach
This method involves accessing the liver through the jugular vein.
Describe the process of obtaining a liver biopsy via the transjugular approach.
The HCP enters the jugular vein, advances a small sheath into the hepatic vein, and passes a biopsy needle through the sheath into the liver tissue
This technique is useful for patients with bleeding risks.
True or False: A liver biopsy can only be performed through a percutaneous approach.
False
Liver biopsies can also be performed using transjugular and other methods.
Fill in the blank: A liver biopsy specimen is obtained from the _______.
[hepatic tissue]
Hepatic tissue is the liver tissue that is sampled during the procedure.
