Chapter 43 Assessment: Gastrointestinal System Flashcards
What is an appendectomy?
Removal of appendix
What is a cholecystectomy?
Removal of gallbladder
What is choledochojejunostomy?
Opening between common bile duct and jejunum
What is choledocholithotomy?
Opening into common bile duct for removal of stones
What is a colectomy?
Removal of colon
What is a colostomy?
Opening into colon
What is esophagoenterostomy?
Removal of part of esophagus with segment of colon attached to remaining part
What is esophagogastrostomy?
Removal of esophagus and anastomosis of remaining part to stomach
What is a gastrectomy?
Removal of stomach
What is a gastrostomy?
Opening into stomach
What is a glossectomy?
Removal of tongue
What is a hemiglossectomy?
Removal of half of tongue
What is herniorrhaphy?
Repair of a hernia
What is an ileostomy?
Opening into ileum
What is a mandibulectomy?
Removal of mandible
What is pyloroplasty?
Enlargement and repair of pyloric sphincter area
What is vagotomy?
Resection of branch of vagus nerve
What are the main organs of the gastrointestinal (GI) system?
Gland, Larynx, Trachea, Esophagus, Diaphragm, Stomach, Spleen, Liver, Gallbladder, Transverse colon, Ascending colon, Small intestine, Cecum, Appendix, Rectum, Pyloric sphincter
Includes major organs involved in digestion and absorption.
What is the role of the parasympathetic nervous system in the GI tract?
Mainly excitatory, increases peristalsis
It stimulates digestive processes.
What is the function of the sympathetic nervous system in the GI tract?
Mainly inhibitory, decreases peristalsis
It inhibits digestive activity.
What is the enteric nervous system (ENS)?
Intrinsic nervous system that regulates motility and secretion in the GI tract
Composed of Meissner plexus and Auerbach plexus.
What are the two networks of the enteric nervous system?
Meissner plexus, Auerbach (myenteric) plexus
Meissner plexus is in the submucosa; Auerbach plexus is between muscle layers.
What is unique about circulation in the GI system?
Venous blood drains into the portal vein, perfusing the liver
This allows the liver to filter bacteria and toxins.
Which arteries supply blood to the GI tract?
Celiac artery, Superior mesenteric artery (SMA), Inferior mesenteric artery (IMA)
These arteries provide arterial blood to different parts of the GI tract.
What is the main function of the GI system?
To supply nutrients to body cells
Achieved through ingestion, digestion, absorption, and elimination.
What is ingestion?
The intake of food
Influenced by appetite and various physiological factors.
What factors stimulate appetite?
Hypoglycemia, empty stomach, decrease in body temperature
Hormones like ghrelin also play a role.
What hormone is released from the stomach mucosa to stimulate appetite?
Ghrelin
It signals hunger to the brain.
What is the function of the omentum?
Hangs like an apron from the stomach to the intestines, contains fat and lymph nodes
Plays a role in immune response and fat storage.
Fill in the blank: The _______ attaches the small intestine to the posterior abdominal wall.
Mesentery
Contains blood and lymph vessels.
What is the peritoneum?
A membrane that covers the abdominal organs
Composed of parietal and visceral layers.
True or False: The enteric nervous system functions independently of the brain and spinal cord.
True
It can regulate GI functions without input from the central nervous system.
What is ingestion?
Ingestion is the intake of food.
Ingestion is the first step in the digestion process.
What influences how much food a person eats?
Appetite influences how much food a person eats.
Appetite is the desire to ingest food.
Where is the appetite center located?
The appetite center is located in the hypothalamus.
The hypothalamus regulates various body functions, including hunger.
What factors stimulate appetite?
Several factors stimulate appetite, including:
* Hypoglycemia
* An empty stomach
* A decrease in body temperature
These factors signal the body that it needs food.
Which hormone plays a role in appetite stimulation?
The hormone ghrelin plays a role in appetite stimulation.
Ghrelin is released from the stomach mucosa.
Fill in the blank: The hormone _______ released from the stomach mucosa plays a role in appetite stimulation.
ghrelin
What is the role of ghrelin and leptin in appetite regulation?
Ghrelin stimulates appetite while leptin is involved in appetite suppression.
See Chapter 48 for more about ghrelin and leptin.
What factors can stimulate appetite?
Factors that can stimulate appetite include:
* Sight of food
* Smell of food
* Taste of food
Other factors include stomach distention and certain drugs.
What factors inhibit appetite?
Factors that inhibit appetite include:
* Stomach distention
* Illness (especially with fever)
* Hyperglycemia
* Nausea and vomiting
* Certain drugs (e.g., amphetamines)
What is deglutition?
Deglutition is the mechanical process of swallowing food.
What are the organs involved in deglutition?
The organs involved in deglutition are:
* Mouth
* Pharynx
* Esophagus
What structures comprise the mouth?
The mouth consists of:
* Lips
* Oral (buccal) cavity
* Hard palate
* Soft palate
* Teeth
* Tongue
What is the function of the tongue?
The tongue aids in:
* Chewing
* Moving food to the back of the throat for swallowing
* Speech
What do salivary glands produce?
Salivary glands produce saliva, which consists of:
* Water
* Protein
* Mucin
* Inorganic salts
* Salivary amylase
What are the three divisions of the pharynx?
The three divisions of the pharynx are:
* Nasopharynx
* Oropharynx
* Laryngeal pharynx
What initiates the swallowing reflex?
Food or liquid stimulates receptors in the oropharynx, initiating the swallowing reflex.
What is the function of the epiglottis during swallowing?
The epiglottis closes over the opening to the larynx to prevent food from entering the respiratory tract.
What is the structure of the esophagus?
The esophagus is a hollow, muscular tube that is:
* 7 to 10 inches long
* 0.8 inches in diameter
* Composed of 4 layers: inner mucosa, submucosa, muscularis propria, and outermost adventitia.
What are the two types of muscle in the esophagus?
The esophagus contains:
* Striated skeletal muscle in the upper third
* Smooth muscle in the distal two-thirds
What is the function of the lower esophageal sphincter (LES)?
The LES controls the opening of the esophagus into the stomach and prevents reflux of acidic gastric contents.
What are the main functions of the stomach?
The stomach’s functions include:
* Storing food
* Mixing food with gastric secretions
* Emptying contents into the small intestine
What is the shape and location of the stomach?
The stomach is usually J-shaped and lies obliquely in the epigastric, umbilical, and left hypochondriac regions of the abdomen.
What are the three main parts of the stomach?
The three main parts of the stomach are:
* Fundus (cardia)
* Body
* Antrum
What does gastric juice consist of?
Gastric juice is made up of:
* Hydrochloric acid (HCl)
* Water
* Intrinsic factor
What is the primary function of the small intestine?
The primary functions of the small intestine are:
* Digestion
* Absorption of nutrients
What are the sections of the small intestine?
The small intestine is composed of:
* Duodenum
* Jejunum
* Ileum
What structures increase the surface area for digestion and absorption in the small intestine?
Structures that increase surface area include:
* Villi
* Microvilli
* Circular folds
What is the role of Brunner’s glands?
Brunner’s glands secrete an alkaline fluid that contains bicarbonate to neutralize acidic fluids and protect the mucosa.
What initiates the process of digestion?
Digestion begins in the mouth with chewing and mixing food with saliva.
What enzyme in saliva breaks down starches?
Salivary amylase breaks down starches into maltose.
True or False: The stomach absorbs large amounts of water and nutrients.
False
What is the daily amount of saliva produced by salivary glands?
1000-1500 mL
What is the daily amount of gastric secretions produced by the stomach?
2500 mL
What is the daily amount of secretions produced by the pancreas?
700 mL
What is the daily amount of bile produced by the liver and gallbladder?
1000 mL
What enzyme initiates starch digestion?
Salivary amylase
What is the action of chymotrypsin?
Protein digestion
What is the function of lipase?
Fat digestion
What is the role of trypsinogen?
Activated to trypsin for protein digestion
What does bile do in digestion?
Emulsifies fats and aids in absorption of fatty acids and fat-soluble vitamins (A, D, E, K)
What is the function of HCl acid in the stomach?
Activation of pepsinogen to pepsin
What is the intrinsic factor essential for?
Cobalamin absorption in the ileum
What is the daily amount of secretions produced by the small intestine?
3000 mL
What do aminopeptidases do?
Protein digestion
What is the action of lactase?
Lactose to glucose and galactose
What is the role of enterokinase?
Activation of trypsinogen to trypsin
What does maltase do?
Maltose to 2 glucose molecules
What is the function of sucrase?
Sucrose to glucose and fructose
Fill in the blank: Salivary amylase initiates _______ digestion.
starch
True or False: Bile aids in the absorption of water-soluble vitamins.
False
What is the process that triggers the release of hormones into the bloodstream during digestion?
The process involves enzymes and motility.
What is chyme?
Chyme is the mixture of food and gastric secretions in the stomach.
What initiates protein digestion in the stomach?
The release of pepsinogen from chief cells.
What role does pepsin play in digestion?
Pepsin begins the breakdown of proteins.
What minimal digestion occurs in the stomach?
Minimal digestion of starches and fats.
What are the main functions of the small intestine?
Digestion and absorption of nutrients.
What substances are absorbed in the small intestine?
- Monosaccharides
- Fatty acids
- Amino acids
- Water
- Electrolytes
- Vitamins
- Minerals
What is the primary function of the large intestine?
Water and electrolyte absorption.
What are the main components of feces?
- Water (75%)
- Bacteria
- Unabsorbed minerals
- Undigested foodstuffs
- Bile pigments
- Desquamated epithelial cells
What do microorganisms in the colon produce?
- Vitamin K
- Some B vitamins
What is the result of bacteria deaminating amino acids?
Ammonia is produced.
How is ammonia processed in the body?
Ammonia is converted to urea in the liver.
What is a significant reflex that triggers peristalsis in the large intestine?
Gastrocolic and duodenocolic reflexes.
What is the reflex action involved in defecation?
Involves voluntary and involuntary control.
What does the Valsalva maneuver involve?
Inspiring deeply, holding the breath, and contracting abdominal muscles.
What are the potential contraindications for the Valsalva maneuver?
- Head injury
- Eye surgery
- Heart problems
- Hemorrhoids
- Abdominal surgery
- Liver cirrhosis with portal hypertension
What is the largest internal organ in the human body?
The liver.
What divides the liver into right and left lobes?
A fibrous capsule.
What are the functional units of the liver called?
Lobules.
What cells are responsible for phagocytic activity in the liver?
Kupffer cells.
Where does bile secretion occur in the liver?
In tiny canals called canaliculi.
What are the two lobes of the liver?
Left lobe and Right lobe
What duct carries bile from the liver?
Right hepatic duct
What is the function of the cystic duct?
Connects the gallbladder to the common bile duct
What is the primary function of the liver?
Performs metabolic, secretory, vascular, and storage functions
What is the source of 75% of the liver’s blood supply?
Portal vein
What does the portal vein carry to the liver?
Absorbed products of digestion
What is bile primarily composed of?
Water, cholesterol, bile salts, electrolytes, fatty acids, and bilirubin
What is the role of bile salts?
Needed for fat emulsification and digestion
What is unconjugated bilirubin?
Bilirubin that is insoluble in water and binds to albumin
What happens to unconjugated bilirubin in the liver?
It is conjugated with glucuronic acid and excreted in bile
What is the color of stool primarily due to?
Stercobilinogen
What triggers the release of cholecystokinin?
The presence of fat in the upper duodenum
What is the function of the gallbladder?
Concentrate and store bile
How much bile can the gallbladder hold?
About 45 mL
What is the composition of bile?
- Water
- Cholesterol
- Bile salts
- Electrolytes
- Fatty acids
- Bilirubin
True or False: The liver is essential for life.
True
Fill in the blank: The __________ duct carries bile from the liver to the duodenum.
Common bile duct
What is the central vein’s role in the liver?
Drains blood from liver lobules
What are sinusoids in the liver?
Specialized blood vessels where blood from the portal vein and hepatic artery mix
What is the Ampulla of Vater?
The junction where the bile duct empties into the duodenum
What does the Sphincter of Oddi regulate?
The flow of bile and pancreatic juices into the duodenum
What is the main function of the liver in blood clotting?
Synthesis of prothrombin, fibrinogen, and clotting factors V, VII, IX, and X
These proteins are essential for the coagulation process.
Define glycogenesis.
Conversion of glucose to glycogen.
What is glycogenolysis?
Process of breaking down glycogen to glucose.
What does gluconeogenesis refer to?
Formation of glucose from amino acids and fatty acids.
What are the detoxification functions of the liver?
Inactivates drugs and harmful substances and excretes their breakdown products.
List the metabolic functions of the liver.
- Synthesis of lipoproteins
- Breakdown of triglycerides into fatty acids and glycerol
- Formation of ketone bodies
- Synthesis of fatty acids from amino acids and glucose
- Synthesis and breakdown of cholesterol
What is the role of the liver in amino acid metabolism?
Synthesis of nonessential amino acids and plasma proteins, synthesis of clotting factors.
What is bile composed of?
- Bile salts
- Bile pigments (mainly bilirubin)
- Cholesterol
What function does the liver serve in blood filtration?
Breakdown of old RBCs, WBCs, bacteria, and other particles.
True or False: The liver serves as a blood reservoir.
True.
What does the liver store?
- Glucose in form of glycogen
- Vitamins (fat-soluble and water-soluble)
- Fatty acids
- Minerals (iron, copper)
- Amino acids in form of albumin and B-globulins
Describe the anatomy of the pancreas.
A long, slender gland lying behind the stomach, consisting of a head, body, and tail.
What are the exocrine functions of the pancreas?
Production and release of digestive enzymes.
What hormones are secreted by the islets of Langerhans?
- Insulin
- Amylin
- Glucagon
- Somatostatin
- Pancreatic polypeptide
Fill in the blank: The process of aging changes the functional ability of the _______.
GI system.
What are common age-related changes in the esophagus?
- Delayed emptying
- Reduced UES opening
- Incompetent LES
What is hypochlorhydria?
Decrease in intrinsic acid and HCl acid secretion.
What percentage of adults over age 60 experience chronic constipation?
30% to 40%.
What factors may 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?
The liver size decreases.
Does the size of the pancreas change with aging?
No, but it undergoes structural changes.
What are some structural changes in the pancreas due to aging?
- Fibrosis
- Fatty acid deposits
- Atrophy
What risk increases for older adults over 85 regarding food intake?
Decreased food intake.
How can economic constraints affect nutrition in older adults?
May reduce the number of fresh fruits and vegetables consumed.
What age-related changes affect the GI system?
Changes include atrophy of gingival tissue, decreased number of taste buds, reduced saliva volume, and gingival retraction
What are some symptoms to assess in a GI system evaluation?
Symptoms include abdominal pain, nausea, vomiting, abdominal distention, jaundice, heartburn, dyspepsia, appetite changes, hematemesis, and indigestion
What health history information should be obtained about GI functioning?
History of problems like peptic ulcer, cancer, diverticula, hernias, food intolerance, allergies, lactose intolerance, and anemia
Fill in the blank: Immobility limits the ability to prepare _______.
[meals]
What are expected aging changes in the mouth?
Atrophy of gingival tissue, decreased number of taste buds, reduced saliva volume, gingival retraction, dry oral mucosa, loss of teeth
What happens to esophageal function as a person ages?
Lower esophageal sphincter (LES) pressure and motility decrease, leading to potential dysphagia and higher risk of aspiration
True or False: Aging increases sensitivity to surface pain in the abdominal wall.
False
What changes occur in the stomach with aging?
Atrophy of gastric mucosa, decreased blood flow, slower gastric emptying, food intolerances, signs of anemia from cobalamin malabsorption
What are the effects of aging on the small intestine?
Slight decrease in motility and secretion of digestive enzymes, leading to indigestion and delayed absorption of fat-soluble vitamins
What impact does aging have on liver function?
Decreased protein synthesis, drug and hormone metabolism, and increased size and lower position of the liver
What are common issues in the large intestine, anus, and rectum due to aging?
Decreased anal sphincter tone, fecal incontinence, decreased muscular tone, and motility
What pancreatic changes occur with aging?
Distended pancreatic ducts, decreased lipase production, and impaired fat absorption
What should be assessed regarding medications in GI patients?
Past and current use of medications, reasons for taking them, doses, frequency, side effects, and effects on GI function
Fill in the blank: Chronic alcohol exposure can lead to _______ and hepatocellular cancer.
[cirrhosis]
What are key questions to assess nutritional-metabolic health in GI patients?
Daily food and fluid intake, use of supplements, changes in appetite, weight changes, and food allergies
What are common GI surgeries listed?
- Appendectomy
- Cholecystectomy
- Colectomy
- Gastrectomy
- Esophagogastrostomy
What is the purpose of obtaining a patient’s health perception regarding GI health?
To understand their health practices related to maintaining weight, dental care, nutrition, and elimination habits
What cultural factors may influence GI treatment?
Cultural or religious beliefs about food and food preparation
What factors should be assessed regarding activity-exercise in GI patients?
Limitations in mobility affecting food procurement and preparation
What should be assessed regarding cognitive-perceptual health in GI patients?
Changes in taste or smell, heat or cold sensitivity affecting eating, and pain interfering with appetite or food preparation
What are the possible causes for acute abdominal pain in a patient?
Potential causes include gastrointestinal obstruction, perforation, pancreatitis, or appendicitis
What is the significance of assessing a patient’s history of drug use?
To identify potential exposure to hepatotoxic substances and assess risk for liver damage
What is the significance of a family history of colorectal cancer (CRC)?
CRC may run in families, especially when diagnosed in first-degree relatives before age 50
About one third of cases of CRC occur in patients with a family history.
What genetic condition is associated with an increased risk for CRC and is caused by mutations in various genes?
Hereditary nonpolyposis colorectal cancer (HNPCC)
HNPCC is also known as Lynch syndrome.
What characterizes Familial adenomatous polyposis (FAP)?
FAP is characterized by multiple noncancerous polyps that can develop into cancer if untreated
Most cases of FAP are due to mutations of the adenomatous polyposis coli (APC) gene.
What is the risk increase for first-degree relatives of individuals with Inflammatory Bowel Disease (IBD)?
5- to 20-fold increased risk
Genetic predisposition plays a role in IBD susceptibility.
What dietary assessment tool can be used to analyze the adequacy of a patient’s diet?
24-hour diet recall
A 1-week recall may provide more information on usual diet patterns.
What factors should be assessed in a nutritional-metabolic pattern evaluation?
- Food preferences
- Portion size
- Use of sugar and salt substitutes
- Caffeine intake
- Fluid and fiber intake
- Changes in appetite
- Food allergies and intolerances
What is the relationship between dietary fiber and bowel health?
Inadequate fiber intake can be associated with constipation
Fiber helps maintain regular bowel movements.
True or False: Activity and exercise have no effect on gastrointestinal motility.
False
Immobility is a risk factor for constipation.
What GI symptoms can interfere with sleep quality?
- Nausea
- Vomiting
- Diarrhea
- Indigestion
- Bloating
What cognitive-perceptual issues may affect a patient’s ability to manage their diet?
Sensory changes affecting taste or smell, vertigo, and communication problems
These changes can influence appetite and eating pleasure.
How can chronic pain affect a patient’s eating behaviors?
Chronic pain can lead to avoiding activity, fatigue, and disrupted eating patterns
Pain can influence intake and appetite.
List some emotional factors that can influence gastrointestinal functioning.
- Stress
- Anxiety
- Depression
What should be assessed to understand a patient’s self-perception related to GI issues?
Body image, self-esteem, and willingness to engage in self-care
Changes from conditions like liver disease can disturb a patient’s self-image.
What factors can affect a patient’s relationships when experiencing GI problems?
- Changes in body image
- Self-esteem issues
- Need for adjustment in work hours or job status
Fill in the blank: Changes in _________ and reproductive status can result from GI system problems such as obesity and jaundice.
sexuality
What types of dietary beliefs should be respected during patient assessments?
Spiritual, religious, and cultural beliefs about food and food preparation
Respecting these preferences can enhance adherence and satisfaction.
What is the first step in a physical assessment of the mouth?
Inspect for symmetry, color, and size
Look for abnormalities like pallor, cyanosis, and ulcers.
What anatomical systems are used to describe the surface of the abdomen?
- 4 quadrants
- 9 regions
What position should the patient be in for an abdominal assessment?
Supine position
The patient should be as relaxed as possible.
True or False: A patient’s bladder should be full during an abdominal assessment.
False
The patient should have an empty bladder.
What should be noted when palpating the mouth during a physical assessment?
Ulcers, nodules, indurations, and areas of tenderness
Special attention is needed for older adults’ oral health.
What is the standard approach for examining the abdomen in an older adult?
The abdomen may be thinner and laxer unless the patient is obese.
What should be assessed during abdominal inspection?
- Skin changes (color, texture, scars, striae, dilated veins, rashes, lesions)
- Umbilicus (location and contour)
- Symmetry and contour (flat, rounded, concave, protuberant, distended)
- Observable hernias or masses
- Movement (pulsations, peristalsis)
What is peristalsis and when can it be seen?
Peristalsis is the movement of the intestines and may be visible in a thin person.
When should auscultation be performed during an abdominal exam?
Auscultate before percussion and palpation because these may alter bowel sounds.
What part of the stethoscope is used to auscultate bowel sounds?
Use the diaphragm for high pitched sounds and the bell for lower pitched sounds.
How long should you listen for bowel sounds in each quadrant?
Listen for bowel sounds for at least 2 minutes.
What are the types of bowel sounds and their meanings?
- Normal: high pitched and gurgling
- Hyperperistalsis: stomach growling or loud gurgles (borborygmi)
- Tension: high pitched rushes and tinkling
What indicates hypoactive bowel sounds?
If bowel sounds are not absent but are hypoactive after listening for several minutes.
What is a bruit and what does it indicate?
A bruit is a swishing or buzzing sound indicating turbulent blood flow.
What is the purpose of percussion in an abdominal exam?
To estimate the size of the liver and spleen and determine the presence of fluid, distention, and masses.
What sound does air produce when percussing the abdomen?
Air produces a higher pitched, hollow sound termed tympany.
What is the normal range of liver height in the right midclavicular line?
2.4 to 5 in (6 to 12.7 cm).
What is the initial technique for palpation during an abdominal exam?
Begin with light palpation.
What should be noted during palpation?
- Location
- Size
- Shape of masses
- Presence of tenderness
What is the benefit of having the patient relax during palpation?
It allows for deeper palpation.
In which abdominal quadrant should you start auscultation?
Start in the right lower quadrant.
What is the significance of observing the patient’s facial expression during palpation?
It provides nonverbal cues of discomfort or pain.
Fill in the blank: The abdominal regions include the _______.
[Right hypochondriac, Right lumbar, Right inguinal, Epigastric, Umbilical, Hypogastric, Left hypochondriac, Left lumbar, Left inguinal]
What structures are located in the Right Upper Quadrant?
- Liver and gallbladder
- Lower pole of right kidney
- Pylorus
- Head of pancreas
- Right adrenal gland
- Duodenum
- Right ovary and fallopian tube
- Portion of right kidney
- Stomach
- Bladder (if distended)
- Right spermatic cord
What structures are located in the Left Upper Quadrant?
- Left lobe of liver
- Spleen
- Body of pancreas
- Left adrenal gland
- Portion of ascending colon
- Portion of left kidney
- Uterus (if enlarged)
- Hepatic flexure of colon
- Splenic flexure of colon
What structures are located in the Right Lower Quadrant?
- Cecum and appendix
- Portion of ascending colon
- Bladder (if distended)
- Right ureter
- Right ovary and fallopian tube
- Portion of right kidney
- Uterus (if enlarged)
- Right spermatic cord
What structures are located in the Left Lower Quadrant?
- Lower pole of left kidney
- Sigmoid flexure
- Part of descending colon
- Bladder (if distended)
- Left ovary and fallopian tube
- Uterus (if enlarged)
- Left spermatic cord
- Left ureter
Fill in the blank: The _______ is located in the Right Upper Quadrant.
[liver and gallbladder]
True or False: The spleen is located in the Right Upper Quadrant.
False
Which quadrant contains the sigmoid flexure?
Left Lower Quadrant
Fill in the blank: The _______ is located in the Left Upper Quadrant.
[spleen]
What is located in the Right Lower Quadrant?
- Cecum and appendix
- Portion of ascending colon
- Bladder (if distended)
- Right ovary and fallopian tube
True or False: The left ovary is located in the Left Lower Quadrant.
True
What is the method for deep abdominal palpation using two hands?
Place one hand on top of the other and apply pressure with the fingers of the top hand.
This method helps in feeling for organs and masses.
How can rebound tenderness be assessed in the abdomen?
Press in slowly and firmly over the painful site, then withdraw the palpating fingers quickly.
Pain on withdrawal indicates peritoneal inflammation.
When should rebound tenderness be assessed during an examination?
At the end of the assessment.
It should only be performed by an experienced practitioner due to the potential for pain and muscle spasm.
What is the technique for palpating the liver?
Place your left hand behind the patient to support the right ribs, press the left hand forward, and place the right hand on the right abdomen lateral to the rectus muscle.
The patient should take a deep breath to help palpate the liver edge.
What should the liver edge feel like during palpation?
Firm, sharp, and smooth.
The surface and contour should be described, along with any tenderness.
How does chronic obstructive pulmonary disease affect liver palpation?
The liver may be palpated 0.4 to 0.8 in (1 to 2 cm) below the right costal margin.
This is due to large lungs or a low diaphragm.
What is the technique for palpating the spleen?
Move to the patient’s left side, place your right hand under the patient, and support the left lower rib cage, then press in toward the spleen with your left hand.
Ask the patient to breathe deeply to feel the tip of an enlarged spleen.
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 thick (3.8 cm).
The spleen is normally not palpable.
What should you do if the spleen is palpable?
Do not continue palpation.
Manual compression may cause complications.
What should be inspected in the perianal and anal areas?
Color, texture, masses, rashes, scars, erythema, fissures, and external hemorrhoids.
Palpate any masses or unusual areas with a gloved hand.
What is the procedure for a digital examination of the rectum?
Place a gloved, lubricated index finger against the anus while the patient bears down, then insert the finger toward the umbilicus.
Assess all surfaces for nodules, tenderness, or irregularities.
What should be done with the gloved finger during the rectal examination?
Use it to remove a stool sample and check for occult blood.
What are the characteristics of normal lips in a physical assessment?
Moist and pink lips
Indicates good hydration and circulation.
What should be observed in the buccal mucosa and gingivae during a physical assessment?
Pink and moist without plaques or lesions
Healthy oral mucosa indicates good oral hygiene.
What is a sign of good dental health during an assessment?
Teeth in good repair
Reflects proper dental care.
What is a normal finding when assessing the tongue?
Protrusion of tongue in midline without deviation or twitches
Indicates normal motor function and no neurological issues.
What should be observed in the uvula and soft palate during a physical assessment?
Pink uvula (in midline), soft palate, tonsils, and posterior pharynx
Normal appearance suggests no infection or inflammation.
What indicates normal swallowing function during an assessment?
Swallows smoothly without coughing or gagging
Suggests intact swallowing reflex and no obstruction.
What are the characteristics of a normal abdomen during a physical assessment?
Flat without masses or scars; no bruises
Indicates normal abdominal structure.
What should be noted about bowel sounds during an abdominal assessment?
Bowel sounds in all quadrants
Indicates normal gastrointestinal activity.
What is expected regarding abdominal tenderness during a physical examination?
No abdominal tenderness; nonpalpable liver and spleen
Suggests no underlying abdominal issues.
What is the normal size of the liver in the right midclavicular line?
10 cm
A normal liver size indicates healthy liver function.
What is a normal finding regarding tympany during an abdominal assessment?
Generalized tympany
Indicates the presence of gas in the gastrointestinal tract.
What should be observed during a rectal examination?
Absence of lesions, fissures, and hemorrhoids; good sphincter tone; rectal walls smooth and soft; no masses
Indicates normal rectal health.
What is a normal characteristic of stool during a physical assessment?
Soft, brown, and heme negative
Suggests normal digestion and absence of gastrointestinal bleeding.
What is acute marginal gingivitis?
Friable, edematous, painful, bleeding gingivae
Commonly caused by irritation from ill-fitting dentures or orthodontic appliances, calcium deposits on teeth, or food impaction.
What are the characteristics of candidiasis in the mouth?
White, curdlike lesions surrounded by erythematous mucosa
Caused by the fungus Candida albicans.
Define cheilitis.
Inflammation of lips (usually lower) with fissuring, scaling, crusting
Often related to irritation, injury, or vitamin B deficiencies.
What is cheilosis?
Softening, fissuring, and cracking of lips at angles of mouth
Can be associated with riboflavin deficiency.
What does geographic tongue look like?
Scattered red, smooth (loss of papillae) areas on dorsum of tongue
The etiology is often unknown.
What are the symptoms of glossitis?
Reddened, ulcerated, swollen tongue
May be caused by exposure to streptococci, irritation, or vitamin deficiencies.
What is herpes simplex?
Vesicular lesion
Caused by the herpesvirus.
What does leukoplakia present as?
Thickened white patches
Considered a premalignant lesion.
What is pyorrhea?
Recessed gingivae, purulent pockets
Associated with periodontitis.
Describe a smooth tongue.
Red, slick appearance
Often linked to cobalamin deficiency.
What is the clinical significance of an ulcer or plaque on lips or in mouth?
Sore or lesion
Can indicate various oral health issues.
What is dyspepsia?
Burning or indigestion
Commonly associated with gastrointestinal problems.
Define dysphagia.
Difficulty swallowing, sensation of food sticking in esophagus
Can be a symptom of esophageal problems or cancer.
What is eructation?
Belching
A normal physiological response, but can indicate gastrointestinal distress.
What does hematemesis refer to?
Vomiting of blood
May be caused by esophageal varices or bleeding peptic ulcers.
What are the symptoms associated with nausea and vomiting?
Feeling of impending vomiting, expulsion of gastric contents through mouth
Can be caused by various gastrointestinal issues, stress, or fear.
What are possible etiologies of gastrointestinal problems?
- Cancer
- Viral infections
- Peptic ulcer disease
- Gallbladder disease
- Esophageal problems
- GERD
- Dyspepsia
- Rumination
These conditions can lead to various symptoms in the gastrointestinal tract.
What is odynophagia?
Painful swallowing
Often associated with conditions like esophagitis or cancer of the esophagus.
What does pyrosis refer to?
Heartburn, burning in epigastric or substernal area
Commonly linked to hiatal hernia or esophagitis.
What finding indicates an absence of liver dullness?
Tympany on percussion
Suggests possible air in the abdomen, such as from a perforated ulcer.
What does an absence of bowel sounds indicate?
No bowel sounds on auscultation
Can signify peritonitis, paralytic ileus, or obstruction.
What is ascites?
Accumulated fluid within abdominal cavity
Often presents with eversion of the umbilicus.
What are borborygmi?
Waves of loud, gurgling sounds
Typically associated with hyperactive bowel activity.
What does a bruit indicate?
Humming or swishing sound heard through stethoscope over vessel
Suggests partial arterial obstruction or turbulent flow.
What does distention in the abdomen signify?
Excessive gas accumulation, enlarged abdomen
Often presents with generalized tympany.
What is hepatomegaly?
Enlargement of liver, liver edge >1-2 cm below costal margin
Can be caused by conditions like cirrhosis or metastatic cancer.
What is a hernia?
Bulge or nodule in abdomen, usually appearing on straining
Types include inguinal, femoral, umbilical, and incisional.
What does hyperresonance in the abdomen indicate?
Loud, tinkling rushes
Often associated with intestinal obstruction.
What could indicate the presence of masses in the abdomen?
Lump on palpation
May suggest tumors or cysts.
What is a nodular liver?
Enlarged, hard liver with irregular edge or surface
Can indicate cirrhosis or focal nodular hyperplasia.
What does rebound tenderness signify?
Sudden pain when fingers withdrawn quickly
Often a sign of peritoneal inflammation or appendicitis.
What is splenomegaly?
Enlarged spleen
Can be caused by chronic leukemia, hemolytic states, or portal hypertension.
What is a fissure?
Ulceration in anal canal
Can be painful and may lead to bleeding.
What are hemorrhoids?
Thrombosed veins in rectum and anus (internal or external)
Often associated with straining or prolonged sitting.
What does melena refer to?
Abnormal, black, tarry stool containing digested blood
Indicates bleeding in the upper GI tract.
What is a pilonidal cyst?
Opening of sinus tract, cyst in midline just above coccyx
Often congenital in nature.
What does steatorrhea indicate?
Fatty, frothy, foul-smelling stool
Associated with chronic pancreatitis or biliary obstruction.
What is tenesmus?
Painful and ineffective straining, sense of incomplete evacuation
Often linked to inflammatory bowel disease or irritable bowel syndrome.
What is the key role in teaching patients about GI procedures?
Obtaining written consent and asking about known allergies
Important allergies to inquire about include drugs and iodine.
What are the two main requirements for GI diagnostic procedures?
(1) Measures to cleanse the GI tract and (2) ingestion or injection of a contrast medium
A radiopaque tracer may also be used.
Why is it important to monitor patients closely during GI diagnostic tests?
To avoid problems such as dehydration from prolonged fluid restriction and diarrhea from bowel-cleansing procedures
Older adults may experience more discomfort and require adjustments.
What adjustments may be needed for older patients during GI procedure preparation?
Consideration of physical limitations and pressure points during positioning
Health conditions such as diabetes may also require special attention.
What does an upper GI series visualize?
Oropharyngeal area, esophagus, stomach, and small intestine
This is done through the ingestion of a contrast medium.
What is the procedure for an upper GI series?
Patient swallows contrast medium and assumes different positions on the x-ray table
Fluoroscopy is used to observe the movement of the contrast medium.
What conditions can an upper GI series help identify?
- Esophageal strictures
- Polyps
- Tumors
- Hiatal hernias
- Foreign bodies
- Ulcers
Useful for diagnosing various abnormalities in the upper GI tract.
What is the purpose of a lower GI series?
To observe the colon filling with contrast medium and to observe the filled colon using x-ray
This procedure is also known as a barium enema.
What does the patient receive during a lower GI series?
An enema of contrast medium
This allows for visualization of the colon during the procedure.
What can a lower GI series help identify?
Polyps and other abnormalities in the colon
Similar to the upper GI series, it aids in diagnosing various conditions.
What is the purpose of adding air contrast after barium in imaging?
To provide better visualization of tumors and other lesions in the colon
Air contrast helps to enhance the clarity of images obtained during the procedure.
What is virtual colonoscopy?
A less invasive imaging technique that combines CT scanning or MRI to produce images of the colon and rectum
Virtual colonoscopy requires radiation and prior cleansing of the colon but no sedation.
How does virtual colonoscopy compare to conventional colonoscopy in terms of sensitivity?
It may be less sensitive in obtaining details and color of the mucosa and in detecting small or flat polyps
Specifically, it has difficulty detecting polyps less than 10 mm.
What does endoscopy refer to?
The direct visualization of a body structure through an endoscope
An endoscope is a fiberoptic instrument with a light and camera.
What structures can be examined using endoscopy?
- Esophagus
- Stomach
- Duodenum
- Colon
Endoscopy allows for the examination of various gastrointestinal structures.
What is endoscopic retrograde cholangiopancreatography (ERCP)?
A procedure that visualizes the pancreatic, hepatic, and common bile ducts
ERCP is often used for diagnosing issues related to these ducts.
What are some examples of procedures that can be performed during endoscopy?
- Biopsy
- Polypectomy
- Sclerosis or banding of varices
- Cauterization of bleeding sites
- Common bile duct stone removal
- Balloon dilation
These procedures can be diagnostic or therapeutic in nature.
Fill in the blank: An endoscope is a _______ instrument with a light and camera attached.
fiberoptic
True or False: Virtual colonoscopy requires sedation.
False
What is the purpose of a colonoscopy?
Directly visualizes entire colon up to ileocecal valve with flexible fiberoptic scope
Used to diagnose or detect inflammatory bowel disease, polyps, tumors, and diverticulosis and dilate strictures. Allows for biopsy and removal of polyps without laparotomy.
What should a patient avoid for up to 72 hours prior to a colonoscopy?
Fiber
This is to prepare the bowel for the procedure.
What type of diet should a patient follow 24 hours before a colonoscopy?
Clear or full liquid diet
This aids in bowel preparation.
What is the recommended bowel cleansing regimen before a colonoscopy?
Split-dose regimen
The second dose should begin 4-6 hours before the procedure.
When should the first dose of bowel cleansing solution be taken?
The evening before the procedure
This timing helps ensure effective bowel preparation.
What should patients be encouraged to do regarding the cleansing solution?
Drink all the solution
Stools should be clear or clear yellow liquid when the colon is clean.
What medications may be given before the cleansing solution?
Bisacodyl tablets or suppositories
These may help remove the bulk of the stool.
In what position should the patient be during the insertion of the flexible scope?
Side-lying position
Sedation will be given during the procedure.
What may cause abdominal cramps after a colonoscopy?
Stimulation of peristalsis due to air inflation
The bowel is constantly inflated with air during the procedure.
What should patients be taught about post-colonoscopy pain?
Characteristics of the pain
Patients should be informed to notify HCP if pain lasts longer than 24 hours.
What vital signs should be checked after a colonoscopy?
Vital signs
Important for monitoring the patient’s condition.
What signs should be observed for after a colonoscopy?
Rectal bleeding and manifestations of perforation
Symptoms like malaise, abdominal distention, and tenesmus should be monitored.
What is Endoscopic retrograde cholangiopancreatography (ERCP)?
A fiberoptic endoscope is orally inserted into the descending duodenum to visualize the common bile and pancreatic ducts.
It allows for retrieval of gallstones, dilation of strictures, biopsy, and diagnosis of pseudocysts.
What is the purpose of Esophagogastroduodenoscopy (EGD)?
To directly visualize the mucosal lining of the esophagus, stomach, and duodenum using a flexible endoscope.
It can detect inflammation, ulcerations, tumors, varices, or Mallory-Weiss tears and allow for biopsies.
What does laparoscopy (peritoneoscopy) visualize?
The peritoneal cavity and contents using a laparoscope.
It allows for better visualization of the abdominal cavity and can obtain biopsy specimens.
What is the purpose of sigmoidoscopy?
To directly visualize the rectum and sigmoid colon using a lighted flexible endoscope.
It detects tumors, polyps, inflammatory diseases, and hemorrhoids.
What is video capsule endoscopy?
A patient swallows a vitamin-sized capsule with a camera that provides endoscopic visualization of the GI tract.
It takes over 50,000 images and relays them to a monitoring device worn by the patient.
What is Magnetic Resonance Cholangiopancreatography (MRCP)?
An MRI technology used to obtain images of biliary and pancreatic ducts.
It is non-invasive and helps in diagnosing disorders in these ducts.
What is the purpose of a percutaneous transhepatic catheter (PTC)?
To remove bile from the liver and inject radiopaque contrast medium into the biliary system.
It helps determine the filling of hepatic and biliary ducts.
What is the function of a surgical cholangiogram?
To inject contrast medium into the common bile duct during surgery on biliary structures.
What does a computed tomography (CT) scan detect?
Biliary tract, liver, and pancreatic disorders using noninvasive radiologic examination.
Oral and IV contrast medium is used to enhance density differences.
What is defecography?
A test that uses fluoroscopy or MRI to assess the shape and position of the rectum during defecation.
It detects pelvic floor abnormalities.
What are the nursing responsibilities before an ERCP procedure?
Explain the procedure, keep patient NPO for 8 hours, ensure consent form is signed, and provide sedation.
Antibiotics may be given if ordered.
What should be monitored after an EGD procedure?
Vital signs, signs of perforation or infection, and return of gag reflex.
Sudden temperature spike may indicate perforation.
Fill in the blank: Before a sigmoidoscopy, the patient should be kept ______ for 8 hours.
NPO
What is the complication to observe for after a laparoscopy?
Bleeding and bowel perforation.
What is a key post-procedure instruction for a patient after video capsule endoscopy?
The capsule is disposable and will be present in a bowel movement.
What should be assessed before administering contrast medium during a CT scan?
Renal function and possible allergies to shellfish.
The contrast medium is iodine-based.
True or False: Patients may eat food 2 hours after swallowing the capsule in video capsule endoscopy.
False
What is the purpose of using barium in defecography?
To visualize the small bowel and assess rectal position during defecation.
What is the purpose of the Gastric emptying breath test (GEBT)?
Used to diagnose delayed gastric emptying
Involves measuring CO2 in a patient’s breath after consuming a special test meal.
What is a barium enema?
Fluoroscopic x-ray examination of the colon using contrast medium given rectally
Used to detect tumors, diverticula, and polyps.
What does MRI stand for and what is its purpose?
Magnetic Resonance Imaging; used to detect hepatobiliary disease, hepatic lesions, and GI bleeding
May use IV contrast medium (gadolinium).
How do nuclear imaging scans work?
Tracer doses of a radioactive isotope are injected IV and a scanning device records emissions
Identifies functional disorders and structural defects.
What is assessed during gastric emptying studies?
The ability of the stomach to empty solids
Involves consuming cooked egg containing 99mTc.
What is the purpose of hepatobiliary scintigraphy (HIDA)?
Identifies obstructions of bile ducts, gallbladder disease, and bile leaks
Involves IV injection of 99mTc and imaging of the liver and biliary tree.
What is the small bowel series used for?
To assess the passage of contrast medium through the small intestine
Contrast medium is ingested and films taken every 30 minutes.
What should be done before a gastric emptying study?
Teach patient to be NPO after midnight and that the test takes 4 hours
Ensures accurate test conditions.
What are nursing responsibilities before a barium enema?
Give laxatives and enemas until colon is clear, follow clear liquid diet, and keep patient NPO for 8 hours
Helps ensure the colon is prepared for imaging.
What precautions should be taken before an MRI?
Check for pregnancy, allergies, and renal function; remove all metal objects
Ensures patient safety during the procedure.
What is the upper GI or barium swallow used to diagnose?
Structural abnormalities of the esophagus, stomach, and duodenum
Involves fluoroscopic x-ray study using contrast medium.
What is the role of ultrasound in gastrointestinal studies?
Uses high-frequency ultrasound waves to show size and shape of an organ
Noninvasive procedure that records reflected waves.
Fill in the blank: The procedure that assesses the ability of the stomach to empty solids involves eating cooked egg containing _______.
99mTc
True or False: The barium enema requires the patient to be NPO for 8 hours before the test.
False
The patient should be NPO for 8 hours before an MRI, not a barium enema.
What should be explained to the patient before a nuclear imaging scan?
The substance used contains only traces of radioactivity and poses little to no danger
Important for patient reassurance.
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) differ from traditional ultrasound?
Provides more accurate and detailed images due to the proximity of the EUS transducer to the organ(s) being examined
A small ultrasound transducer is installed on the tip of the endoscope.
What does ultrasound elastography (Fibroscan) assess?
Level of liver fibrosis
Used to monitor patients with chronic liver disease.
What is the technique used in virtual colonoscopy?
Combines CT scanning or MRI with computer virtual reality software
Air is introduced via a tube placed in the rectum to enhance visualization.
What conditions can virtual colonoscopy detect?
Intestine and colon diseases, including:
* Polyps
* Cancer
* Diverticulosis
* Lower GI bleeding
Images are formed into 2D and 3D pictures that are viewed on a monitor.
What is a nursing responsibility before an abdominal ultrasound?
Teach patient to be NPO for 8-12 hours
Air or gas can reduce quality of images; food intake can cause gallbladder contraction.
What should a patient be informed about before an endoscopic ultrasound?
Need to lie in dorsal decubitus position with right arm in extreme abduction
Same as EGD.
What is required for bowel preparation before a virtual colonoscopy?
Bowel preparation similar to colonoscopy
Important for clear imaging.
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) differ from traditional ultrasound?
Provides more accurate and detailed images due to the proximity of the EUS transducer to the organ(s) being examined
A small ultrasound transducer is installed on the tip of the endoscope.
What does ultrasound elastography (Fibroscan) assess?
Level of liver fibrosis
Used to monitor patients with chronic liver disease.
What is the technique used in virtual colonoscopy?
Combines CT scanning or MRI with computer virtual reality software
Air is introduced via a tube placed in the rectum to enhance visualization.
What conditions can virtual colonoscopy detect?
Intestine and colon diseases, including:
* Polyps
* Cancer
* Diverticulosis
* Lower GI bleeding
Images are formed into 2D and 3D pictures that are viewed on a monitor.
What is a nursing responsibility before an abdominal ultrasound?
Teach patient to be NPO for 8-12 hours
Air or gas can reduce quality of images; food intake can cause gallbladder contraction.
What should a patient be informed about before an endoscopic ultrasound?
Need to lie in dorsal decubitus position with right arm in extreme abduction
Same as EGD.
What is required for bowel preparation before a virtual colonoscopy?
Bowel preparation similar to colonoscopy
Important 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
Reference interval: 60-120 U/L (30-220 U/L)
What is Gastrin?
Hormone secreted by cells of the antrum of the stomach, the duodenum, and the pancreatic islets of Langerhans
Reference interval: 25-100 pg/mL when fasting
What is Lipase?
Enzyme secreted by pancreas. Important in diagnosing pancreatitis. Level stays higher longer than serum amylase in acute pancreatitis
Reference interval: 0-160 U/L
What is the purpose of fecal analysis?
Specimen examined for mucus, blood, pus, parasites, and fat content
Important for detecting various gastrointestinal issues.
What does fecal DNA testing detect?
Detects shredded cell debris from polyps, adenomas, and cancers
Useful in screening for colorectal cancer.
What does fecal occult blood test detect?
Detects blood in stool related to the presence of inflammatory bowel disease, diverticulosis, ulcers, cancer, and other GI problems
Teach patient to keep diet free of red meat for 24-48 hr before test.
What is the purpose of stool culture?
Tests for the presence of bacteria, including Clostridium difficile
Important for diagnosing bacterial infections in the gastrointestinal tract.
What is the reference interval for Amylase?
60-120 U/L (30-220 U/L)
Used in diagnosing acute pancreatitis.
What is the reference interval for Gastrin?
25-100 pg/mL when fasting
Indicates normal hormone levels in fasting state.
What is the reference interval for Lipase?
0-160 U/L
Important for diagnosing pancreatitis.
Fill in the blank: The _______ is an enzyme secreted by the pancreas and is important in diagnosing acute pancreatitis.
[Amylase]
Fill in the blank: The _______ is a hormone secreted by cells of the antrum of the stomach.
[Gastrin]
Fill in the blank: The _______ is an enzyme that remains elevated longer than serum amylase during acute pancreatitis.
[Lipase]
What is the major complication of GI endoscopy?
Perforation through the structure being studied
What type of sedation is often required for endoscopic procedures?
Short-acting IV sedation
What is required for all endoscopic procedures?
Informed, written consent
What is capsule endoscopy?
A noninvasive approach to visualize the GI tract
What is the utility of colon capsule endoscopy?
Diagnosing small bowel disease and monitoring inflammation in patients with IBD
What is being researched regarding colon capsule endoscopy?
Its sensitivity in detecting small lesions, colonic polyps, and CRC
What do liver function tests (LFTs) reflect?
Hepatic disease
What is the purpose of a liver biopsy?
To obtain hepatic tissue
What can liver biopsy tissue be used for?
Establish a diagnosis of cancer or liver disease, assess and stage fibrosis and cirrhosis
Why might a liver biopsy be performed?
To follow the progression of liver disease
What is the reference interval for total serum bilirubin?
0.3-1.0 mg/dL (5.1-17 umol/L)
Total bilirubin measures the combined amount of direct and indirect bilirubin in the blood.
What does urinary bilirubin indicate?
Measures urinary excretion of conjugated bilirubin
High levels of urinary bilirubin can indicate obstructive jaundice.
What is the purpose of measuring prothrombin time (PT)?
Determination of prothrombin activity
Prothrombin time is critical for assessing the blood’s ability to clot.
What is the normal reference interval for cholesterol levels?
200 mg/dL (<5.2 mmol/L)
Cholesterol levels vary with age and can indicate liver function.
What does a-fetoprotein indicate?
Sign of hepatocellular cancer
Elevated levels of a-fetoprotein can be a marker for liver cancer.
What is the normal range for ammonia levels in the blood?
10-80 mcg/dL (6-47 umol N/L)
Increased ammonia levels can lead to hepatic encephalopathy.
What is the reference interval for serum albumin?
3.5-5.0 g/dL (35-50 g/L)
Albumin is a major protein synthesized by the liver.
What does an elevation in alanine aminotransferase (ALT) indicate?
High in liver damage and inflammation
ALT is an enzyme that is primarily found in the liver.
What is the reference interval for alkaline phosphatase (ALP)?
30-120 U/L (0.5-2.0 ukat/L)
ALP levels can rise due to liver or bone disease.
What is the significance of gamma-glutamyl transpeptidase (GGT) levels?
High in hepatitis, cholestatic liver diseases, and alcoholic liver diseases
GGT is more sensitive for liver dysfunction than ALP.
What is the normal reference interval for aspartate aminotransferase (AST)?
0-35 U/L (0.0-0.58 ukat/L)
Elevated AST levels can indicate liver damage or disease.
Fill in the blank: The liver synthesizes and excretes _______.
[cholesterol]
Cholesterol levels can vary with age and health conditions.
True or False: High urinary bilirubin levels indicate unconjugated bilirubin.
False
High urinary bilirubin indicates conjugated bilirubin.
What is the purpose of measuring vitamin K levels?
Essential cofactor for many clotting factors
Vitamin K is critical for the synthesis of clotting proteins in the liver.
What does a low serum protein level indicate?
Possible liver dysfunction
Low protein levels can result from liver cirrhosis or malnutrition.
What is the first step in the preprocedure nursing management for a patient undergoing closed liver biopsy?
Perform baseline assessment, including vital signs and pulse oximetry.
How long should food and fluids be withheld before a closed liver biopsy?
8-12 hours.
What should be checked regarding the patient’s coagulation status before the procedure?
Prothrombin time, clotting or bleeding time.
What medications might be administered prior to the closed liver biopsy?
Sedative and other drugs, as ordered.
Why is it important to obtain a type and crossmatch before the procedure?
In case the patient bleeds and requires blood.
What should the nurse teach the patient and caregiver about the closed liver biopsy procedure?
About the procedure and postprocedure care, including the need to hold breath after expiration when the needle is inserted.
What document must be ensured to be signed before the procedure?
Informed consent.
How often should vital signs be checked postprocedure to detect internal bleeding?
q15min x 2, q30min x 4, q1hr x 4.
What symptoms should the healthcare provider be notified of postprocedure?
Dyspnea, cyanosis, and restlessness.
How should the patient be positioned after the closed liver biopsy?
Lying on right side for a minimum of 2 hours.
What is the recommended bed rest duration after the procedure?
12-14 hours, as ordered.
What should be applied over the needle insertion site postprocedure?
A small dressing.
What should the nurse teach the patient and caregiver about discharge care?
Signs and symptoms to report to HCP and any activity restrictions.
What activities should the patient be advised to avoid after the procedure?
Straining or coughing.
Fill in the blank: The patient should hold their breath after _______ when the needle is inserted.
[expiration].
What is the purpose of a liver biopsy?
To obtain a specimen of hepatic tissue.
What is the common method of guidance for a liver biopsy?
Ultrasound or CT guidance.
What is administered by the HCP before performing a liver biopsy?
A local anesthetic.
Where is the needle inserted for a liver biopsy?
Between the 6th and 7th or 8th and 9th intercostal spaces on the right side.
What is a transjugular liver biopsy?
A biopsy obtained through the jugular vein into the hepatic vein.
What is the first step in a transjugular liver biopsy?
Entering the jugular vein.
What does the HCP use to advance into the hepatic vein during a transjugular biopsy?
A small sheath.
What is the role of the biopsy needle in a transjugular liver biopsy?
It is passed through the sheath into the vein wall and liver tissue.
What are the two main types of liver biopsy methods?
Open and closed methods.
What does the open method of liver biopsy involve?
Making an incision and removing a wedge of tissue.
In what setting is an open liver biopsy typically performed?
In the operating room under general anesthesia.
What is a closed liver biopsy also known as?
A percutaneous biopsy.
Fill in the blank: A liver biopsy can be performed through a _______ approach.
[transjugular]
True or False: A liver biopsy can only be performed with the patient under general anesthesia.
False.
