DIGESTIVE AND GASTROINTESTINAL FUNCTION Flashcards

1
Q

DIGESTIVE AND GASTROINTESTINAL FUNCTION

I. Anatomy of the Digestive System

The digestive system is made up of the __ & __ that help the body break down and absorb food.

  • pathway that extends from the
A

gastrointestinal tract and accessory organs

Gastrointestinal tract

mouth to the esophagus, stomach, small and large intestines, and rectum to the terminal structure, the anus .

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2
Q

Upper GI:

Lower GI

A
  1. Esophagus
  2. Stomach
  3. Duodenum
  4. Small Intestine
  5. Large Intestine
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3
Q

It receives food and begins the mechanical breakdown of food by the action of chewing and grinding the food

Give 5 parts

A

Oral cavity

  1. Lips
  2. Cheeks
  3. Palate
  4. Tongue
  5. Teeth
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4
Q
  • The __ is permanently moist due to a continuous coating of ___ which makes swallowing easier.
    ( 3 categories)
A

oral cavity

Saliva

  1. parotid
  2. submandibular
  3. sublingual.
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5
Q

3 Pharynx

A
  1. nasopharynx,
  2. oral pharynx and
  3. laryngeal pharynx
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6
Q
  • located in the mediastinum, anterior to the spine and posterior to the trachea and heart.
  • receives food from your __ when you __.
  • at the bottom, contains the ___ that controls the flow of food.
A

Esophagus

mouth
swallow

esophageal sphincter

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7
Q
  • Situated in the ___ of the abdomen.
  • Has four anatomic regions: __,__, __,__
  • A hollow muscular organ with a capacity of approximately ___.
  • Stores during eating
  • Secretes ___
  • ____ is secreted when food enters the stomach and secretion stops when the stomach pH
    drops ____
  • Propels ___ (consisting of gastric juices and partly digested food) into the small intestine through the __.
A

Stomach
left upper portion

the cardia (entrance), fundus, body, and pylorus (outlet).

1500 mL

food

digestive fluids

Gastrin
below 1.5

chyme
pyloric sphincter

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8
Q
  • The __ is the longest section of small intestine.

Main function is ___

A

Ileum

absorption of nutrients

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9
Q
  • The longest segment of the GI tract.
  • Breaks down food using __ and __
  • Has three sections:
A

Small Intestine

enzymes released by the pancreas and bile from the liver.

duodenum, jejunum and ileum.

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10
Q
  • The ___ continues the process of mechanical digestion by the action of ___
A

duodenum

peristalsis

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11
Q

Large intestine

  • Consists of (5)
  • absorption of water, electrolytes and vitamins (___ and some _____ (___)

Responsible for processing ____ passing by means of __

  • Stool is stored in the _
  • Normally takes about ____ for stool to get through the colon.
A

cecum, ascending colon, transverse colon, descending colon, sigmoid colon.

vitamin K
B complexes (B 1 , B 2 and folic acid)

waste
peristalsis.

sigmoid (S-shaped) colon.

36 hours

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12
Q

___

  • Chamber that connects the
  • Receive stool from the
  • When ___ comes into the rectum, sensors send a message to the brain.
A

Rectum

colon to the anus.

colon.

anything (gas or stool)

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13
Q

Anus

  • Consists of the __ and ___
  • The lining of the upper anus is able to detect ___
  • The __ sphincter is always __, except when __
A

pelvic floor muscles and the two anal sphincters (internal and external).

rectal contents.

internal
tight
stool enters the rectum

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14
Q

Pancreas

  • Exocrine function - ______ (with a mesurement of ___)
  • __ (carbohydrates)
  • __ (Protein)
  • __ (fats)
  • Endocrine function
  • ___ from pancreatic ___ cells – increases blood glucose levels
  • ____ from pancreatic ___ cells – lowers blood glucose levels
  • _____ from pancreatic ___ cells – regulates both glucagon and insulin levels.
A

pancreatic juice (1500 mL of pancreatic juice are produced per day)

pancreatic amylase
Trypsin
Lipase

glucagon - alpha
insulin - beta
somatostatin - delta

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15
Q

glucagon - from? and function
insulin - from? and function
somatostatin - from? and function

A
  • ___ from pancreatic alpha cells – increases blood glucose levels
  • ____ from pancreatic beta cells – lowers blood glucose levels
  • _____ from pancreatic delta cells – regulates both glucagon and insulin levels.
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16
Q

Liver

  • __, __, __ metabolism
  • modifies waste products and toxic substances, i.e. drugs such as ____
  • produces and stores ____ (___ blood glucose levels)
  • converts __ to __, which is a waste product
  • stores __, __, __
  • manufactures __ such as ___
  • production of ___, which emulsifies ___ in the diet for ___
A

carbohydrate, protein and fat

paracetamol, aspirin and alcohol

glycogen
maintains

ammonia into urea

minerals (iron and copper)
fat soluble vitamins (A, D, E and K)
water soluble vitamins (B 12)

plasma proteins
prothrombin

bile
fats
absorption

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17
Q

water soluble vitamins

A

Vitamin B 12

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18
Q

what are fat soluble vitamins

A

A D E K

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19
Q

Gallbladder

  • Stores and concentrates ___ from the __ and releases it into the ___.

Give 4 illness of gall bladder

A

bile
liver
duodenum

Cholecystitis, Choledocholithiasis, Cholelithiasis, cholangitis

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20
Q

A. Mouth function

Chewing (___ ) and Swallowing (___)

  • The process of digestion begins with the act of ___ .
  • Eating—or even the sight, smell, or taste of food—can cause _____.
  • __ & __, also contained in saliva, help lubricate the food.
  • ___ begins as a voluntary act to ___.
A

Mastication
Deglutition

chewing

reflex salivation

Water and mucus

Swallowing
esophageal peristalsis

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21
Q

is an enzyme that begins the digestion of starches.

A
  • Ptyalin, or salivary amylase,
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22
Q

B. Gastric Function

  • The ___ secretes a highly acidic fluid (___) in response to the ingestion of food: (2)
A

stomach
HCl, up to pH1

  1. to break down food into more absorbable components
  2. to aid in the destruction of most ingested bacteria.
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23
Q

an important enzyme for protein digestion in gastric juice

A
  • Pepsin
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24
Q

__ combines with dietary vitamin __.

A
  • Intrinsic factor
    B12
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* ___ come from the ___ and the glands in the wall of the intestine itself.
Duodenal secretions accessory digestive organs
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* Secretions contain digestive enzymes: (3)
amylase, lipase, (secreted by the pancreas) and bile (liver)
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* Pancreatic secretions have an __ due to their ____
alkaline pH high concentration of bicarbonate.
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aids in emulsifying ingested fats, making them easier to digest and absorb.
* Bile
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controls the flow of bile.
* The sphincter of Oddi
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* Two types of contractions in the small intestine: NH * Both movements are stimulated by the presence of ___.
1. Segmentation contractions - produce mixing waves that move the intestinal contents back and forth in a churning motion. 2. Intestinal peristalsis - propels the contents of the small intestine toward the colon. chyme
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___ (small, finger-like projections that extend into the lumen of the ___) line the ___ intestine and function to produce ___ as well as to absorb nutrients.
* Villi small intestine entire digestive enzymes
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D. Colonic Function * ___ assist in completing the breakdown of waste material. * Two types of colonic secretions are added to the residual material: __ __ * __ transport allows for __ of water and electrolytes.
Bacteria 1. an electrolyte solution 2. mucus. Slow efficient reabsorption
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E. Elimination Function (____) * ___ consist of undigested foodstuffs, inorganic materials, water, and bacteria. * The ___ color of the feces results from the breakdown of ___ * Chemicals formed by intestinal bacteria are responsible in large part for the fecal odor. * The internal sphincter is controlled by the __ the external sphincter is __ The average frequency of defecation in humans is ___, but this varies among people.
Defecation Feces brown bile by the intestinal bacteria. autonomic nervous system; under the conscious control of the cerebral cortex. once daily
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is controlled by the autonomic nervous system;
* The internal sphincter
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* ____ cause the most discomfort because they remain in the stomach for digestion longer than proteins or carbohydrates.
Fatty foods
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(INDIGESTION)
Dyspepsia
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is under the conscious control of the cerebral cortex.
the external sphincter
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* ___ is a medical term for releasing gas from the digestive system through the ___. The accumulation of gas in the GI tract may result in ___. * Patients often complain of bloating, distention, or feeling “full of gas” with excessive flatulence as a symptom of ___ or ___.
flatulence anus belching or flatulence food intolerance or gallbladder disease
39
* ___ is __, often fluctuating pain in the abdomen caused by intestinal gas or obstruction in the intestines and suffered especially by __.
Colic severe babies
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* The emesis or vomitus may vary in color and content (e.g. hematemesis). * May result from: (3)
1. visceral afferent stimulation 2. CNS disorders 3. irritation of the chemoreceptor trigger zone
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* Upper abdominal discomfort associated with eating.
dyspepsia
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* is a common cause of nausea.
Distention of the duodenum or upper intestinal tract
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is a physiologic protective response.
* Vomiting
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is a vague, uncomfortable sensation of sickness or “queasiness” that may or may not be followed by vomiting.
Nausea
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- an abnormal increase in the frequency and liquidity of the stool.
* Diarrhea
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- a decrease in the frequency of stool, or stools that are hard, dry, and of smaller volume than typical.
* Constipation
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Bright or dark red stool
lower GI tract bleeding.
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Streaking of blood on the surface of the stool (or in the tissue)
- Lower rectal or anal bleeding
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Tarry-black color (melena)
upper GI tract bleeding.
50
bulky, greasy, foamy stools that are foul in odor and may or may not float
Steatorrhea – malabsorption
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* The most common symptom of patients with GI dysfunction.
dyspepsia
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Light-gray or clay-colored stool
- blockage in the bile ducts - caused by a decrease or absence of conjugated bilirubin
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Stool with mucus threads or pus that may be visible on gross inspection of the stool
- irritable bowel syndrome (IBS), ulcerative colitis (UC), or Crohn's disease
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Small, dry, rock-hard masses occasionally streaked with blood
constipation
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Loose, watery stool that may or may not be streaked with blood
diarrhea
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can be a major symptom of GI disease.
Pain (Referred pain)
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the pain travels from one part of the body to another. The pain literally moves through the body.
With radiating pain
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the source of pain doesn't move or get larger. The pain is simply felt in areas other than the source.
referred pain
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2. Past Health, Family, and Social History The nurse asks about the patient’s:
a. normal toothbrushing and flossing routine; b. frequency of dental visits; c. awareness of any lesions or irritated areas in the mouth, tongue, or throat; d. recent history of sore throat or bloody sputum; e. discomfort caused by certain foods; f. daily food intake; g. the use of alcohol and tobacco h. Past and current medication use i. Previous diagnostic studies, treatments, or surgery j. Changes in appetite or eating patterns k. Unexplained weight gain or loss over the past year. l. Psychosocial, spiritual, or cultural factors that may be affecting the patient.
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B. Physical assessment Oral Cavity Inspection and Palpation * ____ should be removed to allow good visualization of the entire oral cavity. 1. Lips * the presence of ___ * buccal mucosa for an assessment of __ and __ * ____ of each parotid gland is visible as a ____ in the buccal mucosa next to the upper molars. 2. Gums * inspected for inflammation, bleeding, retraction, and discoloration. (___) * The ___ of the breath is also noted. (____) * The ___ is examined for color and shape. 3. Tongue * The dorsum (back) of the tongue is inspected for __,__,__ * Frenulum, roof of the mouth, tonsils, uvula, and posterior pharynx.
Denture ulcerations or fissures. color and lesions Stensen’s duct small red dot Gingivitis odor halitosis hard palate texture, color, and lesions.
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Rectal Inspection and Palpation * Gloves, ____ lubrication, a penlight, and drapes are necessary tools for the evaluation. * Positions include ______, left lateral with hips and knees flexed, or standing with hips flexed and upper body supported by the examination table. * The patient is asked to ___, allowing the ready appearance of fistulas, fissures, rectal prolapse, polyps, and internal hemorrhoids. * ________- Internal examination is performed with a gloved lubricated index finger inserted into the anal canal while the patient bears down.
water-soluble knee-chest bear down Digital Rectal Exam (DRE)
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Auscultation * The frequency and character of the sounds are usually heard as __ and ___ that occur ___ and range from ____ to ___
clicks and gurgles irregularly 5 to 30 per minute
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* Normal (sounds heard about every ___),
5 to 20 seconds
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* hypoactive (___), * hyperactive (____), or * absent (____) * Borborygmi (___) * All quadrants are percussed for ___ and ___ To know the location of organs. * Light palpation is appropriate for identifying areas of ___ * Deep palpation is used to___
one or two sounds in 2 minutes 5 to 6 sounds heard in less than 30 seconds no sounds in 3 to 5 minutes (“stomach growling”) is heard as a loud prolonged gurgle. overall tympani and dullness. tenderness or muscular resistance. masses
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Diagnostic test Serum Laboratory Studies * Initial diagnostic tests begin with serum laboratory studies. * These include: * CBC, * complete metabolic panel, (____) * prothrombin time (____) * partial thromboplastin time, (____) * triglycerides, * liver function tests, aspartate transaminase (AST) or SGOT, alanine transaminase (ALT) or SGPT * amylase, and lipase (____) * Specific studies may be indicated, such as carcinoembryonic antigen (CEA), cancer antigen (CA) 19–9, and alpha-fetoprotein, which are sensitive and specific for colorectal and hepatocellular carcinomas, respectively.
electrolytes ability to clot for blood thinning therapy effectivity pancreas function
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Stool Tests * Include inspecting the specimen for consistency, color, and occult (not visible) blood. * Stool samples are usually collected on a ____basis. * Random specimens should be sent ___ to the laboratory for analysis.
random promptly
67
is one of the most commonly performed stool tests to detect blood in the stool
* Fecal occult blood testing (FOBT)
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Breath Tests - determines the amount of hydrogen expelled in the breath after it has been produced in the colon (on contact of galactose with fermenting bacteria) and absorbed into the blood to evaluate carbohydrate absorption. * bacterial overgrowth, or intolerances to lactose, fructose, or sucrose.
* Hydrogen breath test
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- detect the presence of Helicobacter pylori. After the patient ingests a capsule of carbon-labeled urea, a breath sample is obtained 10 to 20 minutes later.
* Urea breath tests
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(inflammation of the mucous membrane of the stomach) or ulcers in the stomach and small intestine
* gastritis
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* A noninvasive diagnostic technique in which high-frequency sound waves are passed into internal body structures. * Useful in the detection of an ___ or ___, the presence of gallstones, an enlarged ovary, an ectopic pregnancy, or appendicitis. * Advantages of abdominal ultrasonography include no noticeable ___, relatively ___, and almost ____ results. * The patient is instructed to fast for _____before ultrasound testing to decrease the amount of gas in the bowel.
Abdominal Ultrasonography enlarged gallbladder or pancreas side effects low cost immediate 8 to 12 hours
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Genetic Testing * To identify people who are at risk for certain GI disorders.
Genetic Testing
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- delineates the entire GI tract after the introduction of a contrast agent (radiopaque liquid). Nursing consideration: - Clear ___, with ___ from ___before the stud
Upper GI fluoroscopy liquid diet NPO midnight the night
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– can detect the presence of polyps, tumors, or other lesions of the large intestine and demonstrate any anatomic abnormalities or malfunctioning of the bowel. Nursing consideration: - ___ diet ____ before the test, a clear liquid diet and a laxative the evening before, NPO after midnight, and cleansing enemas until returns are clear the following morning.
Barium enema low-residue 1 to 2 days
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may be performed with or without oral or intravenous (IV) contrast
A CT scan
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- contraindicated in patients with any device containing ___ because the magnetic field could cause malfunction. Nursing Consideration: - NPO status ____ before the study and removal of all jewelry and other metals. - May induce feelings of ___, and the machine will make a ____ sound during the procedure.
Magnetic Resonance Imaging metal 6 to 8 hours claustrophobia knocking
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*___ Produces images of the body by detecting the radiation emitted from radioactive substances. * IT looks at their function and shows unusual ___ Nursing Consideration: * The ____ are injected into the body __ and are usually tagged with radioactive isotopes of oxygen, nitrogen, carbon, or fluorine
Positron Emission Tomography cellular activity. radioactive substances IV
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relies on the use of radioactive isotopes (i.e., technetium, iodine, and indium) to reveal displaced anatomic structures, changes in organ size, and the presence of neoplasms or other focal lesions such as ___ Nursing Consideration: - A sample of __ is removed, mixed with a ___, and reinjected into the patient. - Abnormal concentrations of blood cells are then detected at ____ intervals.
Scintigraphy cysts or abscesses. blood radioactive substance
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- the liquid and solid components of a meal (typically scrambled eggs) are tagged with radionuclide markers. - After ingestion of the meal, the patient is positioned under a ___
Gastrointestinal Motility Studies scinti scanner.
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G. Endoscopic Procedures
1. Upper Gastrointestinal Fibroscopy/Esophagogastroduodenoscopy 2. Endoscopic retrograde cholangiopancreatography (ERCP) 3. Fiberoptic Colonoscopy 4. Anoscopy, Proctoscopy, and Sigmoidoscopy 5. Endoscopy Through an Ostomy 6. Laparoscopy (Peritoneoscopy)
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- allows direct visualization of the esophageal, gastric, and duodenal mucosa through a lighted endoscope (gastroscope). - valuable when esophageal, gastric, or duodenal disorders or inflammatory, neoplastic, or infectious processes are suspected. - the gastroenterologist views the GI tract through a viewing lens and can obtain images through the scope to document findings.
Upper Gastrointestinal Fibroscopy/ Esophagogastroduodenoscopy
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- uses the endoscope in combination with x-rays to view the bile ducts, pancreatic ducts, and gallbladder.
Endoscopic retrograde cholangiopancreatography (ERCP)
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___ - useful for visualizing a segment of the small or large intestine. - may be indicated to evaluate the ___ for recurrent disease - To visualize and treat ___ in a segment of the bowel
Endoscopy Through an Ostomy anastomosis bleeding
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___ - Direct visual inspection of the large intestine (anus, rectum, sigmoid, transcending and ascending colon) is possible by means of a flexible fiberoptic colonoscope. - ____ can be used to document the procedure and findings. - The procedure can be used to remove all visible ___ with a special __ & __ through the colonoscope. - Colonoscopy is performed while the patient is ___ - Adequate colon cleansing provides optimal visualization and decreases the time needed for the procedure.
Fiberoptic Colonoscopy Still and video recordings polyps snare and cautery lying on the left side with the legs drawn up toward the chest.
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___ - Biopsies and polypectomies can be performed during this procedure. - These examinations require only ___, including a warm tap water or Fleet ___ until returns are clear
Anoscopy, Proctoscopy, and Sigmoidoscopy limited bowel preparation enema
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____ * a small incision is made lateral to the umbilicus, allowing for the insertion of the fiberoptic laparoscope. * permits direct visualization of the organs and structures within the __ * permits visualization and identification of any __, __, __ * __ can be taken from the structures and organs as necessary. * after visualization of a problem, ___ can then be performed at the same time, if appropriate.
Laparoscopy (Peritoneoscopy) abdomen growths, anomalies, and inflammatory processes. biopsy samples excision
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____ * insertion of a flexible tube into the stomach, or beyond the pylorus into the duodenum or the jejunum. * The tube may be inserted through the mouth, the nose, or the abdominal wall. * GI intubation may be performed in order to: (give 4)
Gastrointestinal Intubation 1. Decompress the stomach and remove gas and fluid 2. Lavage the stomach and remove ingested toxins or other harmful materials 3. Diagnose GI disorders 4. Administer tube feedings, fluids, and medications 5. Compress a bleeding site 6. Aspirate GI contents for analysis
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Type of tubes: 1. __ - a large-bore tube inserted through the mouth into the stomach that contains a wide outlet for removal of gastric contents. 2. __ - introduced through the nose into the stomach, often before or during surgery or at the bedside, to remove fluid and gas from the upper GI tract.
Orogastric tube Gastric tube (nasogastric (NG) tube)
89
is delivered through a tube to your stomach or the small intestine
Enteral nutrition
90
1. ___ is a procedure in which an opening is created into the stomach either for the purpose of administering nutrition, fluids, and medications via a feeding tube, or for gastric decompression. * preferred over a __ inserted tube to deliver enteral nutrition support longer than ___. * also preferred over __ or __ feedings in the patient who is ___ because the __ remains intact. * a permanent gastric stoma (an artificially created opening) is created surgically.
A gastrostomy nasally 4 weeks nasogastric or orogastric comatose gastroesophageal sphincter
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2. A ___ is a surgically placed opening into the jejunum for the purpose of administering nutrition, fluids, and medications. * indicated when the __ is not accessible, or to decrease __ risk when the stomach is not functioning adequately to process and empty food and fluids.
jejunostomy gastric route aspiration
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is the placement of a feeding tube using an endoscope
Percutaneous endoscopic gastrostomy or jejunostomy
93
"Parenteral" means
outside of the digestive tract
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___ * a method of providing nutrients to the body by an _ * The nutrients are a __ containing proteins, carbohydrates, fats, electrolytes, vitamins, trace minerals, and sterile water in a __container. * to improve ___, establish a positive nitrogen balance, maintain muscle mass, promote weight maintenance or gain, and enhance the healing process. * The indications for PN include an inability to __ within a __ timeframe.
Parenteral Nutrition IV route. complex admixture single nutritional status ingest adequate oral food or fluids 7- to 10-day
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There are two primary types of PN:
(Partially) PPN (Total) TPN
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(Partially) PPN is (Total) TPN is
generally used for patients who need supplementary nutrition for patients who require all of their dietary needs replaced
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* The ___ is to further break down the nutrients coming from the duodenum.
jejunum
98
- used to evaluate colonic motility and obstructive defecation syndromes. - The patient is given a capsule containing 20 radionuclide markers and instructed to follow a regular diet and usual daily activities. - Abdominal x-rays are taken every 24 hours (4-5 days) until all markers are passed.
b. Colonic transit studies