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CHAPTER 12 Digestive System Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Digestive System Overview • Digestive System – Known as gastrointestinal tract • Also known as digestive tract or alimentary canal – Approximately 30 feet long • Begins with mouth (oral cavity), ends with anus Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Digestive System Overview • Digestive System – Functions • Prepare foods for absorption into the bloodstream • Prepare foods for use by the body cells • Responsible for elimination of solid wastes from the body Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Digestive System Structures • Oral cavity (buccal cavity) – Lips – Cheeks – Hard palate • Rugae – Soft palate Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Digestive System Structures • Oral cavity (buccal cavity) – Uvula – Tongue • Principle organ of the sense of taste • Also assists in process of chewing (mastication) and swallowing (deglutition) Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Digestive System Structures Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Digestive System Structures • Salivary glands – Three pairs • Parotids • Submandibulars • Sublinguals – Secrete saliva • Mostly water, but contains mucus and digestive enzymes that aid in digestive process Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Digestive System Structures • Salivary glands – Digestive enzymes contained in saliva • Amylase – aids in digestion of carbohydrates • Lipase – aids in digestion of fats Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Digestive System Structures • Pharynx – Known as the throat – Serves as passageway for both respiratory and digestive systems – Oropharynx • Section leading away from oral cavity Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Digestive System Structures • Pharynx – Nasopharynx • Behind nasal cavity – Laryngopharynx • Lower portion – opens into esophagus and larynx Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Digestive System Structures • Esophagus – Receives food from pharynx and propels it to stomach – Cardiac sphincter (lower esophageal sphincter) controls passage of food from esophagus into the stomach • Relaxes = food enters stomach • Contracts = stomach contents prevented from reentering the esophagus Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Digestive System Structures • Stomach – Fundus • Upper rounded portion – Body • Central part Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Digestive System Structures • Stomach – Pylorus • Lower tubular part (also called the gastric antrum) • Pyloric sphincter regulates passage of food from stomach into the duodenum – Folds in mucous membranes of stomach = rugae Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Digestive System Structures • Stomach – Gastric juices break down food in stomach – Muscular action of stomach causes churning of food • Mixes food with the secretions • Chyme = liquid-like mixture of partially digested food and digestive secretions Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Digestive System Structures Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Digestive System Structures • Small intestine – Approximately 20 feet long – Also known as the small bowel – Divided into three parts • Duodenum • Jejunum • Ileum Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Digestive System Structures • Large intestine – Cecum • Appendix hangs from lower portion of cecum – Ascending colon • Hepatic flexure – Transverse colon • Splenic flexure Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Digestive System Structures • Large intestine – – – – Descending colon Sigmoid colon Rectum Anus Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Digestive System Structures Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Digestive System Structures Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Question True or False: Basically, this 30-foot digestive system from mouth to anus breaks down food into what the body can use and gets rid of what it cannot. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Answer True. Food must be broken down to a cellular level. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Accessory Organs of Digestion • Liver – Located immediately under diaphragm, slightly to the right – Only one digestive function • Production of bile for emulsification of fats in small intestine – Additional functions of liver • Excretion of bile pigments into bile • Synthesis of vitamin K-dependent plasma proteins • Amino acid metabolism Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Accessory Organs of Digestion • Liver – Additional functions of liver • • • • • Carbohydrate metabolism Fat metabolism Phagocytosis Detoxification Storage of vital nutrients Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Accessory Organs of Digestion • Gallbladder – Pear-shaped sac, located under surface of liver – Main function: • To store and concentrate bile produced by the liver • Releases bile in response to presence of fatty content of food present in duodenum • Emulsifies fats Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Accessory Organs of Digestion • Pancreas – Located in upper left quadrant of abdomen, behind stomach – Functions as exocrine gland to manufacture digestive juices • • • • Trypsin – breaks down proteins Pancreatic lipase – breaks down fats Pancreatic amylase – breaks down carbohydrates Sodium bicarbonate – neutralizes acidic stomach contents Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Accessory Organs of Digestion • Pancreas – Functions as endocrine gland to manufacture insulin and glucagon • Insulin – hormone that makes it possible for glucose to pass from blood through cell membranes to be used for energy • Insulin also promotes conversion of excess glucose into glycogen • Glucagon – hormone that stimulates the liver to convert glycogen into glucose in time of need Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Animation Click Here to Play Pancreas Animation Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Accessory Organs of Digestion • Teeth – Primary responsibility • Chewing (mastication) • Food is ground by teeth and softened by saliva – Primary teeth = deciduous teeth • Set of 20 teeth – appears around age 6 months – Secondary teeth = permanent teeth • Begin to appear around age 6 Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Accessory Organs of Digestion • Teeth – Incisors • Chisel shape with sharp edges for biting food – Canine or cuspid teeth • Useful for grasping and tearing food – Bicuspids (premolars) and molars • Flat surfaces, multiple projections for crushing and grinding food Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Accessory Organs of Digestion • Teeth – Crown • Visible part of the tooth • Covered with enamel – hardest substance in body – Neck • Lies just beneath the gum line Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Accessory Organs of Digestion • Teeth – Root • Embedded in bony socket of the jaw bone – Root canal = pulp cavity • Central core of the tooth Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Question The ducts from the liver, gallbladder, and pancreas all converge to empty into what part of the digestive tract? a. b. c. d. stomach colon duodenum esophagus Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Answer c. The duodenum is the first part of the small intestine, where digestion is completed and nutrients can be passed to the bloodstream. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Accessory Organs of Digestion Layers of Teeth Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Animation Click Here to Play Digestion Animation Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Common Signs and Symptoms • Achlorhydria – Abnormal condition characterized by the absence of hydrochloric acid in the gastric juice • Anorexia – Lack or loss of appetite, resulting in the inability to eat Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Common Signs and Symptoms • Aphagia – Condition characterized by the loss of the ability to swallow as a result of organic or psychologic causes • Ascites – Abnormal accumulation of fluid within the peritoneal cavity • Fluid contains large amounts of protein and electrolytes Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Common Signs and Symptoms • Borborygmus – An audible abdominal sound produced by hyperactive intestinal peristalsis • Borborygmi are rumbling, gurgling, and tinkling noises heard when listening with a stethoscope Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Common Signs and Symptoms • Constipation – Difficulty in passing stools, or an incomplete or infrequent passage of hard stools • Diarrhea – Frequent passage of loose, watery stools Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Common Signs and Symptoms • Dyspepsia – Vague feeling of epigastric discomfort after eating – Involves an uncomfortable feeling of fullness, heartburn, bloating, and nausea • Dysphagia – Difficulty in swallowing, commonly associated with obstructive or motor disorders of the esophagus Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Question This symptom may be relieved with Tums or Prilosec OTC. a. b. c. d. aphagia dyspepsia dysphagia borborygmus Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Answer b. Otherwise known as heartburn. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Common Signs and Symptoms • Emaciation – Excessive leanness caused by disease or lack of nutrition • Emesis – Material expelled from the stomach during vomiting – Vomitus Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Common Signs and Symptoms • Eructation – Act of bringing up air from the stomach with a characteristic sound through the mouth – Belching • Flatus; flatulence – Air or gas in the intestine that is passed through the rectum Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Common Signs and Symptoms • Gastroesophageal reflux – Backflow of contents of stomach into esophagus – Often result of incompetence of the lower esophageal sphincter Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Common Signs and Symptoms • Icterus – A yellowish discoloration of the skin, mucous membranes, and sclera of the eyes, caused by greater than normal amounts of bilirubin in the blood – Also called jaundice Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Common Signs and Symptoms • Melena – An abnormal, black, tarry stool containing digested blood • Nausea – Unpleasant sensation often leading to the urge to vomit • Pruritus ani – A common chronic condition of itching of the skin around the anus Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Common Signs and Symptoms • Steatorrhea – Greater than normal amounts of fat in the feces • Characterized by frothy, foul-smelling fecal matter that floats • Vomit – To expel the contents of the stomach through the esophagus and out of the mouth Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Question True or False: Nausea can lead to eructation and vomiting, which produces icterus. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Answer False. Vomitus, or more commonly emesis, is the result of vomiting. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. PATHOLOGICAL CONDITIONS Digestive System Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Achalasia • Pronounced – (ak-al-LAY-zee-ah) • Defined – Decreased mobility of the lower two-thirds of the esophagus along with constriction of the lower esophageal sphincter Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Anal Fistula • Pronounced – (AY-nal FISS-too-lah) • Defined – Abnormal passageway in the skin surface near the anus, usually connecting with the rectum • May occur as the result of a draining abscess Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Aphthous Stomatitis • Pronounced – (AFF-thus stoh-mah-TYE-tis) • Defined – Small, inflammatory, noninfectious, ulcerated lesions occurring in the lips, tongue, and inside the cheeks of the mouth – Also called canker sores Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Appendicitis • Pronounced – (ap-pen-dih-SIGH-tis) • Defined – Inflammation of the vermiform appendix • Usually an acute condition that can lead to rupture (perforation) with resultant inflammation of the peritoneum (peritonitis) Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Celiac Disease • Pronounced – (SEE-lee-ak dih-ZEEZ) • Defined – Nutrient malabsorption due to damaged small bowel mucosa • Gluten-sensitive disease Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Cirrhosis • Pronounced – (sih-ROH-sis) • Defined – Disease of the liver that is chronic and degenerative, causing injury to the hepatocytes (liver’s functional cells) • Fat infiltrates lobules of the liver, causing tissue covering the lobes to become fibrous • Functions of liver eventually deteriorate Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Question If appendicitis is not caught in time, the appendix ruptures and spills its contents into the abdominal cavity. This causes inflammation of its lining, which is called the _____________. a. b. c. d. peritoneum pleura meninges perineum Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Answer a. Peritonitis is inflammation of the peritoneum. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Colorectal Cancer • Pronounced – (koh-loh-REK-tal KAN-sir) • Defined – Presence of a malignant neoplasm in the large intestine Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Constipation • Pronounced – (kon-stih-PAY-shun) • Defined – A state in which the individual’s pattern of bowel elimination is characterized by a decrease in the frequency of bowel movements and the passage of hard, dry stools • Individual experiences difficult defecation Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Crohn’s Disease • Pronounced – (KROHNZ dih-ZEEZ) • Defined – Digestive tract inflammation of a chronic nature causing fever, cramping, diarrhea, weight loss, and anorexia Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Dental Caries • Pronounced – (DEN-tal KAIR-eez) • Defined – Tooth decay caused by acid-forming microorganisms Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Diverticular Disease • Pronounced – (dye-ver-TIK-yoo-lar dih-ZEEZ) • Defined – Expression used to characterize both diverticulosis and diverticulitis • Diverticulosis = non-inflamed outpouchings or herniations of the muscular layer of the intestines, typically the sigmoid colon • Diverticulitis = inflammation of these outpouchings Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Diverticular Disease Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Dysentery • Pronounced – (DISS-en-ter-ee) • Defined – A term used to describe painful intestinal inflammation typically caused by ingesting water or food containing bacteria, protozoa, parasites, or chemical irritants • Person has frequent stools that often contain blood Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Question True or False: Diverticular disease is a collective way of saying a person has diverticulosis with episodes of diverticulitis. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Answer True. Diverticulosis must exist in order to have diverticulitis. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Esophageal Varices • Pronounced – (eh-soff-ah-JEE-al VAIR-ih-seez) • Defined – Swollen, twisted (tortuous) veins located in the distal end of the esophagus Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Gallstones (Cholelithiasis) • Pronounced – (koh-lee-lih-THIGH-ah-sis) • Defined – Pigmented or hardened cholesterol stones formed as a result of bile crystallization Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Hemorrhoids • Pronounced – (HEM-oh-roydz) • Defined – Hemorrhoid is an unnaturally distended or swollen vein (varicosity) in distal rectum or anus Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Hepatitis • Pronounced – (hep-ah-TYE-tis) • Defined – Acute or chronic inflammation of the liver due to a viral or bacterial infection, drugs, alcohol, toxins, or parasites Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Hernia • Pronounced – (HER-nee-ah) • Defined – Irregular protrusion of tissue, organ, or a portion of an organ through an abnormal break in the surrounding cavity’s muscular wall Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Hernia Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Herpetic Stomatitis • Pronounced – (her-PEH-tik stoh-mah-TYE-tis) • Defined – Inflammatory infectious lesions in or on the oral cavity occurring as a primary or a secondary viral infection caused by herpes simplex Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Question In the picture of a hernia (Figure 12-9), what muscle is the stomach protruding through? a. b. c. d. abdominal muscle diaphragm intercostal muscle the stomach's own muscle Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Answer b. The cardiac sphincter is enlarged, which causes part of the stomach to protrude through the opening. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Hirschsprung’s Disease (Congenital Megacolon) • Pronounced – (HIRSH-sprungz dih-ZEEZ) – (kon-JEN-ih-tal meg-ah-KOH-lon) • Defined – Absence at birth of the autonomic ganglia in a segment of the intestinal smooth muscle wall that normally stimulates peristalsis Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Ileus • Pronounced – (ILL-ee-us) • Defined – Obstruction of the intestine • May occur due to twisting of the bowel, absence of peristalsis, or presence of adhesions or tumor Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Intestinal Obstruction • Pronounced – (in-TESS-tin-al ob-STRUCK-shun) • Defined – Complete or partial alteration in the forward flow of the contents in the small or large intestine Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Intussusception • Pronounced – (in-tuh-suh-SEP-shun) • Defined – Telescoping of a portion of proximal intestine into distal intestine usually in the ileocecal region, causing an obstruction • Typically occurs in infants and young children Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Intussusception Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Irritable Bowel Syndrome (Spastic Colon) • Pronounced – (EAR-it-ah-b’l BOW-el SIN-drohm) – (SPAS-tik KOH-lon) • Defined – Increased motility of the small or large intestinal wall resulting in abdominal pain, flatulence, nausea, anorexia, and the trapping of gas throughout the intestines Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Oral Leukoplakia • Pronounced – (OR-al loo-koh-PLAY-kee-ah) • Defined – Precancerous lesion occurring anywhere in the mouth Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Question True or False: Ileus or intestinal obstruction is not an imminent threat, so it is best to let nature take its course. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Answer False. It must be diagnosed and treated within 24 hours, or death could result. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Pancreatitis • Pronounced – (pan-kree-ah-TYE-tis) • Defined – Destructive inflammatory condition of the pancreas • May be acute or chronic Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Peptic Ulcers (Gastric, Duodenal, Perforated) • Pronounced – (PEP-tik ULL-sirz) – (GAS-tric, doo-OD-en-al, PER-foh-ray-ted) • Defined – Break in the continuity of the mucous membrane lining of the gastrointestinal tract as a result of hyperacidity or the bacterium Helicobacter pylori (H. pylori) Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Peptic Ulcers • Peptic ulcer descriptions – Acute or chronic – Singular or clustered – Shallow or deep Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Peptic Ulcers • Symptoms of an ulcer – – – – Gnawing epigastric pain Heartburn or indigestion Nausea and vomiting Bloated feeling after eating Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Periodontal Disease • Pronounced – (pair-ee-oh-DON-tal dih-ZEEZ) • Defined – Group of inflammatory gum disorders (gingivitis) – May lead to degeneration of teeth, gums, and sometimes surrounding bones • Purulent inflammation of gums (pyorrhea) in late stages Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Polyps, Colorectal • Pronounced – (PALL-ips, koh-loh-REK-tal) • Defined – Small growths projecting from the mucous membrane of the colon or rectum • May be sessile (attached by a base) or pedunculated (attached by a stalk) • May vary in size and may be benign or pre-cancerous Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Thrush • Pronounced – (THRUSH) • Defined – Fungal infection in the mouth and throat producing sore, creamy white, slightly raised curdlike patches on the tongue and other oral mucosal surfaces • Caused by Candida albicans Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Thrush (Image courtesy of Dr. Joseph Konzelman, School of Dentistry, Medical College of Georgia) Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Ulcerative Colitis • Pronounced – (ULL-sir-ah-tiv koh-LYE-tis) • Defined – Chronic inflammatory condition resulting in a break in the continuity of the mucous membrane lining of the colon in the form of ulcers • Characterized by large, watery, diarrheal stools containing mucus, pus, or blood Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Volvulus • Pronounced – (VOL-vyoo-lus) • Defined – Rotation of loops of bowel causing a twisting on itself that results in an intestinal obstruction Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Volvulus Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Question Peptic ulcers and ulcerative colitis are a break in what lining? a. b. c. d. muscular lining serosal membrane mucous membrane epithelial membrane Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Answer c. The mucous coating is needed to protect underlying structures in a highly acidic environment. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. DIAGNOSTIC TECHNIQUES, TREATMENTS, AND PROCEDURES Digestive System Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Diagnostic Techniques, Treatments, and Procedures • Abdominal ultrasound – Use of very high-frequency sound waves to provide visualization of the internal organs of the abdomen (liver, gallbladder, bile ducts, pancreas, kidneys, bladder, and ureters) Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Diagnostic Techniques, Treatments, and Procedures • Abdominocentesis (paracentesis) – Insertion of a needle or trocar into abdominal cavity to remove excess fluid • Person is in a sitting position Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Diagnostic Techniques, Treatments, and Procedures • Alanine aminotransferase (ALT) – Hepatocellular enzyme released in elevated amounts due to liver dysfunction – Also known as serum glutamic pyruvic transaminase (SGPT) Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Diagnostic Techniques, Treatments, and Procedures • Alkaline phosphatase (ALP) – Enzyme found in highest concentrations in liver, biliary tract, and bone • Amylase – Enzyme secreted normally from pancreatic cells that travels to the duodenum by way of pancreatic duct – Aids in digestion Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Diagnostic Techniques, Treatments, and Procedures • Appendectomy – Surgical removal of an inflamed appendix – May be removed via laparoscope if no rupture has occurred Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Diagnostic Techniques, Treatments, and Procedures • Barium enema (BE) – Infusion of a radiopaque contrast medium, barium sulfate, into the rectum and held in the lower intestinal tract while x-ray films are obtained of the lower GI tract Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Diagnostic Techniques, Treatments, and Procedures • Barium swallow (upper GI series [UGI]) – Involves oral administration of a radiopaque contrast medium, barium sulfate, which flows into the esophagus as the person swallows Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Diagnostic Techniques, Treatments, and Procedures • Capsule endoscopy – Process of viewing entire length of small intestine using an ingestible video camera with a light source, enclosed in a capsule Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Diagnostic Techniques, Treatments, and Procedures • Capsule endoscopy – Camera pill produces digital images of entire length of small intestine, visualizing areas other diagnostic techniques cannot • No disruption to digestive tract • Also known as wireless endoscopy Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Diagnostic Techniques, Treatments, and Procedures • Cheiloplasty – Surgically correcting a defect of the lip • Cholecystectomy – Surgical removal of the gallbladder • Cholecystography (oral) – Visualization of the gallbladder through X-ray following the oral ingestion of pills containing a radiopaque iodinated dye Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Diagnostic Techniques, Treatments, and Procedures • Colonoscopy – Visualization of the lining of the large intestine using a fiberoptic colonoscope • Colostomy – Surgical creation of a new opening on the abdominal wall through which the feces will be expelled, by bringing the incised colon out to the abdominal surface • Abdominal-wall anus Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Question True or False: Appendectomy and cholecystectomy remove body parts that have little effect on bodily function. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Answer True. The appendix aids in fighting infection, and the gallbladder aids in digestion of fatty material. The diet may need to be adjusted, but otherwise a person can live just fine without them. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Diagnostic Techniques, Treatments, and Procedures • CT of the abdomen – Painless, noninvasive X-ray procedure – Produces an image created by the computer representing a detailed cross section of the tissue structure within the abdomen • Example: computerized tomography (CT) of the abdomen Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Diagnostic Techniques, Treatments, and Procedures • CT colonography (virtual colonoscopy) – Uses CT scanning (or MRI) to obtain interior view of colon that is usually seen with endoscope – Noninvasive, painless procedure provides 2- to 3-dimensional images that can show polyps and other lesions as clearly as with direct visual colonoscopy • Allows growths to be detected in early stages Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Diagnostic Techniques, Treatments, and Procedures • Endoscopic retrograde cholangiopancreatography (ERCP) – Examines the size of and filling of the pancreatic and biliary ducts through direct radiographic visualization with a fiberoptic endoscope Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Diagnostic Techniques, Treatments, and Procedures • Esophagogastroduodenoscopy (EGD) – Process of direct visualization of the esophagus, stomach, and duodenum using a lighted, fiberoptic endoscope • Also known as an upper endoscopy Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Diagnostic Techniques, Treatments, and Procedures • Extracorporeal shock wave lithotripsy (ESWL) – Alternative treatment for gallstones by using ultrasound to align the computerized lithotripter and source of shock waves with the stones – To crush the gallstones and thus enable the contraction of the gallbladder to remove stone fragments Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Diagnostic Techniques, Treatments, and Procedures • Fluoroscopy – Radiological technique used to examine the function of an organ or a body part using a fluoroscope • Gastric analysis – Study of the stomach contents to determine the acid content and to detect the presence of blood, bacteria, bile, and abnormal cells Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Diagnostic Techniques, Treatments, and Procedures • Gastric lavage – Irrigation, or washing out, of the stomach with sterile water or a saline solution Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Diagnostic Techniques, Treatments, and Procedures • Herniorrhaphy – Surgical repair of a hernia by closing the defect using sutures, mesh, or wire • Liver biopsy – Piece of liver tissue obtained for examination by inserting a specially designed needle into the liver through the abdominal wall Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Question A colonoscopy evaluates the lower portion of the digestive tract with a scope, while a(n) ___________ evaluates the upper portion. a. b. c. d. EGD CT colonography capsule endoscopy fluoroscopy Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Answer a. The abbreviation EGD stands for esophagogastroduodenoscopy. The majority of the small intestine cannot be not reached with either test, however. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Diagnostic Techniques, Treatments, and Procedures • Liver scan – Noninvasive scanning technique – Enables visualization of shape, size, and consistency of liver after IV injection of a radioactive compound • Magnetic resonance imaging (MRI) – Noninvasive scanning procedure that provides visualization of fluid, soft tissue, and bony structures without the use of radiation Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Diagnostic Techniques, Treatments, and Procedures • Nasogastric intubation – Placement of a tube through the nose into the stomach – To relieve gastric distension by removing gastric secretions, gas, or food Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Diagnostic Techniques, Treatments, and Procedures • Percutaneous transhepatic cholangiography (PTC) or (PTHC) – Examination of bile duct structure using a needle to pass directly into an intrahepatic bile duct to inject a contrast medium Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Diagnostic Techniques, Treatments, and Procedures • 48-hour pH study – Measures and monitors amount of gastric acid reflux into the esophagus during specified period – Monitoring system determines how often stomach contents reflux into esophagus, how long acid stays in esophagus, and how much reflux occurs at night – Used to determine presence of and severity of gastroesophageal reflux disease (GERD) Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Diagnostic Techniques, Treatments, and Procedures • Serum bilirubin – Measurement of bilirubin level in serum • Serum bilirubin levels are a result of the breakdown of red blood cells • Serum glutamic-oxaloacetic transaminase (SGOT) – Enzyme that has very high concentrations in liver cells • Also known as aspartate aminotransferase (AST) Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Diagnostic Techniques, Treatments, and Procedures • Small bowel follow-through – Oral administration of a radiopaque contrast medium, barium sulfate – Flows through the GI system – X-ray films are obtained at timed intervals to observe the progression of the barium through the small intestine Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Diagnostic Techniques, Treatments, and Procedures • Stool analysis for occult blood – Analysis of a stool sample to determine presence of blood not visible to naked eye • Stool culture – Collection of a stool specimen placed on one or more culture mediums – Allowed to grow colonies of microorganisms to identify specific pathogen(s) Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Diagnostic Techniques, Treatments, and Procedures • Stool guaiac – Test on a stool specimen using guaiac as a reagent – Identifies presence of blood in stool • Urinary bilirubin – Tests for conjugated or direct bilirubin in a urine specimen Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Question True or False: An elevated serum bilirubin gives babies their yellowish appearance after birth, which is quite common. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Answer True. Usually, a few sessions of phototherapy (special blue light) will correct this. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.