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Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Chapter 32
Gastrointestinal,
Hepatobiliary, and Pancreatic
Systems Function,
Assessment, and Therapeutic
Measures
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Anterior View of the
Digestive System
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Stomach: Anterior View and
Partial Section
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Gastrointestinal Anatomy
and Physiology
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Oral Cavity and Pharynx
Esophagus
Stomach
Small Intestine
Large Intestine
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Liver, Gallbladder, Pancreas,
and Duodenum
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Liver, Gallbladder, Pancreas
 Accessory Organs of Digestion
 Produce or Store Digestive Secretions
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Liver
 Hepatic Portal Circulation
 Bile
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Liver Functions
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Carbohydrate Metabolism
Amino Acid Metabolism
Lipid Metabolism
Synthesis of Plasma Proteins
Phagocytosis by Kupffer Cells
Formation of Bilirubin
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Liver Functions (cont’d)
 Storage
 Detoxification
 Activation of Vitamin D
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Gallbladder
 Stores Bile
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Pancreas
 Amylase
 Starch to Maltose
 Lipase
 Emulsified Fats to Fatty Acids/Monoglycerides
 Trypsin
 Polypeptides to Peptides
 Bicarbonate Juice
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Aging Effects on the
Gastrointestinal, Hepatic, and
Pancreatic Systems
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Aging and the
Gastrointestinal System
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Tooth Enamel Harder/More Brittle
Tongue Atrophy
Sweet Taste Sensation Lost
Saliva Production Decreased 33%
Esophagus Motility Less, Emptying Slower
Weaker Gag Reflex
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Aging and the Gastrointestinal
System (cont’d)
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Decreased Motility of Stomach
Decreased Gastric HCL Production
Fat Absorption Slower
Atrophy of Large/Small Intestine
Decreased Mucous Secretions
Decreased Elasticity of Rectal Wall
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Aging and theGastrointestinal
System (cont’d)
 Weakness of Intestinal Wall
 Faulty Absorption of Vitamins B1 and B12,
Calcium, Iron
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Aging and the Gallbladder
 Gallstones
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Assessment
 Health History
 Travel
 Elimination
 Medications
 Clostridium Difficile
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Assessment (cont’d)
 Nutritional Assessment
 Family History
 Cultural Influences
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Physical Assessment
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Height and Weight
Body Mass Index
Oral Cavity
Abdomen
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Physical Assessment (cont’d)
 Inspection
 Jaundice
 Auscultation
 Percussion
 Palpation
 Abdominal Girth
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Abdominal Auscultation
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Diagnostic Tests
 Laboratory Tests
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CBC
Electrolytes
Carcinoembryonic Antigen (CEA)
Bilirubin
Liver Enzymes
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Diagnostic Tests (cont’d)
 Laboratory Tests (cont’d)
 Pancreatic Enzymes
 Stool Tests
 Gastric Analysis
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Diagnostic Tests (cont’d)
 Radiographic Tests
 Flat Plate of the Abdomen
 Upper GI Series (Barium Swallow)
 Lower GI Series (Barium Enema)
 Barium Impaction
 Computed Tomography (CT) Scan
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Diagnostic Tests (cont’d)
 Nuclear
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Cholesintigraphy
DISIDA
HIDA
IDA
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Diagnostic Tests (cont’d)
 Angiography
 Liver Scan
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Diagnostic Tests (cont’d)
 Endoscopy
 Esophagogastroduodenoscopy (EGD)
 Endoscopic Retrograde
Cholangiopancreatography (ERCP)
 Lower Gastrointestinal Endoscopy
 Proctosigmoidoscopy
 Colonoscopy
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Gastroscopy
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Endoscopic Retrograde
Cholangiopancreatography
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Diagnostic Tests
 Ultrasonography
 Endoscopic Ultrasonography
 Percutaneous Liver Biopsy
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Therapeutic Measures
 Gastrointestinal Intubation
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Tube Feedings
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Gravity
Pump
Bolus
Intermittent
Continuous
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Tube Feeding Nursing Care
 Placement Check
 Residual
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Feeding Tubes
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Therapeutic Measures
 Tube Feeding Formulas
 Gastrointestinal Decompression
 Total Parenteral Nutrition (Intravenous
Hyperalimentation)
 Peripheral Parenteral Nutrition
Copyright © 2011. F.A. Davis Company