1. The Digestive System
Gastrointestinal, Hepatic, and Pancreatic Systems Function, Assessment, and Therapeutic Measures

2. Anterior View of Digestive System

3. Stomach: Anterior View and Partial Section

4. Gastrointestinal Anatomy and Physiology
Oral Cavity and Pharynx- mechanical digestion begins in the oral cavity.
Esophagus
Stomach
Small Intestine
Large Intestine

5. Liver, Gallbladder, Pancreas, and Duodenum

6. Liver Functions Carb metabolism- stores glycogen
Amino acid metabolism- converts excess to urea to be removed by kidneys.
Lipid metabolism- excretes excess cholestrol
Produces clotting factors prothrombin and fibrinogen
Form bilirubin
Stores iron, copper, Vitamins A, E, D, K
Detoxification (alcohol, meds, ammonia)

7. Gallbladder/Pancreas Functions
 Stores bile and contracts to secrete bile into duodenum in response to cholecystokinin
Pancreas secretes digestive enzymes amylase, lipase, trypsinogen, and bicarbonate juice
Gallbladder stores bile

8. Pancreas Amylase- changes Starch to Maltose
Lipase – changes Emulsified Fats to Fatty Acids and glycerol
Trypsinogen- changes to Trypsin in duodenum and digests polypeptides to amino acids
Bicarbonate Juice- neutralizes hydrochloric acid as it enters the deudenum

9. Aging and Gastrointestinal System
Tooth Enamel Harder/More Brittle
Tongue Atrophy-sweet/sour taste decrease
Saliva Production Decreased 33%
Esophagus Motility Less, Emptying Slower
Weaker Gag Reflex
Faulty absorption of B1, B12, calcium, iron

10. Aging and Gastrointestinal System (cont’d)
Decreased Motility of Stomach
Decreased Gastric HCL Production
Fat Absorption Slower
Atrophy of Large/Small Intestine
Decreased Mucous Secretions
Decreased Elasticity of Rectal Wall

11. Data Collection: Subjective Data
Health History
Travel (Clostridium Difficile)
Elimination
Medications
Nutritional assessment
Family History
Cultural influences “Which foods do you most commonly consume?”

12. Objective Data (cont’d)
Inspection- look
Jaundice, N/V, pain, distention
Auscultation- listen, normal BS 5-30 per min
Percussion- detect fluid, air or masses (usually NP or Dr.)
Palpation- feel for masses, rigidity, pain
RUQ tenderness, distended
Appetite/wt changes, bowel changes, HT, Wt, body mass

13. Physical Assessment Inspection
Striae- light silver colored or thin red lines on the abdomen
Bruising
Caput medusae- bluish purple swollen vein pattern extended out from navel
Spider angiomas- thin reddish-purple vein lines close to the skin
Jaundice(icterus) yellowing of skin

14. Jaundice Pathophysiology
Destruction of old red blood cells yeild bilirubin
Liver converts bilirubin to water-soluble compound for excretion
Jaundice (icterus) occurs if liver unable to convert bilierubin and buildup occurs
may also occur if bile drainage obstructed

15. Abdominal Auscultation

16. Diagnostic Lab Tests Laboratory Tests CBC- reveals anemia or infection
Electrolytes- imbalance occurs from vomiting, diarrhea, or malabsorption disorders
Carcinoembryonic Antigen (CEA)- monitor effectiveness of GI cancer tx and reoccurrence
Liver Enzymes- ALT,AST increase indicates liver damage
Stool test-test for occult blood, false + with bleeding gums and eating red meats

17. Diagnostic Tests (cont’d)
Radiographic Tests
Flat Plate of the Abdomen
Upper GI Series (Barium Swallow)
Lower GI Series (Barium Enema)
Computed Tomography (CT) Scan
Magnetic Resonance Imaging (MRI)
Nuclear Scan

18. Diagnostic Tests (cont’d)
Angiography
Liver Scan
Endoscopy
Esophagogastroduodenoscopy [EGD]
Cholangiopancreatography (ERCP)
Lower Gastrointestinal Endoscopy
Proctosigmoidoscopy
Colonoscopy

19. Gastroscopy

20. Endoscopic Retrograde Cholangiopancreatography

21. Diagnostic Tests
Ultrasonography- will use lubricating gel on abd with a tranducer that produces sound waves. A picture of your abd will appear on a screen
Endoscopic Ultrasonography
Percutaneous Liver Biopsy
Oral Cholecystogram- (gallbladder series) if gallstones. Pt ingests a radiopaque dye that collects in the bile in the liver. Dye shows up in xray. Pretest- high-fat diet x2 days, low-fat day before test. Take tablets evening before test with water 5mins apart. NPO after MN

22. Therapeutic Measures Gastrointestinal Intubation
Tube feedings- Gravity, bolus, pump
Gastrointestinal decompression
Total Parenteral Nutrition (intravenous hyperalimentation

23.   Feeding Tubes

24. NG Tubes Purposes Remove gas or fluids from stomach or intestines.
Obtain gastric secretions fro analysis
Tx obstructions or bleeding in GI tract
Provide means for nutrition (gavage feeding) hydration, and medications.