1. Linda S. Williams / Paula D. Hopper Copyright © 2011. F.A. Davis Company Understanding Medical Surgical Nursing, 4th Edition Chapter 32 Gastrointestinal, Hepatobiliary, and Pancreatic Systems Function, Assessment, and Therapeutic Measures

2. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Anterior View of the Digestive System

3. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Stomach: Anterior View and Partial Section

4. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Gastrointestinal Anatomy and Physiology  Oral Cavity and Pharynx  Esophagus  Stomach  Small Intestine  Large Intestine

5. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Liver, Gallbladder, Pancreas, and Duodenum

6. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Liver, Gallbladder, Pancreas  Accessory Organs of Digestion  Produce or Store Digestive Secretions

7. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Liver  Hepatic Portal Circulation  Bile

8. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Liver Functions  Carbohydrate Metabolism  Amino Acid Metabolism  Lipid Metabolism  Synthesis of Plasma Proteins  Phagocytosis by Kupffer Cells  Formation of Bilirubin

9. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Liver Functions (cont’d)  Storage  Detoxification  Activation of Vitamin D

10. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Gallbladder  Stores Bile

11. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Pancreas  Amylase  Starch to Maltose  Lipase  Emulsified Fats to Fatty Acids/Monoglycerides  Trypsin  Polypeptides to Peptides  Bicarbonate Juice

12. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Aging Effects on the Gastrointestinal, Hepatic, and Pancreatic Systems

13. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Aging and the Gastrointestinal System  Tooth Enamel Harder/More Brittle  Tongue Atrophy  Sweet Taste Sensation Lost  Saliva Production Decreased 33%  Esophagus Motility Less, Emptying Slower  Weaker Gag Reflex

14. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Aging and the 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

15. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Aging and theGastrointestinal System (cont’d)  Weakness of Intestinal Wall  Faulty Absorption of Vitamins B 1 and B 12, Calcium, Iron

16. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Aging and the Gallbladder  Gallstones

17. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Assessment  Health History  Travel  Elimination  Medications  Clostridium Difficile

18. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Assessment (cont’d)  Nutritional Assessment  Family History  Cultural Influences

19. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Physical Assessment  Height and Weight  Body Mass Index  Oral Cavity  Abdomen

20. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Physical Assessment (cont’d)  Inspection  Jaundice  Auscultation  Percussion  Palpation  Abdominal Girth

21. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Abdominal Auscultation

22. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Diagnostic Tests  Laboratory Tests  CBC  Electrolytes  Carcinoembryonic Antigen (CEA)  Bilirubin  Liver Enzymes

23. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Diagnostic Tests (cont’d)  Laboratory Tests (cont’d)  Pancreatic Enzymes  Stool Tests  Gastric Analysis

24. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition 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

25. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Diagnostic Tests (cont’d)  Nuclear  Cholesintigraphy  DISIDA  HIDA  IDA

26. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Diagnostic Tests (cont’d)  Angiography  Liver Scan

27. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Diagnostic Tests (cont’d)  Endoscopy  Esophagogastroduodenoscopy (EGD)  Endoscopic Retrograde Cholangiopancreatography (ERCP)  Lower Gastrointestinal Endoscopy  Proctosigmoidoscopy  Colonoscopy

28. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Gastroscopy

29. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Endoscopic Retrograde Cholangiopancreatography

30. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Diagnostic Tests  Ultrasonography  Endoscopic Ultrasonography  Percutaneous Liver Biopsy

31. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Therapeutic Measures  Gastrointestinal Intubation

32. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Tube Feedings  Gravity  Pump  Bolus  Intermittent  Continuous

33. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Tube Feeding Nursing Care  Placement Check  Residual

34. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Feeding Tubes

35. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Therapeutic Measures  Tube Feeding Formulas  Gastrointestinal Decompression  Total Parenteral Nutrition (Intravenous Hyperalimentation)  Peripheral Parenteral Nutrition