Gastrointestinal, Hepatobiliary, and Pancreatic Systems

Anatomy of the Gastrointestinal System

  • Structures:
    • Mouth
    • Pharynx
    • Esophagus
    • Stomach
    • Small Intestine
    • Large Intestine
    • Rectum
    • Anus
    • Accessory Organs: Liver, Gallbladder, Pancreas

Functions of the Gastrointestinal Organs

  • Mouth: Begins digestion via chewing and saliva secretion.
  • Esophagus: Transports food to the stomach via peristalsis.
  • Stomach: Secretes acid and enzymes; churns food to facilitate digestion.
  • Small Intestine: Major site for nutrient absorption.
  • Large Intestine: Absorbs water; compacts waste.
  • Liver:
    • Functions:
    • Carbohydrate metabolism
    • Amino acid metabolism
    • Lipid metabolism
    • Synthesis of plasma proteins
    • Phagocytosis by Kupffer cells
    • Formation of bilirubin
    • Storage of nutrients
    • Detoxification
      • Activation of Vitamin D
  • Gallbladder: Stores and concentrates bile.
  • Pancreas:
    • Produces enzymes:
    • Amylase: Converts starch to maltose
    • Lipase: Breaks down fats
    • Trypsin: Breaks down proteins into peptides
    • Produces bicarbonate to neutralize gastric acid in the small intestine.

Aging and the Gastrointestinal System

  • Effects:
    • General:
    • Slower gastric motility.
    • Atrophy of gastric mucosa, affecting absorption.
    • Liver:
    • Increased risk of gallstones and drug toxicity.
    • Increased risk of hepatic issues due to drug metabolism changes.
    • Gallbladder:
    • Higher incidence of gallstones due to increased cholesterol secretion.
    • Pancreas:
    • Increased risk of pancreatic cancer.

Data Collection for Gastrointestinal Disorders

  • Health History:
    • Travel history
    • Elimination patterns
    • Medications
    • Family history of gastrointestinal diseases
  • Nutritional Assessment: Consider cultural influences.

Physical Assessment Techniques

  • Inspect:
    • Height and weight, BMI
    • Oral cavity (e.g., signs of dehydration, lesions)
    • Abdomen (check for jaundice)
  • Palpate:
    • Check abdominal girth
    • Assess for organomegaly
  • Auscultate and Percuss
  • Assessment of Abdominal Quadrants:
    • Right Upper (RUQ), Left Upper (LUQ)
    • Right Lower (RLQ), Left Lower (LLQ)

Diagnostic Tests

  • Laboratory Tests:
    • Complete blood count (CBC)
    • Electrolytes
    • Liver enzymes
    • Pancreatic enzymes (e.g., amylase and lipase)
  • Radiographic Tests:
    • Barium swallow/enema
    • Computed tomography (CT) scan
  • Endoscopy Tests:
    • Esophagogastroduodenoscopy (EGD)
    • Colonoscopy
  • Ultrasonography and Liver Biopsy

Therapeutic Measures for Gastrointestinal Disorders

  • Gastrointestinal Intubation:
    • Nasogastric tube types: nasogastric, nasoduodenal, nasojejunal.
    • Care for feeding tubes (predominately associated with enteral nutrition):
    • Maintenance of proper tube placement and function.
    • Monitoring patient tolerance and adjusting feeding accordingly.

Nursing Care Planning for Diagnostic Tests

  • Prepare patients for tests and explain procedures (e.g., endoscopy, imaging).
  • Assess and monitor post-test complications (e.g., after barium enema).

Review of Concepts

  • Functions of the Liver:
    • Include bile storage, synthesis of proteins, metabolism of carbohydrates, fats, and proteins.
  • Functions of Trypsin:
    • Converts polypeptides to peptides.
  • Gastrointestinal Changes with Aging:
    • Decreased salivary production and gastric motility.
    • Tooth and taste changes.