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Chapter 32: Gastrointestinal, Hepatobiliary, and Pancreatic Systems Function, Data Collection, and Therapeutic Measures

Introduction

This chapter focuses on the anatomy and physiology of the gastrointestinal (GI) system, including accessory organs such as the liver, gallbladder, and pancreas. It aims to educate healthcare professionals about the various components, their functions, implications of aging, data collection techniques, diagnostic testing, and nursing care associated with disorders of these systems.

Learning Outcomes

  1. Structures of the Gastrointestinal Tract and Accessory Glands
       - Identifying the anatomy of the following structures:
         - Mouth
         - Pharynx
         - Esophagus
         - Stomach
         - Small intestine
         - Large intestine
         - Accessory organs: liver, gallbladder, pancreas

  2. Functions of each Organ
       - Explaining the physiological functions for each organ:
         - Liver: Metabolism, detoxification, bile production, and storage
         - Gallbladder: Storing bile and releasing it into the small intestine
         - Pancreas: Producing digestive enzymes and bicarbonate

  3. Effects of Age on Functionality
       - Discussing age-related changes that affect the GI tract and accessory glands, including structural degeneration and functional decline.

  4. Data Collection for Gastrointestinal Disorders
       - Listing data crucial for assessing gastrointestinal system disorders, including:
         - Health history
         - Travel history
         - Medications (impact of Clostridioides difficile)
         - Nutritional history and cultural influences
         - Family medical history

  5. Differentiating Normal and Abnormal Findings
       - Knowledge about how to identify normal versus abnormal data collection findings.

  6. Physical Examination Techniques
       - Techniques to perform physical examinations of the abdomen: inspection, auscultation, percussion, and palpation.

  7. Planning Nursing Care for Diagnostic Tests
       - Assisting in planning for patients undergoing diagnostic tests and understanding implications for nursing care.
       - Example: Different types of nasogastric tubes, their uses, and care procedures.

  8. Therapeutic Measures for Gastrointestinal Diseases
       - Understanding various therapeutic measures associated with GI diseases, including medication management and nutritional interventions.

Chapter Concepts

  • Elimination: Understanding the body's processes for waste removal.
  • Nutrition: Connecting nutrition and dietary requirements to the functioning of the GI tract.

Gastrointestinal Anatomy and Physiology

Major Structures
  • Oral Cavity and Pharynx: Initiation of digestion through mechanical and enzymatic breakdown of food.
  • Esophagus: A muscular tube that conveys food from the throat to the stomach.
  • Stomach: A hollow organ that holds food while being mixed with stomach enzymes and acids.
  • Small Intestine: Comprised of duodenum, jejunum, and ileum; site for further digestion and nutrient absorption.
  • Large Intestine: Responsible for water reabsorption and formation of feces.
Accessory Organs
  • Liver: Functions include carbohydrate metabolism, amino acid metabolism, lipid metabolism, synthetizing plasma proteins, phagocytosis by Kupffer cells, bilirubin formation, storing nutrients, detoxifying substances, and activating vitamin D.
  • Gallbladder: Stores and concentrates bile produced by the liver until needed during digestion.
  • Pancreas: Produces digestive enzymes like amylase (breaks starches into maltose), lipase (breaks emulsified fats into fatty acids/monoglycerides), and trypsin (breaks polypeptides into peptides), along with secretion of bicarbonate for neutralization of stomach acid.

Aging Effects on the Gastrointestinal, Hepatobiliary, and Pancreatic Systems

Certain physiological and functional changes occur due to aging:

  • Liver Changes:
       - Decreased drug metabolism
       - Reduced blood flow and volume
       - Increased risk of pancreatic cancer
  • Gallbladder: Increased secretion of cholesterol leading to gallstone formation.
  • Gastrointestinal System:
       - Decreased gag reflex, resulting in aspiration risk
       - Slower gastric motility and increased constipation
       - Dysphagia (difficulty swallowing)
       - Decreased absorption of drugs and nutrients
       - Malnutrition risks due to decreased appetite and ability to taste harmful substances

Data Collection for Gastrointestinal Dysfunctions

Health History Components
  • Collecting comprehensive patient history including travel, elimination patterns, medications (noting effects of specific conditions such as Clostridioides difficile), nutritional intake, and familial predispositions to gastrointestinal disorders.
Physical Assessment Steps
  • Comprehensive examination techniques:
      1. Height and Weight: Gathering baseline information
      2. Body Mass Index (BMI): Evaluating body composition and nutritional status
      3. Oral Cavity Assessment: Checking for signs of oral cancer, periodontal disease, and other anomalies
      4. Abdominal Assessment: Inspection (noting jaundice), auscultation (checking for bowel sounds), percussion, and palpation (measuring abdominal girth).
Abdominal Quadrants

   - Right Upper Quadrant (RUQ)
   - Left Upper Quadrant (LUQ)
   - Right Lower Quadrant (RLQ)
   - Left Lower Quadrant (LLQ)

Diagnostic Tests for GI Disorders

Laboratory Tests
  • Complete Blood Count (CBC)
  • Electrolytes
  • Carcinoembryonic Antigen (CEA) levels
  • Bilirubin levels (stool and urine)
  • Liver enzymes (e.g., AST, ALT)
  • Ammonia levels
  • Pancreatic enzyme levels (e.g., lipase, amylase)
  • Stool tests (for occult blood and infections)
Radiographic Tests
  • Flat Plate of Abdomen: Basic imaging to assess for gas patterns or obstructions
  • Barium Swallow/Enema: To visualize the upper and lower GI tract
       - Note: Risks of barium impaction
  • CT Scan: Provides detailed cross-sectional images of the abdominal organs
Nuclear Tests
  • Hepatobiliary Scan
       - Cholescintigraphy (evaluation of gallbladder and liver function)
       - HIDA Scan (measures bile excretion)
Endoscopic Procedures
  • EGD (Esophagogastroduodenoscopy): Visual examination of the upper GI tract
  • ERCP (Endoscopic Retrograde Cholangiopancreatography): Examines bile ducts, pancreatic duct, and gallbladder
       - Uses contrast medium to visualize
  • Lower GI Endoscopy: Proctosigmoidoscopy and Colonoscopy for bowel assessment

Therapeutic Measures for Gastrointestinal Conditions

Gastrointestinal Intubation
  • Types of tubes used for enteral feeding:
       - Nasogastric Tube: Commonly utilized for administering food directly into the stomach
         - Care includes verifying placement, elevating the head of the bed
         - Monitoring patient tolerance to the feeding
       - Jejunostomy and Gastrostomy Tubes: For long-term feeding solutions
Enteral Nutrition Considerations
  • Types of enteral nutrition formulas
  • Care during gastrointestinal decompression and parenteral nutrition

Review Questions

  1. Functions of the Liver: Choose applicable functions among listed options.
       - Correct Answers: Bile storage, Amino acid metabolism, Lipid metabolism, Synthesis of plasma proteins, Phagocytosis by Kupffer cells.

  2. Post-ERCP Nursing Intervention Priority: Identify the most crucial interventions after the procedure.
       - Correct Answer: Maintain NPO status.

  3. Aging and GI Changes: Understand changes that occur with aging, including decreased gag reflex and motility.
       - Correct Answers: Decreased taste sensation, Esophagus motility lessens, Weaker gag reflex.

  4. Post-Barium Enema Care: Recommendations for patient care following the procedure.
       - Correct Answer: Encourage fluids to help eliminate barium.

  5. PEG Tube Medication Administration: Steps to take prior to administering medications via PEG.
       - Correct Answers: Check placement, Check allergies, Observe abdominal distention, Verify tube length.