Chapter 32
Gastrointestinal, Hepatobiliary, and
Pancreatic Systems Function,
Assessment, and Therapeutic
Measures
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Learning Outcomes
 List the structures of the gastrointestinal
tract and of the accessory glands: Liver,
gallbladder, and pancreas.
 Describe the functions of each organ of the
gastrointestinal tract and of the accessory
glands: Liver, gallbladder, and pancreas.
 Discuss how age affects the gastrointestinal
tract and accessory glands.
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Learning Outcomes (continued_1)
 List data to collect when caring for a patient
with a disorder of the gastrointestinal
system, liver, gallbladder, or pancreas.
 Differentiate normal and abnormal data
collection findings.
 Explain techniques used to conduct a
physical examination of the abdomen.
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Learning Outcomes (continued_2)
 Plan nursing care for patients having
diagnostic tests of the gastrointestinal tract.
 Explain types of nasogastric tubes and their
uses.
 Plan nursing care for insertion and
maintenance of nasogastric tubes.
 Describe therapeutic measures used for
patients with gastrointestinal diseases.
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Anterior View of the Digestive System
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Anterior View and Partial Section of the
Stomach
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Gastrointestinal Anatomy and Physiology
 Oral cavity and pharynx
 Esophagus
 Stomach
 Small intestine
 Large intestine
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Liver, Gallbladder, Pancreas, and
Duodenum
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Liver, Gallbladder, and Pancreas
 Accessory organs of digestion
 Produce or store digestive secretions
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Liver
 Hepatic portal circulation
 Bile
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Liver Functions
 Carbohydrate metabolism
 Amino acid metabolism
 Lipid metabolism
 Synthesis of plasma proteins
 Phagocytosis by Kupffer cells
 Formation of bilirubin
 Storage
 Detoxification
 Activation of vitamin D
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Gallbladder
 Stores bile
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Pancreas
 Amylase
• Starch to maltose
 Lipase
• Emulsified fats to fatty acids/monoglycerides
 Trypsin
• Polypeptides to peptides
 Bicarbonate juice
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Aging Effects on the Gastrointestinal,
Hepatobiliary, and Pancreatic Systems
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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
 Decreased motility of stomach
 Decreased gastric hydrochloric acid production
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Aging and the Gastrointestinal System
(continued)
 Fat absorption slower
 Atrophy of large/small intestine
 Decreased mucous secretions
 Decreased elasticity of rectal wall
 Weakness of intestinal wall
 Faulty absorption of vitamins B subscript 1
and B subscript 2, calcium, and iron
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Aging and the Gallbladder
 Gallstones
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Data Collection
 Health history
• Travel
• Elimination
• Medications
‒ Clostridium difficile
 Nutritional assessment
• Cultural
 Family history
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Physical Assessment




Height and weight
Body mass index
Oral cavity
Abdomen
 Inspection
• Jaundice
 Auscultation
 Percussion
 Palpation
• Abdominal girth
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Abdominal Quadrants
A. Abdominal quadrants
B. Nine abdominal regions
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Diagnostic Tests
 Laboratory tests
•
•
•
•
•
•
•
•
Complete blood count
Electrolytes
Carcinoembryonic antigen
Bilirubin
Liver enzymes
Pancreatic enzymes
Stool tests
Gastric analysis
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Diagnostic Tests (continued_1)
 Radiographic tests
• Flat plate of the abdomen
• Barium swallow
• Barium enema
‒ Barium impaction
• Computed tomography (C T) scan
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Diagnostic Tests (continued_2)
 Nuclear
•
•
•
•
Cholescintigraphy
Diisopropyl iminodiacetic acid (D I S I D A)
Hepatobiliary iminodiacetic acid (H I D A)
Iminodiacetic acid (I D A)
 Angiography
 Liver scan
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Diagnostic Tests (continued_3)
 Endoscopy
• Esophagogastroduodenoscopy (E G D)
• Endoscopic retrograde
cholangiopancreatography (E R C P)
• Lower gastrointestinal endoscopy
‒ Proctosigmoidoscopy
‒ Colonoscopy
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Gastroscopy
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Endoscopic Retrograde
Cholangiopancreatography
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Diagnostic Tests (continued_4)
 Ultrasonography
 Endoscopic ultrasonography
 Percutaneous liver biopsy
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Therapeutic Measures
 Gastrointestinal intubation
• Tube feedings
‒
‒
‒
‒
‒
Gravity
Pump
Bolus
Intermittent
Continuous
• Nursing care
‒ Placement check
‒ Head of bed elevation 30 to 45 degrees
‒ Monitor for tolerance
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Feeding Tubes
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Therapeutic Measures (continued)
 Enteral feeding
• Enteral nutrition formulas
 Gastrointestinal decompression
 Parenteral nutrition
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Review Question
The nurse teaches a patient with cirrhosis
functions of the liver. Which of these would the
nurse include as functions of the liver? Select all
that apply.
1.
2.
3.
4.
5.
6.
Bile storage
Amino acid metabolism
Lipid metabolism
Synthesis of plasma proteins
Phagocytosis by Kupffer cells
Deactivation of vitamin C
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Review Question Answer
Correct Answer: 2, 3, 4, 5
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Review Question (continued_1)
Which of these converting functions does the
pancreatic enzyme trypsin have?
1.
2.
3.
4.
Starch to maltose
Emulsified fats to fatty acids
Emulsified fats to monoglycerides
Polypeptides to peptides
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Review Question Answer (continued_1)
Correct Answer: 4
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Review Question (continued_2)
The nurse would evaluate the patient as
understanding teaching for gastrointestinal
changes that occur with aging if the patient
included which of these? Select all that apply.
1.
2.
3.
4.
5.
6.
Tooth enamel softens
Increased gastric hydrochloride production
Sweet taste sensation lost
Saliva production increases by 33%
Esophagus motility lessens
Weaker gag reflex
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Review Question Answer (continued_2)
Correct Answer: 3, 5, 6
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Review Question (continued_3)
For which complication does the nurse monitor
that can occur following a barium enema?
1.
2.
3.
4.
Barium impaction
Diarrhea
Anorexia
Reflux
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Review Question Answer (continued_3)
Correct Answer: 1
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Review Question (continued_4)
Prior to administering medications via a
percutaneous endoscopic gastrostomy (P E G)
tube, which of these actions does the nurse
take? Select all that apply.
1.
2.
3.
4.
5.
Check placement.
Observe for abdominal distention.
Provide skin care.
Check allergies.
Verify tube length.
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Review Question Answer (continued_4)
Correct Answer: 1, 2, 4, 5
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