Chapter 32 Med Surg

Front 1

hormone that is produced in the duodenum when acidic chyme enters the small intestine, and stimulates production of bile

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secretin

Front 2

Carbohydrate Metabolism, Amino Acid Metabolism, Lipid Metabolism, Synthesis of Plasma Proteins, Phagocytosis by Kupfer Cells, Formation of Bilirubin, Storage, Detox, and Activation of Vitamin D are all:

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functions of the liver

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Glucose is stored as ______ by the liver and changed back to glucise when the blood glucose level is low

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glycogen

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Of the 20 amino acids needed for the production of human proteins, the liver is able to synthesize 12, called the:

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nonessential amino acids

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The process by which nonessential amino acids are synthesized is called

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transamination

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Why do we need essential amino acids in our diet

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because the liver cannot synthesize them

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Salivary glands secrete:

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amylase which converts starch to maltose

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Stomach secretes

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pepsin which converts proteins to polypeptides, and hydrochloric acid which changes pepsinogen to pepsin and maintains a ph of 1-2 and destroys pathogens

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Liver secretes:

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bile salts which emulsify fats

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Pancreas secretes:

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amylase (converts starch to maltose), Lipas (converts emulsified fats into fatty acids and glycerol), and Trypsin (converts polypeptides to peptides)

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Small Intestine secretes:

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peptidases (converts peptides to amino acids) and surcrase/maltase/lactase (converts dissacharides into monosaccharides)

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Salivary glands act in this site:

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oral cavity

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Liver act in this site:

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small intestine

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Pancreas act in this site:

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small intestine

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Excess amino acids are deaminated in the liver and converted to:

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urea, a nitrogenous waste product that is removed from the blood by the kidneys and excreted in urine

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formed for the transport of lipids into the blood to other tissues

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lipoproteins

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liver is the main site of the process called

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beta oxidation

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process where fatty acid molecules are split into two carbon acetyl groups and used by the liver to produce energy or combined to form ketones for transport to other cells for energy production

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beta oxidation

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synthesizes albumin, clotting factors, and globulins

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the liver

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the most abundant plasma protein, helps maintain blood volume by pulling tissue fluid into capillaries

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albumin

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clotting factors produced by the liver that circulate in the blood until needed for chemical clotting

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prothrombin and fibrinogen

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synthesized by the liver to become part of lipoproteins or act as carriers for other molecules in the blood

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globulins

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fixed macrophages of the liver

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Kupffer cells (or stellate reticuloendothelial cells)

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they phagocytize worn blood cells and pathogens that circulate through the liver

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Kupffer cells (or stellate reticuloendothelial cells)

Front 25

Many bacteria enter the liver from this place after being absorbed along with water

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colon

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formed from the heme portion of the hemoglobin of worn red blood cells

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bilirubin

Front 27

stores the minerals iron and copper; fat soluable vitamins A, D, E, and K, and the watersoluable vitamin B12

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Liver

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syntehsizes enzymes that alter hamrful substances to less harmful ones

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liver

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comes from the colon bacteria and is converted to urea, a less toxic substance

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ammonia

Front 30

activates vitamin D

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liver

Front 31

muscular sac about 3 to 4 inches long, located on the undersurface of the left lobe of the liver

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gallbladder

Front 32

bile in the common hepatic duct from the liver flows through the

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cystic duct

Front 33

stores bile until it is needed in the small intestine

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gall bladder

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concentrates bile by absorbing water

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gallbladder

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stimulates contraction of the smooth muscle of the wall of the gallbladder

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cholecystokinin, hormone secreted by the duodenal mucosa of the duodenum

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contraction of this forces bile into the cystic duct, then into the common bile duct, which empties into the duodenum

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gallbladder

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about 6 inches long, located posterior to the greater curvature of the stomach

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pancreas

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the digestive secretions of the pancreas are produced by

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exocrine glands called acini

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small ducts of the acini unite to form larger ducts and finally converge into the:

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pancreatic duct

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the pancreatic duct joins the common bile duct to enter the duodenum at the

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hepatopancreatic ampulla

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this duct has a direct line from the pancreas into the duodenum

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accessory duct

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Name the pancreatic enzymes:

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pancreatic lipase (converts emulsified fats to fatty acids and monoglycerides), trypsinogen (an incative enzyme that is changed to active trypsin in the duodenum and digests polypeptides to shorter chains of amino acids), chymotrypsin, carboxypeptidase, elastase, ribonuclease and deoxyribonuclease

Front 43

bicarbonate juice is (alkaline/acidic) because of its high sodium bicarbonate content

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alkaline

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The function of bicarbonate juice is to:

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neutralize the hydrochloric acid in gastric juice as it enters the duodenum

Front 45

The pH of duodenal chyme is__________ to prevent corrosive damage to the mucosa and create the optimal pH for intestinal enzyme action

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7.5

Front 46

Secretion of the pancreatic juice is stimulated by

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the hormones of the duodenal mucosa

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stimulates the production of bicarbonate pancreatic juice

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secretin

Front 48

stimulates secretion of the pancreatic enzyme juice

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cholecystokinin, hormone secreted by the duodenal mucosa of the duodenum

Front 49

Why would you consider a liver function test when giving medications?

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because the liver metabolizes many drugs and there could be a toxic level of the drug in the system if it was not metabolized at a normal rate

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diminished sense of taste, greater liklihood of periodontal disease and oral cancer, decrecreased GI tract secretions, decreased effectiveness of peristalsis, indigestion, constipation and the risk of colon cancer are all affected by:

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growing older

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blood in stool can indicate:

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hemorrhoids, early sign of cancer, inflammatory diseases such as ulcerative colitis

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abdominal distention in the presence of nausea and vomiting may indicate:

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intestinal obstruction

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Rationale for asking "are you or have you recently taken antibiotics"

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diarrhea due to C. difficile can be caused by recen antibiotic use

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Black stools may indicate:

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bleeding

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Fatty stools can occur with

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pancreatic disease

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Excess alcohol intake is associated with:

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liver disease and pancreatitis

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You would ask "do you bruise or bleed easily" because:

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bleeding is associated with liver disease, b/c clotting factors are made in the liver

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A foul smell from a patient's stool indicates:

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bacteria

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Stool that has a pale or clay color may indicate

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liver or gallbladder disease

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medications that can cause irritation and bleeding in the GI tract

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NSAIDs or aspirin

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hospitalization or recent antibiotic use is a risk factor for

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C. difficile

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there can be an overgrowth of C. difficile with antibiotic use due to:

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decrease in the normal flora

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The toxins produced by this can cause diarrhea, colitits, toxic megacolon, dehydration, colonic perforation and sometimes death

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C. difficile

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signs of C. difficle infection are:

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diarrhea, nausea, anorexia, and abdominal tenderness or pain

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This culture has a diet of foods high in animal fat and fried foods and low in fiber, fruits and vegetables. They see obesity as a positive sign and see those who are thin as "not having enough meat on their bones"

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African Americans

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Their diet is deficient in Vit A, iron and calcium

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Appalachians

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This culture may eat food only w/ their right hand (and toileting w/ their left), may consider eating and drinking at the same meal as unhealthy, as well as mixing hot and cold foods. May also refuse to eat meat that is not halal.

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Arabs

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This culture is prohibited from ingesting alcohol or eating pork so may refuse medications that include alcohol, like mouthwashes, toothpaste, alcohol based syrups and elixers, and products derived from grafts

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Muslim Arabs

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This body system has priority over all other body parts in the Arab's perception of health, and thus are the most common reason why they seek care

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Arabs

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Means "fit for eating"

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kosher

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Culture that avoids pork and may separate their milk products from meat products by use of different bowls/utensils/serving materials

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Jewish

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Good health is largely a part of "God's will" to this culture, and many believe in a "hot and cold balance theory"

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Mexican Americans