Assessment: Gastrointestinal System Quiz

c. The parasympathetic nervous system stimulates activity of the
gastrointestinal (GI) tract, increasing motility and secretions and relaxing
sphincters to promote movement of contents. A drug that blocks this
activity decreases secretions and peristalsis, slows gastric emptying, and
contracts sphincters. The enteric nervous system of the GI tract is
modulated by sympathetic and parasympathetic influence.

d. There is decreased tone of the lower esophageal sphincter with
aging and regurgitation of gastric contents back into the esophagus
occurs, causing heartburn and belching. There is a decrease in
hydrochloric acid secretion with aging. Jaundice and intolerance to fatty
foods are symptoms of liver or gallbladder disease and are not normal
age-related findings.

d. When food enters the stomach and duodenum, the gastrocolic and
duodenocolic reflexes are started and are more active after the first daily
meal. Additional laxatives or laxative abuse contribute to constipation in
older adults. Decreasing food intake is not recommended, as many older
adults have a decreased appetite. Fiber and fluids should be increased.

c. The aspartate aminotransferase (AST) level is elevated in liver
disease but it is important to note that it is also elevated in damage to the
heart and lungs and is not a specific test for liver function. Measurement
of most of the transaminases involves nonspecific tests unless isoenzyme
fractions are determined. Hepatic encephalopathy is related to elevated
ammonia levels.

c. A thin, white coating of the dorsum (top) of the tongue is normal. A
red, slick appearance is characteristic of cobalamin deficiency, and
scattered red, smooth areas on the tongue are known as geographic
tongue. The uvula should remain in the midline while the patient is saying
“Ahh.”

d. Cholecystokinin is secreted by the duodenal mucosa when fats and
amino acids enter the duodenum and stimulate the gallbladder to release
bile to emulsify the fats for digestion. The bile is produced by the liver
but stored in the gallbladder. Secretin stimulates pancreatic bicarbonate
secretion. Gastrin increases gastric motility and acid secretion.

c, d, f. Because the liver is a vascular organ, vital signs are monitored
to assess for internal bleeding. Prevention of bleeding is the reason for
positioning on the right side for at least 2 hours and for splinting the
puncture site. Again, because of the vasculature of the liver, coagulation
status is checked before the biopsy is done. White stools occur with upper
gastrointestinal (UGI) or barium swallow tests. The bowel must be
cleared before a lower GI or barium enema, a virtual colonoscopy, or a
colonoscopy. Rectal bleeding may occur with a sigmoidoscopy or
colonoscopy.

a. Left upper quadrant (LUQ) pain, nausea, and vomiting could occur
from perforation. The return of gag reflex is essential to prevent
aspiration after an ERCP. A perforation may occur with an EGD, ERCP,
or peritoneoscopy. The gag reflex is also assessed with an EGD. These
are not relevant assessments for the colonoscopy, barium swallow, or
defecography.

b. The body of the pancreas is in the left upper quadrant, the liver is in
the right upper quadrant, the appendix is in the right lower quadrant, and
the gallbladder is in the right upper quadrant.

Pepsinogen is changed to pepsin by acidity of the stomach, where
it begins to break down proteins. Gastrin stimulates gastric acid secretion
and motility and maintains lower esophageal sphincter tone. The stomach
also secretes lipase for fat digestion. Bile is secreted by the liver and
stored in the gallbladder for emulsifying fats. Maltase is secreted in the
small intestine and converts maltose to glucose. Secretin is secreted by
the duodenal mucosa and inhibits gastric motility and acid secretion.
Amylase is secreted in the small intestine and by the pancreas for
carbohydrate digestion.

. c. The ampulla of Vater is the site where the pancreatic duct and
common bile duct enter the duodenum and the opening and closing of the
ampulla is controlled by the sphincter of Oddi. Because bile from the
common bile duct is needed for emulsification of fat to promote digestion
and pancreatic enzymes from the pancreas are needed for digestion of all
nutrients, a blockage at this point would affect the digestion of all
nutrients. Gastric contents pass into the duodenum through the pylorus or
pyloric valve

c. The stomach secretes intrinsic factor, necessary for cobalamin
(vitamin B12
) absorption in the intestine. When part or all the stomach is
removed, cobalamin must be supplemented for life. The other options will
not be a problem

a. Borborygmi are loud gurgles (stomach growling) that indicate
hyperperistalsis. Normal bowel sounds are relatively high-pitched and are
heard best with the diaphragm of the stethoscope. High-pitched, tinkling
bowel sounds occur when the intestines are under tension, as in bowel
obstructions. If you do not hear bowel sounds, note the amount of time
you listened in each quadrant without hearing bowel sounds.

a. Bacteria in the colon: (1) synthesize vitamin K, which is needed to
produce prothrombin by the liver; and (2) deaminate undigested or
nonabsorbed proteins, producing ammonia, which is converted to urea by
the liver. A reduction in normal flora bacteria by antibiotic therapy can
lead to decreased vitamin K, resulting in decreased prothrombin and
coagulation problems. Bowel bacteria do not influence protein absorption
or the secretion of mucus

a. The abdomen should be assessed in the following sequence:
inspection, auscultation, percussion, palpation. The patient should empty
their bladder before assessment begins.

b. The pulsation of the aorta in the epigastric area is a normal finding.
Bruits indicate that blood flow is abnormal, the liver is percussed in the
right midclavicular line, and a normal spleen cannot be palpated.