Gastrointestinal

System

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 Lab Values Related to the Gastrointestinal System

Expected Range Interpretation Description

Lipase
AMYLASE
30 - 110 U/L is a better indicator
Pancreatic enzyme
of pancreatitis than
↑ levels amylase because
could indicate serum lipase lipase think
pancreatitis longer
remains elevated
LIPASE
< 200 U/L for a longer period
Pancreatic enzyme
of time.

Jaundice
normal
is a yellow discoloration
↑ levels
BILIRUBIN Total of the skin due to high
could indicate
Produced by the liver 0.2 – 1.2 mg/dL levels of bilirubin. It
liver dysfunction jaundice
is visible when serum
bilirubin is > 2 mg/dL.

↑ levels
Albumin helps keep
ALBUMIN 3.5 - 5.5 g/dL could indicate
fluid in the bloodstream.
dehydration

↓ levels
PREALBUMIN 15 - 36 mg/dL could indicate Prealbumin is great for assessing
malnutrition nutritional status.

AST
0 - 35 U/L
Part of the liver function

Liver enzyme
↑ levels AST must be taken with ALT.
test (LFT)

could indicate AST is a less specific marker of

liver dysfunction liver function than the enzyme ALT.
ALT
0 - 48 U/L
Liver enzyme

Ammonia (NH3) is produced

by cells throughout the body and is
used by the liver to make urea.
↑ levels
If the liver stops working,
AMMONIA 10 - 80 mcg/dL could indicate
ammonia increases
liver dysfunction
in the body.
Too much ammonia is very toxic,
especially to the brain.

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 Gastrointestinal System Overview
N IC AL DIGE
ST I C A L D I G ES T
HA EM I
ORAL CAVITY COMPONENTS

ON
C

CH
IO
ME

N amylase protease lipase

When food is broken When food is broken

down into smaller down by enzymes and pancreas
pieces digestive juices
amylase:
Examples: TIP Enzymes end in "-ase" breaks down carbs into glucose
• Chewing protease:
• Churning of the stomach Protease think Proteins breaks down proteins
Lipase think Lipids (fat) lipase:
breaks down fats
(lipids = fats)

ESOPHAGUS STOMACH
A hollow muscular tube A hollow muscular organ
that carries food & Functions:
liquid from the mouth • Stores food during eating
to the stomach using • Secretes digestive fluids
peristalsis • Moves partially digested
LIVER food (chyme) into the
small intestine
Functions:
• Filters the blood
• Metabolizes sugar, protein & fat
• Synthesizes lipoproteins (VLDL & HDL)
• Makes vitamin D PANCREAS LARGE INTESTINE
• Detoxifies/excretes bilirubin Helps make By the time food reaches the large intestines, most
and other toxins pancreatic juice of the absorption & digestion have been completed.
• Forms bile (enzymes), which breaks down In the large intestines, stool begins to form and is
• Metabolizes drugs sugar, fat & starch. The pancreas pushed toward the rectum.
• Helps in blood clotting has both exocrine & endocrine
Functions:
• Synthesizes proteins functions.
• ABSORPTION of water and electrolytes from food
such as albumin & that has not been digested yet
coagulation factors
• defecation rids the body of any waste left over from
food & removes it through the rectum & anus
SMALL INTESTINE
Transverse
The longest portion of the GI tract colon
(longer than the large intestine)
Functions:
• Digestion of food from the stomach Ascending
Descending
colon
• Absorption of nutrients, fats, carbohydrates, colon
vitamins, minerals & water
from food into the
bloodstream to be Proximal Duodenum Cecum
used by the body
Jejunum
Proximal Cecum
distal Ileum Ascending colon Sigmoid
Rectum
Transverse colon colon
Descending colon
Anus
Sigmoid colon
To remember the order of Proximal
Rectum
to Distal think DJ Ileum in the club! distal Anus

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 Acute vs. Chronic Pancreatitis
Pathology
Pancreatitis is
AUTODIGESTION of the ACUTE VS. CHRONIC
pancreas by its own Sudden inflammation that is
digestive enzymes that Chronic inflammation
reversible with prompt
are released improperly in that is irreversible
recognition and treatment
the pancreas. This causes
the pancreatic enzymes ∙ Gallstones ∙ Repeated episodes of acute pancreatitis
to destroy its own tissue, ∙ Block the bile duct
∙ Excessive & prolonged consumption of
CAUSES

leading to inflammation. ∙ Alcohol (ETOH) alcohol (ETOH)

∙ Damages the cells of the pancreas ∙ Recurrent damage to the cells
∙ Infection ∙ Medications of the pancreas
If the pancreas isn't
working, the enzymes ∙ Tumor ∙ Trauma ∙ Cystic fibrosis
aren't working properly
either. In Acute, there will still be working In chronic, you will see different S&S
functions of the pancreas due to the prolonged damage & loss of function
DIGESTIVE ENZYMES (exocrine)
Amylase: ∙ Sudden, severe PAIN
∙ Chronic epigastric pain or no pain
• Breaks down carbs to glucose ∙ Mid-epigastric pain LUQ
Protease: ∙ Pain increases after drinking alcohol
∙ Nausea & vomiting
• Breaks down proteins or eating a fatty meal
SIGNS & SYMPTOMS

∙ Fever
Lipase: ∙ Steatorrhea or "fatty stools"
• Breaks down fats ∙ ↑ HR & ↓ BP ∙ Oily/greasy, frothy stool
∙ ↑ Glucose ∙ Weight loss
Labs ∙ Mental confusion & agitation ∙ Can't digest food properly
normal
Amylase ∙ Abdominal guarding ∙ Jaundice
∙ Yellowish color of the
Lipase ∙ Rigid/board-like abdomen
skin from buildup of bile
WBCs ∙ Grey Turner's sign
∙ Diabetes mellitus jaundice
∙ Bluish discoloration at the flanks
Bilirubin ∙ Damage to the islet of Langerhans
Glucose ∙ Cullen's sign
∙ Dark urine
∙ Bluish discoloration of the umbilicus
Platelets ∙ From excess bile in the body
Ca+ & Mg Cullen's = Circle belly button

Cullen’s
Nursing Considerations Medications
∙ Rest the pancreas! ∙ Opioid analgesics
∙ NPO (we don't want stimulation of the enzymes) ∙ Antibiotics
Grey-Turner’s
∙ Administer IV fluids ∙ Pancreatic enzymes
∙ Manage pain ∙ Insulin
∙ Position the patient: ∙ Proton pump inhibitors (PPIs),
Side lying → Fetal position H2 antagonists, antacids
NOT supine
∙ Insert NG tube
∙ Remove stomach contents Patient Education
Diet Modifications
∙ Monitor:
∙ Avoid alcohol
• Glucose
• Blood pressure ∙ Protein
• Intake & output (I&O) ∙ Complex carbohydrates (fruits, vegetables, grains)
• Laboratory values ∙ Fat (no greasy, fatty foods)
• Stools ∙ Limit sugars
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 Ulcerative Colitis vs. Crohn’s Disease
Types of Inflammatory Bowel Disease (IBD) This is not the same
thing as irritable bowel
syndrome (IBS)

MOST
N
ULCERATIVE Colitis Crohn’s disease
C MMO
O
description

Chronic ulceration Inflammation of the

& inflammation gastrointestinal tract wall
of the rectum at ANY point through
& colon ALL layers
location

Affects the large intestine Can affect anywhere in the GI tract

& rectum only (mouth to anus)
thickness

Inflammation affects the Inflammation is transmural

submucosa or mucosa (occurring across the entire wall)

Patches of inflammation
APPEARANCE

Inflamed areas are

are present throughout
continuous with no
ulcerative the bowel
patches showing the Crohn's think
colitis think This makes a
appearance of ulcers Cobblestone
bloody ulcers cobblestone appearance
no! but surgical intervention (colectomy)
complications cure

no cure, but surgery can help with symptoms

can help with symptoms

Toxic megacolon,
rupture of bowel, Increased risk for Abscess, fistulas Increased risk for
dehydration hemorrhage/shock infection (sepsis)

• Diarrhea ULCERATIVE COLITIS

symptoms

• Abdominal pain
classic

Can have mucus, pus, or blood in the stool

• Weight loss
• Nutritional deficiencies CROHN’S DISEASE
• Fatigue Steatorrhea (fat in the stool)
Diagnostic

Colonoscopy

Both: Diet modifications for both:

similarities

• Are a form of inflammatory bowel disease (IBD) fiber

• Have causes that are not completely known Small,
protein
frequent
• Increase the risk for colon cancer calories meals
• Cause inflammation & ulcers fluids

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 Types of Hepatitis
HEPATITIS CAUSED BY:
MOST
• Virus (A, B, C, D, E) COMMON
• Excessive use of alcohol
liver inflammation • Hepatotoxic medications
"Inflammation of the liver"
TRANSMISSION SIGNS & SYMPTOMS DIAGNOSTIC TREATMENT VACCINE

A
Anti-HAV

H V Fecal & oral

Food & water
IgM =
Active infection
Supportive
therapy &
ACUTE ONLY Igg = REST
Recovered (it’s gone)

BV
GI symptoms

H
B think Body fluids (N&V, stomach pain, anorexia) HBsAg = ACUTE
(blood, semen, saliva)
Active infection Supportive
• Childbirth therapy & rest
• Blood Dark-colored urine
ACUTE & CHRONIC Anti-HBs =
• Sex CHRONIC
• IV drugs Immune/recovered Antivirals
Clay-colored stool

CV
Vomiting ACUTE

H
Anti-HCV Supportive
Body fluids therapy & rest
Most common: Flu-like symptoms
IV drug users
No post-exposure CHRONIC
ACUTE & CHRONIC immunoglobulin • Antivirals
Jaundice
• Interferon

DV
ACUTE
Depends on B
H
HDAg Supportive
B & D = BuDs therapy & rest
Hep D only occurs Anti-HDV CHRONIC
ACUTE & CHRONIC • Antivirals
with Hep B YELLOW DISCOLORATION
of the skin from the • Interferon

EV
buildup of bilirubin

H Fecal & oral

Food & water Anti-HEV
Supportive
therapy &
ACUTE ONLY
(uncooked meats,
REST
developing countries)
normal jaundice

Patient Education for all types of hepatitis Labs All will

∙ Rest elevate be
Diet modifications: Liver enzymes: dw
hepatit ith
∙ Practice proper hand hygiene ALT: 0–48 U/L is
Carbohydrates
∙ Do not share personal hygiene products AST: 0–35 U/L
Calories Small,
∙ Avoid sex until hepatitis antibodies are negative Bilirubin: 0.2–1.2 mg/dL
Protein & fat frequent
∙ Avoid hepatotoxic substances: meals Ammonia: 10–80 mcg/dL
∙ Alcohol, acetaminophen,
aspirin, sedatives

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 Cirrhosis
• Liver cells are DESTROYED and replaced with fibrotic (scar) tissue
• Normal function of the liver is compromised

Stages of Liver Damage Functions of a healthy liver

healthy liver 1 DETOXES the body If the fu

2
nction
of the
Helps to CLOT the blood
liver is
disrupte
d, then
none o

3
functio f these
Helps to METABOLIZE
ns will
w
properl ork
y

fatty cirrhosis (break down) drugs

liver
liver
liver
liver cell
4 SYNTHESIZES (makes) albumin
enlargement destruction
due to fat
deposits
Causes MOST
∙ Alcoholic cirrhosis COMMO
N
∙ Caused by excessive
alcohol intake • Viral hepatitis B or C
fibrosis liver ∙ Nonalcoholic • Autoimmune disorders
healthy liver tissue • Hepatotoxic drugs
fatty liver disease
replaced with scar tissue • Toxins & parasites
(NAFLD)
• Fat collection in the liver
(obesity, diabetes, ↑ cholesterol)
When
Signs & Symptoms th
is unab e liver
Labs
toxins le to filter
like am
mo
∙ Hepatic encephalopathy/coma they bu
ild up in nia,
∙ Asterixis “liver flap”
blood
and e the Bilirubin & ammonia
reach t ventually BLEEDING PRECAUTIONS
∙ Jaundice
he brain Platelets
∙ Use electric razor
∙ Yellow discoloration ∙ Risk for bleeding
∙ Use soft-bristled
of the eyes & skin WBCs toothbrush
∙ Itchy skin ∙ Risk for infection ∙ Hold pressure on
∙ From buildup of toxins scrapes/cuts to
minimize bleeding
∙ Ascites
∙ Edema
∙ Abdominal pain
Medications
normal jaundice
∙ Heartburn Lactulose Lactulose think
• ↓ Serum ammonia Lactuloose because
through the stool it loosens the bowels
Treatment Acid reducers
Treat underlying cause of cirrhosis (antacids & Histamine (H2) Receptor Antagonists)

∙ Fibrosis (scarring) of liver cannot be reversed, Diuretics

but progression can be slowed Vitamins
∙ Possibly a paracentesis
for those with ascites Removal AVOID:
∙ In severe cases, of fluid from
the peritoneal Narcotics
a liver transplant cavity
may be needed Acetaminophen

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