Metabolism Lecture Revisions Addtl

8/3/2019 Metabolism Lecture Revisions Addtl

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METABOLISM



THE DIGESTIVE SYSTEM

MOUTHStimulated bypresenceof food in themouthChewing = 5th CN

SALIVARY G.Submandibular

SublingualParotidProduces: PTYALIN

STOMACHChurns to form CHYMEMucosal BarrierRugae : Parietal Cells – HCl +

Epithelial Cells – HCOChief Cells – PepsinGoblet Cells - Mucus

ESOPHAGUSPeristalsis

MALL

NTESTINESPartsPayer’s Patches Plica Circularis – VilliAbsorptionDuodenum – Fe & CaJejunum – Na, Cl,CHO, CHON,FATSleum – VB12,

Bile saltsall throughoutMg, P, K

LARGEINTESTINESPartsReabsorptionEliminationGoblet cells – mucuNo VilliFermentation of gaPutrefaction – liberates NH4,indol, skatol tostools

Bacteria: E. ColiFecesAPPENDIXLymphatic Functions



GASTROINTESTINALTRACTEPITHELIAL LAYERS



THE LIVER, PANCREAS,& GALLBLADDER

CELLS OF ISLANDS OF LANGERHANS(ENDOCRINE)

PANCREATIC ACINI(EXOCRINE)

DUCT

BETA CELLS

ALPHA CELLS

THE DIGESTIVE SYSTEM



LIVER

GALL

BLADDER

CYSTIC DUCT

COMMON HEPATIC DUCT

AMPULLA OF VATER

SPHINCTER OF ODDI

R & L HEPATIC DUCT

PANCREATIC DUCT

PANCREAS

LIVERLargest Gland - RUQFunctions:

Regulate Blood glucoseSecrete BileStore filter detoxify bloodSynthesize Vit KSynthesize Plasma proteinsKupffer cells phagocytic axnStores vitamins & mineralsConverts NH4 & bacteria to

urea

GALL BLADDER

Storage of bile 30-50ml (70ml max)Bile = emulsify fatBile salts, acids, cholesterol, bilirubin, phospholipids

PANCREASExocrine:juices pH ^1200-3000ml

Endocrine

BIGADS

THE DIGESTIVE SYSTEM ACCESSORY

ORGANS



G.I.T. FUNCTIONRESPONSIBLE FOR PROCESSING FOOD,BREAKING IT DOWN INTO USABLEPROTEINS, CARBOHYDRATES,

MINERALS, FATS, AND OTHERSUBSTANCES, AND INTRODUCINGTHESE INTO THE BLOODSTREAM SOTHAT THEY CAN BE USED BY THE BODY.

PROCESSES1. INGESTION2. DIGESTION

- Mechanical- Chemical

- Secretion of Digestive enzymes3. ABSORPTION4. ELIMINATION



DIGESTIVE ENZYMESENZYMES THAT DIGEST SOURCE PRODUCTS

CARBOHYDRATES

FATS

PROTEIN

OTHERS

Amylase Salivary glands Starch→

MaltoseSucrase, Maltase, iso- Intestinal fluids disaccharides→ maltase, lactase monosaccharides

Pancreatic amylase Pancreas starch→maltose &isomaltose

Gastric Lipase Gastric Mucosa Digests butterfat

Intestinal Lipase Intestinal fluids fats→ glycerol & fattyBile Gall Bladder acids

Pepsin Gastric Mucosa proteoses, peptones &polypeptides

Hydrochloric acid Gastric Mucosa protein → polypeptds

Peptidases Intestinal glands polypeptds→ amino a. Trypsin Pancreas peptides & amino acidChymotrypsin Pancreas proteins→ polypeptideCarboxypeptidase Pancreas pp→ smaller peptides

Enterokinase Duodenal Mucosa Activates trypsin

Nucleases Pancreas Splits nucleic acids



REGULATORY SUBSTANCESSUBSTANCE FUNCTION

HORMONAL REGULATORS

NEUROREGULATORS

LOCAL REGULATORS

Gastrin Stimulates gastric glands to increase secretion ofHCl. Triggered by stomach distention

Cholecystokinin Stimulates gall to release bile into duodenum afterdetection of fat in duodenum

Secretin Stops gastric secretion in the stomach ( inhibitory )when pH of chyme in duodenum is less than 4-5

Acetylcholine Sight, smell, chewing and stomach distention,stimulate gastric glands to increase production ofacids.

Norepinephrine Inhibitory stimulus decreasing sphincter tone

especially due to stress

Histamine Increases gastric acid production.

Stimulates gastric glands



METABOLISM AN ORGANIC PROCESS THAT

CONTRIBUTE TO THE CHEMICALCHANGES WITHIN THE CELL TOOBTAIN ENERGY.

2 PART PROCESS ANABOLISM

CATABOLISM

GLUCOSE METABOLISM

CARBOHYDRATES

(Polysaccharides)

DISACCHARIDES

(Sucrose, Maltose,Lactose)

MONOSACCHARIDES

(Glucose+Fructose)

(Glucose+Galactose)

SALIVARY AMYLASE

SUCRASE, MALTASE,LACTASE

END PRODUCT: GLUCOSE OXIDATION = ATP+H2O+CO2



Glucoseycogen

Glucagon

Insulin

Stimulatesglucose uptakefrom blood

Tissue Cells(Muscles, kidney, fat)

BETA

cells

ALPHAcells

HIGHBloodSugar

RaisesBloodSugar

LOWBlood

Sugar

LowersBlood

Sugar



PROTEIN METABOLISM

PROTEINS

PEPTIDES

AMINO ACIDS

PEPSIN (Stomach)

TRYPSIN (Pancreas)

PEPTIDASES

(Small Intestines)

FAT METABOLISMFATS (Triglyceride)

EMULSIFIED FATS

MONOGLYCERIDES –

GLYCEROL & Free Fatty Acids

BILE

LIPASE

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ASSESSMENTChief ComplaintsAbdominal painNausea & VomitingAbdominal distentionDyspepsia

DiarrheaConstipation & HemorrhoidsAnorexia & Weight lossAscitesHematemesis

Hematochezia / MelenaChokingDysphagiaJaundiceFlatulence, Heartburn & Eructation



JAUNDICE

CHOKING

ASCITES



ASSESSMENT

Health HistoryHeredofamilial diseasesCultural & Religious beliefsHistory of surgery or traumaChanges in energy levelElimination & Urinary patternAllergiesLifestyle – activity, habits, copingHabits – smoking, caffeine, alcoholPast Medical historyNormal dietary pattern – Collect dietary data

Anthropometric Measurements – weight,height, skin folds, IBW, BMIarm muscle circumference

InspectionGeneral appearance & posture OralSkin characteristicsAbdominal structure

Abdominal contour



AuscultationListen to bowel soundsRecord location, frequency and characteristics

L : RUQ, LUQ, RLQ, LLQ

F : N 8-20 per minuteC : hypoactive ( 1-2 sounds in 2 mins )

hyperactive ( 5-6 sounds in less than 30 secs)absent ( no sounds within 5 minutes )

1. hyperperistalsis2. paralytic ileus

3. borboygmi

4 QUADRANTS

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PercussionStomach – tympanyLiver size – dull to percussioLarge intestines

PalpationPain, tenderness, organ size and positionMasses especially liver enlargement; fluid wave test

RightHypochondriac

Hypogastric

LeftHypochondriac

Umbilical

Epigastric

RightLateral

RightInguinal

LeftLateral

LeftInguinal

9 REGIONS




1. Hematologic studies:CBCElectrolytesSerum Protein: A-G ratio

Albumin:Globulin = 1.5-2.5:1BUN – Blood Urea Nitrogen = 7-20mg/100mlSerum Creatinine

2. Liver function test:Alkaline phosphatase 44-147 IU/LProthrombin time 10 – 13 secondsSerum transaminase studies

AST (aspartate aminotransferase )formerly (SGOT): Serum glutamic

oxaloacetic transaminase

ALT (Alanine aminotransferase)formerly (SGPT): Serum glutamic

pyruvic transaminase LDH (Lactodehydrogenase enzyme)

CholesterolBilirubin

DIAGNOSTIC EXAMS




3. Analysis of Gastrointestinal SecretionsStool analysis – Guaiac test, fecal fat analysis,

culture. No red meat, NSAIDs, Vit C for 3 daysTo assess for bacteria, ova & parasites,

malabsorption and bloodGastric secretion analysis –contents of stomachAssess ulcers. NPO for 8-10 hours, no anti-cholinergic meds, no smoking

4. Pancreatic functions – Glucose levels

RBS, FBS, OGTTN˚ Glucose level : 80-120 mg/dl

5. Urine exam – urea, glucose, acetone

6. Radiologic examsFlat plate of the abdomen – abdominal x-ray

No preparation neededUltrasound of the gallbladder and liver

Strict NPO after midnight prior to procedureAble to visualize if stones are present

DIAGNOSTIC EXAMS



LIVER ULTRASOUND



7. Radiographic studiesa. Upper GI series (barium swallow)b. Lower GI series (barium enema)

: NPO 6-8 hours before procedure: Lower GI – liquid diet before procedure: Laxatives before and after procedure: Feces will be white. Normal within 72 hr

8. Endoscopya. Esophagogastroduodenoscopy

b. Sigmoidoscopy / colonoscopy: NPO 6-8 hours before the procedure: Colon preps – enema: upper visualization, check activation of

gag reflex

9. Gallbladder evaluationa. Cholecystogramb. Cholangiogram

: Introduction of dye – check allergy: NPO post midnight

: 12 telepaque tablets taken before test

DIAGNOSTIC EXAMS



VentrodorsaView

Abdomen 3.hours afte

barium

swallow

A. Ileum

B. AscendinColo

C. TransversColo

D. DescendinColo

E. Site oIleocolic

Cecocol

Orifice

F. Cecum

G. Gas iStomac




LOWER G.I. SERIES

BARIUM ENEMA



CHOLECYSTOGRAM

GALL BLADDER

CHOLECYSTOGRAM



10. Liver biopsy: Removal of liver tissue: Secure consent for procedure: No aspirin, NSAIDs, anticoagulants

2 weeks prior to scheduled procedure: NPO after midnight: Position on left side during biopsy: Position on right side after biopsy for

2 hours: Bed rest, observe for complications

11. Paracentesis: Removal of fluid accumulated in the

peritoneum ( Diagnostic / Therapeutic ): Void immediately prior to procedure: During procedure: sitting up with feet

resting on stool: Fluid should be removed slowly over

30-90 minutes, generally below 1500cc

DIAGNOSTIC EXAMS



LIVER BIOPSY

PARACENTESIS



THE ENDOCRINE SYSTEM



THE HORMONESGLAND OF ORIGIN HORMONES ABBREV

ANTERIORPITUITARY

Thyroid Stimulating H

Luteinizing Hormone

Follicle Stimulating H

Interstitial Cell Stim H

Growth Hormone

Prolactin

Adrenocorticotropic H

Melanocyte Stim HOxytocin

Antidiuretic Hormone

L-thyronine

Glucocorticoids

Minieralocorticoids

Aldosterone

Parathyroid Hormone

Calcitonin

Triiodothyronine

TSH

FSH

LH

ICSH

GH

ACTH

MSH

ADH

T4

T3

PTH

POSTERIORPITUITARY

THYROIDGLAND

PARATHYROID

ADRENALCORTEX



THE HORMONES

GLAND OF ORIGIN HORMONES ABBREV

ADRENALMEDULLA

Epinephrine

Estrogen

Norepinephrine

ProgesteroneTestosterone

Insulin

Glucagon

OVARY

PANCREASBETA CELLS

TESTES

PANCREAS

ALPHA CELLS



NURSING DIAGNOSIS& OBJECTIVES

DIAGNOSIS•Altered Nutrition ( less / more / potential )•Altered Elimination ( diarrhea / constipation )

•Altered Comfort•Activity intolerance•Fluid loss / excess•Impaired skin integrity•Self care deficit, feeding•Self esteem disturbance

GOALS•Maintain or Restore optimal nutritional status•Promote healthy nutritional practices•Decrease / regain specific weight•Establish & maintain normal elimination patter•Promote comfort / alleviate pain•Perform activities of daily living•F & E will be restored or maintained•Maintain or restore tissue integrity•

Client will feed self or receive help in feeding•Develop or demonstrate positive self image



NUTRITION

THE SUM OF ALL THE INTERACTIONBETWEEN AN ORGANISM AND THE FOOD ITCONSUMES

3 MAJOR FUNCTIONS OF NUTRIENTS

providing energy for body processes & movementproviding structural material for body tissues &regulating body processes

3 PRINCIPLES OF NUTRITION

I. ENERGY BALANCE - BMR, Body WeightStandards & Caloric Requirements

II. ENERGY NUTRIENTS - Carbohydrates,

Proteins & Fats

III. REGULATING NUTRIENTS - Vitamins,Minerals & Water

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ENERGY NUTRIENTS

CARBOHYDRATES

Simple (sugar)- Monosaccharides: glucose, fructose,

galactose- Disaccharides: combination, lactose

Complex (starch & fibers)

- Polysaccharide PROTEINS

Essential amino acids (9)Non essential amino acids FATS

LipidsSaturated, Unsaturated, Polysaturated, MonoCholesterol



VITAMINSWater soluble

VitaminsProlongedDeficiency

C (Ascorbic acid)

B1 (Thiamine)B2 (Riboflavin)B3 (niacin/nicotinic acid)B6 (Pyridoxine)B9 (Folacin/Folic Acid)B12 (Cobalamine)Panthothenic Acid

Biotin

Scurvy

BeriberiSkin LesionsPellagraPeripheral neutrilsMegaloblastic anemiaPernicious anemiaFatigue ,sleep

disturbance, Nausea,poor coordinationFatigue, depepression,muscle pain,dermatitis

Fat SolubleVitamins

ProlongedDeficiency

A (Retinol)

D (Ergocalciferol)

E (Tocopherol)K (Menadione)

Night BlindnessOpacity of the lensRicketsOsteomalaciaAnemiaBleeding

REGULATORY NUTRIENTS



FOOD PYRAMID GUIDE



FACTORS AFFECTINGNUTRITION

1. Development2. Gender3. Ethnicity and Culture4. Beliefs about food5. Personal preferences6. Religious practices

7. Lifestyle8. Medications and Therapy9. Health10.Alcohol Consumption11.Advertising

12.Psychological Factors










ELIMINATION & DEFECATION

Waste products of metabolism should be

eliminated from the body as feces or stool.

Defecation – expulsion of feces, bowelmovement

Factors that affect defecation

1. Developmental2. Diet3. Fluid intake4. Activity & exercise

5. Psychological factors6. Medication7. Diagnostic procedures8. Anesthesia9. Pathologic condition





















MEASURES TO STIMULATE APPETITE TO EAT

1. Serve food in pleasant and attractive

manner2. Place patient in comfortable

position3. Provide good hygiene measures4. Promote comfort – relieve pain,

humidity, ventilation,5. Remember that color affects

appetiteto eat

6. Assist weak patient in feeding



















INTERVENTIONS FOR NAUSEA & VOMITING

1. Position: Conscious –semi-Fowler’s

Unconsious – later2. Prevent aspiration3. Provide good oral care and hygiene4. Suction the mouth as needed5. Relieve sensation of nausea by

providing any of the following:- Ice chips- Hot tea with lemon / calamansi- Hot ginger ale

- Dry toast or crackers- Cold cola beverage
























THEHEIMLICHMANEUVER






KINDS OF DIET1. NPO2. Clear diet / Liquid diet3. Soft Diet4. DAT5. No Dark colored foods6. Low fat, low cholesterol7. High protein, low protein

8. Purine restricted9. Gluten-free10.Alkaline – ash11.Acid – ash12.Diabetic Diet

13.Kosher diet14.Giovanni-giovanetti diet15.Sattvic, Rajastic, Tamasic

Vegetarian diet






















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