Добавил:
Sekretar
kiopkiopkiop18@yandex.ru
t.me/Prokururor I Вовсе не секретарь, но почту проверяю
Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз:
Предмет:
Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5519_Библиотеки_им_академика_М_И_Перельмана.pdf
Chapter 7 Digestive System and Nutrition 141
usually avoid sour foods such as citrus, which will cause
more pain or discomfort. If there are missing or decayed
teeth (dental caries), we may avoid foods that require more
chewing. Other conditions that affect the mouth are gingivitis, gum infection, and periodontitis, a more serious
condition of gum disease that if untreated may lead to
tooth loss. These conditions are treated with proper dental
hygiene. A fungal infection that affects the mouth is caused
by the yeast organism Candida albicans. It is commonly
called
oral thrush and might develop following antibiotic
therapy killing normal bacteria found in the mouth. The
normal bacteria prevent the growth of this fungus.
Parotitis is inammation of the parotid glands
located in the back of the mouth. Mumps is a viral,
contagious infection of the parotid glands. When young
males are affected during or after puberty, they are at
risk of becoming sterile because this virus may attack
the testicles.
Disorders of the Esophagus
andStomach
The esophagus and stomach are the next organs where
food travels once it leaves the mouth. As the food enters
the stomach, it passes through the esophageal sphincter.
There are disorders that affect the area where these two
organs join. The common disorders of these organs are:
GERD, gastroesophageal reux disease; treated with
antacids and medication that decreases the production of hydrochloric acid in the stomach.
Gastritis—any inammation of the stomach lining
r
that develops from numerous causes including bacteria, overuse of drugs like aspirin, and chronic use of
alcohol and cigarette smoking.
Stomach ulcer—erosion of the lining of the stomach
r
typically due to chronic gastritis; Helicobacter pylori
is the bacteria that reside in the mucous coating of
the stomach and stimulates HCL production leading
to the development of stomach ulcers; peptic ulcer is
found in the esophagus and stomach or may develop
in the duodenum and is then called a duodenal ulcer.
Stomach cancer—develops in the lining of the stom-
r
ach; adenocarcinoma is one type usually resulting
from long history of indigestion, which is the most
important warning sign of stomach cancer.
Nausea and vomiting are not diseases of the stomach
however are symptoms associated with the disorders of
the stomach.
stomach contents through the mouth.
ing of queasiness that usually precedes vomiting. Nausea
and vomiting can be caused by stomach inammation,
motion sickness, medications (chemotherapy drugs),
and pregnancy.
Vomiting is the process of expelling the
Nausea is a feel-
Hiatal hernia—weakened area of the diaphragm
r
allowing the stomach to protrude upward causing the
hernia; symptoms include pain following meals and
frequent gastritis; surgical repair of the hernia may be
needed. Figure 7-5 demonstrates a hiatal hernia.
Gastric reux—stomach acid ows back into the
r
lower end of the esophagus; chronic reux is called
Esophagus
Gastroesophageal
junction
Stomach
Figure 7-5 Hiatal hernia. A weakness in the diaphragm
allows a portion of the stomach to protrude upward
through that muscle. (Reprinted from Cohen BJ.
Memmler’s The Human Body in Health and Disease.
13thed. Philadelphia, PA: Wolters Kluwer; 2014.)
Intestinal and Abdominal Disorders
Beyond the stomach are the intestines, which also can
develop diseases and conditions that may affect the
further breakdown and absorption of the nutrients our
body needs. Among these disorders are:
Peritonitis—inammation of the peritoneum, the lin-
r
ing of the abdomen and organs; may be localized or
generalized; a ruptured appendix might cause generalized peritonitis.
Appendicitis—inammation of the appendix due
r
to infection or obstruction; symptoms include nausea, vomiting, and localized pain in the right lower
quadrant of the abdomen; treatment is to surgically
remove the appendix (appendectomy).
Inammatory bowel disease (IBD)—generalized
r
inammation of the intestine causing pain, diarrhea,
rectal bleeding, and occasionally weight loss; two
types include:
Crohn disease—an autoimmune disease causing
inammation of the distal end of the small intestine
Ulcerative colitis—inammation and ulceration of
the colon and rectum
Celiac disease—inability to tolerate gluten, protein
r
found in wheat, rye, and barley; causes inammation that damages or destroys the intestinal villi;
symptoms similar to IBD and may include constipation and bloating after eating foods with gluten
142 Section II Anatomy and Physiology
Irritable bowel syndrome (IBS)—GI disorder that
r
causes constipation or diarrhea and pain; usually due
to stress
Diverticulosis—development of large numbers of
r
diverticula, small pouches in the wall of the intestine;
inammation of these is called diverticulitis; may be
caused from low ber in the diet (Fig. 7-6)
Intestinal obstruction—blockage of the intestine; may
r
be caused from twisting of the intestine or from slipping of part of the intestine into an adjacent part of
the intestine (intussusception)
Hemorrhoids—varicose veins of the rectum; cause
r
pain and bleeding
Colon cancer—malignant tumor of the colon or
r
rectum; may arise from benign polyps in the lining
of the colon
Terms used to describe digestive disorders include
enteritis, intestinal inammation and gastroenteritis, and
inammation of both the stomach and intestines. These
are general terms usually used to describe disorders until
the actual or absolute cause can be determined. Diarrhea,
frequent watery bowel movements, is usually one of the
symptoms of inammation. Diarrhea can be caused from
contaminated food or water, viral and bacterial infections, and as a result of other diseases of the GI tract. The
primary concern with diarrhea is the loss of uid, which
leads to dehydration. Physicians may request a stool
specimen to aid in determining the cause of the diarrhea.
Constipation is also a symptom that accompanies
some disorders. Constipation is caused by hard stools or
difculty moving the bowels. Certain medications may
cause constipation as well as a decrease in the amount
of ber in the diet, which will help with regularity.
Laxatives and enemas are used to soften and loosen the
stool for elimination (defecation).
Endoscopy is the use of a lighted scope to visualize
the gastrointestinal tract. Gastroscopy is used to examine the stomach, and colonoscopy is a procedure used to
examine the colon. Prior to performing these exams, the
physician may order an occult (hidden) blood test of the
stool to determine if there is any blood in the stool that
is not visible with the naked eye. A positive test indicates
that there is a source of bleeding in the intestine that
needs to be investigated.
C
O
G
DISORDERS OF THE
ACCESSORY ORGANS OF
THE DIGESTIVE SYSTEM
We cannot overlook the disorders that affect the liver,
gallbladder, and pancreas. When these organs are diseased or not functioning well, digestion and absorption
can be affected.
The Liver
Cirrhosis of the liver is a chronic disease, commonly
caused by excessive alcohol consumption. The disease
causes the healthy liver cells to become inactive and
replaced with scar tissue. When this occurs, the normal
blood ow into the liver is obstructed causing accumulation of blood in other areas of the GI tract. Varicose
veins develop due to the increased pressure within the
vessels. These veins may rupture causing hemorrhage
and possibly death from sudden bleeding.
Jaundice is a visible symptom of liver malfunction. Signs
of this condition include a yellowish color to the white of
the eyes and skin, and the stool will become pale, chalky
in color due to lack of bilirubin. Figure 7-7 is a photo of a
patient’s eye showing the yellowish coloration to the sclera.
Figure 7-6 Diverticula of the colon. (Reprinted with
permission from Neil Hardy, Westpoint, CT.)
Figure 7-7 A patient with jaundice. (From Bickley
LS, Szilagyi P. Bates’ Guide to Physical Examination
and History Taking. 8th ed. Philadelphia, PA: Lippincott
Williams & Wilkins; 2003.)
Chapter 7 Digestive System and Nutrition 143
Bilirubin is a byproduct of blood cell destruction, a
function of the liver. Bilirubin is normally excreted in the
bile. When the liver is not functioning properly, bilirubin
may be blocked from reaching the bile ducts. Bilirubin
levels in the blood will then be elevated.
Hepatitis is inammation of the liver that may be
caused by drugs, infection, or alcohol consumption.
There are different types of hepatitis caused by a virus
and named with the letter A through E.
Hepatitis A (HAV)—transmitted through contami-
r
nated food and water and contact with fecal matter;
food workers who do not use frequent, proper hand
hygiene can spread hepatitis A through food preparation and service.
Hepatitis B (HBV)—transmitted through blood or
r
body uids but may also be spread through fecal contamination; health care workers are usually required
to have the hepatitis B vaccine to help prevent contracting the disease from contaminated needles and
blood and body uids.
Hepatitis C (HCV)—primarily transmitted through
r
infected blood; may also be through sexual
transmission.
Hepatitis D (HDV)—transmitted by direct blood
r
exchange with those infected with hepatitis B.
Hepatitis E (HEV)—transmitted by fecal contamina-
r
tion of water.
Most hepatitis patients recover well, but some forms
of hepatitis may lead to liver cancer. Liver cancer may
not originate in the liver but is the result of metastasis
of cancer from another area of the body. For example, a
patient may have pancreatic or intestinal cancer, which
is the primary source. Cancer cells are carried to the
liver through the blood.
The Gallbladder
The gallbladder stores bile until the body needs it for
metabolism of fat. One of the more common conditions
is that stones will form from the bile. This condition
known as cholelithiasis will cause the development of
stones that may become large enough to block the bile
ducts. When this occurs, it may lead to inammation of
the gallbladder, cholecystitis. Surgery may be required to
remove the stones or in some cases the entire gallbladder. The removal of the gallbladder is called
tectomy
removed due to numerous gallstones.
. Figure 7-8 is a photo of a gallbladder that was
cholecys-
The Pancreas
Pancreatitis is inammation of the pancreas, which may
be caused from a blockage in the pancreatic ducts that
supply the pancreatic enzymes to the small intestine. The
enzymes back up into the pancreas causing damage to
Figure 7-8 Gallstones from surgically removed
gallbladder. (Image from Shutterstock.com.)
the pancreas. This will result in malabsorption of the
nutrients in the small intestine that would have been
broken down by the enzymes. Acute pancreatitis will
usually have a short duration; however, if chronic, it is a
risk factor for development of pancreatic cancer.
C
O
G
There are other conditions not directly related to a specic
organ of the digestive tract but may affect the body’s
nutrition and absorption of nutrients. Malnutrition simply means bad nutrition. Something is probably missing
from the diet or is not able to be absorbed into the body.
It could be caused from not eating enough or not eating
the right foods that will supply the necessary nutrition to
keep us healthy. Kwashiorkor is a condition when there
is a serious shortage of protein in the diet and is frequently seen in impoverished areas of the world where
the food supply is limited. Most signicant visible symptom is the accumulation of uid in the abdomen (ascites)
causing it to bulge. In some countries where this is more
prevalent, it is the primary cause of death for children
under age ve.
tries where food is abundant and good food choices are
replaced by processed foods that are high in fat and
sugar. Overweight is also prevalent in persons who have
a more sedentary lifestyles. Childhood obesity has been a
concern for years with the increase in fast food available
and decreased activity due to more technology engaging
the children rather than physical activity. It is no surprise that there is also an increase in diseases involving
the cardiovascular system and specic conditions such
as diabetes. Figure 7-9 is the MyPyramid guide that
RELATED DISORDERS OF
THE DIGESTIVE SYSTEM
Weight control is a problem faced by many in coun-
144 Section II Anatomy and Physiology
Figure 7-9 MyPyramid guide based on a 2,000-calorie diet. (Reprinted from Kronenberger J, Ledbetter J. Lippincott
Williams & Wilkins’ Comprehensive Medical Assisting. 5th ed. Philadelphia, PA: Wolters Kluwer; 2016.)
Figure 7-10 MyPlate icon. The plate shows the
recommended proportion of each food category in
the diet. (Reprinted from Kronenberger J, Ledbetter J.
Lippincott Williams & Wilkins’ Comprehensive Medical
Assisting, 5th ed. Philadelphia, PA: Wolters Kluwer; 2016.)
was developed by the U.S. Department of Agriculture.
This image was established by the USDA in 2005 and
serves as a guide to the proper nutrition we need in our
diets.
In 2011, the USDA added ChooseMyPlate, which is
easier to visualize and shows the distribution of the ve
food groups on a plate. See Figure 7-10, which is the
image of ChooseMyPlate.
Chapter 7 Digestive System and Nutrition 145
Underweight may not be quite as common as overweight, but there are those who struggle gaining weight or
maintaining a healthy weight for their stature. Anorexia,
chronic loss of appetite, is the more common cause of
underweight. Causes of anorexia may be physical or
mental. Certain medications may cause a loss of appetite
as well as acute illnesses like gastrointestinal infections.
Anorexia nervosa is a psychological problem in which the
person starves themselves. The person with this problem
perceives that they are overweight and is attempting to
lose weight through not eating. Bulimia is a similar problem as anorexia however the person eats food then forces
vomiting to get the food out before it can be digested
and absorbed. It is called a binge and purge syndrome.
Anorexia and bulimia lead to many physical problems
other than just weight loss. Over a long period of time,
the person experiences muscle loss, cardiac irregularities,
and erosion of the esophagus from the repeated vomiting.
In serious cases, these disorders may lead to death.
Study Skill
To study the digestive system, it might be helpful to
build a roadmap. Use a large sheet of paper, start at
the mouth, and draw a highway the leads to the end
of the digestive tract. For each structure along the
road, build a city that lists the function of the organ
or structure, how the structure contributes to the
digestion of food, and what happens when it malfunctions. This exercise will give you a great visual
to study from. Make it colorful and full of animation.
Case Question
Cultural Connection
The American Indian community has a very high
incidence of type 2 diabetes among its population.
The Centers for Disease Control (CDC) stated that
Native American youth ages 10 to 19 have a higher
rate of developing diabetes than other ethnic and
racial groups. There are reasons that contribute to this including the more sedentary lifestyle
and poor diet decisions. The CDC partnered with
Indian communities throughout the United States
to set up projects encouraging these populations
to reclaim their traditional foods and adopt the
healthy lifestyle that includes increased physical
activity. Traditionally, Native Americans grew an
abundant supply of fresh vegetables and relied on
the bounty of Mother Earth to sustain a healthy
lifestyle. For more information about these projects, visit the CDC Web site and Native American
Diabetic Projects.
Remember the case study patient, Mary Ann? Her
mother is in the waiting room and Mary Ann is
having her blood drawn for a complete metabolic
panel. While she and Rosa are alone, she shares
that she has been vomiting quite a bit lately and
wants to know if this will cause any problems with
her stomach. She said the doctor asked her if she if
purposely vomiting. If you were the medical assis-
tant how would you explain to her why the doctor
was asking her that question?
BMI is the body mass index. It calculates the height
and weight of an individual to determine the body fat.
The standard says that an individual with <18.5 BMI
is considered underweight and >30 BMI is overweight.
Food allergy is another related problem that can
affect our nutrition. Some of the more common food
allergies are related to wheat (gluten), shellsh, eggs,
milk (lactose), and nuts (peanuts). An allergic reaction
can cause symptoms like hives, wheezing, and GI discomfort. For those with more sensitivity to the allergen,
anaphylactic shock may occur, which can lead to death.
146 Section II Anatomy and Physiology
Preparing for Externship
You should treat your externship as a job, but remember that you are still a student. The externship does
not pay students for hours worked at the site. Some
students adopt the attitude that if they are not paid
they do not need to apply 100% of their effort each
day. This is a negative approach to the externship.
You should always strive to give your best in all you
do. Think of the patients that you work with and the
Chapter Recap
● The digestive system includes the structures of the
mouth, esophagus, stomach, small and large intestine,
rectum, and anus.
● Accessory organs that support the digestive process
include the liver, gallbladder, and pancreas.
● The digestive process requires substances to help
breakdown the food into usable nutrients that can be
absorbed into the bloodstream. These include saliva,
hydrochloric acid, bile, and pancreatic enzymes.
● Minerals and vitamins are essential to the function of the
body. Vitamins are primarily responsible for assisting in
metabolism and the manufacture of red blood cells.
coworkers that rely on you. You need to be assertive
asking what you can do to help everyone. Be prepared to be on your feet most of the time. Students
who do not appear to be alert and busy give the perception of being lazy or uninterested. Ask a lot of
good questions and be involved observing as much
as you can. There is always something to do in the
medical ofce.
● Disorders and diseases of the digestive organs can
affect the overall health of the body due to the
inability of nutrients to get into the body cells. These
include infections, organ malfunction and defects,
and lack of enzyme secretion for the breakdown of
nutrients for absorption.
● Protein, carbohydrates, and fats are necessary in the
daily diet in order to provide the proper nutrition for
healthy body cells. These nutrients are required for
cell production and repair and energy for adequate
functioning of the cells.
Online Resources for Students
Resources for students available on thepoint.
lww.com include the following:
● Audio Glossary
● Animations
Exercises and Activities
Certication Preparation Questions
1. Which of these is the substance produced in the
stomach that breaks down protein and destroys
foreign organisms?
a. Vitamin K
b. Chyme
c. Hydrochloric acid
d. Bile
e. Pepsin
● Competency Evaluation Forms
● Harris CareTracker Case Studies
● Interactive Games & Activities
● Certication Preparation Question Bank
● Videos
2. Which of these are the three sections of the small
intestine in the order they are located?
a. Duodenum, ileum, jejunum
b. Ileum, sigmoid, jejunum
c. Jejunum, duodenum, ileum
d. Sigmoid, ileum, duodenum
e. Duodenum, jejunum, ileum
Chapter 7 Digestive System and Nutrition 147
3. The term used for the surgical removal of the
gallbladder is:
a. colectomy.
b. colectomy.
c. cholecystotomy.
d. cholecystectomy.
e. cholehepatectomy.
4. Which of these are fat-soluble vitamins?
a. A, B, C
b. B, C, D
c. E, D, K
d. B, C, E
e. A, D, B
5. Which of these is a condition associated with
excessive alcohol consumption and causes healthy
liver cells to be replaced with scar tissue?
a. Jaundice
b. Cirrhosis
c. Hepatitis A
d. Hepatitis C
e. Celiac disease
6. Which of these is a condition caused by
inammation of small pouches in the intestine?
a. Crohn disease
b. Celiac disease
c. Cirrhosis
d. Diverticulitis
e. Peritonitis
7. A hiatal hernia is located
a. At the junction of the small and large intestine
b. Between the stomach and the pylorus
c. At the distal end of the small intestine
d. At the junction of the esophagus and stomach
e. At the point where the descending colon becomes
the sigmoid colon
8. Which of these statements describes cholelithiasis?
a. It is inammation of the gallbladder.
b. It is the development of gallstones in the
gallbladder.
c. It is inammation of the liver and gallbladder.
d. It is blockage of the bile ducts leading from the
liver to the gallbladder.
e. It is the surgical removal of the gallbladder.
9. GERD is a condition that involves the:
a. stomach and esophagus.
b. stomach and pylorus.
c. duodenum and pylorus.
d. ileum and ascending colon.
e. descending colon and sigmoid colon.
10. Mastication is a term meaning the process of:
a. elimination of waste products from the body.
b. changing food into chyme.
c. chewing food into smaller pieces.
d. moving digested food through the intestines.
e. swallowing a bolus of food.
P
S
Y
CareTracker Connection
Documenting Clinical Data and
Ordering Laboratory Tests Related to
the Digestive System and Nutrition
CareTracker Activities Related to
This Chapter
Case Study 8: Gerontology Patient Practicum
r
Although many factors that affect our health are beyond
our control—such as genetics, age, race, and sociocultural values and norms—some can signicantly inuence in our day-to-day choices. One of the biggest health
choices we make is what we put in our mouths. Many
diseases and conditions, not just of the gastrointestinal
system but of the body as a whole, are strongly associated
with our diet. As a medical assistant, you will be responsible for gathering and entering much gastrointestinaland nutrition-related patient information in the form
of complaints, signs and symptoms, history of disease,
examination ndings, laboratory and diagnostic test
results, diagnoses, and treatments. CareTracker facilitates all of these tasks.
Tasks discussed in this chapter that can be performed
in CareTracker include the following:
Documenting the following patient clinical information
r
related to gastrointestinal conditions and nutrition:
Health history
Diseases and conditions
Hospitalizations
Alcohol use
Caffeine use
Surgeries and procedures
Preventive care
Family history
Review of systems
Physical examination ndings
148 Section II Anatomy and Physiology
Tests and procedures completed during the visit
Lipid panel
Fecal occult blood
Diagnoses
Treatment plan
BMI follow-up plan documented
Nutrition counseling
Dietary consultation order
Colonoscopy
Air contrast barium enema
Sigmoidoscopy
Fecal analysis
High ber
Healthy diet
Low cholesterol
Lose weight
Junk-free
Gain weight
Ordering the following related to gastrointestinal
r
conditions and nutrition:
Medications
Laboratory tests
Diagnostic tests
Many of these tasks are discussed in CareTracker
Connection features in other chapters. A task we’ll consider here is ordering a laboratory test.
Once the primary care provider has nished examining
the patient and diagnosed any conditions present, he or she
may ask you, the medical assistant, to enter a medication
prescription or order a laboratory or diagnostic test related
to the diagnosis. To order a laboratory test, you rst click
on the
screen in the Medical Record (either from the main screen
or from within the Progress Note).
icon in the Clinical Toolbar near the top of the
Alternatively, you may click on the icon at the bot-
tom of the PLAN tab in the Progress Note.
Within the Order window, you may select Lab as the
Order Type. The ordering physician and facility may be
selected from drop-down menus in these elds, as can
the diagnosis associated with the test being ordered. In
the example below, for instance, the order for a comprehensive metabolic panel (CMP) is related to the patient’s
diagnosis of acute intestinal obstruction. The due date,
collection date and time, requested time of day to
receive the test results, and the frequency of the test may
also be selected. The test itself may be selected from the
list of preloaded tests or searched for in CareTracker’s
database of tests using the search eld. The selected test
or tests appear in the Tests Summary eld below. The
urgency and fasting status can be entered to the right.
Below is an example of a completed order for a laboratory test.
Chapter 7 Digestive System and Nutrition 149
Once you have completed the order, click on Save,
and a printable copy of the order will appear.
150 Section II Anatomy and Physiology
You’ll get a chance to practice this task in Case Study 8:
Gerontology Patient Practicum.
To access Case Study 8, go to http://thepoint.lww.
com, log in using your username and password, search
for The Complete Medical Assistant, click on “Student
Resources,” nd the Harris CareTracker materials, and
click on “Case Study 8.”
P
S
Y
www.choosemyplate.gov U.S. Department of
www.cdc.gov Center for Disease Control, Native
Internet Resources
Agriculture—investigate this Web site for additional
information on nutrition and dietary plans.
American Diabetic Projects—access this site for
additional information on the federal diabetic
programs established for Native Americans.