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Digestive System. CHAPTER 12. Digestive System Overview. Digestive System Known as gastrointestinal tract Also known as digestive tract or alimentary canal Approximately 30 feet long Begins with mouth (oral cavity), ends with anus Functions

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Digestive System

CHAPTER 12


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Digestive System Overview

  • Digestive System

    • Known as gastrointestinal tract

      • Also known as digestive tract or alimentary canal

    • Approximately 30 feet long

      • Begins with mouth (oral cavity), ends with anus

    • Functions

      • Prepare foods for absorption into the bloodstream

      • Prepare foods for use by the body cells

      • Responsible for elimination of solid wastes from the body


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Digestive System Structures

  • Oral cavity (Buccal cavity)

    • Lips

    • Cheeks

    • Hard palate

      • Rugae

    • Soft palate

    • Uvula

    • Tongue

      • Principle organ of the sense of taste

      • Also assists in process of chewing (mastication) and swallowing (deglutition)


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Digestive System Structures

  • Salivary glands

    • Three pairs

      • Parotids

      • Submandibulars

      • Sublinguals

    • Secrete saliva

      • Mostly water, but contains mucus and digestive enzymes that aid in digestive process

    • Digestive enzymes contained in saliva

      • Amylase – aids in digestion of carbohydrates

      • Lipase – aids in digestion of fats


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Digestive System Structures

  • Pharynx

    • Known as the throat

    • Serves as passageway for both respiratory and digestive systems

    • Oropharynx

      • Section leading away from oral cavity

    • Nasopharynx

      • Behind nasal cavity

    • Laryngopharynx

      • Lower portion – opens into esophagus and larynx


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Digestive System Structures

  • Esophagus

    • Receives food from pharynx and propels it to stomach

    • Cardiac sphincter (lower esophageal sphincter) controls passage of food from esophagus into the stomach

      • Relaxes = food enters stomach

      • Contracts = stomach contents prevented from reentering the esophagus


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Digestive System Structures

  • Stomach

    • Fundus

      • Upper rounded portion

    • Body

      • Central part


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Digestive System Structures

  • Stomach

    • Pylorus

      • Lower tubular part (also called the gastric antrum)

      • Pyloric sphincter regulates passage of food from stomach into the duodenum

    • Folds in mucous membranes of stomach = Rugae


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Digestive System Structures

  • Stomach

    • Gastric juices breakdown food in stomach

    • Muscular action of stomach causes churning of food

      • Mixes food with the secretions

      • Chyme = liquidlike mixture of partially digested food and digestive secretions


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Digestive System Structures

  • Small intestine

    • Approximately 20 feet long

    • Also known as the small bowel

    • Divided into three parts

      • Duodenum

      • Jejunum

      • Ileum


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Digestive System Structures

  • Large intestine

    • Cecum

      • Appendix hangs from lower portion of cecum

    • Ascending colon

      • Hepatic flexure

    • Transverse colon

      • Splenic flexure

    • Descending colon

    • Sigmoid colon

    • Rectum

    • Anus


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Accessory Organs of Digestion

  • Liver

    • Located immediately under diaphragm, slightly to the right

    • Only digestive function

      • Production of bile for emulsification of fats in small intestine


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Accessory Organs of Digestion

  • Liver

    • Additional functions of liver

      • Excretion of bile pigments into bile

      • Synthesis of vitamin K-dependent plasma proteins

      • Amino acid metabolism

      • Carbohydrate metabolism

      • Fat metabolism

      • Phagocytosis

      • Detoxification

      • Storage of vital nutrients


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Accessory Organs of Digestion

  • Gallbladder

    • Pear-shaped sac, located under surface of liver

    • Main function:

      • To store and concentrate bile produced by the liver

      • Releases bile in response to presence of fatty content of food present in duodenum

      • Emulsifies fats


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Accessory Organs of Digestion

  • Pancreas

    • Located in upper left quadrant of abdomen, behind stomach

    • Functions as exocrine gland to manufacture digestive juices

      • Trypsin – breaks down proteins

      • Pancreatic lipase – breaks down fats

      • Pancreatic amylase – breaks down carbohydrates

      • Sodium bicarbonate – neutralizes acidic stomach contents


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Accessory Organs of Digestion

  • Pancreas

    • Functions as endocrine gland to manufacture insulin and glucagon

      • Insulin – hormone that makes it possible for glucose to pass from blood through cell membranes to be used for energy

      • Insulin also promotes conversion of excess glucose into glycogen

      • Glucagon – hormone that stimulates the liver to convert glycogen into glucose in time of need


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Accessory Organs of Digestion

  • Teeth

    • Primary responsibility

      • Chewing (mastication)

      • Food is ground by teeth and softened by saliva

    • Primary teeth = deciduous teeth

      • Set of 20 teeth – appears around age 6 months

    • Secondary teeth = permanent teeth

      • Begin to appear around age 6


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Accessory Organs of Digestion

  • Teeth

    • Incisors

      • Chisel shape with sharp edges for biting food

    • Canine or cuspid teeth

      • Useful for grasping and tearing food

    • Bicuspids (premolars) and molars

      • Flat surfaces, multiple projections for crushing and grinding food


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Accessory Organs of Digestion

  • Teeth

    • Crown

      • Visible part of the tooth

      • Covered with enamel – hardest substance in body

    • Neck

      • Lies just beneath the gum line

    • Root

      • Embedded in bony socket of the jaw bone

    • Root canal = pulp cavity

      • Central core of the tooth



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Common Signs and Symptoms

  • Achlorhydria

    • Abnormal condition characterized by the absence of hydrochloric acid in the gastric juice

  • Anorexia

    • Lack or loss of appetite, resulting in the inability to eat


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Common Signs and Symptoms

  • Aphagia

    • Condition characterized by the loss of the ability to swallow as a result of organic or psychologic causes

  • Ascites

    • Abnormal accumulation of fluid within the peritoneal cavity

      • Fluid contains large amounts of protein and electrolytes


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Common Signs and Symptoms

  • Borborygmus

    • An audible abdominal sound produced by hyperactive intestinal peristalsis

      • Borborygmi are rumbling, gurgling, and tinkling noises heard when listening with a stethoscope


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Common Signs and Symptoms

  • Constipation

    • Difficulty in passing stools, or an incomplete or infrequent passage of hard stools

  • Diarrhea

    • Frequent passage of loose, watery stools


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Common Signs and Symptoms

  • Dyspepsia

    • Vague feeling of epigastric discomfort after eating

    • Involves an uncomfortable feeling of fullness, heartburn, bloating, and nausea

  • Dysphagia

    • Difficulty in swallowing, commonly associated with obstructive or motor disorders of the esophagus


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Common Signs and Symptoms

  • Emaciation

    • Excessive leanness caused by disease or lack of nutrition

  • Emesis

    • Material expelled from the stomach during vomiting

    • Vomitus


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Common Signs and Symptoms

  • Eructation

    • Act of bringing up air from the stomach with a characteristic sound through the mouth

    • Belching

  • Flatus; Flatulence

    • Air or gas in the intestine that is passed through the rectum


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Common Signs and Symptoms

  • Gastroesophageal Reflux

    • Backflow of contents of stomach into esophagus

    • Often result of incompetence of the lower esophageal sphincter

  • Icterus

    • A yellowish discoloration of the skin, mucous membranes, and sclera of the eyes, caused by greater than normal amounts of bilirubin in the blood

    • Also called jaundice


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Common Signs and Symptoms

  • Melena

    • An abnormal, black, tarry stool containing digested blood

  • Nausea

    • Unpleasant sensation often leading to the urge to vomit

  • Pruritus ani

    • A common chronic condition of itching of the skin around the anus


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Common Signs and Symptoms

  • Steatorrhea

    • Greater than normal amounts of fat in the feces

      • Characterized by frothy, foul-smelling fecal matter that floats

  • Vomit

    • To expel the contents of the stomach through the esophagus and out of the mouth


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PATHOLOGICAL CONDITIONS

Digestive System


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Achalasia

  • Pronounced

    • (ak-al-LAY-zee-ah)

  • Defined

    • Decreased mobility of the lower two-thirds of the esophagus along with constriction of the lower esophageal sphincter


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Anal Fistula

  • Pronounced

    • (AY-nal FISS-too-lah)

  • Defined

    • Abnormal passageway in the skin surface near the anus usually connecting with the rectum

      • May occur as the result of a draining abscess


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Aphthous Stomatitis

  • Pronounced

    • (AFF-thus stoh-mah-TYE-tis)

  • Defined

    • Small inflammatory noninfectious ulcerated lesions occurring in the lips, tongue, and inside the cheeks of the mouth

    • Also called canker sores


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Appendicitis

  • Pronounced

    • (ap-pen-dih-SIGH-tis)

  • Defined

    • Inflammation of the vermiform appendix

      • Usually an acute condition that can lead to rupture (perforation) with resultant inflammation of the peritoneum (peritonitis)


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Celiac Disease

  • Pronounced

    • (SEE-lee-ak disease)

  • Defined

    • Nutrient malabsorption due to damaged small bowel mucosa


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Cirrhosis

  • Pronounced

    • (sih-ROH-sis)

  • Defined

    • Disease of the liver that is chronic and degenerative causing injury to the hepatocytes (functional cells of the liver)

      • Fat infiltrates lobules of the liver, causing tissue covering the lobes to become fibrous

      • Functions of liver eventually deteriorate


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Colorectal Cancer

  • Pronounced

    • (koh-loh-REK-tal CAN-sir)

  • Defined

    • Presence of a malignant neoplasm in the large intestine


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Constipation

  • Pronounced

    • (kon-stih-PAY-shun)

  • Defined

    • A state in which the individual’s pattern of bowel elimination is characterized by a decrease in the frequency of bowel movements and the passage of hard, dry stools

      • Individual experiences difficult defecation


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Crohn’s Disease

  • Pronounced

    • (KROHNZ dih-ZEEZ)

  • Defined

    • Digestive tract inflammation of a chronic nature causing fever, cramping, diarrhea, weight loss, and anorexia


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Dental Caries

  • Pronounced

    • (DEN-tal KAIR-eez)

  • Defined

    • Tooth decay caused by acid-forming microorganisms


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Dysentery

  • Pronounced

    • (DISS-en-ter-ee)

  • Defined

    • A term used to describe painful intestinal inflammation typically caused by ingesting water or food containing bacteria, protozoa, parasites, or chemical irritants

      • Person has frequent stools that often contain blood


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Diverticular Disease

  • Pronounced

    • (dye-ver-TIK-yoo-lar dih-ZEEZ)

  • Defined

    • Expression used to characterize both diverticulosis and diverticulitis

      • Diverticulosis = non-inflamed outpouchings or herniations of the muscular layer of the intestines, typically the sigmoid colon

      • Diverticulitis = inflammation of these outpouchings


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Esophageal Varices

  • Pronounced

    • (eh-soff-ah-JEE-al VAIR-ih-seez)

  • Defined

    • Swollen, twisted (tortuous) veins located in the distal end of the esophagus


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Gallstones (Cholelithiasis)

  • Pronounced

    • (koh-lee-lih-THIGH-ah-sis)

  • Defined

    • Pigmented or hardened cholesterol stones formed as a result of bile crystallization


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Hemorrhoids

  • Pronounced

    • (HEM-oh-roydz)

  • Defined

    • Hemorrhoid is an unnaturally distended or swollen vein (varicosity) in distal rectum or anus


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Hepatitis

  • Pronounced

    • (hep-ah-TYE-tis)

  • Defined

    • Acute or chronic inflammation of the liver due to a viral or bacterial infection, drugs, alcohol, toxins, or parasites


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Hernia

  • Pronounced

    • (HER-nee-ah)

  • Defined

    • Irregular protrusion of tissue, organ, or a portion of an organ through an abnormal break in the surrounding cavity’s muscular wall


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Herpetic Stomatitis

  • Pronounced

    • (her-PEH-tic stoh-mah-TYE-tis)

  • Defined

    • Inflammatory infectious lesions in or on the oral cavity occurring as a primary or a secondary viral infection caused by herpes simplex


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Hirschsprung’s Disease (Congenital Megacolon)

  • Pronounced

    • (HIRSH-sprungz dih-ZEEZ)

    • (kon-JEN-ih-tal meg-ah-KOH-lon)

  • Defined

    • Absence at birth of the autonomic ganglia in a segment of the intestinal smooth muscle wall that normally stimulates peristalsis


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Ileus

  • Pronounced

    • (ILL-ee-us)

  • Defined

    • Obstruction of the intestine

      • May occur due to twisting of the bowel, absence of peristalsis, or presence of adhesions or tumor


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Intestinal Obstruction

  • Pronounced

    • (in-TESS-tin-al ob-STRUCK-shun)

  • Defined

    • Complete or partial alteration in the forward flow of the contents in the small or large intestines


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Intussusception

  • Pronounced

    • (in-tuh-suh-SEP-shun)

  • Defined

    • Telescoping of a portion of proximal intestine into distal intestine usually in the ileocecal region causing an obstruction

      • Typically occurs in infants and young children


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Irritable Bowel Syndrome Spastic Colon

  • Pronounced

    • (EAR-it-ah-b’l BOW-el SIN-drom)

    • (SPAS-tik COH-lon)

  • Defined

    • Increased motility of the small or large intestinal wall resulting in abdominal pain, flatulence, nausea, anorexia, and the trapping of gas throughout the intestines


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Oral Leukoplakia

  • Pronounced

    • (OR-al loo-koh-PLAY-kee-ah)

  • Defined

    • Precancerous lesion occurring anywhere in the mouth


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Pancreatitis

  • Pronounced

    • (pan-kree-ah-TYE-tis)

  • Defined

    • Acute or chronic destructive inflammatory condition of the pancreas

      • May be acute or chronic


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Peptic Ulcers(Gastric, Duodenal, Perforated)

  • Pronounced

    • (PEP-tik ULL-sir)

    • (GAS-tric, doo-oh-DEE-nal, PER-foh-ray-ted)

  • Defined

    • Break in the continuity of the mucous membrane lining of the gastrointestinal tract as a result of hyperacidity or the bacterium, Helicobacter pylori


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Peptic Ulcers

  • Peptic ulcer descriptions

    • Acute or chronic

    • Singular or clustered

    • Shallow or deep

  • Symptoms of an ulcer

    • Gnawing epigastric pain

    • Heartburn or indigestion

    • Nausea and vomiting

    • Bloated feeling after eating


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Periodontal Disease

  • Pronounced

    • (pair-ee-oh-DON-tal dih-ZEEZ)

  • Defined

    • Group of inflammatory gum disorders

    • May lead to degeneration of teeth, gums, and sometimes surrounding bones


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Polyps, Colorectal

  • Pronounced

    • (PALL-ips koh-loh-REK-tal)

  • Defined

    • Small growths projecting from the mucous membrane of the colon or rectum

      • May be sessile (attached by a base) or pedunculated (attached by a stalk)

      • May vary in size and may be benign or pre-cancerous


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Thrush

  • Pronounced

    • (THRUSH)

  • Defined

    • Fungal infection in the mouth and throat producing sore, creamy white, slightly raised curdlike patches on the tongue and other oral mucosal surfaces

      • Caused by Candida albicans


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Ulcerative Colitis

  • Pronounced

    • (ULL-sir-ah-tiv koh-LYE-tis)

  • Defined

    • Chronic inflammatory condition resulting in a break in the continuity of the mucous membrane lining of the colon in the form of ulcers

      • Characterized by large watery diarrheal stools containing mucus, pus, or blood


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Volvulus

  • Pronounced

    • (VOL-vyoo-lus)

  • Defined

    • Rotation of loops of bowel causing a twisting on itself that results in an intestinal obstruction


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DIAGNOSTIC TECHNIQUES, TREATMENTS AND PROCEDURES

Digestive System


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Diagnostic Techniques, Treatments, and Procedures

  • Abdominal ultrasound

    • High-frequency sound waves to provide visualization of the internal organs of the abdomen (liver, gallbladder, bile ducts, pancreas, kidneys, bladder, and ureters)

  • Abdominocentesis (Paracentesis)

    • Insertion of a needle or trochar into abdominal cavity to remove excess fluid

      • Person is in a sitting position


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Diagnostic Techniques, Treatments, and Procedures

  • Alanine Aminotransferase (ALT)

    • Hepatocellular enzyme released in elevated amounts due to liver dysfunction

    • Also known as serum glutamic pyruvic transaminase (SGPT)


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Diagnostic Techniques, Treatments, and Procedures

  • Alkaline Phosphatase (ALP)

    • Enzyme found in highest concentrations in liver, biliary tract, and bone

  • Amylase

    • Enzyme secreted normally from pancreatic cells that travels to the duodenum by way of pancreatic duct

    • Aids in digestion


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Diagnostic Techniques, Treatments, and Procedures

  • Appendectomy

    • Surgical removal of an inflamed appendix

    • May be removed via laparoscope if no rupture has occurred


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Diagnostic Techniques, Treatments, and Procedures

  • Barium Enema (BE)

    • Infusion of a radiopaque contrast medium, barium sulfate, into the rectum and held in the lower intestinal tract while x-ray films are obtained of the lower GI tract


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Diagnostic Techniques, Treatments, and Procedures

  • Barium Swallow (Upper GI Series)

    • Involves oral administration of a radiopaque contrast medium, barium sulfate, which flows into the esophagus as the person swallows


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Diagnostic Techniques,Treatments, and Procedures

  • Cheiloplasty

    • Surgically correcting a defect of the lip

  • Cholecystectomy

    • Surgical removal of the gallbladder

  • Cholecystography (Oral)

    • Visualization of the gallbladder through x-ray following the oral ingestion of pills containing a radiopaque iodinated dye


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Diagnostic Techniques, Treatments, and Procedures

  • Colonoscopy

    • Visualization of the lining of the large intestine using a fiberoptic colonoscope

  • Colostomy

    • Surgical creation of a new opening on the abdominal wall through which the feces will be expelled, by bringing the incised colon out to the abdominal surface

      • Abdominal-wall anus


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Diagnostic Techniques, Treatments, and Procedures

  • CT of the abdomen

    • Painless, noninvasive x-ray procedure

    • Produces an image created by the computer representing a detailed cross section of the tissue structure within the abdomen

    • Computerized tomography (CT) of the abdomen


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Diagnostic Techniques, Treatments, and Procedures

  • Endoscopic Retrograde Cholangiopancreatography

    • Examines the size of and filling of the pancreatic and biliary ducts through direct radiographic visualization with a fiberoptic endoscope


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Diagnostic Techniques, Treatments, and Procedures

  • Esophagogastroduodenoscopy (EGD)

    • Process of direct visualization of the esophagus, stomach, and duodenum using a lighted, fiberoptic endoscope

      • Also known as an upper endoscopy


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Diagnostic Techniques, Treatments, and Procedures

  • Extracorporeal Shock Wave Lithotripsy (ESWL)

    • Alternative treatment for gallstones by using ultrasound to align the computerized lithotripter and source of shock waves with the stones

    • To crush the gallstones and thus enable the contraction of the gallbladder to remove stone fragments


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Diagnostic Techniques, Treatments, and Procedures

  • Fluoroscopy

    • Radiological technique used to examine the function of an organ or a body part using a fluoroscope

  • Gastric analysis

    • Study of the stomach contents to determine the acid content and to detect the presence of blood, bacteria, bile, and abnormal cells


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Diagnostic Techniques, Treatments, and Procedures

  • Gastric Lavage

    • Irrigation, or washing out, of the stomach with sterile water or a saline solution


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Diagnostic Techniques,Treatments, and Procedures

  • Herniorrhaphy

    • Surgical repair of a hernia by closing the defect using sutures, mesh, or wire

  • Liver biopsy

    • Piece of liver tissue obtained for examination by inserting a specially designed needle into the liver through the abdominal wall


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Diagnostic Techniques, Treatments, and Procedures

  • Liver scan

    • Noninvasive scanning technique

    • Enables visualization of shape, size, and consistency of liver after IV injection of a radioactive compound

  • Magnetic Resonance Imaging (MRI)

    • Noninvasive scanning procedure that provides visualization of fluid, soft tissue, and bony structures without the use of radiation


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Diagnostic Techniques, Treatments, and Procedures

  • Nasogastric intubation

    • Placement of a tube through the nose into the stomach

    • To relieve gastric distension by removing gastric secretions, gas, or food


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Diagnostic Techniques, Treatments, and Procedures

  • Percutaneous Transhepatic Cholangiography (PTC) or (PTHC)

    • Examination of bile duct structure using a needle to pass directly into an intrahepatic bile duct to inject a contrast medium


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Diagnostic Techniques, Treatments, and Procedures

  • Serum Bilirubin

    • Measurement of bilirubin level in serum

      • Serum bilirubin levels are a result of the breakdown of red blood cells

  • Serum Glutamic-oxaloacetic Transaminase (SGOT)

    • Enzyme that has very high concentrations in liver cells

      • Also known as aspartate aminotransferase (AT)


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Diagnostic Techniques, Treatments, and Procedures

  • Small bowel follow-through

    • Oral administration of a radiopaque contrast medium, barium sulfate

    • Flows through the GI system

    • X-ray films are obtained at timed intervals to observe the progression of the barium through the small intestine


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Diagnostic Techniques, Treatments, and Procedures

  • Stool analysis for occult blood

    • Analysis of a stool sample to determine presence of blood not visible to naked eye

  • Stool culture

    • Collection of a stool specimen placed on one or more culture mediums

    • Allowed to grow colonies of microorganisms to identify specific pathogen(s)


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Diagnostic Techniques,Treatments, and Procedures

  • Stool Guaiac

    • Test on a stool specimen using guaiac as a reagent

    • Identifies presence of blood in stool

  • Urinary Bilirubin

    • Tests for conjugated or direct bilirubin in a urine specimen


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