NCM 116 Theory Module 1: Concept of Metabolism and Alteration in Ingestion PDF

NCM 116: THEORY MODULE 1: CONCEPT OF METABOLISM AND ALTERATION IN INGESTION Clinical Instructor: Ms. Ortiz, J. Cebu Doctors’ University l Fated Nurses Review of the Anatomy and Physiology of the Esophagus...

NCM 116: THEORY MODULE 1: CONCEPT OF METABOLISM AND ALTERATION IN INGESTION Clinical Instructor: Ms. Ortiz, J. Cebu Doctors’ University l Fated Nurses Review of the Anatomy and Physiology of the Esophagus Bamba Digestive System m2017 Found anterior to the spine and posterior Nutrients are required by all of the body’s cells to the trachea and heart in the mediastinum. Proteins It is a collapsible muscular tube about 10 Lipids inches long and it travels through the Carbohydrates diaphragm at an opening called Vitamins DIAPHRAGMATIC HIATUS Minerals The esophagus carries food from the Cellulose fibers pharynx to the stomach and other vegetable matter Stomach Functions of Digestive System: Located within the peritoneal cavity (under the left lobe of the liver) and the To process food substances diaphragm (upper left part of the Absorb the products of digestion into the abdomen) blood Mostly covers the pancreas Excretion of unabsorbed materials Hollow muscular organ that holds about Provide an environment for 1500 ml of liquid microorganisms to synthesize nutrients FUNCTION: serve as a food storage (vitamin K - essential in blood clotting) during eating; secretes digestive fluids and propels the partially digested food or Mouth time into the small intestine. Contains the lips, cheeks, palate, teeth, The stomach is divided into 4 regions: salivary glands, muscles and maxillary 1. The cardia, which surrounds the bone. opening of the esophagus into the These organs are responsible for stomach mastication or chewing up food into 2. The fundus of stomach, which is smaller particles to be swallowed. the area above the level of the cardial orifice. Saliva amylase 3. The body of stomach, which is the largest region of the stomach Reflex salivation can be triggered by 4. The pyloric part, which is divided eating or even sight, smell or taste of food. into the pyloric antrum and The parotid, submaxillary and sublingual pyloric canal and is the distal end glands create about 1.5 Liters of saliva of the stomach everyday Ptyalin (also known as salivary amylase) is a starch digestive enzyme The first breakdown of starch starts in the mouth with the help/ presence of amylase Saliva also contains water and glucose which assists lubricating the meal as it is being chewed making swallowing easier. CEBU DOCTORS’ UNIVERSITY – COLLEGE OF NURSING 1  NCM 116: THEORY MODULE 1: CONCEPT OF METABOLISM AND ALTERATION IN INGESTION Clinical Instructor: Ms. Ortiz, J. Cebu Doctors’ University l Fated Nurses Small Intestine Bamba m2017 which is the gastrointestinal tract’s longest part accounting for roughly three quarters of the entire length. It folds inwards and outwards providing approximately (70 m or 230 ft) of surface area It is where secretion and absorption takes place 3 Parts: Duodenum, Jejunum, Ileum Duodenum - most proximal region Jejunum - midsection Ileum - distal portion The Ileum comes to an end in the illusive The stomach also has (mucous glands?) valve (also known as a sphincter) that are located in the gastric mucosa and regulates the flow of digested material prevent autodigestion by providing an from the ileum into the sequel part of the alkaline protecting covering. large intestine while preventing bacterial 2 sphincters: reflux into the small intestine. The vermiform appendix is an extension > the cardiac sphincter (lower that attaches to the cecum. esophagus sphincter) closes off the top Physiologically, it serves little to no end of the stomach. purpose - prevents a reflux of gastric The common bowel duct which empties contents into the into the duodenum at the ampulla of vater esophagus permits both bile and pancreatic fluids to pass through > the pyloric sphincter closes off the bottom. - which regulates the rate of the stomach emptying into the small intestine Large Intestine The length is around 5 ft or 1.5 m It is made up of an ascending section and the right side of the abdomen. Transverse segment in the upper abdomen that runs from right to left CEBU DOCTORS’ UNIVERSITY – COLLEGE OF NURSING 2  NCM 116: THEORY MODULE 1: CONCEPT OF METABOLISM AND ALTERATION IN INGESTION Clinical Instructor: Ms. Ortiz, J. Cebu Doctors’ University l Fated Nurses Descending segment on the left side Bamba Sigmoid colon, rectum and anus make Pancreas m2017 up the large intestine terminal section. Anal outlet is controlled by a network of Has both an exocrine and endocrine striated muscle that forms both the function internal and external anal sphincters Exocrine gland: secretes sodium FUNCTION: to absorb water and waste bicarbonate that neutralizes the acidity of elimination; responsible for the synthesis the stomach contents that enter the of vitamin B complex and vitamin K with duodenum the help of the intestinal bacteria. Pancreatic juices contains enzymes for digesting carbohydrates, fats and proteins Endocrine gland: secretes glucose to raise blood glucose levels and secretes somatostatin to exert hypoglycemic effect. : located in the pancreas (islets of langerhans) which secretes insulin - important for carbohydrate metabolism Refer to book (Table 44-1) DIGESTIVE ACCESSORY ORGAN Liver Largest gland in the body weighing about 3 to 4 lbs It contains kupffer cells which remove bacteria in the portal venous blood Removes excess glucose and amino acids from the portal blood It synthesizes glucose, amino acids and Normal Digestion to Elimination Process fats It aids in the digestion of fats as it produces bile, carbohydrates and proteins Also stores and filters blood so it is highly vascularized About 200 to 400 ml of blood is being stored by the liver It also stores vitamin A, B and iron Secretes bile about 500 to 1000 ml per day which helps emulsify fats and broken down into fatty acids so that the body can use it. CEBU DOCTORS’ UNIVERSITY – COLLEGE OF NURSING 3  NCM 116: THEORY MODULE 1: CONCEPT OF METABOLISM AND ALTERATION IN INGESTION Clinical Instructor: Ms. Ortiz, J. Cebu Doctors’ University l Fated Nurses 1. INGESTION to allow the entry food, as it relaxes it also Bamba closesm2017 tightly to prevent reflux of the Begins with Ingestion in our mouth with stomach contents into the esophagus the help of the salivary glands. In the mouth, it is where we chew food 3. DIGESTION and our food eaten has been broken down into little particles that are injected and - this has two processes: combined with other enzymes which is Mechanical also the start of the digestion process. Mechanical breakdown of food happens With the help of saliva produced by the when the contents of the stomach are salivary glands particularly the parotid, being propelled toward the pylorus by the submaxillary (submandibular) and peristaltic contraction. Now the large food sublingual glands. With the help in the particles are being turned back into the breakdown of food. stomach since it cannot pass through the Saliva also contains ptyalin (salivary pyloric sphincter. amylase) which breaks down Inside our stomach the food is then mechanically broken down into small carbohydrates. Saliva also has water and pieces or into smaller particles. mucus which is helpful in lubricating the meal as it is being chewed making Chemical swallowing easier. This happens when the stomach releases different gastric juices containing gastric enzymes to produce or breakdown the 2. PROPULSION food particles into smaller portions so that the ingested food that has been broken it will pass through the pyloric sphincter, it down into pieces and there is already an is then known as chyme initial breakdown of carbohydrates. With Chyme contains food particles that has the salivary amylase it has been passed been broken down mechanically by our down or propelled into our esophagus stomach and it also contains gastric through the act of swallowing. enzymes swallowing begins initially as a voluntary Hormones, neural regulators, and local action controlled by the central nervous regulators present in the gastric secretions system’s medulla oblongata swallowing impact the stomach’s mobility or center. influences the stomach’s motility and epiglottis moves to cover the tracheal modulate the rate of secretions opening as a bolus of food is swallowed. The duodenum, also the first part of the This prevents food aspiration into the small intestines there is a continuation of a lungs. chemical process. With the help of the swallowing also forces the food bolus into different accessory digestive organs which the upper esophagus, thereby comes to a are the: liver, gallbladder, pancreas. help as a reflex action They release different enzymes to help to move the bolus of food into the system, breakdown the food into absorbable the smooth muscle in the esophageal wall particles that is utilized by our body contracts into a rhythmic sequence from Take note that our pancreas releases the upper esophagus to the stomach. This amylase which breaks down rhythmic contraction pushes down food carbohydrates, lipase that digests fats, towards the stomach. Subsequently the trypsin and chymotrypsin which leaves lower esophageal sphincter then relaxes CEBU DOCTORS’ UNIVERSITY – COLLEGE OF NURSING 4  NCM 116: THEORY MODULE 1: CONCEPT OF METABOLISM AND ALTERATION IN INGESTION Clinical Instructor: Ms. Ortiz, J. Cebu Doctors’ University l Fated Nurses protein. The gallbladder releases or of small intestine are pushed into the Bamba emulsifies fats. colon by the intestinal peristalsis m2017 The pancreas also releases sodium The process of digestion breaks down bicarbonate. Sodium bicarbonate is food into absorbable particles when it is alkalotic in nature, so it neutralizes the consumed through lipids, proteins and chyme that has been passed from the carbohydrates. stomach to the duodenum is alkalotic in When carbohydrates are ingested, this nature, so it neutralizes the chyme that will be broken down into glucose, fructose, has been passed from the stomach to the maltose, sucrose and galactose. When duodenum so as to protect lining of the proteins are ingested, this will be broken duodenum. down into amino acids and peptides. If These chemicals or enzymes are released fats are ingested, this will be broken down into their common pathway which is the into monoglycerides and fatty acids. common bile duct, where everything Now the chyme lingers in the small drains. intestine for about 6 hours, to allow Common bile duct is connected to the nutrients to broken down and absorbed. duodenum. As these progresses, this Absorption also happens in the small intestine branches out to the different organs through the villi draining into the common bile duct. From the common bile duct, this releases these Villi are little finger-like extension that run combined enzymes into the duodenum to the length of the gastrointestinal tract and complete the chemical digestion process. serve as a liner The bile is released by the gallbladder helps the small intestine to both absorb passing through the cystic duct, releases nutrition and to create digestive enzymes and draining into the common bile duct The pancreas releases: sodium Main role of the small intestine is absorption. bicarbonate, amylase, lipase and Absorption of vitamins and minerals is trypsin through the pancreatic duct, flows unaffected in the small intestine. and meets at common bile duct. Then Active transport and diffusion over the release into the duodenum breaking intestinal wall into the circulation begin in furthermore the chyme into its absorbable the jejunum while nutrients are absorbed contents in all throughout the intestine and Bile is produced in the liver and stored in duodenum. Ilium is where vitamin b12 the gallbladder, its function is to aid in and bile salts are being absorbed. All digestion and absorption of fats through throughout the small intestine as well emulsification. The flow of the bile is being absorption of magnesium phosphate and controlled by Sphincter of Oddi which is potassium happens. located at the junction of the common bile duct 5. DEFECATION AND EXPULSION Pancreatic juice, bile, and small intestine gland secretions total about 1 liter each Food is now being pushed through the ileocecal day including about 0.5 liter of bile and 3 valve - start of defecation and expulsion liters of small intestine gland secretions happens The Small Intestine contracts twice a Passes through the ileocecal valve day in two methods: Segmentation and Leftover waste material moves into the Contraction terminal ileum and slowly into the right Segmentation contractions produce colon proximal part within four hours of mixing waves that move the contents of eating the intestine back and forth. The contents CEBU DOCTORS’ UNIVERSITY – COLLEGE OF NURSING 5  NCM 116: THEORY MODULE 1: CONCEPT OF METABOLISM AND ALTERATION IN INGESTION Clinical Instructor: Ms. Ortiz, J. Cebu Doctors’ University l Fated Nurses Valves opens briefly and allows some of in the rectum three days after the Bamba the contents of the small intestine to enter meal m2017 has been ingested into the colon with each peristaltic wave of the small intestine 6. SECRETION The entry and the opening of the ileocecal Undigested meals in organic elements water and valve is dependent on the peristaltic bacteria make up the feces movement made by the small intestine As a substantial component of the fluid content of feces is roughly 75% contents of the large intestine, bacteria feces is mostly liquid in nature and only play an important role in the complete 25% of our feces is solid because a major breakdown of waste materials such as amount of the fecal mass is of non-dietary proteins and bile salts that have not been origin produced from the secretions of the digested or absorbed in the small intestine gastrointestinal tract electrolyte solution and mucous are the dietary changes have little effect on two types of colonic secretions that are decomposition added to the leftover material bile is broken down by the bacteria that is Majority of the electrolyte solution in the present in the large intestine resulting in colon is bicarbonate the brown color of the feces ▪ neutralizes the bacterial stench or the smell of the feces is largely end products created in the due to chemicals produced by the colon bacteria present in the large intestine Mucous protects the colonic mucosa from o methane hydrogen sulfide and the interluminal contents and helps the ammonia are among the gases fecal bulk cling to the feces that are produced - either Colonic contents are moved along the absorbed into the portal circulation track by a slow feeble peristalsis and detoxified by the liver or Colon's main rule is to allow for efficient ejected from the rectum are reabsorption of water and electrolytes generally found in the GI tract and Because of the slow movement or the it is expelled as a flatus slow peristalsis that is happening all stool elimination begins with rectal throughout the large intestine, the slow distension which triggers a reflex - it movement allows reabsorption mainly of relaxes the normally closed internal anal water and other nutrients sphincter and spasms of the rectal o to make sure that the things that muscles we are passing outside our body is autonomic nervous system is in charge really waste of the internal sphincter while the cerebral The contents are propelled for long cortex is in charge of the external distances with strong peristaltic waves sphincter that occur on a regular basis external anal sphincter relaxes freely o usually happens when intestines during feces to allow the content of colon stimulating hormones are released to be evacuated after another meal o normally, in a tonic contraction o In roughly 12 hours, the waste condition by maintaining the component from a meal reach and external anal sphincter closed distend the rectum Defecation can be understood as a spinal reflex o As much as 1/4 of the waste that can be actively inhibited. materials from a meal may still be CEBU DOCTORS’ UNIVERSITY – COLLEGE OF NURSING 6  NCM 116: THEORY MODULE 1: CONCEPT OF METABOLISM AND ALTERATION IN INGESTION Clinical Instructor: Ms. Ortiz, J. Cebu Doctors’ University l Fated Nurses Bamba Digestive Enzymes Caution: m2017 Hydrochloric acid (HCl) kills Since most food comes from living organisms like microorganisms breaks down food into plants and animals, these plants and animals small particles and provides a chemical also contain an array of proteins, fats, environment that facilitates gastric carbohydrates and nucleic acids but not enzyme activation necessarily in the same flavor or configuration Pepsin is the chief coenzyme of gastric that our bodies would prefer. juice which converts proteins into What do our bodies do? proteoses and peptones intrinsic factor comes from parietal cells In our bodies, we go ahead and eat the food. We and is necessary for the absorption of break down this food through a process called vitamin b12 digestion. Gastrin is responsible for controlling the Smallest subunit of proteins is called an gastric acidity amino acid and our body breaks down all Two Types of Metabolism the different types of proteins that we digest into individual amino acids 1. Anabolism 2. Catabolism The same pattern continues for the rest of the biomolecules Metabolism is as a series of chemical reactions that take place inside of our bodies to sustain life. Fatty acids which are the smallest subunits of fats the requirements of life in a human being Carbohydrates are long chains of sugars is maintaining a constant internal o one of the most common subunits temperature, reproducing, growing of carbohydrates that our body body's ability to utilize four essential bio loves is called glucose molecules Nucleic acids Four essential biomolecules nucleotides 1. Macromolecules our body has a delicate balance going on a. proteins, between the processes of breaking down b. fats, molecules such as in the process of c. carbohydrates or carbs digestion and then taking these products d. nucleic acids like DNA and RNA and building them back up All of these biomolecules perform different life- Metabolism is a balance between breaking things sustaining reactions inside of all of the cells in our down and building them back up in our body. body to promote life. Metabolism is the study of how we're able to Catabolism: (to remember, think of the obtain these important biomolecules to sustain letter C. Cutting. Cutting molecules up life. into tiny pieces. How do we obtain biomolecules? Anabolism: used to describe the Eat food to obtain all of these important process of building molecules back up. biomolecules. (To remember, think of the letter A. Apex. Apex of a building. Building molecules back up requires energy. CEBU DOCTORS’ UNIVERSITY – COLLEGE OF NURSING 7  NCM 116: THEORY MODULE 1: CONCEPT OF METABOLISM AND ALTERATION IN INGESTION Clinical Instructor: Ms. Ortiz, J. Cebu Doctors’ University l Fated Nurses Discussion: Factors influencing an individual’s Bamba metabolic rate (MR) m2017 The energy comes from eating food. The energy currency of our bodies is a molecule Activity/ Exercise called ATP or adenosine triphosphate. This Elevated body temperature high energy molecule, when it is broken down Hormonal activity into ADP so it loses a phosphate group. It Digestion releases usable chemical energy that can fuel Age and growth energy-requiring processes of in our body Gender such as the building up process of anabolism. Climate In order for this process to continue non-stop Drugs or taking in medications in our bodies, ADP must be regenerated into ATP, and that is where food comes in. FACTOR VARIATION EFFECT ON Remember: We digest our food into all of BMR these subunits. Some of these subunits such Surface Large in relation to as glucose and fatty acids mainly but Area body volume = occasionally amino acids can essentially be thin/small used as fuels in our body. These fuels in our individuals body can essentially be broken down even further to produce the energy that’s necessary Small = large to convert ADP back into ATP. Thus, allowing individuals this cycle to continue. Sex Male = higher Cellular Respiration involves breaking down Female = things even further. It is a catabolic process. Thyroxine Increased = Catabolism fuels anabolism. production Decreased = Catabolism is coupled with this process Age Young, rapid of building things back up. In essence, growth = they need one relies on the other. These more energy, more processes are really tightly regulated in calories our bodies because you wouldn’t want to be breaking down something while Aging, elderly = you're building something back up. In slower MBR fact, catabolism and anabolism are Strong emotions often regulated through the use of (anger/fear) hormones. & infections Hormones are a form of regulation and they tell the body whether it should be in a catabolic or anabolic state. CEBU DOCTORS’ UNIVERSITY – COLLEGE OF NURSING 8  NCM 116: THEORY MODULE 1: CONCEPT OF METABOLISM AND ALTERATION IN INGESTION Clinical Instructor: Ms. Ortiz, J. Cebu Doctors’ University l Fated Nurses World Food Programme (WFP) According to UN research, some Bamba20 millionm2017 children are born mentally In-charge of food aid impaired because their mothers did not Largest humanitarian organization consume enough iodine. dedicated to hunger and food security in the world Zinc The largest provider of school meals Contributes to growth failure and Based in Rome and has offices in 80 weakened immunity in young children. countries It is linked to a higher risk of diarrhea Founded in 1961. and pneumonia, resulting in nearly It serviced 115.5 million people in 80 800,000 death per year. plus countries as of 2020 and it is the highest number since 2012 This program has been created to BODY BUILD (Type, Size, Composition) address deficiencies of iron vitamin A and Zinc which are ranked among the Type - refers to the category if physique. It is world health organization’s top 10 a description of any kind of human body shape leading causes of death through using general body descriptors. disease in developing countries. Example: slim, fat, tall, petite, wide shoulder, Micronutrient Deficiencies: mostly affects pear shape, etc) children Size – refers to the person’s height and weight Iron Composition – refers to the person’s body fat The most prevalent form of malnutrition percentage. worldwide, affecting millions of people. Iron deficiency also impedes cognitive 3 Extreme Body Types development, affecting 40-60% of children aged 6-24 months in 1. Endomorph (Pykinic) developing countries. A pear-shaped body Vitamin A A rounded head Wide hips and shoulders Increases the risk of dying from diarrhea, measles and malaria by 20- Wider front to back rather than side to 24% side Affecting 140 million preschool children A lot of fat on the body, upper arms, and in 118 countries and more than seven thighs million pregnant women, it is also a 2. Mesomorph (Sthenic) leading cause of child blindness across developing countries. A wedged-shaped body A cubical head Iodine Wide broad shoulders Affects 780 million people worldwide. Muscled arms and legs The clearest symptom is a swelling of Narrow hips the thyroid gland. CEBU DOCTORS’ UNIVERSITY – COLLEGE OF NURSING 9  NCM 116: THEORY MODULE 1: CONCEPT OF METABOLISM AND ALTERATION IN INGESTION Clinical Instructor: Ms. Ortiz, J. Cebu Doctors’ University l Fated Nurses Narrow from front to back rather than Fat is mainly accumulated in hip, middle Bamba side to side abdomen and m2017 thigh surroundings A minimum amount of fat Aging = whole figure assumes a stooping posture and the spine is never 3. Ectomorph (Asthenic) erect due to the heavy hips and thighs A high forehead Vital organs affected mostly are Receding chin kidneys, uterus, intestines, bladder, Narrow shoulders and hips and bowels A narrow chest and abdomen Exercises or dieting will not help Thin arms and legs appreciably in reducing weight Little muscle and fat B. Android/ Apple-Shaped FAT AND MUSCLE DISTRIBUTION Most are males Obesity Fat is mainly stored in abdomen Vital organs affected will be mostly the Increases the risk of diabetes, heart heart, live, kidneys & lungs (major risk disease stroke, arthritis, and some for heart damage & heart disease due cancers to high cholesterol) If an obese person loses even 5-10% of his/her body weight, it can delay or C. Ovoid/ Barrel-Shaped even prevent some of these diseases Gait is more rolling rather than walking Overweight Fat tissues in body hinder the movement of all the internal organs & Weighing too much consequently affect their brisk Weight may come from muscle bone fat functioning and or body water Any exercise is difficult due to the Note: Both terms means that a person’s weight enormous size of the body is greater than what’s considered healthy for his or her height. Comparison of the Body Fat Cachexia Percentage between a Man and a Extreme loss of weight and body Woman wasting associated with a serious illness Starvation Can be reversed through refeeding A. Gynoid/ Pear-Shaped Most are females Narrow shoulders Small breast Slim waist