Managing Disorders

Tests of Cholestasis

Alkaline phosphatases are enzymes that catalyze hydrolysis of organic phosphate esters at an alkaline pH. These enzymes are found in many tissues. The serum enzyme is principally derived from three sources: (a) the hepatobiliary system: the bile canalicular surface of the hepatocytes and biliary epithelium, (b) bone: the osteoblasts, and (c) the intestinal tract: the brush border of the intestinal mucosal cells (10% of the total serum enzyme).

Jaundice and Interpretation of Laboratory Liver Tests

Laboratory tests have an important role in the recognition of liver disease and determination of the nature and extent of the liver dysfunction. There is no one specific test for assessment of liver disease.

Management of Heartburn and GERD

Heartburn is a common complaint reported frequently by individuals in the general population. It has been estimated that 40% of the population report at least one episode of heartburn per month, and up to 20% report heartburn several times per week.

Managing Acid-Reflux Disorders

Gastroesophageal reflux (acid reflux) is a condition that occurs when transient relaxation of the lower esophageal sphincter permits the reflux of acidic gastric contents into the esophagus. Esophageal peristalsis will remove most of the refluxed bolus of gastric acid, and saliva will neutralize the rest, but the esophageal epithelium is still damaged by the acid. The primary symptom is a characteristic substernal burning sensation that radiates to the neck.

Ostomy Care

The word ostium means Thus the words ileostomy and colostomy refer to openings into the ileum and colon, respectively, which are the subjects of this chapter. Other ostomies include gastrostomies and jejunostomies, which usually are formed for the purpose of alimentation, and ileal loop urostomies, which are formed to replace the urinary bladder.