Gastrointestinal System
Sasha Alexis Rarang, RN, MSN
A.
B.
C.
D.
Elimination
Mouth
Mouth
Saliva
Swallowing
Involves 3 phases
>>oral phase
>>involuntary pharyngeal phase
>>esophageal phase
> The time it takes for the bolus to reach the
stomach depends on the consistency of the
bolus and individuals position.
Esophagus
Esophagus
stomach
Stomach
Structures
a.1. fundus
a.2. body/central area
a.3. antrum/pyloric region
a.4. cardiac sphincter
a.5. Pyloric sphincter
B. Microscopic Glands ( epithelial lining of the stomach)
b.1. Cardiac glands mucus
b.2. Peptic (Chief Cells) mucus and pepsinogen
b.3. Parietal (Oxyntic) HCl acid and water
protein digestion
intrinsic factor B12 absorption
b.4. Neck cells mucus
b.5. Pyloric glands gastrin and mucus
stimulates HCl acid production
A.
Stomach
C. Functions
c.1. storage, mixing and liquefaction of the
bolus of food into chyme, control of
passage of food into the duodenum.
c.2. first stage of protein breakdown
c.3. mechanical breakdown of food
c.4. absorption of water, alcohol, glucose,
and some drugs.
c.5. protection
Stomach
D. Innervation
d.1. parasympatehetic vagus nerve
d.1.1. increased gastric secretion
of acid, gastrin and pepsin.
d.1.2. increased gastric acid motor
activity.
d.2. sympathetic inhibit gastric
secretion and motility.
Stomach
E. Secretions 1.5L to 3.0.L of gastric juice per day.
e.1. HCl acid, pepsin, and mucus.
e.2. mucin, intrinsic factor, lipase, and
pepsinogen.
e.3. Gastric acid secretion is directly stimulated by
the distention of the stomach and presence of
protein.
e.4. vagal stimulation, acetylcholine, histamine, and
the hormone gastrin.
e.5. gastrin is released when the stomach becomes
distended with food.
Stomach
Stomach
Small intestines
Small Intestine
Structure (22 feet long/1 inch in diameter)
a.1. duodenum
a.2. jejunum
a.3. ileum
B. Function
b.1. completes the digestion of foods
b.2. absorbs the products of digestion
b.3. secretes hormones control
secretions of
bile, pancreatic juice, and
intestinal secretions.
A.
Small Intestine
C. Innervation
c.1. sympathetic inhibits motility
c.2. parasympathetic increases intestinal
tone and motility.
D. Secretions
d.1. Brunners glands(duodenal) mucus
d.1.1. glucagon, presence of chyme, and vagal
stimulation.
d.1.2. sympathetic stimulation inhibits secretions of the
glands.
d.2. Goblet cells mucus
d.3. crypts of Lieberkuhn secretes an alkaline fluid
d.4. epithelial cells digestive enzymes
d.4.1. enterokinase activates trypsin
d.4.2. maltase,lactase, and sucrase disaccharides
into simple sugars.
Small Intestine
E. Absorption
e.1. Complex foods are converted into its simplest
forms.
e.1.1. CHO monosaccharides
e.1.2. CHON amino acids
e.1.3. Fats fatty acids,
monoglycerides, diglycerides and triglycerides.
e.2. Water absorption 8L/day
e.3. water-soluble vitamins, electrolytes,
minerals.
e.4. B12 absorption takes place in the
ileum
Large intestines
Large Intestines
Structures ( 5-6 feet long)
a.1. Cecum
a.2. Colon
a.2.1. Ascending
a.2.2. Transverse
a.2.3. descending
a.2.4. Sigmoid colon
a.3. Rectum and Anus ( final segments of the large intestine)
B. Function
b.1. absorb the remaining water, urea,and electrolytes.
b.2. secretes mucus
b.3. form and store the feces until defecation
A.
Large Intestine
C. Innervation
c.1. parasympathetic vagus nerve
increases peristalsis, decrease
tone of the sphincter.
c.2. sympathetic reduce peristaltic
activity and increase tone of
sphincters.
D. Secretion
d.1. water, mucus, potassium, and bicarbonate
alkaline solution.
d.2. Mucus lubricates, allows passage of the fecal matters,
protects the mucosa from injury.
Rectum
Anus
Liver
B.
C.
D.
Secretions
Mucous secretions
a. produced throughout the entire length of the
tract.
b. protects and lubricate the walls of the GI tract.
2. Digestive secretions.
a. produced in the mouth, stomach,
duodenunum, and jejunum.
b. break down ingested food so that it can be
absorbed.
1.
Secretion:
Motility
2 types of movement in the GIT
A. Mixing
B.
Propulsion / Peristalsis
C.
D.
E.
Assessment.
B. Medications:
b.1. past and current use of medications
b.1.1. OTC drugs
b.1.2. prescription drugs
b.1.3. herbal products and nutritional
supplements.
b.2. hepatotoxic, diarrhea, GI bleeding
C. Surgeries and other treatments
c.1. information about hospitalizations for
problems related to GI
system
any
AssessmentObjective Data
A.
Inspection
a.1. Lips symmetry, color and size
observe for abnormalities pallor or cyanosis, cracking,
ulcers, or fissures.
a.2. Tongue color, fissures, deviation
and lesions
a.3. Buccal Mucosa color and lesions and
distinctive breath
odors
a.4. teeth and gums caries, loose teeth,
abnormal shape
and position of the
teeth, presence of swelling , bleeding,
discoloration.
Assessment.
a.5. Abdomen
a.5.1. Skin changes ( color, texture, scars,
dilated veins, rashes, and lesions.)
a.5.2. umbilicus location and contour
a.5.3. symmetry
a.5.4. contour flat, rounded, distended.
a.5.5. observable masses hernias and other
a.5.6. movement observable peristalsis and
striae,
masses.
pulsation.
Assessment
AbdominalDraping
distention;
dilated veins
the Abdomen
Obese abdomen
Hepatomegaly
ascites
Umbilical Hernia
Pregnancy
Assessment.
B. Auscultation (done before percussion and palpation)
b.1. listening for increased or decreased bowel
sounds.
b.2. diaphragm of the stethoscope bowel sounds
are
high pitched, occur 5-35x per
minute.
b.3. warm up stethoscope in the hands to prevent
abdominal
muscle contraction.
b.4. listen for BS for 2-5 minutes. Absent BS
means no sounds for 5
minutes on each
quadrant.
C. Percussion
c.1. purpose??? Determine the presence of fluid, distention, and masses.
Presence of air
tymphany,
fluid or masses dull sounds
Assessment: Percussion
Purpose?????
Determine the presence of fluid,
distention, and masses
Assessment: Palpation
Deep palpation
Delineate body abdominal organs
Diagnostic Studies
Upper GI Series or Barrium Swallow
> X-ray study with fluoroscopy with contrast medium
> used to diagnose structural abnormalities of the
esophagus, stomach, and duodenal bulb
>NPO for 8-12 hours
> pt. will drink contrast medium
> give pt. laxatives and fluid to prevent contrast medium
impaction.
> the stool may be white up to 72 hours after the test
B. Small Bowel Series same as upper GI series
A.
Diagnostic tests
C. Lower GI or Barium Enema
> Fluoroscopic examination of the colon using contrast medium
w/c is administered rectally.
> administer laxatives and enemas the night
before the
procedure.*****CLEAR****
> clear liquid diet the night before.
> NPO for 8 hours before the procedure.
> cramping and urge to defecate may occur.
> explain that pt will be assuming various position in tilt table.
> give laxatives, fluids to assist in expelling barium.
Diagnostic tests
C. Ultrasound
> noninvasive procedure uses high frequency soundwaves to
visualize the solid organs.
> NPO 8-12 hours
D. CT-Scan
> non invasive radiologic examination that combines x-ray machine
and computer.
E. MRI
> non invasive procedure using radiofrequency waves and magnetic
field
> NPO for 6 hours
> C/I in pt with metal implants or who is pregnant
Diagnostic tests
End of Topic