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Ncm103 27th Gi I
Ncm103 27th Gi I
Ncm103 27th Gi I
Alterations I
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Digestion Occurs when enzymes mix with 4. General Signs and Symptoms ingested foods and when protein, fats and sugars are broken down into their component molecule Absorption Occurs when small molecules, vitamins and minerals pass through the walls of the small and large intestine and into the blood stream Elimination - Occurs after digestion and absorption when waste products are eliminated from the body
Topics Discussed Here Are: 1. Gastrointestinal Anatomy and Physiology a. Mouth b. Esophagus c. Stomach d. Small Intestine e. Large Intestine 2. Diagnostic Procedures 3. Assessment of the GIT System
Blood Supply
The thoracic artery and abdominal aorta Portal venous system 5 large veins o Superior mesenteric o Inferior mesenteric o Gastric o Splenic and o Cystic veins Form the vena portal Liver Stomach Gastric Artery Intestines Mesenteric Artery
CHANS
C Cardiogenic H Hypovolemia A Anaphylactic N Neurogenic S Septic Shock
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Mouth
Speech, nutrient ingestion, initiation of mechanical and chemical digestion, swallowing Important for the mechanical digestion of food The saliva contains salivary amylase / Ptyalin then starts the initial digestion of carbohydrates
Important Structures of the Mouth 1. Teeth: Mechanical breakdown of food 2. Tongue: Tears and cut food into small pieces 3. Palate: Facilitates in swallowing : Articulation of words : It forms the roof of the mouth : Facilitates mastication / chewing 4. Salivary Glands: Produces serous / watery fluid Parotid Glands Produces PTYALIN for breakdown of starch Largest salivary gland Submandibular Gland Mixture of mucus and serous Produces serous and mucus Sublingual Gland Physiology of Mastication / Chewing Produces lubricating fluid, mucus Smallest salivary gland
Digesting Process
Chewing o 1.5 L of saliva is secreted daily from the parotid, submandibular and sublingual gland o Ptyalin / Salivary Amylase is an enzyme that begins the digestion of STARCH Swallowing o Begins as a VOLUNTARY act, which is regulated by the swallowing center in the medulla oblongata of the central nervous system (CNS)
The Esophagus
A hollow muscular tube Length: 25 cm (10 inches) Made up of stratified squamous epithelium Located in the mediastinum, anterior to the spine and posterior to the trachea and heart The Upper 3rd: Skeletal muscle, the upper esophagus / hypopharyngeal sphincter
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The Middle 3rd: Mixed skeletal and smooth muscle The Lower 3rd: Smooth muscle and the esophago-gastric / cardiac sphincter is formed here Functions to carry or propel foods from the oropharynx to the stomach Swallowing / Deglutition is composed of 3 phases: VPE 1. Orophyaryngeal Phase / Voluntary Phase 2. Pharyngeal Phase (Involuntary) 3. Esophageal Phase (Involuntary)
Stomach
It stores ingested food, secretes digestive juices and propels partially digests food (Chyme) into the duodenum J-shaped organ in the LUQ Contains several parts, the fundus, cardiac sphincter, body and pyloric sphincter The cardiac sphincter prevents the reflux of the contents into the esophagus (Entrance) The pyloric sphincter regulates the **** of gastric emptying into the duodenum (Exit) Capacity is 1,500 mL
Layers of the Digestive Tract Serosa Muscularis (Tunica Muscularis) Submucosa Mucosa
Outermost layer of the stomach, visceral peritoneum Produces the peristaltic activity of the stomach during digestion It contains the muscular and mucous layer of the stomach walls, and contains blood, lymph channels and nerve plexus
Gastric Function Stomach Secretes a high acidic fluid in response to the presence of ingested food Fluid can total as 2.4 L/day, can have a pH as low as 1 and derives its acidity from hydrochloric acid a. To breakdown food into more absorbable components b. To aid in the destruction of ingested bacteria Gastric Enzymes b. Secreted by Zymogenic cells / Chief Cells Amylase = For STARCH digestion Lipase = For FAT digestion Pepsin = For PROTEIN digestion Rennin = For MILK and PROTEIN digestion
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Secreted by Parietal Cells HCl = Main acid! 1.0 pH, destroys some bacteria ingested, aids also in digestion of food Intrinsic Factor = Aids in absorption of vitamin B12 *Pernicious Anemia* Secreted by Endocrine Cells Gastrin, Somatostatin, Serotonin Contraction of muscles
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Cephalic Phase Is dependent on stimulation of gastric secretion by receptors in the brain that are mediated by the vagus nerve Gastric Phase Secretion occurs when the bolus of food reaches the antrum. This phase consists of 3 mechanisms: 1. When food enters the stomach 2. Secretion of gastric juice 3. Continuity of phase until acidity of the gastric contents reaches a pH of 1.5 Distention of stomach > Carried action potential to medulla oblongata > stimulate stomach secretion, distend of stomach activate local reflex to increase HCl, pepsinogen and gastrin by the stomach mucosa Intestinal Phase Primarily inhibits gastric secretion in 3 ways 1. Sensory Vagal Inhibit motor action, potential from medulla 2. Local Reflex Inhibit secretion of the stomach mucosa 3. Secretin, gastric inhibitory polypeptide and cholecystokinin Inhibit secretion of stomach mucosa Stimulate with passage of food into the duodenum resulting to secretion of small amount of gastrin by intestine
Pathophysiology of Deglutition and Digestion Swallowing causes the fundus to relax to receive a bolus
Anticipatory and prepare stomach to receive food, tactile sensation stimulate the medulla oblongata > action carried to vagus > stomach stimulate to secrete HCl, pepsinogen, IF, gastrin > gastrin stimulate parietal cell secrete HCl and chief cell secrete pepsinogen
Mixing occurs as food is propelled toward the antrum Food apply the pylorus
Movement in the Stomach Mixing Wave o Weak contraction of muscle causing thoroughly mixed ingestion o Food with stomach secretions o Primarily act to combine ingested nutrients with gastric secretion Peristaltic Wave o Stronger contraction which force the chime towards the pylorus *** Ingested nutrients remain in the stomach until they have been thoroughly mixed with gastric content and converted to semi-fluid material called CHYME
The passage of the contractile wave over the gastric content forces the chyme back towards the body of the stomach Retropulsion
Small Intestine
Circular and longitudinal layer Function: Duodenal secretion concentrate from the accessory digestive organs pancreas, liver and gall bladder and glands on the intestinal walls (Pancreatic secretions have an alkaline pH) Has 3 Parts: Duodenum
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30 30 cm Connects CBD and Pancreatic duct both empty at the Duodenum at the Ampulla of Vater to pyloric sphincter Jejunum 2/3 Major organ for absorption of nutrients Has very prominent villi, consistent with its role in nutrient absorption Ileum 3/5 Peyers Patches, cluster of lymph nodes that are numerous in the ileum LONGEST PART! 12 feet For absorption of nutrient not absorbed in the duodenum and jejunum Villi are less prominent Site for absorption of IF, Vit B12, and bile salts, found in the terminal ileum
Large Intestine
Circular and longitudinal layers Functions: Absorption of water and salt, bacteria inhabit the colon, synthesize Vit K which is absorbed in the colon
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Different Parts: Cecum: Proximal end of large intestine, located in RLQ of abdomen (Loudest part for auscultation of bowel sounds) Connects ileum to colon, which contain the ileococal valve A one way valve that prevents reflux of large bowel content into the SI Organ responsible for storing and eliminating waste products produced by nutrient digestion and absorption Appendix Tube that is about 6 cm past ileococal junction, attached to the cecum Colon Ascending, transverse, descending, sigmoid Rectum Straight muscular, signals defecation IF Stretched! It will DEFECATE Opens internal sphincter to defecate (involuntary) and external anal sphincter (voluntary) Transit Time = Watery stool / diarrhea Transit Time = HARD STOOL!
Defecation Reflex Mass Movement (Occurs 8 12 hours) Colonic Motility: Propulsive movement of the colon occur as mass movement which is a series of peristaltic waves that sweep stool rapidly through the colon Peristaltic movement = 10 15 minutes 2 3 times per day, common in the 1st hour after breakfast Feces Component Undigested food stuff, inorganic matter, undigestive roughage, epithelial cells, components of digestive juices Gases Methane, Hydrogen sulfide * ammonia Elimination begins with distention of the rectum which initate contraction of the rectal musculature Stool is normally brown in color, due to the derivatives of bilirubin FLATUS ACTION of colonic bacteria on undigested food
DIAGNOSTIC PROCEDURES
PAPER! Provides information about the procedure Alleviate anxiety, help client cope with the discomfort Provide instruction about post procedure care and activities Encourage family members to offer emotional support Reassess and assess patient for adequate hydration before, during and after the procedure GIT Study: X-Ray Scope Direct visualization Laparoscopy Fiber, optic tube Endoscopy and Fibernoscopy Get consent 24 hours prior to procedure On NPO (at least 8 hours before procedure) Left SIMS position to prevent aspiration Light sedation Upper GI series / Barium swallow Lower GI series / Barium Enema
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PostOp!: Monitor gag reflex, bleeding, reflex bradycardia, pulse Andoscopy and Sigmoidoscopy CT Scan: Visualize to see a tumor, organ enlargement MRI: Exact Metastatic structure Remove METAL APPLIANCE! Assess allergy to dye (Iodine) Contraindicated with renal failure OFI Ultrasonography Lab Studies Fecalysis: Integrity of GI tract, yellow in color Stool Culture Bacteriostatic study, specific bacteria, bacteria will manifest in stool They will get every morning for 3 consecutive days via cotton applicator to anus then rotate cotton applicator then place on sterile bottle Gastric Analysis Occult Blood Test: Normal blood in stool: 25 mL or less/day
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Percussion Has limited values of physical assessment, it may be difficult to perform if patients are obese. Findings may vary due to different proportions TYMPANY will be appreciated on hollow organs (Stomach) DULLNESS will be over solid organs (Liver and suspected masses) Instruct the client to VOID prior to PHYSICAL ASSESSMENT of the abdomen Palpation Light Palpation: 1. Used to identify areas of tenderness or swelling (at least inch or 2 3 cm) 2. In light palpation, note any palpable mass Deep Palpation: 1. Used to identify masses in any of the quadrants (at least 2 inches) 2. In deep palpation, detail examination of the mass found in the light palpation All four quadrants Light, then DEEP
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Constipation Abnormal multiple Pathophysiology - Interference with the 3 functions of the COLON 1. Mucosal transport 2. Myoelectric activity 3. Process of defecation Nursing Intervention Assist physically in treating the underlying cause of constipation Diarrhea Frequency of bowel movement More than 3 times a day amount of stool Altered consistency Abnormal fluid of the stool Multiple causes Gastrointestinal Disease Hyperthyroidism Food Poisoning Nursing Intervention: Fluid intake Determine and manage case Antidiarrheal drugs Prescribed symptoms of a number GIT diseases Causes: Mechanical Inflammation Ischemic Abdominal Pain Kinds of Abdominal Pain Parietal Pain Visceral Pain Associated Pain Referred pain
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