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Structure and Functions of The Gastro Intestinal System
Structure and Functions of The Gastro Intestinal System
Structure and Functions of The Gastro Intestinal System
System
The Gastrointestinal System is a 23- to 26 foot pathway for food,
water, vitamins and minerals for which has the primary function of
breaking down food products that can fuel the body as a source of
energy.
consist of a long hollow muscular tube extending from the mouth
to the anus.
Gastro-intestinal System
1.The gastrointestinal system consists of the mouth, the pharynx or
throat, esophagus, stomach, and small and large intestines.
2. Accessory Organs are the teeth and salivary glands in the mouth, the
liver, gallbladder, and pancreas.
Secretions of the Gastrointestinal System
1. Exocrine secretions
- prepare food for absorption by diluting
osmolality of plasma (isotonic in nature),
altering the ph for the purpose of hydrolysis,
and hydrolyzing complex foods. It also
protects the mucosa from physical and
chemical irritants.
2. Endocrine secretions
- critical in the control and coordination of
secretory and motor activities involved in the
digestion and absorption of food.
3. Microflora or indigenous bacteria exist throughout the g.i. tract. This
protects the host from pathogens if maintained to a normal level.
Review of Anatomy and Physiology
I. Mouth or the buccal cavity
- lined by the mucous membrane that secretes mucus to mix
food
- prepares food for ingestion and functions as an organ of speech
Parts of the mouth
1. Roof of the mouth
- hard palate & soft palate
2. Uvula
conical muscular process at the center of the posterior border of the
soft palate
3.Tongue or glossa
- muscular tissue covered by papillae that contains taste buds
4. Teeth
32 permanent teeth, 16 per jaw
I. Front teeth
bitting & tearing
II. The rest
grinding & masticating
III. Salivary glands parotid, submandibular, sublingual
Saliva
- Contains :
a. water
b. mucin
c. enzyme salivary amylase or ptyalin
d. calcium
e. potassium
f. chloride
g. bicarbonate
- 1,500 ml is produced daily
Ampulla of vater
- opening in the duodenum where bile & pancreatic secretions are
emptied
Small Intestines
Small, fingerlike projections called villi are present in the entire
intestines that produce the digestive enzymes and absorb nutrients from
food. Absorption is the primary function of the small intestines which
begins in the jejunum by active transport and diffusion across the
intestinal wall.
Vitamins & minerals are not digested but absorbed essentially
unchanged
Activities in the Small Intestine :
a. Mucus secretion
b. Secretion of enzymes: sucrose, maltose, lactose, enterokinase
c. Secretion of hormones
d. Chemical digestion
e. Absorption
f. Motor activities
Innervation: ANS
Accessory Organs
Upon reaching the duodenum, accessory organs contribute to the
secretions encountered by food therein:
1. Pancreas: secretes alkaline ph, high in concentrations of
bicarbonate, to neutralize the acid entering the duodenum from the
stomach. Digestive enzymes involved from the pancreas are:
a. Trypsin: digests proteins.
b. Amylase: digests starch.
c. Lipase: digests fats.
2. Liver: secretes bile which emulsifies fats.
3. Gallbladder: stores bile secreted by the liver that will aid in the
digestion and absorption of fats.
V. Large Intestine
- A muscular tube approx. 2 m (6 ft) long & 5 cm (2 in) in diameter
- Normally contains large amount of bacteria
Functions :
I. Mechanical digestion
II. Absorption of water (approx. 1600 ml/day) & electrolyte from
chyme
III. Formation of some vitamins (K, riboflavin, thiamine)
IV. Storage & eliminates wastes
Parts :
a. Cecum
- 5-7 cm
- vermiform appendix is attached to the apex of the cecum
b. Colon
- four segments :
ascending, transverse
descending, Sigmoid
c. Rectum
- extends from sigmoid to external opening (anus)
- 12 to 15 cm
Other Parts
Ileocecal valve prevents contents of large intestine from entering ileum
Anal sphincter guard the anal canal
Feces undigested food, inorganic materials, water & bacteria, 75%
fluid, 25% solid
Mucus protects colonic mucosa & provide adherence for fecal mass
Assessment of the GIT
I. History
A. General Data :
Demographic Data (age, sex)
Address, Occupation
Informant
Referring physician
B. Chief Complaints
List of symptoms and their duration
Reasons for seeking care
Onset
Duration
Quality & Severity
Location
Precipitating Factors
Relieving Measures
Associated Symptoms
C. History of Present Illness
Clarify symptoms
Quantitate statements
Characterize symptoms (PQRST)
Provocative/ palliative factors
Quality
Region
Severity
Timing
Chronological relation and progression of symptoms
Current activity
Current medications
D. Past History
General health weight loss, previous examinations
Personal & Family History
Psychosocial History
Diet History
Infectious diseases
Operations/ injuries
Hospitalizations (dates, reasons, hospital names, locations)
E. Review of Symptoms
Endocrine
a. Polyphagia, polydipsia, polyuria, glycosuria
b. Temperature sensitivity, appetite and weight change
E. Review of Symptoms
Allergies
a. Drug allergies
b. Sensitivity to foods
c. Dermatitis, urticaria, angioneurotic edema
Mouth
Sores, gingival bleeding, toothaches
Throat
sore throat, hoarseness, voice changes
Neck
Swelling, lympadenopathy, goiter, stiffness
Gastrointestinal System
a. Appetite, weight changes, dysphagia, nausea, vomiting,
hematemesis
b. Abdominal pain or colic, jaundice, diarrhea, constipation
c. Hematochezia, melena, change in bowel habits
d. Hemorrhoids, rectal pain, hernia
E. Review of symptoms
Nervous System
Cranial nerves -
1 Olfactory smell
5 Trigeminal facial muscles incl. chewing & Facial sensations
7 Facial taste, tears, saliva, facial expressions
9 Glossopharyngeal swallowing, saliva taste
10 Vagus controls PNS e.g. smooth muscles of GI tract
12 Hypoglossal tongue muscle- speech and swallowing
a. Autonomic system - incontinence
II. Physical Examination
Patient draped and sitting (Physician Facing)
Mouth
a. Lips
b. Teeth and gingiva
c. Buccal mucosa
d. Tongue
e. Pharynx (tongue depressor)
Patient Draped and Sitting (Physician to right and back)
Thyroid and trachea
Inspect and palpate
Patient Draped and Supine (Physician to Right)
Abdomen
Auscultate for bruits and bowel sounds (stethoscope)
Inspect for configuration, scars, herniae
Percuss and palpate for liver, spleen, aorta, masses
Assessment
Physical Examination of Abdomen
Inspection
Auscultation
Percussion
Palpation
Rectum
Inspect and palpate for hemorrhoids and masses (gloves)
Test stool on glove for occult blood
DIAGNOSTIC EXAMINATIONS
Laboratory Tests
CEA ( Carcinoembryonic Antigen)
(+) colorectal Ca
X heparin for 2 days
Specimen by venipuncture
Exfoliative Cytology
Detect malignant cells
Written consent
Liquid diet
UGI : NGT insertion
LGI : laxative; enema
Cells are obtained from saline
Lavage NGT / Proctoscope
Fecal Analysis
Stool for Occult Blood (Guaiac Stool Exam)
Detect G.I. Bleeding
fiber diet 48 72 hours
X red meats, poultry, fish, turnips, horseradish
Withold for 48 hrs: Iron, Steroids, Indomethacine, Colchicine
3 stool specimen ( 3 successive days)
Stool for Ova and Parasites
Send fresh, warm stool specimen
Stool Culture
Sterile test tube / cotton tipped applicator
Stool for Lipids
Assess steatorrhea
fat diet, No alcohol ( 3 days )
72 hour stool specimen ( store on ice )
X mineral oil, neomycin SO4
Gastric Analysis
Measures secretion of HCI and pepsin
NPO for 12 hours
NGT is inserted , connected to suction
Gastric contents collected every 15 minutes to 1 hour
RADIOGRAPHIC TESTS
Scout Film / Flat Plate of the Abdomen
Plain X ray of the abdomen
X belts / jewelries