Nursing Assessment: Gastrointestinal System (Chapter 39)

STRUCTURES AND FUNCTIONS

 The main function of the gastrointestinal (GI) system is to supply nutrients to body cells.

 The GI tract is innervated by the autonomic nervous system. The parasympathetic system
is mainly excitatory, and the sympathetic system is mainly inhibitory.

 The two types of movement of the GI tract are mixing (segmentation) and propulsion
(peristalsis).

 The secretions of the GI system consist of enzymes and hormones for digestion, mucus
to provide protection and lubrication, water, and electrolytes.

 Mouth:
o The mouth consists of the lips and oral (buccal) cavity.
o The main function of saliva is to lubricate and soften the food mass, thus
facilitating swallowing.

 Pharynx: a musculomembranous tube that is divided into the nasopharynx, oropharynx,

and laryngeal pharynx.

 Esophagus:
o A hollow, muscular tube that receives food from the pharynx and moves it to the
stomach by peristaltic contractions.
o Lower esophageal sphincter (LES) at the distal end remains contracted except
during swallowing, belching, or vomiting.

 Stomach:
o The functions are to store food, mix the food with gastric secretions, and empty
contents into the small intestine at a rate at which digestion can occur.
o The secretion of HCl acid makes gastric juice acidic.
o Intrinsic factor promotes cobalamin absorption in the small intestine.

 Small intestine: two primary functions are digestion and absorption.

 Large intestine:
o The four parts are (1) the cecum and appendix; (2) the colon (ascending,
transverse, descending, sigmoid colon); (3) the rectum; and (4) the anus.
o The most important function of the large intestine is the absorption of water and
electrolytes.

 Liver:
o Hepatocytes are the functional unit of the liver.
 o Is essential for life. It functions in the manufacture, storage, transformation, and
excretion of a number of substances involved in metabolism.

 Biliary tract:
o Consists of the gallbladder and the duct system.
o Bile is produced in the liver and stored in the gallbladder. Bile consists of
bilirubin, water, cholesterol, bile salts, electrolytes, and phospholipids.

 Pancreas:
o The exocrine function of the pancreas contributes to digestion.
o The endocrine function occurs in the islets of Langerhans, whose beta cells
secrete insulin; alpha cells secrete glucagon; and delta cells secrete somatostatin.

GERONTOLOGIC CONSIDERATIONS
 Aging causes changes in the functional ability of the GI system.

 Xerostomia (decreased saliva production) or dry mouth is common.

 Taste buds decrease, the sense of smell diminishes, and salivary secretions diminish,
which can lead to a decrease in appetite.

 Although constipation is a common complaint of elderly patients, age-related changes in

colonic secretion or motility have not been consistently shown.

 The liver size decreases after 50 years of age, but liver function tests remain within
normal ranges. There is decreased ability to metabolize drugs and hormones.

ASSESSMENT
 Subjective data:
o Important health information: the patient is asked about abdominal pain, nausea
and vomiting, diarrhea, constipation, abdominal distention, jaundice, anemia,
heartburn, dyspepsia, changes in appetite, hematemesis, food intolerance or
allergies, excessive gas, bloating, melena, hemorrhoids, or rectal bleeding.
o The patient is asked about (1) history or existence of diseases such as gastritis,
hepatitis, colitis, gallbladder disease, peptic ulcer, cancer, or hernias; (2) weight
history; (3) past and current use of medications and prior hospitalizations for GI
problems.
o Many chemicals and drugs are potentially hepatotoxic and result in significant
patient harm unless monitored closely.

 Objective data:
o Anthropometric measurements (height, weight, skinfold thickness) and blood
studies (e.g., serum protein, albumin, hemoglobin) may be performed.
o Physical examination
  Mouth. The lips are inspected for symmetry, color, and size. The lips,
tongue, and buccal mucosa are observed for lesions, ulcers, fissures, and
pigmentation.
 Abdomen. The skin is assessed for changes (color, texture, scars, striae,
dilated veins, rashes, lesions), symmetry, contour, observable masses, and
movement.
 Auscultation of the four quadrants of the abdomen includes listening for
increased or decreased bowel sounds and vascular sounds.
 Percussion of the abdomen is done to determine the presence of distention,
fluid, and masses. The nurse lightly percusses all four quadrants of the
abdomen.
 Light palpation is used to detect tenderness or cutaneous hypersensitivity,
muscular resistance, masses, and swelling.
 Deep palpation is used to delineate abdominal organs and masses.
Rebound tenderness indicates peritoneal inflammation.
 During inspiration the liver edge should feel firm, sharp, and smooth. The
surface and contour and any tenderness are described.
 The spleen is normally not palpable. If palpable, manual compression of
an enlarged spleen may cause it to rupture.
 The perianal and anal areas should be inspected for color, texture, lumps,
rashes, scars, erythema, fissures, and external hemorrhoids.

DIAGNOSTIC STUDIES
 Many of the diagnostic procedures of the GI system require measures to cleanse the GI
tract, as well as the use of a contrast medium or a radiopaque tracer.

 An upper GI series with small bowel follow-through provides visualization of the

esophagus, stomach, and small intestine.

 A lower GI series (barium enema) x-ray examination is done to detect abnormalities in

the colon.

 Ultrasonography is used to show the size and configuration of organs.

 Virtual colonoscopy combines computed tomography (CT) scanning or magnetic

resonance imaging (MRI).

 Endoscopy refers to the direct visualization of a body structure through a lighted

fiberoptic instrument.

 Retrograde cholangiopancreatography (ERCP) is an endoscopic procedure that visualizes

the pancreatic, hepatic, and common bile ducts.

 Endoscopy of the GI tract is often done with biopsy and cytologic studies. A
complication of GI endoscopy is perforation.
 Capsule endoscopy is a noninvasive approach to visualize the GI tract.

 Liver biopsy is performed to obtain tissue for diagnosis of fibrosis, cirrhosis, and
neoplasms.

 Liver function tests reflect hepatic disease and function.