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GASTROINTESTINAL SYSTEM 1 Ngan 2
GASTROINTESTINAL SYSTEM 1 Ngan 2
The GI system has the critical task of supplying essential nutrients to fuel the brain, heart, and lungs.
Gi function also profoundly affects the quality of life through its impact on overall health.
What is Digestion?
Digestion is the complex process of turning the food you
eat into nutrients, which the body uses for energy, growth
and cell repair needed to survive. The digestion process
also involves creating waste to be eliminated.
The digestive tract is a long twisting tube that starts from
the mouth and ends at the anus.
It is made up of series of muscles that coordinate the
movement of food and other cells that produce enzymes
and hormones to aid in the breakdown of food. Along the
way are three other organs that are needed for digestion:
the (1)liver, (2)gallbladder, and (3)pancreas.
o Also known as the GI tract, the digestive system begins at the mouth, includes the esophagus,
stomach, small intestine, large intestine (colon), rectum, and ends at the anus. The entire
system – from mouth to anus – is about 30 feet (9 meter) long.
o The small intestine is a 20-feet (6 meter) tube-shaped organ. The large intestine is about 5 feet
long (1.5 meters) and primary functions as storage and fermentation of indigestible matter.
Also called the colon, it has four parts: (1) the ascending colon, (2) the transverse colon, (3)
the descending colon, and the (4) sigmoid colon.
INTRODUCTION
The digestive system is used for breaking down food into nutrients which then pass into the
circulatory system and are taken to where they are needed in the body.
o The average length of the human tongue from the oropharynx to the tip is 10 cm
o The tongue moves the food around until it forms a ball called bolus.
o The bolus is passed to the pharynx and the epiglottis makes sure the bolus passes into the
esophagus and not down the windpipe
ESOPHAGUS
STOMACH
o To enter the stomach, the bolus must pass through the lower esophageal sphincter, a tight
muscle that keeps stomach acid out of the esophagus.
o The stomach has folds called rugae and is a big muscular pouch which churns the bolus
(physical digestion) and mixes it with gastric juice, a mixture of stomach acid, mucus, and
enzymes.
o The acid kills off any invading bacteria or viruses
o The enzymes help breakdown proteins and lipids
o The mucus protects the lining of the stomach from being eaten away by the acid.
o The stomach does do some absorption too.
o Some medicines (i.e., aspirin), water, and alcohol are all absorbed through the stomach.
o The digested bolus is now called chyme and it leaves the stomach by passing through the
pyloric sphincter.
PANCREAS
o The pancreas is about 6 inches long and sits across the back of the abdomen, behind the
stomach.
o The pancreas secretes digestive enzymes into the duodenum, the first segment of the small
intestine. These enzymes break down protein, fats, and carbohydrates. The pancreas also
makes insulin, secreting it directly into the bloodstream. Insulin is the chief hormone for
metabolizing sugar.
LIVER
o The liver has multiple functions but its main function within the digestive system is to process
the nutrients absorbed from the small intestine. Bile from the liver secreted into the small
intestine also plays an important role in digesting fat. The liver also detoxifies potentially
harmful chemicals. It breaks down many drugs.
GALLBLADDER
The gallbladder stores and concentrates bile, and then releases it into the duodenum to help absorb
and digest fats.
SMALL INTESTINE
1. Duodenum
- Bile, produced in the liver but stored in the gall bladder, enters through the bile duct. It
breaks down fats.
- The pancreas secretes pancreatic juice to
reduce acidity of the chyme.
2. Jejunum
- It is where the majority of absorption takes
places.
- It has tiny fingerlike projections called villi
lining it, which increase the surface area for
absorbing nutrients.
- Each villus itself has tiny fingerlike projections
called microvilli, which further increase the
surface area for absorption.
-
3. Ileum
- The last portion of the small intestine which has
fewer villi and basically compacts the leftovers to
pass through the caecum into the large intestine.
RECTUM
o The rectum is an 8-inch chamber that connects the colon to the anus. It is the rectum’s job to
receive stool from the colon. When anything (gas or stool) comes into the rectum, sensors
send message to the brain. The brain then decides if the rectal contents can be released or
not.
ANUS
o The anus is the last part of the digestive tract. It is a 2-inch-long canal consisting of the pelvic
floor muscles and the two anal sphincters (internal and external). The lining of the upper anus
is specialized to detect rectal contents. It lets you know whether the contents are liquid, gas, or
solid. The anus is surrounded by sphincter muscles that are important in allowing control of
stool.
ASSESSMENT
• Physical Examination
– Inspection – Palpation
– Auscultation – Percussion
HISTORY
o Ask the patient about changes in appetite, difficulty chewing or swallowing, indigestion,
nausea, vomiting, diarrhea, constipation, and abdominal pain. Has he noticed a change in
bowel movements? Has he ever seen blood in his stool?
o Ask the patient if he’s taking any medications. Some drugs – including aspirin, sulfonamides,
nonsteroidal anti-inflammatory drugs (NSAIDS), and some antihypertensive –can cause GI
signs and symptoms.
o Don’t forget to ask about laxative use; habitual use may cause constipation. Also ask the
patient’s if he’s allergic to medications or food. Such allergies commonly cause GI symptoms.
Family History
o Because some GI disorders are hereditary, ask the patient whether anyone in his family has
had a GI disorder. Disorders with a familial link include:
o Ulcerative colitis o Stomach Ulcers o Alcoholism
o GI cancer o Diabetes o Crohn’s Disease
Lifestyle Patterns
PHYSICAL EXAMINATION
Physical assessment of the GI system includes evaluation of the mouth, abdomen, liver, and rectum.
To perform an abdomen al assessment, use this section: Inspection, Auscultation, percussion, and
palpation. Palpating or percussing the abdomen before auscultation can change the character of the
patient’s bowel sounds and lead to an inaccurate assessment.
MOUTH
ABDOMEN
Have the patient lie in the supine position, with knees slightly flexed. Use inspection,
auscultation, and palpation to examine the abdomen. Assess painful areas last to help prevent
the patient from experiencing increased discomfort and tension.
Observe the abdomen for symmetry, checking for bumps, bulges, or masses. Also note the
patients abdominal shape and contour.
Assess the umbilicus, which should be located midline in the abdomen and inverted. If his
umbilicus protrudes, the patient may have an umbilical hernia.
The skin of the abdomen should be smooth and uniform in color. Note stretch marks, or striae,
and dilated veins. Record the length of any surgical scars on the abdomen.
What do I do?
EMERGENCY SIGNALS
When assessing a patient with a GI problem, stay alert for the signs and symptoms described here
because they may signal an emergency. If you note any of these signs or symptoms, notify the
practitioner and assess the patient for deterioration such as signs of shock. Intervene, as necessary,
by providing oxygen therapy and I.V. fluids as ordered. Place the patient on a cardiac monitor if
appropriate. Provide emotional support.
Abdominal Pain
Progressive, severe, or colicky pain for more than 6 hours without improvement.
Acute pain associated with hypertension
Acute pain in an elderly patient(such a patient may have minimal tenderness, even with a
ruptured abdominal organ or appendicitis.
Severe pain with guarding and a hx of recent abdominal surgery.
Pain accompanied by X-ray evidence of free intraperitoneal air (gas) or mediastinal gas
Disproportionately severe pain under benign conditions (soft abdomen with normal physical
findings).
Abdominal Tenderness
Abdominal tenderness and rigidity, even when the patient is distracted
Rebound tenderness
Other Signs
- Fever - Hypotension
- Tachycardia - Dehydration
DIAGNOSTIC TESTS
Using a fiber-optic endoscope, the doctor can directly view hallow visceral linings to diagnose
inflammatory, ulcerative, and infectious diseases, benign and malignant neoplasm, and other
esophageal, gastric, and intestinal mucosal lesions. Endoscopy can also be used for therapeutic
interventions or to obtain biopsy specimens.
Lower GI Endoscopy
NURSING CONSIDERATIONS
o Tell the patient that he will need to undergo a bowel preparation consisting of laxatives and
enemas for 1 to 2 days before the procedure.
o Tell him that he must maintain a clear liquid diet the day before the procedure and then fast the
morning of the test.
o Explain that he should review the medications he should take before the procedure with his
practitioner.
o If the patient will undergo a sigmoidoscopy, explain that he most likely won’t be sedated; if he
will undergo a colonoscopy, tell him he’ll be under I.V. sedation.
o Inform the patient that the doctor will insert a flexible tube into his rectum.
o Tell him that he may feel some lower abdominal discomfort and the urge to move his bowels
as the tube is advanced. To control the urge to defecate and ease the discomfort, instruct him
to breathe deeply and slowly through his mouth.
o Explain that air may be introduced into the bowel through the tube. If he feels the urge to expel
some air, tell him not to try to control it.
o Tell him that he may hear a suction machine removing any liquid that may obscure the doctor’s
view, but it won’t cause any discomfort.
o Let him know he can eat after recovering from the sedative, usually about 1 hour after the test.
o If air was introduced into the bowel, the patient may pass large amounts of flatus. Explain that
this is normal and helps prevent abdominal cramping.
o Tell him to report any blood in his stool.
Upper GI endoscopy
NURSING CONSIDERATIONS
o Tell the patient that he must restrict food and fluids for at least 6 hours before the test.
o If the test is an emergency procedure, inform the patient that he’ll have his stomach contents
suctioned to permit better visualization.
o Explain that he’ll be given I.V. sedation to help keep him comfortable.
o Before insertion of the tube, the patient’s throat will be sprayed with a local anesthetic. Explain
that the spray will taste unpleasant and will make his mouth feel swollen and numb, causing
different swallowing.
o Reassure the patient that he’ll have a mouthguard to protect his teeth from the tube.
o Before the test, ask the patient to remove dentures and dental appliances, as applicable.
o Tell the patient that he can expect to feel some pressure in the abdomen and some fullness or
bloating as the tube is inserted and advanced and as air is introduced to inflate the stomach
o The patient can resume eating when his gag reflex returns – usually in about 1 hour.
LABORATORY TESTS
Common laboratory test used to diagnose GI disorders include studies of stool, urine, and
esophageal, gastric, and peritoneal contents as well as percutaneous liver biopsy.
24-hour pH testing
Most stool contains 10% to 20% fat. However, higher fat content can turn stool pasty or greasy
– a possible sign of intestinal malabsorption or pancreatic disease.
NURSING CONSIDERATIONS
NURSING CONSIDERATIONS
o Tell the patient to restrict food and flush for at least 4 hours before the test.
o Explain the testing procedure to the patient.
- He will be able to wake up during the test and, although the test is uncomfortable,
medication is available to help him relax.
- The doctor will drape and clean an area on his abdomen. Then he’ll receive a local
anesthetic, which may sting and cause brief discomfort.
- He’ll be instructed how and when to hold his breath and to hold his breath and to lie still as
the doctor inserts the biopsy needle into the liver.
- The needle may cause a sensation of pressure and some discomfort in the right upper
back but will remain in his liver for only a few seconds.
The peritoneal fluid analysis series includes examination of gross appearance, erythrocyte and
leukocyte counts, cytologic studies, microbiological studies for bacteria and fungi, and determinations
of protein, glucose, amylase, ammonia, and alkaline phosphatase levels. A sample of peritoneal
fluids. A sample of peritoneal fluids is obtained by paracentesis, which involves inserting a trocar and
cannula through the abdominal wall while the patient is under a local anesthetic. If the sample of fluid
is being removed for therapeutic purposes, the cannula can be connected to a drainage system.
NURSING CONSIDERATIONS
Urinalysis provides valuable information about hepatic and billary function. Urinary bilirubin and
urobilinogen tests are commonly used to evaluate liver function.
NURSING CONSIDERATIONS
Nuclear imaging methods whivh include liver spleen scanning an=d magnetic resonance imaging
(MRI), analyze concentrations of injected or ingested radiopaque substances to enhance visual
evaluation of possible disease processe. Nuclear Imaging methods can study the liver, spleen, and
other abdominal organs. Ultrasonogrpahy creates images of internal organs, such as the gallbladder
and liver. Gas-filled structures, such as the intestines, can’t be seen with this technique.
Liver-Spleen Scan
In a liver-spleen scan , a scanner or gamma
camera records the distribution of radioactivity
within the liver and spleen after I.V injection of a
radioactive colloid.
NURSING CONSIDERATIONS
MRI
NURSING CONSIDERATIONS
Ultrasonography
Uses a focused beam of high-frequency sound waves
to create echoes , which then appear as images on a
monitor. Echoes vary with tissue density.
When used with liver-spleen scanning, it can clarify
the nature of cold spots, such as tumors, abscesses,
and cysts. The technique also helps diagnose
pancreatitis, pseudocysts, pancreatic cancer, ascites,
and splenomegaly.
NURSING CONSIDERATIONS
o If the patient is undergoing pelvic ultrasonogrpahy, he’ll need a full bladder, therefore, he must
drink three or four glasses of water before the test and must avoid urinating until after the test.
o For gallbladder evaluation, tell the patient that he shoudn’t eat solid food for 12 hours before
the test.
o For pancreas, liver, and spleen evaluation, tell the patient that he should fast for 8 hours
before the test.
o If the patient is undergoing a barium enema or an upper GI series, make sure it occurs after
abdominal ultrasonography because sound waves can’t penetrate barium.
Radiographic Tests
Abdominal X-ray
NURSING CONSIDERATIONS
CT Scan
In CT scanning, a computer translates the action of multiple X-ray beams into three-dimensional
oscilloscope images of the biliary tract, liver, and pancreas. The test can be done with or without a
contrast medium, but contrast is preferred (unless the patient is allergic to contrast medium).
This test:
NURSING CONSIDERATIONS
o Tell the patient to restrict food and fluids after midnight before the test but to continue any drug
regimen, as ordered.
o Explain that the patoient should lie still, relax, breathe normally, and rema in quiet during the
test because movement blurs the X-ray picture and prolongs the test.
Contrast Radiography
Some X-ray require contrast media to more accurately assess the GI system because the media
accentuate differences among densities of air, fat, soft tissue, and bone. These tests include barium
enema, barium swallow test, cholangiography, endoscopic retrograde cholangiopancreatography
(ERCP), small-bowel series and enema, and upper GI series.
NURSING CONSIDERATIONS
o Tell the patient where and when the test will take place.
o Explain that the test will take only 30 to 40 mins for a barium swallow or enema but can take
up to 6 hours for an upoer GI or small-bowel series.
o Instruct the patient to maintain a low-residue diet for 2 to 3 days and restrict food , fluids, and
smoking after midnight before the test . he’ll receive a clear liquid diet for 12 to 24 hours before
the test. As ordered, he’s to stop taking medications for up to 24 hours before the test.
o Unless he’s undergoing a barium swallow test, the patient will receive a laxative the afternoon
before the test and up to three cleaning enemas the evening before or the morning of the test.
Explain that the presence of food or fluid may obscure details of the structures being studied.
o Let the patient having a barium enema know that he will lie on his leftside while the practitioner
inserts a small, lubricated tube into his rectum. Instruct the patient to keep his anal sphincter
tightly contracted against the tube to hold it in position and help
prevent barium leakage. Stress the importance of retaining the
barium.
Virtual Colonoscopy
It is a nonsurgical approach to evaluate the colon. A soft-tipped catheter introduces air into the colon
while a three-dimensional CT scan is performed.
NURSING CONSIDERATIONS
o Tell the patient that he may feel discomfort when air is introduced into the colon.
o Instruct the patient to remain still while images are taken.
o Tell the patient that he’ll have no restrictionsafter the test but that he may feel blooded from the
air introduced into his colon.
TREATMENT
Drug Therapy
The most commonnly used GI drugs include antacids, digestants, histamine-2(H 2) receptor
antagonists, proton pump inhibitors, anticholinergics, antidiarrheal agents, laxatives, emetics, and
antiemetics.
Surgery
The patient who has undergone GI surgery may need special postoperative support because he may
have to make permanent and difficult changes in his lifestyle.
Esophageal Surgeries
Gastric Surgeries
In this procedure, the surgeon resects the vagus nerves and creates a stoma for
gastric drainage. He’ll perform selective, truncal, or parietal cell vagotomy,
depending on the degree of decreased gastric acid secretion.
Vagotomy with Antrectomy
Billroth I
Billroth II