NurseReview.Org Gastrointestinal System

Slide 1: Medical Surgical Nursing The GASTRO-INTESTINAL System Nurse Licensure Examination Review

Slide 2: The Gastro-Intestinal System Review of the GIT Anatomy and Physiology  Review of Common laboratory procedures  Review of Common Symptoms and their  nursing interventions Review of common disorders of the:  Esophagus -gallbladder   Stomach -exocrine pancreas  Small intestine -liver  Large Intestine

Slide 4: The GIT System: Anatomy and Physiology The GIT is composed of two general parts  The main GIT starts from the mouth  EsophagusStomachSILI The accessory organs are the  Salivary glands   Liver  Gallbladder  Pancreas

Slide 5: The GIT ANATOMY The Mouth  Contains the lips, cheeks, palate, tongue, teeth, salivary glands, masticatory/facial muscles and bones  Anteriorly bounded by the lips  Posteriorly bounded by the oropharynx

Slide 6: The GIT Physiology The Mouth  Important for the mechanical digestion of food  The saliva contains SALIVARY AMYLASE or PTYALIN that starts the INITIAL digestion of carbohydrates

Slide 7: The GIT ANATOMY The Esophagus  A hollow collapsible tube  Length- 10 inches  Made up of stratified squamos epithelium

Slide 8: The GIT ANATOMY The Esophagus  The upper third contains skeletal muscles  The middle third contains mixed skeletal and smooth muscles  The lower third contains smooth muscles and the esophago-gastric/ cardiac sphincter is found here

Slide 9: The GIT PHYSIOLOGY The Esophagus  Functions to carry or propel foods from the oropharynx to the stomach  Swallowing or deglutition is composed of three phases:

Slide 10: The GIT ANATOMY The stomach  J-shaped organ in the epigastrium  Contains four parts- the fundus, the cardia, the body and the pylorus  The cardiac sphincter prevents the reflux of the contents into the esophagus  The pyloric sphincter regulates the rate of gastric emptying into the duodenum  Capacity is 1,500 ml!

Slide 11: The GIT PHYSIOLOGY The functions of the stomach are  generally to digest the food (proteins) and to propel the digested materials into the SI for final digestion  The Glands and cells in the stomach secrete digestive enzymes:

Slide 12: The GIT PHYSIOLOGY Stomach:  1. Parietal cells- HCl acid and Intrinsic  factor 2. Chief cells- pepsin digestion of  PROTEINS! 3. Antral G-cells- gastrin  4. Argentaffin cells- serotonin  5. Mucus neck cells- mucus 

Slide 13: The GIT ANATOMY The Small intestine  Grossly divided into the Duodenum, Jejunum and Ileum  The duodenum contains the two openings for the bile and pancreatic ducts  The ileum is the longest part (about 12 feet)

Slide 14: The GIT physiology The intestinal glands secrete digestive  enzymes that finalize the digestion of all foodstuff Enzymes for carbohydrates  disaccharidases Enzymes for proteins dipeptidases and  aminopeptidases Enzyme for lipids intestinal lipase 

Slide 15: The GIT ANATOMY The Large intestine  Approximately 5 feet long, with parts:  1. The cecum widest diameter, prone to rupture  2. The appendix  3. The ascending colon  4. The transverse colon  5. The descending colon  6. The sigmoid most mobile, prone to twisting  7. The rectum

Slide 16: The GIT Physiology Absorbs water  Eliminates wastes  Bacteria in the colon synthesize Vitamin K  Appendix participates in the immune system 

Slide 17: The GIT Physiology SYMPATHETIC PARASYMPATHETIC  Generally INHIBITORY!  Generally EXCITATORY!  Decreased gastric  Increased gastric secretions secretions  Decreased GIT motility  Increased gastric motility But: Increased sphincteric But: Decreased sphincteric   tone and constriction of tone and dilation of blood blood vessels vessels

Slide 18: The GIT ANATOMY The Liver  The largest internal organ  Located in the right upper quadrant  Contains two lobes- the right and the left  The hepatic ducts join together with the cystic duct to become the common bile duct

Slide 19: The GIT Physiology: LIVER Functions to store excess glucose, fats and  amino acids Also stores the fat soluble vitamins- A, D  and the water soluble- Vitamin B12 Produces the BILE for normal fat digestion  The Von Kupffer cells remove bacteria in the  portal blood Detoxifies ammonia into urea 

Slide 20: The GIT anatomy The gallbladder  Located below the liver  The cystic duct joins the hepatic duct to become the bile duct  The common bile duct joins the pancreatic duct in the sphincter of Oddi in the first part of the duodenum

Slide 21: The GIT Physiology Stores and concentrates bile  Contracts during the digestion of fats to  deliver the bile Cholecystokinin is released by the duodenal  cells, causing the contraction of the gallbladder and relaxation of the sphincter of Oddi

Slide 22: The GIT anatomy The pancreas  A retroperitoneal gland  Functions as an endocrine and exocrine gland  The pancreatic duct (major) joins the common bile duct in the sphincter of Oddi

Slide 23: The GIT Physiology The exocrine function of the pancreas is the  secretion of digestive enzymes for carbohydrates, fats and proteins Pancreatic amylase carbohydrates  Pancreatic lipase (steapsin) fats  Trypsin, Chymotrypsin and Peptidases  proteins Bicarbonate to neutralize the acidic  chyme. Stimulated by SECRETIN!

Slide 24: Gastrointestinal Assessment Laboratory Procedures

Slide 25: COMMON LABORATORY PROCEDURES FECALYSIS  Examination of stool consistency, color and the presence of occult blood.  Special tests for fat, nitrogen, parasites, ova, pathogens and others

Slide 26: COMMON LABORATORY PROCEDURES FECALYSIS: Occult Blood Testing  Instruct the patient to adhere to a 3-day meatless diet  No intake of NSAIDS, aspirin and anti-coagulant  Screening test for colonic cancer

Slide 27: COMMON LABORATORY PROCEDURES Upper GIT study: barium swallow  Examines the upper GI tract  Barium sulfate is usually used as contrast

Slide 28: COMMON LABORATORY PROCEDURES Upper GIT study: barium swallow  Pre-test: NPO post-midnight  Post-test: Laxative is ordered, increase pt fluid intake, instruct that stools will turn white, monitor for obstruction

Slide 31: COMMON LABORATORY PROCEDURES Lower GIT study: barium enema  Examines the lower GI tract  Pre-test: Clear liquid diet and laxatives, NPO post-midnight, cleansing enema prior to the test

Slide 32: COMMON LABORATORY PROCEDURES Lower GIT study: barium enema  Post-test: Laxative is ordered, increase patient fluid intake, instruct that stools will turn white, monitor for obstruction

Slide 34: COMMON LABORATORY PROCEDURES Gastric analysis  Aspiration of gastric juice to measure pH, appearance, volume and contents  Pre-test: NPO 8 hours, avoidance of stimulants, drugs and smoking  Post-test: resume normal activities

Slide 35: COMMON LABORATORY PROCEDURES EGD (esophagogastroduodenoscopy)  Visualization of the upper GIT by endoscope  Pre-test: ensure consent, NPO 8 hours, pre-medications like atropine and anxiolytics

Slide 37: COMMON LABORATORY PROCEDURES EGD esophagogastroduodenoscopy  Intra-test: position : LEFT lateral to facilitate salivary drainage and easy access

Slide 38: COMMON LABORATORY PROCEDURES EGD (esophagogastroduodenoscopy)  Post-test: NPO until gag reflex returns, place patient in SIMS position until he awakens, monitor for complications, saline gargles for mild oral discomfort

Slide 39: COMMON LABORATORY PROCEDURES Lower GI- scopy  Use of endoscope to visualize the anus, rectum, sigmoid and colon  Pre-test: consent, NPO 8 hours, cleansing enema until return is clear

Slide 41: COMMON LABORATORY PROCEDURES Lower GI- scopy  Intra-test: position is LEFT lateral, right leg is bent and placed anteriorly  Post-test: bed rest, monitor for complications like bleeding and perforation

Slide 43: COMMON LABORATORY PROCEDURES Cholecystography  Examination of the gallbladder to detect stones, its ability to concentrate, store and release the bile  Pre-test: ensure consent, ask allergies to iodine, seafood and dyes; contrast medium is administered the night prior, NPO after contrast administration

Slide 44: COMMON LABORATORY PROCEDURES Cholecystography Post-test: Advise that dysuria is common as the dye is excreted in the urine, resume normal activities

Slide 45: COMMON LABORATORY PROCEDURES Paracentesis Removal of peritoneal fluid for analysis

Slide 46: COMMON LABORATORY PROCEDURES Paracentesis  Pre-test: ensure consent, instruct to VOID and empty bladder, measure abdominal girth

Slide 47: COMMON LABORATORY PROCEDURES Paracentesis Intra-test: Upright on the edge of the bed, back supported and feet resting on a foot stool

Slide 48: COMMON LABORATORY PROCEDURES Liver biopsy  Pretest  Consent  NPO  Check for the bleeding parameters

Slide 49: COMMON LABORATORY PROCEDURES Liver biopsy  Intratest  Position: Semi fowler’s LEFT lateral to expose right side of abdomen

Slide 50: COMMON LABORATORY PROCEDURES Liver biopsy  Post-test: position on RIGHT lateral with pillow underneath, monitor VS and complications like bleeding, perforation. Instruct to avoid lifting objects for 1 week

Slide 51: The NURSING PROCESS in GIT Disorders Assessment  Health history Nursing History  PE  Laboratory procedures

Slide 52: The ABDOMINAL examination The sequence to follow is:  Inspection  Auscultation  Percussion  Palpation

Slide 54: COMMON GIT SYMPTOMS AND MANAGEMENT CONSTIPATION DIARRHEA DUMPING SYNDROME

Slide 55: COMMON GIT SYMPTOMS AND MANAGEMENT CONSTIPATION  An abnormal infrequency and irregularity of defecation  Multiple causations

Slide 56: COMMON GIT SYMPTOMS AND MANAGEMENT CONSTIPATION: Pathophysiology  Interference with three functions of the colon  1. Mucosal transport  2. Myoelectric activity  3. Process of defecation

Slide 57: COMMON GIT SYMPTOMS AND MANAGEMENT NURSING INTERVENTIONS  1. Assist physician in treating the underlying cause of constipation  2. Encourage to eat HIGH fiber diet to increase the bulk  3. Increase fluid intake  4. Administer prescribed laxatives, stool softeners  5. Assist in relieving stress

Slide 58: COMMON GIT SYMPTOMS AND MANAGEMENT Diarrhea  Abnormal fluidity of the stool Multiple causes   Gastrointestinal Diseases  Hyperthyroidism  Food poisoning

Slide 59: COMMON GIT SYMPTOMS AND MANAGEMENT Diarrhea Nursing Interventions 1. Increase fluid intake- ORESOL is the most important treatment! 2. Determine and manage the cause 3. Anti-diarrheal drugs

Slide 60: COMMON GIT SYMPTOMS AND MANAGEMENT DUMPING SYNDROME  A condition of rapid emptying of the gastric contents into the small intestine usually after a gastric surgery  Symptoms occur 30 minutes after eating

Slide 61: COMMON GIT SYMPTOMS AND MANAGEMENT PATHOPHYSIOLOGY  Foods high in CHO and electrolytes must be diluted in the jejunum before absorption takes place.

Slide 62: COMMON GIT SYMPTOMS AND MANAGEMENT PATHOPHYSIOLOGY The rapid influx of stomach contents will cause distention of the jejunum early symptoms

Slide 63: COMMON GIT SYMPTOMS AND MANAGEMENT PATHOPHYSIOLOGY The hypertonic food bolus will draw fluid from the blood vessels to dilute the high concentrations of CHO and electrolytes in the food bolus

Slide 64: COMMON GIT SYMPTOMS AND MANAGEMENT Later, there is increased blood glucose stimulating the increased secretion of insulin

Slide 65: COMMON GIT SYMPTOMS AND MANAGEMENT Then, blood glucose will fall causing reactive hypoglycemia

Slide 66: COMMON GIT SYMPTOMS AND MANAGEMENT DUMPING SYNDROME ASSESSMENT FINDINGS: early symptoms  1. Nausea and Vomiting  2. Abdominal fullness  3. Abdominal cramping  4. Palpitation  5. Diaphoresis

Slide 67: COMMON GIT SYMPTOMS AND MANAGEMENT DUMPING SYNDROME ASSESSMENT FINDINGS: LATE symptoms:  6. Drowsiness  7. Weakness and Dizziness  8. Hypoglycemia

Slide 68: COMMON GIT SYMPTOMS AND MANAGEMENT DS NURSING INTERVENTIONS  1. Advise patient to eat LOW- carbohydrate HIGH-fat and HIGH- protein diet  2. Instruct to eat SMALL frequent meals, include MORE dry items.  3. Instruct to AVOID consuming FLUIDS with meals

Slide 69: COMMON GIT SYMPTOMS AND MANAGEMENT DS NURSING INTERVENTIONS  4. Instruct to LIE DOWN after meals  5. Administer anti-spasmodic medications to delay gastric emptying

Slide 70: GIT SYMPTOMS AND MANAGEMENT PERNICIOUS ANEMIA  Results from Deficiency of vitamin B12 due to autoimmune destruction of the parietal cells, lack of INTRINSIC FACTOR or total removal of the stomach

Slide 71: GIT SYMPTOMS AND MANAGEMENT PERNICIOUS ANEMIA ASSESSMENT  Severe pallor  Fatigue  Weight loss  SMOOTH BEEFY-RED TONGUE  Mild jaundice  Paresthesia of extremities  Balance disturbance

Slide 72: GIT SYMPTOMS AND MANAGEMENT NURSING INTERVENTION for Pernicious Anemia  Lifetime injection of Vitamin B 12 weekly initially, then MONTHLY

Slide 73: Conditions of the GIT UPPER GI system

Slide 74: CONDITION OF THE ESOPHAGUS HIATAL HERNIA  Protrusion of the esophagus into the diaphragm thru an opening  Two types- Sliding hiatal hernia ( most common) and Axial hiatal hernia

Slide 75: CONDITION OF THE ESOPHAGUS ASSESSMENT Findings in Hiatal hernia  1. Heartburn  2. Regurgitation  3. Dysphagia  4. 50%- without symptoms

Slide 76: CONDITION OF THE ES