The Gastro-Intestinal System Deadline is 4pm on the last lecture day Project - handwritten Choose one case Detailed

schematic pathophysiology Formulate 2 complete nursing diagnosis PES Give 5 nursing interventions for each nursing diagnosis This is a take home project but if I see 2 or more similar papers submitted, the equivalent grade is 70% Select only one case: Cirrhosis, Colonic Cancer, Gastritis, Pancreatitis Cholelithiasis , Amoebiasis , Orrientation

The alimentary canal and digestive glands is an integrated system responsible for the ingestion, digestion, absorption and elimination of food Aside from organic disease like bleeding, perforation, cancer, inflammation that manifest GI disturbances, emotional problems like stress and anxiety often also manifest indigestion, anorexia, constipation and diarrhea. Definition of terms Ingestion Digestion Absorption Elimination Definition of terms Ingestion - phase of digestive process which occurs when food is taken into the GI tract via the mouth and esophagus Digestion phase of digestive process which occurs when digestive enzymes and secretions mix with ingested food and when proteins, fats and sugar are broken down into smaller particles Absorption phase of digestive process which occurs when small molecules, vitamins and minerals pass through the walls of the small and large intestine and into the blood stream Elimination phase of digestive process which occurs after digestion and absorption when waste products are evacuated from the body Phases of gastric acid secretion Cephalic phase - before food enters the stomach. Involves preparation of the body for eating and digestion. Sight and thought, taste and smell

stimulate gastric secretion. At this phase gastric acid rises to 40% of maximum rate. (ex. Green mango) Gastric phase - takes 3 to 4 hours. It is stimulated by distension and presence of food in stomach and decrease in pH (acidic) Intestinal phase - Partially digested food fills the duodenum. o Anatomic physiologic overview The GI tract measures 23 to 26 feet long or 7 to 7.9 meters pathway that extends from the mouth to the esophagus, stomach, small and large intestines and rectum to the anus Compose of two general parts: Main GIT starts from the mouth to the large intestine The accessory organs like _________, ______, _________ and _________ Question: Out of 4, give me 1 accessory organ for digestion? 2 answers Anatomic physiologic overview The GI tract measures 23 to 26 feet long or 7 to 7.9 meters pathway that extends from the mouth to the esophagus, stomach, small and large intestines and rectum to the anus Compose of two general parts: Main GIT starts from the mouth to the large intestine The accessory organs like salivary gland, liver, gallbladder and pancreas Anatomic physiologic overview Mouth Contains the lips, cheeks, palate, tongue, teeth, salivary glands, muscles of mastications and bones Anteriorly bounded by the lips Posteriorly bounded by oropharynx Anatomic physiologic overview Mouth Important for the mechanical digestion of food Saliva contains salivary amylase and ptyalin that starts the initial digestion of carbohydrates Anatomic physiologic overview Esophagus located anterior to the spine and posterior to the trachea and heart. It is approximately 25 cm (10 Inches) in length. Functions to carry or propel foods from the oropharynx to the stomach Anatomic physiologic overview

 Stomach J - shaped organ located in the peritoneal cavity and situated in the left upper portion of the abdomen under the left lobe of the liver and diaphragm. A hallow muscular organ with a capacity of approximately 1500ml, it stores food during eating and propels partially digested food (Chyme) into the small intestine. Anatomic physiologic overview Stomach Gastroesophageal junction - the inlet to the stomach from esophagus. Cardiac Sphincter - prevents the reflux of the contents into the esophagus Stomach has four anatomic regions: Cardia (entrance), fundus, body and pylorus (outlet). Pyloric sphincter - controls the opening between the stomach and the small intestine Anatomic physiologic overview Functions of the Stomach generally to digest the food (proteins) and to propel the digested materials into the small intestine for final digestion The Glands and cells in the stomach secrete digestive enzymes Anatomic physiologic overview Stomach Parietal cells - hydrochloric acid and Intrinsic factor Chief cells pepsin needed for digestion of proteins Antral G-cells - gastrin Argentaffin cells - serotonin Mucus neck cells - mucus Anatomic physiologic overview Small Intestine longest segment of the GI tract is about two thirds of the entire length. Secretion and absorption of nutrients takes place. Question: what are the parts of the small intestine? Anatomic physiologic overview Small Intestine 3 sections duodenum most proximal section, contains two openings for the bile and pancreatic ducts

 jejunum middle section ileum it is the longest part at around 12 feet long. The distal section terminates at the ileocecal valve. This valve is responsible for controlling the flow of digested materials from the ileum to the cecal portion of the large intestine and prevents reflux of bacteria into the small intestine. Attached to the cecum is the vermiform appendix which has little or no physiologic function at all. Anatomic physiologic overview Large Intestine approximately 5 feet long Ascending segment (R side of abdomen) Transverse segment (extends from R to L abdomen) Descending segment (L side of abdomen) and the terminal portion consist of sigmoid colon, rectum and anus. Cecum, appendix, sigmoid, rectum Anatomic physiologic overview Large Intestine Absorbs water Eliminates waste Bacteria present in the colon synthesize vitamin K Anatomic physiologic overview Oxygen and nutrients are supplied to the stomach via the gastric artery and the intestine via the mesenteric artery. The GI tract is innervated by the autonomic nervous system. Sympathetic nerves exert inhibitory effect causing decrease gastric acid secretion and motility while the parasympathetic nerve exert excitatory stimulation causing peristalsis and increase secretory activities (anti diaarheal) Primary function of GI tract Breakdown of food particles into the molecular form for digestion Absorption into the blood stream of small nutrient molecules produced by digestion Elimination of undigested unabsorbed foodstuffs and other waste products Anatomic physiologic overview parotid, submaxillary and sublingual gland secretes approximately 1.5l of saliva daily Ptyalin or salivary amylase is an enzyme that begins the digestion of starches. epiglottis moves to cover the trachea to prevent aspiration.

 Peristalsis allows the bolus food to move from the upper esophagus to the stomach pyloric sphincter relaxes to allow food to enter the stomach and likewise prevent reflux from stomach back to esophagus (gravity) Anatomic physiologic overview Hydrochloric acid breaks down food into absorbable components and aid in destruction of ingested bacteria. Pepsin end product of pepsinogen conversion. It is an important enzyme for protein digestion Intrinsic Factor secreted by gastric mucosa, combines with vitamin b12 needed for its absorption in the ileum. Question: what disease condition will occur when there is absence of intrinsic factor in the stomach? Anatomic physiologic overview Hydrochloric acid breaks down food into absorbable components and aid in destruction of ingested bacteria. Pepsin end product of pepsinogen conversion. It is an important enzyme for protein digestion Intrinsic Factor secreted by gastric mucosa, combines with vitamin b12 needed for its absorption in the ileum. Absence of intrinsic factor may lead to disease called pernicious anemia. Anatomic physiologic overview Digestion continues in the duodenum. Duodenal secretions come from accessory digestive organs such as the pancreas, liver and gall bladder. These secretions contain digestive enzymes such as amylase, lipase and bile Anatomic physiologic overview Liver Largest internal organ Located at the right upper quadrant Contains 2 lobes the right and left lobe The hepatic ducts join together with the cystic duct to become the common bile duct Anatomic physiologic overview Function of the Liver store excess glucose, fats and amino acids stores the fat soluble vitamins- A, D and the water soluble- Vitamin B12

produces the BILE for normal fat digestion detoxifies ammonia into urea Anatomic physiologic overview Gallbladder Located below the liver Stores bile Contracts during fat digestion to deliver bile (stonemile) Anatomic physiologic overview Pancreas Functions both as an endocrine and exocrine gland The exocrine function of the pancreas is the secretion of digestive enzymes for carbohydrates, fats and proteins Anatomic physiologic overview Pancreatic secretions have an alkaline pH due to high concentration of bicarbonates which neutralizes the acid entering the duodenum from the stomach Pancreas secretes the following enzymes; trypsin - protein digestion amylase - starch digestion lipase - fat digestion Bile is secreted by the liver and stored in the gall bladder, aids in emulsification of fat making them easier to digest and absorb Sphincter of Oddi found between the CBD and duodenum controls the flow of bile Summary of Digestive Enzymes Anatomic physiologic overview Villi are small fingerlike projections lining the entire small intestine which functions to produce digestive enzyme and absorption of nutrients. 4 hours after eating, waste materials passes the terminal ileum to the right colon through the ileocecal valve. Bacteria a major component in the large intestine, assist in the breakdown of waste materials. Re-absorption of water and electrolytes also takes place in the large intestine. Feces consist of undigested food. 75% fluid and 25% solid material. Brownish coloration of feces is brought about by breakdown of bile. Assessment

Nursing history Health history habit, food preference, Developmental history environmental factors Social history lifestyle, smoking, drinking Psychological history personality type, temper Physical assessment IPPA Diagnostic test Assessment Nursing history GI assessment includes complete history and information on: abdominal pain Dyspepsia intestinal gas nausea and vomiting Diarrhea Constipation fecal incontinence jaundice Assessment Nursing history Common symptoms associated with GI Problems; Pain - can be a major GI symptom. Note the character, duration, pattern, frequency, location, time of pain. Either aggravated or relieved by food. Dyspepsia - is an upper abdominal discomfort associated with eating (indigestion). Intestinal Gas bloating, distension, feeling of full of gas is a symptom of food intolerance or gas bladder disease Nausea and vomiting - may result from different problems associated with CNS disorders (IICP, infection), visceral afferent stimulation (dysmotility, hepatobiliary, pancreatic disorders) Assessment Nursing history Common symptoms associated with GI Problems; Change in bowel habits and stool characteristics - may signal colonic dysfunction. Stool characteristic may include; Bulky, greasy, foamy stool that are foul in odor Clay colored due to absence of bilirubin Stool with mucous thread or pus visible upon inspection Small dry rock hard

 Loose and watery Assessment Nursing history The nurse must ask for any presence of lesions on the mouth, tongue or throat, discomfort caused by certain foods, use of alcohol and tobacco. Surgical history and current and previous medications used must also be discussed. Assessment Physical Assessment includes assessment of the mouth, abdomen and rectum requires a good source of light full exposure of the abdomen a comfortable, relaxed client with empty bladder Assessment Physical Assessment Oral cavity (inspection and palpation) - remove dentures to allow good visualization of the oral cavity Lips inspect for moisture, color, symmetry and presence of ulcerations. Lips should be moist, pink, smooth and symmetrical. A tongue depressor may be used to aid when assessing the oral cavity. Gums inspect for inflammation, bleeding, retraction and discoloration. Note odor of breath Assessment Physical Assessment Abdomen (inspection, auscultation, palpation, percussion) position the client in supine with knees flexed. Question: the abdominal cavity can be divided into how many quadrants and how many regions? Assessment Physical Assessment Abdomen (inspection, auscultation, palpation, percussion) position the client in supine with knees flexed. Abdomen can be divided or labeled into 4 quadrants or 9 regions. 4 quadrants method involves use of imaginary vertical line from sternum to the pubis and horizontal line across the abdomen through the umbilicus Assessment Physical Assessment Abdomen Inspection is done first noting skin changes, nodules, lesions, scarring, discoloration, inflammation and bruising. Lesion may indicate GI diseases. Contour (flat or round) and symmetry are noted for any localized bulging, distension, and peristaltic wave.

 Assessment Physical Assessment Abdomen Auscultation should be done before percussion and palpation since they may alter sound. Determine character, location and frequency of bowel sound (gurgling sound) using the diaphragm of stethoscope. Bowel sound maybe describe as normal (1 for every 5 to 20 sec), hypoactive ( 1 or 2 every 2 mins), hyperactive ( 5 to 6 in less than 30 sec),or absent (no sound in 3 to 5 min). Assessment Physical Assessment Abdomen Percussion is used to assess presence of air, fluid and solid masses and together with palpation to validate findings. Tympani are the sound produce as a result of presence of air in the stomach Assessment Physical Assessment Rectal inspection and palpation - used to evaluate the terminal portion of the GI tract. Position at left lateral and inspect for lumps, rashes, inflammation, tears, scars. Internal exam is used to note for nodules and patient is encourage to do deep breathing exercises during procedure. Assessment Diagnostic test is used to confirm, rule out, stage or diagnose a disease. Assessment Diagnostic test Serum studies includes CBC, PT, PTT, liver function test, and other blood chemistry. CEA (carcinoembryonic antigen) and CA 19-9 (cancer antigen) have high sensitivity to colorectal and pancreatic cancer. Fecalysis Examination of stool consistency, color and the presence of occult blood Special tests for fat, nitrogen, parasites, ova, pathogens and others FOBT (fecal occult blood testing) is one of the most commonly performed test for early cancer detection but should not be done when there is hemorrhoid bleeding. Instruct the patient to adhere to a 3-day meatless diet No intake of NSAIDS, aspirin and anti-coagulant

 Breath test urea breath test detect presence of helicobacter pylori, a bacteria that can live in the stomach and cause PUD Assessment Diagnostic test Abdominal ultrasound noninvasive diagnostic technique using high frequency sound wave. Useful in detection of gallbladder, pancreatic, stones. Special preparation are done prior to specific procedure Assessment Diagnostic test Imaging studies This test aid in diagnosing ulcers, varices, and tumors. UGIS / Barium swallow detect problems on the upper GI organs. Barium sulfate as contrast medium Pre-test: NPO post-midnight Post-test: Laxative is ordered, increase fluid intake, instruct that stools will turn white, monitor for obstruction Barium enema detect presence of polyps, tumors and lesions of the large intestines or lower GI organs Pre-test: Clear liquid diet and laxatives, NPO post-midnight, cleansing enema prior to the test Post-test: Laxative is ordered, increase patient fluid intake, instruct that stools will turn white, monitor for obstruction Computed tomography scan multiple x-ray are performed. Often used with contrast medium for better visualization. MRI done to supplement CT scan and UTZ. Contraindicated for patients with internal metal devices such as pacemaker, implants. END LECTURE