GASTROINTESTINAL SYSTEM

Anatomy Of Digestive System

 Alimentary Canal
 Mouth
 Pharynx
 Esophagus
 Stomach
 Small / Large Intestine
 Anatomy Of Digestive System

 Accessory
glands
 Liver
 Gallbladder

 Salivary glands

 Pancreas
 Esophagus
 Long muscular tube carries food and saliva
from laryngopharynx to stomach
 Approximately 10 in. long in adult
 Lies in midsagittal plane
 Esophagus
 Originates around C-6
 In thorax, it is anterior
to spine, posterior to
trachea and heart
 Passes through
diaphragm through
esophageal hiatus
 Esophagus
 Inferior to diaphragm
curves sharply left
 Joins stomach at
esophagogastric
junction
 Stomach
 Dilated saclike portion
of digestive tract
 Composed of same 4
layers as esophagus
 Outermost - fibrous
 Muscular
 Submucosal
 Innermost - Mucosal
 Stomach (cont’d)

 Divided into 4 parts

 Cardia
 Fundus
 Body
 Pyloric portion
 Entrance to stomach is
cardiac orifice
 Controlled by cardiac sphincter
 Exit is the pyloric orifice
 Controlled by pyloric sphincter
 Stomach (cont’d)

 Body
 Begins at cardiac notch

 Contains rugae

 Terminates at angular
notch
 Pyloric portion
 Consists of pyloric
antrum and canal
 Functions Of Stomach

 Food is chemically broken down

 Storage area for further digestion

 Broken down material is called?

 chyme
 Small Intestine
 Extends from pyloric
sphincter to ileocecal
valve
 Joins large intestine at
right angle
 Digestion and absorption
of food occur in small
intestine
 Approximately 22 feet in
length in adult
 Small Intestine
 Contains same four layers as
stomach and esophagus
 Mucosa contains projections
called villi to facilitate
digestion and absorption
 Divided into 3 parts:
 Duodenum
 Jejunum
 Ileum
 Duodenum
 8 - 10 inches in length

 Widest portion of small intestine

 Follows a C-shaped course

 Duodenum (cont’d)
 Contains 4 regions
 Superior, descending,
horizontal, ascending
 Head of pancreas is
contained in duodenal
loop - second portion
 Jejunum And Ileum
 Jejunum
 Upper remaining 2/5 of small
bowel
 Ileum
 Terminates at ileocecal valve
 Both are gathered into freely
movable loops (gyri)
 Attached to posterior
abdominal wall by mesentary
 Generally found in central and
lower part of abd. cavity
within arch of large intestine
 Large Intestine
 Begins at right iliac
region
 Joins ileum of small
intestine
 Forms arch around
small intestine
 Four main parts
 Cecum
 Colon
 Rectum
 Anal canal
 Large Intestine cont’d
 About 5 feet in length in adult
 Greater in diameter than small intestine
 Contains same four layers as esophagus,
small intestine, and stomach
 Portions Of Large Intestine
 Cecum
 Ascending
 Joins transverse colon at right
colic flexure
 Transverse
 Descending
 Joins transverse colon at left
colic flexure
 Sigmoid
 Rectum
 Anal canal
 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
 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
Radiographic Exams
 Contrast Media
 Barium sulfate
 Water insoluble

 Iodinated contrast media

 Water soluble

 Horrible taste

 Does not adhere to wall of

alimentary tract
 Indicated in case of
perforation
 Contrast Media
 Air
 Considered a negative
contrast
 Generally administered
by carbon dioxide
crystal ingestion
 Barium and Air are often
used as a double contrast
agent
 Preparing pt. for GI study
 Have contrast agents mixed and ready to
go
 Explain exam to pt.

 Ensure pt. has followed preparation

instructions!
 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
 Preparation cont’d
Ensure that footboard is securely on table!

Use short exposure times

Take exposures end of full expiration!

 Radiography Of Esophagus
 Can use double or single
contrast
 Barium should flow to
sufficiently coat esophagus
 Can be done upright or
recumbent
 Exam will usually be
started with fluoroscopy
 AP or PA Projection
 Pt. supine or prone
 Bottom of cassette
should be placed just
below tip of xyphoid
 Pt. drinks contrast
before exposure and
continues drinking
during exposure
 Pt should be
rotated 35 - 40
degrees
Pt must drink
before and
during exposure

Use shielding!
 Structures Shown/Film Evaluation
 Entire barium filled
esophagus from lower neck
to stomach
 Barium should be
sufficiently penetrated
 Surrounding structures
should be visible, not
overpenetrated
 Esophagus should be
displayed between heart and
spine on oblique projections
What is the Valsalva Maneuver?
 Useful in demonstrating esophageal varices
 Have pt. first deeply inspire
 Swallow contrast
 Bear down
 Recumbent position
 Esophageal varices
Extremely dilated sub-
mucosal veins in the lower
esophagus

Most often a consequence

of portal hypertension,
commonly due to cirrhosis

Pts with esophageal varices

have a strong tendency to
develop bleeding
 Radiography Of The Stomach

Upper GI Series
 Generally consists of fluoroscopy and serial
radiographs
 Single or double contrast

 Pt. should follow a low residue diet for 2 days

prior to exam
 Pt. must be NPO after midnight
 Single v. Double Contrast
 Single Contrast
 Shows size, shape, and
position of stomach
 Examines changing
contour of stomach
during peristalsis
 Observe filling and
emptying of duodenal
bulb
 Double Contrast

 Mucosal lining is
well visualized
 Small lesions are
less easily
obscured
 Small Bowel Follow Through
 Preparation
 Low residue diet for 2 days prior when possible
 NPO after midnight before exam

 Examination Procedure
 Scout film obtained
 Patient drinks barium

 Images obtained in prone or supine position

 Images begin 15 minutes after barium ingested

 Barium usually reaches ileocecal valve in about 2 -3

hours
Radiography Of Small Intestine
 Contrast administration 3 Ways
 Orally

 Retrograde
 Reflux filling via barium enema

 Direct injection of contrast through NG tube

 Enteroclysis (Radiocontrast is infused through tube inserted
through nose to duodenum, and images are taken in real time as contrast
moves through)
 Small Intestine Follow Through

Immediate 15 minutes
Small Intestine Follow Through

30 minutes 1 hour
 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
 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
 Preparation of Colon
 Pt must take laxative on day prior to exam
 Pt may have clear liquid day prior to exam
 NPO after midnight
 Cleansing enemas may also be indicated
 Pt. Preparation
 Explain exam fully to pt.
 Use care when inserting enema tip!
 Retention-type balloon tips should only be
inflated under fluoroscopic control
 Barium should only be administered under
fluoroscopic control by radiologist
 Single or double contrast

 Single
demonstrates
anatomy and tonus
(contraction) of
colon, along with
most abnormalities

Feces
 Double Contrast
 Double allows
visualization of
lumen along
with any
polyps or
lesions
 PA Projection - Barium Enema
 Pt. prone

 Entire colon must be

visualized
 Barium should be
sufficiently penetrated
with surrounding
structures visible
PA Axial Projection - BE
 Lateral Projection - Barium Enema

Best demonstrates
rectum and distal
sigmoid portions of
colon
Rectosigmoid area
should be centered,
no rotation
Upright Position - Barium Enema
 Demonstrates air-filled flexures and
transverse colon
 Defecography is used to Evaluate:
 Chronic Constipation
 Rectal prolapse (walls of rectum protrude through anus
and become visible outside body)
 Rectocele (outpouching of rectum)
 Fecal incontinence
 Anismus (inappropriate spasm of anal sphincter)
 Defecography
 A thickened barium
contrast putty is injected
into rectum and then
excreted by the patient
while radiologist
watches and videotapes
 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
 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
 COMMON LABORATORY
PROCEDURES
EGD
esophagogastroduodenoscopy
 Intra-test: position : LEFT lateral to facilitate salivary drainage
and easy access
 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
 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
 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
 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
 COMMON LABORATORY
PROCEDURES
Cholecystography
 Post-test: Advise that dysuria is common as the dye is
excreted in the urine, resume normal activities
 COMMON LABORATORY
PROCEDURES
Paracentesis
 Removal of peritoneal fluid for analysis
 COMMON LABORATORY
PROCEDURES
Paracentesis

 Pre-test: ensure consent, instruct to VOID and

empty bladder, measure abdominal girth
 COMMON LABORATORY
PROCEDURES
Paracentesis
 Intra-test: Upright on the edge of the bed, back
supported and feet resting on a foot stool
 COMMON LABORATORY
PROCEDURES
Liver biopsy
 Pretest

 Consent

 NPO

 Check for the bleeding parameters

 COMMON LABORATORY
PROCEDURES
Liver biopsy
 Intratest

 Position: Semi fowler’s LEFT lateral to expose right

side of abdomen
 COMMON LABORATORY
PROCEDURES
Liver biopsy
 Post-test: position on RIGHT lateral with pillow underneath,
and complications like bleeding, perforation. Instruct to
avoid lifting objects for 1 week
 The NURSING PROCESS in GIT
Disorders
Assessment
 Health history Nursing History

 PE

 Laboratory procedures
 The ABDOMINAL examination
The sequence to follow is:
 Inspection

 Auscultation

 Percussion

 Palpation
THANX