Nursing Assessment of the Gastrointestinal System

1
Nursing Assessment of the Gastrointestinal System

• Sasha Alexis Rarang, RN, MSN

2
The digestive system
3
Structures and Function of the GastroIntestinal
System

• Main Function of the GI System?????
• Supply Nutrients to body cells

4
Process of Digestion and Elimination

1. Ingestion ( Taking In Food)
2. Digestion ( Breakdown of Food)
3. Absorption ( transfer of food products into the
   circulation)
4. Elimination

5
Concepts of Structures and Functions

• The GI System consists of the GI tract and its
  associated organs and glands
• GI tract
• 1. mouth
• 2. esophagus
• 3. stomach
• 4. small intestines
• 5. large intestines
• 6. rectum
• 7. anus
• B. Associated organs
• 1. liver
• 2. gall bladder
• 3. pancreas

6
Mouth

7
Mouth

• Oral or buccal cavity
• Chewing
• gtgt break food products into smaller
• portions.
• gtgt allows digestion and prevent trauma to
  the mucous lining of the esophagus.
• gtgt person exert 25 to 275 lbs during the
  chewing process.
• gtgt Dentures vs. Natural teeth
• gtgt poorly chewed foods are not readily
  digested.

8
Saliva

• Secreted by the sublingual and submandibular
  glands.
• Lubricate and softens the food mass
• Amylase breaks down starches to maltose.

9
Swallowing

• Involves 3 phases
• gtgtoral phase
• gtgtinvoluntary pharyngeal phase
• gtgtesophageal phase
• gt The time it takes for the bolus to reach the
  stomach depends on the consistency of the bolus
  and individuals position.

10
Esophagus

11
Esophagus

• A hollow muscular tube
• Lies posterior to the trachea and larynx
• Serves as a passage for food from mouth to
  stomach.
• gtgt upper esophageal sphincter
• gtgt lower esophageal sphincter
• Antireflux barrier
• Act as a vent for increased intragastric
  pressure.

12
stomach
13
Stomach

• Structures
• a.1. fundus
• a.2. body/central area
• a.3. antrum/pyloric region
• a.4. cardiac sphincter
• a.5. Pyloric sphincter
• B. Microscopic Glands ( epithelial lining of the
  stomach)
• b.1. Cardiac glands mucus
• b.2. Peptic (Chief Cells) mucus and pepsinogen
• b.3. Parietal (Oxyntic) HCl acid and water
• protein digestion
• intrinsic factor B12 absorption
• b.4. Neck cells mucus
• b.5. Pyloric glands gastrin and mucus
• stimulates HCl acid production

14
Stomach

• C. Functions
• c.1. storage, mixing and liquefaction of the
• bolus of food into chyme, control of
• passage of food into the duodenum.
• c.2. first stage of protein breakdown
• c.3. mechanical breakdown of food
• c.4. absorption of water, alcohol, glucose,
• and some drugs.
• c.5. protection

15
Stomach

• D. Innervation
• d.1. parasympatehetic vagus nerve
• d.1.1. increased gastric secretion of
  acid, gastrin and pepsin.
• d.1.2. increased gastric acid motor
  activity.
• d.2. sympathetic inhibit gastric secretion
  and motility.

16
Stomach

• E. Secretions 1.5L to 3.0.L of gastric juice
  per day.
• e.1. HCl acid, pepsin, and mucus.
• e.2. mucin, intrinsic factor, lipase, and
• pepsinogen.
• e.3. Gastric acid secretion is directly
  stimulated by the distention of the stomach and
  presence of protein.
• e.4. vagal stimulation, acetylcholine,
  histamine, and the hormone gastrin.
• e.5. gastrin is released when the stomach
  becomes distended with food.

17
Stomach
18
Stomach
19
Small intestines
20
Small Intestine

• Structure (22 feet long/1 inch in diameter)
• a.1. duodenum
• a.2. jejunum
• a.3. ileum
• B. Function
• b.1. completes the digestion of foods
• b.2. absorbs the products of digestion
• b.3. secretes hormones control
• secretions of bile, pancreatic juice, and
• intestinal secretions.

21
Small Intestine

• C. Innervation
• c.1. sympathetic inhibits motility
• c.2. parasympathetic increases intestinal
• tone and motility.
• D. Secretions
• d.1. Brunners glands(duodenal) mucus
• d.1.1. glucagon, presence of chyme, and vagal
• stimulation.
• d.1.2. sympathetic stimulation inhibits
  secretions of the
• glands.
• d.2. Goblet cells mucus
• d.3. crypts of Lieberkuhn secretes an alkaline
  fluid
• d.4. epithelial cells digestive enzymes
• d.4.1. enterokinase activates trypsin
• d.4.2. maltase,lactase, and sucrase
  disaccharides
• into simple sugars.

22
Small Intestine

• E. Absorption
• e.1. Complex foods are converted into its
  simplest forms.
• e.1.1. CHO monosaccharides
• e.1.2. CHON amino acids
• e.1.3. Fats fatty acids,
• monoglycerides, diglycerides and
  triglycerides.
• e.2. Water absorption 8L/day
• e.3. water-soluble vitamins, electrolytes,
• minerals.
• e.4. B12 absorption takes place in the
• ileum

23
Large intestines
24
Large Intestines

• Structures ( 5-6 feet long)
• a.1. Cecum
• a.2. Colon
• a.2.1. Ascending
• a.2.2. Transverse
• a.2.3. descending
• a.2.4. Sigmoid colon
• a.3. Rectum and Anus ( final segments of the
  large intestine)
• B. Function
• b.1. absorb the remaining water, urea,and
  electrolytes.
• b.2. secretes mucus
• b.3. form and store the feces until defecation

25
Large Intestine

• C. Innervation
• c.1. parasympathetic vagus nerve
• increases peristalsis, decrease
• tone of the sphincter.
• c.2. sympathetic reduce peristaltic
• activity and increase tone of
• sphincters.
• D. Secretion
• d.1. water, mucus, potassium, and bicarbonate
• alkaline solution.
• d.2. Mucus lubricates, allows passage of the
  fecal matters, protects the mucosa from
  injury.

26
Rectum
27
Anus
28
Associated Organs of the GI System
29
Liver
30
Activities of the tract

• Secretion of electrolytes, hormones, and enzymes
• Movement of the Ingested products
• Digestion of food and fluids
• Absorption of end products into the bloodstream.

31
A. Secretion of electrolytes, hormones, and
enzymes

• Hormones gastrin
• Electrolytes H2, Cl, Na, K,
• Enzymes pancreatic lipase, enterokinase, ptyalin

32
Movement of the Ingested products
33
Digestion of food and fluids
34
Absorption of end products into the bloodstream
35
Secretions

• Mucous secretions
• a. produced throughout the entire length of the
  tract.
• b. protects and lubricate the walls of the GI
  tract.
• 2. Digestive secretions.
• a. produced in the mouth, stomach, duodenunum,
  and jejunum.
• b. break down ingested food so that it can be
  absorbed.

36
Secretion
37
Motility

• 2 types of movement in the GIT
• Mixing
• Propulsion / Peristalsis
• Soft muscle tissues of the GIT

38
Digestion and Absorption

• Food is broken down into small and simple
  compounds enough to be absorbed into the
  bloodstream by diffusion or active transport.

39
Digestion and secretion
40
Effects of Aging on the Gastrointestinal Tract

• Teeth may loosen up from the supporting gums and
  bones.
• Decreased output of the salivary glands leads to
  dryness of mucous membranes and increased
  susceptibility to breakdown, difficulty
  swallowing and decrease stimulation of the taste
  buds.
• Decreased secretion of digestive enzymes and bile
  decrease ability to digest and absorb food.
• gtgt impaired absorption of fat and fat soluble
  vitamins
• D. Atrophy of gastric mucosa leads to decrease
  HCl acid production.
• gtgtdecrease iron and B12 absorption anemia
• gtgtproliferation of bacteria diarrhea and
  infection
• E. Decrease peristalsis in the large intestine,
  decrease muscular tone of the intestinal wall and
  decrease abdominal muscle strength decrease
  sensation to defecate and increase incidence of
  constipation.

41
Teeth may loosen up from the supporting gums

42
Decreased output of the salivary gland

• Dryness of the mucous membrane
• Difficulty swallowing
• Decrease stimulation of the taste buds

43
Effects of aging on the gastrointestinal tract

• Decreased secretion of digestive enzymes and bile
  decrease ability to digest and absorb food.
• Ex.
• Impaired absorption of fat and fat soluble
  vitamins

44
Effects of aging on the GI tract

• gt Atrophy of gastric mucosa leads to decrease HCl
  acid production

45
Assessment of the GI System
46
Assessment of the GI System

• Past Health History
• a.1. history or existence of
• gt abdominal pain gt nausea and
• vomiting
• gt diarrhea gt constipation
• gt abdominal distention gt jaundice
• gt anemia gt heartburn
• gt dyspepsia gt changes in appetite
• gt hematemesis gt food intolerance
• gt allergies gt indigestions
• gt excessive gas gt bloating
• gt melena gt hemorrhoids
• gt rectal bleeding

47
Assessment.

• B. Medications
• b.1. past and current use of medications
• b.1.1. OTC drugs
• b.1.2. prescription drugs
• b.1.3. herbal products and nutritional
• supplements.
• b.2. hepatotoxic, diarrhea, GI bleeding
• C. Surgeries and other treatments
• c.1. information about hospitalizations for
  any problems related to GI system

48
Functional Health Assessment

49
AssessmentObjective Data

• Inspection
• a.1. Lips symmetry, color and size
• observe for abnormalities pallor or
  cyanosis, cracking, ulcers, or fissures.
• a.2. Tongue color, fissures, deviation
• and lesions
• a.3. Buccal Mucosa color and lesions and
  distinctive breath odors
• a.4. teeth and gums caries, loose teeth,
  abnormal shape and position of the teeth,
  presence of swelling , bleeding,
  discoloration.

50
Assessment.

• a.5. Abdomen
• a.5.1. Skin changes ( color, texture, scars,
  striae, dilated veins, rashes, and lesions.)
• a.5.2. umbilicus location and contour
• a.5.3. symmetry
• a.5.4. contour flat, rounded, distended.
• a.5.5. observable masses hernias and other
  masses.
• a.5.6. movement observable peristalsis and
  pulsation.

51
Assessment Inspection (Skin changes)
52
Assessment
Quadrants of the Abdomen                        
                                                  
                                                  
                           
53
Abdominal distention dilated veins
Draping the Abdomen                             
                                                  
                                          
54
Obese abdomen
55
Hepatomegaly
56
ascites
57
Umbilical Hernia
58
Pregnancy
59
Assessment.

• B. Auscultation (done before percussion and
  palpation)
• b.1. listening for increased or decreased bowel
  sounds.
• b.2. diaphragm of the stethoscope bowel sounds
  are high pitched, occur 5-35x per minute.
• b.3. warm up stethoscope in the hands to prevent
  abdominal muscle contraction.
• b.4. listen for BS for 2-5 minutes. Absent BS
  means no sounds for 5 minutes on each quadrant.
• C. Percussion
• c.1. purpose??? Determine the presence of fluid,
  distention, and masses. Presence of air
  tymphany,
• fluid or masses dull sounds

60
Auscultation Listen for.
61
Increased or decreased bowel sounds

• Normoactive, hypoactive,hyperactive, or absent

62
Listen with the diaphragm side of the stethoscope

• BS are high pitched sounds,
• 3-5x a minute

63
Warm up the stethoscope in the hands to avoid
undue abdominalmuscle contraction
64
Listen for BS for 2-5 minutes on each quadrant

• Absent BS means no sounds for 5 minutes.

65
Assessment Percussion
66
Purpose?????

• Determine the presence of fluid, distention, and
  masses

67
Tymphany is normally present in most areas of the
abdomen

• Dullness!!!!! Ac lue to an underlying mass

68
(No Transcript)
69
Assessment Palpation
70
Light palpation 1cm deep

• Look for area of tenderness
• Look for patients facial expression and guarding

71
Deep palpation

• Delineate body abdominal organs

72
Use two-hand method
73
(No Transcript)
74
Diagnostic Studies

• Upper GI Series or Barrium Swallow
• gt X-ray study with fluoroscopy with contrast
  medium
• gt used to diagnose structural abnormalities of
  the esophagus, stomach, and duodenal bulb
• gtNPO for 8-12 hours
• gt pt. will drink contrast medium
• gt give pt. laxatives and fluid to prevent
  contrast medium impaction.
• gt the stool may be white up to 72 hours after
  the test
• B. Small Bowel Series same as upper GI series

75
Diagnostic tests

• C. Lower GI or Barium Enema
• gt Fluoroscopic examination of the colon using
  contrast medium w/c is administered rectally.
• gt administer laxatives and enemas the night
  before the procedure.CLEAR
• gt clear liquid diet the night before.
• gt NPO for 8 hours before the procedure.
• gt cramping and urge to defecate may occur.
• gt explain that pt will be assuming various
  position in tilt table.
• gt give laxatives, fluids to assist in expelling
  barium.

76
Diagnostic tests

• C. Ultrasound
• gt noninvasive procedure uses high frequency
  soundwaves to visualize the solid organs.
• gt NPO 8-12 hours
• D. CT-Scan
• gt non invasive radiologic examination that
  combines x-ray machine and computer.
• E. MRI
• gt non invasive procedure using radiofrequency
  waves and magnetic field
• gt NPO for 6 hours
• gt C/I in pt with metal implants or who is
  pregnant

77
Diagnostic tests
78
(No Transcript)
79
End of Topic