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 • Ingestion ( Taking In Food) • Digestion ( Breakdown of Food) • Absorption ( transfer of food products into the circulation) • 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 >> break food products into smaller portions. >> allows digestion and prevent trauma to the mucous lining of the esophagus. >> person exert 25 to 275 lbs during the chewing process. >> Dentures vs. Natural teeth >> 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 >>oral phase >>involuntary pharyngeal phase >>esophageal phase > The time it takes for the bolus to reach the stomach depends on the consistency of the bolus and individual’s 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. >> upper esophageal sphincter >> 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. Brunner’s 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. >> impaired absorption of fat and fat soluble vitamins D. Atrophy of gastric mucosa leads to decrease HCl acid production. >>decrease iron and B12 absorption – anemia >>proliferation 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. Dryness of the mucous membrane Difficulty swallowing Decrease stimulation of the taste buds Decreased output of the salivary gland

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 > 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 ; > abdominal pain > nausea and vomiting > diarrhea > constipation > abdominal distention > jaundice > anemia > heartburn > dyspepsia > changes in appetite > hematemesis > food intolerance > allergies > indigestions > excessive gas > bloating > melena > hemorrhoids > 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. Assessment…Objective 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.