Nursing Assessment of the Gastrointestinal System

Sasha Alexis Rarang, RN, MSN

The digestive system

Structures and Function of the GastroIntestinal System

Main Function of the GI System?????

Supply Nutrients to body cells

Process of Digestion and Elimination

A. Ingestion ( Taking In Food)

B. Digestion ( Breakdown of Food)

C. Absorption ( transfer of food products into the circulation)

D. Elimination

Concepts of Structures and FunctionsThe GI System consists of the GI tract and its associated organs and glandsA. GI tract

1. mouth2. esophagus3. stomach4. small intestines5. large intestines6. rectum7. anus

B. Associated organs1. liver2. gall bladder3. pancreas

Mouth

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.

Saliva Secreted by the sublingual and

submandibular glands. Lubricate and softens the food mass Amylase – breaks down starches to

maltose.

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.

Esophagus

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.

stomach

StomachA. Structures

a.1. fundusa.2. body/central areaa.3. antrum/pyloric regiona.4. cardiac sphinctera.5. Pyloric sphincter

B. Microscopic Glands ( epithelial lining of the stomach)b.1. Cardiac glands – mucusb.2. Peptic (Chief Cells) – mucus and pepsinogenb.3. Parietal (Oxyntic) – HCl acid and water

protein digestionintrinsic factor – B12 absorption

b.4. Neck cells – mucusb.5. Pyloric glands – gastrin and mucus

stimulates HCl acid production

StomachC. 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 breakdownc.3. mechanical breakdown of foodc.4. absorption of water, alcohol, glucose,and some drugs.c.5. protection

StomachD. Innervation

d.1. parasympatehetic – vagus nerved.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.

StomachE. 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.

Stomach

Stomach

Small intestines

Small IntestineA. Structure (22 feet long/1 inch in diameter)

a.1. duodenuma.2. jejunuma.3. ileum

B. Functionb.1. completes the digestion of foodsb.2. absorbs the products of digestionb.3. secretes hormones – control

secretions of bile, pancreatic juice, andintestinal secretions.

Small IntestineC. Innervation

c.1. sympathetic – inhibits motilityc.2. parasympathetic – increases intestinal tone and motility.

D. Secretionsd.1. Brunner’s glands(duodenal) – mucusd.1.1. glucagon, presence of chyme, and vagal stimulation.d.1.2. sympathetic stimulation inhibits secretions of the glands.d.2. Goblet cells – mucusd.3. crypts of Lieberkuhn – secretes an alkaline fluidd.4. epithelial cells – digestive enzymesd.4.1. enterokinase – activates trypsind.4.2. maltase,lactase, and sucrase – disaccharides into simple sugars.

Small IntestineE. Absorption

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

Large intestines

Large IntestinesA. Structures ( 5-6 feet long)

a.1. Cecuma.2. Colon

a.2.1. Ascendinga.2.2. Transversea.2.3. descendinga.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 mucusb.3. form and store the feces until defecation

Large IntestineC. Innervation

c.1. parasympathetic – vagus nerveincreases peristalsis, decreasetone of the sphincter.c.2. sympathetic – reduce peristalticactivity and increase tone ofsphincters.

D. Secretiond.1. water, mucus, potassium, and bicarbonate –alkaline solution.d.2. Mucus – lubricates, allows passage of the fecal matters, protects the mucosa from injury.

Rectum

Anus

Associated Organs of the GI System

Liver

Activities of the tractA. Secretion of electrolytes, hormones, and

enzymes

B. Movement of the Ingested products

C. Digestion of food and fluids

D. Absorption of end products into the bloodstream.

A. Secretion of electrolytes, hormones, and enzymes

Hormones – gastrin

Electrolytes – H2, Cl, Na, K,

Enzymes – pancreatic lipase, enterokinase, ptyalin

Movement of the Ingested products

Digestion of food and fluids

Absorption of end products into the bloodstream

Secretions1. 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.

Secretion:

Motility2 types of movement in the GITA. Mixing

B. Propulsion / Peristalsis

****Soft muscle tissues of the GIT****

Digestion and AbsorptionFood is broken down into small and simple

compounds enough to be absorbed into the bloodstream by diffusion or active

transport.

Digestion and secretion

Effects of Aging on the Gastrointestinal TractA. Teeth may loosen up from the supporting gums and bones.B. 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.

C. 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.

Teeth may loosen up from the supporting gums

Decreased output of the salivary gland Dryness of the mucous

membrane Difficulty swallowing Decrease stimulation of the

taste buds

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

Effects of aging on the GI tract> Atrophy of gastric mucosa leads to decrease

HCl acid production

Assessment of the GI System

Assessment of the GI SystemA. 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

Assessment….B. Medications:

b.1. past and current use of medicationsb.1.1. OTC drugsb.1.2. prescription drugsb.1.3. herbal products and nutritional supplements.b.2. hepatotoxic, diarrhea, GI bleeding

C. Surgeries and other treatmentsc.1. information about hospitalizations for any problems related to GI system

Functional Health Assessment

Assessment…Objective DataA. Inspection

a.1. Lips – symmetry, color and sizeobserve for abnormalities – pallor or cyanosis, cracking, ulcers, or fissures.a.2. Tongue – color, fissures, deviation and lesionsa.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.

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

Assessment: Inspection (Skin changes)

AssessmentQuadrants of the Abdomen

                                                                                        

                                                              

Abdominal distention; dilated veinsDraping the Abdomen

                                                                                                                        

Obese abdomen

Hepatomegaly

ascites

Umbilical Hernia

Pregnancy

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. Percussionc.1. purpose??? Determine the presence of fluid, distention, and masses. Presence of air – tymphany,

fluid or masses – dull sounds

Auscultation: Listen for…….

Increased or decreased bowel sounds

Normoactive, hypoactive,hyperactive, or absent

Listen with the diaphragm side of the stethoscope

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

Warm up the stethoscope in the hands to avoid undue abdominalmuscle contraction

Listen for BS for 2-5 minutes on each quadrant

Absent BS means no sounds for 5 minutes.

Assessment: Percussion

Purpose?????

Determine the presence of fluid, distention, and masses

Tymphany is normally present in most areas of the abdomen

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

Assessment: Palpation

Light palpation – 1cm deep

Look for area of tendernessLook for patient’s facial expression and guarding

Deep palpation

Delineate body abdominal organs

Use two-hand method

Diagnostic StudiesA. Upper GI Series or Barrium Swallow

> X-ray study with fluoroscopy with contrast medium> used to diagnose structural abnormalities of the esophagus, stomach, and duodenal bulb>NPO for 8-12 hours> pt. will drink contrast medium> give pt. laxatives and fluid to prevent contrast medium impaction.> the stool may be white up to 72 hours after the test

B. Small Bowel Series – same as upper GI series

Diagnostic testsC. Lower GI or Barium Enema

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

Diagnostic testsC. Ultrasound

> noninvasive procedure uses high frequency soundwaves to visualize the solid organs.> NPO 8-12 hours

D. CT-Scan – > non invasive radiologic examination that combines x-ray machine and computer.

E. MRI> non invasive procedure using radiofrequency waves and magnetic field> NPO for 6 hours> C/I in pt with metal implants or who is pregnant

Diagnostic tests

End of Topic