GI system

Mr. Homood Alharbi

Anatomy

Function of G I system

The Primary Digestive Functions are

1. Break down food particles “molecular forms ” for digestion

2. Absorb into the bloodstream the small molecules produced by digestion

3. Eliminate waste products & undigested food

Function of G I system

Chewing & Swallowing1. Food is broken down into small praticles that

can be swallowed. 2. 3 glands secreted 1.5 L of saliva daily3. Saliva contain Ptyalin enzyme “salivary

amylase” which aids for starch digestion4. Saliva contain mucus and water which

lubricates food as it chewed & swallowed.5. Swallowing begins as voluntary act (Medulla).6. When food swallowed, epiglottis moves and

close the trachea (aspiration).

Gastric function

1. Hydrochloric acid (HCI) to destruct most ingest bacteria ,&

break down food

2. Pepsin for initiation of protein digestion

3. Intrinsic factors combined with B12, which allow it to be

absorbed by intestine (anemia)

4. The food mixed with gastric secretions is called chyme .

5. Stomach peristalsis moves chyme into small inesitine.

Function of G I system

Small Intestine function1- Pancreas : - pancreas secretion has alkaline PH to neutralize acid

entering duodenum. - Trypsin aids in digestion of proteins - Amylase aids in digestion starch - Lipase aids in digestion of fats 2- Liver : - bile produced by liver and stored in gallbladder. - bile aids, in emulsifying ingested fats making it

easier to digest and absorb.

3- Intestinal Glands :

- secrete mucus ,hormones ,electrolytes ,and enzymes

4- Two types of contractions in intestine:

Segmentation contraction: back and forth waving

Intestinal peristalsis: moves contents toward the colon.

5- foods, initially ingested in forms of proteins, fats, and carbohydrates,

is broken down into small absorbable particles.

6- Absorption is the primary function of small intestine

Function of GI system

Colonic Function1. Bacteria make up major componenet of the large intestine

(breakdowm unabsrobed and undigested food).

2. Two types of colonic secretion:

-Mucus: protect colonic mucosa

-Electrolytes: mainly “HCo3” neutralize the end products

3. Slow peristaltic to allow absorption of water & electrolytes.

4. The waste materials reaches the distended rectum & pass through anus.

Health assessment for GI patients

Pain: location, duration, freguency, factors, associated with, and severity.

Intestinal gas: from mouth or rectumPatient may complain of gas or abdominal distention.Excessive gas may indicates food intolerance or

gallbladder diseases. Bowel sounds: normal, hypoactive, hyperactive,

absent.

Health assessment for GI patients Nausea and Vomiting:Nausea triggered by odors, activities, food

intakes.Emesis contain undigested food, and blood

“hematemesis”. If blood is bright red “ fresh bleeding”, if blood is

coffee ground “ old blood”. Change in bowel habits “diarrhea, constpiation” Abdominal Ultrasound. Endoscopy/ Colonoscopy.

Achalasia

characterized by impaired peristalsis of smooth muscle of esophagus and impaired relaxation of lower esophageal sphincter

Manifestations: Dysphagia , chest pain (pyrosis), Sensation of food stick in lower esophagus, Food regurgitation.

Tratment:

Eat slowly &drink fluids with meals Calcium channel blockers Endoscopically guided injection of botulinum toxin Balloon dilation of lower esophageal sphincter or pneumatic

dilation Esophageal myotomy (abdominal or thoracic approach

ANOREXIA: lack of appetite, could be from emotional or physical

factors

lab tests may be done to assess nutritional status

Medical treatment: supplements may be ordered, TPN or enteral feedings

Nursing Interventions:oral hygiene, clean room, determine cause of nausea

and treat, include family and friends(socialization), respect likes and dislikes, education

Gastroesophageal Reflux Disease (GERD)

Gastroesophageal reflux is the backward flow of gastric content into the esophagus.

Manifestations: 1. Heartburn after meals, while bending over, or

recumbent2. Dyspepsia or indigestion 3. May have regurgitation of sour materials in mouth,

pain with swallowing4. Atypical chest pain5. Sore throat with hoarseness

Gastroesophageal Reflux Disease (GERD)

Diagnostic TestsBarium swallow (evaluation of esophagus, stomach,

small intestine)Upper endoscopy: direct visualization; biopsies may

be done24-hour ambulatory pH monitoring

Gastroesophageal Reflux Disease (GERD)

MedicationsAntacids for mild to moderate symptoms, e.g. Maalox,

Mylanta, GavisconH2-receptor blockers: decrease acid production; ranitidine,

famotidine, nizatidineProton-pump inhibitors: reduce gastric secretions, promote

healing of esophageal erosion and relieve symptoms, e.g. omeprazole (prilosec); lansoprazole

Promotility agent: enhances esophageal clearance and gastric emptying

Gastroesophageal Reflux Disease (GERD)

Dietary and Lifestyle Management Elimination of acid foods (tomatoes, spicy, citrus

foods, coffee) Avoiding food which relax esophageal sphincter or

delay gastric emptying (fatty foods, chocolate, alcohol) Maintain ideal body weight Eat small meals and stay upright 2 hours post eating;

no eating 3 hours prior to going to bed Elevate head of bed on 6 – 8 blocks to decrease reflux No smoking Avoiding bending and wear loose fitting clothing

Gastroesophageal Reflux Disease (GERD)

9.Surgery indicated for persons not improved by diet and life style changes

a. Laparoscopic procedures to tighten lower esophageal sphincter

b. Open surgical procedure: fundoplication

10. Nursing Carea. Pain usually controlled by treatmentb. Assist client to institute home plan

Perforation

May result from stab or bullet wounds of the neck & the chest as well as from accidental puncture by surgical instrument

Clinical Manifestations1. Persistent pain followed by dysphagia

2. Infection ,fever ,& leukocytosis

3. May sign of Pnuemothorax

Perforation

Management

1. Broad spectrum antibiotics

2. Nasogastric tube & suctioning

3. NPO – total parenteral nutrition “gastrostomy”

4. Closed the wound &post op management

Gastritis Inflammation of stomach lining from irritation of

gastric mucosa (normally protected from gastric acid and enzymes by mucosal barrier)

TypesAcute Gastritis

1.Disruption of mucosal barrier allowing hydrochloric acid and pepsin to have contact with gastric tissue: leads to irritation, inflammation, superficial erosions

2.Gastric mucosa rapidly regenerates; self-limiting disorder

•Gastritis

Causes of acute gastritis1. Eating too much or too rapid. 2. Eating contaminated foods. 3. Alcohol, NSAID, and bile reflux

Manifestations1. Abdominal discomfort. 2. Nausea, vomiting, and anorexia. 3. Headache. 4. Hiccuping.

GastritisTreatment

The patient usually recovers within few days spontaneously.If bleeding present, it needs surgery.NPO status to rest GI tract for 6 – 12 hours,

reintroduce clear liquids gradually and progress; intravenous fluid and electrolytes if indicated

b. antacids If gastritis from corrosive substance: immediate dilution and removal of substance by gastric lavage (washing out stomach contents via nasogastric tube),

If extreme condition Gastrojejunostomy or gastric resection

Gastritis

Nursing Management 1. Reducing anxiety2. Promoting optimal nutrition 3. Promoting fluid balance4. Relieving pain Chronic Gastritis Progressive disorder beginning with

superficial inflammation and leads to atrophy of gastric tissues (prolong Gastritis)

Chronic Gastritis

Causes: 1. Benign or malignant ulcers of stomach.

2. Bacteria Helicobacter Pylori (H. Pylori).

3. Smoking and alcohol.

Diagnostic Investigation: 1. Upper GIT endoscopy and biopsies.

2. Serologic testing for H. Pylori antigen- antibodies.

Chronic Gastritis (cont’d)

Clinical Manifestations: 1. Heart burn after eating. 2. Anorexia, nausea and vomiting. 3. Sour taste in the stomach. 4. Belching. 5. Vitamin B12 deficiency. Medical Management: 1. No irritating diet. 2. Antibiotics. 3. Vit. B12 IM injection.

Chronic Gastritis (cont’d)

Nursing Management: 1. Stress reduction techniques. 2. Promoting optimal nutrition: a. Keep patient NPO. b. When the symptoms subside , offer ice chips followed by clear fluid diet then regular diet. 3. Promoting fluid and electrolytes balance. 4. Relief pain: a. Avoid irritating foods. b. Discourage smoking and alcohol.

Peptic Ulcer Disease (PUD) Break in mucous lining of GI tract comes into contact with

gastric juice , referred to as gastric ,duodenal , or esophageal ulcer

Causes:

1. Result from infection with H. pylori or Zollinger-

Ellison syndrome.

2. Stress ulcer caused by stressful event such as:

a. Burns.

b. Shock.

c. Sever sepsis.

Gastric & Duodenal Ulcers (cont’d)

Peptic Ulcer Disease (PUD)

Predisposing Factors: 1. Heredity. 2. Blood group O. 3. Smoking and alcohol. 4. Long use of NSAIDs. 5. Anxiety. Clinical Manifestations: 1. Epigastric pain or in the back. 2. Vomiting ( in duodenal ulcer). 3. Constipation. 4. Bleeding

Peptic Ulcer Disease (PUD)Medical Management 1. Smoking cessation encouraged. 2. Medications: a. Histamine receptor antagonists ( H2 receptor antagonist); ranitidine. b. Proton pump inhibitors; (Omeprazole) c. Antibiotics. 3. Surgical intervention is recommended for intractable ulcers( those who fail to heal after 12-16 weeks). Vagotomy, Pyloroplasty, Partial or total gastroectomy.

Peptic Ulcer Disease (PUD)

Surgical Management Vagotomy1. Truncal2. Selective Pyloroplasty Antrectomy1. Gastroduodenostomy2. Gastrojejunostomy3. Subtotal gastroectomy with anastomosis

Gastric & Duodenal Ulcers (cont’d)

Gastric & Duodenal Ulcers (cont’d)

Gastric & Duodenal Ulcers (cont’d)

Nursing Management: 1. Preoperative care;

a. preparing patient for diagnostic procedures.

b. Limiting oral intake.

c. Clearing and emptying the GIT.

- NGT inserting.

- Mechanical (Gumco) and manual /2hrs suctioning.

- enema for emptying colon.

2. Monitoring and managing complications of

hemorrhage, perforation, and pyloric obstruction.

INTESTINAL OBSTRUCTION

Exists when there is obstruction in the normal flow of intestinal contents through the intestinal tract

Mechanical-Pressure on the intestinal wall

Paralytic-Intestinal musculature unable to propel contents along the bowel

May be partial or complete

Intestinal obstruction causesSMALL BOWEL: adhesions most common intussusception volvulus paralytic ilieus abdominal hernia

LARGE BOWEL: carcinoma diverticulitis inflammatory bowel disorders volvulus

Small Bowel vs Large Bowel

Small:

abdominal pain

vomiting

pass blood and mucous, no stool, no gas

over time signs of dehydration

Large:

symptoms develop slowly

constipation

distended abdomen

crampy lower abdominal pain

fecal vomiting

Management of bowel obstruction

Small Decompression

Large

surgical resection with formation of colostomy

Nursing care: same as gastric surgery, management of NG tube

Constipation

Abnormal hardening of stool that makes difficult & some time painfull, decrease in stool volume , or retention of stool on rectum for prolonged period of time

Clinical Manifestations Abdominal distention & intestinal rumbling Pain & pressure Anorexia fatigue & headache Incomplete emptying & strain defecation Complications: hypertension, hemorrhoid &

fissure, fecal impaction & megacolon

Constipation

Medical Management 1. Treatment of the underlying cause 2. High Fiber Diet & increase fluid intake3. Maintain regular pattern of exercises4. Laxatives & bulk forming Agents5. Bran 6-12 tsp

Diarrhea It is an increase frequency of bowel movement

more than three times /day Causes : 1. Certain medications2. Tube feeding formula 3. Certain metabolic disease 4. Viral & bacterial infectious disease5. Ulcerative colitis .enteritis & chrons disease

Complications: cardiac arrhythmia due to fluid & K loss, and drowsiness & hypotension

Diarrhea

Clinical Manifestations1. Abdominal cramps, distention, intestinal

rumbling

2. Increase frequency & fluid content of stool

3. Anorexia , thirst , & dehydration

4. Fluid electrolytes imbalance

Intestinal and rectal disorders Diarrhea

Medical Management1. Treatment of underlying cause 2. Controlling symptoms & preventing complications3. Antibiotics & antinflammatory agents4. Antidiarrheal & antispasmoic agents Nursing Managements1. Assessment the ch.ch. & pattern of diarrhea2. Bed rest & monitoring of fluid status 3. Serum electrolytes (K)4. Perenial care

Appendicitis Appendicitis is an inflammation of appendix.

Causes: Kinking, or Occlusion.

Clinical Manifestations: 1. Right lower quadrant pain.

2. Nausea, vomiting and anorexia.

3. Lower grade fever.

4. Rebound tenderness.

Appendicitis Medical Management1. Surgery is indicated if surgery diagnosed

(laprascopic or open appendectomy)2. NPO ,IVF , antibiotics3. Analgesic after diagnosis is made Nursing Management1. Relieving pain &preventing FVD2. Elimination of potential infection3. Maintaining skin integrity4. Reducing anxiety5. Pre&post care

Haemorrhoids

Dilated portions of veins in the anal canal.Causes: 1. Pregnancy. 2. Obesity. 3. Chronic constipation. 4. long sitting or standing.Clinical Manifestations: 1. Itching and pain with defecation. 2. Bright red bleeding with defecation.

Haemorrhoids (cont’d)

Medical Management:

Surgical removal of haemorrhoids (haemorrhoidectomy)

Nursing Management:

1. Provide high fibers diet and increase fluids intake.

2. Administer stool softeners, analgesics as prescribed.

3. Provide sitz baths or warm compresses.

4. Instruct the patient to do proper personal hygiene and

to avoid excessive straining during defecation