1
Q
DIGESTIVE AND GASTROINTESTINAL FUNCTION
I. Anatomy of the Digestive System
The digestive system is made up of the __ & __ that help the body break down and absorb food.
- pathway that extends from the
A
gastrointestinal tract and accessory organs
Gastrointestinal tract
mouth to the esophagus, stomach, small and large intestines, and rectum to the terminal structure, the anus .
2
Q
Upper GI:
Lower GI
A
- Esophagus
- Stomach
- Duodenum
- Small Intestine
- Large Intestine
3
Q
It receives food and begins the mechanical breakdown of food by the action of chewing and grinding the food
Give 5 parts
A
Oral cavity
- Lips
- Cheeks
- Palate
- Tongue
- Teeth
4
Q
- The __ is permanently moist due to a continuous coating of ___ which makes swallowing easier.
( 3 categories)
A
oral cavity
Saliva
- parotid
- submandibular
- sublingual.
5
Q
3 Pharynx
A
- nasopharynx,
- oral pharynx and
- laryngeal pharynx
6
Q
- located in the mediastinum, anterior to the spine and posterior to the trachea and heart.
- receives food from your __ when you __.
- at the bottom, contains the ___ that controls the flow of food.
A
Esophagus
mouth
swallow
esophageal sphincter
7
Q
- Situated in the ___ of the abdomen.
- Has four anatomic regions: __,__, __,__
- A hollow muscular organ with a capacity of approximately ___.
- Stores during eating
- Secretes ___
- ____ is secreted when food enters the stomach and secretion stops when the stomach pH
drops ____ - Propels ___ (consisting of gastric juices and partly digested food) into the small intestine through the __.
A
Stomach
left upper portion
the cardia (entrance), fundus, body, and pylorus (outlet).
1500 mL
food
digestive fluids
Gastrin
below 1.5
chyme
pyloric sphincter
8
Q
- The __ is the longest section of small intestine.
Main function is ___
A
Ileum
absorption of nutrients
9
Q
- The longest segment of the GI tract.
- Breaks down food using __ and __
- Has three sections:
A
Small Intestine
enzymes released by the pancreas and bile from the liver.
duodenum, jejunum and ileum.
10
Q
- The ___ continues the process of mechanical digestion by the action of ___
A
duodenum
peristalsis
11
Q
Large intestine
- Consists of (5)
- absorption of water, electrolytes and vitamins (___ and some _____ (___)
Responsible for processing ____ passing by means of __
- Stool is stored in the _
- Normally takes about ____ for stool to get through the colon.
A
cecum, ascending colon, transverse colon, descending colon, sigmoid colon.
vitamin K
B complexes (B 1 , B 2 and folic acid)
waste
peristalsis.
sigmoid (S-shaped) colon.
36 hours
12
Q
___
- Chamber that connects the
- Receive stool from the
- When ___ comes into the rectum, sensors send a message to the brain.
A
Rectum
colon to the anus.
colon.
anything (gas or stool)
13
Q
Anus
- Consists of the __ and ___
- The lining of the upper anus is able to detect ___
- The __ sphincter is always __, except when __
A
pelvic floor muscles and the two anal sphincters (internal and external).
rectal contents.
internal
tight
stool enters the rectum
14
Q
Pancreas
- Exocrine function - ______ (with a mesurement of ___)
- __ (carbohydrates)
- __ (Protein)
- __ (fats)
- Endocrine function
- ___ from pancreatic ___ cells – increases blood glucose levels
- ____ from pancreatic ___ cells – lowers blood glucose levels
- _____ from pancreatic ___ cells – regulates both glucagon and insulin levels.
A
pancreatic juice (1500 mL of pancreatic juice are produced per day)
pancreatic amylase
Trypsin
Lipase
glucagon - alpha
insulin - beta
somatostatin - delta
15
Q
glucagon - from? and function
insulin - from? and function
somatostatin - from? and function
A
- ___ from pancreatic alpha cells – increases blood glucose levels
- ____ from pancreatic beta cells – lowers blood glucose levels
- _____ from pancreatic delta cells – regulates both glucagon and insulin levels.
16
Q
Liver
- __, __, __ metabolism
- modifies waste products and toxic substances, i.e. drugs such as ____
- produces and stores ____ (___ blood glucose levels)
- converts __ to __, which is a waste product
- stores __, __, __
- manufactures __ such as ___
- production of ___, which emulsifies ___ in the diet for ___
A
carbohydrate, protein and fat
paracetamol, aspirin and alcohol
glycogen
maintains
ammonia into urea
minerals (iron and copper)
fat soluble vitamins (A, D, E and K)
water soluble vitamins (B 12)
plasma proteins
prothrombin
bile
fats
absorption
17
Q
water soluble vitamins
A
Vitamin B 12
18
Q
what are fat soluble vitamins
A
A D E K
19
Q
Gallbladder
- Stores and concentrates ___ from the __ and releases it into the ___.
Give 4 illness of gall bladder
A
bile
liver
duodenum
Cholecystitis, Choledocholithiasis, Cholelithiasis, cholangitis
20
Q
A. Mouth function
Chewing (___ ) and Swallowing (___)
- The process of digestion begins with the act of ___ .
- Eating—or even the sight, smell, or taste of food—can cause _____.
- __ & __, also contained in saliva, help lubricate the food.
- ___ begins as a voluntary act to ___.
A
Mastication
Deglutition
chewing
reflex salivation
Water and mucus
Swallowing
esophageal peristalsis
21
Q
is an enzyme that begins the digestion of starches.
A
- Ptyalin, or salivary amylase,
22
Q
B. Gastric Function
- The ___ secretes a highly acidic fluid (___) in response to the ingestion of food: (2)
A
stomach
HCl, up to pH1
- to break down food into more absorbable components
- to aid in the destruction of most ingested bacteria.
23
Q
an important enzyme for protein digestion in gastric juice
A
- Pepsin
24
Q
__ combines with dietary vitamin __.
A
- Intrinsic factor
B12
25
* ___ come from the ___ and the glands in the wall of the intestine itself.
Duodenal secretions
accessory digestive organs
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* Secretions contain digestive enzymes: (3)
amylase, lipase, (secreted by the pancreas) and bile (liver)
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* Pancreatic secretions have an __ due to their ____
alkaline pH
high concentration of bicarbonate.
28
aids in emulsifying ingested fats, making them easier to digest and absorb.
* Bile
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controls the flow of bile.
* The sphincter of Oddi
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* Two types of contractions in the small intestine: NH
* Both movements are stimulated by the presence of ___.
1. Segmentation contractions - produce mixing waves that move the intestinal contents back and
forth in a churning motion.
2. Intestinal peristalsis - propels the contents of the small intestine toward the colon.
chyme
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___ (small, finger-like projections that extend into the lumen of the ___) line the ___ intestine and function to produce ___ as well as to absorb nutrients.
* Villi
small intestine
entire
digestive enzymes
32
D. Colonic Function
* ___ assist in completing the breakdown of waste material.
* Two types of colonic secretions are added to the residual material: __ __
* __ transport allows for __ of water and electrolytes.
Bacteria
1. an electrolyte solution
2. mucus.
Slow
efficient reabsorption
33
E. Elimination Function (____)
* ___ consist of undigested foodstuffs, inorganic materials, water, and bacteria.
* The ___ color of the feces results from the breakdown of ___
* Chemicals formed by intestinal bacteria are responsible in large part for the fecal odor.
* The internal sphincter is controlled by the __
the external sphincter is __
The average frequency of defecation in humans is ___, but this varies among people.
Defecation
Feces
brown
bile by the intestinal bacteria.
autonomic nervous system;
under the conscious control of the cerebral cortex.
once daily
34
is controlled by the autonomic nervous system;
* The internal sphincter
35
* ____ cause the most discomfort because they remain in the stomach for digestion longer
than proteins or carbohydrates.
Fatty foods
36
(INDIGESTION)
Dyspepsia
37
is under the conscious control of the cerebral cortex.
the external sphincter
38
* ___ is a medical term for releasing gas from the digestive system through the ___.
The accumulation of gas in the GI tract may result in ___.
* Patients often complain of bloating, distention, or feeling “full of gas” with excessive flatulence
as a symptom of ___ or ___.
flatulence
anus
belching or flatulence
food intolerance or gallbladder disease
39
* ___ is __, often fluctuating pain in the abdomen caused by intestinal gas or obstruction in
the intestines and suffered especially by __.
Colic
severe
babies
40
* The emesis or vomitus may vary in color and content (e.g. hematemesis).
* May result from: (3)
1. visceral afferent stimulation
2. CNS disorders
3. irritation of the chemoreceptor trigger zone
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* Upper abdominal discomfort associated with eating.
dyspepsia
42
* is a common cause of nausea.
Distention of the duodenum or upper intestinal tract
43
is a physiologic protective response.
* Vomiting
44
is a vague, uncomfortable sensation of sickness or “queasiness” that may or may not be
followed by vomiting.
Nausea
45
- an abnormal increase in the frequency and liquidity of the stool.
* Diarrhea
46
- a decrease in the frequency of stool, or stools that are hard, dry, and of smaller volume than typical.
* Constipation
47
Bright or dark red stool
lower GI tract bleeding.
48
Streaking of blood on the surface of the stool (or in the tissue)
- Lower rectal or anal bleeding
49
Tarry-black color (melena)
upper GI tract bleeding.
50
bulky, greasy, foamy stools that are foul in odor and may or may not float
Steatorrhea
– malabsorption
51
* The most common symptom of patients with GI dysfunction.
dyspepsia
52
Light-gray or clay-colored stool
- blockage in the bile ducts
- caused by a decrease or absence of conjugated bilirubin
53
Stool with mucus threads or pus that may be visible on gross inspection of the stool
- irritable bowel syndrome (IBS), ulcerative colitis (UC), or Crohn's disease
54
Small, dry, rock-hard masses occasionally streaked with blood
constipation
55
Loose, watery stool that may or may not be streaked with blood
diarrhea
56
can be a major symptom of GI disease.
Pain (Referred pain)
57
the pain travels from one part of the body to another. The pain literally moves through the body.
With radiating pain
58
the source of pain doesn't move or get larger. The pain is simply felt in areas
other than the source.
referred pain
59
2. Past Health, Family, and Social History
The nurse asks about the patient’s:
a. normal toothbrushing and flossing routine;
b. frequency of dental visits;
c. awareness of any lesions or irritated areas in the mouth, tongue, or throat;
d. recent history of sore throat or bloody sputum;
e. discomfort caused by certain foods;
f. daily food intake;
g. the use of alcohol and tobacco
h. Past and current medication use
i. Previous diagnostic studies, treatments, or surgery
j. Changes in appetite or eating patterns
k. Unexplained weight gain or loss over the past year.
l. Psychosocial, spiritual, or cultural factors that may be affecting the patient.
60
B. Physical assessment
Oral Cavity Inspection and Palpation
* ____ should be removed to allow good visualization of the entire oral cavity.
1. Lips
* the presence of ___
* buccal mucosa for an assessment of __ and __
* ____ of each parotid gland is visible as a ____ in the buccal mucosa next to the upper molars.
2. Gums
* inspected for inflammation, bleeding, retraction, and discoloration. (___)
* The ___ of the breath is also noted. (____)
* The ___ is examined for color and shape.
3. Tongue
* The dorsum (back) of the tongue is inspected for __,__,__
* Frenulum, roof of the mouth, tonsils, uvula, and posterior pharynx.
Denture
ulcerations or fissures.
color and lesions
Stensen’s duct
small red dot
Gingivitis
odor
halitosis
hard palate
texture, color, and lesions.
61
Rectal Inspection and Palpation
* Gloves, ____ lubrication, a penlight, and drapes are necessary tools for the evaluation.
* Positions include ______, left lateral with hips and knees flexed, or standing with hips flexed
and upper body supported by the examination table.
* The patient is asked to ___, allowing the ready appearance of fistulas, fissures, rectal
prolapse, polyps, and internal hemorrhoids.
* ________- Internal examination is performed with a gloved lubricated index
finger inserted into the anal canal while the patient bears down.
water-soluble
knee-chest
bear down
Digital Rectal Exam (DRE)
62
Auscultation
* The frequency and character of the sounds are usually heard as __ and ___ that occur
___ and range from ____ to ___
clicks and gurgles
irregularly
5 to 30 per minute
63
* Normal (sounds heard about every ___),
5 to 20 seconds
64
* hypoactive (___),
* hyperactive (____), or
* absent (____)
* Borborygmi (___)
* All quadrants are percussed for ___ and ___ To know the location of organs.
* Light palpation is appropriate for identifying areas of ___
* Deep palpation is used to___
one or two sounds in 2 minutes
5 to 6 sounds heard in less than 30 seconds
no sounds in 3 to 5 minutes
(“stomach growling”) is heard as a loud prolonged gurgle.
overall tympani and dullness.
tenderness or muscular resistance.
masses
65
Diagnostic test
Serum Laboratory Studies
* Initial diagnostic tests begin with serum laboratory studies.
* These include:
* CBC,
* complete metabolic panel, (____)
* prothrombin time (____)
* partial thromboplastin time, (____)
* triglycerides,
* liver function tests, aspartate transaminase (AST) or SGOT, alanine transaminase (ALT)
or SGPT
* amylase, and lipase (____)
* Specific studies may be indicated, such as carcinoembryonic antigen (CEA), cancer antigen (CA)
19–9, and alpha-fetoprotein, which are sensitive and specific for colorectal and hepatocellular
carcinomas, respectively.
electrolytes
ability to clot
for blood thinning therapy effectivity
pancreas function
66
Stool Tests
* Include inspecting the specimen for consistency, color, and occult (not visible) blood.
* Stool samples are usually collected on a ____basis.
* Random specimens should be sent ___ to the laboratory for analysis.
random
promptly
67
is one of the most commonly performed stool tests to detect blood in the stool
* Fecal occult blood testing (FOBT)
68
Breath Tests
- determines the amount of hydrogen expelled in the breath after it has been produced in the colon (on contact of galactose with fermenting bacteria) and absorbed into the blood to evaluate carbohydrate absorption.
* bacterial overgrowth, or intolerances to lactose, fructose, or sucrose.
* Hydrogen breath test
69
- detect the presence of Helicobacter pylori. After the patient ingests a capsule of carbon-labeled urea, a breath sample is obtained 10 to 20 minutes later.
* Urea breath tests
70
(inflammation of the mucous membrane of the stomach) or ulcers in the stomach and small intestine
* gastritis
71
* A noninvasive diagnostic technique in which high-frequency sound waves are passed into
internal body structures.
* Useful in the detection of an ___ or ___, the presence of gallstones, an enlarged ovary, an ectopic pregnancy, or appendicitis.
* Advantages of abdominal ultrasonography include no noticeable ___, relatively ___, and almost ____ results.
* The patient is instructed to fast for _____before ultrasound testing to decrease the amount of gas in the bowel.
Abdominal Ultrasonography
enlarged gallbladder or pancreas
side effects
low cost
immediate
8 to 12 hours
72
Genetic Testing
* To identify people who are at risk for certain GI disorders.
Genetic Testing
73
- delineates the entire GI tract after the introduction of a contrast agent (radiopaque liquid).
Nursing consideration:
- Clear ___, with ___ from ___before the stud
Upper GI fluoroscopy
liquid diet
NPO
midnight the night
74
– can detect the presence of polyps, tumors, or other lesions of the large intestine and demonstrate any anatomic abnormalities or malfunctioning of the bowel.
Nursing consideration:
- ___ diet ____ before the test, a clear liquid diet and a laxative the evening before, NPO after midnight, and cleansing enemas until returns are clear the following morning.
Barium enema
low-residue
1 to 2 days
75
may be performed with or without oral or intravenous (IV) contrast
A CT scan
76
- contraindicated in patients with any device containing ___ because the magnetic field could cause malfunction.
Nursing Consideration:
- NPO status ____ before the study and removal of all jewelry and other metals.
- May induce feelings of ___, and the machine will make a ____ sound during the procedure.
Magnetic Resonance Imaging
metal
6 to 8 hours
claustrophobia
knocking
77
*___ Produces images of the body by detecting the radiation emitted from radioactive substances.
* IT looks at their function and shows unusual ___
Nursing Consideration:
* The ____ are injected into the body __ and are usually tagged with radioactive isotopes of oxygen, nitrogen, carbon, or fluorine
Positron Emission Tomography
cellular activity.
radioactive substances
IV
78
relies on the use of radioactive isotopes (i.e., technetium, iodine, and indium) to reveal displaced anatomic structures, changes in organ size, and the
presence of neoplasms or other focal lesions such as ___
Nursing Consideration:
- A sample of __ is removed, mixed with a ___, and reinjected into the patient.
- Abnormal concentrations of blood cells are then detected at ____ intervals.
Scintigraphy
cysts or abscesses.
blood
radioactive substance
79
- the liquid and solid components of a meal (typically scrambled eggs) are tagged with radionuclide markers.
- After ingestion of the meal, the patient is positioned under a ___
Gastrointestinal Motility Studies
scinti scanner.
80
G. Endoscopic Procedures
1. Upper Gastrointestinal Fibroscopy/Esophagogastroduodenoscopy
2. Endoscopic retrograde cholangiopancreatography (ERCP)
3. Fiberoptic Colonoscopy
4. Anoscopy, Proctoscopy, and Sigmoidoscopy
5. Endoscopy Through an Ostomy
6. Laparoscopy (Peritoneoscopy)
81
- allows direct visualization of the esophageal, gastric, and duodenal mucosa through a lighted
endoscope (gastroscope).
- valuable when esophageal, gastric, or duodenal disorders or inflammatory, neoplastic, or
infectious processes are suspected.
- the gastroenterologist views the GI tract through a viewing lens and can obtain images through
the scope to document findings.
Upper Gastrointestinal Fibroscopy/ Esophagogastroduodenoscopy
82
- uses the endoscope in combination with x-rays to view the bile ducts, pancreatic ducts, and
gallbladder.
Endoscopic retrograde cholangiopancreatography (ERCP)
83
___
- useful for visualizing a segment of the small or large intestine.
- may be indicated to evaluate the ___ for recurrent disease
- To visualize and treat ___ in a segment of the bowel
Endoscopy Through an Ostomy
anastomosis
bleeding
84
___
- Direct visual inspection of the large intestine (anus, rectum, sigmoid, transcending and ascending colon) is possible by means of a flexible fiberoptic colonoscope.
- ____ can be used to document the procedure and findings.
- The procedure can be used to remove all visible ___ with a special __ & __ through
the colonoscope.
- Colonoscopy is performed while the patient is ___
- Adequate colon cleansing provides optimal visualization and decreases the time needed for the
procedure.
Fiberoptic Colonoscopy
Still and video recordings
polyps
snare and cautery
lying on the left side with the legs drawn up
toward the chest.
85
___
- Biopsies and polypectomies can be performed during this procedure.
- These examinations require only ___, including a warm tap water or Fleet ___ until returns are clear
Anoscopy, Proctoscopy, and Sigmoidoscopy
limited bowel preparation
enema
86
____
* a small incision is made lateral to the umbilicus, allowing for the insertion of the fiberoptic
laparoscope.
* permits direct visualization of the organs and structures within the __
* permits visualization and identification of any __, __, __
* __ can be taken from the structures and organs as necessary.
* after visualization of a problem, ___ can then be performed at the same time, if
appropriate.
Laparoscopy (Peritoneoscopy)
abdomen
growths, anomalies, and inflammatory processes.
biopsy samples
excision
87
____
* insertion of a flexible tube into the stomach, or beyond the pylorus into the duodenum or the jejunum.
* The tube may be inserted through the mouth, the nose, or the abdominal wall.
* GI intubation may be performed in order to: (give 4)
Gastrointestinal Intubation
1. Decompress the stomach and remove gas and fluid
2. Lavage the stomach and remove ingested toxins or other harmful materials
3. Diagnose GI disorders
4. Administer tube feedings, fluids, and medications
5. Compress a bleeding site
6. Aspirate GI contents for analysis
88
Type of tubes:
1. __ - a large-bore tube inserted through the mouth into the stomach that contains a
wide outlet for removal of gastric contents.
2. __ - introduced through the nose into the stomach, often
before or during surgery or at the bedside, to remove fluid and gas from the upper GI tract.
Orogastric tube
Gastric tube (nasogastric (NG) tube)
89
is delivered through a tube to your stomach or the small intestine
Enteral nutrition
90
1. ___ is a procedure in which an opening is created into the stomach either for the purpose of administering nutrition, fluids, and medications via a feeding tube, or for gastric decompression.
* preferred over a __ inserted tube to deliver enteral nutrition support longer than ___.
* also preferred over __ or __ feedings in the patient who is ___ because the __ remains intact.
* a permanent gastric stoma (an artificially created opening) is created surgically.
A gastrostomy
nasally
4 weeks
nasogastric or orogastric
comatose
gastroesophageal sphincter
91
2. A ___ is a surgically placed opening into the jejunum for the purpose of administering
nutrition, fluids, and medications.
* indicated when the __ is not accessible, or to decrease __ risk when the stomach is not functioning adequately to process and empty food and fluids.
jejunostomy
gastric route
aspiration
92
is the placement of a feeding tube using an endoscope
Percutaneous endoscopic gastrostomy or jejunostomy
93
"Parenteral" means
outside of the digestive tract
94
___
* a method of providing nutrients to the body by an _
* The nutrients are a __ containing proteins, carbohydrates, fats, electrolytes, vitamins, trace minerals, and sterile water in a __container.
* to improve ___, establish a positive nitrogen balance, maintain muscle mass, promote weight maintenance or gain, and enhance the healing process.
* The indications for PN include an inability to __ within a __ timeframe.
Parenteral Nutrition
IV route.
complex admixture
single
nutritional status
ingest adequate oral food or fluids
7- to 10-day
95
There are two primary types of PN:
(Partially) PPN
(Total) TPN
96
(Partially) PPN is
(Total) TPN is
generally used for patients who need supplementary nutrition
for patients who require all of their dietary needs replaced
97
* The ___ is to further break down the nutrients coming from the duodenum.
jejunum
98
- used to evaluate colonic motility and obstructive defecation syndromes.
- The patient is given a capsule containing 20 radionuclide markers and instructed to follow a
regular diet and usual daily activities.
- Abdominal x-rays are taken every 24 hours (4-5 days) until all markers are passed.
b. Colonic transit studies
