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The Gastro

The Gastro

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Published by angel_maui
GIT
GIT

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Published by: angel_maui on Mar 01, 2010
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01/19/2013

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Medical Surgical Nursing The GASTRO-INTESTINAL systemBy: Maricel S. Jose MD,RN The Gastro-Intestinal System
Review of the GIT Anatomy and Physiology
Review of 
Review of Common Symptoms and theirnursing interventions
Review of common disorders of the:
--
EsophagusEsophagus
--
StomachStomach
--
Small intestineSmall intestine
--
Large IntestineLarge Intestine
--
GallbladderGallbladder
--
exocrine pancreasexocrine pancreas
--
liverliver
Organs of the Digestive SystemOrgans of the Digestive SystemThe GIT System: Anatomy and Physiology
The GIT is composed of two general parts
The main GIT starts from the mouth
Esophagus
Stomach
SI
LI
Rectum
23-26 foot-long
The accessory organs are the
-
Salivary glands
-
Liver
-
Gallbladder
-
Pancreas
The Mouth
Anatomy
-
Contains the lips, cheeks, palate, tongue, teeth, salivaryglands, masticatory/facial muscles and bones
-
Anteriorly bounded by the lips
-
Posteriorly bounded by the oropharynx
Physiology
-
Important for the mechanical digestion of food
-
The saliva contains SALIVARY AMYLASE or PTYALIN thatstarts the INITIAL digestion of carbohydrates
The Esophagus
Anatomy
-
A hollow muscular tube
-
Length- 25 cm
-
Made up of stratified squamos epithelium
-
Located in the mediastinum, anterior to thespine,posterior to the trachea and heart
-
The upper third contains skeletal muscles, contains theupper esophageal or hypopharyngeal sphincter
-
The middle third contains mixed skeletal and smoothmuscles
-
The lower third contains smooth muscles and theesophago-gastric/ cardiac sphincter is found here
Physiology
-
Functions to carry or propel foods from the oropharynxto the stomach
-
Swallowing or deglutition is composed of three phases:
Upper 3
rd
Miidle 3
rd
Lower 3
rd
The stomach
Anatomy
-
J-shaped organ in the LUQ
-
Contains four parts- the fundus, the cardia, the body andthe pylorus
-
The cardiac sphincter prevents the reflux of the contentsinto the esophagus(entrance)
-
The pyloric sphincter regulates the rate of gastricemptying into the duodenum(exit)
-
Capacity is 1,500 ml!
 
Medical Surgical Nursing The GASTRO-INTESTINAL systemBy: Maricel S. Jose MD,RN
Physiology
-
The functions of the stomach are generally to digest thefood (proteins) and to propel the digested materials intothe SI for final digestion
-
The Glands and cells in the stomach secrete digestiveenzymes:1.Parietal cells- HCl acid and Intrinsic factor
2.
Chief cells- pepsin
digestion of PROTEINS!3.Antral G-cells- gastrin4.Argentaffin cells- serotonin5.Mucus neck cells- mucus
The Small intestine
Anatomy
-
Longest segment, about 2/3 of the total length
-
Grossly divided into the Duodenum (proximal),Jejunum(middle) and Ileum(distal)
-
Duodenum w/ampulla of vater-common bile duct empties,passage of bile and pancreatic secretions
-
The ileum is the longest part (about 12 feet)
Physiology
-
The intestinal glands secrete digestive enzymes thatfinalize the digestion of all foodstuffs
-
Enzymes for carbohydrates
disaccharidases
-
Enzymes for proteins
dipeptidases and aminopeptidases
-
Enzyme for lipids
intestinal lipase
The Large intestine
Anatomy
-
Approximately 5 feet long, with parts:
1.
The cecum
widest diameter, prone to rupture2.The appendix3.The ascending colon4.The transverse colon5.The descending colon
6.
The sigmoid
most mobile, prone to twisting7.The rectum8.The Anus
BLOOD SUPPLY
-
GIT recieves blood from arteries that originate along theentire length of the thoracic and abdominal aorta
-
The portal venous system is composed of 5 large veins:superior mesenteric, inferior mesenteric, gastric, splenic,and cystic veins w/c form the vena portae that enters theliver
-
Oxygen and nutrients are supplied to the stomach by thegastric artery and to the intestines by the mesentericarteries.
Physiology
-
Sympathetic
Generally
INHIBITORY!
Decreased gastric secretions
Decreased GIT motility
Sphincters and blood vessels constrict
-
Parasympathetic
Generally
EXCITATORY!
Increased gastric secretions
Increased gastric motility
Sphincters relax
Terms
Digestion: phase of the digestive process that occurs whenenzymes mix with ingested food and when proteins, fats,and sugars are broken down into their component molecules
Absorption: phase of the digestive process that occurs whensmall molecules, vitamins, and minerals pass through thewalls of the small and large intestine and into thebloodstream
Elimination: phase of the digestive process that occurs afterdigestion and absorption, when waste products areeliminated from the body
Functions of the GIT
The breakdown of food particles into the molecular form fordigestion
The absorption into the bloodsteam of small nutrientmolecules produced by digestion
The elimination of undigested unabsorbed foodstuffs andother waste products
Digestive Processes
Chewing
-
1.5ml of saliva is secreted daily from the parotid,submaxillary and sublingual glands
-
PTYALIN or SALIVARY AMYLASE is an enzyme that beginsthe digestion of starches
Swallowing begins as a voluntary act, w/c is regulated bythe swallowing center in the medulla oblongata of the CNS
Gastric Function
-
stomach-secretes a highly acidic fluid in response to thepresence of ingested food
-
fluid can total as 2.4L/day can have a ph as low as 1 andderives its acidity from hydrochloric acid (HCl)a.to breakdown food into more absorbable componentsb.to aid in the destruction of ingested bacteriaGastric EnzymesSecreted by zymogens or chief cellsAmylase=for starch digestionLipase=for fat digestionPepsin=for protein digestionRennin=for milk and protein digestionSecreted by parietal cellsHCl - maintains acidity 1.0 pH destroy some bacteriaingested aids also in digestion of foodIntrinsic factor - aids in absorption of vit B12* pernicious anemiaSecreted by endocrine cellsGastrin, somatostatin and serotonin
 
Medical Surgical Nursing The GASTRO-INTESTINAL systemBy: Maricel S. Jose MD,RN
Small Intestine Function
-
duodenal secretions come from the accessory digestiveorgans- pancreas, liver and gallbladder and the glands onthe intestinal walls
-
pancreatic secretions have alkaline pH due to the highconcentration of bicarbonate- this neutralizes the acidentering the duodenum from the stomachDigestive enzymes secreted by the pancreas:
-
trypsin aids in digesting protein
-
amylase aids in digesting starches
-
lipase aids in digesting fatspancreatic secretions
pancreatic duct
ampulla of vater2 Types of contractions in the small intestinesa. segmental contractions- mixing waves that movethe intestinal contents back and forth in a churning motionb. intestinal peristalsis- propels the contents towardsthe colon* both movements are stimulated by the presence of chymeFinger like projections/villi are present throughout the smallintestines- absorption-begins in the jejunum by activetransport and diffusion
Colonic Function
-
bacteria make up a major component of the contents of the large intestine, assist in completing the breakdown of waste material esp undigested and unabsorbed proteinsand bile salts2 types of colonic secretions:a.electrolyte solution- is chiefly bicarbonate solution thatact to neutralize the end products formed by the colonicbacterial actionb.mucus- protects the colonic mucosa
Waste Products of Digestion
-
Feces - undigested foodstuff, inorganic materials, waterand bacteria
-
75% fluid 25% solid material
-
brown color results from the breakdown of bile
-
gases- methane, hydrogen sulfide and ammonia
-
Elimination begins with distention of the rectum w/cinitiates contractions of the rectal musculature andrelaxes the closed internal anal sphincter
-
internal anal sphincter- autonomic nervous system
-
external anal sphincter- cerebral cortex; maintained intonic contraction
Gastrointestinal Assessment
Laboratory Procedures
FECALYSIS
-
Examination of stool consistency, color and the presenceof occult blood.
-
Special tests for fat, nitrogen, parasites, ova, pathogensand others
FECALYSIS: Occult Blood Testing
-
Instruct the patient to adhere to a 3-day meatless diet
-
No intake of NSAIDS, aspirin and anti-coagulant
-
Screening test for colonic cancer
Upper GIT study: Barium swallow
-
Examines the upper GI tract
-
Barium sulfate is usually used as contrast
-
Pre-test: NPO post-midnight
-
Post-test: Laxative is ordered, increase pt fluid intake,instruct that stools will turn white, monitor forobstruction
Lower GIT study: Barium enema
-
Examines the lower GI tract
-
Pre-test 
: Clear liquid diet and laxatives, NPO post-midnight, cleansing enema prior to the test
-
Post-test:
Laxative is ordered, increase patient fluidintake, instruct that stools will turn white, monitor forobstruction

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