COURSE OBJECTIVES

At the end of the allotted hours the student will be able

to;
review the anatomy and physiology of
gastrointestinal system;
discuss the mechanism of processes
involve in metabolism;
enumerate different regulatory factors
of digestive and metabolic process;
 COURSE OBJECTIVES
enumerate the various diagnostic procedure and its
corresponding nursing action;
present the pathophysiology of the different
metabolic disorders with its related signs and
symptoms; and
discuss the applicable management and
nursing care systematically.
 COURSE OUTLINE
OVERVIEW OF THE ANATOMY AND PHYSIOLOGY OF
GASTROINTESTINAL SYSTEM AND THE ACCESSORY
ORGANS
MECHANISM OF PROCESSES INVOLVE IN
METABOLISM
REGULATORY FACTORS OF METABOLISM
PRINCIPLES AND TECHNIQUES OF PHYSICAL
EXAMINATION IN ADULT
DIAGNOSTIC EXAMINATIONS
 COURSE OUTLINE
METABOLIC DISTURBANCES
Disturbances in ingestion
Disturbances in absorption and digestion
Gastrointestinal infections
Inflammatory disorders
Disturbance in Elimination
Disorder in Accessory Organs
Endocrine disorders
Disorder of Pancreas
• 11-13 give 3
functions/pro
cesses
involve in
digestive
system
• 14-15: give 2
out of the 9
regions of
the abdomen.
GASTROINTESTINAL
SYSTEM
GASTROINTESTINAL SYSTEM

FUNCTIONS
:
DIGESTION
ABSORPTION
ELIMINATION
 Anatomy of the
Gastrointestinal System
4 DIVISIONS
UPPER
-Oral cavity
-esophagus
-stomach
MIDDLE
small intestine
-duodenum
- jejunum
-ileum
Figure 21-2a
 Anatomy of the
Gastrointestinal System
LOWER
Large intestine
- cecum , colon, rectum

ACCESSORY ORGANS
- Salivary glands
-liver
- Pancreas
Anatomy of the

Gastrointestinal System

Mouth Mouth

contains the lips,

cheeks, palate, tongue, contains the lips, cheeks,

teeth, salivary glands, muscles, and maxillary palate, tongue, teeth, salivary

bones. glands, muscles, and

Forms the entryway of maxillary bones.

gastrointestinal tract for Forms the entryway of

food gastrointestinal tract for food

 Anatomy of the
Gastrointestinal System
Esophagus
a collapsible
muscular tube
about 10 inches
long
carries food from
the pharynx to the
stomach
Anatomy of the

Gastrointestinal System

STOMACH

Comprised of the cardia, fundus, body, and pylorus.

Pouch like structure

Serves as the food storage during early stage of digestion

2 Sphincters lower esophageal (cardiac) sphincter pyloric sphincter

 Anatomy of the Gastrointestinal System

SMALL INTESTINE

Major digestive enzyme

Portion of final digestion and food absorption

3 parts / subdivision

duodenum – contains the openings of the bile and pancreatic ducts

approximately 22 cm Jejunum- approximately about 8 ft long ileum – approximately about 12 ft long

terminal part of small intestine

 Anatomy of the
Gastrointestinal System
LARGE INTESTINE
5 feet long,6-7 cm diameter
absorbs water and eliminates wastes
3 Divisions
CECUM– blind pouch that projects down at the
junction of ileum and cecum

Ileocecal valve
- prevents the reflux of feces from the
cecum to small intestine
 Anatomy of the
Gastrointestinal System
APPENDIX– Wormlike structure
- Arise from the cecum approxiamtely
2.5 cm
COLON
Ascending colon
Transverse colon
Descending colon
Sigmoid colon
RECTUM
ANAL CANAL
 Accessory digestive Organs

• Pancreas
• Liver and Gall
Bladder
• Salivary
glands
Liver

Largest gland in the body, weighing 3 to 4 lbs.

Contains Kupffer’s cells, which remove bacteria in the portal venous blood

Removes excess glucose and amino acids from the portal blood

Synthesizes glucose, amino acids, and fats

Liver
Aids in the digestion of fats,
carbohydrates, and proteins
Stores and filters blood
Stores vitamins A, D, and B and iron
Secretes bile to emulsify fats
Hepatic ducts

deliver bile to the gallbladder via the cystic duct

deliver bile to the duodenum via the common bile duct

The common duct opens into the duodenum, with the pancreatic duct at the Ampulla of Vater
Gallbladder

stores and concentrates bile Contracts to force bile into the duodenum during the digestion of fats

cystic duct joins the hepatic

duct to form the common bile

duct

Sphincter of Oddi guards the entrance into the duodenum

Presence of fatty materials in the duodenum stimulates the liberation of cholecystokinin, which causes contraction of the gallbladder and
relaxation of the sphincter of Oddi
 Pancreas
Exocrine gland
Secretes sodium bicarbonate
Pancreatic juices contain enzymes for
digesting carbohydrates, fats,
proteins
ENDOCRINE GLAND

islets of Langerhans secrete insulin

Insulin is secreted into the bloodstream and is important for carbohydrate

metabolism

Secretes glucagon to raise blood glucose levels

Secretes somatostatin to exert a hypoglycemic effect

 SALIVARY GLANDS
CONSIST MAINLY OF
- PAROTID GLAND
- SUBMAXILLARY GLAND
- SUBLINGUAL GLAND
- BUCCAL
 Secretes saliva
Functions of Saliva
 lubrication
Protection
Initiate digestion of dietary starches.( saliva contains
Ptyalin)
 MECHANISM OF
PROCESSES INVOLVE IN
METABOLISM
6 Basic Processes in the Digestive System

Ingestion: Food must be placed into the mouth before it can be acted upon. This is an active, voluntary process.

Propulsion: since food are to be processed by more than one digestive organ, they must be propelled from one organ to the next.

eg. Peristalsis- waves of contraction seen in tube like organs; propels substances along the tract.

Mechanical Digestion: physical processes like mixing of food in the mouth by the tongue, churning of food in the stomach, and segmantation in the small
intestine.

6 Basic Processes in the Digestive System

Chemical digestion: the sequence of steps in which large food molecules are broken down into their building blocks by enzymes.

Absorption: Active or passive transfer of substances from the lumen of the GI tract to the blood or lymph.

Defecation: elimination of indigestible substances form the body via the anus in the form of feces.
REGULATORY
FACTORS OF
METABOLISM
 REGULATORY FACTORS OF
METABOLISM

HORMONAL REGULATORS
GIT- largest endocrine organ
- produces hormones that act locally
HORMONES PRODUCE IN GIT
GASTRIN
GHRELIN
SECRETIN
CHOLECYSTOKININ
INCRETIN
GASTRIN

Source : produced by G cells in the stomach

Stimulus for production: Stomach distention with food

Effects on secretions:

 stimulation of gastric secretion

Effects on Motility

Constriction of gastroesophagel sphincter

Relaxation of ileocecal sphincter

Increased motility of stomach

 GHRELIN
Source:Produced by endocrine cells in the
mucosal layer of the fundus of the
stomach
Function
: Stimulatory effect of food intake
CHOLECYSTOKININ

Source: secreted by the I cells in the intestinal mucosa

Stimulus for production: Fat in the duodenum Target tissue: Gallbladder, pancreas Effects on secretion:

Release of bile into duodenum

Increase production pancreatic enzyme

Inhibit food intake ( control of meal size)

Potentiates action secretion of secretin

SECRETIN

Source: secreted by S cells in the mucosa of duodenum and jejunun Stimulus of production:

- pH of chyme in duodenum below 4-5 Target tissue: stomach, pancreas

Effects on Secretions: Inhibit gastric secretions

: Stimulate pancreas to release bicarbonate rich pancreatic juice.

INCRETIN

- Increase insulin release after an oral glucose load

NEUROREGULATORS

ACETYLCHOLINE

Stimulus for production: sights, smell, chewing food, stomach distention

Target Tissue: Gastric gland, gastric and intestinal muscle

Effects on secretion: Increase gastric acid

Effects on Motility: Generally increased or decreased sphincter tone

NOREPINEPHRINE

Stimulus for production

: Stress over various stimuli
Target cells:Secretory glands, gastric and intestinal
muscle
Effects on Secretions
: Generally Inhibitory
Effects on Motility:
Generally decreased motility,
increased sphincter tone
MAJOR DIGESTIVE ENZYMES

SECRETIONS

ACTIONS OF ENZYMES THAT DIGEST CARBOHYDRATES

ENZYME SOURCE

PTYALIN SALIVARY GLANDS AMYLASE PANCREAS AND

INTESTINAL MUCOSA

MALTASE INTESTINAL MUCOSA SUCRASE INTESTINAL MUCOSA LACTASE INTESTINAL MUCOSA

ACTION OF ENZYMS THAT DIGEST PROTEINS

ENZYMES SOURCE

PEPSIN Gastric mucosa ( chief cells)

TRYPSIN Pancreas

AMINOPEPTIDASE Intestinal Mucosa

DIPEPTIDASE Intestinal mucosa

HYDROCHLORIC ACID Gastric mucosa

( parietal cells)

ACTION OF ENZYMES THAT DIGEST FATS

ENZYME SOURCE

PHARYNGEAL LIPASE PHARYNX MUCOSA

STEAPSIN GASTRIC MUCOSA

PANCREATIC LIPASE PANCREAS • BILE LIVER AND

GALLBLEDDER
Nasogastric
tubes
NASOGASTRIC AND NASOINTESTINAL INSERTION

Nasogastric insertion refers to the insertion of a tube through the nasopharynx into the stomach.

Nasointestinal insertion is performed by inserting a small-bore tube, that is carried by way of peristalsis into the duodenum or jejunum

PURPOSES OF NASOGASTRIC INSERTION

1.Remove fluid and gas from the stomach

(decompression)

2.Prevent or relieve nausea and vomiting after surgery or traumatic events

3.Determine the amount of pressure and motor activity in the GI tract

4.Irrigate the stomach (lavage) for active bleeding or poisoning

5. Treat mechanical obstruction
6. Administer medications and feeding
7. Obtain a specimen of gastric contents for
laboratory studies when pyloric or intestinal
obstruction is suspected
TYPES OF
TUBES
 Levine tube
 The Levin tube is a one-
lumen nasogastric tube
usually made of plastic
with several drainage
holes near the gastric
end of the tube.
 Useful in instilling
material into the
stomach or suctioning
material out of the
stomach.
 Levinetube
•Two-lumen tube: a
drainage lumen and a
smaller secondary
tubethat is open to the
atmosphere.

• The major advantage

of this two-lumen tube
is that it can be used
for continuous suction
Miller-Abbott Tube

Two-lumen nasogastric tube

Has a rubber balloon at the tip of one tube; the other tube has holes near its tip

One lumen is used to introduce water or saline or air into the balloon at the end of the tube for weighting of the tube; the other lumen is used for
aspiration or suction.

CANTOR TUBE – SINGLE LUMEN

One lumen and a bag on the end

Before the tube is inserted into the patient, mercury is injected directly into the bag with needle and syringe.

Used for intestinal decompression (relief of stretching of the intestine through suctioning out

intestinal contents)
SENGSTAKEN BLAKEMORE
TUBE-TRIPLE LUMEN
A Sengstaken-Blakemore tube is a large red rubber tube which stops or slows bleeding from the esophagus and stomach.

The tube is put in through the nose or mouth and passes into the stomach. There are three openings (ports) seen at the end of the tube:

Take fluid and air out of the stomach

Put air into a balloon in the stomach - Put air into a balloon in the esophagus

Pressure from the balloons helps stop the bleeding.

While the tube is in place, a helmet or a catcher's mask must be worn to help keep the tube in.