Medical-Surgical Nursing 2: Digestive System & Assessment Lecturer: Mr. Laurence Santos, MAN, RN March 23, 2021

MEDICAL-SURGICAL NURSING 2
Digestive System & Assessment

Lecturer: Mr. Laurence Santos, MAN, RN
March 23, 2021
Two Main Groups of Digestive System

OUTLINE
1. Alimentary Canal
➢ performs the whole menu of digestive
I. Anatomy of the Digestive System
functions (ingests, digests, absorbs, and
A. Organs of the Alimentary Canal
defecates).
B. Accessory Organs of Digestive System
C. Function of the Digestive System ➢ also called the gastrointestinal (GI) tract,
D. Nutrition and Metabolism is a continuous, coiled, hollow, muscular
II. Assessment of the Gastrointestinal Function tube that winds through the ventral
A. Health History & Clinical Manifestation body cavity and is open at both ends. Its
B. Physical Assessment organs are the mouth, pharynx,
C. Diagnostic Evaluation esophagus, stomach, small intestine,
and large intestine.
I. ANATOMY OF THE DIGESTIVE SYSTEM
2. Accessory Organs
➢ assist the process of digestive
breakdown in various ways. (e.g. teeth,
tongue, and several large digestive
glands)
Organs of the Alimentary Canal

1. Mouth
➢ A mucous membrane lined cavity where
food first enter; also called oral cavity
➢ Also known as “buccal cavity” (pH 7.0)
A. Hard Palate
➢ Forms the anterior roof of the
mouth.
B. Soft Palate
➢ Forms the posterior roof of the
mouth.
1|Transcriber: Ericson Candelaria | BSN 3A

Knowledge | Skills | Attitude
March 23, 2021
C. Uvula 3. Esophagus
➢ fleshy fingerlike projection of the ➢ Also called gullet, runs from the pharynx
soft palate, which extends through the diaphragm to the stomach;
downward from its posterior edge. about 25cm (10in) long.
➢ Is a continuation of the soft palate
Helps in: Peristalsis
o Swallowing ✓ Series of wave-like movement
o Snoring or muscle contractions which
o Speech moves the bolus/chyme
o Salivation throughout the digestive tract.
D. Tongue Division of the Esophagus:

➢ occupies floor of the mouth i. Muscular Controlled
➢ For deglutition
Muscles of the tongue: ii. Mixed Controlled
i. Extrinsic tongue muscles ➢ Controlled by both sensory
➢ Elevates, depress, and muscular control.
protrudes, & retracts the iii. Involuntary Controlled
tongue
ii. Intrinsic tongue muscles
➢ Shortens, widens,
elongates, and narrows the
tongue.
2. Pharynx
➢ Located posterior to the mouth and the
nasal cavity and superior to the Sphincters of the Esophagus:
esophagus and the trachea. i. Upper Esophageal Sphincter
➢ Serves as the passageway to the ➢ Striated muscle situated at
esophagus and the trachea. Passageway the junction between the
for the food through the esophagus, and pharynx and the esophagus.
for the air through the latter. ➢ Formed from
cricopharyngeal muscle.

March 23, 2021
➢ Prevents the entrance of air

into the esophagus. Chyme
ii. Lower Esophageal Sphincter o Heavy-cream like resemblance
➢ Situated between the of food after being processed by
stomach and the esophagus the stomach.
(gastro-esophageal Bolus → Chyme
junction)
➢ Lacks the character of Regions of the Stomach
sphincter muscle. i. Cardiac Region
➢ Sheet-like sphincter ➢ Surrounds the cardiac
➢ Regulated by sphincter, through which
o Acute-angle food enters the stomach
entrance of the from the esophagus
esophagus into the ii. Fundus
stomach ➢ the expanded part of the
o Mucosal folds in the stomach lateral to the
gastro-esophageal cardiac region
junction iii. Body
o Compression due to ➢ the midportion of the
the positive intra- stomach
abdominal pressure iv. Pylorus
o Pinch-cock effect ➢ terminal part of the
due to the stomach which contains the
diaphragm pyloric sphincter or valve.
4. Stomach
➢ A C-shaped organ on the left side of the
abdominal cavity, nearly hidden by the
liver and diaphragm.
➢ Further breaking down of the food
through churning
➢ Rugae of the stomach (folding) increases
the surface area of it.

March 23, 2021
Cells of the Stomach iii. Ileum

i. Parietal Cells ➢ Absorption of vitamins
➢ produce corrosive ADEK
hydrochloric acid, which
makes the stomach A. Villi
contents acidic and ➢ Projection-like in the small
activates the enzyme intestines which increases the
ii. Chief Cells surface area of the intestine for
➢ produce protein absorption
digesting enzymes, B. Brush Borders
mostly pepsinogens ➢ Releases enzymes which helps in
(inactive form of the enzymatic breakdown of the
pepsin) food.
iii. Mucous Cells

➢ Produces mucin which
helps neutralizes the
acid.
…GEN
➢ Suffix “gen” denotes inactive form.
5. Small Intestine
➢ The body’s major digestive organ.
➢ Longest section of the alimentary tube in C. Pancreatic Duct
anatomy. (22 ft.) ➢ port where enzymes produced by
➢ Is where absorption of nutrients the intestinal cells and pancreas
happens. travel to complete the chemical
breakdown of foods in the intestine
D. Bile Duct
Subdivisions of the Small Intestine ➢ duct where bile, produced by the
i. Duodenum liver, travels
➢ Where most of the
digestion happens.
➢ With HCl
➢ Emulsification of fat through
bile.
ii. Jejunum
➢ Where most of the
absorption of nutrients
happens.

March 23, 2021
6. Large Intestine Accessory Organs of the Digestive System

➢ Larger in diameter than the small
intestine but shorter in length 1. Salivary Glands
➢ It extends from the ileocecal valve to ➢ Produces saliva in the mouth which aids
the anus in lubrication, swallowing, protection
➢ Its major functions are to dry out the against bacteria, & digestion.
indigestible food residues from the
body as feces Salivary Glands
➢ Where water absorption/reabsorption i. Parotid
happens. ii. Submandibular
iii. Sublingual
Subdivisions of the Large Intestine
i. Cecum 2. Teeth
ii. Appendix ➢ Aids in mastication/ chewing of foods.
iii. Colon
iv. Rectum
v. Anal Canal
Regions of the Large Intestine

i. Ascending colon
ii. Transverse colon
iii. Descending colon
iv. Sigmoid colon
Goblet Cells
➢ Produces mucus that acts to ease
the passage of the feces to the
anus.
Classification of Teeth
i. Deciduous Teeth
➢ baby or milk teeth; begin to
erupt around 6mos in a baby
and has a full set (20 teeth)
at the age of 2years.
ii. Permanent Teeth
➢ usually erupted by the end
of adolescence (28 teeth)

March 23, 2021
iii. Wisdom Teeth Exocrine Function of Pancreas

➢ the third molars; emerge o The exocrine function of the
later between the ages of 17 pancreas is the acini which
and 25 produces digestive enzymes and
Classification According to shape and is secreted to the duodenum
Function with bicarbonate through the
i. Incisors pancreatic duct.
➢ Chisel-shaped which aids for
cutting
ii. Canines Pancreatic Enzyme
➢ Fang-like used for tearing/ o secreted into the duodenum
piercing which neutralizes the acidic
iii. Premolars chime coming in from the
➢ Broad crowns which aids for stomach
grinding.
iii. Molars Bicarbonate Secretion
➢ Broad crowns which aids for o To protect the intestinal lining
grinding. from damage due to acidity, the
pancreas epithelium secretes
Major Regions of the Teeth bicarbonate mixed with
i. Crown pancreatic enzymes into the
ii. Root duodenum which then
neutralizes acidic chyme.
3. Pancreas 4. Liver and Gallbladder

➢ Soft, pink, triangular gland that extends ➢ Liver is considered as the largest gland in
across the abdomen from the spleen to the body.
the duodenum ➢ Considered as storage for carbohydrates
➢ The pancreas is a complex organ and fats in a form of glycogen (inactive
composed of both exocrine and form of energy)
➢ The only organ that can regenerate
endocrine tissues which perform
itself.
digestive and regulatory function.
➢ Detoxify and inactivate toxins/
medication.
Endocrine Function of Pancreas ➢ Located under the diaphragm, more to
o The endocrine function of the right side of the body
pancreas is consisting of islets of ➢ Gallbladder is a small, thin-walled green
Langerhans which produces sac that snuggles in a shallow fossa in the
hormones that regulates the inferior surface of the liver; bile storage
body’s serum glucose level. area

March 23, 2021
The First-Pass Effect on Medication ➢ The blood in this route

o A phenomenon wherein the contains nutrients & toxins
medication absorbed through which came from the
the GI tract enters in the liver via digestion.
portal vein. Some of the drug ii. Hepatic Artery
particles were metabolized and ➢ Supplies oxygenated blood
inactivate by the liver which to the liver. (also routed into
results in a reduced drug the stomach, duodenum,
concentration before the drug pancreas, and gallbladder.
circulates systematically.
Output in the Liver

i. Hepatic Vein
➢ Routes the deoxygenated
blood from the liver going to
the inferior vena cava.
➢ Drains from the left, middle,
and right part of the liver.
ii. Common Hepatic Duct
➢ Carries the bile produced by
the liver.
iii. Biliary Tree of the Liver
Bile
➢ System of vessels which
o produced by the liver that leaves
directs the secretion of the
through the common hepatic duct
liver, gallbladder, and
and enters the duodenum through
pancreas through a system
the bile duct; yellow-to-green
of ducts into the duodenum.
secretion that emulsify fats by
➢ Consists of Common bile
physically breaking large fat globules
duct, cystic duct, & the
into smaller ones
gallbladder.
Hepatic Lobule
➢ Papilla of Vater entrance of
o Where the exchange of nutrients,
the secretions to the
oxygen, and by-products happens in
duodenum.
the liver.
Input in the Liver

i. Portal Vein
➢ Also known as hepatic
portal vein.
➢ Carries blood from the
gastrointestinal tract,
gallbladder, pancreas, and
spleen into the liver.

March 23, 2021
Functions of the Digestive System

Action of enzymes that digest proteins
Gastrointestinal Processes and Controls
1. Ingestion Enzyme Source Digestive Action
2. Propulsion Trypsin Pancreas Proteins &
Peristalsis Polypeptides →
✓ Series of wave-like movement polypeptides,
or muscle contractions which dipeptides,
moves the bolus/chyme amino acids
throughout the digestive tract. Aminopeptidase Intestinal Polypeptides →
3. Food Breakdown mucosa dipeptides,
➢ Mechanical digestion amino acids
4. Food Breakdown Dipeptidase Intestinal Dipeptides →
➢ Chemical digestion mucosa amino acids
5. Absorption Hydrochloric Gastric mucosa Proteins→
6. Defecation acid (HCl) polypeptides,
amino acids
Action of enzymes that digest fats

Action of enzymes that digest carbohydrates
Enzyme Source Digestive Action
Enzyme Source Digestive Action
Pharyngeal Pharynx mucosa Triglycerides →
Ptyalin Salivary glands Starch → lipase fatty acids,
dextrin, maltose, diglycerides,
glucose monoglycerides
Pancreatic Pancreas & Starch → Steapsin Gastric mucosa Triglycerides →
Amylase intestinal dextrin, maltose, fatty acids,
glucose diglycerides,
Maltase Mucosa & Maltose→ 2 monoglycerides
intestinal glucose Pancreatic lipase Pancreas Triglycerides →
mucosa fatty acids,
Sucrose Intestinal Sucrose→ diglycerides,
mucosa glucose, fructose monoglycerides
Bile Liver and Fat
Lactase Intestinal Lactose → gallbladder organization/
mucosa glucose, emulsification
galactose

March 23, 2021
2. Metabolism
Nutrition & Metabolism
➢ A broad term referring to all chemical
reactions that are necessary to maintain
Most foods are used as metabolic fuels. That is, life.
they are oxidized and transformed into ATP, the
chemical energy form needed by body cells to A. Catabolism
drive their many activities. The energy value of ➢ Where the substance/ nutrients
foods is measured in units called kilocalories were broken down to simpler
(kcal) or “large calories” (C) substances.
➢ E.g. Maltose → 2 glucose, cellular
respiration, anaerobic cellular
respiration
B. Anabolism
➢ A metabolic pathway where large
molecules were constructed from
smaller molecules.
➢ E.g. Cellular Protein synthesis
1. Nutrition
Nutrients
✓ a substance in food that is used by
the body to promote normal growth,
maintenance, and repair. 3. Body Energy Balance
➢ “Energy cannot be created nor
Dietary sources of major nutrients destroyed – it can only be converted
i. Carbohydrates from one form to another”
ii. Lipids
iii. Proteins Energy Intake
iv. Vitamins ✓ The energy liberated during food
v. Minerals oxidation.

March 23, 2021
Energy Output II. ASSESSMENT OF GASTROINTESTINAL FUNCTION

✓ the energy we immediately lose as
heat plus that used to do work plus
energy that is stored in the form of fat
or glycogen.
Energy intake = Total energy output

(heat + work+ energy storage)
4. Metabolic Rate and Body Heat Production

Basal Metabolic Rate
✓ The amount of heat produced by the
body per unit of time when it is under
basal condition– that is, at rest.
✓ In simple definition, it is the needed
calories of the body to keep
functioning at rest.
Total Metabolic Rate

✓ It refers to the total amount of Health History and Clinical Manifestations
kilocalories the body must consume
to fuel all ongoing activities. 1. Pain
✓ BMR + Other energy needed for ➢ Can be a major symptom of a
activities = TMR gastrointestinal disease. However,
factors such as meals, rest, activity, and
defecation pattern may affect the pain.
5. Body Temperature Regulation ➢ When assessing the pain, we must
Heat Promoting Mechanisms assess for its:
✓ Vasoconstriction, shivering i. Characteristics
ii. Duration
Heat Loss Mechanisms iii. Pattern
✓ Radiation, evaporation iv. Frequency
v. Location
vi. Distribution of referred pain
vii. Time
2. Dyspepsia
➢ An upper abdominal discomfort
associated with eating a.k.a. indigestion
10 | T r a n s c r i b e r : E r i c s o n C a n d e l a r i a | B S N 3 A
March 23, 2021
➢ It can be referred as to discomfort, infections, psychogenic

fullness, early satiety, belching, disorders
heartburn, & regurgitation which
happens to approximately 25% of adult iii. Irritation of the Chemoreceptor
population. trigger zone from radiation therapy,
➢ Ingestion of fatty foods causes the most systemic disorders, and antitumor
discomfort due to its long time of chemotherapy medication
digestion as compared to other
nutrients such as carbohydrates, and 5. Change in Bowel Habits and Stool
proteins. Characteristics
➢ May signal a dysfunction or a disease in
3. Intestinal Gas the colon.
➢ Accumulation of gas in the
gastrointestinal tract which may result in i. Diarrhea
the expulsion of gas from the mouth ➢ Abnormal increase in the
(belching), or in the rectum (flatulence) frequency and liquidity of
➢ Excessive flatulence may be a symptom the stool, stool weight, &
of food intolerance or gallbladder volume.
disease. ➢ Due to the rapid movement
of the GI contents through
4. Nausea & Vomiting the colon.
➢ A vague, uncomfortable sensation of ➢ May be associated with
sickness or queasiness that may or may abdominal pain, cramping,
not be followed by vomiting. N&V.
➢ Can be triggered by many factors such as ii. Constipation
odors, activity, medication, and food ➢ Decrease in the frequency
intake. of defecation.
➢ Medically termed as emesis ➢ Stools are often hard, dry,
➢ Hematemesis is when a patient coughs and smaller in volume as
up with blood. compared to normal
defecation.
Causes of N&V ➢ May be associated with anal
i. Visceral stimulation discomfort, and rectal
✓ e.g. dysmotility, peritoneal bleeding.
irritation, infections, iii. Tarry-black stool
hepatobiliary or pancreatic ➢ When the bleeding occurs in
disorders, mechanical the upper gastrointestinal
obstruction. tract, a tarry-black stool may
ii. CNS disorders be observed.
✓ e.g. vestibular disorders, ➢ A.k.a. melena
increased intracranial pressure,
March 23, 2021
iv. Bright/ Dark Reddish Stool Physical Assessment

➢ When the bleeding occurs at
the lower part of the GI 1. Inspection, Auscultation, Palpation,
tract. Percussion (IAPaPe)
v. Blood Streak on Stool Surface ➢ Auscultation of the abdomen should be
➢ Rectal/ anal bleeding is done first (always) prior to the palpation
suspected if this is observed. and percussion. The later may cause
vi. Light-Gray/ Clay-colored stool alteration to the bowel movement when
➢ May be caused by a performed first.
decrease or an absence of 2. Dorsal Recumbent Positioning
conjugated bilirubin.
vii. Stool with Mucus threads/ pus

➢ May be a sign of bacterial
infections, anal fissures,
bowel obstruction, or 3. Imaginary Division of Abdomen into
Chron’s disease. Quadrants
➢ It utilizes an imaginary line drawn
Some of the substances that may cause vertically from the sternum to the pubis
alteration in the stool sample’s color: of the patient through the umbilicus.
Altering Substance Color
Meat Protein Dark brown 4. Nine Regions of the Abdomen
Spinach Greenish i. Epigastric Region
Carrots & Beets Reddish ii. Umbilical Region
Cocoa Dark reddish/ brownish iii. Hypogastric/ Suprapubic Region
Senna Yellowish iv. Right Hypochondriac Region
Bismuth, iron, licorice, Blackish v. Left Hypochondriac Region
and charcoal vi. Right Lumbar Region
Barium Milky white vii. Left Lumbar Region
 For other characteristics of stool, refer to viii. Right Inguinal Region
Bristol Stool Chart in page 10 ix. Left Inguinal Region
March 23, 2021
oSteroids,
Diagnostic Evaluation Indomethacin,
Colchicine may
1. Hematologic Tests cause GI irritation
i. CBC, PT, PTT, Triglycerides panel leading to bleeding
ii. Carcinoembryonic Antigen (CEA) ✓ 3 stool specimens (3
➢ A protein that is not successive days)
normally detected in the
blood of a healthy person - ii. Stool for Ova and Parasites Screening
Presence indicates ➢ uses a microscope to
colorectal cancer. examine a stool sample and
➢ Can be used to determine look for parasites. A variety
the stage and the extent of of parasites can cause
the disease and its infections of the digestive
prognosis for those pt. with system (gastrointestinal (GI)
colorectal cancer. infections).
👐 Nursing Responsibility
2. Stool Test/ Fecal Analysis/ Fecalysis ➢ Send fresh, warm stool
➢ Is ordered for a patient to detect specimen (this may prevent
bleeding in the GI tract. further growth of microbes
which may cause a false
i. Guaiac Stool Examination positive result.
➢ This stool examination is
indicated for occult iii. Stool Culture
presence of blood in a stool ➢ a test that detects and
sample. identifies bacteria that
➢ Done by placing the fecal cause infections of the
sample at a guaiac paper lower digestive tract. The
and applying hydrogen test distinguishes between
peroxide. the types of bacteria that
👐 Nursing Responsibility cause disease (pathogenic)
✓ ↑ fiber diet 48-72 hours and the types that are
before the test normally found in the
✓ No red meats, poultry, fish, digestive tract (normal
turnips flora). The test helps to
✓ Withhold for 48hrs: Iron, determine if pathogenic
Steroids, Indomethacin, bacteria are the cause of a
Colchicine person's gastrointestinal
o Iron causes symptoms (gastroenteritis)
blacking/ greenish
discoloration of the
stool
March 23, 2021
👐 Nursing Responsibility ✓ Avoid sucralfate and

➢ Sterile test tube / cotton- omeprazole for 1 week before
tipped applicator in the test
collecting specimen ✓ Avoid antihistamine (e.g.
Ranitidine) for 24 hours before
iv. Fecal Fat Testing the test
➢ Measures the amount of fat
in a stool sample. Excess fecal 4. Abdominal Ultrasonography
fat (termed steatorrhea) may ➢ Use of high-frequency sound waves to
be an indication that your detect enlarged gallbladder or
digestive system is not pancreas, presence of gallstones,
working properly and/or that enlarged ovary, ectopic pregnancy or
you have a condition appendicitis
affecting the digestion of 👐 Nursing Responsibility
food and absorption of ✓ Instruct patient to fast for 8-
nutrients (malabsorption). 12hours
👐 Nursing Responsibility ✓ Laxative as ordered to ↓ bowel
✓ Assess for steatorrhea gas
✓ ↑ fat diet, no alcohol (3days)
✓ 72-hour stool specimen (stored 5. Imaging Studies
on ice) i. Upper GI Series/ Barium Swallow
✓ No mineral oil, neomycin SO4 (UGIS)
➢ It is used to visualize esophagus,
3. Breath Tests stomach, duodenum, and
i. Hydrogen Breath Test jejunum after the introduction
➢ Used to evaluate of a contrast agent (Barium
carbohydrate absorption, in sulfate) per orem.
addition to aiding in the 👐 Nursing Responsibility
diagnosis of bacterial ✓ NPO for 6 – 8 hours
overgrowth in the intestine ✓ X-ray taken on standing or lying
and short bowel syndrome position
✓ After the procedure:
ii. Urea Breath Test o Laxative as ordered
➢ Detects the presence of H. o Increase fluid intake
pylori that normally lives in o Inform the client that
the stomach lining and the stool is white for 24-
cause PUD 72hours
👐 Nursing Responsibility o Observe for BaSO4
✓ Avoid antibiotics or loperamide impaction: distended
for 1 month before the test abdomen, constipation
March 23, 2021
ii. Lower GI Series/ Barium Enema o Assess of allergy to

(UGIS) seafoods and iodine
➢ To visualize colon for presence ✓ Inform the client that the
of polyps, tumors, lesions, or procedure is painless
anatomic malfunctions after the ✓ Advise the client to remain still
introduction of BaSO4 per during the entire procedure
rectum
iv. Magnetic Resonance Imaging (MRI)

➢ Produces cross-sectional images
of organs by using magnetic
fields
✓ Instruct NPO for 6-8hours
✓ Instruct to remain still during
the procedure
✓ Instruct that the procedure lasts
for 60-90min
✓ Remove jewelries / metals
✓ Contraindications:
o Patient with
👐 Nursing Responsibility pacemakers
✓ Instruct low residue / clear o Aneurysm clips
liquid diet for 2 days o Orthopedic screws
✓ Laxative for cleansing the bowel o Claustrophobics
as ordered
✓ Suppository / cleansing enema 6. Endoscopic Procedures
in AM i. UGI Endoscopy
✓ Discontinue enemas in patients ➢ Direct visualization of the
with active inflammatory esophagus, stomach and
disease of the colon duodenum through a lighted
✓ After the procedure: (same as endoscope
UGIS) ➢ Used to detect esophageal,
gastric or duodenal
iii. Computed Tomography abnormalities or inflammatory,
➢ Uses beam of radiation to assess neoplastic or infectious
cross sections of the body. processes are suspected
✓ Instruct liquid diet in AM 👐 Nursing Responsibility
✓ If done with contrast medium: ✓ Obtain written consent
o NPO for 2-4hours ✓ NPO for 6-8hours
✓ Anticholinergic (AtSO4) as
March 23, 2021
ordered ✓ Administer cathartic /

laxative as ordered
✓ Sedatives, narcotics,
✓ Cleansing enema
tranquilizers (e.g. Diazepam, ✓ Instruct knee – chest or
Meperidine HCl) lateral position during the
✓ Remove dentures, bridges examination
✓ Local spray anesthetic on ✓ After the procedure:
posterior pharynx o Supine position for
✓ After the procedure: few minutes
o Side-lying position o Assess for signs of
o NPO until gag reflex perforation
returns (2-4hours) o Hot sitz bath for
o NSS gargle; throat discomfort in the
lozenges anorectal area
o Monitor VS o Monitor VS (note
o Assess for bleeding, for vasovagal
crepitus (neck), fever, response, e.g.
neck/throat pain, bradycardia,
dyspnea, dysphagia, hypotension)
back/shoulder pain
o Advise to avoid driving iii. Endoscopy through Ostomy
for 12 hours if sedative ➢ Endoscopic procedure through
was used an ostomy stoma is useful for
visualizing a segment of the
ii. LGI Endoscopy small or large intestine and may
➢ Includes Anoscopy, be indicated to evaluate
Proctoscopy, Sigmoidoscopy, anastomosis for recurrent
and Colonoscopy. disease, or to visualize and treat
➢ Endoscopic examination of the internal bleeding.
anus, rectum, sigmoid colon,
descending, transverse and 👐 Nursing Responsibility
ascending colon to evaluate ✓ Same as other endoscopic
chronic diarrhea, fecal procedure
incontinence, ischemic colitis,
lower GI hemorrhage, 7. Gastric Analysis
ulceration, abscesses, tumors, ➢ Yields information about the secretory
polyps, etc. activity of the gastric mucosa; measures
secretion of HCl and pepsin
👐 Nursing Responsibility ➢ Useful in diagnosing Zollinger-Ellison
✓ Obtain written consent syndrome or atrophic gastritis
✓ Clear liquid diet 24 before
the test 👐 Nursing Responsibility
✓ NPO for 12 hours
March 23, 2021
✓ NGT is inserted, connected (cont…) If you are interested in collaborating in

to suction making of these transcriptions just HMU dejk pero
✓ Gastric contents collected seryoso HAHAHA hindi ko alam if mapapanindigan
every 15 minutes to 1hour ko gawan lahat ng trans.
Common Diseases HCl Analysis Anyway, here are the legends in this & the next
Pernicious Anemia ↓HCl (kung kakayanin ng time lol) transcription:
Atrophic/ Gastric Cancer ↓HCl  Information was provided by the Lecturer
Peptic Ulcer (Gastric) None / ↓HCl  Transer’s note
Peptic Ulcer (Duodenal) ↑HCl 👐 Nursing Responsibility
Zollinger-Ellison ↑HCl ℞ Medication
Syndrome
👨 Medical Management
8. Laparoscopy ☣ Diagnostics
➢ An invasive procedure, usually under 💉 Signs and Symptoms
general anesthesia, done by making a
small incision lateral to the umbilicus
allowing the insertion of the fiberoptic
laparoscope. Readings:
➢ This permits direct visualization of
abdominal organs for detecting Vanputte, C., Regan, J., and Russo, A. (2018).
abnormal growths, anomalies, and Seeley’s Essential of Anatomy and
inflammatory processes Physiology (10th ed) C&E Publishing Inc.
➢ One of the benefits of this procedure is
that after visualization of a problem, Smeltzer S.C., Bare B.G., Hinkle J.L., and Cheever
excision can then be performed at the K.H. (2010) Brunner and Suddarth’s
same time Textbook of Medical-Surgical Nursing
(12th ed) C&E Publishing Inc. Volume 2
Transcriber’s Message: pages 976-995
This transcription is based from the
handouts provided by Sir John Paul M. Mendoza,
additional information provided by our lecturer Mr.
Laurence Santos, and some information obtained in -End of Digestive Part 1-
the book Brunner & Suddarth’s Textbook of Medical-
Surgical Nursing (12th Edition)
Please treat this transcription as an

additional reading only for the subject and not a
substitution for the modules provided by the clinical
instructors, and the textbook mentioned above. (…)

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MEDICAL-SURGICAL NURSING 2

Digestive System & Assessment

Two Main Groups of Digestive System

Organs of the Alimentary Canal

1|Transcriber: Ericson Candelaria | BSN 3A

D. Tongue Division of the Esophagus:

2|Transcriber: Ericson Candelaria | BSN 3A

➢ Prevents the entrance of air

3|Transcriber: Ericson Candelaria | BSN 3A

Cells of the Stomach iii. Ileum

iii. Mucous Cells

4|Transcriber: Ericson Candelaria | BSN 3A

6. Large Intestine Accessory Organs of the Digestive System

Regions of the Large Intestine

5|Transcriber: Ericson Candelaria | BSN 3A

iii. Wisdom Teeth Exocrine Function of Pancreas

3. Pancreas 4. Liver and Gallbladder

6|Transcriber: Ericson Candelaria | BSN 3A

The First-Pass Effect on Medication ➢ The blood in this route

Output in the Liver

Input in the Liver

7|Transcriber: Ericson Candelaria | BSN 3A

Functions of the Digestive System

Action of enzymes that digest fats

8|Transcriber: Ericson Candelaria | BSN 3A

9|Transcriber: Ericson Candelaria | BSN 3A

Energy Output II. ASSESSMENT OF GASTROINTESTINAL FUNCTION

Energy intake = Total energy output

4. Metabolic Rate and Body Heat Production

Total Metabolic Rate

➢ It can be referred as to discomfort, infections, psychogenic

iv. Bright/ Dark Reddish Stool Physical Assessment

vii. Stool with Mucus threads/ pus

👐 Nursing Responsibility ✓ Avoid sucralfate and

ii. Lower GI Series/ Barium Enema o Assess of allergy to

iv. Magnetic Resonance Imaging (MRI)

ordered ✓ Administer cathartic /

✓ NGT is inserted, connected (cont…) If you are interested in collaborating in

Please treat this transcription as an

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