The Gastro-Intestinal

System (Digestive System)

Frederick Nsatimba (Mr)
Objectives
• By the end of the lecture, the leaners will be able to :
1. Understand the Structure of the GIT
2. Understand and apply the Functions of the GIT when caring for the aged
3. Identify and utilize the Normal Changes Associated with Ageing in caring for the
aged
4. Utilize Signs and Symptoms of GIT Disorders in caring for the aged
5. Identify Common Health Problems of the GIT and care for the resident
6. Administer Dietary Needs of acute residents
7. Advise the aged on Healthy Lifestyle Interventions for the GIT System
8. Know Responsibilities of aged Care nurse and apply them
 STRUCTURES OF THE GIT
The GIT has many parts. These include:
1. The Mouth
2. The Pharynx
3. The Salivary Glands
4. The Oesophagus
5. The Stomach
6. The Small Intestine
7. The Large Intestine
8. The Rectum and Anal Canal
9. The Liver
10. The Gall Bladder
11. The Pancreas
The Functions of the GIT
The function of the digestive system is divided into three main components:
Ingestion is the taking in of foods, liquids or drugs by mouth.

 This process commences in the mouth, which means that teeth, saliva and the mouth
are active components in the digestive process.
 The mouth begins the process of breaking down food components into pieces that are
small enough to begin the digestive process.
 Saliva contains enzymes which soften the bonds holding food together.
 Digestion is the mechanical and chemical breakdown of
food to simple molecules so that the body is able to utilize
them.
 The stomach contains an enzyme called pepsin which
reduces the food down to more useable components by
breaking down the connective tissue in proteins and
breaking the chemical bonds that hold carbohydrates
together.
Absorption is the movement of molecules as nutrients
across gastrointestinal walls into the circulatory system
where they can be utilized by the body at the cellular level.

 90% of the absorption of all nutrients takes place in the

small intestine.
 The other 10% take place in the stomach and large intestine.
The GIT ranges from the mouth to the bottom of the trunk, which when
we look at it, seems like no more than two or three feet, but is really
about 8 metres and like a railway station consisting of signals,
checkpoints, and control devices in a turning, zigzagging, coiling track
system.

From the moment the three main types of food - carbohydrates, fats
and proteins - enter the mouth, they are exposed to chemical and
mechanical actions that begin to break them apart so that they can be
absorbed through the intestinal walls into the circulatory system.
Normal Changes Associated with Ageing
Loss of teeth - gums shrink, poor chewing
Taste buds – not as effective, loss of appetite
Reduction in saliva production – taste affected, dry mouth
(painful), difficult to breakdown food.
reduced peristalsis - difficulty swallowing, constipation
Flap over epiglottis less effective = weakened gag reflex –
risk of choking
Reduction in digestive juices – slower digestion, absorption,
constipation, wind ( flatulence)
Loss muscle tone through GIT – decreased digestion,
absorption, constipation, wind, leakage, incontinence
Signs and Symptoms of GIT Disorders
Changes to the mouth
Mouth pain
Swallowing difficulties
Reflux
Changes in bowel habits
Diarrhoea
Constipation
Rectal bleeding
Changes in faeces
Anorexia
Weight Loss
Nausea
Vomiting
Abdominal Pain
Common Health Problems of the GIT
Dental Caries (tooth decay) and gum disease - linked to series health conditions.
 Issues with dental health may be caused by:
 poor oral hygiene,
bacteria,
impacted food,
cigarette smoke and
some medications.
 Problems with oral health can result in pain, eating problems which may even lead to
malnutrition and serious conditions such as pneumonia and heart disease.
Dysphagia (difficulty swallowing) - amongst older people
about one third have some dysphagia but occasionally
younger people may also experience the condition.
 There are various causes for dysphagia including:
 stroke and other neurological conditions such as Motor
Neuron Disease,
obstructive disorders such as cancer and some vascular
conditions.
Constipation - the infrequent passage of hard dry stools, usually with a lot of difficulty.
 This can cause pain as they are passed.
 Constipation occurs when faeces move slowly through the bowel, which allows more
time for water absorption.
 Common causes are:
 low fibre diets,
ignoring the need to have a bowel motion,
drugs,
dehydration and
certain disease processes.
A large percentage of elderly people suffer from constipation due to
the decrease in effectiveness of muscle tone through the GIT and
also the decrease in effectiveness of the nervous system.
Clients may also become constipated following surgery due to the
interruption of normal bowel function and decreased food and fluid
intake.
A major complication of constipation is faecal impaction which at
the very least is extremely painful and at the very worst, can be fatal.
It may require emergency surgery
Management of constipation
Prevention of constipation is better than cure.

Care Workers play a vital role in the prevention of constipation

in the following ways:
 Keep accurate bowel records and report any issues in
frequency, consistency or colour immediately.
 Be aware that watery stools may be an indication of
constipation or faecal impaction.
 Encourage and assist the client to be as active as possible
 Assist with a diet high in fibre and report any issues. Fibre
supplements are available where fibre cannot be taken in a
normal diet.
 Ensure the client is well hydrated – water is best where
possible
 Facilitate good bowel routines e.g. toileting after breakfast
each day and ensure good positioning, privacy and time.
 Administer bowel medication if within the scope of practice.
Diarrhoea - results from increased fluidity or frequency of bowel
movements.
 There are many causes of diarrhoea including:
viral or bacterial infections,
faecal impaction and
medication.
can also result from diseases such as diverticulitis and irritable bowel
syndrome.
 Diarrhoea may be dangerous for the client due to loss of fluid and
electrolytes such as sodium, potassium and chloride from the body
(dehydration).
Hernia - a protrusion of viscera through an abnormal opened or
weakened area in the wall of the cavity in which it is normally
contained. There are different types of hernias including:
 Hiatus Hernia:
This occurs when the stomach moves up through the diaphragm at
the hiatus (the junction of the oesophagus and the stomach).
A hiatus hernia can cause regurgitation, flatulence and acid
vomiting and reflux into the oesophagus which can in turn cause
the tissue in the oesophagus to break down.
 Abdominal Hernia - The abdominal wall weakens and
intestines push out. Inguinal (spermatic cord in men, round
ligament I women)
 These hernias may become “strangulated” if part of the
intestine becomes trapped.
 This is then a medical emergency requiring urgent surgery
Gastritis - inflammation of the stomach lining.

 It usually results from a decrease in hydrochloric acid

secretion, which leads to a decreased absorption of iron and
vitamin B12.
 It may be associated with indigestion, pain, nausea and/or
vomiting inflammation lining of stomach.
 Often gastritis is a side effect of certain medications such as
aspirin and non steroidal anti inflammatory drugs (NSAIDs).
Gastroenteritis - Gastroenteritis is inflammation of the
stomach and small intestine.
 It is most commonly caused by a viral infection but
occasionally the infection may be bacterial, requiring
antibiotics.
 It is transmitted on the hands of infected persons or in
contaminated food and water.
 Gastroenteritis can cause nausea, vomiting, diarrhoea and
abdominal pain.
Management of gastroenteritis
Gastroenteritis is very dangerous in babies and children, the sick and the elderly and
may even be fatal if not managed carefully.
 It may be necessary to replace lost fluids and electrolytes in clients with gastroenteritis.

 ALERT: Gastroenteritis is a highly infectious disease.

 Standard precautions must be strictly adhered to and additional infection control
precautions must be implemented in healthcare facilities such as:
 wearing gowns and masks,
isolation and limiting visitors.
Strict hand washing is the key to preventing the spread of infection.
Gastric Ulcers:
 There are different causes for gastric ulcers including:
 alcohol,
smoking,
anti-inflammatory drugs,
 stress,
diet and
bacterial infections.
 Gastric ulcers may be peptic (In the stomach) or duodenal which are the most common.
 Ulcers may cause indigestion and pain.
 Complications may include: haemorrhage, perforation of the stomach or bowel into the
peritoneal cavity resulting in peritonitis, abscess or fistula.
Liver Disorders
Cirrhosis of the liver may be caused by excessive alcohol
consumption or tumours.

Hepatitis is a viral infection of which there are many strains.

 It is an infectious disease which may be transmitted by infected
food and water and faeces (Hepatitis A), or infected bodily
fluids (Hepatitis B and C).
Drug reactions may also damage the liver as many drugs are
metabolized in the liver.
 Indications of liver impairment include jaundice (a yellow tinge
to the skin and eyes, loss of appetite, weight loss, abdominal
swelling and pain.
Management of hepatitis
ALERT: If the client has an infectious disease such as
Hepatitis, additional infection control precautions may need
to be implemented depending on the individual strain and
status of the infection e.g. active.
Care workers must always strictly follow standard
precautions when dealing with bodily fluids and sharps and
when food handling.
Bowel Obstruction – a blockage of the bowel which may be caused by intestinal
twisting, severe constipation, tumour or mass.
 Occasionally it is complication of surgery.
 If left untreated, a bowel obstruction will cause gangrene and will be fatal.
 Symptoms may include:
abdominal pain,
 nausea,
vomiting,
abdominal distension,
absence of faecal excretion (or faecal overflow).

Haemorrhoids – are varicose veins that protrude from the anal lining. They are a
common cause of rectal bleeding and discomfort and are aggravated by constipation
and straining.
Faecal Incontinence – is more common in the elderly due to a decline
in the effectiveness of the nervous system and the muscles of the GIT.
 Cognitive impairment such as dementia may also be a contributing
factor.
However younger people may also suffer faecal incontinence from
disorders such as
 Multiple Sclerosis,

 Motor Neurone Disease or

 Spinal Injury and other neurological conditions.

Tumours - both benign and malignant tumours can occur in
all parts of the GIT.
 Benign growths are much more common, but malignant
tumours are responsible for 30% of all deaths from cancer in
most countries.
 For early diagnosis, complete routine examinations and
checkups are necessary.
Cholecystitis (inflammation of the gallbladder) /
Cholelithiais (gallstones)
 Gallstones are caused when the cholesterol in bile
crystallizes into “stones”.
 These gallstones may cause obstruction to the outflow of
bile from the gallbladder and irritate the surface of the
gallbladder.
 Following their formation, gallstones usually grow in size
and number.
 Symptoms may include :
abdominal pain or discomfort, especially after eating.
The pain may radiate to the right shoulder or lower back.

Appendicitis – is an inflammation of the appendix.

 If not treated, the appendix may rupture which results in

peritonitis.
 Typically, appendicitis begins with referred pain in the
umbilical region of the abdomen, followed by lack of
appetite, nausea and vomiting.
 Pain will then often localize in the lower right quadrant of
the abdomen.
Principles of Healthy Nutrition

Changes in the GIT result in the need for a well

balanced diet where dry, fried and fatty foods are
avoided
Dietary Needs
The dietary requirements of a client receiving acute medical or surgical care are
particular to each individual client.
Care Workers must be aware of each client’s instructions for diet and fluid intake.
Some examples of special dietary requirements include:
 Nil by mouth (NBM)
 Clear fluids
 Soft diet
 Pureed Diet
 Thickened fluids
 Nutritional supplements
 Low fat
 Reduced salt
 Low protein
 High protein
 Fluid restriction
Some clients may be receiving nutrition enterally for
example via a percutaneous endoscopic gastroscopy (PEG)
tube or nasogastric (NG) tube, or parenterally via an
intravenous infusion.
Special care must be taken when caring for a client with a
feeding tube or intravenous infusion.
Health care professionals are required to chart food and/or
fluid intake for clients on nutrition or fluid balance charts
and report any issues.
Healthy Lifestyle Interventions for the GIT
System
Many of the lifestyle interventions for maintaining a health GIT have
been discussed. However, in summary they include:
 Eat a healthy diet with plenty of fibre
 Stay well hydrated with plenty of water
 Exercise regularly
 Don’t smoke
 Limit alcohol
 Know your family health history and have regular health checks
 Avoid constipation – practice healthy bowel habits e.g. routine
toileting
Responsibilities of Care Workers
The care of clients with a disorder of the gastrointestinal
system will depend on the individual client and their
condition.
Management of constipation, gastroenteritis and nutrition
have been discussed.
Other responsibilities may include:
Care of the oral hygiene of clients including recording and reporting
any issues
Taking, recording and reporting vital signs (temperature, blood
pressure, pulse, respirations)
Collecting faecal specimens

Completing food and / or fluid charts

Maintaining bowel charts

Assisting with feeding

Observing, recording and reporting any client signs and symptoms (as
above) such as abdominal pain or diarrhoea
ACTIVITY
1. Why do you think the elderly are more at risk of developing
Dysphagia?
2. Mr Lucas is a 77 year old gentleman who is a client in your
aged care facility. Due to his arthritis, he has difficulty
moving and the side effects of his medications have
decreased his appetite. Name some interventions that
may be implemented to prevent him from developing
constipation.
Summary