1. Nursing Assessment of the Gastrointestinal System
Sasha Alexis Rarang, RN, MSN

2. The digestive system

3. Structures and Function of the GastroIntestinal System
Main Function of the GI System?????
Supply Nutrients to body cells

4. Process of Digestion and Elimination
Ingestion ( Taking In Food)
Digestion ( Breakdown of Food)
Absorption ( transfer of food products into the circulation)
Elimination

5. Concepts of Structures and Functions
The GI System consists of the GI tract and its associated organs and glands
GI tract
1. mouth
2. esophagus
3. stomach
4. small intestines
5. large intestines
6. rectum
7. anus
B. Associated organs
1. liver
2. gall bladder
3. pancreas

6. Mouth

7. Mouth Oral or buccal cavity Chewing
>> break food products into smaller
portions.
>> allows digestion and prevent trauma to the mucous lining of the esophagus.
>> person exert 25 to 275 lbs during the chewing process.
>> Dentures vs. Natural teeth
>> poorly chewed foods are not readily digested.

8. Saliva Secreted by the sublingual and submandibular glands.
Lubricate and softens the food mass
Amylase – breaks down starches to maltose.

9. Swallowing Involves 3 phases >>oral phase
>>involuntary pharyngeal phase
>>esophageal phase
> The time it takes for the bolus to reach the stomach depends on the consistency of the bolus and individual’s position.

10. Esophagus

11. Esophagus A hollow muscular tube
Lies posterior to the trachea and larynx
Serves as a passage for food from mouth to stomach.
>> upper esophageal sphincter
>> lower esophageal sphincter
Antireflux barrier
Act as a vent for increased intragastric pressure.

12. stomach

13. Stomach Structures a.1. fundus a.2. body/central area
a.3. antrum/pyloric region
a.4. cardiac sphincter
a.5. Pyloric sphincter
B. Microscopic Glands ( epithelial lining of the stomach)
b.1. Cardiac glands – mucus
b.2. Peptic (Chief Cells) – mucus and pepsinogen
b.3. Parietal (Oxyntic) – HCl acid and water
protein digestion
intrinsic factor – B12 absorption
b.4. Neck cells – mucus
b.5. Pyloric glands – gastrin and mucus
stimulates HCl acid production

14. Stomach C. Functions c.1. storage, mixing and liquefaction of the
bolus of food into chyme, control of
passage of food into the duodenum.
c.2. first stage of protein breakdown
c.3. mechanical breakdown of food
c.4. absorption of water, alcohol, glucose,
and some drugs.
c.5. protection

15. Stomach D. Innervation d.1. parasympatehetic – vagus nerve
d.1.1. increased gastric secretion of acid, gastrin and pepsin.
d.1.2. increased gastric acid motor activity.
d.2. sympathetic – inhibit gastric secretion and motility.

16. Stomach E. Secretions – 1.5L to 3.0.L of gastric juice per day.
e.1. HCl acid, pepsin, and mucus.
e.2. mucin, intrinsic factor, lipase, and
pepsinogen.
e.3. Gastric acid secretion is directly stimulated by the distention of the stomach and presence of protein.
e.4. vagal stimulation, acetylcholine, histamine, and the hormone gastrin.
e.5. gastrin is released when the stomach becomes distended with food.

17. Stomach

18. Stomach

19. Small intestines

20. Small Intestine Structure (22 feet long/1 inch in diameter)
a.1. duodenum
a.2. jejunum
a.3. ileum
B. Function
b.1. completes the digestion of foods
b.2. absorbs the products of digestion
b.3. secretes hormones – control
secretions of bile, pancreatic juice, and
intestinal secretions.

21. Small Intestine C. Innervation c.1. sympathetic – inhibits motility
c.2. parasympathetic – increases intestinal
tone and motility.
D. Secretions
d.1. Brunner’s glands(duodenal) – mucus
d.1.1. glucagon, presence of chyme, and vagal
stimulation.
d.1.2. sympathetic stimulation inhibits secretions of the
glands.
d.2. Goblet cells – mucus
d.3. crypts of Lieberkuhn – secretes an alkaline fluid
d.4. epithelial cells – digestive enzymes
d.4.1. enterokinase – activates trypsin
d.4.2. maltase,lactase, and sucrase – disaccharides
into simple sugars.

22. Small Intestine E. Absorption
e.1. Complex foods are converted into its simplest forms.
e.1.1. CHO – monosaccharides
e.1.2. CHON – amino acids
e.1.3. Fats – fatty acids,
monoglycerides, diglycerides and triglycerides.
e.2. Water absorption – 8L/day
e.3. water-soluble vitamins, electrolytes,
minerals.
e.4. B12 absorption takes place in the
ileum

23. Large intestines

24. Large Intestines Structures ( 5-6 feet long) a.1. Cecum a.2. Colon
a.2.1. Ascending
a.2.2. Transverse
a.2.3. descending
a.2.4. Sigmoid colon
a.3. Rectum and Anus ( final segments of the large intestine)
B. Function
b.1. absorb the remaining water, urea,and electrolytes.
b.2. secretes mucus
b.3. form and store the feces until defecation

25. Large Intestine C. Innervation c.1. parasympathetic – vagus nerve
increases peristalsis, decrease
tone of the sphincter.
c.2. sympathetic – reduce peristaltic
activity and increase tone of
sphincters.
D. Secretion
d.1. water, mucus, potassium, and bicarbonate –
alkaline solution.
d.2. Mucus – lubricates, allows passage of the fecal matters, protects the mucosa from injury.

26. Rectum

27. Anus

28. Associated Organs of the GI System

29. Liver

30. Activities of the tract
Secretion of electrolytes, hormones, and enzymes
Movement of the Ingested products
Digestion of food and fluids
Absorption of end products into the bloodstream.

31. A. Secretion of electrolytes, hormones, and enzymes
Hormones – gastrin
Electrolytes – H2, Cl, Na, K,
Enzymes – pancreatic lipase, enterokinase, ptyalin

32. Movement of the Ingested products

33. Digestion of food and fluids

34. Absorption of end products into the bloodstream

35. Secretions Mucous secretions
a. produced throughout the entire length of the tract.
b. protects and lubricate the walls of the GI tract.
2. Digestive secretions.
a. produced in the mouth, stomach, duodenunum, and jejunum.
b. break down ingested food so that it can be absorbed.

36. Secretion:

37. Motility 2 types of movement in the GIT Mixing
Propulsion / Peristalsis
****Soft muscle tissues of the GIT****

38. Digestion and Absorption
Food is broken down into small and simple compounds enough to be absorbed into the bloodstream by diffusion or active transport.

39. Digestion and secretion

40. Effects of Aging on the Gastrointestinal Tract
Teeth may loosen up from the supporting gums and bones.
Decreased output of the salivary glands leads to dryness of mucous membranes and increased susceptibility to breakdown, difficulty swallowing and decrease stimulation of the taste buds.
Decreased secretion of digestive enzymes and bile – decrease ability to digest and absorb food.
>> impaired absorption of fat and fat soluble vitamins
D. Atrophy of gastric mucosa leads to decrease HCl acid production.
>>decrease iron and B12 absorption – anemia
>>proliferation of bacteria – diarrhea and infection
E. Decrease peristalsis in the large intestine, decrease muscular tone of the intestinal wall and decrease abdominal muscle strength – decrease sensation to defecate and increase incidence of constipation.

41. Teeth may loosen up from the supporting gums

42. Decreased output of the salivary gland
Dryness of the mucous membrane
Difficulty swallowing
Decrease stimulation of the taste buds

43. Effects of aging on the gastrointestinal tract
Decreased secretion of digestive enzymes and bile – decrease ability to digest and absorb food.
Ex.
Impaired absorption of fat and fat soluble vitamins

44. Effects of aging on the GI tract
> Atrophy of gastric mucosa leads to decrease HCl acid production

45. Assessment of the GI System

46. Assessment of the GI System
Past Health History
a.1. history or existence of ;
> abdominal pain > nausea and
vomiting
> diarrhea > constipation
> abdominal distention > jaundice
> anemia > heartburn
> dyspepsia > changes in appetite
> hematemesis > food intolerance
> allergies > indigestions
> excessive gas > bloating
> melena > hemorrhoids
> rectal bleeding

47. Assessment…. B. Medications: b.1. past and current use of medications
b.1.1. OTC drugs
b.1.2. prescription drugs
b.1.3. herbal products and nutritional
supplements.
b.2. hepatotoxic, diarrhea, GI bleeding
C. Surgeries and other treatments
c.1. information about hospitalizations for any problems related to GI system

48. Functional Health Assessment

49. Assessment…Objective Data
Inspection
a.1. Lips – symmetry, color and size
observe for abnormalities – pallor or cyanosis, cracking, ulcers, or fissures.
a.2. Tongue – color, fissures, deviation
and lesions
a.3. Buccal Mucosa – color and lesions and distinctive breath odors
a.4. teeth and gums – caries, loose teeth, abnormal shape and position of the teeth, presence of swelling , bleeding, discoloration.

50. Assessment….
a.5. Abdomen
a.5.1. Skin changes ( color, texture, scars, striae, dilated veins, rashes, and lesions.)
a.5.2. umbilicus – location and contour
a.5.3. symmetry
a.5.4. contour – flat, rounded, distended.
a.5.5. observable masses – hernias and other masses.
a.5.6. movement – observable peristalsis and pulsation.

51. Assessment: Inspection (Skin changes)

52. Quadrants of the Abdomen
Assessment
Quadrants of the Abdomen
                                                                                                                                                      

53. Abdominal distention; dilated veins
Draping the Abdomen
                                                                                                                        

54. Obese abdomen

55. Hepatomegaly

56. ascites

57. Umbilical Hernia

58. Pregnancy

59. Assessment…. B. Auscultation (done before percussion and palpation)
b.1. listening for increased or decreased bowel sounds.
b.2. diaphragm of the stethoscope – bowel sounds are high pitched, occur 5-35x per minute.
b.3. warm up stethoscope in the hands to prevent abdominal muscle contraction.
b.4. listen for BS for 2-5 minutes. Absent BS means no sounds for 5 minutes on each quadrant.
C. Percussion
c.1. purpose??? Determine the presence of fluid, distention, and masses. Presence of air – tymphany,
fluid or masses – dull sounds

60. Auscultation: Listen for…….

61. Increased or decreased bowel sounds
Normoactive, hypoactive,hyperactive, or absent

62. Listen with the diaphragm side of the stethoscope
BS are high pitched sounds,
3-5x a minute

63. Warm up the stethoscope in the hands to avoid undue abdominalmuscle contraction

64. Listen for BS for 2-5 minutes on each quadrant
Absent BS means no sounds for 5 minutes.

65. Assessment: Percussion

66. Determine the presence of fluid, distention, and masses
Purpose?????
Determine the presence of fluid, distention, and masses

67. Tymphany is normally present in most areas of the abdomen
Dullness!!!!! Ac lue to an underlying mass

69. Assessment: Palpation

70. Light palpation – 1cm deep
Look for area of tenderness
Look for patient’s facial expression and guarding

71. Delineate body abdominal organs
Deep palpation
Delineate body abdominal organs

72. Use two-hand method

74. Diagnostic Studies Upper GI Series or Barrium Swallow
> X-ray study with fluoroscopy with contrast medium
> used to diagnose structural abnormalities of the esophagus, stomach, and duodenal bulb
>NPO for 8-12 hours
> pt. will drink contrast medium
> give pt. laxatives and fluid to prevent contrast medium impaction.
> the stool may be white up to 72 hours after the test
B. Small Bowel Series – same as upper GI series

75. Diagnostic tests C. Lower GI or Barium Enema
> Fluoroscopic examination of the colon using contrast medium w/c is administered rectally.
> administer laxatives and enemas the night before the procedure.*****CLEAR****
> clear liquid diet the night before.
> NPO for 8 hours before the procedure.
> cramping and urge to defecate may occur.
> explain that pt will be assuming various position in tilt table.
> give laxatives, fluids to assist in expelling barium.

76. Diagnostic tests C. Ultrasound
> noninvasive procedure uses high frequency soundwaves to visualize the solid organs.
> NPO 8-12 hours
D. CT-Scan –
> non invasive radiologic examination that combines x-ray machine and computer.
E. MRI
> non invasive procedure using radiofrequency waves and magnetic field
> NPO for 6 hours
> C/I in pt with metal implants or who is pregnant

77. Diagnostic tests

79. End of Topic