GASTROINTESTINAL SYSTEM
I. Upper alimentary canal - function for digestion
a. Mouth
b. Pharynx (throat)
c. Esophagus
d. Stomach
e. 1st half of duodenum
II. Middle Alimentary canal – Function: for absorption
- Complete absorption – large intestine
a. 2nd half of duodenum
b. Jejunum
c. Ileum
d. 1st half of ascending colon
III. Lower Alimentary Canal – Function: elimination
a. 2nd half of ascending colon
b. Transverse
c. Descending colon
d. Sigmoid
e. Rectum
IV. Accessory Organ
a. Salivary gland
b. Verniform appendix
c. Liver
d. Pancreas – auto digestion
e. Gallbladder – storage of bile
I. Salivary Glands
1. Parotid – below & front of ear
2. Sublingual
3. Submaxillary
- Produces saliva – for mechanical digestion
- 1200 -1500 ml/day - saliva produced
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PAROTITIS – “mumps” – inflammation of parotid gland
-Paramyxo virus
S/Sx:
1. Fever, chills anorexia, gen body malaise
2. Swelling of parotid gland
3. Dysphagia
4. Ear ache – otalgia
Mode of transmission: Direct transmission & droplet nuclei
Incubation period: 14 – 21 days
Period of communicability – 1 week before swelling & immediately when swelling
begins.
Nursing Mgt:
1. CBR
2. Strict isolation
3. Meds: analgesic
Antipyretic
Antibiotics – to prevent 2° complications
4. Alternate warm & cold compress at affected part
5. Gen liquid to soft diet
6. Complications
Women – cervicitis, vaginitis, oophoritis
Both sexes – meningitis & encephalitis/ reason why antibiotics is
needed
Men – orchitis might lead to sterility if it occur during / after puberty.
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VERNIFORM APPENDIX – Rt iliac or Rt inguinal area
- Function – lymphatic organ – produces WBC during fetal life - ceases to
function upon birth of baby
APENDICITIS – inflamation of verniform appendix
Predisposing factor:
1. Microbial infection
2. Feacalith – undigested food particles – tomato seeds, guava seeds
3. Intestinal obstruction
S/Sx:
1. Pathognomonic sign: (+) rebound tenderness
2. Low grade fever, anorexia, n/v
3. Diarrhea / & or constipation
4. Pain at Rt iliac region
5. Late sign due pain – tachycardia
Diagnosis:
1. CBC – mild leukocytosis – increase WBC
2. PE – (+) rebound tenderness (flex Rt leg, palpate Rt iliac area – rebound)
3. Urinalysis
Treatment: - appendectomy 24 – 45°
Nursing Mgt:
1. Consent
2. Routinary nursing measures:
a.) Skin prep
b.) NPO
c.) Avoid enema – lead to rupture of appendix
3. Meds:
Antipyretic
Antibiotics
*Don’t give analgesic – will mask pain
- Presence of pain means appendix has not ruptured.
4. Avoid heat application – will rupture appendix.
5. Monitor VS, I&O bowel sound
Nursing Mgt: post op
1. If (+) to Pendrose drain – indicates rupture of appendix
Position- affected side to drain
2. Meds: analgesic due post op pain
Antibiotics, Antipyretics PRN
3. Monitor VS, I&O, bowel sound
4. Maintain patent IV line
5. Complications- peritonitis, septicemia
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Liver – largest gland
- Occupies most of right hypochondriac region
- Color: scarlet red
- Covered by a fibrous capsule – Glisson’s capsule
- Functional unit – liver lobules
Function:
1. Produces bile
Bile – emulsifies fats
- Composed of H2O & bile salts
-Gives color to urine – urobilin
Stool – stircobilin
2. Detoxifies drugs
3. Promotes synthesis of vit A, D, E, K - fat soluble vitamins
Hypevitaminosis – vit D & K
Vit A – retinol
Def Vit A – night blindness
Vit D – cholecalciferon
- Helps calcium
- Rickets, osteoarthritis
4. It destroys excess estrogen hormone
5. For metabolism
A. CHO –
1. Glycogenesis – synthesis of glycogens
2. Glycogenolysis – breakdown of glycogen
3. Gluconeogenesis – formation of glucose from CHO sources
B. CHON-
1. Promotes synthesis of albumin & globulin
Cirrhosis – decrease albumin
Albumin – maintains osmotic pressure, prevents edema
2. Promotes synthesis of prothrombin & fibrinogen
3. Promotes conversion of ammonia to urea.
Ammonia like breath – fetor hepaticus
C. FATS – promotes synthesis of cholesterol to neutral fats – called
triglycerides
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LIVER CIRRHOSIS - lost of architectural design of liver leading to fat necrosis &
scarring
Early sign – hepatic encephalopathy
1. Asterixis – flapping hand tremors
Late signs – headache, restlessness, disorientation, decrease LOC – hepatic
coma.
Nursing priority – assist in mechanical ventilation
Predisposing factor:
Decrease Laennac’s cirrhosis – caused by alcoholism
1. Chronic alcoholism
2. Malnutrition – decreaseVit B, thiamin - main cause
3. Virus –
4. Toxicity- eg. Carbon tetrachloride
5. Use of hepatotoxic agents
S/Sx:
Early signs:
a.) Weakness, fatigue
b.) Anorexia, n/v
c.) Stomatitis
d.) Urine – tea color
Stool – clay color
e.) Amenorrhea
f.) Decrease sexual urge
g.) Loss of pubic, axilla hair
h.) Hepatomegaly
i.) Jaundice
j.) Pruritus or urticaria
2. Late signs
a.) Hematological changes – all blood cells decrease
Leukopenia- decrease
Thrombocytopenia- decrease
Anemia- decrease
b.) Endocrine changes
Spider angiomas, Gynecomastia
Caput medusate, Palmar errythema
c.) GIT changes
Ascitis, bleeding esophageal varices – due to portal HPN
d.) Neurological changes:
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Hepatic encephalopathy - ammonia (cerebral toxin)
Late signs: Early signs:
Headache asterexis
Fetor hepaticus (flapping hand tremors)
Confusion
Restlessness
Decrease LOC
Hepatic coma
Diagnosis:
1. Liver enzymes- increase
SGPT (ALT)
SGOT (AST)
2. Serum cholesterol & ammonia increase
3. Indirect bilirubin increase
4. CBC - pancytopenia
5. PTT – prolonged
6. Hepatic ultrasonogram – fat necrosis of liver lobules
Nursing Mgt
1. CBR
2. Restrict Na!
3. Monitor VS, I&O
4. With pt daily & assess pitting edema
5. Measure abdominal girth daily – notify MD
6. Meticulous skin care
7. Diet – increase CHO, vit & minerals. Moderate fats. Decrease CHON
Well balanced diet
8. Complications:
a.) Ascites – fluid in peritoneal cavity
Nursing Mgt:
1. Meds: Loop diuretics – 10 – 15 min effect
2. Assist in abdominal paracentesis - aspiration of fluid
- Void before paracentesis to prevent accidental
puncture of bladder as trochar is inserted
b.) Bleeding esophageal varices
- Dilation of esophageal veins
1. Meds: Vit K
Pitrisin or Vasopresin (IM)
2. NGT decompression- lavage
- Give before lavage – ice or cold saline solution
- Monitor NGT output
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3. Assist in mechanical decompression
- Insertion of sengstaken-blackemore tube
- 3 lumen typed catheter
- Scissors at bedside to deflate balloon.
c.) Hepatic encephalopathy –
1. Assist in mechanical ventilation – due coma
2. Monitor VS, neuro check
3. Siderails – due restless
4. Meds – Laxatives – to excrete ammonia
HEPATITIS- jaundice (icteric sclera)
Bilirubin
Kernicterus/ hyperbilirubinia
Irreversible brain damage
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Pancreas – mixed gland (exocrine & endocrine gland)
PANCREATITIS – acute or chronic inflammation of pancreas leading to
pancreatic edema, hemorrhage & necrosis due to auto digestion.
Bleeding of pancreas - Cullen’s sign at umbilicus
Predisposing factors:
1. Chronic alcoholism
2. Hepatobilary disease
3. Obesity
4. Hyperlipidemia
5. Hyperparathyroidism
6. Drugs – Thiazide diuretics, pills Pentamidine HCL (Pentam)
7. Diet – increase saturated fats
S/Sx:
1. Severe Lt epigastric pain – radiates from back &flank area
- Aggravated by eating, with DOB
2. N/V
3. Tachycardia
4. Palpitation due to pain
5. Dyspepsia – indigestion
6. Decrease bowel sounds
7. (+) Cullen’s sign - ecchymosis of umbilicus hemorrhage
8. (+) Grey Turner’s spots – ecchymosis of flank area
9. Hypocalcemia
Diagnosis:
1. Serum amylase & lipase – increase
2. Urine lipase – increase
3. Serum Ca – decrease
Nursing Mgt:
1. Meds
a.) Narcotic analgesic - Meperidine Hcl (Demerol)
Don’t give Morphine SO4 –will cause spasm of sphincter.
b.) Smooth muscle relaxant/ anti cholinergic
- Ex. Papavarine Hcl
Prophantheline Bromide (Profanthene)
c.) Vasodilator – NTG
d.) Antacid – Maalox
e.) H2 receptor antagonist - Ranitidin (Zantac) to decrease
pancreatic stimulation
f.) Ca – gluconate
2. Withold food & fluid – aggravates pain
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3. Assist in Total Parenteral Nutrition (TPN) or hyperalimentation
Complications of TPN
1. Infection
2. Embolism
3. Hyperglycemia
4. Institute stress mgt tech
a.) DBE
b.) Biofeedback
5. Comfy position - Knee chest or fetal like position
6. If pt can tolerate food, give increase CHO, decrease fats, and increase CHON
7. Complications: Chronic hemorrhagic pancreatitis
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GALLBLADDER – storage of bile – made up of cholesterol.
CHOLECYSTITIS/ CHOLELITHIASIS – inflammation of gallbladder with
gallstone formation.
Predisposing factor:
1. High risk – women 40 years old
2. Post menopausal women – undergoing estrogen therapy
3. Obesity
4. Sedentary lifestyle
5. Hyperlipidemia
6. Neoplasm
S/Sx:
1. Severe Right abdominal pain (after eating fatty food). Occurring especially
at night
2. Fatty intolerance
3. Anorexia, n/v
4. Jaundice
5. Pruritus
6. Easy bruising
7. Tea colored urine
8. Steatorrhea
Diagnosis:
1. Oral cholecystogram (or gallbladder series)- confirms presence of stones
Nursing Mgt:
1. Meds – a.) Narcotic analgesic - Meperdipine Hcl – Demerol
b.) Anti cholinergic - Atropine SO4
c.) Anti emetic
Phenergan – Phenothiazide with anti emetic properties
2. Diet – increase CHO, moderate CHON, decrease fats
3. Meticulous skin care
4. Surgery: Cholecystectomy
Nursing Mgt post cholecystectomy
-Maintain patency of T-tube intact & prevent infection
Stomach – widest section of alimentary canal
- J shaped structures
1. Anthrum
2. Pylorus
3. Fundus
Valves
1. 1.cardiac sphincter
2. Pyloric sphincter
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Cells
1. Chief/ Zymogenic cells – secrets
a.) Gastric amylase - digest CHO
b.) Gastric lipase – digest fats
c.) Pepsin – CHON
d.) Rennin – digests milk products
2. Parietal / Argentaffin / oxyntic cells
Function:
a.) Produces intrinsic factor – promotes reabsorption of vit B12
cyanocobalamin – promotes maturation of RBC
b.) Secrets Hcl acid – aids in digestion
3. Endocrine cells - Secrets gastrin – increase Hcl acid secretion
Function of the stomach
1.Mechanical
2.Chem. Digestion
3.Storage of food
-CHO, CHON- stored 1 -2 hrs. Fats – stored 2 – 3 hrs
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PEPTIC ULCER DISEASE – (PUD) – excoriation / erosion of submucosa &
mucosal lining due to:
a.) Hypercecretion of acid – pepsin
b.) Decrease resistance to mucosal barrier
Incidence Rate:
1. Men – 40 – 55 yrs old
2. Aggressive persons
Predisposing factors:
1. Hereditary
2. Emotional
3. Smoking – vasoconstriction – GIT ischemia
4. Alcoholism – stimulates release of histamine = Parietal cell release Hcl
acid = ulceration
5. Caffeine – tea, soda, chocolate
6. Irregular diet
7. Rapid eating
8. Ulcerogenic drugs – NSAIDS, aspirin, steroids, indomethacin, ibuprofen
Indomethacin - S/E corneal cloudiness. Needs annual eye
check up.
9. Gastrin producing tumor or gastrinoma – Zollinger Ellisons sign
10. Microbial invasion – helicobacter pylori. Metromidazole (Flagyl)
Types of ulcers
Ascending to severity
1. Acute – affects submucosal lining
2. Chronic – affects underlying tissue – heals & forms a scar
According to location
1. Stress ulcer
2. Gastric ulcer
3. Duodenal ulcer – most common
Stress ulcers – common among eritically ill clients
2 types
1.Curing’s ulcer – cause: trauma & birth
hypovolemia
GIT schemia
Decrease resistance of mucosal barriers to Hcl acid
Ulcerations
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2.Cushing’s ulcer – cause – stroke/CVA/ head injury
Increase vagal stimulation
Hyperacidity
Ulcerations
GASTRIC ULCER DUODENAL ULCER
SITE Intrum or lesser curvature Duodenal bulb
PAIN -30 min – 1 hr after eating -2-3 hrs after eating
- epigastrium - mid epigastrium
- gaseous & burning - cramping & burning
- not usually relieved by food - usually relieved by food
& antacid & antacid
- 12 MN – 3am pain
HYPERSECRETION Normal gastric acid secretion Increased gastric acid
secretion
VOMITING common Not common
HEMORRHAGE hematemeis Melena
WT Wt loss Wt gain
COMPLICATIONS a. stomach cause a. perforation
b. hemorrhage
HIGH RISK 60 years old 20 years old
Diagnosis:
1. Endoscopic exam
2. Stool from occult blood
3. Gastric analysis – N – gastric
Increase – duodenal
4. GI series – confirms presence of ulceration
Nursing Mgt:
1. Diet – bland, non irritating, non spicy
2. Avoid caffeine & milk/ milk products
Increase gastric acid secretion
3. Administer meds
a.) Antacids
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AAC
Aluminum containing antacids Magnesium containing antacids
Ex. aluminum OH gel ex. milk of magnesia
(Ampho-gel) S/E diarrhea
S/E constipation
Maalox (fever S/E)
b.) H2 receptor antagonist
Ex
1. Ranitidine (Zantac)
2. Cimetidine (Tagamet)
3. Tamotidine (Pepcid)
- Avoid smoking – decrease effectiveness of drug
Nursing Mgt:
1. Administer antacid & H2 receptor antagonist – 1hr apart
-Cemetidine decrease antacid absorption & vise versa
c.) Cytoprotective agents
Ex
1. Sucralfate (Carafate) - Provides a paste like subs that coats
mucosal lining of stomach
2. Cytotec
d.) Sedatives/ Tranquilizers - Valium, lithium
e.)Anticholinergics
1. Atropine SO4
2. Prophantheline Bromide (Profanthene)
(Pt has history of hpn crisis With peptic ulcer disease. Rn should not administer
alka seltzer- has large amount of Na.
3. Surgery: subtotal gastrectomy - Partial removal of stomach
Billroth I (Gastroduodenostomy) Billroth II (Gastrojejunostomy)
-Removal of ½ of stomach & - removal of ½ -3/4 of stomach &
anastomoses of gastric stump to the duodenal bulb & anastomostoses of
duodenum. gastric stump to jejunum.
Before surgery for BI or BII - Do vagotomy (severing of vagus nerve) &
pyloroplasty (drainage) first.
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Nursing Mgt:
1. Monitor NGT output
a.) Immediately post op should be bright red
b.) Within 36- 42h – output is yellow green
c.) After 42h – output is dark red
2. Administer meds:
a.) Analgesic
b.) Antibiotic
c.) Antiemetics
3. Maintain patent IV line
4. VS, I&O & bowel sounds
5. Complications:
a.) Hemorrhage – hypovolemic shock
Late signs – anuria
b.) Peritonitis
c.) Paralytic ileus – most feared
d.) Hypokalemia
e.) Thromobphlebitis
f.) Pernicious anemia
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7.)Dumping syndrome – common complication – rapid gastric emptying of
hypertonic food solutions – CHYME leading to hypovolemia.
Sx of Dumping syndrome:
1. Dizziness
2. Diaphoresis
3. Diarrhea
4. Palpitations
Nursing mgt:
1. Avoid fluids in chilled solutions
2. Small frequent feeding s-6 equally divided feedings
3. Diet – decrease CHO, moderate fats & CHON
4. Flat on bed 15 -30 minutes after q feeding
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