Module11

GIT(GastroIntestinalTract)

DIGESTIVESYSTEM
Digestivesystemactsuponingestedfood,mechanicallyandchemically Processingittobeusedtonourishindividualcellofbody

Anatomyofthedigestivesystem
Consistsof: o Mouth o Salivaryglands o Pharynx Oropharynx o Oesophagus o Stomach o Smallintestines o Largeintestines o Appendix o Liver o Gallbladder o Pancreas o Rectumandanus

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GIT(GastroIntestinalTract)

Mouth
Consistsof o Lips o Cheeks o Gums o Teeth o Tongue Mucousmembranelinesmouth Hardpalateinbonyplatelyinganteriorly Softpalatefoldofmucousmembraneandmusclethatextendsposteriorlyfromhardpalatetothroat Softpalatedesignedto: o Holdfoodbeingchewed o Helpinitiateswallowing Foodgroundedintosmallpiecesbyteethandtongue

1.2

Salivaryglands
6salivaryglands o Twosalivaryglandsunderthetongue o Oneeachsideofjaw o Oneinsideeachcheek Theyproduce1.5Lofsalivadaily Saliva98%water Remaining2%composedofmucus,salt,organiccompounds Salivaseversasbinderforchewedfoodbeingswallowedalsolubricantwithinmouth Salivaryglandsalsosecreteenzymes Enzymesbeingchemicalbreakdownofstarch

1.3

Pharynx
SharebyrespiratoryANDdigestivesystem Liesbetweennoseandoesophagus/larynx o Oesophagusispipethatgoestothestomach Nasopharynx Oropharynx

1.3.1

Oropharynx
Tubularstructure Extendsverticallyfrombackofmouthtooesophagusandtrachea(+12.5cm) Automaticmovementofpharynxduringswallowingliftslarynxcausingepiglottistocloseoverpharynx o Sosolids/liquidsmoveintooesophagusandawayfromtrachea

1.4

Oesophagus
Softtube+25cmlong Extendsfromendofpharynxtostomach Liesanteriortospinalcolumninchest Peristalsis o Musclesinwallofoesophaguscontract o Thispropellingfoodtowardstostomach

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GIT(GastroIntestinalTract)

1.5

Stomach
HolloworganUpperleftquadrantofabdominalcavityprotectedbylowerleftribs Foodenteringstomach o Mixedwithdigestivechemicals+gastricjuicesbymuscularactiontoformsemisolidmass Stomachproduces+1.5Lofgastricjuicesdaily Smallquantitiesofsemisolidmassreleasedintosmallintestine 13hourssemisolidmassfromonemealispropelledintosmallintestine

1.6

Pancreas
Flatsolidorganupperleftquadrantbelow+behindstomachandliver Fixedwithinpositiondeepwithinabdomen+noteasilydamaged Containstwosetsofglands Onesetsecrets+2Lpancreaticjuicesdaily o Pancreaticjuicecontainmanyenzymesaidindigestionoffat,starchandprotein o Pancreaticjuiceflowdirectlyintoduodenumthroughpancreaticducts IsletsifLangerhans(othergland) Producesinsulin Insulinsecreteddirectlyintobloodstream Itregulatesamountofglucoseinblood

1.7

Liver
Largesolidorganliesbehinddiaphragmrightupperquadrant Largemassofbloodvesselsandcellspackedtightlytogether Fragileorganlargelyprotectedbylowerribs Poisonoussubstancesproducesbydigestionbroughttoliveandrenderedharmless Liverformsnecessaryfactorsforbloodclottingandproductionofnormalplasma +0.5L1Lofbilemadebyliverdailytoassistinnormaldigestionoffat Principalorganforstorageofsugar/starchforimmediateusebybodyforenergy Producesmanyfactorsaidinginregulationofimmuneresponse AllbloodpumpedtoGITpassesthroughliverbeforereturningtoheart +1.5Lbloodpassesthroughliverperminute

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GIT(GastroIntestinalTract)

Gallbladder
Liverconnectedtointestinebybileducts Gallbladdersitsunderliver+connectedtosmalltubes/ductsandstorebileproducesbyliver Gallbladderdischargesstored+concentratedbileintoduodenumthroughcommonbileduct Usuallycontains6090mlofbile

1.9

Smallintestines
Majorholloworganofabdomenliescoiledinfrontofabdomen(inallfourquadrants) Hangsfreelyinabdominalcavity SuspendedbytoughmembranecalledTheMesentery o TheMesenteryalsocarrybloodvesselsofGIT +3.3mlongdividedintothreesection o Duodenum(30cm) o Jejunum(1.5m) o Ileum(1.5m) Cellsliningsmallintestinesproduceenzymesandmucustoassistindigestion Enzymesfrompancreas+smallintestinescarryoutfinalprocessofdigestion Foodmovedthroughsmall+largeintestinebywavelikecontractionofwallsofintestines o Thiscalledperistalsis

1.10 Largeintestines
+1.5mlongholloworgan(inallfourquadrants) Consistsof: o Cecum o Colon o Rectum Majorfunctions: Absorptionoffluids+formationofsolidstoolstoredinrectum Stoolthenpassedoutbodyviaanus

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GIT(GastroIntestinalTract)

Smallclosetubeattachedtofirstpartoflargeintestine(cecum) Lowerrightquadrant o Mayeasilybecomeinfected/inflamed/obstructed o Thiscalledappendicitis o Oneofmajorcausesofabdominaldistress Appendixhasnoknowmajorfunctioninbody

1.12 Rectumandanus
Lowermostsectionofcolon Largeholloworgan Adaptedtostorequantitiesoffaecesuntilexpelled Endofrectumisanus Rectumandanussuppliedwithcircularmuscle o Calledsphincters o Sphincterscontrolescapeofsolids/liquids/gases

1.13 Howdigestionworks
Fromtimetakenintomouthuntilessentialcompoundsextractedanddeliveredbycirculatorysystemtonourish allcellsinbody: Differentsecretions(mainlyenzymes)addedtofoodby: o Salivaglands o Stomach o Liver o Pancreas o Smallintestine Convertsfoodintobasicsugars,fattyacidsandaminoacids Thesebasicproductscarriedacrosswallofintestineandtransportedviaportalveintoliver Inliverproductsprocessedfurtherandsortedortransportedtoheartviaveinsdrainingliver Heartpumpsnutrientsrichbloodviaarteriesandeventuallycapillarieswallstonourishindividualcells 8L10LoffluidsecreteddailyintoGIT(with/withoutfoodintake) Fluidcomesfrom o Salivaryglands o Stomach o Liver o Pancreas o Smallintestine Ifvomiting/diarrhoeamorethan23dayspt.losessubstantialportionofbodycompositionandbecome hypovolemic

2
2.1

ClinicalconditionsAcuteabdominal
Acuteabdominaldefinition
Intraabdominalconditionwhichmayworsen/becomelifethreateningwithinshortperiodoftime Infection/inflammation/ruptureofviscus/otherstructureusuallycauseforacuteabdomen ImperativeNOdelayintransportingthesept.tohospital o Duetolargenumberoforgans/structuresinabdomenthatmaybecomediseased/disorderthat maybecomelifethreatening

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GIT(GastroIntestinalTract)

Commoncausesacuteabdominaldefinition
Appendicitis Cholecystitis(inflammationsofgallbladder) Perforatedpepticulcer(e.g.Duodenalulcer) Obstructionofbowl(small/largeintestine) Leak/rupturedabdominalaorticaneurysm Kidneystones Pancreatitis Infectionoffemaleinternalgenitalia(pelvicinflammatorydisease) Rupturedectopicpregnancy Miscarriage/spontaneousabortion o Manyoftheseconditionswillbeinflammatory/infectionofperitoneumperitonitis o Leadingtocertainsignsandsymptoms

2.3 2.3.1

SignsandSymptomsacuteabdominaldefinition Signsacuteabdominaldefinition
Tachycardia(signsofshock) LowBP(signsofshock) Distendedabdomen Tenderabdomenmayberigid Abdominalguarding o Establishedperitonitiscausespain Dependingonseveritymaybeassociatewithtender/rigidabdomen Notallcausesofacuteabdomenduetostructuresinabdominalcavity o Sometimesmimickedbye.g.heartattack/pneumonia o Thereforeexaminept.closelyevenifallpointstoabdomen

2.3.2

Symptomsacuteabdominaldefinition

Pt.complainingof: Abdominalpain o Painmaybemild/extreme o Causingpt.torollaround/lieimmobileforfearofmakingworse Visceralpain o Cramping/gastypepain o Generallydiffusedoverentireabdomen o Difficulttolocalize o Usuallyindicatesdistensionofholloworgans Somaticpain o Usuallyconstant+localized o Sharp/stabbingpains o Pt.willexhibitabdominalguarding o Indicationsofinflammatione.g.appendicitis Referredpain o Painfeltinpartofbodydistanceawayfromactualsiteofproblem o Lossofappetite o Nausea/vomiting o Failuretopassstool(faeces)/changeinotherbowelhabits

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GIT(GastroIntestinalTract)

Treatmentacuteabdominaldefinition
ABC Oxygen Vitalsigns Entonox(ifnocontraindications) Beawareofvomiting Nilpermouth Obtainhistory Avoidroughhandlingofpt. TransportASAP(donotdelay) Positionappropriately Callforbackupifneeded

Abdominaltrauma
Classified: o Close o Open(penetrating) Mostcommonorgansinvolved o Liver o Spleen o Intestines

3.1

Closedabdominaltrauma
Maybecausedbybluntforcetrauma/blows/compressionsinjuries Examples o Pedestrianstruckbyvehicle o Assault o Sportinjuries o Seatbelt o Steeringwheel Asresultofsuddendeceleration Maybedifficulttoassesssincebruisingmaybeonlysignspresentinpt.complainingofabdominalpain Muchsafertoassumelaceration/ruptureofabdominalviscusoccurredineverycase o Topreventattitudeofcomplacency

3.2

Openabdominaltrauma
Causedwhenabdominalwallispenetrated Mayresultfromgunshot/sharpobject Penetratinginjuriestrajectoryofwoundingobjectcannotbedeterminedinfield Awarenessthatstructuresabovediaphragmmaybeeffected o E.g.abdominalcontentsmayenterpleuralspacefrompenetratingwoundindiaphragm o Andpt.mayhaverespiratoryproblems o Diaphragmaticherniation Largeopeninginabdominalwallmaycauseboweltoprotrudefromabdomenevisceration Penetratinginjurieseasiertoassess o Howeversmallpuncturewoundse.g.assaultwithbicyclespoke/smallcalibrebulletwoundmaynot easilybevisiblebutmaycauseinternaldamage Presenceofrapidpulsewith/withoutfallinBPMUSTbetakenseriously o Mayindicateinternalbleeding

3.2.1

Treatmentandmanagementopenabdominalwounds
ABC Oxygen

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Module11

GIT(GastroIntestinalTract)

Stopbleeding/sealanwoundswithdrymoisteneddressing Vitalsigns History Positionpt.Trendelenburg o Ifunconsciousplacelateral TransportASAP(donotdelay) Callforbackupifneeded

3.3

Objectsimpaledinabdomen
DONOTremoveobject

3.3.1

Treatmentandmanagementobjectsimpaledinabdomen
ABC Stopbleeding Stabilizeobjectwithbulkydressing Keeppt.still Treatforshock TransportASAP

3.4

Evisceration
DONOTattempttoreintroduceorganbackintoabdomen

3.4.1

Treatmentandmanagementevisceration
ABC DONOTadministerEntonox Coverexposedorgan(s)withmoiststeriledressing Shouldthenbecoveredwithrescueblank/cleanplasticwrapping o Inordertopreventheatloss/infection/haemorrhaging Edgesoffoil/plastictobetapeddownontopt.ensuregoodseal CallforbackASAP TransportASAP

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