ANATOMY & PHYSIOLOGY REVIEW

• The GIT is a 23- to 26-foot long pathway that extends

from the mouth to the espohagus, stomach, small &
large intestines, and rectum, to the terminal structure
the anus.
 ANATOMY & PHYSIOLOGY REVIEW
• Primary Function of the GIT:
• DIGESTION1
• ABSORPTION2
• ELIMINATION3

• IN THE MOUTH : Approximately 1.5 L of saliva is secreted daily from the ff

salivary glands: 1) Parotid; 2) Submaxillary; & 3) Sublingual glands.
• Ptyalin, or salivary amylase, is an enzyme that begins the digestion of
starches.
 ANATOMY & PHYSIOLOGY REVIEW

• The PHARYNX connects the mouth to the esophagus.

• It aids in swallowing1
 ANATOMY & PHYSIOLOGY REVIEW

• The esophagus1 is located in the mediastinum anterior to the

spine & posterior to the trachea and heart. It passes
through the diaphragm at an opening called the
diaphragmatic hiatus.
 ANATOMY & PHYSIOLOGY REVIEW
• The stomach is a hollow muscular organ w/ a capacity of approximately 1500 ml
• It stores food during eating, secretes digestive fluids & propels the partially digested
food, or chyme, into the small intestine.
• The stomach has 4 anatomic regions :
1. CARDIA1
2. FUNDUS 2
3. BODY 1
4. PYLORUS2
3
4
 ANATOMY &
PHYSIOLOGY
REVIEW
• Primary function of the stomach : STORAGE & MIXING of food with secretions1.
• Food remains in the stomach for a variable length of time, from 30 minutes to several
hours2
• Secretions of the Stomach
• HCl’s 2-fold function : 1) break down food3; 2) aid in destruction of most ingested bacteria.
• Pepsin4 is an important enzyme for protein digestion.
• Intrinsic factor5 combines w/ dietary vit B12
 ANATOMY & PHYSIOLOGY REVIEW
• The small intestine1 has 7000 cm of surface area for secretion &
absorption2. This is the main area for DIGESTION.
• It has 3 sections6: 1) DUODENUM3; 2) JEJUNUM4; AND 3) ILEUM5
• Duodenal secretions come from the accessory digestive organs:
PANCREAS, LIVER, & GALBLADDER
• 2 types of contraction in the Small Intestine : 1) Segmentation
contractions7; and 2) Intestinal Peristalsis8
 ANATOMY & PHYSIOLOGY REVIEW
• PRIMARY PURPOSES OF THE LARGE INTESTINE : 1) Reabsorption of
water & electrolytes; and 2) Elimination of wastes
• The large intestine consists of an ascending segment7, a transverse
segment8, and a descending segment9.
• Fecal matter is about 75% fluid and 25% solid material.
• The brown color of feces results from the breakdown of bile by the
intestinal bacteria.
 ANATOMY & PHYSIOLOGY REVIEW
Sympa OR Parasympa?
1. Inhibitory effect on the GIT
2. Decreases gastric secretion and motility
3. Sphincters & blood vessels constrict
4. Peristalsis
5. Increases secretory activities
6. Sphincters relax
7. Gastrin
8. Cholecystokinin Stimulation or
9. Secretin Inhibition?
10. Histamine
 ASSESSMENT FINDINGS
• Key Signs and Symptoms of a GI • Stool Abnormalities Associated
Disorder w/ GI Disorders
Weight changes Melena
Rectal bleeding Clay-colored stools
Jaundice Frothy stools
Hematemesis Steatorrhea
Abdominal Pain1 Occult blood in stool
Nausea & vomiting
 RISK FACTORS
• MODIFIABLE • NON-MODIFIABLE
Smoking
Stress Family History
Alcohol History of GI Disorders
Inactivity
Diet
PUD DRUGS

S • Sucralfate

P • Proton-Pump Inhibitors

H • H2-Receptor Antagonists

A • Antacids
ANTACIDS
MAGNESIUM
laxative
SE : diarrhea

ALUMINUM
SE: Constipation

Calcium
Carbonate Neutralize HCl Acid
Contraindication : Best time : 1-3 h after
high milk & vit.D content eating
 H2-RECEPTOR ANTAGONISTS
Cimetidine
SE: Diarrhea; Crosses
blood-brain barrier esp.
in elderly
Side
Effects
Famotidine
SE: Headache, vertigo HCl
By competing

Ranitidine w/ histamine
on receptor
SE: Anaphylaxis, Burning sites of
parietal cells
& itching at injection site,
Angioedema
PROTON-PUMP INHIBITORS

Axn: Decrease HCl by

blocking proton pump @
secretory surface of
parietal cells

Best time: 30 mins before

meals
• Coats the Ulcer by
Forming a Barrier
• Best time: 1 hour before
meals
HIATAL HERNIA

• Definition: portion of the

stomach passes thru
diaphragmatic opening into the
chest, usually as a result of
weakening of the diaphragm
 HIATAL HERNIA
Increased Abdominal Pressure
HIATAL HERNIA
SLIDING HERNIA
• stomach & gastroesophageal
junction slip into the chest.
• permits gastric reflux & heart burn
(major concern)
• more common type

PARAESOPHAGEAL / ROLLING
HERNIA
• part of the greater curvature rolls
through the diaphragmatic defect.
• usually doesn’t cause symptoms
but may cause strangulation of
herniated parts.
 HIATAL HERNIA
Signs & Symptoms
PARAESOPHAGEAL /
SLIDING HIATAL HERNIAS ROLLING HERNIAS
• Heartburn • Feeling of fullness after eating
• Regurgitation • Breathlessness after eating
• Chest Pain • Feeling of suffocation
• Dysphagia
• Belching
• Chest pain that mimics angina
• Worsening of manifestations in
a recumbent position
HIATAL HERNIA

Diagnostic Exam:
• Barium swallow & chest x-ray
• Esophagogastroduodenoscopy
• Esophagoscopy

Medical Mgt for Sliding Hernia

•PUD drugs except sucralfate (no
ulcer)
•Cholinergic agent : Bethanecol
(Urecholine)
HIATAL HERNIA
Nursing Intervention:
• Diet: Small Freq. meals; NO:
Spicy foods, alcohol, choco,
peppermint, caffeine, & citrus
• Position : YES to Semi-fowler’s /
Upright for 2 hours pc; Sleep at
night with the head of the bed
elevated 6 inches; NO to lifting,
bending, straining, and flexion @
waist.
• Lifestyle : Don’t smoke, lose
weight (if indicated), avoid
constrictive clothing around the
abdomen
HIATAL HERNIA
SURGICAL
INTERVENTION

FUNDOPLICATION :

Portion of the stomach

fundus wrapped around
distal esophagus
GASTROESOPHAGEAL REFLUX DISORDER

Definition: backflow of gastric

contents into the esophagus & past
the LES

Causes
1. Impaired LES Function
2. Increased intra-abdominal
pressure
3. Risk Factors: Hiatal Hernia &
ingestion
 GERD Signs & Symptoms

CARDIO-LIKE RESPI-LIKE OTHERS

• Heart burn* • Laryngitis • Regurgitation2 *

• Pain radiating to neck, jaws, • Chronic cough • Pain worsens with lying
& arms1 down / bending over
GASTROESOPHAGEAL REFLUX DISORDER
Diagnostic Procedures
• Endoscopy
• Esophageal manometry

Nursing Interventions
•Same with Hiatal Hernia
•Encourage diet that increase
LES Pressure e.g., CHO,
CHON, non-fat milk

Medical Management
Cholinergic Agent
GASTROESOPHAGEAL REFLUX DISORDER

COMPLICATIONS
•Esophagitis with possible
ulceration
•Esophageal bleeding
BARRETT’S ESOPHAGUS
Def’n: Complication from
persistent reflux predisposing to
cancerous transformation
(esophageal cancer)
CAUSE: GERD
MANIFESTATION: Difficulty in
swallowing
COMPLICATIONS
Hemorrhage & aspiration
pneumonia
 GASTRITIS
DEF: Inflammation of the gastric mucosa (lining)
CAUSES: H. Pylori, Aspirin & other NSAIDs, Alcohol,
Smoking, Stress, Toxic Substances
TYPES: Acute (exposure to irritants) heals w/n a few days;
Chronic leads to pernicious anemia & gastric cancer
 PEPTIC ULCER
DEFINITION: CAUSES:
Excavation (hollowed-out Helicobacter Pylori
area) that forms in areas Aspirin & other NSAIDs
exposed to acid secretion
Alcohol
Smoking
Type A Personality
Type O Blood
 GASTRIC Ulcer DUODENAL Ulcer

Zollinger-Ellison
STRESS Ulcer
Syndrome

CUSHING’S Ulcer CURLING’S Ulcer

 PEPTIC ULCER
Diagnostic Procedure: Complication
H. PYLORI TEST, FECAL OCCULT
BLOOD TEST, EGD
Hemorrhage
Nursing Intervention:
• Lifestyle: Smoking & alcohol
cessation; Stress reduction &
rest
• Diet: NO meat extracts,
alcohol, coffee, milk, cream
 Billroth I Billroth II
Gastroduodenostomy Gastrojejunostomy

Vagotomy
Severing the Vagus Nerve1
 Dumping Syndrome
DEFINITION: Unpleasant set of GI sypmtoms when food is
quickly “dumped” into the SI, usu d/t gastric surgery (Billroth II)

Early S&S:
• SENS’N OF full’ss (prematurely reaches duodenum)
• Anorexia
• Cramping pain
• Diarrhea (^ peristalsis, ^H20)
• Steatorrhea
• Weak’ss, faint’ss, dizziness, palpitations, diaphoresis (signs of
dehydration)

Late S&S: HYPOGLYCEMIA

 Dumping Syndrome
• MANAGEMENT GOAL: Decrease water & peristalsis
1. (-) salt
2.(-) fld w/ meals
3.N to HIGH-fat (slow peristalsis)
4.Supine 30 mins after eating
5. A somatostatin analog, octreotide (Sandostatin)
 LIVER CIRRHOSIS

Alcoholism • “LAENNEC’S CIRRHOSIS”

Biliary • “BILIARY CIRRHOSIS”

Obstruction
Right CHF • “CARDIAC CIRRHOSIS”
Acetaminophen • “POST-NECROTIC CIRRHOSIS
SENGSTAKEN-BLAKEMORE
HEPATIC ENCEPALOPATHY STAGES
1. Impaired Handwriting

2. Asterixis, Confusion

3. Decreased Level of Consciousness

4. Comatose
CHOLELITHIASIS
PANCREATITIS
DIVERTICULAR DISEASE
• DIVERTICULUM is the outpouching of
intestinal mucosa thru muscular wall
• DIVERTICULOSIS – presence of
diverticulum; asymptomatic
• DIVERTICULITIS – inflammation of
diverticula
• Typical sites : Sigmoid Colon &
Duodenum
Acute Inflammatory Bowel Disease:
APPENDICITIS

Psoas Sign
 Chronic Inflammatory
Bowel Disease

Crohn’s Disease : Ulcerative Colitis :

5 – 6 stools / day 10 – 40 stools / day
IRRITABLE BOWEL
SYNDROME

Not explained by
any structural or
biochemical
abnormalities?!