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109 Cards in this Set
- Front
- Back
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What does the GI system consist of?
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mouth, esophagus, stomach, small intestine, large intestine (colon), rectum, anus
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What is the capacity of the stomach, what does it do, and what are the four regions?
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-1500 mL capacity
-stores food, secretes digestive fluids, propels partially digested food or chyme into sm intestine -cardia, fundus, body, pylorus |
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What does the small intestine do and what are the three sections?
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-secretes and absorbs nutrients into bloodstream
-duodenum, jejunum, ileum |
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What does the ileocecal value do?
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controls the flow of digested material from the ileum into the cecal portion of the lg intestine, prevents reflux of bacteria into the sm intestine
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What is the ampulla of Vater?
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where the common bile duct empties into the duodenum allowing for the passage of both bile and pancreatic secretions
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What does the large intestine consist of?
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ascending, transverse, descending, sigmoid colon, rectum, anus
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How does the GI tract receive blood?
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(O2 and nutrients supplied via) gastric artery and superior and inferior mesenteric arteries (via thoracic and abd aorta)
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How much of the total cardiac output is blood flow to the GI tract?
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20%
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How does the GI tract return blood?
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portal venous system: superior mesenteric, inferior mesenteric, gastric, splenic, cystic veins, which eventually form the vena portae that enters the liver, and then eventually into the inferior vena cava
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What does sympathetic nerve innnervation do?
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has inhibitory effect, decreases GI secretions and mobility, sphincter and blood vessels to contrict
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What does parasympathetic nerve innervation do?
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causes peristalsis, increased secretory activities, sphincter relaxation
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What are the primary functions of the GI tract?
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breakdown of food for DIGESTION, ABSORPTION of broken down nutrients, ELIMINATION of undigested unabsorbed food stuffs and waste
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How much saliva is secreted daily and where is it secreted from?
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-1.5 L
-parotid, submaxillary, and sublingual glands |
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What does amylase digest?
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starches and dextrin
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What covers tracheal openning?
What covers prevents reflux of stomach contents into esophagus? |
-epiglottis
-esophageal sphincter |
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How much gastric fluid is produced per day, what is the pH, what is it primarily made of and where does that come from?
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-2.4 l/day
-pH <1 -hydrochloric acid -secreted from glands of stomach |
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What are the functions of gastric secretions?
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-break down of food to more absorbable components
-aid in the destruction of ingested bacteria |
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What does pepsin do?
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breaksdown proteins into polypeptides
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What produces intrinsic factor and what does it do?
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-gastric mucosa
-combines with vit B12 to help absorb vit in the ileum |
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Define chyme
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partially digested food mixed with gastric secretions
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What regulates the rate of gastric secretions and gastric mobility?
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hormones, neuroregulators and local regulators
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What effect does acetylcholine have on GI regulation?
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increases gastric acid and increased motility
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What effect does norepinephrine have on GI regulation?
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inhibites secretions and decreases mobility
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What effect does gastrin have on GI regulation?
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increases gastric joice secretion which is rich in HCL, increase mobility of stomach, relaxation of ileocecal sphincter, excitation of colon
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What effect does cholecystokinin have on GI regulation?
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releases bile into duodenum, increase production of pancreatic secretions, inhibits gastric secretions
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What effect does secretin have on GI regulation?
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inhibits gastric secretion, increases production of bicarbonate-rich pancreatic juice, inhibits stomach contractions
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What effect does histamine have on GI regulation?
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increases gastric acid production
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Where do duodenal secretions come from?
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pancreas, liver, gallbladder and small intestine itself
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What do the duodenal secreations contain?
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digestive enzymes: amylase, lipase, bile
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What is the pH of pancreatic secretions?
What is the purpose of this? |
alkaline, high concentration of bicarb
neutralizes acid entering stomach from duodenum |
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What are the digestive enzymes secreted by the pancreas and what are their function?
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-trypsin- aids in protein digestion
-amylase- aids in starch digetion -lipase- aids in digestion of fats |
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Where do the pancreatic secretions go?
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into pancreatic duct, into common bile duct at ampulla of Vater
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Where is bile secreted from and what does it do?
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secreted by liver, stored in gallbladder, aids in (digestion, absorbtion)emulsifying ingested fats
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What controls the flow of bile?
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sphincter of Oddi, found in duodenum and common bile duct confluence
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What controls the the intestinal secretions and GI motility?
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hormones, neuroregulators, local regulators found in intestinal secretions
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What do the intestinal secretions total?
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pancreatic juices = 1 L/day
bile = 0.5 L/day secreations from glands of small intestine = 3 L/day |
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What are the two types of contractions in the small intestine?
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segmentation- mixing waves that churns intestinal content
intestinal peristalsis- propels contents of small intestine to colon |
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How long does chyme stay in the small intestine, and what does it allow for?
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3-6 hours, allows for breakdown and absorbtion of nutrients
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What are villi?
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small finger like projections in entire intestine that produce digestive enzymes and absorb nutrients
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What is the primary function of the small intestine?
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absorption
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Where does absorption begin and how is it done?
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jejunum via active transport and diffusion
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Where are nutrients absorbed?
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small intestine and duodenum
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Where are fats, proteins, carbohydrates, sodium, chloride absorbed?
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jejunum
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Where are vit B12, bile salts absorbed?
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ileum
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Where are magnesium, phosphate, and potassium absorbed?
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throughout the small intestine
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Within 4 hours after eating where does the residual waste go?
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into terminal ileum, through ileocecal valve to right colon
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What does bacteria in the large intestine do?
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assists in completing the breakdown of waste material, esp undigested or unabsorbed proteins and bile salts
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What two colonic secretions are added to the residual material?
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1. electrolyte solution- bicarbonate that neutralizes end product of bacterial action
2. mucus prtects colonic mucosa from contents and provides adherence for the fecal mass |
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Why is slow peristalic activity important in colon?
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allows for reabsorption of water and electrolytes
*which is primary purpose of colon |
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How long does it take for a meal to reach and distend the rectum?
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12 hours
1/4 of the waste material from a meal may still be in the rectum 3 days after |
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What does feces consist of?
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undigested foodstuff, inorganic materials, water, and bacteria
75% fluid, 25% solid material |
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What causes the color and odor of feces?
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color- bile breakdown by bacteria
odor- chemicals formed from intestinal bacteria |
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What gases are in the GI tract, how much, and where do they go?
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methane, hydrogen sulfide, ammonia, others
150 mL absorbed into portal circulation and detox by liver, or through rectum |
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How does elimination of stool begin?
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distention of rectum initiates contractions of rectual musculature and relaxes internal anal sphincter
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What controls the internal anal sphincter?
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autonomic nervous system
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What happens during defecation?
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external anal sphincter voluntarily relaxes, abdominal muscles facilitate emptying and contents is expelled
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What controls the external anal sphincter?
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conscious control of cerebral cortex
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What GI age related considerations are there?
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teeth decay, taste bud diminishment, decreased production of saliva, decreased mobility/sphincter of esophagus, decreased gastric motility/emptying, decrease in digestive enzymes/HCL, decreased absorption/mucosa secretion
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GI assessment includes:
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HX, abd pain, dyspepsia, gas, N/V/D, constipation, incontinence, jaundice, med use, nutritional status, CBC, alcohol, tobacco, stress, change in bowel habits
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Define dyspepsia?
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upper abdominal discomfort, indigestion-pain, discomfort, bloating, fullness, belching, heart burn, regurg
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What order is the assessment done in?
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inspection, auscultation, percussion, palpitation
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What are normal , hypoactive, hyperactive bowel sounds?
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-normal every 5-20 secs
-hypoactive 1-2 sounds every 2 minutes -hyperactive 5-6 sounds in <30 seconds |
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What lab tests are used?
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CBC, complete metabolic panel, prothrombin/partial thromoboplastin time, triglycerides, LFT, amylase, lipase, CEA, cancer antigen, alpha-fetoprotein
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What does CEA measure?
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presence of cancer and stage, esp GI and colorectal
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What does CA 19-9 measure?
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advanced pancreatic cancer, colorectal cancer, lung, gallbladder, gallstone, pancreatitis, cystic fibrosis, liver disease
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What is assessed in a basic stool examination?
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consistency, color, occult, blood, urobilinogen, fecal fat, nitrogen, c-diff, fecal leukocytes, osmolar gap, parasites, pathogens, food residues
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What is fecal occult blood testing used for?
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early cancer detection
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What things should be avoided if a hemoccult II is being performed?
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vit c, red meat, aspirin, NSAIDS, turnips, horseradish
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What does the hydrogen breath test determine?
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overgrowth of bacteria in the intestine and short bowel syndrome
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What does the urea breath test determine?
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presense of helocobacter pylori
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What can an abdominal ultrasonography detect?
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enlargement of pancreas, gallbladder, presence of gallstones, enlarged ovary, ectopic pregnancy, appendicitis, acute colonic diverticulitis
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What can an endoscopic ultrasonography detect?
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submucosal lesions, Barrett's esophagus, portal hypertension, chronic pancreatitis, suspected pancreatic neoplasm, biliary tract disease, ulcerative colitis
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Before an abdominal ultrasonography what do patients need to do?
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fast 8-12 hours, if gallbladder studied fatfree before test
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What can an upper GI series enable the examiner to detect?
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derangement of GI organs, sphincters, diagnosis of ulcers, varies, tumors, regional enteritis, malabsorption syndromes, stomach mobility, gastric wall thickness, mucosal pattern, pyloric valve, duodenum, obstructions, ileitis, diverticula
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What is used in a Upper GI study?
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-radiopaque liquid (barium sulfate or hypaque and water)
-fluoroscopy -x-ray |
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What is a double-contrast upper GI study?
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thick barium suspension along with tablets that release CO2 outline the stomach and esphageal wall, show esophagus and stomach in more detail, can see superficial neoplasms
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What is an enteroclysis upper GI study?
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continuous infusion thru duodenal tube of barium sulfate and methylcellulose, jejunum and ileum viewed thru fluoroscopy, can take 6 hours, detects small bowel obstruction or diverticula
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Nursing interventions for upper GI study?
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clear liquid diet, NPO from midnight on, no smoking, gum chewing, mints, oral meds held in morning, fluids increased after study to facilitate evaculation of barium
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How is a lower GI study done?
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rectal installation of barium/barium enema or water soluble contracts with air, then x-ray
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What can a lower GI study find?
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polyps, tumors, lesions of large intestine, anatomical abnormalities, malfunctioning of bowel
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When is a water-soluable contrast used for a lower GI study?
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iodine allergy, suspected inflammatory disease, fistula, perforation of the colon, obstruction
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What are the nursing interventions for lower GI study?
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Before: emptying and cleansing lower bowel- low residue diet 1-2 days before, liquid diet and laxative evening before, NPO after midnight, cleansing enema in the morning, barium enema is scheduled before upper GI
After: increase fluid intake, bowel movement eval |
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What are CT scans good at detecting with regards to the GI tract?
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inflammatory conditions in the colon- appendicitis, diverticulitis, regional enteritis, ulcerative colitis
evaluation of liver, spleen, kidney, pancreas, pelvic organs, abd wall |
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Nursing interventions for CT scan:
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not useful for very thin, best with contrast agent (check for iodine allergy, serum creatine levels, urine chorionic gonadotrophin), renal prodection with admin of IV sodium bicarb 1 hour before, 6 hours after and oral acetylcysteine
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What can an MRI detect in GI?
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abd soft tissues, blood vessels, abscesses, fistulas, neoplasms, sources of bleeding
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Nursing interventions for MRI:
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NPO 6-8 hours before, remove all jewelry and metals (pacemaker)
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What other tests may be used for lower GI?
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PET, scintigraphy, GI motility studies
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Describe fibroscopy
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direct visualization of esophageal, gastric, and duodenal mucosa thru lighted endoscope
-can detect abdnormalities, inflammation, neoplasm, infection |
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Describe esophagogastroduodenoscopy (EGD)
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views GI tract with lens that can take photographs or video
-detects esophageal, gastric, duodenal abnormalities, inflammtion, neoplasms, infections |
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Describe endoscopic retrograde cholangiopancreatography (ERCP)
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uses endoscope and x-ray to view ductal structures of biliary tract
-detects jaundice, panreatitis, pancreatic tumors, common dile duct stones, biliary tract disease |
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What other things can be done with upper GI flibroscopy?
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-removal of common bile duct stones, dilate strictures, treat gastric bleeding, esophageal varices, injection of sclerosing solution to stop bleeding
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Nursing interventions for endoscopic procedures
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sedated, down back of mouth into esophagus, duodenum, NPO 8 hours prior, may use atropine to reduce secretions, glucagon to relax smooth muscles, sore throat, VS
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Describe fiberoptic colonoscopy
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direct visual inspection of the large intestine with flexible fiber optic, still and video recording available
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What else beside screening and diagnosis can colonscopy be used for?
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tissue biopsy, polyp removal, evaluation of diarrhea, bleeding, inflammatory bowel disease
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How are polyps removed via colonscopy?
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coagulators, heater probes, injection of vasoconstrictors/sclerosing agents, lasar therapy
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What are some complications of colonoscopy?
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cardiac dysrhythmias and resp dep from meds, vasovagal reactions, circulatory overload or hypotension, electrolyte and fluid imbalance, hypothermia, nausea, bloating cramping, hyper/hypoglycemia
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nursing interventions for colonoscopy
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adequate colon cleanse before, laxatives 2 nights before, enema day of, clear liquid diet
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What special considerations are there for colonoscopies?
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cannot be performed if suspected colon perforation, acute severe diverticulitis, fulminant colitis, prosthetic heart valves or endocarditis must take prophylactic antibiotics, special precautions for those with defib/pacemakers, elderly
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Describe anoscopy, proctoscopy, sigmoidoscopy
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flexible fiberoptic sigmoidoscope that allow video and still pictures, can do biopsy and polypectomies, used to evaluate chronic diarrhea, fecal incontience, ischemic colitis, lower GI hemorrhage, ulceration, fissures, absecesses, tumores, polyps or other
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What are signs of intestinal perforation?
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fever, rectal drainage, abd distention, pain
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Describe endoscopy thru ostomy
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flexible endoscope thru ostomy stoma, good for recurrent disease or bleeding in the bowel
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Describe small bowel enteroscopy
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long flexible balloon inserted into distal ileum and intestinal wall is examined as tube is retracted
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Describe how manometry and electrophysiology is used in GI studies
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detect and measure motility of esophagus (GERD), duodenum, small intestine, colon, rectum
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Describe gastric analysis and pH monitoring
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ability of mucosa to secrete HCL, pH levels in esophagus over 24 hours
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What is pernicious anemia?
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patient secretes no stomach acid under basal conditions or after stimulation
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What is server chronic atrophic gastritis or gastric cancer?
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secrete little or no stomach acid
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What is a peptic ulcer?
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secretes on some stomach acid
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What is a duodenal ulcer?
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excess amount of stomach acid secreted
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How is laparoscopy used in GI studies?
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fiberoptic laparoscope is inserted through small incision to allow for direct visualization of organs and structures, also can biospy, does require gen anesthesia
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