Chapter 38 Assessment of the Digestive & GI Function Flashcards by Carrie Ortiz

Where does the GI tract extend to?

The GI tract extends from the mouth to the esophagus,
stomach, small and large intestines, and rectum, to the
terminal structure-> the anus

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Major Functions of the GI Tract

Breakdown food for digestion

Absorption into bloodstream of small nutrient molecules produced via digestion

Elimination of undigested unabsorbed food & waste products

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GI Tract: Chewing & Swallowing

Swallowing is a voluntary act that is regulated by the medulla oblongata of the CNS
* Swallowing->esophageal peristalsis sphincter relaxation (causing food to enter the stomach)->lower esophageal sphincter closing tightly to prevent reflux of stomach contents

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Stomach

Located in LUQ, under LT lobe of liver & diaphragm, overlaying most of the pancreas

Hollow muscular organ w/ capacity of ~1500 mL

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Function of the Stomach

Stores food during eating

Secretes digestive fluids

Propels the partially digested food (chyme) -> small intestine

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What stimulates the stomach to secrete acid?

Secretes HCl in response to presence or anticipated ingestion of food

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Amylase

Enzyme that begins the digestion of starches

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Hydrochloric Acid (HCl)

Acid secreted by the glands

Can total 2.4 L/day

pH can be low as 1

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What is the function of HCL?

Break down food into more absorbable components & aid in the destruction of most ingested bacteria

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Pepsin

Gastric enzyme that plays a major role in protein digestion

End product of the conversion of pepsinogen from the chief cells

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Intrinsic Factor

Gastric secretion that combines w/ vitamin B12 to be absorbed in the ileum

Prevents pernicious anemia

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Chyme

Partially digested food mixed w/digestive secretions

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Small Intestine

Longest segment of the GI tract

Provides ~70m of surface area for secretion & absorption
- Nutrients enter the bloodstream through the intestinal walls

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Function of Small Intestine

Aids in further digestion of food coming from the stomach

Absorbs nutrients & H2O from food so they can be used in the body

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Large Intestine

Consists of:
- Ascending segment on RT side of abdomen
- Transverse segment that extends from RT to LT in upper abdomen
- Descending segment on LT side of abdomen

Network of striated muscle that forms both internal & external anal sphincters regulates the anal outlet

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Trypsin

Aids in digesting proteins

Amylase

Aids in digesting starches

Lipase

Aids in digesting fats

Gerontological Considerations for GI Function

Difficulty Chewing & Swallowing
- Injury/loss or decay of teeth
- Atrophy of taste buds
- Decreased saliva production

Reflux & heartburn
- Decreased motility & emptying
- Weakened gag reflex
- Decreased resting pressure of lower esophageal sphincter

Food Intolerances, malabsorption, or decreased vitamin B12 absorption
- Degeneration & atrophy of gastric mucosal surfaces w/ decreased production of HCl
- Decreased secretion of gastric acids & most digestive enzymes
- Decreased gastric motility & emptying

Decreased motility & transit time-> c/o indigestion constipation
- Atrophy of muscle & mucosal surfaces
- Thinning of villi & epithelial cells

Decreased absorption of nutrients

Health History

Focused GI assessment info about:
Pain
- Gas
- Dyspepsia
- N/V/D
- Constipation
- Fecal incontinence
- Jaundice, & GI disease

Common GI SYmptoms

Pain (note character, duration, pattern, frequency, location, distribution)

Dyspepsia- Describe dyspepsia? What foods cause the most distress?

Intestinal Gas- pts c/o bloating, belching, distention, or
feeling “gassy”

Nausea & Vomiting- many causes; nausea is sickness or
“queasiness” that may or may not be followed by vomiting

Changes in Bowel Habits- signals colonic dysfunction or
disease

Stool Tests: Fecal Occult Blood Testing (gFOBT)

Indications:
- Most common performed stool test
- Used most frequently in early cancer detection programs
- Inexpensive, noninvasive, minimal risks

Where can it be performed?
- Bedside, lab, MD office, home

Precautions
- Do not perform FOBT if there is hemorrhoidal bleeding
- Avoid ingesting red meats, ASA, NSAIDS, and Vitamin C for 72 hours prior to testing-> false-positive results

Urea Breath Tests

Detects the presence of Helicobacter pylori, the bacteria that causes peptic ulcer disease

The pt ingests a capsule of carbon-labeled urea, a breath sample is obtained 10-20 min later

Before testing the pt is advised to avoid antibiotics or bismuth for 1 month before the test

Proton pump inhibitors should be avoided for 2 weeks before the test

Cimetidine and Famotidine is avoided for 24 hours before the test

GI Tract Study Overview

Upper GI imagining is done by having the patient drink a radiopaque liquid (barium swallow)

Lower GI imaging is done by instilling a barium enema into the rectum; a bowel cleansing prep such as [Polyethylene glycol] is needed the night of the procedure

Indications for GI Tract Study

Upper GI: Potential diagnoses are ulcers, varices, tumors, regional enteritis, and malabsorption syndrome Lower GI: Detects the presence of polyps, tumors, or other lesions of the large intestine

Pre-procedure Considerations for GI Tract Study

Low residue diet at lunch, clear liquid diet at dinner, and NPO after midnight before the study Explain bowel prep (laxatives, enemas), so the image will not be distorted by feces Advise against smoking and chewing gum- why? - They are both GI stimulants-> will increase motility

Post-procedure Considerations for GI Tract Study

Monito elimination of constract and increase fluid intake to promote elimination

Client Education

Instruct client that stools will be white for 24-72 hrs until barium clears

EGD) Esophagogastroduodenoscopy

Insertion of endoscope via mouth into the esophagus, stomach, & duodenum

EGD Considerations

Moderate anesthesia: Suppress the gag reflex - Atropine may be administered to decrease secretions LT side-lying Pre-procedure: NPO 6-8 hrs, remove dentures prior Post-procedure: - Monitor VS - Notify the provider of bleeding, abdominal/chest pain, and any evidence of infection - W/hold fluids until return of gag reflex - Pt must remain in bed until fully alert

ERCP

Insertion of an endoscope through the mouth into the biliary tree via duodenum Allows visualization of the biliary ducts, gallbladder, liver, & pancreas

ERCP Considerations

Conscious sedation--topical anesthetic Positioning: Initially semi-prone w/repositioning throughout procedure Prep: - NPO 6-8hrs; remove dentures prior to procedure - Explain the procedure & need to change the positions during the procedure Postprocedure: - Monitor VS & respiratory status - Notify the provider of bleeding, abdominal/chest pain, & any evidence of infection - W/hold fluids until gag reflex return

Colonoscopy

Use of flexible fiber-optic colonoscope, entering via anus, to visualize the rectum & sigmoid, descending, transverse, & ascending colon

Colonoscopy Considerations

Moderate sedation: Midazolam (Versed) w/ opiate analgesic LT side w/knees to chest Post-procedure: -Notify the provider of severe pain (possible perforation)/ sign of hemorrhage - Monitor for rectal bleeding - Monitor VS & resp status - Resume normal diet as prescribed - Encourage fluid intake - Instruct the client that there may be increased flatulence due to air instillation during the procedure

Colonoscopy Prep

Bowel prep: May include , such as bisacodyl & polyethylene glycol Clear liquid diet (avoid red, orange, purple fluids); NPO after midnight Client must avoid meds indicated by provider Side effects: Nausea, bloating, crampy, fluid/electrolyte imbalance & hypothermia Monitor elderly patients for fluid loss

Contraindications for Colonoscopy

Suspected colon perforation & Acute severe diverticulitis or colitis Pts w/ prosthetic heart valves or hx of endocarditis req prophylactic antibiox - Possibility of transient bacteria on the scope

Computed Topography (CT) Scan

Detects & localizes inflammatory conditions in the colon, as well as evaluate the abdomen for diseases of the liver, spleen, kidney, & pancreas Painless procedure with considerable amounts of radiation Performed w/ or w/out IV contrast, ask pt for allergies to contrast, iodine, shellfish Obtain serum creatinine levels & pregnancy status in females prior to administering contrast- why?