Chapter 38 Assessment of the Digestive & GI Function Flashcards
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
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
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
Stomach
Located in LUQ, under LT lobe of liver & diaphragm, overlaying most of the pancreas
Hollow muscular organ w/ capacity of ~1500 mL
Function of the Stomach
Stores food during eating
Secretes digestive fluids
Propels the partially digested food (chyme) -> small intestine
What stimulates the stomach to secrete acid?
Secretes HCl in response to presence or anticipated ingestion of food
Amylase
Enzyme that begins the digestion of starches
Hydrochloric Acid (HCl)
Acid secreted by the glands
Can total 2.4 L/day
pH can be low as 1
What is the function of HCL?
Break down food into more absorbable components & aid in the destruction of most ingested bacteria
Pepsin
Gastric enzyme that plays a major role in protein digestion
End product of the conversion of pepsinogen from the chief cells
Intrinsic Factor
Gastric secretion that combines w/ vitamin B12 to be absorbed in the ileum
Prevents pernicious anemia
Chyme
Partially digested food mixed w/digestive secretions
Small Intestine
Longest segment of the GI tract
Provides ~70m of surface area for secretion & absorption
- Nutrients enter the bloodstream through the intestinal walls
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
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
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?
