Chapter 38 Assessment of the Digestive & GI Function

Question 1

Where does the GI tract extend to?

Answer 1

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

Question 2

Major Functions of the GI Tract

Answer 2

Breakdown food for digestion

Absorption into bloodstream of small nutrient molecules produced via digestion

Elimination of undigested unabsorbed food & waste products

Question 3

GI Tract: Chewing & Swallowing

Answer 3

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

Question 4

Stomach

Answer 4

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

Hollow muscular organ w/ capacity of ~1500 mL

Question 5

Function of the Stomach

Answer 5

Stores food during eating

Secretes digestive fluids

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

Question 6

What stimulates the stomach to secrete acid?

Answer 6

Secretes HCl in response to presence or anticipated ingestion of food

Question 7

Amylase

Answer 7

Enzyme that begins the digestion of starches

Question 8

Hydrochloric Acid (HCl)

Answer 8

Acid secreted by the glands

Can total 2.4 L/day

pH can be low as 1

Question 9

What is the function of HCL?

Answer 9

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

Question 10

Pepsin

Answer 10

Gastric enzyme that plays a major role in protein digestion

End product of the conversion of pepsinogen from the chief cells

Question 11

Intrinsic Factor

Answer 11

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

Prevents pernicious anemia

Question 12

Chyme

Answer 12

Partially digested food mixed w/digestive secretions

Question 13

Small Intestine

Answer 13

Longest segment of the GI tract

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

Question 14

Function of Small Intestine

Answer 14

Aids in further digestion of food coming from the stomach

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

Question 15

Large Intestine

Answer 15

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

Question 16

Trypsin

Answer 16

Aids in digesting proteins

Question 17

Amylase

Answer 17

Aids in digesting starches

Question 18

Lipase

Answer 18

Aids in digesting fats

Question 19

Gerontological Considerations for GI Function

Answer 19

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

Question 20

Health History

Answer 20

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

Question 21

Common GI SYmptoms

Answer 21

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

Question 22

Stool Tests: Fecal Occult Blood Testing (gFOBT)

Answer 22

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

Question 23

Urea Breath Tests

Answer 23

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

Question 24

GI Tract Study Overview

Answer 24

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

Question 25

Indications for GI Tract Study

Answer 25

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

Question 26

Pre-procedure Considerations for GI Tract Study

Answer 26

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

Question 27

Post-procedure Considerations for GI Tract Study

Answer 27

Monito elimination of constract and increase fluid intake to promote elimination

Question 28

Client Education

Answer 28

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

Question 29

EGD) Esophagogastroduodenoscopy

Answer 29

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

Question 30

EGD Considerations

Answer 30

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

Question 31

ERCP

Answer 31

Insertion of an endoscope through the mouth into the biliary tree via duodenum

Allows visualization of the biliary ducts, gallbladder, liver, & pancreas

Question 32

ERCP Considerations

Answer 32

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

Question 33

Colonoscopy

Answer 33

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

Question 34

Colonoscopy Considerations

Answer 34

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

Question 35

Colonoscopy Prep

Answer 35

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

Question 36

Contraindications for Colonoscopy

Answer 36

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

Question 37

Computed Topography (CT) Scan

Answer 37

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?