GASTRIOINTESTINAL SYSTEM Functions of the GI Ingestion Digestion Absorption Elimination Organs Mouth Esophagus Stomach Small intestine Large intestine Rectum Anus Liver Pancreas Gallbladder Coordinates GI movement secretory activities Gut brain Enteric Nervous System Circulatory System INGESTION Intake of food Hypothalamus appetite center Stimulated by Portal perfuses the liver Visceral abdominal organs Parietal abdominal cavity Hypoglycemia Empty stomach Decrease in body temperature Empty stomach o o o o o o o o o o Inhibited by Stomach distention Illness Nausea and vomiting Certain drugs Hyperglycemia Drugs DEGLUTITION Swallowing Mouth Speech Mastication chewing Swallowing deglutition Taste buds Salivary glands Pharynx Oropharynx secretes mucus Epiglottis Closes over the larynx Esophagus Receives food Moves down by peristalsis Lower esophageal sphincter prevents reflux of acidic gastric contents GASTROINTESTINAL SYSTEM 1 P a g e Factors Affecting the GI Stress Anxiety Anorexia Epigastric abdominal pain Nausea Diarrhea Physical Factors Dietary Intake Alcohol caffeine Fatigue Cigarettes Poor sleep DIGESTION AND ABSORPTION Mouth Mastication Chemical digestion Saliva Lubricates and softens food mass Facilitates swallowing Contains amylase Stomach Stores food Mixes food with gastric secretions J shape changes based on degree of distention Layers of the Stomach Longitudinal outer layer Circular middle layer Oblique inner layer Rugae folds secretes gastric juice Small intestine Digestion and absorption 23 feet and 1 inch in diameter Parts of the Small Intestine Duodenum Jejenum Ileum Villi minute fingerlike projections in the mucus membrane increases absorption Goblet cells secretes mucus PHYSIOLOGY OF DIGESTION Physical and chemical breakdown of food into absorbable substances Enzymes break down food into appropriate size for absorption 1 Mouth chewed broken down and mixed with saliva 2 Esophagus peristalsis 3 Stomach digestion of proteins by pepsin mixed with gastric solutions 3 4 average time 4 Small intestine carbs break down fats break down proteins break down 5 Chyme food with gastric secretions and stimulates motility and secretion SECRETIONS IN DIGESTION Enzymes from pancreas Bile from the liver Intestinal secretions Secretin stimulates pancreas to secrete fluid and neutralizes acid in chime CCK cholecystokinin stimulates contractions relaxes Oddi sphincter ELIMINATION Large Intestine 5 6 feet 2 inches in diameter Absorbs water and electrolytes and forms feces Four Parts of the Intestine Cecum Appendix Colon o o o o Rectum Anus Ascending on the right Transverse across Descending on the left Sigmoid colon Facilitates defacation Contraction of chest muscles Increased abdominal pressure VALSAVA MANEUVER Contraindicated in CONSTIPATION Slower peristalsis Inactivity Decreased dietary fiber Decreased fluid intake Depression Medications Laxative abuse Head injury Eye surgery Abdominal surgery Cardiac problems Hemorrhoids Liver cirrhosis GASTROINTESTINAL SYSTEM 2 P a g e Largest internal organ in the body Right epigastric region Hepatic cells hepatocytes LIVER BILIARY TRACT AND PANCREAS Liver Kuppfer Cells Phagocytic activity Manufactures transforms and excretes substances involved in metabolism Biliary Tract Gallbladder and duct system Below liver Stores bile Bilirubin Metabolism Bilirubin breakdown of hemoglobin and bound to albumin Unconjugated insoluble in water Conjugated soluble secreted in bile Pancreas Head body tail Exocrine digestion cells secrete enzymes Endocrine o o o o o Islet of Langerhans Beta cells secrete insulin and amylin Alpha cells glucagon Delta cells somatostatin F cells pancreatic polypeptide GERONTOLOGIC CONSIDERATIONS Tooth enamel wear down Periodontal disease loss of teeth Xerostomia decreased saliva production Dysphagia Taste buds decrease Sense of smell diminished Decrease in appetite Less pleasurable eating Delayed emptying smooth muscle weakenss GERD decreased esophageal clearance ASSESSMENT OF THE GI SYSTEM PAST MEDICAL SYSTEM Abdominal pain Nausea and vomiting Diarrhea Allergies Lactose intolerance Hemorrhoids Constipation Abdominal distention Jaundice Indigestion Melena Rectal bleeding Anemia Heartbuern Dyspepsia Excess gas bloating Trouble swallowing Changes in appetite Hematemesis Food intolerance Reflux Gastritis Diverticuli Hepatits Colitis Hemorrhoids Gallbladder disease Peptic ulcer Hiatal hernias Cancer Unexplained weight loss gain within 6 12 months Chronic dieting Repeated weight loss gain MEDICATIONS Names of all drugs Past and current use of medications Frequency of medications Duration of use Potentially hepatotoxic drugs Tylenol Amiodarone Arsenic Azathioprine Thiazide diuretics o o o o o Can also cause GI bleed Antacids laxatives and the frequency SURGERY OR OTHER TREATMENTS Abdominal rectal surgery Year and reason for surgery Preoperative course Possible blood transfusions Maintenance of normal body weight Proper dental care Adequate nutrition Effective elimination habits Recent foreign travel Exposure to hepatitis Parasitic infection Alcoholic intake Cigarette smoking Bacterial infestation Hepatitis A B vaccination HEALTH PERCEPTION HEALTH MANAGEMENT PATTERN NUTRITIONAL METABOLIC PATTERN ELIMINATION PATTERN ACTIVITY EXERCISE PATTERN Frequency Time of day Enemas Consistency of stool Laxatives Change in bowel patterns Fluid and fiber intake Ambulatory status Limitations Commode ostomy supplies Dietary history Open ended questions Food intake Snacks vitamin supplements Caffeine Fluid fiber intake Changes in appetite Food allergies GASTROINTESTINAL SYSTEM 3 P a g e SLEEP REST PATTERN Nausea and vomiting Diarrhea Indigestion Bloating hunger Bedtime ritual COGNITIVE PERCEPTUAL PATTERN Changes in taste smell Vertigo Chronic pain Avoidance of activity Fatigue Disruption of eating patterns Heat cold sensitivity Opoid meds Constipation Nausea Sedation Appetite suppression o o o o Self esteem body image Depression Colostomy ileostomy Jaundice ascites Assess attitude Cirrhosis Hepatitis Obesity Alcoholism Ostomies Carcinoma Changes in body image SELF PERCEPTION SELF CONCEPT PATTERN ROLE RELATIONSHIP PATTERN SEXUALITY REPRODUCTIVE PATTERN COPING STRESS TOLERANCE PATTERN VALUE BELIEF PATTERN Food preparation Anemia vegetarian high meat diet Epigastric pain Nausea Diarrhea Bloating Constipation Question to determine presence of potential problems OBJECTIVE DATA Height and weight Blood studies Protein Albumin Liver enzymes Hemoglobin Pre albumin o