Summary NSG 202 GI system - Medical surgical nursing Concepts for Interpersonal Collaborative Care

GI system
Function
 The function of the GI tract includes secretion, digestion, absorption, motility, and elimination
 Chyme is the liquid product of the food after it went through digestion
 Upper esophageal sphincter (UES) is closed at rest to prevent air into the esophagus
 LUS is also closed at rest to prevent acid reflux, GERD can develop if LUS doesn’t work properly
 The stomach has 3 functional regions, the cardia is the narrow portion of the stomach below the
gastroesophageal junction
o Fundus
 Nearest to the cardia
o Body
 Main area
o Antrum
 Is the lower portion of the stomach
 The parietal cells produce intrinsic factor which helps in the absorption of vitamin B12,
pernicious anemia could result if these cells don’t produce intrinsic factors
 The exocrine part of the pancreas produces digestion enzymes
o Amylase and lipase are two enzymes that help with digestion
 The liver has 3 main functions: storage, protection, and metabolism
o Bile is essential for the breakdown of fat
o Bile is emptied into the duodenum at the sphincter of Oddi (if it’s closed, the bile goes to
the gallbladder)
 The small intestine is composed of 3 different regions
o Duodenum
 Bile and pancreatic ducts empty in the duodenum
o Jejunum
o Ileum
 The small intestine has three main functions: movement, digestion, and absorption
 The large intestine composed of 4 parts
o Ascending colon
o Transverse colon
o Descending colon
o Sigmoid colon
 The large intestine’s functions are movement, absorption, and elimination

GI changes with aging
 Decrease in HCL levels (hypochlorhydria)
o Leads to decreased B12 and Iron absorption
 Decreased peristalsis and nerve impulses are dulled
o Leads to decreased sensation to defecate which can result in constipation and impaction
o Digital impaction could cause a vasovagal response and arrythmias
 Pancreatic duct changes

, o Leads to decreased fat absorption which results in steatorrhea (fatty stool)
 Decrease in the number and size of the hepatic cells
o Leads to decreased enzyme activity which results in depressed drug metabolism
 Decreased good microbial flora
o Can leads to obesity, inflammation, and reduced immunity

Assessment
 History
o Nutrition history
o Family history and genetic risk
o Current health problems
 Physical assessment
o Inspect
 Starts at RUQ, LUQ, LLQ, and RLQ
 RUQ – Liver, Gallbladder, Duodenum, Pancreas, and part of the ascending and
transverse colon
 LUQ – stomach, spleen, part of the pancreas, and part of the transverse and
descending colon
 RLQ – Cecum, appendix, right ureter, and right spermatic cord
 LLQ - part of the descending colon, sigmoid colon, left ureter, and left spermatic
cord
o Auscultate
 The most reliable method for assessing the return of peristalsis after abdominal
surgery is to ask the patient if he/she passed flatus within the past 8 hours or
had a stool within the past 12-24 hours
 Borborygmus is increased motility of the bowel and results in increased high-
pitched bowel sounds
 If swooshing sounds (bruits) are heard, it could indicate the presence of
aneurysm. Notify the health care provider immediately
 High pitched, hallow sounds indicate empty cavity
o Palpate
 Don’t palpate if appendicitis or abdominal aneurysm are suspected
 Depress ½ - 1 inch
 Rebound tenderness with severe pain could indicate peritoneal inflammation
 Diagnostic assessment
o CBC – anemia and infection
o PT – clotting factors levels
o Electrolytes
o AST & ALT
o Serum amylase and lipase – increase in these levels may indicate acute pancreatitis
 Characterized by sudden onset of abdominal pain, nausea, and vomiting
o Bilirubin
o Ammonia serum level – evaluate hepatic function