Learning Objectives:At the end of this lecture, you will be able to:1. Describe the structure and function of the organs o...
3. Use assessment parameters appropriate fordetermining the status of gastrointestinal function.4. Describe the appropriat...
Anatomy and Physiology
Anatomy & Physiology
Two groups of organs compose the digestive system:• GASTROINTESTINAL TRACT include the mouth, mostof the pharynx, esophagu...
Anatomy and Physiology
Anatomy & Physiology
Anatomy & Physiology
Anatomy & Physiology
Anatomy & Physiology
Anatomy & Physiology
Functions of the digestive system1. Ingestion: taking food into the mouth.2. Secretion: release of water, acid, buffers, a...
• The branch of dentistry that is concerned with theprevention, diagnosis, and treatment of diseases thataffect the pulp, ...
Anatomy and Physiology
Anatomy & Physiology
Anatomy & Physiology
Anatomy & Physiology
• Mechanical digestion in the mouth results from chewing,or mastication.• Salivary amylase, which is secreted by the saliv...
PHARYNX• The pharynx, a funnel-shaped tube that extends from theinternal nares to the esophagus posteriorly and to thelary...
ESOPHAGUS• The esophagus is a collapsible muscular tube, about 25cm (10 in.) long, that lies posterior to the trachea. The...
• The mucosa of the esophagus consists of nonkeratinizedstratified squamous epithelium, lamina propria, and amuscularis mu...
DEGLUTITIONSwallowing occurs in three stages:• the voluntary stage, in which the bolus is passed intothe oropharynx• the p...
Anatomy and Physiology
Anatomy and Physiology
Anatomy of the Stomach
Anatomy of the Stomach
FUNCTIONS OF THE STOMACH1. Mixes saliva, food, and gastric juice to form chyme.2. Serves as a reservoir for food before re...
Anatomy and Physiology
Anatomy and Physiology
Anatomy and Physiology
Anatomy and Physiology
Anatomy and Physiology
Anatomy and PhysiologyBLOOD SUPPLY OF THE LIVER
ROLE AND COMPOSITION OF BILE• Each day, hepatocytes secrete 800–1000 mL (about 1 qt)of bile, a yellow, brownish, or olive-...
• Bile salts, play a role in emulsification, the breakdown oflarge lipid globules into a suspension of small lipidglobules...
FUNCTIONS OF THE LIVER• Carbohydrate metabolism.• Lipid metabolism.• Protein metabolism.• Processing of drugs and hormones...
FUNCTIONS OF THE LIVER• Storage for certain vitamins (A, B12, D, E, and K) andminerals (iron and copper)• Phagocytosis.• A...
Anatomy and Physiology
SFunctions of the Small Intestine1. Segmentations mix chyme with digestive juices andbring food into contact with the muco...
SMECHANICAL DIGESTION IN THE SMALL INTESTINEThe two types of movements of the small intestine:Segmentations• Segmentations...
Anatomy and Physiology
Anatomy and Physiology
FUNCTIONS OF THE LARGE INTESTINE1. Haustral churning, peristalsis, and mass peristalsis drivethe contents of the colon int...
THE DEFECATION REFLEX• Diarrhea is an increase in the frequency, volume, andfluid content of the feces caused by increased...
PHASES OF DIGESTION• During the cephalic phase of digestion, the smell, sight,thought, or initial taste of food activates ...
• The intestinal phase of digestion begins once foodenters the small intestine.• The intestinal phase of digestion begins ...
Anatomy and Physiology
Health History and Clinical ManifestationsSUBJECTIVE DATA1. GENERAL DATAa. presence of dental prosthesis, comfort of usage...
Health History and Clinical Manifestations
Health History and Clinical ManifestationsSUBJECTIVE DATA2. SPECIFIC DATAa. situations or events that effect symptomsb. on...
Health History and Clinical ManifestationsSUBJECTIVE DATA3. NORMAL PATTERN OF BOWEL ELIMINATIONa. frequency and character ...
Health History and Clinical ManifestationsSUBJECTIVE DATAb. changes in color of stool melena hematocheziac. drugs /medic...
Health History and Clinical ManifestationsINDIGESTION• Indigestion can result from disturbed nervous systemcontrol of the ...
Health History and Clinical ManifestationsNAUSEA AND VOMITING• Vomiting is usually preceded by nausea, which can betrigger...
Health History and Clinical ManifestationsBOWEL HABITS AND STOOL CHARACTERISTIC• Diarrhea commonly occurs when the content...
Health History and Clinical Manifestations• Blood entering the lower portion of the GI tract or passingrapidly through it ...
Health History and Clinical Manifestations• Stool with mucus threads or pus that may be visible ongross inspection of the ...
Physical Assessment• The patient lies supine with knees flexed slightly forinspection, auscultation, palpation, and percus...
Physical AssessmentInspecting the abdomen Auscultating the abdomen
Physical Assessment• The nurse assesses bowel sounds in all four quadrantsusing the diaphragm of the stethoscope; the high...
Physical Assessment• The nurse notes tympani or dullness during percussion.Use of light palpation is appropriate for ident...
Physical AssessmentPalpating the abdomen Percussing the abdomen
Diagnostic EvaluationCommon blood tests include complete blood count (CBC),carcinoembryonic antigen (CEA), liver function ...
Diagnostic Evaluation• Providing needed information about the test and theactivities required of the patient• Providing in...
Stool TestBasic examination of the stool includes:• inspecting the specimen for consistency and color andtesting for occul...
Stool Test• The most widely used occult blood test is the Hematest.False-positive results may occur if the patient has eat...
Breath Test• The hydrogen breath test was developed to evaluatecarbohydrate absorption. It also is used to aid in thediagn...
Abdominal Ultrasonography• During abdominal ultrasonography, an image of theabdominal organs and structures is produced on...
Nursing Interventions• The patient fasts for 8 to 12 hours before the test todecrease the amount of gas in the bowel.• If ...
DNA Testing• DNA testing allows practitioners to prevent (or minimize)disease, by intervening before its onset, and to imp...
Imaging StudiesImaging studies include:• x-ray and contrast studies• computed tomography (CT) scans• magnetic resonance im...
Upper GI Tract Study• X-rays can delineate the entire GI tract after theintroduction of a contrast agent.• Variations of t...
Nursing InterventionsBEFORE THE PROCEDURE:• maintain a low-residue diet several days before the test• receive nothing by m...
Nursing InterventionsAFTER THE PROCEDURE:• Follow-up care is needed after any of the upper GIprocedures to ensure that the...
Lower GI Tract Study• When barium is instilled rectally to visualize the lowerGI tract, the procedure is called a barium e...
Nursing InterventionsBEFORE THE PROCEDURE:• a low-residue diet 1 to 2 days before the test• a clear liquid diet and a laxa...
Nursing InterventionsCONTRAINDICATIONS FOR BARIUM ENEMA• patient has active inflammatory disease of the colon• patients wi...
Nursing InterventionsCONTRAINDICATIONS FOR BARIUM ENEMA• patient has active inflammatory disease of the colon• patients wi...
Nursing InterventionsAFTER THE PROCEDURE:• The nurse administers an enema or laxative after thesetests to facilitate bariu...
Computed Tomography• CT provides cross-sectional images of abdominalorgans and structures.• Multiple x-ray images are take...
Nursing Interventions• The patient should not eat or drink for 6 to 8 hoursbefore the test.• The practitioner may prescrib...
Magnetic Resonance Imaging• MRI is used in gastroenterology to supplementultrasonography and CT scanning.• It is a noninva...
Magnetic Resonance ImagingCONTRAINDICATION FOR MRI• patients with permanent pacemakers, artificial heartvalves and defibri...
Nursing Interventions• The patient should not eat or drink for 6 to 8 hoursbefore the test.• Patient must remove all jewel...
Scintigraphy• Scintigraphy relies on the use of radioactive isotopes(i.e., technetium, iodine, and indium) to revealdispla...
Gastrointestinal Motility Studies• Radionuclide testing also is used to assess gastricemptying and colonic transit time.• ...
Endoscopic ProceduresEndoscopic procedures in GI tract assessment include:• fibroscopy / esophagogastroduodenoscopy• anosc...
Endoscopic ProceduresUPPER GI FIBROSCOPY/ESOPHAGOGASTRODUODENOSCOPY• Fibroscopy of the upper GI tract allows directvisuali...
Endoscopic Procedures
Nursing InterventionsBEFORE THE PROCEDURE• The patient should not eat or drink for 6 to 12 hoursbefore the examination.• H...
Nursing InterventionsAFTER THE PROCEDURE• After the procedure, the nurse instructs the patient notto eat or drink until th...
Nursing InterventionsAFTER THE PROCEDURE• The nurse monitors the pulse and blood pressure forchanges that can occur with s...
Endoscopic ProceduresANOSCOPY, PROCTOSCOPY, AND SIGMOIDOSCOPY• The lower portion of the colon also can be vieweddirectly t...
Endoscopic Procedures• For rigid scope procedures, the patient assumes theknee-chest position at the edge of the bed or th...
Endoscopic Procedures
Nursing Intercentions• These examinations require only limited bowelpreparation, including a warm tap water or Fleet’senem...
Endoscopic ProceduresFIBEROPTIC COLONOSCOPY• Fiberoptic colonoscope are larger in diameter andlonger.• It is most frequent...
Endoscopic Procedures• Colonoscopy is performed while the patient is lying onthe left side with the legs drawn up toward t...
Endoscopic Procedures• Colonoscopy is performed while the patient is lying onthe left side with the legs drawn up toward t...
Endoscopic Procedures
Nursing InterventionsBEFORE THE PROCEDURE• Patient should limit the intake of liquids for 24 to 72hours before the examina...
Nursing Interventions• Instructing the patient not to take routine medicationswhen the lavage solution is ingested; the me...
Nursing InterventionsDURING THE PROCEDURE:• Informed consent is obtained before the test.• Before the examination, the nur...
Nursing Interventions• The nurse monitors for changes in oxygen saturation,vital signs, color and temperature of the skin,...
Nursing InterventionsAFTER THE PROCEDURE:• Patients who were sedated are maintained on bed restuntil fully alert.• Some wi...
Nursing Interventions• It is important to provide written instructions, becausethe patient may be unable to recall verbal ...
Nursing InterventionsSide effects of the electrolyte solutions include:• nausea• bloating• cramps or abdominal fullness• f...
Nursing IntercentionsCONTRAINDICATIONS:• Patients with intestinal obstruction or inflammatorybowel disease.• Implantable d...
Nursing Interventions• Therapeutic colonoscopy may be contraindicated inpatients with coagulopathies and in those receivin...
Endoscopic ProceduresENDOSCOPY THROUGH OSTOMY• Endoscopy using a flexible endoscope through anostomy stoma is useful for v...
Manometry and Electrophysiologic Studies• The manometry test measures changes in intraluminalpressures and the coordinatio...
Defecography• Defecography measures anorectal function. Very thickbarium paste is instilled into the rectum, and thenfluor...
Gastric Analysis• Analysis of the gastric juice yields information about thesecretory activity of the gastric mucosa and t...
Nursing Interventions• The patient is kept NPO for 8 to 12 hours before theprocedure.• Any medications that affect gastric...
Gastric Stimulation Test• The gastric acid stimulation test usually is performed inconjunction with gastric analysis.• His...
Nursing Interventions• Inform the patient that this injection may produce aflushed feeling.• The nurse monitors blood pres...
Laparoscopy• This procedure is performed through a small incision inthe abdominal wall. Special fiberoptic laparoscopesall...
Assignment!1. As a student nurse assigned at the emergency room,you are in charge of a 24-year-old male patient whowas adm...
Assignment!2. A 58-year-old patient assigned to you this morning hasjust left to go to the Endoscopy Suite, where she will...
Upcoming SlideShare
Loading in …5
×

GI System 1 Lecture

1,139 views

Published on

Published in: Health & Medicine
0 Comments
2 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
1,139
On SlideShare
0
From Embeds
0
Number of Embeds
5
Actions
Shares
0
Downloads
204
Comments
0
Likes
2
Embeds 0
No embeds

No notes for slide

GI System 1 Lecture

  1. 1. Learning Objectives:At the end of this lecture, you will be able to:1. Describe the structure and function of the organs of thegastrointestinal tract.2. Describe the mechanical and chemical processesinvolved in digesting and absorbing foods andeliminating waste products.JOFRED M. MARTINEZ, RN
  2. 2. 3. Use assessment parameters appropriate fordetermining the status of gastrointestinal function.4. Describe the appropriate preparation, teaching, andfollow-up care for patients who are undergoingdiagnostic testing of the gastrointestinal tract.Learning Objectives (Cont’d.):
  3. 3. Anatomy and Physiology
  4. 4. Anatomy & Physiology
  5. 5. Two groups of organs compose the digestive system:• GASTROINTESTINAL TRACT include the mouth, mostof the pharynx, esophagus, stomach, small intestine, andlarge intestine.• ACCESSORY DIGESTIVE ORGANS include the teeth,tongue, salivary glands, liver, gallbladder, and pancreas.Anatomy and Physiology
  6. 6. Anatomy and Physiology
  7. 7. Anatomy & Physiology
  8. 8. Anatomy & Physiology
  9. 9. Anatomy & Physiology
  10. 10. Anatomy & Physiology
  11. 11. Anatomy & Physiology
  12. 12. Functions of the digestive system1. Ingestion: taking food into the mouth.2. Secretion: release of water, acid, buffers, and enzymes intothe lumen of the GI tract.3. Mixing and propulsion: churning and propulsion of foodthrough the GI tract.4. Digestion: mechanical and chemical breakdown of food.5. Absorption: passage of digested products from the GI tractinto the blood and lymph.6. Defecation: the elimination of feces from the GI tract.Anatomy and Physiology
  13. 13. • The branch of dentistry that is concerned with theprevention, diagnosis, and treatment of diseases thataffect the pulp, root, periodontal ligament, and alveolarbone is known as Endodontics.• Orthodontics is a branch of dentistry that is concernedwith the prevention and correction of abnormally alignedteeth.• Periodontics is a branch of dentistry concerned with thetreatment of abnormal conditions of the tissuesimmediately surrounding the teeth, such as gingivitis.Anatomy and Physiology
  14. 14. Anatomy and Physiology
  15. 15. Anatomy & Physiology
  16. 16. Anatomy & Physiology
  17. 17. Anatomy & Physiology
  18. 18. • Mechanical digestion in the mouth results from chewing,or mastication.• Salivary amylase, which is secreted by the salivaryglands, initiates the breakdown of starch.• Lingual lipase, which is secreted by lingual glands in thetongue. It breaks down dietary triglycerides into fatty acidsand diglycerides.Mechanical and Chemical Digestion
  19. 19. PHARYNX• The pharynx, a funnel-shaped tube that extends from theinternal nares to the esophagus posteriorly and to thelarynx anteriorly.• The pharynx is composed of skeletal muscle and lined bymucous membrane, and is divided into three parts: thenasopharynx, the oropharynx, and the laryngopharynx.Anatomy and Physiology
  20. 20. ESOPHAGUS• The esophagus is a collapsible muscular tube, about 25cm (10 in.) long, that lies posterior to the trachea. Theesophagus begins at the inferior end of thelaryngopharynx and passes through the mediastinumanterior to the vertebral column.• Then it pierces the diaphragm through an opening calledthe esophageal hiatus, and ends in the superior portionof the stomach.Anatomy and Physiology
  21. 21. • The mucosa of the esophagus consists of nonkeratinizedstratified squamous epithelium, lamina propria, and amuscularis muscosae.• At each end of the esophagus, the muscularis becomesslightly more prominent and forms two sphincters—theupper esophageal sphincter• (UES), which consists of skeletal muscle, and the loweresophageal sphincter (LES), which consists of smoothmuscle.Anatomy and Physiology
  22. 22. DEGLUTITIONSwallowing occurs in three stages:• the voluntary stage, in which the bolus is passed intothe oropharynx• the pharyngeal stage, the involuntary passage of thebolus through the pharynx into the esophagus• the esophageal stage, the involuntary passage of thebolus through the esophagus into the stomachAnatomy and Physiology
  23. 23. Anatomy and Physiology
  24. 24. Anatomy and Physiology
  25. 25. Anatomy of the Stomach
  26. 26. Anatomy of the Stomach
  27. 27. FUNCTIONS OF THE STOMACH1. Mixes saliva, food, and gastric juice to form chyme.2. Serves as a reservoir for food before release into smallintestine.3. Secretes gastric juice, which contains HCl, pepsin,intrinsic factor, and gastric lipase .4. Secretes gastrin into blood.Anatomy and Physiology
  28. 28. Anatomy and Physiology
  29. 29. Anatomy and Physiology
  30. 30. Anatomy and Physiology
  31. 31. Anatomy and Physiology
  32. 32. Anatomy and Physiology
  33. 33. Anatomy and PhysiologyBLOOD SUPPLY OF THE LIVER
  34. 34. ROLE AND COMPOSITION OF BILE• Each day, hepatocytes secrete 800–1000 mL (about 1 qt)of bile, a yellow, brownish, or olive-green liquid. It has apH of 7.6–8.6 and consists mostly of water, bile salts,cholesterol, a phospholipid called lecithin, bile pigments,and several ions.• The principal bile pigment is bilirubin. The phagocytosisof aged red blood cells liberates iron, globin, and bilirubin.• One of its breakdown products—stercobilin—gives fecestheir normal brown color.Anatomy and Physiology
  35. 35. • Bile salts, play a role in emulsification, the breakdown oflarge lipid globules into a suspension of small lipidglobules.• Between meals, after most absorption has occurred, bileflows into the gallbladder for storage because thesphincter of the hepatopancreatic ampulla (sphincterof Oddi) closes off the entrance to the duodenum.Anatomy and Physiology
  36. 36. FUNCTIONS OF THE LIVER• Carbohydrate metabolism.• Lipid metabolism.• Protein metabolism.• Processing of drugs and hormones.• Excretion of bilirubin.• Synthesis of bile salts.Anatomy and Physiology
  37. 37. FUNCTIONS OF THE LIVER• Storage for certain vitamins (A, B12, D, E, and K) andminerals (iron and copper)• Phagocytosis.• Activation of vitamin D.Anatomy and Physiology
  38. 38. Anatomy and Physiology
  39. 39. SFunctions of the Small Intestine1. Segmentations mix chyme with digestive juices andbring food into contact with the mucosa for absorption;peristalsis propels chyme through the small intestine.2. Completes the digestion of carbohydrates, proteins, andlipids; begins and completes the digestion of nucleicacids.3. Absorbs about 90% of nutrients and water that passthrough the digestive system.Anatomy and Physiology
  40. 40. SMECHANICAL DIGESTION IN THE SMALL INTESTINEThe two types of movements of the small intestine:Segmentations• Segmentations mix chyme with the digestive juices andbring the particles of food into contact with the mucosafor absorptionMigrating motility complex (MMC)• begins in the lower portion of the stomach and pusheschyme forward along a short stretch of small intestinebefore dying outAnatomy and Physiology
  41. 41. Anatomy and Physiology
  42. 42. Anatomy and Physiology
  43. 43. FUNCTIONS OF THE LARGE INTESTINE1. Haustral churning, peristalsis, and mass peristalsis drivethe contents of the colon into the rectum.2. Bacteria in the large intestine convert proteins to aminoacids, break down amino acids, and produce some Bvitamins and vitamin K.3. Absorbing some water, ions, and vitamins.4. Forming feces.5. Defecating (emptying the rectum).Anatomy and Physiology
  44. 44. THE DEFECATION REFLEX• Diarrhea is an increase in the frequency, volume, andfluid content of the feces caused by increased motility ofand decreased absorption by the intestines.• Constipation refers to infrequent or difficult defecationcaused by decreased motility of the intestines.Anatomy and Physiology
  45. 45. PHASES OF DIGESTION• During the cephalic phase of digestion, the smell, sight,thought, or initial taste of food activates neural centers inthe cerebral cortex, hypothalamus, and brain stem. Thebrain stem then activates the facial (VII),glossopharyngeal (IX), and vagus (X) nerves. The facialand glossopharyngeal nerves stimulate the salivaryglands to secrete saliva, while the vagus nerves stimulatethe gastric glands to secrete gastric juice.Anatomy and Physiology
  46. 46. • The intestinal phase of digestion begins once foodenters the small intestine.• The intestinal phase of digestion begins once foodenters the small intestine. Those occurring during theintestinal phase have inhibitory effects that slow the exit ofchyme from the stomach.Anatomy and Physiology
  47. 47. Anatomy and Physiology
  48. 48. Health History and Clinical ManifestationsSUBJECTIVE DATA1. GENERAL DATAa. presence of dental prosthesis, comfort of usageb. difficulty eating or digesting foodc. nausea or vomitingd. weight losse. pain
  49. 49. Health History and Clinical Manifestations
  50. 50. Health History and Clinical ManifestationsSUBJECTIVE DATA2. SPECIFIC DATAa. situations or events that effect symptomsb. onset, possible cause, location, duration, characterof symptomsc. relationship of specific foods, smoking or alcohol toseverity of symptomsd. how the symptoms was managed before seekingmedical help
  51. 51. Health History and Clinical ManifestationsSUBJECTIVE DATA3. NORMAL PATTERN OF BOWEL ELIMINATIONa. frequency and character of stoolb. use of laxatives, enemas4. RECENT CHANGES IN NORMAL PATTERNSa. changes in character of stool (constipation, diarrhea,or alternating constipation and diarrhea)
  52. 52. Health History and Clinical ManifestationsSUBJECTIVE DATAb. changes in color of stool melena hematocheziac. drugs /medications being takend. measures taken to relieve symptoms
  53. 53. Health History and Clinical ManifestationsINDIGESTION• Indigestion can result from disturbed nervous systemcontrol of the stomach or from a disorder in the GI tractor elsewhere in the body.INTESTINAL GAS• The accumulation of gas in the GI tract may result inbelching or flatulence.
  54. 54. Health History and Clinical ManifestationsNAUSEA AND VOMITING• Vomiting is usually preceded by nausea, which can betriggered by odors, activity, or food intake.• When vomiting occurs soon after hemorrhage, theemesis is bright red.• If blood has been retained in the stomach, it takes on acoffee-ground appearance because of the action of thedigestive enzymes.
  55. 55. Health History and Clinical ManifestationsBOWEL HABITS AND STOOL CHARACTERISTIC• Diarrhea commonly occurs when the contents move sorapidly through the intestine and colon that there isinadequate time for the GI secretions to be absorbed.• Constipation may be associated with anal discomfortand rectal bleeding.• Blood in the stool can present in various ways and mustbe investigated.
  56. 56. Health History and Clinical Manifestations• Blood entering the lower portion of the GI tract or passingrapidly through it will appear bright or dark red.• Lower rectal or anal bleeding is suspected if there isstreaking of blood on the surface of the stool.Other common abnormalities in stool characteristics includethe following:• Bulky, greasy, foamy stools that are foul in odor; stool coloris gray, with a silvery sheen• Light gray or clay-colored stool, caused by the absence ofurobilin
  57. 57. Health History and Clinical Manifestations• Stool with mucus threads or pus that may be visible ongross inspection of the stool• Small, dry, rock-hard masses called scybala; sometimesstreaked with blood from rectal trauma as they passthrough the rectum• Loose, watery stool that may or may not be streaked withblood
  58. 58. Physical Assessment• The patient lies supine with knees flexed slightly forinspection, auscultation, palpation, and percussion ofthe abdomen.• The nurse performs inspection first, noting skin changesand scars from previous surgery. It also is important tonote the contour and symmetry of the abdomen, toidentify any localized bulging, distention, or peristalticwaves.
  59. 59. Physical AssessmentInspecting the abdomen Auscultating the abdomen
  60. 60. Physical Assessment• The nurse assesses bowel sounds in all four quadrantsusing the diaphragm of the stethoscope; the high-pitchedand gurgling sounds can be heard best in this manner.• It is important to document the frequency of the sounds,using the terms normal (sounds heard about every 5 to20 seconds), hypoactive (one or two sounds in 2minutes), hyperactive (5 to 6 sounds heard in less than30 seconds), or absent (no sounds in 3 to 5 minutes).
  61. 61. Physical Assessment• The nurse notes tympani or dullness during percussion.Use of light palpation is appropriate for identifying areasof tenderness or swelling; the nurse may use deeppalpation to identify masses in any of the four quadrants.• The final part of the examination is inspection of the analand perineal area. The nurse should inspect and palpateareas of excoriation or rash, fissures or fistula openings,or external hemorrhoids.
  62. 62. Physical AssessmentPalpating the abdomen Percussing the abdomen
  63. 63. Diagnostic EvaluationCommon blood tests include complete blood count (CBC),carcinoembryonic antigen (CEA), liver function tests, serumcholesterol, and triglycerides.General nursing interventions for the patient who is havingGI diagnostic assessment include the following:• Providing general information about a healthy diet andthe nutritional factors that can cause GI disturbances;after a diagnosis has been confirmed, the nurse providesinformation about specific nutrients that should beincluded in the diet.
  64. 64. Diagnostic Evaluation• Providing needed information about the test and theactivities required of the patient• Providing instructions about post procedure care andactivity restrictions• Alleviating anxiety• Helping the patient cope with discomfort• Encouraging family members or others to offer emotionalsupport to the patient during the diagnostic testing• Assessing for adequate hydration before, during, andimmediately after the procedure
  65. 65. Stool TestBasic examination of the stool includes:• inspecting the specimen for consistency and color andtesting for occult blood• tests for fecal urobilinogen, fat, nitrogen,• parasites, pathogens, food residues, and othersubstances
  66. 66. Stool Test• The most widely used occult blood test is the Hematest.False-positive results may occur if the patient has eatenrare meat, liver, poultry, turnips, broccoli, cauliflower,melons, salmon, sardines, or horseradish within 7 daysbefore testing.• Medications that can cause gastric irritation, such asaspirin, ibuprofen, indomethacin, colchicine,corticosteroids, cancer chemotherapeutic agents, andanticoagulants, may also cause false-positive results.
  67. 67. Breath Test• The hydrogen breath test was developed to evaluatecarbohydrate absorption. It also is used to aid in thediagnosis of bacterial overgrowth in the intestine and shortbowel syndrome.• Urea breath tests detect the presence of Helicobacterpylori. The patient takes a capsule of carbon labeled ureaand then provides a breath sample 10 to 20 minutes later.The patient is instructed to avoid antibiotics or loperamidefor 1 month before the test; sucralfate and omeprazole for 1week before the test; and cimetidine, famotidine, ranitidine,and nizatidine for 24 hours before urea breath testing.
  68. 68. Abdominal Ultrasonography• During abdominal ultrasonography, an image of theabdominal organs and structures is produced on theoscilloscope. This procedure is generally used to indicatethe size and configuration of abdominal structures.• Endoscopic ultrasonography (EUS) is a specializedenteroscopic procedure that aids in the diagnosis of GIdisorders by providing direct imaging of a target area. Asmall high-frequency ultrasonic transducer is mounted atthe tip of the fiberoptic scope so that a transintestinalstudy can be completed.
  69. 69. Nursing Interventions• The patient fasts for 8 to 12 hours before the test todecrease the amount of gas in the bowel.• If gallbladder studies are being performed, the patientshould eat a fat-free meal the evening before the test.• If barium studies are to be performed, the nurse shouldmake sure they are scheduled after this test; otherwise,the barium will interfere with the transmission of the soundwaves.
  70. 70. DNA Testing• DNA testing allows practitioners to prevent (or minimize)disease, by intervening before its onset, and to improvetherapy.• Persons at risk for colon cancer often are targeted forDNA testing because it can provide a head start on thispreventable cancer.
  71. 71. Imaging StudiesImaging studies include:• x-ray and contrast studies• computed tomography (CT) scans• magnetic resonance imaging (MRI)• and scintigraphy (radionuclide imaging)
  72. 72. Upper GI Tract Study• X-rays can delineate the entire GI tract after theintroduction of a contrast agent.• Variations of the upper GI study include double-contraststudies and enteroclysis.• The double-contrast method of examining the upper GItract involves administration of a thick barium suspensionto outline the stomach and esophageal wall, after whichtablets that release carbon dioxide in the presence ofwater are given.
  73. 73. Nursing InterventionsBEFORE THE PROCEDURE:• maintain a low-residue diet several days before the test• receive nothing by mouth after midnight before the test• physician may prescribe a laxative to clean out theintestinal tract• discourage the patient from smoking on the morningbefore the examination• withhold all medications as ordered by the physician
  74. 74. Nursing InterventionsAFTER THE PROCEDURE:• Follow-up care is needed after any of the upper GIprocedures to ensure that the patient has completelyeliminated the ingested barium.• Fluids must be increased to facilitate evacuation ofstool and barium.• The nurse monitors the patient’s stools until they returnto their normal color.• A laxative or enema may be needed as ordered by thphysician.
  75. 75. Lower GI Tract Study• When barium is instilled rectally to visualize the lowerGI tract, the procedure is called a barium enema.• The purpose of a barium enema is to detect thepresence of polyps, tumors, and other lesions of thelarge intestine and to demonstrate any abnormalanatomy or malfunction of the bowel.• The procedure usually takes about 15 to 30 minutes,during which time x-ray images are taken.
  76. 76. Nursing InterventionsBEFORE THE PROCEDURE:• a low-residue diet 1 to 2 days before the test• a clear liquid diet and a laxative the evening before• nothing by mouth after midnight• cleansing enemas until returns are clear the followingmorningThe nurse should make sure that bariumenemas are scheduled before any upperGI studies.
  77. 77. Nursing InterventionsCONTRAINDICATIONS FOR BARIUM ENEMA• patient has active inflammatory disease of the colon• patients with signs of perforation or obstruction• active GI bleeding may prohibit the use of laxatives andenemasIn patients with perforation or obstruction;a water-soluble contrast study may beperformed in these situations.
  78. 78. Nursing InterventionsCONTRAINDICATIONS FOR BARIUM ENEMA• patient has active inflammatory disease of the colon• patients with signs of perforation or obstruction• active GI bleeding may prohibit the use of laxatives andenemasIn patients with perforation or obstruction;a water-soluble contrast study may beperformed in these situations.
  79. 79. Nursing InterventionsAFTER THE PROCEDURE:• The nurse administers an enema or laxative after thesetests to facilitate barium removal.• Increasing fluid intake also will assist in eliminating thebarium.• As with any barium study, the nurse monitors thepatient for complete elimination of the barium.
  80. 80. Computed Tomography• CT provides cross-sectional images of abdominalorgans and structures.• Multiple x-ray images are taken from many differentangles, digitized in the computer, reconstructed, andthen viewed on a computer monitor.• Indications for abdominal CT scanning are diseases ofthe liver, spleen, kidney, pancreas, and pelvic organs.• CT is a valuable tool for detecting and localizing manyinflammatory conditions in the colon, such asappendicitis, diverticulitis, regional enteritis, andulcerative colitis.
  81. 81. Nursing Interventions• The patient should not eat or drink for 6 to 8 hoursbefore the test.• The practitioner may prescribe an intravenous or oralcontrast agent. Therefore, the nurse should questionthe patient about contrast dye allergies.• If barium studies are to be performed, it is important toschedule them after CT scanning, so as not to interferewith imaging.
  82. 82. Magnetic Resonance Imaging• MRI is used in gastroenterology to supplementultrasonography and CT scanning.• It is a noninvasive technique that uses magnetic fieldsand radio waves to produce an image of the area beingstudied.• It is useful in evaluating abdominal soft tissues as wellas blood vessels, abscesses, fistulas, neoplasms, andother sources of bleeding.
  83. 83. Magnetic Resonance ImagingCONTRAINDICATION FOR MRI• patients with permanent pacemakers, artificial heartvalves and defibrillators, implanted insulin pumps, orimplanted transcutaneous electrical nerve stimulationdevices• patients with internal metal devices (e.g., aneurysmclips) or intraocular metallic fragments
  84. 84. Nursing Interventions• The patient should not eat or drink for 6 to 8 hoursbefore the test.• Patient must remove all jewelry and other metals.• It is important to warn patients that the close-fittingscanners used in many MRI facilities may inducefeelings of claustrophobia and that the machine willmake a knocking sound during the procedure.• Open MRIs that are less close-fitting eliminate theclaustrophobia that many patients experience.
  85. 85. Scintigraphy• Scintigraphy relies on the use of radioactive isotopes(i.e., technetium, iodine, and indium) to revealdisplaced anatomic structures, changes in organ size,and the presence of neoplasms or other focal lesions,such as cysts or abscesses.• Scintigraphic scanning is also used to measure theuptake of tagged red blood cells and leukocytes.• A sample of blood is removed, mixed with a radioactivesubstance, and reinjected into the patient.• Abnormal concentrations of blood cells are thendetected at 24- and 48-hour intervals.
  86. 86. Gastrointestinal Motility Studies• Radionuclide testing also is used to assess gastricemptying and colonic transit time.• For gastric emptying studies, the liquid and solidcomponents of a meal are tagged with radionuclidemarkers.• After the patient ingests the meal, the patient ispositioned under a scintiscanner, which measures therate of passage of the radioactive substance out of thestomach.• Abdominal x-rays are taken every 24 hours until allmarkers are passed. This process usually takes 4 to 5days.
  87. 87. Endoscopic ProceduresEndoscopic procedures in GI tract assessment include:• fibroscopy / esophagogastroduodenoscopy• anoscopy• proctoscopy• sigmoidoscopy• colonoscopy• small-bowel enteroscopy• endoscopy through ostomy
  88. 88. Endoscopic ProceduresUPPER GI FIBROSCOPY/ESOPHAGOGASTRODUODENOSCOPY• Fibroscopy of the upper GI tract allows directvisualization of the esophageal, gastric, and duodenalmucosa through a lighted endoscope (gastroscope).• Esophagogastroduodenoscopy (EGD), is valuablewhen esophageal, gastric, or duodenal abnormalities orinflammatory, neoplastic, or infectious processes aresuspected.• This procedure also can be used to evaluateesophageal and gastric motility and to collectsecretions and tissue specimens for further analysis.
  89. 89. Endoscopic Procedures
  90. 90. Nursing InterventionsBEFORE THE PROCEDURE• The patient should not eat or drink for 6 to 12 hoursbefore the examination.• Help the patient spray or gargle with a local anesthetic,and administer midazolam (Versed) intravenously justbefore the scope is introduced.• The nurse also may administer atropine to reducesecretions, and may give glucagon, if needed andprescribed, to relax smooth muscle.• The nurse positions the patient on the left side tofacilitate saliva drainage and to provide easy access forthe endoscope.
  91. 91. Nursing InterventionsAFTER THE PROCEDURE• After the procedure, the nurse instructs the patient notto eat or drink until the gag reflex returns (in 1 to 2hours), to prevent aspiration of food or fluids into thelungs.• The nurse places the patient in the Simms position untilhe or she is awake and then places the patient in thesemi-Fowler’s position until ready for discharge.• After gastroscopy, assessment by the nurse includesobserving for signs of perforation, such as pain,bleeding, unusual difficulty swallowing, and an elevatedtemperature.
  92. 92. Nursing InterventionsAFTER THE PROCEDURE• The nurse monitors the pulse and blood pressure forchanges that can occur with sedation.• After the patient’s gag reflex has returned, the nursecan offer lozenges, saline gargle, and oral analgesicsto relieve minor throat discomfort.• Patients who were sedated for the procedure must stayon bed rest until fully alert.
  93. 93. Endoscopic ProceduresANOSCOPY, PROCTOSCOPY, AND SIGMOIDOSCOPY• The lower portion of the colon also can be vieweddirectly to evaluate rectal bleeding, acute or chronicdiarrhea, or change in bowel patterns and to observefor ulceration, fissures, abscesses, tumors, polyps, orother pathologic processes.• The anoscope is a rigid scope that is used to examinethe anus and lower rectum.• Proctoscopes and sigmoidoscopes are rigid scopesthat are used to inspect the rectum and the sigmoidcolon.
  94. 94. Endoscopic Procedures• For rigid scope procedures, the patient assumes theknee-chest position at the edge of the bed or theexamining table. With the back inclined at about a 45-degree angle, the patient is properly positioned for theintroduction of an anoscope, proctoscope, orsigmoidoscope.• For flexible scope procedures, the patient assumes acomfortable position on the left side with the right legbent and placed anteriorly.• Biopsy is performed with small biting forcepsintroduced through the endoscope; one or more smallpieces of tissue may be removed.
  95. 95. Endoscopic Procedures
  96. 96. Nursing Intercentions• These examinations require only limited bowelpreparation, including a warm tap water or Fleet’senema until returns are clear.• During the procedure, the nurse monitors vital signs,skin color and temperature, pain tolerance, and vagalresponse.• After the procedure, the nurse monitors the patient forrectal bleeding and signs of intestinal perforation (ie,fever, rectal drainage, abdominal distention, and pain).
  97. 97. Endoscopic ProceduresFIBEROPTIC COLONOSCOPY• Fiberoptic colonoscope are larger in diameter andlonger.• It is most frequently used for cancer screening and forsurveillance in patients with previous colon cancer orpolyps.• Tissue biopsies can be obtained as needed, and polypscan be removed and evaluated.• Therapeutically, the procedure can be used to removeall visible polyps, areas of bleeding or stricture.
  98. 98. Endoscopic Procedures• Colonoscopy is performed while the patient is lying onthe left side with the legs drawn up toward the chest.• The procedure usually takes about 1 hour. Discomfortmay result from instillation of air to expand the colon orfrom insertion and moving of the scope.• Potential complications of colonoscopy include cardiacdysrhythmias and respiratory depression resulting fromthe medications administered, vasovagal reactions,and circulatory overload or hypotension resulting fromoverhydration or underhydration during bowelpreparation.
  99. 99. Endoscopic Procedures• Colonoscopy is performed while the patient is lying onthe left side with the legs drawn up toward the chest.• The procedure usually takes about 1 hour. Discomfortmay result from instillation of air to expand the colon orfrom insertion and moving of the scope.• Potential complications of colonoscopy include cardiacdysrhythmias and respiratory depression resulting fromthe medications administered, vasovagal reactions,and circulatory overload or hypotension resulting fromoverhydration or underhydration during bowelpreparation.
  100. 100. Endoscopic Procedures
  101. 101. Nursing InterventionsBEFORE THE PROCEDURE• Patient should limit the intake of liquids for 24 to 72hours before the examination.• The physician may prescribe a laxative for two nightsbefore the examination and a Fleet’s or saline enemauntil the return runs clear the morning of the test.• Polyethylene glycol electrolyte lavage solutions(Golytely, Colyte, NuLytely) are used as intestinallavages for effective cleansing of the bowel.• The patient maintains a clear liquid diet starting at noonthe day before the procedure. Then the patient ingestslavage solutions orally at intervals over 3 to 4 hours.
  102. 102. Nursing Interventions• Instructing the patient not to take routine medicationswhen the lavage solution is ingested; the medicationswill not be digested and therefore will be ineffective• Advising the diabetic patient to consult with his or herphysician about medication adjustment to preventhyperglycemia or hypoglycemia resulting from dietarymodifications required in preparation for the test• Instructing all patients, especially the elderly, tomaintain adequate fluid, electrolyte, and caloric intakewhile undergoing bowel cleansing
  103. 103. Nursing InterventionsDURING THE PROCEDURE:• Informed consent is obtained before the test.• Before the examination, the nurse may administerintravenously an opioid analgesic or a sedative (eg,midazolam) to provide moderate sedation and relieveanxiety during the procedure.• Glucagon may be used, if needed, to relax the colonicmusculature and to reduce spasm during the test.• Elderly or debilitated patients may require a reduceddosage of these medications to decrease the risks ofoversedation and cardiopulmonary complications.
  104. 104. Nursing Interventions• The nurse monitors for changes in oxygen saturation,vital signs, color and temperature of the skin, level ofconsciousness, abdominal distention, vagal response,and pain intensity.
  105. 105. Nursing InterventionsAFTER THE PROCEDURE:• Patients who were sedated are maintained on bed restuntil fully alert.• Some will have abdominal cramps caused byincreased peristalsis stimulated by the air insufflatedinto the bowel during the procedure.• The nurse observes the patient for signs andsymptoms of bowel perforation (eg, rectal bleeding,abdominal pain or distention, fever, focal peritonealsigns).• If midazolam was used, the nurse explains its amnesiceffects.
  106. 106. Nursing Interventions• It is important to provide written instructions, becausethe patient may be unable to recall verbal information.• If the procedure is performed on an outpatient basis,someone must accompany and transport the patienthome.• After a therapeutic procedure, the nurse instructs thepatient to report any bleeding to the physician.
  107. 107. Nursing InterventionsSide effects of the electrolyte solutions include:• nausea• bloating• cramps or abdominal fullness• fluid and electrolyte imbalance• hypothermia (patients are often told to drink thepreparation as cold as possible to make it morepalatable)
  108. 108. Nursing IntercentionsCONTRAINDICATIONS:• Patients with intestinal obstruction or inflammatorybowel disease.• Implantable defibrillators and pacemakers are at highrisk for malfunction if electrosurgical procedures (ie,polypectomy) are performed in conjunction withcolonoscopy.• Colonoscopy cannot be performed if there is asuspected or documented colon perforation, acutesevere diverticulitis, or fulminant colitis.
  109. 109. Nursing Interventions• Therapeutic colonoscopy may be contraindicated inpatients with coagulopathies and in those receivinganticoagulation therapy, because of the high risk forexcessive bleeding during and after the procedure.• Nonsteroidal anti-inflammatory agents (NSAIDs),aspirin, ticlopidine, and pentoxifylline must bediscontinued before the test and for 2 weeks after theprocedure. Patients taking coumadin or heparin mustconsult the physician for specific instructions.• Those with prosthetic heart valves or a history ofendocarditis require prophylactic antibiotics before theprocedure.
  110. 110. Endoscopic ProceduresENDOSCOPY THROUGH OSTOMY• Endoscopy using a flexible endoscope through anostomy stoma is useful for visualizing a segment of thesmall or large intestine.• It may be indicated to evaluate an anastomosis, toscreen for recurrent disease, or to visualize and treatbleeding in a segment of the bowel.
  111. 111. Manometry and Electrophysiologic Studies• The manometry test measures changes in intraluminalpressures and the coordination of muscle activity in theGI tract. The pressures can be recorded manually, on aphysiograph, or on a computer.• Electrogastrography, an electrophysiologic study, isperformed to assess gastric motility disturbances.Electrodes are placed over the abdomen, and gastricelectrical activity is recorded for up to 24 hours.Electrogastrography can be useful in detecting motor ornerve dysfunction in the stomach.
  112. 112. Defecography• Defecography measures anorectal function. Very thickbarium paste is instilled into the rectum, and thenfluoroscopy is performed to assess the function of therectum and anal sphincter while the patient attempts toexpel the barium.• Electromyographic (EMG) studies can supplementanorectal manometry to measure the integrity andfunction of the anal sphincters in an effort to treatfunctional bowel incontinence and constipation.
  113. 113. Gastric Analysis• Analysis of the gastric juice yields information about thesecretory activity of the gastric mucosa and thepresence or degree of gastric retention in patientsthought to have pyloric or duodenal obstruction.• Important diagnostic information to be gained fromgastric analysis includes the ability of the mucosa tosecrete HCl.
  114. 114. Nursing Interventions• The patient is kept NPO for 8 to 12 hours before theprocedure.• Any medications that affect gastric secretions arewithheld for 24 to 48 hours before the test.• Smoking is not allowed on the morning before the test,because it increases gastric secretions.
  115. 115. Gastric Stimulation Test• The gastric acid stimulation test usually is performed inconjunction with gastric analysis.• Histamine is administered subcutaneously to stimulategastric secretions. It is important to inform the patientthat this injection may produce a flushed feeling.• Gastric specimens are collected after the injectionevery 15 minutes for 1 hour and are labeled to indicatethe time of specimen collection after histamineinjection.• The volume and pH of the specimen are measured.
  116. 116. Nursing Interventions• Inform the patient that this injection may produce aflushed feeling.• The nurse monitors blood pressure and pulsefrequently to detect hypotension.
  117. 117. Laparoscopy• This procedure is performed through a small incision inthe abdominal wall. Special fiberoptic laparoscopesallow direct visualization of the organs and structureswithin the abdomen, permitting visualization andidentification of any growths, anomalies, andinflammatory processes.• Biopsy samples can be taken from the structures andorgans as necessary.• This procedure can be used to evaluate peritonealdisease, chronic abdominal pain, abdominal masses,and gallbladder and liver disease.
  118. 118. Assignment!1. As a student nurse assigned at the emergency room,you are in charge of a 24-year-old male patient whowas admitted for acute abdominal pain. He is beingscheduled for tests this afternoon. What laboratorytests would you expect to be ordered? Whatpreparation is needed for these tests? Whatpreprocedure education is needed?
  119. 119. Assignment!2. A 58-year-old patient assigned to you this morning hasjust left to go to the Endoscopy Suite, where she willundergo a colonoscopy. You know that your patient willreceive moderate sedation during the procedure and thatshe will be returned to your care once she is fully alert.What should you anticipate in the course of recovery foryour patient after the colonoscopy? What medicationsmight be used for the moderate sedation, and whateffects of those medications would you expect to seeduring the recovery period? Describe the potentialcomplications that could occur and what you will monitor.What are the goals for care during this period?

×