GI System 1 Lecture

Learning Objectives:
At the end of this lecture, you will be able to:
1. Describe the structure and function of the organs of the
gastrointestinal tract.
2. Describe the mechanical and chemical processes
involved in digesting and absorbing foods and
eliminating waste products.
JOFRED M. MARTINEZ, RN

3. Use assessment parameters appropriate for
determining the status of gastrointestinal function.
4. Describe the appropriate preparation, teaching, and
follow-up care for patients who are undergoing
diagnostic testing of the gastrointestinal tract.
Learning Objectives (Cont’d.):

Two groups of organs compose the digestive system:
• GASTROINTESTINAL TRACT include the mouth, most
of the pharynx, esophagus, stomach, small intestine, and
large intestine.
• ACCESSORY DIGESTIVE ORGANS include the teeth,
tongue, salivary glands, liver, gallbladder, and pancreas.
Anatomy and Physiology

Functions of the digestive system
1. Ingestion: taking food into the mouth.
2. Secretion: release of water, acid, buffers, and enzymes into
the lumen of the GI tract.
3. Mixing and propulsion: churning and propulsion of food
through the GI tract.
4. Digestion: mechanical and chemical breakdown of food.
5. Absorption: passage of digested products from the GI tract
into the blood and lymph.
6. Defecation: the elimination of feces from the GI tract.

• The branch of dentistry that is concerned with the
prevention, diagnosis, and treatment of diseases that
affect the pulp, root, periodontal ligament, and alveolar
bone is known as Endodontics.
• Orthodontics is a branch of dentistry that is concerned
with the prevention and correction of abnormally aligned
teeth.
• Periodontics is a branch of dentistry concerned with the
treatment of abnormal conditions of the tissues
immediately surrounding the teeth, such as gingivitis.

• Mechanical digestion in the mouth results from chewing,
or mastication.
• Salivary amylase, which is secreted by the salivary
glands, initiates the breakdown of starch.
• Lingual lipase, which is secreted by lingual glands in the
tongue. It breaks down dietary triglycerides into fatty acids
and diglycerides.
Mechanical and Chemical Digestion

PHARYNX
• The pharynx, a funnel-shaped tube that extends from the
internal nares to the esophagus posteriorly and to the
larynx anteriorly.
• The pharynx is composed of skeletal muscle and lined by
mucous membrane, and is divided into three parts: the
nasopharynx, the oropharynx, and the laryngopharynx.

ESOPHAGUS
• The esophagus is a collapsible muscular tube, about 25
cm (10 in.) long, that lies posterior to the trachea. The
esophagus begins at the inferior end of the
laryngopharynx and passes through the mediastinum
anterior to the vertebral column.
• Then it pierces the diaphragm through an opening called
the esophageal hiatus, and ends in the superior portion
of the stomach.

• The mucosa of the esophagus consists of nonkeratinized
stratified squamous epithelium, lamina propria, and a
muscularis muscosae.
• At each end of the esophagus, the muscularis becomes
slightly more prominent and forms two sphincters—the
upper esophageal sphincter
• (UES), which consists of skeletal muscle, and the lower
esophageal sphincter (LES), which consists of smooth
muscle.

DEGLUTITION
Swallowing occurs in three stages:
• the voluntary stage, in which the bolus is passed into
the oropharynx
• the pharyngeal stage, the involuntary passage of the
bolus through the pharynx into the esophagus
• the esophageal stage, the involuntary passage of the
bolus through the esophagus into the stomach

FUNCTIONS OF THE STOMACH
1. Mixes saliva, food, and gastric juice to form chyme.
2. Serves as a reservoir for food before release into small
intestine.
3. Secretes gastric juice, which contains HCl, pepsin,
intrinsic factor, and gastric lipase .
4. Secretes gastrin into blood.

BLOOD 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-green liquid. It has a
pH 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 phagocytosis
of aged red blood cells liberates iron, globin, and bilirubin.
• One of its breakdown products—stercobilin—gives feces
their normal brown color.

• Bile salts, play a role in emulsification, the breakdown of
large lipid globules into a suspension of small lipid
globules.
• Between meals, after most absorption has occurred, bile
flows into the gallbladder for storage because the
sphincter of the hepatopancreatic ampulla (sphincter
of Oddi) closes off the entrance to the duodenum.

FUNCTIONS OF THE LIVER
• Carbohydrate metabolism.
• Lipid metabolism.
• Protein metabolism.
• Processing of drugs and hormones.
• Excretion of bilirubin.
• Synthesis of bile salts.

FUNCTIONS OF THE LIVER
• Storage for certain vitamins (A, B12, D, E, and K) and
minerals (iron and copper)
• Phagocytosis.
• Activation of vitamin D.

S
Functions of the Small Intestine
1. Segmentations mix chyme with digestive juices and
bring food into contact with the mucosa for absorption;
peristalsis propels chyme through the small intestine.
2. Completes the digestion of carbohydrates, proteins, and
lipids; begins and completes the digestion of nucleic
acids.
3. Absorbs about 90% of nutrients and water that pass
through the digestive system.

S
MECHANICAL DIGESTION IN THE SMALL INTESTINE
The two types of movements of the small intestine:
Segmentations
• Segmentations mix chyme with the digestive juices and
bring the particles of food into contact with the mucosa
for absorption
Migrating motility complex (MMC)
• begins in the lower portion of the stomach and pushes
chyme forward along a short stretch of small intestine
before dying out

FUNCTIONS OF THE LARGE INTESTINE
1. Haustral churning, peristalsis, and mass peristalsis drive
the contents of the colon into the rectum.
2. Bacteria in the large intestine convert proteins to amino
acids, break down amino acids, and produce some B
vitamins and vitamin K.
3. Absorbing some water, ions, and vitamins.
4. Forming feces.
5. Defecating (emptying the rectum).

THE DEFECATION REFLEX
• Diarrhea is an increase in the frequency, volume, and
fluid content of the feces caused by increased motility of
and decreased absorption by the intestines.
• Constipation refers to infrequent or difficult defecation
caused by decreased motility of the intestines.

PHASES OF DIGESTION
• During the cephalic phase of digestion, the smell, sight,
thought, or initial taste of food activates neural centers in
the cerebral cortex, hypothalamus, and brain stem. The
brain stem then activates the facial (VII),
glossopharyngeal (IX), and vagus (X) nerves. The facial
and glossopharyngeal nerves stimulate the salivary
glands to secrete saliva, while the vagus nerves stimulate
the gastric glands to secrete gastric juice.

• The intestinal phase of digestion begins once food
enters the small intestine.
• The intestinal phase of digestion begins once food
enters the small intestine. Those occurring during the
intestinal phase have inhibitory effects that slow the exit of
chyme from the stomach.

Health History and Clinical Manifestations
SUBJECTIVE DATA
1. GENERAL DATA
a. presence of dental prosthesis, comfort of usage
b. difficulty eating or digesting food
c. nausea or vomiting
d. weight loss
e. pain

SUBJECTIVE DATA
2. SPECIFIC DATA
a. situations or events that effect symptoms
b. onset, possible cause, location, duration, character
of symptoms
c. relationship of specific foods, smoking or alcohol to
severity of symptoms
d. how the symptoms was managed before seeking
medical help

SUBJECTIVE DATA
3. NORMAL PATTERN OF BOWEL ELIMINATION
a. frequency and character of stool
b. use of laxatives, enemas
4. RECENT CHANGES IN NORMAL PATTERNS
a. changes in character of stool (constipation, diarrhea,
or alternating constipation and diarrhea)

SUBJECTIVE DATA
b. changes in color of stool
 melena
 hematochezia
c. drugs /medications being taken
d. measures taken to relieve symptoms

INDIGESTION
• Indigestion can result from disturbed nervous system
control of the stomach or from a disorder in the GI tract
or elsewhere in the body.
INTESTINAL GAS
• The accumulation of gas in the GI tract may result in
belching or flatulence.

NAUSEA AND VOMITING
• Vomiting is usually preceded by nausea, which can be
triggered by odors, activity, or food intake.
• When vomiting occurs soon after hemorrhage, the
emesis is bright red.
• If blood has been retained in the stomach, it takes on a
coffee-ground appearance because of the action of the
digestive enzymes.

BOWEL HABITS AND STOOL CHARACTERISTIC
• Diarrhea commonly occurs when the contents move so
rapidly through the intestine and colon that there is
inadequate time for the GI secretions to be absorbed.
• Constipation may be associated with anal discomfort
and rectal bleeding.
• Blood in the stool can present in various ways and must
be investigated.

• Blood entering the lower portion of the GI tract or passing
rapidly through it will appear bright or dark red.
• Lower rectal or anal bleeding is suspected if there is
streaking of blood on the surface of the stool.
Other common abnormalities in stool characteristics include
the following:
• Bulky, greasy, foamy stools that are foul in odor; stool color
is gray, with a silvery sheen
• Light gray or clay-colored stool, caused by the absence of
urobilin

• Stool with mucus threads or pus that may be visible on
gross inspection of the stool
• Small, dry, rock-hard masses called scybala; sometimes
streaked with blood from rectal trauma as they pass
through the rectum
• Loose, watery stool that may or may not be streaked with
blood

Physical Assessment
• The patient lies supine with knees flexed slightly for
inspection, auscultation, palpation, and percussion of
the abdomen.
• The nurse performs inspection first, noting skin changes
and scars from previous surgery. It also is important to
note the contour and symmetry of the abdomen, to
identify any localized bulging, distention, or peristaltic
waves.

Physical Assessment
Inspecting the abdomen Auscultating the abdomen

Physical Assessment
• The nurse assesses bowel sounds in all four quadrants
using the diaphragm of the stethoscope; the high-pitched
and 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 to
20 seconds), hypoactive (one or two sounds in 2
minutes), hyperactive (5 to 6 sounds heard in less than
30 seconds), or absent (no sounds in 3 to 5 minutes).

Physical Assessment
• The nurse notes tympani or dullness during percussion.
Use of light palpation is appropriate for identifying areas
of tenderness or swelling; the nurse may use deep
palpation to identify masses in any of the four quadrants.
• The final part of the examination is inspection of the anal
and perineal area. The nurse should inspect and palpate
areas of excoriation or rash, fissures or fistula openings,
or external hemorrhoids.

Physical Assessment
Palpating the abdomen Percussing the abdomen

Diagnostic Evaluation
Common blood tests include complete blood count (CBC),
carcinoembryonic antigen (CEA), liver function tests, serum
cholesterol, and triglycerides.
General nursing interventions for the patient who is having
GI diagnostic assessment include the following:
• Providing general information about a healthy diet and
the nutritional factors that can cause GI disturbances;
after a diagnosis has been confirmed, the nurse provides
information about specific nutrients that should be
included in the diet.

Diagnostic Evaluation
• Providing needed information about the test and the
activities required of the patient
• Providing instructions about post procedure care and
activity restrictions
• Alleviating anxiety
• Helping the patient cope with discomfort
• Encouraging family members or others to offer emotional
support to the patient during the diagnostic testing
• Assessing for adequate hydration before, during, and
immediately after the procedure

Stool Test
Basic examination of the stool includes:
• inspecting the specimen for consistency and color and
testing for occult blood
• tests for fecal urobilinogen, fat, nitrogen,
• parasites, pathogens, food residues, and other
substances

Stool Test
• The most widely used occult blood test is the Hematest.
False-positive results may occur if the patient has eaten
rare meat, liver, poultry, turnips, broccoli, cauliflower,
melons, salmon, sardines, or horseradish within 7 days
before testing.
• Medications that can cause gastric irritation, such as
aspirin, ibuprofen, indomethacin, colchicine,
corticosteroids, cancer chemotherapeutic agents, and
anticoagulants, may also cause false-positive results.

Breath Test
• The hydrogen breath test was developed to evaluate
carbohydrate absorption. It also is used to aid in the
diagnosis of bacterial overgrowth in the intestine and short
bowel syndrome.
• Urea breath tests detect the presence of Helicobacter
pylori. The patient takes a capsule of carbon labeled urea
and then provides a breath sample 10 to 20 minutes later.
The patient is instructed to avoid antibiotics or loperamide
for 1 month before the test; sucralfate and omeprazole for 1
week before the test; and cimetidine, famotidine, ranitidine,
and nizatidine for 24 hours before urea breath testing.

Abdominal Ultrasonography
• During abdominal ultrasonography, an image of the
abdominal organs and structures is produced on the
oscilloscope. This procedure is generally used to indicate
the size and configuration of abdominal structures.
• Endoscopic ultrasonography (EUS) is a specialized
enteroscopic procedure that aids in the diagnosis of GI
disorders by providing direct imaging of a target area. A
small high-frequency ultrasonic transducer is mounted at
the tip of the fiberoptic scope so that a transintestinal
study can be completed.

Nursing Interventions
• The patient fasts for 8 to 12 hours before the test to
decrease the amount of gas in the bowel.
• If gallbladder studies are being performed, the patient
should eat a fat-free meal the evening before the test.
• If barium studies are to be performed, the nurse should
make sure they are scheduled after this test; otherwise,
the barium will interfere with the transmission of the sound
waves.

DNA Testing
• DNA testing allows practitioners to prevent (or minimize)
disease, by intervening before its onset, and to improve
therapy.
• Persons at risk for colon cancer often are targeted for
DNA testing because it can provide a head start on this
preventable cancer.

Imaging Studies
Imaging studies include:
• x-ray and contrast studies
• computed tomography (CT) scans
• magnetic resonance imaging (MRI)
• and scintigraphy (radionuclide imaging)

Upper GI Tract Study
• X-rays can delineate the entire GI tract after the
introduction of a contrast agent.
• Variations of the upper GI study include double-contrast
studies and enteroclysis.
• The double-contrast method of examining the upper GI
tract involves administration of a thick barium suspension
to outline the stomach and esophageal wall, after which
tablets that release carbon dioxide in the presence of
water are given.

BEFORE 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 the
intestinal tract
• discourage the patient from smoking on the morning
before the examination
• withhold all medications as ordered by the physician

AFTER THE PROCEDURE:
• Follow-up care is needed after any of the upper GI
procedures to ensure that the patient has completely
eliminated the ingested barium.
• Fluids must be increased to facilitate evacuation of
stool and barium.
• The nurse monitors the patient’s stools until they return
to their normal color.
• A laxative or enema may be needed as ordered by th
physician.

Lower GI Tract Study
• When barium is instilled rectally to visualize the lower
GI tract, the procedure is called a barium enema.
• The purpose of a barium enema is to detect the
presence of polyps, tumors, and other lesions of the
large intestine and to demonstrate any abnormal
anatomy or malfunction of the bowel.
• The procedure usually takes about 15 to 30 minutes,
during which time x-ray images are taken.

BEFORE 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 following
morning
The nurse should make sure that barium
enemas are scheduled before any upper
GI studies.

CONTRAINDICATIONS 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 and
enemas
In patients with perforation or obstruction;
a water-soluble contrast study may be
performed in these situations.

• The nurse administers an enema or laxative after these
tests to facilitate barium removal.
• Increasing fluid intake also will assist in eliminating the
barium.
• As with any barium study, the nurse monitors the
patient for complete elimination of the barium.

Computed Tomography
• CT provides cross-sectional images of abdominal
organs and structures.
• Multiple x-ray images are taken from many different
angles, digitized in the computer, reconstructed, and
then viewed on a computer monitor.
• Indications for abdominal CT scanning are diseases of
the liver, spleen, kidney, pancreas, and pelvic organs.
• CT is a valuable tool for detecting and localizing many
inflammatory conditions in the colon, such as
appendicitis, diverticulitis, regional enteritis, and
ulcerative colitis.

• The patient should not eat or drink for 6 to 8 hours
before the test.
• The practitioner may prescribe an intravenous or oral
contrast agent. Therefore, the nurse should question
the patient about contrast dye allergies.
• If barium studies are to be performed, it is important to
schedule them after CT scanning, so as not to interfere
with imaging.

Magnetic Resonance Imaging
• MRI is used in gastroenterology to supplement
ultrasonography and CT scanning.
• It is a noninvasive technique that uses magnetic fields
and radio waves to produce an image of the area being
studied.
• It is useful in evaluating abdominal soft tissues as well
as blood vessels, abscesses, fistulas, neoplasms, and
other sources of bleeding.

Magnetic Resonance Imaging
CONTRAINDICATION FOR MRI
• patients with permanent pacemakers, artificial heart
valves and defibrillators, implanted insulin pumps, or
implanted transcutaneous electrical nerve stimulation
devices
• patients with internal metal devices (e.g., aneurysm
clips) or intraocular metallic fragments

before the test.
• Patient must remove all jewelry and other metals.
• It is important to warn patients that the close-fitting
scanners used in many MRI facilities may induce
feelings of claustrophobia and that the machine will
make a knocking sound during the procedure.
• Open MRIs that are less close-fitting eliminate the
claustrophobia that many patients experience.

Scintigraphy
• Scintigraphy relies on the use of radioactive isotopes
(i.e., technetium, iodine, and indium) to reveal
displaced 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 the
uptake of tagged red blood cells and leukocytes.
• A sample of blood is removed, mixed with a radioactive
substance, and reinjected into the patient.
• Abnormal concentrations of blood cells are then
detected at 24- and 48-hour intervals.

Gastrointestinal Motility Studies
• Radionuclide testing also is used to assess gastric
emptying and colonic transit time.
• For gastric emptying studies, the liquid and solid
components of a meal are tagged with radionuclide
markers.
• After the patient ingests the meal, the patient is
positioned under a scintiscanner, which measures the
rate of passage of the radioactive substance out of the
stomach.
• Abdominal x-rays are taken every 24 hours until all
markers are passed. This process usually takes 4 to 5
days.

Endoscopic Procedures
Endoscopic procedures in GI tract assessment include:
• fibroscopy / esophagogastroduodenoscopy
• anoscopy
• proctoscopy
• sigmoidoscopy
• colonoscopy
• small-bowel enteroscopy
• endoscopy through ostomy

UPPER GI FIBROSCOPY/
ESOPHAGOGASTRODUODENOSCOPY
• Fibroscopy of the upper GI tract allows direct
visualization of the esophageal, gastric, and duodenal
mucosa through a lighted endoscope (gastroscope).
• Esophagogastroduodenoscopy (EGD), is valuable
when esophageal, gastric, or duodenal abnormalities or
inflammatory, neoplastic, or infectious processes are
suspected.
• This procedure also can be used to evaluate
esophageal and gastric motility and to collect
secretions and tissue specimens for further analysis.

BEFORE THE PROCEDURE
before the examination.
• Help the patient spray or gargle with a local anesthetic,
and administer midazolam (Versed) intravenously just
before the scope is introduced.
• The nurse also may administer atropine to reduce
secretions, and may give glucagon, if needed and
prescribed, to relax smooth muscle.
• The nurse positions the patient on the left side to
facilitate saliva drainage and to provide easy access for
the endoscope.

AFTER THE PROCEDURE
• After the procedure, the nurse instructs the patient not
to eat or drink until the gag reflex returns (in 1 to 2
hours), to prevent aspiration of food or fluids into the
lungs.
• The nurse places the patient in the Simms position until
he or she is awake and then places the patient in the
semi-Fowler’s position until ready for discharge.
• After gastroscopy, assessment by the nurse includes
observing for signs of perforation, such as pain,
bleeding, unusual difficulty swallowing, and an elevated
temperature.

AFTER THE PROCEDURE
• The nurse monitors the pulse and blood pressure for
changes that can occur with sedation.
• After the patient’s gag reflex has returned, the nurse
can offer lozenges, saline gargle, and oral analgesics
to relieve minor throat discomfort.
• Patients who were sedated for the procedure must stay
on bed rest until fully alert.

ANOSCOPY, PROCTOSCOPY, AND SIGMOIDOSCOPY
• The lower portion of the colon also can be viewed
directly to evaluate rectal bleeding, acute or chronic
diarrhea, or change in bowel patterns and to observe
for ulceration, fissures, abscesses, tumors, polyps, or
other pathologic processes.
• The anoscope is a rigid scope that is used to examine
the anus and lower rectum.
• Proctoscopes and sigmoidoscopes are rigid scopes
that are used to inspect the rectum and the sigmoid
colon.

• For rigid scope procedures, the patient assumes the
knee-chest position at the edge of the bed or the
examining table. With the back inclined at about a 45-
degree angle, the patient is properly positioned for the
introduction of an anoscope, proctoscope, or
sigmoidoscope.
• For flexible scope procedures, the patient assumes a
comfortable position on the left side with the right leg
bent and placed anteriorly.
• Biopsy is performed with small biting forceps
introduced through the endoscope; one or more small
pieces of tissue may be removed.

Nursing Intercentions
• These examinations require only limited bowel
preparation, including a warm tap water or Fleet’s
enema until returns are clear.
• During the procedure, the nurse monitors vital signs,
skin color and temperature, pain tolerance, and vagal
response.
• After the procedure, the nurse monitors the patient for
rectal bleeding and signs of intestinal perforation (ie,
fever, rectal drainage, abdominal distention, and pain).

FIBEROPTIC COLONOSCOPY
• Fiberoptic colonoscope are larger in diameter and
longer.
• It is most frequently used for cancer screening and for
surveillance in patients with previous colon cancer or
polyps.
• Tissue biopsies can be obtained as needed, and polyps
can be removed and evaluated.
• Therapeutically, the procedure can be used to remove
all visible polyps, areas of bleeding or stricture.

• Colonoscopy is performed while the patient is lying on
the left side with the legs drawn up toward the chest.
• The procedure usually takes about 1 hour. Discomfort
may result from instillation of air to expand the colon or
from insertion and moving of the scope.
• Potential complications of colonoscopy include cardiac
dysrhythmias and respiratory depression resulting from
the medications administered, vasovagal reactions,
and circulatory overload or hypotension resulting from
overhydration or underhydration during bowel
preparation.

BEFORE THE PROCEDURE
• Patient should limit the intake of liquids for 24 to 72
hours before the examination.
• The physician may prescribe a laxative for two nights
before the examination and a Fleet’s or saline enema
until the return runs clear the morning of the test.
• Polyethylene glycol electrolyte lavage solutions
(Golytely, Colyte, NuLytely) are used as intestinal
lavages for effective cleansing of the bowel.
• The patient maintains a clear liquid diet starting at noon
the day before the procedure. Then the patient ingests
lavage solutions orally at intervals over 3 to 4 hours.

• Instructing the patient not to take routine medications
when the lavage solution is ingested; the medications
will not be digested and therefore will be ineffective
• Advising the diabetic patient to consult with his or her
physician about medication adjustment to prevent
hyperglycemia or hypoglycemia resulting from dietary
modifications required in preparation for the test
• Instructing all patients, especially the elderly, to
maintain adequate fluid, electrolyte, and caloric intake
while undergoing bowel cleansing

DURING THE PROCEDURE:
• Informed consent is obtained before the test.
• Before the examination, the nurse may administer
intravenously an opioid analgesic or a sedative (eg,
midazolam) to provide moderate sedation and relieve
anxiety during the procedure.
• Glucagon may be used, if needed, to relax the colonic
musculature and to reduce spasm during the test.
• Elderly or debilitated patients may require a reduced
dosage of these medications to decrease the risks of
oversedation and cardiopulmonary complications.

• The nurse monitors for changes in oxygen saturation,
vital signs, color and temperature of the skin, level of
consciousness, abdominal distention, vagal response,
and pain intensity.

• Patients who were sedated are maintained on bed rest
until fully alert.
• Some will have abdominal cramps caused by
increased peristalsis stimulated by the air insufflated
into the bowel during the procedure.
• The nurse observes the patient for signs and
symptoms of bowel perforation (eg, rectal bleeding,
abdominal pain or distention, fever, focal peritoneal
signs).
• If midazolam was used, the nurse explains its amnesic
effects.

• It is important to provide written instructions, because
the patient may be unable to recall verbal information.
• If the procedure is performed on an outpatient basis,
someone must accompany and transport the patient
home.
• After a therapeutic procedure, the nurse instructs the
patient to report any bleeding to the physician.

Side effects of the electrolyte solutions include:
• nausea
• bloating
• cramps or abdominal fullness
• fluid and electrolyte imbalance
• hypothermia (patients are often told to drink the
preparation as cold as possible to make it more
palatable)

Nursing Intercentions
CONTRAINDICATIONS:
• Patients with intestinal obstruction or inflammatory
bowel disease.
• Implantable defibrillators and pacemakers are at high
risk for malfunction if electrosurgical procedures (ie,
polypectomy) are performed in conjunction with
colonoscopy.
• Colonoscopy cannot be performed if there is a
suspected or documented colon perforation, acute
severe diverticulitis, or fulminant colitis.

• Therapeutic colonoscopy may be contraindicated in
patients with coagulopathies and in those receiving
anticoagulation therapy, because of the high risk for
excessive bleeding during and after the procedure.
• Nonsteroidal anti-inflammatory agents (NSAIDs),
aspirin, ticlopidine, and pentoxifylline must be
discontinued before the test and for 2 weeks after the
procedure. Patients taking coumadin or heparin must
consult the physician for specific instructions.
• Those with prosthetic heart valves or a history of
endocarditis require prophylactic antibiotics before the
procedure.

ENDOSCOPY THROUGH OSTOMY
• Endoscopy using a flexible endoscope through an
ostomy stoma is useful for visualizing a segment of the
small or large intestine.
• It may be indicated to evaluate an anastomosis, to
screen for recurrent disease, or to visualize and treat
bleeding in a segment of the bowel.

Manometry and Electrophysiologic Studies
• The manometry test measures changes in intraluminal
pressures and the coordination of muscle activity in the
GI tract. The pressures can be recorded manually, on a
physiograph, or on a computer.
• Electrogastrography, an electrophysiologic study, is
performed to assess gastric motility disturbances.
Electrodes are placed over the abdomen, and gastric
electrical activity is recorded for up to 24 hours.
Electrogastrography can be useful in detecting motor or
nerve dysfunction in the stomach.

Defecography
• Defecography measures anorectal function. Very thick
barium paste is instilled into the rectum, and then
fluoroscopy is performed to assess the function of the
rectum and anal sphincter while the patient attempts to
expel the barium.
• Electromyographic (EMG) studies can supplement
anorectal manometry to measure the integrity and
function of the anal sphincters in an effort to treat
functional bowel incontinence and constipation.

Gastric Analysis
• Analysis of the gastric juice yields information about the
secretory activity of the gastric mucosa and the
presence or degree of gastric retention in patients
thought to have pyloric or duodenal obstruction.
• Important diagnostic information to be gained from
gastric analysis includes the ability of the mucosa to
secrete HCl.

• The patient is kept NPO for 8 to 12 hours before the
procedure.
• Any medications that affect gastric secretions are
withheld for 24 to 48 hours before the test.
• Smoking is not allowed on the morning before the test,
because it increases gastric secretions.

Gastric Stimulation Test
• The gastric acid stimulation test usually is performed in
conjunction with gastric analysis.
• Histamine is administered subcutaneously to stimulate
gastric secretions. It is important to inform the patient
that this injection may produce a flushed feeling.
• Gastric specimens are collected after the injection
every 15 minutes for 1 hour and are labeled to indicate
the time of specimen collection after histamine
injection.
• The volume and pH of the specimen are measured.

• Inform the patient that this injection may produce a
flushed feeling.
• The nurse monitors blood pressure and pulse
frequently to detect hypotension.

Laparoscopy
• This procedure is performed through a small incision in
the abdominal wall. Special fiberoptic laparoscopes
allow direct visualization of the organs and structures
within the abdomen, permitting visualization and
identification of any growths, anomalies, and
inflammatory processes.
• Biopsy samples can be taken from the structures and
organs as necessary.
• This procedure can be used to evaluate peritoneal
disease, chronic abdominal pain, abdominal masses,
and gallbladder and liver disease.

Assignment!
1. As a student nurse assigned at the emergency room,
you are in charge of a 24-year-old male patient who
was admitted for acute abdominal pain. He is being
scheduled for tests this afternoon. What laboratory
tests would you expect to be ordered? What
preparation is needed for these tests? What
preprocedure education is needed?

Assignment!
2. A 58-year-old patient assigned to you this morning has
just left to go to the Endoscopy Suite, where she will
undergo a colonoscopy. You know that your patient will
receive moderate sedation during the procedure and that
she will be returned to your care once she is fully alert.
What should you anticipate in the course of recovery for
your patient after the colonoscopy? What medications
might be used for the moderate sedation, and what
effects of those medications would you expect to see
during the recovery period? Describe the potential
complications that could occur and what you will monitor.
What are the goals for care during this period?

GI System 1 Lecture

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GI System 1 Lecture