Nutrition: Gastrointestinal System


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Nutrition: Gastrointestinal System

  1. 1. Gastrointestinal System Nursing Assessment
  2. 2. Function of the G.I. System <ul><li>Ingestion </li></ul><ul><li>Digestion </li></ul><ul><li>Absorption </li></ul><ul><li>Elimination </li></ul>
  3. 3. G.I. Tract <ul><li>Mouth </li></ul><ul><li>Pharynx </li></ul><ul><li>Esophagus </li></ul><ul><li>Stomach </li></ul><ul><li>Small Intestine (duodenum, jejunum, ileum) </li></ul><ul><li>Large Intestine </li></ul><ul><li>Rectum </li></ul><ul><li>Anus </li></ul>
  4. 4. G.I. Associated Organs <ul><li>Liver </li></ul><ul><li>Pancreas </li></ul><ul><li>Gallbladder </li></ul>
  5. 7. Factors that influence G.I. functioning <ul><li>Psychological </li></ul><ul><li>Emotional </li></ul><ul><li>Stress </li></ul><ul><li>Diet </li></ul><ul><li>Alcohol </li></ul><ul><li>Caffeine </li></ul><ul><li>Nicotine </li></ul><ul><li>Organic diseases </li></ul><ul><li>fatigue </li></ul>
  6. 8. Structures and Functions of the G.I. Tract
  7. 9. Composition <ul><li>The G.I. Tract is a tube approximately 30 ft. (9m) extending from mouth to anus. </li></ul><ul><li>It is composed of four layers </li></ul><ul><li>Mucosa </li></ul><ul><li>Submucosa </li></ul><ul><li>Muscle </li></ul><ul><li>Serosa </li></ul>
  8. 10. Neuro Intervention <ul><li>Autonomic nervous system </li></ul><ul><li>Parasympathetic </li></ul><ul><li>Excitatory :Increase of peristalsis </li></ul><ul><li>Sympathetic </li></ul><ul><li>Inhibatory : Decrease of peristalsis </li></ul><ul><li>Sensory information is relayed via both parasympathetic and sympathetic afferent fibers. </li></ul>
  9. 11. Enteric Nervous System <ul><li>Composed of two layers </li></ul><ul><li>Lie between the mucosa and the circular muscle layer and the circular and longitudinal muscle layers </li></ul><ul><li>Neurons contribute to the coordination of the G.I. Motor and sensory activities </li></ul><ul><li>“ Gut Brain” </li></ul><ul><li>Contains numerous neurons </li></ul><ul><li>Ability to control movement and secretion of the G.I. Tract </li></ul>
  10. 12. C.V. Intervention <ul><li>G. I. Tract and the accessory organs get 25-30% of the cardiac output </li></ul><ul><li>Venous blood draining the GI tract organs empties in the portal vein, which then perfuses the liver </li></ul><ul><li>Splanchnic artery innervates the upper GI tract </li></ul><ul><li>Hepatic and superior mesenteric artery branches innervate the small intestine </li></ul>
  11. 13. C.V. (cont) <ul><li>Superior and inferior mesenteric arteries supply blood to the large intestines </li></ul><ul><li>Because such a large % of the cardiac output perfuses these organs, the GI tract is a major source from which blood flow can be diverted during exercise and stress. </li></ul>
  12. 14. G.I. Movement <ul><li>Segmentation (mixing) </li></ul><ul><li>Peristalsis (propulsion) </li></ul>
  13. 15. G.I. Secretions <ul><li>Enzymes and hormones for digestion </li></ul><ul><li>Mucus to provide protection and lubrication </li></ul><ul><li>Water </li></ul><ul><li>Electrolytes </li></ul>
  14. 16. Peritomeum <ul><li>Covers the abdominal organs </li></ul><ul><li>Parietal layer lines the abdominal cavity wall </li></ul><ul><li>Visceral layer covers the abdominal organs </li></ul><ul><li>Peritoneal cavity is the potential space between the parietal and visceral layers </li></ul><ul><li>Two folds of the peritoneum are called the mesentery and the omentum </li></ul>
  15. 17. Mesentery <ul><li>Attaches to the small intestine and part of the large intestine to the posterior abdominal wall </li></ul><ul><li>Contains blood and lymph vessels </li></ul>
  16. 18. Omentum <ul><li>The lesser omentum goes from the lesser curvature of the stomach to the upper duodenum to the liver </li></ul><ul><li>The greater omentum hangs from from the stomach over the intestines like an apron </li></ul><ul><li>Contains fat and lymph nodes </li></ul>
  17. 19. Ingestion <ul><li>The mouth is the entrance of the GI tract. </li></ul><ul><li>The food is moved on to the stomach and other organs for digestion and absorbtion. </li></ul>
  18. 20. Ingestion <ul><li>Intake of food </li></ul><ul><li>Hypothalamus “appetite center” </li></ul><ul><li>Directly of indirection stimulated by hypoglycemia, empty stomach, decrease of body temp </li></ul><ul><li>Input from higher brain centers </li></ul><ul><li>Appetite stimulated by taste, smell and sight </li></ul>
  19. 21. Ingestion (cont) <ul><li>Appetite decreased by stomach distention, illness, hyperglycemia, N&V, and certain drugs </li></ul><ul><li>Deglutition, swallowing, mechanical component of ingestion involving the mouth, pharynx, and esophagus </li></ul>
  20. 22. Digestion <ul><li>Releases nutrients from food </li></ul><ul><li>Separation of other nutrients from food components </li></ul><ul><li>Takes place in the small intestine </li></ul>
  21. 23. Absorbtion <ul><li>Delivers nutrients into the blood. </li></ul><ul><li>Absorbing structures (microvilli) located in the small intestine transfer the nutrients into the portal blood and lymph. </li></ul><ul><li>Water is absorbed in colon later. </li></ul>
  22. 24. Elimination <ul><li>Excretes nondigestible waste </li></ul><ul><li>The fecal mass moves from the colon to the rectum, where it is stored and excreted. </li></ul>
  23. 25. Before the mouth <ul><li>Smell and vision and hunger </li></ul>
  24. 26. Smell
  25. 29. Vision
  26. 33. Mouth <ul><li>Lips and oral (buccal) cavity </li></ul><ul><li>Hard and soft palate </li></ul><ul><li>Teeth </li></ul><ul><li>Tongue </li></ul><ul><li>Taste buds </li></ul><ul><li>Salivary glands </li></ul>
  27. 37. What happens in the mouth? <ul><li>Teeth? </li></ul><ul><li>Tongue? </li></ul><ul><li>Salivary glands? </li></ul>
  28. 38. Extra Credit <ul><li>What type of pathophysiology or conditions can cause problems while eating? </li></ul>
  29. 39. Pharynx <ul><li>Muscleomembranous tube that may be divided into the nasopharynx, oropharynx, and the laryngealpharynx. The mucus membrane of the pharynx is continuous with the nasal cavity, mouth, auditory tubes and larynx. </li></ul>
  30. 40. Functions <ul><li>Oropharynx secretes mucus </li></ul><ul><li>Epiglottis closes over the larynx during swallowing </li></ul><ul><li>Oropharynx moves the food down </li></ul><ul><li>Receptors in the oropharynx are stimulated by food and liquids which initiates swallowing </li></ul>
  31. 43. Any Problems?
  32. 44. Esophagus <ul><li>Hollow , muscular tubing that receives food from the pharynx and moves it to the stomach by peristaltic contractions. Located in the thoracic cavity and starts behind the trachea and the lower end of the pharynx and extends to the stomach. The upper third is composed of striated skeletal muscle and the distal two thirds is composed of smooth muscle. </li></ul>
  33. 45. Functions <ul><li>Upper esophageal sphincter (criphapharyngeal) relaxes and the peristaltic wave moves the bolus into the esophagus. The muscular layers contract and propels the food in the stomach. The lower esophageal sphincter (LES) at the distal end of the esophagus remains contracted except during swallowing, belching, or vomiting. </li></ul>
  34. 46. LES <ul><li>Important barrier that prevents reflux of acidic gastric contents into the esophagus </li></ul>
  35. 49. Name That Pathophysiology
  36. 50. Stomach <ul><li>Stores food, mix food with gastric secretions and empties into the small intestine. Very little water, alcohol, electrolytes, or drugs are absorbed </li></ul>
  37. 51. Back to digestion <ul><li>Muscular </li></ul><ul><li>Chemical </li></ul>
  38. 52. Muscular <ul><li>Mixing and propulsive movements </li></ul><ul><li>Controlled by the nervous system </li></ul>
  39. 53. Longitudinal Muscle <ul><li>Long smooth muscles arranged in fiber bundles that extend lengthwise along the GI tract help propel the food mass downward. </li></ul>
  40. 54. Circular contractile muscles <ul><li>Smooth muscle fibers that extend around the hallow tube forming the alimentary canal. </li></ul><ul><li>These rhythmic contractile rings cause sweeping waves along the digestive tract pushing food forward. </li></ul><ul><li>This movement is called peristalsis </li></ul>
  41. 55. Sphincter muscles <ul><li>More defined circular muscles at strategic points form muscle sphinters that act as valves--pyloric, ileocecal, and anal—to prevent reflux and backflow and keep the food mass moving in a forward direction. </li></ul>
  42. 56. Mucosal muscles <ul><li>Thin embedded layer of smooth muscle produces local constrictive contractions every few centimeters. </li></ul><ul><li>They contact mix and chop, the food mass, effectively churning and mixing it with secretions to form a semiliquid called chyme that is ready for digestion and absorption. </li></ul>
  43. 57. Gastrointestinal Secretions <ul><li>Enzymes </li></ul><ul><li>HCl acid and buffer ions </li></ul><ul><li>Mucus </li></ul><ul><li>Water and electrolytes </li></ul>
  44. 58. Enzymes <ul><li>Specific enzymes attack designated chemical bonds within the structure of nutrient compounds freeing their component parts. </li></ul>
  45. 59. Enzymes <ul><li>The major enzyme of the stomach is pepsin, which begins the breakdown of protein. </li></ul><ul><li>Pepsin is secreted in the form of pepsinogen and is activated by HCl acid. </li></ul><ul><li>Small amount of gastric lipase (tributyrase) that acts only on butter fat </li></ul>
  46. 60. Enzymes <ul><li>Children have a gastric enzyme called renin (don’t confuse it with renal renin) that aids in the coagulation of milk. It coagulates the protein of milk from liquid to solid which slows the emptying of the stomach, ensuring a gradual passage to the small intestine. </li></ul>
  47. 62. Hydrochloric acid and buffer ions <ul><li>The agents produce the pH necessary for the activity of certain enzymes </li></ul>
  48. 63. ACID!!!!!! <ul><li>HCl acid creates the acidic environment necessary for certain enzymes to work. </li></ul><ul><li>A pH of 1.8-3.5 is needed for pepsin to work . A pH of 5 or above there will be little or no pepsin activity </li></ul>
  49. 64. Mucus <ul><li>This sticky, slippery fluid lubricates and protects the lining of the inside wall of the gastrointestional tract and eases the passage of the food mass. </li></ul>
  50. 65. Water and electrolytes <ul><li>These agents provide an appropriate solution in the amounts needed to circulate the substances released in the digestive process. </li></ul>
  51. 66. Small Intestine <ul><li>Digestion and absorption </li></ul><ul><li>Duodenum, jejunum, and ileum </li></ul><ul><li>Ileocecal valve </li></ul>
  52. 67. Duodenum <ul><li>Mixes the chyme from the stomach and the digestive secretions from the pancreas and the liver from the common bile duct </li></ul>
  53. 69. Enzymes <ul><li>Specific enzymes act on specific macronutrients to bring out their final breakdown to form the body can absorb and use. </li></ul>
  54. 70. Mucus <ul><li>Glands located at the entrance to the duodenum secrete large amounts of mucus to decrease the acidity of the chyme </li></ul><ul><li>Other mucus lubricates and protects the mucosal lining in the duodenum </li></ul>
  55. 71. Hormones <ul><li>Secretin: stimulates the pancreas to send alkaline pancreatic juices into the duodenum </li></ul>
  56. 72. Bile <ul><li>Emulsifies the fats and facilitates digestion </li></ul>
  57. 73. Composition <ul><li>The serous coat is formed by the peritoneum. The mucosa is thick, vascular, and glandular. Circular folds in the mucous and submucous layers provide greater surface for digestion and absorption. </li></ul>
  58. 74. Villi <ul><li>Finger like projections in the mucous membrane. They also increase surface area for digestion and absorption. </li></ul>
  59. 76. Duodenum absorbs: <ul><li>Iron </li></ul><ul><li>Calcium </li></ul><ul><li>Magnesium </li></ul>
  60. 77. Jejunum <ul><li>Nutrients area absorbed in the blood stream </li></ul><ul><li>Simple sugars </li></ul><ul><li>Water soluble vitamins (C and all B’s except B-12 </li></ul>
  61. 78. Ileum absorbs: <ul><li>Amino Acid (the end product of protein digestion) </li></ul><ul><li>Fat soluble vitamins (A,D,E, and K) </li></ul><ul><li>Fatty acids and cholestrol </li></ul><ul><li>Vitamin B-12 </li></ul><ul><li>Sodium, potassium, and alcohol </li></ul>
  62. 80. Large Intestine <ul><li>Absorbs fluids and electrolytes </li></ul><ul><li>Garbage compactor </li></ul><ul><li>Secretes mucus </li></ul>
  63. 81. Garbage <ul><li>Feces consist of water, bacteria, unabsorbed minerals, undigested food stuffs, bile pigment, and desquamated epithelial cells </li></ul>
  64. 82. Large Intestine <ul><li>Manufactures Vitamin B-12 </li></ul><ul><li>Produce Vitamin K </li></ul><ul><li>Break down of amino acids and produce nitrogen </li></ul><ul><li>Moves and breaks down indigestible complex carbohydrates (Methane) </li></ul>
  65. 83. Liver <ul><li>Largest solid organ in the body </li></ul><ul><li>Stores, manufactures, transforms and excretes a number of substances involved in metabolism. </li></ul>
  66. 85. Functions <ul><li>Carbohydrate metabolism </li></ul><ul><li>Protein metabolism </li></ul><ul><li>Fat metabolism </li></ul><ul><li>Steroid metabolism </li></ul><ul><li>Bile production and secretion </li></ul><ul><li>Storage </li></ul><ul><li>Mononuclear phagocyte system </li></ul>
  67. 86. Gallbladder <ul><li>Pear shaped sac located below the liver </li></ul><ul><li>Concentrates and stores bile </li></ul><ul><li>Bile is produced by hepatic cells and secreted into the bile ducts by hepatic cells and secreted into the biliary canaliculi of the lobes </li></ul>
  68. 87. Common Bile Duct <ul><li>The hepatic duct merges with the cystic duct from the gallbladder and form the common bile duct </li></ul>
  69. 88. Back to the GB <ul><li>Most bile is stored and concentrated in the gall bladder </li></ul><ul><li>It is released into the cystic duct and moves down the common bile duct to enter the duodeum at the ampulla of Vater </li></ul><ul><li>In the intestines most of the bilirubin os reduced to stercobilinogen and urobilogen by bacterial action </li></ul>
  70. 89. Too much information <ul><li>Stercobilinogen accounts for the brown color of stool </li></ul>
  71. 90. Pancreas <ul><li>Exocrine and endocrine gland </li></ul><ul><li>Exocrine gland: enzymes to metabolize food. </li></ul>
  72. 91. Spleen <ul><li>Who cares???????? </li></ul>
  73. 92. The Effects of Aging on the G.I. Tract
  74. 93. It’s Happening Right Now <ul><li>Tooth and dentin wear down; cavities </li></ul><ul><li>Periodontal disease lead to tooth loss </li></ul><ul><li>Taste buds and sense of smell go </li></ul><ul><li>Esophageal smooth muscle weakens </li></ul><ul><li>LES becomes more incompetent </li></ul><ul><li>Decrease on HCL, delayed gastric emptying, and constipation </li></ul>
  75. 94. Okay….Spleen <ul><li>Phagocytosis </li></ul><ul><li>However it may be removed and the liver will compensate. </li></ul>
  76. 95. Physical Inspection <ul><li>Mouth </li></ul><ul><li>Abdomen </li></ul><ul><li>Rectum and anus </li></ul>
  77. 96. Mouth <ul><li>Lips: color, cracking, ulcers, symmetry </li></ul><ul><li>Mouth: Ulcers, color </li></ul><ul><li>Tongue: </li></ul><ul><li>Teeth: dentures, cavities </li></ul><ul><li>Pharynx </li></ul>
  78. 97. Abdomen <ul><li>Inspection </li></ul><ul><li>Auscultation </li></ul><ul><li>Percussion </li></ul><ul><li>Palpation </li></ul>
  79. 98. Inspection <ul><li>4 Quadrants </li></ul><ul><li>Color, texture, scars striae, dilated veins, rashes, lesions </li></ul><ul><li>Umbilicus </li></ul><ul><li>Pulsations </li></ul>
  80. 99. Auscultation <ul><li>Listen for 5 minutes (yeah, right) </li></ul><ul><li>Warm it up </li></ul><ul><li>Present, absent, increased, decreased, high pitched, tinkling, gurgling, rushing </li></ul><ul><li>Aortic bruits? </li></ul>
  81. 100. Percussion <ul><li>Tympany </li></ul><ul><li>Dullness </li></ul>
  82. 101. Palpation <ul><li>Light palpation </li></ul><ul><li>Deep palpation </li></ul>
  83. 102. Rectum and anus <ul><li>Inspection </li></ul><ul><li>Palpation </li></ul>