Chapter044

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Timby/Smith: Introductory Medical-Surgical Nursing, 10/e

Timby/Smith: Introductory Medical-Surgical Nursing, 10/e

Chapter 44: Introduction to the Gastrointestinal System and Accessory

Structures


Anatomy and PhysiologyAnatomy and Physiology• Mouth

– Mastication; Food containing starch

– Partial digestion; Salivary amylase

• Esophagus

– Location; Esophageal muscle tissue; Peristalsis

– Upper esophageal sphincter

• Stomach

– Temporarily holds ingested food; Semiliquid form

– Cardiac sphincter; Muscle fibers; Pyloric sphincter contracts, relaxes


Anatomy and PhysiologyAnatomy and Physiology• Stomach (Cont’d)

– Gastric secretions; Chyme; Peristalsis; Emptying time

• Small Intestine

– Three portions; Primary function: Absorb nutrients from chyme

• Duodenum

• Jejunum

• Ileum


Anatomy and PhysiologyAnatomy and Physiology• Large Intestine

– Primary function: Receives waste from the small intestine; Absorbs water, some electrolytes, bile acids

– Structure: Cecum, colon (ascending, transverse, descending, sigmoid), rectum, anal canal; Appendix

• Accessory Structures

– Three accessory digestive organs

• Liver, gallbladder, and pancreas


Accessory StructuresAccessory Structures• Peritoneum

– Membrane lining the inner abdomen

• Liver

– Largest glandular organ in the body

– Location and functions

• Gallbladder

– Location; Structure; Contraction

– Bile; Digestive enzymes; Alkaline fluid


Accessory StructuresAccessory Structures• Pancreas

– Exocrine and endocrine gland

– Endocrine organ: Hormones insulin and glucagon

– Exocrine organ: Protein, fat, and carbohydrate—digesting enzymes

– Pancreatic enzymes


Nursing AssessmentNursing Assessment

• Physical Examination

– General appearance

– Skin

– Mouth

– Abdomen

– Anus


Diagnostic TestsDiagnostic Tests• Radiographic Studies

– Identify location, structural appearance of organs in abdomen, chest, or GI system

– Radiopaque contrast media; Fluoroscopy

• Barium Swallow or Upper Gastrointestinal Series

– Fluoroscopic observation—esophagus

– Identify structural abnormalities of the esophagus, swallowing discoordination, oral aspiration


Diagnostic TestsDiagnostic Tests• Barium Swallow or Upper Gastrointestinal Series

– Radiographic observation

– Preprocedural requisites: Low-residue diet; Laxative; Smoking

– Postprocedural requisites: Drink fluids liberally; Obtain stool specimens; Laxative

• Small Bowel Series

– Fluoroscopy of the small intestine

• Identify obstruction in jejunum or ileum, tumors, and inflammation


Diagnostic TestsDiagnostic Tests• Enteroclysis: Small Bowel Enema

• Barium Enema or Lower Gastrointestinal Series

– Identifies polyps, tumors, inflammation, strictures, and abnormalities of the colon

– Observe rectum, sigmoid colon, and descending colon fluoroscopically

– Position changes; Retain the instilled barium; Stool specimens

– Restrictions and procedures to reduce the formation of stool and remove any residual stool


Diagnostic TestsDiagnostic Tests• Oral Cholecystography or Gallbladder Series

– Identifies stones in the gallbladder, common bile duct and tumors; Ability to store a dye-like, iodine-based, radiopaque contrast medium

– Radiography: Should be performed before other GI examinations

– Dye tablets; No eating or drinking; Fatty test meal


Diagnostic TestsDiagnostic Tests

• Cholangiography

– Determines the patency of the ducts from the liver and gallbladder

– Uses: Gallbladder not distinctly visible; Vomiting interferes with oral dye

• ERCP

• Intraoperative cholangiography

• MRCP

• PTC


• Radionuclide Imaging

– Detects lesions of the liver or pancreas and assists in evaluating gastric emptying

– Injected IV or ingested orally

• Computed Tomography

– Detect structural abnormalities of the GI tract and metastatic lesions

– Hollow GI organs: Oral barium sulfate or IV calcium phosphate

– Before the test: Cleanse bowels



Diagnostic TestsDiagnostic Tests• Nonradiographic Studies

– Magnetic Resonance Imaging (MRI)

• Uses magnetic energy rather than radiation; Examines GI structures; Oral contrast agents

– Magnetic Resonance Elastrophy (MRE)

• MRI + low frequency sound waves

• Ultrasonography

– High-frequency sound waves detect size, location of organs

– Outlines structures, abnormalities, cholelithiasis, and pyloric stenosis; Appendicitis changes


Diagnostic TestsDiagnostic Tests• Percutaneous Liver Biopsy

– Obtain liver tissue and examine microscopically

– Detects malignant changes, infectious or inflammatory processes, liver damage, and signs of rejection in clients who have received a liver transplant

• Gastrointestinal Endoscopy

– Visual examination of the lumen of the GI tract; Flexible fiberoptic endoscope

– Evaluates the appearance, integrity of the GI mucosa; Detects lesions



• Laboratory Tests

– Includes complete blood count, urinalysis, serum bilirubin, cholesterol, serum ammonia level, prothrombin time, protein electrophoresis, and enzymes

– Common tumor marker blood studies

– Gastric analysis; H. pylori Test

– Hydrogen breath testing

– Stool analysis


Nursing ManagementNursing Management

• Assessment

• Diagnosis

• Planning

• Interventions

• Evaluation of Expected Outcomes


End of Presentation

Chapter044

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