What is the Alimentary tube?

Where does the absorption of most nutrients take place?

Teeth begin mechanical digestion.

The tongue is made of skeletal muscle innervated by the hypoglossal nerve which is the twelfth cranial nerve.

The tongues main function is chewing.

There are three pairs of salivary glands:

1. parotid

2. submandibular

3. sublingual

Oral cavity and pharynx

Saliva is mostly water

Amylase is the only digestive enzyme in saliva.

The pharynx is a muscular tube that is a passageway for food exiting the oral cavity and entering the esophagus.

About 10 inches long.

No digestion takes place here.

Peristalisis of the esophagus allows food to reach the stomach.

Appears in the upper left abdominal quadrant, to the left of the liver and in front of the spleen.

It extends from the esophagus to the duodenum of the small intestines.

1. some digestion

2. reservoir for food

About one inch in diameter and approximately 20 feet long.

Extends from the stomach to the cecum of the colon.

Digestion is complete in the small intestines.

Extends from the ileum of the small intestine to the anus.

It is about 5 feet long and 2.5 inches in diameter.

No digestion takes place here.

1. Stores and then eliminates undigestable material

2. Absorbs water, minerals, and vitamins

3. Elimination of feces

Important to know!!!!!!!!!

Remember black tarry stools can mean GI bleeding!

GI assessment begins with the oral cavity.

The lips are examined for abnormalities.

Look inside the oral cavity for any ulcers, bleeding and discolorations.

Note the odor of the pts. breath

Certain infections carry certain odors

Look at dentures to make sure they properly fit

Look at the pts teeth to see if they may have trouble chewing

Assess their knowledge of dental care.

Place the pt supine to assess the abdomen.

Visually note the condition and contour of the abdomen.

Is it round, concave, flat, distended?

Note the presence of any scars, lesions, wounds, tubes, or ostomy devices.

Start with the upper right quadrant.

Follow a clockwise pattern.

5 to 15 seconds

Lightly depress on the abdomen with the fingertips in the same clockwise pattern and note any pain, tenderness, or rigidity.

Adbominal girth is measured by placing a tape measure around the patients abdomen at the iliac crest.

Make sure to place a mark at the measurement site.

Usually done by a physician or advanced nurse practitioner

Tympanic sounds indicate the location of air

Dull thuds indiciate fluid or solid organs

Flat plate of the abdomen (Radiographic test)

noninvasive procedure

an x-ray exam giving an anterior to posterior view

It visualizes abdominal organs and can detect tumors, obstructions and strictures.

Pt. should be in a hospital gown without any metal zippers, belts, or jewerly.

Pregnant women cannot have this

Upper GI series with Barium

invasive procedure

(mouth) x-ray of the esophagus, stomach, duodenum and jejunum using a radiopaque oral liquid contrast and fluroscopy to outline contours of these structures.

Pt. is NPO for 6-8 hrs. before procedure.

Laxative is usually ordered after the procedure to get rid of the barium and to prevent impaction. 

Barium will cause the pts. stool to be white (or yellow to brown in color), but should return to normal within three days.

Atropine may be given to help dry up secretions

Pt. needs plenty of fluid

Used to diagnose tumors, diverticula, stenosis, obstructions, inflammation, ulcerative colitis, and polyps.

Pt’s. are usually on a clear liquid or low residue diet 2 days before the procedure.

Laxatives, enemas or oral bowel evacuation meds such as Go-lytely will usually be given to the pt. to help completely clean the lower colon.

The pt. may have a clear liquid diet the morning of the test or might be NPO.

*Active GI bleeding may also prohibit the use of laxatives or enemas.

Consent must be signed

NPO 2-4 hours prior to procedure

May have a clear liquid tray the morning of the test

Visualized the esophagus, stomach and duodenum

Abnormalities such as cancer, inflammation, bleeding, injury and infection can be seen.

Pt. is NPO 8-12 hours before the procedure.

Sedatives such as Valium (to calm the pt. down) are given prior to the procedure.

A local anesthetic is given prior to the procedure to stop the gag reflex.

Pt. is placed on (L) side (drops into the stomach easier) and the tube is passed orally down the GI tract with photos taken.

Pt. remains NPO until the gag reflex returns.

Clear liquid diet 24 hours before the test.

The morning of the procedure give a warm tap water enema or a fleets.

Positioned in the (L) lateral knee position.

After procedure the pt. is placed in the supine position to avoid orthostatic hypotension

Clear liquid diet 24 hours before the test

Go-lytely is given the night before the procedure

Conscious sedation is used

Positioned on the (L) side with knees bent

Measures the secretions in the stomach

Used to diagnose duodenal ulcers, gastric carcinoma, pyloric or duodenal obstruction and pernicious anemia

What are the two tests used during the procedure, Gastric Analysis?

1. Basal cell secretion test for cancer

2. Gastric acid stimulation test

The pt. is NPO after midnight and the pt. should avoid taking any drugs that could interfere with gastric acid secretion such as cholinergics and antacids

NG tube is inserted to remove contents

Stomach contents are collected q 15 mins. for one hour

Also any meds that cause drying up should be avoided

Performed through the endoscope using sound waves.

Used to detect tumors in various GI structures and organs.

This is the placement of the tube within the GI tract for therapeutic or diagnostic purposes

1. To remove gas and fluids from the stomach or intestines

2. To diagnose GI motility and to obtain gastric secretions for analysis

3. To relieve and treat obstructions or bleeding within the GI tract

4. To provide means for nutrition

5. To promote healing

6. To remove toxic substances

1. inability to swallow
2. severe burns or trauma to the face and the jaw
3. mental retardation
4. oropharyngeal or esophageal paralysis
5. comatose pts.

1. Gravity: Placed above the level of the stomach and dripped in by gravity slowly or given as a bolus feeding
2. Controlled Pump:
   1. Intermittent feedings: feedings either delivered continuously throughout the day and they is continued each night. These allow the stomach to rest at night and more closely stimulate normal eating and nutrient absorption patterns.

Sitting or High Fowlers

Stop the feeding

Also known as intravenous hyperailimentation

This is supplying nutrients via IV route

glucose levels for hyperglycemia

supplying nutrition intravenously other than a central vein

used for less than 10 days when the pt. does not need more than 2000 calories daily

measures the fat content in the stool

What is an AST? Normal Range? What is it elevated with?

enzyme found in highly metabolic tissues

8-20 units/L

chronic liver failure, viral hepatitis, acute pancreatitis

serum protein levels

3.1-4.3 g/dl

liver disease

When is a serum ammonia level elevated?

clear liquid diest for 24 hours prior to exam

laxative the night before exam

enemas the morning of the exam

a biopsy specimen may be obtained or polyps be removed

inflammation, ulcers, polyps or cancer

clear liquid diet for 24 hours prior to exam

bowel preparation (Golytely) the night before exam

possibly enemas the evening prior to examination and the morning of the examination

pt will receive conscious sedation during examination

monitor for complications suh as hemorrhage and severe pain

instruct pt. that cramping will last for several hours after test, and blood may be present in stool if specimen was taken

nausea is the subjective feeling of the urge to vomit

vomiting is the act of expelling stomach contents from the body through the esophagus and mouth

nausea R/T various causes

risk for aspiration R/T decrease gag reflex or unconsciousness

deficient fluid volume

Benadryl

Vistaril

Reglan

Phenergan

Compazene

Zofran

Transdermscop

Torecan

Tigan

1. weakness

2. headache

3. muscle cramps

4. restlessness

5. inability to concentrate

6. postural hypotension

pulse & BP fall

heart & kidney failure at risk

osteoporosis & muscle loss occur

vitamin and electrolyte imbalances

diabetes may develop with a high morbidity

restoration of nutritional health

nutrition is supplied by IV infusions containing electrolytes

oral food supplements

1.refusal to maintain body weight over a minimum normal weight for age & height

2.intense fear of gaining weight or becoming fat, even though underweight

3.disturbance in the way in which one's body weight, shape or size is experienced

4.absence of menstrual cycle 

s/s of bulimia nervosa

enamel erosion of the front teeth & staining

spend a lot of time in the bathroom vomiting

hypokalemia

hypocalcemia

imbalanced nutrition: less than body requirments R/T inadequate food intake

self-induced vomiting, and/or chronic/excessive laxative use

body image, disturbed R/T psychosocial or cognitive perceptual changes

IgG antibody

urea breath test

EGD

Upper GI

High L epigastric pain

knawing and burning pain

1-2 hrs. after meals and with food

malnourished (why? : anorexic)

hematemesis more common than melena

antacids are ineffective

intermittent mid epigastric pain

burning/cramping

increase 2-4 hrs after meals (why? middle of night)

relieved by antacids

generally well nourished

melena more common than hematemesis

stools

ps- pain meds

six small meals

nonacidic fluids

Which med should not be taken longer than 8wks?

Pepcid

Riopan

maalox

mylanta

gelusil

tums

titralac

tums

titralac

PO

IM

IV

Which meds have rash as a side effect?

tagamet

pepcid

axid

prilosec

prevacid

Tagamet

Zantac

1. Apthous stomatitis (cancker sores)

2. Herpes simplex I (cold sores, fever blisters)

-can lead to Herpes Simplex II if active oral sex

1. Small white painless ulcers on inner checks, lips, tongue, gums, palate, pharnyx - last up to 2 wks

2. painful blisters to face, lips, cheeks, nose, conjunctiva

topical tetracycline, topical anesthetic

acyclovir ointment for pain

oral acyclovir for reoccurrences

sore throat, does not heal in 2 wks.

often painless but tender with disease progression

difficulty swallowing, chewing or speaking

swollen cervical lymph glands

radical neck dissection

-done when cancer has metasticized to the lymph nodes

radiation

chemo

surgery

curable if caught early

high incidence in tobacco and alcohol useage

tube feedings or tpn post surgery

DG - biopsy

usually detected late

close to lymph nodes- metasticizes easily

DG/Tests for esophageal cancer

EGD

biopsy

difficulty swallowing

feeling of fullness

chest pain after eating

foul breath

regurgitation of foods

esophageal resection (Dacron)

esophageal dilation (to relieve dysphagia)

watch w/morphin

1. pain relief

2. s/s dehydration

3. lung sounds

4. TPN (may lead to tube feedings)

5. IV fluids

6. I/O

7. S/S hypovolemia shock

they need to be in semi fowlers to high fowlers position

lower part of the esophagus slides up through the hiatus of the diaphragm

sliding: most pain when sleeping

Rolling: stays all the time

pain

heartburn

feeling of fullness (after small meals)

reflux

1.assess for dysphagia after surgery (wrapped to tight)

 2.antacids

 3.6 small meals - do not recline x 1hr. after meals

 4.elevate head 6-12ins.

 5.no bedtime snacks

 6.avoid smoking, caffeine, spicy foods, and alcohol

x-ray

fluoroscopy

erosions

heartburn

regurgitation

dysphagia

bleeding

scar tissue from inflammation

barium swallow

esophagoscopy

pH monitoring (esophagus is normally alkaline)

1. esophagitis

2. bronchospasm

3. laryngospasm

4. aspiration pneumonia

1. antacids: mylanta, tums, gaviscon

2. H2 antagonist: (decrease acid) tagamet, zantac, axid

3. proton pump inhibitors (PPI) for severe symptoms and with barretis esophagus: nexium, prevacid, prilosec, aciphex, protonix

4. prokinetic agents (used last D/T side effects): reglan- increase gastric emptying

1. increase HOB 4-6'' (home)

2. small meals

3. pain meds

4. breath sounds

5. semi fowlers

inflammation of stomach mucosa

acute or chronic

stomach lining becomes edematous and may hemmorrhage

1. remove irritating substance

2.bland diet (liquids)

3. soft food

4. antacids

5. phenothiazines

6. h2 antagonists

abdominal pain

nausea

anorexia

abdominal tenderness

bloating

reflux

belching

hematemesis (vomiting blood)

asymptomatic

autoimmune

fundus of stomach

Dg - endoscopy

upper GI

x-ray

gastric aspirate

lack intrinsic factor:

usually leads to vitamin b12 def.

antrum and pylorus

h-pylori bacteria infection

s/s - poor appetite

heartburn

belching

sour taste

endoscopy

upper GI

x-ray

gastric analysis

tx - antibiotitcs

upper gastric x-ray examination

gastroscopy

gastric fluid analysis

measurement of serum gastrin levels

surgical removal

chemotherapy and radiation

subtotal or total gastrectomy

metastasis to another organ

indigestion

anorexia

pain relieved by antacids

weight loss

n/v

anemia

occult blood

hemorrhage

acute gastric distention

nutritional problems

gastric surgeries

(Billroth I)

gastric surgeries

(billroth II)

gastric surgeries

(total gastrectomy)

gastric surgeries

(vagotomy)

evaluate pain

v/s

comfort measures

medicate

monitor incision

encourage ambulation

hemorrhage

acute gastric distention

nutritional problems

steatorrhea

pyloric obstruction

dumping syndrome

single lumen, may be used for gastric decompression, irrigations, lavages, and feedings

tube is not vented, avoid use with suction to prevent injury to stomach lining

double lumen, "pigtail" acts as an air vent and prevents excess suction, which could damage stomach lining. Air vent must not be plugged off. Used for decompression, irrigations, and lavage.

May be used with continuous suction because of air vent

small-bore tubes for tubes for tube feedings only; less injury, remains in place for extended periods

suction collapses tube. use a 10-ml syringe or greater, because smaller syringe creates too much pressure and possible rupture of tube

double-lumen tube used to drain and decompress the small intestine in cases of partial or complete obstruction, one lumen for aspiration, the other to inflate the balloon with mercury so that the tube is weighted and moves by gravity and peristalsis into the small intestine

rarely used, this tube is inserted by the physician or a specially trained nurse. tube is not secured with tape, but passed through gauze taped to pts. forehead to allow tube to advance into intestines. usually the tube advances 1-2 inches every 2 hours until it reaches small intestine, turning and ambulating the patient, if possible, facilitates tube's advancement

single-lumen tubes with distal mercury-filled balloons and proximal drainage ports

percautions with mercury disposal

weight 10% to 20% above ideal body weight is overweight

20% or more above ideal body weight is obesity