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Questions and Answers

What is the primary function of the ileum?

To secrete digestive enzymes

To absorb nutrients (correct)

To store fecal matter

To initiate digestion of starches

Which segment of the large intestine follows the cecum?

Transverse colon (correct)

Ascending colon

Rectum

Sigmoid colon

What role does salivary amylase (ptyalin) have in the digestive process?

Digestion of fats

Breakdown of proteins

Initiating starch digestion (correct)

Absorbing nutrients

Which part of the gastrointestinal tract primarily influences the autonomic nervous system?

Entire GI tract Signup and view all the answers

What is the main purpose of chewing in the digestive process?

To break down food into smaller particles Signup and view all the answers

The primary function of the anal sphincters is to regulate which of the following?

Passage of fecal matter Signup and view all the answers

What percentage of the total cardiac output is directed to the GI tract?

20% Signup and view all the answers

The vermiform appendix is primarily associated with which part of the gastrointestinal system?

Cecum Signup and view all the answers

Which symptom is commonly related to food intolerance or gallbladder disease?

Bloating Signup and view all the answers

What is the definition of nausea?

A vague sensation of sickness or queasiness Signup and view all the answers

What is the approximate length of the gastrointestinal tract?

7 to 7.9 meters Signup and view all the answers

Which aspect must be assessed before percussion and palpation of the abdomen?

Auscultation Signup and view all the answers

What color denotes the presence of blood in the stool from the upper GI tract?

Tarry-black (melena) Signup and view all the answers

Which of the following correctly describes the function of the stomach?

Stores food and secretes digestive fluids Signup and view all the answers

What condition is characterized by hard, dry stools and a decrease in frequency?

Constipation Signup and view all the answers

What are the four anatomic regions of the stomach?

Cardia, Fundus, Body, Pylorus Signup and view all the answers

How does the esophagus relate to the heart and trachea?

Posterior to the trachea, anterior to the spine Signup and view all the answers

Which of the following can be a cause of nausea and vomiting?

Anxiety Signup and view all the answers

What does streaking of blood on a stool surface indicate?

Lower GI bleeding Signup and view all the answers

What is the approximate capacity of the stomach?

1500 mL Signup and view all the answers

What information can percussion provide during an abdominal assessment?

Size and density of abdominal organs Signup and view all the answers

Which organ is primarily involved in nutrient absorption in the digestive system?

Small Intestine Signup and view all the answers

What is the primary function of the gastroesophageal junction?

To act as the inlet to the stomach Signup and view all the answers

Which structure is NOT part of the gastrointestinal tract?

Pancreas Signup and view all the answers

What is the primary purpose of deep palpation during a physical assessment?

To identify masses Signup and view all the answers

Which position is NOT appropriate for a rectal examination?

Supine position Signup and view all the answers

What is the purpose of guaiac-based fecal occult blood testing (gFOBT)?

To detect early signs of cancer Signup and view all the answers

What is a key advantage of abdominal ultrasonography?

It is less costly and noninvasive. Signup and view all the answers

What must patients do prior to an abdominal ultrasound procedure?

Be NPO for 8-12 hours Signup and view all the answers

What does the upper gastrointestinal tract study mainly detect?

Anatomic or functional disorders Signup and view all the answers

Which of the following is NOT a benefit of endoscopic ultrasonography (EUS)?

Requires general anesthesia Signup and view all the answers

What should patients be instructed about their meal the night before a gallbladder procedure?

A fat-free meal Signup and view all the answers

What is the primary reason for ensuring that a patient is NPO after midnight before certain imaging procedures?

To ensure a clear imaging study without interference from food Signup and view all the answers

Which condition would contraindicate the use of a barium enema for imaging?

Signs of perforation or obstruction Signup and view all the answers

What adjustment needs to be made for a patient with insulin-dependent diabetes undergoing imaging studies?

Adjust the timing and dosage of insulin Signup and view all the answers

What type of imaging is particularly useful for detecting inflammatory conditions in the colon?

Computed Tomography (CT) scan Signup and view all the answers

Which imaging procedure is contraindicated in patients with metallic implants?

Magnetic Resonance Imaging (MRI) Signup and view all the answers

What is a common side effect a patient might experience during a barium enema procedure?

Cramping or discomfort Signup and view all the answers

Why is follow-up care important after an upper GI procedure involving barium?

To ensure proper elimination of barium from the body Signup and view all the answers

Which imaging technique uses radioactive substances to produce images of the body?

Positron Emission Tomography (PET) scan Signup and view all the answers

What is the purpose of tagging radioactive substances with isotopes during medical procedures?

To enhance the scanning process and identify hotspots Signup and view all the answers

What is the recommended position for a patient undergoing upper gastrointestinal fibroscopy?

Left lateral position Signup and view all the answers

Which of the following interventions should be performed before an endoscopic procedure?

Keeping the patient NPO for 8 hours Signup and view all the answers

What potential conditions could prevent the performance of a colonoscopy?

Suspected colon perforation Signup and view all the answers

Which of the following factors is considered during the assessment after a gastroscopy?

Signs of perforation Signup and view all the answers

What therapeutic benefit does endoscopic retrograde cholangiopancreatography (ERCP) provide?

Removes common bile duct stones Signup and view all the answers

What is a necessary preparation for a patient undergoing fiberoptic colonoscopy?

Achieving adequate colon cleansing Signup and view all the answers

Which patients require prophylactic antibiotics before undergoing colonoscopy?

Patients with prosthetic heart valves Signup and view all the answers

Study Notes

Learning Outcomes

Students will be able to describe the structure and function of the gastrointestinal (GI) tract organs.
Students will be able to explain mechanical and chemical processes involved in digesting and absorbing nutrients and eliminating waste products.
Students will be able to distinguish between normal and abnormal GI system assessment findings.
Students will be able to recognize and evaluate major gastrointestinal dysfunction symptoms using health history and physical assessment findings.
Students will be able to identify diagnostic tests used to assess GI tract function and related nursing implications.

Anatomic and Physiologic Overview

The GI tract extends from the mouth to the anus.
Organs include: oral cavity, pharynx, esophagus, stomach, liver, gallbladder, duodenum, pancreas, small intestine, large intestine, rectum, and anus.
The esophagus is located in the mediastinum, anterior to the spine.

Anatomy of the Gastrointestinal System: Stomach

The stomach is located in the left upper abdomen, under the left lobe of the liver, and over the pancreas.
Its capacity is roughly 1500 mL.
Functions include storing food, secreting digestive fluids, and propelling partially digested food into the small intestine.
The stomach has four anatomic regions: cardia, fundus, body, and pylorus.
The gastroesophageal junction is the inlet to the stomach.

Anatomy of the Gastrointestinal System: Small Intestine

The small intestine is the longest part of the GI tract, measuring approximately 70 meters.
Its surface area is important for secretion and absorption.
Three sections: duodenum (proximal), jejunum (middle), and ileum (distal).
The ileum terminates at the ileocecal valve.
The vermiform appendix is attached to the cecum.

Anatomy of the Gastrointestinal System: Large Intestine

The large intestine consists of an ascending, transverse, and descending segment.
It includes the sigmoid colon, rectum, and anus.
The anus has both internal and external anal sphincters, regulating the anal outlet.
The portal venous system is composed of five large veins (superior mesenteric, inferior mesenteric, gastric, splenic, and cystic) that eventually form the vena portae, which enters the liver.
Blood flow to the GI tract is approximately 20% of the total cardiac output and increases significantly after eating.

Function of the Digestive System

Major functions include breaking down food into molecules for digestion, absorbing nutrients into the bloodstream, and eliminating undigested waste products.
The parasympathetic and sympathetic nervous systems innervate the GI tract.

Process of Digestion: Chewing

Food is broken into smaller pieces for enzyme mixing and easier swallowing.
Approximately 1.5 liters of saliva are secreted daily by parotid, submaxillary, and sublingual glands.
Saliva contains ptyalin (salivary amylase) which starts digesting starches.

Process of Digestion: Swallowing

The voluntary act is regulated by the swallowing center in the medulla oblongata of the central nervous system (CNS).
The lower esophageal sphincter prevents stomach contents from refluxing into the esophagus.

Process of Digestion: Gastric Function

Gastric secretions (totaling 2.4 liters/day) can have a pH as low as 1. Hydrochloric acid (HCl) contributes to the acidity.
Gastric secretion is important for breaking down food into absorbable components, and for destroying bacteria.
Pepsin (a protein-digesting enzyme) is produced by chief cells.
Intrinsic factor assists with vitamin B12 absorption in the ileum.

Process of Digestion: Large Intestine Function

Within 4 hours of eating, waste material enters the large intestine, with bacteria assisting in waste breakdown.
Key function: absorbing water and electrolytes.
Waste products are 75% fluid, 25% solids, and include undigested food, inorganic material, water, and bacteria.
Stool color results from bile breakdown by intestinal bacteria.

Process of Digestion: Small Intestine Function

Duodenal secretions come from accessory glands (pancreas, liver, and gallbladder) as well as glands in the intestine wall itself.
Secretions include digestive enzymes (amylase, lipase, and bile).
Pancreatic secretions are alkaline due to high bicarbonate content.
Enzymes like trypsin, amylase, and lipase aid in digesting proteins, starches, and fats respectively.

Process of Digestion: Small Intestine Contractions

Two main types:
- Segmentation contractions mix intestinal contents.
- Peristalsis propels contents towards the colon.

Process of Digestion: Ingestion of Food

Carbohydrates are broken down into disaccharides and monosaccharides (glucose).
Glucose is used by body cells for energy.
Proteins are broken down into amino acids and peptides.
Fats are emulsified, becoming monoglycerides and fatty acids.
Chyme, partially digested food mixed with gastric secretions, remains in the small intestine for 3 to 6 hours.

Assessment of the Gastrointestinal System: Pain

Important symptom of GI disease, especially abdominal pain.
Characterization is crucial: duration, pattern, frequency, location, and referred pain distribution.

Assessment of the Gastrointestinal System: Dyspepsia

Commonly described as upper abdominal discomfort after eating.
Also called indigestion.
Affects 25% to 40% of the population.
Fatty foods often cause more discomfort.

Assessment of the Gastrointestinal System: Intestinal Gas

Accumulation of gas can cause belching or flatulence.
Symptoms relate to bloating and distention.
Can be a symptom of food intolerance or gallbladder disease.

Assessment of the Gastrointestinal System: Nausea and Vomiting

Nausea is a vague discomfort; vomiting may or may not follow.
Causes are numerous, including side effects of medications, side effects of medical procedures, inner ear disorders, torsion or trauma in certain organs, and anxiety.

Assessment of the Gastrointestinal System: Bowel Habits and Stool Characteristics

Changes in bowel habits may indicate colonic dysfunction or disease.
Diarrhea is characterized by increased frequency and liquidity of stool.
Constipation is a decrease in stool frequency, with hard, dry stool.
Stool color, consistency, and presence of blood can be important diagnostic clues.

Physical Assessment: Oral Cavity

Inspection and palpation of the oral cavity, including lips, gums, and tongue is important for assessment of GI health

Physical Assessment: Abdominal Inspection, Auscultation, Percussion and Palpation

Auscultation precedes percussion and palpation.
Percussion evaluates organ size and density; while palpation identifies tenderness or masses.

Physical Assessment: Rectal Inspection and Palpation

Postions for rectal exams include knee-chest, left lateral, or standing positions.
Examinations can identify rectal abnormalities.

Diagnostic Evaluation/Laboratory: Serum Laboratory Studies

CBC, PT, PTT, Triglycerides, Liver Function Test, Amylase, and Lipase.

Diagnostic Evaluation/Laboratory: Stool Tests

Stool color, consistency, and occult blood are assessed.
Guaiac-based fecal occult blood testing (gFOBT) is used often for detecting early cancer.

Diagnostic Evaluation/Imaging: Abdominal Ultrasonography

Noninvasive technique using high-frequency sound waves to image internal structures.
Useful for detecting enlarged gallbladder or pancreas, gallstones, and other abnormalities.
Less costly and does not involve radiation.
Not suitable for imaging structures behind bone.

Diagnostic Evaluation/Imaging: Endoscopic Procedures (Upper Gastrointestinal)

Esophagogastroduodenoscopy (EGD), is used to visualize the esophagus, stomach, and duodenum.
This procedure is used for detecting and treating various esophageal, gastric, and duodenal disorders.

Diagnostic Evaluation/Imaging: Endoscopic Procedures (Lower Gastrointestinal)

Colonoscopy is a procedure that uses a flexible tube with a camera to view the inside of the colon and rectum.
Used for detecting colorectal cancer, polyps, and other conditions.

Diagnostic Evaluation/Imaging: Computed Tomography (CT)

CT provides cross-sectional images of abdominal organs and structures.
Useful for diagnosing inflammatory conditions of the colon, including appendicitis, diverticulitis, regional enteritis, and ulcerative colitis.
May be performed with or without contrast.

Diagnostic Evaluation/Imaging: Magnetic Resonance Imaging (MRI)

Noninvasive technique that uses magnetic fields and radio waves to produce images.
Useful for evaluating abdominal soft tissues, blood vessels, abscesses, fistulas, and other sources of bleeding.
Patients with metal implants may not be able to undergo this procedure.

Diagnostic Evaluation/Imaging: Positron Emission Tomography (PET)

Uses radioactive substances to capture and view activity within the GI tract.
Provides critical information for staging conditions.

Nursing Interventions: Endoscopic Procedures

Preparation for procedures: NPO status, local anesthetic application, and position adjustments.
Post-procedure monitoring: vital signs, consciousness level, pain assessment, and respiratory distress observation.

Nursing Interventions: Fiberoptic Colonoscopy

Colon preparation, position for examination.
Vital signs, assessment of comfort during examination.
Post-procedure recovery and monitoring.

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