Structure and Functions of the Gastro Intestinal

System
The Gastrointestinal System is a 23- to 26 foot pathway for food,
water, vitamins and minerals for which has the primary function of
breaking down food products that can fuel the body as a source of
energy.
consist of a long hollow muscular tube extending from the mouth
to the anus.

Functions of the gastrointestinal (GI) system :

1. Process food substances
2. Absorb the products of digestion into the blood
3. Excrete unabsorbed materials
4. Provide an environment for microorganisms to synthesize nutrients
such as vitamin k
Furnishing nutrients and fluids to the tissues is accomplished by :
1. Ingestion and movement of foods and liquids through the tract
Peristalsis wavelike contractions by which smooth muscles
propel contents through the tract
2. Digestion of ingested food stuffs by both mechanical and chemical
means
a. Mechanical digestion - breaking of
components to smaller parts
b. Chemical digestion secretion of
digestive juices, acid, mucus, bile & other
materials in various parts of the tract
3. Absorption of basic food elements
3 Main Processes of the Gastrointestinal System
1. Digestion:
the mechanical and chemical
breakdown of food into amino acids, glucose
and fatty acids for usage of the bodys cellular
functions.
2. Absorption:
the passage of digested food
products (i.e., essential nutrients) from the lumen
of the gastrointestinal tract into the blood and the
lymphatic system.
3. Metabolism:
use of the basic food products by the
cell.

Gastro-intestinal System
1.The gastrointestinal system consists of the mouth, the pharynx or
throat, esophagus, stomach, and small and large intestines.
2. Accessory Organs are the teeth and salivary glands in the mouth, the
liver, gallbladder, and pancreas.
Secretions of the Gastrointestinal System
1. Exocrine secretions
- prepare food for absorption by diluting
osmolality of plasma (isotonic in nature),
altering the ph for the purpose of hydrolysis,
and hydrolyzing complex foods. It also
protects the mucosa from physical and
chemical irritants.
2. Endocrine secretions
- critical in the control and coordination of
secretory and motor activities involved in the
digestion and absorption of food.
3. Microflora or indigenous bacteria exist throughout the g.i. tract. This
protects the host from pathogens if maintained to a normal level.
Review of Anatomy and Physiology
I. Mouth or the buccal cavity
- lined by the mucous membrane that secretes mucus to mix
food
- prepares food for ingestion and functions as an organ of speech
Parts of the mouth
1. Roof of the mouth
- hard palate & soft palate
2. Uvula
conical muscular process at the center of the posterior border of the
soft palate
3.Tongue or glossa
- muscular tissue covered by papillae that contains taste buds
4. Teeth
32 permanent teeth, 16 per jaw
I. Front teeth
bitting & tearing
II. The rest
grinding & masticating
III. Salivary glands parotid, submandibular, sublingual
Saliva
- Contains :
a. water
b. mucin
c. enzyme salivary amylase or ptyalin
d. calcium
e. potassium
f. chloride
g. bicarbonate
- 1,500 ml is produced daily

Functions of the saliva

1. Maintains moisture in the mouth
2. Aids in swallowing
3. Acts as a solvent for the molecules that stimulate the taste buds
4. Assists in speech
5. Aids in keeping the teeth & mouth clean
6. May have antibacterial action
Activities in the mouth :
a. Mastication
b. Secretion of saliva from the parotid, sublingual and submandibular
glands
c. Deglutition / swallowing
II. Pharynx and Esophagus
a. Pharynx or throat
- serves as pathway for both food & air
b. Esophagus
- a hollow, muscular cylindrical organ about 25cm (10 in) long & 2.5
cm (1 in) in diameter
- located in the mediastinum in the thoracic cavity
- anterior to the spine and posterior to the trachea and heart
Functions of the Esophagus
1. Receive bolus of food from the pharynx
2. Transport the bolus along its length by peristalsis propels the bolus
into the stomach
Innervation sympathetic & parasympathetic nerve system (major nerve
is vagus nerve)
Deglutition or swallowing
- A physiologic mechanism where food passes from the mouth through
the esophagus to the stomach.
3 Phases of swallowing
1. Voluntary phase occurs when food is ready to swallow, tongue
forces food to the pharynx
2. Pharyngeal phase (1-2 sec)
3. Esophageal phase (5-15 sec)
Esophageal Peristalsis
A reflex action into the upper esophagus propels the bolus of food
contracting in a rhythmic sequence toward the stomach. The process of
esophageal peristalsis simultaneously relaxes the esophageal sphincter to
permit this movement of food to the stomach.
III. Stomach
- An enlarged muscular pouch with a capacity of approx. 1,500 ml
arranged in longitudinal folds called rugae

Major landmarks of the stomach :

1. Cardiac sphincter
2. Cardia
3. Fundus
4. Body (parietal cells, chief cells)
5. Pylorus or antrum (G cells)
6. Pyloric sphincter
Innervation ANS
Length of stay of food 30 min or more
Activities in the stomach :
1. Mechanical digestion
2. Secretion of gastric juices
3. Chemical digestion
absorption
protection mucus secretions: prevents autodigestion & lubricant
Controls passage of chyme into duodenum
Chyme
- mixture of food, saliva and ptyalin as it
moves from the mouth through the
esophagus to the stomach
Mucus glands
- located in mucosa
- prevent auto digestion by providing an
alkaline protective covering

Lower esophageal (cardiac) sphincter

- prevents reflux of gastric contents into the esophagus
Pyloric sphincter
- regulates the rate of stomach emptying into the small intestine
The stomach produces acidic fluid called the hydrochloric acid. Its
purpose is to further breakdown food into a more absorbable component
and to aid in the destruction of ingested bacteria.
1. The enzyme pepsin, initiates protein digestion.
2. Intrinsic factor is also secreted by the gastric mucosa which
combines with dietary vitamin B12 so that it can be absorbed in the
ileum. The absence of this intrinsic factor results to pernicious anemia.
GASTROINTESTINAL HORMONES
A. Gastrin
Inhibits excessive amount of acid controls the acid
Stimulates production of gastric acid & pepsin
Increases gut motility
B. Cholecystokinin
Secreted by cells in the duodenum & jejunum
 Secreted in response to presence of digested fats & protein
Causes gallbladder to contract, forcing bile into the duodenum for
fat absorption
C. Secretin
Produced by duodenum
Secreted in response to free fatty acids in the intestines
Stimulates the production of pancreatic juice
D. Enterogastrone
hormone of small intestine
Secreted in response to presence of acid in the duodenum
Inhibits secretion of gastric acid
IV. Small Intestine
- extended folded tube extending from the stomach to the large
intestine
- Approx. 4-6 m (13 to 20 ft) long & 2.5 cm in diameter
Functions :
a. Continue mechanical & chemical digestion
b. Absorb end products of digestion of carbo, CHON and fats
c. Absorb water, vitamins and mineral
Parts :
1. Duodenum
- approx. 25 cm (10 in) long
- upper part of the small intestine
- contains the openings of the bile & pancreatic ducts
2. Jejunum
- middle part
- approximately 8 feet long
3. Ileum
- lower part
- approx. 12 feet long
ileocecal sphincter or ileocecal valve
- usually closed to avoid reflux

Ampulla of vater
- opening in the duodenum where bile & pancreatic secretions are
emptied
Small Intestines
Small, fingerlike projections called villi are present in the entire
intestines that produce the digestive enzymes and absorb nutrients from
food. Absorption is the primary function of the small intestines which
begins in the jejunum by active transport and diffusion across the
intestinal wall.
Vitamins & minerals are not digested but absorbed essentially
unchanged
Activities in the Small Intestine :
a. Mucus secretion
b. Secretion of enzymes: sucrose, maltose, lactose, enterokinase
c. Secretion of hormones
d. Chemical digestion
e. Absorption
f. Motor activities
Innervation: ANS
Accessory Organs
Upon reaching the duodenum, accessory organs contribute to the
secretions encountered by food therein:
1. Pancreas: secretes alkaline ph, high in concentrations of
bicarbonate, to neutralize the acid entering the duodenum from the
stomach. Digestive enzymes involved from the pancreas are:
a. Trypsin: digests proteins.
b. Amylase: digests starch.
c. Lipase: digests fats.
2. Liver: secretes bile which emulsifies fats.
3. Gallbladder: stores bile secreted by the liver that will aid in the
digestion and absorption of fats.
V. Large Intestine
- A muscular tube approx. 2 m (6 ft) long & 5 cm (2 in) in diameter
- Normally contains large amount of bacteria
Functions :
I. Mechanical digestion
II. Absorption of water (approx. 1600 ml/day) & electrolyte from
chyme
III. Formation of some vitamins (K, riboflavin, thiamine)
IV. Storage & eliminates wastes
Parts :
a. Cecum
- 5-7 cm
- vermiform appendix is attached to the apex of the cecum
b. Colon
- four segments :
ascending, transverse
descending, Sigmoid
c. Rectum
- extends from sigmoid to external opening (anus)
- 12 to 15 cm
Other Parts
Ileocecal valve prevents contents of large intestine from entering ileum
Anal sphincter guard the anal canal
Feces undigested food, inorganic materials, water & bacteria, 75%
fluid, 25% solid
Mucus protects colonic mucosa & provide adherence for fecal mass
Assessment of the GIT
I. History
A. General Data :
Demographic Data (age, sex)
Address, Occupation
Informant
Referring physician
B. Chief Complaints
List of symptoms and their duration
Reasons for seeking care
Onset
Duration
Quality & Severity
Location
Precipitating Factors
Relieving Measures
Associated Symptoms
C. History of Present Illness
Clarify symptoms
Quantitate statements
Characterize symptoms (PQRST)
Provocative/ palliative factors
Quality
Region
Severity
Timing
Chronological relation and progression of symptoms
Current activity
Current medications
D. Past History
General health weight loss, previous examinations
Personal & Family History
Psychosocial History
Diet History
Infectious diseases
Operations/ injuries
Hospitalizations (dates, reasons, hospital names, locations)
E. Review of Symptoms
Endocrine
a. Polyphagia, polydipsia, polyuria, glycosuria
b. Temperature sensitivity, appetite and weight change
E. Review of Symptoms
Allergies
a. Drug allergies
b. Sensitivity to foods
c. Dermatitis, urticaria, angioneurotic edema
Mouth
Sores, gingival bleeding, toothaches
Throat
sore throat, hoarseness, voice changes
Neck
Swelling, lympadenopathy, goiter, stiffness
Gastrointestinal System
a. Appetite, weight changes, dysphagia, nausea, vomiting,
hematemesis
b. Abdominal pain or colic, jaundice, diarrhea, constipation
c. Hematochezia, melena, change in bowel habits
d. Hemorrhoids, rectal pain, hernia
E. Review of symptoms
Nervous System
Cranial nerves -
1 Olfactory smell
5 Trigeminal facial muscles incl. chewing & Facial sensations
7 Facial taste, tears, saliva, facial expressions
9 Glossopharyngeal swallowing, saliva taste
10 Vagus controls PNS e.g. smooth muscles of GI tract
12 Hypoglossal tongue muscle- speech and swallowing
a. Autonomic system - incontinence
 II. Physical Examination
Patient draped and sitting (Physician Facing)
Mouth
a. Lips
b. Teeth and gingiva
c. Buccal mucosa
d. Tongue
e. Pharynx (tongue depressor)
Patient Draped and Sitting (Physician to right and back)
Thyroid and trachea
Inspect and palpate
Patient Draped and Supine (Physician to Right)
Abdomen
Auscultate for bruits and bowel sounds (stethoscope)
Inspect for configuration, scars, herniae
Percuss and palpate for liver, spleen, aorta, masses
Assessment
Physical Examination of Abdomen
Inspection
Auscultation
Percussion
Palpation
Rectum
Inspect and palpate for hemorrhoids and masses (gloves)
Test stool on glove for occult blood

DIAGNOSTIC EXAMINATIONS
Laboratory Tests
CEA ( Carcinoembryonic Antigen)
(+) colorectal Ca
X heparin for 2 days
Specimen by venipuncture
Exfoliative Cytology
Detect malignant cells
Written consent
Liquid diet
UGI : NGT insertion
 LGI : laxative; enema
Cells are obtained from saline
Lavage NGT / Proctoscope
Fecal Analysis
Stool for Occult Blood (Guaiac Stool Exam)
Detect G.I. Bleeding
fiber diet 48 72 hours
X red meats, poultry, fish, turnips, horseradish
Withold for 48 hrs: Iron, Steroids, Indomethacine, Colchicine
3 stool specimen ( 3 successive days)
Stool for Ova and Parasites
Send fresh, warm stool specimen
Stool Culture
Sterile test tube / cotton tipped applicator
Stool for Lipids
Assess steatorrhea
fat diet, No alcohol ( 3 days )
72 hour stool specimen ( store on ice )
X mineral oil, neomycin SO4

Gastric Analysis
Measures secretion of HCI and pepsin
NPO for 12 hours
NGT is inserted , connected to suction
Gastric contents collected every 15 minutes to 1 hour

RADIOGRAPHIC TESTS
Scout Film / Flat Plate of the Abdomen
Plain X ray of the abdomen
X belts / jewelries

UGIS ( Barium Swallow)

To visualize the esophagus, stomach, duodenum and jejunum
NPO for 6 8 hours
Barium Sulfate (BaSO4) per orem
X rays taken on standing, lying position
After the procedure:
Laxative
 Increase fluid intake
Inform client that the stool is white for 24 72 hours
Observe for Ba impaction : distended abdomen, constipation

LGITS (Ba Enema)

To visualize the colon
Low residue / clear liquid diet for 2 days
Laxative for cleansing the bowel
Suppository / cleansing enema in A.M.
BaSO4 per rectum
Care after the procedure same as UGIS
ENDOSCOPY
UGI Endoscopy
o Direct visualization of esophagus, stomach, and duodenum
o Obtain written consent
o NPO for 6 8 hours
o Anticholinergic (AtSO4) as ordered
o Sedatives, narcotics, tranquilizers
E.g. Diazepam, Meperidine HCl
o Remove dentures, bridges
o Local spray anesthetic on posterior pharynx instruct : X
swallow saliva
o After the procedure
Side lying position
NPO until gag reflex returns (2 4 hrs)
o NSS gargle; throat lozenges
o Monitor VS
o Assess : bleeding, crepitus (neck), fever, neck / throat pain,
dyspnea, dysphagia, back / shoulder pain
o Advise to avoid driving for 12 hours if sedative was use
LGI Endoscopy
Proctosigmoidoscopy (sigmoid, rectum)
Clear liquid diet 24 hours before
Administer cathartic / laxative as ordered
Cleansing enema
Knee chest / lateral position
 After the procedure
Supine position for few minutes
Assess for signs of perforation
o Bleeding
o Pain
o Fever
Hot sitz bath for discomfort
Colonoscopy
Sedation
Position : left side, knees flexed
After the procedure:
Monitor VS (note for vasovagal response)
Assess for s and sx of perforation.
DIAGNOSTIC TESTS
Ultrasonography
NPO for 8 12 HOURS
Laxative as ordered ( bowel gas)
Magnetic Resonance Imaging
Non-invasive producing cross sectional images of soft tissues and
blood vessels using magnetic fields.
C/I: pacemakers, aneurysm clips, or orthopedic screws
NPO 6h before
Instruct to lie still for 60-90 mins.
Remove all jewelries