ENGLISH IN NURSING

GASTROINTESTINAL SYSTEM

By Group 4:

Desy Anwar Kusuma W. 131411131010

Lucy Kartika Dewi 131411131031
Rahendra Wahyu A. 131411131046
Retty Merdianti 131411131064
Senja Putrisia F. E. 131411131082
Ridha Cahya Prakhasita 131411131100
Thaliah Jihan N 131411133014
Prasetiya Wahyuni 131411133032

NURSING FACULTY
AIRLANGGA UNIVERSITY
SURABAYA
2015
 PREFACE

We extend our gratitude to Allah SWT for all His mercy so that we can
complete the task group for Small Group Discussion (SGD) English In Nursing
course entitled "Gastrointestinal System” well.
We express gratitude to the deepest:
1. Setho Hadisuyatmana, S.Kep., Ns., M.Ns., as a facilitator who gives
guidance and direction in the completion of this paper
2. Group 4 who have cooperated in this task.
The writers realize that this paper is not perfect and there are still many short
comings. Therefore, the authors hope to get constructive criticism and suggestions
in the preparation of the paper so that the next will be better. Finally the authors
hope that this paper is useful for us personally and for those who need it.

Surabaya, May 15th, 2015

 CHAPTER 1
INTRODUCTION

1.1 Background
The gastrointestinal (GI) system includes the gastrointestinal tract
(mouth, pharynx, esophagus, stomach, small intestine, and large intestine)
plus the accessory organs (salivary glands, liver, gallbladder, and pancreas)
that are not part of the tract but secrete substances into it via connecting ducts.
The overall function of the gastrointestinal system is to process ingested foods
into molecular forms that are than transferred, along with salts and water to
the body’s internal environment, where they can be distributed to cells by the
circulatory system.

The adult gastrointestinal tract is a tube approximately 15 ft long,

running through the body from mouth to anus. The lumen of the tract, like the
hole in a doughnut, is continuous with the external environment, which means
that its contents are technically outside the body. This fact is relevant to
understanding some of the tract’s properties. For example, the large intestine
is inhabited by billions of bacteria, most of which are harmless and even
beneficial in this location. However, if the same bacteria enter the internal
environment, as may happen, for example, in the case of a ruptured appendix,
they may cause a severe infection.

The function of the gastrointestinal system can be described in terms of

these four processes digestion , secretion, absorption, and mobilityband the
mechanisms controlling them.

The gastrointestinal system is designed to maximize absorption, and

within fairly wide limits it will absorb as much of any particular substance as
is ingested. With a few important exceptions (to be described later), therefore,
the gastrointestinal system does not regulate the amount of nutrients absorbed
or their concentrations in the internal environment. The regulation of the
plasma concentration of the absorbed nutrients is primarily the function of the
kidneys
1.2 Purpose
1. General Purpose
After this group discussion, students are expected to understand anatomy
physiology, types and classification, etiology, and clinical appearance of
Gastrointestinal System.
2. Specific Purpose
After this group discussion, students are expected to implemented the
nursing process of Gastrointestinal System.
1.3 Benefit
1. Advancing knowledge and experience about gastrointestinal system.
2. Adding more vocabularies and grammar.
 CHAPTER 2
FUNDAMENTAL THEORIS

2.1 Anatomy & Physiology

The digestive system, also known as the gastrointestinal (GI) tract or the
alimentary system, is responsible for breaking down complex food into simple
nutrients the body can absorb and convert into energy. The GI system consists
of the mouth, pharynx, esophagus, stomach, small and large intestine, and
rectum. The accessory organs (salivary glands, liver, gallbladder, and pancreas)
secrete digestive catalysts (a substance that speeds up a chemical reaction) into
the GI tract through connecting ducts.

1. Mouth
Mechanical digestion in the mouth with mastication, where the
teeth break down into smaller pieces by chewing and mixing it with
saliva. There are three pairs of salivary glands: Parotid, submandibular,
and sublingual. Saliva is mostly water that dissolves food for tasting
and moistens it for swallowing. Chemical breakdown of cooked
starches begins in the mouth with the help of the enzyme ptyain, a
salivary amylase.
The tongue assists with chewing by keeping food between the
teeth. The food is formed into a bolus as the tongue compresses it
against the hard palate. Sensory receptors are activated as the bolus
enters the oropharynx, stimulating the swallowing reflex. The larynx
pulls upward as the epiglottis closes over the glottis, thus preventing
food from entering the trachea.
2. Throat
The throat is part of both the digestive and respiratory systems
and is responsible for coordinating the functions of breathing and
swallowing. From superior to inferior, the throat is subdivided into 3
sections: oropharynx, hypopharynx, and larynx. Together, the
oropharynx, hypopharynx, and larynx function to sense and propel a
food bolus from the mouth to the esophagus in a coordinated fashion
while protecting the airway.
3. Pharynx
The pharynx consists of the oropharynx and the laryngopharynx.
Both structures provide passageways for food, fluids and air. The
pharynx is made of skeletal muscles and is lined with mucous
membranes. The skeletal muscles move food to the oesophagus via the
pharynx through peristalsis (alternating waves of contraction and
relaxation of involuntary muscle). The mucosa of the pharynx contains
mucus-producing glands that provide fluid to facilitate the passage of
the bolus of food as it is swallowed.
4. Esophagus
Peristalsis, coordinated rhythmic contractions of the muscles,
pushes the bolus through the esophagus. The esophagus is a hollow,
mucular tube approximately 10 inches long that goes through the
diaphragm at the hiatus and enters the stomach at the gastroesophageal
junction. The cardiac sphincter, also called the lower esophageal
sphincter (LES) or gastroesophageal sphincter, located at the distal end
of esophagus, relaxes and allows to food to pass into the stomach.
5. Abdomen
The first layer mucosa is the innermost layer, and it consist of an
epithelium, the lamina, and the muscularis mucosae. In the epithelium,
it contains exocrine gland cells and endocrine gland cells, which secrete
mucus and digestive enzymes into the lumen, and release GI hormones
into the blood, respectively. In the lamina propri, it contains small
blood vessels, nerve fibers, and lymphatic cells/tissues. In addition, a
thin muscle layer called muscularis mucosae is also found and the
activity of its muscle is responsible for controlling mucosal blood flow
and GI secretion.
The second layer submucosa is a connective tissue with major
blood and lymphatic vessels, along with a network of nerve cells, called
the submucosal nerve plexus, passing through.
The third layer muscularis externa is a thick muscle and its
contraction contributes to major gut motility (segmentation and
peristaltis). This muscle layer typically consist of two substansial layers
of smooth muscle cells; an inner circular layer and an outer
longitudinal layer. A prominent network of nerve cells, called the
myenteric nerve plexus.
 The fourth layer serosa is the outermost layer, which mainly
consist of connective tissues and it connects to the abdominal wall, thus
supporting the GI tract in the abdominal cavity.

6. Stomach
The peristaltic movement of the stomach mixes the partially
digested food and digestive enzymes into a semiliquid mass called
chyme. The chyme will not pass the small intestine until it is proper
consistency and particles are 1 milimeter or less. When the chyme has
reached the proper consistency, the pyloric sphincter relaxes, releasing
a portion at a time of the chyme into the small intestine and then
contracts, preventing the backup of intestinal contents into the stomach.
7. Small Intestine
The small intestine begins at the pyloric sphincter and ends at the
ileocaecal junction at the entrance of the large intestine. The small
intestine is about 6 m long but only about 2.5 cm in diameter. This long
tube hangs in coils in the abdominal cavity, suspended by the mesentery
and surrounded by the large intestine. The small intestine has three
regions: the duodenum, the jejunum and the ileum. The duodenum
begins at the pyloric sphincter and extends around the head of the
pancreas for about 25 cm. Both pancreatic enzymes and bile from the
liver enter the small intestine at the duodenum. The jejunum, the middle
region of the small intestine, extends for about 2.4 m. The ileum, the
terminal end of the small intestine, is approximately 3.6 m long and
meets the large intestine at the ileocaecal valve.
Food is chemically digested, and most of it is absorbed, as it
moves through the small intestine. Circular folds (deep folds of the
mucosa and submucosa layers), villi (finger-like projections of the
mucosa cells) and microvilli (tiny projections of the mucosa cells)
increase the surface area of the small intestine to enhance absorption of
food. Although up to 10 L of food, liquids and secretions enter the GI
tract each day, less than 1 L reaches the large intestine.
 Enzymes in the small intestine break down carbohydrates,
proteins, lipids and nucleic acids. Pancreatic amylase acts on starches,
converting them to maltose, dextrins and oligosaccharides; the
intestinal enzymes dextrinase, glucoamylase, maltase, sucrose and
lactase further break down these products into monosaccharides.
Pancreatic enzymes (trypsin and chymotrypsin) and intestinal enzymes
continue to break down proteins into peptides. Pancreatic lipases digest
lipids in the small intestine. Triglycerides enter as fat globules and are
coated by bile salts and emulsified. Nucleic acids are hydrolysed by
pancreatic enzymes and then broken apart by intestinal enzymes. Both
pancreatic enzymes and bile are excreted into the duodenum in response
to the secretion of secretin and cholecystokinin, hormones produced by
the intestinal mucosa cells when chyme enters the small intestine.
8. Large Intestine
The large intestine is a tube 2.5 in. in diameter and about 4 ft long.
Its first portion, the cecum, forms a blind-ended pouch from which
extends the appendix, a small fingerlike projection having no known
essential function. The colon consists of three relatively straight
segments-the ascending, transverse, and descending portions. The
terminal portion of descending colon is S-shaped, forming the sigmoid
colon, which empties into a relatively straight segment of the large
intestine, the rectum, which ends at the anus.
The primary absorptive process in the large intestine is the active
transport of sodium from lumen to blood, with the accompanying
osmotic absorption of water. If fecal material remains in the large
intestine for a long time, almost all the water is absorbed, leaving
behind hard fecal pellets. There is normally a net movement of
potassium from blood into the large-intestine lumen, and severe
depletion of total-body potassium can result when large volumes of
fluid are excreted in the feces. There is also a net movement of
bicarbonate ions into the lumen, and loss of this bicarbonate (a base) in
patients with prolonged diarrhea can cause the blood to become acidic.
9. Pancreas
The pancreas, a gland located between the stomach and small
intestine, is the primary enzyme-producing organ of the digestive
system. It is a triangular gland extending across the abdomen, with its
tail next to the spleen and its head next to the duodenum. The body and
tail of the pancreas are retroperitoneal, lying behind the greater
curvature of the stomach. The pancreas is actually two organs in one,
having both exocrine and endocrine structures and functions. The
exocrine portion of the pancreas, through secretory units called acini,
secretes alkaline pancreatic juice containing many different enzymes.
The acini, cluster of secretory cells surrounding ducts, drain into the
 pancreatic duct. The pancreatic duct joins with the common bile duct
just before it enters the duodenum.
The pancreas produces from 1 to 1.5 L of pancreatic juice daily.
Pancreatic juice is clear and has high bicarbonate content. This alkaline
fluid neutralizes the acidic chyme as it enters the duodenum, optimizing
the pH for intestinal and pancreatic enzyme activity. The secretion of
pancreatic juice is controlled by the vagus nerve and the intestinal
hormones secretin and cholecystokinin. Pancreatic juice contains
enzymes that aid in the digestion of all categories of food: lipase
promote fat breakdown and absorption; amylase completes starch
digestion; and trypsin, chymotrypsin and carboxypeptidase are
responsible for half of all protein digestion. Nuclease break down
nucleic acids.
10. Liver and Gallbladder
The liver weighs about 1.4 kg in the average size adult. It is
located in the right side of the abdomen, inferior to the diaphragm and
anterior to the stomach. The liver has four lobes: right, left, caudate and
quadrate. A mesenteric ligament separates the right and left lobes and
suspends the liver from the diaphragm and anterior abdominal wall. The
liver is encased in a fibroelastic capsule, called the glisson capsule. This
capsule contains blood vessels, lymphatic and nerves. When the liver is
diseased or swollen, distension causes pain and the lymphatics may
ooze fluid into the peritoneal cavity.
Liver tissue consist of units called lobules, which are composed
of plates of hepatocytes. A branch of the hepatic artery, a branch of the
hepatic portal vein and bile dust communicate with each lobule.
Sinusoids, blood-filled spaces within the lobules, are lined with kupffer
cells. These phagocytic cells remove debris from the blood.
Bile production is the liver’s primary digestive function. Bile is a
greenish, watery solution containing bile salts, cholesterol, bilirubin,
electrolytes, water and phospholipids. These subtances are necessary to
emulsify and promote the absorption of fats. Liver cells make from 700
to 1200 mL of bile daily. When bile is not needed for digestion, the
sphincter of Oddi (located at the point at which bile enters the
duodenum) is closed and the bile backs up the cystic duct into the
gallbladder for storage.
Bile is concentrated and stored in the gallbladder, a small sac
cupped in the inferior surface of the liver. When food containing fats
enters the duodenum, hormones stimulate the gallbladder to secrete bile
into the cystic duct into the gallbladder for storage.
Bile is concentrated and stored in the gallbladder, a small sac
cupped in the inferior surface of the liver. When food containing fats
enters the duodenum, hormones stimulate the gallbladder to secrete bile
 into the cystic duct. The cystic duct joins the hepatic duct to form the
common bile duct, from which bilw enters into the duodenum.
2.2 Types & Classification
Gastrointestinal system is divided into two parts: the Luminary GI
(alimentary canal) and hepato-biliary-pancreatic GI.
1. Alimentary Canal (Luminal GI)
The alimentary canal is a hollow tube lined with mucous
membrane. The alimentary canal includes mouth, esophagus, stomach,
small intestine, large intestine, rectum. The GI tract is a muscular tube
of about 5 m long when one is alive; however, after person dies and
during autopsy or postmortem examination, the lenght of the tract can
be doubled to 10 m. This is due the loss of muscle tone. The motor and
secretory activities of the GI system are highly controlled and integrated
by the gut endocrine and enteric nervous systems (ENS).
2. Accessory Organs (Hepato-biliary-pancreatic GI)
The accessory organs includes salivary glands (parotid,
sublingual, and submandibular glands), liver, pancreas, gallbladder.
The salivary glands secrete saliva for digestion and lubrication; the
pancreas produces hydrolytic enzymes for the digestion of our daily
foostuff and bicarbonate for the neutralizations of our gastric contents;
the liver secretes bile, which is stored temporarily in the gallbladder
and susequenly delivered to the duodenum for that digestion and
absorption.
3. Ducts

4. Digestion
Mechanical digestion begins in the mouth with mastication, where the
teeth break food down into smaller pieces by chewing and mixing with
saliva. There are three pairs of salivary glands: parotid, submandibular,
and sublingual.

2.3 Etiology
 Gastritis is an inflammation of the stomach lining due to either erosion or
atrophy. Erosive causes include stresses such as physical illness or medication
such as nonsteroial anti-inflammatory drugs (NSAID’s). Atrophic causes
include a history of prior surgery (such as gastrectomy), pernicious anemia,
alcohol use, or Helicobacter pylori infection.
Prognosis
Gatritis may causes changes within the cells of the stomach lining leading
to malnutrition, lymphoma, or gastric cancer. Hospitalized patients, especially
in critical care settings, should have preventive medications to avoid the
development of gastritis.

2.4 Clinical Appearances

Signs and Symtomps
a. Nausea and vomiting
b. Anorexia
c. Epigastric area discomfort
d. Epigastric tenderness on palpitation due to gastric irritation
e. Bleeding from irritation of the gastric mucosa
f. Hematemesis possible coffee ground emesis due to partial digestion
of blood
g. Melena black, tarry stool.
Interpreting Test Results
a. Hemoglobin and hematocrit decrease
b. Anemia (iron deficiency) due to chronic, slow blood loss
c. Fecal occult blood pos n 8jitive
d. Helicobacter pylori shows inflammation, allows biopsy.
Treatment
a. Administer antacids: Maalox, Mylanta, Tums, Gaviscon
b. Administer sucralfate to protect gastric lining.
c. Administer histamine 2 blockers: ranitidine, famotidine, nizatidine,
cimetidine
d. Administer proton pump inhibitors: omeprazole, esomerazole,
pantoprazole, raberprazole, lansoprazole
e. Eradicate Helicobacter pyroli infection if present
f. Diet modification
g. Monitor hemoglobin and hematocrit.
Nursing Diagnoses
a. Risk for imbalanced nutrition: Less than what body requires
 b. Risk for imbalanced fluid volume
c. Nausea
Nursing Intervention
a. Monitor vital signs
b. Monitor intake and output
c. Monitor stool for occult blood
d. Assess abdomen for bowel sounds, tenderness
e. Teach patient about:
 Diet restrictions (avoid alcohol, caffeine, acidic foods)
 Medications
 Avoid smoking
 Avoid NSAIDs.
 BIBLIOGRAPHY

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