Nursing Assessment of the

Gastrointestinal System
Sasha Alexis Rarang, RN, MSN

The digestive system

Structures and Function of the

GastroIntestinal System
Main Function of the GI System?????

Supply Nutrients to body cells

Process of Digestion and Elimination

A.

Ingestion ( Taking In Food)

B.

Digestion ( Breakdown of Food)

C.

Absorption ( transfer of food products into

the circulation)

D.

Elimination

Concepts of Structures and Functions

The GI System consists of the GI tract and its associated organs and glands
A.
GI tract
1. mouth
2. esophagus
3. stomach
4. small intestines
5. large intestines
6. rectum
7. anus
B. Associated organs
1. liver
2. gall bladder
3. pancreas

Mouth

Mouth

Oral or buccal cavity

Chewing
>> break food products into smaller
portions.
>> allows digestion and prevent trauma to the mucous
lining of the
esophagus.
>> person exert 25 to 275 lbs during the chewing process.
>> Dentures vs. Natural teeth
>> poorly chewed foods are not readily digested.

Saliva

Secreted by the sublingual and

submandibular glands.
Lubricate and softens the food mass
Amylase breaks down starches to
maltose.

Swallowing
Involves 3 phases
>>oral phase
>>involuntary pharyngeal phase
>>esophageal phase
> The time it takes for the bolus to reach the
stomach depends on the consistency of the
bolus and individuals position.

Esophagus

Esophagus

A hollow muscular tube

Lies posterior to the trachea and larynx
Serves as a passage for food from mouth to
stomach.
>> upper esophageal sphincter
>> lower esophageal sphincter
Antireflux barrier
Act as a vent for increased intragastric pressure.

stomach

Stomach
Structures
a.1. fundus
a.2. body/central area
a.3. antrum/pyloric region
a.4. cardiac sphincter
a.5. Pyloric sphincter
B. Microscopic Glands ( epithelial lining of the stomach)
b.1. Cardiac glands mucus
b.2. Peptic (Chief Cells) mucus and pepsinogen
b.3. Parietal (Oxyntic) HCl acid and water
protein digestion
intrinsic factor B12 absorption
b.4. Neck cells mucus
b.5. Pyloric glands gastrin and mucus
stimulates HCl acid production
A.

Stomach
C. Functions
c.1. storage, mixing and liquefaction of the
bolus of food into chyme, control of
passage of food into the duodenum.
c.2. first stage of protein breakdown
c.3. mechanical breakdown of food
c.4. absorption of water, alcohol, glucose,
and some drugs.
c.5. protection

Stomach
D. Innervation
d.1. parasympatehetic vagus nerve
d.1.1. increased gastric secretion
of acid, gastrin and pepsin.
d.1.2. increased gastric acid motor
activity.
d.2. sympathetic inhibit gastric
secretion and motility.

Stomach
E. Secretions 1.5L to 3.0.L of gastric juice per day.
e.1. HCl acid, pepsin, and mucus.
e.2. mucin, intrinsic factor, lipase, and
pepsinogen.
e.3. Gastric acid secretion is directly stimulated by
the distention of the stomach and presence of
protein.
e.4. vagal stimulation, acetylcholine, histamine, and
the hormone gastrin.
e.5. gastrin is released when the stomach becomes
distended with food.

Stomach

Stomach

Small intestines

Small Intestine
Structure (22 feet long/1 inch in diameter)
a.1. duodenum
a.2. jejunum
a.3. ileum
B. Function
b.1. completes the digestion of foods
b.2. absorbs the products of digestion
b.3. secretes hormones control
secretions of
bile, pancreatic juice, and
intestinal secretions.
A.

Small Intestine
C. Innervation
c.1. sympathetic inhibits motility
c.2. parasympathetic increases intestinal
tone and motility.
D. Secretions
d.1. Brunners glands(duodenal) mucus
d.1.1. glucagon, presence of chyme, and vagal
stimulation.
d.1.2. sympathetic stimulation inhibits secretions of the
glands.
d.2. Goblet cells mucus
d.3. crypts of Lieberkuhn secretes an alkaline fluid
d.4. epithelial cells digestive enzymes
d.4.1. enterokinase activates trypsin
d.4.2. maltase,lactase, and sucrase disaccharides
into simple sugars.

Small Intestine
E. Absorption
e.1. Complex foods are converted into its simplest
forms.
e.1.1. CHO monosaccharides
e.1.2. CHON amino acids
e.1.3. Fats fatty acids,
monoglycerides, diglycerides and triglycerides.
e.2. Water absorption 8L/day
e.3. water-soluble vitamins, electrolytes,
minerals.
e.4. B12 absorption takes place in the
ileum

Large intestines

Large Intestines
Structures ( 5-6 feet long)
a.1. Cecum
a.2. Colon
a.2.1. Ascending
a.2.2. Transverse
a.2.3. descending
a.2.4. Sigmoid colon
a.3. Rectum and Anus ( final segments of the large intestine)
B. Function
b.1. absorb the remaining water, urea,and electrolytes.
b.2. secretes mucus
b.3. form and store the feces until defecation
A.

Large Intestine
C. Innervation
c.1. parasympathetic vagus nerve
increases peristalsis, decrease
tone of the sphincter.
c.2. sympathetic reduce peristaltic
activity and increase tone of
sphincters.
D. Secretion
d.1. water, mucus, potassium, and bicarbonate
alkaline solution.
d.2. Mucus lubricates, allows passage of the fecal matters,
protects the mucosa from injury.

Rectum

Anus

Associated Organs of the GI

System

Liver

Activities of the tract

A.

Secretion of electrolytes, hormones, and

enzymes

B.

Movement of the Ingested products

C.

Digestion of food and fluids

D.

Absorption of end products into the bloodstream.

A. Secretion of electrolytes, hormones,

and enzymes
Hormones gastrin
Electrolytes H2, Cl, Na, K,
Enzymes pancreatic lipase, enterokinase,
ptyalin

Movement of the Ingested products

Digestion of food and fluids

Absorption of end products into the

bloodstream

Secretions
Mucous secretions
a. produced throughout the entire length of the
tract.
b. protects and lubricate the walls of the GI tract.
2. Digestive secretions.
a. produced in the mouth, stomach,
duodenunum, and jejunum.
b. break down ingested food so that it can be
absorbed.
1.

Secretion:

Motility
2 types of movement in the GIT
A. Mixing
B.

Propulsion / Peristalsis

****Soft muscle tissues of the GIT****

Digestion and Absorption

Food is broken down into small and simple
compounds enough to be absorbed into the
bloodstream by diffusion or active
transport.

Digestion and secretion

Effects of Aging on the

Gastrointestinal Tract
A.
B.

C.

D.

E.

Teeth may loosen up from the supporting gums and bones.

Decreased output of the salivary glands leads to dryness of mucous
membranes and increased susceptibility to breakdown, difficulty
swallowing and decrease stimulation of the taste buds.
Decreased secretion of digestive enzymes and bile decrease ability
to digest and absorb food.
>> impaired absorption of fat and fat soluble vitamins
Atrophy of gastric mucosa leads to decrease HCl acid production.
>>decrease iron and B12 absorption anemia
>>proliferation of bacteria diarrhea and infection
Decrease peristalsis in the large intestine, decrease muscular tone of
the intestinal wall and decrease abdominal muscle strength
decrease sensation to defecate and increase incidence of constipation.

Teeth may loosen up from the supporting

gums

Decreased output of the salivary gland

Dryness of the mucous

membrane
Difficulty swallowing
Decrease stimulation of the
taste buds

Effects of aging on the gastrointestinal tract

Decreased secretion of digestive enzymes and
bile decrease ability to digest and absorb
food.
Ex.
Impaired absorption of fat and fat soluble
vitamins

Effects of aging on the GI tract

> Atrophy of gastric mucosa leads to decrease
HCl acid production

Assessment of the GI System

Assessment of the GI System

A.

Past Health History

a.1. history or existence of ;
> abdominal pain > nausea and
vomiting
> diarrhea > constipation
> abdominal distention
> jaundice
> anemia > heartburn
> dyspepsia
> changes in
appetite
> hematemesis
> food intolerance
> allergies > indigestions
> excessive gas
> bloating
> melena > hemorrhoids
> rectal bleeding

Assessment.
B. Medications:
b.1. past and current use of medications
b.1.1. OTC drugs
b.1.2. prescription drugs
b.1.3. herbal products and nutritional
supplements.
b.2. hepatotoxic, diarrhea, GI bleeding
C. Surgeries and other treatments
c.1. information about hospitalizations for
problems related to GI
system

any

Functional Health Assessment

AssessmentObjective Data
A.

Inspection
a.1. Lips symmetry, color and size
observe for abnormalities pallor or cyanosis, cracking,
ulcers, or fissures.
a.2. Tongue color, fissures, deviation
and lesions
a.3. Buccal Mucosa color and lesions and
distinctive breath
odors
a.4. teeth and gums caries, loose teeth,
abnormal shape
and position of the
teeth, presence of swelling , bleeding,
discoloration.

Assessment.
a.5. Abdomen
a.5.1. Skin changes ( color, texture, scars,
dilated veins, rashes, and lesions.)
a.5.2. umbilicus location and contour
a.5.3. symmetry
a.5.4. contour flat, rounded, distended.
a.5.5. observable masses hernias and other
a.5.6. movement observable peristalsis and

striae,

masses.
pulsation.

Assessment: Inspection (Skin changes)

Assessment

Quadrants of the Abdomen

AbdominalDraping
distention;
dilated veins
the Abdomen

Obese abdomen

Hepatomegaly

ascites

Umbilical Hernia

Pregnancy

Assessment.
B. Auscultation (done before percussion and palpation)
b.1. listening for increased or decreased bowel
sounds.
b.2. diaphragm of the stethoscope bowel sounds
are
high pitched, occur 5-35x per
minute.
b.3. warm up stethoscope in the hands to prevent
abdominal
muscle contraction.
b.4. listen for BS for 2-5 minutes. Absent BS
means no sounds for 5
minutes on each
quadrant.
C. Percussion
c.1. purpose??? Determine the presence of fluid, distention, and masses.
Presence of air
tymphany,
fluid or masses dull sounds

Auscultation: Listen for.

Increased or decreased bowel

sounds
Normoactive,
hypoactive,hyperactive, or absent

Listen with the diaphragm side of

the stethoscope
BS are high pitched sounds,
3-5x a minute

Warm up the stethoscope in the

hands to avoid undue
abdominalmuscle contraction

Listen for BS for 2-5 minutes on

each quadrant
Absent BS means no sounds for 5
minutes.

Assessment: Percussion

Purpose?????
Determine the presence of fluid,
distention, and masses

Tymphany is normally present in

most areas of the abdomen
Dullness!!!!! Ac lue to an underlying
mass

Assessment: Palpation

Light palpation 1cm deep

Look for area of tenderness
Look for patients facial expression and guarding

Deep palpation
Delineate body abdominal organs

Use two-hand method

Diagnostic Studies
Upper GI Series or Barrium Swallow
> X-ray study with fluoroscopy with contrast medium
> used to diagnose structural abnormalities of the
esophagus, stomach, and duodenal bulb
>NPO for 8-12 hours
> pt. will drink contrast medium
> give pt. laxatives and fluid to prevent contrast medium
impaction.
> the stool may be white up to 72 hours after the test
B. Small Bowel Series same as upper GI series
A.

Diagnostic tests
C. Lower GI or Barium Enema
> Fluoroscopic examination of the colon using contrast medium
w/c is administered rectally.
> administer laxatives and enemas the night
before the
procedure.*****CLEAR****
> clear liquid diet the night before.
> NPO for 8 hours before the procedure.
> cramping and urge to defecate may occur.
> explain that pt will be assuming various position in tilt table.
> give laxatives, fluids to assist in expelling barium.

Diagnostic tests
C. Ultrasound
> noninvasive procedure uses high frequency soundwaves to
visualize the solid organs.
> NPO 8-12 hours
D. CT-Scan
> non invasive radiologic examination that combines x-ray machine
and computer.
E. MRI
> non invasive procedure using radiofrequency waves and magnetic
field
> NPO for 6 hours
> C/I in pt with metal implants or who is pregnant

Diagnostic tests

End of Topic