Nutrition: Gastrointestinal System

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Information about Nutrition: Gastrointestinal System

Published on December 14, 2007

Author: Bates2ndQuarterLPN

Source: slideshare.net

Gastrointestinal System Nursing Assessment

Function of the G.I. System Ingestion Digestion Absorption Elimination

Ingestion

Digestion

Absorption

Elimination

G.I. Tract Mouth Pharynx Esophagus Stomach Small Intestine (duodenum, jejunum, ileum) Large Intestine Rectum Anus

Mouth

Pharynx

Esophagus

Stomach

Small Intestine (duodenum, jejunum, ileum)

Large Intestine

Rectum

Anus

G.I. Associated Organs Liver Pancreas Gallbladder

Liver

Pancreas

Gallbladder

 

 

Factors that influence G.I. functioning Psychological Emotional Stress Diet Alcohol Caffeine Nicotine Organic diseases fatigue

Psychological

Emotional

Stress

Diet

Alcohol

Caffeine

Nicotine

Organic diseases

fatigue

Structures and Functions of the G.I. Tract

Composition The G.I. Tract is a tube approximately 30 ft. (9m) extending from mouth to anus. It is composed of four layers Mucosa Submucosa Muscle Serosa

The G.I. Tract is a tube approximately 30 ft. (9m) extending from mouth to anus.

It is composed of four layers

Mucosa

Submucosa

Muscle

Serosa

Neuro Intervention Autonomic nervous system Parasympathetic Excitatory :Increase of peristalsis Sympathetic Inhibatory : Decrease of peristalsis Sensory information is relayed via both parasympathetic and sympathetic afferent fibers.

Autonomic nervous system

Parasympathetic

Excitatory :Increase of peristalsis

Sympathetic

Inhibatory : Decrease of peristalsis

Sensory information is relayed via both parasympathetic and sympathetic afferent fibers.

Enteric Nervous System Composed of two layers Lie between the mucosa and the circular muscle layer and the circular and longitudinal muscle layers Neurons contribute to the coordination of the G.I. Motor and sensory activities “ Gut Brain” Contains numerous neurons Ability to control movement and secretion of the G.I. Tract

Composed of two layers

Lie between the mucosa and the circular muscle layer and the circular and longitudinal muscle layers

Neurons contribute to the coordination of the G.I. Motor and sensory activities

“ Gut Brain”

Contains numerous neurons

Ability to control movement and secretion of the G.I. Tract

C.V. Intervention G. I. Tract and the accessory organs get 25-30% of the cardiac output Venous blood draining the GI tract organs empties in the portal vein, which then perfuses the liver Splanchnic artery innervates the upper GI tract Hepatic and superior mesenteric artery branches innervate the small intestine

G. I. Tract and the accessory organs get 25-30% of the cardiac output

Venous blood draining the GI tract organs empties in the portal vein, which then perfuses the liver

Splanchnic artery innervates the upper GI tract

Hepatic and superior mesenteric artery branches innervate the small intestine

C.V. (cont) Superior and inferior mesenteric arteries supply blood to the large intestines Because such a large % of the cardiac output perfuses these organs, the GI tract is a major source from which blood flow can be diverted during exercise and stress.

Superior and inferior mesenteric arteries supply blood to the large intestines

Because such a large % of the cardiac output perfuses these organs, the GI tract is a major source from which blood flow can be diverted during exercise and stress.

G.I. Movement Segmentation (mixing) Peristalsis (propulsion)

Segmentation (mixing)

Peristalsis (propulsion)

G.I. Secretions Enzymes and hormones for digestion Mucus to provide protection and lubrication Water Electrolytes

Enzymes and hormones for digestion

Mucus to provide protection and lubrication

Water

Electrolytes

Peritomeum Covers the abdominal organs Parietal layer lines the abdominal cavity wall Visceral layer covers the abdominal organs Peritoneal cavity is the potential space between the parietal and visceral layers Two folds of the peritoneum are called the mesentery and the omentum

Covers the abdominal organs

Parietal layer lines the abdominal cavity wall

Visceral layer covers the abdominal organs

Peritoneal cavity is the potential space between the parietal and visceral layers

Two folds of the peritoneum are called the mesentery and the omentum

Mesentery Attaches to the small intestine and part of the large intestine to the posterior abdominal wall Contains blood and lymph vessels

Attaches to the small intestine and part of the large intestine to the posterior abdominal wall

Contains blood and lymph vessels

Omentum The lesser omentum goes from the lesser curvature of the stomach to the upper duodenum to the liver The greater omentum hangs from from the stomach over the intestines like an apron Contains fat and lymph nodes

The lesser omentum goes from the lesser curvature of the stomach to the upper duodenum to the liver

The greater omentum hangs from from the stomach over the intestines like an apron

Contains fat and lymph nodes

Ingestion The mouth is the entrance of the GI tract. The food is moved on to the stomach and other organs for digestion and absorbtion.

The mouth is the entrance of the GI tract.

The food is moved on to the stomach and other organs for digestion and absorbtion.

Ingestion Intake of food Hypothalamus “appetite center” Directly of indirection stimulated by hypoglycemia, empty stomach, decrease of body temp Input from higher brain centers Appetite stimulated by taste, smell and sight

Intake of food

Hypothalamus “appetite center”

Directly of indirection stimulated by hypoglycemia, empty stomach, decrease of body temp

Input from higher brain centers

Appetite stimulated by taste, smell and sight

Ingestion (cont) Appetite decreased by stomach distention, illness, hyperglycemia, N&V, and certain drugs Deglutition, swallowing, mechanical component of ingestion involving the mouth, pharynx, and esophagus

Appetite decreased by stomach distention, illness, hyperglycemia, N&V, and certain drugs

Deglutition, swallowing, mechanical component of ingestion involving the mouth, pharynx, and esophagus

Digestion Releases nutrients from food Separation of other nutrients from food components Takes place in the small intestine

Releases nutrients from food

Separation of other nutrients from food components

Takes place in the small intestine

Absorbtion Delivers nutrients into the blood. Absorbing structures (microvilli) located in the small intestine transfer the nutrients into the portal blood and lymph. Water is absorbed in colon later.

Delivers nutrients into the blood.

Absorbing structures (microvilli) located in the small intestine transfer the nutrients into the portal blood and lymph.

Water is absorbed in colon later.

Elimination Excretes nondigestible waste The fecal mass moves from the colon to the rectum, where it is stored and excreted.

Excretes nondigestible waste

The fecal mass moves from the colon to the rectum, where it is stored and excreted.

Before the mouth Smell and vision and hunger

Smell and vision and hunger

Smell

 

 

Vision

 

 

 

Mouth Lips and oral (buccal) cavity Hard and soft palate Teeth Tongue Taste buds Salivary glands

Lips and oral (buccal) cavity

Hard and soft palate

Teeth

Tongue

Taste buds

Salivary glands

 

 

 

What happens in the mouth? Teeth? Tongue? Salivary glands?

Teeth?

Tongue?

Salivary glands?

Extra Credit What type of pathophysiology or conditions can cause problems while eating?

What type of pathophysiology or conditions can cause problems while eating?

Pharynx Muscleomembranous tube that may be divided into the nasopharynx, oropharynx, and the laryngealpharynx. The mucus membrane of the pharynx is continuous with the nasal cavity, mouth, auditory tubes and larynx.

Muscleomembranous tube that may be divided into the nasopharynx, oropharynx, and the laryngealpharynx. The mucus membrane of the pharynx is continuous with the nasal cavity, mouth, auditory tubes and larynx.

Functions Oropharynx secretes mucus Epiglottis closes over the larynx during swallowing Oropharynx moves the food down Receptors in the oropharynx are stimulated by food and liquids which initiates swallowing

Oropharynx secretes mucus

Epiglottis closes over the larynx during swallowing

Oropharynx moves the food down

Receptors in the oropharynx are stimulated by food and liquids which initiates swallowing

 

 

Any Problems?

Esophagus Hollow , muscular tubing that receives food from the pharynx and moves it to the stomach by peristaltic contractions. Located in the thoracic cavity and starts behind the trachea and the lower end of the pharynx and extends to the stomach. The upper third is composed of striated skeletal muscle and the distal two thirds is composed of smooth muscle.

Hollow , muscular tubing that receives food from the pharynx and moves it to the stomach by peristaltic contractions. Located in the thoracic cavity and starts behind the trachea and the lower end of the pharynx and extends to the stomach. The upper third is composed of striated skeletal muscle and the distal two thirds is composed of smooth muscle.

Functions Upper esophageal sphincter (criphapharyngeal) relaxes and the peristaltic wave moves the bolus into the esophagus. The muscular layers contract and propels the food in the stomach. The lower esophageal sphincter (LES) at the distal end of the esophagus remains contracted except during swallowing, belching, or vomiting.

Upper esophageal sphincter (criphapharyngeal) relaxes and the peristaltic wave moves the bolus into the esophagus. The muscular layers contract and propels the food in the stomach. The lower esophageal sphincter (LES) at the distal end of the esophagus remains contracted except during swallowing, belching, or vomiting.

LES Important barrier that prevents reflux of acidic gastric contents into the esophagus

Important barrier that prevents reflux of acidic gastric contents into the esophagus

 

 

Name That Pathophysiology

Stomach Stores food, mix food with gastric secretions and empties into the small intestine. Very little water, alcohol, electrolytes, or drugs are absorbed

Stores food, mix food with gastric secretions and empties into the small intestine. Very little water, alcohol, electrolytes, or drugs are absorbed

Back to digestion Muscular Chemical

Muscular

Chemical

Muscular Mixing and propulsive movements Controlled by the nervous system

Mixing and propulsive movements

Controlled by the nervous system

Longitudinal Muscle Long smooth muscles arranged in fiber bundles that extend lengthwise along the GI tract help propel the food mass downward.

Long smooth muscles arranged in fiber bundles that extend lengthwise along the GI tract help propel the food mass downward.

Circular contractile muscles Smooth muscle fibers that extend around the hallow tube forming the alimentary canal. These rhythmic contractile rings cause sweeping waves along the digestive tract pushing food forward. This movement is called peristalsis

Smooth muscle fibers that extend around the hallow tube forming the alimentary canal.

These rhythmic contractile rings cause sweeping waves along the digestive tract pushing food forward.

This movement is called peristalsis

Sphincter muscles More defined circular muscles at strategic points form muscle sphinters that act as valves--pyloric, ileocecal, and anal—to prevent reflux and backflow and keep the food mass moving in a forward direction.

More defined circular muscles at strategic points form muscle sphinters that act as valves--pyloric, ileocecal, and anal—to prevent reflux and backflow and keep the food mass moving in a forward direction.

Mucosal muscles Thin embedded layer of smooth muscle produces local constrictive contractions every few centimeters. They contact mix and chop, the food mass, effectively churning and mixing it with secretions to form a semiliquid called chyme that is ready for digestion and absorption.

Thin embedded layer of smooth muscle produces local constrictive contractions every few centimeters.

They contact mix and chop, the food mass, effectively churning and mixing it with secretions to form a semiliquid called chyme that is ready for digestion and absorption.

Gastrointestinal Secretions Enzymes HCl acid and buffer ions Mucus Water and electrolytes

Enzymes

HCl acid and buffer ions

Mucus

Water and electrolytes

Enzymes Specific enzymes attack designated chemical bonds within the structure of nutrient compounds freeing their component parts.

Specific enzymes attack designated chemical bonds within the structure of nutrient compounds freeing their component parts.

Enzymes The major enzyme of the stomach is pepsin, which begins the breakdown of protein. Pepsin is secreted in the form of pepsinogen and is activated by HCl acid. Small amount of gastric lipase (tributyrase) that acts only on butter fat

The major enzyme of the stomach is pepsin, which begins the breakdown of protein.

Pepsin is secreted in the form of pepsinogen and is activated by HCl acid.

Small amount of gastric lipase (tributyrase) that acts only on butter fat

Enzymes Children have a gastric enzyme called renin (don’t confuse it with renal renin) that aids in the coagulation of milk. It coagulates the protein of milk from liquid to solid which slows the emptying of the stomach, ensuring a gradual passage to the small intestine.

Children have a gastric enzyme called renin (don’t confuse it with renal renin) that aids in the coagulation of milk. It coagulates the protein of milk from liquid to solid which slows the emptying of the stomach, ensuring a gradual passage to the small intestine.

 

Hydrochloric acid and buffer ions The agents produce the pH necessary for the activity of certain enzymes

The agents produce the pH necessary for the activity of certain enzymes

ACID!!!!!! HCl acid creates the acidic environment necessary for certain enzymes to work. A pH of 1.8-3.5 is needed for pepsin to work . A pH of 5 or above there will be little or no pepsin activity

HCl acid creates the acidic environment necessary for certain enzymes to work.

A pH of 1.8-3.5 is needed for pepsin to work . A pH of 5 or above there will be little or no pepsin activity

Mucus This sticky, slippery fluid lubricates and protects the lining of the inside wall of the gastrointestional tract and eases the passage of the food mass.

This sticky, slippery fluid lubricates and protects the lining of the inside wall of the gastrointestional tract and eases the passage of the food mass.

Water and electrolytes These agents provide an appropriate solution in the amounts needed to circulate the substances released in the digestive process.

These agents provide an appropriate solution in the amounts needed to circulate the substances released in the digestive process.

Small Intestine Digestion and absorption Duodenum, jejunum, and ileum Ileocecal valve

Digestion and absorption

Duodenum, jejunum, and ileum

Ileocecal valve

Duodenum Mixes the chyme from the stomach and the digestive secretions from the pancreas and the liver from the common bile duct

Mixes the chyme from the stomach and the digestive secretions from the pancreas and the liver from the common bile duct

 

Enzymes Specific enzymes act on specific macronutrients to bring out their final breakdown to form the body can absorb and use.

Specific enzymes act on specific macronutrients to bring out their final breakdown to form the body can absorb and use.

Mucus Glands located at the entrance to the duodenum secrete large amounts of mucus to decrease the acidity of the chyme Other mucus lubricates and protects the mucosal lining in the duodenum

Glands located at the entrance to the duodenum secrete large amounts of mucus to decrease the acidity of the chyme

Other mucus lubricates and protects the mucosal lining in the duodenum

Hormones Secretin: stimulates the pancreas to send alkaline pancreatic juices into the duodenum

Secretin: stimulates the pancreas to send alkaline pancreatic juices into the duodenum

Bile Emulsifies the fats and facilitates digestion

Emulsifies the fats and facilitates digestion

Composition The serous coat is formed by the peritoneum. The mucosa is thick, vascular, and glandular. Circular folds in the mucous and submucous layers provide greater surface for digestion and absorption.

The serous coat is formed by the peritoneum. The mucosa is thick, vascular, and glandular. Circular folds in the mucous and submucous layers provide greater surface for digestion and absorption.

Villi Finger like projections in the mucous membrane. They also increase surface area for digestion and absorption.

Finger like projections in the mucous membrane. They also increase surface area for digestion and absorption.

 

Duodenum absorbs: Iron Calcium Magnesium

Iron

Calcium

Magnesium

Jejunum Nutrients area absorbed in the blood stream Simple sugars Water soluble vitamins (C and all B’s except B-12

Nutrients area absorbed in the blood stream

Simple sugars

Water soluble vitamins (C and all B’s except B-12

Ileum absorbs: Amino Acid (the end product of protein digestion) Fat soluble vitamins (A,D,E, and K) Fatty acids and cholestrol Vitamin B-12 Sodium, potassium, and alcohol

Amino Acid (the end product of protein digestion)

Fat soluble vitamins (A,D,E, and K)

Fatty acids and cholestrol

Vitamin B-12

Sodium, potassium, and alcohol

 

Large Intestine Absorbs fluids and electrolytes Garbage compactor Secretes mucus

Absorbs fluids and electrolytes

Garbage compactor

Secretes mucus

Garbage Feces consist of water, bacteria, unabsorbed minerals, undigested food stuffs, bile pigment, and desquamated epithelial cells

Feces consist of water, bacteria, unabsorbed minerals, undigested food stuffs, bile pigment, and desquamated epithelial cells

Large Intestine Manufactures Vitamin B-12 Produce Vitamin K Break down of amino acids and produce nitrogen Moves and breaks down indigestible complex carbohydrates (Methane)

Manufactures Vitamin B-12

Produce Vitamin K

Break down of amino acids and produce nitrogen

Moves and breaks down indigestible complex carbohydrates (Methane)

Liver Largest solid organ in the body Stores, manufactures, transforms and excretes a number of substances involved in metabolism.

Largest solid organ in the body

Stores, manufactures, transforms and excretes a number of substances involved in metabolism.

 

Functions Carbohydrate metabolism Protein metabolism Fat metabolism Steroid metabolism Bile production and secretion Storage Mononuclear phagocyte system

Carbohydrate metabolism

Protein metabolism

Fat metabolism

Steroid metabolism

Bile production and secretion

Storage

Mononuclear phagocyte system

Gallbladder Pear shaped sac located below the liver Concentrates and stores bile Bile is produced by hepatic cells and secreted into the bile ducts by hepatic cells and secreted into the biliary canaliculi of the lobes

Pear shaped sac located below the liver

Concentrates and stores bile

Bile is produced by hepatic cells and secreted into the bile ducts by hepatic cells and secreted into the biliary canaliculi of the lobes

Common Bile Duct The hepatic duct merges with the cystic duct from the gallbladder and form the common bile duct

The hepatic duct merges with the cystic duct from the gallbladder and form the common bile duct

Back to the GB Most bile is stored and concentrated in the gall bladder It is released into the cystic duct and moves down the common bile duct to enter the duodeum at the ampulla of Vater In the intestines most of the bilirubin os reduced to stercobilinogen and urobilogen by bacterial action

Most bile is stored and concentrated in the gall bladder

It is released into the cystic duct and moves down the common bile duct to enter the duodeum at the ampulla of Vater

In the intestines most of the bilirubin os reduced to stercobilinogen and urobilogen by bacterial action

Too much information Stercobilinogen accounts for the brown color of stool

Stercobilinogen accounts for the brown color of stool

Pancreas Exocrine and endocrine gland Exocrine gland: enzymes to metabolize food.

Exocrine and endocrine gland

Exocrine gland: enzymes to metabolize food.

Spleen Who cares????????

Who cares????????

The Effects of Aging on the G.I. Tract

It’s Happening Right Now Tooth and dentin wear down; cavities Periodontal disease lead to tooth loss Taste buds and sense of smell go Esophageal smooth muscle weakens LES becomes more incompetent Decrease on HCL, delayed gastric emptying, and constipation

Tooth and dentin wear down; cavities

Periodontal disease lead to tooth loss

Taste buds and sense of smell go

Esophageal smooth muscle weakens

LES becomes more incompetent

Decrease on HCL, delayed gastric emptying, and constipation

Okay….Spleen Phagocytosis However it may be removed and the liver will compensate.

Phagocytosis

However it may be removed and the liver will compensate.

Physical Inspection Mouth Abdomen Rectum and anus

Mouth

Abdomen

Rectum and anus

Mouth Lips: color, cracking, ulcers, symmetry Mouth: Ulcers, color Tongue: Teeth: dentures, cavities Pharynx

Lips: color, cracking, ulcers, symmetry

Mouth: Ulcers, color

Tongue:

Teeth: dentures, cavities

Pharynx

Abdomen Inspection Auscultation Percussion Palpation

Inspection

Auscultation

Percussion

Palpation

Inspection 4 Quadrants Color, texture, scars striae, dilated veins, rashes, lesions Umbilicus Pulsations

4 Quadrants

Color, texture, scars striae, dilated veins, rashes, lesions

Umbilicus

Pulsations

Auscultation Listen for 5 minutes (yeah, right) Warm it up Present, absent, increased, decreased, high pitched, tinkling, gurgling, rushing Aortic bruits?

Listen for 5 minutes (yeah, right)

Warm it up

Present, absent, increased, decreased, high pitched, tinkling, gurgling, rushing

Aortic bruits?

Percussion Tympany Dullness

Tympany

Dullness

Palpation Light palpation Deep palpation

Light palpation

Deep palpation

Rectum and anus Inspection Palpation

Inspection

Palpation

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