NCM 118 - Critical Care Nursing (Lecture) Centro Escolar University - School of Nursing
Transcribed By: Roxas, Julie Mae Dexie A.
Overview PARTS OF SMALL INTESTINE
Module 4: Gastrointestinal System 1. Duodenum:
Module 5: Renal System ➔ Here, digestive juices from the pancreas
(digestive enzymes) and the gallbladder (bile)
mix together. The digestive enzymes break
GASTROINTESTINAL SYSTEM down proteins and bile and emulsify fats into
Gastrointestinal disorder, dysfunction, and bleeding micelles.
were usually recognized and admitted to the ICU. GI ➔ The duodenum contains Brunner’s glands that
problems can be wide-ranging to functional impairment produce bicarbonate and pancreatic juice that
of the GI tract which contributes to patient morbidity, contains bicarbonate to neutralize
may aggravate multi-organ failure, and may further hydrochloric acid in the stomach.
deteriorate to life-threatening emergencies 2. Jejunum:
➔ This is the midsection of the intestine,
DIGESTIVE SYSTEM connecting the duodenum to the ileum.
The human gastrointestinal tract refers to the structures ➔ It contains the plicae circulares and villi to
from the mouth to the anus. GI also refers to the increase the surface area of that part of the GI
stomach and intestine. tract.
3. Ileum:
➔ This has villi, where all soluble molecules are
absorbed into the blood (through the
capillaries and lacteals).
PARTS OF SMALL INTESTINE
2 Major Functions of GI Tract ● Cecum, the vermiform appendix that is attached to
1. To digest and absorb ingested nutrients the cecum.
2. To excrete waste product of digestion ● Colon, which includes the ascending colon,
transverse colon, descending colon, and sigmoid
UPPER GASTROINTESTINAL TRACT flexure.
● The upper gastrointestinal tract consists of the ● Rectum
esophagus, stomach, and duodenum. ● Anus
● The exact demarcation between upper and lower ● The ligament of Treitz is sometimes used to
can vary. Upon gross dissection, the duodenum divide the upper and lower GI tracts.
may appear to be a unified organ, but it is often
divided into two parts based on function, arterial PROCESSES AND FUNCTIONS OF THE
supply, or embryology. DIGESTIVE SYSTEM
● Esophagus, the fibromuscular tube that food
passes through—aided by peristaltic DIGESTION
contractions—the pharynx to the stomach. ➔ is necessary for absorbing nutrients from food and
● Stomach, which secretes protein-digesting occurs through two processes: mechanical and
enzymes called proteases and strong acids to aid chemical digestion.
in food digestion, before sending the partially ➔ breakdown and absorption of the various foods
digested food to the small intestines. and liquids needed to sustain life.
● Duodenum, the first section of the small intestine ➔ Bile production plays an important role in digestion
may be the principal site for iron absorption. ➔ Pancreatic juices are excreted into the digestive
system to break down complex molecules such as
LOWER GASTROINTESTINAL TRACT proteins and fats. (Proteases: Trypsin and
● The lower gastrointestinal tract includes most of Chymotrypsin, Lipase, amylase)
the small intestine and all of the large intestine.
According to some sources, it also includes the ABSORPTION
anus. ➔ Absorption occurs in the small intestines, where
nutrients directly enter the bloodstream.
DEMARCATION: Between upper and lower GIT
Duodenojejunal (DJ) junction (ligament of Treitz)
PROCESSES OF DIGESTION
● Food is the body’s source of fuel. The nutrients in
food give the body’s cells the energy they need to
,NCM 118 - Critical Care Nursing (Lecture) Centro Escolar University - School of Nursing
Transcribed By: Roxas, Julie Mae Dexie A.
encompasses the process of digestion
TWIN PROCESSES
● Mechanical Digestion
➔ Larger pieces of food get broken down into
smaller pieces while being prepared for
chemical digestion; this process starts in the
mouth and continues into the stomach
● Chemical Digestion
➔ Several different enzymes break down
macromolecules into smaller molecules that
can be absorbed. The process starts in the
mouth and continues into the intestines.
GASTROINTESTINAL BLEEDING
● Life-threatening GI bleeding usually occurs in the
upper GI tracts and requires immediate therapy to
prevent complications.
● Patients presenting with sudden blood loss are at
risk for decreased tissue perfusion and
oxygen-carrying capability, which can affect every
organ in the body
PEPTIC ULCER DISEASE
● The most common cause of upper GI bleeding.
● A peptic ulcer is an excavation that forms in the
mucosal wall of the stomach, in the pylorus, in the
duodenum, or in the esophagus.
● The erosion of a circumscribed area may extend as
deep as the muscle layers or through the muscle to
the peritoneum.
● Pathogenesis is related to the hypersecretion of
gastric acid, coupled with impaired GI tract mucus
COMMON SOURCES OF UPPER GI BLEEDING secretion,
● Peptic Ulcer Disease ● Helicobacter pylori, an organism found in GI tract
○ Gastric Ulcer can be an implication to the pathogenesis of the
○ Duodenal Ulcer PUD
● Varices
○ Esophageal
○ Gastric
● Pathologies of the Esophagus
○ Tumors
○ Mallory-Weiss Syndrome - results from
prolonged and forceful vomiting, coughing or
convulsions due to excessive alcohol intake
○ Inflammation
○ Ulcers
● Pathologies of the Stomach
○ Cancer
○ Erosive Gastritis
○ Stress Ulcers CLASSIFICATION
○ Tumors ● Gastric ulcer. Gastric ulcers tend to occur in the
lesser curvature of the stomach, near the pylorus.
, NCM 118 - Critical Care Nursing (Lecture) Centro Escolar University - School of Nursing
Transcribed By: Roxas, Julie Mae Dexie A.
PATHOPHYSIOLOGY
SENGSTAKEN-BLAKEMORE TUBE
CLINICAL MANIFESTATIONS
➔ Melena - black or tarry stool
➔ Coffee-ground emesis
➔ Hematemesis
➔ Dyspepsia or epigastric pain
➔ Nausea
ASSESSMENT FINDINGS
● Esophagogastroduodenoscopy. (golden
standard test) Confirms the presence of an ulcer ● Used in emergency medicine to stop bleeding
and allows cytologic studies and biopsy to rule out in the stomach or esophagus. The technique
H. pylori or cancer. used to place the tube is called balloon
● Physical examination. A physical examination tamponade
may reveal pain, epigastric tenderness, or ● Is a redtube with three ports on one end and
abdominal distention. two balloons on the other.
● Barium study. A barium study of the upper GI ● One balloon goes into the stomach and is filled
tract may show an ulcer. with air using one port
● Endoscopy. Endoscopy is the preferred diagnostic ● The other balloon sits in your esophagus and
procedure because it allows direct visualization of is inflated with the second port.
inflammatory changes, ulcers, and lesions. It ● The third port, called the gastric suction port,
should be done between 6-24 hrs following suctions fluid and air out of the stomach
gastroenterological consultation ● Is not often used unless other treatments don’t
● Occult blood. Stools may be tested periodically work or are not available
until they are negative for occult blood.
● Carbon 13 (13C) urea breath test. Reflects MANAGEMENT
activity of H. pylori
MEDICAL MANAGEMENT
● Pharmacologic therapy. Currently, the most
CARBON 13 (13C) UREA BREATH TEST - HOW TO
commonly used therapy for peptic ulcers is a
COLLECT BREATH
combination of antibiotics, proton pump inhibitors,
and bismuth salts that suppress or eradicate the
infection.
● Stress reduction and rest. Reducing
environmental stress requires physical and
psychological modifications on the patient’s part as
well as the aid and cooperation of family members
and significant others.
● Smoking cessation. Studies have shown that
smoking decreases the secretion of bicarbonate
from the pancreas into the duodenum, resulting in
increased acidity of the duodenum.
● Dietary modification. Avoiding extremes of the
Transcribed By: Roxas, Julie Mae Dexie A.
Overview PARTS OF SMALL INTESTINE
Module 4: Gastrointestinal System 1. Duodenum:
Module 5: Renal System ➔ Here, digestive juices from the pancreas
(digestive enzymes) and the gallbladder (bile)
mix together. The digestive enzymes break
GASTROINTESTINAL SYSTEM down proteins and bile and emulsify fats into
Gastrointestinal disorder, dysfunction, and bleeding micelles.
were usually recognized and admitted to the ICU. GI ➔ The duodenum contains Brunner’s glands that
problems can be wide-ranging to functional impairment produce bicarbonate and pancreatic juice that
of the GI tract which contributes to patient morbidity, contains bicarbonate to neutralize
may aggravate multi-organ failure, and may further hydrochloric acid in the stomach.
deteriorate to life-threatening emergencies 2. Jejunum:
➔ This is the midsection of the intestine,
DIGESTIVE SYSTEM connecting the duodenum to the ileum.
The human gastrointestinal tract refers to the structures ➔ It contains the plicae circulares and villi to
from the mouth to the anus. GI also refers to the increase the surface area of that part of the GI
stomach and intestine. tract.
3. Ileum:
➔ This has villi, where all soluble molecules are
absorbed into the blood (through the
capillaries and lacteals).
PARTS OF SMALL INTESTINE
2 Major Functions of GI Tract ● Cecum, the vermiform appendix that is attached to
1. To digest and absorb ingested nutrients the cecum.
2. To excrete waste product of digestion ● Colon, which includes the ascending colon,
transverse colon, descending colon, and sigmoid
UPPER GASTROINTESTINAL TRACT flexure.
● The upper gastrointestinal tract consists of the ● Rectum
esophagus, stomach, and duodenum. ● Anus
● The exact demarcation between upper and lower ● The ligament of Treitz is sometimes used to
can vary. Upon gross dissection, the duodenum divide the upper and lower GI tracts.
may appear to be a unified organ, but it is often
divided into two parts based on function, arterial PROCESSES AND FUNCTIONS OF THE
supply, or embryology. DIGESTIVE SYSTEM
● Esophagus, the fibromuscular tube that food
passes through—aided by peristaltic DIGESTION
contractions—the pharynx to the stomach. ➔ is necessary for absorbing nutrients from food and
● Stomach, which secretes protein-digesting occurs through two processes: mechanical and
enzymes called proteases and strong acids to aid chemical digestion.
in food digestion, before sending the partially ➔ breakdown and absorption of the various foods
digested food to the small intestines. and liquids needed to sustain life.
● Duodenum, the first section of the small intestine ➔ Bile production plays an important role in digestion
may be the principal site for iron absorption. ➔ Pancreatic juices are excreted into the digestive
system to break down complex molecules such as
LOWER GASTROINTESTINAL TRACT proteins and fats. (Proteases: Trypsin and
● The lower gastrointestinal tract includes most of Chymotrypsin, Lipase, amylase)
the small intestine and all of the large intestine.
According to some sources, it also includes the ABSORPTION
anus. ➔ Absorption occurs in the small intestines, where
nutrients directly enter the bloodstream.
DEMARCATION: Between upper and lower GIT
Duodenojejunal (DJ) junction (ligament of Treitz)
PROCESSES OF DIGESTION
● Food is the body’s source of fuel. The nutrients in
food give the body’s cells the energy they need to
,NCM 118 - Critical Care Nursing (Lecture) Centro Escolar University - School of Nursing
Transcribed By: Roxas, Julie Mae Dexie A.
encompasses the process of digestion
TWIN PROCESSES
● Mechanical Digestion
➔ Larger pieces of food get broken down into
smaller pieces while being prepared for
chemical digestion; this process starts in the
mouth and continues into the stomach
● Chemical Digestion
➔ Several different enzymes break down
macromolecules into smaller molecules that
can be absorbed. The process starts in the
mouth and continues into the intestines.
GASTROINTESTINAL BLEEDING
● Life-threatening GI bleeding usually occurs in the
upper GI tracts and requires immediate therapy to
prevent complications.
● Patients presenting with sudden blood loss are at
risk for decreased tissue perfusion and
oxygen-carrying capability, which can affect every
organ in the body
PEPTIC ULCER DISEASE
● The most common cause of upper GI bleeding.
● A peptic ulcer is an excavation that forms in the
mucosal wall of the stomach, in the pylorus, in the
duodenum, or in the esophagus.
● The erosion of a circumscribed area may extend as
deep as the muscle layers or through the muscle to
the peritoneum.
● Pathogenesis is related to the hypersecretion of
gastric acid, coupled with impaired GI tract mucus
COMMON SOURCES OF UPPER GI BLEEDING secretion,
● Peptic Ulcer Disease ● Helicobacter pylori, an organism found in GI tract
○ Gastric Ulcer can be an implication to the pathogenesis of the
○ Duodenal Ulcer PUD
● Varices
○ Esophageal
○ Gastric
● Pathologies of the Esophagus
○ Tumors
○ Mallory-Weiss Syndrome - results from
prolonged and forceful vomiting, coughing or
convulsions due to excessive alcohol intake
○ Inflammation
○ Ulcers
● Pathologies of the Stomach
○ Cancer
○ Erosive Gastritis
○ Stress Ulcers CLASSIFICATION
○ Tumors ● Gastric ulcer. Gastric ulcers tend to occur in the
lesser curvature of the stomach, near the pylorus.
, NCM 118 - Critical Care Nursing (Lecture) Centro Escolar University - School of Nursing
Transcribed By: Roxas, Julie Mae Dexie A.
PATHOPHYSIOLOGY
SENGSTAKEN-BLAKEMORE TUBE
CLINICAL MANIFESTATIONS
➔ Melena - black or tarry stool
➔ Coffee-ground emesis
➔ Hematemesis
➔ Dyspepsia or epigastric pain
➔ Nausea
ASSESSMENT FINDINGS
● Esophagogastroduodenoscopy. (golden
standard test) Confirms the presence of an ulcer ● Used in emergency medicine to stop bleeding
and allows cytologic studies and biopsy to rule out in the stomach or esophagus. The technique
H. pylori or cancer. used to place the tube is called balloon
● Physical examination. A physical examination tamponade
may reveal pain, epigastric tenderness, or ● Is a redtube with three ports on one end and
abdominal distention. two balloons on the other.
● Barium study. A barium study of the upper GI ● One balloon goes into the stomach and is filled
tract may show an ulcer. with air using one port
● Endoscopy. Endoscopy is the preferred diagnostic ● The other balloon sits in your esophagus and
procedure because it allows direct visualization of is inflated with the second port.
inflammatory changes, ulcers, and lesions. It ● The third port, called the gastric suction port,
should be done between 6-24 hrs following suctions fluid and air out of the stomach
gastroenterological consultation ● Is not often used unless other treatments don’t
● Occult blood. Stools may be tested periodically work or are not available
until they are negative for occult blood.
● Carbon 13 (13C) urea breath test. Reflects MANAGEMENT
activity of H. pylori
MEDICAL MANAGEMENT
● Pharmacologic therapy. Currently, the most
CARBON 13 (13C) UREA BREATH TEST - HOW TO
commonly used therapy for peptic ulcers is a
COLLECT BREATH
combination of antibiotics, proton pump inhibitors,
and bismuth salts that suppress or eradicate the
infection.
● Stress reduction and rest. Reducing
environmental stress requires physical and
psychological modifications on the patient’s part as
well as the aid and cooperation of family members
and significant others.
● Smoking cessation. Studies have shown that
smoking decreases the secretion of bicarbonate
from the pancreas into the duodenum, resulting in
increased acidity of the duodenum.
● Dietary modification. Avoiding extremes of the
