GI/Hepatic-Bilary System

esophagus

Transports food from the pharynx to the stomach

Stomach

Stores, mixes, and begins chemical digestion of food

Small Intestine

Primary site of digestion and nutrient absorption (Duodenum, jejunum, Ileum)

large intestine

Absorbs water and electrolytes; forms feces

rectum

temporarily stores feces

anus

controls elimination of feces

upper GI system

Mouth → Duodenum

Ingestion and digestion of food

lower GI system

Jejunum → Rectum

Nutrient and water absorption

Formation, storage, and elimination of waste

liver

Produces bile

Processes nutrients

Filters blood and metabolizes toxins

gallbladder

Stores and concentrates bile

Releases bile when food enters the small intestine

pancreas

Produces digestive enzymes

entry into the GI tract

Bile and pancreatic secretions enter the duodenum

Secretions converge near the ampulla of Vater

Support the digestion and absorption of nutrients

bile

• Contains bile salts and pigments

• Emulsifies fats to support digestion

• Flows into the duodenum when food is present

• Most bile salts are recycled

GI benefits of regular exercise

• Supports healthy GI function

• May help prevent and manage some GI disorders

• Regular activity may increase lower GI motility

GI response to low to moderate intensity exercise

gastric emptying may accelarate

GI response to high intensity exercise (75% aerobic capacity)

• gastric emptying slows

• small intestine motility decreases due to reduces GI blood flow

• exercise- related hormonal changes

• upright activity and gravity may promote bowel motility

jostling of intestines may contribute to

• abdominal cramping

• urgency

• diarrhea

• proper hydration may reduce GI symptoms

abdominal pain

Location: Identify the abdominal quadrant

Severity: Mild, moderate, or severe

Quality: Cramping, sharp, dull, burning, or pressure

Pattern: Constant, intermittent, or progressive

Timing: Onset, duration, and relationship to meals or activity

colicky pain

• Severe, intermittent waves of cramping

• Caused by repeated organ or duct contractions

• May indicate inflammation or obstruction

acute, localized or constant pain

• May indicate irritation of the parietal peritoneum

• Concerning for peritonitis or underlying organ pathology

mild abdominal cramping

• more commonly associated with lower GI dysfunction

pain referral

Severe, progressive, or well-localized abdominal pain warrants

further evaluation

nausea

Sensation or urge to vomit

vomiting (emesis)

• Forceful expulsion of stomach contents

• Common signs of upper GI dysfunction

upper GI irrritation may be

• chemical

• mechanical

• autonomic (vagus nerve)

nausea/ vomiting stimulation causes

• Reversal of normal GI movement

• Movement of contents toward the stomach

• Abdominal muscle contraction

• Increased intra-abdominal pressure

• Expulsion through the esophagus

when evaluating nasuea/ vomiting…

• onset, duration, frequency

• appearance and amount of vomit

• associated abdominal pain

• recent illness, food intake, medications, trauma or exercise

diarrhea

• Frequent, loose, or watery bowel movements

• Typically ≥3 loose stools within 24 hours

causes of diarrhea

• increased intestinal motility

• Infection or intestinal irritation

• Impaired nutrient or fluid absorption

• Medication effects

• Vigorous or prolonged exercise

increases intsetinal secretion of sodium, potassium and water can lead to

• dehydration

• electrolyte imbalance

if severe…

• hypovolemic shock

diarrhea, abdominal pain, rigidity or distention or ileus

ER

• bowel obstruction or perforation

diarrhea, red blood in stool, pus in stool, abdominal pain

urgent

• dysentry

• ulcerative colitis

diarrhea, vomiting, abdominal cramps beginning 1-6 hrs after eating

urgent

• food poisoning

diarrhea and perianal/rectal trauma

urgent

• rectal or perianal tissue injury

diarrhea and history of hemmorrhoids

standard

• thrombosed hemorrhoid

diarrhea and melena (black, tarry stool)

urgent or ER

• ulcer or ither upper GI bleeding

none

• ingestion of cherries, iron, bismuth w/in 24 hrs

diarrhea, vomiting, umbilical pain, mcburneys sign or rebound tenderness or positive jar sign

ER

• eppendicitis

• peritonitis

diarrhea, vomiting, myalgia, no abdominal pain, tenderness, rigidity

standard

• viral gastroenteritis

diarrhea and recurrent vomiting

standard

• food poisoning

diarrhea and hx of alcohol, drugs (antibiotics, vitamin C, laxatives) in past 24 hrs

standard

• pharmacologically increased peristalsis

diarrhea, chronic nonbloody loose stool and fatty/ greasy stool

urgent

• pancreatitis

diarrhea, abdominal pain, weight loss, borborygmi

urgent

• inflammatory bowel disease

diarrhea, abdominal cramps, anxiety, no weight loss

standard

• IBS

diarrhea, abdominal cramps, no tenderness or rigidity

standard

• food allergy

constipation

• abnormal retention or delayed passage of stool

• may result from: Hardened, dehydrated stool; decreased intestinal motility

common contributing factors to constipation

• low fiber

• highly processed food diet

• inadequate fluid intake

• physical inactivity

• stress

• medications that slow bowel motility

• underlying GI disease

management of constipation

• increase dietary fiber and fluid intake

• encourage regular physicla activity

• est consistent bowel habits

• laxitives

emergent constipation

if accompanied with

• severe pain

• vomiting

• abdominal distention

• inability to pass stool or gas

vomiting and recent head trauma

ER

• rising intracranial pressure

hematemesis (bright red vomiting)

ER

• peptic ulcer, gastritis, esophageal varices

vomiting, substantial abdominal pain, rigidity and distsention progressively worse

ER

• peritonitis

vomiting and fecal odor in vomitus absent bowel sounds

ER

• bowel obstruction

vomiting and upper abdomen pain and right shoulder pain

urgent

• cholecystitis

• cholelithiasis

vomiting and acute back or flank pain, hematuris

• kidney stones

• ER

vomiting and chronic nocturia and pallor

ER

• renal disorder

vomiting, headache, rigid neck, rising fever

ER

• meninigitis

vomiting and photophobia, phonophobia, no systemic signs

standard

• migraine (history of recurrence)

vomiting and cyclic pain with diarrhea OR loss of appetite or borborygmi

urgent

• food poisoning

• gastroenteritis

vomiting, female, amennorrhea, weight gain, polyuria

standard

• pregnancy

vomiting after use of alcohol, aspirin, caffeine or drugs

standard

• gastritis

• peptic ulcer

• drug toxicity

vomiting, low body weight, obsession with weight or calories, “russels sign” on hands/ knuckles, self-induced vomiting

urgent

• disordered eating

abdominal pain with rigidity or rebound tenderness, jar sign, signs of shock

ER

• peritonitis, abdominal hemorrhage

progressively worse abdominal pain, distention or rigidity or worse when rising from supine

ER

• peritonitis

• abdominal hemorrhage

abdominal pain and absence of bowel sounds > 3 min

ER

• bowel obstruction

epigastric or general abdominal pain with severe pain and hx of marfan’s

ER

• aortic aneurysm

epigastric or general abdominal pain with decreasing BP, syncope, chest pain or dyspnea

ER

• CV event

epigastric or general abdominal pain that is chronic and recurs after meals

standard

• peptic ulcer

epigastric or general abdominal pain that is chronic, gnawing, night pain, vague location

urgent

• pancreatic tumor

• pancreatitis

epigastric or general abdominal pain burning, worse with caffeine, spices, alcohol, when supine

standard

• esophageal reflux, peptic ulcer

epigastric or general abdominal pain with distention, borborygmi, ususcally after ingestion of diary products

standard

• lactose intolerance

suprapubic abdominal pain, female, amenorrhea and unusual vaginal discharge

ER

• miscarriage

• ruptured ecctopic pregnancy

• reptured ovarian/uterine cysts

suprapubic abdominal pain, amenorrhea, nausea, recent weight gain

standard

• pregnancy

suprapubic abdominal pain and unusual vaginal discharge

urgent

• ovarian/uterine cysts

• STD

• UTI

suprapubic abdominal pain, currently menstruatig, referred to back/thigh, no fever

standard

• menstrual cramps

suprapubic abdominal pain recurrent, worse with menstruation

standard

• endometriosis

suprapubic abdominal pain, groin pain, vomiting

ER

• strangulated hernia

suprapubic abdominal pain with flank or groin pain, incapacitating in intensity, and recurring at intervals

ER

• kidney stones

RUQ pain, trauma to right side flank, palpable rib fx or positive compression test

ER

• possible liver, kidney damage

RUQ pain, tender, rigid RUQ without hematuria

ER

• ruptured liver

RUQ pain, tender, rigid RYQ w hematuria

ER

• ruptured or contused right kidney

RUQ pain, no hx of trauma, severe cramping and rigidity w intermittent full relief

ER

• cholelithiasis (gall stones)

RUQ pain, diffuse, vague pain, tender RUQ and possitive hammering

urgent

• cholecystitis, hepatitis

LUQ pain after trauma to left side and palpable rib fx or positive compression test

ER

• possible spleen, kidney damage

LUQ pain, tender and rigid wo hematuria

ER

• ruptured spleen

LUQ pain, tender and rigid w hematuria

ER

• ruptured or contused left kidney

RLQ pain with vomiting, pain originating from epigastric region

ER

• appendicitis

• inflammatory bowel disease

• diverticulitis

RLQ pain, vomiting, positive rebound, positive “jar” rigidity

ER

• perforated appendix

LLQ pain and tenderness, no rigidity

urgent

• diverticulitis

• inflammatory bowel disease

ER

if fever also present

LLQ pain and nontender mass and reports straining to defecate small stools

standard

• constipation

abdominal rigidity

• Involuntary, protective spasm of the abdominal muscles

• abdomen feels “board-like”

signifigance of abdominal rigidity

• may indicate signifigant intra-abdominal injury or disease

• requires immediate medical evaluation

loss of appetite

• may indicate upper GI dysfunction

• may occur with

  • infection

  • chronic disease

  • malignancy

  • signifigant unintentional weight liss

changes in bowel habits and stool quality

• lower GI pathology

• impaired digestion or absorption

• infection or inflammation

• biliary dysfunction

hematochezia

⚬ Bright red blood passed through the rectum

⚬ Indicates bleeding from the lower GI tract

⚬ May be visible or detected through stool testing

causes of hematochezia

• hemmorrhoids

• anal fissures

melena

⚬ Black, sticky, tar-like stool

⚬ Suggests bleeding from the upper GI tract

⚬ Blood darkens as it moves through the GI tract

⚬ Some medications may darken stool and mimic melena

occult GI bleeding

brought on by…

• endurance events

• heavy training

• prolonged running

bright red blood in stool

lower colon or rectum

dark red blood in stool

high in the colon or in the colon or in the small intestine

dark and tar like stool

stomach