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Digestive Process Overview
Digestion begins in the oral cavity.
Absorption occurs primarily in the small intestine.
Water reabsorption happens in the large intestine.
Key processes in digestion:
Teeth chew food.
Saliva dissolves and moistens food.
Salivary glands secrete amylase, converting starch to maltose.
Peristalsis propels food through the esophagus to the stomach.
Stomach Functions
Uses gastric acids to break food into a liquid called chyme.
Pyloric sphincter regulates chyme movement into the duodenum.
Nutrient absorption order:
Carbohydrates (most readily absorbed)
Proteins
Fats
Small Intestine
Duodenum (First 10 inches): Entry point for the common bile duct and pancreatic duct.
Jejunum (~8 feet): Major site of digestion and absorption.
Ileum (~11 feet): Nutrient absorption.
Large Intestine
5 feet long.
Functions: Stores and eliminates indigestible material.
Accessory Organs
liver
spleen
Gallbladder
Pancreas
Liver
Largest internal organ, located in the right upper quadrant (RUQ), protected by the rib cage.
Functions of the liver
Produces bile to emulsify fats.
Stores vitamins and minerals.
Detoxifies chemicals and filters blood.
Stores glycogen, releases it as needed.
Produces clotting factors.
Regulates blood nutrients.
Blood supply:
Hepatic artery brings oxygen-rich blood.
Hepatic portal vein carries nutrient-rich blood from the GI tract.
Gallbladder
Small organ beneath the liver.
Stores bile produced by the liver and releases it into the duodenum in response to fatty foods.
Cholecystokinin (CCK) stimulates bile release.
Pancreas
Location: Behind the stomach, in the upper left quadrant (LUQ).
Functions:
Exocrine: Releases digestive enzymes:
Amylase (starch digestion)
Lipase (fat digestion)
Trypsin (protein digestion)
Endocrine: Secretes insulin and glucagon to regulate blood sugar.
Spleen
Located in the LUQ, near the liver.
Functions:
Filters red blood cells.
Produces white blood cells (lymphocytes) to fight infections.
Aging and the GI System
Slower metabolism of drugs, increasing toxicity risk.
Increased risk of gallstones.
Tooth enamel hardens, increasing difficulty in chewing.
Decreased saliva production, increasing periodontal disease risk.
Esophageal motility declines, increasing risk of aspiration.
Slower stomach emptying, leading to early satiety.
Decreased hydrochloric acid affects digestion.
Fat absorption slows down.
Weakening of rectal elasticity, contributing to constipation.
Abdominal Assessment (History Taking)
History Taking
Present health: Any chronic conditions?
Symptoms: Pain, bloating, nausea, vomiting, heartburn, indigestion.
Bowel habits: Frequency, color, consistency, recent changes.
Dietary habits: Appetite changes, weight loss/gain.
Risk factors: Travel, smoking, alcohol use.
Family history: GI diseases, hepatitis, cancer.
Abdominal Assessment
Inspection
Normal: Smooth, even tone, symmetrical.
Unexpected: Lesions, bruising, jaundice, distension.
Striae:
Pink/purple: Recent stretching (weight gain, ascites).
Silver/white: Older scarring.
Auscultation
Normoactive: 5-34 sounds/min.
Hyperactive (>34/min): Associated with diarrhea.
Hypoactive (<5/min): Associated with constipation or post-op.
Absent sounds (5 mins of listening): Possible obstruction or ileus.
Bruits: Swishing sounds indicating vascular abnormalities.
Palpation
Light palpation (~1 inch deep).
Expected: Non-tender, relaxed.
Unexpected:
Rigidity or guarding → Possible inflammation.
Tenderness or masses → Further evaluation needed.
Health Promotion
Exercise: At least 30 minutes/day to improve peristalsis and reduce stress.
High-fiber diet: Promotes GI health.
Adequate hydration: 8-10 glasses of water daily.
Routine screening:
Colonoscopy starting at age 45, then every 10 years.
Fecal occult blood test (FOBT) to detect hidden blood.
Diagnostic Tests
CBC: Checks for infection or anemia.
Electrolytes: Imbalances from vomiting/diarrhea.
Liver function tests (LFTs):
ALT, AST, albumin, bilirubin.
Stool tests:
FOBT (blood in stool).
Steatorrhea (fat in stool).
Imaging:
X-rays, CT scans, endoscopy, colonoscopy.
Barium swallow (NPO before, white stool after).
Enteral Nutrition
Used when oral intake is insufficient.
Methods:
NG tube, OG tube, PEG tube.
Nursing Considerations:
Keep Head of bed elevated (30-45°) to reduce aspiration risk.
Check placement before use.
Flush with water before and after feedings/medications.
Monitor for complications: Obstruction, bloating, aspiration.
Nasogastric (NG) Tube Uses
Decompression (removing gas/fluid).
Lavage (removing toxins).
Diagnostics (gastric fluid sampling).
Nutrition/hydration.
Medication administration.
Post-surgical healing.