Digestive System, The Digestive Process,Functions,ASSESSMENT, Most Common Problem
The Digestive Process
The digestive process consists of;-
1- Mechanical digestion
Breakdown of food through chewing,
peristalsis.
2-chemical digestion
breakdown of food through a series of
metabolic reactions with enzymes.
•
The digestive process
begins in the mouth, The bolus of food is then swallowed into the esophagus,
where it is propelled
slowly via peristaltic contraction to the
stomach. In the stomach, the food bolus is churned, breaking it down further.
Functions
-Ingest food
-Break down food
-Move food through digestive tract
-Absorb digested food and water
-Eliminates waste materials
in children GI system begins to develop
during the third week of gestation.
At birth, all structures and functions
are present, but some functions are immature.
Organs:-
Mouth
Pharynx
Esophagus
Stomuch
Large intestine
Small intestine
Rectum
Anus
Accessory Digestive Organs:-
Salivary glands
Liver
gallbladder
pancreas
Mouth
Breaks down food into small pieces
Begins starch digestion (amylase)
Saliva produces amylase and lubricates
food
Moves food into esophagus
Peristalsis moves food to stomach
Esophagus
the tube that connects the mouth and stomach
Pushes food to Stomach
Stomach
Muscles churn food – mechanical
digestion.
Glands produce gastric juice = pepsin +
HCl
Pepsin breaks down proteins .
Food leaves after 2-4 hrs
Pushes food through pyloric sphincter to
small intestine
Small Intestine
Digestion is finished here
Peristalsis finishes mechanical digestion
Pancreatic juice produces enzymes to
finish chemical digestion of fats, proteins and carbohydrates
Parts
duodenum
jejunum
Ileum
Food stays in small intestine for 4 to 8 hours
Large Intestine
Absorbs water
Bacteria live here (produce methane)
Bacteria produce B vitamins and Vitamin K
Stores solid waste in rectum until
elimination.
Parts;-
Large Bowel:
colon
cecum
appendix
Colon:
ascending
hepatic flexure
transverse
splenic flexure
descending
Sigmoid
Rectum
Anus
Pancreas
Makes enzymes to break down fats,
carbohydrates and proteins
internal - endocrine function
-insulin
-glucagon
external - exocrine function
-amylase
- carbohydrates
-trypsin-
proteins
-lipase
– fats
Liver
Functions
production of bile glucose - glycogen
storage of vitamins, B12, A, D, E, K
removes toxins from blood
manufactures blood protein.
Gallbladder
pear-shaped sac under the liver
gallbladder contracts forcing bile out
cystic duct into common bile duct.
Bile;-
bile is a digestive juice
travels via hepatic duct to cystic duct
to gall bladder, where stored.
ASSESSMENT
vInclude:
•
History
•
Physical
examination
•
Laboratory and
diagnostic testing
History
Ø -complain of
Ø History of present illness
Ø Appetite (increase, decrease or lost),Nausea (cause)
Heart burn (aggravating factors,
relieving factors)
Abdominal pain: site, onset,
Duration, intensity, radiation,
Character, aggravating factors,
relieving factors)
Vomiting : Frequency, amount,
consistency, smell (offensive or e out smell), color (white - colorless -
yellowish) aggravating factors, relieving factors
-
Bowel habit: passage of hard or loose,
Constipation, flatulence (distention)
Diarrhea: Duration, Frequency,
amount, color
(colorless
– black (Melina) - white)
containing blood or mucous, smell
(offensive
or e out smell).
Developmental history
Nutritional history
-
Breast feeding
-
supplementary feeding
-
Weaning
EXAMINATION STEPS
Inspection
Palpation
Percussion
Auscultation
1- Inspection :
1- Mouth Examination :
-
Lips- teething-
tongue
•
Tonsils -Oral
Candidacies
•
scars
-
stomatitis
- 2-EYES:-
-
Jaundice
-
dehydration
Ø Abdominal size, shape, contour, symmetry, scars,
dilatation of veins
o Abdominal contour :
- Normal : the abdomen has appearance of
potbelly until child reaches puberty .
-
Scaphoid : in dehydration
-
Distended :( enlarged organ , tumors )
Ascitis
Ø Ability to mobilize and gait
Ø Movement of abdominal wall with respiration , Visible
masses, hernias
v Umbilical hernia of up to 2.5 cm may be present up to
one year
PALPATION OF THE ABDOMEN
Always watch the patients face
Ask the patient if there is any pain in the abdomen
Kneel down to get to the optimum position
Examine the abdomen in four quadrants
LIGHT ABDOMINAL palpation
Ask the patient to localise any areas of
pain or tenderness, if present begin the examination in the segment furthest
from discomfort.
Palpate all four quadrants lightly, looking
at the patients face and identify the areas of tenderness,masses,rigidity.
Deep Palpation of the Abdomen
Repeat palpation with gentle deep pressure using the palmar
surface of the fingers to feel for abdominal masses
We palpate spleen,liver,and kidney
PALPATION OF THE LIVER
Surface anatomy of the liver (Upper
border of the liver is at the 5th rib and lower anterior border extend to the
costal margin
Start from the right iliac fossa,
making the way to the right upper
quadrant, asking the patient to take a deep breath as you proceed upwards.
Press with the radial surface of the
index finger to feel the lower liver edge as it moves during inspiration.
vNormal liver span :
- 6
months = 5 cm .
- 3
years = 7 cm .
-
10 years = 8-10 cm .
-
adolescence = 9-12 cm
PALPATION OF THE SPLEEN
Start palpation at the right iliac fossa
towards the left costal margin whilst asking the patient to take a deep breath.
Wrap the palmar surface of the left hand
around the back and side of the left lower rib cage
Percussion
Helps to identify the amount and
distribution of
gas and to identify possible masses that
are solid
or fluid
•
Can be used to assess size of liver and spleen
•
Large dull areas may indicate an underlying mass;
PERCUSSION OF THE LIVER
Percuss for the lower edge of the liver
from the right iliac fossa.
For the upper liver edge starting from
the upper chest .
PERCUSSION OF THE SPLEEN
Start from the right iliac fossa towards
the left upper quadrant up to the ninth intercostal space anterior to the
anterior axillary line.
AUSCULTATION
Listen for bowel sounds
Bowel sounds--- metallic tinkling sound/
10 to 30 seconds (5 bowel sound/min.)
Hyperactive: diarrhea.
Hypo activity or absent: obstructive
bowel.
LABROTORY DIAGNOSIS
Abdominal ultrasonography
To visualize abdominal organ &
vessels.
-
Indication:
Abdominal pain, vomiting,
abdominal masses
Abdominal X-ray
Indication:
Constipation, abdominal
distension, forging body, ascites.
Liver function tests
Lower endoscopy (colonoscopy) .
Stool culture .
Urea breath test : Helicobacter pylori
infection
Barium or contrast enema
Stool for occult blood
Serum electrolyte
Indication
-
To determine
extent of dehydration.
-
Stool analysis
-
CBC
Cardinal Signs and Symptoms of GIT disorders :
• Abdominal Pain
• Nausea, Vomiting or Regurgitation
• Dysphagia
• Hematemesis
• diarrhea & constipation
• melena
Common GI Problems of Infants and Children
Diarrhoea
Vomiting
Constipation
Acute abdominal pain
STOMATITIS,oral thrush
Worm infestation
Gastroesophageal Reflux Disease
STOMATITIS
Inflammation of the oral mucosa (mouth)
It is most common in children 1-2 years
old.
Causes: trauma, organisms, irritants,
nutritional deficiency, diseases.
S/S: swelling, pain, ulcerations,
excessive salivation, halitosis, sore mouth,refusal feeding
Treatment: Acyclovir is commonly used.
pain relief, oral hygiene, soft diet.
NURSING CARE
Washing hands any items that come into
contact with child mouth.
Tech child to washing hand frequently
Do not share drinks, food, or eating with
siblings.
Give child plenty of cool liquids, Ice
chips to help ease mouth pain.
Soft foods, Clear liquids, milk, is
preferred.
Use a straw if child has blisters on his lips or tongue
Oral hygiene
Don't give citrus juices (such as
orange juice and lemonade)
these will probably make the mouth
hurt more.
Rinse child mouth with warm water after
eat.
Gastroenteritis:-
also known as infectious diarrhea, is inflammation
of the gastrointestinal tract -- the stomach and small intestine.
Symptoms may include
Diarrhea,
vomiting,
Abdominal pain.
Fever,
lack of energy,
dehydration
may also occur
Prevention includes
hand washing
drinking clean water,
proper disposal of human waste,
Breastfeeding
babies instead of using formula.
Rotavirus
vaccine
Diarrhea:
• Definition:
An increase in the fluidity, volume and
frequency of stools.
• Acute diarrhea:
Short in duration (less than 2 weeks).
• Chronic diarrhea:
4
weeks or more
Major cause of infant mortality in
developing countries
Primarily viral or bacterial
Most commonly viral, usually d/t
rotaviruses or adenoviruses
Bacterial pathogens usually are Common. ,
salmonella, Giardia, and Camplyobacter
Rotavirus Diarrhea
Most common cause of severe, dehydrating
diarrhea
Strikes almost all children at least once
in the first 5 years of life
Primary prevention: breastfeed for at
least 6 mos to get antibody and vaccination.
Etiology of Diarrhea(infant)
Acute Diarrhea
Gastroenteritis
Systemic infection
Antibiotic association
Overfeeding
Chronic Diarrhea
Post infections
Irritable colon syndrome
milk
protein intolerance
Types of Diarrhea
• Acute watery diarrhea: (80% of cases)
Dehydration
Malnutrition
• Dysentery: (10% of cases)
• visible fresh blood in stool
Anorexia/weight loss
Damage to the mucosa
• Persistent diarrhea: (10% of cases)
Dehydration
Malnutrition
Dehydration
definition
Dehydration is the excessive loss of
water and body salts .
Types of dehydration :
q according plasma Na concentrate :
1.
Isotonic
“ more than 75% of
cases:
(
water loss = sodium loss)
2.
Hypertonic:
(
loss of water greater than sodium )
2.
Hypotonic
:
(
loss of sodium greater than water )
q according S&S :
Ø mild - loss
less than 5%
Ø moderate -
loss 5 -
10%
Ø sever -
loss more than 10 %
v using 5 item dehydration scale (general appearance,
eyes, mucous membranes, tears , fontanel ) .
Assessment of Dehydration
The management of dehydration :
Classify to three plan according to
S&S :
A.
plan ( A ) :
for mild dehydration :
§ give more fluid after each stool loose
- 50
- 100
ml / for less than 2 years
- 100 - 200 ml /
for more than 2 years
§ O.R.S , water
, home made fluid , breast milk
§ BY :
spoon
, cup , dropper , syringe .
B. plan (
B ) :
for moderate dehydration
- 75 ml / kg in 4 / hours
§ By :
all method of plan A + NGT
C. Plan
( C ) :
for sever dehydration
§ gives
-
ringer lactate
-
poly electrolyte
-
normal saline
100
ml / kg :
- 30 ml / kg
through first 3 - 6 /
h
- 70 ml / kg second
By :
IV administration .
O R S
oral rehydration solution it ,s mixture
of water ,glucose and electrolyte used to correct or prevent dehydration .
ORS is a great way to replace fluids and
nutrients lost through vomiting and diarrhea
ORS is safe for babies and older
children.
ORS can come in several forms, including
a powder that you mix with water, a liquid that is already mixed and as frozen
popsicles.
Composition of ORS :
q the nursing should be advice the mother :-
The children less than one year of age,
give (two to three teaspoons) every half hour for one to two hours.
The children over one year, give double
above amounts.
Anti-diarrheal medications are not
recommended for infants and children.
Record fluid intake and urine output.
(dry
diapers for longer than usual may indicate dehydration).
Checking weight 2 to 3 times per day in
babies and children to check fluid replacement.
How to give ORS
Tap water is used (no boiling )
Given by cup &spoon .
Given by nasogastric tube :
(vomiting
– shock )
I.V rehydration .
(sever
dehydration –coma –sever
abdominal distension).
Put the contents of the ORS packet in a
clean container. Check the packet for directions and add the correct amount of
clean water. Too little water could make the diarrhea worse.
Add water only. Do not add ORS to milk,
soup, fruit juice or soft drinks. Do not add sugar.
Do not use a bottle .
If ORS is not available :-
Give the child a drink made with 6 level
teaspoons of sugar and 1/2 level teaspoon of salt dissolved in 1 liter of clean
water.
Be very careful to mix the correct
amounts. Too much sugar can make the diarrhea worse. Too much salt can be
extremely harmful to the child.
Nursing diagnosis
q Deficient Fluid Volume related to diarrheal stools
q Impaired Skin Integrity related to constant presence
of diarrheal stools
q Hyperthermia related to dehydration
q Imbalanced Nutrition: Less Than Body Requirements
related to malabsorption of nutrients
Worm Infestation
o Medical term- “Helminthiasis”
o Most common infection worldwide
o Includes different worms like
n Hookworm
n Roundworm
n Pin worms
How are Helminthes Transmitted
o Contaminated food
o Contaminated water
o Habits like eating mud in children (“Pica”)
Predisposing Factors
o Unsanitary conditions
o Malnutrition
o Improperly cooked meals
o Improper hygiene
WORM INFESTATION- SYMPTOMS
o Abdominal pain
o Nausea/vomiting
o Diarrhea
o General malaise & weakness
o Anemia
n Retarded physical growth & development in
children
o Intestinal obstruction
Drugs used for Deworming
o Albendazole
o Mebendazole
o Levamiso
o Ivermectin
Signs/Symptoms
Nausea, vomiting, feeling of fullness,
pain in stomach, indigestion, With
chronic may have only mild indigestion
Treatment
Treat symptoms, and fluid replacement
Medications:
antacids, H2 receptor blockers, B 12 injections, corticosteroids analgesics,
antibiotics if H Pylori
frequent meals
Eliminate the cause
surgical intervention
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