Module 11 GIT (Gastro-Intestinal Tract)

DIGESTIVE SYSTEM
Digestive system acts upon ingested food, mechanically and chemically
Processing it to be used to nourish individual cell of body

1 Anatomy of the digestive system

 Consists of:
o Mouth
o Salivary glands
o Pharynx
 Oropharynx
o Oesophagus
o Stomach
o Small intestines
o Large intestines
o Appendix
o Liver
o Gallbladder
o Pancreas
o Rectum and anus

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1.1 Mouth
 Consists of
o Lips
o Cheeks
o Gums
o Teeth
o Tongue
 Mucous membrane lines mouth
 Hard palate in bony plate lying anteriorly
 Soft palate – fold of mucous membrane and muscle that extends posteriorly from hard palate to throat
 Soft palate designed to:
o Hold food being chewed
o Help initiate swallowing
 Food grounded into small pieces by teeth and tongue

1.2 Salivary glands

 6 salivary glands
o Two salivary glands under the tongue
o One each side of jaw
o One inside each cheek
 They produce 1.5L of saliva daily
 Saliva 98% water
 Remaining 2% composed of mucus, salt, organic compounds
 Saliva severs as binder for chewed food being swallowed also lubricant within mouth
 Salivary glands also secrete enzymes
 Enzymes being chemical breakdown of starch

1.3 Pharynx
 Share by respiratory AND digestive system
 Lies between nose and oesophagus/larynx
o Oesophagus is pipe that goes to the stomach

 Nasopharynx
 Oropharynx

1.3.1 Oropharynx
 Tubular structure
 Extends vertically from back of mouth to oesophagus and trachea (+-12.5cm)
 Automatic movement of pharynx during swallowing lifts larynx causing epiglottis to close over pharynx
o So solids / liquids move into oesophagus and away from trachea

1.4 Oesophagus
 Soft tube +-25cm long
 Extends from end of pharynx to stomach
 Lies anterior to spinal column in chest
 Peristalsis
o Muscles in wall of oesophagus contract
o This propelling food towards to stomach

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1.5 Stomach
 Hollow organ - Upper left quadrant of abdominal cavity – protected by lower left ribs
 Food entering stomach
o Mixed with digestive chemicals + gastric juices by muscular action to form semi-solid mass
 Stomach produces +- 1.5L of gastric juices daily
 Small quantities of semi-solid mass released into small intestine
 1-3hours – semi-solid mass from one meal is propelled into small intestine

1.6 Pancreas
 Flat solid organ – upper left quadrant – below + behind stomach and liver
 Fixed within position deep within abdomen + not easily damaged
 Contains two sets of glands
 One set – secrets +-2L pancreatic juices daily
o Pancreatic juice contain many enzymes – aid in digestion of fat, starch and protein
o Pancreatic juice flow directly into duodenum through pancreatic ducts
 Islets if Langerhans (other gland)
 Produces insulin
 Insulin secreted directly into blood stream
 It regulates amount of glucose in blood

1.7 Liver
 Large solid organ – lies behind diaphragm – right upper quadrant
 Large mass of blood vessels and cells packed tightly together
 Fragile organ – largely protected by lower ribs
 Poisonous substances produces by digestion – brought to live and rendered harmless
 Liver forms necessary factors for blood clotting and production of normal plasma
 +-0.5L – 1L of bile made by liver daily to assist in normal digestion of fat
 Principal organ for storage of sugar / starch for immediate use by body for energy
 Produces many factors aiding in regulation of immune response
 All blood pumped to GIT passes through liver before returning to heart
 +-1.5L blood passes through liver per minute

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1.8 Gallbladder
 Liver connected to intestine by bile ducts
 Gallbladder sits under liver + connected to small tubes / ducts and store bile produces by liver
 Gallbladder discharges stored +concentrated bile into duodenum through common bile duct
 Usually contains 60-90ml of bile

1.9 Small intestines

 Major hollow organ of abdomen – lies coiled in front of abdomen (in all four quadrants)
 Hangs freely in abdominal cavity
 Suspended by tough membrane called The Mesentery
o The Mesentery also carry blood vessels of GIT
 +- 3.3m long – divided into three section
o Duodenum (30cm)
o Jejunum (1.5m)
o Ileum (1.5m)
 Cells lining small intestines produce enzymes and mucus to assist in digestion
 Enzymes from pancreas + small intestines carry out final process of digestion
 Food moved through small + large intestine by wave like contraction of walls of intestines
o This called peristalsis

1.10 Large intestines

 +- 1.5m long hollow organ (in all four quadrants)
 Consists of:
o Cecum
o Colon
o Rectum
 Major functions:
 Absorption of fluids + formation of solid stool – stored in rectum
 Stool then passed out body via anus

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1.11 Appendix
 Small close tube – attached to first part of large intestine (cecum)
 Lower right quadrant
o May easily become infected / inflamed / obstructed
o This called appendicitis
o One of major causes of abdominal distress
 Appendix has no know major function in body

1.12 Rectum and anus

 Lowermost section of colon
 Large hollow organ
 Adapted to store quantities of faeces until expelled
 End of rectum is anus
 Rectum and anus supplied with circular muscle
o Called sphincters
o Sphincters control escape of solids / liquids / gases

1.13 How digestion works

 From time taken into mouth until essential compounds extracted and delivered by circulatory system to nourish
all cells in body:
 Different secretions (mainly enzymes) added to food by:
o Saliva glands
o Stomach
o Liver
o Pancreas
o Small intestine
 Converts food into basic sugars, fatty acids and amino acids
 These basic products carried across wall of intestine and transported via portal vein to liver
 In liver – products processed further and sorted or transported to heart via veins draining liver
 Heart pumps nutrients rich blood via arteries and eventually capillaries walls to nourish individual cells

 8L – 10L of fluid secreted daily into GIT (with/without food intake)

 Fluid comes from
o Salivary glands
o Stomach
o Liver
o Pancreas
o Small intestine
 If vomiting / diarrhoea more than 2 – 3 days pt. loses substantial portion of body composition and become
hypovolemic

2 Clinical conditions – Acute abdominal

2.1 Acute abdominal definition
 Intra-abdominal condition which may worsen / become life-threatening within short period of time
 Infection / inflammation / rupture of viscus / other structure usually cause for acute abdomen
 Imperative – NO delay in transporting these pt. to hospital
o Due to large number of organs / structures in abdomen that may become diseased / disorder that
may become life-threatening

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2.2 Common causes acute abdominal

 Appendicitis
 Cholecystitis (inflammations of gallbladder)
 Perforated peptic ulcer (e.g. Duodenal ulcer)
 Obstruction of bowl (small / large intestine)
 Leak / ruptured abdominal aortic aneurysm
 Kidney stones
 Pancreatitis
 Infection of female internal genitalia (pelvic inflammatory disease)
 Ruptured ectopic pregnancy
 Miscarriage / spontaneous abortion
o Many of these conditions will be inflammatory / infection of peritoneum – peritonitis
o Leading to certain signs and symptoms

2.3 Signs and Symptoms acute abdominal

2.3.1 Signs acute abdominal definition

 Tachycardia (signs of shock)
 Low BP (signs of shock)
 Distended abdomen
 Tender abdomen – may be rigid
 Abdominal guarding
o Established peritonitis causes pain
 Depending on severity may be associate with tender / rigid abdomen

 Not all causes of acute abdomen due to structures in abdominal cavity

o Sometimes mimicked by e.g. heart attack / pneumonia
o Therefore examine pt. closely even if all points to abdomen

2.3.2 Symptoms acute abdominal

Pt. complaining of:
 Abdominal pain
o Pain may be mild / extreme
o Causing pt. to roll around / lie immobile for fear of making worse
 Visceral pain
o Cramping / gas type pain
o Generally diffused over entire abdomen
o Difficult to localize
o Usually indicates distension of hollow organs
 Somatic pain
o Usually constant + localized
o Sharp / stabbing pains
o Pt. will exhibit abdominal guarding
o Indications of inflammation – e.g. appendicitis
 Referred pain
o Pain felt in part of body distance away from actual site of problem
o Loss of appetite
o Nausea / vomiting
o Failure to pass stool (faeces) / change in other bowel habits

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2.4 Treatment acute abdominal

 ABC
 Oxygen
 Vital signs
 Entonox (if no-contra indications)
 Be aware of vomiting
 Nil per mouth
 Obtain history
 Avoid rough handling of pt.
 Transport ASAP (do not delay)
 Position appropriately
 Call for back up if needed

3 Abdominal trauma
 Classified:
o Close
o Open (penetrating)
 Most common organs involved
o Liver
o Spleen
o Intestines

3.1 Closed abdominal trauma

 Maybe caused by blunt force trauma / blows / compressions injuries
 Examples
o Pedestrian struck by vehicle
o Assault
o Sport injuries
o Seat belt
o Steering wheel
 As result of sudden deceleration
 May be difficult to assess – since bruising may be only signs present in pt. complaining of abdominal pain
 Much safer to assume laceration / rupture of abdominal viscus occurred in every case
o To prevent attitude of complacency

3.2 Open abdominal trauma

 Caused when abdominal wall is penetrated
 May result from gunshot / sharp object
 Penetrating injuries – trajectory of wounding object cannot be determined in field
 Awareness that structures above diaphragm may be effected
o E.g. abdominal contents may enter pleural space from penetrating wound in diaphragm
o And pt. may have respiratory problems
o Diaphragmatic herniation
 Large opening in abdominal wall may cause bowel to protrude from abdomen – evisceration
 Penetrating injuries – easier to assess
o However small puncture wounds e.g. assault with bicycle spoke / small calibre bullet wound may not
easily be visible – but may cause internal damage
 Presence of rapid pulse – with / without fall in BP MUST be taken seriously
o May indicate internal bleeding

3.2.1 Treatment and management open abdominal wounds

 ABC
 Oxygen

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 Stop bleeding / seal an wounds with dry moistened dressing

 Vital signs
 History
 Position pt. – Trendelenburg
o If unconscious place lateral
 Transport ASAP (do not delay)
 Call for back up if needed

3.3 Objects impaled in abdomen

 DO NOT remove object

3.3.1 Treatment and management objects impaled in abdomen

 ABC
 Stop bleeding
 Stabilize object with bulky dressing
 Keep pt. still
 Treat for shock
 Transport ASAP

3.4 Evisceration
 DO NOT attempt to reintroduce organ back into abdomen

3.4.1 Treatment and management evisceration

 ABC
 DO NOT administer Entonox
 Cover exposed organ(s) with moist sterile dressing
 Should then be covered with rescue blank / clean plastic wrapping
o In order to prevent heat loss / infection / haemorrhaging
 Edges of foil / plastic to be taped down onto pt. ensure good seal
 Call for back ASAP
 Transport ASAP

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