Anatomy & Physiology

Upper GI Tract – mouth,

esophagus, stomach
Mouth - buccal cavity –
entrance to the GI tract;
food is broken down &
mixed with saliva
Esophagus – at birth 10
cms. in length; 18-25
cms by adulthood
Upper esophageal
sphincter prevents the
reflux of esophageal
contents into
pharynx & lungs
Lower esophageal
sphincter prevents the
reflux of gastric contents
into the lower esophagus
Stomach – a muscular
pouch that receives the
bolus. Chyme is
produced by a mixture of
bolus & digestive juices
Chyme is propelled into
the pylorus & duodenum
Mucus bicarbonate
layer in the stomach acts
as a buffer to neutralize
acidity
Lower Gastrointestinal
System
Liver
Duodenum
Gall bladder
Pancreas
Jejunum
Ileum
Cecum
Appendix
Ascending colon
Transverse colon
Descending colon
Sigmoid colon
Rectum
Anus
Duodenum – 1st part of
the of the small
intestine; extends from
pylorus to jejunum
Partially digested
chyme enter the
duodenum; acted by
pancreatic enzymes &
bile for further digestion
of fats, carbohydrates &
proteins
Pancreas oblong in
shape gland located at
the back of stomach that
secretes enzymes that
aids in the digestion of
food & secretes insulin &
glucagon for the
maintenance of
Liver – largest organ of
the body; located under
the right diaphragm; it
predominantly lies in the
right upper quadrant
Functions:
Phagocytosis
Bile production
Detoxification
Glycogen storage &
breakdown
Vitamin storage
Gall bladder – sac-like
structure attached to the
underside of the right
lobe of the liver; stores
bile to be secreted into
the duodenum in the
presence of fats
Jejunum & ileum – form
the remainder of the
small intestine.
Absorption of Vitamin
B12 at terminal ileum
Absorption of nutrients
& vitamins happen here
through the microvilli &
villi by diffusion & active
transport
Cecum- the beginning
of the large intestine;
blind pouch about 2-3
inches long; begins in
the ileocecal valve
Ascending/transverse/d
es-cending colon forms
part of the large
intestine
Function of the large
intestine is for water
absorption
 that occurs in the cecum
& ascending colon
Intestinal bacteria aid in
the synthesis of Vitamin
B & K; & final breakdown
of bile
Secretes mucus &
peristalsis of waste
happen
Rectum – the last 7-8
inches of the digestive
tract
Anal canal- the last 1-2
inches of the digestive
tract
Stool is stored in the
rectum until the
distension of rectal walls
in preparation for the
defecation reflex
Diagnostics:
Fiberoptic endoscopy
Colonoscopy
Barium enema
Assessment:
GI disorders among
children can lead to
dehydration especially if
vomiting & diarrhea are
the presenting
symptoms
Assess for poor skin
turgor, dry mucous
membranes & lack of
tearing
Alert: All children with
diarrhea must be seen
by a health care provider
because of rapid change
in fluids & electrolyte
levels
Greater percentage of
fluid held extracellularly
rather than
intracellularly
Vomiting
forcible ejection of
stomach contents
through the mouth
Etiology:
Infections
Obstructions
Motion sickness
Metabolic alterations
Psychological alterations
Allergic reactions
Side effects of
medications
(chemotherapy)
Toxic effects of
medications

Manifestations:
Sour milk curds without
green or brown color
Undigested food
(stomach)
Diagnostic Evaluation:
CBC
Electrolyte studies
Blood Urea Nitrogen
(BUN)
Glucose levels
Urine tests
Radiographic studies
Blood cultures
Arterial blood gas
analysis
Assessment:
Major concern:
Dehydration
Fluid & electrolyte
imbalance
Accurate monitoring of
intake & output
Assess weight
Fontanels in infants
Skin turgor
Eyes/skin
Heart/respiratory rates
Determine/describe
type & force of vomiting
(regurgitation, projectile
vomiting)
Assess amount, color,
consistency, time (ACCT)
Nursing diagnoses:
Fluid volume deficit
Imbalanced Nutrition:
Less than Body
Requirements
Interventions:
Position child upright or
side lying
Educate family
regarding appropriate
feeding techniques (eg.
Burping)
Educate family
(avoiding certain foods)
fatty foods
Minimize stimuli ( stress,
anxiety)
Avoid unfavorable
smelling food
Therapeutic
Management:
Oral Rehydration
Treatment (ORT)
IV therapy (prolonged
vomiting
neonates/infants)
Anti-emetics
Dehydration
Fluid loss in excess of
fluid intake
Can cause fluid &
electrolyte deficiencies
Classification:
Isonatremic dehydration –
most common type of
dehydration in children
Water & electrolytes are
lost the same proportion
they exist in the body
Normal serum Na level
(135-145 mEq./L)
Hyponatremic
dehydration – electrolyte
loss greater than water
loss
Serum Na less than 130
mEq./L
Hypernatremic
dehydration – water loss
is greater than the
electrolyte loss
Serum Na concentration
above 150 mEq./L
Etiology:
GI tract- vomiting,
diarrhea, malabsorption
Endocrine system: -
fever, DM,
Skin – burns
Lungs – tachypnea
Kidneys - Renal failure
Heart - CHF
Neonates/infants –
vulnerable to the effects
of dehydration
Mild dehydration – 4-5%
loss of body weight; fluid
volume loss less than
50ml/kg
Moderate dehydration –
6-10% loss of body
weight; fluid volume loss
50-100 ml/kg.
Severe dehydration –
10% or more loss of
body weight; fluid
volume loss of 100 ml/kg
or more
Signs & symptoms of
Dehydration:
Fewer wet diapers (6-8
hours)
No tears when crying (if
older than 2-4 months)
Sticky/dry mouth
Irritability/high pitched
cry
Difficulty in awakening
Increased RR/DOB
Sunken
fontanels/sunken eyes
with dark circles
Abnormal skin color,
temperature or dryness
Signs of impending shock:
Changes in heart rate
Changes in sensorium
Urine output
Skin qualities
Fontanels (infants)
Pathophysiology:
Reduced fluid intake
Increased fluid loss
Vomiting, diarrhea,
fever,
hyperventilation/burns
Trauma, hemorrhage,
DM
Rapid ECF loss

Electrolyte
imbalance

ICF Loss
 Cellular
dysfunction

Hypovolemi
c shock

Death
Management:
Directed toward
correcting the fluid &
electrolyte imbalance &
then treating the
causative factors
Oral rehydration therapy
(Rehydralyte, Pedialyte,
Infalyte)
Rehydralyte (WHO’s
solution) – best source of
oral rehydration
Children (mild to
moderate dehydration)
50-100 ml/kg of ORT
over 4 hours
Parenteral fluid &
electrolyte therapy
Lactated Ringer’s
solution/0.9% NaCl
Assessment Parameters:
Intake & output
Urine output & Specific
gravity
Output < 2-3 ml./kg./hr –
infants & toddlers
1-2 ml/kg/hr –
preschoolers & young
school- age children
0.5 ml./kg/hr in school-
age children or
adolescents
Specific gravity above
Weight crucial indicator
of fluid status
Stools/vomitus
Sweating
Skin, Mucous
membranes & presence
of tears
Anterior fontanel
Vital signs/behavior
Nursing diagnosis
Fluid volume deficit
Diarrhea
One of the most
common disorders in
childhood
Increased in the
frequency, fluidity &
volume of stools
Gastroenteritis –
diarrhea caused by
infection
Acute diarrhea can lead
to dehydration,
electrolyte imbalance &
hypovolemic shock
Most common viral
pathogens - rotavirus &
adenovirus
Bacterial pathogens
include – Campylobacter
jejuni, Salmonella,
Giardia lamblia &
Clostridium difficile
Mild Diarrhea
Fever, anorectic,
irritable & appear unwell
2-10 loose, watery
stools per day
Dry mucous
membranes, rapid pulse,
warm skin
Normal skin turgor,
normal urine output
Management:
Rest the GI tract; 1 hour
after offer OHT
Ask parents to wash
hands after changing
diapers
Continue breastfeeding
Notify healthcare
provider if condition
worsens
Severe diarrhea
Rectal temperature is
high (103-104⁰) F
Pulse/RR weak & rapid
Skin pale/cool
Depressed fontanelle,
sunken eyes, poor skin
turgor
Bowel movement every
few minutes
Liquid green stool,
mixed with mucus &
Urine output is scanty &
concentrated
Elevated hemoglobin,
hematocrit & serum
protein levels
Treatment:
Focus is centered in
regulating electrolyte &
fluid balance
Oral or IV rehydration
therapy
Rest the GI tract
Identifying the
responsible organism
All children with severe
diarrhea must have a
stool culture taken
IV fluids – NSS or 5%
glucose in NS
Nursing diagnosis:
Fluid volume deficit