The document describes the anatomy and functions of the gastrointestinal tract, from the mouth to the anus. It explains the role of various organs like the liver, gallbladder, and pancreas in digesting food. The document also covers common conditions that can affect parts of the GI tract, like oral cancer, esophageal cancer, and stomach cancer, including their causes, symptoms, diagnosis, and treatment.
3. The gastrointestinal tract (GIT)
consists of a hollow muscular tube
starting from the oral cavity, where
food enters the mouth, continuing
through the pharynx, oesophagus,
stomach and intestines to the rectum
and anus, where food is expelled.
5. The primary purpose of the
gastrointestinal tract is to
break food down into
nutrients, which can be
absorbed into the body to
provide energy
11. The Strategy
• Digestive enzymes are
secreted from cells lining
the inner surfaces of
various exocrine glands.
• The enzymes hydrolyze
the macromolecules in
food into small, soluble
molecules that can be
• absorbed into cells.
12. • IngestionThe Topology
• -Food placed in the mouth -Ground into finer
particles by the teeth,
• -Moistened and lubricated by saliva
• -small amounts of starch are digested by
the amylase present in saliva
• the resulting bolus of food is swallowed into
the esophagus and
• carried by peristalsis to the stomach.
14. • THE STOMACH
• The wall of the stomach is lined with millions
of gastric glands, which together secrete
400–800 ml of gastric juice at each meal.
Several kinds of cells are found in the gastric
glands
• parietal cells
• chief cells
• mucus-secreting cells
• hormone-secreting (endocrine) cells
15. • The Liver
• The liver secretes bile. Between meals it
accumulates in the gall bladder. When
food, especially when it contains fat,
enters the duodenum, the release of the
hormone cholecystokinin (CCK) stimulates
the gall bladder to contract and discharge
its bile into the duodenum.
• Bile contains:
• bile acids..
• bile pigments..
16. • The Hepatic Portal System
• Glucose is removed and converted into glycogen.
• Other monosaccharides are removed and converted into
glucose.
• Excess amino acids are removed and deaminated.
– The amino group is converted into urea.
– The residue can then enter the pathways of cellular
respiration and be oxidized for energy.
• The liver serves as a gatekeeper between the intestines and
the general circulation.
• the liver releases more to the blood by converting
its glycogen stores to glucose (glycogenolysis),
• converting certain amino acids into glucose (gluconeogenesis).
17. • The Pancreas
• The pancreas consists of clusters of endocrine cells
(the islets of Langerhans) and exocrine cells whose
secretions drain into the duodenum. Pancreatic fluid
contains:
• sodium bicarbonate (NaHCO3).
• pancreatic amylase
• pancreatic lipase
• 4 "zymogens
• trypsin
• chymotrypsin.
• elastase.
• carboxypeptidase
18. • The Small Intestine
Digestion within the small intestine produces a
mixture of disaccharides, peptides, fatty acids,
and monoglycerides.
• The Large Intestine (colon)
• The large intestine receives the liquid residue
after digestion and absorption are complete.
This residue consists mostly of water as well as
any materials that were not digested.
19. CONDITION NO-1
ORAL CAVITY CANCER
• There are several types of oral cancers, but
around 90% are squamous cell carcinomas
originating in the tissues that line the mouth
and lips. Oral or mouth cancer most
commonly involves the tongue. It may also
occur on the floor of the mouth, cheek
lining, gingiva (gums), lips, or palate (roof of
the mouth).
20. The Mouth
(Cavum Oris; Oral Or Buccal Cavity)
The cavity of the mouth is placed at the
commencement of the digestive tube . it is a
nearly oval-shaped cavity which consists of two
parts: an outer, smaller portion,
the vestibule, and an inner, larger part,
the mouth cavity proper.
22. SIGN AND SYMPTOMS
OF ORAL CANCER
• Common symptoms of oral cancer include:
• Patches inside your mouth or on your lips
White patches (leukoplakia)
–Mixed red and white patches
(erythroleukoplakia)
–Red patches (erythroplakia) are brightly
colored
23. • A sore on your lip or in your mouth
that won't heal
• Bleeding in your mouth
• Loose teeth
• Difficulty or pain when swallowing
• Difficulty wearing dentures
• A lump in your neck
• An earache
24. Diagnosis of oral
cancer
• HISTORY OF THE PATIENT
• PHYSICAL EXAMINATION OF THE MOUTH
• Biopsy
• Dental x-rays
• Chest x-rays:
• CT scan:
• MRI:
32. Treatment for oralcancer
• surgery, radiation therapy,
or chemotherapy. Other health
care include a dentist, speech
pathologist, nutritionist,
and mental healthcounselor.
33. 1-Surgery
• Maxillectomy (can be done with or
without Orbital exenteration)
• Mandibulectomy (removal of the mandible or
lower jaw or part of it)
• Glossectomy (tongue removal, can be total, hemi
or partial)
• Radical neck dissection
• Moh's procedure or CCPDMA
• Combinational e.g. glossectomy and laryngectomy
done together.
• Feeding tube to sustain nutrition
34. • •partial maxillectomy removes portions of maxilla, incisive
bone, palatine bone ± portions of the zygomatic and
lacrimal bones
• •premaxillectomy: unilateral or bilateral with removal of
incisive bone and perhaps rostral maxilla
• •central maxillectomy: maxilla and portions of hard palate
resected
• •caudal maxillectomy: maxilla, hard palate, zygomatic, and
lacrimal bones removed
• •hemimaxillectomy: removal of entire maxilla on 1 side
extending dorsally to ventral orbit
• •orbitectomy: removal of orbit ± caudal maxilla and
vertical mandibular ramus
•
36. POSTOPERATIVE
MANAGEMENT
• sedation may be required if anxious
when cannot nose breathe
• •analgesic drug
• • nutrition-
• Cosmetic Appearance
37. COMPLICATIONS
• Oronasal Fistula
• Mucosal Ulceration on Labial Flap or Lateral Skin of Lip
• Hemorrhage
• Infection
• Sneezing and Nasal Discharge
• Epiphora
• Other Complications
• •prehension and mastication problems, pain, cosmetic
alterations, dehiscence, infection, tumor recurrence,
subcutaneous emphysema, and failure to nose breathe
•
40. • Esophageal cancer (or oesophageal
cancer) is malignancy of the esophagus.
There are various subtypes, primarily
squamous cell cancer and
adenocarcinoma , Squamous cell cancer
arises from the cells that line the upper
part of the esophagus. Adenocarcinoma
arises from glandular cells that are
present at the junction of the esophagus
and stomach
41. • Classification
• Most esophageal cancers fall into one of two
classes: squamous cell carcinomas, which are
similar to head and neck cancer in their
appearance and association with tobacco and
alcohol consumption, and adenocarcinomas,
which are often associated with a history of
gastroesophageal reflux disease and Barrett's
esophagus.
42. Signs and symptoms
• Dysphagia (difficulty swallowing) and
odynophagia (painful swallowing
• Pain behind the sternum or in the
epigastrium, often of a burning,
heartburn-like nature, may be severe
• Another sign may be an unusually husky,
raspy, or hoarse-sounding cough, a result
of the tumor affecting the recurrent
laryngeal nerve
43. • nausea and vomiting,
• regurgitation of food,
• coughing and an increased risk of aspiration
pneumonia.
• The tumor surface may be fragile and bleed,
causing hematemesis (vomiting up blood).
• upper airway obstruction
• superior vena cava syndrome
• Fistulas may develop between the esophagus
and the trachea, increasing the pneumonia
risk; this condition is usually heralded by
cough, fever or aspiration.
44. • If the disease has spread
elsewhere, this may lead to
symptoms related to this: liver
metastasis could cause jaundice
and ascites,
• lung metastasis could cause
shortness of breath, pleural
effusions, etc.
45. Causes
• Barrett's esophagus is considered to be a risk
factor for esophageal adenocarcinoma.
• There are a number of risk factors for
esophageal cancer.
• Age - most patients are over 60, and the
median in US patients is 67.
• Sex - the disease is more common in men.
• Heredity - it is more likely in people who have
close relatives with cancer.
• Tobacco smoking and heavy alcohol
46. • Gastroesophageal reflux disease (GERD
• Human papillomavirus (HPV)
• Corrosive injury
• A medical history of other head and neck
cancers increases
• Plummer-Vinson syndrome(anemia and
esophageal webbing)
• Tylosis and Howel-Evans
syndrome(hereditary thickening of the
skin of the palms and soles)
47. • Radiation therapy for other conditions
in the mediastinum
• Coeliac disease predisposes towards
squamous cell carcinoma.
• Obesity
• Thermal injury as a result of drinking
hot beverages
• Alcohol consumption in individuals
predisposed to alcohol flush reaction
• Achalasia
57. Types of
esophagectomy:
• The thoracoabdominal approach opens the
abdominal and thoracic cavities together.
• The two-stage Ivor Lewis (also called Lewis-
Tanner) approach involves an initial
laparotomy and construction of a gastric
tube, followed by a right thoracotomy to
excise the tumor and create an
esophagogastric anastomosis.
58. • The three-stage McKeown approach
adds a third incision in the neck to
complete the cervical anastomosis
• Laser
• Photodynamic therapy,
• Chemotherapy
• Radiotherapy
59. CONDITION NO-3
STOMACH CANCER
• Stomach cancer, or gastric cancer,
refers to cancer arising from any
part of the stomach. Stomach
cancer causes about 800,000
deaths worldwide per year
60. Signs and symptoms
• Endoscopic image
of linitis plastica, a
type of stomach
cancer where the
entire stomach is
invaded, leading
to a leather
bottle-like
appearance with
blood coming out
of it.
61. • Discomfort or pain in the stomach
area
• Difficulty swallowing
• Nausea and vomiting
• Weight loss
• Feeling full or bloated after a small
meal
• Vomiting blood or having blood in
the stool
62. • Stage 1 (Early)
• Indigestion or a burning
sensation (heartburn)
• Loss of appetite, especially for
meat
• Abdominal discomfort or
irritation
63. • Stage 2 (Middle)
• Weakness and fatigue
• Bloating of the stomach,
usually after meals
64. • Stage 3 (Late)
• Abdominal pain in the upper abdomen
• Nausea and occasional vomiting
• Diarrhea or constipation
• Weight loss
• Bleeding (vomiting blood or having blood in
the stool) which will appear as black. This
can lead to anemia.
• Dysphagia; this feature suggests a tumor in
the cardia or extension of the gastric tumor
in to the esophagus..
65. Causes
• Infection by Helicobacter pylori.
• gastritis, intestinal metaplasia and various
genetic factors
• smoked foods, salted fish and meat, and
pickled vegetables
• Nitrates and nitrites are substances
commonly found in cured meats.
• Smoking increases the risk of developing
gastric cancer
66. • consumption of alcohol.
• Alcohol along with tobacco smoking increase
the risk of developing other cancers .
• Gastric cancer shows a male predominance
in its incidence as up to three males are
affected for every female
• Some researchers showed a correlation
between Iodine deficiency or excess, iodine-
deficient goitre and gastric cancer
67. Diagnosis
• To find the cause of symptoms,
asks about the patient's medical
history, does a physical exam,
and may order laboratory
studies. The patient may also
have one or all of the following
exams:
71. • Various blood
tests may be
done; including:
Complete Blood
Count (CBC) to
check for
anemia. Also, a
stool test may be
performed to
check for blood
in the stool.
73. • These are the stages of stomach cancer:
• Stage 0: The tumor is found only in the inner
layer of the stomach. Stage 0 is also called
carcinoma in situ.
• Stage I is one of the following:
– The tumor has invaded only the submucosa.
Cancer cells may be found in up to 6 lymph
nodes.
– Or, the tumor has invaded the muscle layer or
subserosa. Cancer cells have not spread to
lymph nodes or other organs.
74. • Stage II is one of the following:
–The tumor has invaded only the
submucosa. Cancer cells have spread to
7 to 15 lymph nodes.
–Or, the tumor has invaded the muscle
layer or subserosa. Cancer cells have
spread to 1 to 6 lymph nodes.
–Or, the tumor has penetrated the outer
layer of the stomach. Cancer cells have
not spread to lymph nodes or other
75. • Stage III is one of the following:
–The tumor has invaded the muscle layer
or subserosa. Cancer cells have spread to
7 to 15 lymph nodes.
–Or, the tumor has penetrated the outer
layer. Cancer cells have spread to 1 to 15
lymph nodes.
–Or, the tumor has invaded nearby organs,
such as the liver, colon, or spleen. Cancer
cells have not spread to lymph nodes or
to distant organs.
76. • Stage IV is one of the following:
–Cancer cells have spread to more than 15
lymph nodes.
–Or, the tumor has invaded nearby organs
and at least 1 lymph node.
–Or, cancer cells have spread to distant
organs
78. 1-Surgery-----Total
gastrectomy
• 2- Chemotherapy
• The use of chemotherapy to treat stomach cancer has no
firmly established standard of care.
• Some drugs used in stomach cancer treatment have
included:
• 5-FU (fluorouracil) or its analog capecitabine,
• BCNU (carmustine), methyl-CCNU (Semustine), and
• doxorubicin (Adriamycin), as well as Mitomycin C, and
• more recently cisplatin and taxotere, often using drugs in
various combinations
79. • 3-Radiation therapy
• Nutrition
• Nutrition after stomach surgery
• Some people have problems eating and drinking after
stomach surgery. Liquids may pass into the small intestine
too fast, which causes dumping syndrome. The symptoms
are cramps, nausea, bloating, diarrhea, and dizziness. To
prevent these symptoms, it may help to make the following
changes:
• Plan to have smaller, more frequent meals (some doctors
suggest 6 meals per day)
• Drink liquids before or after meals
• Cut down on very sweet foods and drinks (such as cookies,
candy, soda, and juices)
80. • Supportive care
• Stomach cancer and its treatment can lead to
other health problems. You can have supportive
care before, during, and after cancer treatment.
• Supportive care is treatment to control pain and
other symptoms, to relieve the side effects of
therapy, and to help you cope with the feelings
that a diagnosis of cancer can bring. You may
receive supportive care to prevent or control
these problems and to improve your comfort
and quality of life during treatment.
•
81. CONDITION NO-4
Colorectal cancer
Colorectal cancer, commonly known as
bowel cancer, is a cancer from
uncontrolled cell growth in the colon or
rectum (parts of the large intestine), or in
the appendix. Symptoms typically include
rectal bleeding and anemia which are
sometimes associated with weight loss
and changes in bowel habits.
82. Signs and symptoms
• worsening constipation,
• blood in the stool,
• weight loss,
• fever,
• loss of appetite,
• nausea or vomiting in someone over 50
years
• While rectal bleeding or anemia are high-
risk features in those over the age of 50,
83. Cause
• Greater than 75-95% of colon cancer occurs in
people with little or no genetic risk.
• While some risk factors such as older age and male
gender cannot be changed many can.
• A high fat, alcohol or red meat intake are risk
factors for colorectal cancer .
• obesity,
• smoking
• a lack of physical exercise.
• Inflammatory bowel disease
84. Diagnosis
• Appearance of
the inside of
the colon
showing one
invasive
colorectal
carcinoma (the
crater-like,
reddish,
irregularly
shaped tumor).
85. • Diagnosis of colorectal cancer is via tumor
biopsy typically done during
sigmoidoscopy or colonoscopy.
• The extent of the disease is then usually
determined by a CT scan of the chest,
abdomen and pelvis.
• There are other potential imaging test
such as PET and MRI which may be used in
certain cases. Colon cancer staging is done
next and based on the TNM system .
92. Management
• Surgery
• . This can either be done by an
open laparotomy or sometimes
laparoscopically. If there are only
a few metastases in the liver or
lungs they may also be removed.
93. • Chemotherapy
• . Chemotherapy drugs may include
combinations of agents including
fluorouracil, capecitabine, UFT,
leucovorin, irinotecan, or oxaliplatin.
• Radiation
• Palliative care
96. • Find the condition of the patient disease
symptoms
• Watch the vital sign of the patient
• Watch the site of the operation for bleeding
or infection
• Maintain proper position after surgery.
• Provide proper and safe environment after
surgery.
• Maintain proper intravenous fluid therapy as
per doctor order.
• Observe patient for any abnormal
97. • Common nursing
diagnosis related to
cancer of G I tract
with nursing intervention
98. 1)-knowledge deficit relted
to disease condition
• Intervention-
• Determine present knowledge base and
concerns regarding the diagnosis of disease.
• Discuss the treatment plan and explain the
expected effects of treatment.
• Provide written information about cancer
treatment and disease condition.
•
99. 2) body image disturbance
• Intervention-
• Encourage patient to verbalize feeing both positive
and negative about actual changes.
• Acknowledge the appropriateness of patient’s
response to the change and loss of body fuction and
control.
• Encourage the patient to look at, touch and care of
the stoma.
• Identify and include family members in education and
care of ostomy site.
• Identify at risk for unsuccessful adjustment to body
image change as evidence by –
• 1 --lack of motivation
100. 3) Altered nutrition less than body
requirement
• Intervention-
• Assess nutritional status ,current, weight, appetite,
food and caloric intake.
• Monitor serum level of the patient.
• Assess for sign and symptoms that interfere with
nutritional intake.
• Educate the patient about the sign and symptoms
of treatment that can interfere with adequate
nutritional intake.
• Determine time of day when appetite may be
greater.
101. 4) Ineffective Airway clearance-
Intervention
Assess patient’s ability to swallow liquids and solid
foods
Assess breathing sound,rate and depth of
respiration at rest .
Assess patient’s ability to clear secretions,cough
mechanism and amount of sputum.
Administer oxyzen therapy as required.
Educate patient for self care of cough .
102. 5) Diarrhea
• Intervention-
• Assess hydration level of the patient.
• Monitor intake and output
• Provide law residue, bland, high protein diet.
Avoid too hot and too cool diet.
• Give fluids, avoid fluids such as orange juice,
milk, alcoholic beverages.
• Monitor serum level of patient.
• Administer antidiarrheal treatment
• Provide skin care to perineal area.
103. 6) Altered oral mucous membrane
• Intervention
• Assess mucous membrain for
pain,ulcers,lesions and dryness.
• Monitor oral intake.
• Encourage oral care.
• Teach patient for oral care protocol.
• Teach patient for sign and symptoms for
bleeding.
• Keep lips moist and lubricanted.