1 / 33

ANATOMY & PHYSIOLOGY OF THE BOWEL Gill Nottidge Continence Nurse Specialist

ANATOMY & PHYSIOLOGY OF THE BOWEL Gill Nottidge Continence Nurse Specialist. CC01 Assess bladder and bowel dysfunction.

amaranta
Download Presentation

ANATOMY & PHYSIOLOGY OF THE BOWEL Gill Nottidge Continence Nurse Specialist

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. ANATOMY & PHYSIOLOGY OF THE BOWEL Gill Nottidge Continence Nurse Specialist

  2. CC01 Assess bladder and bowel dysfunction • an in-depth understanding of the anatomy and physiology of the male and female lower gastro intestinal tract in relation to lower bowel function and continence status including: • a) stool production and what influences this • b) normal defaecation • c) the nervous system including autonomic dysreflexia • d) the bowel • e) the pelvic floor/complex and anal sphincter muscles • f) the endocrine system • g) reflexes

  3. Digestion period • Stomach: • 3hours – converted to chyme • Small intestine: • 4 – 6 hours • Large intestine: • 12 – 72 hours

  4. Absorption – Minerals, water, fats, medicines Secretion – Enzymes secreted by the small intestine Mucus secreted by the colon to help lubricate the faeces Synthesis – Synthesises some vitamins Storage – unabsorbed food residue Elimination – Propulsion of faecal matter and absorption of fluid 5 Main functions of the bowel

  5. Small intestine • Duodenum 12 ins • Jejunum 5-8 feet • Ileum 16-20 feet • Goblet cells in the mucosa produce mucus. • The duodenum is the major portion of the small intestine where enzyme secretion takes place.

  6. Absorptive surface in adults 7600cm Lined with villi to increase surface area 90% of our daily fluid intake is absorbed in the small intestine Small intestine

  7. Large intestine • 5-6 feet in length • Caecum with appendix • Ascending colon • Transverse colon • Descending colon • Sigmoid colon

  8. Structure of intestine • Small & large intestine has 4 layers • Peritoneal • Muscular • Submucosal • Mucosal

  9. 2-3 mass peristaltic movements per day Stimulated by consumption of food and warm drinks Peristalsis

  10. Excretion • How does it work? • Muscles work together to propel waste matter (Peristalsis) • During process substances not absorbed by the body becomes faeces • Faeces arrives in rectum to be expelled

  11. +

  12. Pelvic floor muscles • Supports the pelvic organs • Contraction causes urethral compression – helps maintain continence during abdominal pressure • Collectively called “Levator Ani” • Striated muscle slow and fast • muscle fibres (under Voluntary control)

  13. Full rectum Adopt correct posture Raise intra-abdominal pressure Internal and external anal sphincters relax Rectum contracts to expel stool Should pass soft formed stool with minimal effort Sphincter “snaps shut” after completion “Normal” 3 times / day to 3 times / week Normal Defaecation

  14. Correct position

  15. Bristol Stool Chart

  16. What affects the bowel? • Poor diet • Lack of fluid • Mobility • Medications • Surgery

  17. Continence is Complex • Anal sphincters (structural integrity, residual function if damaged) Internal anal sphincter - passive stool retention External anal sphincter- control of urge to stool • Pelvic floor and mucosal seal • Sensory function and co-ordination • Stool consistency (e.g. diet) • Gut motility • Emotional factors • Lifestyle and toilet access

  18. Effect of endocrine system • Pancreas – Diabetes • Adrenal glands – fight/flight • Corticotrophin-releasing factor (CRF) – (Stress hormone) eg. IBS

  19. Nervous system • Vagus nerves – stimulate acid secretion • Intestine – sympathetic and parasympathetic nerve supply - sub mucosa • Internal sphincter – autonomic (smooth muscle) • External sphincter – under voluntary control (striated muscle)

  20. Reflexes • Anal wink • Anal reflex • Perineal reflex • Reflexive contraction of external anal sphincter on touching/stimulation

  21. WHAT ISAUTONOMIC DYSREFLEXIA? • It develops after spinal cord injury/ lesion at or above T6 • Exaggerated response of nervous system to localised trigger below level of spinal cord injury • This causes an sudden extreme rise in blood pressure • It can occur without warning and is a medical emergency

  22. Autonomic Dysreflexia • Normally a harmful stimulus causes the autonomic nervous system to respond resulting in a rise in blood pressure. • If T6 lesion or above present, stimulus below the injury causes BP to rise, but autonomic nervous system does not act to lower it below the lesion. • Therefore BP continues to rise until stimulus is removed • Autonomic nervous system attempts to lower BP above lesion: this causes the symptoms that aid the diagnosis of AD

  23. Signs and symptoms • Stuffy nose / nasal obstruction • Severe pounding headache, usually frontal • Raised BP (by 20mm/hg) / bradycardia • Cutis anserina (goose bumps) above and possibly below level of SCI and shivering • Flushing above level of lesion due to vasodilatation • Reduced urine output • Blurring vision – spots before eyes • Increased spasms

  24. What Goes Wrong? • Anal sphincter (childbirth, injury, iatrogenic damage, degeneration) Internal - passive soiling; External - urge incontinence • Gut motility (infection, inflammation, radiation, hypermotility, emotions) • Stool consistency (diet, motility, anxiety)

  25. What Goes Wrong? • Local pathology (prolapse, piles, fistula) • Neurological damage (motor or sensory) • Lifestyle, toilets, drugs, immobility, frailty • Impaction with “overflow diarrhoea” most common in frail dependent individuals

  26. Facts • Annual spend on laxatives in the UK is £50 million per year. (DH 2001) • The UK has the highest incidence of bowel cancer in the world with 20,000 new cases per year • One in three people consulting GPs have a bowel problem • Bowel disorders such as irritable bowel syndrome, colitis, crohns disease and diverticulitus affect 1:250 people in the UK (National association for colitis and crohn’s disease 2010)

  27. Constipation!

  28. Thank you for your attention. Any questions? Gill Nottidge Tel: 01274 322210 Gillian.nottidge@bradford.nhs.uk

More Related