Professional Documents
Culture Documents
Overview
Functions:
digestion
absorption
elimination
Overview
Accessory organs
I. Salivary Glands - for mechanical
digestion (amylase:
ptyalin)
Parotid (below & in front of ears)
oSaliva produced- 1,200-1,500
ml/day
Sublingual
Submaxillary
Salivary Glands
MUMPS
Causative agent:
Paramyxovirus
Signs & Symptoms
swollen parotid gland
dysphagia
fever
chills
anorexia
MUMPS
MUMPS
MUMPS
Prevent Complications
Male
orchitis (puberty stage
sterility)
virus attacks the sperms
produced by Leydig cells
at seminiferous tubules
Orchitis
MUMPS
Female
vaginitis
cervicitis
oophoritis
MUMPS
Nursing Management
Strict respiratory isolation
Administer meds as
ordered
Antipyretic
Analgesic
Antibiotics
MUMPS
Nursing
Management
Cool pack
General liquid to soft
diet
APPENDICITIS
Inflammation
of Vermiform
Appendix
small structure extending
from the cecum at the R
iliac/inguinal region
produces WBC during fetal
life, ceases to function once
baby is born
APPENDICITIS
APPENDICITIS
Predisposing
Factors
Microbial agents
Fecalith (undigested
food particles)
Intestinal obstruction
APPENDICITIS
Signs & Symptoms
(+) rebound
tenderness &
abdominal
rigidity
Pain at the R
iliac region
Position of
comfort: sidelying with
abdominal
guarding & legs
flexed
APPENDICITIS
Signs &
Symptoms
Low grade
fever
Anorexia,
N/V, diarrhea,
constipation
Late Sign tachycardia
APPENDICITIS
(+)
rebound
tenderne
ss at
McBurne
ys point
APPENDICITIS
Diagnostic Procedure
CBC- mild leukocytosis
U/A- acetone
Surgery
Appendectomy within
24-48 hrs
Monitor
VS, I/O, pain level,bowel sounds
N: 5-30X/min or q 5-15 sec,
Listen to each quadrants for 5
mins
Borborygmi- > 60 sounds/minhyperactive bowel
WOF ruptured appendix &
peritonitis
PERITONITIS
Peritoneum
Lines
PERITONITIS
LIVER
LIVER
Largest
gland, occupies
most of the R
hypochondriac region
Weighs 3-4 lb (adult)
Covered by fibrous capsule
(capsule of Glisson)- makes
the liver scarlet brown,
transparent in natureb
With
LIVER
R & L lobes
Functional unit: liver lobules
With canaliculi (receptacles of
bile) produced by the hepatocytes
Composed of sinusoids
(Processing Plant)
Lined with Mononuclear
Phagocyte Sytem (Kuppfer
Cells) which remove pathogens
in the portal venous blood
Blood
LIVER
Supply
Even if the liver
receives 30% of
CO/min., the portal
system remains lowpressured
Blood
LIVER
Supply
From Hepatic artery & Portal
vein Sinusoids (capillaries
of the liver, carries admixture
of venous & arterial blood
Provide both O2 & nutrients
LIVER
Blood
Supply
LIVER
Functions
Produce BILE- to
emulsify fats; gives
color to urine
(urobilinogen) & stool
(stercobilinogen to
stercobilin)
BILE
Liver
LIVER
FATE OF HEMOGLOBIN
Hemoglobin
Heme Globin
Unconjugated
Iron
(Ferritin)
Amino
acid
Indirect Bilirubin
(stored in liver)
pool
(Fat-soluble)
FATE OF HEMOGLOBIN
LIVER
Hepatic Ducts
Deliver bile to the gall bladder
via cystic duct
Deliver bile to the duodenum
via common bile duct
Common bile duct: with
pancreatic duct at the ampulla
of Vater
Sphincter prevents reflux of
intestinal contents into the
common bile duct &
pancreatic duct
LIVER
Functions
Vitamin
ADEK synthesis
Stores & filters blood
(200-400 ml)
Stores Vitamins A, D, B &
iron
Detoxifies drugs
LIVER
Functions
Metabolize
macronutrients:
CHO
glycogenesis
glycogenolysis
LIVER
Functions
CHON
synthesis
of albumin &
globulin
Synthesis of prothrombin
& fibrinogen
Conversion of NH4 to
urea
LIVER
Functions
FATS
synthesis of
cholesterol to
neutral fats or
triglycerides
LIVER DISORDER:
CIRRHOSIS
Chronic, progressive
disease characterized by
diffuse damage to cells with
fibrosis & nodular
regeneration
Repeated destruction of
hepatic cells causes
formation of scar tissue
Types of Cirrhosis
Postnecrotic Cirrhosis
After
Types of Cirrhosis
Biliary Cirrhosis
From
chronic biliary
obstruction, bile stasis,
inflammation resulting
in severe obstructive
jaundice
Types of Cirrhosis
Cardiac Cirrhosis
Associated
with severe
RSHF, resulting enlarged,
edematous congested liver
Anoxic liver cell
necrosis & fibrosis
Types of Cirrhosis
Laennecs Cirrhosis
Alcohol-induced,
nutritional, portal
Cellular necrosis scar
tissue with fibrotic
infiltration
LAENECS CIRRHOSIS
LIVER DISORDERS
Predisposing Factors
Chronic alcoholism
Malnutritionprimary reason for
Laennecs cirrhosis
Viruses
LIVER DISORDERS
Predisposing Factors
Toxicity- CCl4
Hepatotoxic agents
(Acetaminophen,
Chlorpromazine,
INH, Halothane)
LIVER DISORDERS
Early
LIVER DISORDERS
Early
LIVER DISORDERS
Late
Hema
changes
Pancytopenia,
ecchymosis
Spider
petechiae,
angiomas/telangiectasi
Caput medussae (abdomen)
Endocrine changes
Gynecomastia
LIVER DISORDERS
Late
Signs &
Symptoms
GIT
changes
Ascites, peripheral
edema
Bleeding esophageal
varices
LIVER DISORDERS
Late Signs
&
Symptoms
CNS
changes:
Asterixis
LIVER DISORDERS
Late Signs & Symptoms
Hepatic encephalopathy
Asterixis (liver flap)-coarse,
flapping hand tremors
LOC
headache, confusion,
delirium
Fetor hepaticus (fruity,
musty breath odor of
chronic liver disease)
LIVER DISORDERS
Diagnostic Procedure
Liver Enzymes
SGPT/ALT(specific
for liver disease) &
SGOT (AST)
Serum indirect
bilirubin
LIVER DISORDERS
Diagnostic Procedure
Serum cholesterol &
NH4
CBC- pancytopenia
Prolonged PT
Hepatic UTZ- fat necrosis
of liver lobules
LIVER DISORDERS
Nursing Management
LIVER DISORDERS
Nursing Management
LIVER DISORDERS
Nursing Management
Prevent Complications
ASCITES- fluid in peritoneal
cavity
Administer meds as ordered
Loop Diuretic
K+ supplements
LIVER DISORDERS
Nursing Management
Prevent Complications
ASCITES
Na+ diet
Assist in abdominal
paracentesis
LIVER DISORDERS
Paracentesis: transabdominal
removal of fluid from the peritoneal
cavity for analysis
Pre-op
Informed consent
Empty the bladder (to prevent
puncture)
Baseline wt, abdominal girth, VS
Position: Upright (High Fowlers)
on the edge of the bed with back
support & feet resting on a stool
LIVER DISORDERS
Paracentesis
Post op
Dry, sterile pressure dressing at
insertion site, WOF bleeding
Measure fluid collected, describe
& record, label & send to lab for
analysis
Monitor VS, abdominal girth & wt
WOF hypovolemia, e+ loss,
encephalopathy, hematuria
(bladder trauma)
LIVER DISORDERS
Nursing Management
Prevent Complications
Bleeding esophageal varices
Administer meds as ordered
Vitamin K
Vasopressin (Pitressin)
BT
LIVER DISORDERS
Nursing Management
Bleeding esophageal
varices
NGT decompression
via gastric lavage
Monitor for NGT
output
LIVER DISORDERS
Nursing Management
Bleeding esophageal varices
Assist in mechanical
decompression (gastric
intubation)
Sengstaken Blakemore tube
(Esphagogastric balloon
tamponade)
WOF hemorrhage
Prepared at bedside: scissors
LIVER DISORDERS
Nursing Management
Prevent Complications
Hepatic Encephalopathy: endstage hepatic failure
characterized with altered LOC,
neuro Sxs & neuromuscular
disturbances
Assist in mechanical
ventilation
Monitor VS, neuro VS
LIVER DISORDERS
Nursing Management
Hepatic Encephalopathy
Side rails up
Administer meds as ordered
Neomycin (Mycifradin): NH4
production by N bacterial flora of
the bowel
Lactulose (Chronulac): promotes
excretion of NH4
No sedatives, narcotics,
barbiturates & hepatotoxic
meds/substances
LIVER DISORDERS
Nursing Management
Prevent Complications
Hepatorenal syndrome:
progressive renal failure
associated with hepatic
failure
Sudden in U.O., serum
BUN & Crea, urine Na
excretion, urine osmolality
PANCREAS
Located behind stomach
As exocrine gland (80%)
Secretes NaHCO3: neutralizes
stomachs contents entering
the duodenum
Secretes pancreatic juices:
with enzymes for digesting
macronutrients
PANCREAS
As endocrine gland (20%)
Islets of Langerhanssecretes insulin (hypogly)
& glucagon (hypergly)
Secretes Somatostatin:
with hypogly effect
PANCREAS
PANCREATITIS
Acute
or Chronic inflammation
of pancreas leading to
pancreatic edema,
suppuration, necrosis &
hemorrhage due to
autodigestion
Cause: activation of proteolytic
pancreatic enzymes (Trypsin,
Elastase, Lipases)
PANCREATITIS
PANCREATITIS
Predisposing Factors
Alcoholism
Hepatobiliary disorder
(Cholelithiasis)
Drugs toxic to pancreas:
steroids, OCP, thiazide
diuretics, Rentam (for
AIDS), ASA
Peptic ulcer disease
PANCREATITIS
Predisposing Factors
Metabolic disorders
hyperparathyroidism
(hyperCa)
hyperlipidemia
(obesity)
Ischemic vascular
disease
PANCREATITIS
Predisposing Factors
Na+ intake
Trauma
Surgery
Pancreatic Tumor
Viral/Bacterial
Infection
ACUTE PANCREATITIS
ACUTE PANCREATITIS
HR & T, BP to Shock
Shallow respiration
Anorexia, N/V, wt. loss
bowel sounds (paralytic
ileus)
Indigestion/dyspepsia
ACUTE PANCREATITIS
ACUTE PANCREATITIS
Diagnostic Procedure
ACUTE PANCREATITIS
Diagnostic
Procedure
serum amylase (
200 Somogyi units) &
lipase ( 1.5 U/ml)
ACUTE PANCREATITIS
Nursing Management
NPO,
NGT to suction,
TPN (with vit. & min.) as
ordered
Cx: hyperglycemia, air
embolism, infection
If can eat: diet- CHO,
CHON, fats
ACUTE PANCREATITIS
Nursing Management
Administer meds as ordered
Narcotic analgesic- Demerol
(no Morphine & Codeine SO4causes spasms of sphincter of
Oddi aggravating pain)
Antacids, H2 blockers:
Ranitidine (to HCL
production & prevent activation
of pancreatic enzymes)
ACUTE PANCREATITIS
Nursing Management
Administer meds as ordered
Anticholinergics (to
vagal stimulation, GI
motility, inhibit pancreatic
enzyme secretion)
Smooth muscle relaxant
Vasodilators- NTG
Calcium gluconate
ACUTE PANCREATITIS
Nursing Management
Assume comfortable position
Knee-chest, fetal-like
Stress
Management Technique:
DBE, yoga
Prevent
Complications:
chronic hemorrhage,
septicemia
CHRONIC PANCREATITIS
CHRONIC PANCREATITIS
Nursing
Interventions
Diet: limited fat & CHON,
vit. & min. supplements, no
heavy meals, no alcohol
Administer meds as ordered
Pancreatic
enzymes with
meals
Insulin & OHA to control DM
PANCREATITIS
Health Teachings
Importance
of avoiding alcohol
Importance of follow-up
care/visit with the MD
Notify MD if acute abdominal
pain, jaundice, clay-colored
stools, steatorrhea or dark
urine develops
GALL BLADDER
Receives
GALL BLADDER
Cholecystitis-
gall bladder
inflammation
Acute: caused by gallstones
Chronic: r/t inefficient bile emptying
& gall bladder muscle disease
fibrotic & contracted gall bladder
Acalculus: (-) gallstones, r/t
bacterial invasion via the lymphatic
or vascular systems
Cholelithiasis- gallstones
GALL BLADDER
Predisposing Factors
High risk
Female, 40 years
old, menopausal,
obese
Cholelithiasis
GALL BLADDER
Signs & Symptoms
Localized pain at RUQ, (+) mass
Epigastric pain radiating to
scapula 2-4 hrs after taking
heavy meal/fatty foods,
persisting for 4-6 hrs, usually at
night
Fatty intolerance, N/V,
indigestion, belching, flatulence
GALL BLADDER
Signs & Symptoms
Guarding, rigidity & rebound
tenderness
Murphys sign: cant take a
deep breath when examiners
fingers are passed below the
hepatic margin
HR, T, S/Sx of dehydration
GALL BLADDER
Signs & Symptoms (Biliary
Obstruction)
Jaundice
Dark orange & foamy urine
Steatorrhea & clay-colored
stools
Pruritus
Easy bruising
GALL BLADDER
Diagnostic Procedures
Cholecystography: to detect gall stones;
to assess the ability of the gall bladder
to fill, concentrate its contents, contract
& empty
Pre-op
Ask for hx of allergies to iodine, seafood
or dye
Contrast dye may be given 10-12 hrs
prior to test (evening before)
NPO after giving of dye
WOF anaphylactic reaction to dye
GALL BLADDER
Diagnostic Procedures:
Cholecystography
Post-op
Dysuria is common because
the dye is excreted in the
urine
N diet is resumed: fatty meal
enhances excretion of dye
GALL BLADDER
Diagnostic Procedures
Endoscopic retrograde
cholangiopancreatography
(ERCP): exam of the
hepatobiliary system via
endoscope inserted into the
esophagus to the duodenum;
multiple positions are required
during the procedure to pass
the endoscope
GALL BLADDER
Diagnostic Procedure: ERCP
Pre-op
NPO X several hrs
Sedation as ordered
Post-op
Monitor VS, return of gag
reflex
WOF perforation or infection
GALL BLADDER
Diagnostic Procedures
Oral cholecystogram
Gall Bladder Series)(+) gall stones
Serum alkaline
phosphatase
GALL BLADDER
Nursing Management
Administer meds as ordered
Narcotic analgesic- Demerol
(no Morphine & Codeine SO4)
Anticholinergics/
Antispasmodics to relax
smooth muscles
Pro-Banthine
AtSO4
Anti-emetics
GALL BLADDER
Nursing Management
Monitor V/S, bowel sounds
Small, frequent meals
Diet: CHO, CHON,
fats, no gas-forming foods
Meticulous skin care
GALL BLADDER
Non-Surgical Interventions
Dissolution therapy (of
cholesterol stones)
Meds: Chenodeoxycholic acid
(Chenodiol) or Ursodiol
(Actigall) po
Direct contact with repeated
injections & aspirations of a
dissolution agent via
percutaneous cath
GALL BLADDER
Surgical Interventions
under Exploration
Laparoscopy/Peritoneoscopy:
direct visualization of organs &
structures within the abdomen
using fiberscope; bx can be
obtained
Cholecystectomy: gall bladder
removal
Choledochotomy: common bile
duct incision to remove stone
GALL BLADDER
GALL BLADDER
GALL BLADDER
Nursing Interventions:
s/p Gall Bladder Surgery
Semi-Fowlers position,
drain system by gravity
Avoid irrigation,
aspiration or clamping
the T-tube without MDs
orders
GALL BLADDER
ESOPHAGUS
Collapsible
or
Chalasia
Backflow of
gastric &
duodenal contents
into the
esophagus
GERD
GERD
Causes
Incompetent
lower
esophageal sphincter (LES)
Pyloric stenosis
Motility disorder
Prolonged gastric intubation
Ingestion of corrosive
chemicals
GERD
Causes
Uremia
Infections
Mucosal
alterations
Systemic disease
(SLE)
GERD
Signs
of MI)
Substernal pain (due to
frequent regurgitation through
gastroesophageal junction),
aggravated by postural changes
especially when in supine
Dyspepsia
Dysphagia
Hypersalivation
GERD
Complications
Pulmonary
aspiration
Esophagitis
Esophageal
CA
ESOPHAGITIS
Inflammation
of
esophageal mucosa,
most often results
from GERD due to
prolonged vomiting
or an incompetent
LES
ESOPHAGITIS
precipitated
by ingestion
of fatty foods & alcohol
Heart burn
Retrosternal discomfort
Regurgitation of sour,
bitter material
ESOPHAGITIS
Dysphagia
Diagnostic Procedures
pH in esophagus- 0.82
Esophageal biopsy(+) inflammatory
changes
Procedure: GASTRIC
ANALYSIS
Esophageal reflux of gastric
acid may be done by
ambulatory pH monitoring; a
probe is placed just above the
LES & connected to an external
recording device; provides a
computer analysis & graphic
display of results
Procedure: GASTRIC
ANALYSIS
Pre-op: NPO X 8-12 hrs, no
tobacco & chewing gum X 6
hrs, hold meds that can
stimulate gastric secretions X
1-2 days
Post-op: Resume N activities,
place gastric samples in ref if
not tested within 4 hrs
Diagnostic Procedures
Upper GI study/series
(Barium swallow): done
under fluoroscopy after the
pt drinks Barium SO4
Pre-op: NPO after 12 MN
Post-op: Laxative as ordered,
Force fluids, WOF passage of
chalk-white stools (Barium
can cause GI obstruction)
H2 blockers,
proton-pump inhibitors
Prokinetic meds (to
gastric emptying)
No anticholinergic
meds! ( gastric
emptying)
MEDICAL MANAGEMENT
Cholinergic Meds
Bethanecol to
esophageal tone &
peristaltic activity
Metochlopramide
(Reglan/Plasil)- to
esophageal pressure by
relaxing pyloric & duodenal
segments, peristalsis
MEDICAL MANAGEMENT
Cholinergic Meds
H2 blockers- to gastric
acidity & pepsin
secretion
Proton-pump inhibitors gastric acidity
Antacids (Maalox)- to
neutralize gastric acid
SURGICAL MANAGEMENT
Nissen Fundoplication
(under EL)
Creation of valve
mechanism by
wrapping the greater
curvature of stomach
(gastric fundus) around
the LES
NISSEN FUNDOPLICATION
HIATAL HERNIA
or
Esophageal or
Diaphragmatic Hernia
A portion of the
stomach herniates
through the weak
muscles of the
diaphragm & into the
HIATAL HERNIA
HIATAL HERNIA
Aggravated by factors
intraabdominal pressure:
pregnancy, ascites,
obesity, tumors, heavy
lifting
Cx: ulceration,
hemorrhage,
regurgitation, aspiration,
strangulation,
incarceration of the
HIATAL HERNIA
Signs
& Symptoms
Heartburn
Regurgitation
or
vomiting
Dysphagia
Feeling of fullness
HIATAL HERNIA
Nursing,
Medical &
Surgical Interventions
Same as in GERD
Small frequent meals,
minimal amount of
fluids
Avoid reclining for 1
STOMACH
- shape
Widest section of alimentary
canal
With valves
Cardiac sphincter - between
esophagus & stomach
Pyloric sphincter- between
stomach & duodenum, oliveshape
STOMACH
Parts
Cardia
Fundus
Body
Antrum
Pylorus
STOMACH
STOMACH
Mucous
Glands
Prevent
autodigestion by
providing alkaline
protective covering
STOMACH
Cells
Chief/zymogenic
cells
Gastric amylase - digests
CHO
Gastric lipase - digests
fats
Pepsin - digests CHON
Rennin - digests milk
products
STOMACH
Parietal/Oxyntic cells
Produces Intrinsic
Factor (glycoprotein)
for reabsorption of
Vit B12 for RBC
maturation
Secretes HCl- aids
in digestion
STOMACH
STOMACH
Functions
Mechanical &
chemical digestion
Storage of food
CHO & CHON: 2-3
hrs
Fats: 3-4 hrs
GASTRITIS
Inflammation
GASTRITIS
Signs & Symptoms: Acute
Gastritis
A/N/V
Abdominal discomfort
Headache
Hiccuping
GASTRITIS
Causes of Chronic Gastritis
Benign or malignant ulcers
H. pylori bacteria
Autoimmune diseases
Diet, Meds
Smoking & alcoholism
Reflux
GASTRITIS
Signs & Symptoms:
Chronic Gastritis
A/N/V
Belching
Heartburn after eating
Sour taste in the mouth
Vit. B12 deficiency
GASTRITIS
Nursing
Interventions
NPO until Sx subside, then progressive
diet
WOF hemorrhagic gastritis & notify
MD: hematemesis, HR, BP
Avoid irritating/spicy/highly seasoned
foods, caffeine, alcohol & nicotine
Administer as ordered
Antibiotics
Bismuth salts (Pepto-Bismol)
Vit B12 injections
PEPTIC ULCER
Erosion/excoriation of
mucosal & submucosal
lining (extending to
muscle) due to
Hypersecretion of acid
pepsin
resistance of mucosal
barrier to hyperacidity
PEPTIC ULCER
PEPTIC ULCER
Incidence Rate
M- 2-3 X higher risk
Low income, laborer
Predisposing Factors
Hereditary
Hx of gastritis
Emotional stress
PEPTIC ULCER
Predisposing Factors
Smoking
Alcoholism
Caffeine
Irregular Diet
Rapid Eating
PEPTIC ULCER
Predisposing Factors
Ulcerogenic drugs
ASA
Ibuprofen
Indomethacin
Phenylbutazones
Steroids
PEPTIC ULCER
Predisposing Factors
Gastrin-producing
tumors
Zollinger-Ellison
syndrome
Microbial invasion
Helicobacter
pylori
PEPTIC ULCER
Types depending on:
Severity
Acute-
affects
submucosal & mucosal
linings
Chronic- affects deeper
tissues heals scars
PEPTIC ULCER
Types depending on:
Location
Stress ulcer
Esophageal
Gastric ulcer
Duodenal ulcer- 90-95%
less Bicarbonate
PEPTIC ULCER
Stress
Ulcer
common among
critically-ill pt
PEPTIC ULCER
Stress
Ulcer
Curlings Ulcer- due to
trauma & major burns
hypovolemia GIT
ischemia resistance of
mucosal barrier to HCl acid
secretion ulceration
PEPTIC ULCER
Stress
Ulcer
Cushings Ulcer- due to
head trauma/injury (e.g.
CVA) Vagal stimulation
hyperacidity
ulceration
PEPTIC ULCER
GASTRIC
VS.
DUODENAL ULCER
ULCER
Antrum
Duodenal bulb
30 mins- 1 or 2 hrs 2-3 or 4 hrs p.c.
p.c.
Epigastric pain
Mid-epigastric
(L midepigastric pain) pain
PEPTIC ULCER
GASTRIC VS.
ULCER
Gaseous pain &
burning
Not relieved by
food/antacid
N gastric acid
secretion
DUODENAL
ULCER
Cramping &
burning
Relieved by
food/antacid
Gastric acid
secretion
PEPTIC ULCER
GASTRIC
VS.
DUODENAL ULCER
ULCER
Hematemesis
Melena
Weight loss
Weight gain
Stomach CA,
Perforation, gastric
pyloric obstruction,
outlet obstruction,
hemorrhage, perforation intractable disease
60 y/o &
20 y/o &
PEPTIC ULCER
Diagnostic
Procedures
Upper GI Fiberoscopy
(Esophagogastroduodenoscopy
)
After sedation, an endoscope
is passed down the esophagus
to view the gastric wall,
sphincters & duodenum; tissue
specimens can be obtained
Upper GI Fiberoscopy
PEPTIC ULCER
Diagnostic
Procedures:
Esophagogastroduodenoscopy
Pre-op
NPO X 6-12 hrs
Local anesthetic (spray or gargle) along
with Midazolam IV (conscious sedation)
AtSO4 IV ( secretions), Glucagon (to
relax smooth muscles)
Position: L-side lying (to drain secretions
& easy access of endoscope)
Prepare emergency equipment at bedside
PEPTIC ULCER
Diagnostic
Procedures:
Esophagogastroduodenoscopy
Post-op
CBR until pt is alert
NPO X 1-2 hrs (until gag reflex
returns)
Lozenges, saline gargles or oral
analgesics can relive minor sore
throat
WOF perforation (pain, bleeding,
dysphagia, T)
PEPTIC ULCER
Diagnostic
Endoscopic
Procedures
exam- extent
& depth of ulceration
Stool- (+) occult blood
Upper GI series (Barium
swallow)- (+) ulceration
PEPTIC ULCER
Diagnostic
Procedure: GASTRIC
ANALYSIS
(pH, apperance, vol.): after NGT
insertion, the entire gastric
contents are aspirated,
specimens are collected q 15
mins X 1hr
Histamine or Pentagastrin SQ (to
stimulate gastric secretions, may
produce a flushed feeling
Pre & Post-op Care: See GERD
PEPTIC ULCER
Nursing
Management
Avoid smoking, NSAIDs
Diet: bland, no caffeine
& chocolate, no milk & its
products, give crackers
Adequate rest, reduce
stress
PEPTIC ULCER
Administer meds as ordered
Antacids
Maalox- combined with
S/E than 2 antacids
separately
MAD- Mg containing
antacid, S/E- diarrhea
AAC- Al containing
PEPTIC ULCER
Nursing
Management
Administer
meds as
ordered
H2 blockers
Ranitidine (Zantac)
Cimetidine (Tagamet)
Famotidine (Pepsin)
PEPTIC ULCER
Nursing
Management
Administer
meds as ordered
Mucosal barrier protectants:
creates a paste-like
substance that coats the
gastric mucosa
Taken 1 hr a.c.
Sucralfate
Cytotec
PEPTIC ULCER
Nursing
Management
Administer
meds as ordered
Anticholinergics,
Antispasmodics
AtSO4, Buscopan
Sedatives/Tranquilizer
(Valium)
PEPTIC ULCER
Nursing Management
Assist
in surgical procedures
Vagotomy- prior to gastric
surgery to hemorrhage
Pyloroplasty: to
obstruction, to gastric
emptying
PEPTIC ULCER
Nursing
SUBTOTAL
Management
GASTRECTOMY
Bilroth I (Gastroduodenostomy)
Removal of 1/3 to
uppermost stomach &
anastomosis of the gastric
stump to the duodenum
PEPTIC ULCER
Nursing
SUBTOTAL
Management
GASTRECTOMY
Bilroth II (Gastrojejunostomy)
Removal of 2/3 of stomach
duodenal walls &
anastomosis of the gastric
stump to the jejunum
SUBTOTAL GASTRECTOMY
PEPTIC ULCER
Nursing
Management
GASTRIC RESECTION or
Antrectomy: removal of lower
half of stomach
TOTAL GASTRECTOMY
Removal of the stomach &
attachment of esophagus to
the jejunum or duodenum
(Esophagojejunostomy)
PEPTIC ULCER
Nursing Management
Post-op
Monitor VS, I/O, bowel sound
Fowlers position
NPO for 1-3 days, NGT to
suction (dont
irrigate/remove NGT)
PEPTIC ULCER
Nursing
Management Post-op
Monitor NGT output
Immediately post-op- bright red
12-16 hrs post-op- greenish
> 24 hrs- tea-colored, dark red
Progressive diet to 6 small, bland
meals/day
PEPTIC ULCER
Nursing
Management Post-op
Administer
IVF
as ordered
& e+
Antibiotics
Analgesics
Anti-emetics
PEPTIC ULCER
Nursing Management
Post-op
Prevent Complications
Bleeding Hemorrhage
Shock
Paralytic ileus
Peritonitis
PEPTIC ULCER
Nursing Management
Post-op
Prevent Complications
Pernicious anemia
Thrombophlebitis
HypoK, Hypogly
Dumping Syndome
DUMPING SYNDROME
Rapid
emptying of
hypertrophic
food solution
(chyme) from
stomach to
jejunum
hypovolemia
DUMPING SYNDROME
Signs
Abdominal
fullness, cramping
Diaphoresis
Palpitation, HR
Weakness, dizziness
Diarrhea
Borborygmi
DUMPING SYNDROME
Nursing
Management
SMALL INTESTINE
SMALL INTESTINE
Divided
into:
Duodenum (with openings of the
bile & pancreatic ducts)
Jejunum (8 ft long)
Ileum (12 ft long)
Terminates into the cecum
Functions: digestion & absorption
of ingested nutrients & water
Alterations:
Malabsorption
Maldigestion
SMALL INTESTINE
Pancreatic
SMALL INTESTINE
Disorders
Vomiting,
diarrhea
Gastroenteritis
Malabsorption syndrome
Cystic
Fibrosis (CF)
Celiac Disease (Non-tropical
sprue/Gluten Enteropathy)
Tropical sprue
Regional enteritis (Chrons
Or Mucoviscidosis or
Fibrocystic disease of the
Pancreas
Multisystem disorder
Incidence: most fatal
genetic disease in
Caucasians & Europeans
Genetic characteristics
Transmitted by autosomal
recessive inheritance
Mutation on gene on
Chromosome 7q31
Deletion of an AA resulting CF
transmembrane conductance
regulator (CFTR)
Pathophysiology
CFTR: N located on cells of exocrine
gl&s (lungs, liver, pancreas,
intestines, sweat gl&s, RT)
regulating electrolytes & water
channels
In CF: inadequate sythesis of CFTR
pores are lacking for release of
electrolytes at cell surfaces
affects Cl- transport ( NaCl in
Pathophysiology
On stimulation: exocrine
ducts release thick,
viscous secreations
causing plug
anatomical & physiologic
changes
Characteristics
Pancreatic enzyme
deficiency fat & Vit
ADEK malabsorption
Characteristics
Large volume of thick,
viscous bronchial
secretions chronic
pulmonary disease
NaCl in sweat
Diagnostic Tests
Pancreatic deficiency: (-)
trypsin
Fecal fat test: steatorrhea
(+) 15-30 g fat/day
N:
4 g fat/day
Management
Gene therapy
Respiratory:
Tobramycin
IV & aerosol:
prevent P. aeruginosa
Coenzyme Q10,NAcetylcystein: mucus
Management: GI
Vit ADEK supplement
Ursodeoxycholic acid
(UDCA): bile viscosity
Correct
steatorrhea
Pancreatic
enzyme
replacement therapy
Lecithin, Taurine, MCT
CHRONS DISEASE
Or Regional Enteritis
Idiopathic, chronic,
relapsing granulomatous
inflammatory disease of
the intestinal tract,
affecting the terminal ileum
or colon
With periods of remissions
& exacerbations
CHRONS DISEASE
Predisposing
Factors
M=F, depressed &
dependent
higher in members
of Jewish race
familial
CHRONS DISEASE
Predisposing
Factors
onset- 15-20 y/o;
peak- 55 & 60 y/o
common in US,
Britain, Scandinavia
CHRONS DISEASE
Causes
Infectious
(viruses,
Pseudomonas spp.,
atypical
mycobacteria)
Immunologic
CHRONS DISEASE
Causes
Psychosomatic
Dietary
Hormonal
Unknown
CHRONS DISEASE
Pathogenesis
Lesions
CHRONS DISEASE
Complications
intestinal
stenosis/stricture due
to abscesses
obstruction
Fistula development
rupture peritonitis
CHRONS DISEASE
Signs & Symptoms
Cramplike & Colicky pain in
RLQ p.c.
Mild, intermittent diarrhea
with mucus & pus (2-5
stools/day)- dominant
feature
Steatorrhea
(+) occult blood in stool
CHRONS DISEASE
Signs
& Symptoms
A/N/V, wt. loss, fever,
anemia, malaise
Dehydration & e+
imbalance,
Malnutrition
CHRONS DISEASE
Diagnostic
Procedures
CBC- RBC, WBC
Deranged Serum electrolytes
ileum biopsy- (+) inflammatory
changes
Barium swallow- (+) String
Sign
Endoscopic exam- (+) skip
lesions
CHRONS DISEASE
Nursing, Medical
Interventions
Same as in ulcerative colitis
Surgery is avoided as much
as possible because
recurrence of the disease
process in the same region
is likely to occur
LARGE INTESTINE
About 5 ft long
Absorbs water (1,800 to
3,000 ml) with few
electrolytes, provides for the
final water balance in the
GIS
Eliminates wastes
Bacterial flora synthesize
some B Vitamins & Vit. K
LARGE INTESTINE
From cecum, colon
(subdivided into ascending,
transverse & descending),
sigmoid, rectum & anus
Ileoceccal valve: prevents
backflow of LI contents to
the ileum
Anal sphincters: guard the
anal canal
ULCERATIVE COLITIS
Chronic
inflammatory disease of
the mucous membranes of the
colon
Commonly begins in the rectum &
spreads upward toward the cecum
Bowel fills with bloody, mucoid
secretion that produces a
characteristic cramping pain,
rectal urgency & diarrhea
With
ULCERATIVE COLITIS
ULCERATIVE COLITIS
Predisposing
Unknown
Factors
cause
Genetic basis suggested
Associated with viruses other
microorganisms & autoimmunity
Peak occurrence: 15-35 y/o
Common among Whites than in
other races
ULCERATIVE COLITIS
Pathogenesis
ACUTE PHASE
edematous colon develop
bleeding lesions & ulcers
perforation
CHRONIC PHASE
ulcerations become scars
elasticity malabsorption, bowel
thickening, shortening & narrowing
ULCERATIVE COLITIS
Signs & Symptoms
Abdominal tenderness &
cramping
Severe bloody diarrhea with
mucus
Vit. K deficiency
A/,
ULCERATIVE COLITIS
Diagnostic
Procedures
CBC- RBC, WBC
Serum albumin
Deranged serum
electrolytes
serum alkaline
phosphatase
ULCERATIVE COLITIS
Diagnostic
Procedures
Lower GI study/series (Barium enema)fluoroscopic & radiographic exam of LI
after rectal instillation of Barium SO4,
may be done with or without air
Pre-op: fiber diet X 1-2days, CL diet or
laxative at pm, NPO after 12MN,
cleansing enemas in am
Post-op: Laxative as ordered, Force
fluids, WOF passage of chalk-white
stools (Barium can cause GI
obstruction), Notify MD if no bowel
movt within 2 days
ULCERATIVE COLITIS
Diagnostic
Procedures
Barium
enemasigmoidoscopic appearance
of the mucosa
Colon Biopsy & culture to
r/o carcinoma & bacterial
diarrhea
ULCERATIVE COLITIS
Complications
Intestinal
obstruction
Dehydration
Fluid & electrolyte
imbalances
Malabsorption
Chronic IDA
ULCERATIVE COLITIS
Nursing Interventions
CBR
NPO, IVF or TPN as ordered
to progressive diet (CL to
fiber, CHON, vit. & min.)
Avoid gas-forming foods,
milk products, wheat grains,
nuts, raw fruits, vegetable,
pepper, alcohol & caffeine
ULCERATIVE COLITIS
Nursing Interventions
Avoid smoking
Monitor stool color,
consistency, presence of
blood
WOF perforation,
peritonitis & hemorrhage
ULCERATIVE COLITIS
Nursing
Interventions
Administer
as ordered
Bulk-forming
agents: bran,
psyllium, methylcellulose
Antibiotics
Corticosteroids
Immunosuppressants
ULCERATIVE COLITIS
Surgical
Interventions
Total
proctocolectomy with
permanent ileostomy
Curative,
removal of entire
colon, rectum & anus with anal
closure
Terminal ileum at RLQ: with
stoma
ULCERATIVE COLITIS
Surgical Interventions
Kock
(continent) ileostomy
Intraabdominal
KOCKS ILEOSTOMY
ULCERATIVE COLITIS
Surgical
Interventions
Ileoanal reservoir
A 2-stage procedure
Involves excision of rectal
mucosa, an abdominal
colectomy, construction of a
reservoir to the anal canal &
temporary loop ileostomy
The ileostomy is closed in 3-4
mos. after the capacity of the
reservoir is increased
ILEOANAL RESERVOIR
ULCERATIVE COLITIS
Surgical
Interventions
Ileoanal anastomosis
(Ileorectostomy)
Does not require ileostomy
Requires a large, compliant
rectum
A 12- to 15-cm rectal stump is
left after the colon is removed,
the SI is inserted into this rectal
perineal wound
infection (if present)
Administer as ordered
Analgesics & antibiotics
Stoma irrigation
COLOSTOMY
COLOSTOMY APPLIANCE
COLOSTOMY IRRIGATION
Enema
COLOSTOMY IRRIGATION
If
COLOSTOMY IRRIGATION
COLOSTOMY IRRIGATION
DIVERTICULOSIS &
DIVERTICULITIS
DIVERTICULOSIS: outpouching
of herniation of the intestinal
mucosa, can occur in any part
of the intestine (most common
in the sigmoid colon)
DIVERTICULITISinflammation of one of the
diverticula when these
perforates peritonitis
DIVERTICULOSIS/DIVERTICULITIS
Signs
DIVERTICULOSIS &
DIVERTICULITIS
& Symptoms
LLQ
DIVERTICULOSIS &
DIVERTICULITIS
Nursing
CBR
NPO
Interventions
DIVERTICULOSIS &
DIVERTICULITIS
Nursing
Interventions
Avoid
gas forming-foods,
indigestible roughage, seeds
or nuts (can be trapped in the
diverticula & cause
inflammation)
Avoid any form of Valsalva
maneuver
WOF perforation,
hemorrhage, fistulas &
DIVERTICULOSIS &
DIVERTICULITIS
Nursing Interventions
Administer as ordered
Antibiotics
Analgesics
Anticholinergics
Small
amount of bran OD
Bulk-forming laxatives
DIVERTICULOSIS &
DIVERTICULITIS
Surgical
Interventions
Colon resection with
primary anastomosis
Temporary or
permanent colostomy
(for bowel
inflammation)
HEMORRHOIDS
Dilated
HEMORRHOIDS
Signs & Symptoms
Bright
red bleeding
with defecation
Rectal pain & itching
HEMORRHOIDS
Nursing Interventions
Cold packs followed by
Sitz bath as ordered
Apply witch hazel soaks &
topical anesthetics as
ordered
Stool softeners as ordered
fiber-diet, force fluids
HEMORRHOIDS
Endoscopic procedures
Sclerotherapy
Endoscopic
ligation
Surgical interventions
Cryosurgery
Hemorrhoidectomy
HEMORRHOIDS
Post-op
Nursing Interventions
Position: prone or side-lying
Ice packs over dressing as
ordered
fiber-diet, force fluids
Stool softeners as ordered
Limit sitting to short periods
of time
Sitz bath 3-4X/day as ordered
WOF urinary retention
CGFNS/NCLEX Question
When
assessing a pt
who underwent
colostomy several
months ago, a nurse
would expect the
stoma to appear
CGFNS/NCLEX Question
A. dry
B. red
C. edematous
D. retracted
CGFNS/NCLEX Question
Which
of the following
statements would a
nurse include in the preoperative instructions for
a pt who is scheduled for
an ileostomy?
CGFNS/NCLEX Question
A. Your urine will be collected in
a pouch subsequent to surgery.
B. Your bowel will be visualized
with a laparoscope during
surgery.
C. You will have a NGT in your
nose after surgery.
D. You can drink liquids within 24
hours following surgery.
CGFNS/NCLEX Question
Which
of the following
assessment techniques
should a nurse use to
determine the
appropriate placement of
NGT?
CGFNS/NCLEX Question
A. Aspirating drainage through
the NGT
B. Auscultating for bowel
sounds
C. Palpating over the
epigastric region
D. Inserting the open end of
the NGT into water
CGFNS/NCLEX Question
RN would instruct a
pt who had an
ileostomy to avoid
which of the following
food?
CGFNS/NCLEX Question
A. potatoes
B. beef
C. popcorn
D. yogurt
CGFNS/NCLEX Question
Which
of the following
serum lab results
would a nurse expect
to identify in a pt who
has pancreatitis?
CGFNS/NCLEX Question
A. cholesterol
B. glucose
C. amylase
D. creatinine
CGFNS/NCLEX Question
Which
of the following
questions would be most
important for a nurse to ask
when gathering data from a
pt who is suspected of
having acute pancreatitis?
CGFNS/NCLEX Question
A. Have you had a recent blood
work-up?
B. Do you have a hx of diabetes?
C. When was your last bowel
movement.
D. How much alcohol do you
drink in a week?
CGFNS/NCLEX Question
The
CGFNS/NCLEX Question
A. Meperidine HCl (Demerol)
B. Morphine SO4
C. Propantheline Br
(Pro-Banthine)
D. Cimetidine (Tagamet)
CGFNS/NCLEX Question
The
nurse should
teach a pt who has
acute pancreatitis to
avoid which of the
following foods?
CGFNS/NCLEX Question
CGFNS/NCLEX Question
Which
of the following
factors, if noted in a pts
hx, would indicate a
predisposition for
developing cholecystitis?
CGFNS/NCLEX Question
A. obesity
B. hypertension
C. depression
D. childlessness
CGFNS/NCLEX Question
A
CGFNS/NCLEX Question
A. maintain the child in
recumbent position
B. apply warm compress to the
affected area
C. obtain an order for an age
appropriate analgesic
D. distract the child with an age
appropriate video
CGFNS/NCLEX Question
When
CGFNS/NCLEX Question
A. tympanic temp of 101.2 F
(38.4 C)
B. absence of stool for 24 hrs
C. nausea when exposed to
food odors
D. cessation of abdominal
pain
CGFNS/NCLEX Question
Which
of the following
statements, if made by a pt
who has gastroesophageal
reflux disease (GERD),
would support a nursing dx
of Knowledge Deficit?
CGFNS/NCLEX Question
A. I will lie down for 30 minutes
after meals.
B. I will restrict spicy foods in my
diet.
C. I should sleep with the head of
the bed elevated.
D. I should decrease my intake of
caffeine.
CGFNS/NCLEX Question
Which
of the following
findings in a pt who has
Chrons disease would
indicate that
corticosteroid therapy
has been effective?
CGFNS/NCLEX Question
A. expansion of muscle mass
B. increase in the bulk of
stool
C. moon-like appearance of
the face
D. decreased complaints of
abdominal pain
CGFNS/NCLEX Question
Which
of the following
explanations should a
nurse give to a pt
regarding the primary
cause of peptic ulcer
disease?
CGFNS/NCLEX Question
A. A spicy diet contributes to ulcer
development.
B. Seasonal changes are associated
with ulcer disease.
C. Executive job positions
predispose people to ulcer
formation.
D. Infection with Helicobacter pylori
causes ulcers.
CGFNS/NCLEX Question
The
nurse should
monitor a pt who is
receiving lactulose
(Cephulac) for which of
the following adverse
side effects?
CGFNS/NCLEX Question
A. Diarrhea
B. Petechiae
C. Polyuria
D. Flushing
CGFNS/NCLEX Question
A
CGFNS/NCLEX Question
A. cause vasoconstriction to
the splenic artery
B. ensure airway patency
C. provide for enteral
nutrition
D. apply direct pressure to
the area
CGFNS/NCLEX Question
Which
of the following
nursing measures would
be most appropriate for
a pt who has ascites?
CGFNS/NCLEX Question
A. withholding fluids
B. measuring abdominal
girth
C. encouraging ambulation
D. monitoring for pedal
edema