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Adult Health Nursing CH 5 GI Disorder CH 6 Gallbladder, Liver, Biliary Tract or Exocrine Pancreastic Disorder

Terms in this set (67)

Digestive Tract
(AKA: Alimentary Canal)
Muscular tube containing mucous membrane lining;
extending from the mouth to the anus;
approximately 9 meters or 30 feet long
Organs of Digestive Tract
Mouth
Pharynx (throat)
Esophagus (food pipe)
Stomach
Small intestine (Duodenum, jejunum, ileum)
Large Intestine (colon)
Cecum (Ascending, Transverse, Descending Sigmoid ---COLON)
Accessory Organs of Digestive Tract
Teeth & Gums
Salivary Glands (Parotid, Submandibular, Sublingual)
Tongue
Liver
Gallbladder
Pancreas
Vermiform Appendix
Small Intestine
20 feet long & 1" inch diameter
3 parts: duodenum, jejunum & ileum
Large Intestine
5-6 feet long & 2"inch diameter
4 Functions of the Lg Intestine
Complete absorption of water
Manufactures Vitamin K & B-12
Formation of Feces
Expulsion of Feces
Cecum
Blind pouch formation 2-3 " inches long
Vermiform Appendix
Small worm like tubular structure dangles from the cecum in RLQ;
houses immune system cells & tissue
Appendicitis
Most common in 10-30 years old;
common cause obstruction of lumen by fecalith (accumulation of feces), foreign bodies & tumor of the cecum or appendix;
Pathogenic bacteria (E.coli) begins to build from the obstruction & inflammation causing infection w/the formation of pus;
ruptures cause generalized peritonitis as infection may be contained w/an appendiceal abscess & spread to the abdominal
Medical Management Appendicitis
WBC will be 10,000/mm (N. Range 4.500-11,000/mm);
Tests done: abdominal CT, ultrasound or urine test might be done; surgery is required for removal;
(S) C/O RLQ pain in abdomen around McBurney's point (1/2 way between umbilicus & crest of R-ileum), nausea & anorexia;
(O) vomiting, fever, elevated WBC, rebound tenderness, a rigid abdomen & decreased or absent bowel sounds;
Medications: Antibiotics administer at time of surgery helping to avoid infection; biggest fear is perforation & Peritonitis; Pain med's might include Opioids
Diverticulosis
Presence of pouchlike herniations through the circular smooth muscle of the colon, particularly the sigmoid colon; increased after age 40; (S)Constipation, diarrhea accompanied by pain in the LLQ, flatus & chronic constipation alternating w/diarrhea, anoxeria, nausea;
(O) Abdominal distention, lowgrade fever, leukocytosis, vomtting, blood in the stool, abdominal tenderness on palpation & sometimes a palpable abdominal mass;
Diverticulitis
Inflammation of one or more of the diverticular sacs;
complication of diverticulosis. may lead to perforation, abscess, peritonitis, obstruction & hemorrhage; most common cause of lower GI hemorrhage;
if patient has this a colonoscopy & barium enema (BE) will be used due to possibility of perforation & peritonitis
Diagnositic tests for both: Ultrasound & CT scan w/oral contrast used to confirm diagnosis & evaluate the severity of disease, CBC, urinalysis, fecal occult blood test should be preformed, BE occasionally used to determine narrowing or obstruction of the colonic lumen, Colonoscopy used to rule out polyps or malignancy.
Surgery's done could be Hartmann's couch, Double-barrel transverse colonoscopy & transverse loop
Hepatitis A
Infects liver causing flu like symptoms;
Get it thru fecal contaminated food & water (E-Coli), contact with someone who is infected.
preventable by vaccine
Symptoms include fatigue, nausea, abdominal pain, loss of appetite, and low-grade fever.
The condition clears up on its own in one or two months. Rest and adequate hydration can help.
Pain areas: in the abdomen, joints, or muscles
Gastrointestinal: diarrhea, nausea, or vomiting
Whole body: fatigue, fever, or loss of appetite
Also common: dark urine, itching, weight loss, or yellow skin and eyes
Hepatitis B
Commonly spread by exposure to infected body fluids.
Symptoms are variable and include yellowing of the eyes, abdominal pain, and dark urine. Some people, particularly children, don't experience any symptoms. In chronic cases, liver failure, cancer, or scarring can occur.
condition often clears up on its own. Chronic cases need medication and possibly a liver transplant.
Can have no symptoms, but people may experience:
Pain areas: in the abdomen
Pain types: can be mild
Whole body: fatigue, loss of appetite, or malaise
Gastrointestinal: fluid in the abdomen or nausea
Skin: web of swollen blood vessels in the skin or yellow skin and eyes
Also common: dark urine or itching
Hepatitis C
Virus spread by contact with contaminated blood, sharing used contaminated needles, un-sterile tattoo & piercing equipment, bodily fluids.
Most people have no symptoms. Those who do develop symptoms may have fatigue, nausea, loss of appetite, and yellowing of the eyes and skin.
Treated with antiviral medications. In some people, newer medicines can eradicate the virus.
but people may experience:
Pain areas: in the abdomen
Gastrointestinal: bleeding, bloating, fluid in the abdomen, or nausea
Whole body: fatigue, fever, or loss of appetite
Skin: web of swollen blood vessels in the skin or yellow skin and eyes
Also common: depression or weight loss
Hepatitis D
Coinfection w/ people who have Hepatiis B
Occurs only among people who are infected with Hepatitis B virus. Transmission requires contact with infectious blood. At-risk populations include intravenous drug abusers and men who have sex with men.
Symptoms include abdominal pain, nausea, and fatigue.
There are few treatments specifically for although different regimens may be tried. Management also focuses on supportive care.
Symptoms include abdominal pain, nausea, and fatigue
Hepatitis E
The virus is mainly transmitted through drinking water contaminated with fecal matter.
Symptoms include jaundice, lack of appetite, and nausea. In rare cases, it may progress to acute liver failure.
Usually resolves on its own within four to six weeks. Treatment focuses on supportive care, rehydration, and rest.
Cirrhois
(AKA: Hepatic Cirrhois)
Chronic liver damage from a variety of causes leading to scarring and liver failure.
Hepatitis and chronic alcohol abuse are frequent causes. Liver damage caused by cirrhosis can't be undone, but further damage can be limited.
Initially patients may experience fatigue, weakness, and weight loss. During later stages, patients may develop jaundice (yellowing of the skin), gastrointestinal bleeding, abdominal swelling, and confusion.
Treatments focus on the underlying cause. In advanced cases, a liver transplant may be needed.
Medications: Diuretics, Ammonia Reducer, Beta Blockers, Anitvirals, Antibiotics, Synthetic hormones
Gastroesophageal Reflux Disease (GERD)
Back flow of gastric contents into the esophagus through the lower esophageal sphincter;
affects all age people & about 19 million are affected;
severe & frequent episodes of this can trigger more asthma attacks or severe chest pain results in bleeding or promote a narrowing or chronic irritation of the esophagus (Uses PPI in this case); Most cases caused by inappropriate relation of the lower esophageal sphincter (LES); procedures to help this condition can be Nissen fundoplication, Esophy X, LINX, & Barrett's esophagus
Medical Management of GERD
(S) heartburn (Pyrosis) either substernal or retrosternal burning sensation may radiate to back or jaw, may mimic angina, regurgitation causes sour or bitter taste in the pharynx (throat);
(O) noctural cough, wheezing, & hoarseness; Interventions to help patients would be stop smoking, avoid problem foods or beverages, elevating head of bed, weight loss, sit upright 1-2 hrs after meal & not to eat 2-3 hrs before bedtime may help;
Drugs that helps are antacides or acidblocking (H2 receptors antagonists cimetidine (Tagamet), ranitidine (Zantac), famotidine (Pepid), nizatidine (Axid) or Proton pump inhibitors (PPI) omeprazole (Prilosec), esomeprazole (Nexium), pantoprazole (Protonix), rabeprazole (Aciphex, lansoprazole (Prevacid), sucralfate (Carafate); Promotility agents like metoclopramide (Reglan) used in moderate to sever causes
Gastritis
Any of a group of conditions in which the stomach lining is inflamed;
Causes include infection, injury, regular use of pain pills called NSAIDs, and too much alcohol.
Symptoms include upper belly pain, nausea, and vomiting. Sometimes, there are no symptoms.
Treatment depends on the cause. Antibiotics and antacids might help
Peptic Ulcer
(AKA: Stomach Ulcer);
A sore that develops on the lining of the esophagus, stomach, or small intestine;
Ulcers occur when stomach acid damages the lining of the digestive tract.
Causes include the bacteria H. Pylori and anti-inflammatory pain relievers including aspirin.
Upper abdominal pain is a common symptom.
Treatment usually includes medication to decrease stomach acid production. If a bacteria is the cause, antibiotics may be needed.;
affects more men than woman;
Treatment consists of antacids
Medications: Antacids, Antibiotics, Proton-Pump inhibitor, Diarrhea medication
Diagnositic: Therapeutic endoscopy & labs
Celiac Disease (Celiac Sprue)
Immune reaction to eating gluten, a protein found in wheat, barley, and rye;
Over time, the mmune reaction to eating gluten creates inflammation that damages the small intestine's lining, leading to medical complications. It also prevents absorption of some nutrients (malabsorption).
The classic symptom is diarrhea. Other symptoms include bloating, gas, fatigue, low blood count (anemia), and osteoporosis. Many people have no symptoms.
The mainstay of treatment is a strict gluten-free diet that can help manage symptoms and promote intestinal healing.
Irritable Bowel Syndrome (IBS)
(AKA: spastic colon)
Intestinal disorder causing pain in the belly, gas, diarrhea, and constipation;
The cause of irritable bowel syndrome isn't well understood. A diagnosis is often made based on symptoms.
Symptoms include abdominal pain, bloating, diarrhea, and constipation.
Some people can control their symptoms by managing diet, lifestyle, and stress. Others will need medication and counseling.
Affect 14-60 years old mostly
Gastrointestinal: change in bowel habits, constipation, diarrhea, inability to empty bowels, indigestion, nausea, passing excessive amounts of gas, or urgent need to defecate;
Common: anxiety, depression, discomfort, loss of appetite, or symptoms alleviated by defecation;*
Medications: Diarrhea medication, Gut antispasmodic, Laxative, Nerve pain medication, Antibiotics Rifaximin (Xifaxan), Dietary supplement
Inflammatory Bowel Disease (IBD)
The inflammatory bowel diseases (IBD) are Crohn's disease (CD) and ulcerative colitis (UC).
The intestinal complications of Crohn's disease and ulcerative colitis differ because of the characteristically dissimilar behaviors of the intestinal inflammation in these two diseases.
The intestinal complications of IBD are caused by intestinal inflammation that is severe, widespread, chronic, and/or extends beyond the inner lining (mucosa) of the intestines.
Ulcerative Colitis (UC) VS. Crohns
UC: INVOLVES INFLAMMATION of INNER LINING only LG INTESTINE (colon); At HIGHER RISK of COLON CANCER, ANNUAL COLONOSCOPIES & BIOPSIES done after 8-10 years of colitis

*Crohns: throughout gastrointestinal tract, involves the entire thickness of the bowel wall most commonly in lower part of the small intestine (ileum). Small intestinal bacterial overgrowth (SIBO) in can result from an intestinal stricture, diagnosed by a hydrogen breath test. It is treated with antibiotics. More common in this condition intestinal strictures, fistulas, and fissures; disease of the duodenum and jejunum (the first two parts of the small intestine), malabsorption of nutrients can cause malnutrition, weight loss, and diarrhea, whereas in Crohn's disease of the ileum, malabsorption of bile salts can cause diarrhea. Malabsorption of vitamin B12 can lead to anemia.

BOTH: Intestinal ulceration & bleeding are complications of severe mucosal inflammation

AVOID: Narcotics, codeine, and anti-diarrheal medications such as Lomotil and Imodium should be avoided during severe episodes of colitis because they might induce a condition known as toxic megacolon.
Ulcerative Colitis
(AKA: colitis ulcerosa)
A chronic, inflammatory bowel disease causes inflammation in the digestive tract.;
Usually only in the innermost lining of the large intestine (colon) and rectum. Forms range from mild to severe. Having puts a patient at increased risk of developing colon cancer.
Symptoms include rectal bleeding, bloody diarrhea, abdominal cramps, and pain.
Treatment includes medications and surgery.;
Affects 19-60+ mostly
People may experience:
Pain areas: in thejoints or rectum
Pain types: can be intermittent in the abdomen
Gastrointestinal: bloating, blood in stool, constipation, diarrhea, inability to empty bowels, leaking of stool, or urgent need to defecate*
Whole body: anemia, fatigue, fever, or loss of appetite
Abdominal: cramping or tenderness
Also common: weight loss or scarring within bile ducts;
Treatment consists of anti-inflammatory medications (NSAIDs), Antibiotics, Immunosuppressive drug, Steroid, Analgesic, Dietary supplement
Surgery: Colonstomy, colectomy, ileostomy, proctocolectomy
Treatment: enema
Crohn's Disease
(AKA: ileitis )
A chronic inflammatory bowel disease that affects the lining of the digestive tract;
Can sometimes causes life-threatening complications.
Can cause abdominal pain, diarrhea, weight loss, anemia, and fatigue. Some people may be symptom free most of their lives, while others can have severe chronic symptoms that never go away.
Disease cannot be cured. Medications such as steroids and immunosuppressants are used to slow the progression of disease. If these aren't effective, a patient may require surgery. Additionally, patients with disease may need to receive regular screening for colorectal cancer due to increased risk.
Mostly effect 19-40 years old
Treatment consists of anti-inflammatory medications
Can't be cured. Medications such as steroids and immunosuppressants are used to slow the progression of disease. If these aren't effective, a patient may require surgery. Additionally, patients with Crohn's disease may need to receive regular screening for colorectal cancer due to increased risk.
Cause abdominal pain, diarrhea, weight loss, anemia, and fatigue. Some people may be symptom free most of their lives, while others can have severe chronic symptoms that never go away.
People may experience:
Pain areas: in the abdomen, joints, lower abdomen, or rectum
Pain types: can be mild or severe
Gastrointestinal: bloating, blood in stool, bowel obstruction, diarrhea, nausea, vomiting, or flatulence
Whole body: fatigue, fever, or loss of appetite
Abdominal: cramping or tenderness
Also common: anal fissure, depression, flare, mouth ulcer, slow growth, or weight loss
Peritonitis
Inflammation of the membrane lining the abdominal wall and covering the abdominal organs;
Usually infectious and often life-threatening. It's caused by leakage or a hole in the intestines, such as from a burst appendix. Even if the fluid is sterile, inflammation can occur.
Symptoms usually include pain, tenderness, rigid abdominal muscles, fever, nausea, and vomiting.
Antibiotics are almost always needed, along with surgery or drainage.
Affects 19-60+ mostly
Pain areas: in the abdomen
Gastrointestinal: bloating, fluid in the abdomen, nausea, or vomiting
Whole body: chills, fever, or loss of appetite
Abdominal: tenderness or abdominal guarding
Also common: organ dysfunction
Intestinal Infection
Gastrointestinal infections are viral, bacterial or parasitic infections that cause gastroenteritis, an inflammation of the gastrointestinal tract involving both the stomach and the small intestine. Symptoms include diarrhea, vomiting, and abdominal pain;
Infections of the large intestine. The major infections discussed in this section include: *pseudomembranous colitis: Clostridium difficile (C-diff) a bacteria
bacterial dysentery: campylobacteriosis, shigellosis, salmonellosis, yersiniosis and Escherichia coli (E-Coli) dysentery.
parasitic dysentery. Bacterial dysentery includes*
Cancer of Stomach
(AKA: Gastric Cancer)
Risk factors may include smoking and a diet of highly processed or salty foods.
No symptoms of stomach cancer early on. Later, symptoms include feeling bloated after eating, feeling full after eating small amounts of food, nausea, heartburn, or indigestion.
Treatment options include surgery, medications, radiation, and chemotherapy.
Mostly affects 19-60+ years old;
Treatment depends on stage
here may be no symptoms of stomach cancer early on. Later, symptoms include feeling bloated after eating, feeling full after eating small amounts of food, nausea, heartburn, or indigestion.
Can have no symptoms, but people may experience:
Gastrointestinal: dark stool from digested blood, indigestion, nausea, or vomiting blood
Whole body: cancer-related fatigue or loss of appetite
Also common: abdominal fullness, difficulty swallowing, or weight loss
Carcinoma of the Esophagus
(AKA: Espohageal Cancer)
Cancer of the tube (esophagus) that runs from the throat to the stomach
Smoking and poorly controlled acid reflux are significant risk factorsr.
Symptoms include trouble swallowing, unintentional weight loss, chest pain, worsening indigestion or heartburn, and coughing or hoarseness.
Treatment focuses on removing the cancer through surgery. Chemotherapy and radiation also may be used.
Mostly affects 40-60+ years old
Treatment focuses on removing the cancer through surgery. Chemotherapy & radiation used.
People may experience:
Pain areas: in the abdomen
Gastrointestinal: dark stool from digested blood, heartburn, indigestion, nausea, or vomiting blood
Also common: difficulty swallowing, iron deficiency anemia, loss of appetite, or weight loss
Achalasia
(AKA: cardiospasm)
A rare disorder making it difficult for food and liquid to pass into the stomach;
Results from damage to nerves in the food tube (esophagus), preventing the esophagus from squeezing food into the stomach. It may be caused by abnormal immune system response.
Symptoms include a backflow of food in the throat (regurgitation), chest pain, and weight loss.
Can usually be managed with minimally invasive (endoscopic) therapy or surgery.
Mostly affect 41-60+;
Treatment consists of calcium channel blockers
can usually be managed with minimally invasive (endoscopic) therapy or surgery;
People may experience:
Pain areas: in the chest
Gastrointestinal: heartburn or regurgitation
Also common: difficulty swallowing, difficulty belching, or weight loss
Fissures
A narrow slit or cleft, especially one of the deeper or more constant furrows seperating the gyri of the brain.
Fistulas
Any abnormal, tube like passage within body tissue, usually between two internal organs, or leading from an internal organ to the body surface.
Hemorrhoid
A mass of dilated, tortuous veins in the anorectum involving the venous plexuses of that are
External Hernia's
Protrusion of a viscus through an abnormal opening or a weakened area in the wall of the cavity in which it is normally contained; different types are ventral,femoral, inguinal & umbilical
Hiatal Hernia
Esophageal hernia or diaphragmatic hernia results from a weakness of the diaphragm; protrusion of the stomach & other abdominal viscera through an opening or hiatus in the diaphragm; it is a problem of the diaphragm that affects the alimentary tract; Anatomical condition not a disease;
GERD common & complication strangulation, infarction or ulceration of the herniated stomach are serious & require surgical intervention;
Contributing factors are obesity, trauma, general weakening of the supporting structures resulting from aging;
May perform posterior gastropexy, a laproscopically performed nissen fundoplication
intussuception
Infolding of one segment of the intestine into the lumen of another segment in children (generally);
Barium Enema (BE) Lower GI series may be used to reduce or treat a nonstrangulated ileocolic ___'
Rectum
20 cm or 8" inches long
Pancreas
Produces 1000-1500 mL of pancreatic juice aiding in digestion
Bilirubin
Broken down red cells that is water insoluble which must be converted by the liver
T-tubes bag
Nurses need to ensure that what is in proper position & level for secure drainage
Lay on side (generally R) but could be L for 2 hours
What should the nurse make sure a patient does after a liver needle biopsy
A pneumothorox
After a liver needle biopsy if a patient beings experiences signs of SOB, tachycardia & respiratory distress what might the nurse suspect
Abdominal pain in the RUQ
What is the classic sign of cholecystitis
Serum Amylase & Serum Lipase
Which labs are used to diagnose pancreasitis
Serum Amylase
What levels in the blood can rise as early as 2 hours indicating pancreatitis
Serum Lipase
Which levels in the blood can rise as early as 8 hours indication pancreatitis
Normal Lab Levels
Serum Ammonia Levels 10 to 80 mL/dL
Serum Amylase Levels 60-120 Somogyl units/dL
Serum Lipase Levels 10-140 units/L
AST (aspartate aminotransferase
Liver Enzyme Lab Tests
0-35 units/L: Level is elevated in myocardial infarction, hepatitis, cirrhosis, hepatic necrosis, hepatic tumor, acute pancreatitis, & acute hemolytic anemia
ALT (alanine aminotransferase)
Liver Enzyme Lab Tests
Adults & kids 4-36 units/L Elevated in hepatitis, cirrhosis, hepatic necrosis & hepatic tumors & by hepatotoxic drugs
LDH (Lactic acid dehydrogenase)
Liver Enzyme Lab Tests
Adult 100-190 units/L Values are increased in Myocardial Infarction, pulmonary infarction, hepatic, disease (e.g. hepatitis active cirrhosis, neoplasm), pancreatitis & skeletal muscle disease
Alkaline Phosphatase
Liver Enzyme Lab Tests
Adults 30-120 units/L level is elevated in obstructive disorders of the biliary tract, hepatic tumors, cirrhosis, hepatitis, primary & metastatic tumors, hyperparathyroidism, metastatic tumor in bones, & healthing fractures*
GGT (gamma-glutamyl transpeptidase)*
Liver Enzyme Lab Tests
M & F older than 45 years old 8-38 units/L
M & F younger thand 45 years old 5-27 units/L
Levels are elevated in leiver cell dysfunction surch as hepatitis & cirrhosis; in hepatic tumors w/ the use of hepatotoxic drugs; in jaundice & in myocardial infarction (4-10 days after), heart failure alcohol ingestion, pancreatitis & cancer of the pancreas
Laparoscopic
Which method is generally used for a cholecystectomy
Through fecal contamination of food & water
How is Hepatitis A transmitted
Pruritis
What will a patient who has cirrhosis & jaundice (yellow skin) suffer from
Low Protein (Restriction of) Diet
What kind of a diet will patient be put on if he has liver disease due to the liver not being able to process & break down the protein into amino acids then into ammonia eliminating the ammonia out of the body thru the blood
Infection
#1 prevention nurse needs to help the patient avoid after liver transplant
NPO
If patient is having pancreasitis issue what one thing will the doctor insist the patient is
High fat foods, milk, PB, spicy foods (PB, whole milk, chocolate donuts) (SATA)
What foods should a patient w/cholecystitis avoid
Jaundice
What is it called when patient has yellowing to the skin & sclera of eye
CA19-9
Name of a tumor marker showing elevated liver enzymes
Hepatitis D
If patient has Hepatitis B what Hepatitis could patient get which would be a co-infection of to Hep B
Pt NPO & consent form signed
If patient has an invasive procedure done like blood transfusion, surgery & or IV med's what 2 things does the nurse to ensure
Blood clotting (low) / risks of bleeding (high)
If a patient has to high or low Prothrombin (PT/PTT) & INR (Ratio) or (aPTT) due to Vitamin K what process will it affect in the body
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