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411 Cards in this Set
- Front
- Back
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Define Alimentary Canal
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Another Name for Digestive Tract
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Alimentary Canal Extends from __________ to ________
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Mouth to Anus
(all ingested foods travel this) |
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6 Acessory organs of Digestion:
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Teeth, Tongue, Salivary Glands, Liver, Gallbladder and Pancreas
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Function and Location of Incisors?
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Incisors bite and cut food and are located in center of mouth.
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Function and Location of Canine Teeth?
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Canine are next to incisors and before molars. They Tear and Shred food.
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Function and Location of Molars?
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Molars are located in back of the jaw. They crush and grind food.
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List 3 Pairs of Salivary Glands?
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1. Parotid Glands
2.Submandibular Glands 3.Sublingual Glands |
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What is the composition of Saliva?
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99% Water and also contains muous and enzymes.
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What are 2 enzymes in Saliva?
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1. Amylase
2. Lysozome |
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What is Amylase function in Saliva?
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Begins the break down of carbohydrates.
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What is Lysozome function in Saliva?
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Destroys Bacteria which helps reduce risk for cavaties and infection in mouth.
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What is a flat muscular tubge that stretches from the throat to the stomach? It is also 10 inches in length.
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Esophagus
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Why does esophagus stretch when you swallow food?
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Esophagus stretches to allow room for the Bolus of Food.
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What action moves food down the esophagus and into the stomach?
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Peristalsis
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What is located at the ENTRANCE and EXIT of the stomach?
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Sphincter Muscles
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Where is the Entrance Stomach SPHINCTER located and its action?
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It is called the Cardiac Sphincter b/c it is close to the Heart. Round muscle. Its goal is to allow food to pass through and hold food and fluids in the stomach.
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Where is the EXIT Stomach SPHINCTER located and its action?
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Pyloric Sphincter. It is a round muscle that allows food to pass through and to hold food and fluids inside the stomach.
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Why do the Stomach Sphincters Relax and Contract?
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They are rtound muscles and they allow food to pass through the stomach and hold food and fluids in the stomach.
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What are 2 types of Digestion in the Stomach?
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1.Mechanical
2.Chemical |
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Why do the Muscles of the Stomach Contract?
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Help mix the food with the Gastric Juices.
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What do Gastric Juices do in the stomach?
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Break down Protein
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What do you call food once it is broken down in the STOMACH before it goes to the Intestines?
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Chyme, a thick liquid.
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What 3 Main Parts are the SMALL INTESTINES made up of?
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1,Duodenum
2.Jejunum 3.Ileum |
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Where is the Duodenum section of the Small Intestine located?
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Just past the Pyloric Sphincter and next to the stomach.
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What startes its Digestive process in the Duodenum of the Small Intestine?
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FATS with BILE and PANCREATIC ENZYMES entering the Duodenum
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The Small Instestine is _____ long and ___ inch in diameter?
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20 FEET Long
1 Inch in Diameter |
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How does the Small Intestine fit into the Abdominal Cavity?
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Small Intestine is FOLDED
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What does the INSIDE of the Small Intestine Contain?
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VILLI
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How would you describe VILLI?
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Fingerlike Projections into the Lumen
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What is the function of VILLI?
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To absorb digested food and nutrients.
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How much does the VILLI presence increase the Surface Area of the Inside of the Small Intestines?
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600 times
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What 2 things do the VILLI contain?
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1.Blood Capillaries
2.Lymph Lacteal |
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What do the Blood Capillaries and Lymph Lacteal of the Villi do?
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Absorb FATTY ACIDS
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What is the Middle section of the Small Intestine?
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Jejunum
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What is the THIRD part of the Small Intestine closest to the Colon aka Large Intestine?
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Ileum
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Pneumonic:
DJI of Small Intestine stands for? D______ J_______ I____ |
Order from stomach to colon:
Duodenum Jejunum Ileum |
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What is the percentage of DIGESTION that occurs in the Small Intestine?
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90% of of digestion occurs in the Small Intestine.
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What is the purpose of the Ileocecal Valve?
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Allows digestive products to pass from the small intestine into the large intestine.
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What dangles below the Ileocecal Valve?
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Appendix
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Describe the Appendix and its Function.
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Appendix is a worm-like tubular pouch that dangles below the the ileocecal valve.
Its FUNCTION is NOT Understood. |
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List four Functions of the Large Intestine AKA Colon
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1.Absorption of Water and remaining Nutrients.
2.Manufacture of certain Vitamins. 3.Forming Feces and moving it through the body. 4.Expelling Feces |
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What is normal length of time for FOOD to pass through the Large Intestine aka Colon?
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3-5 Days
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What is the final 8 inches of the Large Intestine and its function?
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Rectum and its function is to be a holding pouch for fecal material until its expelled.
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Describe MECHANICAL Digestion.
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Mechanical Digestion is when FOOD is broken into smaller particles, mixed and moistened, and moved along the digestion tract.
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Describe CHEMICAL Digestion.
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Breaking down FOOD into Nutrients to be absorbed into the BLOODSTREAM.
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Where does MECHANICAL Digestion Occur (Begin)?
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Mechanical Begins;
The Mouth with Chewing and Swallowing. |
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Where does MECHANICAL Digestion continue to after it startes in the Mouth?
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Mechanical Continues to:
1.Peristalsis of the esophagus. 2.Churning action of the stomach. 3.Ends in Peristalsis of the Intestines. |
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What are the 2 Places/Organs that CHEMICAL Digestion occurs?
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1.Stomach
2.Small Intestine |
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How are FOODS broken down in the Stomach and the Small Intestines?
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By Digestive Juices and Enzymes.
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What is similar about the Stomach and the Small Intestine?
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BOTH Have Chemical Digestion.
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Name the 3 Accessory Organs that are Used for CHEMICAL Digestion:
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1.Liver
2.Gallbladder 3.Pancreas |
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How does the Liver aid as an Accessory Organ in Chemical Digestion?
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Liver produces BILE
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Who manufactures BILE and what is it used for in the Digestive Process?
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The LIVER manufactures BILE.
Bile breaks down and emulsifies fats for digestion. |
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How does the Gallbladder aid as an Accessory Organ in Chemical Digestion?
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The GallBladder stores the BILE for the Liver. Once the Duodenum sends a signal of the Presence of FAT, it then empties the BILE.
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When does the Gallbladder release its store of BILE and where does the BILE Go?
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Gallbladder releases its store of BILE once the DUODENUM sends signal of Presence of Fat. The bile then goes to DUODENUM to aid it in digestion.
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How does the PANCREAS aid as an Accessory Organ in Chemical Digestion?
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Pancreas produces Digestive Enzymes.
Enzymes help break down Carbohydrates, Proteins, and Fats for Digestion |
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What are the Enzymes created by the Pancreas as an Accessory Organ for Chemical Digestion USED for?
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Enzymes help BREAK Down:
Carbohydrates, Proteins, Fats for Digestion |
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What is the Function of the BILIARY SYSTEM OF Digestion?
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Make, Store, and Release BILE.
Make, Store and Release Digestive Enzymes |
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What do BILE and Digestive Enzymes have in Common?
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Both are part of the BILIARY System and Chemical Digestion.
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Describe the Appearance of BILE:
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Bile is a greenish-brown or yellowish-brown liquid.
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What is the FUNCTION of BILE?
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Helps the BODY Digest FAT
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How does BILE help the Body Digest Fats?
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By EMULSIFYING (breaking it apart into tiny droplets) the FAT and allow it to be DIGESTED into FATTY ACIDS
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What is the Function of the Gall Bladder?
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Stores BILE until it is needed to Emulsify FAT
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What are 8 Functions of the Liver?
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Make Bile, Coagulate Blood, Make Cholesterol, Make Albumin for Normal Blood Volume, Filter Toxins FROM the Blood, Store Glucose as Glycogen, Activate Vit-D, Change Wasted Products of Protein Metabolism into UREA
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What does the Pancrease produce in aid to Chemical Digestion as an Accessory Organ?
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Pancreatic Juice, which contains Pancreatic Enzymes
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What is the Function the Pancreatic Enzymes that aid in Digestion?
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Break down:
Proteins Carbohydrates Fats |
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What do the Pancreatic Juice and Enzymes EMPTY into and WHY?
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DUODENUM to break down FOOD.
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How does the Pancreas affect Hydrochloric Acid that enters the SMALL Intestine from the STOMACH?
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It NEUTRALIZES the Hydrochloric Acid by releasing Sodium Bicarbonate.
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How does BILE mix with FOOD?
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When FAT is present in the DUODENUM it causes a signal to the GALLBLADDER to Release the BILE through the COMMON BILE DUCT into the DUODENUM.
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What does the Bile do when it is realesed from GallBladder through the Common Bile Duct into the DUODENUM?
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Mixes with CHYME.
Chyme is product of FOOD broken down by Gastric Juices. |
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How are Nutrients from Digested Food are Absorbed and Circulated in the BLOOD.
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This is part of the CHEMICAL digestion that occurs in SI and Stomach. When food is digested it is broken down into Amino Acids, Fatty Acids, and Simple Sugars. These nutrients are absorbed by the BloodStream via the VILLI in the SI. The Messenteric Veins carry the digested food from the VILLI to the PORTAL Vein. It carries the blood loaded with nutrients from digested food to the LIVER where some nutrients are extracted and stored. Then the Blood leaves the liver through the Hepatic Veins, which empty into the Inferior Vena Cava.
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What does the UPPER GI System Include? What are the 3 main Parts?
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1.Mouth
2.Esophagus 3.Stomach |
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What part of the Upper GI System would use an Oral Examination to Diagnose a Condition?
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The MOUTH, TEETH, GUMS
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What part of the Upper GI System would use Upper GI Diagnostic Studies to detect or diagnose a Condition?
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ESOPHAGUS and STOMACH
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What is THRUSH?
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CANDIDA ALBICANS
Mouth Infection that is a fungus and usually affects the Mucus Membranes and Skin. |
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What group of Patients are Highly Susceptible to THRUSH?
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1,Infants
2.Patients using Steriods 3.Patients using Antibiotics 4.Patients on Chemotherapy |
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What would you expcet to see with THRUSH if found in the MOUTH?
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Small white patches on the:
Mouth and Tongue |
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If you remove the White Patches associated to Thrush what would you expect to happen?
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Patient with complaint of:
Pain and Bleeding. |
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How can the NURSE help prevent spread of THRUSH?
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Careful, Thourogh HandWashing.
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What should a nursing Mother with Infant who has thrush be advised?
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1. To know how to clean her nipples carefully.
2. Carefully clean Infant feeding equipment. 3.Clean hands thoroughly. |
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What is STOMATITIS?
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Inflammation of the Mouth and can refer to any condition that causes heat, pain, or mouth soreness.
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What is STOMATITIS caused by?
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A variety of factors such as:
Infection, Mechanical Trauma, Irritants, Sensitivity to toothpaste or mouthwash, and a decrease in immune function. |
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What is Leukoplakia?
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Smooth, Irregular, White patch on the Mucosa of the mouth, lips, cheeks, or tongue.
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How can Leukoplakia be rubbed off with?
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FORCE
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What can become of Leukoplakia Lesions?
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Malignant Lesions may develop.
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What is recommended if a Leukoplakia lesion lasts more than 2 weeks?
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NEED for a BIOPSY.
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List 4 Risk Factors for the development of CANCER in the Oral Cavity?
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1. Heavy Alcohol Intake
2. Heavy Smoking 3. Use of Useless Tobacco 4. Exposure to Sun and Wind |
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What are 3 EARLY Complaints a patient may make in Early Stages of Oral Cancer?
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1. Difficulty Chewing, Swallowing, and Speaking.
2.Numbness or Swelling in mouth. 3.Constant pain in ear, face, or tooth. |
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List Objective Assessments to make for a Pt with Possible Oral Cancer?
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1. Assess for Leukoplakia
2. Assess for Oral Bleed or Blood tinged Sputum 3. Assess for swelling or knots in the neck. 4.Assess for Hoarseness. |
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4 Nursing Dx for Pt with Oral Cancer:
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1.altered nutrition; less than body requirements due to pain or discomfort in the mouth.
2.disturbance in body image due to disfigurement. 3.anxiety due to cancer diagnosis. 4.fear of the unknown. |
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Name factors that Influence the Prognosis of the Patient with Oral Cancer?
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1. Size of the Tumor
2. Whether the Cancer has spread to Lymph Nodes 3. Whether the Cancer has spread to the Surrounding Structures. 4.Condition of the Patient's Immune System. 5. The patient's General Condition. |
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What is Esophagitis?
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INFLAMMATION OF THE ESOPHAGUS
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What is Usually the Cause of Esophagitis?
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Swallowing Irritants or Acid Reflux from the Stomach into the Esohpagus.
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What is the ACHALASIA of the Esophagus?
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Condition that causes the Cardiac Sphincter of the Stomach to Stay CONTRACTED.
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What is the cause of ACHALASIA?
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Unknown
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In ACHALASIA what does the tightened spincter cause the lower portion of the esophagus to do?
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DILATE enough to hold a liter or more.
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In ACHALASIA what does the patient complain OF?
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Food not going down and eventually complains of Regurgitation.
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How is ACHALASIA treated?
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By dilating the narrowed area and the Cardiac Spincter.
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How is the DILATION done in relation to ACHALASIA?
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Inserting a balloon into the Sphincter and Inflating it.
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In ACHALASIA what can medications do to help?
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Help relax the Sphincter.
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What is the surgery that uses dilation of the Sphincter? Also surgery for ACHALASIA?
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CARDIOMYOTOMY
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What does CARDIOMYOTOMY do?
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Cuts the Muscle Layers of the SPHINCTER to allow it to EXPAND.
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What is Another Name for Gastroesophageal Reflux Disease?
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GERD
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What is GERD?
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When Food and Gastric Acid Splash into the Lower Esophagus.
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What Causes GERD to occur?
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Cardiac Sphincter is too Relaxed.
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What other things can cause GERD?
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Hiatal Hernia
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A patient with GERD Commonly complains of?
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RETROSTERNAL Heartburn
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Other Things a patient with GERD may Complain of?
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Dysphagia, Regurgitation, or Belching.
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What is the most common symptom of Esophageal Cancer?
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Dysphagia that lasts longer than 6 months.
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5 Objectives that that nurse should Assess in the Pt with Esophageal Cancer.
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Assess for:
1.Regurgitation 2.Vomiting 3.Hoarseness 4.Chronic Cough 5.Iron-Deficiency Anemia |
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What Interventions Can the Nurse use to Improve the Nutritional Status of the Patient with ESOPHAGEAL CANCER?
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1. Indentify Foods/Fluids the patient can tolerate and Provide them.
2.Carefully Monitor I&O 3.Assess for symptoms of Dehydration 4.Weigh DAILY to detect weight loss due to inadequate nutrition. 5.Provide Gastrostomy Feedings as ordered. |
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What are possible 7 Causes of GASTRITIS?
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1. Alcoholism
2. Smoking 3. Major Surgery 4. Food Allergens 5. Toxins 6. Chemotherapy 7. Radiation Therapy |
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What OTC Rx could cause GASTRITIS?
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1. Salicytes
2. NSAIDS |
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What does the Term PEPTIC ULCER refer to?
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Ulcers of the STOMACH and the DUODENUM
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What are PEPTIC ULCERS believed to be the Result of?
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Stomach Acids and the digestive enzyme PEPSIN eroding the Mucosa but the exact cause remains under investigation.
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What is THOUGHT to Influence the Development of a PEPTIC ULCER?
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Presence of the bacterium:
H. Pylori |
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What are the 2 most common types of Peptic Ulcers that are Name for their LOCATION?
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GASTRIC and DUODENAL Ulcers
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Where do GASTRIC ULCERS (peptic ulcer) occur?
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The STOMACH, most commonly in the DISTAL Half
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Where do the DUODENAL ULCERS (peptic ulcer) occur?
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First part of the Small Intestine connected to the Stomach
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Describe the PAIN of a Typical Ulcer?
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BURNING, DULL, or a GNAWING Sensation located in the EPIGASTRIUM
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What does the Term DYSPEPSIA mean?
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Discomfort that includes: Nausea, Burping, Bloating, or Distention
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What Assessment should a Nurse make to Determine if an Ulcer is Causing a GI BLEED?
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Assess for Vomitus that looks like Coffee Grounds, Black Tarry Stools, and Bright Red Blood in the Stool
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What should the nurse Review in relation to GI BLEED and Lab H&H Values?
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If the H&H is low or following.
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If an (Peptic) Ulcer Perforates the Wall of the Stomach or the Duodenum, What symptoms would the Patient have?
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Severe PAIN, Vomiting, Fever, Hematemesis, a BOARD-Like Abdomen, and SHOCK
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What other Complications can Occur from a PEPTIC ULCER?
(in addition to a perforation) |
Bleeding, Formation of Scar Tissue, and Obstruction
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What type of Tubes are used in the treatment of complications of Peptic Ulcers?
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NG aka Nasogastric
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What are 3 types of NG tubes for treatment of a Peptic Ulcer?
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1. Decompression
2.Compression (Sensatken-Blackemore tube) 3.Lavage |
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What is a Decompression NG tube used for in the treatment of a Peptic Ulcer?
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To remove secretions, especially gastric acid from the stomach so ulcers can heal; to relieve abdominal distention and gas.
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What is a Compression Sensatken-Blakemore tube used for in the treatment of a Peptic Ulcer?
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To Apply Pressure to areas of bleeding or hemorrhage withing the esophagus or entrance to the stomach.
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What is a Lavage NG tube used for in the treatment of a Peptic Ulcer?
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To wash out blood when an ulcer is actively bleeding; use of iced saline helps constrict blood vessels and decrease or stop bleeding.
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What are 7 NURSING Actions to take for a pt with GI Bleeding who is at RISK for FVD (FLUID VOLUME DEFICIT)?
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1. Monitor I&O every HOUR
2. Report output less than 30mL per HOUR 3. Assess for S/S of Dehydration. 4. Assess Urine for Color,Odor and Clarity 5.Assess NG tube function, if present: Aspirate as part of output 6. Apply Petrolatum to DRY Lips; encouraging Fluids if allowed. 7. Test N/G Aspirate and Stool for presence of Occult Blood. |
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What is PUD?
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Peptic Ulcer Disease
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What are 4 Nursing Actions to take to help relieve the ANXIETY of a pt Hospitalized with PUD? (Peptic Ulcer DX)
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1. Assess for evidence of Anxiety, verbal and Non-Verbal
2. Explain what will be done before it is done 3. Explain Disease process and its Resolution. 4. Teach pt about self-care to relieve anxiety about what will happen after discharge. |
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What are Changes in a PT Lifestyle that may need to be changed by a Pt that has PUD (peptic ulcer dx)
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Stop smoking, avoid Alcoholic beverages, Change eating habits to 6 small meals a day, and use POSITIVE coping skills for stress.
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What is the most Common Age group for Stomach Cancer?
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Age 50-70 years of age.
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What kind of Hx would you expect a patient with Stomach Cancer to have?
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Chronic Stomach problems such as: Polyps, Pernicious Anemia, Insufficient Hydrochloric Acid Levels (Achlorhydria), and Gastric Ulcers
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What does Achlorhydria mean?
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Insufficient Hydrochloric Acid Levels, in relation to possible symptom of Stomach Cancer
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What are Early Symptoms of Stomach Cancer?
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Usally none, this is not detected until in advanced stages.
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What are Later Symptoms of Stomach Cancer?
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Vague Indigestion or Ulcer Type Pain that doesn't respond to the usual Ulcer Treatment
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What are 4 Objective Assessments that the Nurse shoud make when a pt is diagnosed with possible Cancer of the Stomach?
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1. Assess for WEIGHT Loss
2. Assess for VOMITING OF BLOOD 3. Assess for Vomiting after Eating and Drinking Fluids 4. Assess for Occult Blood or in the Stool |
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What 3 Treatments Might a Pt with Gastric Cancer Undergo?
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1. Surgery
2. Chemotherapy 3. Radiation Therapy |
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How would you expect the pt to be supported nutritionally after surgery to remove part of the stomach?
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TPN- Total Parenteral Nutrition
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Why might the Patient who has had surgery for Stomach Cancer develop Pernicious Anemia?
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Stomach can no longer produce the INTRINSIC factor which must be present for Vitamin B12 to be absorbed from food.
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When does a Hernia Occur?
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When an ORGAN or part of an Organ portrudes through the muscular wall of the cavity that normally holds it?
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What 3 things can cause the MUSCLES of the Abdominal Wall be DAMAGED?
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1. Surgery
2. Trauma 3. Congenitally Weak |
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When does an ABDOMINAL Hernia occur?
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When organs of the Abdominal Cavity protrude through the muscular wall.
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What may Cause the Layers of Muscle to SEPERATE after abdominal Surgery?
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Increased Pressure in the Abdomen from Coughing or Straining.
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What Might some Patients call a HERNIA?
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RUPTURE
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When does a HIATAL Hernia Occur?
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When the Stomach Protrudes through an enlarged opening in the diaphragm around the esophagus.
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When a Hiatal Hernia Occurs what PUSHES through the Enlarged Diaphragmatic Opening?
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A Portion of the FUNDUS (top section) of the Stomach
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What Symptoms can A Hiatal Hernia Cause?
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Reflux, Heartburn (partiularly after a Large Meal)
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What 3 things Can Cause a HIATAL HERNIA?
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1.OBESITY
2.Trauma 3.General Muscular Weakening in the Diaphragm |
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When do Patients Notice Increased Symptoms with this Condition of A HIATAL HERNIA?
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If they lie down after EATING.
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Why does lying down after eating cause symptoms for a patient with a HIATAL HERNIA?
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Lying down allows a SLIDING HIATAL HERNIA to move up into the chest cavity more easily.
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Can the Nurse see or feel a Hiatal Hernia?
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NO
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What Symptoms can Cause A Hiatal Hernia and WHY?
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Chest Pain (CP) and Shortness of Breath (SOB) , because a portion of the stomach has displaced to the chest cavity.
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What can be done if the Hiatal Hernia causes unrelieved by Medical Management?
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SURGERY
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What is the term IBD (Inflammatory Bowel diesease)used to describe?
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Several Chronic Bowel Disorders
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What does IBD stand for?
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Inflammatory Bowel Disease
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What are 2 Diagnosis generally included in IBS?
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Chron's Disease and Ulcerative Colitis
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What is Enteritis?
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Inflammation of the Intestines
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What might Enteritis be caused by?
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Pathogens ingested with contaminated food
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What are 6 Possible Causes of Enteritis?
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1. Eating Food Contaminated with Salmonella, such as dairy products and eggs.
2.Clotridia Infections 3.2nd Infections due to the use of Antibiotics, also known as AAPMC (Antibiotic-Associated Psudomembranous Colitis) 4. Shellfish Allergy 5. Heavy Metal Poisoning 6. Ingestion of Toxic Mushrooms or Fish |
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What does TENESMUS mean?
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A painful, ineffective straining with a constant URGE to Empy Bowels
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List 5 Major Concerns in the Nursing Care of a PT with Enteritis?
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1. FVD (Fluid Volume Deficit) related to Vomiting/Diarrhea
2. Altered Nutrtition related to Inability to eat or absorb nutrition 3. Anxiety related to Urgency of Stool with Possible Incontinence. 4. Fear of the Unknown related to possible causes of symptoms 5. Pain related to Cramping and Spasms. |
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What does IBS stand for?
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Irritable Bowel Syndrome
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What are 2 other NAMES for IBS?
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1. Spastic Colon
2. Mucous Colitis |
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What are the Symptoms of IBS?
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May be intermittent
Abdominal Discomfort Cramping Flatulence Diarrhea Constipation |
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Is IBS caused by Infection?
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NO
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Can IBS cause Altered Bowel Function?
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YES
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What are the Symptoms that Often bring on IBS or worsen symptoms?
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Emotional Stress
Eating Highly Seasoned or Bulky Foods |
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What medications are prescribed for IBS?
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An ANTISPASMODIC
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List 4 Objective Assessments to make in a pt with IBS?
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1. Assess Stools for Mucous or Blood
2. Assess Color, Consistency and Frequency of stools. 3. Assess for Abdominal Distention. 4. Assess for Hyperactive Bowel Sounds in all 4 Quadrants |
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What PT Teaching would you provide a pt with IBS?
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1. Keep a log of diet and bowel activity.
2. Charateristics of pain 3. Side Effects of Medication 4. Recognize relationship between stress and IBS episodes. 5.Teach patient how to recognize S/S TRIGGERS |
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What would you teach an IBS Patient about FIBER?
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Increase Fiber if the patient has more constipation-domninant IBS, and to Regulate Fiber if the problem is more Diarrhea-Dominant
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When does APPENDICITIS Occur?
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When the VEMIFORM Appendix becomes INFLAMED.
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Why can the Appendix Easily become OBSTRUCTED?
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B/C it is a BLIND Pouch with a Narrow Opening.
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What happens if an obstruction in the Appendix Occurs?
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Bacteria (e.coli) is trapped within the Appendix where it multiplies and infection Develops.
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What happens in an Obstruction of the Appendix and PUS is Formed?
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Appendix will DISTEND
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If the obstruction and pus that causes the Appendix to Distend is not stopped what will happen?
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Appendix will RUPTURE
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Where is the McBurney's Point located? (In relation to the appendix)
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Halfway between the Umbilicus (navel) and the crest of of the right ilieum.
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What is the common complaint of patients with APPENDICITIS?
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Constant pain in the area of McBurney's point in the RLQ
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List 5 Objective Assessments to make on a PT with Possible Appendictis:
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1. Assess for VOMITING
2. Assess for Temp Range from 99-102 3. Assess for Rebound Tenderness over McBurney's Point 4. Assess for Blood Work for an Elevated WBC Count 5. Assess for Symptoms of Peritonitis such as: Board like abdomen, lack of bowel sounds |
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Why would the DR. Refrain from ordering Narcotics for pain
If APPENDICITIS Is Suspected? What would this put the patient at Greater Risk for? |
Symptoms would be masked by the Action of the Narcotic, therby Delaying the Diagnosis. This could put the patient at RISK for RUPTURE and PERITONITIS
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Why are the Enemas or Laxitives Contraindicated if the Possibility of Appendicitis Exists?
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Increase the Chance of the Appendix RUPTURING
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What Condition will OCCUR if the APPENDIX Ruptures?
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PERITONITIS
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Pt has hx of diverticulitis. Admitted for Diagnosis of Ruptured Diverticulum and Peritonitis. Prior to this complaint was LLQ with alternating diarrhea and constipation. Temp 102, pulse 124, BP 86/50. Pt had emergency surgery to remove the section containing the diverticuli. Pt has a temp colostomy with a Hartmann's Pouch and NG tube to low suction. Abd dress that is clean, dry, and intact. What complications of of peritonitis were developing when Mr. Cline was admitted to the hosp?
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SHOCK and Septicemia
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Pt has hx of diverticulitis. Admitted for Diagnosis of Ruptured Diverticulum and Peritonitis. Prior to this complaint was LLQ with alternating diarrhea and constipation. Temp 102, pulse 124, BP 86/50. Pt had emergency surgery to remove the section containing the diverticuli. Pt has a temp colostomy with a Hartmann's Pouch and NG tube to low suction. Abd dress that is clean, dry, and intact. Why did pt need a temp colostomy?
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To allow the operated part of the colon to rest and heal before fecal material could pass through it again.
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Pt has hx of diverticulitis. Admitted for Diagnosis of Ruptured Diverticulum and Peritonitis. Prior to this complaint was LLQ with alternating diarrhea and constipation. Temp 102, pulse 124, BP 86/50. Pt had emergency surgery to remove the section containing the diverticuli. Pt has a temp colostomy with a Hartmann's Pouch and NG tube to low suction. Abd dress that is clean, dry, and intact. Pt spouse tells you that she doesn't understand his original dx of Diverticulosis. How will you explain it to her?
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Diverticulosis occurs when the muscle wall of the COLON weakens and allows the Inner Layers to herniate through causing Pouches along the outside of the COLON.
These pouches can be filled with fecal material that causes inflammation and abcesses. |
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What is Peritonitis?
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Peritonitis is an INFLAMMATION of the or INFECTION of the inside of the Abdominal Cavity, the PERITONEUM
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What Causes PERITONITIS?
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Fecal Matter Leaves the Bowel and Enters the otherwise Sterile Cavity
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What causes the INFECTION in relation to PERITONITIS?
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Normal BACTERIAL in Fecal material
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Pt has hx of diverticulitis. Admitted for Diagnosis of Ruptured Diverticulum and Peritonitis. Prior to this complaint was LLQ with alternating diarrhea and constipation. Temp 102, pulse 124, BP 86/50. Pt had emergency surgery to remove the section containing the diverticuli. Pt has a temp colostomy with a Hartmann's Pouch and NG tube to low suction. Abd dress that is clean, dry, and intact. What caused the infection/inflammation in pt?
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Diverticula became inflamed and abcessed, then RUPTURED allowing Fecal Material into the Abdominal cavity.
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Pt has hx of diverticulitis. Admitted for Diagnosis of Ruptured Diverticulum and Peritonitis. Prior to this complaint was LLQ with alternating diarrhea and constipation. Temp 102, pulse 124, BP 86/50. Pt had emergency surgery to remove the section containing the diverticuli. Pt has a temp colostomy with a Hartmann's Pouch and NG tube to low suction. Abd dress that is clean, dry, and intact.
Before patient went to surgery what did the Bowel Sounds sound like? |
NOTHING
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Pt has hx of diverticulitis. Admitted for Diagnosis of Ruptured Diverticulum and Peritonitis. Prior to this complaint was LLQ with alternating diarrhea and constipation. Temp 102, pulse 124, BP 86/50. Pt had emergency surgery to remove the section containing the diverticuli. Pt has a temp colostomy with a Hartmann's Pouch and NG tube to low suction. Abd dress that is clean, dry, and intact.
Why before surgery was there no BOWEL SOUNDS? |
Peristalsis would stop B/C the BOWEL is PERFORATED.
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Pt has hx of diverticulitis. Admitted for Diagnosis of Ruptured Diverticulum and Peritonitis. Prior to this complaint was LLQ with alternating diarrhea and constipation. Temp 102, pulse 124, BP 86/50. Pt had emergency surgery to remove the section containing the diverticuli. Pt has a temp colostomy with a Hartmann's Pouch and NG tube to low suction. Abd dress that is clean, dry, and intact.
Why does this patient have an NG Tube in place on low Suction? |
To empty the Gastric Juices from his stomach and to prevent Gastrointestinal Distention.
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Pt has hx of diverticulitis. Admitted for Diagnosis of Ruptured Diverticulum and Peritonitis. Prior to this complaint was LLQ with alternating diarrhea and constipation. Temp 102, pulse 124, BP 86/50. Pt had emergency surgery to remove the section containing the diverticuli. Pt has a temp colostomy with a Hartmann's Pouch and NG tube to low suction. Abd dress that is clean, dry, and intact. What IV meds would you expect to to administer to pt during the post-op phase?
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IV Antibiotics, Fluids, Electrolytes, and Pain Med
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What is the Hartmann's Pouch Procedure
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A Hartmann's Pouch Procedure involves removing a section of the Descending Colon and forming a Temporary Colostomy with the Proximal End of the Descending Colon
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What happens to the remaining Portion of Sigmoid Colon after a Hartmann's Pouch Procedure?
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It is STITCHED Closed, Forming a Pouch
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When is the Sigmoid Colon reconnected in relation to the pouch stitched closed due to Hartmann's Pouch Procedure?
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After the Bowel has had time to Rest and Heal.
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What is ULCERATIVE COLITIS a result of?
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ABSCESS Formation of the Large Intestine
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How do the Tiny Abcesses of the Large Intestine lead to ULCER Formation?
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They cause SLOUGHING of the Mucosal Lining in the COLON
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Where do the Ulcers in the Large Intestine referred to as Ulcerative Colitis begin?
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Left Side of the Colon
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Where do the Ulcers in the Large Intestine AKA Colon found usually on the Left side of the Colon progress to?
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The RIGHT side of the Colon
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Why is it not UNCOMMON for the Stool in relation to Ulcerative Colitis to have blood and PUS in it?
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B/C irritated , Ulcerated Mucosa bleeds easily
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What is the MAJOR symptom of Ulcerative Colitis?
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DIARRHEA
(most likely with blood and pus) |
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Why does the Colon lose its ELASTICITY in relation to Ulcerative Colitis?
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B/C of Scar tissue that forms as it heals.
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Things to know about patient and Ulcerative Colitis.
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1. Patient may b/c incontinent of liquid stool
2. Unaware of need for a Bowel Movement |
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What is the CAUSE of Ulcerative Colitis
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Cause is UNKNOWN
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What part of the INTESTINES is affected by Ulcerative Colitis?
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The MUCOSA, SUBMUCOSAL Layers of the Colon aka Large Intestine
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List 3 OBJECTIVE Assessments to make for the PT with Ulcerative Colitis:
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1.Assess for Weight Loss
2.Assess for Symptoms of Infection (fever, elevated WBC, and Tachycardia) 3.Assess for Stools for Frequency, Color, and Consistency |
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What 4 MAJOR Complications can result from Chronic Diarrhea, such as would occur with Ulcerative Colitis?
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1. Fluid and Electrolyte (dehydration)
2. Toxic Megacolon 3. Carcinoma of the Bowel 4. Scarring of the Bowel Leading to Incontinence |
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List 4 Classifications of RX that would be used to Treat ULCERATIVE COLITIS:
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1. SULFASLAZINE (Azulfadine)
2. NON SULFA DRUGS 3. STERIODS 4. ANTIDIARRHEALS |
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How does STRESS affect Ulceritive Colitis?
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Increases the SYMPTOMS
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How does a Diagnosis of of Ulcerative Colitis Influence a Patients Risk for Cancer of the Colon?
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When the patient has had the disease of ULCERATIVE COLITIS for Several years, and when It involves most of the COLON.
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PT: 20 y/o f w/ Crohn's Dx. Lives at home at is p/t student in college. DX at age 16. HX Resection of to ILEUM with Anastomosis to to the COLON. She is 5'4 and 85lbs. HX 5-6 Diarrhea stools per day. Complains often of weak and poor appetite. Complains not hungry and that eating causes more diarrhea. DR is considering starting her on TPN to decrease any further weight loss. What question would you ask about her stools?
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About the # and Consistency of her Stools
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PT: 20 y/o f w/ Crohn's Dx. Lives at home at is p/t student in college. DX at age 16. HX Resection of to ILEUM with Anastomosis to to the COLON. She is 5'4 and 85lbs. HX 5-6 Diarrhea stools per day. Complains often of weak and poor appetite. Complains not hungry and that eating causes more diarrhea. DR is considering starting her on TPN to decrease any further weight loss. What 5 Objective Assessment would you make?
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Assess for:
1. STEATORRHEA 2. FEVER 3. ANEMIA 4. ANAL FISSURES 5. ANAL FISTULAS |
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PT: 20 y/o f w/ Crohn's Dx. Lives at home at is p/t student in college. DX at age 16. HX Resection of to ILEUM with Anastomosis to to the COLON. She is 5'4 and 85lbs. HX 5-6 Diarrhea stools per day. Complains often of weak and poor appetite. Complains not hungry and that eating causes more diarrhea. DR is considering starting her on TPN to decrease any further weight loss. What 4 Complications is she at risk for?
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1. Anemia due to decreased Vitamin B12 absorption
2. Electrolyte Imbalances, Fluid Imbalance and Acid-Base Balance 3. Anal Fistulas and Anal Fissures 4. Malnutrition |
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What are 4 COMPLICATIONS of CROHN's Disease?
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1. Anemia due to decreased Vitamin B12 absorption
2. Electrolyte Imbalances, Fluid Imbalance and Acid-Base Balance 3. Anal Fistulas and Anal Fissures 4. Malnutrition |
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What Objective Assessment for Crohn's Disease would you review:
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Assess for:
1. STEATORRHEA 2. FEVER 3. ANEMIA 4. ANAL FISSURES 5. ANAL FISTULAS |
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In an INGUINAL Hernia of the Man what happens to the INTESTINES?
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An opening the lower abdomonial wall occurs due to muscle weakness. In MEN, the Spermatic cord and possibly the loop of the intestine protrude through the opening and may drop down into the SCROTUM.
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In an INGUINAL Hernia of the Woman what happens to the INTESTINES?
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In Women, The ROUND Ligament and possibly intestine protrudes through the opening.
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In an UMBILICAL HERNIA what happens in the INTESTINES?
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Occurs where the Rectus Abdominus Muscle is Weak and Seperates, Allowing Intestines to PROTRUDE around the Navel (UMBILICUS)
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In an ABDOMINAL HERNIA what happens in the INTESTINES?
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Referst to any protrusion of the Abdominal Contents through a Weakened Muscular Wall. OFTEN this type occurs AFTER Surgery at the SITE OF THE INCISION
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In an INCARCERATED HERNIA waht happens in the INTESTINES?
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Occurs when the Flow of Fecal Material through the Intestines is Obstructed, Causing a BOWEL OBST.
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In an STRANGULATED Hernia what happens in the INTESTINES?
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Occurs when the BLOOD Supply to the Herniated Intestines is cut off. NECROSIS and Gangrene will occur if a Strangulated Hernia is not Surgically treated right away.
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When do OBSTRUCTIONS in the Intestines Occur?
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When the Intestinal Contents cannot pass through and Exit the GI System.
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What are 2 Kinds of an Intestinal OBSTRUCTION?
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1. Mechanical
2. Non Mechanical |
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What is a MECHANICAL Obstruction of the Intestines caused by?
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A TWIST OR KINK in the Intestine itself.
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What is a NON-MECHANICAL Obstruction of thet Intestines caused by?
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Decrease in or Absence of Peristalsis
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What are the 2 MOST COMMON cause of a MECHANICAL Obstruction?
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1. Adhesions
2. Incarcerated Hernias |
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What is the MOST COMMON Cause of a NON Mechanical Obstruction?
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Paralytic Ileus
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Can Bowel Obstructions Complete and Partial?
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YES
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What is an Adhesion in Relation to an MECHANICAL OBSTRUCTION In the Large Instestine?
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An ADHESION is a Fibrous Band of Scar Tissue that Binds Intestines together after Trauma, Surgery or Infection
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How do Adhesions cause MECHANICAL BOWEL OBSTRUCTIONS?
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Adhesions tightly bind the intestines together, fecal material cannot flow through easily, and as the lumen narrows due to the adhesions, a bowel obstruction results.
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What is meant by VOLVULUS?
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Intestine twists upon itself.
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What does the twisting of the intestine in "VOLVULUS" cause?
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Traps the contents within the intestine and obstructs the flow of fecal material.
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What would you expect to FIND when you Auscultate the Bowel Sounds of a PT with a Complete Intestinal Obstruction?
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NO BOWEL SOUNDS
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What reason would a patient with a complete Bowel Obstruction continue to have Bowel Movements for a TIME?
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The part of the COLON distal to the obstruction might continue to empty due to being below the OBSTRUCTION
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What 5 Assessment Findings would you expect to find with a PT with COMPLETE BOWEL Obstruction?
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1. Vomiting
2. Dehydration 3. Abdominal Tenderness 4. Distention 5. Decreased Blood Pressure |
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In relation to a BOWEL Obstruction what is the PURPOSE of Inserting a NASOJEJUNAL TUBE with a Mercury Weight at the DISTAL end?
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To DECOMPRESS the Intestine
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How does a NASOJEJUNAL TUBE with a Mercury Weight placed at the Distal END help to Decompress the INTESTINE?
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The weighted end helps move the tube further into the small intestine so gas and contents can be removed via suction.
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Why is the NASOJEJUNAL TUBE with Mercury Weight not TAPED in Place?
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So it can ADVANCE into the Intestine.
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Where is the cancer of the Colon/Large Intestine most Frequently Seen? What 2 places?
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1.Sigmoid Colon
2.Rectum |
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What 5 places can cancer of the Colon/Large Intestine Occur?
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Most Common 2:
1.Sigmoid Colon 2.Rectum Other 3 places: 3. Ascending Colon and Cecum 4. Tranverse Colon and Flexures 5. Descending Colon |
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Although Cause of Cancer of Colon aka Large Intestine is UNKNOWN, Who Seems at RISK?
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Those who have chronic conditions of the Intestine such as:
Diverticulosis Ulcerative Colitis Polyps Familial Tendency Link Between Diet |
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What happens when a TUMOR blocks the LUMEN of the Large Intestine?
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Can Cause a Complete or a Partial Bowel Obstruction
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What can be a Patients first sign of a problem related to Cancer of the Colon / Large Intestine?
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When Tumor blocks the Lumen of the Large Intestine and causes a partial or complate Bowel Obstruction.
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Why is testing for OCCULT blood in the Stool a good Screening Tool for Colorectal Cancer?
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It is one of the most reliable ways of determining the possibility of COLORECTAL CANCER. While other conditions can cause the occult blood in the stool, the detection of occult blood followed by PROCTOSIDMOIDOSCOPY helps ID the conditions before noticable symptoms OCCUR.
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What 4 Objective Assessments would the nurse make for a pt with colon cancer?
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1.Assess for vomiting
2.Assess for weight loss 3.Assess for Abdomen for DISTENTION and ASCITES 4.Assess for lab results for ANEMIA and CEA (carcinoembryonic antigen) |
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What kind of 4 things for BOWEL prep will be ordered for a pt with COLON CA who is scheduled for surgery to remove the diseased bowel?
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1.Liquid diet for several days
2.Laxatives 3.Oral Antibiotics 4.Enemas until clear or ORAL go lytely solution. |
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A pt has had an Abdominoperineal Resection for Cancer of the descending colon and rectum. What assessment findings would indicate a lack of blood flow to the STOMA?
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Stoma color appears pale, bluish or black
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Why might a patient who has bowel surgery for colon cancer have difficulty voiding after the Foley Catheter is Removed?
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Might have had damage to the Nerves that control the Bladder
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What Complications after Bowel Surgery could cause the Absence of Bowel Sounds?
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Paralytic Ileus can occur as a complication of abdominal surgery.
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What 3 measures can a Nurse help to relieve Paralytic Ileus a complication of Abdominal Surgery?
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1. Inserting a NG Tube as ordered
2. Keeping the pt NPO if ordered 3. Increasing the Pt's Activity as ordered to INCREASE PERISTALSIS |
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What are the 3 Disorders that Affect the Anal and Rectal Area?
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1. Hemorrhoids
2. Anal Fissure 3. Anal Fistula |
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What are Hemorrhoids, which are a disorder of the anal and rectal area?
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Varicose Veins in the rectum or the anus
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Where do the External Hemorrhoids occur?
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Outside the Anal Sphincter
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Where do the Internal Hemorrhoids occur?
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Inside the Anal Sphincter
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List 6 possible causes of Hemorrhoids:
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1. Constipation
2. Diarrhea 3. Pregnancy 4. Congestive Heart Failure 5. Portal Hypertension 6. Sitting or Standing for Long periods at a time. |
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What is meant by prolapse of INTERNAL HEMORRHOIDS?
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When they fall or drop down to the outside of the rectum.
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What 2 symptoms of Hemorrhoids are also symptoms of RECTAL CA?
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1. Rectal Bleeding
2. Constipation |
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How can a NURSE Minimize embarrassment when examining and interviewing the Pt with Rectal Disorders?
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Be DIRECT, FACTUAL, and Show Concern
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What is an ANAL Fissure?
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A Crack or Ulceration of the Skin around the Anus
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Where does an ANAL Fissure Occur?
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In a line in the puckering area around the ANUS
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What is an ANAL FISTULA?
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Abnormal Opening in the skin around the Anus, which drains pus from an abcess within the body.
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How can the nurse help promote comfort for the pt with a rectal disorder?
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Sitz bath as ordered.
Use of local anesthetics such as Nupercainal Cream or Tucks Pads |
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What is a PILONIDAL CYST?
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Developmental Defect that causes a fold of skin to form an inward pouch
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Where is a PILONIDAL Cyst located?
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Top of the INTERGLUTEAL Cleft, above the anus.
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What can a Pilonidal cyst become?
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Infected and Drain Pus
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What is done or can be done is Infection of a Pilonidal Cyst becomes recurrent?
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It can be Surgically removed.
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How is the Pilonidal Cyst related to Digestion when it is a skin disorder?
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It may form a FISTULA to the Rectum.
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What is a Cleft Lip?
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In Cleft LIP: entire thickness of the lip does not join under the nose. It may be on one side or on both sides, and may involve the nose as well.
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What is a Cleft Pallate?
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Cleft Palate Occurs when the top of the mouth does not join correctly, causing an abnormal opening between the nasal cavity and the mouth.
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When does the Cleft lip and Cleft palate occur?
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During Fetal Development
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What 3 types of problems does the infants with Cleft lip/pallate experience?
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1. Difficulty sucking
2. Breast Milk or Formula may go into the nasal area and be inhaled. 3. Causes choking or gagging |
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What 3 other problems do children with Cleft lip/pallate experience?
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1. Delayed Speech, and/or difficulty forming words.
2. If the palate is cleft, it may contribute to problems with middle ear infections. 3. Children may endure emotional or social difficulties due to facial appearance and speech problems. |
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How should the infant with an unrepaired cleft lip/ palate be fed?
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Use a special feeding device or a special nipple
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How should the infant be held during the feeding with a cleft lip and or palate with a special device or nipple?
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So the head is an upright postition.
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Why should the infant with an unrepaired cleft lip/ palate be burped frequently through the feeding?
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Greater than normal amounts of air are swallowed.
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How should the infant with a cleft lip repair be fed after surgery?
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A BRECK Feeder (syringe with rubber tubing attached) is usually initiated, with the tubing going in along the side of the infant's mouth AWAY from the suture line.
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After surgery to repair the cleft lip, what will it be allowed to take?
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Clear liquids after anethesia until it has worn off.
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What should be done after feedings post surgery of cleft lip repair?
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Suture line cleansed with cotton swabs and placed in an infant chair.
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Why should infant post surgery for cleft lip repair and post cleaning after feeding be placed in an INFANT CHAIR?
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Decreases chances for ASPIRATION
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How can the nurse assist with bonding between the infant with this condition and his parents? Cleft lip and/or palate.
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By compliementing other aspects of the infants appearance, and emphasizing personality and behavior. Before and after pictures of repair shown.
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Explain what Occurs when an Infant is Born with Esophageal Artesia?
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Esophagus fails to form Normally.
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What Happens to the Esophagus in Esophageal Artesia?
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It is Interrupted, ending in a blind pouch. Therefore, FOOD and FLUID Cannot enter the Stomach through the Esophagus.
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What occurs when a TRACHEOESAPHAGEAL FISTULA forms with Esophageal Artesia?
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The portion of the Esophagus just above the stomach connects to the TRACHEA.
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How do you FEED a baby with Esophageal Artesia and Tracheosaphageal Fistulas?
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A GASTROMOTY is Formed
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How LONG will a baby with Esophageal Artesia and Tracheosaphageal Fistulas and A GASTROTOMY be fed through a Gastrotomy TUBE?
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Until Surgical Reconstruction of the Esophagus can be done.
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Why does an infant with Esophageal Artesia and Tracheosaphageal Fistulas and A Gastrotomy SUCK on a PACIFIER?
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To retain the sucking reflex and to help comfort themselves.
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What is the most common Cause of INFANT Surgeries?
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PYLORIC STENOSIS aka Hypertrophic Pyloric Stenosis
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Does PYLORIC STENOSIS occur more often in FEMALES or MALES?
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Males
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What is the cause of PYLORIC STENOSIS?
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Cause is UNKNOWN
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In PYLORIC STENOSIS what happens to the PYLORIC Sphincter?
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It becomes ENLARGED and TIGHTENS
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When the PYLORIC SPHINCTER becomes enlarged what happens? (in relation to PYLORIC STENOSIS)
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PYLORIC SPHINCTER cannot Relax so the stomach cannot empty adequately into the intestinces.
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What age do Infants show Signs of PYLORIC STENOSIS?
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4-6 Weeks of Age
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What is the HALLMARK symptom of PYLORIC STENOSIS?
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PROJECTILE (forceful) vomiting after feeding.
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What is done to Correct PYLORIC STENOSIS?
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A surgical procedure called FEDET-RAMSTEDT aka pyloromyotomy.
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Who would most likely have a Pyloromyotomy aka Fedet-Ramstedt surgery, and what condition is it correcting?
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An Infant of age 4-6 weeks and it is correction Pyloric Stenosis.
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What does the surgeion do in a Pyloromyotomy aka Fedet-Ramstedt surgery?
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Cuts the muscle of the sphincter to allow a larger opening from the STOMACH to the SMALL INTESTINE
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Who is more likely to suffer Intestinal Intussusception, a FEMALE or MALE
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Male, it is more common in males.
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What does Intestinal Intussusception most commonly involve?
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The telescoping of the Ileum (distal portion of the small intestine) into the large intestine at the ILEOCECAL VALVE
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What is the HALLMARK Sign of Intestinal Intussusception?
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"CURRANT JELLY STOOLS" Stools that contain a large amount of Mucus and Blood
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What causes Intestinal Intussusception to have Currant Jelly Stools?
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As the walls of the intestine rub against each other, blood and mucus are generated. Feces is trapped and cannot pass easily through the telescoped portion of the bowel. The bowel movement will be mostly blood and mucus without feces.
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What is done to correct Intestinal Intussusception?
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A BARIUM Enema is given for Diagnostic Studies, it can help push the ILEUM out of the COLON
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What can be done if an BARIUM ENEMA is not successful in treating a Intestinal Intussusception?
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Surgery to Open the Abdomen and pull the ILEUM into place.
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What is Celiac Disease?
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Life-long inability to digest a Substance called GLUTEN
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Who suffers from Celiac Disease when diagnosed and what causes it?
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Usually found in childhood. The child cannot tolerate foods with a Gluten Count.Cause is unknown.
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What is the HALLMARK Symptom of Celiac Disease?
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LARGE, Foul-Smelling, Frothy Stools Containing Fat aka STEATORRHEA
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What 5 Things can happen if a child with Celiac Disease is not treated? What would cause these symptoms?
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1.Poor Growth
2.Osteoporosis 3.Osteomalacia 4.Anemia 5.Poor Blood Clotting Due to POOR Absorption of Vitamins and Nutrients. |
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What is the TREATMENT for Celiac Disease?
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Gluten-Free or Gluten-Restricted Diet
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What 4 foods must be ELIMINATED in a Child's Diet with Celiac Disease?
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All Foods Containing:
1.Wheat 2.Oats 3.Rye 4.Barley |
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What is HIRSCHPRUNG'S Disease?
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An ENLARGED Colon
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What is HIRSCHPRUNG'S Disease caused by?
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Lack of NERVE Development in the Rectum and Sigmoid Colon.
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In relation to the cause of HIRSCHPRUNG'S Disease and the Rectum/Sigmoid Colon's NERVE not developing what will NOT OCCUR?
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PERISTALSIS
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In HIRSCHPRUNG'S Disease what happens to the RECTUM/SIGMOID COLON?
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They both stretch greatly as FECES Accumulates within but does not pass out of the anus Effectively.
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What are the 3 Symptoms of HIRSCHPRUNG'S Disease?
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1. ABDOMINAL Distention
2. History of Chronic Constipation 3. May Vomit BILE or Fecal Material. |
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Does FOOD pass through the ORGANS of the Biliary System?
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No
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What are the 3 ORGANS of the BILIARY SYSTEM?
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Accessory Organs of the Digestive System
1.LIVER 2.PANCREAS 3.GALL BLADDER |
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What do the ORGANS of the Biliary System play an active role in?
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DIGESTION and ABSORPTION OF FOOD
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What is LAENNEC's Cirrhosis?
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Is associated with CHRONIC Alcohol Abuse
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What is Postnecrotic Cirrhosis?
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Occurs as the Result of Exposure to toxins or Infection
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What is the difference between LAENNEC's and POSTNECROTIC Cirrhosis?
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In Laennec's it is caused by person's ETOH abuse and can be modified. In Postnecrotic Cirrhosis, it is exposure to toxins or Infection (this may or may not be avoidable)
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What is PRIMARY Biliary Cirrhosis?
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Cirrhosis caused by DESTRUCTION of Common Bile Ducts
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What is Secondary Biliary Cirrhosis?
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This Cirrhosis causes Liver Damage due to OBSTRUCTION of Bile Flow.
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What can Cause Secondary Biliary Cirrhosis? Which is the OBSTRUCTION of Bile Flow?
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Gallstones and Tumors
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What is PORTAL HYPERTENSION?
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The PORTAL Vein normally drains blood from the GI tract and brings it to the Liver. When Cirrhosis causes Liver Dysfunction, the PORTAL Vein cannot EMPTY Completely. The Blood in the PORTAL Vein backs up into the Veins and the Abdomen. There is INCREASED pressure B/C the Blood Cannot Circulate Appropriately.
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What is ASCITES?
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Abnormal Collection of Fluid in the Abdominal Cavity.
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Why does ASCITES occur in the Patient with Cirrhosis?
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Occurs as a Result of Liver Dysfunction and PORTAL Hypertension
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Why does the Patient with Cirrhosis have Bleeding Tendencies?
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The liver usually uses VIT K from diet to manufacture Clotting factors. When the liver is Damaged it cannot Absorb and Use VIT K. This causes the person to be DEFICIENT in needed Clotting Factors
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What causes Jaundice in the Patient with Cirrhosis?
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Large amounts of BILIRUBIN Circulate in the Blood causing Jaundice of the Skin, Mucus Membranes and SCLERA
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What is ESOPHAGEAL VARICES?
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Enlarged, Varicose Veins in the ESOPHAGUS
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When do ESOPHAGEAL VARICES Occur?
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When Severe PORTAL HYPERTENSION causes congestion of the Blood in the Veins of the Stomach and Esophagus.
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Why Does ESOPHAGEAL VARICES Rupture easily?
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Because of their location
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What 4 Things can Cause ESOPHAGEAL VARICES to Rupture?
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1.Coughing
2.Sneezing 3.Vomiting 4.Straining to Pass A Bowel Movement |
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Why does Sneezing, Vomiting, Coughing and Straining for a BM cause ESOPHAGEAL VARICES to Rupture?
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Because all of these actions increase VENOUS Pressure
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What Happens if a ESOPHAGEAL VARICES Ruptures?
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Patient Bleeds into the Stomach.
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What Generally Happens with the Bleed into the stomach from a Ruptured ESOPHAGEAL VARICES?
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Large amount of Blood is Swallowed and then Vomited. If DIGESTED it will be in the Stool.
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If ESOPHAGEAL VARICES causes a severe hemorrhage or uncorrected hemorrhage what are they AT RISK for?
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Hypovolemic SHOCK
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If ESOPHAGEAL VARICES causes a severe hemorrhage or uncorrected hemorrhage what is the TREATMENT?
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Actions to STOP BLEED
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What is Vasopressin and how is it administered in RELATION to ESOPHAGEAL VARICES?
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Potent Vasoconstrictor administered via IV.
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When treating a Patient with ESOPHAGEAL VARICES and a rupture what is INSERTED via nose and into Stomach?
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SENGSTAKEN-BLAKEMORE Tube.
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What does a SENGSTAKEN-BLAKEMORE Tube Contain?
And what does it do? |
A BALLOON, that once inflated applies direct pressure to the Blood Vessels in the Esophagus to stop bleeding.
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Why is a SENGSTAKEN-BLAKEMORE Tube in treatment of ESOPHAGEAL VARICES kept of LOW, Intermittent Suction?
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To Remove Stomach contents.
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Why is a ICED SALINE LAVAGE used via the SENGSTAKEN-BLAKEMORE Tube in a ESOPHAGEAL VARICES Rupture?
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To Promote Vasoconstriction in the Stomach and Remove any Swallowed Blood.
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Why would different SHUNTS be done in a RUPTURE of ESOPHAGEAL VARICES?
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To RE ROUTE Blood away from the PORTAL VEIN
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What is HEPATIC ENCEPHALOPATHY?
What is it due to? |
Hepatic Encephalopathy is a Condition that Affects the Brain
and is due to a DECREASED LIVER Function. |
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In HEPATIC ENCEPHALOPATHY what can the LIVER not Filter Out?
What is a Particular Substance? |
Substances that are TOXIC to the Brain.
Specifically AMMONIA |
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If a patient Liver cannot filter out AMMONIA what happens to the Patient?
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Patient becomes Increasingly DISORIENTED, with Twitching of Extremities, "Liver Flap" (asterixis), Tremors, and Inventually goes into a COMA
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What are the 4 TREATMENTS for HEPATIC ENCEPHALOPATHY?
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A. Giving Supportive Care
B. Low Protein Diet is Ordered C. Medications to Help Decrease Ammonia Levels are Given D. LACTULOSE (Chronulac) Helps decrease Ammonia Production in the Intestines. |
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What is HEPATITIS?
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Inflammation of the Liver
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What is 3 Things Can HEPATITIS Caused By?
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1. Virus
2. Exposure to Toxic Substances 3. Certain Medications |
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What is Infectious Hepatitis Caused by?
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A VIRUS
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How many types of Hepatitis Exist at this time?
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5
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Which types of Hepatitis uses the ORAL-FECAL route?
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HEPATITIS A and E
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Which Types of Hepatitis are Transmitted via BLOOD or SERUM?
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HEPATITIS B,C,D
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What Effect does Hepatitis have on the LIVER?
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Causes Liver Cells to DEGENERATE and DIE due to a Widespread Inflammation. The damaged Liver can no longer perform all of its functions.
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What is the TX for Viral Hepatitis?
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Supportive care is given while the liver heals, and patient is closely observed for complications.
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HOW Long after TX of Hepatitis should a patient REFRAIN From Alcohol and WHY?
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One Year, to allow liver to heal and alcohol is a TOXIN that can slow this process down.
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3 People at RISK for exposure to HEPATITIS B?
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1. Healthcare workers
2. People at high risk to exposure with blood and bodily fluid (IV drug user, prostitutes and Gay Men) 3. INFANTS born to mothers with it |
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What are 5 PreCautions to be Used to Avoid Spread of Hepatitis A
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1. Good PERSONAL Hygiene
2. Wash hands after ORAL or FECAL Contact. 3. Use of Gloves 4. 7 days after Diagnosis use ENTERIC PRECAUTIONS. 5. Vaccine is also Available |
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How many days after a Diagnosis should ENTERIC PRECAUTIONS be used?
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7 Days
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What Precautions should be USED with HEP B?
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Universal Precaution
PPE: Gloves, Gown, Mask, Face Shield as needed. And a HEP B VACCINE |
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What can the Liver also be Infected by?
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Any Infection of the GI tract that is not destroyed by the Body's Defense system.
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What happens if BACTERIA enters the Liver in Relation to an Infection of GI Tract? Or other Reasons:
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Areas of NECROSIS
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What happens when Bacteria Enter Liver to fight infection and send in the Leukocytes to the NECROTIC Area of the LIVER?
|
An ABCESS forms filled with Liquid and PUS
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What is different about treatment TODAY vs. Past in regards to Treatment of Liver Abcesses?
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In Past hard to detect and treatment would occur in Advanced Stage of Illness. Now we use CT Scan
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Once Symptoms of Liver Abcess recognized and Confirmed by a CT SCAN, what is the next 2 forms of treatment?
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1.Systemic Antibiotics
And/OR 2.Surgical Drainage if needed |
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What are the 2 MOST Common DISORDERS of the Gall Bladder?
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1. Cholecystitis
2. Cholelithiasis |
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What is the difference between Cholecystitis and Cholelithiasis?
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CHOLELITHIASIS refers to presence of GALL STONES and CHOLECYSTITIS is the Inflammation of the Gall Bladder due to STONES, Obstruction or Tumor
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Define CHOLECYSTITIS and 3 Reasons:
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INFLAMMATION Of the Gall Bladder due to:
1. Stones 2. Obstruction 3. Tumor |
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What are the 5 ACUTE symptoms of CHOLECYSTITIS aka Gall Bladder Attack?
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1. Sudden N/V, especially after a meal high in fat.
2. Severe Pain in RUQ 3. Pain may Radiate through or Around the Back 4. Anorexia 5. Flatulence |
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What 5 Objective Assessments would you make of a PT with CHOLECYSTITIS aka Gall Bladder Attack?
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1. Assess for WBC elevation
2. Assess Temp for elevation 3. Assess stools for CLAY color and STEATORRHEA due to Lack of BILE 4. Assess URINE for Dark AMBER color indication of Increased Urobilinogen 5. Assess Skin for Jaundice |
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What is the 2 PURPOSEs of a T TUBE being placed in the Common Bile DUCT after an open Abdominal CHOLECYSTECTOMY?
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1. Keeps the Common Bile Duct Open if it is EDAMATOUs
2. Allows Access for DYE to be inserted into the Common Bile Duct after Surgery (Post Op Cholangiogram) |
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Why is a CHOLANGIOGRAM done after a T TUBE is placed after an OPEN ABDOMINAL CHOLECYSTECTOMY?
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To be sure the DUCT is OPEN and no new STONES have Lodged there.
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How does the LAPAROSCOPIC CHOLECYSTECTOMY Differ from an OPEN ABD CHOLECYSTECTOMY?
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A Laparoscopic is performed using ENDOSCOPY with 4 small punctures in the Abdomen, and an ENDOSCOPE is inserted. Laser or Cautery is used to free the GallBladder and it is removed via Endoscope.
OPEN ABD Removal has an Incision at the COSTAL Border on the Right, the abdomen is opened, gall bladder visualized, freed from liver and extracted. Then a Drain may be placed and a T TUBE may be used. |
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Define LAPAROSCOPIC CHOLECYSTECTOMY
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Uses Endoscope to remove out of 4 small Punctures made into abdomen via a Laser or Cautery. Removed via Endoscope.
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Define OPEN ABDOMINAL CHOLECYSTECTOMY
|
Incision at Right Costal Border. Open Abdomen, observe Gallbladder, cut away from Liver first, then remove. May use Drain and a T TUBE.
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What is a T TUBE Connected to regaring the CHOLECYSTECTOMY.
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A Drainage Bag
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Where is the Drainage Bag connected to the T TUBE kept? Why? In regards to the CHOLECYSTECTOMY
|
Below the LEVEL of Incision to PROMOTE Gravity Drainage and Prevent Reflux.
The tubing should be free from KINKS! |
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What should the NURSE observe frequently related to a T TUBE Drain regarding the Cholecystectomy?
|
Amount and Color of Drainage
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How much might the T TUBE Drain in relation to the Cholecystectomy?
|
Up to 500mL in the First Day, then the amount should decrease.
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When will the T Tube be removed in relation to the CHOLECYSTECTOMY?
|
When the drainage has nearly stopped.
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Why must a T TUBE be handled carefully in relation to the CHOLECYSTECTOMY?
|
To PREVENT IT from being DISLODGED.
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How might a T TUBE for a CHOLECYSTECTOMY be Supported?
|
With a Gauze roll and taped to the Patient's side.
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What might be ordered for a patient with a T TUBE for a Cholecystectomy when they resume ORAL INTAKE Fluids?
|
T-TUBE may be clamped 1-2 Hours before and after Meals.
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What is the TERM Obstructive Jaundice?
|
Yellowish Discoloration of the Skin.
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What is OBSTRUCTIVE JAUNDICE due to?
|
Blockage in the flow of Bile from the Liver to the Small Intestine.
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What is often the Cause of OBSTRUCTIVE JAUNDICE?
|
GALL STONES
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What do Pancreatitis and Pancreatic Cancer Involve?
|
EXOCRINE Function of the Pancreas
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What is the EXOCRINE Function of the PANCREAS?
|
Production of DIGESTIVE ENZYMES produced by the Pancreas that cannot EMPTY into the DUODENUM
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What does the Pancreatic Duct eventually when the Digestive Enzymes cannot empty into the Duodenum?
|
RUPTURES Due to Pressure
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When the Pancreatic Duct Ruptures due to Pressure from inability to empty Digestive Enzymes to Duodenum what do the ENZYMES BEGIN TO DO?
|
Digest the PANCREAS Itself
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When the Pancreatic Duct Ruptures due to Pressure from inability to empty Digestive Enzymes to Duodenum and the it EATS the Pancreas what MIGHT HAPPEN TO SOME OF THE DIGESTED AREAS?
|
They may WALL Off and Form Abcesses.
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Describe the TYPICAL Pain of PANCREATITIS?
|
Severe PAIN in the Abdomen that radiates to the Back
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If a Patient is in Severe Pain from PANCREATITIS what POSITION might the Patient Use? Why?
|
Leaning FORWARD so it can take the WEIGHT of the STOMACH off of the Pancreas and help releive the pain.
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What 6 OBJECTIVE Assessments would you Assess for a Pt with Pancreatitis?
|
Assess for:
1. Vomiting 2. Mildly Elevated Temperature 3. Jaundice in Skin and Sclera 4. Weight Loss 5. Stools with STEATORRHEA 6. Tachycardia |
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What is the USUAL 6 TX's for PANCREATITIS?
|
1. Usually Treated Medically
2. NPO 3. NG TUBE Inserted 4. Severe PAIN tx narcotic analgesics, NOT Usually MS!! 5. Medications to decrease Pancreatic Activity and Decreased GASTRIC Acidity 6. TPN May be Ordered, until able to self eat again |
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A NG Tube is ordered for a Patient with PANCREATITIS. What 3 Things is the Order for?
|
1. To DECOMPRESS Stomach
2. Alleviate N/V 3. Decrease Stimulation of the Pancreas to Produce Digestive Enzymes |
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Why might a Patient with Severe ACUTE Pancreatitis have an order for TPN?
|
Allows pt to rest while providing nutritional needs of the patient. No digestion is required so patient can HEAL.
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Pancreatic Cancer is ____ of leading Cause of death in Males of Cancer Deaths.
|
4th
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Pancreatic Cancer is _____ of leading Cause of Death in Females.
|
6th Leading Cause of Cancer in Females
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Why is Cancer of the PANCREAS more Difficult to TREAT?
|
B/C it is difficult to DIAGNOSE until it has PROGRESSED.
B/C Pancreas may have been the Primary Site or it may have metastisized from Stomach, Gall Bladder, Lung, or Common Bile Duct |
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4 Groups of People most at Risk for Developing Pancreatic Cancer:
|
1. Cigarette Smokers
2. Persons with Diabetes Mellitus 3. Persons with Pancreatitis 4. Diet high in Coffee, Fat or Meat Consumption. |
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What are 5 Subjective Assessments for Patients with Pancreatic CA?
|
Assess for:
1.Complaints of Anorexia 2.Complaints of Fatigue 3.Changes in Stool 4.Complaints of Nausea 5.Steady Pain in the Epigastric Region that may Radiate to the Back |
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What are 3 Objective Assessments for a Patient with Pancreatic Cancer Include:
|
Assess for:
1. Gradual, Progressive Weight Loss 2. Progressive Jaundice 3. Recent ONSET of Diabetes Mellitus |
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What are 5 Major concerns of POST OP Care of patient with Pancreatic CA?
|
1. Maintenance of FLUID and ELECTROLYTE Balance
2. Preventing Hemorrhage 3. Maintaining a Stable BSL 4. Promoting Digestion of FOOD with Enzymes 5. Preventing Respiratory Complications |
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|
What is the PROGNOSIS for Pancreatic Cancer?
|
Very POOR
Most people survive only 4-8 months after diagnosis |
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|
Symptoms of HEPATITS?
|
Flu like symptoms
Abdominal Pain Indigestion Diarrhea/Constipation Liver Enlarges Lymph Nodes in area enlarge Liver tender Jaundice of skin Clay Color Stool Dark Amber Urine |
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|
Treatment of HEPATITIS
|
-Bed rest for several weeks
-No Uneccessary Meds due to Liver usually responsible for this to breakdown -Small frequent meals -Diet LOW FAT High CARB -Vitamins B and C help promote healing -Vit K may be added if pt has bleed tendancy. |
