Ms(T3-39,40,42-44)

Front 1

GI Primary Organs

7

Back 1

GI tract (mouth, esophagus, stomach, small intestine ← Upper GI /// Lower GI→ large intestine, rectum, anus)

Front 2

GI Associated Organs – 3

Back 2

liver, pancreas, gallbladder

Front 3

The majority of the water is reabsorbed to the body in the _____

Back 3

large intestine.

Front 4

Nutrients are absorbed in the ____

Back 4

small intestine

Front 5

Past and current health history, medications, surgeries or other treatments; health patterns, nutritional assessment, elimination patterns, exercise regimens, sleep habits, among others.

Back 5

Subjective data –

Front 6

Physical examination (inspection, auscultation, percussion, palpation).

Back 6

Objective data –

Front 7

____: tissue is inflamed (Large intestine) and cannot preform the job that it is supposed to

Back 7

Crohns Disease

Front 8

Diagnostic Studies

aids in diagnosing structural abnormalities of the esophagus, stomach, and duodenum.

Back 8

Upper GI or Barium Swallow –

Front 9

Diagnostic Studies

aids in diagnosing colon abnormalities.

Back 9

Small Bowel Series (SBS), Lower GI, or Barium Enema –

Front 10

Diagnostic Studies

detects abdominal masses, biliary and liver disease, gallstones. NPO

Back 10

Abdominal ultrasound –

Front 11

Diagnostic Studies

____aids in diagnosing hepatobiliary disease, hepatic lesions, sources of GI bleeding, staging colorectal cancer.

Back 11

MRI –

Front 12

Diagnostic Studies

direct visualization of esophagus, stomach, and duodenum. Aids in detecting inflammation, ulcerations, tumors, varices. Biopsies may be obtained. NPO x8 hours before procedure.

This could be used because of emesis, nausea, vomiting, indigestion, etc

Back 12

Esophagogastroduodenoscopy (EGD) –

Front 13

Diagnostic Studies

– direct visualization of the colon. Aids in diagnosing/detecting inflammatory bowel disease, polyps, tumors, diverticulosis, and dilate strictures. Biopsies may be obtained. Requires bowel prep

Back 13

Colonoscopy

Front 14

Diagnostic Studies

direct visualization of the rectum and sigmoid colon. Aids in detecting tumors, polyps, inflammatory and infectious diseases, fissures, and hemorrhoids. Requires enemas until sigmoid clear

Back 14

Sigmoidoscopy

Front 15

Upper GI or Barium Swallow Directions

____ before procedure (so we can see better with an empty stomach)(Usually 6-8 hours before procedure),

____(and increased fluids) post procedure to pass contrast because it will stay in the colon and cause a bowel obstruction

Ordered for patients with stroke or with difficult swallowing

Back 15

NPO

Laxatives

Front 16

Small Bowel Series (SBS), Lower GI, or Barium Enema Directions

___ before procedure, ___ post procedure to pass contrast

Back 16

NPO

Laxatives

Front 17

Patients that are being sedated must remain NPO until _____

Complications include possible aspiration and damage to tissues

_____ is required

Back 17

gag reflex returns

informed consent

Front 18

Colonoscopy Requires____ (often has to drink a very strong laxative (Golytely) .
Nurse monitors stool coming out because it will start putting out watery liquid (Good)
After the procedure, nurse monitors for bleeding
A paralyzed pt will not know when the need to use the bathroom and are prone to skin breakdown

Back 18

bowel prep

Front 19

____– enzyme produced by the pancreas. Increases during pancreatitis. (30-122 U/L)

Back 19

Amylase

Front 20

____ – enzyme produced by the pancreas that breaks down fats. Increases during pancreatitis. Levels stay elevated longer than amylase. (31-186 U/L)

Back 20

Lipase

Front 21

____ stool specimen examined for mucus, blood, pus, parasites, and fats.

Back 21

fecal Analysis –

Front 22

____ – tests for bacteria in the stool.

Back 22

Stool Culture

Front 23

____ – measures direct and indirect bilirubin (0.2-1.2 mg/dL).

Back 23

Total Bilirubin

Front 24

____ – measures conjugated (hemoglobin broken down by the liver and excreted in bile) bilirubin, elevated when jaundice is noted (0.1 – 0.3 mg/dL).

Back 24

Direct bilirubin

Front 25

_____ – measures unconjugated (hemoglobin that has not been broken down by the liver) bilirubin (0.1-1.0 mg/dL).

Back 25

Indirect bilirubin

Front 26

____ – enzyme found in the liver. Increases with liver damage (38-126 U/L).

____ – enzyme found in the liver. Increases with liver damage (10-30 U/L).

______ – enzyme found in the liver. Increases with liver damage (10-40 U/L).

Back 26

Alkaline phosphatase (ALP)

Aspartate aminotransferase (AST)

Alanine aminotransferase (ALT)

Front 27

_____ – synthesized and excreted by the liver. Increases with liver or biliary damage (<200 mg/dL).

Back 27

Cholesterol

Front 28

protrusion of a portion of the stomach into the esophagus. caused by pressure to the stomach

IE: Obesity, pregnancy, straining, spanks

Back 28

Hiatal Hernia

Front 29

Pathophysiology – Structural changes, such as weakening of the muscles of the diaphragm around the esophagogastric opening which leads to an increase in intraabdominal pressure. Acidic stomach secretions are allowed to enter the esophagus.

Back 29

Hiatal Hernia

Front 30

______ causes Indigestion, caused by intraabdominal pressure causing acid coming back up to the esophagus (certain foods)
If this is untreated, an ulcer will form which can eat through esophageal lining

Back 30

Hiatal Hernia

Front 31

Risk Factors – obesity, pregnancy, ascites, tumors, intense physical exertion, persistent heavy lifting.

Back 31

Hiatal Hernia

Front 32

Clinical Manifestations
• Heartburn after eating or when lying supine
• Severe burning pain when bending over – pain relieved by sitting or standing

Back 32

Hiatal Hernia

Front 33

Hiatal Hernia

Diagnostic Studies
2

Back 33

• Barium Swallow
• Endoscopy

Front 34

Hiatal Hernia Nursing and Collaborative Management
• Reduce intraabdominal pressure
3
• Medical Management
3
• Surgical Management
2

Back 34

➢ Discourage restrictive clothing
➢ Avoid persistent lifting and straining
➢ Weight loss

➢ Proton Pump Inhibitors – Prilosec, Nexium, Protonix, etc.
➢ H2 – receptor blockers – Tagament, Pepcid, Zantac, etc.
➢ Antacids

➢ Herniotomy – excision of the hernia sac
➢ Herniorraphy – closure of the hiatal defect

Front 35

Complications of Hiatal Hernia
3

Back 35

• Gastroesophageal Reflux Disease (GERD)
• Esophagitis – inflammation of the esophagus
• Upper GI Bleeding – persistent inflammation leads to ulceration

Front 36

defined as mucosal damage secondary to reflux of gastric contents into the lower esophagus.

Back 36

Gastroesophageal Reflux Disease (GERD) –

Front 37

Etiology and Pathophysiology

Incompetent Lower Esophageal Sphincter (LES) – allows gastric contents to move from the stomach to the esophagus when the patient is supine or has an increase in abdominal pressure.

Back 37

Gastroesophageal Reflux Disease (GERD) –

Front 38

****Relieved with drinking milk, antacids, or water*****

Back 38

Gastroesophageal Reflux Disease (GERD) –

Front 39

*****Often mistaken for angina******

Back 39

Gastroesophageal Reflux Disease (GERD) –

Front 40

Clinical Manifestations
HEARTBURN
REGURGITATION
Dyspepsia

Back 40

Gastroesophageal Reflux Disease (GERD) –

Front 41

– described as hot, bitter, or sour liquid coming into the throat or mouth.

Back 41

REGURGITATION

Front 42

pain centered in the upper abdomen (epigastric region).

Back 42

Dyspepsia –

Front 43

_____ – also known as pyrosis, normally occurs after a meal.

Back 43

HEARTBURN

Front 44

Gastroesophageal Reflux Disease (GERD) – Complications
2

Back 44

1.Esophagitis – if left untreated may lead to upper GI bleeding or Barrett’s esophagus (precancerous lesion).
2. Asthma, pneumonia, bronchitis related to aspirated stomach contents.

Front 45

Gastroesophageal Reflux Disease (GERD) – Diagnostic Studies
2

Back 45

1.Signs and symptoms
2.Endoscopy

Front 46

****Goal of therapy is to decrease intraabdominal pressure***** This may be accomplished collaboratively by:
1.Encourage lifestyle changes – lose weight, stop smoking, avoid persistent heavy lifting, etc.
2.Suggest nutritional changes – avoid acid producing foods, avoid late night meals, elevate HOB at least 30 degrees, avoid supine positioning for 2-3 hours following a meal.
3.Drug therapy – PPI’s, H2-receptor blockers, antacids

Back 46

Gastroesophageal Reflux Disease (GERD) –

Front 47

____ loves the stomach lining. It secretes an enzyme that blocks hydrochloric acid
It causes most stomach ulcers

The patient receives 2 antibiotics and a protein pump inhibitor

Back 47

H pylori

Front 48

_____ a condition characterized by erosion of GI mucosa resulting from the digestive actions of HCL acid and pepsin.

Back 48

Peptic Ulcer Disease (PUD) –

Front 49

ulcer normally occur in the antrum region of stomach

Back 49

1.Gastric ulcers –

Front 50

ulcer normally occur in the first 1-2 cm of the duodenum—Most Common Type

Back 50

2.Duodenal ulcers –

Front 51

Etiology and Pathophysiology
The back diffusion of HCL acid into the gastric mucosa results in cellular destruction and inflammation. This cellular destruction causes Histamine to be released from the damaged mucosa, which then causes vasodilation and increased capillary permeability and further secretion of acid and pepsin.

Back 51

Peptic Ulcer Disease (PUD) –

Front 52

Contributing Factors Associated with PUD
5

Back 52

1.H.Pylori* most common cause leading to PUD.
2. Ulcerogenic drugs – ASA, NSAIDS, etc.
3.Alcohol, coffee (both caffeinated and uncaffeinated) , spicy foods, etc.
4.Smoking
5.Stress and depression

Front 53

____ ulcers – “Burning”pain located in the epigastrium that occurs 1-2 hours after meals. FOOD CAN BRING ON THE PAIN.

Back 53

Gastric

Front 54

_____ ulcers – FOOD RELIEVES THE PAIN by buffering the acids being secreted.

Back 54

Duodenal

Front 55

Peptic Ulcer Disease (PUD) – Complications
2

Back 55

1.Hemorrhage –GI Bleeding – MOST COMMON COMPLICATION
2.Perforation – MOST LETHAL – stomach and duodenal contents are entering the peritoneal cavity. If untreated, can lead to peritonitis in as little as 6-12 hours

Front 56

Signs and Symptoms Associated with _____
a.Sudden, severe abdominal pain that radiates throughout the abdomen and back
b.Pain is not relieved by food or antacids.
c.Abdomen appears “rigid and board-like” with absent bowel sounds; N/V may/may not be present

Back 56

Ulcerative Perforations

Front 57

Management of _____
GOAL of THERAPY – Stop the spillage of contents into the peritoneal cavity and restore blood volume.
a.NPO
b.NG tube for stomach aspiration and decompression – often decreases pain
c.Lactated Ringers – to replace lost blood volume and restore hydration
d.Pain management, Antibiotic therapy, Surgical interventions

Back 57

Ulcerative Perforations

Front 58

– obstruction of the distal stomach and duodenum as a result of persistent inflammation and edema. PROJECTILE VOMITING CONTAINING UNDIGESTED FOOD IS A VERY COMMON SIGN OF OBSTRUCTION!

Back 58

Gastric Outlet Obstruction

Front 59

Diagnostic Studies for PUD
4

Back 59

1. History and Physical
2. Endoscopy with tissue biopsy –examining tissue for H. Pylori
3. Barium contrast
4. Standard labs – CBC, etc.

Front 60

Peptic Ulcer Disease (PUD) – Collaborative Care/Conservative Therapy

5

Back 60

1. NPO
2. Rest
3. Drug Therapy – PPI, H2-receptor blockers, antacids, antibiotics, pain management
4. Encourage lifestyle changes –Requires patient teaching!
5. Monitor for complications such as hemorrhage, perforation, etc. and treat as soon as possible.

Front 61

Possible Nursing Diagnosis for Patients with PUD

3

Back 61

Pain, Acute
Potential for Fluid Volume Deficit
Knowledge Deficit

Front 62

Gastrointestinal System Function
5

Back 62

-Supply nutrients to the body cells (This is the main function – below are necessary for this)
-Ingestion – taking in foods
-Digestion – breaking down foods
-Absorption – transfer of food products into the circulation
-Elimination – excreting waste products

Front 63

Reflux and ____ are used interchangeably

Back 63

Regurgitation

Front 64

30 with GERD, avoid ____ positioning for 2-3 hours following a meal.

Back 64

supine

use 30 degrees

Front 65

____ is a broad subject including gastritis, hiatal hernia – anything that can cause acids to come back up. Most of the damage due to this is from the acidity.

Back 65

GERD

Front 66

____ reduces hydrogen secretion – therefore, reducing hydrochloric acid. And reducing the stomachs acidity

Back 66

Protein pump inhibitor

Front 67

____ also reduce the amount of Hydrochloric acid in the stomach.

Back 67

Histamine receptor blockers

Front 68

____ neutralizes buffers the stomach environment – decreasing the acidity.

Back 68

Antacids

Front 69

____ wears away at the esophageal, stomach, SI mucosa; which can lead to ulceration (sore on mucosa). Most common problem from this is ____ because

Back 69

Hydrochloric acid

Bleeding

blood loss

Front 70

If a patient says there is blood in the stool, the first action the nurse should take is ____

Back 70

get a Fecal Occult test (stool sample)

Front 71

with a Fecal Occult test (stool sample), You need ____, but you can get that at a later time.

Back 71

a physicians order

Front 72

Duodenal and gastric ulcer complications can be very similar.

Back 72

Nursing

Front 73

Patients with GERD will receive ____ (first line therapy)(OTC)

Back 73

PPI

Front 74

It is already in our stomach, everyone has it. When the normal flora becomes compromised, _____take the opportunity to invade stomach lining/ ulcers. Then it replicates a lot.

Back 74

Helicobacter pylori

Front 75

with Ulcerative Perforations,

Abdomen appears ____with ____

Back 75

“rigid and board-like”

absent bowel sounds;

You don’t hear anything because the contents of the stomach are going out to the peritoneal cavity. Stomach will be hard upon palpation, and possibly distended

Front 76

with Ulcerative Perforations,

GOAL of THERAPY – Stop the spillage of contents into the peritoneal cavity and restore blood volume.

So the first intervention is ____

Back 76

NPO

Front 77

PROJECTILE VOMITING CONTAINING UNDIGESTED FOOD IS A VERY COMMON SIGN OF ____

Back 77

OBSTRUCTION!

Front 78

The sequence of examining the GI system is 4

Back 78

Inspection, Auscultation, Palpation, Percussion

Front 79

____– characterized by intermittent and recurrent abdominal pain and stool pattern irregularities.

Back 79

Irritable Bowel Syndrome (IBS)

Front 80

Etiology and Pathophysiology

a. cause unknown

Occurs more in women than in men.

b. altered bowel motility, increased visceral sensitivity, inflammation, and psychologic distress are thought to influence the occurrences of IBS.

Back 80

Irritable Bowel Syndrome (IBS)

Front 81

a. intermittent and recurrent abdominal pain

Occurs in irregular intervals

b. diarrhea or constipation

c. abdominal distention “Bloating”

d. excessive flatulence

Patient is miserable. There is no cure, but there is treatment (very expensive)

Back 81

Irritable Bowel Syndrome (IBS)

Front 82

Irritable bowel syndrome Diagnostic Studies 3

Back 82

a. Thorough history and physical examination

b. ROME III criteria:

a) at least 2 of the following occurring within the last 6 months:

1. Abdominal pain relieved by defecation

2. Change in stool frequency

3. Change in stool appearance

b) abdominal pain for at least 3 months

Front 83

a. Encourage patient to keep journal of symptoms, diet, and episodes that trigger the IBS.

b. Increase dietary fiber intake (at least 20g/day), consider Metamucil

c. Avoid gas forming foods (broccoli, cabbage, beans, etc.) *

d. ____ for diarrhea, ____ for constipation

e. Cognitive –Behavioral Therapy, Stress management, etc.

Back 83

IBS Medical and Nursing Management

Imodium

Amitiza

Front 84

Patients with irritable bowel syndrome must Avoid _____

Back 84

gas forming foods (broccoli, cabbage, beans, etc.) *

Front 85

_____– chronic inflammation of the GI tract characterized by periods of remission followed by exacerbations (on and off effect).

Back 85

Inflammatory Bowel Disease (IBD)

Front 86

____ has a broad label with crohns disease and ulcerative colitis.

Crohns is generally more genetic

Ulcerative colitis has many causes

Back 86

IBD

Front 87

IBD Risk factors 3

Back 87

a.Genetic predisposition – autoimmune disease, genetic mutations result in an abnormal immune response to normal intestinal bacteria. In other words, the body fights against normal intestinal flora.

b. Commonly presents during the teenage years and early adulthood

c. More common in whites (particularly of Jewish descent) and in family members.

Front 88

Classifications of IBD

_____ – involves all layers of the bowel wall, mostly seen in the small bowel

Back 88

a. Crohn’s Disease

Front 89

Classifications of IBD

____ – involves the innermost layer of the bowel wall, mostly seen in the large bowel

Usually in lower colon

Inflamed, infected (upon inspection [colonoscopy]), possible bleeding

Back 89

b. Ulcerative Colitis

Front 90

Bright red blood in stool is from _____

Black, brown, grainy blood in stool is from ___

Back 90

lower GI

upper GI.

Front 91

IBD

____ is patches of infected segments, which impairs the intestines ability to preform their job.

Back 91

Crohns

Front 92

IBD

____ is long continuous infected segments.

Back 92

Ulcerative Colitis

Front 93

-_____ leads to more malnourishment due to SB damage.

Back 93

Crohns

Front 94

-________leads to lots of watery diarrhea due to LB damage.

There is a lot of water loss here. which leads to

Back 94

Ulcerative Colitis

(Electrolyte imbalances)

Front 95

a.Occurs most commonly in the ileum and colon, but can occur anywhere along the GI tract.

b.Skip lesions – segments of inflammation followed by segments of healthy bowel – causes cobblestone appearance.

c.Inflammatory strictures often lead to bowel obstructions

d. Susceptible to fistula formation between bowel and bladder, bowel and vagina

Back 95

Crohn’s Disease

Pathophysiology

Front 96

a.Usually begins in the rectum and moves towards the cecum

b.Affects the inner-most layer of the bowel wall – Fistula formation is rare!

c. Water and electrolytes cannot be absorbed through inflamed mucosa resulting in diarrhea with large fluid and electrolytes losses.

Back 96

Ulcerative Colitis

Pathophysiology

Front 97

Clinical Manifestations of Inflammatory Bowel Disease

Crohn’s Disease

4

Back 97

• Diarrhea

• Colicky abdominal pain

• Weight loss due to malabsorption

• Fluid and electrolyte imbalances related to diarrhea

Front 98

Clinical Manifestations of Inflammatory Bowel Disease

Ulcerative Colitis

5

Back 98

• Bloody diarrhea – number of stools/day increases with the severity of disease

• Abdominal pain usually in the lower regions

• Toxic megacolon (dilated colon)

• Fluid and electrolyte imbalances related to diarrhea

• Weight loss due to patient decreasing oral intake to control amount of diarrheal episodes

Front 99

Complications of Inflammatory Bowel Disease

7

Back 99

• Hemorrhage

• Strictures

• Perforation

• Fistulas

• Nutritional deficits related to malabsorption

• Predisposition to cancers of the colon

• Arthritis, thromboembolism, kidney stones

Front 100

IBD Diagnostic Studies

4

Back 100

• Sigmoidoscopy

• Colonoscopy

• Endoscopy

• Barium enema

Front 101

Goals – a) rest the bowel

b) control inflammation

c) combat infection

d) correct malnutrition

e) alleviate stress

f) provide symptomatic relief

g) improve quality of life

Back 101

IBD

Front 102

IBD

Drugs –5

Back 102

a) aminosalicylates (sulfasalazine)

b) antimicrobials (Flagyl, Cipro)

c) corticosteroids (Prednisone)

d) immunosuppressants (Imuran)

e) biologic and targeted therapy (Humira)

Front 103

IBD

Surgical Therapy – 3

Back 103

a) surgical removal of segments of the bowel with anastomosis

b) strictureplasty – widens or opens up a narrowed bowel

c) Colectomy with ileostomy – continence is not possible with a ileostomy

Front 104

As stool moves down the colon, water is reabsorbed from the LI, giving the stool form. Lots of colostomy are ____ which will always be watery stool. (Ileum in between SI and LI)

Back 104

ileostomies

Front 105

Goals:

a) provide adequate nutrition – patient may need enteral feedings:

1. Elemental diets – diets high in calories and nutrients, lactose free, and are absorbed in the proximal small intestine, which allows the lower bowel to rest.

b) correct and prevent malnutrition

c) replace fluid and electrolyte imbalances

d) prevent weight loss

Back 105

IBD

Front 106

Nursing Diagnosis for ____

Diarrhea related to ……….

Imbalanced nutrition: less than body requirements related to …………

Body Image, Disturbance related to ………….

Fluid Volume Deficit

Back 106

Inflammatory Bowel Disease

Front 107

IBD Planning

1) experience a decrease in severity and number of exacerbations.

2) maintain normal fluid and electrolyte balance.

3) be free from pain and discomfort.

4) comply with medical regimen.

5) maintain nutritional balance.

6) have improved quality of life.

Back 107

Nursing

Front 108

Nursing Interventions

a)Monitor I/O

b)Monitor the number and appearance of stools.

c) Monitor nutritional intake -- % of meal consumption if not NPO

d) Until diarrhea is controlled, keep patients clean and dry

e) provide sitz baths or soothing ointments for anal irritation and discomfort resulting fromexcessive loose stools.

f) teach the importance of rest and diet management, action and side effects of drugs, and symptoms of disease recurrence.

Back 108

IBD

Front 109

surgically creating an opening in the abdomen ___

Back 109

(ostomy)

Front 110

A _____ involves creating an opening in the abdomen (ostomy) and pulling through a portion of the large intestine (colon).

Back 110

colostomy

Front 111

____ -- mucosal “pockets” or pouches that develop along the colon as a result of a narrowing in the colon– mostly occurring along the sigmoid colon.

Back 111

Diverticula

Front 112

_____ – when multiple pockets are present in the colon.

Back 112

Diverticulosis

Front 113

_____ – when the pockets in colon become inflammed.

Back 113

Diverticulitis

Front 114

Although the exact cause is unknown, the most prevalent theory is that ____ occur because of high intraluminal pressure within weakened segments of the colon. Because of the narrowing in the colon, stool has a hard time passing through and may become lodged in the pockets leading to this. When inflammation occurs, signs and symptoms begin to appear.

Back 114

diverticula

Front 115

Clinical Manifestations of Diverticulitis

2

Back 115

a)LEFT LOWER QUADRANT ABDOMINAL PAIN (REMEMBER THIS IS WHERE THE SIGMOID COLON IS LOCATED)

b)fever

Front 116

Complications of Diverticulitis

4

Back 116

a)Perforation – which could lead to peritonitis

b)Obstruction

c)Abscess or fistula formation

d)Bleeding

Front 117

a)HIGH-FIBER DIET – aids bulk to stools allowing easier passage through narrowed lumen

b) NPO – Lets the colon rest and the inflammation subside – will resume diet in stages—fluids—bland, soft foods – regular foods

c)IV fluids

d)Antibiotics

e) stool softeners

f) Surgical interventions – colon resection with temporary colostomy possible.

Back 117

Diverticulitis

Front 118

_____ -- an autoimmune disease characterized by damage to the small intestine from the ingestion of wheat, barley, and rye. Most common in people of European ancestry.

Back 118

Celiac disease

Front 119

Inflammation is activated by the ingestion of gluten found in wheat, rye, and barley. Inflammation damages the microvilli of the small intestine, particularly in the duodenum, which decreases the amount of surface area available for nutrient absorption.

Back 119

Celiac disease

Front 120

1. Weight loss – related to decreased absorption of protein, fat, and carbohydrates

2. malnutrition

3. foul-smelling diarrhea

4. steatorrhea

5. flatulence, bloating

6. dermatitis herpetiformis – rash located on the buttocks, scalp, face, elbows, and knees

7. lactose intolerance

Back 120

Celiacs disease

Front 121

Celiacs Disease Diagnostic Studies

2

Back 121

1. Tissue biopsy of the small intestine – will show flattened mucosa and decreased villi.

2. Symptoms disappear when gluten-free diet is followed.

Front 122

Celiacs disease Management

3

Back 122

1. Gluten-free diet (See table 43-33 for list of foods)

2. Teach patient regarding foods containing gluten

3. Teach patients that certain medications contain gluten

Front 123

Celiacs Complications

2

Back 123

1. Osteoporosis – related to lactose intolerance—decreased intake of calcium.

2. Iron-deficiency anemia – related to low iron and folate levels – decreased absorption of proteins.

Front 124

____ – inflammation of the liver

Back 124

Hepatitis

Front 125

Hepatitis ____ – eating or drinking foods that contain the virus – can be transmitted from person to person

Back 125

A

Front 126

Hepatitis _____ – Blood or blood products, sexual contact with infected partner

Back 126

B

Front 127

Hepatitis ____ – sharing contaminated needles and equipment – drug users

Back 127

C

Front 128

Hepatitis ____ – must have HBV to replicate

Back 128

D

Front 129

Hepatitis ____ – contaminated water – BE AWARE WHEN TRAVELING OUTSIDE THE COUNTRY!

Back 129

E

Front 130

Hepatitis ____ – can not exist alone – must have HBV,HCV, or HIV to replicate

Back 130

G

Front 131

____ – caused by systemic poisons or are converted to toxic metabolites in the liver (Tylenol)

It is Drug Induced – medications that cause hypersensitivity resulting in liver cell damage.

Back 131

Toxic Hepatitis

Front 132

During the acute phase, the virus attacks the hepatic cells which lead to cell necrosis. Systemically, the antigen-antibody complex forms, which activates the complement immune system which is responsible for the clinical manifestations seen with This.

Back 132

Hepatitis

Front 133

Acute phase – Incubation – 4 months (PERIOD of MAXIMAL INFECTIVITY)

a) Right Upper Quadrant Pain

b) Loss of appetite

c) Fatigue

d) Jaundice

e) Low-grade fever

f) hepatomegaly

g) arthralgia

h) bilirubinuria

i) increased AST and ALT levels

j) increased Total Bilirubin levels

a) malaise

b) easily fatigued

c) hepatomegaly continues

Back 133

Hepatitis

Front 134

____ – begins when jaundice disappears, lasts 2-4 months on average

Back 134

Convalescent phase

Front 135

increased Total Bilirubin levels leads to

Back 135

Jaundice

Front 136

Hep Diagnostic Studies

2

Back 136

a)antibodies – immunoglobulins

b)liver biopsy – performed with chronic hepatitis

Front 137

There is no specific or treatment therapy for ___hepatitis.

Back 137

acute viral

Front 138

a)Stress handwashing before and after defecation : Infection Control Precautions

b) Provide rest periods

c) encourage small, frequent meals

d) Teach importance of vaccinations

e) Teach measures to reduce risk of contracting virus: Lifestyle Modifications

Back 138

Hepatitis

Front 139

Hep Complications

4

Back 139

a)Fulminant viral hepatitis – severe liver impairment

b)Liver failure – will require liver transplantation for survivability to ensue.

c) Cirrhosis

d) hepatic carcinoma

Front 140

____ – progressive destruction of liver cells. Mainly caused by chronic Hep. C infection and alcoholism

Back 140

Cirrhosis

Front 141

Continued inflammation leads to cell necrosis which results in fibrosis. Chronic hep. C combined with alcohol ingestion is synergistic in accelerating liver damage.

Back 141

Cirrhosis

Front 142

Hepatitis Diagnostic Studies

2

Back 142

1. Elevated liver enzymes

2. Liver biopsy

Front 143

Cirrhosis Early Signs –

1

Back 143

1. fatigue

Front 144

1. Jaundice r/t decreased ability of liver cells to conjugate and excrete bilirubin

2. Spider angiomas –small, dilated blood vessels that branch out—seen mostly on the nose, cheeks, upper trunk, neck, and shoulders – results from liver’s inability to metabolize steroid hormones

3. Palmar erythema – a red area on the palms that blanches with pressure – results from the liver’s inability to metabolize steroid hormones.

4. Thrombocytopenia – liver is unable to produce prothrombin

a. Hemorrhaging or bleeding tendencies may occur – epistaxis, gingival bleeding, etc.

5. Anemia – related to inadequate RBC production and survival, poor diet, poor absorption of folic acid, and bleeding from varices.

6. gynecomastia

7. Peripheral neuropathy – due to a deficiency in thiamine, folic acid, and cobalamin.

8. Edema – related to sodium and water retention

9. Hypokalemia – related to potassium loss from sodium and water retention.

Back 144

Cirrhosis Late signs

Front 145

Cirrhosis Complications

Back 145

1. Portal Hypertension – an abnormally high blood pressure in the portal veins – can lead to:

a. Esophageal varices – distended and tortuous vessels due to increased portal pressure – danger lies in that they can rupture secondary to coughing, sneezing, vomiting—this can lead to

hemorrhaging – MEDICAL EMERGENCY

b. Ascites – an accumulation of fluid in the peritoneal cavity r/t portal hypertension

c. Hepatic encephalopathy – neurological changes related to an accumulation of ammonia

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1. Fluid restrictions

2. Measure abdominal girth daily

3. Low sodium-low protein diet

4. Provide small, frequent meals with between meal snacks

5. Bleeding Precautions

6. Provide respiratory support – high-Fowler’s positioning, supplemental oxygen

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Cirrhosis Management

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____ – continuous, prolonged, inflammation of the pancreas, normally affecting the head of the pancreas and pancreatic duct, which leads to fibrosing.

Found exclusively in individuals that abuse alcohol

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Chronic Pancreatitis

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The pancreas creates secretes ____

___ breaks down fats

____ breaks down starches, carbs to usuable form for body.

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enzymes and insulin.

Lipase

Amilase

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a)heavy, “gnawing, cramping, burning” pain located in the left upper quadrant or midepigastrium that radiates to the back causes patient to assume a fetal position

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Pancreatitis

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b)Pain is aggravated by eating, not relieved by foods, antacids, or vomiting

c) Grey Turner’s sign – bluish flank discoloration

d) Cullen’s sign – bluish periumbilical discoloration

e) N/V

f) jaundice

g) low grade fever

h) elevated WBC’s

I) elevated amylase and lipase levels

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Pancreatitis

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Pancreatitis may cause _____

Monitor glucose because insulin is not being secreted adequately

____ (fatty stool) (caused by increase in lipase so cant digest fat

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hyperglycemia

steatorrhea

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Diagnostic Studies

a)Elevated amylase and lipase

Monitor this

b)Elevated sedimentation rate

c)ERCP

d)CT

e)MRI

f) ultrasound

g) stool specimens –

examining for fat content

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Pancreatitis

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a)Pain management

b) NPO

c) NG suctioning –

d) Bland, low fat diet when oral intake resumes

e) IV fluids

f) Monitor stools

g) Monitor glucose levels and treat s/s of hyperglycemia

h) Pancreatic enzyme replacements – Pancrease

I) Stress the importance of decreased alcohol consumption – provide resourcesFor cessation

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Pancreatitis Collaborative and Nursing Management

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GI Primary Organs

7

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GI tract (mouth, esophagus, stomach, small intestine ← Upper GI /// Lower GI→ large intestine, rectum, anus)