8D Gastrointestinal Finalwithdx

8/12/2019 8D Gastrointestinal Finalwithdx

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Gastrointestinal

COMMON LABORATORY TESTS FOR GASTROINTESTINAL DISORDERS1. Blood

a. CBC

b. Serum electrolytesc. Serum chemistryd. Enzyme-linked immunosorbent assays (ELISA)e. Serum amylase. !ierential blood count". #rothrombin timeh. AL$% AS$% Alanine aminotranserase% L!&i. Serum bilirubin

'. lucosek. Ammonial. Serum liasem. Alkaline hoshatase

*. Stoola. +ccult bloodb. &c. +,a arasitesd. ualitati,e ate. /educin" substances. Bacterial cultures". 0ital atho"ensh. Leukocytes

. 2rinea. +smolalityb. Sodium

c. #otassiumd. 3itro"ene. 2robilino"en. &

Endoscopy

1. obtain oerati,e ermit rior to rocedure*. tell the client about the rocedure. remo,e dental aliances beore the rocedure4. kee client 3#+ beore rocedure5. hoarseness is normal6 7atch or laryn"osasm or bronchosasm

8. 7atch client and maintain 3#+ until "a" and s7allo7in" rele9es return:. mild anal"esics may relie,e ost rocedure discomort

Bariu contrast studies

1. barium s7allo7*. uer "astrointestinal and small bo7el series. barium enema4. seciic nursin" inter,entions 7ith barium

1. lo7 residue diet or clear li;uid diet or t7o days*. client 3#+ ater midni"ht. use cathartic< ma"nesium citrate% oL=$EL=

4. beore test% "i,e suository or enema5. retained barium may harden and cause an obstruction6 e9amine

client>s stools6 a mild la9ati,e or cleansin" enema may beordered to hel client e9el barium

8. clear li;uid beore and orce luids ater a barium rocedure:. encoura"e drinkin" o more luids to aid in elimination o barium

5. 7hite stools or *4 to :* hours are common


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Esop!a"eal #unction studies

a. client s7allo7s three thin tubes 7hich ass into stomachb. transducers measure esoha"eal ressures

$aracentesis

a. drains abdominal luid o client 7ith ascites

b. small incision is made 'ust belo7 umbilicus andtrocaris inserted

c. nursin" inter,entionsi. client should ,oid beore rocedureii. sit client 7ith eet irmly on looriii. remo,e luid slo7ly o,er a eriod o ?-@?

minutes to re,ent sudden chan"es in bloodressure
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i,. monitor client or hyo,olemiaor electrolyteimbalance

,. obser,e incision site or leakin" or bleedin",i. obtain and label secimens or laboratory

analysis,ii. standard recautions

Gastrointestinal intu%ation

1. /outesa. nasoharyn9< naso"astric% nasointestinalb. oroharyn9c. throu"h abdominal 7all by incision< "astrostomy% 'e'unostomyd. ,ia endoscoy< ercutaneousendoscoic "astrostomy (#E) or

'e'unostomy% (#E)*. /e;uires a ro,ider>s order. 2ses

a. dia"nostic

b. "astric decomressionc. "astric irri"ationd. eedin"

4. 3aso"astric and nasointestinala. tyes o tube

1. naso"astric1. sin"le lumen< Le,ine*. Salem

*. nasointestinal1. sin"le lumen< Cantor% &arris*. double lumen< iller-Abbott

b. comlications o rolon"ed nasal intubation

1. nasal erosion% sinusitis*. haryn"itis% esoha"itis% esoha"eal shincter

incometence. "astric ulceration% ulmonary asiration4. asiration risk is hi"her 7ith nasal tubes

c. nursin" inter,entions in "astric or intestinal intubation


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Gastrostoy&'e'unostoy

a. tube lacement is in uer let ;uadrant o abdomenb. or clients 7ho cannot tolerate nasal route% or or lon" term enteral eedin"c. ro,ides more secure and reliable accessd. nursin" care

i. cleanse skin around insertion site daily 7ith 7arm 7ater and mildsoa

ii. aly dressin" i indicatediii. obser,e or comlications

e. comlicationsi. skin breakdo7n at insertion siteii. inectioniii. seea"e o enteral ormula or "astric draina"e

Ostoy

1. Sur"ical rocedure 7hich creates an oenin" into the abdominal 7all or ecal orurinary elimination (enterostomy)

*. #ortion o intestinal mucosa or ureter brou"ht throu"h abdominal 7all creatin" astomathrou"h 7hich eces or urine drains

. $yesa. bo7el< ileostomy or colostomyb. urinary di,ersions

i. ileal conduit (ileal loo)ii. ureterostomies

4. Ileostomya. stool is li;uid% re;uent% hi"hly alkaline% contains di"esti,e enzymesb. re;uires constant ouchin" and re;uent emtyin"

5. Colostomy< thicker% ormed stool

a. trans,erse colon< must be ouched at all timesb. si"moid colon< can be mana"ed by daily irri"ation% so no need or

ouch
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Nursin" inter(entions #or a client )it! ostoy* additional "uidelines #or nursin"care+

a. emty ouches 7hen they are about 1 to 1* ull% standard recautionsb. i needed% rotect skin around ileostomy stomac. ostomies threaten body ima"e.

d. ears o mutilation% shame% re'ection are commone. clients may eel o7erless because they cannot ully control bodily unctions. assist client to establish normal elimination routine. /eort immediately is a simliied story o 7hat the normal -I system does

Esophagus- con,eys ood mi9ed 7ith sali,a to stomach.

Stomach- secretes di"esti,e 'uices% includin" hydrochloric acid.Stomach contents (chyme) "o throu"h ylorus into small intestine

Small intestine - 7hose arts (in order) are duodenum% 'e'unum%and ileum6 their 7alls absorb nutrients. Drom ileum% chymead,ances into cecum o lar"e intestine. ean7hile%

Liver- makes many crucial roteins% ,itamins% ats% ironcomounds% etc.6 neutralizes to9ins such as alcohol% and con,ertsammonia into urea6 con'u"ates bilirubin% e9cretes it in bile. Bileasses ,ia the heatic duct into the "allbladder

Gallbladder - stores bile% 7hich "oes to small intestine ,ia thecystic duct common bile duct to break do7n at

Large intestine- undi"ested matter is urther absorbed androcessed6 remnants orm as eces in the si"moid colon andrectum.


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1. #urose - con,erts oods into a orm 7hich can be absorbed andused by the body

*. !i"esti,e enzymes. Basic rocesses

a. absortion - accomlished by acti,e transort ,ia intestinalcells. ater and solutes mo,e throu"h the intestinal

mucosa in oosite direction e9ected in osmosis anddiusion

b. metabolism - consists o the sum o all hysical andchemical chan"es that take lace 7ithin an or"anism

c. catabolism - series o chemical reactions that take lace7ithin the cell6 breaks do7n ood molecules to roduceener"y

i. anabolism - synthesis o comounds rom simlercomounds

II, Disorders o# Stoac! and Colon
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A. $ernicious aneia- anemia caused 7hen tissues ail to absorb enou"h,itamin B1*

1. !einitionetiolo"yriska. mucosaand arietalcells o stomach atrohy6 stomach

ails to roduceintrinsic actor%thus cannot roerly absorb,itamin B1*

b. ossibly an autoimmune diseasec. may ollo7 "astric resection

*. #athohysiolo"ya. lar"e /BCs - macrocytic normochromicb. hydrochloric acid

. Dindin"sa. anemia- indin"s deend on se,erityb. tissuehyo9iaroducin" ati"ue% 7eakness% dysnea%

allor% alitationsc. I symtoms< sore ton"ue% anore9ia% nausea% ,omitin"%

abdominal ain% neurolo"ical symtomsd. neurolo"ical symtoms< aresthesia in hands and eet%

7eakness% imaired coordination% chan"es in L+C4. Comlications< I symtoms are re,ersible% but neurolo"ical

chan"es are not5. !ia"nostics

a. CBCb. bone-marro7 biosyc. lack o ree hydrochloric acid in stomachd. Schillin" test

8. ana"ementa. lielon" ,itamin B1* theray 7ith lack o intrinsic actor

must be "i,en arenterallyb. ade;uate nutrition

c. blood transusions as needed:. 3ursin" inter,entions

a. monitor or imaired "as e9chan"eb. mana"e ati"uec. risk o in'ury rom deressed L+C and imaired

coordinationd. kno7led"e deicit- need to understand chronic illness

B. $eptic ulcer diseases- include disorders that ulcerate any art ostomach or intestines.

1. astric ulcersa. deinitionetiolo"y

I. incidence hi"her in the middle-a"ed and elderly6most common in men a"es 45-55

II. risk actors< asirin% 3SAI!s% steroids% caeine% andalcohol intake6 stress

III. atho"en< H. pylorib. athohysiolo"y

I. somethin" disruts mucosal layer and acid diusesback into mucosa

II. commonest site< 'unction o undus and ylorusIII. normal "astric acid secretion

c. indin"sI. ain% burnin" or "as% 7orse 7ith ood

II. ain in let uer ei"astric areaIII. nausea,omitin"I0. bleedin"6hematemesis

d. dia"nostic studiesI. endoscoy

II. comlete blood count (CBC)III. test stool or occult blood

e. comlications
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I. hemorrha"eI. administer intra-arterial ,asoressin

II. administer intra,enous luids and bloodrelacement

II. eroration and eritonitisI. indin"< se,ere abdominal ain

II. indin"< board-like abdomenIII. aralytic ileus (obstruction)< scarrin" may obstruct

ylorus*. !uodenal ulcers

a. etiolo"yrisk actorsI. e9cess roduction o hydrochloric acid

II. more raid "astric emtyin"III. amilial tendencyI0. stress0. more re;uent in eole 7ith tye + blood

0I. more common in men a"es *5 to 5?b. athohysiolo"y

I. located ?.5 to * cm belo7 ylorusII. arteriosclerotic chan"es in ad'acent blood ,esselsIII. ,a"us ner,e stimulation causes tissues to release

"astrin% 7hich increases secretion o hydrochloricacid

c. indin"sI. ain% heartburn occur durin" ni"ht or 7hen stomach

is emtyII. ain relie,ed by ood intakeIII. melena (tarry stool6 black 7ith di"ested blood)

d. dia"nostic studiesI. endoscoy - esoha"o"astroduodenoscoy

II. comlete blood count (CBC)III. test stool or occult blood

e. comlicationsI. hemorrha"e

I. administer intra-arterial ,asoressinII. administer intra,enous luids and blood

relacementII. erorationand eritonitis

I. indin"< se,ere abdominal ainII. indin"< board-like abdomen

III. aralytic ileus (obstruction)< scarrin" may obstructylorus

. ana"ement o etic ulcer diseasea. 3#+ (nothin" by mouth)b. naso"astric tubec. antibiotics< clarithromycin (Bia9in)6 metronidazole (Dla"yl)d. &*recetor anta"onists< cimetidine ($a"amet)6 rantidine

hydrochloride (Fantac)6 amotidine (#ecid)6 nizatidine(A9id)

e. anticholiner"ics< dicyclomine hydrochloride (Bentyl). antacids6 aluminum hydro9ide (Amho"el)6 aluminum-

ma"nesium combinations (aalo9% ylanta% elusil)6calcium carbonate ($ums)

". cytorotecti,e< sucrulate (Caraate)

h. roton um inhibitors< omerazole (#rilosec)%iansorazole (#re,acid)

i. an9iolytics'. blood administrationk. sur"ical Inter,ention

I. ,a"otomy< eliminates stimulation o "astric cellsII. ylorolasty< 7idenin" ylorus to imro,e "astric

emtyin"
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III. subtotal "astrectomyI0. billroth I ("astroduodenostomy)0. billroth II ("astro'e'unostomy)

0I. total "astrectomy4. #ostoerati,e comlications

a. dumin" syndrome- rom raid emtyin" o the stomach

I. tachycardia% alitations% syncoe% diahoresis%diarrhea% nausea% abdominal distention

II. more common 7ith Billroth IIIII. subsides ater se,eral monthsI0. decrease 7ith slo7 eatin"% lo7-carbohydrate% hi"h-

rotein and at diet0. a,oid li;uids 7ith meals

b. ernicious anemia secondary to loss o intrinsic actor5. 3ursin" inter,entions

a. ain relieb. assess or bleedin"c. discuss lie-style chan"es< sto smokin"% decrease stress

d. teachin" - medications% diete. assess or ost-oerati,e comlications - inection%

bleedin"% resiratory comlications. maintain atency o 3 tube

". obser,e draina"e or si"ns o bleedin" (draina"e should bedark red ater *4 hours)

h. mouth care

III, Disorders o# IntestinesA. In#laatory intestinal diseases- chronic% recurrent inlammation6

etiolo"y unkno7n1. ulcerati,e colitis

a. deinitionetiolo"yi. aects youn" eole a"es 15 to 4?

b. athohysiolo"yi. ulceration and inlammation entire len"th o colonii. in,ol,esmucosaandsubmucosaiii. be"ins in rectum and e9tends to distal coloni,. abscess and ulcers lead to bleedin" and diarrhea,. colon cannot absorb% so luids and electrolytes "o

out o balance,i. rotein is lost in stools,ii. scarrin" roduces narro7in"% thickenin"% and

shortenin" o colon

,iii. remissions and e9acerbationsc. indin"s

i. bloody diarrhea ran"in" rom t7o to three er dayto ten to *? er day

ii. stools may also contain us and mucusiii. abdominal (tenderness and cramin") aini,. e,er% 7ei"ht loss% anemia%tachycardia%

dehydration,. imaired absortion o at-soluble ,itamins such as

E% G,i. systemic maniestations

skin lesions -erythema nodosum

'oint inlammation inlammation o the eyes - u,eitis

li,er disease

d. dia"nosisi. si"moidoscoyii. colonoscoyiii. barium enema
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i,. comlete blood count (CBC)e. mana"ement

i. restii. luid% electrolyte% and blood relacementiii. steroids as anti-inlammatoriesi,. immunosuressi,es

,. anti-inecti,es< sulasalazine (Azulidine) rimarydru" o choice

,i. anticholiner"ics,ii. antidiarrheals,iii. dietary restrictions - hi"h calorie and hi"h roteini9. sur"ical mana"ement

total roctolectomy andileostomy

ileorectal anastomosis

total roctolectomy 7ith continent ileostomy

(Gock ouch) total colectomy 7ith ileal ouch (reser,oir)

. comlicationsi. increased risk o colon cancerii. luid and electrolyte imbalances

". nursin" inter,entionsi. mana"e ainii. mana"e diarrhea

iii. teach 7ei"ht loss and nutritioni,. teach coin",. remedy kno7led"e deicit

,i. reduce an9iety

*. Crohn>s diseasea. deinitionetiolo"y

i. youn" eole 15 to ? years oldii. inlammation o se"ments o bo7el% esecially

ileum% 'e'unum% and colon% 7ith areas o normalbo7el bet7een inlamed bo7el - cobblestoneaearance

iii. inlammation in,ol,es all layers o bo7el 7all -transmural

i,. ulceration%issures%istula% and abscess ormation,. bo7el 7all thickens and narro7s% roducin"

strictures,i. slo7ly ro"ressi,e

b. indin"s

BARI.M ENEMA ith a barium enema - bo7el re rior to test% includin" cathartics% enemas6 ater study

use cathartic a"ain to cleanse bo7el Increased iber may cause latulence

Increase luid to ???ccday (unless contraindicated)

!on>t conuse these threeH

Ileum last art o the small intestine% beore it emties into the lar"e intestine. (An ileal ouchis illed rom the ileum.)

Ileus an obstruction (oten in an intestine).

Ilium art o the hibone
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i. diarrhea 7ith steatorrhea (ats not rocessed)

ii. abdominal ain - ri"ht lo7er ;uadrantiii. ati"ue% 7ei"ht loss% dehydration% e,eri,. systemic maniestations

arthritis% clubbin" o in"ers

skin inlammations

nehrolithiasis

c. comlicationsi. obstruction rom stricturesii. istulaormationiii. bo7el may erorate and inect< eritonitisi,. medical mana"ement

rest

nutritional suort hyeralimentation

diet hi"h in calories and rotein% lo7 in

rou"ha"e and at steroids as anti-inlammatories

immunosuressi,es

anti-inecti,es< sulasalazine (Azulidine)

rimary dru" o choice anticholiner"ics

antidiarrheals

loeramide (Imodium) dru" o choice

balloon dilation o strictures

sur"ery 7ill not cure Crohn>s disease6 may

limit dama"e1. colectomy 7ith ileostomy*. subtotal colectomy 7ith ileostomy or

ileorectal anastomosisd. nursin" inter,entions

i. ater sur"ery% monitor diarrhea

luid balance and nutrition

skin inte"rity

coin" and sel-care

se9uality medications

B. Di(erticular disease- outouchin" o the intestinal mucosa
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1. !einitionetiolo"ya. most common in si"moid colonb. constiation% lo7 iber diet% obesityc. colon 7all thickens 7ith increased ressure in bo7eld. stool and bacteria retained in di,erticulum become

inlamed and small erorations occur

e. inlammation o surroundin" tissue*. Dindin"s

a. re;uently asymtomaticb. cramy% lo7er% let abdominal ainc. alternatin" constiation and diarrhead. lo7 "rade e,er% chills% anore9ia% nauseae. leukocytosis

. !ia"nosisa. barium enemab. comlete blood count% urinalysis% stool or occult bloodc. colonoscoy

4. ana"ement

a. di,erticulosis (outouchin")1. hi"h iber diet*. bulk la9ati,es. stool soteners4. anticholiner"ics

b. di,erticulitis (inlammation)1. 3#+*. rest bo7el. antibiotics4. sur"ery

1. bo7el resection*. temorary colostomy

5. Comlicationsa. abscess ormationb. eroration 7ith eritonitisc. istulad. bo7el obstruction

8. 3ursin" inter,entionsa. teach aroriate dietb. a,oid strainin"% cou"hin"% litin"c. a,oid increased abdominal ressure

C, Constipation1. !einitionetiolo"y

a. chan"e in normal bo7el habits characterized by1. decreased re;uency*. stool is hard% dry% diicult to ass. stool is retained in rectum

b. etiolo"yrisk actors1. insuicient dietary iber*. insuicient luid intake. medications% esecially oiates4. lack o acti,ity5. i"norin" ur"e to deecate8. chronic la9ati,e abuse:. lack o ri,acysycholo"ical actors

J. re"nancy@. neuromuscular imairment1?. hyothyroidism

*. Dindin"sa. hard% dry stoolb. abdominal distentionc. decreased re;uency o usual atternsd. strainin"
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e. nauseaanore9ia. alable mass". hemorrhoidsh. ecal imaction 7ith diarrhea

. Comlicationsa. obstructioneroration

b. cardio,ascular alterations4. ana"ement

a. cathartics1. saline la9ati,es - milk o ma"nesia*. stimulant la9ati,es - bisacodyl (!ulcola9). bulk-ormin" la9ati,es - syllium (etamucil)4. lubricant-emollient - mineral oil5. stool soteners - docusate sodium (Colace)

b. enemas1. cleansin" - saline% soa solution*. sotenin" - oil retention

5. 3ursin" inter,entions

a. teach nutrition% increased iber% and increased luidsb. teach< obey ur"e to deecatec. ro,ide ri,acy and comortd. increase acti,ity

!. !iarrhea1. !einitionetiolo"y - loose stools due to

a. ecal imactionb. ulcerati,e colitisc. intestinal inectionsd. increased ibere. medications

*. Dindin" - loose 7atery stools. Comlications - dehydration% electrolyte imbalance4. ana"ement

a. mild diarrhea - oral luids to relace lost luidb. moderate diarrhea - dru"s that decrease motility (Lomotil%

Imodium)c. se,ere diarrhea - due to inection% antimicrobials and luid

relacement5. 3ursin" inter,entions

a. monitor or luid and electrolyte imbalanceb. re,ent skin e9coriationc. teach client about oods that may aect bo7el elimination%

e.".% ruits% ,e"etables

E, Bo)el o%struction1. !einitionetiolo"y

a. mechanical< adhesions% hernias% neolasms%,ol,ulus%intussuscetion

b. nonmechanical< aralytic ileus% occlusion o ,ascularsuly

c. distended abdomen rom accumulation o luid% "as%intestinal contents

d. luid shits due to increased ,enous ressure 7ithhyotension and hyo,olemic shock

e. bacteria rolierate*. Dindin"s

a. abdominal ainb. distention (more 7ith lar"e bo7el obstruction)c. nausea,omitin" (more 7ith small bo7el obstruction)d. hyo9iae. metabolic acidosis. bo7el necrosis rom imaired circulation
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. Comlicationsa. eroration and eritonitisb. shockc. stran"ulationo bo7el

4. !ia"nosisa. uer-I and lo7er-I series

b. abdominal K rays sho7 air in bo7elc. lo7 luid ,olume increases 7hite blood cells% hemo"lobin

hematocrit% B235. ana"ement

a. decomress the abdomenb. nasointestinal tubec. sur"ical bo7el resection

8. 3ursin" inter,entionsa. mana"e ain% but a,oid morhine or codeine% 7hich slo7

bo7el motionb. measure abdominal "irthc. 7ith naso"astric or nasointestinal tubes% ro,ide oral care

d. naso"astric tubes< Salem sum (double lumen)% Le,in(sin"le lumen)

e. nasointestinal tubes1. cantor tube - sin"le lumen% mercury illed 7ei"ht on

ti*. miller-Abbott - double lumen 7ith mercury 7ei"hted

ti. ad,ance t7o inches er hour

. maintain luid and electrolyte balance

F, Colon cancer1. !einitionetiolo"y

a. may de,elo rom adenomatous olysb. risk actors - lo7 residue diet% hi"h-at diet% reined oods

*. #athohysiolo"ya. adenocarcinoma is the most common tyeb. most common locations are si"moid rectum and ascendin"

colonc. oten metastasizes to the li,erd. classiication (sta"in") systems< $3 or !uke>s

. Dindin"sa. rectal bleedin"b. chan"e in bo7el habits - constiation% diarrheac. chan"e in shae o stool

d. anore9ia and 7ei"ht losse. abdominal ain% alable mass

4. !ia"nosticsa. colonoscoyb. si"moidoscoyc. di"ital e9aminationd. stool or occult bloode. barium enema. C$ scan". carcinoembryonic anti"en (CEA)h. alkaline hoshataseandAS$(asartate

aminotranserase)

5. Comlications - obstruction8. ana"ement

a. radiationb. chemotherayc. treatment o choice is sur"ery - bo7el resection% colostomy

1. ri"ht hemicolectomy - in,ol,es ascendin" colon*. let hemicolectomy - in,ol,es descendin" colon


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. abdominal-erineal resection< remo,al o si"moidcolon and rectum 7ith ormation o a colostomy

:. 3ursin" inter,entionsa. mana"e ainb. monitor or comlications

1. 7ound inection

*. atelectasis. thrombohlebitis

c. maintain luid and electrolyte balanced. care o ostomy

I/, Disorders o# t!e Li(er$LASMA /AL.ES

A. Albumin< .8-5.? "dl (see also #roteins% belo7)B. Alcohol< ne"ati,eC. Alkaline hoshatase

adults ?-J5 Im2ml

children "reater than t7o years J5-*5 Im2mlo t7o to ei"ht years 85-*1? Im2ml

o nine to 15 years 8?-?? Im2ml

!. Ammonia

adults @- molliter

children 4?-J? "dl

ne7borns @?-15? "dl

E. Bilirubin% direct - u to ?. m"dlD. Bilirubin% indirect - ?.1-1.? m"dl. Bilirubin total

adults and children ?.-1.1 m"dl

ne7borns 1-*1 m"dl

&. Bleedin" time one to nine minutesI. Dibrino"en 15?-8? m"dl. amma "lobulin ?.J-1.8 "dlG. Lead 1*? ("dl or less) M*5 "dlL. Liids (total) 4??- J?? m"dl. Cholesterol M*?? m"dl3. &!

emales< ?-J5 m"dl

males< ?-85 m"dl

+. ldlM 1@? m"dl#. $ri"lycerides M*5?. #hosholiids 1J?-*? m"dl/. Dree atty Acids @.?-15.? mLS. #artial thrombolastin time% acti,ated (A#$$) *1-* seconds to7 to three times 7hen antico"ulated)$. #rotein (total) 8.*-J.* "dl

albumin .8-5.? "dl

"lobulin *.-.4 "dl

2. #rothrombin $ime (#$) 11.-1J.5 seconds (t7o to three times 7hen anticoa"ulated)0. 2rea 3itro"en J-*5 m"L. 2ric acid -J m"dl
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A, 0epatitis1. !einitionetiolo"y - acute inlammatory disease o the li,er caused

by ,iral% bacterial% or to9ic in"estion*. #athohysiolo"y

a. inlammation o li,er% enlar"ement oGuer cells% bilestasis

b. re"eneration o cells 7ith no residual dama"ec. tyes

i. heatitis A transmitted rom inected ood% 7ater% milk%

shellish ecal-oral route o inection common in oor

sanitationo,ercro7din" hi"her incidence in all and 7inter

ne7 ,accine a,ailable

ii. heatitis B blood-borne and se9ually transmitted

may become a carrier

iii. heatitis C transmitted arenterally (ost-transusion

heatitis) and ossibly ecal-oral route may become a carrier

i,. heatitis ! blood borne

coe9ists 7ith heatitis B

,. heatitis E 7ater borne

contaminated ood or 7ater6 rare in the

2nited States

B, 0epatitis B1. /isk actorsinection route

a. homose9ualityb. i, dru" usec. health roessionalsd. hemodialysise. transmission routes

i. se9ualii. ecal-oral route< incubation 1* to 14 7eeks or

lon"eriii. contaminated body luids

. athohysiolo"yi. heatitis B has three distinct anti"ens

&BsA" - surace anti"en

&BcA" - core anti"en

&BeA" - e anti"en

ii. dama"e to the heatocytescauses inlammationand necrosis

iii. li,er unction decreased in roortion to dama"ei,. healin" takes three - our months

*. Dindin"sa. 'aundicei li,er ails to con'u"ate bilirubin or e9crete itb. clay-colored stools rom lack o urobilin

c. urine is dark rom urobilin e9creted in urine rather thanstoold. urine oams 7hen shakene. ruritusrom bile saltse9creted throu"h skin. ri"ht uer ;uadrant ain rom edema and inlammation o

li,er". anore9ia% nausea% ,omitin"% malaise% 7ei"ht lossh. rolon"ed bleedin" rom imaired absortion o ,itamin G
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i. anemiarom decreased /BC liesan. !ia"nostics - serolo"ic markers o &B0

a. &BsA" - heatitis B surace anti"enb. anti-&bc - antibodies to B core anti"ensc. ele,atedalanine aminotranserase(AL$ re,iously S#$)d. ele,ated bilirubin

e. ele,ated asartate aminotranserase (AS$6 re,iouslyS+$)

. ele,atedalkaline hoshatase". rolon"ed rothrombin time

4. ana"ement- nonseciic and suorti,ea. symtomatic treatment o ain

b. antiemetics as needed

5. 3ursin" inter,entionsa. ati"ue - ro,ide rest eriods6 may re;uire bed rest initially

b. maintain skin inte"rityc. client 7ill tolerate less acti,ityd. nutrition needss osition

ASCITES 1 $ARACENTESIS #aracentesis - asiration o abdominal ascites% usually 1???-15??cc remo,ed

Beore aracentesis< emty client>s bladder !urin" rocedure< client sits uri"ht

Ater rocedure< take re;uent ,ital si"ns6 monitor urine outut6 and monitor or

draina"e rom uncture site
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e. monitor or imaired skin inte"rity. remedy kno7led"e deicit

D. &eatic encehaloathy - mental dysunction associated 7ith se,ere li,erdisease

1. !einitionetiolo"y

a. imaired ammonia metabolism in li,er oisons brain tissueb. ammonia roduced in bo7el rom action o bacteria on

rotein*. Dindin"s

a. chan"es in L+C rom conusion to comab. chan"es in slee atternc. memory lossd. asteri9is - lain" tremore. imaired hand7ritin". hyer,entilation7ith resiratoryalkalosis

". etor heaticus - musty% s7eet odor to breath. !ia"nostics - serum ammonia le,el

4. ana"ementa. neomycin sulate (yciradin) - inhibits action o intestinal

bacteriab. lactulose (Cehulac) - absorbs ammonia and roduces

e,acuation o the bo7elc. lo7 rotein diet

5. 3ursin" inter,entionsa. tremor% conusion can lead to in'ury< maintain saetyb. ascites and lo7 intake decrease luid ,olumec. diarrhea rom medications

/, Disorders o# $ancreas and Gall%ladderA, Acute pancreatitis

1. !einitionetiolo"y - inlammation o the ancreasa. alcohol in"estionb. "all stonesc. dru" in"estiond. ,iral inectionse. trauma

*. #athohysiolo"ya. autodi"estion rom remature acti,ation o ancreatic

enzymesb. roteases and liases% normally acti,e in small intestine%

are acti,ated in the ancreas

c. hosholiase A di"ests adioseand arenchymal tissuesd. elastase di"ests elastic ibers o blood ,essels% roducin"

bleedin"e. amylase di"ests carbohydrates. inlammation resonse occurs rom enzyme release

. Dindin"sa. let uer ;uadrant abdominal ainb. ain 7orsens ater eatin" and 7hen lyin" latc. nausea and ,omitin"d. e,er% a"itation% conusione. hyo,olemiaand shock. hemorrha"e into retroeritonealsace may roduce

ecchymosis in lank or around umbilicus". tachynea% ulmonary iniltrates% atelectasisrom

circulatin" enzymes4. !ia"nostics

a. ele,ated enzymes< serum amylase% serum liase% andurinary amylase

b. ele,ated BCs% decreased hemo"lobin and hematocritc. ele,ated L!& and AS$ (S+$)


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d. hyer"lycemiae. hyocalcemia. chest 9- ray% C$ scan% ultrasound% E/C#

5. Comlicationsa. resiratory roblems - atelectasis% neumonia rom the

immobility imosed by ainb. tetanyrom decreased calcium le,elsc. abscessor seudocyst

8. ana"ementa. treat causeb. ain relie - meeridine (!emerol)c. luid maintenance to re,ent shockd. insulin or hyer"lycemiae. calcium relacement. decrease stimulation o ancreas

i. 3#+-$#3 (nothin" by mouth6 total arenteralnutrition)

ii. 3 tubeiii. anticholiner"ics

iv. h*-recetor anta"onists

:. 3ursin" inter,entionsa. mana"e ainb. monitor alteration in breathin" atternsc. monitor nutritional statusd. oral care 7hen 3#+e. i eatin" is allo7ed% diet hi"h in roteins and carbohydrates

and lo7 in at. monitor luid and electrolyte balances

B. Cholecystitis1. !einitionetiolo"y - inlammation o the "allbladder

a. usually due to "allstones (Cholelithiasis)b. tyes

i. cholesterol - most common

Endoscoy hels dia"nose and treat many abdominal (and other) disorders. &ere are t7oendoscoic rocedures desi"ned or the abdomen

8D Gastrointestinal Finalwithdx

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