julie c.

yu-santos

GASTROINTESTINAL SYSTEM
JULIE C. YU-SANTOS, M.D.

Main organ includes : mouth, pharynx, esophagus, stomach , small intestine and large intestine Function: 1. Normally, It is the only source of intake for the body 2. Provide the body with fluids, nutrients, and electrolytes 3. Provides means of disposal for waste residues
julie c. yu-santos

Physiology of digestion and absorption :
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digestion: physical and chemical breakdown of food into absorptive substances
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Initiated in the mouth where the food mixes with saliva and starch is broken down Food then passes into the esophagus where it is propelled into the stomach In the stomach, food is processed by gastric secretion into the substance called CHYME In the small intestine , carbohydrates are hydrolyzed to monosaccharides, fats to glycerols and fatty acids, CHON to amino acids to complete the digestive process julie c. yu-santos

 When

chyme enters the duodenum, mucus is secreted to neutralize HCL acid , in response to release of secretin , pancreas releases HCO3 to neutralize acid chyme and pancreozymin (CCK-PZ) are also produced by the duodenal mucosa, stimulate the contraction of GB along with relaxation of the sphincter of Oddi and stimulates release of pancreatic enzymes
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 Cholecystokinin

yu-santos . increases significantly after eating julie c.Blood supply to GIT 5    GIT receives blood from arteries that originates along the entire length of the thoracic and abdominal aorta Venous drainage – portal vein Blood flow to the GI tract is about 20% of total cardiac output.

yu-santos .Nerve innervation to GIT 6   ANS-both parasympathetic and sympathetic system innervate the GI tract Only portion of the tract that are under voluntary control are the upper esophagus and external anal sphincter julie c.

D. SYMPATHETIC     Generally INHIBITORY! Decreased gastric secretions Decreased GIT motility Sphincters and blood vessels constrict PARASYMPATHETIC  Generally EXCITATORY!  Increased gastric secretions  Increased gastric motility  Sphincters relax julie c.The GIT Physiology LIEZEL ADAJAR CASTILLO R. yu-santos .M.N.

 A clinic nurse is performing an abdominal assessment on client and preparing to auscultate bowel sounds. Right lower quadrant c. yu-santos . The nurse places the stethoscope in which quadrant first? a. Left lower quadrant d. Right upper quadrant b. Left upper quadrant julie c.

julie c. yu-santos GASTROINTESTINAL ASSESSMENT Laboratory Procedures .

ova.COMMON LABORATORY PROCEDURES 10 FECALYSIS Examination of stool consistency. pathogens and others  julie c. yu-santos . parasites. color and the presence of occult blood. nitrogen.  Special tests for fat.

yu-santos .COMMON LABORATORY PROCEDURES 11 FECALYSIS: Occult Blood Testing Instruct the patient to adhere to a 3day meatless diet  No intake of NSAIDS. aspirin and anticoagulant  Screening test for colonic cancer  julie c.

COMMON LABORATORY PROCEDURES 12 Upper GIT study: Barium swallow  Examines the upper GI tract  Barium sulfate is usually used as contrast julie c. yu-santos .

COMMON LABORATORY PROCEDURES 13 Upper GIT study: Barium swallow  Pre-test: NPO post-midnight  Post-test: Laxative is ordered. yu-santos . monitor for obstruction julie c. increase pt fluid intake. instruct that stools will turn white.

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yu-santos .COMMON LABORATORY PROCEDURES 16 Lower GIT study: Barium enema  Examines the lower GI tract  Pre-test: Clear liquid diet and laxatives. cleansing enema prior to the test julie c. NPO post-midnight. .

instruct that stools will turn white.COMMON LABORATORY PROCEDURES 17 Lower GIT study: barium enema  Post-test: Laxative is ordered. increase patient fluid intake. yu-santos . monitor for obstruction julie c.

yu-santos R.18 LIEZEL ADAJAR CASTILLO julie c.M.D. .N.

19 COMMON LABORATORY PROCEDURES Gastric analysis Aspiration of gastric juice to measure pH. drugs and smoking  Post-test: resume normal activities  julie c. volume and contents  Pre-test: NPO 8 hours. appearance. avoidance of stimulants. yu-santos .

COMMON LABORATORY PROCEDURES 20 EGD esophagogastroduodenoscopy Visualization of the upper GIT by endoscope  Pre-test: ensure consent. NPO 8 hours. yu-santos . pre-medications like atropine and anxiolytics  julie c.

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yu-santos .Gastroscopy 22 julie c.

.M. yu-santos R.COMMON LABORATORY PROCEDURES 23 EGD  esophagogastroduodenoscopy Intra-test: position : LEFT lateral to facilitate salivary drainage and easy access LIEZEL ADAJAR CASTILLO julie c.N.D.

COMMON LABORATORY PROCEDURES 24 EGD(esophagogastroduodenoscop y)  Post-test: NPO until gag reflex returns. . saline gargles for mild oral discomfort julie c. yu-santos . monitor for complications. place patient in SIMS position until he awakens.

NPO 8 hours. . sigmoid and colon  Pre-test: consent.scopy  Use of endoscope to visualize the anus. rectum.M.N.D. yu-santos R.COMMON LABORATORY PROCEDURES 25 Lower GI. cleansing enema until return is clear LIEZEL ADAJAR CASTILLO julie c.

D. yu-santos R.N. .M.26 LIEZEL ADAJAR CASTILLO julie c.

M. yu-santos R.D.Colonoscopy 27 LIEZEL ADAJAR CASTILLO julie c. .N.

N.COMMON LABORATORY PROCEDURES 28 Lower GI.scopy  Intra-test: position is LEFT lateral. right leg is bent and placed anteriorly  Post-test: bed rest. .D.M. monitor for complications like bleeding and perforation LIEZEL ADAJAR CASTILLO julie c. yu-santos R.

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its ability to concentrate. store and release the bile  Pre-test: ensure consent.M. seafood and dyes. .30 COMMON LABORATORY PROCEDURES Cholecystography  Examination of the gallbladder to detect stones. contrast medium is administered the night prior. NPO after contrast administration LIEZEL ADAJAR CASTILLO julie c.D. ask allergies to iodine. yu-santos R. fat free meal night before the test.N.

M. yu-santos R.COMMON LABORATORY PROCEDURES 31 Cholecystography Post-test: Advise that dysuria is common as the dye is excreted in the urine.D. .N. resume normal activities LIEZEL ADAJAR CASTILLO julie c.

Liquid julie c. Low protein b. A nurse would order what type of diet for the evening meal before the test? a. Fat free c. yu-santos . High carbohydrates d. A client is scheduled for an oral cholecystogram.

yu-santos .COMMON LABORATORY PROCEDURES 33 Paracentesis Removal of peritoneal fluid for analysis julie c.

instruct to VOID and empty bladder. yu-santos . measure abdominal girth julie c.COMMON LABORATORY PROCEDURES 34 Paracentesis  Pre-test: ensure consent.

yu-santos .COMMON LABORATORY PROCEDURES 35 Paracentesis  Intra-test: Upright on the edge of the bed. back supported and feet resting on a foot stool julie c.

yu-santos .COMMON LABORATORY PROCEDURES 36 Liver biopsy Pretest  Consent  NPO  Check for the bleeding parameters  julie c.

yu-santos .COMMON LABORATORY PROCEDURES 37 Liver biopsy  Intratest Position: Semi fowler’s LEFT lateral to expose right side of abdomen julie c.

Instruct to avoid lifting objects for 1 week julie c. perforation.COMMON LABORATORY PROCEDURES 38 Liver biopsy  Post-test: position on RIGHT lateral with pillow underneath. yu-santos . monitor VS and complications like bleeding.

Supine with the right hand under the head julie c. The client is receiving local anesthetic for the procedure. The nurse would assist the client for the position? a. Left lateral side lying c. Prone with the hands crossed under the head d. An ambulatory nurse is preparing to assist in physician performing liver biopsy. yu-santos . Right lateral side lying b.

PHARYNX and ESOPHAGUS   Buccal cavity includes: 1. Muscles 4.MOUTH. Cheeks 2. yu-santos . oropharynx. laryngopharynx julie c. Hard and soft palates 3. Tongue Pharynx.tube like structure that extends from the base of the skull to the esophagus Has 3 types: nasopharynx. Maxillary bones 5.

yu-santos .Buccal acvity julie c.

Larynx julie c. yu-santos .

yu-santos . Serving as a pathway for the respiratory and digestive tracts 2. Function: 1. Playing an important role in phonation Esophagus: begins at the lower end of the pharynx and is a collapsible muscular tube about 10 inches long ( 25cm) Function: Convey food from the mouth to the stomach julie c.

Oral infection Stomatitis. or infectious Types: 1.inflammation of the tongue Gingivitis. treated symptomatically julie c.inflammation of the gums Causes: maybe mechanical. chemical. Herpes Simplex.group of vesicles on an erythematous base    Usually located at the mucocutaneous junctions of the lips and face Cause by a virus Treated with acyclovir. yu-santos .is an inflammation of the mouth Glossitis.

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Apthous ulcer( canker sores)  Unknown etiology  Usually less than 1cm in diameter  Duration is weeks to months  Very painful . foul breath  Treated with antibiotic 3. Vincent’s angina (Trench mouth). CLAD. yu-santos . anorexia.shallow erosion of the mucous membrane  Well circumscribed julie with a white or yellow center c.2.purplish red gums covered by pseudomembrane  Caused by fusiform bacteria and spirochetes  Symptoms include fever.

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Nursing intervention: Provide and teach the client with good oral hygiene, including avoidance of commercial mouthwash Rinse with viscous lidocaine before meals to provide an analgesic effects Advise client to suck on popsicles to provide moisture

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Cancer of the mouth
-occur in the lips, or with in the mouth( tongue, floor of mouth, buccal mucosa, pharynx and tonsils) -most common is squamous cell carcinoma( lower lip) Etiology: 1. Excessive sun exposure 2. Tobacco (cigar, pipe, cigarette) julie c. yu-santos 3. Excessive alcohol intake

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julie c. yu-santos

Assessment findings: 1. Ulceration (often painless) on the lip; tongue or buccal mucosa 2. Pain or soreness of the tongue upon eating hot or highly seasoned foods 3. Erythroplakia, leukoplakia 4. Difficulty chewing/speaking, dysphagia 5. Positive toluidine blue test
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removal of half the tongue julie c. Chemotherapy 3. Surgery. Hemiglossectomy.removal of the mandible b. yu-santos . Mandibulectomy. Radiation therapy (affect primary lesion and affected lymph nodes) 2.depend on location and extent of tumor a.  Early detection (very important) Medical mgt: 1.

Glossectomy.removal of entire tongue d.c. Radical neck dissection julie c. yu-santos .

yu-santos . Suction mouth c. place in sidelying position initially then fowlers b.Nursing intervention: 1. Maintain patency of drainage tubes julie c. Promote drainage a. Routine pre-op care 2. Post-op care: a.

diluted peroxide . Provide foods/fluids that are nonirritating . Place oral fluids in back of the throat with an asepto syringe julie c.normal saline b. lemon and glycerine swabs c. Monitor/promote optimum nutritional status a. Avoid use of commercial mouthwashes.b. Provide mouth irrigations with sterile water. Provide tube feedings following a hemiglossectomy b. Promote oral hygiene/comfort a. yu-santos c.

d. Monitor for signs and symptoms of facial nerve damage( drooping, uneven smile, circumoral numbness or tingling)

julie c. yu-santos

Hiatal hernia

Sliding hiatal hernia- occurs when a portion of the stomach and vagus nerve slide upward into the thorax through an enlarged hiatus in the diapragm Occurs often in women (40-70) Cause: 1. Congenital weakening of the muscles in the diaphragm around the esophagogastric opening 2. Increased intraabdominal pressure( obesity, pregnancy, ascites )
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julie c. yu-santos

julie c. yu-santos

 Pathophysiology: causative factor reflux of gastric juices and inflamamtion of the lower portion of the esophagus sign/symptoms julie c. yu-santos .

regurgitation several hours after meals without vomiting julie c.  Diagnosis: barium swallow. heartburn especially after meals at night or with position changes 2.reveals an incompetent cardiac sphincter Assessment: 1.protrusion of the gastric mucosa through a hiatus esophagoscopy. yu-santos . dysphagia 3.

elimination of spicy foods and caffeine 3.Reduction of the hiatal hernia via abdominal or thoracic approach julie c.Antacids to reduce acidity and relieve discomfort. Medical mgt: 1. Modification of diet. Surgery. cholinergic drug 2. yu-santos . Drug therapy.

 1. 2. Nursing intervention: Provide a bland diet with six feeding Administer medication as order Provide pre-op and post-op care Provide client teaching and discharge planning concerning: 1. Modification of diet Sitting up for meals and for 2 hours after meals will help reduce gastric acid reflux Use of antacids Eating small frequent meals slowly to help prevent gastric distention Need to avoid carbonated beverages and anti c. 3. 5. 3. 4. yu-santos cholinergic drugs(julie OTC) . 2. 4.

which is contraindicated with hiatal hernia? a. yu-santos .Lying recumbent following meals c. A client with hiatal hernia chronically experiences heartburn following meals.Racing the head of the bed 6 inch blocks d. blands diet b. The nurse would plan to teach the client to avoid which of the following .Taking in small frequent .Taking histamine H2 receptors antagonist medication julie c.

Which statement indicates effective client teaching about hiatal hernia and its treatment? a. “ I eat 3 large meals without food restriction” b. yu-santos . “I’ll lie down immediately after meal” c. “I’II eat small bland meal that are high in fiber” julie c. “I’II gradually increase the amount of heavy lifting I do” d.     A client is diagnosed with hiatal hernia.

yu-santos R. .GERD 68      Backflow of gastric or duodenal contents into esophagus Cause: Incompetent lower esophageal sphincter Pyloric stenosis Motility disorder LIEZEL ADAJAR CASTILLO julie c.N.M.D.

yu-santos .gastroesophageal reflux julie c.

. yu-santos . 70       Sign and symptoms: Pyrosis( burning sensation in the esophagus ) Dyspepsia Regurgitation Dysphagia or odynophagia Hypersalivation Esophagitis julie c.

71     Diagnostic studies: endoscopy Barium swallow.evaluate damage to esophageal mucosa Ambulatory 12-36hours esophageal Phevaluate the degree of acid reflux julie c. yu-santos .

yu-santos .Diagnostics 72  Endoscopy julie c.

Barium swallow 73 julie c. yu-santos .

carbonated drinks Avoid eating 2 hours before bedtime Maintain normal weight Avoid tight fitting clothes Medication Surgery (nissen fundoplication-wrapping of a portion of gastric fundus around the sphincter area of the esophagus) julie c. milk.  74       Management: Low fat diet avoid caffeine .tobacco. yu-santos . beer.

ranitidine PPI-decrease the release of gastric acid Lansoprazole .esomeprazole Prokinetic agents –accelerate gastric emptying (bethanicole )domperidone (motilium) julie c.Medication 75      Antacids or H2 receptors antagonist: Famotidine . yu-santos .nizatidine.

Parietal cells of stomach c. Lower esophageal sphincter d. The nurse interprets that the client has dys function of which of the following part of digestive system. a. Chief cells of stomach b. yu-santos . Upper esophageal sphincter julie c. A client has been diagnosed with GERD.

Stomach     located on the left side of the abdominal cavity occupying the hypochondriac . Cephalic phase of digestion.epigastric and umbilical region Store and mixes food with gastric juices and mucus producing chemical and mechanical changes in the bolus of food Has fundus. yu-santos . body and antrum 2 phases of digestion: 1. tasting. and chewingjulie food c.secretion of digestive juices is stimulated by smelling.

2. yu-santos . Gastric phase – stimulated by the presence of food in the stomach .regulated by neural stimulation via PNS and hormonal stimulation through secretion of gastrin by gastric mucosa  Chyme –ingested food plus the gastric juices julie c.

Hydrochloric acid.secreted by chief cells .B12 4. Gastric secretions: 1. Mucoid secretions: coat stomach wall and prevent autodigestion julie c. yu-santos . aids in protein digestion 2. promote absorption of Vit.located in fundus. released in response to gastrin 3.secreted by parietal cells. Pepsinogen.secreted by parietal cells. function in CHON digestion. Intrinsic factor.

yu-santos .stomach julie c.

stomach julie c. yu-santos .

a nurse anticipates that the client will be treated with? a. thiamine b. Folic acid julie c. iron c. Vitamin B12 d. yu-santos .A client has been diagnosed with pernicious anemia. In planning care for the client.

alcohol. food poisoning. steroids). irritating food in the diet julie c.Gastritis  An acute inflammatory condition that causes a breakdown of the normal gastric protective barriers with subsequent diffusion of HCL acid into gastric lumen Etiology: excessive ingestion of certain drugs(salycilates. large quantities of spicy. yu-santos  .

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yu-santos . ulcerations and adhesion of the gastric mucosa sign and symptoms julie c. Pathophysiology: Causative agent acute inflammation in the gastric mucosa He.

  Diagnostic :Endoscopy. nausea and vomiting 5.inflammation and ulceration of gastric mucosa Gastric analysis. anorexia 4. yu-santos . hematemesis julie c.HCL acid usually increased except in atrophic gastritis Assessment: 1. epigastric fullness 2. epigastric tenderness 3.

yu-santos . until food is tolerated) Administer medication as ordered Discharge teaching ( avoidance of food and medication ) julie c. 3. 1. 2. Nursing intervention: Monitor and maintain F and E balance Nausea and vomiting(NPO. 4.

yu-santos .antrum Pathophysiology: Rapid diffusion of gastric acid from the gastric lumen into the gastric mucosa – inflamation and tissue breakdown Reflux into the stomach of bile containing duodenal contents julie c. Gastric ulcer-ulcerations of the lining of the stomach.Peptic ulcer disease   1. 2.

  Occurs more often in men. Emotional tension  4. in unskilled laborers and in lower socioeconomic groups Predisposing factor:  1. drugs( salicylates. smoking  2. Alcohol abuse  3. yu-santos . steroids) julie c.

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normal HCL acid level Upper GI series. weight loss julie c. yu-santos 3.radaiting to the back.  Diagnostic :Endoscopy-reveals ulcerations gastric analysis.usually 1-2 hours after meal 2. Epigastric pain .(+) of ulcer confirmed Assessment: 1. nausea and vomiting .

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antibiotic (metronidazole. Supportive: rest. julie c. surgery: gastrectomy. 2. Drug therapy: antacids .H2receptors antagonist. Vagotomy. stress mgt. amoxicillin for ulcer cause by H-pylori) 3. bland diets. Medical mgt: 1. sucralfate. yu-santos .

Provide client teaching and discharge planning: 1. Avoid ulcerogenic drugs c. yu-santos . Nursing intervention: 1. action and side effects julie c. know proper dosage . administer medication as ordered 2. Take medication at all times b. medical regimen: a.

Avoid acid producing substances d. yu-santos .2. bland diet( 6 small feeding) b. Avoid late bedtime snacks julie c. Eat meals slowly c. Avoid stressful situations at mealtime e. Proper diet: a.

Duodenal ulcer     Most commonly found in the first 2cm of the doudenum Characterized by gastric hyperacidity and significant increased rate of gastric emptying Commonly occur in younger men. alcohol abuse. yu-santos . bacterial infection julie c. peak age 35-45 years of age Predisposing factor: smoking .

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epigastric pain. usually occurs 2-4 hours after meal. yu-santos . described as burning . relieved by food julie c.(+) of ulcer confirmed assessment:  1.  Diagnosis: Diagnostic :Endoscopy-reveals ulcerations gastric analysis.cramping.increase HCL acid level Upper GI series.

know proper dosage . yu-santos . administer medication as ordered 2. medical regimen: a. Avoid ulcerogenic drugs c. action and side effects julie c. Take medication at all times b. Nursing intervention: 1. Provide client teaching and discharge planning: 1.

Avoid late bedtime snacks julie c. bland diet( 6 small feeding) b.2. Avoid acid producing substances d. Proper diet: a. yu-santos . Eat meals slowly c. Avoid stressful situations at mealtime e.

M.N.Medication 101 **Antibiotic. yu-santos R. PPI and Bismuth salts Antibiotics  Amoxicillin (bactericidal)  Tetracycline (bacteriostatic)  Clarithromycin (bactericidal) LIEZEL ADAJAR CASTILLO julie c.D. .

Proton Pump Inhibitor – dec acid secretion by slowing H-K Atpase 102 pump .N.M. yu-santos R. .D.4-8 weeks medications ie Omeprazole (Prilosec) Lansoprazole (Prevacid) LIEZEL ADAJAR CASTILLO julie c.

Antacids (non absorbable)   gastric acidity 103  Chew thoroughly then swallow  Taken 1 hour after meals/at bedtime Aluminum Hydroxide  Don’t give other drugs within 1-2 hour after taking antacids  SE: constipation Magnesium Oxide  Taken in between meals or at bedtime  May increase serum Magnesium level in RF client  Chew follow with water  SE: diarrhea LIEZEL ADAJAR CASTILLO julie c.D.N.M. . yu-santos R.

.104   Calcium Carbonate Taken in between meals or at bedtime with milk SE:  uric acid  NaHCO3 SE: metabolic alkalosis and tetany LIEZEL ADAJAR CASTILLO julie c.M. yu-santos R.N.D.

s. skin rash. Famotidine (Pepcid). yu-santos R.D.105 Histamine H2 receptors antagonists ( po/iv)  HCl production by blocking histamine on histamine receptors Taken with meals or at h. cigarettes reduce the action. Nizatidine (Axid) LIEZEL ADAJAR CASTILLO julie c. . SE: headache. bleeding and diziness 8 weeks medication (if s/sx will not improve start antibiotics)      Ie Cimetidine (Tagamet).Ranitidine (Zantac).M.N.

yu-santos R.Cytoprotectives 106 Sucralfate (Carafate) –creates a mucosal barrier and prevents digestion by pepsin  30 min interval before taking antacids  SE: constipation.N.D. nausea  Give 1-2 hour after meal or during bedtime on an empty stomach  5 hours duration LIEZEL ADAJAR CASTILLO julie c. .M.

D. yu-santos R.N.M. . inc mucus and hco3 levels  Administer w/ food  SE: diarrhea and cramping LIEZEL ADAJAR CASTILLO julie c.107 Misoprostol (Cytotec)  Protects gastric mucosa.

antacids and famotidine. “ avoid aspirin and products that contain aspirin” julie c. yu-santos d. the nurse should provide . “ stop taking the drugs when symptoms subsides” c. “increase intake of fluid containing . which instruction? a.     A client with Peptic ulcer is about to start a therapeutic regimen that includes bland diet. Before the client discharged. “ eat 3 balanced meals 3x aday” b.

Severing of part of the vagus nerve innervating the stomach to decrease gastric acid secretion 2.Gastric surgery   Performed when the medical regimen fail Types: 1.Enlargement of the pyloric sphincter with acceleration of gastric emptying julie c. Vagotomy. Antrectomy-Removal of the antrum of the stomach to eliminate the gastric phase of digestion 3. yu-santos . Pyloroplasty.

Gastroduodenustomy-(billroth I). Gastrojejunostomy (billroth II)-removal of the antrum and distal portion of the stomach and duodenum with anastomosis of the remaining portion of stomach to the jejunum 5. Gastrectomy.Removal of 60-80% of the stomach 7.4. yu-santos the loop of jejunumjulie anastomosed to the . Esophagojejunostomy-(total gastrectomy)removal of entire stomach with c.removal of the lower portion of the stomach with anastomosis of the remaining portion of duodenum 6.

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112 LIEZEL ADAJAR CASTILLO julie c.M. yu-santos R. .D.N.

 A client with peptic ulcer is schedule for vagotomy. The client ask the nurse about the procedure. The nurse tell the client that the procedure is? a.Halts the stress reaction d.Decreases food absorption in the stomach b.Heals the gastric mucosa c. yu-santos . Remove the stimulus for acid production julie c.

Remove fluids from the meal tray b. high carbohydrates food julie c. A nurse caring for the client would do which of the following to minimize the risk of dumping syndrome? a. A client has been advanced to a solid diet after subtotal gastrectomy.Ask the client to sit up for an hour after eating c. yu-santos .Provide concentrated .

yu-santos .Dumping syndrome  Abrupt emptying of the stomach contents into the intestine .which draws fluid from the ECF( by osmosis) into the bowel that result in decreased plasma volume . distension of the bowel. stimulates increased intestinal motility julie c.Common complication of gastric surgery  Associated with the presence of hyperosmolar chyme in the jejunum .

faintness 6. feeling of fullness 2. Weakness 5. Diarrhea(15-30mins after 4. diaphoresis meal and last for 20 to 60 mins) julie c. yu-santos . palpitations 7. Sign and symptoms : 1. nausea 3.

5. 4. Medical mgt: Avoidance of concentrated sweets Adherence to six. 2. small dry meals /day Maintenance of modified diet Refraining from taking fluids during meals but rather 2 hours after meals Assuming a recumbent position for ½ hour after meals julie c. yu-santos . 1. 3.

Ambulate of at least 30 mins after each meal julie c.Maintain a low fowlers position while eating d.Increase fluid intake particularly at mealtime b. yu-santos . The nurse tells the client to do which of the following ? a.Maintain a high CHO diet c. A nurse is providing instruction to a client about measure to minimize the risk of Dumping syndrome.

Double vision and chestpain julie c. Which of the following symptoms indicates this occurrence ? a.Bradycardia and indigestion c. A nurse is monitoring a client for the early sign symptoms of dumping syndrome. yu-santos .Sweating and pallor d.Abdominal cramping and pain b.

Eat small meal six times daily d.Avoid concentrated sweets julie c.Drink liquid with meals c. Which of the following would not be a component of this teaching plan? a.Lie down after eating b. yu-santos . A nurse is preparing diet plan for postgastrectomy client with dumping syndrome.

M.Stress ulcer 121    Term given to the acute mucosal ulceration of duodenal or gastric area that occurs after physiologcally stressful events Cushing ulcers. . yu-santos R.N.common in patient having trauma in the brain Curling ulcers-seen in patient 72hrs after extensive burns LIEZEL ADAJAR CASTILLO julie c.D.

5. 4. yu-santos H. 2. pylori infection  1. 3.Cancer of the stomach   Most commonly affect distal third More common in men than women Etiology: Excessive intake of highly salted or smoked foods Diet low in quantity of vegetables and fruits Atrophic gastritis Achlorydia julie c. .

yu-santos .julie c.

Diagnosis: Stool for occult blood CEA. 1. 3. yu-santos .positive Hgb and Hct.decreased Gastric analysis-reveal histologic changes ( anaplasia) julie c. 2. 4.

 Assessment: 1. 3. 8. yu-santos . 4. 5. 7. 2. 6. Fatigue Weight loss Indigestion Epigastric fullness Feeling of early satiety when eating Epigastric pain( later) Palpable epigastric mass pallor julie c.

3. yu-santos . gastric decompression. 4. 2. Medical mgt: Chemotherapy Radiation therapy Treatment for anemia. fluid and electrolyte maintenance Surgery.subtotal gastrectomy (billroth I or II) total gastrectomy julie c. 1.

functional unit of SI . which regulates flow into the large intestine and prevents reflux into the small intestine Major function. Composed of duodenum.contain goblets cell that secrete mucus -also absorptive cell that absorb digested food stuffs julie c.for digestion and absorption Structural features: villi. yu-santos . jejunum and ileum Extend from the pylorus to the ileo cecal valve.Small intestine     1.

yu-santos . Brunners glands.found in the submucosa of the duodenum .produce secretion containing digestive enzymes 3.secrete mucus julie c. Crypts of Lieberkuhn.2.

small intestine julie c. yu-santos .

The nurse interprets that the client has lost the ability to absorb Cyanocobalamin( Vit B12) in which of the following? a.Colon julie c. A client who has had gastrectomy is not producing sufficient intrinsic factors.Stomach b.Small intestine c. yu-santos .Large intestine d.

2. 3.Can be manually placed back into the abdominal cavity Irreducible-Cannot be placed back into the abdominal cavity Inguinal –occurs when there is weakness in the abdominal wall where the spermatic cord in men and round ligaments in women emerge julie c.Hernia   1. yu-santos . Protrusion of the viscus from its normal cavity through an abnormal opening/weaknend area Types : Reducible.

femoral. 7.more common in female Incisional .occurs at the site of a previous surgical incision as a result of inadequate healing postoperatively Umbilical – most commonly found in children Strangulated. 6. 5. yu-santos .4.protrusion through the femoral ring .irreducible with obstruction to intestinal flow and blood supply julie c.

yu-santos .julie c.

yu-santos .julie c.

julie c. yu-santos .

4. Diagnosis: clinical Assessment: Vomiting Protrusion of involved area( obvious after coughing) Crampy abdominal pain Abdominal distention ( if strangulated with bowel obstruction) julie c. 2. 3. . yu-santos  1.

2.surgical repair of hernia by suturing the defect julie c. 1. 3. yu-santos . Medical mgt: Manual reduction Bowel surgery when strangulated Herniorrhaphy.

2. 3. 4. Nursing intervention: Observe for complication Prepare client for surgery Post-op care: 1. 1. Assess for possible distended bladder( inguinal hernia) Discourage coughing but deep breathing Apply ice bags to scrotal area to decrease edema Assist to splint incision when coughing or julie c. yu-santos sneezing . 3. 2.

Need to avoid strenuous physical activity for at least 6 weeks 2. yu-santos .Discharge teaching: 1. Need to report any difficulty with urination  julie c.

intussusception . yu-santos  . shock. neoplasm . peritonitis. Adhesion. hernia. Surgery.fecal impaction 2.Intestinal obstruction Types : 1. Mechanical –physical blockage of the passage of intestinal contents with subsequent distention by fluid and gas ex. Paralytic ileus – interference with nerve supply to the intestine resulting in decreased or absent peristalsis ex. electrolytes imbalance julie c. volvulus .

atherosclerosis julie c.interference with the blood supply to a portion of the intestine resulting in ischemia and gangrene of the bowel ex. yu-santos . Vascular obstruction. Caused by embolus.3.

yu-santos .julie c.

4.increased julie c.Cl. 1. Diagnosis: Flat plate of the abdomen-reveals presence of gas/fluid Hct –increased Serum Na.K.decreased BUN . yu-santos . 3. 2.

Small intestine. high pitched bowel sound obstruction above the level of decreased or absent BS distal to obstruction 2.nonfecal vominting colicky intermittent abd. Assessment: 1. Pain abdominal distention and rigidity. high pitched bowel sound above the level obstruction . Large intestine – Cramplike abdominal pain Fecal-type vomitus unable to pass stool or flatus abdominal distention rigidity.decreased or absent BS distal to obstruction of julie c. yu-santos .

julie c. yu-santos .

julie c. yu-santos .

2. 1. 3. Nursing intervention: Monitor fluid and electrolytes Keep client on NPO Place client in fowlers position to alleviate pressure on the diaphragm Institute comfort measure associated with NG intubation and intestinal decompression Prevent complication 1. yu-santos . 3. 4. Measure abdominal girth Assess for sign and symptom of peritonitis Monitor UO julie c. 5. 2.

yu-santos .contributing factor : Food allergies Autoimmune reaction julie c.Chronic inflammatory bowel disease  Regional enteritis( crohn’s disease)  Chronic inflammatory bowel disease that affect both the large and small intestine ( terminal ileum. cecum and ascending colon)  Both sexes are equally affected  Causes: unknown .

yu-santos .julie c.

julie c. yu-santos .

yu-santos . narrowing and scarring of intestinal wall sign /symptoms julie c. Pathophysiology: causation (+) granuloma that may affect all the bowel wall layers thickening.

julie c. yu-santos .

scattered ulcers Barium enema. 2.narrowing with areas of strictures separated by segment of normal bowel julie c. 3. 1. yu-santos . Diagnostic: Hgb and Hct ( if with anemia) –decreased Sigmoidoscopy.

abdominal distention Nausea and vomiting( 3-4 semisoft stools/day with mucus and pus) Decreased skin turgor Increased peristalsis pallor julie c. 1. 5. 4. 2. yu-santos . Assessment: Right lower quadrant pain. 3.

antibiotics (sulfasalazine). Medical mgt: Diet – High calorie. 2. milk free. high vitamins . 4.control infection Corticosteroids Antidiarrheal Anticholinergics julie c. 3. high protein. low residue. 1. 2. with supplementary iron Drug therapy : 1. yu-santos .

3. yu-santos . Supplemental and parenteral nutrition Surgery – resection of diseased portion of bowel and temporary or permanent ileostomy julie c. 4.

 1. 3. Nursing intervention: Provide appropriate nutrition while reducing bowel motility Administer medication Record number and characteristic of stools daily Provide tepid fluids to avoid stimulation of the bowel Provide care for client undergone bowel surgery julie c. 2. 5. 4. yu-santos .

rectum.Bowels surgery 1. (cancer of the colon /rectum) Ileostomy. 2. regional enteritis) Continent ileostomy(kock’s pouch).an intra abdominal resevoir with a nipple valve is julie c. 3.distal sigmoid colon.opening of the ileum onto the abdominal surface (ulcerative colitis. Abdominoperineal resection. yu-santos formed from the distal ileum . and anus are removed through a perineal incision and permanent colostomy is created.

julie c. yu-santos .

Double –barreled – colon is resected and both ends are brought through the abdominal wall creating two stomas( proximal and distal) julie c. Cecostomy .usually located in the ascending or transverse colon. yu-santos .4.an opening between the cecum and abdominal base temporarily diverts the fecal flow to rest the distal portion of the colon after some types of surgery 5. done to rest the bowel 6. Temporary colostomy.

yu-santos .julie c.

yu-santos .Ulcerative colitis     Inflammation and ulcerations that start in the rectosigmoid area and spreads upward Common in women Causes: unknown Contributing factors:  Autoimmune  Viral infection  Allergies  Emotional stress julie c.

julie c. yu-santos .

yu-santos . Diagnostic test:  Sigmoidoscopy- reveals mucosa that bleeds easily with ulcer development  Hgb and Hct.decreased  Assessment:  Severe diarrhea(15-20 liquid stools/day containing blood mucus and pus)  Severe tenesmus  Weight loss  Anorexia. weakness  Low grade fever  Left lower quadrant pain julie c.

yu-santos . Medical mgt:  Mild to moderate form:  Low-roughage diet with no milk  Drug therapy.Ab. anticholinergics . antidiarrheal. corticosteroids. immunosuppresive drugs)  Severe  Client form: kept on NPO with IV and electrolytes replacement  Blood transfusion  surgery julie c.

yu-santos . 2. Nursing intervention: Provide appropriate nutrition while reducing bowel motility Administer medication Record number and characteristic of stools daily Provide tepid fluids to avoid stimulation of the bowel Provide care for client undergone bowel surgery julie c. 4. 5. 3. 1.

Sensitivity to sunlight may occur b.This medication should be taken when prescribed d. The nurse instruct the client about the medication.The medication will cause julie c.I need to take the medication with meals c. Which statement made by the client need further education? a. Sulfasalazine ( azulfidine ) is prescribed to client with ulcerative colitis. yu-santosconstipation .

Which findings if noted on assessment of the client.Hypotension c. A nurse is caring for a hospitalized client with diagnosis of ulcerative colitis.Rebound tenderness julie c.Hemoglobin level of 12 mg/dl d. yu-santos .Bloody diarrhea b. would the nurse report on the physician? a.

Improved intestinal tone .Elimination of peristalsis b. Lomotil ( diphenoxylate hydrochloride and atropine sulfate) is prescribed for the client with ulcerative colitis.Decreased cramping julie c. The nurse monitors the client.Decreased diarrhea c. knowing that which of the following is a therapeutic effect of this medication? a. yu-santos d.

 Absorb water and electrolytes julie c. yu-santos .Large intestine  Divided into 4 parts:  Cecum  Colon  Rectum  Anus  Function  Serve as reservoir for fecal material until defecation occurs.

 Has microorganism: acids – deaminated by bacteria resulting in ammonia  Aid in the synthesis of vit K  Amino  Feces:  75% fluids and 25% solid material  Internal anal sphincter and external anal sphincter julie c. yu-santos .

ANS External anal sphincter. .172     Elimination of stool-distention of rectum Internal anal sphincter.N.cerebral cortex Average frequency of defecation in humanonce a day or it may varies LIEZEL ADAJAR CASTILLO julie c.D. yu-santos R.M.

D.N. walls of sigmoid and rectum contract. convenient to defecate.173 defecation reflex – walls of rectum are stretched.M. forcing feces out -gastrocolic reflex – food in the stomach increases motility in colon and frequency of mass movement LIEZEL ADAJAR CASTILLO julie c. internal anal sphincter relaxes. . 25% filled – urge to defecate. external anal sphincter relaxes. yu-santos R.

yu-santos .large intestine julie c.

yu-santos .Diverticulosis/diverticulitis    Diverticulum.an outpouching of the intestinal mucosa: sigmoid colon Diverticulosis.multiple diveirticula Diverticulitis.inflammation of diverticula Causes:  Stress  Congenital  weakening  Dietary deficiency of roughage and fiber julie c.

julie c. yu-santos .

julie c. yu-santos .

indicate inflammatory process 2. yu-santos .  Diagnosis: 1. Hgb and Hct.decreased Assessment:  Intermittent lower left quadrant pain  Alternate constipation and diarrhea with blood and mucus  Fever julie c. Barium enema.

stool softener. anticholinergics. antibiotic  Surgical treatment: resection of deseased portion of colon with temporary colostomy julie c. Medical mgt:  High residue diet with no seeds for diverticulosis  Low residue diet for diverticulitis  Drug therapy: bulk laxatives. yu-santos .

yu-santos . Nursing intervention:  Administer medication as ordered  Provide nursing care for client with bowel surgery  Discharge planning:  Importance of adhering to dietary regimen  Prevention of increased intrabdominal pressure  Teach sign and symptoms of peritonitis julie c.

yu-santos .Peritonitis  Local or generalized inflammation of part or all of the parietal and visceral surfaces of the abdominal cavity  Causes:  Trauma  Inflammation intestinal obstruction  Volvulus  Intestinal ischemia julie c.

hypovolemia (UO) julie c.outpouring of plasmalike fluid from ECF into peritoneal space Later response: abdominal distention. yu-santos . hypermotility. Pathophysiology: causes initial response: edema. vascular congestion.

rapid pulse julie c. Diagnostic:  WBC- elevated  Hct elevated ( if hemoconcentration)  Assessment:  Severe abdominal pain  Rebound tenderness  Muscle rigidity  Absent bowel sounds  Anorexia. yu-santos . nausea and vomiting  Shallow respiration  Fever.

yu-santos .determine the cause Bowel resection julie c.analgesics  Surgery: Laparotomy. Medical mgt:  NPO with fluid replacement  Drug therapy: antibiotics .

5. 2. 6. Nursing intervention: Assess respiratory status Assess characteristics of abdominal pain Administer medicatio as ordered Perform frequent abdominal assessment Palce pt on fowler’s position Maintain patency of NG tubes julie c. 4. 3. yu-santos . 1.

yu-santos  .Cancer of the colon/rectum    Adenocarcinoma.most common type Spread through direct extension or lymphatic system Often metastasis to the liver Causes: diverticulosis chronic ulcerative colitis familial polyposis julie c.

positive  Hgb and Hct. Diagnosis:  Stool for occult blood.positive  Sigmoidoscopy.shows colon mass  DRE-indicates a palpable mass julie c.reveals mass  Barium enema.decreased  CEA. yu-santos .

julie c. yu-santos

Assessment:
 Alternating

diarrhea and constipation  Lower abdominal cramps  Abdominal distention  Weakness  Anorexia, weight loss  Pallor  Dyspnea

julie c. yu-santos

Medical mgt:
 Chemotherapy
 Radiation

therapy  Bowel surgery

Nursing intervention:
 Administered

chemotherapy as ordered  Provide care for client receiving radiation therapy  Provide care for client with bowel surgery

julie c. yu-santos

appendicitis

Inflammation of the appendix that prevents mucus from passing into the cecum that result to ischemia, gangrene, rupture and peritonitis Common among school age children

Causes:1. mechanical obstruction-fecalith, intestinal parasites julie c. yu-santos

2. At the RLQ Nausea and vomiting Guarding of abdomen. 3. walk stooped over Fever and decreased bowel sounds julie c. yu-santos . 4. 2. rebound tenderness. 1. 3. Diagnostic : WBC – increased (+) Rovsing sign (+) Mc burney’s point tenderness (+) psoas and obturator sign Assessment: diffuse pain loc.  1. 4.

Administer ab as ordered  julie c.Nursing intervention : 1. yu-santos . Prepare pt for surgery( appendectomy) 4. Prevent perforation of appendix( do not give enema/cathartic/or using heating pad) 3. position in semi fowler’s position or lying on right side to facilitate drainage b. Post –op care: a. Administer ab and antipyretic as ordered 2. monitor penrose drain ( rupture AP) c.

Rupture of appendix b.      A client with severe abdominal pain is being evaluated for appendicitis. Obstruction of appendix c. What is the most common cause of appendicitis? a. A duodenal ulcer julie c. yu-santos . A high fat diet d.

Ages 20 and 50 years of age Causes: impairment of flow of blood through the venous plexus Predisposing factor:  Occupation requiring prolong standing  Inc. intra abdominal pressure 2 to prolonged constipation . pregnancy.Hemorrhoids     Congestion and dilation of the veins of the rectum and anus Commonly occur bet.obesity julie c. heavy lifting . yu-santos .

sitting or walking julie c. yu-santos . Diagnosis:  proctoscopy- (+) of internal Hemorrhoids  Protrusion of external hemorrhoids upon inspection  Assessment:  Bleeding with defecation  Hard stool with streaks of blood  Pain with defecation.

severe pain and excessive bleeding   Nursing intervention : pre-op  Prepare client for surgery  Post-op care  Assess for rectal bleeding q 2-3 hrs julie c.( prolapse. yu-santos . Medical mgt:  Stool softeners  Diet modifications: high fibers. adequate liquids  hemorrhoidectomy_.

     Assist client to side-lying position or prone position Administer stool softeners as ordered( give analgesics before first post-op bowel movement) Dietary modification. continue pain on defecation. puslike drainage from rectal area julie c.high fiber diet and ingestion of at least 2000 ml/day Sitz bath after each bowel movement for atleast 2 weeks after surgery Instruct the client to report any complication like rectal bleeding. yu-santos .

pancreas and intestines julie c. yu-santos  . located in the right hypochondriac and epigastric regions of the abdomen  Kupffers cell.Accessory organ of digestion  Largest internal organ. spleen.carry out the process of phagocytosis Portal circulation –brings blood to the liver from the stomach.

yu-santos .julie c.

2. 3. yu-santos . 4. 6. Functions: Metabolism of fats CHO and CHON Production of bile Conjugation and excretions of bilirubin Storage of vitamins fat soluble vitamins and iron Synthesis of coagulation factors Detoxification of many drugs and conjugation of sex hormones julie c. 1. 5.

Cirrhosis of the liver  Chronic progressive disease characterized by inflammation . yu-santos . fibrosis and degeneration of the liver parenchymal cells  Occurs twice as often in men as in women. ages 40-60 julie c.

yu-santos of bile excretion . 3. 4.progress to widespread scar formation Postnecrotic cirrhosis.assoc.result in severe inflammation with massive necrosis as a complication of viral hepatitis Cardiac cirrhosis. with biliary obstruction(CBD).occurs as a consequences of RSHF. manifested by hepatomegaly with some fibrosis Biliary cirrhosis.result in chronic impairment julie c.characterized by accumulation of fats in the liver cells.associated with alcohol abuse and malnutrition . 2. Pathophysiology: depend on types Laennec’s cirrhosis. 1.

julie c. yu-santos .

prolonged Serum albumin –decreased Hgb and Hct. SGPT(ALT). 4. Diagnostic: SGOT(AST). 3.LDH. 2. 1. yu-santos .alkaline phosphatase – increased Serum bilirubin –increased PT. 5.decreased julie c.

stages of alcoholic cirrhosis julie c. yu-santos .

spider angiomas. alertness. 2. 6.pruritus Easy bruising. 7. 4. yu-santos . 5. 3. and mental ability Gynecomastia in male. palmar erythema julie c. Assessment: Hepatomegaly(early) Right upper quadrant pain Atrophy of the liver( later)-hard nodular liver upon palpation Increased abdominal girth Changes in mood. 1. amenorrhea in young female Jaundice . 8.

4. provide cool . bath in tepid water ff by application of an emollient lotion. yu-santos . 6.light. 2.reverse isolation ( pt c severe leukopenia) Monitor/prevent bleeding Give diuretics as ordered julie c. 5. 1. 3. low-mod CHON. nonrestrictive clothing. Nursing intervention: Institute measures to relieve pruritus Do not use soaps and detergents. keep nail short Encourage small frequent feeding Diet: High calorie. low fat diet with supplemental vitamins Prevent infection. high CHO. 7.

yu-santos .julie c.

 1. yu-santos . 3. Discharge planning: Avoidance of agent that maybe hepatotoxic (sedatives. 4. opiates) How to assess weight gain and increased abdominal girth Avoidance of person c URTI Avoidance of all alcohol Avoidance of straining at stool. 2. vigorous blowing of nose and coughing julie c. 5.

SGOT. hyperaldosteronism Diagnostic:  Potassium and serum albumin.increased julie c.decreased  PT.prolonged  LDH. SGPT.Ascites    Accumulation of free fluid in the abdominal cavity Causes: CHF. increase portal venous pressure . Liver cirrhosis. BUN. yu-santos .Na .

julie c. yu-santos .

 Assessment:  Positive fluid wave and shifting dullness on percussion  Flat or protruding umbilicus  Abdominal distension/tautness with striae and prominent veins  Peripheral edema  Shortness of breath julie c. yu-santos .

yu-santos . specific gravity. 1. Medical mgt: supportive: modify diet . Paracentesis (fluid assess for cell count. 3.bed rest. salt-poor albumin Diuretic therapy Surgery: 1. 2. CHON and microorganism) LeVeen shunt( peritoneal venous shunt) julie c. 2.

allowing ascitic fluid to flow into the venous system julie c. LeVeen shunt:  Permits continous reinfusion of ascitic fluid back into the venous system through the silicone catheter with one-way pressure sensitive valve  One end of the catheter is implanted into the peritoneal cavity and is channeled through the subcutaneous tissue to the SVC. where the other end of the catheter is implanted  The valve opens when the pressure in the peritoneal cavity is 3-5 cm H2O. yu-santos .

LeVEEN SHUNT julie c. yu-santos .

7. 2. 4. Nursing intervention: Provide adequate nutrition with modified diet Restrict fluid to 1L -1. yu-santos .to high fowler’s position julie c. 6. 1. 5.5L/day Restrict Na to 200-500mg/day Promote high calorie food/snacks Administer diuretics Measure abdominal girth Place client in mid. 3.

uremia. hyperbilirubinemia. GI he. thiazide diuretics. DHN   Diagnostic:  Serum ammonia-increased  PT – prolonged julie c. BT.Hepatic encephalopathy  Frequent terminal complication in liver disease Causes: cirrhosis. yu-santos .

 Pathophysiology: causes liver unable to convert ammonia to urea Large quantities of urea remain in the systemic circulation and cross the blood/brain barriers (+) neurologic symptoms julie c. yu-santos .

yu-santos . disorientation. impaired judgement. hyperreactive reflexes  Progressive disease:  Asterixis. slight tremors. slowed affect. tremors.  changes in mental functioning. apraxia. facial grimacing  Late stage:  Coma . insomia. slow slurred speech. absent reflexes julie c. fetor hepaticus. Assessment findings:  Early in the course of dse.

Nursing intervention: Assess neurological status of patient Restrict CHON in the diet: provide high carbohydrates and vit k supplements Administer enema. 4. 6.decreased julie c. 1. 2. intestinal ab and lactulose as ordered to reduced ammonia level Protect client from injury: keep siderails up. acetaminophen) Maintain client on bedrest. 3. methyldopa. 5. provide eye care Avoid administration of drug detoxified in liver( phenothiazines. yu-santos metabolic demands of liver .

Which of the following essential item is needed during the administration of this edication? a. Vasopressin (Pitressin ) is prescribed to client diagnosed with bleeding esophageal varices. A tracheotomy tube julie c. yu-santos .An airway c.A suction set up d.A cardiac monitor b. The nurse is preparing to administer the medication to client.

All of the above julie c.Chronic alcoholism b.Chonic hepatitis infection d. The nurse plans care knowing that this type of cirrhosis is most commonly caused by long-term? a.Biliary obstruction c. A nurse is reviewing the record of client admitted to the nursing unit and notes that the client has history of laennec’s cirrhosis. yu-santos .

Stool frequency d.     The physician prescribed lactulose 30ml 3x daily. To evaluate the effectiveness of lactulose. yu-santos . Level of consciousness julie c. Abdominal girth c. when the client with cirrhosis develops an increased serum ammonia level. Urine output b. the nurse should monitor? a.

but it is the common site of metastasis Higher incidence in male Prognosis is poor.increased liver biopsy.Cancer of the liver  Primary cancer of the liver is rare. yu-santos    .(+) cancer cell julie c.well advanced before dx Diagnostic: AFP.

6. 4. 5. 2. 3. Assessment: Weight loss Slight increase in temperature RUQ pain. 1. hepatomegaly Jaundice Peripheral edema Blood tinged ascites julie c. yu-santos .

 1. 2. Medical mgt: Chemotherapy and radiation therapydecrease tumor size and pain Resection of tumor if tumor is localized julie c. yu-santos .

Administer 10% glucose for the 1st 48 hrs to avoid rapid blood sugar drop Monitor for hyper /hypoglycemia julie c. 1. 3. Perform bowel prep to decreased ammonium Administer vit K 5. yu-santos Assess for sign of hepatic encephalophaty . Nursing intervention: Provide emotional support to the client Provide care for client receiving chemotherapy Provide care for client with a abdominal surgery Pre-op: 1. 4. 2. 3. 2. Post-op: 1. 2.

lies on the under surface of the liver. bile enter the duodenum .Biliary system   Gallbladder. yu-santos gallbladder  . bile is stored in julie c. function is to concentrate and store bile Ductal system.provide route for bile to reach the intestine bile is formed in the liver excreted into the hepatic duct  Hepatic duct joints with the cystic duct to form CBD  If sphincter of oddi is relaxed.if contracted.

formation of gallstones Common among women after age 40 ( 4 F’s) Causes: genetic defect of bile composition gallbladder/bile stasis julie c. commonly associated with gallstones Cholelithiasis. yu-santos infection   .acute or chronic inflammation of the gallbladder.Cholecystitis/ cholelithiasis   Cholecystitis.

yu-santos . ischemia and necrosis julie c. Pathophysiology: causes inflammation within the wall of the gallbladder thickening and edema of the gallbladder impaired circulation.

lipaseincreased Oral cholecystogram. alkaline phosphatase . 1.positive for gallstone julie c. Diagnostic: Direct bilirubin transaminase. WBC .amylase . yu-santos . 2.

jaundice Dark amber urine steatorrea julie c. easy bruising. Assessment: Epigastric or RUQ pain precipitated by a heavy meal or occurring at night Intolerance for fatty foods Pruritus. 1. yu-santos . 2. 5. 3. 4.

3. 1. 2. yu-santos . 3. Narcotics analgesic ( demerol) Anticholinergic (tropine) for pain –relaxes smooth muscles and open bile ducts Antiemetic julie c. 2. Medical mgt: Supportive treatment: NPO with NG intubation and IV fluid Diet modification with administration of fat soluble vitamins Drug therapy: 1.

Administer medication as ordered 2. Provide small frequent meals of modified diet( if oral intake is allowed) 3.cholecystectomy/choledochostomy Nursing intervention: 1. yu-santos . Surgery. Provide care to relieve pruritus  julie c.

 A nurse would assess a client experiencing an acute episode of cholecystitis for pain that is located on the right……  Upper quadrant and radiate to the left scapula and shoulder  Upper quadrant and radiate to the right scapula and shoulder  Left upper quadrant pain radiating to back  Left upper quadrant radiating to groin julie c. yu-santos .

chymotrypsin for protein digestion. yu-santos . body and tail Has exocrine and endocrine function  Exocrine cell of the pancreas secrete trypsinogen. amylase to breakdown starch to disaccharides and lipase for fat digestion  Endocrine function is related to islets of lanferhans julie c.Pancreas    Positioned transversely in the upper abdominal cavity Consist of head.

fat necrosis or he Proteolytic /lipolytic enzymes are activated in the pancreas rather than in the duodenum resulting in tissue damage and autodigestion of pancreas Occur most often in middle aged julie c. yu-santos   .Pancreatitis  Inflammatory process with varying degree of pancreatic edema.

yu-santos . diuretics. 2. Causes: Alcoholism Biliary tract disease Trauma Viral infection Penetrating duodenal ulcer Drugs ( steroids. 4. thiazide. 3. 6. 5. oral contraceptives ) julie c. 1.

shows enlargement of the pancreas  Assessment:  LUQ pain radiating to the back.abdominal tenderness with muscle guarding  (+)grey turners spot( ecchymoses on flanks)  (+) cullen’s sign (ecchymoses on the periumbilical area)  Absent bowel sounds julie c. blood sugar lipidincrease  Serum calcium –decrease  CT scan. lipase. Diagnostic:  Serum amylase. tachycardia . yu-santos . flank mybe accompanied by DOB and aggravated by eating  Vomiting.

4.decrease pancreatic stimulation H2 antagonist. Medical mgt: Drug therapy: Analgesic to relieve pain Smooth muscle relaxant( nitroglycerine )relieve pain Anticholinergic agent( atropine. calcium julie c. yu-santos gluconate . 2. 3. propantheline bromide ) to decrease pancreatic stimulation Antacids. vasodilators. 5. 6. 1.

2. yu-santos . Nursing intervention: Administer medication as ordered Withhold food /fluid and eliminate odor and sight of food to decrease pancreatic stimulation Maintain NG tube and assess for drainage Place pt in comfortable position( fetal position/knee chest position) julie c. 1. 4. 3.

yu-santos . eating small frequent feeding c.5. High carbohydrates . Discharge planning: a. high CHON low fat diet b. Dietary regimen when oral intake permitted a. eliminate alcohol consumption julie c. avoid caffeine product d.

 A nurse is performing an assessment of client suspected to have acute pancreatitis. yu-santos . The nurse assesses the client knowing that the hallmark sign of this disorder is?  Severe abdominal pain relieved by vomiting  Severe abdominal pain unrelieved by vomiting  Hypothermia  Hypogastric pain radiating to the back julie c.

yu-santos .thank you !!!!! julie c.

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