Patient with

Selected GIT Disorder (Peptic Ulcer)

&
Hepatobiliary Disorders
Prepared By
Dr. Safaa M. AbdelMotaleb
Assist.Prof/ Med-Surg.Nursing
 Objectives
By the end of the current lecture; each student should be able to:
▪ Discuss health problems associated with GIT system (Peptic
Ulcer).
▪ Discuss management of peptic ulcer (Medical, Surgical and
Nursing).
▪ Revise the anatomy & physiology of the Hepatobiliary.
▪ Understand the causes of Hepatic disorders.
▪ Understand the Liver Cirrhosis.
▪ Discuss management of Liver Cirrhosis (Medical, Surgical and
Nursing).
▪ Understand the Cholecystitis disorders.
▪ Discuss management of Cholecystitis disorders (Medical,
Surgical and Nursing).
2
Safaa Mohammed
PEPTIC ULCER

Safaa Mohammed-2019- 3
The stomach

4
 Peptic Ulcer
▪ Peptic ulcers are sores that develop in the
lining of the stomach, lower esophagus, or
small intestine. They’re usually formed as
a result of inflammation as well as from
erosion from stomach acids. Peptic ulcers
are a fairly common health problem.

5
Safaa Mohammed-2019-
 Peptic Ulcer cont’d
There are three types of peptic ulcers:
▪ 3-a-gastric ulcers: ulcers that develop
inside the stomach
▪ 3-b-esophageal ulcers: ulcers that
develop inside the esophagus
▪ 3-c-duodenal ulcers: ulcers that develop
in the upper section of the small
intestines, called the duodenum

Safaa Mohammed-2019- 6
 Peptic Ulcer cont’d
Predisposing Factors
▪ Helicobacter pylori (H. pylori), a type of bacteria
that can cause a stomach infection and
inflammation
▪ Frequent use of aspirin and other anti-
inflammatory drugs (risk associated with this
behavior increases in women and people over
the age of 60)
▪ Smoking
▪ drinking too much alcohol
▪ Radiation therapy
▪ stomach cancer Safaa Mohammed-2019- 7
 Peptic Ulcer cont’d
It might be asymptomatic (No S & S)
Other common signs of a peptic ulcer include:
▪ Changes in appetite
▪ Nausea
▪ Bloody or dark stools
▪ unexplained weight loss
▪ Indigestion
▪ Vomiting
▪ Chest pain
Safaa Mohammed-2019- 8
 Peptic Ulcer Complications cont’d
▪ Perforation: A hole develops in the lining of
the stomach or small intestine and causes an
infection. A sign of a perforated ulcer is sudden,
severe abdominal pain.
▪ Internal bleeding: Bleeding ulcers can result in
significant blood loss and thus require
hospitalization. Signs of a bleeding ulcer
include lightheadedness, dizziness, and black
stools.
▪ Scar tissue: This is thick tissue that develops
after an injury. This tissue makes it difficult for food
to pass through your digestive tract. Signs of scar
tissue include vomiting and weight loss. 9

Safaa Mohammed-2019-
 Peptic Ulcer Diagnosis cont’d
▪ Laboratory tests for H. pylori.
▪ Endoscopy.
▪ Upper gastrointestinal series.

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Peptic Ulcer Management cont’d
▪ Antibiotic medications to kill H. pylori.
▪ Medications that block acid production and
promote healing.
▪ Medications to reduce acid production. Acid
blockers — also called histamine (H-2) blockers
▪ Antacids that neutralize stomach acid.
▪ Medications that protect the lining of your
stomach and small intestine.

Safaa Mohammed-2019- 11
Nursing Management of Peptic Ulcer cont’d
▪ Assessment
▪ Monitor S&S
▪ Changing Life Style:
-Choose a healthy diet. Choose a healthy diet full of fruits,
especially with vitamins A and C, vegetables, and whole
grains.
-Consider foods containing probiotics. .
-Consider eliminating milk.
-Consider switching pain relievers.
-Control stress.
-Do Not smoke.
-Limit or avoid alcohol.
12
-Get enough sleep. Safaa Mohammed-2019-
HEPATIC DISORDER

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 Overview of the Hepatobilary

▪ The liver is a gland;

Weighing about 3
pounds, normally cannot
be feel. It has two large
sections, called the right
and the left lobes. The
gallbladder sits under the
liver, along with parts of
the pancreas and
intestines. The liver and
these organs work
together to digest,
absorb, and process food.
14
 Overview of the Hepatobilary
Main Function
▪ 1-Bile production: Bile helps the small intestine break
down and absorb fats, cholesterol, and some vitamins.
Bile consists of bile salts, cholesterol, bilirubin,
electrolytes, and water.
▪ 2-Absorbing and metabolizing bilirubin: Bilirubin is
formed by the breakdown of hemoglobin. The iron
released from hemoglobin is stored in the liver or bone
marrow and used to make the next generation of blood
cells.
▪ 3-Supporting blood clots: Vitamin K is necessary for
the creation of certain coagulants that help clot the
blood. Bile is essential for vitamin K absorption and is
created in the liver. If the liver does not produce
enough bile, clotting factors cannot be produced.
15
 Overview of the Hepatobilary
Main Function Cont’d
▪ 4-Fat metabolization: Bile breaks down fats and
makes them easier to digest.
▪ 5-Metabolizing carbohydrates: Carbohydrates are
stored in the liver, where they are broken down into
glucose and siphoned into the bloodstream to maintain
normal glucose levels. They are stored as glycogen
and released whenever a quick burst of energy is
needed.Vitamin and mineral storage:
▪ 6-Stores vitamins: A, D, E, K, and B12. It keeps
significant amounts of these vitamins stored. In some
cases, several years' worth of vitamins is held as a
backup.
▪ 7-Stores iron: from hemoglobin in the form of ferritin,
ready to make new red blood cells. The liver also
stores and releases copper. 16
 Overview of the Hepatobilary
Main Function Cont’d
▪ 8-Helps metabolize proteins: Bile helps
break down proteins for digestion.
▪ 9-Filters the blood: The liver filters and
removes compounds from the body, including
hormones, such as estrogen and aldosterone,
and compounds from outside the body,
including alcohol and other drugs.
▪ 10-Immunological function: The liver is part
of the mononuclear phagocyte system. It
contains high numbers of Kupffer cells that are
involved in immune activity. These
cells destroy any disease-causing agents that
might enter the liver through the gut. 17
 Overview of the Hepatobilary
Main Function Cont’d
▪ 11-Synthesis of angiotensinogen: This
hormone raises blood pressure by narrowing
the blood vessels when alerted by production
of an enzyme called renin in the kidneys.
▪ 12-Production of albumin: Albumin is the
most common protein in blood serum. It
transports fatty acids and steroid hormones to
help maintain the correct pressure and prevent
the leaking of blood vessels (Oncotic
pressure/colloidal pressure).

18
 Overview of the Hepatobilary
Main Function Cont’d
▪ (Oncotic pressure/colloidal pressure).

19
 Hepatitis

▪ Inflammation of the liver, usually caused

by viruses like hepatitis A, B, and C...etc
Hepatitis can have non-infectious causes
too, including heavy drinking, drugs,
allergic reactions, cancer or obesity….etc

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 Hepatic Diseases
▪ 1-Liver cancer: The most common type of
liver cancer, hepatocellular carcinoma, almost
always occurs after cirrhosis is present.
▪ 2-Fascioliasis: This is caused by the parasitic
invasion of a parasitic worm known as a liver
fluke, which can lie dormant in the liver for
months or even years. Fascioliasis is
considered a tropical disease.
▪ 3-Liver failure: Liver failure has many causes
including infection, genetic diseases, and
excessive alcohol.
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 Hepatic Diseases Cont’d
▪ 4-Hemochromatosis: Hemochromatosis allows
iron to deposit in the liver, damaging it. The iron
also deposits throughout the body, causing
multiple other health problems.
▪ 5-Gilbert's syndrome: This is a genetic disorder
affecting 3 to 12 percent of the population. Bilirubin
is not fully broken down. Mild jaundice can occur,
but the disorder is harmless.
▪ 6-Primary sclerosing cholangitis: A rare disease
with unknown causes, primary sclerosing
cholangitis causes inflammation and scarring in the
bile ducts in the liver.
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 Hepatic Diseases Cont’d
▪ 7-Primary biliary cirrhosis: In this rare
disorder, an unclear process slowly destroys the
bile ducts in the liver. Permanent liver scarring
(cirrhosis) eventually develops.
▪ 8-Ascites: As cirrhosis results, the liver leaks
fluid (ascites) into the abdominal cavity, which
becomes distended and heavy.
▪ 9-Fatty liver disease: This usually occurs
alongside obesity or alcohol abuse. In fatty liver
disease, vacuoles of fat build up in the liver cells.
If it is not caused by alcohol abuse, the condition
is called non-alcoholic fatty liver disease
23
(NAFLD). Safaa Mohammed
 Hepatic Diseases Cont’d

▪ 10-Gallstones: If a gallstone becomes stuck in

the bile duct draining the liver, hepatitis and
bile duct infection (cholangitis) can result.
▪ 11-Colloidal Pressure: Mainly by albumin to
maintain water within intracellular.
▪ 12-Viral Infection: Viruses of A, B, C, F…etc

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 Liver Blood Function/Tests
▪ Liver function panel: A liver function panel
checks how well the liver is working and consists
of many different blood tests.
▪ ALT (Alanine Aminotransferase): An elevated
ALT helps identify liver disease or damage from
any number of causes, including hepatitis.
▪ AST (Aspartate Aminotransferase): Along with
an elevated ALT, the AST checks for liver
damage.
▪ Alkaline phosphatase: Alkaline phosphatase is
present in bile-secreting cells
Safaa Mohammed
in the liver; 25
 Liver Blood Tests Cont’d
▪ Bilirubin: High bilirubin levels suggest a problem
with the liver.
▪ Albumin: As part of total protein levels.
▪ Ammonia: As the liver cannot convert the uric acid
▪ Prothrombin Time (PT): to check for blood clotting
problems.
▪ Partial Thromboplastin Time (PTT): A PTT is
done to check for blood clotting problems.
▪ Hepatic viral infection:
▪ Hepatitis A tests, Hepatitis B tests, Hepatitis C
tests…any other hepatic virus: Patient perform blood
test antibodies to detect the hepatitis A virus.
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 Imaging Tests
▪ Ultrasound: An abdominal ultrasound can test for
many liver conditions, including cancer, cirrhosis,
or problems from gallstones.
▪ CT scan (computed tomography): A CT scan of
the abdomen gives detailed pictures of the liver
and other abdominal organs.
▪ Liver biopsy: A liver biopsy is most commonly
done after another test, such as a blood test or
ultrasound, indicates a possible liver problem.
▪ Liver and spleen scan: This nuclear scan uses
radioactive material to help diagnose abscesses,
tumors, and other liver function problems...etc. 27
Safaa Mohammed
HEPATIC DISORDER

1-LIVER CIRRHOSIS

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 Liver Cirrhosis
▪ Cirrhosis is a complication of liver disease that
involves loss of liver cells and irreversible
scarring of the liver. N.b. While fibrosis is the
early damage which reversible to some extent.
▪ The diseases lead to cirrhosis as liver cells be
killed, after which the inflammation and repair
that is associated with the dying liver cells
causes scar tissue to form. This results in
clusters of newly formed liver cells (regenerative
nodules) within the scar tissue.

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 Causes of Liver Cirrhosis
▪ Chronic viral hepatitis (A, B, and C)
▪ Autoimmune hepatitis
▪ Inhereited (genetic) disorders
▪ Primary biliary cirrhosis (PCB)
▪ Primary sclerosing cholangitis (PSC)
▪ Infants born without bile ducts
Less common causes of cirrhosis include:
▪ Unusual reactions to some drugs
▪ Prolonged exposure to toxins
▪ Chronic heart failure (cardiac cirrhosis).

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 Liver Cirrhosis
S&S Advanced S & S
▪ Weakness. ▪ Spontaneous
▪ Loss of appetite. bacterial peritonitis.
▪ Easy bruising. ▪ Muscle waisting
▪ Yellowing of the skin ▪ Bleeding from varices.
(jaundice/ectrus). ▪ Caput Medusae.
▪ Itching. ▪ Spider Angioma.
▪ Fatigue. ▪ Occult blood
▪ In women disturbed ▪ Averted sleep hours
menstrual cycle ▪ Swelling of the abdomen
▪ In men, enlargement of the (ascites) and/or in the hip,
breasts (gynecomastia). thigh, leg, ankle, and foot.
▪ Palmar Erythema.
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Pathophysiology of Ascites

32
 Liver Cirrhosis
Advanced S & S

Ascites Palmar Erythema

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 Liver Cirrhosis
Advanced S & S

Caput Medusae Spider Angioma

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 Advanced Liver Cirrhosis Complications

1-Hepatic Encephalopathy:
▪ Ammonia is the end products of protein, which can have
toxic effects on the brain. Ordinarily, these toxic
substances are carried from the intestine in the portal
vein to the liver where they are removed from the blood
and detoxified.
▪ When cirrhosis is present, liver cells cannot function
normally either because they are damaged or because
they have lost their normal relationship with the blood.
▪ The result of these abnormalities is that other toxic
substances beside amonia cannot be removed by the
liver cells, and instead accumulate in the blood.
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Pathophysiology of Liver Cirrhosis
Hepatic encephalopathy

36
 Advanced Liver Cirrhosis Complications
cont’d
2-Hepatorenal syndrome:
This syndrome is a serious complication in which the
function of the kidneys is reduced. It is a functional
problem in the kidneys, meaning there is no physical
damage to the kidneys. Instead, the reduced function is
due to changes in the way the blood flows through the
kidneys themselves. The hepatorenal syndrome is
defined as progressive failure of the kidneys to clear
substances from the blood and produce adequate
amounts of urine while other important functions of the
kidney, such as retention of salt, are maintained.

37
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Pathophysiology of Liver Cirrhosis
Hepatorenal Syndrome

38
 Advanced Liver Cirrhosis Complications
cont’d
3-Hepatopulmonary Syndrome:
These patients can experience difficulty breathing because
certain hormones released in advanced cirrhosis cause
the lungs to function abnormally. The basic problem in
the lung is that not enough blood flows through the small
blood vessels in the lungs that are in contact with the
alveoli (air sacs) of the lungs. Blood flowing through the
lungs is shunted around the alveoli and cannot pick up
enough oxygen from the air in the alveoli. As a result, the
patient experiences shortness of breath, particularly with
exertion.

39
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Pathophysiology of Liver Cirrhosis
Hepatopulmonary Syndrome

40
 Advanced Liver Cirrhosis Complications
cont’d
4-Hypersplenism:
As the pressure in the portal vein rises in cirrhosis, it
increasingly blocks the flow of blood from the spleen. The
blood "backs-up," accumulating in the spleen, and the
spleen swells in size, a condition referred to
as splenomegaly. Sometimes, the spleen is so enlarged it
causes abdominal pain
5-Hepatic Cancer:
Chronic hepatitis B virus (HBV) and chronic hepatitis C virus
(HCV) are associated with hepatic fibrosis and
development of hepatocellular carcinoma (HCC)

41
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 Stages of Liver Cirrhosis
▪ Stage 0: Normal liver
▪ Stage 1 cirrhosis involves some scarring of the liver, but
few symptoms. This stage is considered compensated
cirrhosis, where there are no complications.
▪ Stage 2 cirrhosis includes worsening
portal hypertension and the development of varices.
▪ Stage 3 cirrhosis involves the development of swelling
in the abdomen and advanced liver scarring. This stage
marks decompensated cirrhosis, with serious
complications and possible liver failure.
▪ Stage 4 cirrhosis can be life threatening and people
have develop end-stage liver disease (ESLD), which is
fatal without a transplant. Safaa Mohammed
42
 Treatment of Liver Cirrhosis
Medical Treatment:
Treat underlining cause:
Generally/Treat the underlining cause.
▪ Treatments for Autoimmune Hepatitis and Primary Biliary
Cirrhosis
▪ Non-Alcoholic Fatty Liver Disease Treatments
▪ Stop Alcohol drinking
▪ Treat Viruses:
▪ Antiviral drugs; Ex. Sovaldi…etc
▪ Interferon (interferon alpha 2b, pegylated interferon)

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 Treatment of Liver Cirrhosis
Medical Treatment:
Treat Complication :
▪ Portal Hypertension: Administer beta-blockers lower
pressure in the portal vein and other blood vessels so they
don't swell to the point of breaking.
▪ Varices: by band ligation. A surgery called TIPS is
sometimes needed to “shunt” -- meaning redirect -- the
blood flow.
▪ Fluid build up: Administer diuretics, albumin, paracentesis
▪ Amonia: Administer antibiotics to reduce intestinal flora.
Administer antibiotics.
▪ …………….etc
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 Treatment of Liver Cirrhosis
Surgical Treatment:
Treat Complication: Cont’d
▪ Liver cancer: Monitor liver condition 6-12 month by CT;
if advanced surgical removal is required, and liver
transplantation may be recommended
▪ Hepto-renal Syndrome: Liver transplantation
▪ Hepato-pulmonary Syndrome: Liver transplantation

Safaa Mohammed 45
 Nursing Role for Patient with Liver Cirrhosis

Monitor:………See (Brunner Ref.)

▪ Medication administration as (Diuretics, Lactulose, Analgesics, Blood
products, Vitamin K…etc)
▪ Maintain IV infusion as prescribed
▪ Monitor related Lab. Investigation
▪ Monitor/prevent medication complication
▪ Complete vitals and respiratory assessment
▪ impaired gas exchange and compromised respiratory function
▪ Initiate bleeding precautions per facility protocol
▪ No straight razors
▪ Use soft toothbrush and good oral hygiene
▪ Use stool softeners to avoid straining with bowel movement
▪ Assess for decreased or labored breathing
▪ Provide adequate nutrition and education, encourage lifestyle changes
▪ Measure conscious level
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 Nursing Role for Patient with Liver Cirrhosis
cont’d
Monitor:…………See (Brunner Ref.)
▪ Assist with paracentesis as necessary:
▪ Maintain Albumin administration as prescribed
▪ Maintain aseptic technique
▪ Maintain patient position during procedure as he is placed in the
supine position and slightly rotated to the side of the procedure
to further minimize the risk of perforation during paracentesis
▪ Measure Blood pressure (Should not be hypotensive)
▪ Patient must be fully conscious
▪ Coagulation (Must not suffer from coagulopathy (international
normalized ratio [INR] >2.0)
▪ Severe hypoproteinemia (relative contraindication)
▪ Free from abdominal adhesion or infection
▪ Monitor fluid and electrolyte balance
▪ Daily weights 47
▪ Assess for JVD Safaa Mohammed
HEPATIC DISORDER

2-CHOLECYSTITIS

Safaa Mohammed 48
 The gallbladder
▪ The gallbladder is a small pear-shaped
organ located beneath the liver. It's main
purpose is to store and concentrate bile.
▪ The liver produces bile, a liquid that
helps digest fats and carries toxins
excreted by the liver.
▪ Bile is passed from the liver through a
series of channels called bile ducts into
the gallbladder, where it's stored.
▪ Over time bile becomes more
concentrated, which makes it more
effective at digesting fats.
▪ The gallbladder releases bile into the
digestive system when it's needed.

Safaa Mohammed 49
 Cholecystitis
▪ Cholecystitis is defined as
an inflammation of the
gallbladder that occurs most
commonly because of an
obstruction of the cystic duct
from cholelithiasis. Ninety
percent of cases involve
stones in the gallbladder (ie,
calculous cholecystitis), with
the other 10% of cases
representing acalculous
cholecystitis.
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 General Symptoms of Cholecystitis

▪ High temperature (fever)

▪ Feeling sick/Being sick
▪ Sweating
▪ Loss of appetite
▪ Yellowing of the skin and the whites of the eyes (jaundice)
▪ a bulge in the abdomen
▪ Pain

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 Types of Cholecystitis
▪ Calculous: ▪ Acalculous :
It develops over hours, Acalculous cholecystitis is
usually because a cholecystitis without stones.
gallstone obstructs the It accounts for 5 to 10% of
cystic duct. Symptoms cholecystectomies done for
include right upper acute cholecystitis. Risk
quadrant pain and factors includes critical
tenderness, sometimes illness (eg, major
accompanied by fever, surgery, burns, sepsis, or
chills, nausea, and trauma). Prolonged fasting
vomiting. Abdominal or TPN (both predispose to
ultrasonography detects bile stasis) Shock. Immune
the gallstone and deficiency
sometimes the associated Vasculitis (eg, SLE, polyarteritis
nodosa)
inflammation.
52
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 Complications of Calculous Cholecystitis

▪ 10% of patients develop localized perforation, and 1%

develop free perforation and peritonitis.
▪ Increasing abdominal pain.
▪ High fever, and rigors with rebound tenderness or ileus
suggest empyema (pus) in the gallbladder
▪ Gangrene, or perforation.
▪ When acute cholecystitis is accompanied by jaundice or
cholestasis, partial common duct obstruction is likely,
usually due to stones or inflammation.

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 Complications of calculous Cholecystitis
Cont’d

▪ Mirizzi syndrome: Rarely, a gallstone becomes impacted in

the cystic duct and obstructs the common bile duct, causing
cholestasis.
▪ Gallstone pancreatitis: Gallstones pass from the
gallbladder into the biliary tract and block the pancreatic
duct.
▪ Cholecystoenteric fistula: Infrequently, a large stone
creating a fistula into the small bowel (or elsewhere in the
abdominal cavity).
▪ Transabdominal ultrasonography: is the best test to
detect gallstones.
▪ Cholescintigraphy; is useful when suggests an obstructed
cystic duct (ie, an impacted stone). False-positive results
54
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 Diagnosis of calculous Cholecystitis
Cont’d
▪ Murphy Sign/Physical:examination: The patient is
instructed to inspire. If the patient stops breathing in (as the
gallbladder is tender and, in moving downward.

▪ Abdominal CT: Identifies complications such as gallbladder

perforation or pancreatitis.

▪ liver function tests: are normal or only slightly elevated.

Mild cholestatic abnormalities (bilirubin up to 4 mg/dL and
mildly elevated alkaline phosphatase) are common

Safaa Mohammed 55
 Complications of acalculous
Cholecystitis
▪ The condition causes approximately 5%-10% of all cases of
acute cholecystitis and is usually associated with more
serious morbidity and higher mortality rates than calculous
cholecystitis.

▪ In addition, acalculous cholecystitis is associated with a

higher incidence of gangrene and perforation compared to
calculous disease.

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 Diagnosis of acalculous
▪ Acute acalculous cholecystitis is suggested if a patient has
no gallstones but has ultrasonographic
▪ Murphy sign or a thickened gallbladder wall and
pericholecystic fluid. A distended gallbladder, biliary sludge,
and a thickened gallbladder wall without pericholecystic fluid
(due to low albumin or ascites) may result from a critical
illness.
▪ CT identifies extrabiliary abnormalities. Cholescintigraphy is
more helpful; failure of a radionuclide to fill may indicate
edematous cystic duct obstruction.

Safaa Mohammed 57
Management of Cholecystitis

58
 Management of Cholecystitis

▪ Medical Management:
▪ Treat the underlining cause.
▪ Fasting: Patient may not be allowed to eat or drink at first in
order to take stress off inflamed gallbladder.
▪ Fluids through a vein’s arm: This treatment helps prevent
dehydration.
▪ Antibiotics to fight infection: If gallbladder is infected,
your doctor likely will recommend antibiotics.
▪ Pain medications. These can help control pain until the
inflammation in gallbladder is relieved.

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 Management of Cholecystitis cont’d

▪ Surgical Management:
▪ 1-Endoscopic retrograde
cholangio-pancreatography,
(ERCP): Procedure to remove
stones. Surgeon may perform a
procedure called endoscopic
retrograde
cholangiopancreatography
(ERCP) to remove any stones
blocking the bile ducts or cystic
duct

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 Management of Cholecystitis cont’d

▪ Surgical Management:
▪ 2-Open cholecystectomy, a
surgical incision of around 8 to
12 cm is made below the edge
of the right rib cage and the
gallbladder is removed
through this large opening,
typically
using electrocautery, Open
cholecystectomy is often done
if difficulties arise during a
laparascopic cholecystecomy
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 Management of Cholecystitis cont’d

▪ Examples of Nursing Management of

Cholecystitis and Cholelithiasis:
▪ Risk for Deficient Fluid Volume
▪ Acute Pain
▪ Risk for Imbalanced Nutrition: Less Than Body
Requirements
▪ Deficient Knowledge
▪ Post operative Nursing care in case of
Cholesyctectomy…Please Revise Post-
Operative Lecture.
Safaa Mohammed 62
Nursing Management of of Cholecystitis
and Cholelithiasis cont’d
▪ Risk for Deficient Fluid Volume:
▪ Maintain accurate record of I&O
▪ Monitor for signs and symptoms of increased or
continued nausea or vomiting, abdominal cramps,
weakness, twitching, seizures, irregular heart
rate,…etc
▪ Perform frequent oral hygiene
▪ Assess for unusual bleeding: oozing from injection
sites, epistaxis, bleeding gums,…etc
▪ Keep patient NPO as necessary
▪ Insert NG tube, connect to suction, and maintain
patency as indicated.Safaa Mohammed 63
Nursing Management of of Cholecystitis
and Cholelithiasis cont’d
▪ Acute Pain:
▪ Observe and document location, severity (0–10 scale), and
character of pain
▪ Note response to medication, and report to physician if pain is not
being relieved.
▪ Promote bed rest, allowing patient to assume position of comfort.
▪ Use soft or cotton linens; calamine lotion, oil bath; cool or moist
compresses as indicated.
▪ Control environmental temperature.
▪ Encourage use of relaxation techniques.
▪ Make time to listen to and maintain frequent contact with patient.
▪ Maintain NPO status, insert and/or maintain NG suction as
indicated.
Safaa Mohammed 64
 Nursing Management of of Cholecystitis
and Cholelithiasis cont’d
▪ Risk for Imbalanced Nutrition: Less Than Body
Requirements
▪ Calculate caloric intake.
▪ Weigh as indicated.
▪ Provide oral hygiene before meals.
▪ Assess for abdominal distension, frequent belching, guarding,
reluctance to move.
▪ Consult with dietitian
▪ Begin low-fat liquid diet after NG tube is removed.
▪ Advance diet as tolerated, usually low-fat, high-fiber. Restrict gas-
producing foods (onions, cabbage, popcorn) and foods or fluids
high in fats (butter, fried foods, nuts).
▪ Monitor laboratory studies: BUN, prealbumin, albumin, total
protein, transferrin levels.
▪ Provide parenteral and/or enteral feedings as prescribed 65
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Nursing Management of of Cholecystitis
and Cholelithiasis cont’d
▪ Deficient Knowledge:
▪ Explain reasons for test procedures and preparations as needed.
▪ Review disease process and drug regimen
▪ Discuss weight reduction programs if indicatedas instruct Patient
to avoid high fat and carbohydrates diet
▪ Review signs and symptoms requiring medical intervention:
recurrent fever; persistent nausea and vomiting, or pain; jaundice
of skin or eyes, itching; dark urine; clay-colored stools; blood in
urine, stools, vomitus; or bleeding from mucous membranes.
▪ Resting in semi-Fowler’s position after meals.
▪ limit gum chewing, sucking on straw and hard candy, or smoking.
▪ Avoidance of aspirin-containing products, forceful blowing of
nose, straining for bowel movement, contact sports.
▪ Recommend use of soft toothbrush, electric razor.
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 References
▪ Brunner
▪ https://www.medicalnewstoday.com/articles/305075.php
▪ https://www.hepmag.com/blog/difference-fibrosis-cirrhosis
▪ https://www.webmd.com/digestive-disorders/picture-of-the-liver#2
▪ https://www.emedicinehealth.com/cirrhosis/article_em.htm#what_is_cirrhosis
▪ https://www.medicinenet.com/cirrhosis/article.htm
▪ J Gastrointest Oncol. Viral hepatitis and hepatocellular carcinoma: etiology and
management 2017 Apr; 8(2): 229–242.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5401856/
▪ https://www.webmd.com/digestive-disorders/understanding-cirrhosis-treatment#3
▪ https://academy.nrsng.com/lesson/nursing-care-plan-for-cirrhosis-liver/
▪ https://5minuteconsult.com/collectioncontent/30-156350/procedures/abdominal-
paracentesis
▪ https://bestpractice.bmj.com/topics/en-gb/78
▪ https://www.medscape.com/answers/171886-20430/what-is-the-definition-of-
cholecystitis
▪ https://www.nhs.uk/conditions/acute-cholecystitis/
▪ https://emedicine.medscape.com/article/187645-overview
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Safaa Mohammed
 References Cont’d
▪ https://www.msdmanuals.com/professional/hepatic-and-biliary-disorders/gallbladder-
and-bile-duct-disorders/acute-cholecystitis
▪ https://www.aafp.org/afp/2014/0515/p795.html
▪ https://www.mayoclinic.org/diseases-conditions/cholecystitis/diagnosis-treatment/drc-
20364895
▪ Yeo, Charles J. (2018). Shackelford's surgery of the alimentary tract. Yeo, Charles J.
(Eighth ed.). Philadelphia, PA. ISBN 978-0323402323. OCLC 1003489504.
▪ https://nurseslabs.com/4-cholecystitis-cholelithiasis-nursing-care-plans/4/
▪ https://en.wikipedia.org/wiki/Murphy%27s_sign

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