GASTRO INTESTINAL

DISORDER
 Case scenario
PSR, 42-year-old male was admitted in the medical ward due to confusion and decreased
responsiveness. SR is well-developed adult male who appears to be sleeping in bed. He is
arousable to light tactile stimulation, is oriented to person only, has slurred speech, a moderate
cough, and adequate air movement with clear breath sounds. He moves all extremities slowly,
but his strength is equal bilaterally in both his upper and lower extremities and his face is
symmetric. Although his skin is tan, it appears jaundiced and his scleras are icteric. He has no
evidence ofinjury to hishead or upper body. Although he has been changedinto a hospitalgown,
the ED staff reports he has not been incontinent. His bedside monitor shows a sinus tachycardia
at 105 beats per minute and a pulse oximetry reading of 96% on room air.
According to his brother, he has been taking bioflu for headaches, neozep for
colds, and decolgen for clogged nose, and has been drinking more recently,
slurring his words and his eyes were almost yellow.
 Case scenario
He has a medical history of hypertension, but is not currently on any medication, and he had his
appendix removed as a teenager and surgery on his left ankle after breaking it playing softball. His
ankle gives him a lot of discomfort, especially when the weather changes. The family claims there is
no history of liver disease in the familySocial history of heavy drinking of alchihol and smoked
marijuana during his college days. He currently manages a convenience store but has had financial
problems related to the business for the last year. He was married for 18 years. Although they
separated 4 years ago, it was only last year that his wife filed for divorce. The divorce was finalized
a month prior to this admission.His current vital signs are : pulse 102 beats per minute, blood
pressure 126/72 mm Hg, respiratory rate 18 breaths per minute, oral temperature 99.4°F;
p ulse oximetry 96% on 2 L O2 via nasal cannula (NC), telemetry—sinus tachycardia
From his physical examination, the doctor determined SR's level of encephalopathy.
All of which indicates between Grade II and Grade III level encephalopathy.
The follwing laborotary test are :Potassium ,Blood urea nitrogen or BUN Creatinine,
Total bilirubin Alanine transaminase or ALT ,Aspartate aminotransferase or AST ,
Alkaline phosphatase ,PT, INR ,ammonia level and the venous lactate.
 a brief description about the case

Chronic liver disease is a progressive deterioration of liver functions. Liver functions include the
production of clotting factors and other proteins, detoxification of harmful products of
metabolism, and excretion of bile. This is a continuous process of inflammation, destruction, and
regeneration of liver parenchyma leading to fibrosis and cirrhosis. Chronic liver Disease
(ALD)stands for Alcoholic Liver disease. alcoholic liver disease is a spectrum of disease which
includes alcoholic fatty liver with or without hepatitis, alcohol hepatitis (reversible because of
acute ingestion) to cirrhosis (irreversible). Patients with severe alcohol use disorder mostly
develop chronic liver disease; this is the most frequent cause of CLD. Globally, according to the
Clinical Liver Disease (2021) the absolute number of CLD cases (inclusive of any stage of disease
severity) is estimated at 1.5 billion worldwide. The most common causes of prevalent disease are
up to 59% of NAFLD cases are of the nonalcoholic steatohepatitis (NASH) phenotype, the main
disease subtype with risk for fibrotic progression to cirrhosis, followed by HBV (29%), HCV (9%),
and ALD (2%). Other liver diseases, including primary biliary cholangitis, primary sclerosing
cholangitis, alpha-1-antitrypsin deficiency, Wilson’s disease, and autoimmune hepatitis, account
for 1% of cases.
 a brief description about the case
There is a need to study Liver failure because as student nurses,
we have to gain more knowledge about it for us to effectively
render care to our patients in the future who have this kind of
condition. There is no data found in terms of national
(Philippines) statistics found about the chronic liver disease
related to NASH, however, according to the latest WHO data
published in 2018 Liver Disease Deaths in Philippines reached
7,491 or 1.23% of total deaths. The age adjusted Death Rate is
9.88 per 100,000 of population ranks Philippines #128 in the
world (WHO 2018).in terms of local (Davao), there is no data
found related to the chronic liver disease.
1
PATHOPHYSIOLOGY
SCHEMATIC DIAGRAM
 1
2. Why are the tests indicated for the patient?

3. List the important nursing consideration in performing the tests

(pre, intra, post).
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laBORATORY/DIAGNOSTIC EXAMINATION
4. How will you relate the results to the
condition of the patient?

5. In consideration of the results, what will

be your nursing responsibilities?
Test Results and nursing responsibilities
Test Results and nursing responsibilities
Test Results and nursing responsibilities
Test Results and nursing responsibilities
Test Results and nursing responsibilities
Test Results and nursing responsibilities
Test Results and nursing responsibilities
REferences:
 alcoholic liver disease (ALD). Cedars Sinai. (n.d.). Retrieved October 4, 2021, from
https://www.cedars-sinai.org/health-library/diseases-and- conditions/n/non-alcoholic-
steatohepatitis-nash.html.
 Global Health Estimates. Geneva: World Health Organization; 2016 Available at:
https://www.who.int/healthinfo/global_burden_disease/estimates/en/.
John Hopkins Medicine. (2021). Nonalcoholic Fatty Liver Disease. Retrieved from John
Hopkins Medicine: https://www.hopkinsmedicine.org/health/conditions-and-
diseases/nonalcoholic-fatty-liver-disease
Mayo Clinic. Nonalcoholic fatty liver disease. https://www.mayoclinic.org/diseases-
conditions/nonalcoholic-fatty-liver-disease/symptoms-causes/syc- 20354567?p=1.
MedLinePlus (2021).Prothrombin Time Test and INR (PT/INR).https://medlineplus.gov/lab-
tests/prothrombin-time-test-andinr-ptinr