MEDICAL SURGICAL NURSING – Gastrointestinal Disorders _

o Systemic damage >> causes

LIVER CIRRHOSIS Hepatomegaly >> high venous
pressure >> portal
- Damage in the parenchymal tissues in the hypertension >> liver damage
Liver o Systemic damage >> Failure
- Hepatocytes are dying to provide O2 blood to the
- Reversible during earlier stages liver because liver is already
- Irreversible in late stages occupied with too much
unoxygenated blood
Hepatocytes 4) Post-necrotic Cirrhosis
- Functional units in the liver ▪ A.k.a. Macronodular Cirrhosis
▪ (+) Big nodules in liver
Types of Liver Cirrhosis “LBC PO” ▪ Due to infection
1) Laennec’s o Hepatitis
▪ A.k.a. Micronodular Cirrhosis o Leptospirosis
▪ (+) Tiny nodules o Helminths
▪ Leading Cause: LAKLAK ▪ Liver flukes
o Chronic Alcohol Consumption ▪ Due to hepatotoxic drugs
▪ Addictive substance in Alcohol o Anti-TB drugs (RIPE)
o Ethanol or Methanol o Some antibiotics
▪ Normal Blood Alcohol level: ▪ Tetracyclines
0.08gram g/dL o Acetaminophen
▪ Leading cause of Liver Cirrhosis ▪ Tylenol
▪ Decreased Vitamin B1 or Thiamine ▪ Paracetamol
o Very low during chronic • TSL: 10 –
alcohol consumption 20mcg/mL
o Adverse effect: Korsakoff’s ▪ Antidote: N-
Psychosis and Wernicke’s Acetylcysteine
Encephalopathy (Mucomyst)
▪ Psych conditions
▪ Antidote for alcohol poisoning: Types of hepatitis
Fomepizole 1. Hepatitis A
o Blocks the effect of alcohol ▪ Feco-oral
2) Billiary Cirrhosis ▪ Contaminated food and water
▪ Due to bile obstruction secondary to ▪ Infectious hepatitis - Most common
presence of gallstones feco-oral hepa
o Diet: fat 2. Hepatitis B
o Fatty liver disease ▪ Blood borne
▪ Storage of bile: Gallbladder ▪ Serum hepatitis - Most common
▪ Produces bile: Liver blood hepa
▪ Pathophysiology 3. Hepatitis C
o Gallstones >> obstruction in ▪ Blood borne
bile duct ▪ Transfusion hepatitis
o Food reaches the small o Common in blood transfusion
intestine >> liver release bile 4. Hepatitis D
>> bile passes obstructed bile ▪ Blood borne
duct >> cannot pass through ▪ Reactivation hepatitis
>> goes back to liver >> bile o Cant have hepa D if you did
will get activated inside the not have hepa B before
liver >> AUTODIGESTION 5. Hepatitis E
inside the liver ▪ Feco-oral
▪ Management ▪ Contaminated food and water
o NPO first if obstruction still 6. Hepatitis G
present ▪ Blood borne
o Low fat if no obstruction ▪ Dialysis hepatitis
3) Cardiac Cirrhosis
▪ Due to Right sided congestive heart
failure (RCHF)
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Patricia Marie A. Braulio, BSN - Velez College - SLRC
 MEDICAL SURGICAL NURSING – Gastrointestinal Disorders _
Clinical manifestation High fever
▪ RUQ pain - Infection
▪ Abdominal swelling and tenderness Low grade fever
▪ Low grade fever - Inflammation and swelling
▪ Jaundice
o Skin Albumin
o Sclera ▪ CHON >> Liver >> Albumin
o Mucosa ▪ Converted thru oncotic pressure
o Will cause tremendous itchiness & o “Sealant” of fluids in blood vessels
dryness ▪ Damaged liver >> low albumin >> no oncotic
▪ Severe fatigue and weakness pressure >> no sealant of fluids >> fluid goes
o Due to low blood sugar to third space (cellular) >> causing edema >>
▪ Vitamin Deficiency weight gain
o Malnutrition ▪ Ammonia: created by colonic bacteria: E.coli
▪ ADEK is affected
o Bleeding tendencies Complications
▪ ALOC ▪ Liver cancer
o Due to increased metabolic waste >> o Fast deterioration
increase Ammonia ▪ Treatment is hard
▪ Indigestion ▪ Hepatic encephalopathy
o Causes flatulence and belching o Liver damage >> ammonia >> enters
▪ Steatorrhea brain >> brain irritation >> brain will
o Fatty foul smelling stool inflammation >> fluid shifting >>
▪ Clay colored stool cerebral edema >> skull will resist the
o Grey expansion >> puts pressure to brain
o Due to loss of bile salts >> increased ICP >> irreversible brain
▪ Tea colored or dark colored urine or cola damage
colored ▪ Portal hypertension
o Kidney will remove more metabolic o Lead to bleeding esophageal varices
waste since liver is not functional ▪ Increase venous pressure
▪ Fetor hepaticus o There is distention esophageal veins
o Halitosis due to high venous pressure
▪ Hypoalbuminemia o Distention of esophageal veins >>
o Low plasma protein increase risk for point of rupture of the
▪ Ascites veins >> risk for aspiration >> prone
o Can cause SOB to shock
▪ Weight gain o Can be detected by endoscopy
▪ Asterexis ▪ Malnutrition
o “Liver flap”
o Flapping tremors Management
o Due to excess ammonia >> CNS ▪ Place a tube on the affected area
irritation >> hyperreflexia o Tube: Sengstaken-Blakemore Tube
o How to check: ▪ Balloon tip tube
1) Ask patient to raise arms ▪ Composed of 3 lumens
forward ▪ 1 lumen: esophageal ballon
2) Push their fingers then after ▪ 1 lumen: anchor
few seconds release the ▪ 1 lumen: gavage lavage
pressure o Puts pressure on bleeder
3) Observe their fingers if its o Disadvantage
flapping ▪ Mucus can accumulate on
▪ Spider angiomas top of the tube >> might be
o Due to increase permeability of blood aspirated
vessels due to loss of Vitamin K ▪ Place Minnesota tube
o Common in abdomen o Composed of 4 lumen
o Can be found anywhere o 4th lumen: secretion suctioning
▪ Kernictirus? ▪ Bedside item
o Scissors
▪ Cuts the inflator
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Patricia Marie A. Braulio, BSN - Velez College - SLRC
 MEDICAL SURGICAL NURSING – Gastrointestinal Disorders _
▪
To establish airway ▪ TPN as needed
▪
After cutting >> pull out the ▪ No NGT
tube ▪ IV albumin or blood transfusion of albumin
▪ Coil first then cut o Plasma expanders
o Trach set o 1 -2 hrs transfusion time
o Bag valve mask ▪ Wash skin with plain warm water and baking
soda
Normal ICP o To lessen itchiness
- 5 – 15 mmHg ▪ Blood transfusion as needed
- 7 – 25 cmH20 ▪ Paracentesis
▪ Treat underlying cause
Diagnostic ▪ Glucagon prn
▪ LFT ▪ Dextrose fluid prn
o SGPT
▪ Specific to liver FRBC and PRBC
▪ N: 0 – 30 u/ml - 4 hrs
o SGOT
▪ Specific to liver and heart Whole blood
▪ N: 0 – 35 u/ml - 4 – 6hrs
▪ CT scan
▪ MRI FFP, Cryoprecipate, Platelet concentrate
▪ Fibro scan - Fast drip within 30 minutes
o Checks for fibrosis or scarring of the - To control bleeding
liver
▪ Abdominal utz Albumin plasma
▪ Serum bilirubin levels - 1 – 2 hrs
o Increase
▪ Serum alkaline phosphatase Medications
o Increase 1. Vitamin K injections
▪ Serum ammonia 2. Vitamin D injections
o High ▪ Helps with calcium absorption
▪ Serum albumin 3. Tranexamic acid
o Low 4. Mannitol prn
o Low Oncotic pressure ▪ Cross BB barrier
▪ CBC ▪ Lowers ICP
o Hemoglobin and HCT 5. Lactulose
▪ Low ▪ Duphalac
o ESR and WBC ▪ Laxative
▪ High ▪ Prevents ICP
▪ Bleeding parameters ▪ “Labay ammonia”
▪ Blood sugar test ▪ Ammonia binder
o FBS is enough o Gets ammonia from blood
o Screening bs test are enough and excretes via stool
▪ Liver biopsy 6. Neomycin
o During procedure: left side ➢ Amino glycoside
o After procedure: affected side ➢ Broad spectrum
Management ➢ Can be used in all types of liver
▪ NPO if with obstruction cirrhosis
▪ No obstruction ➢ Prevents new formation of ammonia
o Low fat o By lowering the colonic
o Low protein bacteria >> decreases
o High carbs ammonia converters >>
o High calorie decrease ammonia production
o High fiber 7. Sylimarin
▪ Easy removal of fats 8. Phospholipids
▪ Prevents constipation
• To decrease ICP
o Limit fluids
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Patricia Marie A. Braulio, BSN - Velez College - SLRC
 MEDICAL SURGICAL NURSING – Gastrointestinal Disorders _
▪ Hurried meals: Improperly chewed
PEPTIC ULCER DISEASE meals could result to more production
of HCL
Predisposing factors 8. Eating Disorders
1. Stress ▪ Anorexia: Does not eat + purging
▪ Stress decreases prostaglandin and ▪ Bulimia: Hurried meals + purging
causes decreases mucus productions 9. Genetics
o Increases hydrochloric acid ▪ Type O blood type
2. H. Pylori Infection o Increase pepsinogen
▪ Wastes of the bacteria adds acidity ▪ Base product to
▪ Produces additional acid produce HCL acid
▪ DOC: Metronidazole & Bismuth 10. Type A personality
o Also given for amoebiasis ▪ Stress personality
o Avoid any intake of alcohol 11. Burns
▪ Rationale: has ▪ A.k.a. Curling’s Ulcer
Antabuse-like effect o If ulcer is triggered by burns
• Aversion ▪ Burns >> fluid loss >> hypovolemia
Therapy for >> ischemia >> necrosis
Alcoholism o No blood flow to the stomach
• Prevents >> less mucus production in
addiction stomach
from alcohol 12. Age
• Can cause ▪ Higher age: Increase risk
violent nausea 13. Cancer
and vomiting 14. Radiation or Chemotherapy
• Even a smell ▪ Affects good and bad cells
of alcohol can ▪ Iatrogenic
trigger 15. Co-morbidities
antabuse-like ▪ Cushing’s syndrome
effect
GASTRIC ULCER DUODENAL ULCER
3. Long-term use of NSAIDS, Analgesics, A.k.a. Poor man’s Ulcer A.k.a. Executive Ulcer
Steroids Laborer’s Ulcer Rich man’s Ulcer
▪ If cannot take with meals: Take Busy man’s ulcer
Epigastric pain
Enteric coated medications ✓ “Burning pain or Gnawing pain”
o Rationale: Melts in the Onset: Onset:
intestine, not in the stomach 30 minutes after meals or right 2 – 3 hours after meals
after meals ✓ Common at night
o Never crush enteric coated ✓ Mouth to stomach within 30
drugs minutes
Common site: Common site:
4. Zollinger Ellison Syndrome Upper Portion (Antrum) Lower end of the stomach + first
▪ Having PUD secondary to a pancreatic 2cm of duodenum
tumor Radiation of pain: Radiation of pain:
Going to the left Going to the right
o Gastrinoma: A type of tumor Relief of pain: Relief of pain:
that produces acid By vomiting By eating
5. Smoking and Alcoholism Pain worsened by: Pain worsened by:
Eating
▪ Smoking is a stimulant of HCL Weight: Weight:
▪ Too much alcohol causes dryness to ✓ Weight loss ✓ Normal weight
the mucosa inside the stomach ✓ Prone to malnutrition ✓ Normal nutrition
Risk of cancer: Risk of cancer:
6. Diet 10% Higher of malignancy Lesser risk
▪ Spicy foods Acid level: Acid level:
▪ Carbonated Lesser HCL production Higher HCL production
Metabolic Alkalosis Metabolic Alkalosis
▪ Stimulants (Coffee) Higher risk Lesser risk
▪ Acidic fruits Bleeding: Bleeding:
▪ Vitamins Hematemesis Melena Black tarry stools
✓ Upper GI bleeding
o Sodium ascorbate: Complications of both:
Alternative for it to be less ✓ Hemorrhage
acidic o Most common
✓ Perforation
7. Skipped or Hurried Meals
▪ Could trigger auto-digestion
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Patricia Marie A. Braulio, BSN - Velez College - SLRC
 MEDICAL SURGICAL NURSING – Gastrointestinal Disorders _
Cause of Death: ➢ Issue: Crosses BBB >> Nerve Tangles >> affects
✓ Shock neurological symptoms & ALOC
Diagnostic Tests ➢ Cimetidine: Crosses the BBB the most; most potent
1. Endoscopy or EGD ▪ Avoided in Geriatrics
o A.k.a. Esophagogastroduodonoscopy ➢ Ranitidine: Safest! Least potent
o Confirmatory test o PPI
o Lidocaine spray to suppress gag reflex ➢ Similar with H2 blockers
➢ Do not feed right after procedure ➢ -prazole
2. CT Scan or MRI ➢ Does NOT cross BBB
3. Abdominal UTZ ➢ Safer compared to H2
4. Gastric or PH analysis o Cyto-protectives
5. Barium swallow ➢ “Coaters”
o A.k.a. Upper GI series ➢ To coat ulcerated parts
o Uses Radioactive Dye ➢ Best time: 30 minutes before meals
6. ABG ➢ S/e: Constipation
7. CBC ➢ Ex: Succralfate (Carafate)
Management o Prostaglandin Analogues
▪ Treat underlying cause ➢ “Fillers”
▪ Diet: ➢ Agonists
o Bland diet everything is low ➢ Elevate Prostaglandin = mucus = shield
o Soft diet ➢ Best time: 30 minutes before meals
o TPN ➢ Ex: Misoprostol (Cytotec)
o No NGT ➢ S/e: Constipation
▪ Blood Transfusion as needed ➢ A/e: Uterine Contractions >> Abortifacient
o Increment ratio: 1 bag = 1g/dL Hgb 2 – 3% Hct ▪ Surgery
o Small gauge, blood set o Vagotomy
o Most Common to cause reaction: Whole Blood then RBC ➢ Lowers down HCL production
o Least common to cause reaction: Platelet concentrate o Gastrectomy or Gastric Bypass or Bariatric Surgery
o Main reason BT reaction: ABO incompatibility ➢ Last option!
o Most common reaction: Febrile reaction ➢ Many complicaitons
o Most life-threatening: Anaphylactic shock then Hemolytic
o Consume within: 30 minutes
o First 30 minutes: KVO rate to monitor BT reactions Food Travel time
o KVO rate during BT: 20 – 25 - Mouth to stomach: Within 30 minutes
o KVO rate of PNSS: 10 – 15 - Mouth to small intestine: 2 -3 hours
o Multiple BT:
➢ 1 bag = 100 mg Citrate - Mouth to colon: 6 – 8 hours
➢ Prevents production of Calcium >> Hypocalcemia
➢ If > 3 bag: Ca Gluconate
o Hyperkalemia causes:
Hematochezia
➢ Due to hemolysis - Lower GI bleeding
➢ Old blood
➢ Prolonged time of infusion
➢ Heat Diagnostic test for Melena
o Whole Blood: 4 – 6 hours - OBT, GUAC, Cassette Tape Test
o PRBC: 4 hours
o FRBC: 4 hours
o Done in 3 consecutive days
o FFP: Fast drip within 30 minutes o No Dark Colored Foods (NDCF )
o Cryoprecipitate: Fast drip within 30 minutes
o Platelets: Fast drip within 30 minutes
o Albumin: 1 -2 hours 2 types of Gastrectomy
▪ Anti-ulcer medication 1) Billroth I
o Antacids
➢ Neutralizes HCL acidity
▪ Gastroduodenostomy
➢ Best time: After meals to prevent indigestion ▪ Connect to the remaining duodenum
➢ If with (+) Hx of hyperacidity: Before meals ▪ Indicated for: Gastric Ulcer
➢ Ex: Aluminum Hydroxide (AmPHOjel)
▪ Phosphate binder: Decreases Pho = Increases Ca 2) Billroth II
▪ S/e: Constipation ▪ Gastrojejunostomy
▪ A/e: Renal Calculi & Arrhythmia ▪ Connect to jejunum
➢ Ex: Magnesium Hydroxide (Milk of Magnesia)
▪ S/e: Diarrhea ▪ Indicated for: Duodenal Ulcer
➢ Best antacid: MAALOX or Combination
▪ Kremil-S
▪ Magnesium and Aluminum Hydroxide
Post Gastrectomy Complications
▪ Results to normal bowel movement 1. Dumping Syndrome
➢ Ex: Calcium Carbonate (Tums)
▪ Also a calcium supplement
2. Pernicious Anemia
▪ S/e: Constipation
▪ A/e: Renal Calculi & Arrhythmia DUMPING SYNDROME
➢ Ex: Sodium Bicarbonate
▪ DOC: For metabolic acidosis >> Duodenal Ulcer
o H2 Blockers - Rapid emptying of gastric contents going to
➢ Histamine 2 antagonists the LGI secondary to a shortened GI tract
➢ Decreasing HCL acid production o Leading to fast digestive process
➢ -tidine
➢ Best time of the day: Hours of sleep - Self-limiting behavior
➢ Best time: After meals o Will go away on its own
➢ If with (+) Hx of hyperacidity: Before meals

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Patricia Marie A. Braulio, BSN - Velez College - SLRC
 MEDICAL SURGICAL NURSING – Gastrointestinal Disorders _
Common in o Ex: Loperamide (Diatabs)
- Billroth II ▪ Anti-spasmodic
o Ex: Hyoscine (Buscopan)
Average recovery
- 6 – 12 months PERNICIOUS ANEMIA
Onset
- 5 – 30 minutes after meals - Due to low levels of Vitamin B12
Duration (Cyanocobalamin)
- 15 – 30 minutes o Sources: Animal sources
- Usually common in Vegan
Clinical manifestations
▪ Increased bowel sounds Low B12
o Rationale: Peristalsis - Decreases production of Intrinsic Factor
o A.k.a. Borborygmi Bowel sound o Low RBC production = low blood
volume
▪ Diarrhea
▪ Pain or Abdominal cramps
▪ Diaphoresis Pre-disposing Factors
▪ Surgery
▪ Cold clammy skin
▪ Risk for dehydration ▪ Genetic problem
o Ex: Autoimmune
▪ Metabolic Acidosis
▪ H. Pylori
▪ Fatigue
▪ Light headed ▪ Diet
o Pure vegan diet
▪ Electrolyte imbalance
▪ Low sugar ▪ Pancreatitis
o Due to overstimulation of pancreas =
Clinical Manifestations of Pernicious Anemia
insulin ▪ Classic symptoms of anemia
▪ Shock-like symptoms ▪ Cardinal signs
o Red beefy tongue
Normal Bowel Sounds o RBC morphology: Megaloblastic
- 5 – 30 clicks/min
▪ Big RBC, count
▪ Compensatory to prevent
Management for Dumping Syndrome sudden shock
1. Diet ▪ Remaining RBC will increase
▪ Low CHO in size >> under the tongue is
o Rationale: CHO is fast to highly vascularized >> Red
digest beefy tongue
▪ No simple sugar Complications
▪ Moderate to high fat 1. Shock
o Rationale: Fats are hard to 2. Organ failure
digest
▪ Dry meals Cooley’s Anemia
o Anything with sauce or soup - Immune system attacking RBC causing
are contraindicated hemolysis
▪ SFF
o Avoid bulk Kawasaki vs. Scarlett fever
▪ Fluid should be taken IN-BETWEEN - Kawasaki: red strawberry tongue
meals - Scarlet: white strawberry tongue
▪ Instruct the patient to lie down for at
least 30 minutes after meals Diagnostic Tests for Pernicious Anemia
▪ No ambulation, No abdominal 1) CBC
massage, No heat application for at 2) Blood Electrophoresis
least 30 minutes after meal ▪ Detailed CBC
o Rationale: To prevent 3) Schilling’s Test
stimulation of peristalsis ▪ CONFIRMATORY test
2. Medications ▪ 24 hour urine test
▪ Anti-motility ▪ To check ability on absorption of
o Rationale: To slow down vitamin B 12
peristalsis
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Patricia Marie A. Braulio, BSN - Velez College - SLRC
 MEDICAL SURGICAL NURSING – Gastrointestinal Disorders _
▪ Stage 1: Patient is given radioactive ▪ Flatulence
vitamin B12 ▪ Belching post heavy meal
o Co57 or Co58 ▪ Jaundice
o Oral or IM ▪ Yellowish, dry, itchy skin
o (+) Vitamin B12 = (-) PA ▪ WOF: Hypocalcemia
o >10% given Vitamin B12 o There are calcium deposits in the
urine = (-) PA Pancreas
o Inversely proportional ▪ Calcium from the pancreas
▪ Stage 2: Co57 or Co 58 + Intrinsic will leak to peritoneum
Factor ▪ Nausea and vomiting
o Directly proportional ▪ Cold clammy skin
▪ First voided urine: Discard ▪ Diaphoresis
▪ 2nd voided urine: Save for the next 24 ▪ Malnutrition
hours ▪ Weight loss
▪ Placed in cold temperature
▪ Make sure there is label Cardinal Signs
1. Cullen’s Sign
Management ▪ Bluish-purple discoloration of the
1. Treat underlying cause umbilical region
2. Blood Transfusion as needed ▪ Or bruising, ecchymosis
3. Drug of choice ▪ Due to Hemorrhage >> blood pools by
▪ Artificial B12 gravity in umbilical region
▪ IM, once every month, for life 2. Grey Turner Sign
▪ Bluish-purple discoloration in the
flank region
PANCREATITIS
Diagnostic Tests
Two types of Pancreatitis 1) ERCP
1) Acute Pancreatitis ▪ Endoscopic Retrograde Cholangio
2) Chronic Pancreatitis Pancreaotography
▪ Confirmatory Test
Pathophysiology ▪ Can also be a management
▪ Obstruction >> digestive enzymes are o Rationale: Can get Gallstone
activated inside the pancreas >> Auto- obstruction
digestion >> injury or inflammation ▪ Uses Contrast medium for better
visualization
ACUTE PANCREATITIS CHRONIC PANCREATITIS ▪ WOF: Allergies to Contrast Media
Gallstone obstruction in the Alcoholism >> scarring >>
pancreatic duct or Duct of stenosis >> obstruction 2) CT scan & MRI of the abdomen
Santorini 3) Abdominal UTZ
(+) OBSTRUCTION 4) Elevated serum bilirubin level elevated
5) CBC
▪ ESR/WBC
Complications of Pancreatitis
1. Hemorrhage ▪ Hgb/Hct
▪ Most common 6) Serum Amylase
2. Perforation ▪ 3 – 4x higher than its normal level
3. Shock ▪ Amylase: Peaks within 6hrs
▪ Cause of death ▪ Lipase: within 12hrs
4. Diabetes ▪ Trypsin: within 18hrs
▪ Type 2 DM 7) Serum Alkaline Phosphatase level
▪ Alkaline Phosphatase
Clinical Manifestations of Pancreatitis 8) Serum electrolytes
▪ Severe epigastric and LUQ pain ▪ Low Ca
▪ Sharp pain radiating to the shoulder ▪ High Phosphorous
▪ Abdominal swelling and tenderness 9) ECG
▪ Low-grade fever 10) Bleeding Parameters
▪ Indigestion
o Steatorrhea
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Patricia Marie A. Braulio, BSN - Velez College - SLRC
 MEDICAL SURGICAL NURSING – Gastrointestinal Disorders _

Management for Pancreatitis

▪ If (+) Obstruction APPENDICITIS
o NPO
o TPN - Acute inflammation of the vermiform
▪ If (-) Obstruction appendix
o Low fat - Appendix: Accessory Organ
o Low CHO o RLQ
o Low CHON o Right Ileac Region
o High Fiber o McBurney’s Point
o Soft Diet Leading cause
▪ Medications - Obstruction secondary to Fecalith
o Analgesics o Stone made up of feces
▪ Morphine o Impacted feces
▪ Meperidine (Demerol) - Trauma
▪ WOF: Spasm of Sphincter of - Infection
ODI >> Contributes to
additional pain Clinical manifestations
o Pancrease & Cholestyramine ▪ Severe RLQ pain
▪ Synthetic digestive enzymes ▪ Abdominal swelling and tenderness
▪ If patient accidentally eats ▪ Low-grade fever
when NPO ▪ Diaphoresis
o Ursodiol (UDCA) ▪ Cold clammy skin
▪ Dissolves the Gallstone ▪ Decreases Bowel sounds
o Calcium Gluconate o Less than 5
▪ For hypocalcemia ▪ WOF: Sudden loss of pain
o Tranexamic Acid (Hemostan) o Possible sign of ruptured appendix
▪ To stop possible bleeding ▪ Peritonitis >> sepsis
▪ Lithotripsy • Board-like rigid
o Lith: Stone abdomen
o Tripsy: “Shock” Cardinal signs
o 2 types: 1. Blumberg’s Sign
▪ Extracorporeal ▪ Bouncing pain in the RLQ
▪ Percutaneous ▪ A.k.a. Rebound tenderness
• More effective but 2. Rovsing’s sign
more invasive ▪ Palpation at LLQ, pain elicited at RLQ
▪ Surgery ▪ Reverse pain
o Whipple’s procedure 3. Psoas sign
▪ A.k.a. ▪ Pain elicited at RLQ when leg is
Pancreaticuduodonostomy flexed towards the hip
▪ A.k.a. Pancreatic Bypass 4. Obturator sign
▪ Last option ▪ Right leg internal rotation causes RLQ
▪ Pancreatic duct is removed pain
▪ Anastomosing of the 5. Dunphys sign
pancreatic head directly to the ▪ Coughing causes RLQ pain
duodenum 6. Kosher’s sign
▪ Palpation at umbilical region causes
RLQ pain

Diagnostic Tests
1) MRI & CT scan
▪ Confirmatory
2) Abdominal UTZ
▪ Less accurate, less reliable
▪ Note: No deep palpation
3) CBC
▪ WBC
4) KFT
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Patricia Marie A. Braulio, BSN - Velez College - SLRC
 MEDICAL SURGICAL NURSING – Gastrointestinal Disorders _
▪To rule out kidney problems Clinical Manifestations
▪(-) results = (+) appendicitis ▪ Severe RUQ pain
▪ Sharp pain radiating to the shoulders
Management ▪ Jaundice
▪ Never give analgesics or pain meds ▪ Abdominal swelling tenderness
o Rationale: May mask s/s of rupture ▪ Low-grade fever
▪ Diet ▪ Indigestion
o NPO o Flatulence
▪ Rationale: If with peristalsis o Belching
>> causes rupture to appendix o Steatorrhea
▪ TPN
▪ IV fluids Cardinal signs
o Isotonic Solutions 1. Murphy’s sign
▪ D5W or PNSS ▪ Inability to breath in when fingers are
▪ Position placed on the RUQ secondary to pain
o Supine position 2. Boas Sign
▪ NEVER bend on your waist ▪ Not accurate
o Side – lying position ▪ (+) Hyperesthesia
▪ (+) pain: Left side o Hypersensitivity of the RUQ
▪ (-) pain: Right side to light touch
• Rationale: To localize
the leakage from the Diagnostic Test
rupture. Prevents 1. ERCP
spreading 2. CT scan & MRI
▪ Avoid any form of exertion 3. Abdominal Utz
o Heavy lifting 4. CBC
o Coughing 5. Serum Bilirubin
▪ IAPePa ▪ Elevated
▪ Neomycin 6. Serum alkaline phosphatase
o Antibiotic; Aminoglycosides ▪ Elevated
o Pre-op meds
o Rationale: To decrease colonic Management
bacteria - Same management of pancreatitis
▪ Surgery - Surgery
o Appendectomy o Cholecystectomy

CHOLECYSTITIS

- Inflammation of Gall bladder

- Accessory organ
- For extra storage of bile

Leading cause
- Obstruction of bile duct secondary to
gallstones
o Autodigestion of bile inside the
gallbladder

Predisposing Factors “F5”

1. Fat
▪ Obesity, overweight, fat diet
2. Female
▪ Estrogen = fat
3. Forty and above
▪ Slow metabolism
4. Fertile
5. Fair

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Patricia Marie A. Braulio, BSN - Velez College - SLRC