Gastro Liver And Biliary System Bago 2


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Gastro Liver And Biliary System Bago 2

  2. 4. ANATOMY AND PHYSIOLOGY <ul><li>Major Functions: </li></ul><ul><li>Ingestion of food </li></ul><ul><li>Digestion of food </li></ul><ul><li>Elimination of waste products </li></ul><ul><li>2 Main Groups: </li></ul><ul><li>Alimentary Canal </li></ul><ul><li>Accessory Organs </li></ul>
  3. 5. Organs of the Alimentary Canal <ul><li>MOUTH </li></ul><ul><li>also known as ________ </li></ul><ul><li>_______ protects its anterior opening </li></ul><ul><li>_______ protects its lateral walls </li></ul><ul><li>_______ forms its anterior roof </li></ul><ul><li>_______ forms its posterior roof </li></ul><ul><li>_______ fleshy fingerlike projection of the soft </li></ul><ul><li>palate </li></ul>
  4. 6. <ul><li>_____ occupies the floor of the mouth </li></ul><ul><li>_____ a pair of lymphatic tissue located at posterior end of the oral cavity </li></ul><ul><li>_____ lubricates the food for easy swallowing </li></ul><ul><li>PHARYNX </li></ul><ul><li>allows the passage of food from the mouth to the esophagus </li></ul>
  5. 7. <ul><li>ESOPHAGUS </li></ul><ul><li>Hollow, muscular tube that propels the food from the pharynx down to the stomach </li></ul><ul><li>STOMACH </li></ul><ul><li>A dilated, saclike structure that lies on the left side of the abdominal cavity nearly hidden by the liver and diaphragm </li></ul><ul><li>Contains 2 important sphincters </li></ul><ul><li>The fundus is the expanded part of the stomach lateral to the cardiac region </li></ul>
  6. 8. <ul><li>The body is the midportion and the funnel-shaped pylorus is the terminal part of the stomach </li></ul><ul><li>It has 3 major function such as: </li></ul><ul><li>Stores food </li></ul><ul><li>Mixes food with gastric juices </li></ul><ul><li>Passes chyme </li></ul><ul><li>An average meal can remain in the stomach for 3 to 4 hours </li></ul>
  7. 9. <ul><li>An accordion-like folds in the stomach lining, allows the stomach to expand when large amount of foods and fluids are ingested </li></ul><ul><li>Chemical breakdown of protein begins in the stomach </li></ul><ul><li>SMALL INTESTINE </li></ul><ul><li>Considered as the body’s major digestive organ </li></ul><ul><li>Longest section of the GI tract and hangs in sausage like coils in the abdominal cavity </li></ul>
  8. 11. SMALL INTESTINE <ul><li>It has 3 sections: </li></ul><ul><li>Duodenum </li></ul><ul><li>Jejunum </li></ul><ul><li>Ileum </li></ul><ul><li>Nearly all food absorption occurs in the small intestine </li></ul>
  9. 12. LARGE INTESTINE <ul><li>It frames the small intestine on three sides and has the following subdivisions: </li></ul><ul><li>Cecum </li></ul><ul><li>Appendix </li></ul><ul><li>Colon </li></ul><ul><li>Rectum </li></ul><ul><li>Anal canal </li></ul>
  10. 13. 3 Main functions: 1. Absorbs excess water and electrolytes 2. Stores food residue 3. Eliminate waste products in the form of feces
  11. 14. ACCESSORY ORGANS <ul><li>LIVER </li></ul><ul><li>Heaviest organ in the body </li></ul><ul><li>Located in the right upper quadrant and almost completely covers the stomach </li></ul><ul><li>Has 2 major lobes divided by the falciform ligament </li></ul><ul><li>The liver’s function includes </li></ul><ul><li>M-etabolism of Carbohydrates, Fats and </li></ul><ul><li>Proteins </li></ul><ul><li>C-onverts ammonia to urea for excretion </li></ul><ul><li>D-etoxify blood </li></ul><ul><li>O - synthesizing plasma proteins, nonessential </li></ul><ul><li>amino acids </li></ul>
  12. 15. <ul><li>acids, vitamin A and essential nutrients </li></ul><ul><li>such as iron, and vitamins D,K, and B12 </li></ul><ul><li>S-ecretes bile. A greenish fluid that helps </li></ul><ul><li>digest fats and absorbs fatty acids, </li></ul><ul><li>cholesterol, and other lipids. </li></ul><ul><li>GALLBLADDER </li></ul><ul><li>Small, pear-shaped organ that lies halfway under the right lobe of the liver </li></ul><ul><li>Its main function is to store bile from the liver until it is emptied into the duodenum </li></ul>
  13. 16. <ul><li>PANCREAS </li></ul><ul><li>Soft, pink, triangular gland that extends across the abdomen from the spleen to the duodenum </li></ul><ul><li>Produces enzymes that digest carbohydrates fats and proteins ( ALT ) </li></ul><ul><li>BILE DUCTS </li></ul><ul><li>Provide the passageways for bile to travel from the liver to the intestines </li></ul><ul><li>2 hepatic ducts drain the liver and 1 cystic duct drains the gallbladder </li></ul>
  14. 18. METABOLISM <ul><li>It includes all chemical breakdown and building reactions needed to maintain life </li></ul><ul><li>Carbohydrates are the body’s major energy fuel </li></ul><ul><li>Fats insulates the body, protects the organs, build some cell structure and provide reserve energy </li></ul><ul><li>Proteins forms the bulk of the cell structure and most functional molecules </li></ul><ul><li>The liver is the body’s key metabolic organ </li></ul>
  15. 19. <ul><li>Diagnostic Assessment: </li></ul><ul><li>1. Hematologic liver function studies </li></ul><ul><ul><li>To determine excretory function </li></ul></ul><ul><ul><ul><li>Serum bilurubin </li></ul></ul></ul><ul><ul><ul><li>Serum alkaline phosphatase N=2-5 bodansky unit </li></ul></ul></ul><ul><ul><ul><li>SGOT Serum Glutamic Oxalo Transaminase or AST Aspartate Aminotransferase N= 7-40 U </li></ul></ul></ul><ul><ul><ul><li>SGPT Serum Glatamic Pyruvic Transaminase or ALT Alanine Aminotransferase N= 10-40 U </li></ul></ul></ul>
  16. 20. <ul><ul><li>To determine metabolic function </li></ul></ul><ul><ul><ul><li>Serum protein- albumin, globulin </li></ul></ul></ul><ul><ul><ul><li>Serum ammonia- N= 20-150 ug/ 100ml </li></ul></ul></ul><ul><ul><ul><li>Serum amylase N= 4-25 u/ml </li></ul></ul></ul><ul><ul><ul><li>Prothrombin time N=11-16 secs </li></ul></ul></ul>
  17. 21. <ul><ul><ul><ul><li>Barium swallow </li></ul></ul></ul></ul><ul><ul><ul><ul><li>- identifies structural abnormalities of the esophagus, stomach, duodenum and jejunum as well as swallowing discoordination </li></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Pre-test prep: </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Low-residue diet several days before the procedure </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>NPO for 8 to 12 hrs before the test </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>BaSO4 per orem is administered </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>X-rays are taken in standing and lying positon </li></ul></ul></ul></ul></ul>
  18. 22. <ul><li>Post-test: </li></ul><ul><li>Laxative is administered </li></ul><ul><li>Increase fluid intake </li></ul><ul><li>Inform patient that the stool is white for 24-72 hours </li></ul><ul><li>Observe for Barium impaction: abdominal distention and constipation </li></ul>
  19. 23. Barium Enema <ul><li>- identifies polyps, tumors, inflammation, strictures and other abnormalities of the colon </li></ul><ul><li>Pre-test prep: </li></ul><ul><li>1. Low-residue diet 1 to 2 days before the test </li></ul><ul><li>2. Clear liquid diet the evening before the test </li></ul><ul><li>3. Laxative is given the evening before the </li></ul><ul><li>test </li></ul><ul><li>4. NPO after midnight </li></ul>
  20. 24. <ul><li>5. Cleansing enemas the morning of the test ( if not contraindicated) </li></ul><ul><li>6. BaSO4 is administered per rectum </li></ul><ul><li>Oral Cholecystography </li></ul><ul><li>- identifies stones in the gallbladder or CBD and tumors or other obstructions </li></ul><ul><li>Pre-test prep: </li></ul><ul><li>Client swallows 6 dye tablets-one every 5 mins. after the evening meal with a total of 250 ml of water. Once the initial x-ray is taken, a fatty test meal is given to determine GB ability to empty. </li></ul>
  21. 25. Cholangiography <ul><li>Determines the patency of the ducts from the liver and gallbladder. It is used when oral cholycystogram, vomiting interferes with the retention of the oral dye. </li></ul><ul><li>- dye is usually instilled intraveneously (IV) </li></ul><ul><li>or through the T-tube surgically placed in </li></ul><ul><li>the CBD. </li></ul>
  22. 26. <ul><li>Pre-test prep: </li></ul><ul><li>1. Client must sign a consent form </li></ul><ul><li>2. Ask if the patient is allergic to iodine or shellfish. </li></ul><ul><li>3. Restrict food and fluids several hrs. before the examination. </li></ul>
  23. 27. Percutaneous Liver Biopsy <ul><li>Obtaining a small core of liver tissue by placing needle (FNB) through the client’s lateral abdominal wall directly into the liver. </li></ul><ul><li>Detects malignancies, infectious and inflammatory processes, liver damage and sign of rejection post liver transplant </li></ul><ul><li>Pre-test prep: </li></ul><ul><li>1. CT scan or ultrasound is done to identify the appropriate site of the biopsy needle. </li></ul>
  24. 28. <ul><li>2. Position the patient in supine position with a rolled towel beneath the right lower ribs. </li></ul><ul><li>3. Instruct the patient to take a deep breath and hold it while the needle is being inserted. </li></ul><ul><li>Post-test: </li></ul><ul><li>Position patient on his right side with a small pillow under the costal margin for several hrs. </li></ul><ul><li>Ask the patient to prevent coughing or straining </li></ul><ul><li>Avoid heavy lifting or strenuous activity post procedure </li></ul>
  25. 29. Common Gastrointestinal Endoscopic Procedure <ul><li>Esophagogastroduodenoscopy (EGD) </li></ul><ul><li>- examination of the esophagus, stomach and duodenum through an endoscope </li></ul><ul><li>- local spray anesthetic is given and anxiolytic agent to provide sedation and relieve anxiety. </li></ul><ul><li>Post-test: Nurse monitors for any signs of complication especially signs of perforation </li></ul><ul><li>- may not have food or fluids until the gag reflex returns. </li></ul><ul><li>- Clear fluids are given first then progress to regular foods according to the client tolerance. </li></ul>
  26. 30. Colonoscopy <ul><li>Examination of the entire large intestine with a flexible fiber optic colonoscope </li></ul><ul><li>Air maybe instilled to promote visualization within the folds of the intestinal mucosa </li></ul><ul><li>Clients are sedated briefly and monitored accordingly </li></ul><ul><li>Position the patient in knee-chest/lateral position during the procedure </li></ul>
  27. 31. Proctosigmoidoscopy <ul><li>Examination of the rectum and sigmoid colon using a rigid endoscope. </li></ul><ul><li>Knee-chest position. </li></ul><ul><li>Retrograde Endoscopic Cholangiopancreatography (ERCP) </li></ul><ul><li>Combined endoscopic and radiographic examination using a contrast radiopaque medium instilled in the biliary tree and pancreatic ducts. </li></ul>
  28. 32. Periteneoscopy <ul><li>Examination of GI structures through an endoscope inserted percutaneously through a small incision in the abdominal wall </li></ul><ul><li>Patient can be given either local, spinal or general anesthesia </li></ul><ul><li>Panendoscopy </li></ul><ul><li>Examination of both the upper and lower GI tracts </li></ul>
  29. 33. Stool Analysis <ul><li>Stools are collected to identify WBC (inflammation and infection) RBC (blood loss) and fats (malabsorptions) </li></ul><ul><li>No red meat 3 days prior to collection of stool. </li></ul>
  30. 34. Gastointestinal Intubation for Feedings or Medications <ul><li>Different Types of GI Intubation </li></ul><ul><li>Nasogastric ( nose-stomach via esophagus ) </li></ul><ul><li>Orogastric ( mouth-stomach ) </li></ul><ul><li>Nasoenteric ( nose-esophagus-stomach-small intestine ) </li></ul><ul><li>Gastrostomy ( tube enters the stomach through a surgically created opening into the abdominal wall. </li></ul><ul><li>Jejunostomy ( enters jejunum or small intestine ) </li></ul>
  31. 35. <ul><li>Alternative Feeding: </li></ul><ul><li>Enteral hyperalimentation - delivery of nutrients directly to the GI tract. </li></ul><ul><ul><li>Short- term- esophagostomy; nasogastric tube </li></ul></ul><ul><ul><li>Long- term- gastrostomy; jejunostomy </li></ul></ul><ul><ul><li>Indications of NGT : </li></ul></ul><ul><ul><li>1. Gavage - to deliver nutrients; for feeding purposes </li></ul></ul><ul><ul><li>2. Lavage - to irrigate the stomach </li></ul></ul><ul><ul><li>3. Decompression - to remove stomach contents or air </li></ul></ul>
  32. 36. Types of GI tube <ul><li>Levin tube – single lumen </li></ul><ul><li>Salem-Sump tube - double lumen </li></ul><ul><li>Miller-Abbot tube - double lumen </li></ul><ul><li>intestinal tube </li></ul><ul><li>Cantor-tube - single lumen intestinal tube </li></ul><ul><li>Sengstaken-Blakemore tube - triple lumen tube used to treat bleeding esophageal varices </li></ul>
  33. 37. <ul><li>Hang or elevate the feeding bag or syringe about 18 inches above the patient’s head </li></ul><ul><li>Flush tube with 30-50 ml of water in the end of the feeding </li></ul><ul><li>Care of nares with NGT- apply water soluble lubricant to prevent irritation </li></ul><ul><li>Reposition tube to ensure patency </li></ul><ul><li>If tube is for decompression, observe signs and symptoms for metabolic alkalosis </li></ul>
  34. 38. <ul><li>Nursing Care in NGT: </li></ul><ul><li>Check placement of feeding tube </li></ul><ul><li>-Aspirate 10-20 ml of gastric secretions </li></ul><ul><li>(measure gastric residual and return to </li></ul><ul><li>stomach) </li></ul><ul><li>- Measure the pH of aspirated fluid </li></ul><ul><li>- Inject 10-30 ml of air into feeding tube and </li></ul><ul><li>auscultate over the epigastric area with </li></ul><ul><li>stethoscope </li></ul>
  35. 39. <ul><li>Hyperalimentation (total parenteral nutrition)- method of giving highly concentrated solutions intravenously to maintain a patient’s nutritional balance when oral or enteral nutrition is possible </li></ul><ul><li>Nursing Management: </li></ul><ul><li>Filter is used in the IV tubing to trap bacteria </li></ul><ul><li>Solution and administration equipment should be changed every 24 hours </li></ul><ul><li>Dressing changes every 48-72 hrs with antibiotic ointment to catheter insertion </li></ul>
  36. 40. <ul><li>Medication is never administered in a TPN line </li></ul><ul><li>Do not abruptly discontinue TPN </li></ul><ul><li>Observe for complications </li></ul><ul><ul><li>Infection </li></ul></ul><ul><ul><li>Venous thrombosis </li></ul></ul><ul><ul><li>Hyperglycemia </li></ul></ul>
  37. 41. <ul><li>Nursing Assessment </li></ul><ul><li>Anorexia, nausea or vomiting </li></ul><ul><li>Dysphagia </li></ul><ul><li>Dyspepsia (indigestion) </li></ul><ul><li>Pyrosis (heartburn) </li></ul><ul><li>Diarrhea or constipation </li></ul><ul><li>Regurgitation </li></ul><ul><li>Bleeding- hematemesis, melena, hematochezia, </li></ul><ul><li>flatulence, aerophagia, borborygmus </li></ul><ul><li>Abdominal rigidity </li></ul><ul><li>Hiccup </li></ul><ul><li>Jaundice (obstructive) </li></ul><ul><li>Acholic stools </li></ul>
  38. 42. Common GI Diseases : Appendicitis <ul><li>Inflammation of the verniform appendix </li></ul><ul><li>Predisposing factors: </li></ul><ul><li>Microbial invasion </li></ul><ul><li>Fecaliths – undigested food particles </li></ul><ul><li>Intestinal obstruction </li></ul><ul><li>Nursing Assessment: </li></ul><ul><li>(+) rebound tenderness </li></ul><ul><li>Low grade fever </li></ul>
  39. 43. <ul><li>3. anorexia </li></ul><ul><li>4. nausea and vomiting </li></ul><ul><li>5. pain at the McBurney’s point </li></ul><ul><li>Management: </li></ul><ul><li>Appendectomy within 24-48 hrs. </li></ul><ul><li>Medications: antibiotics, antipyretic, no analgesics </li></ul><ul><li>Avoid heat application, cleansing enema </li></ul>
  40. 44. Nursing Management: <ul><li>Post AP </li></ul><ul><li>FOB for 6-8 hrs (spinal anesthesia) </li></ul><ul><li>Monitor for return of sensation on lower extremities </li></ul><ul><li>NPO until peristalsis returns </li></ul><ul><li>Encourage ambulation </li></ul><ul><li>Proper positioning </li></ul><ul><li>Resume normal activities within 2 to 4 wks. </li></ul>
  41. 46. <ul><li>A. Peptic Ulcer Disease </li></ul><ul><li>- break in the continuity of gastric mucosa that comes in contact with hydrochloric acid and pepsin </li></ul><ul><li>Predisposing Factors </li></ul><ul><li>- emotional stress, irregular meals excessive smoking, drinking coffee or alcohol, drugs; genetics </li></ul><ul><li>Incidence </li></ul><ul><li>- more in men with emotional stress; type O blood </li></ul>
  42. 47. <ul><li>Nursing Management </li></ul><ul><li>Rest </li></ul><ul><li>Bland diet- no caffeine, alcohol and spicy foods </li></ul><ul><li>Stress nursing management </li></ul><ul><li>If with hemorrhage- gastric lavage </li></ul>
  43. 48. <ul><li>Gastric Ulcer </li></ul><ul><li>“ Poor man’s ulcer” (50 y/o and above) </li></ul><ul><li>Incidence: 20% </li></ul><ul><li>Location: Antrum </li></ul><ul><li>Pain: epigastric,30mins. a.c., not relieved by food and antacids </li></ul><ul><li>Weight: loss </li></ul><ul><li>Hemmorhage: hematemesis </li></ul><ul><li>Complication: hemmorhage, CA </li></ul><ul><li>Duodenal Ulcer </li></ul><ul><li>“ Executive ulcer” (25 to 50 y/o) </li></ul><ul><li>- 80% </li></ul><ul><li>- duodenal bulb </li></ul><ul><li>- mid-epigastric, 3-4 </li></ul><ul><li>hrs p.c. 12mn-3am, </li></ul><ul><li>relieved by food </li></ul><ul><li>- weight gain </li></ul><ul><li>- melena </li></ul><ul><li>- perforation </li></ul>
  44. 49. <ul><li>Medications: </li></ul><ul><ul><li>Antacids -neutralizes hydrochloric acid and relieves pain; give 1-2 hrs after meals. </li></ul></ul><ul><ul><li>Ex. Maalox, Kremil S, Amphogel, Milk of Magnesia </li></ul></ul><ul><ul><li>Anti- ulcer agent - protect ulcers from acid and pepsin. Given 1 hr before meals (empty stomach) </li></ul></ul><ul><ul><li>H2 (histamine) receptor antagonists - inhibits gastric secretions; given 1 hour a.c. </li></ul></ul><ul><li>Ex. Cimetidine </li></ul><ul><li>Ranitidine </li></ul><ul><li>Famotidine </li></ul>
  45. 50. <ul><ul><li>Anticholinergics - decreases motility and volume of gastric secretions; give 30 min a.c. </li></ul></ul><ul><ul><li>Prostaglandin analogs – used to sustain the mucosal layer especially those on long treatment with aspirin. Ex. (Cytotec) </li></ul></ul><ul><ul><li>PPI- Proton Pump Inhibitor - supresses gastric acid by blocking enzymes associated with the final step of acid production. Given before meals. Ex.(Losec, Nexium) </li></ul></ul><ul><ul><li>Cytoprotective Drug - coats ulcer, taken on empty stomach. Ex.(Carafate) </li></ul></ul><ul><ul><li>Helicobacter Pylori Drug - anti-microbials </li></ul></ul><ul><ul><li>Ex. (Amoxicillin, Flagyl) </li></ul></ul><ul><ul><li>Anticholinergics - reduce gastric motility and HCL secretion </li></ul></ul><ul><ul><li>Ex. (AtSO4, Bentyl) </li></ul></ul>
  46. 51. <ul><li>Surgery </li></ul><ul><li>Gastrectomy - removal of stomach- anastomosis of esophagus and duodenum </li></ul><ul><ul><li>Billroth I - gastroduodenostomy </li></ul></ul><ul><ul><li>Billroth II - gastrojejunostomy </li></ul></ul><ul><ul><li>Vagotomy - resection of vagus nerve to inhibit vagal stimulation and decrease motility and gastric secretions </li></ul></ul><ul><ul><li>Pyloroplasty - enlargement of pyloric sphincter to permit passage </li></ul></ul>
  47. 52. <ul><li>Complication: </li></ul><ul><li>Dumping Syndrome </li></ul><ul><li>- rapid emptying of food especially concentrated carbohydrates in the duodenum; food draws fluid from the blood stream- hypovolemia </li></ul>
  48. 53. <ul><li>Signs and Symptoms Nursing Management: </li></ul><ul><li>faintness a. Small frequent meals </li></ul><ul><li>dizziness b. Chew food thoroughly </li></ul><ul><li>sweating c. Avoid high carbohydrate diet </li></ul><ul><li>nausea and d. Avoid liquid within meals </li></ul><ul><li>palpitations e. Lying down after meals- </li></ul><ul><li> flat for 5-30min p.c. </li></ul>
  49. 54. Chronic Inflammatory Bowel Disorders <ul><li>Crohn’s Disease </li></ul><ul><li>- ileum/ascending colon </li></ul><ul><li>- unknown, environmental </li></ul><ul><li>- 20-30 years, 40-60 years </li></ul><ul><li>- less, stool with pus and mucus </li></ul><ul><li>- 5-6 stools/day </li></ul><ul><li>Management: TPN, low fiber, Steroids, Ileostomy </li></ul><ul><li>Ulcerative Colitis </li></ul><ul><li>rectum/lower colon </li></ul><ul><li>Unknown, emotional </li></ul><ul><li>stress </li></ul><ul><li>15-40 years </li></ul><ul><li>Severe, stool with blood, pus and mucus </li></ul><ul><li>20-30 watery stools/day </li></ul><ul><li>Management: Diet-low fiber, Steroids, TPN, Ileostomy </li></ul>
  50. 55. <ul><li>Nursing Management of IBD: </li></ul><ul><li>a. Pharmacotherapeutics- sulfonamide or aspirin; corticosteroids; immunosuppressive drugs </li></ul><ul><li>b . Diet- cannot cause IBD; for patient comfort </li></ul><ul><ul><li>high calorie and high protein diet </li></ul></ul><ul><ul><li>bland low residue </li></ul></ul><ul><ul><li>limit dairy products </li></ul></ul><ul><ul><li>multivitamin and mineral supplement </li></ul></ul><ul><ul><li>liberal fluid intake of 2.5-3 liters/ day </li></ul></ul><ul><ul><li>TPN </li></ul></ul><ul><li>c. Surgery - ileostomy </li></ul>
  51. 56. <ul><li>Colorectal Cancer </li></ul><ul><li>80%- distal portion from sigmoid to anus </li></ul><ul><li>Early detection: </li></ul><ul><li>a. digital rectal exam annually after age 40 </li></ul><ul><li>b. occult blood test yearly after age 50 </li></ul><ul><li>c. proctosigmoidoscopy every 5 years after age 50 </li></ul><ul><li>Signs and symptoms </li></ul><ul><li>a. ascending colon- anemia and unexplained GI bleeding </li></ul><ul><li>b. descending colon and sigmoid colon- change in bowel habits and rectal bleeding, tenesmus </li></ul>
  52. 57. Diverticular Disorders <ul><li>Diverticula – sac or pouches caused by herniation of the mucosa through a weakened portion of the intestinal wall </li></ul><ul><li>Diverticulosis – multiple outpouchings </li></ul><ul><li>Diverticulitis – acute inflammation and infection caused by fecal material and bacteria </li></ul>
  53. 58. Management: <ul><li>High fiber diet/low fiber diet </li></ul><ul><li>Avoid nuts and seeds </li></ul><ul><li>Bulk-forming laxatives </li></ul><ul><li>Bed rest </li></ul><ul><li>Antibiotics, analgesics, anti-cholinergic </li></ul><ul><li>NGT to relieve distention </li></ul><ul><li>Weight loss to reduce intra-abdominal pressure </li></ul>
  54. 59. Accessory Organs <ul><li>Normal and altered liver function in cirrhosis : </li></ul><ul><li>1. Maintenance of normal size and drainage of blood from gastrointestinal tract- gastrointestinal symptoms like nausea and vomiting </li></ul><ul><li>2. Metabolism of carbohydrates- decreased energy </li></ul><ul><li>3. Metabolism of fats- hepatomegaly (fatty liver); </li></ul><ul><li>- decreased energy production; weight loss </li></ul>
  55. 60. <ul><li>4. Protein metabolism- decreased albumin production- </li></ul><ul><li>edema and ascites </li></ul><ul><li>- decreased production of clotting factors- bleeding; </li></ul><ul><li>anemia </li></ul><ul><li>5. Detoxification of exogenous substances- decreased </li></ul><ul><li>metabolism of sex hormones- loss of sex </li></ul><ul><li>characteristics; </li></ul><ul><li>- decreased metabolism of aldosterone- edema or </li></ul><ul><li>ascites; </li></ul><ul><li>- increased K or H2 excretion (hypokalemia or </li></ul><ul><li>alkalosis); </li></ul><ul><li>- decreased metabolism of ammonia- hepatic </li></ul><ul><li>encephalopathy </li></ul>
  56. 61. <ul><li>6. Detoxification of exogenous substances- decreased metabolism of drugs- altered effects, increased toxicity and side effects </li></ul><ul><li>7. Metabolism and storage of vitamins and minerals- decreased stores of vitamins and minerals- anemia and decreased energy production </li></ul><ul><li>8. Bile production and excretion- obstruction of bile </li></ul><ul><li>flow </li></ul><ul><li>- decreased Vit. K absorption- decreased clotting </li></ul><ul><li>factors- bleeding </li></ul>
  57. 62. <ul><li>9. Bilurubin metabolism- decreased uptake </li></ul><ul><li>from circulation- jaundice and pruritus; </li></ul><ul><li>- decreased conjugation- increased urine </li></ul><ul><li>bilurubin (dark urine); </li></ul><ul><li>- decreased GI excretion- acholic stools </li></ul>
  58. 63. Liver Cirrhosis <ul><li>Degenerative liver disorder caused by generalized cellular damage </li></ul><ul><li>Types: </li></ul><ul><li>Laennec’s or Alcoholic – results from chronic alcohol intake and is usually associated with malnutrition. </li></ul><ul><li>Postnecrotic – results from destruction of liver cells secondary to infection, metabolic liver disease or exposure to industrial chemicals </li></ul><ul><li>Biliary cirrhosis – scarring occurs around the bile ducts in the liver, usually related to chronic obstruction </li></ul>
  59. 64. Nursing Assessment: <ul><li>Early S/S </li></ul><ul><li>Weakness and fatigue </li></ul><ul><li>Anorexia </li></ul><ul><li>Tea-colored urine, clay-colored stool </li></ul><ul><li>Loss of axillary and pubic hair </li></ul><ul><li>Abdominal pain and shortness of breath </li></ul><ul><li>Skin itching </li></ul>
  60. 65. <ul><li>Late S/S </li></ul><ul><li>Nosebleeding, anemia </li></ul><ul><li>Spider angioma </li></ul><ul><li>Palmar erythema </li></ul><ul><li>Gynecomastia and testicular atrophy </li></ul><ul><li>Ascites and jaundice </li></ul>
  61. 66. <ul><li>Nursing Management: </li></ul><ul><li>Provide good nutrition. Vitamins and nutritional supplements promote healing of liver cells </li></ul><ul><li>Monitor vital signs for alcohol withdrawal </li></ul><ul><li>Weight patient daily. </li></ul><ul><li>Monitor intake and output </li></ul><ul><li>Give small frequent feedings rather than 3 full meals </li></ul><ul><li>Health teaching on abstinence from alcohol </li></ul>
  62. 67. <ul><li>7. Omission of all sedatives (detoxified by </li></ul><ul><li>liver) </li></ul><ul><li>8. Butter ball diet- foods rich in </li></ul><ul><li>carbohydrates are protein sparing </li></ul><ul><li>nutrients- they are used by the body for </li></ul><ul><li>energy in place of protein </li></ul><ul><li>9. Abdominal paracentesis </li></ul>
  63. 68. <ul><li>Complications: </li></ul><ul><li>1. Hepatic encephalopathy and coma </li></ul><ul><li>2. Portal hypertension- pressure >25-30 cm. of saline </li></ul><ul><li>3. Bleeding esophagastric varices </li></ul>
  64. 69. <ul><li>Nursing Management: </li></ul><ul><li>1. IV fluids </li></ul><ul><li>2. Antiemetics </li></ul><ul><li>3.Blakemore- Sengstaken Tube (esophageal balloon tamponade) </li></ul><ul><li>Nursing Interventions: </li></ul><ul><li>a. Keep a pair of scissors at bedside- in the event of </li></ul><ul><li>acute respiratory distress cut across tubing to </li></ul><ul><li>deflate balloon </li></ul><ul><li>b. Deflate esophageal balloon for 5 minutes at 8-10 </li></ul><ul><li>hrs interval to prevent necrosis </li></ul>
  65. 70. <ul><li>4. Porta- Systemic Shunting </li></ul><ul><li>a. Porta caval (portal vein to inferior vena </li></ul><ul><li>cava) </li></ul><ul><li>b. Splenorenal shunt (splenic to renal) </li></ul><ul><li>5. Diet high calorie, low to moderate protein, high carbohydrate, low fat with vitamins ABCDK </li></ul>
  66. 71. <ul><li>Cholelithiasis - stone formation in the gall bladder </li></ul><ul><li>Cholecystitis - inflammation of gall bladder usually precipitated by gallstones </li></ul><ul><li>Choledocholithiasis - stone formation at the common bile duct </li></ul><ul><li>Incidence: (5 F’s) </li></ul><ul><li>a. Female </li></ul><ul><li>b. Forty (age- 40 years and above) </li></ul><ul><li>c. Fair complexion </li></ul><ul><li>d. Fertile </li></ul><ul><li>e. Fat </li></ul>
  67. 72. <ul><li>Nursing Management: </li></ul><ul><li>a. Pain control - Demerol (drug of choice) </li></ul><ul><li>b. Anticholinergic - Atropine </li></ul><ul><li>c. ESWL Extracorporeal Shock Wave Lithotripsy- shock waves used to disintegrate gallstones </li></ul>
  68. 73. Pancreatitis <ul><li>Inflammation brought about by the digestion of this organ by the very enzymes it produces </li></ul><ul><li>Nursing Assessment: </li></ul><ul><li>- extreme upper abdominal pain </li></ul><ul><li>- persistent vomiting </li></ul><ul><li>- abdominal distention </li></ul><ul><li>- weight loss </li></ul><ul><li>- steatorrhea </li></ul><ul><li>- elevated serum amylase and lipase </li></ul><ul><li>- ecchymosis around umbilicus </li></ul><ul><li>- ecchymosis at flank area </li></ul>
  69. 74. Nursing Management : <ul><li>Administer anticholigernics, antacids, pancreatic extracts. Pancrealipase (Viokase) </li></ul><ul><li>NPO with NGT in place, no ice chips or hard candies as these will stimulate the pancreas. </li></ul><ul><li>IV fluids. May require TPN in moderate or severe cases </li></ul><ul><li>Provide Demerol for pain relief </li></ul><ul><li>Administer fat soluble vitamins </li></ul>
  70. 75. Hepatitis Inflammatory disease of the liver, usually caused by a virus, bacteria and toxic injury to the liver Types of Hepatitis 1. Toxic 2. Viral Viral Hepatitis Hepatitis A, B, C Prevention: - handwashing - enteric and blood, body fluids - do not recap needles - cannot donate blood - no intimate sexual contact during period of infection
  71. 76. <ul><li>Pre-icteric (prodromal phase) </li></ul><ul><li>- last for 1 week </li></ul><ul><li>Assessment : </li></ul><ul><li>1. fever and chills </li></ul><ul><li>2. nausea and vomiting </li></ul><ul><li>3. anorexia </li></ul><ul><li>4. hepatomegaly </li></ul>
  72. 77. <ul><li>Icteric Phase </li></ul><ul><li>- starts with onset of jaundice </li></ul><ul><li>- last from 4 to 6 weeks </li></ul><ul><li>Assessment : </li></ul><ul><li>- worsening anorexia </li></ul><ul><li>- dyspnea </li></ul><ul><li>- liver tenderness increases </li></ul><ul><li>Post icteric </li></ul><ul><li>- begins with disappearance of jaundice, normally lasts for several weeks up to 4 months </li></ul>
  73. 78. Management: <ul><li>Promote rest </li></ul><ul><li>Maintenance of food and fluid intake </li></ul><ul><li>Prevention of injury </li></ul><ul><li>Provide comfort </li></ul>
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