1. Eat smaller meals at more frequent intervals / adherence to six,small,dry, meals per day. 2. Avoid high-carbohydrate intake and concentrated sweets. 3. Consume liquids only between meals or refraining from taking fluids during meals but rather 2 hours after meals. 4. Lie down or rest after eating or on a recumbent position for ½ hour after meals. 1. Eat smaller meals at more frequent intervals / adherence to six,small,dry, meals per day. 2. Avoid high-carbohydrate intake and concentrated sweets. 3. Consume liquids only between meals or refraining from taking fluids during meals but rather 2 hours after meals. 4. Lie down or rest after eating or on a recumbent position for ½ hour after meals.
Abdominal cramps and spasms after meals Chronic diarrhea / steatorrhea Fever Flatulence Nausea Pain in the lower right quadrant Weight loss 3-4 semisoft stools / day with mucus and pus.
1. Subjective: indigestion after eating fatty or fried foods; pain, usually in the right upper quadrant of the abdomen, which may radiate to the back, nausea. 2. Objective: a. Vomiting; elevated temperature and WBC; jaundice may be present b. Diagnostic tests - Serum bilirubin is elevated - Ultrasonography determines the presence of gallstones; - Endoscopic retrograde cholangiopancreatography (ERCP) reveals presence of gallstones
1. Secure the drainage bag; avoid kinking of the tube 2. Measure drainage at least every shift; drainage during the first day may reach 500 to 1000 ml and then gradually decline 3. Apply ordered protective ointments around tube to prevent excoriation 4. When the tube is removed, usually in 7 days, observe stool for normal brown color, which indicates bile is again entering the duodenum T-tube tract removal – threaded catheter with basket ERCP removal – cut papilla of sphincter of Oddi enlarge opening, threaded cath with basket
Pain – meperidine, NG sxn, oral care, bedrest Nutrition – IVF, BT, wt, I/O, abd. Girth Respi – position, cough, deep breath Teaching – biliary dse, alcohol Goals: control pain, rest pancreas, support nutrition/hydration
Rest- wt, I/O, position, O2 Nutrition – early-CHON, B complex, Vit ACK, small freq, NGT/TPN, Aquasol ADE Late – adeq CHON – encephalopathy – (-) nitrogen balance mm wasting Skin care- SQ edema, immobility, jaundice, infxn, position, lotion Bleeding- pad rails, pressure injection site, melena, v/s, stool softeners Teaching- Alco Anon, low Na
varicesSengstaken - Blakemore tube for bleeding esophageal varices to apply direct pressure to the varices; vasopressin may be administered IV to control GI bleeding; plasminogen inhibitors to limit fibrinolysis
The pancreatic duct (major) joins the common bile duct in the sphincter of Oddi
The exocrine function of the pancreas is the secretion of digestive enzymes for carbohydrates, fats and proteins Pancreatic amylase - carbohydrates Pancreatic lipase (steapsin) - fats Trypsin, Chymotrypsin and Peptidases - proteins Bicarbonate - to neutralize the acidic chyme.
A series of x-rays of the esophagus and stomach. The patient drinks a liquid that contains barium (a silver-white metallic compound). The liquid coats the esophagus and x-rays are taken. This procedure is also called an upper GI series
Endoscopy is the use of a flexible tube (the fiberoptic endoscope) to visualize the GI tract and to perform certain diagnostic and therapeutic procedures. Images are produced through a video screen or telescopic eyepiece. The tip of the endoscope moves in four directions, allowing for wide-angle visualization.
Customizable to meet specific surgical needs, endoscopes can be fitted with scissors, knives, lasers, or cameras. Here, the endoscope is fitted with a small grasping tool to remove a toy lodged in the esophagus of an infant
34 yr old female. She also had an endoscopy first. (bleeding and/or pain was the reason she came in.) That pinkish/white mass is cancer. It's right by/on the valve between the ileum (small intestine) and cecum (large intestine.)
In most cases, administer TPN through a central vein such as subclavian. The fluid is highly concentrated to provide rapid dilution and thus decrease the risks of peripheral inflammation and thrombosis
GASTRITIS is an inflammation of the gastric mucosa (the stomach lining).
It may be acute or chronic. Acute gastritis produces mucosal reddening, edema, hemorrhage, and erosion. Chronic gastritis is common among elderly people and people with pernicious anemia. In chronic atrophic gastritis, all stomach mucosal layers are inflamed.
Diverticular disease has 2 clinical forms: DIVERTICULOSIS and DIVERTICULITIS.
Diverticulosis occurs when the intestinal mucosa protrudes through the muscular wall. The common sites for diverticula are in the descending and sigmoid colon, but they may develop anywhere from the proximal end of the pharynx to the anus.
Diverticulitis is an inflammation of the diverticula that may lead to infection, hemorrhage, or obstruction.
CROHN’s DISEASE is a chronic inflammatory disease of the small intestine, usually affecting the terminal ileum. It also sometimes affects the large intestine, usually in the ascending colon. It’s slowly progressive with exacerbations and remissions.
ULCERATIVE COLITIS is a major health problem and a potentially debilitating disease. It’s a type of inflammatory bowel disease that produces lesions primarily confined to the large bowel, with ulcerations of the large bowel’s mucosa and submucosa .
cholecystitis is the Inflammation of the gallbladder; usually caused by the presence of stones (cholelithiasis), which are composed of cholesterol, bile pigments, and calcium.
Common locations of gallstones Abnormal metabolism of cholesterol & bile salts Gallstone fromation Gallstones may obstruct gall bladder Stasis of bile Autodigestion Migration of gallstones to ducts Inflammatory response Iiritation & impaired blood flow Ischemia of the gallbladder wall Necrosis & gangrene Perforation Abscess & peritonitis
Moctanin is administered through a nasal biliary catheter to dissolve stones left in the bile duct after cholecystectomy. Dissolution may take 1 to 3 weeks. Observe the client for anorexia, nausea, vomiting, and abdominal pain.
Chenodiol ( chenix ) and ursodiol ( actigall ) are administered to dissolve small stones. Side effects include diarrhea ( especially with chenodiol ), elevation of hepatic enzymes,gastritis, and gastric ulcers. Dissolution takes between 6 months and 2 years, and the success rate is only about 30 %
PANCREATITIS is the inflammation of the pancreas. In acute pancreatitis, pancreatic enzymes are activated in the pancreas rather than the duodenum, resulting in tissue damage and autodigestion of the pancreas.
In chronic pancreatitis, chronic inflammation resu lts in fibrosis and calcification of the pancreas, obstruction of the d ucts, and destruction of the secreting acinar cells.
Inflammation caused premature acvtivation of enzymes Causes tissue damage Enzymes back up and spill out into pancreatic tissue Auto digestion Acute pancreatitis: Hemorrhagic necrotising pancreatitis Cell death & tissue damage Hemorrhage Multi organ failure Shock Chronic pancreatitis: Repeated attacks Cell replacement of fibrous tissue Inc.pressure & obstruction Inflammation & destruction Necrosis attack
Sites and position for paracentesis. A , Potential sites of needle or trocar insertion to avoid abdominal organ damage. B , The client sits comfortably; in this position, the intestines float back and away from the insertion site.
7. Surgical intervention to decrease portal hypertension: a portacaval shunt or TIPS
Surgical correction usually involves creation of a temporary colostomy, then a pull-through of the colon to a point near the rectum. After the reanastomosis has healed, the temporary colostomy is closed.