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1. GASTROINTESTINAL
SYSTEM

2. Gastroenterology is the branch of medicine that focuses on
the diagnosis and treatment of diseases of the
gastrointestinal (GI) tract, including the esophagus,
stomach, intestines, liver, gallbladder, and pancreas.

5. Organs Involved:
•Esophagus
•Stomach
•Small intestine
•Large intestine (colon)
•Rectum and anus
•Liver
•Gallbladder
•Pancreas

6. Functions of the Gastric

7. Function Description
Ingestion Taking in food through the mouth
Digestion Breaking down food into smaller molecules (mechanical +
chemical)
Absorption Nutrients from digested food are absorbed into the blood (mostly
in the small intestine)
Secretion Digestive enzymes, acids (like HCl), bile, and mucus are secreted
to aid digestion
Motility (Peristalsis) Coordinated muscular contractions move food through the GI
tract
Excretion (Defecation) Removal of undigested food and waste products via the rectum
as feces
Immune Function The GI tract contains gut-associated lymphoid tissue (GALT) to
protect against pathogens

8. Specific Organ Functions:

9. Organ Function
Mouth Chewing (mechanical digestion), salivary enzyme action (amylase)
Esophagus Moves food to stomach via peristalsis
Stomach Stores food, secretes acid (HCl), digests protein (pepsin), churns food
Liver Produces bile to digest fat, detoxifies substances
Gallbladder Stores and releases bile
Pancreas Secretes digestive enzymes and bicarbonate into small intestine
Small Intestine Major site of digestion and absorption of nutrients
Large Intestine (Colon) Absorbs water and electrolytes, forms stool
Rectum and Anus Stores and expels feces

10. Digestive Enzymes
• Mouth – Begins Digestion
Action: Chewing (mechanical digestion)
Enzyme: Salivary amylase
Acts On: Carbohydrates (starch)
Function: Breaks starch → maltose
• Step 2: Esophagus – Food Transport
Action: Peristalsis moves food to stomach
No enzymes
No digestion

11. Stomach – Protein Digestion Begins
Action: Churns food into chyme (mechanical)
Enzymes:
Pepsin (activated by HCl) → starts protein digestion
Gastric lipase → begins fat digestion (minor)
Acts On: Proteins and fats

12. Small Intestine – Main Site of Digestion & Absorption
➤ In Duodenum:
• Pancreas enzymes enter:
• Pancreatic amylase → carbs
• Trypsin, chymotrypsin → proteins
• Pancreatic lipase → fats
• Liver/Gallbladder:
• Release bile → emulsifies fats (helps lipase work)
➤ In Jejunum/Ileum:
• Intestinal enzymes:
• Maltase → maltose → glucose
• Sucrase → sucrose → glucose + fructose
• Lactase → lactose → glucose + galactose
• Peptidase → peptides → amino acids

13. • Large Intestine – Absorbs Water
No enzymes
Absorbs water, electrolytes
Forms stool
• Rectum/Anus – Elimination
Stores and expels feces
No digestion

14. Risk Factors for GI Disorders

15. Risk Factor Impact on GI System
Food/Drug Allergies Can trigger GI inflammation, nausea, vomiting, or diarrhea
Cardiac, Respiratory, Endocrine Disorders May slow GI motility → constipation or delayed emptying
Chronic Alcohol Use Damages mucosa → gastritis, pancreatitis, liver disease
Chronic Stress Affects GI motility → ulcers, IBS, indigestion
Chronic Laxative Use Leads to dependency and decreased natural bowel function
Chronic NSAID/Aspirin Use Causes mucosal erosion → ulcers, gastritis, bleeding
Diabetes Mellitus Increases risk of oral candidiasis, gastroparesis, constipation
Family History of GI Disorders Increases risk of IBD, colorectal cancer, GERD
Long-Term GI Disorders (e.g., UC) Raises risk of colorectal cancer
Neurological Disorders Affects chewing, swallowing, or peristalsis
Previous Abdominal Surgery/Trauma Can cause adhesions → bowel obstruction or altered motility
Tobacco Use Increases acid, delays healing, promotes GI malignancies

16. DISORDERS

17. Gastro esophageal Reflux Disease (GERD)
Gastro esophageal reflux is the backward flow of gastric content into
the esophagus
Signs and symptoms
Heartburn after meals, while bending over, or recumbent
May have regurgitation of sour materials in mouth, pain with
swallowing
Dyspepsia or indigestion
Atypical chest pain
Sore throat with hoarseness
17

18. Diagnosis
a. Barium swallow (evaluation of esophagus, stomach, small
intestine)
b. Upper endoscopy: direct visualization; biopsies may be
done
a.24-hour ambulatory pH monitoring
Medical management
Antacids for mild to moderate symptoms, e.g. Maalox, Mylanta,
Gaviscon
b. H2-receptor blockers: decrease acid production. e.g.
cimetidine, ranitidine, famotidine, nizatidine
c. Proton-pump inhibitors: reduce gastric secretions, promote
healing of esophageal erosion and relieve symptoms, e.g.
omeprazole (prilosec); lansoprazole
b.Promotility agent: enhances esophageal clearance and gastric
emptying
e.g metachlopromide
18

19. Nursing management
a. Elimination of acid foods (tomatoes, spicy, citrus foods, coffee)
b. Avoiding food which relax esophageal sphincter or delay gastric
emptying (fatty foods, chocolate, alcohol)
c. Maintain ideal body weight
d. Eat small meals and stay upright 2 hours post eating; no eating 3
hours prior to going to bed
e. Elevate head of bed on 6 – 8 blocks to decrease reflux

f. No smoking
a.Avoiding bending and wear loose fitting clothing
b.Drink adequate fluids at meals to increase food passage
c.Decrease the intake of highly seasoned foods
19

20. Gastritis
• Inflammation of the stomach lining (gastric mucosa) caused by
irritants or infection.
Category Examples
Medications NSAIDs, corticosteroids (↑ acid, ↓
mucus)
Infection H. pylori (most common chronic
cause)
Lifestyle Alcohol, caffeine, smoking, stress
Autoimmune Chronic gastritis (↑ risk of cancer)
CAUSES

21. Signs & Symptoms:
Epigastric pain or burning (esp. after eating)
Nausea/Vomiting
Bloating
Loss of appetite
Hematemesis (vomiting blood – red or coffee-ground)
Melena (black tarry stools – indicates GI bleed)

22. Nursing Interventions:
Action Why/
NPO during acute symptoms Rest GI tract
Monitor for GI bleeding Look for hematemesis, melena, ↓ Hgb
Avoid irritants No alcohol, caffeine, spicy foods, smoking
Administer meds as ordered PPIs (omeprazole), H2 blockers (ranitidine), antacids
If H. pylori positive Start triple therapy: PPI + 2 antibiotics

23. Medications
Class Examples NCLEX Note
PPI Omeprazole ↓ acid, promote healing
H2 Blockers Ranitidine ↓ acid, often used with PPIs
Antacids Aluminum/Mg Hydroxide Neutralize acid
Antibiotics Amoxicillin, Clarithromycin,
Metronidazole
For H. pylori eradication

24. Dumping Syndrome

25. • A rapid emptying of stomach contents into the small intestine after
gastric surgery (e.g., gastrectomy, gastric bypass).
Types:
Type Timing Features
Early 15–30 mins after meals GI symptoms (nausea, diarrhea,
cramping, bloating)
Late 1.5–3 hrs after meals Hypoglycemia symptoms
(sweating, weakness, dizziness,
confusion)

26. Symptoms:
Nausea, vomiting
Cramping, diarrhea
Palpitations, tachycardia
Sweating, dizziness
Hypoglycemia (late phase)

27. Management:
Eat small, frequent meals
High-protein, low-carb diet
Avoid fluids with meals (drink 30–60 min before/after)
Lie down after eating (to slow gastric emptying)
Avoid sugar, salt, dairy, and high-fat foods

28. Vitamin B12 Deficiency
(Cobalamin Deficiency)
• Function of Vitamin B12 (Cobalamin):
• DNA synthesis
• RBC production (prevents megaloblastic anemia)
• Maintains nerve function (myelin sheath)

29. • Causes:
Pernicious anemia (no intrinsic factor)
GI surgery (gastrectomy)
Malabsorption (Crohn’s, celiac)
Vegan diet
Drugs: Metformin, PPIs

30. • Symptoms:
• Fatigue, pallor
• Glossitis (red, sore tongue)
• Paresthesia, numbness
• Ataxia, memory issues
• Macrocytic anemia

31. • Treatment:
• IM B12 (pernicious anemia – lifelong)
• Oral B12 (if mild)
• Diet: meat, eggs, dairy

32. Hiatal Hernia
• Part of the stomach pushes through the diaphragm into the chest cavity
🔹 Types:
•Sliding (common): Stomach moves up with position changes → GERD
symptoms
•Rolling (paraesophageal): Stomach rolls beside esophagus → risk of
strangulation

34. • Symptoms:
• Heartburn
• Regurgitation
• Chest pain
• Dysphagia
• Worse when lying down

35. • Management:
• Small meals, avoid lying after eating
• Elevate head of bed
• Avoid spicy/fatty foods
• Meds: Antacids, PPIs, H2 blockers
• Surgery: Nissen fundoplication (if severe/rolling)

36. Diverticulosis vs Diverticulitis
Feature Diverticulosis Diverticulitis
Definition Pouches (diverticula) in colon wall Inflammation/infection of diverticula
Cause Low-fiber diet, aging Food/bacteria trapped in diverticula
Symptoms Usually asymptomatic LLQ pain, fever, nausea, constipation or
diarrhea
Complications Bleeding, diverticulitis Abscess, perforation, peritonitis, fistula

37. Diagnosis:
CT scan with contrast
Colonoscopy (only for diverticulosis; avoided during active diverticulitis)
Management:
Diverticulosis:
High-fiber diet (fruits, vegetables, whole grains)
↑ Fluids
Avoid nuts/seeds (controversial)

38. Diverticulitis:
NPO or clear liquids (rest bowel)
Antibiotics
Pain management
Surgery if severe (recurrent, abscess, perforation)
NCLEX Tip:
If the question says LLQ pain + fever + ↑ WBC, think diverticulitis

39. Inflammatory Bowel Disease (IBD)
• Chronic inflammatory disorders of the GI tract, mainly:
• Crohn’s disease
• Ulcerative colitis (UC)

40. • Crohn’s Disease
• A chronic inflammatory bowel disease (IBD) that causes inflammation anywhere in
the GI tract – from mouth to anus
• Ulcerative Colitis
• A chronic inflammatory bowel disease (IBD) causing continuous inflammation of
the colon and rectum
• Starts in rectum and moves upward (distal to proximal)

41. Crohn's Disease (regional enteritis)
A type of inflammatory bowel disease
Most commonly affects small bowel especially terminal ileum
Edema, inflammation and fibrosis occur in all layers of bowel wall
Signs and symptoms
Continuous or episodic diarrhea; liquid or semi-form
abdominal pain and tenderness in RLQ relieved by defecation
Fever, dehydration
Steatorrhea
Electrolyte imbalance
Fatigue, malaise
Weight loss, anemia
Fissures, fistulas, abscesses
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42. Signs and symptoms of ulcerative colitis
Diarrhea & abdominal pain (> 20 stools/day)
Rectal bleeding
Anorexia , weight loss , fever
Fever and tachycardia
Vomiting & dehydration
Anemia
Diagnosis
Colonoscopy
Barium enema
Stool studies
42

43. Feature Crohn’s Disease Ulcerative Colitis
Location Anywhere mouth to anus
(commonly ileum)
Colon & rectum only
Symptoms Diarrhea, weight loss, abdominal
pain (RLQ)
Bloody diarrhea, urgency, cramping
(LLQ)
Complications Fistulas, strictures, malnutrition Toxic megacolon, perforation, colon
cancer
Surgery Not curative Curative (total colectomy)
Comparison Table:

44. • Management (Both):
Diet: Low-residue, high-protein, high-calorie
Medications:
Aminosalicylates (e.g., sulfasalazine)
Corticosteroids
Immunosuppressants
Biologics (e.g., infliximab)
Surgery if unresponsive or complications

45. Hemorrhoids
• Swollen, inflamed veins in the rectum or anus caused by increased pressure.
🔹 Types:
Type
Location Symptoms
Internal Inside rectum Painless bleeding with stool
(bright red), mucus
External Outside anus Pain, swelling, itching,
bleeding

46. •Causes/Risk Factors:
• Constipation, straining
• Prolonged sitting
• Pregnancy
• Obesity
• Low-fiber diet

47. • Symptoms:
• Bright red rectal bleeding
• Pain or discomfort (esp. with external)
• Anal itching or swelling
• Feeling of incomplete evacuation

48. • Management:
High-fiber diet, ↑ fluids
Avoid straining
Sitz baths
Topical treatments (hydrocortisone, lidocaine)
Stool softeners
Surgical options (e.g., rubber band ligation, hemorrhoidectomy if
severe)

49. NCLEX Tip:
Painless bleeding = internal
Painful swelling = external
Focus on fiber, fluids, stool softeners in teaching

50. Appendicitis
• Inflammation of the vermiform appendix, usually due to obstruction (fecalith,
infection, or foreign body).
• Symptoms:
Initial: Dull periumbilical pain
Later: Sharp RLQ pain (at McBurney’s point)
Rebound tenderness
Nausea, vomiting
Low-grade fever
Anorexia
↑ WBC (mild to moderate)

52. Roving's sign
Deep palpation of the left iliac fossa may cause pain in the right
iliac fossa.
Psoas sign
The patient will lie with the right hip flexed for pain relief.
Obturator sign
Spasm of the muscle can be demonstrated by flexing and internally
rotating the hip.
Medical Management:
1. IV fluids and antibiotics.
2. Appendectomy
52
8/22/16

53. • Diagnosis:
Clinical signs
↑ WBC count
CT scan or ultrasound
Avoid rectal exam if suspected
• Avoid:
• No heat to abdomen
• No laxatives or enemas
• No deep palpation
(May cause rupture)

54. • Management:
• NPO, IV fluids
• Pain meds only after diagnosis
• Antibiotics
• Surgery (appendectomy): Laparoscopic preferred
• Complications:
• Rupture → peritonitis → sepsis (life-threatening)
• Abscess

55. NCLEX Tip:
Sudden pain relief = rupture!
Prep for surgery, maintain NPO, monitor for peritonitis

56. Hepatitis
• Inflammation of the liver caused by viral infection, toxins, alcohol, or
autoimmune conditions.

57. • Types of Viral Hepatitis (A–E):
Type
Transmission Key Points Chronic?
A Fecal–oral (contaminated
food/water)
Acute only, vaccine
available
❌ No
B Blood, sex, perinatal Vaccine available, can lead
to cirrhosis
✅ Yes
C Blood (IV drugs,
transfusion)
No vaccine, most become
chronic
✅ Yes
D Blood (requires Hep B
coinfection)
More severe with Hep B ✅ Yes
E Fecal–oral (common in
Asia)
Dangerous in pregnancy ❌ No (usually)

58. • General Symptoms:
• Fatigue
• Anorexia, nausea
• RUQ pain
• Jaundice
• Dark urine, clay-colored stools
• Hepatomegaly
• ↑ Liver enzymes (ALT, AST)

59. • Management:
• Rest, hydration
• Nutrition: High-calorie, low-fat
• Avoid alcohol, hepatotoxic drugs (e.g., acetaminophen)
• Antivirals for B and C
• Vaccines: A & B
• Post-exposure prophylaxis: immune globulin for A & B

60. • NCLEX Tips:
Hep A & E = fecal-oral → hand hygiene, safe food
Hep B, C, D = bloodborne → gloves, avoid needle sticks
Chronic = monitor for cirrhosis, liver cancer

61. • Client Education
Rest, hydrate, high-calorie low-fat diet
Avoid alcohol & acetaminophen
Practice good hand hygiene
No sharing of razors, toothbrushes
Use condoms, safe sex
• 🔹 Hep A & E (Fecal–oral):
• Wash hands after toilet, before eating
• Drink clean water, avoid raw/unsafe food
• Hep A vaccine available

62. • Hep B, C, D (Bloodborne):
• Avoid sharing needles
• Use condoms
• Hep B vaccine (also protects from D)
• Tip:
• Prevent spread, protect liver, avoid alcohol.

63. Bariatric Surgery
• Surgical procedures for weight loss by restricting food intake and/or nutrient
absorption
• 🔹 Types:
Type Mechanism Example
Restrictive Reduces stomach size Gastric sleeve, gastric band
Malabsorptive Bypasses intestines Biliopancreatic diversion
Combined Restriction + bypass Roux-en-Y gastric bypass

64. • Complications:
• Dumping syndrome
• Nutrient deficiencies (B12, iron, calcium)
• Anastomotic leak
• Gallstones
• Bowel obstruction

65. • Client Education:
Eat small, frequent meals
Chew food thoroughly
Avoid sugar, fat, and fluids with meals
Lifelong vitamin supplements (B12, iron, calcium,
multivitamins)
Watch for signs of dumping syndrome
Avoid NSAIDs & alcohol

66. NCLEX Tip:
After surgery: NPO → clear liquids → pureed → soft foods
B12 injections may be needed long-term

67. CHOLECYSTITIS
• Inflammation of the gallbladder, usually due to gallstones
(cholelithiasis) blocking the cystic duct.
🔹 Causes
Gallstones (most common)
Acalculous (no stones, seen in trauma, burns, sepsis)
Fat, Forty, Female, Fertile, Fair (classic risk factors)

68. • Key Signs & Symptoms
Symptom Description
RUQ pain Especially after fatty meals
Murphy’s sign Pain during inspiration when RUQ is palpated
Referred pain Right shoulder or scapula
Fever, chills Indicates infection
Jaundice
If bile duct obstructed

69. 🔹 Diagnostics:
Ultrasound – first choice
Labs:
• ↑ WBC (infection)
• ↑ Bilirubin, ALP (bile duct obstruction)
• Mild ↑ AST/ALT

70. •Nursing Interventions:
Intervention
Rationale
NPO status Rest GI tract, prepare for surgery
IV fluids Prevent dehydration
Pain management Opioids as prescribed
Antiemetics For nausea/vomiting
Monitor for complications (e.g., peritonitis, sepsis)
Educate post-op Low-fat diet, wound care

71. • 🔹 Surgical Option:
• Laparoscopic cholecystectomy (gold standard)
• Ambulation post-op helps with gas pain
• Watch for signs of infection or bile leak
• 🔹 NCLEX Alert: Fatty food triggers and Murphy’s sign often appear on
exams!

73. PEPTIC ULCER DISEASE
(PUD)
• Peptic ulcers are sores in the lining of the stomach or duodenum
caused by erosion from gastric acid and pepsin.
Type
Location
Gastric ulcer Lining of stomach
Duodenal ulcer First part of duodenum (small intestine)
Main Types:

74. Causes
H. pylori infection (most common cause)
NSAID overuse (e.g., ibuprofen, aspirin)
Smoking, stress, alcohol
Corticosteroids (long-term use)

75. Feature Gastric Ulcer Duodenal Ulcer
Pain timing 30–60 min after eating
(during meals)
1.5–3 hrs after eating (when fasting)
Food effect Worsens pain Relieves pain
Night pain Less common Common
Vomiting May relieve pain Not common
Risk for cancer ↑ Higher ↓ Lower
Hemorrhage risk Higher risk Present but lower
Body weight May cause weight loss Often normal weight
Gastric vs Duodenal Ulcer:

76. Signs & Symptoms (Both Types):
•Epigastric pain (burning, gnawing)
•Nausea/vomiting
•Bloating
•Hematemesis (vomiting blood)
•Melena (black tarry stool)

77. • 🔹 Complications
Hemorrhage (GI bleed)
Perforation → rigid abdomen, severe pain, rebound tenderness →
surgical emergency
Pyloric obstruction (gastric outlet obstruction)
• 🔹 Diagnosis:
• Endoscopy (EGD) – gold standard
• H. pylori testing: urea breath test, stool antigen, biopsy

78. Management
Class Example(s) Purpose
Antibiotics Clarithromycin, Amoxicillin,
Metronidazole
Eradicate H. pylori
PPIs Omeprazole, Pantoprazole Reduce acid secretion
H2 blockers Ranitidine, Famotidine Reduce acid
Antacids Aluminum hydroxide Neutralize acid
Mucosal protectants Sucralfate Forms protective barrier
🔸 Medications:

79. 🔸 Lifestyle/Dietary:
Avoid alcohol, caffeine, spicy/fatty foods, smoking, NSAIDs
Eat small, frequent meals
Stress reduction
🔹 Surgical (if complications):
Partial gastrectomy
Vagotomy (cut vagus nerve to reduce acid)
Pyloroplasty

80. common Surgical Interventions
🔹 a. Total Gastrectomy
Removes entire stomach
Esophagus attached to jejunum or duodenum
Needs lifelong B12
Risk: Dumping syndrome
🔹 b. Vagotomy
Cuts vagus nerve to ↓ acid
May slow gastric emptying

81. 🔹 c. Gastric Resection (Antrectomy)
Removes lower stomach (antrum)
Often with vagotomy
🔹 d. Billroth I (Gastroduodenostomy)
Partial gastrectomy + duodenum anastomosis
Less dumping
🔹 e. Billroth II (Gastrojejunostomy)
Partial gastrectomy + jejunum anastomosis
↑ Dumping syndrome risk

82. 🔹 f. Pyloroplasty
Widens pylorus
Aids gastric emptying, prevents obstruction

83. Postoperative Interventions – Gastric Surgery
a. Monitor vital signs – watch for bleeding, infection
b. Fowler’s position – promotes comfort & drainage
c. IV fluids/electrolytes – maintain balance, monitor I&O
d. Assess bowel sounds – return of peristalsis
e. Monitor NG suction – do not reposition/irrigate unless prescribed
f. NPO 1–3 days – until bowel sounds return
g. Diet progression – NPO → sips of water → small bland meals

84. 🔹 h. Monitor for complications:
Hemorrhage
Dumping syndrome
Diarrhea
Hypoglycemia
Bile reflux gastritis
Vitamin B12 deficiency

85. PANCREATITIS
• Acute or chronic inflammation of the pancreas which is Caused by escape
of digestive enzymes into surrounding tissue → self-digestion
• Acute Pancreatitis
– Sudden onset
– Can be single or recurrent attacks with complete resolution
• Chronic Pancreatitis
– Ongoing inflammation
– Leads to permanent damage, with scar tissue replacing pancreatic tissue

86. Precipitating Factors:
Alcohol use
Gallstones / biliary tract disease
Trauma
Viral/bacterial infections
Hyperlipidemia, hypercalcemia
Cholelithiasis, hyperparathyroidism
Ischemic vascular disease
Peptic ulcer disease

87. Signs & Symptoms:
Symptoms Description
Epigastric pain Radiates to back, worse when lying down, better when leaning forward
N/V Common
Fever, tachycardia Inflammatory response
Abdominal distension ↓ Bowel sounds
Cullen’s sign Bluish discoloration around umbilicus
Grey Turner’s sign Bluish flank discoloration

88. Diagnosis:
•↑ Amylase, ↑ Lipase (lipase more specific)
•↑ WBC, ↑ glucose, ↑ triglycerides
•CT abdomen (most accurate imaging)

89. Nursing Interventions:
Intervention
Rationale
NPO status Rest pancreas
IV fluids Prevent dehydration
Pain control Usually with opioids (e.g., morphine)
NG tube For vomiting or severe ileus
Electrolyte monitoring Especially calcium (↓ Ca = severe case)
Positioning Leaning forward relieves pain

90. 🔸 Complications:
Hypovolemia
Pancreatic pseudocyst
ARDS
Hypocalcemia → Trousseau’s/Chvostek’s signs
Sepsis

91. • NCLEX Tips:
NPO + IV fluids + opioids = initial management
No alcohol, caffeine, or fatty foods
Watch for ↓ calcium: muscle twitching, tetany
Report Cullen’s or Grey Turner’s sign immediately

92. CIRRHOSIS
Cirrhosis is a chronic, progressive liver disease characterized by:
Widespread inflammation
Fibrosis (scarring)
Permanent damage to liver cells
Replacement of healthy liver tissue with non-functional scar tissue
• This leads to disrupted liver function, including:
Impaired detoxification
Reduced protein synthesis
Obstructed blood flow through the liver

93. 🔹 Causes:
Alcohol abuse (Laennec’s)
Hepatitis B/C
Nonalcoholic fatty liver disease
Biliary obstruction
Drugs/toxins

94. 🔹 Key Symptoms:
Fatigue, weakness
Jaundice
Ascites (fluid in abdomen)
Edema
Itching (pruritus)
Bruising/bleeding (↓ clotting factors)
Spider angiomas, palmar erythema
Asterixis (flapping hands – hepatic encephalopathy)
Confusion (↑ ammonia)

97. 🔹 Complications:
Portal hypertension → esophageal varices
Hepatic encephalopathy
Hepatorenal syndrome
Coagulopathy / Bleeding Tendencies
Jaundice
Hypoalbuminemia
Ascites
. Infection Risk

98. • Lab Findings
Lab Test Expected Change Reason
ALT / AST ↑ Elevated Liver cell injury
Bilirubin (total) ↑ Elevated Impaired bilirubin metabolism
Ammonia ↑ Elevated Liver can’t convert to urea → encephalopathy
Albumin ↓ Decreased ↓ Protein synthesis
Platelets ↓ Decreased Hypersplenism from portal HTN
PT / INR ↑ Prolonged ↓ Clotting factor production
Sodium ↓ (with ascites) Dilutional hyponatremia
Creatinine / BUN ↑ (late stages) Hepatorenal syndrome

99. • Physical Assessment Findings
🔹 General Appearance
• Fatigue
• Weight loss
• Weakness
• Jaundice (yellow skin/sclera)

100. 🔹 Skin Changes
• Spider angiomas (face, chest)
• Palmar erythema (red palms)
• Pruritus (itching)
• Ecchymosis (easy bruising)
🔹 Abdomen
• Ascites (abdominal distention, fluid wave)
• Caput medusae (dilated abdominal veins)
• Hepatomegaly or shrunken, nodular liver on palpation
• Splenomegaly

101. 🔹 Neurologic
• Asterixis (flapping tremor of hands)
• Confusion, disorientation
• Signs of hepatic encephalopathy
🔹 Reproductive
• Gynecomastia (male breast enlargement)
• Testicular atrophy
• Menstrual irregularities

102. 🔹 Other
• Peripheral edema (especially in lower extremities)
• Musty or sweet breath odor (fetor hepaticus)
• NCLEX Tip:
• Look for signs of portal hypertension, bleeding, encephalopathy, and
ascites.

103. Nursing Care
🔹 1. Monitor & Assess
Vital signs, weight, abdominal girth (ascites)
Neurologic status (for hepatic encephalopathy)
Bleeding (gums, stool, bruising)
Labs: LFTs, ammonia, PT/INR, albumin

104. 🔹 2. Dietary Management
Low-sodium diet (for ascites)
High-calorie, moderate-protein (unless encephalopathy →
low-protein)
Vitamin supplements (B-complex, A, D, E, K)
🔹 3. Prevent Complications
Position: Semi-Fowler’s (promote breathing)
Monitor for signs of esophageal varices bleeding
Administer lactulose (↓ ammonia)
Give diuretics (e.g., spironolactone) for ascites
Avoid hepatotoxic meds (e.g., acetaminophen)

105. 🔹 4. Promote Skin Integrity
Use soft bedding, turn frequently
Apply lotions for itching
🔹 5. Client Education
Avoid alcohol, NSAIDs, and raw seafood
Importance of med compliance
Report signs of bleeding, confusion, jaundice

106. Esophageal Varices
🔹 Esophageal Varices are:
Dilated veins in the lower esophagus
Caused by portal hypertension Often due to liver cirrhosis
Can rupture → life-threatening bleeding

107. • Pathophysiology
Cirrhosis → Liver scarring
Blocked liver blood flow
↑ Portal vein pressure (portal hypertension)
Blood backs up into esophageal veins
Veins dilate → varices
Thin walls → prone to rupture

108. 🔹 Signs & Symptoms
Hematemesis (vomiting blood)
Melena (black stools)
Hypotension, tachycardia
Signs of shock (if ruptured)

109. • 🔹 Management
Prevent rupture:
▪ Avoid heavy lifting, coughing, constipation
▪ Soft diet, avoid alcohol
Medications:
▪ Beta-blockers (e.g., propranolol) – ↓ portal pressure
▪ Vasopressin, octreotide – control bleeding
Procedures:
▪ Endoscopic banding
▪ Sclerotherapy
▪ Balloon tamponade (Sengstaken-Blakemore tube)
▪ TIPS (shunt between portal & hepatic vein)

111. 🔹 Nursing Care
Monitor for bleeding
Maintain NPO if bleeding
Prepare for endoscopy
Monitor vitals, CBC, coagulation
Educate to avoid alcohol and straining

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