geeeee it’s giiiiiiii: a med-surg review of the gi...
TRANSCRIPT
9/25/2015
1
GEE
it’s
GI:
A Med-Surg Review of the GI
System
Laura Habighorst BSN RN CAPA CGRN
August 26, 2015
Objectives
Identify the organs of the GI System
Identify the accessory organs associated with the GI System
Identify the functions of those organs
Describe pathophysiology associated with the GI System
Develop nursing actions for the various pathologies discussed
ASSESSMENT
Four components and must be done in order
INSPECTION
Cullen’s sign: bruising around umbilicus
indicates intrabdominal bleeding
Grey-Turner’s sign: bruising of the lower
abdomen and flank indicates retroperitoneal
bleeding
ASSESSMENT
AUSCULTATION
Listen each quadrant 2-5 minutes
Bowel sounds are absent if not heard for 5 minutes
PERCUSSION
Tympany: heard over stomach and intestines
Dullness: presence of fluids or masses
PALPATION
Light palpation (one handed) of all four quadrants
Rebound tenderness indicates peritoneal irritation
The GI System
Mouth
Esophagus
Stomach
Small Intestine
Large Intestine
Rectum
Anus
Accessory organs: Gallbladder, biliary tract,
pancreas, and liver
Function of the GI System
Supply nutrients to body cells
Ingestion Digestion Absorption
Mechanical/chemical Movement of
breakdown of nutrients nutrients into
bloodstream
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The Mouth The Mouth
Salivary glands of the mouth secrete saliva and mucus
Humans produce 1-2 liters of saliva per day
Enzymes: Amylase breaks down large carbohydrates
primarily starches
Antibacterial prevent infection of the
mouth
Swallowing begins and is an “all or none reflex involving
over 25 muscles”
ESOPHAGUS ESOPHAGUS
23-25 cm in length and 2-3 cm in diameter
Swallowing reflex is initiated in the medulla
Muscles in esophagus are longitudinal and
circumferential and it is through peristalsis food
moves from mouth to stomach. Movement from
pharynx to stomach is 3-5 cm per second.
Pathophysiology of the
Esophagus Disorders of the esophagus include :
Gastroesophageal reflux disease (GERD)
Esophageal varices Barretts esophagus
Tumors Fistulas
Diverticula Inflammatory disease
Esophageal rings or webs
Foreign body obstruction
Mallory-Weiss tears
Motility disorders
GERD
GERD is the “abnormal reflux of gastric contents into the
esophagus.”
Causes: hiatal hernia, decreased lower esophageal sphincter
pressures, gastroparesis, smoking, and pregnancy
Common symptoms include epigastric pain (dyspepsia),
heartburn, regurgitation, difficulty swallowing (dysphagia),
and may also include asthma as a result of chronic aspiration
pneumonia or esophageal bleeding as a result of esophagitis.
25-35% of US population has GERD
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GERD continued
Diagnosis made by: patient history, EGD,
barium swallow, esophageal manometry,
pH studies.
Objectives for treatment include: relief of
symptoms, healing of damaged mucosa, and
prevention of complications.
GERD continued
Therapies include:
Pharmacologic - H2 Histamine blockers such as Tagamet or
Zantac; PPI (proton pump inhibitors) such as Prilosec,
Aciphex, Prevacid; antacids; Reglan or Urecholine (promote
gastric emptying and increase LES tone)
Patient education – small meals; avoid caffeine, mints, fats;
avoid lying down after meals; elevate head of bed to 40°; take
medications on a regular basis and as prescribed
Surgery - fundoplication
Esophageal Varices
Engorged vessels in the submucosa of the esophagus and may
be caused by portal hypertension as a result of chronic
hepatitis; alcoholic cirrhosis; portal vein thrombosis; or
congenital anomalies such as biliary atresia
Diagnosis made most often as an upper GI bleed (12% of all
upper GI Bleeds) and subsequent EGD
Treatment may include band ligation, use of sclerosing agents
such as sodium morrhuate, use of vasopressin; and
tamponade of the vessels (rare and dangerous)
Esophageal Varices
Esophageal Obstruction
Caused by achalasia ( peristalsis is absent with
increased LES pressures and incomplete
esophageal relaxation), stricture, tumor,
bacterial/viral infections , foreign body, or
anomaly
Occurs 1 in 100000 Americans most often between
the ages of 20 and 60.
Symptoms include dysphagia, painful swallowing,
substernal chest pain, bad breath, weight loss and
malnutrition
Esophageal Obstruction
Treatment includes removal of foreign objects or foodstuffs;
dilation of esophagus; esophageal stents; use of smooth
muscle relaxants such as nitrates and calcium-channel
blockers
Education for patients: frequent dilation may be required;
potential for surgery; sleep with HOB ^; semi-soft bland
diet; “if nifedipine (Procardia, Adalat) is prescribed
instruct to take with water and to avoid consuming
grapefruit because of food-drug interactions”; if stents are
required this is life-long.
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Mallory-Weiss Tears
Esophageal tear occurring most often at the
esophagogastric junction. Occurs in 8% of all
upper GI bleeds.
Causes – prolonged forceful vomiting, dry heaves,
alcohol, aspirin use
Diagnosed by EGD
Treatment includes cautery of bleeding area, liquid
or soft diet, avoidance of sharp foods, use of
medications such as Carafate to heal and protect
the esophagus
Barrett’s Esophagus
Normal esophageal tissue is replaced by epithelial tissue
typically of the fundus of the stomach and occurs as a
result of esophageal reflux. 20% of patients with reflux
will go on to develop Barretts.
Diagnosis is made by EGD and biopsy
Treatment centers on prevention of high-grade dysplasia
through the use of PPIs and esophageal dilatation.
Definitive treatment of high-grade dysplasia is offered
with HALO™ ablation therapy. Without treatment
adenocarcinoma of the esophagus is 30-50 times greater.
Barrett’s Esophagus Inflammatory Disease
Variety of disease processes can cause inflammation
of the esophagus: candida (yeast), herpes simplex
virus, cytomegalovirus (CMV), HIV, eosinophilic
esophagitis (immune mediated reaction
characterized by excessive histamine production)
Diagnosed by EGD, biopsy, and or tissue brushings
Treatment may include nystatin, viscous lidocaine,
histamine 2 blockers, sucralfate, or steroids
Eosinophilic Esophagitis Esophageal Candidiasis
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Stomach Stomach
Comprised of 3 parts: fundus, body, and the antrum but
includes the lower esophageal sphincter (between the
esophagus and stomach) and the pyloric sphincter
(between the stomach and small intestine)
Two functions: mixing and grinding of food through
peristalsis and the controlled emptying of the gastric
contents (CHYME) into the duodenum.
Stomach
Secretes the following : hydrochloric acid ,
pepsinogen, intrinsic factor (essential for
absorption of B12), mucus, gastrin,
serotonin, somatostatin, glucagon, and
bicarbonate.
Normal secretions occur at a rate of 0.5
ml/min; with a full stomach 3ml/min
Secretes a total of 1500-3000 ml of gastric
Pathophysiology of the
Stomach Disorders of the stomach include:
Peptic ulcer disease
Gastritis
Cancer
Hiatal hernia
Gastric outlet obstruction
Gastric motor disorders
Bezoars
Peptic Ulcer Disease
An upset in the balance of factors protecting
the stomach mucosa and those factors that
may cause disease.
Risk factors include: increased hydrochloric
acid production, chronic aspirin and NSAID
use, alcohol, cigarette smoking, family
history of gastric ulcers, and presence of
H.Pylori (a bacterial inflammation of the
stomach)
PUD continued
Stress Ulcers are a subset of Peptic Ulcer Disease
Causes: “severe trauma, burns, multisystem trauma, intense
hypotensive events, cardiac arrest, lengthy cranial surgery,
or massive infection” all of which may cause a decrease in
blood flow r/t shunting to vital organs resulting in
ischemia to gastric mucosa.
Bleeding may occur as late as three weeks post incident and
studies indicate “nearly 100%” of patients with the above
factors will present with stress ulcers. While only 5% may
actually bleed of those that do the mortality rate is
approximately 50%.
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PUD continued
Symptoms of PUD may include: epigastric pain, burning,
belching, “pain-food-relief” cycle, or “food-pain” cycle when
erosion occurs.
Medical treatment includes: In the absence of H. Pylori-PPIs, H2
blockers, Carafate, antacids (taken 1 and 3 hours after meals
and at bedtime) , clipping for bleeding, or surgery
In the presence of H. Pylori treatment includes a PPI, a single
or combination of antibiotics, and an antifungal.
Gastric Ulcer
Complications of PUD
TYPE
Hemorrhage – 15% of all ulcer
patients, hematemesis and/or
black stools
Perforation – 5-7% occurrence;
ulcer has eroded through stomach
wall and has spilled into the
peritoneum
Penetration – ulcer has eroded into
another organ
Obstruction – Pylorus becomes
edematous and does not allow
chyme to pass
TREATMENT
Control bleeding, fluid and
electrolyte replacement; in
presence of perforation or
penetration – antibiotics and
surgery; in presence of
obstruction any of the above
and NG tube decompression
as well as correction of any
metabolic acidosis
PUD continued
Nursing interventions : patient education
regarding medications and importance of
adhering to dosing schedules; elimination of
coffee, caffeine, spicy foods, carbonation,
alcohol, chocolate and any other food that
has caused pain and discomfort; small
meals; smoking cessation; avoidance of
aspirin and NSAIDS (if aspirin use is
necessary then enteric coated is best)
Gastritis
Inflammation of the gastric mucosa most
often caused by an irritant such as gastric
acid, bile reflux, medications, or toxins.
Maybe chronic or acute in nature
Treatment is to discover the pathology and
correct with PPIs, and/or antibiotics
Gastritis
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Cancer
Tends to be hereditary in nature occurring more often in
individuals with type A blood, blacks, men, and northern
United States population.
Incidence increases with “age, and those who eat foods high
in starch, nitrates, pickled vegetables, and salted fish and
meat.” A history of gastric ulcers, previous gastric
surgery, and adenomatous polyps also increase the risk of
gastric cancer - 97% of gastric cancer is adenomatous.
Develop primarily in the antrum or along the lesser curvature
of the stomach.
Cancer continued
Signs and symptoms: “epigastric discomfort,
vomiting , unexplained weight loss, early satiety,
anorexia, anemia, abdominal or epigastric mass,
gastric outlet obstruction, ascites, enlarged lymph
nodes in the supraclavicular areas”
Definitive diagnosis is made by EGD or EUS with
biopsy
5 year survival rate is 95% when caught early or is
superficial in nature (not extending beyond the
submucosa of the stomach)
Cancer continued
In US as compared to other countries with gastric screening
programs, gastric cancer is unfortunately discovered most
often in advanced stages and prognosis for 5 year survival
rate is approximately 5%.
Surgery is treatment of choice with partial or total
gastrectomy required as well as chemotherapy and/or
radiation.
Nursing interventions include emotional support, provision of
adequate nutrition, and good pain control
Hiatal Hernia
Occurs when part of the stomach protrudes through
the diaphragm and into the thoracic cavity. Most
are “sliding” hernias, that is a portion of the
stomach slides up above the level of the
diaphragm.
Common in older people and women
Complications include reflux with esophagitis,
heartburn, acid regurgitation, and dysphagia.
Treatment is surgical - fundoplication.
Gastric Outlet Obstruction
“Obstruction of the pyloric sphincter at the outlet of
the stomach blocks the flow of gastric contents
into the duodenum”
Symptoms include vomiting partially digested food,
gastric pain especially with eating, satiety relieved
by vomiting, metabolic alkalosis as a result of
frequent vomiting
Treatment includes restoration of fluid and
electrolytes, decompression of the stomach,
pyloric dilatation, and surgery if necessary
Gastric Motor Disorders
Most common is “Dumping Syndrome” following
gastrectomy, Roux-en-Y for weight loss, Billroth II or
gastrojejunostomy.
Occurs as a result of rapid food transition through the
stomach remnant and the “rapid introduction of
hyperosmolar solutions into the jejunum and the release of
hormones and vasoactive intestinal polypeptides into the
bloodstream.”
Symptoms include weakness, dizziness, tachycardia with a
pounding pulse, diaphoresis, flushing, abdominal cramps,
and diarrhea within 15-120 minutes of eating
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Gastric Motility Disorders
“Dumping Syndrome” continued:
Nutritional education is important for these patients in order
to slow down the gastric emptying rate.
High fat and high protein diet
Low carbohydrates
Fluids before and after meals not during the meal.
Medications such as Reglan have NOT been shown to be
effective.
Bezoars
THE HUMAN HAIRBALL
Compositions of foreign materials found in
the stomach that may cause gastric outlet
obstruction and abdominal pain. Composed
of vegetable or plant material or hair.
Treatment is EGD with removal of the matter.
Bezoar
Note the ruler in the right lower corner!
Small Intestine
Small Intestine Length: 23 feet Diameter: 1.5 inches
The mucosa of the small intestine is covered in villi and
microvilli. These increase the absorptive area of the small
intestine by 600 fold.
Receives 8 liters of fluid/day but passes 500-1000ml to the large
intestine
Comprised of the duodenum, the jejunum, and the ileum
The jejunum and the ileum are the principle sites for absorption
of nutrients. All nutrients are absorbed upon reaching
ileocecal valve and the majority of water absorption takes
place in the ileum as well.
Small Intestine continued
Duodenum: iron and calcium absorption
Jejunum: absorption of fats, proteins, and
carbohydrates
Ileum: absorption of vitamin B12 and bile
acids
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Small Intestine Pathology
Disease processes include: duodenal ulcers,
parasitic infestations, bacterial and viral
infections, Crohn’s disease, Meckel’s
diverticulum, vitamin B12 deficiency, small
bowel tumors
Malabsorption syndromes include: celiac
disease, Whipple’s disease, short bowel
syndrome, lactose intolerance
Infectious and Parasitic Disease
Nursing assessment is helpful in diagnosis: symptom pattern
and types of stools, exposure to affected individuals,
contaminated food or water, foreign travel.
Treatment may include fluid and volume replacement r/t large
amounts of watery diarrhea and diets should remain
unchanged. Antidiarrheals should not be used as they may
prolong the infection. When the source is identified,
antibiotics or antifungals may be prescribed.
Round Worms in Small Intestine Meckel’s Diverticulum
A congenital anomaly outpouching of the ileum which
contains normal tissues as well as gastric and pancreatic
tissue. These abnormal tissues for the ileum secrete acid
and pepsin and can cause ulcerations of the ileum.
Symptoms include: abdominal pain, bilious vomiting, and
“red currant jelly” like stools.
Diagnosed by Meckel’s scan – a radiology contrast study
Treatment is surgical removal of the diverticulum or resection
of the ileum
Meckel’s Diverticulum Celiac Disease or Celiac Sprue
Defined as poor food absorption and an intolerance to glutens
(wheat, oats, rye, barley, and by-products)
Causes: combination of environment and genetic
predisposition. Most common in females, familial history,
and those of northwestern European ancestry.
Symptoms: recurrent attacks of diarrhea, vomiting,
steatorrhea, abdominal distension, flatulence, cramps,
weakness, and anorexia. Muscle wasting and growth
failure in children and adolescents.
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Celiac continued
Diagnosis is made by EGD and biopsy.
Treatment is lifelong elimination of gluten containing foods.
Patient education includes identification of foods that contain
wheat fillers, ie. hotdogs, ice cream, candies. In some severe
cases of Celiac disease, a lactose free diet may need to be
added until exacerbation of Celiac is over.
www.GlutenFreeDietFoods.com
Complications may include osteoporosis, anemia, predisposition
to small bowel lymphoma, esophageal and gastric cancers
Large Intestine
Large Intestine/Colon
5-6 feet in length; and 2.5 inches in diameter
Consists of the cecum, appendix, ascending colon, hepatic
flexure, transverse colon, splenic flexure, descending
colon, sigmoid colon, rectum, and anus.
Functions in reabsorption of water and as a “reservoir for
fecal contents…and contains bacteria that synthesize
vitamins and breakdown cellulose.”
Large Intestine/Colon
Pathophysiology includes the following:
polyps, angiodysplasia, diverticular disease,
irritable bowel syndrome, colitis
(inflammatory bowel disease), cancer,
tumors, obstructions, anorectal disorders,
and parasitic disease.
POLYPS
Tissue mass that is attached to the colon wall, asymptomatic
in nature, diagnosed by colonoscopy or air-contrast barium
enema
Two Types
Pedunculated Sessile
Has a stem Broad flat base
Removed during colonoscopy and repeat colonoscopy
dependent upon pathology and family history (1-5 years)
Polyps
Pedunculated
Sessile
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Colon Cancer
Number One preventable cancer when colonoscopy is
performed according to standards endorsed by the
American Cancer Society and the American Society of
Gastroenterologists.
Age 50 or 10 years prior to the diagnosing age of a first
degree relative with history of colon cancer.
Repeat colonoscopy every 1-5 years dependent upon type of
polyps discovered.
Requires surgery when mass too big for removal
endoscopically, maybe resection with or without ostomy.
Colon Cancer
DIVERTICULAR DISEASE
Outpouchings or herniation of the colon wall
Diverticulitis is the inflammation of diverticulum
Affects 33-50% of all adults over age 50 and 50% of all
adults over age 80.
Contributing factors: “hypertrophy of the circular muscle of
the colon wall, increased intracolonic pressure, age-related
atrophy or weakness in bowel wall, chronic constipation
and straining, irregular uncoordinated bowel contractions,
lack of dietary fiber, and obesity”
Diverticular disease
Typically asymptomatic unless diverticulitis occurs.
Common symptoms of diverticulitis: fever, abdominal pain,
nausea/vomiting, constipation, left lower quadrant
tenderness
Complications: rupture of diverticulum with localized or
generalized peritonitis, abscess formation, edema, fistula
formation, erosion of underlying artery or vein, fibrosis
and narrowing.
Treatment: Mild – high fiber diet bulk forming laxatives;
Acute – bedrest, antibiotics, analgesics, and possibly
surgery
Diverticulum Irritable Bowel Syndrome
Most common GI disorder in the US; ranking a close second
to the common cold as a cause of work absenteeism.
Symptoms: abdominal distention, pain, constipation and/or
diarrhea. Anatomical abnormalities and other illnesses
have been ruled out. Symptoms may vary and have been
associated with emotional stress.
Treatment: Emotional support, high fiber diet,
anticholinergic agents
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Inflammatory Bowel Disease
Includes the following diagnoses: colitis,
Crohn’s disease, and ulcerative colitis. May
be caused as a result of altered immune
response or genetic.
Diagnosis made by colonoscopy or EGD
when involving the small intestine.
Inflammatory Bowel Disease
Ulcerative Colitis
• Affects 10 in 100000 people of all
races, gender, and society
• Affects left colon, starting in the
rectum and moves up
• Shallow ulcerations
• Bloody diarrhea or fatty stools
and may occur hourly
• Complications : megacolon,
bleeding, absorpton problems,
malignancy
Crohn’s disease
• Occurs between ages 15-30;
most common in Caucasions
and Jewish descent
• Can occur anywhere in the
GI tract primarily right
colon
• “Cobblestone effect”
• Abdominal pain, weight
loss, may have fatty stools
• Complications: fistulas,
stricture, malabsorption
Inflammatory Bowel Disease
Ulcerative Colitis
• Treatment: Bowel rest,
aminosalicylates and
corticosteroids; surgery
Crohn’s Disease
• Treatment: Bowel rest;
aminosalicylates,
corticosteroids, immuno-
suppressants, biologics;
surgery. Care is considered
palliative
Inflammatory Bowel Disease
Patient Education
Diet: high protein, high carbohydrate, low residue, low
roughage, low fat. Starchy foods enhance bowel transition
times. Corn, celery, cabbage, coconut increase risk of
blockage; radishes, spicy foods, onions, asparagus increase
odor of flatus. Enteral feedings may be required.
Meds: Must take meds as directed to prevent flares and heal
Emotional support paramount with Crohn’s
Pancreas
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Pancreas
Located behind the stomach and has 3 parts – head, body, and
tail
Functions: Endocrine – production of glucagon (alpha cells);
insulin (beta cells); somatosin (delta cells) – all of which
regulate blood sugars
Exocrine – produces enzymes that aid in
digestion – amylase, lipase, protease
Pathophysiology consists of pancreatitis, Zollinger-Ellison
Syndrome, malignant and benign tumors, and cystic
fibrosis
Acute Pancreatitis
• “Autodigestion of pancreas due to inappropriate activation
of pancreatic enzymes” causing a severe inflammation of
the pancreas
• Causes: ETOH, biliary disease, mumps, scarlet fever and
endocrine disorders
• S&S: Acutely ill with severe pain, guarding, rigidity of
abdomen, hypotension, respiratory distress, shock. Labs:
Increased amylase. Physical exam: Turner’s or Cullen’s
sign
Acute Pancreatitis
• Interventions: hemodynamic monitoring, antibiotics, pain
management, body positioning – sidelying, knees flexed,
HOB up. Patients hemodynamic status may change rapidly
with acute pancreatitis due to peripheral vascular collapse
and acute respiratory distress from fluid shifts.
• Treatment: Remove potential causes necrotic pancreatic
tissue, gallstones (cholecystectomy, ERCP), or repair
problems within biliary system with stents
• Prognosis: May never experience another episode.
Instruct patient to monitor ETOH and dietary intake
Chronic Pancreatitis
• “Continuous progressive and irreversible
destruction of cells with replacement with fibrotic
tissue.”
• Periods of remission and exacerbation
• Causes: Similar to acute; however, 80% have
history of ETOH abuse
• S&S: Similar to acute but may be less severe;
intense unrelenting pain; hypocalcemia; symptoms
of malabsorption (fatty stools, weight loss);
diabetes mellitus
Chronic Pancreatitis
• Interventions: Low fat, high carbohydrate, high protein
diet – allows pancreatic rest; encourage use of enzymatic
supplements appropriately after every snack and meal;
assess stools for fats; provide ETOH/drug abuse therapy;
provide effective pain management (meperidine preferred,
morphine may cause spasms of Sphinctor of Oddi); assess
for abscesses (elevated temp or change in pain); assess for
S&S of diabetes mellitus (polyuria, polydipsia,
polyphagia)
• Prognosis: Continual problem especially with continued
ETOH/drug use
Biliary System
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Biliary System
• Composed of the gallbladder and biliary duct; located
upper right quadrant of the abdomen
• “Main function is to store and concentrate bile, 600mls of
bile produced daily. Bile contains bile salts which are
needed for fat emulsion and digestion”
• Pathophysiology: cholecystitis, cholelithiasis, cholangitis,
cancer, congenital anamolies, sphincter of Oddi (regulates
flow of bile and pancreatic juices into the small
bowel)disease
Cholecystitis and cholelithiasis
• Inflammation of the gallbladder, typically caused by the
presence of stones or malfunctioning gall bladder
• Two types of stones – cholesterol and pigment
• Occurs in 10% of the US population. Fifth leading cause
of hospitalization. More common in postmenopausal,
postpartum women.
• S&S: Biliary colic pain that radiates to right shoulder,
RUQ tenderness and rigidity, N&V and indigestion
especially after fatty meals, fever, increased WBC,
jaundice with bile duct obstruction; HOWEVER, can be
asymptomatic
Gallstones
Cholecystitis and cholelithiasis • Treatment: pain management, fluid and electrolyte
maintenance, surgical (cholecystectomy, open or laparoscopic)
vs. endoscopic intervention (ERCP – endoscopic retrograde
cholangiopancreatography) vs. shock therapy (ESWL – extra
corporal shock-wave lithotripsy)
• Care after surgical procedure includes good respiratory care,
ie. incentive spirotomy; pain control including opioids and
NSAIDS; fat soluble vitamins
• Dietary instruction should include slow reintroduction of fatty
foods.
• Complications: cirrhosis, pancreatitis, rupture
LIVER Liver
• Largest internal organ and has the ability to regenerate
because of its vascularity
• Function includes: “metabolism and storage of fats,
carbohydrates, proteins, and vitamins; metabolism of
steroids; synthesis of albumin, globulin, prothrombin, and
fibrinogen; detoxification of the blood; excretion of
bilirubin; manufactures bile at a rate of 500-1000ml/24
hours.
• Pathophysiology: Hepatitis, liver failure, cirrhosis, tumors,
Wilson’s disease
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Hepatitis
Inflammation of the liver typically caused by a virus (one of
six different viruses) alcohol or drug induced
Six Viruses of Hepatitis
Hep A: spread through fecal/oral route
Hep B: spread via body fluids – IV drug use, dialysis, sex
Hep C: Posttransfusion or hemophiliacs
Hep D: replicates in the presence of Hep B
Hep E: water-bourne, mostly in underdeveloped countries
Hep G: transmitted parenterally and sexually
Hepatitis and Incidence
50000-60000 cases yearly in the US.
Hep A accounts for 40% of hepatitis worldwide
4 million Americans are infected with Hep C
Higher incidence in health care workers, IV drug users
Hepatitis
Four stages of symptoms
• Prodomal – “lasts 7-10 days, vague symptoms, of malaise,
headache, anorexia, low-grade fever, sometimes RUQ
pain, no jaundice”
• Icteric – “acute phase,” jaundice, lasts 4-6 weeks, minimal
discomfort with liver enlargement and tenderness
• Post-icteric – convalescent lasts 2-4 months
• Recovery – 6-12 months of liver rest
Hepatitis Treatment includes a variety of immuneglobulins dependent upon
virus; however, Hep C, E, and G do not have vaccines. The
CDC recommends all individuals be vaccinated for Hep B.
Nursing care includes dietary instruction (high calories with high
protein and carbs, low fat, and Vitamin B and K supplements;
abstain from ETOH/drugs; enforce and encourage complete
rest; maintain universal precautions; monitor liver enzymes for
liver failure (AST, ALT, bilirubin); instruct patient not to
donate blood, compliance with treatment plan essential to
avoid relapse
AND EVERYTHING ELSE! Obesity and Bariatrics
Body Mass Indexing
(based on height to weight computation)
Overweight: 25-29.9
Obese: greater than 30
Morbidly Obese: greater than 40
65% of Americans over 20 years of age are overweight
Second leading cause of preventable death
Complications: cardiopulmonary, muscular, GI, endocrine
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Obesity
Treatment include DIET, medications (appetite suppressant,
nutrient absorption blocking, UCG) and surgery
Types of surgery include: Lap Band, Roux-en-Y, J-Loop,
Sleeve
Nursing care: Head of bed elevated, use of lifts for moving
and bariatric furnitures, DVT prophylaxis, and dietary
instruction and reinforcement paramount – small frequent
meals, high protein, low carbohydrates and roughage.
Avoid drinking and eating at the sametime.
Bariatrics
Gastric banding Roux-en-Y
Bariatrics
Sleeve
Obesity
Complications include anastomatic leaks, ulcers, dumping
syndrome, malnutrition, vitamin deficiencies, anemia,
psychosocial
Leaks require further surgery and may require resection, roux-en-
y, or gastrectomy depending upon the site
Ulcers can occur in an area of the stomach that has decreased
blood supply after roux-en-y.
Obesity and Bariatrics
Complications, continued
Dumping syndrome: Occurs as a result of rapid
transit of food into the stomach and intestine
Nutritional deficiencies: Requires B-12 injection
due to inability to absorb B-12 in the
diminished gut.
Psychological support: “I am the same person
THANK YOU
GOOD LUCK
TO
EACH OF
YOU!
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BIBLIOGRAPHY
• Core Curriculum for Medical-Surgical
Nursing 4th Edition. 2009. Academy of
Medical-Surgical Nurses.
• Gastroenterology Nursing: A Core
Curriculum, 4th Edition. 2008. Society of
Gastroenterology Nurses and Associates