Chapter 49 Gastrointestinal Problems Part 1 Flashcards
What are the primary functions of the gastrointestinal (GI) system?
Process food substances, absorb products of digestion into the blood, excrete unabsorbed materials, provide an environment for microorganisms to synthesize nutrients
Microorganisms synthesize nutrients such as vitamin K.
What is the role of intrinsic factor in the GI system?
Necessary for the absorption of vitamin B12
Intrinsic factor is produced by parietal cells in the stomach.
What controls gastric acidity in the stomach?
Gastrin
Gastrin is a hormone that stimulates the secretion of gastric acid.
What are the three parts of the small intestine?
- Duodenum
- Jejunum
- Ileum
Each part has specific lengths and functions in digestion.
What is the length of the duodenum?
8 to 10 inches (20 to 25 cm)
The duodenum is attached to the distal end of the pylorus.
What is the function of the jejunum?
About 8 feet (2.5 meters) long
The jejunum is involved in nutrient absorption.
What is the length of the ileum?
About 12 feet (3.7 meters) long
The ileum terminates in the cecum.
What is the role of saliva in digestion?
Contains the enzyme amylase (ptyalin)
Amylase aids in the digestion of starch.
What does amylase do?
Digests starch to maltose
Amylase is present in saliva.
What is the function of maltase in the digestive system?
Reduces maltose to monosaccharide glucose
Maltase is an enzyme produced in the small intestine.
What does lactase split lactose into?
Galactose and glucose
Lactase is essential for lactose digestion.
What is the function of sucrase?
Reduces sucrose to fructose and glucose
Sucrase facilitates the digestion of sugars.
What do nucleases do?
Split nucleic acids to nucleotides
Nucleases are enzymes found in pancreatic intestinal juice.
What is the role of enterokinase?
Activates trypsinogen to trypsin
Enterokinase is secreted in the small intestine.
What is the length of the large intestine?
About 5 feet (1.5 meters) long
The large intestine absorbs water and eliminates wastes.
What are the four parts of the colon?
- Ascending colon
- Transverse colon
- Descending colon
- Sigmoid colon
The colon also includes the rectum.
What is the function of the lower esophageal (cardiac) sphincter?
Prevents reflux of gastric contents into the esophagus
This sphincter helps maintain a one-way flow of food.
What regulates the rate of stomach emptying into the small intestine?
Pyloric sphincter
The pyloric sphincter allows food to exit the stomach gradually.
What is the function of hydrochloric acid in the stomach?
Kills microorganisms, breaks food into small particles, facilitates gastric enzyme activation
Hydrochloric acid is a key component of gastric juice.
What is pepsin’s role in gastric juice?
Converts proteins into proteoses and peptides
Pepsin is the chief coenzyme of gastric juice.
What does the peritoneum do?
Lines the abdominal cavity and forms the mesentery that supports the intestines and blood supply
The peritoneum plays a crucial role in organ support and protection.
What are some risk factors associated with the gastrointestinal system?
- Allergic reactions to food or medications
- Cardiac, respiratory, and endocrine disorders
- Chronic alcohol use
- Chronic high stress levels
- Chronic laxative use
- Chronic use of NSAIDs
- Diabetes mellitus
- Family history of gastrointestinal disorders
- Long-term gastrointestinal conditions
- Neurological disorders
- Previous abdominal surgery or trauma
- Tobacco use
These factors can lead to various gastrointestinal issues, including constipation and increased risk of cancer.
What is the largest gland in the body and its weight range?
The liver, weighing 3 to 4 pounds (1.4 to 1.8 kg)
The liver plays a crucial role in various bodily functions.
What function do Kupffer cells serve in the liver?
They remove bacteria in the portal venous blood
Kupffer cells are specialized macrophages located in the liver.
List three functions of the liver.
- Removes excess glucose and amino acids from portal blood
- Synthesizes glucose, amino acids, and fats
- Aids in the digestion of fats, carbohydrates, and proteins
The liver is essential for metabolism and digestion.
How much bile does the liver secrete daily?
500 to 1000 mL of bile/day
Bile is important for the emulsification of fats.
What is the role of the common bile duct?
Delivers bile to the gallbladder and to the duodenum via the pancreatic duct
The common bile duct plays a key role in digestion.
What is the function of the gallbladder?
Stores and concentrates bile, contracts to force bile into the duodenum
This process is particularly important during the digestion of fats.
What is the sphincter of Oddi?
Located at the entrance to the duodenum
It regulates the flow of bile and pancreatic juices into the duodenum.
Name two diagnostic procedures for the gastrointestinal system.
- Abdominal ultrasound
- Capsule endoscopy
Various diagnostic procedures help in assessing gastrointestinal health.
What does the presence of fatty materials in the duodenum stimulate?
The liberation of cholecystokinin
Cholecystokinin triggers gallbladder contraction.
What are the two main functions of the pancreas?
- Exocrine (secretes sodium bicarbonate and digestive enzymes)
- Endocrine (secretes glucagon and insulin)
The pancreas plays a vital role in digestion and blood sugar regulation.
What is the purpose of a barium swallow study?
To examine the upper gastrointestinal tract under fluoroscopy
The study involves the client drinking barium sulfate.
What should be withheld before a barium swallow procedure?
Foods and fluids for 4 to 8 hours prior to the test
This is crucial for accurate imaging results.
What may be prescribed post-barium swallow procedure?
A laxative may be prescribed
This helps in passing the barium from the body.
Fill in the blank: The liver secretes bile to _______ fats.
[emulsify]
Emulsification is essential for fat digestion.
What color will stools appear after a barium procedure?
Gray or chalky white for 24 to 72 hours postprocedure
Barium can cause a bowel obstruction.
What is capsule endoscopy?
A procedure using a small wireless camera shaped like a medication capsule that detects bleeding or changes in the lining of the small intestine.
How does the capsule in capsule endoscopy function?
The camera travels through the digestive tract and sends multiple pictures to a small box worn by the client.
What is required from the client before capsule endoscopy?
Bowel preparation, informed consent, and a clear liquid diet the evening before the exam.
What is the NPO status for capsule endoscopy?
NPO (nothing by mouth) status is maintained for the first 2 hours of testing.
What should clients do regarding insulin during the NPO period for capsule endoscopy?
Reduce insulin amounts according to the gastroenterologist’s recommendations.
What should be monitored post capsule endoscopy?
Vital signs and the potential for sedation to cause amnesia for a few hours.
What is gastric analysis used for?
To assess clients with recurrent ulcers after surgical vagotomy.
What does gastric analysis involve?
Passage of a nasogastric (NG) tube to aspirate gastric contents for analysis of acidity, appearance, and volume.
How are gastric contents collected during gastric analysis?
Specimens are collected every 15 minutes for 1 hour.
What medications may be administered during gastric analysis?
Histamine or pentagastrin to stimulate gastric secretions.
What is ambulatory pH monitoring used for?
To diagnose esophageal reflux of gastric acid.
What is required before gastric analysis?
Fasting for at least 8 to 12 hours, avoiding tobacco and chewing gum for 24 hours, and withholding medications that stimulate gastric secretions.
What should be done with gastric samples if not tested within 4 hours?
Refrigerate gastric samples.
What is upper GI endoscopy also known as?
Esophagogastroduodenoscopy.
What is the purpose of upper GI endoscopy?
To view the gastric wall, sphincters, and duodenum, and obtain tissue specimens.
What is required from the client before upper GI endoscopy?
Informed consent and NPO status for 6 to 8 hours.
What should be avoided before upper GI endoscopy?
Anticoagulants and nonsteroidal antiinflammatory drugs for several days unless otherwise indicated.
What type of medications are administered before the scope insertion in upper GI endoscopy?
Local anesthetic and medication for moderate sedation.
How should the client be positioned during upper GI endoscopy?
On the left side to facilitate saliva drainage.
What should be monitored during upper GI endoscopy?
Airway patency and oxygen saturation using pulse oximetry.
What are the postprocedure instructions for upper GI endoscopy?
Monitor vital signs, maintain NPO until gag reflex returns, and monitor for signs of perforation.
What can relieve a minor sore throat post upper GI endoscopy?
Lozenges, saline gargles, or oral analgesics (not given until the gag reflex returns).
What is a fiberoptic colonoscopy?
A fiberoptic endoscopy study in which the lining of the large intestine is visually examined; biopsies and polypectomies can be performed.
What is monitored continuously during a colonoscopy?
Cardiac and respiratory function.
What is the preferred position for a client during a colonoscopy?
Lying on the left side with knees drawn up to the chest.
What is required for adequate preparation before a colonoscopy?
Adequate cleansing of the colon as prescribed by the PHCP.
What type of diet should a client follow the day before a colonoscopy?
A clear liquid diet, avoiding red, orange, and purple liquids.
How long should a client be NPO before a colonoscopy?
4 to 6 hours.
What must be obtained before performing a colonoscopy?
Informed consent.
What type of sedation is administered during a colonoscopy?
Moderate sedation administered intravenously.
What should be monitored post-procedure for a colonoscopy?
Vital signs.
What position should be maintained post-procedure to promote passing of flatus?
Left lateral position.
What are expected sensations after a colonoscopy?
Passing flatus, abdominal fullness, and mild cramping.
What should a client report to the PHCP after a colonoscopy?
Any bleeding.
What are signs of bowel perforation and peritonitis?
- Guarding of the abdomen
- Abdominal distention
- Nausea and vomiting
- Diminished bowel sounds
- Inability to pass flatus
- Rebound tenderness or ‘Blumberg’s sign’
- Increased temperature
- Pallor
- Progressive abdominal distention and abdominal pain
- Restlessness or altered mental status
- Tachycardia and tachypnea
- Dizziness and light-headedness
- Decreased blood pressure and tachycardia
What does laparoscopy allow for?
Direct visualization of organs and structures within the abdomen; biopsies may be obtained.
What is endoscopic retrograde cholangiopancreatography (ERCP) used for?
Examination of the hepatobiliary system via a flexible endoscope.
When is ERCP preferred over noninvasive diagnostic tests?
When an intervention will probably be required.
What should be monitored closely if medication is administered before ERCP?
Signs of respiratory and central nervous system depression, hypotension, oversedation, and vomiting.
How long should a client be NPO before an ERCP?
6 to 8 hours.
What must be inquired about pre-procedure for ERCP?
Previous exposure to contrast media and any sensitivities or allergies.
What medications should be avoided before ERCP?
Anticoagulants and nonsteroidal anti-inflammatory drugs unless otherwise indicated.
What should be monitored post-procedure for ERCP?
Return of the gag reflex.
What should be monitored for after gastrointestinal interventions?
Signs of perforation or peritonitis
Refer to Box 49.3 for specific signs.
What does magnetic resonance cholangiopancreatography (MRCP) visualize?
Biliary and pancreatic ducts
It is a noninvasive alternative to ERCP.
What is the primary purpose of endoscopic ultrasonography?
To provide images of the GI wall and digestive organs.
What should be monitored post-endoscopic procedures?
Return of the gag reflex
If the gag reflex has not returned, the client could aspirate.
What is a computed tomography (CT) scan used for?
To obtain a noninvasive cross-sectional view of the abdomen.
What should a client do pre-CT scan if contrast medium will be used?
Assess for previous sensitivities and allergies.
What are the preprocedure instructions for a CT scan?
- NPO for at least 4 hours
- Encourage client to verbalize concerns.
What should a client do post-CT scan to avoid complications?
Drink fluids to avoid dye-induced renal failure.
What is paracentesis?
A procedure to obtain or remove fluid from the peritoneal cavity.
What is the purpose of fluid obtained during paracentesis?
To determine the cause of ascites and evaluate for infection or cancer.
What should be done to prepare a client for a paracentesis?
- Ensure understanding of the procedure
- Obtain vital signs
- Measure abdominal girth.
What are the postprocedure actions for paracentesis?
- Apply dressing to the puncture site
- Monitor for hematuria
- Measure abdominal girth.
What should be monitored closely after paracentesis?
Vital signs, especially blood pressure and pulse.
What can rapid removal of fluid during paracentesis lead to?
Decreased abdominal pressure and potential shock.
What is a liver biopsy?
A procedure where a needle is inserted to obtain a tissue sample from the liver.
What is the required fasting period before a gastrointestinal procedure?
8 to 12 hours
This ensures that the stomach is empty, reducing the risk of complications during the procedure.
What baseline assessments should be performed preprocedure?
Vital signs
This includes measuring temperature, pulse, respiration, and blood pressure.
What coagulation tests should be assessed before a gastrointestinal procedure?
- Prothrombin time
- Partial thromboplastin time
- Platelet count
These tests help evaluate the client’s risk of bleeding during the procedure.
What position should the client be placed in during the procedure?
Supine or left lateral position
This position exposes the right side of the upper abdomen for better access.
What postprocedure care should be provided regarding the biopsy site?
Assess for bleeding
Monitoring for bleeding is crucial to prevent complications.
How long should the client maintain bed rest postprocedure?
12 to 14 hours
This helps ensure stability and reduces the risk of complications.
What should the client do to decrease the risk of bleeding after the procedure?
Lie on the right side with a pillow under the costal margin for 2 hours
This position helps apply pressure to the biopsy site.
What symptoms should prompt notification of the primary health care provider after a procedure?
- Dyspnea
- Cyanosis
- Restlessness
These symptoms may indicate a serious complication like pneumothorax.
What is assessed in stool specimens?
- Consistency
- Color
- Occult blood
These assessments help in diagnosing gastrointestinal issues.
What is required for quantitative 24- to 72-hour stool collections?
Must be kept refrigerated
This preserves the integrity of the sample for accurate testing.
What condition does the urea breath test detect?
Helicobacter pylori
This bacterium is associated with peptic ulcer disease.
How long after consuming carbon-labeled urea should a breath sample be provided?
10 to 20 minutes
This timing is crucial for accurate testing results.
What medications should be avoided before the urea breath test?
- Antibiotics
- Bismuth subsalicylate for 1 month
- Sucralfate and omeprazole for 1 week
- Cimetidine, famotidine, and nizatidine for 24 hours
Avoiding these medications helps ensure accurate test results.
What is the purpose of esophageal pH testing?
To diagnose or evaluate treatment for gastroesophageal reflux disease
This test helps in understanding the severity and management of reflux symptoms.
What liver enzyme levels indicate liver damage or biliary obstruction?
- Alkaline phosphatase (ALP)
- Aspartate aminotransferase (AST)
- Alanine aminotransferase (ALT)
Elevated levels of these enzymes signal potential liver issues.
What is the normal reference interval for prothrombin time (PT)?
11 to 12.5 seconds
Prolonged PT indicates potential liver dysfunction or bleeding risk.
What does an increase in cholesterol level indicate?
Pancreatitis or biliary obstruction
Monitoring cholesterol levels can provide insight into pancreatic and liver health.
What does an increase in bilirubin levels indicate?
Liver damage or biliary obstruction
Normal reference intervals: total, 0.3 to 1.0 mg/dL; indirect, 0.2 to 0.8 mg/dL; direct, 0.1 to 0.3 mg/dL.
What do increased values for amylase and lipase levels indicate?
Pancreatitis
Normal reference intervals: amylase, 60 to 120 Somogyi units/dL; lipase, 0 to 160 U/L.
What is gastroesophageal reflux disease (GERD)?
The backflow of gastric and duodenal contents into the esophagus.
What causes reflux in GERD?
Incompetent lower esophageal sphincter (LES), pyloric stenosis, or motility disorder.
What are risk factors for gastroesophageal reflux disease?
Overweight or obesity, which increases intra-abdominal pressure.
List some assessment findings for GERD.
- Heartburn
- Epigastric pain
- Chest pain
- Voice hoarseness
- Chronic dry cough
- Dyspepsia
- Nausea
- Regurgitation
- Odynophagia
- Globus
- Hypersalivation
What dietary factors should clients with GERD avoid?
- Peppermint
- Chocolate
- Coffee and caffeine
- Fried or fatty foods
- Carbonated beverages
- Alcoholic beverages
- Nitrates
- Citrus fruits
- Tomatoes and tomato products
- Cigarette smoking
What lifestyle modifications should be recommended for GERD?
- Low-fat, high-fiber diet
- Avoid eating and drinking 2 hours before bedtime
- Elevate the head of the bed on 6- to 8-inch blocks
- Small, frequent meals
- Avoid lying down for 2 to 3 hours after eating
What medications should be avoided in GERD management?
- Anticholinergics
- NSAIDs
- Medications with acetylsalicylic acid
- Calcium channel blockers
What are some prescribed medications for GERD?
- Antacids
- H-receptor antagonists
- Proton pump inhibitors
- Prokinetic medications
What surgical intervention may be required for severe GERD?
Fundoplication
This involves wrapping a portion of the gastric fundus around the sphincter area of the esophagus.
What is gastritis?
Inflammation of the stomach or gastric mucosa.
What causes acute gastritis?
- Ingestion of contaminated food
- Irritating or highly seasoned food
- Overuse of NSAIDs
- Excessive alcohol intake
- Bile reflux
- Radiation therapy
What can cause chronic gastritis?
- Benign or malignant ulcers
- H. pylori infection
- Autoimmune diseases
- Dietary factors
- Medications
- Alcohol
- Smoking
- Reflux
What are the interventions for acute gastritis?
- Withhold food and fluids until symptoms subside
- Administer ice chips, clear liquids, then solid food as prescribed
What signs indicate hemorrhagic gastritis?
- Hematemesis
- Tachycardia
- Hypotension
What should clients with gastritis avoid?
- Spicy foods
- Highly seasoned foods
- Caffeine
- Alcohol
- Nicotine
What is peptic ulcer disease?
Ulceration in the mucosal wall of the stomach, pylorus, duodenum, or esophagus.
What types of ulcers can occur in peptic ulcer disease?
- Gastric
- Duodenal
- Esophageal
What are the common assessment findings in acute gastritis?
- Abdominal discomfort
- Anorexia, nausea, and vomiting
- Headache
- Hiccupping
- Reflux or dyspepsia
These symptoms are indicative of acute gastritis and may vary in intensity.
What are the common assessment findings in chronic gastritis?
- Anorexia, nausea, and vomiting
- Belching
- Heartburn after eating
- Sour taste in the mouth
- Vitamin B12 deficiency
Chronic gastritis may lead to long-term complications such as nutrient deficiencies.
What are the most common types of peptic ulcers?
Gastric ulcers and duodenal ulcers.
These ulcers are categorized based on their location in the gastrointestinal tract.
What describes a gastric ulcer?
Ulceration of the mucosal lining that extends to the submucosal layer of the stomach.
Gastric ulcers can be painful and may lead to serious complications.
List some predisposing factors for gastric ulcers.
- Stress
- Smoking
- Use of corticosteroids
- NSAIDs
- Alcohol
- History of gastritis
- Family history of gastric ulcers
- Infection with H. pylori
These factors can increase the risk of developing gastric ulcers.
What are some complications associated with gastric ulcers?
- Hemorrhage
- Perforation
- Pyloric obstruction
These complications can be life-threatening and require immediate medical attention.
What interventions should be taken for a patient with gastric ulcers?
- Monitor vital signs and for signs of bleeding
- Administer small, frequent bland feedings
- Administer H2-receptor antagonists or proton pump inhibitors
- Administer antacids
- Administer anticholinergics
- Administer mucosal barrier protectants
- Administer prostaglandins
- Administer treatment for Helicobacter pylori
These interventions aim to reduce symptoms and promote healing.
What client education should be provided to a patient with gastric ulcers?
- Avoid alcohol
- Avoid caffeine and chocolate
- Avoid smoking
- Avoid aspirin or NSAIDs
Lifestyle changes can help manage symptoms and reduce the risk of complications.
Describe the pain characteristics of gastric ulcers.
Gnawing, sharp pain in or to the left of the midepigastric region occurs 1 to 2 hours after a meal.
Pain may worsen with food ingestion.
What are the pain characteristics of duodenal ulcers?
- Burning pain in the midepigastric area
- Occurs 2 to 5 hours after a meal and midmorning, midafternoon, and during the night
- Pain is often relieved by the ingestion of food
Duodenal ulcers often cause nocturnal symptoms.
True or False: Hematemesis is more common than melena in gastric ulcers.
True.
This indicates the presence of blood in vomit, which is a serious symptom.
What should be monitored during active bleeding in a patient with gastric ulcers?
- Vital signs
- Signs of hemorrhage
- Dehydration
- Hypovolemic shock
- Sepsis
- Respiratory insufficiency
- Hemoglobin and hematocrit
Close monitoring is essential for timely intervention.
Fill in the blank: A _______ is the surgical removal of the stomach.
Total gastrectomy
This procedure may be necessary for severe cases of gastric ulcers.
What is vagotomy?
Surgical division of the vagus nerve to eliminate impulses stimulating hydrochloric acid secretion.
This procedure is performed to reduce acid secretion and help manage ulcers.
What is gastric resection?
Removal of the lower half of the stomach, usually includes a vagotomy; also called antrectomy.
What is gastroduodenostomy?
Partial gastrectomy, with the remaining segment anastomosed to the duodenum; also called Billroth I.
What is gastrojejunostomy?
Partial gastrectomy, with the remaining segment anastomosed to the jejunum; also called Billroth II.
What is pyloroplasty?
Enlargement of the pylorus to prevent or decrease pyloric obstruction, thereby enhancing gastric emptying.
What are postoperative interventions following gastric surgery?
- Monitor vital signs.
- Place in a Fowler’s position for comfort and to promote drainage.
- Administer fluids and electrolyte replacements intravenously as prescribed; monitor intake and output.
- Assess bowel sounds.
- Monitor NG suction as prescribed.
- Maintain NPO status as prescribed for 1 to 3 days until peristalsis returns.
- Progress the diet from NPO to sips of clear water to six small bland meals a day, as prescribed when bowel sounds return.
- Monitor for postoperative complications.
What complications should be monitored for after gastric surgery?
- Hemorrhage.
- Dumping syndrome.
- Diarrhea.
- Hypoglycemia.
- Bile reflux gastritis.
- Vitamin B12 deficiency.
True or False: Following gastric surgery, it is safe to irrigate or remove the NG tube without prescription.
False.
What is a duodenal ulcer?
A break in the mucosa of the duodenum.
What are the risk factors and causes of duodenal ulcers?
- Infection with H. pylori.
- Alcohol intake.
- Smoking.
- Stress.
- Caffeine.
- Use of aspirin, corticosteroids, and NSAIDs.
What are the complications of duodenal ulcers?
- Bleeding.
- Perforation.
- Gastric outlet obstruction.
- Intractable disease.
What should be included in the assessment of duodenal ulcers?
Monitor orthostatic vital signs.
What dietary instructions should be given to a client with a duodenal ulcer?
Instruct on a bland diet, with small, frequent meals.
What lifestyle changes should be encouraged in clients with duodenal ulcers?
- Cessation of smoking.
- Avoidance of alcohol and caffeine.
What medications are typically administered for duodenal ulcers?
- Medications to treat H. pylori.
- Antacids to neutralize acid secretions.
- H2-receptor antagonists or proton pump inhibitors to block acid secretion.
When is surgery indicated for duodenal ulcers?
If the ulcer is unresponsive to medications or if hemorrhage, obstruction, or perforation occurs.
What is dumping syndrome?
The rapid emptying of the gastric contents into the small intestine that occurs following gastric resection.
What symptoms are associated with dumping syndrome?
- Symptoms occurring 30 minutes after eating.
- Nausea and vomiting.
What is one dietary recommendation to prevent Dumping Syndrome?
Eliminate caffeine containing products
Caffeine can exacerbate symptoms associated with Dumping Syndrome.
What type of diet is recommended for preventing Dumping Syndrome?
High-protein and complex carbohydrate diet
Include foods such as oatmeal and other whole-grain foods high in fiber.
What should be limited in the diet to prevent Dumping Syndrome?
High-sugar foods
Examples include candy, table sugar, syrup, sodas, and juices.
How many meals should a client with Dumping Syndrome eat daily?
Five or six small meals
This is preferred over three larger meals.
What is a recommended practice regarding fluid intake for those with Dumping Syndrome?
Avoid consuming fluids with meals
Drink most daily fluids between meals.
What should be done if dairy products cause problems in Dumping Syndrome?
Eliminate dairy products
Lactose may worsen symptoms.
What position should a client lie in after meals to help prevent symptoms of Dumping Syndrome?
Lie down for 20 to 30 minutes
This helps prevent rapid gastric emptying.
What vitamin injections may be prescribed for clients with Dumping Syndrome?
Vitamin B12 injections
These are taken as prescribed.
What type of medications may be prescribed to clients with Dumping Syndrome?
Antispasmodic medications
These medications help delay gastric emptying.
True or False: Clients with Dumping Syndrome should consult with their healthcare provider about drinking alcohol.
True
Alcohol consumption may need to be evaluated.
What are some common symptoms of Dumping Syndrome? (List at least three)
- Feelings of abdominal fullness
- Abdominal cramping
- Diarrhea
- Palpitations and tachycardia
- Perspiration
- Weakness and dizziness
- Borborygmi
Borborygmi refers to loud gurgling sounds resulting from bowel hypermotility.
What is the primary purpose of bariatric surgery?
Surgical reduction of gastric capacity or absorptive ability
This is performed on clients with morbid obesity to promote long-term weight loss.
What pre-surgical assessment is necessary for bariatric surgery?
Thorough psychological assessment
This assessment detects depression, substance abuse, or other mental and behavioral health problems.
What factors influence the decision to perform bariatric surgery by laparoscopy?
- Client’s weight
- Body build
- History of abdominal surgery
- Current medical disorders
These factors help determine the surgical approach.
What are obese clients at increased risk for after bariatric surgery?
Postoperative complications
Risks include pulmonary and thromboembolic complications and death.
What lifestyle changes must clients agree to after bariatric surgery?
- Modify their lifestyle
- Lose weight and keep it off
- Obtain support from community resources
Examples of resources include the American Obesity Association and Overeaters Anonymous.
What are the initial dietary interventions after bariatric surgery?
- Clear liquids introduced slowly in 1-ounce cups
- Followed by puréed foods, juices, thin soups, and milk
This progression generally occurs after bowel sounds return and the client passes flatus.
What is the most common serious complication after gastric bypass surgery?
Anastomotic leaks
Symptoms to monitor include abdominal pain, restlessness, unexplained tachycardia, and oliguria.
What is a hiatal hernia?
A portion of the stomach herniates through the diaphragm into the thorax
Also known as an esophageal or diaphragmatic hernia.
What factors can aggravate a hiatal hernia?
- Pregnancy
- Ascites
- Obesity
- Tumors
- Heavy lifting
These factors increase abdominal pressure.
What are some complications of a hiatal hernia? (List at least two)
- Ulceration
- Hemorrhage
- Regurgitation
- Aspiration of stomach contents
- Strangulation
- Incarceration of the stomach
Possible outcomes include necrosis, peritonitis, and mediastinitis.
What are the common symptoms of a hiatal hernia? (List at least three)
- Heartburn
- Chest pain
- Regurgitation or vomiting
- Dysphagia
- Feeling of fullness
Symptoms may worsen when lying down.
What type of management is similar for hiatal hernia and gastroesophageal reflux disease?
Medical and surgical management
Both conditions may require similar interventions.
What dietary recommendation is suggested for clients with a hiatal hernia?
Provide small frequent meals
Limit the amount of liquids taken with meals.
What dietary measures should be followed after bariatric surgery?
Avoid alcohol, high-protein foods, and foods high in sugar and fat
These measures are critical for patients post-surgery to prevent complications.
What is a key recommendation for eating after bariatric surgery?
Eat slowly and chew food well
This helps with digestion and reduces the risk of complications.
What nutritional supplements may be prescribed after bariatric surgery?
Calcium, iron, multivitamins, and vitamin B12
These supplements are essential for preventing deficiencies.
What signs and symptoms should be monitored after bariatric surgery?
Dehydration and gastric leak (persistent abdominal pain, nausea, vomiting)
Early detection of these symptoms can prevent serious complications.
What lifestyle changes should be encouraged post-bariatric surgery?
Consume a well-balanced diet and make lifestyle changes as indicated
These changes are vital for long-term success after surgery.
How long should a client avoid reclining after eating?
1 hour
This helps prevent discomfort and complications related to digestion.
What type of medication should be avoided after bariatric surgery?
Anticholinergics
These medications delay stomach emptying and can lead to complications.
What is cholecystitis?
Inflammation of the gallbladder that may occur as an acute or chronic process
It can lead to significant complications if not treated properly.
What is acute cholecystitis associated with?
Gallstones (cholelithiasis)
This is the most common cause of acute cholecystitis.
What results in chronic cholecystitis?
Inefficient bile emptying and gallbladder muscle wall disease
This leads to a fibrotic and contracted gallbladder.
What is acalculous cholecystitis?
Cholecystitis that occurs in the absence of gallstones
It is caused by bacterial invasion via the lymphatic or vascular system.
What are common symptoms of cholecystitis?
- Nausea and vomiting
- Indigestion
- Belching
- Flatulence
- Epigastric pain radiating to the right shoulder or scapula
- Pain in the right upper quadrant triggered by a high-fat meal
- Guarding, rigidity, rebound tenderness
- Mass palpated in the right upper quadrant
- Murphy’s sign
- Elevated temperature
- Tachycardia
- Signs of dehydration
These symptoms are crucial for diagnosis and management.
What is choledolithiasis?
Biliary obstruction caused by gallstones.
What are the symptoms of biliary obstruction?
- Jaundice
- Dark orange and foamy urine
- Steatorrhea and clay-colored feces
- Pruritus
What should be maintained during nausea and vomiting episodes?
NPO status.
What is the purpose of NG decompression during severe vomiting?
To relieve pressure and prevent aspiration.
What medications are administered for nausea and vomiting?
Antiemetics.
What is the purpose of administering analgesics in biliary obstruction?
To relieve pain and reduce spasm.
What dietary instructions are given to clients with chronic cholecystitis?
- Eat small, high-fiber, low-fat meals
- Avoid gas-forming foods
What is a cholecystectomy?
The removal of the gallbladder.
What does choledocholithotomy involve?
Incision into the common bile duct to remove a stone.
What type of surgical procedures are commonly performed for biliary obstruction?
Laparoscopy.
What should be monitored postoperatively for respiratory complications?
Pain at the incisional site.
What is encouraged every 2 hours postoperatively?
Coughing, deep breathing, and incentive spirometer use.
What should clients be instructed to do to prevent discomfort during coughing postoperatively?
Splint the abdomen.
What is cirrhosis characterized by?
Diffuse degeneration and destruction of hepatocytes.
What causes the formation of scar tissue in cirrhosis?
Repeated destruction of hepatic cells.
What is the purpose of a T-tube after surgical exploration of the common bile duct?
To preserve duct patency and ensure bile drainage.
What position should a client with a T-tube be placed in to facilitate drainage?
Semi-Fowler’s position.
What should be monitored regarding the T-tube output?
- Amount
- Color
- Consistency
- Odor
What are early signs of cirrhosis?
- Fatigue
- Significant weight changes
- GI symptoms
- Anorexia and vomiting
- Abdominal pain
- Liver tenderness
What are common causes of cirrhosis?
- Chronic hepatitis C
- Alcoholism
- Non-alcoholic fatty liver disease (NAFLD)
- Non-alcoholic steatohepatitis (NASH)
What is portal hypertension?
A persistent increase in pressure in the portal vein due to obstruction.
What is ascites?
Accumulation of fluid in the peritoneal cavity from venous congestion.
What can result from coagulation defects in cirrhosis?
Increased bleeding and easy bruising.
True or False: Vitamin K is synthesized in the liver.
True.
What is choledolithiasis?
Biliary obstruction caused by gallstones.
What are the symptoms of biliary obstruction?
- Jaundice
- Dark orange and foamy urine
- Steatorrhea and clay-colored feces
- Pruritus
What should be maintained during nausea and vomiting episodes?
NPO status.
What is the purpose of NG decompression during severe vomiting?
To relieve pressure and prevent aspiration.
What medications are administered for nausea and vomiting?
Antiemetics.
What is the purpose of administering analgesics in biliary obstruction?
To relieve pain and reduce spasm.
What dietary instructions are given to clients with chronic cholecystitis?
- Eat small, high-fiber, low-fat meals
- Avoid gas-forming foods
What is a cholecystectomy?
The removal of the gallbladder.
What does choledocholithotomy involve?
Incision into the common bile duct to remove a stone.
What type of surgical procedures are commonly performed for biliary obstruction?
Laparoscopy.
What should be monitored postoperatively for respiratory complications?
Pain at the incisional site.
What is encouraged every 2 hours postoperatively?
Coughing, deep breathing, and incentive spirometer use.
What should clients be instructed to do to prevent discomfort during coughing postoperatively?
Splint the abdomen.
What is cirrhosis characterized by?
Diffuse degeneration and destruction of hepatocytes.
What causes the formation of scar tissue in cirrhosis?
Repeated destruction of hepatic cells.
What is the purpose of a T-tube after surgical exploration of the common bile duct?
To preserve duct patency and ensure bile drainage.
What position should a client with a T-tube be placed in to facilitate drainage?
Semi-Fowler’s position.
What should be monitored regarding the T-tube output?
- Amount
- Color
- Consistency
- Odor
What are early signs of cirrhosis?
- Fatigue
- Significant weight changes
- GI symptoms
- Anorexia and vomiting
- Abdominal pain
- Liver tenderness
What are common causes of cirrhosis?
- Chronic hepatitis C
- Alcoholism
- Non-alcoholic fatty liver disease (NAFLD)
- Non-alcoholic steatohepatitis (NASH)
What is portal hypertension?
A persistent increase in pressure in the portal vein due to obstruction.
What is ascites?
Accumulation of fluid in the peritoneal cavity from venous congestion.
What can result from coagulation defects in cirrhosis?
Increased bleeding and easy bruising.
True or False: Vitamin K is synthesized in the liver.
True.
What is jaundice?
Occurs because the liver is unable to metabolize bilirubin and because the edema, fibrosis, and scarring of the hepatic bile ducts interfere with normal bile and bilirubin secretion
Jaundice is a clinical sign indicating the accumulation of bilirubin in the body, leading to yellowing of the skin and eyes.
What characterizes portal systemic encephalopathy?
End-stage hepatic failure characterized by altered level of consciousness, neurological symptoms, impaired thinking, and neuromuscular disturbances caused by failure of the diseased liver to detoxify neurotoxic agents such as ammonia
Portal systemic encephalopathy is a serious complication of liver failure, leading to cognitive and motor dysfunction.
Define hepatorenal syndrome.
Progressive renal failure associated with hepatic failure
Hepatorenal syndrome typically occurs in patients with advanced liver disease and can lead to renal failure if not addressed.
What are the characteristics of hepatorenal syndrome?
Characterized by a sudden decrease in urinary output, elevated blood urea nitrogen and creatinine levels, decreased urine sodium excretion, and increased urine osmolarity
These characteristics indicate severe renal compromise often linked to liver dysfunction.
What is one intervention to minimize shortness of breath in patients?
Elevate the head of the bed
This position can help alleviate pressure on the diaphragm and improve respiratory function.
When should a high-protein diet be prescribed?
If ascites and edema are absent and the client does not exhibit signs of impending coma
Protein intake must be carefully managed in liver disease due to the risk of hepatic encephalopathy.
Which vitamins are typically supplemented in liver disease management?
B complex; vitamins A, C, and K; folic acid; and thiamine
These vitamins are crucial for metabolic processes and overall health in patients with liver dysfunction.
What dietary restrictions are often prescribed for patients with liver disease?
Restrict sodium intake and fluid intake as prescribed
These restrictions help manage fluid retention and ascites.
What should be monitored daily in patients with liver disease?
Weigh client and measure abdominal girth
Monitoring these metrics helps assess fluid retention and overall health status.
What is asterixis?
A coarse tremor characterized by rapid, nonrhythmic extensions and flexions in the wrist and fingers
Asterixis is often associated with metabolic disturbances, particularly in liver failure.
True or False: Diuretics are administered to treat ascites in liver disease.
True
Diuretics can help reduce fluid accumulation in the abdomen.
What should be monitored to assess for pre-coma state?
Monitor level of consciousness; assess for pre-coma state (tremors, delirium)
Early detection of altered mental status can be critical in managing liver failure.
Fill in the blank: The primary cause of portal systemic encephalopathy is the failure of the diseased liver to detoxify _______.
ammonia
Ammonia accumulation can lead to neurological symptoms due to its toxicity.
What is the significance of monitoring electrolyte balance in liver disease patients?
To ensure proper metabolic function and prevent complications
Electrolyte imbalances can exacerbate liver conditions and lead to further health issues.
How do you measure abdominal girth?
With the client supine, bring the tape measure around the client and take a measurement at the level of the umbilicus. Mark the abdomen along the sides of the tape to ensure consistency in later measurements.
This method ensures accurate tracking of changes in abdominal size.
What is fetor hepaticus?
The fruity, musty breath odor of severe chronic liver disease.
This symptom indicates significant liver dysfunction and may require further assessment.
What should be monitored to assess bleeding in patients with liver disease?
Maintain gastric intubation to assess bleeding or esophagogastric balloon tamponade to control bleeding varices as prescribed.
This intervention helps manage complications associated with esophageal varices.
What is the role of vitamin K in liver disease management?
Administer vitamin K if prescribed to help with coagulation laboratory results.
Vitamin K is crucial for blood clotting and may be deficient in liver disease.
What is the purpose of administering lactulose?
Lactulose decreases the pH of the bowel, decreases production of ammonia by bacteria, and facilitates the excretion of ammonia.
This is particularly important in the management of hepatic encephalopathy.
Which medications should be avoided in patients with liver disease?
Opioids, sedatives, barbiturates, and any hepatotoxic medications or substances.
These medications can exacerbate liver damage and complications.
What are esophageal varices?
Dilated and tortuous veins in the submucosa of the esophagus caused by portal hypertension, often associated with liver cirrhosis.
They are at high risk for rupture if portal circulation pressure rises.
What are the main assessment findings in a patient with esophageal varices?
- Hematemesis
- Melena
- Ascites
- Jaundice
- Hepatomegaly
- Splenomegaly
- Dilated abdominal veins
- Signs of shock
These findings indicate severe liver dysfunction and the risk of rupture.
What is the primary concern with ruptured esophageal varices?
Rupture and resultant hemorrhage represent a life-threatening situation.
Immediate medical intervention is critical to manage this emergency.
What are some key interventions for a patient with bleeding varices?
- Monitor vital signs
- Elevate the head of the bed
- Monitor for orthostatic hypotension
- Monitor lung sounds and respiratory distress
- Administer oxygen as prescribed
- Monitor level of consciousness
- Maintain NPO status
- Administer IV fluids as prescribed
- Monitor hemoglobin, hematocrit, and coagulation factors
- Administer blood transfusions or clotting factors as prescribed
- Assist in inserting an NG tube or balloon tamponade as prescribed
These interventions aim to stabilize the patient and prevent further complications.
What is the purpose of administering medications to induce vasoconstriction?
To reduce bleeding
Medications help in controlling hemorrhage by constricting blood vessels.
What should clients avoid to prevent vasovagal responses?
Activities that may trigger vasovagal responses
These activities can include prolonged standing, straining, or sudden changes in position.
What does endoscopic injection (sclerotherapy) involve?
Injection of a sclerosizing agent into and around bleeding varices
This procedure aims to stop bleeding from varices.
What are some complications of endoscopic injection (sclerotherapy)?
- Chest pain
- Pleural effusion
- Aspiration pneumonia
- Esophageal stricture
- Perforation of the esophagus
These complications can arise from the procedure.
What is the main action of endoscopic variceal ligation?
Ligation of the varices with an elastic rubber band
This procedure is designed to prevent bleeding from varices.
What occurs in the area of ligation after endoscopic variceal ligation?
Sloughing followed by superficial ulceration within 3 to 7 days
This is a normal part of the healing process after the ligation.
What is the purpose of shunting procedures?
To shunt blood away from the esophageal varices
This helps to relieve pressure and prevent bleeding.
What does portacaval shunting involve?
Anastomosis of the portal vein to the inferior vena cava
This diverts blood from the portal system to the systemic circulation.
What is the distal splenorenal shunt?
Anastomosis of the splenic vein to the left renal vein
This shunt directs blood from high-pressure varices to the low-pressure renal vein.
What is mesocaval shunting?
Side anastomosis of the superior mesenteric vein to the proximal end of the inferior vena cava
This procedure helps manage portal hypertension.
What does the transjugular intrahepatic portosystemic shunt (TIPS) do?
Creates a shunt between the portal and systemic venous systems in the liver
TIPS uses a metallic stent to relieve portal hypertension.
What is hepatitis?
Inflammation of the liver caused by a virus, bacteria, or exposure to medications or hepatotoxins
Treatment goals include reducing metabolic demands and promoting cellular regeneration.
What are the goals of treatment for hepatitis?
- Resting the inflamed liver
- Increasing blood supply
- Promoting cellular regeneration
- Preventing complications
Treatment aims to aid recovery and minimize liver damage.
What are the types of hepatitis viruses?
- Hepatitis A virus (HAV)
- Hepatitis B virus (HBV)
- Hepatitis C virus (HCV)
- Hepatitis D virus (HDV)
- Hepatitis E virus (HEV)
Each type has different modes of transmission and treatment options.
What characterizes the preicteric stage of viral hepatitis?
Flulike symptoms, anorexia, nausea, vomiting, diarrhea, and elevated serum bilirubin
This stage occurs about 2 weeks after exposure and is highly transmissible.
What occurs during the icteric stage of hepatitis?
- Appearance of jaundice
- Elevated bilirubin levels
- Dark or tea-colored urine
- Clay-colored stools
- Pruritus
This stage begins 1 to 2 weeks after the preicteric stage.
What happens in the posticteric stage of hepatitis?
Resolution of jaundice, normalization of urine and stool color, increased energy
This stage begins about 6 to 8 weeks after exposure.
What is the incubation period for hepatitis A?
15 to 50 days
This is the time between exposure to the virus and the onset of symptoms.
How is hepatitis A transmitted?
- Fecal-oral route
- Person-to-person contact
- Parenteral
- Contaminated food or water
- Poorly washed utensils
These routes highlight the importance of sanitation and hygiene.
What indicates an established hepatitis A infection?
Presence of HAV antibodies (anti-HAV) in the blood
Testing for these antibodies confirms the infection.
What are the two immunoglobulins normally present in the blood that indicate infection and inflammation?
Immunoglobulin M (IgM) and immunoglobulin G (IgG)
Increased levels of these immunoglobulins suggest ongoing infection or inflammation.
What does the presence of elevated levels of IgM antibodies indicate?
Ongoing inflammation of the liver
IgM antibodies typically persist in the blood for 4 to 6 weeks.
What indicates previous infection in terms of antibody levels?
Elevated levels of IgG antibodies.
What is a complication of hepatitis that is characterized as severe acute and often fatal?
Fulminant hepatitis.
List three prevention methods for hepatitis A.
- Strict handwashing
- Avoid contaminated food
- Stool and needle precautions
What is the recommended vaccination schedule for the hepatitis A vaccine?
Two doses are needed at least 6 months apart.
What is administered to individuals exposed to HAV who have never received the hepatitis A vaccine?
Immune globulin
This should be given during the incubation period and within 2 weeks of exposure.
True or False: Hepatitis B is seasonal.
False.
Who are individuals at increased risk for hepatitis B? List at least two groups.
- IV drug users
- Clients undergoing long-term hemodialysis
What is the primary mode of transmission for hepatitis B?
Blood or body fluid contact.
What is the incubation period for hepatitis B?
60 to 180 days.
What serological marker establishes the diagnosis of hepatitis B?
Hepatitis B surface antigen (HBsAg).
What does the presence of HBsAg after 6 months indicate?
A carrier state or chronic hepatitis.
What indicates recovery and immunity to hepatitis B?
Presence of antibodies to HBAg (anti-B).
List two complications of hepatitis B.
- Fulminant hepatitis
- Chronic liver disease
What is one method of preventing hepatitis B infection?
Strict handwashing.
What is the risk associated with individuals born between 1945 and 1965 regarding hepatitis C?
They are at increased risk for HCV infection.
What type of infection is hepatitis C commonly associated with?
Posttransfusion hepatitis.
List three individuals at increased risk for hepatitis C.
- Parenteral drug users
- Clients receiving frequent transfusions
- Health care personnel
What are the two immunoglobulins normally present in the blood that indicate infection and inflammation?
Immunoglobulin M (IgM) and immunoglobulin G (IgG)
Increased levels of these immunoglobulins suggest ongoing infection or inflammation.
What does the presence of elevated levels of IgM antibodies indicate?
Ongoing inflammation of the liver
IgM antibodies typically persist in the blood for 4 to 6 weeks.
What indicates previous infection in terms of antibody levels?
Elevated levels of IgG antibodies.
What is a complication of hepatitis that is characterized as severe acute and often fatal?
Fulminant hepatitis.
List three prevention methods for hepatitis A.
- Strict handwashing
- Avoid contaminated food
- Stool and needle precautions
What is the recommended vaccination schedule for the hepatitis A vaccine?
Two doses are needed at least 6 months apart.
What is administered to individuals exposed to HAV who have never received the hepatitis A vaccine?
Immune globulin
This should be given during the incubation period and within 2 weeks of exposure.
True or False: Hepatitis B is seasonal.
False.
Who are individuals at increased risk for hepatitis B? List at least two groups.
- IV drug users
- Clients undergoing long-term hemodialysis
What is the primary mode of transmission for hepatitis B?
Blood or body fluid contact.
What is the incubation period for hepatitis B?
60 to 180 days.
What serological marker establishes the diagnosis of hepatitis B?
Hepatitis B surface antigen (HBsAg).
What does the presence of HBsAg after 6 months indicate?
A carrier state or chronic hepatitis.
What indicates recovery and immunity to hepatitis B?
Presence of antibodies to HBAg (anti-B).
List two complications of hepatitis B.
- Fulminant hepatitis
- Chronic liver disease
What is one method of preventing hepatitis B infection?
Strict handwashing.
What is the risk associated with individuals born between 1945 and 1965 regarding hepatitis C?
They are at increased risk for HCV infection.
What type of infection is hepatitis C commonly associated with?
Posttransfusion hepatitis.
List three individuals at increased risk for hepatitis C.
- Parenteral drug users
- Clients receiving frequent transfusions
- Health care personnel
What is the incubation period for hepatitis C?
2 weeks to 6 months
What is anti-HCV?
The antibody to HCV measured to detect chronic states of hepatitis C
List three complications of hepatitis C.
- Chronic liver disease
- Cirrhosis
- Primary hepatocellular carcinoma
What are three prevention measures for hepatitis C?
- Strict handwashing
- Needle precautions
- Screening of blood donors
Where is hepatitis D common?
Mediterranean and Middle Eastern areas
What is required for hepatitis D infection to occur?
Active HBV infection
What does co-infection with HDV do to hepatitis B symptoms?
Intensifies the acute symptoms of hepatitis B
How is hepatitis D transmitted?
Same as for HBV, via contact with blood and blood products
What vaccination prevents hepatitis D infection?
HBV vaccine
Who are high-risk individuals for hepatitis D? Name one.
Drug users
What is the incubation period for hepatitis D?
2 to 26 weeks
What is the testing method for hepatitis D?
Detection of hepatitis D antigen (HDAg) and anti-HDV antibody
List two complications of hepatitis D.
- Chronic liver disease
- Fulminant hepatitis
What is hepatitis E classified as?
A waterborne virus
Where is hepatitis E prevalent?
Areas with inadequate sewage disposal
How does hepatitis E infection usually present in healthy individuals?
As a mild disease
What is the risk of hepatitis E infection during pregnancy?
High mortality rate in infected individuals
What is the incubation period for hepatitis E?
2 to 9 weeks
What are specific serological tests for hepatitis E?
Detection of IgM and IgG antibodies to hepatitis E
List two complications of hepatitis E.
- High mortality rate in pregnant individuals
- Fetal demise
What are two prevention measures for hepatitis E?
- Strict handwashing
- Treatment of water supplies and sanitation measures
What should clients with hepatitis avoid according to home care instructions?
Alcohol and over-the-counter medications, particularly acetaminophen and sedatives
What is one requirement for personal hygiene for clients with hepatitis?
Do not share bathrooms unless strict hygiene measures are adhered to
Clients with hepatitis should consume meals that are high in _______.
[key learning term: carbohydrates]
What should clients with hepatitis carry to inform others of their condition?
A MedicAlert card noting the date of hepatitis onset
True or False: Clients with hepatitis can donate blood.
False
What is pancreatitis?
Acute or chronic inflammation of the pancreas, with associated escape of pancreatic enzymes into surrounding tissue.
What characterizes acute pancreatitis?
Occurs suddenly as one attack or can be recurrent, with resolutions.
What defines chronic pancreatitis?
A continual inflammation and destruction of the pancreas, with scar tissue replacing pancreatic tissue.
List some precipitating factors for pancreatitis.
- Trauma
- Use of alcohol
- Biliary tract disease
- Viral or bacterial disease
- Hyperlipidemia
- Hypercalcemia
- Cholelithiasis
- Hyperparathyroidism
- Ischemic vascular disease
- Peptic ulcer disease
What are common assessment findings in acute pancreatitis?
- Abdominal pain (sudden onset at midepigastric or left upper quadrant)
- Pain aggravated by fatty meal, alcohol, or recumbent position
- Restlessness, anxiety, low-grade fever
- Abdominal tenderness, distention, guarding
- Nausea and vomiting
- Weight loss
- Absent or decreased bowel sounds
- Elevated white blood cell count and glucose, bilirubin, alkaline phosphatase, urinary amylase levels
- Elevated serum lipase and amylase levels
- Cullen’s sign
- Turner’s sign
What is Cullen’s sign?
Discoloration of the abdomen and periumbilical area indicative of pancreatitis.
What is Turner’s sign?
Bluish discoloration of the flanks indicative of pancreatitis.
What are the initial interventions for acute pancreatitis?
- Withhold food and fluid during the acute period
- Maintain hydration with IV fluids as prescribed
- Administer parenteral nutrition for severe nutritional depletion
- Administer supplemental preparations and vitamins and minerals if prescribed
When might an NG tube be inserted in acute pancreatitis?
If the client is vomiting or has biliary obstruction or paralytic ileus.
What medications may be administered for pain management in acute pancreatitis?
Opiates as prescribed.
What should be monitored for in acute pancreatitis?
- Significant changes in vital signs that may indicate shock
- Changes in behavior and level of consciousness related to alcohol withdrawal, hypoxia, or impending sepsis
What dietary instructions should be given to clients with chronic pancreatitis?
- Limit fat and protein intake
- Avoid heavy meals
- Avoid alcohol and caffeinated beverages
What are the assessment findings in chronic pancreatitis?
- Abdominal pain and tenderness
- Left upper quadrant mass
- Steatorrhea and foul-smelling stools
- Weight loss
- Muscle wasting
- Jaundice
- Ascites
- Signs and symptoms of diabetes mellitus
- Signs of respiratory compromise
What is steatorrhea?
Foul-smelling stools that may increase in volume as pancreatic insufficiency increases.
What should clients with chronic pancreatitis know about managing diabetes?
Administer insulin or oral hypoglycemic medications as prescribed.
What should clients be instructed to do if they experience increased steatorrhea or abdominal distention?
Notify the PHCP.
What is Irritable Bowel Syndrome (IBS)?
A functional disorder characterized by chronic or recurrent diarrhea, constipation, and/or abdominal pain and bloating.
The cause of IBS is unclear but may be influenced by environmental, immunological, genetic, hormonal, and stress factors.
What dietary changes are recommended for IBS?
Increase dietary fiber and drink 8 to 10 cups of liquids per day.
Medication therapy depends on the predominant symptoms of IBS.
Which medications are recommended for constipation-predominant IBS?
Lubiprostone or linaclotide.
For diarrhea-predominant IBS, alosetron is recommended.
What is Ulcerative Colitis?
An ulcerative and inflammatory disease of the bowel that results in poor absorption of nutrients.
It commonly begins in the rectum and spreads upward toward the cecum.
What are the characteristics of the colon in Ulcerative Colitis?
The colon becomes edematous and may develop bleeding lesions and ulcers; the ulcers may lead to perforation.
Scar tissue develops, causing loss of elasticity and nutrient absorption ability.
What are common symptoms of Ulcerative Colitis?
- Anorexia
- Weight loss
- Malaise
- Abdominal tenderness and cramping
- Severe diarrhea that may contain blood and mucus
- Malnutrition, dehydration, and electrolyte imbalances
- Anemia
- Vitamin K deficiency
- Intermittent fever
What interventions are recommended during the acute phase of Ulcerative Colitis?
- Maintain NPO status
- Administer fluids and electrolytes intravenously or via parenteral nutrition
- Restrict client’s activity to reduce intestinal activity
- Monitor bowel sounds and for abdominal tenderness and cramping
- Monitor stools for color, consistency, and blood
What type of diet is prescribed following the acute phase of Ulcerative Colitis?
The diet progresses from clear liquids to a low-fiber diet as prescribed and tolerated.
A high-protein diet with vitamins and iron supplements is also prescribed.
What foods should be avoided during an exacerbation of Ulcerative Colitis?
- Gas-forming foods
- Milk products
- Whole-wheat grains
- Nuts
- Raw fruits and vegetables
- Pepper
- Alcohol
- Caffeine-containing products
What surgical interventions may be performed for Ulcerative Colitis?
- Minimally invasive procedures
- Restorative proctocolectomy with ileal pouch-anal anastomosis (RPC-IPAA)
Surgical options are considered in extreme cases if medical management is unsuccessful.
What is the purpose of Restorative proctocolectomy with ileal pouch-anal anastomosis (RPC-IPAA)?
Allows for bowel continence.
It may be performed through a laparoscopic procedure.
True or False: Chronic ulcerative colitis causes muscular hypertrophy and bowel thickening.
True
Chronic ulcerative colitis also leads to fat deposits and fibrous tissue.
Fill in the blank: Acute ulcerative colitis results in _______ of the bowel mucosa.
hemorrhage, edema, and ulceration
What is total proctocolectomy with permanent ileostomy?
A surgical procedure involving the removal of the entire colon, rectum, and anus.
This procedure is performed if the client is not a candidate for RPC-IPAA or prefers this type.
What is the location of the stoma in total proctocolectomy?
Right lower quadrant.
The end of the terminal ileum forms the stoma or ostomy.
What are the preoperative interventions for ileostomy surgery?
- Obtain informed consent
- Consult with the enterostomal therapist
- Instruct client on dietary restrictions
- Administer parenteral antibiotics 1 hour before surgery
- Address body image concerns
A low-fiber diet may be required 1 to 2 days before surgery.
What indicates compromised circulation in a stoma?
A stoma that is purple-black in color.
This requires immediate notification to the PHCP.
What are the key assessment signs for Crohn’s Disease?
- Fever
- Cramplike and colicky pain after meals
- Diarrhea (semisolid, may contain mucus, pus, or blood)
- Abdominal pain and distention
- Anorexia, nausea, and vomiting
- Weight loss
- Anemia
- Dehydration
- Electrolyte imbalances
- Malnutrition
Symptoms may vary, with malnutrition potentially worse than in ulcerative colitis.
What is the characteristic stool consistency after ileostomy surgery?
Liquid in the immediate postoperative period.
The stool consistency becomes more solid depending on the area of creation.
What are the postoperative interventions for ileostomy care?
- Place a pouch system with a skin barrier on the stoma
- Monitor stoma for size, bleeding, or necrotic tissue
- Monitor for color changes in the stoma
- Ensure the pouch system fits properly and check for leaks
- Empty the pouch when it is one-third full
- Perform skin assessment and care
Normal stoma color is pink to bright red and shiny, while pale pink indicates low hemoglobin.
What is appendicitis?
Inflammation of the appendix.
When inflamed or infected, rupture may occur, leading to peritonitis and sepsis.
What is the typical pain pattern associated with appendicitis?
Pain in the periumbilical area that descends to the right lower quadrant.
What is McBurney’s point?
Location on the abdomen that is most intense for abdominal pain in appendicitis
It is located in the right lower quadrant.
What are common symptoms of appendicitis?
- Low-grade fever
- Rebound tenderness
- Abdominal rigidity
- Elevated white blood cell count
- Anorexia
- Nausea
- Vomiting
- Guarding and legs flexed
These symptoms help in diagnosing appendicitis.
What is peritonitis?
Inflammation of the peritoneum
It can occur as a complication of appendicitis.
What is an appendectomy?
Surgical removal of the appendix
This procedure is often performed when appendicitis is diagnosed.
What is the first step in preoperative interventions for appendicitis?
Informed consent needs to be obtained.
What does NPO status mean?
Nothing by mouth; the patient should not eat or drink.
What should be monitored preoperatively in a patient with appendicitis?
- Changes in level of pain
- Signs of ruptured appendix
- Bowel sounds
Monitoring these factors is crucial to assess the patient’s condition.
What position should a client with appendicitis be placed in for comfort?
Right side-lying or low to semi-Fowler’s position.
What should be avoided in managing a client with appendicitis?
Application of heat to the abdomen.
What are the postoperative interventions for a client who had an appendectomy?
- Monitor temperature for signs of infection
- Assess incision for infection
- Maintain NPO status until bowel function returns
- Advance diet gradually as tolerated
- Expect drainage management if rupture occurred
- Change dressing as prescribed
- Administer antibiotics and analgesics as prescribed
These interventions are critical for recovery.
What is diverticulosis?
An outpouching or herniation of the intestinal mucosa.
Where is diverticulosis most commonly found?
In the sigmoid colon.
What is diverticulitis?
Inflammation of one or more diverticula due to fecal matter penetration.
What are symptoms of diverticulitis?
- Left lower quadrant abdominal pain
- Elevated temperature
- Nausea and vomiting
- Flatulence
- Cramplike pain
- Abdominal distention
- Tenderness
- Blood in stools
These symptoms help in diagnosing diverticulitis.
What dietary approach is recommended during the acute phase of diverticulitis?
Maintain NPO status or provide clear liquids.
What should be instructed to a client during diverticulitis management regarding physical activity?
Refrain from lifting, straining, coughing, and bending.
What should clients with diverticulitis avoid eating?
- High-fiber foods during inflammation
- Gas-forming foods
- Foods containing indigestible roughage, seeds, nuts, or popcorn
These foods can irritate the diverticula and exacerbate inflammation.
What is the recommended fluid intake for clients with diverticulitis?
2500 to 3000 mL daily, unless contraindicated.
What is the purpose of bulk-forming laxatives in diverticulitis management?
To increase stool mass.
What should be avoided unless prescribed?
Laxatives or enemas
Important to prevent complications from overuse.
What surgical intervention may be an option for gastrointestinal problems?
Colon resection with primary anastomosis
This procedure involves removing a section of the colon and reconnecting the remaining parts.
What might be required for increased bowel inflammation?
Temporary or permanent colostomy
A colostomy diverts waste from the colon to a bag outside the body.
What are hemorrhoids?
Dilated varicose veins of the anal canal
Hemorrhoids can be internal, external, or prolapsed.
Where do internal hemorrhoids lie?
Above the anal sphincter
Internal hemorrhoids cannot be seen on inspection.
Where do external hemorrhoids lie?
Below the anal sphincter
External hemorrhoids can be seen on inspection.
What can happen to prolapsed hemorrhoids?
They can become bosed or inflamed
Prolapsed hemorrhoids may cause additional discomfort.
What causes hemorrhoids?
Portal hypertension, straining, irritation, or increased venous or abdominal pressure
These factors increase pressure in the veins of the anal canal.
What is a common symptom of hemorrhoids during defecation?
Bright red bleeding
This indicates possible irritation or damage to the blood vessels.
What are other assessment symptoms of hemorrhoids?
- Rectal pain
- Rectal itching
These symptoms may vary in intensity.
What is a recommended intervention for hemorrhoids?
Apply cold packs to the anal-rectal area followed by sitz baths
This can help reduce swelling and discomfort.
What dietary changes should be encouraged for hemorrhoid patients?
High-fiber diet and fluids
This promotes bowel movements without straining.
What should be administered as prescribed for hemorrhoids?
Stool softeners
Helps prevent straining during bowel movements.
What should the client be instructed to drink unless contraindicated?
Plenty of water
Adequate hydration is essential for bowel health.
What lifestyle changes should be encouraged for hemorrhoid management?
- Regular exercise
- Maintenance of a healthy weight
- Diet high in fiber and fluids
These changes promote regular bowel movements.
What surgical interventions may be used for hemorrhoids?
- Ultrasound
- Sclerotherapy
- Circular stapling
- Band ligation
- Hemorrhoidectomy
These procedures vary in invasiveness and technique.
What is a postoperative intervention following hemorrhoidectomy?
Assist the client to a prone or side-lying position
This helps prevent bleeding.
What should be maintained over the dressing as prescribed post-surgery?
Ice packs
Helps reduce swelling and discomfort.
What should be monitored for after hemorrhoid surgery?
Urinary retention
This can be a complication of the surgical procedure.
What is an important instruction for the client regarding fluids and diet post-surgery?
Increase fluids and high-fiber foods
This aids in preventing constipation.
How long should the client limit sitting after surgery?
To short periods of time
This reduces pressure on the surgical site.
What might the client experience during their first bowel movement post-surgery?
It may be very painful
Advising support nearby is crucial due to potential light-headedness.
How often should sitz baths be used as prescribed?
Three or four times a day
This helps alleviate discomfort and promotes healing.
