GI 1

Question 1

what is appendicitis?

Answer 1

the inflammation of the vermiform appendix & classified as simple, gangrenous, or perforated.

Question 2

appendicitis is most common in who?

Answer 2

young adults, especially men

Question 3

what are some common s/sx of appendicitis?

Answer 3

RLQ pain
McBurneys point
rebound tenderness
low grade fever
high WBC (10,000)
shift to the left (increase in bands)
-rupture is peritonitis

Question 4

what is McBurney’s point?

Answer 4

halfway between the R anterior iliac crest & umbilicus

Question 5

what are some s/sx of peritonitis?

Answer 5

abdominal pain (generalized)
high temp
higher WBC (20,000)
infection/sepsis

Question 6

how do we treat appendicitis?

Answer 6

must be rapid, include antibiotics & may have drain in incision or open incision

Question 7

what nursing interventions can be done for someone with appendicitis?

Answer 7

1. Avoid laxatives, enemas, or heat as may cause rupture of appendix.
2. pt is NPO. I & O & IV fluids to prevent dehydration.
3. Monitor bowel movements & signs of return of peristalsis.
4. Ambulate ASAP after surgery; usually within 8 to 12 hours.
5. Semi-Fowler’s position to ↓ pain & promote drainage to prevent fluid accumulation.

Question 8

what is cholecystitis?

Answer 8

inflammation of the gallbladder, either calculous or acalculous

Question 9

what is calculous cholecystitis?

Answer 9

hemical irritation and inflammation from cholelithiasis (stones in the gallbladder, usually formed of cholesterol when bile becomes supersaturated with cholesterol) or choledocholithiasis (stones in the common bile duct)

Question 10

what is acalculous cholecystitis?

Answer 10

inflammation occurring without gallstones, typically associated with biliary stasis.

Question 11

cholecystitis is common in who?

Answer 11

4x more common in women (ages of 40-50):
-fair, fertile, overweight, forty or older

Question 12

what are some s/sx of cholecystitis?

Answer 12

RUQ pain/ rebound tenderness (Blumberg’s sign)
Murphy’s sign
steatorrhea (fatty stool)
may have a fever

Question 13

what is Blumberg’s sign?

Answer 13

RUQ - rebound tenderness – called Blumberg’s sign; may radiate to shoulder
-cholecystitis

Question 14

what is murphy’s sign?

Answer 14

patient stops breathing during palpation just below right costal margin.
-cholecystitis

Question 15

how do diagnose cholecystitis?

Answer 15

-Ultrasound determines gallstones and is best initial diagnostic test.

-HIDA (hepatobiliary) scan

-ERCP (endoscopic retrograde cholangiopancreatography) or MRCP

-Lab Values:
– WBC elevated - indicates inflammation.
–↑ amylase and/or lipase- indicates pancreatic involvement (stones in common bile duct).
– ALP (alkaline phosphatase), AST & bilirubin may be elevated (direct & indirect) if obstruction of the
common bile duct & liver involvement.

-Gallbladder X-ray test

Question 16

what is a HIDA?

Answer 16

(hepatobiliary) scan: visualizes gallbladder and determines patency of biliary system.

Question 17

what is a ERCP? or MRCP?

Answer 17

(endoscopic retrograde cholangiopancreatography)
(magnetic resonance
cholangiopancreatography).

Pt. swallows a long, thick, lighted flexible tube connected to a computer and monitor. Dye is injected that stains the bile ducts. Stones can be removed. Assess gag reflex following test.

Question 18

what does gallbladder x-ray test tell us?

Answer 18

radiopaque tablets are taken the evening before so that the gallbladder will be visible on x-
ray examination; this test may be done if the ultrasonography is inconclusive.

Question 19

how do we differenciate between cholecystitis & biliary obstruction?

Answer 19

-cholecystitis/cholelithiasis
–Pain RUQ (2-4 hours after eating high-fat) that may radiate to the R shoulder or back. Discomfort is
experienced because bile flow into the intestine is obstructed.

-choledocholithiasis (stone in the common bile duct)
–pain
–Jaundice due to obstruction/hepatocellular damage. When the common bile duct is completely obstructed, the bile is unable to pass into the duodenum & is absorbed into the blood.
–lab values: amylase, ALP, bilirubin
–feces - clay colored
–pruritis – itching due to accumulation of bile salts under the skin

Question 20

how do we treat cholecystitis?

Answer 20

surgery
–cholecystectomy
–choledochotomy (remove stones)

ABO

antispasmodics, anticholinergics
–reduce the contraction of the gallbladder

morphine or another opioid

lithotripsy (breaks up stones)

biliary catheter drain

Question 21

what are some nursing interventions for cholecystitis?

Answer 21

-low fat healthy diet
-assess liver or pancreatic involvement
-assess bowel sounds
-NPO, NG, F & E balance, TCDB & IS
-semi-fowlers
-may have a t-tube

Question 22

what is the patho of pancreatitis? how does this cause problems?

Answer 22

1. Auto-digestion: injury permits digestive enzymes to leak into pancreatic tissue, then break down
   tissue & cell membranes in the organ & causes vascular damage, edema, hemorrhage, & necrosis → trypsin (initiates pancreatic digestion & activates lactase, which dissolve the elastic fibers of the blood vessels within the pancreas causing hemorrhage), kinins (causes vasodilation and ↑ capillary/vascular permeability), & phospholipase (causes necrosis of the pancreas).
2. As more cells are destroyed, more enzymes are released, causes ↑ inflammation of the peritoneum and the pancreas. Drainage may collect into abscesses, which can eat through the bowel & trigger sepsis.
3. In severe acute pancreatitis, total auto-digestion & pancreatic destruction may lead to diabetic ketoacidosis, shock, coma, & death.

Question 23

what causes pancreatitis?

Answer 23

acute- Obstruction of pancreatic or common bile duct (e.g. biliary stones, stasis) and alcohol consumption

chronic- heavy alcohol consumption

Question 24

what are some s/sx of pancreatitis?

Answer 24

-pain (mid-epigastric or LUQ)
-jaundice
-N/V
-fever
-hypotension, hypovolemia, respiratory distress & electrolyte imbalances.
-hyperglycemia
-steatorrhea

Question 25

what is common result from chronic pancreatitis shown by grey turner’s and cullen’s sign? What are those?

Answer 25

pancreatic hemorrhage

-Grey Turner’s sign: a gray-blue discoloration of the flank

-Cullen’s sign: a gray-blue discoloration around the umbilicus

Question 26

how do we diagnose pancreatitis?

Answer 26

1. Lab values
   –Pancreatic enzymes: amylase, lipase
   –Hyperglycemia
   –Calcium-forming complexes develop because fatty acids have been set free from retroperitoneal fat by lipase, which causes hypocalcemia. Pt may have s/sx of ↓ Ca++.
   –WBC elevation
   –Liver function tests (LDH, AST) may be elevated in alcoholic liver disease & acute pancreatitis
2. Imaging
   –Abdominal ultrasound
   –Contrast-enhanced CT – more reliable

Question 27

how do we treat pancreatitis?

Answer 27

-NPO with gastric suction to suppress enzymes & ↓ pancreatic stimulation

-Pancreatic enzyme supplement for pancreatic insufficiency

-Low fat diet to reduce discomfort & steatorrhea

-Meds
a. Histamine blockers & antacids are used to ↓ gastric secretions
b. Anti-emetics & analgesics such as morphine or other opioid
c. Anticholinergic drugs to ↓ vagal stimulation, inhibit pancreatic enzyme secretion, & relieve spasms
6. Operative procedures - pancreatic resection of the head, body, tail, or total removal of the pancreas (pancreatotomy), which results in compromised pancreatic function.

Question 28

what are some nursing interventions for pancreatitis?

Answer 28

-assess for fluid deficit, F+E imbalance
-resp. assessment
-assess bowel tones
-Nutritional support - TPN (monitor glucose levels) or NG/Peg feedings. Clear liquids → small amts of CHO →
bland low-fat/protein while gradually ↑ CHO. Avoid large meals, alcohol & caffeinated beverages.
-rest periods
-monitor for complications

Question 29

what are the common complications from pancreatitis and or/ pancreatic surgery?

Answer 29

pancreatic abscess (most serious); the most common
fatal complications of severe pancreatitis are hypovolemia & hyperglycemia.

Question 30

what is diverticulosis and diverticulitis?

Answer 30

 diverticulosis: multiple diverticula.
 diverticulitis: inflammation of diverticula.

Question 31

who commonly has diverticulosis/itis?

Answer 31

common after age 65

2/3 of adults > 80 have diverticulosis

Question 32

what are the s/sx of diverticulosis/itis?

Answer 32

no s/sx unless complications occur
1. Constipation, diarrhea, & flatulence.
2. Acute LLQ abd pain - may be relieved by a BM or passing flatus.
3. S/sx may ↑ after a meal or activities causing ↑ intra-abd pressure.
4. May see rectal bleeding or fever if infection present.

Question 33

whata re common complications of Diverticulosis/Diverticulitis?

Answer 33

-retained, undigested food in diverticular sac, resulting in a hard mass, causing abscess, fistulas,
bowel obstruction, peritonitis, & hemorrhage.

Question 34

how do we disgnose Diverticulosis or Diverticulitis?

Question 35

how do we treat Diverticulosis or Diverticulitis?

Question 36

what are some nursing interventions for Diverticulosis Diverticulitis?

Answer 36

1. Treat & watch for s/sx of complications
2. Encourage:
    A soft high fiber diet if a diagnosis of diverticulosis
    NPO if a diagnosis of diverticulitis
    Fluids (at least 8 glasses per day)
    Maintenance: high vegetable fiber diet – seeds?
3. Teach importance of:
    Avoid ↑ intra-abd pressure (e.g. constipation, tight belts, restrictive clothing & improper lifting
   techniques; however low-impact weight lifting is acceptable)
    Encourage activities that ↑ peristalsis (e.g. walking & ↑ fluids)
    Importance of having a daily BM & weight loss
    Notifying the physician of changes in bowel elimination patterns or characteristics, fever, or abd pain.