GI Accessory Disorders Flashcards by Kelsey Klipfel

Appendix becomes inflamed increased intraluminal pressure, causes edema and obstruction of orifice
Etiologies
Result of becoming kinked or occluded with stool
Lymphoid hyperplasia secondary to inflammation or infection - appendicitis can be with or without infection
Rarely, foreign bodies (seeds) or tumors

Patho - GI Accessory: Acute Appendicitis

How well did you know this?

Not at all

Perfectly

Severe/steady pain
Right lower quadrant
McBurney’s point - push on area and release it have rebound tenderness
Rebound tenderness
Low grade fever/nausea
Complications
Largest: Ischemia, gangrene, perforation
Ruptured/disintegration = Peritonitis: go further and cause sepsis/death

CM - GI Accessory: Acute Appendicitis

How well did you know this?

Not at all

Perfectly

As push down little tender but lot more as release
Halfway between umbilicus and ant iliac crest
Go down slow and up fast - pain throughout but greatest pain on rebound

Appendicitis McBurney’s Point: Rebound tenderness - GI Accessory: Acute Appendicitis

How well did you know this?

Not at all

Perfectly

CBC
Elevated WBC & Neutrophils
Normal: WBC (5000-10000 mm3)
Normal: Neutrophils (55-70 %)
Urinalysis: r/o UTI/stones
CT: right lower quadrant density
appendix enlargement (6 mm or >) - show inflammation and thickening of walls around appendix: sign inflammed
Pregnancy test: r/o ectopic pregnancy

Diagnostics - GI Accessory: Acute Appendicitis

How well did you know this?

Not at all

Perfectly

Appendectomy
Laparotomy - open
Laparoscopy - closed
Healing time much less and lot less chance infection
IV Fluids - not feel like drinking and after remove appendix have paralytic ileus need rehydrate
Antibiotics

med/surg - GI Accessory: Acute Appendicitis

How well did you know this?

Not at all

Perfectly

Infection, risk for - if not already got infection
Pain - acute
Fluid volume deficit, risk for
Surgery, knowledge deficit
Anxiety
Risk for: atelectasis, DVT, or ileus - need be up, moving around, turn and cough and deep breathing - trying get lungs clear and get bowels moving to prevent ileus - need be on DVT prophylaxis until moving around again

N. diagnosis - GI Accessory: Acute Appendicitis

How well did you know this?

Not at all

Perfectly

Educate patient on surgery - most specifically: educate what expected of pat post-surgery; warn: IS and how use it and how often
Administer pain medications - enough get pain at stated level that usually 4 - so doing turning, coughing, deep breathing without great deal of pain and splinting
Administer IV fluids/encourage PO fluids (after pass gas) - after bowels wake up
Provide post operative care
Prevent post op complications
Educate patient on T,C,DB; IS
Position: High Fowler’s
Auscultates abdomin-BS - LOT - getting things back again and movement
Ambulate
Abdomen stays soft and not rigid or developing peritonits
Discharge instructions - variety

N. interventions - GI Accessory: Acute Appendicitis

How well did you know this?

Not at all

Perfectly

Inflammation of peritoneum usually result of:
Bacterial infection
External sources such as abdominal surgery or trauma
Peritoneal dialysis - BIG ISSUE; after two issues having this and peritonitis cannot have dialysis - must go to chemo
Inflammation other organs - such as appendicitis

Patho - GI accessory: peritonitis

How well did you know this?

Not at all

Perfectly

Fever - >101-102
Pain
Begins as diffuse pain then constant, localized, more intense over site, increases with movement
Rigid abdominal muscles/Distention of abdomen
N&V; paralytic ileus from the pressure
Hypovolemia-lack of movement of fluid
Without intervention -can lead to sepsis/shock

CM - GI accessory: peritonitis

How well did you know this?

Not at all

Perfectly

WBC elevated with Bands - will see >10% - throwing out immature neutrophils because cannot produce enough mature WBCs to fight infection
Electrolytes
altered levels of potassium, sodium, and chloride
Fluid volume shifts
C&S of aspirate - peritoneal taps - catheter/needle inserted into peritoneum and draw off fluid; know what type antibiotics on - start broad
Abdominal X ray
Look for air and fluid levels; distended bowel loops; bad sign: fre air within abdomen - means somewhere within bowel air leaking out and that is source of peritonitis
CT: abscess formation
MRI: Intra-abdominal Abscesses

Diagnostics - GI accessory: peritonitis

How well did you know this?

Not at all

Perfectly

Find infection source
Fluid/electrolyte replacement
Pain medication - in lot of pain and bowel issues - not stop up already are
Antiemetics - Zofran - stop from vomiting and massive nausea
Antibiotics - before C&S done, look at starting broad spectrum (Zosin)
NG tube-relieve distention on stomach
Airway clearway - airway intubation and ventilator assistance needed end up in ICU if become extremely septic

med/surg - GI accessory: peritonitis

How well did you know this?

Not at all

Perfectly

Risk for infection - peritonitis does not have to have an infection
Deficient fluid volume
Acute pain
Risk for imbalanced nutrition: Less than body requirements - not being able to eat or drink
Constipation - fluid shifts and pain meds
Nausea
Risk for dysfunctional GI motility - lot pressure in peritonitis on bowels and not move appropriately

N. diagnosis - GI accessory: peritonitis

How well did you know this?

Not at all

Perfectly

May prep for surgery - open exploratory laparotomy since not know what is going ok
Monitor: Assessment/Vital signs - good look at abdomen - not rigid abdomen, massive fever
Focus on Bowel sounds
Administer medications - not able swallow meds and NG tube - not able take meds PO; have meds changed into diff form
Advance diet as tolerated
Intensive care for septic shock

N. interventions - GI accessory: peritonitis

How well did you know this?

Not at all

Perfectly

Distentended abdomen - pressure making skin taut
Not corrected - can turn into abdominal compartment syndrome

Is this pt at risk for intra-abdominal HTN - GI accessory: intra-abdominal compartment syndrome; intra-abdominal HTN

How well did you know this?

Not at all

Perfectly

Sepsis - pts been septic/cap leak
Burns - large total body surface area burns
Massive resuscitation
Something in common in terms treatment: fluids; some sorts process making cap leaky; catecholamines act on caps and vascular sys to dilate and become leaky and all fluid instead going through vascular sys leaks out and causes third spacing - edema; fluid from intravascular space - edema and swelling throughout for pt; pts at high risk for intraabdominal pressures
Septic: cram full fluid; burns: replace all fluids lost in burned tissue; massive resuscitation - cont hang fluids - 3-6 L run

Risk factors - GI accessory: intra-abdominal compartment syndrome; intra-abdominal HTN

How well did you know this?

Not at all

Perfectly

Extra pressure on cavity - Splanchnic hypoperfusion (ganglia - when smushed not do job effectively; pressure put on it - not have blood flow or transmit neuron signals freely if not under pressure) - resulting in hepatic ischemia - liver not getting enough O2; liver not do job appropriately and getting squished and liver makes coag factors so get weird Coagulopathy - clot and bleed at same time = acidotic state pt for same time; metabolic acidosis need fix as well; Coagulopathy increase bleeding - Intra-abdominal bleeding - cavity under pressure under exces pressure now have blood loss that will exacerbate pressure prob; bleeding and more pressure in abdomen
Gut - colon, SI, stomach - not enough blood supply - stomach not enough blood supply to refresh rugae get gastric ulcers - hydrochloric acid - not get rugae replaced - eat through and get hydrochloric acid in stomach in peritoneal cavity - autodigestion of various organs causing inflammation and increased swelling and edema; free radicals from extra H floating around damage extra tissues - cause abdominal-compartment syndrome
IAH

Patho - GI accessory: intra-abdominal compartment syndrome; intra-abdominal HTN

How well did you know this?

Not at all

Perfectly

Hepatic ischemia
Gut mucosal acidosis
Bowel edema
Free oxygen radicals
Distant organ damage
Coagulopathy hypothermia acidosis
Intra-abdominal bleeding
If unrelieved can lead to ACS

IAH - GI accessory: intra-abdominal compartment syndrome; intra-abdominal HTN

How well did you know this?

Not at all

Perfectly

Hopefully have transfusion measures in ICU - fill up bladder and measure it; med-surg unit - not as accurate: keep track of it: abdominal girth measurements; ideally same person doing them - track changes over time - also do daily weights - most accurate measure fluid volume status on pt

How measure intra-abdominal pressure

How well did you know this?

Not at all

Perfectly

Cut down through fascia to relieve fascia - ACS - relieve pressure; abdomen squishy - stretch more than cavities - need relieve pressure; laparotomy - incision on pt - swelling pushed it into a circle - same concept - relieve pressure by opening up cavity so organs and vessels not squished
Pt at risk for: infection, sepsis, HF - fluid volume overload issues, impaired gas exchange, TPN/PPN/NG tube/PEG tube, skin integrity issue
High mortality once to this pt - be open like this for long time; covering over it
Swelling go down: combo surgical closure, wound vac and exact situation and natural closure; closure in layers
Too much pressure in body cavity: organs and vessels not do job effectively; depending on organ and sys effected have systemic issues; once hemodynamically stable - fluid off; pressure to high do something to relieve it: surgical intervention

Past intra-abdominal HTN and abdominal compartment syndrome

How well did you know this?

Not at all

Perfectly

formation of gallstones

Cholesis

How well did you know this?

Not at all

Perfectly

Inflammation of gallbladder
Acute vs Chronic
Stones vs not
Women greater than men
Age greater than 40, obese, fertile
Four F’s: Fat, fertile, female, and forty

Patho - GI accessory: cholecystitis

How well did you know this?

Not at all

Perfectly

Biliary colic pain in RU abdomen
Radiates R shoulder and back
N&V - esp after fatty meal
Obstruction (stones/tightening of gallbladder tract) causes jaundice
Urine/stool changes
Urine dark; putty colored stool - bilirubin unable to be conjugated
Vitamin Deficiency
Esp Fat soluble vits: A, D, E, and K - so much pain after fatty mean
Major comps: Complications stone
Necrosis, peritonitis

CM - GI accessory: cholecystitis

How well did you know this?

Not at all

Perfectly

Radiographic
Abdominal X-Ray - looking for thickening of wall
Ultrasonography - looking for thickening of wall
Endoscopic retrograde cholangiopancreatography (ERCP)
Procedural
Look up into biliary tract and see if stones/sphincter of Oddi competent; treatment as well
Laboratory
Increased Bilirubin (0.3-1 mg/dL) - why see jaundice/itchy skin; usually above 2 - organ dysfunc - esp liver

Diagnostics - GI accessory: cholecystitis

How well did you know this?

Not at all

Perfectly

Diet/Supportive Therapy - low fat diet
Pharmacologic therapy - meds: uracil: helps dissolve clots
Dissolve small, gallstones
Nonsurgical removal gallstones
catheter inserted percutaneously
Surgical management
Laparoscopic – less invasive; much easier heal time; can be same day surgery oftne
Open – more invasive

Med/surg - GI accessory: cholecystitis

How well did you know this?

Not at all

Perfectly

Laparoscopic versus traditional Lower complication rate Low death rates Rare bile duct injuries Quicker recovery Less postoperative pain Preoperative, intraoperative, postoperative similarities and differences are pretty much equal with each other Infected gall bladders that are gaseous often done open - teach pts about both before go to surgery - during surgery may need convert from one to another

Cholecystectomy - GI accessory: cholecystitis

Acute pain - pre and post-op Impaired gas exchange - must splint Impaired skin integrity - surgery Imbalanced nutrition; less than - unable to eat, nausea caused by fat Risk for infection –surgical site Also see abdominal surgery diagnosis

N. diagnosis - GI accessory: cholecystitis

Nursing Post op care Pain relief - esp improves resp status; hard take deep breath if painful Improve resp status Maintain skin integrity - more upright position Promote biliary drainage Low fat diet/high carb and protein - low fat for sev weeks or forever Monitor and manage potential complications Bleeding Peritonitis Disruption of GI function Discharge care

N. interventions - GI accessory: cholecystitis

Gas pain from surgery; sit up right/walk to ease; take Esp true for laparoscopic surgery - filled with gas so catheter can go in - tell sit upright, walk, pass gas, take pain med as prescribed

Managing pain - Pt edu: home care - GI accessory: cholecystitis

Light activity Avoid lifting greater than 5 lb for 1 week

Resuming activity - Pt edu: home care - GI accessory: cholecystitis

Daily Not remove steri strips

Caring for the wound - Pt edu: home care - GI accessory: cholecystitis

Fat in diet slowly - back to regular diet if tolerated in 4-6 weeks

Resuming eating - Pt edu: home care - GI accessory: cholecystitis

Know s&s of infection, N&V, abd pain

Managing follow-up care - Pt edu: home care - GI accessory: cholecystitis

Inflammation of the pancreas Self digestion of organ - two are elevated amylated and lipase - and if not allowed empty out backwash and digest pancreas Risk Factors Gallstones Obstruction - backing up into pancreas ETOH Autoimmune disease

Patho - GI accessory: Acute pancreatitis

Abdominal/back pain - lot pain Rigid abdomen/guarding Peritonitis N&V - long periods not able eat or drink; long periods NG tube; often on TPN Ecchymosis (bruising) in the flank or around the umbilicus Fever Jaundice - due to bilirubin going up into blood and not conjugated Hypotension/Hypovolemic shock

CM - GI accessory: Acute pancreatitis

History abdominal pain and hx drinking CBC Elevated WBC (infection and inflammation); H&H (bleeding/erosion) Serum amylase/lipase Elevated within 24 hour of symptoms starting Transient hyperglycemia (pancreas failing to make sufficient insulin - close eye esp if on TPN since has d50 base - high BG) and glycosuria and elevated serum bilirubin in some patients X ray-abdomen US - look for gallstones and obstruction

Diagnostics - GI accessory: Acute pancreatitis

NPO Parenteral feedings - IV and given via central line - infection risk Hyperglycemia (TPN has D50W - high risk for growing medium and must watch for this) NG to suction with decompression Pain management - LOTS Respiratory care - LOTS; may end up on ventilators Biliary drainage - could have obstruction affecting gallbladder and pancreatitis Surgical intervention - rarely used Intensive care - septic and shock

med/surg - GI accessory: Acute pancreatitis

Acute pain - want good pain control able breath and move Altered breathing pattern - pancreas close to lungs and causes issues there Altered nutrition status: less than - unable eat - almost all from TPN Impaired skin integrity, risk for - end up in bed rest for long period time Ineffective health maintenance - can be due to drinking Nausea

N. diagnosis - GI accessory: Acute pancreatitis

Administer analgesics Positioning Improve breathing pattern For good skin integrity - lots major turning to keep lungs draining NPO/NG tube care/IV fluids - good mouth care; NG tube draining appropriately; IV fluids - PO fluids not work Enteral or parenteral nutrition - eye on IV line and not infected - sterile dressing; changing tubing on TPN - nothing in TPN when hung Monitor for complications - infection and bleeding Educate ETOH in pancreatitis - formal plan for Alcoholics Anonymous - one more time drinking sends right back to pancreatitis

N. intervention - GI accessory: Acute pancreatitis

Etiologic factors Alcoholism Gallstones (biliary tract disease) Blunt abdominal trauma Operative manipulation and trauma Drug use Infection Unknown and other causes Pancreatitis - section where obstructed and end up with pancreas eating itself and then necrosis/hemorrhage

Process autodigestion in acute pancreatitis- GI accessory: Acute pancreatitis

Pancreatitis often results in this Adenocarcinoma - super aggressive cancer; all cancers Affect All parts of pancreas - probs with digestion, BG even tho islet cells throughout pancreas - could cause issue with insulin production Incredibly Fast growing Highly invasive Primary/Secondary Metastasis through venous and lymphatic systems - largest issue not know when happening: not lot clear signs that speak to it and by time diagnosed very late stage

Patho - GI accessory: pancreatic cancer:

Smoking - pipe smoking esp Diabetes Mellitus Chronic Pancreatitis Cirrhosis Male Older age Genetic (BRCA2 gene from breast cancer)

Risk factors - GI accessory: pancreatic cancer:

Weakness and Fatigue Abdominal pain (dull/non-specific) Jaundice - some sort of obstruction and non-drainage from bile Clay-colored stools - issues from bile Dark urine - issues from bile Weight loss - not having amylase and lipase to break down food Anorexia Nausea and Vomiting

CM - GI accessory: pancreatic cancer:

Assessment of clinical manifestations Elevated amylase and lipase - 24 hours after beginning of symp; this is big one Elevated alkaline phosphatase - if liver involvement; congruent liver, gallbladder, pancreas Elevated total bilirubin - looking for obstruction Ultrasound/CT - looking for thickening of walls and obstruction ERCP - looking for stones or outlet not working and need sphincterotomy Pancreatic washings - most definitive ways; by use ERCP and taking biopsies little areas of pancreas

Diagnosis - GI accessory: pancreatic cancer:

Not easiest to treat Chemotherapy/Radiation: Shrink Tumors ERCP with Sphincterotomy and Stent - treatment Pain control/Opioids Whipple procedure Open Minimally invasive Massive procedure - takes about ¼ inside - open and minimally invasive portion; takes about 1 week to recover and really good if can get cancer at early stage before traveled to lymph nodes; once lymph nodes involved secondary with chemo and radiation

med/surg - GI accessory: pancreatic cancer:

Anxiety Ineffective family Coping Fear Grieving Deficient knowledge Spiritual distress Risk for impaired liver function - whole tree involved See nursing diagnosis for cancer, chemotherapy, surgery, and radiation depending on what going on with pt Biggest issue with pancreatic cancer: cure/survivial rate extremely low: late presentation and identification

N. diagnosis - GI accessory: pancreatic cancer:

Administer analgesics Positioning Improve breathing pattern NPO/NG tube care/IV fluids Blood Glucose/TPN/Central line Assess for bleeding, infection, abscess formation

N. intervention - GI accessory: pancreatic cancer:

Viral infection of liver with necrosis and inflammation of liver cells - will lead to cirrhosis and same CM of cirrhosis 5 Types A and E fecal-oral route B (Body fluids) C common cause for liver cancer and need for transplant D and with some B: IV drug use

Patho - GI accessory: hepatitis (viral)

Incubation (1-6 months): passed during that time Arthralgia and rashes - lot joint pain Anorexia - not very hungry Malaise, weakness - feel weak and tired Jaundice and dark urine - increased bilirubin in bloodstream and liver unable conjugate that Vague epigastric distress, nausea, heartburn, and flatus Enlarged liver/abdominal tenderness

CM - GI accessory: hepatitis (viral)

Increased liver enzymes ALT (4-36 iu/L) AST (0-35 u/L) Positive Antibodies Liver biopsy - big one; direct needle into liver; if liver not working like should not having coag properties necessary - watch carefully

Diagnostics - GI accessory: hepatitis B

Alpha-interferon injections 3 X weekly 16-24 weeks Two antiviral agents Entecavir Tenofovir Bed Rest until manifestations resolve Diet Liver transplant

med/surg - GI accessory: hepatitis B

Activity intolerance Fatigue Imbalanced nutrition, less than body requirements Acute Pain Social isolation Knowledge deficit

N. diagnosis - GI accessory: hepatitis B

Encourage physical activity as much as possible for pt Avoid sexual contact Chronic-may pass infection for life life Psychosocial issues and concerns that go on Education about self care Prevention of further issues

N. interventions - GI accessory: hepatitis B

Cause Acute liver cell necrosis Similar to acute viral hepatitis, but has more parenchymal destruction and destructive properties so tends to be more extensive Most common cause of acute liver failure greater than 50%

Certain chemicals that have toxic/negative effects on liver- GI accessory: non-viral hepatitis

Acetaminophen Leading cause Any OD - no more than 3 g in 1 day IV acetycysteine - causes liver protection Psychotropic medications Antimetabolites Anesthetic agents Anticonvulsants Could be something that destroy the liver Mushrooms that cause destruction to client’s liver

Common Medications - GI accessory: non-viral hepatitis

Portal HTN leads to ascites and esophageal varices Chronic disease characterized by replacement of normal liver tissue with diffuse fibrosis - liver cells become hardened and non-flexible Disrupts structure and function Liver becomes nodular; blood and lymph flow are impaired - big deal with blood: portal HTN - blood backs up since cannot get through = esophageal varices and ascites Affects Men greater than women; 40-60-year-old

Patho - GI accessory: cirrhosis

Alcoholic cirrhosis MOST COMMON Post-necrotic cirrhosis Late result acute viral hepatitis Biliary cirrhosis Scarring occurs around bile ducts

Three types of cirrhosis - GI accessory: cirrhosis

Serum albumin level decrease - albumin protein made in liver: cirrhotic and nonfunctional albumin no longer able to come out into sys and cause lots of edema Serum globulin level rises Liver function tests Serum alkaline phosphatase, AST, ALT, and GGT levels increase Serum Bilirubin increase - due to livers inability to conjugate it - see darker urine, clay-colored stool, bile salt deposits within the skin CT, MRI, US - obstructions and thickening and enlarging Liver biopsy-confirms diagnosis - know if have clotting available - bleeding out easily since going directly into liver

Diagnosis - GI accessory: cirrhosis

Antacids-GI distress Potassium sparing diuretics Spironolactone –decrease ascites - may spare K must use salt substitutes and major ingredient is K so watch for elevated K - cardiac/muscle issues Diet Colchicine/Statins-antifibrotic effect on liver/activity Herb milk thistle (Silybum marianum)-regenerative properties for liver

med/surg trtment - GI accessory: cirrhosis

What taking/exposed to Exposure to alcohol and drugs, herbs, medications, and chemicals Needle stick injury, tattoo placement Employment as a healthcare worker, firefighter, or police officer - high risk Assess sexual history and orientation Inquire about family history. Collect previous medical history

Risk assessment - GI accessory: cirrhosis

Pallor/Jaundice over pallor Muscle atrophy - in extremities; large central trunks and muscles waste away in arms and legs Edema - in trunk and abd esp - portal HTN and low albumin Skin excoriation(scratching) Petechiae/spider angiomas - veins popping up everywhere - blood not able flow through liver Enlarged liver or small/hard liver Bilateral gynecomastia and testicular atrophy Cognitive status/weakness

CM - GI accessory: cirrhosis

Portal hypertension Ascites and edema Esophageal varices - rupture easily; veins show up easily on body as well Coagulation defects/anemia Jaundice/pruritus Hepatic Encephalopathy/coma - built up ammonia in brain Bacterial peritonitis Metabolic abnormalities - many Vitamin deficiencies

Progression - GI accessory: cirrhosis

Inadequate formation, use, and storage of certain vitamins (vitamins A, C, D and K) Fat soluble - trouble getting out fats

Vitamin Deficiency - GI accessory: cirrhosis

Chronic gastritis and impaired GI function, together with inadequate dietary intake and impaired liver function Never feel like eating so impaired dietary intake

Anemia - GI accessory: cirrhosis

Increased bleeding; platets not produced

Clotting factor deficiency - GI accessory: cirrhosis

Abnormalities of glucose met. Blood glucose high after a meal Hypoglycemia during fasting because no glycogen stores in liver and no conversion from glyconeogenesis from glycogen to glucose and of decreased hepatic glycogen reserves and decreased gluconeogenesis Abnormalities Endocrine Liver cannot properly metabolize hormones Androgens and sex hormones Testicular atrophy and gynecomastia

Metabolic Abnormalities - GI accessory: cirrhosis

Activity intolerance Disturbed body image Excess fluid volume Risk for bleeding Risk for injury: decreased LOC Risk for acute confusion Imbalanced nutrition: less than body requirements Impaired skin integrity related to pruritus from jaundice and edema Fatigue

N. diagnosis - GI accessory: cirrhosis

Promoting Rest Improving Nutritional Status Providing Skin Care Reducing Risk of Injury Monitoring and managing potential complications of pt

N. interventions - GI accessory: cirrhosis

Flow of bile impeded Bilirubin concentration in blood increased; collects in tissues causing Jaundice Serum bilirubin level exceeds 2.0 mg/dL - showing severe organ damage Bile salts cause severe pruritus

Jaundice and Pruritus - issue with cirrhosis - GI accessory: cirrhosis

Cognitive level decreasing due to high levels of ammonia Monitor: to identify early deterioration in mental status Early: include mental status changes and motor disturbances; extensive baseline and ongoing neurologic eval is key - everytime see pt ensure not changing Monitor electrolytes and ammonia levels (low Na and elevated ammonia makes you crazy) Provide pt safety; prevent injury; bleeding infection - side rails, call light, bed alarm, sitter in there Prevention and early identification life-threatening complications; resp failure and cerebral edema - ammonia very high and no longer able breathe on out - result in cerebral edema Treatment: administer lactulose - traps and expels ammonia in feces - med

Cirrhosis Progression and hepatic encephalopathy - GI accessory: cirrhosis

Blood from digestive organs collects portal veins; carried to liver Cirrhotic liver- no free blood passage Blood backs up into spleen and GI tract veining sys-chronic passive congestion - engorged veins in esophagus and fluid in abdomen (varices and ascites) Indigestion/altered bowel function result. Protein rich fluid accumulate in peritoneal cavity, producing Ascites Liver cannot metabolize aldosterone further increasing fluid Reduces plasma albumin = Edema

Formation - Cirrhosis progresion: Ascites and edema - GI accessory: cirrhosis

Measure abdominal girth Daily weights (fluid - gaining fluid/not esp quickly); I&O - accurate Na restricted diet No salt substitutes unless ok with HCP Salt substitutes contain potassium and should be avoided if the patient has impaired renal function. Adm. diuretics (Spironolactone - K sparing) Monitor electrolytes, Cr & BUN, ammonia Adm. Albumin – necessary because pulls extravascular fluid into vascular system to be excreted by kidneys Monitor for signs and symp of infection/peritonitis

Nursing - Cirrhosis progresion: Ascites and edema - GI accessory: cirrhosis

Varices are varicosities that develop from portal hypertension Prone to rupture - very thin - not able heal because pressure; rupture and massive hemorrhages: upper GI tract (esophageal varices) & rectum (hemorrhoids) (hematemesis, melena) When varices ruptures - have yankauer catheters in patient’s mouth trying to suction it out while someone tries to quickly intubate them Major causes of death in patients with cirrhosis Several types of procedures used to treat and stop bleeding - balloon to stop bleeding Nursing

Esophageal varices - GI accessory: cirrhosis

Support through procedure Adm/monitor parenteral nutrition - central line, infection, high volume of sugar NG to suction - depression Good Oral care Close monitoring VS - bleed out quickly Adm Vitamin K/blood products esp if looking at losing lot blood Manage delirium secondary to alcohol withdrawal - SiWa protocol

Nursing - Esophageal varices - GI accessory: cirrhosis

Nothing else can do Take out entire liver - put in whole liver from cadaver right lobe from live Used to treat ESLD when no other treatment is available Total removal disease liver and replacement with healthy liver from cadaver donor or right lobe from live lonor in same anatomic location Pt must undergo thorough eval: model for ESLD (MELD) classification Imp piece: Successful liver transplantation depends on successful immunosuppression - take meds regularly to keep the liver Post-op comps Nursing Home care

- GI accessory: liver transplant

Much less often Bleeding Result from coagulopathy, portal hypertension, and fibrinolysis caused by an ischemic injury Infection Leading cause of death after liver transplantation - not just surgical transplantation but also suppressed immune sys or reject liver Rejection Perceived by the immune system as a foreign antigen Immunosuppressive agents

Post-op comps - GI accessory: liver transplant

Preoperative Stop drinking Must be available at all times in case liver becomes available - wear a pager - get ahold of them immediately Administration of platelets, fresh-frozen plasma, or other blood products Immunosuppression - suppressing person Bacteria free environment All Follow up appointments Recognize signs of organ rejection: fever, jaundice, dark urine, itching, fatigue, headache, ascites

Nursing - GI accessory: liver transplant

Provide written/verbal edu about meds Avoid running out med/skipping dose - can cause pt to reject s&s indicate probs - rejection: consultation transplant team Pt with T-tube in place educated about how manage tube, drainage, skin care Follow-up lab tests and appts with transplant team Trough blood levels immunosuppressive agents Labs assess func of liver and kidneys Routine ophthalmologic exams Cataracts and glaucoma associated with LT corticosteroid therapy Dental care - admin prophylactic antibiotics given before dental exams - so liver not reject Birth contol

Home care - GI accessory: liver transplant

Primary Hepatitis B and C Cirrhosis Secondary Metastases Other primary sites, particularly the digestive system (pancreatic cancer often), breast, and lung

Patho - GI accessory: liver cancer

Pain Weight loss Loss strength Anorexia Anemia due to bleeding Jaundice Ascites

CM - GI accessory: liver cancer

Bleeding, risk for Falls, risk for Imbalanced nutrition, less than body requirements Nausea Fatigue Infection, risk for

N. diagnosis - GI accessory: liver cancer

Education Bleeding precautions - electric razor Antiemetics - zofran Maintain sterile technique - suppressed immune sys Post operative care

N. interventions - GI accessory: liver cancer