GI System Flashcards
Cirrhosis
Extensive scaring(hard)of the liver.Normal liver tissue is replaced with fibrotic tissue that lacks function. Affect liver ability to handle the flow of bile. jaundice is the often the result. Health promotion and disease prevention.
How many types of in cirrhosis
postnecrotic -caused by viral hepatitis or certain medication or toxins.
Laeneecs-Caused by chronic alcoholism.
biliary:caused by chronic biliary obstruction or auto immune disease.
What is the risk factor for cirrhosis?
Alcohol abuse, hepatitis –auto immune/hepatitis BCD/Biliary
steatohepatitis-(fatty liver disease causing chronic inflammation)
Damage to the liver caused by drugs, toxins, and other infections
cardiac cirrhosis:severe right heart failure, inducing necrosis and fibrosis due to lack of blood flow.
Cirrhosis subjective data And assessment findings
Fatigue , weight loss, abdominal pain, distention,
pruritus (Sever itching of skin),
confusion or difficulty thinking -hepatic and encephalopathy
personality and a mentation changes: emotional lability, euphoria(suddenly become happy or so sad),sometimes depression.
Altered sleep/wake pattern.Gastrointestinal bleeding-varices.
Other bleeding signs: patachiae, Ekhymosis, nosebleed.
What is the physical assessment findings of cirrhosis?
Dependent peripheral edema of extremities and sacrum. Asterix(Liver flapping tremor-getting Neuro effect) course tremor characterized by rapid, non-rhythmic extension and flexion of the wrists and fingers. Assess by having client extend arms(continuously not)and dorsiflexion the wrist * Correlates with progression into hepatic and encephalopathy. Fetor hepaticus(liver breath)- fruity or musty order.
What will give Cirrhosis for nursing care?
Respiratory status-Monitor oxygen saturation and distress
Position:sit in a chair or elevated the head of the bed 30° with feet elevated.
Skin integrity- monitor for skin breakdown. Prevent pressure ulcer.
Puritas:wash with cold water, apply lotion
fluid balance-monitor for signs of fluid volume excess. Keep strict intake and output
obtain daily weights, Assess Asities and peripheral edema.
restrict fluids and the Sodium if prescribe.1Lfluid=1kg (fluid collection)
cirrhosis nursing care
vital signs-monitor vital signs and pain level.
Neurological status: hepatic encephalopathy: lactulose( take out ammonia from the body and because of that lactose excreted from the body diarrhea)
Nutritional status: give diet education.
high carbohydrate,low protein, moderate fat, Low sodium diet with vitamins supplements such, thiamine,folate,and multivitamins
Gastrointestinal status
Asities:measures abdominal girth over the largest part of the abdomen
Observe the potential complications 
Medication for cirrhosis
avoid opioids,sedatives and barbiturates.
Give diuretics: excessive fluid in the body.
beta blocking agent: to prevent bleeding varies.
lactulose: used to promote excretion of ammonia from the body through the stool.
Non absorbable antibiotic:rifaximin can be used in place of lactulose.
What is the procedures for Cirrhosis
Surgery:Liver Transplant,
procedure: parasynthesis
complications: Encephalopathy,varices.
client education for cirrhosis
Encourage the client abstain from alcohol and engage in alcohol recovery program.
Helps to prevent further getting on the fibrosis of the liver.
prevents irritation of the stomach,and esophagus’s lining.
Helps decrease the risk of bleeding.
Helps to prevent other life-threatening complications.
Consult with provider prior to taking any over counter medication or herbal supplement.
vitamin B 12 deficiency (pernicious anemia)
Results from inadequate intake of vitamin B 12 are lack of absorption of ingested vitamin from intestinal track.
What are the assessment of vitamin B 12 deficiency (pernicious anemia)
Assessment:smooth, beefy red tongue, paraesthesia of hands and feet, disturbance in gait and balance.
Vitamin B 12 interventions
Administer vitamin B 12 injection says prescribed for life.
Haietal Hernia:portion of the stomach herniates through diaphragm and into thorax .
Heartburn; regurgitation or vomiting; dysphasia; feeling of fullness.
Vitamin B 12 interventions
Provides frequent meals.
Limit amount of liquid taken with meals.
Advise client not to recline for 1hour after feeding.
Appendicitis
Abdominal pain most intense at McBurney‘s point.
Client inside-lying position, with abdominal gardening.
Constipation or diarrhea, peritonitis.
Increased fever;chills; pallor, abdominal distention,; abdominal pain; restlessness; right gardening of abdomen; tachycardia; tachypnea.
What all the Signs
in appendicitis
Rovsing sign(RLQ pain with palpitation of the LLQ):suggested peritoneal irritation obturator sign (RLQ pain with internal and external rotation of the flexed right hip). Suggest the inflamed appendix is located deep in the right hemipelvis.
two more appendicitis
Posas sign (RLQ pain with extension of the right hip or with the flexion of the right hip against resistance). suggests that an inflamed appendix is located along the course of the right posas muscle. Dunphy sign(sharp pain RLQ elicited by a voluntary cough):Suggests localized peritonitis.
Preoperative interventions appendix
Monitor for signs of ruptured appendix, peritonitis,.
Position client in right side- laying or low-to Semi Fowlers position
* avoid application of heat to abdomen, avoid laxatives, enemas
Postoperative interventions, maintaining NPO status until bowl function returns.
with rupture, expect Penrose drain to be in place or incision left open.
Drainage from Penrose may be profuse. 
position the client in right side lying or low to semi fowlers position, legs flexion to facilitate drainage.
Raptured appendix: Peritonitis
Acute inflammation of the peritoneum- the endothelial lining of the abdominal cavity.
clinical manifestation of peritonitis.
Distended abdomen,; , rigid, board like abdomain diminished bowel sounds; inability to pass flatus Abdominal pain (localized poorly localized or referred to the shoulder And thorax). Anorexia, nausea, vomiting; rebound tenderness in the abdomen; high fever; tachycardia; dehydration from the high fever; decreased urinary output; hiccups,possible compromise respiratory status.
lactase intolerance
Due to not enough lactase from small intestine.
Lactase:the enzyme that digests the milk,sugar,lactose.
signs and symptoms: pain, abdominal cramps, bloating,diarrhea and vomiting.
Diagnostics for lactose
Text to diagnose:hydrogen breath test.
more hydrogen produced due to fermentation of lactose in colon (which is not observed in small intestine).
peptic ulcer
It is an erosion of the mucosal lining of the stomach or Duodenum.
There are gastric acid ulcer and Duodenum Ulcer
Pain:Gastric ulcer:30 to60min after a meal.Rarely occurs at night. Pain exacerbated by ingestion of food .
Pain: duodenal ulcer: 1.5 to 3 hours after a meal.often occurs at night.
Pain may be relieved by ingestion of food or antacids.
assessment findings peptic ulcer disease
Epigastric pain upon palpation.
*Pain that radiates to the back may indicate perforation is imminent
Sudden, severe abdominal pain is a sign of perforation.
Maybe left upper epigastrium (gastric),or right epigastrium(Duodenal)
Bloody bloody Emesis(hematemesis) or stools (melena),Weight loss.
risk factors for Peptic ulcer Disease
causes peptic ulcer: Helicobacter (H-pylori) Iinfection.
Nonsteroidal anti-inflammatory drug and corticosteroids-use severe stress,
excess alcohol ingestion, chronic pulmonary or kidney disease,
Zollinger Ellison syndrome (combination of peptic ulcer,and hypersecretion of gastric acid, and gastrin secreting tumors).
diagnostic procedure for peptic ulcer Disease
esophagogastroduodenoscopy (EGD): provide definitive diagnosis.
gastric samples are obtained to test for H. pylori.
Medication for peptic ulcer
Bismuth,misoprostol, sucralfate, histamine2 antagonists can interfere with the testing for H. pylori (false negatives). Therefore a complete medication history should be reviewed prior to testing. 
Nursing care for peptic ulcer 
Avoid foods that cause a distress.
Monitor for orthostatic changes in vital signs and tachycardia as these findings are suggestive of gastrointestinal bleeding.
Administer medication as prescribed.decreased environmental stress.
Encourage rest periods. Increase smoking cessation and avoiding alcohol consumption. medication: antibiotics:eliminate H. pylori infection.
Histamine 2 receptor antagonist:ranitidine hydrochloride (Zantac), famotidine (Pepcid),Suppress the secretion of gastric acid by selectively blocking H2 receptor in parietal cells lining the stomach.
nursing consideration of Peptic ulcer
ranitidine and famotidine can be administered by I/V in acute situation.
Ranitidine can be taken with or without food.
Treatment of peptic ulcer disease is usually started-as oral dose twice a day until the ulcer is healed,followed by a maintenance dose usually taken once a day at bedtime.
*proton pump inhibitor:pantoprazole (proton),Esmoprazole(Nexium)
Reduce gastric acid secretion by is irreversibly inhibiting the enzyme that produces gastric acid.
Reduce basal stimulated acid production.
client education peptic ulcer
not to crash, Chew,or break sustained-release capsules
instruct the client to take med once a day prior to eating in the morning.
Encourage the client to avoid alcohol and irritating medication NSAIDs.
Mucosal protectant: sucralfate Carafate.
Give an 1hour before and ate it bedtime. Monitor for adverse effects of constipation constipation. Antacids: aluminum carbonate, magnesium hydroxide (milk of magnesia).
Antacid are given 1 to 3 hrs after meals to neutralize gastric acid, which occurs with fully ingestion and it’s bedtime.
Gastric surgeries: gastrectomy
All or part of the stomach is removed with Laparoscopic or open approach.
Antrectomy 
the antrum part of the stomach is removed.
