Week 1 GI Flashcards
GERD
PUD
IBD are all what?
GI Disorders and Intestinal Obstructions
IBD is umbrella term for what 3 diseases?
Crohn
UC
Diverticulitis
Incompetent LES
Pyloric Stenosis
Hiatal Hernia
Motility Disorder
Barrett’s Esophagus
GERD
In GERD what generally happens to the LES?
It is relaxed and then causes HCI to reflux back into the esophagus
Hiatal Hernia
Occurs when the upper part of the stomach pushes up into the chest through small opening in the diaphragm the muscle separates the abdomen from the chest.
What happens in Barrett’s Esophagus?
Condition that occurs when the lining of the esophagus is damaged by stomach acid and heals abnormally.
Name the clinical manifestations of GERD
Pyrosis
Dyspepsia
Regurgitation
Dysphagia
Odynophagia
Hypersalivation
Esophagitis
Body Protective Mechanisms
Gravity- Upright body. Assist with the flow back to stomach.
Swallowing-Carries refluxed liquid back to stomach.
Salivary Glands produce saliva that contains bicarbonate.
At night ….
- Gravity has no effect and swallowing stops and secretion of saliva is reduced.
Name some increased risks of GERD
Pregnancy- elevated hormone levels
Growing Fetus
Weaken Esophageal Muscles
Mixed Connective Tissue Diseases - Sclerodermas
Diagnostic for GERD include
Endoscopy
Barium Swallow
Ambulatory 12-36 hr esophageal pH monitoring
Management of GERD self care include
Avoid situations that decrease lower esophageal sphincter pressure or cause esophageal irritation
Elevate HOB
Dietary modification
Weight Loss
Medication management of GERD
Antacids
HS blockers
PPIs
TLERs, Baclofen
Reflux Inhibitors, Bethanecol Chloride
Surface Agents, Sucralfate
Management Self Care for GERD include
Low fat diet
Avoid caffeine
Avoid tobacco
Avoid beer
Avoid milk
Avoid peppermint/ spearmint
Elevate upper body
Complications of GERD include
Throat and laryngeal inflammation
Cough and asthma
Inflammation and infection of lungs
Collection of fluid sinuses and middle ear
Esophagitis
Strictures
Barrett’s Esophagus
Management of Self GERD
Avoid carbonated beverages
Avoid eating 2 hrs before bedtime
Avoid tight fitting clothing
Normal body wt
HOB elevated 6-8 in
Erosion of a mucous membrane forms an excavation in the stomach, pylorus, duodenum, or esophagus
Peptic Ulcer
Associated with H. Pylori
Risk factors of GERD include
Excessive secretion of stomach acid
Dietary factors
Chronic use of NSAIDs
Alcohol
Smoking
Familial Tendency
Manifestation of this disease include
Dull gnawing pain or burning in the mid epigastrium, heart burn and vomiting may occur
Peptic Ulcer
Treatment of this disease includes
Treatment MEDS
Lifestyle changes
Occasionally surgery
Peptic Ulcer
Peptic Ulcers are likely to occur where >
Duodenum
Peptic ulcers are solidarity or nonsolidarity
Solidarity
Chronic gastric ulcers occur where?
Lesser curvature
Near the pylorus
These ulcers occur d/t retrograde flow of HCI
Esophageal Ulcers
70-90% of peptic ulcers are associated with
H. Pylori
What ages are affected with peptic ulcer?
Between 40-60 yr
Can occur in infants/ children
Is peptic ulcer common in childbearing age?
No
Uncommon
Post menopausal women increase the incidence of what?
Peptic Ulcer
Etiologies of Peptic Ulcer include
-H. Pylori- Ingested through food and water
- Blood Type o plus
- Familial Tendency
- COPD, Cirrhosis, CKD and autoimmune disorders
- NSAID- Impair protective gastric mucosa
- ZES- Zollinger Ellison Syndrome
H. Pylori Characteristics
-Gram - rod
- Selective to the stomach
- Inhabits the antrum
- Causes low level inflammation in the lining
- Strongly linked to PUD’s and stomach cancer
- 80% asymptomatic
- Affects > 50% world population
- Prevalence in developing countries
- Transmission: Oral ( Food, water, close contact to emesis)
Pathophysiology of PUD
- Duodenal Ulcers - Increased amounts of the acid
- Increases production of gastric acid HCI or pepsin
-Decrease resistance of mucosa - Damaged mucosa decreases mucous production and protection lining
- Erosion of gastric lining - exposure nerve endings
- In gastric ulcers- normal or decreased acid amount
- Decreases acidity results in decrease resistance to bacteria causes increased bacterial Infections - H. Pylori
Manifestations of Peptic Ulcer
-Symptoms intermittent over days, weeks, and months
- Appearing-Disappearing- reappearing
Chief Complain of PUD is
Dull gnawing burning pain in the mid epigastric region or back
Pain immediately after eating is with
Gastric Ulcer
Pain after 2-3 hours of eating is what type of ulcer is
Duodenal Ulcer
Heartburn is also known as
Pyrosis can be shown in PUD with sour eructation or burping
Manifestation of PUD is
vomiting “ relief” after bout of severe pain and bloating
- Diarrhea/ Constipation
- GIB- Bleeding in 15% - Melena - Tarry stools
Assessment and Diagnostic Findings for PUD
- Physical Examination
- Endoscopy- PREFEERED DIAGNOSTIC
- Histologic Examination- H. Pylori
- Serologic Examination- H. Pylori
Treatments both pharmacological and Surgical is aimed at what for PUD?
Controlling the activity of “ certain portions of the stomach”
The pylorus secretes what?
- Pepsinogen II
- Gastrin- 34
The antrum secretes what?
- Gastrin 17
- Gastrin 34
Pepsinogen II
Pharmacological Treatments for PUD
Medications
- ABX+PPIs+ Bismuth Salts= 10-14 days - suppress or eradicate H. Pylori
H2 Receptors Antagonists- Tx NSAID induced Ulcers
- PO or IV
- Ex: Cimetidine, famotidine, ranitidine, nizatidine
PPIs
- PO or IV
ex- Esomeprazole, omeprazole, pantoprazole, rabeprazole
Ulcer Healing use what meds?
H2 Receptor Antagonist
PPIs
H. Pylori Infection
Quadruple therapy with Bismuth Salts
Prophylactic Therapy for NSAID ulcers
Peptic Ulcer Healing doses
Misoprostol
Dietary Modifications for PUD include
-Avoid extremes in temp. or food and beverages
- Avoid alcohol, coffee, and other caffeinated beverages
- Eat 3 regular meals/ day- Neutralize acid
- Individualized- pts should avoid any foods that cause pain
Name the surgical procedures for Peptic Ulcer Surgery
- Pyloroplasty- Pylorus- note longitudinal incision then have a vertical suture
- Vagotomy- Vagal nerve
- Bili Roth II-gastrojejunostomy
- Antrectomy Bill Roth I- Gastroduodenostomy
Surgical procedure #1 for PUD is
Vagotomy
- Severing the vagus nerve, decreases cholinergic to parietal cells
- Can be done w/ drainage-pyeloplasty to aid w/ emptying
Side effects include: c/o absence of satiety, diarrhea, and gastritis
—– Dumping Syndrome
Surgical Procedure #2 for PUD is
Pyloroplasty
- Note longitudinal incision w/ vertical suture
What is a pyloroplasty?
Longitudinal incision made into the pylorus
- Transversely sutured closed to enlarge the outlet and relax the muscle
Side effects c/o absence of satiety. recurrence of ulcer 10-15%
No dumping
Surgical Procedure - Pyloroplasty
Surgical Procedure #3 for PUD is
Antrectomy- Biliroth I
- Removal lower part of the antrum
- Controls the release of gastrin
- Dumping Syndrome
Surgical Procedure #4 for PUD is
Billroth II
- Removal of the lower portion with anastomosis to jejunum
- Dumping Syndrome
- Anemia
- Malabsorption
- Weight loss
- recurrence rate of ulcer is 10-15%
_________ is a vasomotor response to the food ingested
Dumping Syndrome
Patho of Dumping Syndrome
Rapid emptying of gastric contents into small intestines resulting from the sudden mix of hypertonic fluid- small intestine pulls fluid from EC space to convert to hypertonic state to isotonic fluid consistency
- Fluid shift results in decrease circulating volume
Symptoms in Early Dumping Syndrome
Early
- 30 min after meals - vertigo, syncope, pallor, diaphoresis, increased HR, palpitations)
Late Symptoms of Dumping Syndrome
- 90 min after meals
- Excessive insulin nrelease
- abd distention
- Cramping
- borboryrmi, nausea, dizziness, diaphoresis, confusion
Lying down after meals - delays gastric emptying
- Eliminate liquids with meals one hour before or after
- Consume high PRO, high fat, low to mod CHO diet
- Avoid milk, sweets, or sugars - fruit juices
- Small frequent meals
Dumping Syndrome
Assessment care of PUD patient
- Assess pain/ anxiety
- Dietary intake and 72 hr diet diary
- Lifestyle and habits such as cigarette and alcohol use
- Medications include use of NSAIDs
- S/S of anemia or bleeding
- Abdominal Assessment
Nursing Process Diagnosis of Peptic Ulcer
Imbalanced Nutrition
Acute Pain
Anxiety
Deficient Knowledge
Nursing Process of Peptic Ulcer planning
Major goals include relief of pain, reduced anxiety, maintenance of nutritional requirements, knowledge about the management and prevention of ulcer recurrence, and absence of complications
Relieve pain in PUDs include
Treat with prescriptions medications
Avoid aspirin, NSAIDs, alcohol
Anxiety of PUD
- Assess anxiety
- Calm manner
- Explain all procedures and treatments
Help- Help identify stressors - Explain- Explain the various coping and relaxation methods such as biofeedback, hypnosis, and behavior modification
Patient Education for PUD includes
-Medication Education
- Dietary Restrictions
- Lifestyle Changes
Collaborative Problems and Potential Complications
- Hemorrhage- Most common 15%
- Perforation
- Penetration
- Pyloric Obstruction- Gastric Outlet Obstruction
Hemorrhage is common complication in what?
PUD
Hemorrhage complication in PUD monitor for ?
S/S of anemia or bleeding
- CBC
- > 60 y/o- hematemesis may be fatal
- Occurs in 10-20%
-Manifested
— Hematemesis- Large volumes 2-3 L loss or coffee ground emesis
- Melana- Small volumes loss, blood in stools or tarry stools
Management of Potential Complications
Hemorrhage
- Assess for evidence of bleeding, hematemesis or melena, and symptoms of shock/ impending shock and anemia
Tx: Includes IV fluids, NG, and Saline or water lavage, oxygen, tx of potential shock including monitoring of VS and UO; may require endoscopic coagulation or surgical intervention
Management of Potential Complications Pyloric Obstruction
Symptoms include
- Nausea/ Vomiting, constipation, epigastric fullness, anorexia, and later weight loss
Insert Ng tube to decompress the stomach, provide IV fluids and electrolytes. Balloon dilation or surgery may be required
Management of Potential Complications
Management of perforation or penetration
Signs include
- Severe upper abdominal pain that may be referred to the shoulder, vomiting and collapse, tender board like abdomen, and symptoms of shock or impending shock
patient requires immediate surgery
Diverticulum
Sac like herniation of the lining of the bowel that extends through a defect in the muscle layer
Diverticular Disease may occur anywhere i the intestine but most common where
Sigmoid Colon
Multiple diverticula without inflammation
Diverticulosis
Infection and inflammation of the diverticula
Diverticulitis
Increases with age and is associated with low fiber diet
Diverticular Disease
Diagnosis usually done with colonoscopy
Pathophysiology of this disease is where diverticula form when mucosa/ submucosal layers of colon herniate through muscular wall
Diverticulosis
- High intraluminal pressure
- Low volume in the colon
- Decreased muscle strength
Bowel contents accumulate
- Inflammation
- Infection
- Abcess/ Perforation
Manifestations of Diverticulosis
- Chronic constipation over years
- Bowel irregularity intervals N/D, anorexia
- Bloating or abd distention
Narrowing from fibrotic strictures leading to;
—— Cramps
———— Narrow stools
———– Increased constipation
———- Intestinal obstruction
Stool goes how?
Type 1-7
1 being marble like
7 liquid type
Complications of
abd pain, rigid board like abdomen, loss of bs, s/s of shock
- Abcess formation
- Fistulas
- Bleeding
Medical management for Diverticulitis includes
Diet
- Clear liquid until inflammation subsides
- High Fiber
Bulk Forming Laxative
Medication
- Antibiotics
- Antispasmotics
- Pain Meds
Nursing Process of Diverticulitis Assessment Includes
- Chronic constipation preceding development of diverticulosis, frequently asymptomatic but may include bowel irregularities, nausea, anorexia, bloating, and abd. distention
- With diverticulitis symptoms include mild or severe pain in LLQ : nausea, vomiting, fever, chills, and leukocytosis
- Ask regarding the onset and duration of pain and past present elimination patterns
- Nutrition and dietary patterns including fiber intake
- Inspect stool and monitor complications for symptoms potential comlications
Collaborative Problems and Potential Complications
- Perforation
- Peritonitis
- Bleeding
- Abscess Formation
Nursing Process The care of the patient with Diverticulitis Diagnosis
Constipation
Acute Pain
Nursing Process Planning for pt with Diverticulitis
Major goals may include attainment and maintenance of normal elimination patterns, pain relief, and absence of complications
Maintaining Normal Elimination Pattern
- Encourage fluid intake of at least 2 L/ D
- Soft foods with increased fiber, such as cooked vegetables
- Individualized exercise program
- Bulk laxatives- pysillium and stool softeners
Crohn’s is a disease that is
Regional Enteritis
Right upper quadrant pain
- Gastrodudenal Crohn’s Disease
Left Upper Quadrant Pain and Left Lower Quadrant Pain includes
Ulcerative Colitis
Crohn’s Disease first diagnosed when?
Adolescence or young adulthood
- Incidences increase over past 30 years
Crohn’s Disease affects who more?
Smokers than non smokers
Affects men and women equally
- Familial
- Jewish Heritage Risks
- African Americans are at the least risk
This is an acute/ subacute inflammation of the GI tract and affects any area from the mouth to the anus
Crohn’s Disease
Does Crohn’s extend through all layers?
True
Where is Crohn’s commonly found in?
Ileum
Crohns does have periods of what?
Remission and exacerbation
How does Crohn’s begins?
Begins with edema and thickening of the mucosa- unfamed mucosa develops ulcers
How are the lesions described in Crohn’s?
Not in continuous contact- (separated by normal mucosa)
Ulcer cluster- Cobblestone like
The inflammation in Crohn’s extends into the peritoneum forming what?
Fistulas and fissures and abscess
- Granulomas in 50% of patients
In advanced Crohn’s what happens?
Thicken Bowel wall and fibrotic intestinal lumen
In Crohn’s what happens to the diseased bowel loops and they adhere to?
Other portions of the bowel
Crohn’s is ________________ but worsening diagnosis increases what?
Insidious
Increases extraintestinal symptoms
This disease is unrelieved diarrhea by defecation
Crohn’s
Crohn’s disease the abdominal will be?
Tenderness and spasm
Where is the cramp usually in Crohn’s disease?
RLQ- Crampy abd. pain p.c. d/t food/ peristalsis
- Weight loss- Limit food intake d/t pain leads to anorexia
- Malnutrition and chronic diarrhea and more deficits
-2nd is anemia
How are the ulcers in Crohn’s?
Weepy discharge, weepy into colon
Is the person thin in Crohn’s?
Yes, emaciated r/t malabsorption
What are the stools like in crohn’s?
Steatorrhea- Fatty Stools
Crohn’s disease will show what?
Fever and Leukocytosis
- Intra abd and anal abscesses
Name the diagnostic findings for Crohn’s Disease
- CT Scan
—Wall thickening, mesenteric edema, obstructions, abscesses and fistulas
-MRI
– Identify pelvic and perianal abscesses and fistulas
Labs
–CBC, H&H may be decreased
Elevated WBC and ESR elevated
-Albumin and Protein decreased
Intestinal obstruction
Perianal Disease
Fluid and electrolyte imbalances
Malnutrition from malabsorption
- Fistula– abscess formation (enterocutaneous fistula)
Crohn’s Disease Complication
This is a recurrent ulcerative and inflammatory disease of the mucosal and submucosal layers of the colon and rectum
UC
Highest prevalence in Caucasians and people of Jewish Descent
UC
UC is more common in men than women
False
UC has many complication r/t disease and has a high mortality rate
True
What age group does Crohn’s affect?
15-40
5% develop colon cancer
Where does UC affect more?
The superficial mucosa of colon
Where does UC begin?
Rectum and spreads proximally to entire colon
- Multiple contagious ulcerations and diffuse inflammations
This disease involves desquamation or shedding of colonic epithelium
- Bleeding from ulcerations
UC
The mucosa her becomes edematous and inflamed and the lesions are contagious
UC
This disease has the bowel narrowing, thickening, and shortening
UC
—Muscular hypertrophy
What lining does UC affect?
Only the inner lining
NOT transmural
This disease has passage of mucous, pus, or blood.
UC
LLQ pain
Tenesmus
Rectal bleeding (mild or severe)
UC
This disease has
-pallor, Anemia, and fatigue, hypocalcemia
-Anorexia, wt loss, vomiting, dehydration
- Fever
- Cramping( feeling of urgency to defecate)
6 or more liquid stools/ day
Extraintestinal manifestations
UC
This disease during the assessment is showing
VS: ^HR, Decrease BP, ^RR, ^T
Skin: Pallor Abdominal: BS plus, stool plus occult, distention and tenderness
Hematology: H/H decreased, Increased WBC, Decreased Albumin levels and electrolyte abnormalities
UC Assessment and diagnostic findings
This is a definitive test, reveals friable, inflamed mucosa with exudate and ulcerations; Biopsies taken
Colonoscopy
CT, MRI, and US do what in UC
Identify abscesses and perirectal involvement
In UC we do a stool exam for parasites ?
R/O dysentery from organisms
What are 3 major complications of UC?
Megacolon
Perforation
Bleeding
What is Toxic Megacolon?
Inflammatory process- absence of contractility- colonic distention
-s/s- fever, abd. pain, distention, vomiting, fatigue
Tx if no response for UC is?
Surgery for total colectomy and ileostomy
Interventions: 24-72 with NGT, IV fluids, steroids, abx, then surgery
Management of IBD is aimed at what?
-Remission
-Prevention of flareups
- improving QOL
Nutritional and fluid therapy of IBD includes
Low fiber, high protein, high caloric diet with vitamins and iron
- Severe dehydration- IV therapy and TPN
Pharmacological Therapy for IBD
Aminoacylates- Azulfidine
Corticosteroids- For pt refractory to remission with other meds
-Immunomodulators- alter immune response
- Anti Tumor Necrosis Factor meds- monoclonial Abs inhibit inflammatory effects of cytokine TNF in gut
- ABX (2ndary infections)
For managements of IBD sx are intractable and QOL is affected. t/f
True
33% for UC
60-70% for Crohn’s
True
Strictureplasty is used for
Management for IBD
-Laparoscopic
Management of IBD includes small bowel resection up to 80% tolerated
True
Proctocolectomy with ileostomy
True for management for IBD
- Intestinal Transplant
IBD Assessment includes?
Health Hx
- ID onset, duration, and characteristics of pain
- Diarrhea- urgency, tenesmus
- Nausea, anorexia, wt loss
- Bleeding
- Family Hx
Nursing Process The care of the patient with IBD - Diagnoses
- Diarrhea
- Acute Pain
- Deficient fluid
- Imbalanced Nutrition
- Activity intolerance
- Anxiety
- Ineffective coping
- Risk for impaired skin integrity
- Risk for ineffective therapeutic regimen management
Nursing Process Planning of Care with IBD
Major goals include
- attainment of normal bowel elimination patterns
- relief of abdominal pain and cramping, prevention of fluid deficit
- maintenance of optimal nutrition and weight
- Avoidance of fatigue
- Reduction of anxiety
- Promotion of effective coping
- Absence of skin breakdown
-Increased knowledge of disease process and therapeutic regimen
-Avoidance of complications
How can we maintain normal elimination pattern interventions?
- Identify relationship between diarrhea and food, activities, or emotional stressors
- Provide ready access to bathroom or commode
- Encourage bed rest to reduce peristalsis
- Administer medications as prescribed
- record frequency, consistency, character, and amount of stools
Other Interventions of IBD include
Reduce anxiety- Therapeutic manner, listen and let patients express feelings
- Assessment and tx of pain or discomfort, anticholinergic meds before meals, analgesics, positioning diversional activities, and prevent fatgue
-Optimal Nutrition-Elemental feedings that are in protein and low residue or PN may be needed
- Fluid deficit, I&O, daily weight, assessment of symptoms of dehydration or fluid loss, encourage oral intake, measures to decrease diarrhea
Patient education for IBD include
-Understanding of disease process
- Nutrition and diet
- Medications
- Ileostomy care if applicable
Evaluation of IBD Nursing Process
Patient reports
- Decrease in stool
-Complies with dietary restrictions
- Drink 1-2 L of fluids per day
- Normal T, skin turgor, moist mucosa
- Tolerates small, frequent feedings w/o diarrhea
- Avoids fatigue
- Adequate coping noted( verbalizes feelings, decreased stress)
- Maintains skin integrity- at stomal and anal areas
- Understands disease process and avoid complications
This disease happens in adolescence and young adulthood
-Affects all layers of intestine
- Affects mouth to anus- common in ilium
- Develops ulcer cluster/ cobblestone
- Insidious but worsens
-Diarrhea, cramps. steatorrhea, malnutrition
- No cure
Crohn’s
Ages 15-40
- Only affects mucosal/ submucosal layers
- Begins in rectum/ spreads proximally
- Multiple ulcerations/ diffuse inflammations
- Exacerbations/ remissions
- 10-20 liquid stools/ day (with blood and mucus), cramping and urgency to defecate
- Can surgically treat with the 4 procedures
UC
_____ is body mass indices above 30 ng/ m squared
Obesity
Obesity related mortality rates are _____ greater for every gain of 5kg/ m sqaured of body mass beyond BMI of 25 kg/ m squared
30%
Obesity puts one at the risk for
Disease disorders
Low self esteem ‘impaired body image
Depression
Diminished quality of life
Obesity prevalence is higher in who?
Women
African American
Hispanic
Less educated and who earn less reflects ?
Disparities in the disease burden of obesity
Obesity management includes
Lifestyle modifications
- Diet exercise
Pharmacotherapy
Bariatric Surgery
Pharmacotherapy includes
Olistat (Xenical)
Lorcaserin ( Belviq)
Sibutramine HCL (Meridia)
Rimonabant ( Acomplia)
Morbid obesity persons more than two times IBW, BMW exceeds 30 kg/ m squared, or more than 100 pounds greater than IBW, high risk complications for health
Bariatric Surgery
_____________ surgery is only performed only after nonsurgical methods have failed
Surgery
What are the selection factors for bariatric surgery?
Body weight
pt hx
Failure to lose weight using other means
Absence of endocrine disorders
Psychological Stability
Name the different Bariatric Procedures
Roux en gastric bypass
Gastric Banding
Sleeve Gastrectomy
Biliopancreatic division with duodenal switch
Performed by laparoscopy or by an open surgical technique
Roux en Y Gastric Bypass
Weight loss surgery that restricts food intake and prevents absorption of nutrients
- Creates small pouch in the stomach and connecting the newly created pouch directly to the small intestine
Gastric Banding
Type of weight loss surgery
- Involves placing an adjustable silicone band around the upper part of the stomach to help people with obesity to eat less.
Surgical procedure to help people lose weight
- 50%-85% of the stomach is removed leaving smaller tube shaped stomach that resembles a banana
Sleeve Gastrectomy
Biliopancreatic Diversion with Duodenal Switch
Complex weight loss surgery that combines a sleeve gastrectomy with an intestinal bypass to reduce how much food the body absorbs and how much it can eat
Pre operative care and evaluation and counseling
- Postoperative care is similar to gastric resection, ut patient is at greater risk for complications related to obesity
- Post op diet- small feedings totaling 600-800 calories/ day
- Patient require psychosocial interventions to modify their eating behaviors
- Follow up care
- Education regarding long term effects
Nursing care for patient undergoing bariatric surgery
-Hemorrhage
- Dumping Syndrome
- Bowel or gastric outlet obstruction
- Bile reflux
- Dysphagia
- Venous thromboembolism
Collaborative Problems and Potential Complications
Gallbladder stores what
Bile
Pancreas is responsible
Insulin
Glucagon
Somatostatin
Cholelithiasis Pigment stones is how many %
10-25% cases in US
Cholesterol Stones is how many %?
75%
What are risk factors for cholelithiasis?
-Obesity
- Women- esp mult pregnancies, Native -American or US SW Hispanic ethnicity
- Frequent changes in weight/ rapid weight loss
- Treatment with high- dose estrogen
- Low - dose estrogen therapy
- Ileal resection or disease
- Cystic Fibrosis
- Diabetes
Name the clinical manifestations of cholelithiasis
- None or minimal symptoms - acute or chronic
- Pain (Frequently after rich meal)
- Biliary Colic
- Jaundice (With Obstruction of Bile Duct)
- Grayish or putty colored
Medical Management of Cholelithiasis
- Dietary Management
- Medications– Ursodeoxycholic acid and Chenodeoxycholic acid (takes 6-12 mo)
- ERCP
- Dissolving- Infusion of MTBE into GB
- Laparoscopic Cholecystectomy
Non Surgical removal
- By instrumentation
- Intracorpeal or extracorpeal lithotripsy
ERCP
Procedure that uses an endoscope and X rays to examine the liver, gallbladder, bile ducts and pancreas
Used for diagnosis and to treat problems as well.
Name nonsurgical ways to remove gallstones
A. T- tube tract to remove stone
B. Removal of stone with basket to catheter threaded through T tube tract
C. ERCP endoscope inserted to Duodenum
D. Papillotome inserted into common bile duct
E. Enlarging opening of sphincter of Odi
F. Retrieval and removal of stone with basket inserted through endoscope
Laparoscopic Cholecystectomy
Minimal invasive procedure to remove the diseased gallbladder
Nursing Process Care of the Patients with Cholelithiasis Assessment includes?
-Patient Hx
- Knowledge and education needs
- Resp. status and risk factors for resp. complications post operative
- Nutritonal status
- Monitor for potential bleeding
GI Symptoms
What are the GI symptoms after laparoscopic ?
Loss of appetite
Vomiting
Pain
Distention
Fever
Potential infection or disruption of GI tract
Nursing Process The care of the patient with Cholelithiasis Diagnosis includes
Acute Pain
Impaired Gas exchange
Impaired skin integrity
Imbalanced nutrition
Deficient Knowledge
Collaborative Problems and Potential Complications
- Bleeding
- GI Symptoms
- Complications r/t to surgery in general
—-atelectasis, thrombophlebitis
Planning of care for a patient with cholelithiasis
Goals may include relief of pain, adequate ventilation, intact skin, improved biliary drainage
Then Optimal nutrition
Then Absence of complications
- Understands self- care routines
Nursing Process for patient with cholelithiasis interventions include
–Relieving pain- eds, splinting, and positioning
– Improving resp. status- deep breathing, IS
— Care of biliary drainage system
—Maintain skin integrity
—Improve nutritional status
—Self care education- Refer to chart 44-2`
Pancreas Exocrine function includes
-Secretes digestive enzymes
- Released into pancreatic duct
Pancreas Endocrine Function includes
-Islets of Langerhans
- Alpha
-Beta
Pancreatic duct enzymes becomes obstructed and enzymes back up
- Causing autodigestion and inflammation in the pancreas
Acute Pancreatitis
Progressive inflammatory disorder with destruction of the pancreas
- Cells are replaced by fibrous tissue
- Pressure within the pancreas increases, obstructing the pancreatic and common bile ducts
Chronic Pancreatitis
Severe abd. pain/ back tenderness
- May be accompanied by distention, abd mass, decreased peristalsis, vomiting
Acute Pancreatitis
- Recurring attacks of severe upper abd./ Back pain
- Become more frequent and severe
Chronic Pancreatitis
What is a major symptom of chronic pancreatitis?
- Recurrent attacks of severe abdominal and back pain accompanied by vomiting
- Fever, jaundice, confusion, and agitation
- Ecchymosis in the flank or umbilical area
- ABD. guarding
**Recuurent attacks
Medical Management
Acute
Chronic
