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Digestive System*
Problems of Ingestion,Digestion,Absorption,and Elimination
| Question | Answer |
|---|---|
| The Digestive System | Is responsible for breaking down food into nutrients. |
| Mouth | chewing & mixing with saliva. |
| Esophagus | Transport food peristalsis (contraction of the muscle). |
| Stomach | further breakdown by gastric juices containing hydrochloric acid. |
| Small Intestine | duodenum(1foot),jejunum(8-10ft)& ileum(12ft) all secreting digestive juices. |
| Pancreas | secrets enzymes & regulates blood sugar. |
| Liver(RUQ) | secretes bile,via the common bile duct,to the duodenum where fats are digested. |
| Gallbladder | (attached to the liver)-where bile is stored. |
| Large Instestine | 5ft including the ascending,transverse,descending & rectum. |
| Colon | absorbs water & electrolytes. |
| Important Lab values - GI | Total Protein,Albumin,Pre-Albumin,Total Bilirubin. |
| Total Protein | Normal Value:6.4-8.3 Low levels may be caused by poor nutrition,liver disease,burns,Crohn's disease,or diabetes.Low Level S/S-can cause swelling in the feet and hands. |
| Albumin | Normal Value:3.5-5 is a component of body proteins.Low levels may indicate that the pt has had malnutrition for a long time and may be caused by a lack of protein in their diet,liver failure,renal disease,or DM. |
| Pre-Albumin | Normal Value:15-36 Used to monitor nutrition in pts scheduled for surgery,pts receiving TPN or PPN,or pts on hemdialysis.Low levels are an early indication of protein deficiency. |
| Total Bilirubin | Normal Value:0.3-1.0 is the breakdown of old red blood cells.High levels may be caused by liver disease,billary obstruction,mononucleosis,low exposure to the sun,or hemolytic anemia. |
| Liver Function Tests(LFT) | ALT(ALanine aminoTransferase),AST(ASpartate aminoTransferase),ALP(Alkaline Phosphate) |
| ALT(ALanine aminoTransferase) | Normal Value:4-36 High levels may be caused by monoucleosis,ETOH abuse,liver damage,kidney infection,MI,or chemical pollutants. |
| AST(ASpartate aminoTransferase) | Normal Value:0-35 Enzyme primarily found in the liver,heart,kidney,pancreas,and muscles.High levels may indicate liver disease or tissue damage to the heart. |
| ALP(Alkaline Phosphate) | Normal Value:30-120 High levels may be caused by liver disease,sepsis,chronic inflammatory activity(bone disease) or thyrotoxicosis. |
| Anorexia | "I don't want to eat". N.Dx-Risk for Imbalanced Nutrition! Tx & N. Interventions-NG Tube Enteral Feedings! |
| Nausea | (Subjective)-"I feel like I'm going to puke". |
| Emesis | "I puked". Tx & N.Interventions-IV fluids,NG Tube to suction! |
| Flatulence | "I have gas". |
| Constipation | "I can't poop". |
| Diarrhea | "I'm pooping water". 3Types:Osmotic,Secretory,Motility |
| Osmotic | H2O is drawn into bowel,large volume diarrhea. |
| Secretory | mucus fluid,large volume {w/E-coli & C-diff following antibiotic therapy}or small volume {w/Crohs's}. |
| Motility | food not mixed properly,increased motility. |
| Abdominal Pain | "My belly hurts". |
| GI Bleed | Lower GI:"My poop is black & tarry"(Melena),CA,polyps or hemorrhoids. Upper GI:"coffee grounds"(stomach acid)or Frank Red Blood{bright red}from varices in esophagus or ulcers. |
| Ascites | "My bell is full of fluid". |
| Jaundice | "I'm yellow". |
| Altered GI Function | Inflammation,Mal-absortption:Failure of the chemical processes of digestion.Nutritional Excess or Deficit-Obesity or Starvation.Neoplasm:Cancers,polyps or obsturctions.Ascites:Accumulation of fluid in the peritoneal cavity. |
| Altered GI Function Cont'd | Jaundice:Deposit of Bilirubin in skin. |
| Stomatitis | inflammation of the mouth.Causes:ulcers,infection,chemo or thrush.Assessment:pain,redness,ulcers& inflammation.N.Dx:Acute Pain,Potential for Altered Nutrition,Altered Mucus Membranes. |
| The Esophagus | Swallowed food is moved into the stomach via paristalsis.LES:Lower Esophageal Sphincter(also called Cardiac Sphincter).A rind of smooth muscle fibers at the junction of the esophagus and stomach. |
| Disorders of the Esophagus | Dysphagia:Difficulty Swallowing.Causes:obstruction,impaired mobility,diverrticular herniations,CVA or Parkinson's Disease.Esophageal Diverticulum:Outpunching of esophagus which becomes inflamed & infected. |
| Gastro-Esophageal Reflux Disease (GERD) | Regulation of chyme{Kim}(stomach or intestinal contents)may occur anytime after eating.S/S:HEARTBURN,acid regurgitation,dysphagia,chronic cough,UPPER ABDOMINAL PAIN W/IN 1 HOUR AFTER EATING!May be a trigger for asthma. |
| GERD cont'd | Symptoms worsen if lying down or wearing tight clothes around abdomen.Esophagus may become eroded or fibrosed.Lower Esophageal Sphincter usually keeps the gate closed.GERD pts have weak gate.Reflux occurs with bending & moving.Esophagitis develops. |
| GERD Cont'd | Delayed Emptying:Longer time for reflux to occur.Acid production increased.DX:EGD & UGI barium swallow.Post-op EGD:Assess for the return of the Gag Reflex! |
| GERD Cont'd | TX:antacids,weight reduction,medications to improve emptying & coat ulcers,teach pt to sleep w/HOB elevated 6-8 inches! |
| Hernias | the muscle weakens & the intestine protrudes through the muscle wall.Types of Hernias:Umbilical:in the abdomen.Inguinal:usually from lifting heavy objects.Hiatal:when the stomach protrudes into the diaphragm causing indigestion & heartburn. |
| Hernias Cont'd | Sometimes hernias can be pushed back in but,it is out of a nurses scope of practice. |
| Hiatal Hernia | Is due to a Protrusion of the upper part of the stomach above the diaphragm.Hiatal hernias may contribute to GERD.The upper stomach actually protrudes onto the thorax.S/S:pain caused by a reflux,eating high fat diet. |
| Hiatal Hernia Cont'd | S/S:laying flat(recumbent position)after eating,indigestion from irritating foods!DX:UGI(x-rays w/contrast).TX:teach pt to eat small frequent bland meals,antacids & histamine receptor antagonist medications,elevate HOB after meals and when sleeping. |
| Hiatal Hernia Cont'd | Tx:similar to GERD & surgery as a last resort! |
| "SIR" Hernia | Strangulated:blood suply is cut off,emergency surgery situation. Incarcerated:hernia is trapped outside peritoneal cavity. Reducible:hernia moves back into peritoneal cavity. |
| Hemorrhoids | swollen vascular tissue in the rectal area.Cause:strainging with chronic constipation.TX:increase fiber in diet,increase fluids and surgery. |
| Constipation | can cause intestinal obstruction.Common cause:narcotics.TX:Stool softeners,short term laxative use,increase fiber in diet,increase fluid & increase activity level.Chronic use of laxatives impairs natural bowel tone. |
| Cancer of the Esophagus | Associated with chronic reflux,smoking & ETOH. S/S:First sign:pt c/o of dysphagia!Late sign:pt c/o chest pain,pain on swallowing,fatigue,& weight loss.TX:surgical resection & chemotherapy. |
| The Stomach | stores food,secretes digestive juices,mixes it up & moves it along.Pyloric Sphincter:relaxes as food exits stomach.Gastrin:stimulates secretion of HCl acid & Pepsinogen(pepsin).Mucosal Barrier protects the stomach lining. |
| Gastritis | Acute Gastritis:inflammation of the gastric mucosa of the stomach.Cause:H-Pylori bacteria,drugs,ETOH,or the stomach is not secreting enough mucus to protect stomach lining.Diagnostic Test:UGI,EGD with biopsy to assess for H-Pylori. |
| Gastritis Cont'd | Chronic Gastritis:seen more often in the elderly contributing to pernicious anemia due to the lack of intrinsic factor necessary for absorption of vitamin B12. |
| Peptic Ulcer Disease (PUD) | Ulceration in the protective mucosal lining of the lower ESOPHAGUS,STOMACH OR DUODENUM!Risk factors:H-Pylori infection,smoking,ETOH & NSAID's(Asprin)use.S/S:pain,burning,bleeding,sometimes frequent eating will decrease symptoms. |
| Peptic Ulcer Disease Cont'd | Dx Tests:EGD,Stool may test positive for blood.Stress Ulcers:Ulcers develop due to physiological stress.Ex:Severe illness,trauma & burns. Causing ischemia & tissue acidosis.S/S:painless GI bleeding. |
| Peptic Ulcer Disease Cont'd | Gastric Ulcers(stomach):seen more often in middle age,affects men & women equally,NSAID use,H-Pulori common cause,acid production is not increased. |
| Peptic Ulcer Disease Cont'd | Duodenal Ulcers(duodenum):more common type,seen more often in men,H-Pylori common cause,acid production is increased.Pain 2-3hrs after eating & Pain is relieved by food or antacids.Hemorrhage may be first symptom. |
| Gastric Vs. Duodenal | Duodenal S/S:When I eat food I feel better. Gastric S/S:When I eat food it hurts more. Duodenal S/S:I always hurt at night. Gastric S/S:Constant problem(no remissions). Duodenal S/S:Over secretion of acid Heartburn! |
| Peptic Ulcers Cont'd | TX:Medications-sulcrafate(coats),H2 receptor blockers,proton pump inhibitors{Prilosec},vagal suppression with anticholinergic drugs(Atropine),Antacids-Tums(Calcium Carbonate)!Triple therapy for H-Pylori:antibiotic,Pepto Bismal & H2 antagonists. |
| Peptic Ulcers Cont'd | TX:Possible surgery(Gastrectomy):to remove portion of the stomach if bleeding continues. |
| Dumping Syndrome | Complication of Gastrectomy:(rapid emptying),after eating there is not enough time to absorb nutrients.N.Interventions:No fluids w/meals!AVOID HIGH CARBS & FIBER.Ex:potatoes,sugars,bread,and other starches! |
| Dumping Syndrome Cont'd | N.Interventions:Avoid ibuprofen(Motrin),instruct pt to use Tylenol for pain. |
| Dumping Syndrome Cont'd | Occurs 15-30 min. after eating,Epigastric Fullness,Weakness,Dizziness,vertigo,Diaphoresis,Tachycardia,Abdominal Cramping,Self-Limiting |
| CA of the Stomach | Associated w/genetics,carcinogenic foods(smoked,nitrates),gastritis,polyps,H-pylori & low fiber diets.S/S:often asymptomatic until late in course,then non-specific,indigestion,anorexia,weight loss,vomiting& abdominal mass. |
| CA of the Stomach Cont'd | TX:Surgery,radiation & chemo,palliative care only. |
| The Small Intestines | (5 meters long>20ft).3 parts(duodenum,jejunum,ileum).Chyme enters duodenum,hormones are secreted & pancreatic & biliary juices are added.Absorption of nutrients! |
| The Large Intestines | (1.5 meters long). Cecum,appendix & colon(ascending,transverse,descending,&sigmoid).Reabsorption of water & the formation of stool! |
| "Irritable" Bowel Disease (IBD) | Dx Criteria:Variable combination of chronic & CONSTIPATION for more that 3 months,more than 25% of the time. |
| "Irritable" Bowel Disease (IBD) cont'd | TX:stress mgmt,increase fiber in diet,antispasmodics & avoid caffeine. |
| Crohn's Disease | Inflammatory Bowel Disease:lesions can occur anywhere in the colon or small intestine & usually involves more of the GI tract.Dx:H & P,colonoscopy w/biopsy,barium enema,stool cultures & CT scans. |
| Crohn's Disease cont'd | S/S:abdominal pain,fever,depression,STEATORREA(FATTY STOOL),NOT USUALLY MORE THEN 4-5 STOOLS A DAY OF NON-BLOODY DIARRHEA!TX: NO CURE!,anti-inflammatory drugs,steroid,antibitics & surgery,teach fiber-controlled diet. |
| Crohn's Disease cont'd | IF HOSPITALIZED: TPN,treat complications such as anemia & infection.Monitor for development of Colon Cancer. |
| Ulcerative Colitis | (Inflammatory Bowel Disease):Ulcerations of the colon.S/S:15-20 BLOODY STOOLS A DAY.TX:COLON RESECTION,temporary ILEOSTOMY(to allow rectum & colon rest UNTIL CURED)CORTICOSTEROIDS,ANTIBIOTICS,ELECTROLYTE REPLACEMENT,TPN&high fiber calorie/low residue diet |
| Ulcerative Colitis cont'd | Risk for Colon CA. N. Interventions:APPLY NG TUBE TO SUCTION-to prevent/decrease abdominal distention!ASSESS STOMA:stoma should be Rose to brick red in color! N.Dx: Imbalanced Nutrition,Powerlessness. |
| Infectious Colitis | Causes:bacteria or viral. Clostridium difficile(c-diff):Associated with antibiotic therapy,allows overgrowth of C-diff.S/S:diarrhea & abdominal cramping.DX:stool specimen + for C-difficile toxin.Tx:antibiotics(oral Flagyl or IV Vancomycin). |
| Infectious Colitis cont'd | E.Coli(fast food epidemics):Contaminated dairy or cattle or foods that have come in contact w/them.S/S:Abdominal cramping,bloody diarrhea 3-7days. |
| Infectious Colitis cont'd | Toxins Cause Complications:Acute Renal Failure in Children,5-10%Mortality Rate.Antibiotics do not help & may worsen diarrhea.TX:Symptomatic management. |
| Diverticular Disease | Outpunching of colon wall,which becomes inflamed & infected,more common in sigmoid colon.Seen in elderly & tose with refined diets.S/S:pain,change in bowel elimination,possible perforation->may become inflammed->diverticulitis.Dx:colonoscopy |
| Diverticular Disease Cont'd | Tx:increase dietary fiber,antibiotics & surgical resection. |
| Diverticulosis | a condition of the colon in which pouches are formed & stool gets stuck in these pouches.Causes:low residue(fiber)diet. |
| Diverticulitis | inflammation of the colon.Dx:colonoscopy.TX:stool softeners & antibiotics,if perforation colostomy is perforned. N.Interventions:post-op-NPO,increase to bland low residue(fiber)diet. |
| Diverticulitis | Preventive Interventions:high residue(fiber)diet(oatmeal,spinach,whole grains,plant fiber,apricots,asparagus & beans). |
| Appendicitis | Most common abdominal surgical emergency.Inflammation of the appendix which may proceed to rupture.Cause:may be blocked with feces.Dx tests:ultrasound,x-ray,CT or laparotomy. |
| Appendicitis Cont'd. | S/S:ACUTE PAIN RLQ,rebound tenderness nausea,low grade fever,bowel sounds are absent & WBC (LEUKOCYTES)ELEVATED! TX:appendectomy,usually an emergency. |
| Appendicitis Cont'd. | N.Interventions:NPO,ice packs to abdomen,(NEVER apply heat!),no narcotics,start IV 18-20gage!Complication:rupture and feces spills out into the abdominal cavity CAUSING PERITONITIS which can be fatal! |
| Appendicitis Cont'd. | Peak incidence 10-12 years.Begins as dull,steady pain in periumbilical area.Progresses over 4-6hrs & localizes to RLQ.Low grade fever,nausea,anorexia,sudden pain relief may indicate rupture of appenix(Leads to peritonitis). |
| Appendicitis Cont'd. | Diagnosis:clinical signs and symptoms,Increased WBC Abdominal Sonogram,Exploratory Lap,Rebound pain or tenderness(RLQ)at McBurney's Point. |
| Peritonitis | INFLAMMATION OF THE PERITONEUM(membrane that lines the abdominal cavity & covers the organs). Leading cause of death post-abdomina surgery.CAUSES:RUPTURED APPENDIX,perforated bowel or Crohn's Disease. |
| Peritonitis Cont'd. | TX:surgical intervention,NPO,NG to suction,fluid & electrolyte replacement,antibiotics & narcotics. |
| Peritonitis Cont'd. | Tx: irrigation drains,if BS become absent,very dangerous! |
| Peritonitis "HOT BELLY" | S/S:fever,N/V,Anorexia,"Board-Like"Abdomen,Abd distention & rigidity.Increased WBC,Increased pulse,Increased BP,dehydration,pain,decreased bowel sounds,rebound tenderness.Dx:x-ray,cbc. |
| Peritonitis "HOT BELLY" | Risk Factors:Abdominal Surgery,Ectopic Pregnancy,Perforation:Trauma,Ulcer,Appendix Rupture,Diverticulum.Nursing Care:IVs&Electrolyte Balance & GI Distention,decrease infection process,prevent complications:Immobility,pulmonary,fluid balance. |
| Intestinal Obstructions | Intussusception,Hernia,Volvulus,Tumor. |
| Intussusception | telescoping of bowel in childern(currant-jelly stools)accounts for 80-90% of intestinal obstruction in infants. |
| Hernia | intestine protrudes through weak abdominal muscle. |
| Volvulus | twisting of bowel happens in 5-10% of obstructions. |
| Tumor | adenocarcinoma is most common. |
| Paralytic Illeus | Intestinal Obstruction:a neurogenic or muscular impairment.Post-op pts:can occur in small or large intestine.CAUSES:tumor,fecal impaction,hernias,adhesions or Hx of Crohs's disease.Anything that impedes flow causes serious systemic consequences. |
| Paralytic Illeus Cont'd. | Dx: barium enema or UGI.S/S:pain,abdominal distention,vomiting,sweating,N/V(sometimes stool is in the vomit),hypotension,acid-base disturbances. |
| Paralytic Illeus Cont'd. | Tx:identify site & cause of obstruction,replace fluids & electrolytes,NG tube to suction,non-narcotics(narcotics slow down the digestive system),surgery for strangulation(volvulus)&complete obstruction! |
| Bowel Obstruction | Mechanical Blockage or Paralytic Illeus,Higher the obstruction the quicker the symptoms.May turm malodorous w/fecal smell.Vomiting,Hypovolemia,Electrolytes,abd distention,Constipation w/failure to pass flatus. |
| Bowel Obstruction Cont'd. | Bowel Sounds: Increased to silent,high pitched at first,then go silent. |
| Malabsorption Syndrome | INTERFERENCE WITH NUTRIENT ABSORPTION:PANCREATIC INSUFFICIENCY-caused by pancreatits & pancreatic CA.Most common symptom:steatorrhea. |
| Malabsorption Syndrome Cont'd. | Lactase Deficiency:congenital defect,but may not be evident until adulthood.S/S:bloating &cramping on intake of milk products.TX:lactose free diet. |
| Malabsorption Syndrome Cont'd. | Bile Deficiency:deficient absorption of fat soluble vitamins,decreased motility as manifested by steatorrhea.Surical removal of portions of stomach or intestine may also lead to malabsorption. |
| The Liver | Blood flow:hepatic artery & portal vein. LIVER JOB DESCRIPTION:Glcucose metabolism®ulation,Ammonia conversion,protein &fat metabolism,vitamin & iron storage,medication metabolism&detoxification,bile formation&bilirubin excretion. |
| The Liver Cont'd. | Produce heparin,prothrombin or fibrogen! |
| Hepatitis | Inflammation of the liver. CAUSES:a virus,Hep A,B,or C,bacteria,drugs or alcohol.All can cause permant damage to the liver. |
| Hepatitis of the Liver | Hepatitis A(fecal-oral) Hepatitis B(blood-borne) Hepatitis C(blood-borne) Regeneration of tissue possible. |
| Hep A | caused by fecal contaminatin of food& water. |
| Hep B&C | transmitted through blood. |
| Hep B | frequently spread through sexual contact & from mother to infant at birth.Hep B vaccine recommended at birth & to sexually active teens. |
| Hep C | rarely spread through sexual contact. No vaccine for Hep C. |
| Viral Hepatitis | S/S:depend on stage,abnormal Liver Functoin Tests(LFT's)AST&ALT,pt may be asymptomatic,fatigue,N/V,ANOREXIA,fever,liver enlargement & tenderness(stage1),jaundice & hyperbilirubinemia(stage2).Tx:symptomatic,rest,low fat,high carb diet & antivirals. |
| Viral Hepatitis Cont'd. | N. Interventions:Teach pt to prevent transmission,Monitor for fluid & Electrolytes!Teach Vaccinations-three shots over several months! |
| Hep A | Transmission mode:Food & water.Incubation:2-6wks.Carrier Status:no.Vaccine:yes. |
| Hep B | Transmission mode:Blood & body fluids.Incubation:2-6months.Carrier Status:yes.Vaccine:yes. |
| Hep C | Transmission mode:Blood & body fluids.Incubation:6-12wks.Carrier Status:yes.Vaccine:no. |
| Cirrhosis | changes in the liver,a thickening of the tissue.Patho:irreversible destruction of the liver,a cascade of fatty infiltation & necrosis,liver fibrosis,scarring & loss of function. |
| Cirrhosis Cont'd. | CAUSES:alcoholism accounts for most of the cases,chronic hepatits,CA & obstruction.Women are more prone to ETOH abuse related cirrhosis. |
| Cirrhosis Cont'd. | Dx:Needle liver biopsy. N. Interventions:Assess platelet count,Pt & INR prior to procedure! Monitor for S/S of bleeding after proceducre,q15 min*2,then q30min *4 then qhr*4! |
| Cirrhosis Cont'd. | DANGER: Increased pulse,Increased BP & Increased Respirations! |
| Cirrhosis Cont'd. | S/S:enlarged liver,abnormal Liver Function Tests(LFT's),fatigue,wt loss,jaundice,ascites,malnutrition,hypoglycemia,ascites,clotting disorders(because the liver is not able to produce prothrombin or fibrogen). |
| Cirrhosis Cont'd. | No cure for Cirrhosis.TX:Aldactone(potssium sparing diuretic)to decreaese ascites & Lactose to increase BM's to decrease Ammonia level in blood.N.Dx:Fluid volume Excess.Complications:HEPATIC ENCEPHALOPATHY,PORTAL HYPERTENSION. |
| HEPATIC ENCEPHALOPATHY | (brain),confusion,lethargy and coma. |
| PORTAL HYPERTENSION | distention of the esophageal veins resulting in ESOPHAGEAL VARICES! |
| PORTAL HYPERTENSION | Abnormally High Blood Pressuce in the portal venous system caused by obstruction of blood flow.Complications:Esophageal Varicies:varices can rupture causing hemorrhage,death.Splenomegaly & Ascites,Hepatic Encephalopathy:toxins circulate to the brain. |
| PORTAL HYPERTENSION | Poor prognosis.TX:vasopressors,surgical shunts & liver transplant. |
| Esophageal Varicies | When a vein or artery in the sophagus becomes weak,or ulcerated & bleeds.Can be Fatal!Common in pts w/Cirrhosis of the Liver.TX:EGD(Esophagogastroduo-denoscopu)(emergency)use balloon pressure to stop bleeding,shunt placement. |
| Esophageal Varicies Cont'd. | Medication:(Sandostation),or Carafate liquid to coat esophagus,avoid aspirin,Motrin & anticoagulants. |
| Esophageal Varicies Cont'd. | Assessment:Hx of liver disease,alcohol use,nausea,vomiting blood,occult blood in stool,Melena(black tarry stools)&jaundice.N.Dx:(think bleeding)Fluid Volume Deficit r/t bleeding or vomiting.Anxiety r/t possible death. |
| Oral CA | Cuase:chewing tobacco.S/S:sore throat,a sore in mouth that wont heal.TX:removal of CA w/surrounding lymph nodes,possible trach > feeding. N.DX:Fear |
| Colorectal Cancer | More than 61,000 deaths per year in the U.S..Third most common site of fatal CA.Risk Factors:family Hx of colon CA,Ulcerative Colitis,polyps & over 50 years of age. |
| Colorectal Cancer | S/S:pain,palpable mass in LRQ,anemia,bloody stool & changes in bowel habits.Symptoms often do not occur until disease is advanced. |
| Colorectal Cancer | Dx:barium enema,colonoscopy w/biopsy,elevations of CEA(Carcinoembryonic Antigen),stool + for blood.TX:surgery,NPO until BS return,then high residue(fiber) low fat diet,radiation & chemo.High fibe diet helps in prevention. |
| Colorectal Cancer | American Cancer Society:Recommends men and women over 40 to have digital rectal exam annually.Pts over 50 to have annual stool test for occult blood & a colonoscopy every 3 to 5years. |
| Liver Cancer | very rare.Risks:Hx of cirrhosis and/or Hep B. Uncommon Primary site,rare in U.S. Common site of metastasis.Far advanced at detection.TX:surgical resection & chemo.Survival time from DX 3-4months.5year survival only 1%. |
| The Gallbladder | pear shaped organ.Stores and concentrates bile! Cholecystitis:inflammation of the cases gallstones are present. |
| Cholelithiasis | Gallstones(lime Stones),in the gallbladder or common bile duct causing cholecystitis.S/S:THE 5F'S:Female,Fat,Forty,Family Hx,&Flatulence,clay colored stools,N/V,RUQ abdominal pain,fever,leukocytosis(increased WBC)&fat intolerance. |
| Appendix is in the: Gallbladder is in the: | RLQ RUQ |
| Cholelithiasis | Dx:ultrasound,H&P,oral cholecystogram to outline stones,IV cholangiography,endoscopic,or percutaneous cholangiography.TX:surgical removal of gallbladder(cholecystectomy),but usually done w/laparoscopic surgery(four small incisions endoscope used). |
| Cholelithiasis | If a cholecystectomy is needed the surgeon may use large incision.T-tube or JP(Jackson Pratt)may be left in place after surgery to allow bile to drain from the common bile duct! |
| Cancer of the Gallbladder | found in 2% of people with biliary tract diagnosis.S/S:resemble cholecystitis.Highly associated with gallstone irritation.5year survival rate 3% Tx:Surgery. |
| Disorders of the Pancreas | PANCREAS-EXOCRINE RESPONSIBILITIES:AMYLASE:breaks down carbs.LIPASE:breaks down fats.TRYPSIN:breaks down proteins.Disorders are often associated w/ETOH,bilary obstructon,peptic ulcers,trauma,hyperlipidemia &drugs. |
| Acute Pancreatitis | inflammation of the pancreas.S/S:abdominal pain-->may become severe,fever,leukocytosis,& N&V. |
| Acute Pancreatitis | Exact patho unknown but thought to be leakage of enzymes causing autodigestion & pancreatic inflammation or toxic substance absorbed into the systemic circulation,can cause ARDS & SHOCK.Hypovolemia & Hypotension may result in Life Threatening Emergency. |
| Acute Pancreatitis | DX:Elevate Amylase & Lipase,abdominal pain & distentsion,fever,leukocytosis,N/V & increased blood sugar.TX:fluid & blood administration,bowel rest(NPO),pain relief,meds to reduce acid production in gut & antibiotics. |
| Chronic Pancreatitis | Highly associated with ETOH abuse.Fibrosis,strictures,inflammation of pancreas & loss of function are common. |
| Chronic Pancreatitis | S/S:abdominal pain,pain intensifies after meals,steatorrhea,elevated amylase & lipase.Increased risk of pancreatic CA & IDDM. TX:stop ETOH use,surgery for symptomatic TX. |
| Cancer of the Pancreas | 4th highest cause of cancer deaths.Mortality nearly 100%.Symptoms develop late in disease,hypoglycemia,vague back pain,jaundice,malabsorption, & weight loss. TX: Whipple procedure or total pancreatectomy. |
| Healthy Lifestyles | Diet:moderate levels of protein & fat & High fiber!Reduce processed foods.Exercise,Plenty of fluids,Complete screening exams,follow-up on symptoms. |
| The Abdomen | Largest cavity in the body. |
| Major Organs of the Abdomen | Esophagus,RUQ:Liver,gallbladder,duodenum,head of the pancreas,R kidney,transvers/ascending colon.RLQ:cecum,appendix,R ovary,R urter.LUQ:Stomach,spleen,body of pancreas,L kidney,descending colon.LLQ:Large Intestine,Small Intestine. |
| Assessment of The GI System | Medical HX,Nutritional HX:"Are you able to chew & swallow food?"Diet?Wt loss or gain?Psychological HX:depression,alcohol or drug use.Physical Exam:bowel sounds,palpate for tenderness or firmness.Bowel Elimination HX:diarrhea or constipation. |
| Assessment of The GI System | Lab Values:H&H,albumin & electrolytes. |
| Abdominal Assessment-Auscultation | Active:Heard about q 5-20sec.Hyperactive:heard very frequently-diarrhea/dehydrated.Hypoactive:heard less frequently.Post-operative abdominal sx.Colon may take 3-5days to resume functioning after sx. |
| Abdominal Assessment-Auscultation | Absent-EMERGENCY:listen for 3-5 minutes each quad. Peritonitis,Paralytic Ileus.Vascular Sounds:bruits(blowing,swooshing sound).Use firmer pressure,assess aorta,renal arteries,iliac & femoral arteries,especially in pts w/HTN.May indiate restricted flow. |
| Abdominal Assessment-Auscultation | Vascular Sounds:Pronounced sound might indicate aneurysm. |
| Special Procedures | Ascites:assess for fluid wave(ETOH abuse).Appendicitis-asses for rebound tenderness.Signs of inflammation and/or Infection:Guarding-tensing of abdominal muscle.Rebound tenderness-pain experienced on release of palpation. |
Created by:
LauraHall
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