Gastrointestinal

COMMON LABORATORY TESTS FOR GASTROINTESTINAL DISORDERS

1. Blood
a. CBC
b. Serum electrolytes
c. Serum chemistry
d. Enzyme-linked immunosorbent assays (ELISA)
e. Serum amylase
. !ierential blood count
". #rothrombin time
h. AL$% AS$% Alanine aminotranserase% L!&
i. Serum bilirubin
'. (lucose
k. Ammonia
l. Serum li)ase
m. Alkaline )hos)hatase
*. Stool
a. +ccult blood
b. )&
c. +,a - )arasites
d. .ualitati,e at
e. /educin" substances
. Bacterial cultures
". 0ital )atho"ens
h. Leukocytes
1. 2rine
a. +smolality
b. Sodium
c. #otassium
d. 3itro"en
e. 2robilino"en
. )&
Endoscopy
1. obtain o)erati,e )ermit )rior to )rocedure
*. tell the client about the )rocedure
1. remo,e dental a))liances beore the )rocedure
4. kee) client 3#+ beore )rocedure
5. hoarseness is normal6 7atch or laryn"os)asm or bronchos)asm
8. 7atch client and maintain 3#+ until "a" and s7allo7in" rele9es return
:. mild anal"esics may relie,e )ost )rocedure discomort
Bariu contrast studies
1. barium s7allo7
*. u))er "astrointestinal and small bo7el series
1. barium enema
4. s)eciic nursin" inter,entions 7ith barium
1. lo7 residue diet or clear li;uid diet or t7o days
*. client 3#+ ater midni"ht
1. use cathartic< ma"nesium citrate% (oL=$EL=
4. beore test% "i,e su))ository or enema
5. retained barium may harden and cause an obstruction6 e9amine
client>s stools6 a mild la9ati,e or cleansin" enema may be
ordered to hel) client e9)el barium
8. clear li;uid beore and orce luids ater a barium )rocedure
:. encoura"e drinkin" o more luids to aid in elimination o barium
5. 7hite stools or *4 to :* hours are common
Esop!a"eal #unction studies
a. client s7allo7s three thin tubes 7hich )ass into stomach
b. transducers measure eso)ha"eal )ressures
$aracentesis
a. drains abdominal luid o client 7ith ascites
b. small incision is made 'ust belo7 umbilicus and
trocar is inserted
c. nursin" inter,entions
i. client should ,oid beore )rocedure
ii. sit client 7ith eet irmly on loor
iii. remo,e luid slo7ly o,er a )eriod o 1?-@?
minutes to )re,ent sudden chan"es in blood
)ressure
i,. monitor client or hy)o,olemia or electrolyte
imbalance
,. obser,e incision site or leakin" or bleedin"
,i. obtain and label s)ecimens or laboratory
analysis
,ii. standard )recautions
Gastrointestinal intu%ation
1. /outes
a. naso)haryn9< naso"astric% nasointestinal
b. oro)haryn9
c. throu"h abdominal 7all by incision< "astrostomy% 'e'unostomy
d. ,ia endosco)y< )ercutaneous endosco)ic "astrostomy (#E() or
'e'unostomy% (#EA)
*. /e;uires a )ro,ider>s order
1. 2ses
a. dia"nostic
b. "astric decom)ression
c. "astric irri"ation
d. eedin"
4. 3aso"astric and nasointestinal
a. ty)es o tube
1. naso"astric
1. sin"le lumen< Le,ine
*. Salem
*. nasointestinal
1. sin"le lumen< Cantor% &arris
*. double lumen< Biller-Abbott
b. com)lications o )rolon"ed nasal intubation
1. nasal erosion% sinusitis
*. )haryn"itis% eso)ha"itis% eso)ha"eal s)hincter
incom)etence
1. "astric ulceration% )ulmonary as)iration
4. as)iration risk is hi"her 7ith nasal tubes
c. nursin" inter,entions in "astric or intestinal intubation<
Gastrostoy&'e'unostoy
a. tube )lacement is in u))er let ;uadrant o abdomen
b. or clients 7ho cannot tolerate nasal route% or or lon" term enteral eedin"
c. )ro,ides more secure and reliable access
d. nursin" care
i. cleanse skin around insertion site daily 7ith 7arm 7ater and mild
soa)
ii. a))ly dressin" i indicated
iii. obser,e or com)lications
e. com)lications
i. skin breakdo7n at insertion site
ii. inection
iii. see)a"e o enteral ormula or "astric draina"e
Ostoy
1. Sur"ical )rocedure 7hich creates an o)enin" into the abdominal 7all or ecal or
urinary elimination (enterostomy)
*. #ortion o intestinal mucosa or ureter brou"ht throu"h abdominal 7all creatin" a
stoma throu"h 7hich eces or urine drains
1. $y)es
a. bo7el< ileostomy or colostomy
b. urinary di,ersions
i. ileal conduit (ileal loo))
ii. ureterostomies
4. Ileostomy
a. stool is li;uid% re;uent% hi"hly alkaline% contains di"esti,e enzymes
b. re;uires constant )ouchin" and re;uent em)tyin"
5. Colostomy< thicker% ormed stool
a. trans,erse colon< must be )ouched at all times
b. si"moid colon< can be mana"ed by daily irri"ation% so no need or
)ouch
Nursin" inter(entions #or a client )it! ostoy* additional "uidelines #or nursin"
care+
a. em)ty )ouches 7hen they are about 1C1 to 1C* ull% standard )recautions
b. i needed% )rotect skin around ileostomy stoma
c. ostomies threaten body ima"e.
d. ears o mutilation% shame% re'ection are common
e. clients may eel )o7erless because they cannot ully control bodily unctions
. assist client to establish normal elimination routine. /e)ort immediately i<
i. stoma oozes blood 7hen touched
ii. you see blood in )ouch
iii. you see bleedin" rom stoma
i,. urinary di,ersion out)ut is less than 1?ccChour
,. urine smells oul
,i. there is blood in urine% or it is ,ery cloudy
,ii. client re)orts burnin" sensation around base o urinary di,ersion stoma
,iii. client re)orts back )ain% chills% or e,er
". teach client
i. the ty)es o e;ui)ment and their use
ii. ho7 to irri"ate colostomy
iii. )re,ention o com)lications
i,. ho7 to a,oid consti)ation% diarrhea% e9cessi,e "as
,. that it is ,ital to drink )lenty o luids
Gastric analysis
a. standard )recautions are re;uired
b. masures "astric secretions under astin" conditions
c. histamine is in'ected ,ia naso"astric tube and secretions are as)irated
d. indications< sus)ected "astric ulcer or mali"nancy
e. beore test% client 3#+ or about ei"ht hours and no smokin"
. instruct client to e9)ectorate sali,a rather than s7allo7 it
". 7ithhold the ollo7in" dru"s or *4 hours )rior to test< antacids% anticholiner"ics%
alcohol% &* blockers% reser)ine and adrener"ic blockers
h. standard )recautions are re;uired
i. used to determine )resence o blood ((uaiac test)% at and or cultures
'. ase)tic techni;ue re;uired
k. client must deecate into clean dry bed)an to a,oid contaminatin" s)ecimen 7ith
urine or 7ater (only a sam)le is re;uired)
l. timed test or ecal at may be )erormed
I, Anatoy - $!ysiolo"y
A. 2))er "astrointestinal tract
1. Bouth< teeth and sali,ary "lands
*. Eso)ha"us
1. Stomach
B. Lo7er "astrointestinal tract
1. Small intestine - di"ests and absorbs% mi9es ,ia )eristalsis%
recei,es secretions rom li,er% "allbladder and )ancreas
a. duodenum - )ro9imal section o small intestine 'oins
)ylorus o the stomach di,ided by the )yloric s)hincter is
about ten inches lon"
b. 'e'unum - middle section% is about ei"ht eet lon"
c. illeum - lo7er section% is about 1* eet lon"
*. Colon - a))ro9imately si9 eet lon"% absorbs 7ater and sodium
a. ascendin"
b. trans,erse
c. descendin"
d. si"moid
e. rectum - last se,en - ei"ht inches o intestines
C. Accessory di"esti,e or"ans
1. Li,er - lar"est "land o the body
a. lobes di,ed into lobules by blood ,essels
and ibrous material
b. ducts - he)atic duct rom li,er6 cystic duct
rom "allbladder6 common bile duct
ormed by 'oinin" o he)atic duct and
cystic duct and drains into duodenum
c. unctions< Betabolism o at%
carbohydrates and )rotein
i. con,erts "lucose to "lyco"en or
stora"e
ii. con,erts "lyco"en to "lucose and
releases into blood
iii. orms "lucose rom ats or
)roteins
i,. breaks do7n atty acids into
ketones
,. stores at
,i. synthesizes tri"lycerides%
)hos)holi)ids% cholesterol% and
choline (B com)le9 actor)
,ii. synthesizes ,arious )roteins
,iii. con,erts amino acid to ammonia
i9. con,erts ammonia to urea
d. other
unctions
i. secret
es
bile%
7hich is im)ortant in the emulsiyin" o ats
ii. deto9iies substances such as dru"s% hormones
iii. metabolizes ,itamins
*. #ancreas
a. ish-sha)ed or"an e9tendin" rom
duodenal cur,e to the s)leen
b. both an endocrine and e9ocrine "land
i. )ancreatic cells - em)ty into
duodenum at the
he)ato)ancreatic )a)illa6 secrete
enzymes 7hich di"est ats%
carbohydrates and )roteins
ii. islet o Lan"erhans
al)ha cells secrete "luca"on
to )romote li,er
"lyco"enolysis and
"luconeo"enesis 7hich
ultimately increases blood
"lucose le,el
beta cells secrete insulin
1. (allbladder
a. similar size and sha)e as a )ear
b. made u) o smooth muscle and lined 7ith ru"ae-arran"ed
mucosa
c. only )ur)ose is to store bile
d. em)ties bile into duodenum 7hen at is )resent there
!. #rocess o di"estion
&ere>s a sim)liied story o 7hat the normal (-I system does
Esophagus- con,eys ood mi9ed 7ith sali,a to stomach.
Stomach - secretes di"esti,e 'uices% includin" hydrochloric acid.
Stomach contents (chyme) "o throu"h )ylorus into small intestine
Small intestine - 7hose )arts (in order) are duodenum% 'e'unum%
and ileum6 their 7alls absorb nutrients. Drom ileum% chyme
ad,ances into cecum o lar"e intestine. Bean7hile%
Liver - makes many crucial )roteins% ,itamins% ats% iron
com)ounds% etc.6 neutralizes to9ins such as alcohol% and con,erts
ammonia into urea6 con'u"ates bilirubin% e9cretes it in bile. Bile
)asses ,ia the he)atic duct into the "allbladder
Gallbladder - stores bile% 7hich "oes to small intestine ,ia the
cystic duct C common bile duct to break do7n at
Large intestine - undi"ested matter is urther absorbed and
)rocessed6 remnants orm as eces in the si"moid colon and
rectum.
1. #ur)ose - con,erts oods into a orm 7hich can be absorbed and
used by the body
*. !i"esti,e enzymes
1. Basic )rocesses
a. absor)tion - accom)lished by acti,e trans)ort ,ia intestinal
cells. Eater and solutes mo,e throu"h the intestinal
mucosa in o))osite direction e9)ected in osmosis and
diusion
b. metabolism - consists o the sum o all )hysical and
chemical chan"es that take )lace 7ithin an or"anism
c. catabolism - series o chemical reactions that take )lace
7ithin the cell6 breaks do7n ood molecules to )roduce
ener"y
i. anabolism - synthesis o com)ounds rom sim)ler
com)ounds
II, Disorders o# Stoac! and Colon
A. $ernicious aneia - anemia caused 7hen tissues ail to absorb enou"h
,itamin B1*
1. !einitionCetiolo"yCrisk
a. mucosa and )arietal cells o stomach atro)hy6 stomach
ails to )roduce intrinsic actor% thus cannot )ro)erly absorb
,itamin B1*
b. )ossibly an autoimmune disease
c. may ollo7 "astric resection
*. #atho)hysiolo"y
a. lar"e /BCs - macrocytic normochromic
b. hydrochloric acid
1. Dindin"s
a. anemia - indin"s de)end on se,erity
b. tissue hy)o9ia )roducin" ati"ue% 7eakness% dys)nea%
)allor% )al)itations
c. (I sym)toms< sore ton"ue% anore9ia% nausea% ,omitin"%
abdominal )ain% neurolo"ical sym)toms
d. neurolo"ical sym)toms< )aresthesia in hands and eet%
7eakness% im)aired coordination% chan"es in L+C
4. Com)lications< (I sym)toms are re,ersible% but neurolo"ical
chan"es are not
5. !ia"nostics
a. CBC
b. bone-marro7 bio)sy
c. lack o ree hydrochloric acid in stomach
d. Schillin" test
8. Bana"ement
a. lielon" ,itamin B1* thera)y 7ith lack o intrinsic actor
must be "i,en )arenterally
b. ade;uate nutrition
c. blood transusions as needed
:. 3ursin" inter,entions
a. monitor or im)aired "as e9chan"e
b. mana"e ati"ue
c. risk o in'ury rom de)ressed L+C and im)aired
coordination
d. kno7led"e deicit- need to understand chronic illness
B. $eptic ulcer diseases - include disorders that ulcerate any )art o
stomach or intestines.
1. (astric ulcers
a. deinitionCetiolo"y
I. incidence hi"her in the middle-a"ed and elderly6
most common in men a"es 45-55
II. risk actors< as)irin% 3SAI!s% steroids% caeine% and
alcohol intake6 stress
III. )atho"en< H. pylori
b. )atho)hysiolo"y
I. somethin" disru)ts mucosal layer and acid diuses
back into mucosa
II. commonest site< 'unction o undus and )ylorus
III. normal "astric acid secretion
c. indin"s
I. )ain% burnin" or "as% 7orse 7ith ood
II. )ain in let u))er e)i"astric area
III. nauseaC,omitin"
I0. bleedin"6 hematemesis
d. dia"nostic studies
I. endosco)y
II. com)lete blood count (CBC)
III. test stool or occult blood
e. com)lications
I. hemorrha"e
I. administer intra-arterial ,aso)ressin
II. administer intra,enous luids and blood
re)lacement
II. )eroration and )eritonitis
I. indin"< se,ere abdominal )ain
II. indin"< board-like abdomen
III. )aralytic ileus (obstruction)< scarrin" may obstruct
)ylorus
*. !uodenal ulcers
a. etiolo"yCrisk actors
I. e9cess )roduction o hydrochloric acid
II. more ra)id "astric em)tyin"
III. amilial tendency
I0. stress
0. more re;uent in )eo)le 7ith ty)e + blood
0I. more common in men a"es *5 to 5?
b. )atho)hysiolo"y
I. located ?.5 to * cm belo7 )ylorus
II. arteriosclerotic chan"es in ad'acent blood ,essels
III. ,a"us ner,e stimulation causes tissues to release
"astrin% 7hich increases secretion o hydrochloric
acid
c. indin"s
I. )ain% heartburn occur durin" ni"ht or 7hen stomach
is em)ty
II. )ain relie,ed by ood intake
III. melena (tarry stool6 black 7ith di"ested blood)
d. dia"nostic studies
I. endosco)y - eso)ha"o"astroduodenosco)y
II. com)lete blood count (CBC)
III. test stool or occult blood
e. com)lications
I. hemorrha"e
I. administer intra-arterial ,aso)ressin
II. administer intra,enous luids and blood
re)lacement
II. )eroration and )eritonitis
I. indin"< se,ere abdominal )ain
II. indin"< board-like abdomen
III. )aralytic ileus (obstruction)< scarrin" may obstruct
)ylorus
1. Bana"ement o )e)tic ulcer disease
a. 3#+ (nothin" by mouth)
b. naso"astric tube
c. antibiotics< clarithromycin (Bia9in)6 metronidazole (Dla"yl)
d. &* rece)tor anta"onists< cimetidine ($a"amet)6 rantidine
hydrochloride (Fantac)6 amotidine (#e)cid)6 nizatidine
(A9id)
e. anticholiner"ics< dicyclomine hydrochloride (Bentyl)
. antacids6 aluminum hydro9ide (Am)ho"el)6 aluminum-
ma"nesium combinations (Baalo9% Bylanta% (elusil)6
calcium carbonate ($ums)
". cyto)rotecti,e< sucrulate (Caraate)
h. )roton )um) inhibitors< ome)razole (#rilosec)%
ianso)razole (#re,acid)
i. an9iolytics
'. blood administration
k. sur"ical Inter,ention
I. ,a"otomy< eliminates stimulation o "astric cells
II. )yloro)lasty< 7idenin" )ylorus to im)ro,e "astric
em)tyin"
III. subtotal "astrectomy
I0. billroth I ("astroduodenostomy)
0. billroth II ("astro'e'unostomy)
0I. total "astrectomy
4. #osto)erati,e com)lications
a. dum)in" syndrome - rom ra)id em)tyin" o the stomach
I. tachycardia% )al)itations% synco)e% dia)horesis%
diarrhea% nausea% abdominal distention
II. more common 7ith Billroth II
III. subsides ater se,eral months
I0. decrease 7ith slo7 eatin"% lo7-carbohydrate% hi"h-
)rotein and at diet
0. a,oid li;uids 7ith meals
b. )ernicious anemia secondary to loss o intrinsic actor
5. 3ursin" inter,entions
a. )ain relie
b. assess or bleedin"
c. discuss lie-style chan"es< sto) smokin"% decrease stress
d. teachin" - medications% diet
e. assess or )ost-o)erati,e com)lications - inection%
bleedin"% res)iratory com)lications
. maintain )atency o 3( tube
". obser,e draina"e or si"ns o bleedin" (draina"e should be
dark red ater *4 hours)
h. mouth care
III, Disorders o# Intestines
A. In#laatory intestinal diseases - chronic% recurrent inlammation6
etiolo"y unkno7n
1. ulcerati,e colitis
a. deinitionCetiolo"y
i. aects youn" )eo)le a"es 15 to 4?
b. )atho)hysiolo"y
i. ulceration and inlammation entire len"th o colon
ii. in,ol,es mucosa and submucosa
iii. be"ins in rectum and e9tends to distal colon
i,. abscess and ulcers lead to bleedin" and diarrhea
,. colon cannot absorb% so luids and electrolytes "o
out o balance
,i. )rotein is lost in stools
,ii. scarrin" )roduces narro7in"% thickenin"% and
shortenin" o colon
,iii. remissions and e9acerbations
c. indin"s
i. bloody diarrhea ran"in" rom t7o to three )er day
to ten to *? )er day
ii. stools may also contain )us and mucus
iii. abdominal (tenderness and cram)in") )ain
i,. e,er% 7ei"ht loss% anemia% tachycardia%
dehydration
,. im)aired absor)tion o at-soluble ,itamins such as
E% G
,i. systemic maniestations
skin lesions - erythema nodosum
'oint inlammation
inlammation o the eyes - u,eitis
li,er disease
d. dia"nosis
i. si"moidosco)y
ii. colonosco)y
iii. barium enema
i,. com)lete blood count (CBC)
e. mana"ement
i. rest
ii. luid% electrolyte% and blood re)lacement
iii. steroids as anti-inlammatories
i,. immunosu))ressi,es
,. anti-inecti,es< sulasalazine (Azulidine) )rimary
dru" o choice
,i. anticholiner"ics
,ii. antidiarrheals
,iii. dietary restrictions - hi"h calorie and hi"h )rotein
i9. sur"ical mana"ement
total )roctolectomy and ileostomy
ileorectal anastomosis
total )roctolectomy 7ith continent ileostomy
(Gock )ouch)
total colectomy 7ith ileal )ouch (reser,oir)
. com)lications
i. increased risk o colon cancer
ii. luid and electrolyte imbalances
". nursin" inter,entions
i. mana"e )ain
ii. mana"e diarrhea
iii. teach 7ei"ht loss and nutrition
i,. teach co)in"
,. remedy kno7led"e deicit
,i. reduce an9iety
*. Crohn>s disease
a. deinitionCetiolo"y
i. youn" )eo)le 15 to 1? years old
ii. inlammation o se"ments o bo7el% es)ecially
ileum% 'e'unum% and colon% 7ith areas o normal
bo7el bet7een inlamed bo7el - cobblestone
a))earance
iii. inlammation in,ol,es all layers o bo7el 7all -
transmural
i,. ulceration% issures% istula% and abscess ormation
,. bo7el 7all thickens and narro7s% )roducin"
strictures
,i. slo7ly )ro"ressi,e
b. indin"s
BARI.M ENEMA
Eith a barium enema - bo7el )re) )rior to test% includin" cathartics% enemas6 ater study
use cathartic a"ain to cleanse bo7el
Increased iber may cause latulence
Increase luid to 1???ccCday (unless contraindicated)
!on>t conuse these threeH
Ileum I last )art o the small intestine% beore it em)ties into the lar"e intestine. (An ileal )ouch
is illed rom the ileum.)
Ileus I an obstruction (oten in an intestine).
Ilium I )art o the hi)bone
i. diarrhea 7ith steatorrhea (ats not )rocessed)
ii. abdominal )ain - ri"ht lo7er ;uadrant
iii. ati"ue% 7ei"ht loss% dehydration% e,er
i,. systemic maniestations
arthritis% clubbin" o in"ers
skin inlammations
ne)hrolithiasis
c. com)lications
i. obstruction rom strictures
ii. istula ormation
iii. bo7el may )erorate and inect< )eritonitis
i,. medical mana"ement
rest
nutritional su))ort
hy)eralimentation
diet hi"h in calories and )rotein% lo7 in
rou"ha"e and at
steroids as anti-inlammatories
immunosu))ressi,es
anti-inecti,es< sulasalazine (Azulidine)
)rimary dru" o choice
anticholiner"ics
antidiarrheals
lo)eramide (Imodium) dru" o choice
balloon dilation o strictures
sur"ery 7ill not cure Crohn>s disease6 may
limit dama"e
1. colectomy 7ith ileostomy
*. subtotal colectomy 7ith ileostomy or
ileorectal anastomosis
d. nursin" inter,entions
i. ater sur"ery% monitor
diarrhea
luid balance and nutrition
skin inte"rity
co)in" and sel-care
se9uality
medications
B. Di(erticular disease - out)ouchin" o the intestinal mucosa
1. !einitionCetiolo"y
a. most common in si"moid colon
b. consti)ation% lo7 iber diet% obesity
c. colon 7all thickens 7ith increased )ressure in bo7el
d. stool and bacteria retained in di,erticulum become
inlamed and small )erorations occur
e. inlammation o surroundin" tissue
*. Dindin"s
a. re;uently asym)tomatic
b. cram)y% lo7er% let abdominal )ain
c. alternatin" consti)ation and diarrhea
d. lo7 "rade e,er% chills% anore9ia% nausea
e. leukocytosis
1. !ia"nosis
a. barium enema
b. com)lete blood count% urinalysis% stool or occult blood
c. colonosco)y
4. Bana"ement
a. di,erticulosis (out)ouchin")
1. hi"h iber diet
*. bulk la9ati,es
1. stool soteners
4. anticholiner"ics
b. di,erticulitis (inlammation)
1. 3#+
*. rest bo7el
1. antibiotics
4. sur"ery
1. bo7el resection
*. tem)orary colostomy
5. Com)lications
a. abscess ormation
b. )eroration 7ith )eritonitis
c. istula
d. bo7el obstruction
8. 3ursin" inter,entions
a. teach a))ro)riate diet
b. a,oid strainin"% cou"hin"% litin"
c. a,oid increased abdominal )ressure
C, Constipation
1. !einitionCetiolo"y
a. chan"e in normal bo7el habits characterized by
1. decreased re;uency
*. stool is hard% dry% diicult to )ass
1. stool is retained in rectum
b. etiolo"yCrisk actors
1. insuicient dietary iber
*. insuicient luid intake
1. medications% es)ecially o)iates
4. lack o acti,ity
5. i"norin" ur"e to deecate
8. chronic la9ati,e abuse
:. lack o )ri,acyC)sycholo"ical actors
J. )re"nancy
@. neuromuscular im)airment
1?. hy)othyroidism
*. Dindin"s
a. hard% dry stool
b. abdominal distention
c. decreased re;uency o usual )atterns
d. strainin"
e. nauseaCanore9ia
. )al)able mass
". hemorrhoids
h. ecal im)action 7ith diarrhea
1. Com)lications
a. obstructionC)eroration
b. cardio,ascular alterations
4. Bana"ement
a. cathartics
1. saline la9ati,es - milk o ma"nesia
*. stimulant la9ati,es - bisacodyl (!ulcola9)
1. bulk-ormin" la9ati,es - )syllium (Betamucil)
4. lubricant-emollient - mineral oil
5. stool soteners - docusate sodium (Colace)
b. enemas
1. cleansin" - saline% soa) solution
*. sotenin" - oil retention
5. 3ursin" inter,entions
a. teach nutrition% increased iber% and increased luids
b. teach< obey ur"e to deecate
c. )ro,ide )ri,acy and comort
d. increase acti,ity
!. !iarrhea
1. !einitionCetiolo"y - loose stools due to
a. ecal im)action
b. ulcerati,e colitis
c. intestinal inections
d. increased iber
e. medications
*. Dindin" - loose 7atery stools
1. Com)lications - dehydration% electrolyte imbalance
4. Bana"ement
a. mild diarrhea - oral luids to re)lace lost luid
b. moderate diarrhea - dru"s that decrease motility (Lomotil%
Imodium)
c. se,ere diarrhea - due to inection% antimicrobials and luid
re)lacement
5. 3ursin" inter,entions
a. monitor or luid and electrolyte imbalance
b. )re,ent skin e9coriation
c. teach client about oods that may aect bo7el elimination%
e.".% ruits% ,e"etables
E, Bo)el o%struction
1. !einitionCetiolo"y
a. mechanical< adhesions% hernias% neo)lasms% ,ol,ulus%
intussusce)tion
b. nonmechanical< )aralytic ileus% occlusion o ,ascular
su))ly
c. distended abdomen rom accumulation o luid% "as%
intestinal contents
d. luid shits due to increased ,enous )ressure 7ith
hy)otension and hy)o,olemic shock
e. bacteria )rolierate
*. Dindin"s
a. abdominal )ain
b. distention (more 7ith lar"e bo7el obstruction)
c. nauseaC,omitin" (more 7ith small bo7el obstruction)
d. hy)o9ia
e. metabolic acidosis
. bo7el necrosis rom im)aired circulation
1. Com)lications
a. )eroration and )eritonitis
b. shock
c. stran"ulation o bo7el
4. !ia"nosis
a. u))er-(I and lo7er-(I series
b. abdominal K rays sho7 air in bo7el
c. lo7 luid ,olume increases 7hite blood cells% hemo"lobin -
hematocrit% B23
5. Bana"ement
a. decom)ress the abdomen
b. nasointestinal tube
c. sur"ical bo7el resection
8. 3ursin" inter,entions
a. mana"e )ain% but a,oid mor)hine or codeine% 7hich slo7
bo7el motion
b. measure abdominal "irth
c. 7ith naso"astric or nasointestinal tubes% )ro,ide oral care
d. naso"astric tubes< Salem sum) (double lumen)% Le,in
(sin"le lumen)
e. nasointestinal tubes
1. cantor tube - sin"le lumen% mercury illed 7ei"ht on
ti)
*. miller-Abbott - double lumen 7ith mercury 7ei"hted
ti)
1. ad,ance t7o inches )er hour
. maintain luid and electrolyte balance
F, Colon cancer
1. !einitionCetiolo"y
a. may de,elo) rom adenomatous )oly)s
b. risk actors - lo7 residue diet% hi"h-at diet% reined oods
*. #atho)hysiolo"y
a. adenocarcinoma is the most common ty)e
b. most common locations are si"moid rectum and ascendin"
colon
c. oten metastasizes to the li,er
d. classiication (sta"in") systems< $3B or !uke>s
1. Dindin"s
a. rectal bleedin"
b. chan"e in bo7el habits - consti)ation% diarrhea
c. chan"e in sha)e o stool
d. anore9ia and 7ei"ht loss
e. abdominal )ain% )al)able mass
4. !ia"nostics
a. colonosco)y
b. si"moidosco)y
c. di"ital e9amination
d. stool or occult blood
e. barium enema
. C$ scan
". carcinoembryonic anti"en (CEA)
h. alkaline )hos)hatase and AS$ (as)artate
aminotranserase)
5. Com)lications - obstruction
8. Bana"ement
a. radiation
b. chemothera)y
c. treatment o choice is sur"ery - bo7el resection% colostomy
1. ri"ht hemicolectomy - in,ol,es ascendin" colon
*. let hemicolectomy - in,ol,es descendin" colon
1. abdominal-)erineal resection< remo,al o si"moid
colon and rectum 7ith ormation o a colostomy
:. 3ursin" inter,entions
a. mana"e )ain
b. monitor or com)lications
1. 7ound inection
*. atelectasis
1. thrombo)hlebitis
c. maintain luid and electrolyte balance
d. care o ostomy
I/, Disorders o# t!e Li(er
$LASMA /AL.ES

A. Albumin< 1.8-5.? "Cdl (see also #roteins% belo7)
B. Alcohol< ne"ati,e
C. Alkaline )hos)hatase
adults 1?-J5 Im2Cml
children "reater than t7o years J5-*15 Im2Cml
o t7o to ei"ht years 85-*1? Im2Cml
o nine to 15 years 8?-1?? Im2Cml
!. Ammonia
adults @-11 LmolCliter
children 4?-J? "Cdl
ne7borns @?-15? "Cdl
E. Bilirubin% direct - u) to ?.1 m"Cdl
D. Bilirubin% indirect - ?.1-1.? m"Cdl
(. Bilirubin total
adults and children ?.1-1.1 m"Cdl
ne7borns 1-*1 m"Cdl
&. Bleedin" time one to nine minutes
I. Dibrino"en 15?-18? m"Cdl
A. (amma "lobulin ?.J-1.8 "Cdl
G. Lead 1*? ("Cdl or less) M*5 L"Cdl
L. Li)ids (total) 4??- J?? m"Cdl
B. Cholesterol M*?? m"Cdl
3. &!
emales< 1?-J5 m"Cdl
males< 1?-85 m"Cdl
+. ldlM 1@? m"Cdl
#. $ri"lycerides M*5?
.. #hos)holi)ids 1J?-1*? m"Cdl
/. Dree atty Acids @.?-15.? mBCL
S. #artial thrombo)lastin time% acti,ated (A#$$) *1-1* seconds to7 to three times 7hen antico"ulated)
$. #rotein (total) 8.*-J.* "Cdl
albumin 1.8-5.? "Cdl
"lobulin *.1-1.4 "Cdl
2. #rothrombin $ime (#$) 11.1-1J.5 seconds (t7o to three times 7hen anticoa"ulated)
0. 2rea 3itro"en J-*5 m"CL
E. 2ric acid 1-J m"Cdl
A, 0epatitis
1. !einitionCetiolo"y - acute inlammatory disease o the li,er caused
by ,iral% bacterial% or to9ic in"estion
*. #atho)hysiolo"y
a. inlammation o li,er% enlar"ement o Gu)er cells% bile
stasis
b. re"eneration o cells 7ith no residual dama"e
c. ty)es
i. he)atitis A
transmitted rom inected ood% 7ater% milk%
shellish
ecal-oral route o inection common in )oor
sanitationCo,ercro7din"
hi"her incidence in all and 7inter
ne7 ,accine a,ailable
ii. he)atitis B
blood-borne and se9ually transmitted
may become a carrier
iii. he)atitis C
transmitted )arenterally ()ost-transusion
he)atitis) and )ossibly ecal-oral route
may become a carrier
i,. he)atitis !
blood borne
coe9ists 7ith he)atitis B
,. he)atitis E
7ater borne
contaminated ood or 7ater6 rare in the
2nited States
B, 0epatitis B
1. /isk actorsCinection route
a. homose9uality
b. i, dru" use
c. health )roessionals
d. hemodialysis
e. transmission routes
i. se9ual
ii. ecal-oral route< incubation 1* to 14 7eeks or
lon"er
iii. contaminated body luids
. )atho)hysiolo"y
i. he)atitis B has three distinct anti"ens
&BsA" - surace anti"en
&BcA" - core anti"en
&BeA" - e anti"en
ii. dama"e to the he)atocytes causes inlammation
and necrosis
iii. li,er unction decreased in )ro)ortion to dama"e
i,. healin" takes three - our months
*. Dindin"s
a. 'aundice i li,er ails to con'u"ate bilirubin or e9crete it
b. clay-colored stools rom lack o urobilin
c. urine is dark rom urobilin e9creted in urine rather than
stool
d. urine oams 7hen shaken
e. )ruritus rom bile salts e9creted throu"h skin
. ri"ht u))er ;uadrant )ain rom edema and inlammation o
li,er
". anore9ia% nausea% ,omitin"% malaise% 7ei"ht loss
h. )rolon"ed bleedin" rom im)aired absor)tion o ,itamin G
i. anemia rom decreased /BC lies)an
1. !ia"nostics - serolo"ic markers o &B0
a. &BsA" - he)atitis B surace anti"en
b. anti-&bc - antibodies to B core anti"ens
c. ele,ated alanine aminotranserase (AL$ )re,iously S(#$)
d. ele,ated bilirubin
e. ele,ated as)artate aminotranserase (AS$6 )re,iously
S(+$)
. ele,ated alkaline )hos)hatase
". )rolon"ed )rothrombin time
4. Bana"ement - nons)eciic and su))orti,e
a. sym)tomatic treatment o )ain
b. antiemetics as needed
5. 3ursin" inter,entions
a. ati"ue - )ro,ide rest )eriods6 may re;uire bed rest initially
b. maintain skin inte"rity
c. client 7ill tolerate less acti,ity
d. nutrition needs<
i. increase carbohydrates and )roteins6 decrease at
ii. a,oid alcohol
iii. eat re;uent% small meals
e. remedy kno7led"e deicit
. arran"e or home care needs
0E$ATITIS
Smokers 7ho de,elo) he)atitis oten dislike ci"arettes6 he)atitis may im)air the sense
o smell.
&e)atitis de,elo)s in three sta"es<
1. #re-icteric ()re-'aundice) or )rodromal 7hen "eneral lu-like sym)toms occur
*. Icteric or sta"e durin" 7hich 'aundice occurs (not all )atients 7ith he)atitis
de,elo) 'aundice)
1. #ost-icteric ()ost-'aundice) or reco,ery sta"e< )atient continues to ha,e ati"ue
and malaise
Dor the client 7ith he)atitis<
#ro,ide a restul en,ironment
Dor clients 7ith he)atitis or other se,ere li,er disease% use Acetamino)hen
cautiously.
A,oid o,er-the-counter medications that contain as)irin or 3SAI!s
Steroids may mask si"ns o inections
Bonitor hydration status i 3#+
Bonitor hemo"lobin% hematocrit % and electrolytes
Bonitor ,ital si"ns or shock
I blood )roducts "i,en% monitor ,ital si"ns or ad,erse eects
Bonitor draina"e rom naso"astric tube
Assess or si"ns o )eroration
Bonitor or si"ns o dum)in" syndrome
A,oid oods and drinks that are s)icy% hot% or cold6 a,oid caeine and alcohol
Administer antacids ater meals
!o not "i,e antacids at the same time as &* rece)tor anta"onists (histamine
blockers)
Baintain "astric )& N1.5
Ater sur"ery% teach eecti,e cou"hin" only i secretions are )resent. Cou"hin"
increases )ressure in the chest and narro7s air7ays. In clients 7ith reacti,e
air7ays% it can cause bronchos)asms and 7heezin".
". teach inection control
i. use dis)osable utensils and dishes or kee)
se)arate rom others
ii. "ood hand7ashin"
iii. do not share razors% toothbrush% etc.
8. #re,ention
a. he)atitis B ,accine )ro,ides acti,e immunity
b. he)atitis B immune "lobulin )ro,ides )assi,e immunity
c. obser,e Standard and Enteric #recautions
d. "ood hand7ashin"
C, Cirr!osis
1. !einitionCetiolo"y - irre,ersible% chronic% )ro"ressi,e de"eneration
o the li,er% 7ith ibrosis and areas o nodular re"eneration
a. ty)es
i. Laennec>s cirrhosis - related to alcohol abuse
ii. )ost-necrotic - associated 7ith ,iral he)atitis or
e9)osure to he)atoto9in
iii. biliary cirrhosis - associated 7ith inlammation or
obstruction o "allbladder or bile duct
i,. cardiac cirrhosis - associated 7ith con"esti,e heart
ailure
*. #atho)hysiolo"y
a. nodular li,er 7ith ibrosis and scar tissue
b. destroys he)atocytes and kills tissue (necrosis)
c. necrosis% nodules% and scar tissue obstruct lo7 o blood%
lym)h% and bile
d. im)aired bilirubin metabolism
1. Dindin"s
a. 7eakness% ati"ue% 7ei"ht loss% he)atome"aly
b. ri"ht u))er ;uadrant )ain
c. 'aundice% )ruritus% steatorrhea (decreased absor)tion o at
and at-soluble ,itamins)
d. clay-colored stools
e. increased bilirubin in urine% )roducin" dark colored urine
. im)aired aldosterone metabolism resultin" in edema
". im)aired estro"en metabolism< "ynecomastia% menstrual
chan"es% chan"es in distribution o body hair% ,ascular
chan"es - s)ider an"iomas% )almar erythema
h. im)aired metabolism o )rotein% carbohydrate% and at
i. )roduces less )lasma )rotein% resultin" in edema
and ascites
ii. )roduces less o )roteins needed or clottin"
(ibrino"en and )rothrombin)
iii. absorbs less ,itamin G% resultin" in )rolon"ed
bleedin"
i,. li,er ails to con,ert "lyco"en to "lucose% resultin"
in hy)o"lycemia
4. !ia"nostics
a. li,er unction studies - AL$% AS$% alkaline )hos)hatase
b. )rothrombin time% CBC
c. decreased cholesterol because li,er synthesis im)aired
d. ele,ated serum bilirubin and urine bilirubin
e. E/C# to e9amine bile ducts
. C$ scan o li,er
". li,er bio)sy
5. Bana"ement
a. steroids or )ost-necrotic cirrhosis
b. re)lace B ,itamins and at-soluble ,itamins
c. diet
i. increased carbohydrates
ii. )rotein may be restricted% de)endin" on amount o
dama"e and sym)toms
iii. no alcohol
8. 3ursin" inter,entions
a. monitor or bleedin"
b. alteration in nutrition
i. *%???-1%??? calories daily
ii. lo7 at
c. )ro,ide rest )eriods6 client 7ill not tolerate strenuous
acti,ities
d. remedy any kno7led"e deicit about cirrhosis and its
thera)ies
e. chan"es in L+C
i. conusion
ii. a,oid sedation
. im)aired skin inte"rity% rom edema and )ruritus
". monitor luid balance
h. measure abdominal "irth daily
i. 7ei"h daily
'. measure I - +
:. Com)lications
a. )ortal hy)ertension
b. ascites
c. he)atic ence)halo)athy
!. #ortal hy)ertension
1. !einitionCetiolo"y - increased )ressure in )ortal circulation
*. #atho)hysiolo"y< normal blood lo7 is altered )roducin" an
increased resistance to lo7 throu"h the li,er. Con"estion in the
)ortal system dilates ,eins% es)ecially in eso)ha"us and rectum.
1. Dindin"s
a. )rominent abdominal-7all ,eins (ca)ut medusa)
b. hemorrhoids
c. enlar"ed s)leen
d. anemia rom increased destruction o /BCs
e. eso)ha"eal ,arices and (I bleedin"
4. !ia"nostics< endosco)y
5. Bana"ement
a. sclerothera)y - in'ection o a sclerosin" a"ent into ,arices
b. balloon tam)onade
i. Sen"staken-Blakemore tube is inserted into the
stomach
ii. "astric balloon is inlated and )resses on lo7er
eso)ha"us 7hile allo7in" suctionin"
iii. eso)ha"eal balloon )laces )ressure on ,arices
i,. )ressure is released as ordered to )re,ent necrosis
,. traction or increased )ressure added by attachin"
tube to ootball helmet
,i. assess or bleedin" and si"ns o shock
,ii. assess or res)iratory distress - as)iration or
dis)lacement o tube% suction #/3
,iii. kee) head o bed ele,ated
c. medications
i. ,aso)ressin
A. constricts ,eins and decreases )ortal blood
lo7
B. "i,en I0 or into su)erior mesenteric artery
C. side eects include hy)othermia%
myocardial ischemia% acute renal ailure
ii. nitro"lycerin 7ill decrease myocardial eects
iii. beta-adrener"ic neuron-blockin" a"ents may
decrease risk o recurrent bleedin" by decreasin"
)ressure in )ortal system
i,. cathartics to remo,e blood rom (I tract and
decrease absor)tion o ammonia
d. sur"ical inter,ention
i. shunt to decrease blood lo7 to li,er and thereore
)ressure s)lenorenal shunt
A. mesoca,al shunt
B. )ortaca,al shunt
ii. $I#S (trans'u"ular intrahe)atic )ortosytsemic
shunt) - shunt )laced bet7een he)atic and )ortal
,ein
8. 3ursin" inter,entions
a. )re,ent bleedin"
b. a,oid intake o alcohol% irritatin" or rou"h ood
c. a,oid increased )ressure in abdomen
d. i bleedin" occurs - administer transusions% resh rozen
)lasma% ,itamin G
e. monitor or inection
E. Ascites
1. !einitionCetiolo"y - accumulation o luid in the )eritoneum
*. #atho)hysiolo"y
a. )ortal hy)ertension causes increased )lasma and
lym)hatic hydrostatic )ressure in )ortal system
b. hy)oalbuminemia causes decreased colloid osmotic
)ressure
c. hy)eraldosteronism due to li,er>s inability to metabolize
aldosterone causes body to retain sodium and 7ater
d. abdomen 7ill ha,e e9cess luid% blood ,essels too little
luid
1. Dindin"s
a. abdominal distention% )rotrudin" umbilicus% dull sound on
)ercussion o abdomen% luid 7a,e
b. bul"in" lank
c. dys)nea
4. !ia"nostics
a. abdominal 9-ray
b. C$ scan
c. ultrasound
5. Bedical mana"ement
a. diuretics - s)irnolactone (Aldactone) - aldosterone
anta"onist% s)ares )otassium
b. i, albumin
c. )aracentesis to remo,e luid
d. diet lo7 in sodium
e. )eritoneal ,enous shunt - allo7s draina"e o luid rom the
)eritoneum to su)erior ,ena ca,a
8. 3ursin" inter,entions
a. measure I - +% daily 7ei"ht% abdominal "irth% skin tur"or
b. restrict luids
c. monitor or ineecti,e breathin" )atterns
d. semi-Do7ler>s )osition
ASCITES 1 $ARACENTESIS
#aracentesis - as)iration o abdominal ascites% usually 1???-15??cc remo,ed
Beore )aracentesis< em)ty client>s bladder
!urin" )rocedure< client sits u)ri"ht
Ater )rocedure< take re;uent ,ital si"ns6 monitor urine out)ut6 and monitor or
draina"e rom )uncture site
e. monitor or im)aired skin inte"rity
. remedy kno7led"e deicit
D. &e)atic ence)halo)athy - mental dysunction associated 7ith se,ere li,er
disease
1. !einitionCetiolo"y
a. im)aired ammonia metabolism in li,er )oisons brain tissue
b. ammonia )roduced in bo7el rom action o bacteria on
)rotein
*. Dindin"s
a. chan"es in L+C rom conusion to coma
b. chan"es in slee) )attern
c. memory loss
d. asteri9is - la))in" tremor
e. im)aired hand7ritin"
. hy)er,entilation 7ith res)iratory alkalosis
". etor he)aticus - musty% s7eet odor to breath
1. !ia"nostics - serum ammonia le,el
4. Bana"ement
a. neomycin sulate (Byciradin) - inhibits action o intestinal
bacteria
b. lactulose (Ce)hulac) - absorbs ammonia and )roduces
e,acuation o the bo7el
c. lo7 )rotein diet
5. 3ursin" inter,entions
a. tremor% conusion can lead to in'ury< maintain saety
b. ascites and lo7 intake decrease luid ,olume
c. diarrhea rom medications
/, Disorders o# $ancreas and Gall%ladder
A, Acute pancreatitis
1. !einitionCetiolo"y - inlammation o the )ancreas
a. alcohol in"estion
b. "all stones
c. dru" in"estion
d. ,iral inections
e. trauma
*. #atho)hysiolo"y
a. autodi"estion rom )remature acti,ation o )ancreatic
enzymes
b. )roteases and li)ases% normally acti,e in small intestine%
are acti,ated in the )ancreas
c. )hos)holi)ase A di"ests adi)ose and )arenchymal tissues
d. elastase di"ests elastic ibers o blood ,essels% )roducin"
bleedin"
e. amylase di"ests carbohydrates
. inlammation res)onse occurs rom enzyme release
1. Dindin"s
a. let u))er ;uadrant abdominal )ain
b. )ain 7orsens ater eatin" and 7hen lyin" lat
c. nausea and ,omitin"
d. e,er% a"itation% conusion
e. hy)o,olemia and shock
. hemorrha"e into retro)eritoneal s)ace may )roduce
ecchymosis in lank or around umbilicus
". tachy)nea% )ulmonary iniltrates% atelectasis rom
circulatin" enzymes
4. !ia"nostics
a. ele,ated enzymes< serum amylase% serum li)ase% and
urinary amylase
b. ele,ated EBCs% decreased hemo"lobin and hematocrit
c. ele,ated L!& and AS$ (S(+$)
d. hy)er"lycemia
e. hy)ocalcemia
. chest 9- ray% C$ scan% ultrasound% E/C#
5. Com)lications
a. res)iratory )roblems - atelectasis% )neumonia rom the
immobility im)osed by )ain
b. tetany rom decreased calcium le,els
c. abscess or )seudocyst
8. Bana"ement
a. treat cause
b. )ain relie - me)eridine (!emerol)
c. luid maintenance to )re,ent shock
d. insulin or hy)er"lycemia
e. calcium re)lacement
. decrease stimulation o )ancreas
i. 3#+-$#3 (nothin" by mouth6 total )arenteral
nutrition)
ii. 3( tube
iii. anticholiner"ics
iv. h*-rece)tor anta"onists
:. 3ursin" inter,entions
a. mana"e )ain
b. monitor alteration in breathin" )atterns
c. monitor nutritional status
d. oral care 7hen 3#+
e. i eatin" is allo7ed% diet hi"h in )roteins and carbohydrates
and lo7 in at
. monitor luid and electrolyte balances
B. Cholecystitis
1. !einitionCetiolo"y - inlammation o the "allbladder
a. usually due to "allstones (Cholelithiasis)
b. ty)es
i. cholesterol - most common
Endosco)y hel)s dia"nose and treat many abdominal (and other) disorders. &ere are t7o
endosco)ic )rocedures desi"ned or the abdomen<
Endosco)ic retro"rade cholan"io"ra)hy (E/C#) outlines the common bile duct and hel)s
dia"nose )ancreatitis. (I it hel)s% think o the # in E/C# as )ancreatitis and O)ictureO
because E/C# )ictures the duct.)
Endosco)ic retro"rade catheterization o the "allbladder (E/C() hel)s dia"nose
cholecystitis. ($hink o the ( in E/C( as "allbladder.)
$ANCREATITIS
Acute )ancreatitis can become chronic
Bor)hine sulate is not used to treat )ain since it can cause the s)hincter o +ddi to
s)asm
#ain may be relie,ed by side-lyin"
I clients lose )ancreatic unction% they may ha,e to take )ancreatic enzymes and
bile salts 7ith meals.
Eith )ancreatitis% a,oid stimulation o the )ancreas< do not use enteral eedin"s
ii. )i"ment - uncon'u"ated bilirubin
c. bile is blocked% and inects tissue
d. more common in 7omen% es)ecially those o,er 4? and
those 7ho use birth control )ills
*. #atho)hysiolo"y
a. common bile duct is obstructed by a "allstone
b. bile cannot be e9creted% some is reabsorbed
c. remainin" bile distends and inlames "all bladder
d. may scar "allbladder% resultin" in less storin" o the bile
rom the li,er
e. can )erorate "all bladder
1. Dindin"s
a. colicky )ain in ri"ht u))er ;uadrant 7ith )ossible radiation
to ri"ht shoulder and back
b. indi"estion ater eatin" atty oods
c. nausea and ,omitin"
d. 'aundice (i the li,er is in,ol,ed or inlamed or the common
duct obstructed)
e. lo7 "rade e,er
4. !ia"nostics
a. endosco)ic retro"rade cholan"io"ra)hy (E/C#)
b. endosco)ic retro"rade catheterization o the "allbladder
(E/C()
c. ultrasound
5. Bana"ement
a. rest
b. lo7-at diet
c. remo,al o stone in common duct by endosco)y
d. to dissol,e cholesterol stones
I. chenodeo9ycholic acid (Chenodiol) - side eects
are diarrhea and he)atoto9icity
II. ursodeo9ycholic acid (2!CA)
e. control )ain - me)eridine (!emerol) is dru" o choice
. re)lace ,itamin G i bleedin" time is )rolon"ed
". e9tracor)oreal shock 7a,e lithotri)sy - may ha,e
hematuria ater )rocedure% but not lon"er than *4 hours
h. choledocholithotomy - to remo,e or break u) stones
i. la)arosco)ic laser cholecystectomy
'. cholecystectomy
8. 3ursin" inter,entions
a. monitor ,ital si"ns
b. monitor )ain and medicate as needed
c. teach client - dietary restriction o atty oods
$oints to Ree%er
Bost obstructions occur in the small bo7el.
Bost lar"e bo7el obstructions are caused by cancer.
+nset o cirrhosis is insidious 7ith sym)toms such as anore9ia% 7ei"ht loss%
malaise% altered bo7el habits% nausea and ,omitin".
Bana"ement o cirrhosis is directed to7ards a,oidin" com)lications. $his is
achie,ed by maintainin" luid% electrolyte and nutritional balance.
A client 7ith eso)ha"eal ,arices must be monitored or bleedin" (e.".% melena
stools% hematemesis% and tachycardia.)
$he ru)ture o eso)ha"eal ,arices is lie threatenin" and associated 7ith a hi"h
mortality rate.
#ancreatitis is oten associated 7ith e9cessi,e alcohol in"estion.
#ancreatic cancer is an insidious disease that oten "oes undetected until its
later sta"es.
!i,erticula are most common in the si"moid colon.
Clients 7ith di,erticulosis are oten asym)tomatic.
A deiciency in dietary iber is associated 7ith di,erticulitis.
Colostomies< an ascendin" colostomy drains li;uid eces% is diicult to train and
re;uires daily irri"ation6 a descendin" colostomy drains solid eces and can be
controlled.
Dre;uent li;uid stools can be indicati,e o a ecal im)action or intestinal
obstruction.
Bo7el sounds tend to be hy)eracti,e in the early )hases o an intestinal
obstruction.