GASTROINTESTINAL DISORDERS

Introduction to Anatomy and Physiology

Definition

●​ Anatomy: The study of the structure and organization of the body and its parts.
●​ Physiology: The study of the function of the body’s systems and organs.

Levels of Organization

1.​ Chemical Level: Atoms and molecules that form the building blocks of the body (e.g.,
water, proteins, DNA).
2.​ Cellular Level: The smallest structural and functional units of life.
3.​ Tissue Level: Groups of similar cells performing a common function (e.g., epithelial,
connective, muscular, nervous tissues).
4.​ Organ Level: Structures composed of two or more tissue types working together (e.g.,
heart, lungs).
5.​ Organ System Level: Groups of organs functioning together (e.g., digestive, endocrine
systems).
6.​ Organismal Level: The complete human body.

Body Systems

●​ There are 11 major organ systems, including the digestive system, which encompasses
the pancreas, liver, gallbladder, and biliary tract.

Review of the Pancreas, Liver, Gallbladder, and Biliary Tract

1. The Pancreas

Anatomy

●​ Located in the retroperitoneal space, behind the stomach.

●​ Divided into the head, body, and tail.
●​ Connected to the duodenum via the pancreatic duct.

Physiology
Insulin, Glucagon, somatostatin
●​ Endocrine Function: Regulates blood glucose levels via:
○​ Insulin (lowers blood sugar)
○​ Glucagon (raises blood sugar)
 ○​ Somatostatin (regulates other hormones)
●​ Exocrine Function: Produces digestive enzymes (amylase, lipase, proteases) and
bicarbonate to aid in digestion. amylase=carbohydrates
lipase= fats
Clinical Significance protease= protein

●​ Common disorders:
○​ Pancreatitis (acute or chronic inflammation)
○​ Diabetes mellitus
○​ Pancreatic cancer

2. The Liver

Anatomy

●​ Largest internal organ, located in the right upper quadrant of the abdomen.
●​ Divided into two main lobes (right and left) and further into smaller lobules.
●​ Supplied by the hepatic artery and portal vein.

Physiology

●​ Metabolic Functions:
○​ Glucose metabolism: Glycogenesis, glycogenolysis, gluconeogenesis.
○​ Lipid metabolism: Cholesterol synthesis and lipoprotein production.
●​ Detoxification: Breaks down toxins, drugs, and alcohol.
●​ Protein Synthesis: Produces albumin and clotting factors.
●​ Bile Production: Essential for fat digestion and absorption.
●​ Storage: Stores vitamins (A, D, B12) and minerals (iron, copper).

Clinical Significance

●​ Common disorders:
○​ Hepatitis (inflammation due to viruses, alcohol, or autoimmune conditions)
○​ Cirrhosis (scarring due to chronic liver damage)
○​ Liver cancer

3. The Gallbladder

Anatomy

●​ A small, pear-shaped organ located beneath the liver.

●​ Connected to the biliary tract via the cystic duct.

Physiology

●​ Storage and Concentration of Bile:

○​ Bile is produced by the liver and stored in the gallbladder until needed.
 is the process of breaking down
large fat globules into smaller

○​ Released into the small intestine during digestion to emulsify fats.

Clinical Significance

●​ Common disorders:
○​ Cholelithiasis (gallstones)
○​ Cholecystitis (inflammation of the gallbladder)
○​ Biliary colic (pain caused by gallstones blocking bile flow)

4. The Biliary Tract

Anatomy

●​ Includes bile ducts that transport bile from the liver and gallbladder to the duodenum.
●​ Major components:
○​ Hepatic ducts (right and left)
○​ Common hepatic duct
○​ Cystic duct
○​ Common bile duct

Physiology

●​ Bile Transport:
○​ Bile flows from the liver to the gallbladder for storage and to the duodenum for
digestion.
●​ Bile Composition:
○​ Contains bile salts, bilirubin, cholesterol, and electrolytes.

Clinical Significance

●​ Common disorders:
○​ Bile duct obstruction
○​ Cholangitis (infection of the bile ducts)
○​ Biliary strictures

Diagnostic Tests for Pancreas, Liver, Gallbladder, and Biliary Tract

1.​ Blood Tests:

○​ Liver function tests (ALT, AST, ALP, bilirubin, albumin)
○​ Pancreatic enzymes (amylase, lipase)
2.​ Imaging Studies:
○​ Ultrasound (for gallstones, bile duct obstruction)
○​ CT or MRI (for structural abnormalities)
 ○​ ERCP (endoscopic retrograde cholangiopancreatography) to evaluate bile and
pancreatic ducts.
3.​ Biopsy:
○​ Liver biopsy for diagnosing fibrosis or malignancy.

Dysphagia

Definition

Dysphagia refers to difficulty swallowing, which may involve problems with moving food or
liquids from the mouth to the stomach.

Causes

●​ Neurological conditions: Stroke, Parkinson's disease, multiple sclerosis

●​ Structural abnormalities: Tumors, strictures, esophageal webs
●​ Muscular disorders: Myasthenia gravis, esophageal spasm
●​ Age-related changes: Reduced muscle strength and coordination

Signs and Symptoms

●​ Sensation of food sticking in the throat or chest

●​ Coughing or choking during eating or drinking
●​ Unexplained weight loss
●​ Recurrent aspiration pneumonia

Diagnostic Procedures

●​ Barium swallow study

●​ Esophagogastroduodenoscopy (EGD)
●​ Videofluoroscopic swallowing study
●​ Manometry

Nursing Management

1.​ Assessment:
○​ Monitor for signs of aspiration (e.g., coughing, choking).
○​ Assess dietary intake and weight changes.
2.​ Interventions:
○​ Elevate the head of the bed during and after meals.
○​ Collaborate with speech-language therapists for swallowing therapy.
○​ Provide soft or pureed diets and thickened liquids as prescribed.
 3.​ Education:
○​ Teach patients to eat slowly and take small bites.
○​ Encourage adequate hydration.

Gastroesophageal Reflux Disease (GERD)

Definition

GERD is a chronic condition where stomach acid frequently flows back into the esophagus,
causing irritation.

Also called “acid reflux disease”

Causes:

●​ Weak lower esophageal sphincter (LES)

●​ Hiatal hernia
●​ Obesity
●​ Smoking and alcohol use
●​ Certain foods (e.g., spicy, fatty, or acidic foods)
●​ Can weakened the LES:

Calcium channel blocker “dipine”,antihistamines,

Signs and Symptoms

●​ Heartburn (burning sensation in the chest)

●​ Regurgitation of food or sour liquid
●​ Difficulty swallowing
●​ Chronic cough or hoarseness
●​ Chest pain (non-cardiac origin)

Complications
where the tissue lining the esophagus, the tube connecting
●​ Esophagitis your mouth to your stomach, changes to tissue that is similar
●​ Barrett's esophagus to the lining of your intestine. This happens when stomach
acid repeatedly flows back into the esophagus, causing
●​ Esophageal strictures
damage.
●​ Aspiration pneumonia

Diagnostic Procedures

●​ 24-hour pH monitoring (confirmatory test)

●​ Esophagogastroduodenoscopy (EGD)
●​ Esophageal manometry (to assess the fx. Of the esophagus)
 ●​ Barium swallow study (can help identify structural problems that might contribute to
GERD)
●​ Endoscopy (narrowing ulcers)

Nursing Management

1.​ Assessment:
○​ Monitor for signs of complications (e.g., bleeding, weight loss).
○​ Assess dietary and lifestyle habits.
2.​ Interventions:
○​ Elevate the head of the bed during sleep.
○​ Administer medications such as

Block acid production

proton pump inhibitors (PPIs):

Ex. Omeprazole, Lansoprazole,

Esomeprazole, Pantoprazole

Reduces stomach acid production

H2 receptor blockers:

Ex. Ranitidine, Famotidine, Cimetidine

Neutralizing Stomach acid

Antacids:

Ex. Tums, Rolaids, Maalox, Mylanta

Prokinetic agents: Improved esophageal motility

Ex. Metoclopramide

○​ Encourage weight loss and smoking cessation.

○​ Left-Side Sleeping
○​ Elevating the Head
3.​ Education:
○​ Avoid lying down for at least 2-3 hours after eating.
○​ Identify and eliminate trigger foods.
○​ Wear loose-fitting clothing.
Hiatal Hernia

Definition

Hiatal hernia occurs when a portion of the stomach pushes through the diaphragm into the
chest cavity.

Types

1.​ Sliding Hiatal Hernia: The stomach and the lower esophagus slide up into the chest.
2.​ Paraesophageal Hiatal Hernia: Part of the stomach pushes through the diaphragm next
to the esophagus.

Causes

●​ Weakening of the diaphragm

●​ Increased intra-abdominal pressure (e.g., from obesity, pregnancy, heavy lifting)
●​ Aging

Signs and Symptoms

●​ Many patients are asymptomatic.

●​ Heartburn
●​ Regurgitation
●​ Difficulty swallowing
●​ Chest pain

Complications

●​ Strangulation of the hernia

●​ GERD
●​ Esophageal ulcers
Diagnostic Procedures

●​ Chest X-ray
●​ Barium swallow study
●​ Esophagogastroduodenoscopy (EGD)
●​ Endoscopy(confirmatory test)

Nursing Management

1.​ Assessment:
○​ Monitor for signs of strangulation (e.g., severe pain, vomiting).
○​ Assess for GERD symptoms.
2.​ Interventions:
○​ Encourage small, frequent meals.
○​ Avoid activities that increase intra-abdominal pressure.
○​ Administer prescribed medications (e.g., antacids, PPIs).
3.​ Education:
○​ Teach patients to avoid lying down after eating.
○​ Discuss lifestyle changes similar to those for GERD.

Conclusion

Dysphagia, GERD, and hiatal hernia are interconnected conditions requiring careful
assessment, timely diagnosis, and comprehensive nursing management. Patient education and
lifestyle modifications play a crucial role in managing symptoms and preventing complications.

Lecture Notes: Irritable Bowel Syndrome (IBS)

Introduction
Irritable Bowel Syndrome (IBS) is a functional gastrointestinal disorder characterized by chronic
abdominal pain and altered bowel habits in the absence of detectable organic disease. It is a
common condition with significant impacts on quality of life, causing no inflammation. primarily
affects the large intestine (colon).

Epidemiology

●​ Affects 10-15% of the global population.

●​ More common in females than males.
●​ Typically begins in young adulthood.

Pathophysiology

The exact cause of IBS is unknown, but several factors contribute to its development:

1.​ Altered gut motility: Abnormal intestinal contractions may lead to diarrhea or
constipation.
2.​ Visceral hypersensitivity: Heightened pain perception in response to normal gut
stimuli.
3.​ Gut-brain axis dysfunction: Disrupted communication between the central nervous
system and the gastrointestinal tract.
4.​ Intestinal inflammation: Low-grade inflammation in some patients.
5.​ Microbiota changes: Imbalance in gut bacteria.
6.​ Psychosocial factors: Stress, anxiety, and depression may exacerbate symptoms.

Classification

IBS is classified based on the predominant stool pattern:

1.​ IBS-D: Predominant diarrhea.

2.​ IBS-C: Predominant constipation.
3.​ IBS-M: Mixed diarrhea and constipation.
4.​ IBS-U: Unclassified.

Clinical Manifestations
 ●​ Abdominal pain: Typically relieved by defecation or associated with changes in stool
frequency or form.
●​ Altered bowel habits: Diarrhea, constipation, or alternating patterns.
●​ Bloating and gas.
●​ Mucus in stool.
●​ Symptoms may be triggered or worsened by stress or certain foods.

Common Food Triggers for IBS:

●​ FODMAPs: These are short-chain carbohydrates that are poorly absorbed in the small
intestine.
○​ Examples:
■​ Fruits: Apples, apricots, cherries, mangoes, nectarines, pears, plums,
watermelon.
■​
■​ Vegetables: Garlic, onions, asparagus, beans, lentils, cauliflower,
broccoli.
■​
■​ Dairy: Milk, ice cream, some cheeses.
■​
■​ Grains: Wheat, rye, barley.
■​
■​ Sweeteners: Honey, agave nectar.

Diagnostic Criteria

Rome IV Criteria

Recurrent abdominal pain for at least 1 day per week in the last 3 months, associated with two
or more of the following:

1.​ Related to defecation.

2.​ Associated with a change in stool frequency.
3.​ Associated with a change in stool form.

Exclusion of Other Conditions

●​ Rule out organic diseases such as inflammatory bowel disease (IBD), celiac disease,
and colorectal cancer through history, physical examination, and laboratory tests.

Diagnostic Workup
 ●​ History and physical examination.
●​ BRISTOL STOOL FORM SCALE
●​ Laboratory tests: Complete blood count (CBC), C-reactive protein (CRP), stool tests.
●​ Imaging and endoscopy: As indicated to exclude other conditions.

Management

General Principles

●​ Focus on symptom relief and improving quality of life.

●​ Individualized treatment based on symptom subtype and severity.

Lifestyle Modifications

1.​ Dietary changes:

○​ Low FODMAP diet.
○​ Avoid trigger foods (e.g., caffeine, alcohol, fatty foods).
○​ Increase dietary fiber for IBS-C.
2.​ Exercise:
○​ Regular physical activity to improve gut motility and reduce stress.
3.​ Stress management:
○​ Cognitive-behavioral therapy (CBT), relaxation techniques, or mindfulness.

Pharmacologic Therapy

●​ IBS-D:
○​ Antidiarrheals (e.g., loperamide).
○​ Bile acid sequestrants (e.g., cholestyramine).
○​ Rifaximin (a non-absorbable antibiotic).
○​ Alosetron( six months diarrhea)
●​ IBS-C:
○​ Laxatives (e.g., polyethylene glycol).
○​ Lubiprostone or linaclotide for severe cases.
●​ Abdominal pain and bloating:
○​ Antispasmodics (e.g., hyoscine, dicyclomine).
○​ Peppermint oil.
○​ Low-dose tricyclic antidepressants (TCAs) or selective serotonin reuptake
inhibitors (SSRIs).

Probiotics

●​ Certain strains (e.g., Bifidobacterium, Lactobacillus) may improve symptoms.

Complications

●​ No structural damage, but significant impacts on quality of life.

●​ Increased risk of anxiety and depression.
●​ Potential nutritional deficiencies due to dietary restrictions.

Patient Education

1.​ Explain the chronic nature of IBS and reassure that it does not lead to serious conditions
like cancer.
2.​ Encourage patients to keep a symptom diary to identify triggers.
3.​ Stress the importance of adherence to lifestyle and dietary modifications.
4.​ Highlight the role of psychological health in managing IBS symptoms.

Prognosis

●​ IBS is a chronic condition with variable symptom patterns.

●​ Effective management can significantly improve quality of life.

Conclusion

IBS is a multifactorial and chronic condition requiring a comprehensive and individualized

approach. A combination of dietary modifications, pharmacologic therapy, and psychosocial
support is essential for optimal symptom management.

Lecture Notes: Abdominal Hernia

Introduction
An abdominal hernia occurs when an organ or tissue protrudes through a weak spot or tear
in the abdominal wall. Hernias can develop in various locations and vary in severity, ranging
from asymptomatic to life-threatening if complications occur. This lecture covers the types,
causes, clinical manifestations, diagnosis, management, and nursing care for abdominal
hernias.

Types of Abdominal Hernias

1. Inguinal Hernia

●​ Most common type of hernia.

●​ Occurs in the groin area when the intestine or fatty tissue pushes through the inguinal
canal.
●​ Direct inguinal hernia: Protrudes through a weak spot in the abdominal wall.
●​ Indirect inguinal hernia: Passes through the inguinal ring into the scrotum.

2. Femoral Hernia

●​ Occurs below the inguinal ligament, near the femoral artery and vein.
●​ More common in women than men.

3. Umbilical Hernia

●​ Occurs when part of the intestine protrudes through the umbilical ring.
●​ Common in infants and may resolve spontaneously.

4. Ventral (Incisional) Hernia

●​ Develops at the site of a previous surgical incision due to inadequate healing or

increased intra-abdominal pressure.

5. Epigastric Hernia

●​ Occurs between the navel and the lower part of the rib cage due to a weakness in the
linea alba.

6. Hiatal Hernia

●​ Covered separately in GERD and hiatal hernia lectures. It involves the stomach pushing
through the diaphragm.

Causes
 ●​ Congenital factors: Weakness in the abdominal wall present from birth.
●​ Increased intra-abdominal pressure:
○​ Obesity
○​ Chronic coughing or sneezing
○​ Straining during bowel movements or urination
○​ Heavy lifting
○​ Pregnancy
●​ Post-surgical complications: Weakness in the surgical site.
●​ Aging: Loss of muscle tone.

Clinical Manifestations

●​ Visible bulge or swelling in the abdominal or groin area.

●​ Pain or discomfort, especially during activities that increase intra-abdominal pressure
(e.g., coughing, lifting).
●​ A heavy or dragging sensation.
●​ Incarcerated hernia (non-reducible): Severe pain, nausea, vomiting, and inability to push
the hernia back into place.
●​ Strangulated hernia (emergency):
○​ Severe pain
○​ Redness, swelling, and tenderness at the hernia site
○​ Signs of bowel obstruction (e.g., absence of bowel sounds, vomiting)

Diagnosis

1.​ Physical Examination:

○​ Observation of a bulge, especially when the patient is asked to cough or strain.
2.​ Imaging Studies:
○​ Ultrasound: Commonly used for groin hernias.
○​ CT or MRI: Provides detailed visualization of the hernia and surrounding
structures.
3.​ Differential Diagnosis:
○​ Distinguish hernias from other conditions such as lipomas, lymphadenopathy, or
abscesses.

Management

1. Conservative Management
 ●​ Indicated for small, asymptomatic hernias.
●​ Use of a hernia belt or truss may provide temporary relief.
●​ Lifestyle modifications to reduce intra-abdominal pressure (e.g., weight loss, avoiding
heavy lifting).

2. Surgical Management

●​ Open Herniorrhaphy: Surgical repair of the hernia by suturing the defect.

●​ Hernioplasty: Use of a mesh to reinforce the abdominal wall.
●​ Laparoscopic Surgery: Minimally invasive approach with faster recovery time.
●​ Emergency Surgery: Required for incarcerated or strangulated hernias.

Nursing Management

Preoperative Care

1.​ Assessment:
○​ Monitor for signs of incarceration or strangulation.
○​ Assess the patient’s nutritional and hydration status.
2.​ Interventions:
○​ Educate the patient on the surgical procedure and post-operative expectations.
○​ Ensure bowel preparation if required.

Postoperative Care

1.​ Pain Management:

○​ Administer prescribed analgesics.
○​ Encourage non-pharmacological methods such as positioning.
2.​ Wound Care:
○​ Monitor the surgical site for signs of infection (redness, swelling, discharge).
○​ Teach proper wound care to the patient.
3.​ Activity Restrictions:
○​ Avoid heavy lifting for 4-6 weeks post-surgery.
○​ Gradual resumption of normal activities as per healthcare provider’s advice.
4.​ Education:
○​ Signs of complications (e.g., recurrence, infection).
○​ Importance of maintaining a healthy weight and avoiding straining.

Complications

●​ Incarceration: Entrapment of the herniated tissue, making it irreducible.

 ●​ Strangulation: Compromised blood supply to the herniated tissue, leading to ischemia
and necrosis.
●​ Recurrence: Risk of hernia returning after surgical repair.

Conclusion

Abdominal hernias are common and potentially serious conditions requiring timely recognition
and management. Nurses play a crucial role in assessing, educating, and supporting patients
through both conservative and surgical treatments to promote optimal outcomes.

Intestinal Obstruction

Definition

Intestinal obstruction occurs when the normal flow of intestinal contents is blocked, either
partially or completely, preventing digestion and absorption.
Types

1.​ Mechanical Obstruction: Physical blockage in the intestinal lumen.

○​ Examples: Adhesions, hernias, tumors, volvulus, intussusception.
2.​ Functional Obstruction (Ileus): Impaired peristalsis without a physical blockage.
○​ Examples: Postoperative ileus, electrolyte imbalances, medications (e.g.,
opioids).

Causes

●​ Small Bowel Obstruction (SBO): Adhesions, hernias, Crohn's disease.

●​ Large Bowel Obstruction (LBO): Tumors, diverticulitis, volvulus.

Signs and Symptoms

●​ Small Bowel Obstruction:

○​ Cramping abdominal pain
○​ Nausea and vomiting (often bilious)
○​ Abdominal distension
○​ Hyperactive bowel sounds initially, progressing to hypoactive or absent
●​ Large Bowel Obstruction:
○​ Gradual onset of symptoms
○​ Lower abdominal pain
○​ Constipation or failure to pass gas
○​ Marked abdominal distension

Complications

●​ Bowel ischemia
●​ Perforation
●​ Sepsis

Diagnostic Procedures

●​ Abdominal X-ray
●​ CT scan
●​ Ultrasound (in specific cases like intussusception)
●​ Laboratory tests: Elevated white blood cell count, electrolyte imbalances

Nursing Management

1.​ Assessment:
○​ Monitor for signs of perforation or worsening obstruction (e.g., fever, severe
pain).
○​ Assess for dehydration and electrolyte imbalances.
2.​ Interventions:
 ○​
Place the patient on NPO (nothing by mouth) status.
○​
Insert a nasogastric (NG) tube for decompression as prescribed.
○​
Administer IV fluids and electrolytes.
○​
Prepare the patient for surgery if indicated (e.g., for complete mechanical
obstruction).
3.​ Education:
○​ Explain procedures such as NG tube placement and surgical interventions.
○​ Discuss post-operative care and lifestyle modifications.

Ostomies

Definition

An ostomy is a surgically created opening (stoma) in the abdomen to allow the discharge of
stool or urine. It may be temporary or permanent.

Types of Ostomies

1.​ Colostomy: Stoma created from the colon.

○​ Types: Ascending, transverse, descending, sigmoid.
2.​ Ileostomy: Stoma created from the ileum.
3.​ Urostomy (Ileal Conduit): Stoma created for urinary diversion.

Indications

●​ Colorectal cancer
●​ Inflammatory bowel disease (e.g., Crohn's disease, ulcerative colitis)
●​ Bowel obstruction
●​ Trauma

Nursing Care for Patients with Ostomies

1.​ Preoperative Care:

○​ Provide emotional support and education.
○​ Mark the stoma site with input from the patient and surgeon.
○​ Discuss expectations regarding stoma function and appearance.
2.​ Postoperative Care:
○​ Assess the stoma:
■​ Color: Healthy stoma is pink to red and moist.
■​ Size: May shrink over time.
■​ Output: Monitor for type, consistency, and volume.
○​ Protect peristomal skin:
■​ Use skin barriers and properly fitting appliances.
○​ Address complications:
 ■​ Stoma retraction, prolapse, or necrosis.
3.​ Patient Education:
○​ Stoma care:
■​ How to empty and change the pouching system.
■​ Importance of maintaining skin integrity.
○​ Dietary considerations:
■​ Avoid gas-producing or high-fiber foods initially.
■​ Maintain adequate hydration, especially for ileostomies.
○​ Lifestyle adaptations:
■​ Encourage normal activities and provide resources for ostomy support
groups.

Psychosocial Aspects

●​ Address body image concerns.

●​ Provide resources for counseling or support groups.
●​ Encourage open communication about feelings and challenges.

Conclusion

Intestinal obstructions and ostomies require comprehensive nursing care that focuses on patient
assessment, timely interventions, and patient-centered education. By addressing both the
physical and emotional needs of patients, nurses can significantly enhance their quality of life.

Appendicitis

Definition
Appendicitis is the inflammation of the appendix, a small, finger-like pouch attached to the
cecum in the lower right abdomen. It is a medical emergency that often requires surgical
intervention.

Pathophysiology

●​ Obstruction of the appendix lumen by fecalith, lymphoid hyperplasia, or foreign bodies.

●​ Obstruction leads to increased intraluminal pressure, bacterial overgrowth, and
inflammation.
●​ If untreated, it can progress to gangrene, perforation, and peritonitis.

Signs and Symptoms

●​ (McBurney's point)Initial periumbilical pain that migrates to the right lower quadrant
●​ Rovsing's sign (pain in RLQ when LLQ is palpated)
●​ Psoas sign: extension of the right leg will cause RLQ pain
●​ Obturator: flexion of the right leg will cause RLQ pain.
●​ Nausea and vomiting
●​ Anorexia
●​ Fever
●​ Rebound tenderness and guarding

Complications

●​ Perforation
●​ Abscess formation
●​ Generalized peritonitis(rigid, board like abdomen)
●​ Contraindicated: pain medication, warm compress, enema

Diagnostic Procedures

●​ Physical exam: Assess for localized tenderness and signs of peritoneal irritation.
●​ Lab tests: Elevated white blood cell (WBC) count.
●​ Imaging:
○​ Ultrasound: First-line imaging in children and pregnant women.
○​ CT scan: Gold standard for diagnosing appendicitis.

Treatment

1.​ Non-Surgical Management:

○​ For uncomplicated cases: IV antibiotics and observation (in select cases).
2.​ Surgical Management:
○​ Appendectomy (laparoscopic or open): Definitive treatment.
3.​ Postoperative Care:
○​ Monitor for infection and complications such as ileus.
○​ Pain management and ambulation encouragement.
Nursing Care

●​ Preoperative:
○​ Maintain NPO status.
○​ Administer IV fluids and antibiotics as prescribed.
○​ Monitor for signs of perforation (sudden relief of pain followed by severe
abdominal pain).
●​ Postoperative:
○​ Monitor vital signs and surgical site.
○​ Encourage early mobilization to prevent complications.
○​ Educate about wound care and activity restrictions.

Peritonitis

Definition

rigid, board like abdomen, Peritonitis is the inflammation of the peritoneum, typically caused
by bacterial infection resulting from perforation of abdominal organs or other conditions.

Types

●​ Primary Peritonitis: Infection without a clear source, often associated with liver disease
and ascites.
●​ Secondary Peritonitis: Caused by perforation of abdominal organs (e.g., ruptured
appendix, perforated ulcer).
●​ Tertiary Peritonitis: Persistent or recurrent peritonitis after treatment.

Pathophysiology

●​ Introduction of bacteria or irritants into the peritoneal cavity.

●​ Leads to an inflammatory response, exudate formation, and fluid shifts.
●​ Results in hypovolemia, sepsis, and multisystem organ failure if untreated.

Signs and Symptoms

●​ Severe, generalized abdominal pain that worsens with movement.

●​ Abdominal rigidity and guarding.
●​ Fever and chills.
●​ Nausea and vomiting.
●​ Tachycardia and hypotension.
●​ Altered mental status (in severe cases).

Complications
 ●​ Sepsis and septic shock
●​ Abscess formation
●​ Paralytic ileus

Diagnostic Procedures

●​ Physical exam: Signs of acute abdomen (rigidity, rebound tenderness).

●​ Lab tests:
○​ Elevated WBC count.
○​ Blood cultures to identify the causative organism.
●​ Imaging:
○​ Abdominal X-ray: May show free air under the diaphragm (indicating perforation).
○​ CT scan: Helps identify the source of infection.
●​ Peritoneal fluid analysis: To confirm infection.

Treatment

1.​ Medical Management:

○​ Broad-spectrum IV antibiotics.
○​ Fluid resuscitation to address hypovolemia.
○​ Nasogastric tube to decompress the stomach.
2.​ Surgical Management:
○​ Exploratory laparotomy or laparoscopy: To locate and repair the source of
infection or perforation.

Nursing Care

●​ Assessment:
○​ Monitor for signs of sepsis (e.g., hypotension, tachycardia).
○​ Assess for changes in pain and abdominal rigidity.
●​ Interventions:
○​ Administer prescribed antibiotics and fluids.
○​ Maintain strict asepsis during invasive procedures.
○​ Monitor and record intake and output.
●​ Education:
○​ Teach patients to recognize signs of infection or complications.
○​ Provide dietary and activity guidance after surgery.

Conclusion

Appendicitis and peritonitis are serious abdominal conditions that require timely intervention to
prevent life-threatening complications. Nurses play a pivotal role in early detection, pre- and
postoperative care, and patient education, ensuring better outcomes for affected individuals.
Ulcerative Colitis (UC)

Definition

Ulcerative colitis is a chronic inflammatory bowel disease (IBD) characterized by inflammation

and ulceration of the colon and rectum’s mucosal lining. Can be operated.

Pathophysiology

●​ Inflammation(continuous), begins in the rectum and spreads proximally.

●​ Affects only the mucosa and submucosa layers.
●​ Results in continuous lesions (no skipped areas).

Causes and Risk Factors

●​ Autoimmune dysfunction
●​ Genetic predisposition
●​ Environmental triggers
●​ Commonly diagnosed between 15-30 years of age

Clinical Manifestations

●​ LLQ Abdominal pain (usually left lower quadrant)

●​ Bloody diarrhea
●​ Hemorrhagic
●​ Tenesmus (urge to defecate)
●​ Fatigue and weight loss
●​ Extraintestinal symptoms (e.g., arthritis, uveitis, skin lesions)

Complications

●​ Toxic megacolon
●​ Perforation
●​ Colorectal cancer

Diagnostic Procedures

●​ Colonoscopy with biopsy

●​ Stool tests (to rule out infections)
●​ Blood tests (e.g., anemia, inflammatory markers)

Nursing Management
 1.​ Assessment:
○​ Monitor stool frequency and characteristics.
○​ Assess for signs of complications (e.g., fever, severe pain).
2.​ Interventions:
○​ Administer medications:
○​ INFLIXIMAB (It's a type of biologic medication called a tumor necrosis factor
(TNF) alpha inhibitor. TNF-alpha is a protein that plays a role in inflammation.)

•Anti-Inflammatory Drug: Aminosalicylates, Corticosteroids

•Immunosuppressants: Azathioprine, Cyclosporine(These medications work by

suppressing the activity of the immune system, reducing inflammation and
allowing the colon to heal.)

○​ Monitor for dehydration and electrolyte imbalances.

○​ Encourage small, frequent meals.
○​ Anti-diarrheal
3.​ Education:
○​ Teach patients about medication adherence.
○​ Avoid high-fiber and high-fat foods during flare-ups.
○​ Discuss stress management techniques.

Crohn’s Disease

Definition

Crohn's disease is a chronic inflammatory bowel disease that can affect any part of the
gastrointestinal tract from mouth to anus, most commonly the terminal ileum and colon.(No
operation).

Pathophysiology

●​ Transmural inflammation affects all layers of the bowel wall.

●​ Results in skipped lesions (normal areas between inflamed segments).
●​ Can lead to strictures, fistulas, and abscesses.

Causes and Risk Factors

●​ Autoimmune dysfunction
●​ Genetic predisposition
●​ Smoking
●​ Commonly diagnosed between 15-35 years of age

Clinical Manifestations
 ●​ RLQ Abdominal pain (usually right lower quadrant)
●​ Mucoid Diarrhea (often non-bloody)
●​ Fatigue and weight loss
●​ Malnutrition and vitamin deficiencies
●​ Extraintestinal symptoms (similar to UC)
●​ RISK FOR COLON CANCER

Complications

●​ Intestinal obstruction
●​ Abscesses and fistulas
●​ Malabsorption
●​ Colorectal cancer

Contraindicated: Non-Steroidal Anti-Inflammatory Drugs (NSAIDs): Such as ibuprofen (Advil,

Motrin) and naproxen (Aleve).

Diagnostic Procedures

●​ Colonoscopy and endoscopy with biopsy(risk for colon cancer)

●​ Imaging (e.g., CT, MRI)
●​ Blood tests (e.g., anemia, elevated inflammatory markers)

Nursing Management

1.​ Assessment:
○​ Monitor for signs of complications (e.g., fever, abscess formation).
○​ Assess nutritional status and weight.
2.​ Interventions:
○​ Administer medications:

•Anti-Inflammatory Drug: Aminosalicylates, Corticosteroids

•Immunosuppressants: Azathioprine, Cyclosporine(These medications work by

suppressing the activity of the immune system, reducing inflammation and
allowing the colon to heal.)

○​
○​ Encourage high-protein, high-calorie, low-residue diets.
○​ Monitor for signs of dehydration and electrolyte imbalance.
3.​ Education:
○​ Teach about the importance of regular follow-ups.
○​ Discuss avoiding trigger foods (e.g., dairy, spicy foods).
○​ Encourage smoking cessation.
Diverticulitis

Definition

Diverticulitis refers to inflammation or infection of diverticula, which are small pouches that can
form in the lining of the colon.

WALL OF INTESTINES:

Mucosa (direct contact with digested food)

Submucosa (blood vessels, lymphatic, nerves)

Muscular layer (contracts to move foods)

Serosa/Adventitia

Pathophysiology

●​ Diverticula form due to increased intraluminal pressure.

●​ Mucosa & Submucosa bubbles out through weak spots
●​ Inflammation occurs when diverticula becomes blocked by fecal material or undigested
food, leading to bacterial overgrowth.

Causes and Risk Factors

●​ Low-fiber diet
●​ genetics
●​ Aging (common after age 50)
●​ Obesity
●​ Sedentary lifestyle

Clinical Manifestations

●​ LLQ Abdominal pain

●​ Fever and chills
●​ Nausea and vomiting
●​ Constipation or diarrhea
●​ HEMATOCHEZIA(bright red blood in the stool)

Complications

●​ Abscess formation
●​ Perforation and peritonitis
●​ Bowel obstruction
●​ Fistulas
Diagnostic Procedures

●​ CT scan (preferred imaging)

●​ Blood tests (e.g., leukocytosis, elevated C-reactive protein)
●​ Avoid colonoscopy during acute inflammation( increase the risk of perforation)

Nursing Management

1.​ Assessment:
○​ Monitor for signs of peritonitis (e.g., rigid abdomen, severe pain).
○​ Assess bowel sounds and stool patterns.
2.​ Interventions:
○​ Administer prescribed antibiotics and pain relief medications.
○​ Maintain patients on a clear liquid diet during acute episodes, transitioning to a
high-fiber diet after resolution.
○​ Monitor for signs of complications (e.g., fever, hypotension).
3.​ Education:
○​ Teach the importance of a high-fiber diet to prevent recurrence.
○​ Encourage regular physical activity.
○​ Advise avoiding nuts, seeds, and popcorn if instructed by a healthcare provider
(though recent evidence challenges this restriction).

Conclusion

Ulcerative colitis, Crohn's disease, and diverticulitis are significant gastrointestinal disorders that
require careful assessment and management. Nurses play a vital role in patient care, focusing
on symptom management, preventing complications, and providing patient education to improve
quality of life.

Lecture Notes: Pancreatitis

Introduction
Pancreatitis is an inflammatory condition of the pancreas that can be acute or chronic. This
lecture will cover the anatomy of the pancreas, pathophysiology of pancreatitis, assessment,
diagnostic tests, and interventions for effective management.

Anatomy of the Pancreas

Structure

●​ The pancreas is a glandular organ located in the upper abdomen, behind the stomach.
●​ It has both exocrine and endocrine functions:
○​ Exocrine function: Secretes digestive enzymes (amylase, lipase, protease) into
the duodenum.
○​ Endocrine function: Produces hormones such as insulin, glucagon, and
somatostatin.
●​ Divided into three parts:
○​ Head: Lies near the duodenum.
○​ Body: Middle portion.
○​ Tail: Closest to the spleen.

Blood Supply

●​ Supplied by the splenic artery, superior mesenteric artery, and gastroduodenal artery.

Normal pancreatic function

●​ The pancreas has endocrine (insulin) and exocrine (digestive enzymes)
functions.
●​ Digestive enzymes made in acinar cells → stored as zymogens (inactive
form) → released in the pancreatic duct and small intestine → activation by
trypsin
●​ Protective mechanisms against organ injury (autodigestion) include:
○​ Negative feedback mechanism (↑ trypsin in duodenum → ↓
cholecystokinin (CCK) and secretin → ↓ pancreatic secretion)
○​ Zymogens are controlled with protease inhibitors.
○​ ↓ Acinar cell pH and calcium concentrations → prevent premature
activation of trypsin
●​ Anything that disrupts the homeostasis of normal pancreatic function can
cause acute pancreatitis.
Pathophysiology of Pancreatitis

Acute Pancreatitis

●​ Inflammation occurs due to premature activation of pancreatic enzymes, leading to

autodigestion of the pancreatic tissue.
●​ Triggers inflammation, edema, vascular damage, and necrosis.
●​ Systemic effects include the release of inflammatory mediators, potentially causing
multi-organ dysfunction.

Chronic Pancreatitis

●​ Chronic inflammation leads to fibrosis, loss of pancreatic function, and irreversible

structural damage.
●​ Results in exocrine and endocrine insufficiency.

Causes and Risk Factors

●​ Acute Pancreatitis:​

○​ Gallstones
○​ Alcohol abuse
○​ Hypertriglyceridemia
○​ Medications (e.g., corticosteroids, thiazides)
○​ Trauma or surgery
●​ Chronic Pancreatitis:​

○​ Prolonged alcohol abuse (most common)

○​ Genetic predisposition (e.g., cystic fibrosis)
○​ Recurrent acute pancreatitis

Clinical Assessment

Signs and Symptoms

●​ Acute Pancreatitis:​

○​ Severe, sudden epigastric pain radiating to the back.

○​ Nausea and vomiting.
○​ Fever.
○​ Tachycardia and hypotension.
○​ Abdominal distension and guarding.
 ○​ Cullen’s sign (periumbilical discoloration)bluish discoloration around the
umbilicus due to blood in the peritoneum.
○​ Grey Turner’s sign (flank discoloration) in severe cases.reddish-brown
discoloration on the flanks due to blood in the retroperitoneum or pancreatic
exudates.
●​ Chronic Pancreatitis:​

○​ Recurrent episodes of abdominal pain.

○​ Steatorrhea (fatty stools).
○​ Weight loss.
○​ Symptoms of diabetes mellitus (in advanced cases).

Assessment

●​ Obtain a detailed history of:

○​ Alcohol consumption.
○​ Recent biliary symptoms (e.g., gallstones).
○​ Medications and family history.
●​ Conduct a thorough physical examination:
○​ Assess for abdominal tenderness, distension, and signs of peritonitis.

Diagnostic Tests

Laboratory Tests

●​ Serum amylase and lipase: Elevated levels (lipase is more specific).

●​ Complete blood count (CBC): Elevated white blood cell count.
●​ Liver function tests (LFTs): Elevated bilirubin and alkaline phosphatase in
gallstone-related pancreatitis.
●​ Serum calcium: Hypocalcemia in severe cases.(The released fatty acids from fat
necrosis bind with calcium to form insoluble calcium soaps.This process effectively
removes calcium from circulation, leading to hypocalcemia.)
●​ Serum triglycerides: Elevated in hypertriglyceridemia-induced pancreatitis.

Imaging Studies

●​ Ultrasound: Identifies gallstones or biliary obstruction.

●​ CT scan: Evaluates pancreatic inflammation, necrosis, or complications.
●​ Magnetic Resonance Cholangiopancreatography (MRCP): Assesses biliary and
pancreatic ducts.
●​ Endoscopic Retrograde Cholangiopancreatography (ERCP): Diagnostic and
therapeutic in bile duct obstruction.
Interventions

Acute Pancreatitis

1.​ Supportive Care:​

○​ NPO (nothing by mouth): Rest the pancreas by withholding oral intake.

○​ IV fluids: Aggressive hydration to maintain perfusion.
○​ Pain management: Use opioids as prescribed (e.g., morphine or
hydromorphone).
○​ Electrolyte replacement: Correct imbalances.
2.​ Monitor and Prevent Complications:​

○​ Monitor for signs of systemic inflammatory response syndrome (SIRS).

○​ Monitor blood glucose and treat hyperglycemia if needed.
○​ Administer antibiotics if infection is suspected (e.g., abscess or necrosis).
3.​ Surgical or Interventional Procedures:​

○​ ERCP for gallstone removal.

○​ Drainage of abscesses or pseudocysts.
○​ Cholecystectomy if gallstones are the cause.

Chronic Pancreatitis

1.​ Pain Management:​

○​ Administer analgesics as prescribed.

○​ Consider nerve blocks or surgical options for refractory pain.
2.​ Nutritional Support:​

○​ Low-fat diet.
○​ Pancreatic enzyme replacement therapy (PERT) for malabsorption.
○​ Vitamin supplementation (A, D, E, K).
3.​ Management of Diabetes:​

○​ Insulin therapy for endocrine insufficiency.

4.​ Lifestyle Modifications:​

○​ Advise complete abstinence from alcohol and smoking.

5.​ Surgical Interventions:​

○​ Partial pancreatectomy or drainage procedures for severe cases.

Conclusion

Pancreatitis requires early recognition and prompt management to prevent complications.

Nurses play a vital role in monitoring, providing supportive care, and educating patients about
lifestyle changes and long-term management.

Cirrhosis

Anatomy and Pathophysiology

Cirrhosis is the end-stage of chronic liver disease characterized by irreversible fibrosis and
nodular regeneration of liver tissue.

●​ Anatomy: The liver is essential for metabolism, detoxification, bile production, and blood
clotting factor synthesis. In cirrhosis, normal liver architecture is replaced by scar tissue,
impairing its function.
●​ Pathophysiology:
○​ Chronic liver damage leads to activation of hepatic stellate cells, causing fibrosis.
○​ Portal hypertension develops due to increased resistance to blood flow through
the liver.
○​ Impaired liver function leads to reduced detoxification, hypoalbuminemia, and
coagulation disorders.
○​ Complications include ascites, hepatic encephalopathy, and esophageal varices.

Causes and Risk Factors

●​ Alcoholic liver disease

●​ Chronic viral hepatitis (Hepatitis B and C)
●​ Non-alcoholic fatty liver disease (NAFLD)
●​ Autoimmune hepatitis
●​ Hemochromatosis
●​ Wilson’s disease

Clinical Assessment

●​ Early signs: Fatigue, weight loss, anorexia, nausea

●​ Late signs:
○​ Jaundice
○​ Ascites
 ○​ Spider angiomas(Small, red, spider-shaped marks on the skin). The liver plays
a crucial role in metabolizing estrogen. In cirrhosis, the damaged liver cannot
effectively break down estrogen.This leads to an increase in circulating estrogen
levels, which can stimulate the growth of blood vessels and contribute to the
formation of spider angiomas.
○​ Hepatomegaly or splenomegaly
○​ Palmar erythema
○​ Gynecomastia
○​ Asterixis (flapping tremor in hepatic encephalopathy)

Diagnostic Tests

●​ Liver function tests (LFTs): Elevated ALT, AST, bilirubin; decreased albumin
●​ Coagulation profile: Prolonged PT/INR
●​ Ultrasound or CT scan: Detects nodular liver and ascites
●​ Liver biopsy: Confirms cirrhosis
●​ Endoscopy: Screens for esophageal varices
●​ Serum ammonia: Elevated in hepatic encephalopathy

Nursing Interventions

1.​ Assessment:
○​ Monitor for complications (e.g., bleeding, confusion, abdominal distension).
○​ Assess fluid status and electrolyte imbalances.
2.​ Interventions:
○​ Administer diuretics (e.g., spironolactone, furosemide) for ascites.
○​ Provide vitamin K and blood products as needed.
○​ Restrict sodium and fluid intake for ascites management.
○​ Administer lactulose for hepatic encephalopathy.
3.​ Education:
○​ Avoid alcohol and hepatotoxic substances.
○​ Encourage a low-protein diet if encephalopathy is present.
○​ Discuss the importance of regular follow-ups.

Paracentesis

Definition

Paracentesis is a procedure to remove excess fluid (ascites) from the peritoneal cavity,
commonly performed in patients with cirrhosis and severe ascites.

Indications

●​ Diagnostic: Evaluate the cause of ascites (e.g., infection, malignancy).

 ●​ Therapeutic: Relieve symptoms like abdominal discomfort and dyspnea.

Procedure

1.​ Pre-procedure:
○​ Obtain informed consent.
○​ Assess coagulation profile to minimize bleeding risk.
○​ Instruct the patient to void before the procedure to avoid bladder injury.
○​ Position the patient in an upright or semi-Fowler’s position.
2.​ During procedure:
○​ A sterile needle or catheter is inserted into the abdominal wall to drain fluid.
○​ Fluid is collected for analysis (e.g., cell count, albumin, culture).
3.​ Post-procedure:
○​ Monitor vital signs and for signs of hypovolemia or infection.
○​ Check the puncture site for bleeding or leakage.
○​ Measure and record the amount of fluid removed.

Nursing Considerations

●​ Monitor for hypotension and electrolyte imbalances.

●​ Administer albumin if large volumes of fluid are removed to prevent circulatory collapse.
●​ Educate the patient to report signs of infection (e.g., fever, abdominal pain).

Esophageal Varices abnormally high blood pressure in the portal vein, the major vein that carries
blood from the digestive organs to the liver.
Anatomy and Pathophysiology

●​ Esophageal varices are dilated veins in the lower esophagus or upper stomach caused
by portal hypertension.
●​ Increased pressure in the portal venous system causes blood to divert to collateral veins,
which can rupture and lead to life-threatening bleeding.

Causes and Risk Factors

●​ Portal hypertension (most common in cirrhosis)

●​ Alcohol use
●​ Chronic viral hepatitis
●​ History of gastrointestinal bleeding

Clinical Assessment

●​ Signs of varices: Often asymptomatic until they rupture.

●​ Signs of rupture: HMH
○​ Hematemesis (vomiting blood)
 ○​ Melena (black, tarry stools)
○​ Hypovolemic shock (tachycardia, hypotension, pallor)

Diagnostic Tests

●​ Endoscopy: Confirms diagnosis and severity.

●​ Hemoglobin and hematocrit: Decreased levels in bleeding.
●​ Coagulation profile: May show abnormalities in clotting.

Nursing Interventions

1.​ Assessment: management of acute

○​ Monitor for signs of active bleeding. variceal bleeding. It is
○​ Assess hemodynamic stability. a synthetic analog of
somatostatin
2.​ Interventions:
○​ Administer beta-blockers (e.g., propranolol) to reduce portal pressure.
○​ Administer octreotide to decrease bleeding risk.
○​ Prepare for endoscopic procedures like band ligation or sclerotherapy.
○​ If bleeding occurs, assist with resuscitation (e.g., fluids, blood transfusion).
○​ In severe cases, prepare for transjugular intrahepatic portosystemic shunt
(TIPS).
is a procedure to create new
3.​ Education: connections between two blood
○​ Avoid activities that increase abdominal pressure. vessels in your liver.
○​ Adhere to prescribed medications.
○​ Importance of regular endoscopic surveillance.

Conclusion

Cirrhosis, paracentesis, and esophageal varices are interconnected conditions that require
diligent assessment, timely intervention, and patient education. Early detection of complications
and appropriate management can significantly improve outcomes and quality of life for affected
individuals.

Hepatitis

Anatomy

●​ The liver is a large organ in the right upper quadrant of the abdomen.
●​ Functions include metabolism, detoxification, bile production, and storage of vitamins
and minerals.
Pathophysiology

●​ Hepatitis is inflammation of the liver, which may result from viral infection, autoimmune
diseases, alcohol abuse, or drug toxicity.
●​ Types of viral hepatitis: A, B, C, D, and E.
○​ Hepatitis A: Fecal-oral transmission.
○​ Hepatitis B: Bloodborne, sexual contact, or perinatal transmission.
○​ Hepatitis C: Bloodborne transmission.
○​ Hepatitis D: Requires Hepatitis B for replication.
○​ Hepatitis E: Fecal-oral transmission, often via contaminated water.

Assessment

●​ Fatigue
●​ Jaundice (yellowing of the skin and eyes)
●​ Abdominal pain (right upper quadrant)
●​ Dark urine, pale stools
●​ Nausea, vomiting, anorexia
●​ Fever (especially in viral hepatitis)

Diagnostic Tests

●​ Blood tests:
○​ Liver function tests (ALT, AST, bilirubin, alkaline phosphatase)
○​ Serological markers to identify the type of hepatitis
○​ Albumin levels (decreased in chronic hepatitis)
●​ Imaging: Ultrasound, CT, or MRI to assess liver size and complications
●​ Liver biopsy: Confirms diagnosis and determines severity
Entecavir (Baraclude)
Interventions
Tenofovir disoproxil fumarate (Viread)
Tenofovir alafenamide (Vemlidy)
1.​ Medical Management:
○​ Antiviral medications (for chronic Hepatitis B and C)
○​ Supportive care for acute hepatitis (hydration, rest)
○​ Avoid hepatotoxic substances (e.g., alcohol, certain medications)
2.​ Nursing Interventions:
○​ Monitor vital signs, liver function tests, and signs of complications (e.g., ascites,
encephalopathy).
○​ Provide small, frequent meals high in carbohydrates and low in fat.
○​ Educate about hygiene and preventive measures (e.g., vaccination for Hepatitis
A and B).

Cholecystitis
Anatomy

●​ The gallbladder is a small organ located beneath the liver, responsible for storing and
concentrating bile.
●​ Bile aids in the digestion and absorption of fats.

Pathophysiology

●​ Cholecystitis is inflammation of the gallbladder, commonly caused by gallstones

obstructing the cystic duct (calculous cholecystitis).
●​ Acalculous cholecystitis can occur without stones, often related to critical illness or
trauma.
●​ Inflammation may lead to infection, ischemia, or perforation.

Assessment

●​ Right upper quadrant pain (may radiate to the right shoulder or back)
●​ Nausea and vomiting
●​ Fever and chills
●​ Positive Murphy’s sign (pain with deep inspiration during palpation of the right upper
quadrant)
●​ Jaundice (if bile flow is obstructed)

Diagnostic Tests

●​ Blood tests: Elevated WBC count, liver enzymes, and bilirubin

●​ Imaging:
○​ Ultrasound (preferred initial test)
○​ HIDA scan (assesses gallbladder function)
○​ CT scan (identifies complications like perforation)

Interventions

1.​ Medical Management:

○​ NPO status to rest the gastrointestinal tract
○​ IV fluids for hydration
○​ Analgesics for pain relief
○​ Antibiotics to treat infection
2.​ Surgical Management:
○​ Laparoscopic cholecystectomy (removal of the gallbladder)
3.​ Nursing Interventions:
○​ Monitor for signs of complications (e.g., perforation, peritonitis).
○​ Educate patients postoperatively about dietary changes (low-fat diet).
○​ Encourage early ambulation after surgery.
 also known as weight loss surgery, encompasses
a variety of procedures that help people with
obesity lose weight by making changes to their
digestive system.
Bariatric Surgery
by: Restricting food intake
Anatomy Reducing nutrient absorption
Hormonal changes
●​ Bariatric surgery affects the gastrointestinal tract, specifically the stomach and
sometimes the small intestine, to promote weight loss.
●​ Types include restrictive procedures (e.g., sleeve gastrectomy) and malabsorptive
procedures (e.g., Roux-en-Y gastric bypass).
satisfied feeling
Pathophysiology of being full after
eating
●​ Restrictive procedures reduce stomach capacity, leading to early satiety.
●​ Malabsorptive procedures reduce nutrient absorption by bypassing portions of the small
intestine.
●​ Combined procedures achieve both effects.

Assessment

●​ Assess for obesity-related comorbidities (e.g., diabetes, hypertension, sleep apnea).

●​ Evaluate psychological readiness for surgery.
●​ Monitor for preoperative nutritional deficiencies (e.g., vitamin D, iron, B12).

Diagnostic Tests

●​ Comprehensive metabolic panel

●​ Complete blood count
●​ Nutritional assessment (e.g., vitamin levels)
●​ Imaging studies (e.g., upper GI series) if indicated

Interventions

1.​ Preoperative Care:

○​ Educate patients on dietary and lifestyle changes required post-surgery.
○​ Assess for contraindications (e.g., uncontrolled mental health disorders).
○​ Encourage preoperative weight loss to reduce surgical risks.
2.​ Postoperative Care:
○​ Monitor for complications (e.g., anastomotic leak, dumping syndrome, nutritional
deficiencies).
○​ Advance diet gradually: clear liquids → pureed foods → soft foods → regular diet
(as tolerated).
○​ Provide vitamin and mineral supplementation (e.g., B12, iron, calcium).
3.​ Nursing Interventions:
○​ Educate about the importance of lifelong follow-up to monitor for complications
and ensure adequate nutrition.
○​ Encourage adherence to dietary guidelines and portion control.
○​ Provide emotional support and counseling as needed.
Conclusion

Hepatitis, cholecystitis, and bariatric surgery involve different anatomical systems and require
unique nursing care approaches. Comprehensive assessment, timely diagnosis, and patient
education are critical to ensuring optimal outcomes and improving quality of life.