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GI Systems/Med Sur

Med Surgery II

Liver has how many lobes 4 Lobes
Process of breaking down complex food into simple nutrients body can absorb and convert to energy. Digestion
Digestion begins here by mechanical breakdown of food, salivary glands begin chemical breakdown of food initiating digestion of carbohydrates. Mouth
Part of both digestive and respiratory systems Pharynx
Transport from throat to stomach Esophagus
Small container with thick (acid)folding layers, expands with food, digestion per churning and chemcial breakdown. Gastric secretions (very acidic) will mix with food and create chyme Stomach
Continues chemical digestion in duodenum and jejunun along with majority of absorption in ileum! 20 feet long! Peristalsis to push to large bowel. Small Intestine
Ascending, tranverse, descending and sigmoid colon. Reabsords water and forms stool. (Water follows salt) Large Intesine
Storage of fecal waste until voluntary elimination. Anus
What are the accessory organs Liver, Gallbladder and Pancreas
Blood from aorta delivered through what? Hepatic artery
Portal vein delivers blood from what? Intestines to liver, portal circulation through liver
What does the kupper cells ingest? old RBC and bacteria
Due to the breakdown of the RBCs what is the product? Bilirubin
Initial product is unconjugated bilirubin then what happens after that process? Liver converts it to conjugated bilirubin and sectretes into the bile.
Where is the bile produced? In the liver and passes through cystic duct into the gallbladder for storage.
Bile will be excreted into what? Duodenum with chyme by the gallbladder.
Bile will become what? Emulsify fats
Excess glucose taken into liver and stored in form of glycogen is what. Glycogenesis
Response when blood glucose levels fall, liver will breakdown glycogen into glucose and return it to serum. Glycogenolysis
Fats and proteins broken down in response to low blood glucose levels-these are used to make new glucose. Gluconeogenesis
Synthesized in the liver is what? Some nonesssential amino acids, plasma proteins, and clotting factors.
What does the liver convert to? Ammoonia to urea
The Liver synthezies what? Prothrombin and Fibrinogen - two essential clotting factors?
Metabolism of protein to amino acids. Amino acids byproduct is ammonia and ammonia is converted into urea to be excreted in the urine. Build up of ammonia in blood is toxic. Protein Metabolism
Breaks down triglycerides and synthesizes break down of cholesterol Lipid Metabolism
Per Metabolism 2 essential factors for clotting are synthesized by the liver, prothrombin and fibrinogen Blood Coagulation
Filters blood and inactivates chemical including most medications Detoxification
Antibodies produced in Liver Immunity
Plays a part in metabolism of adrenocortical hormones, estrogen, testosterone and aldosterone. If not metabolized properly can cause exaggerated effect on target organs. Hormone Metabolism
Disorders of the Livers are: Hepatits A, B, C, D, E, G
Transmitted by water, food or infected medical equipment per feces. Most common type of viral hepatitis. Hepatitis A
Caused b Hepatitis B virus (serum hepatitis), found in all body fluids. Transmitted by intimate contact, blood or medical equipment, mother to baby as well. Hepatitis B
Transmitted by contact with contaminated blood or infected body fluids and mother to baby. 40-60% of these pts dvelop chronic infections and becomes carriers. Hepatitis C
Caused by virus delta agent, defective RNA agent that survices only in presene of heptatis B virus. Transmitted percutaneoulsy (skin or mucous membrans). Hepatitis D
Transmitted food or water that is infected with contaminated fecal matter. Rare in US but more common in developing countries. No chronic, long term form of this type Hepatitis E
Blood transfusion, effects are not fully know at this time Hepatitis G
What are the three phase of Hepatitis Preicter, icteric, posticteric
Malaise, severe headache, RUQ pain, anorexia, N/V, fever, joint pain,rash, enlarged lymph nodes, urticaria, liver enlargement and tenderness of liver. 1-21 days most infectious phase. Preicteric Phase
Jaundice, clay colored stools, dark urine characteristic of imparied bile production and secretion. Pruritus d/t accumulation of bile salts under skin. 2-4 weeks. Icteric Phase
Fatigue, malaise and liver enlargement for several months Posticteric Phase
Complication of Liver Chronic persistent, active, fulminant hepatitis.
What are s/s of chronic persistent hepatitis chronic fatigue, liver enlargment with prolonged recovery time but eventaually resolves.
What are s/s of chronic active hepatitis s/s perssist greater than 6 months and cirrhosis occurs with continued liver damage
What are s/s of fulminant hepatitis necrosis to damaged hepatic cells without regeneration and if often fatal.
Inflammation and ulcerations in mouth caused by infections, damage to cucous membranes by irritants, or chemotherapy. Stomatitis
Treatment for Stomatitis Possibly order topical anesthetics and analgesics and monitor dietary an fluid intake, soft bland diet.
Bacterial infection causes a metallic taste, bleeding ulcers in mouth and foul odor, increased salivation Vincent's Infection (Trench Mouth)
What is Esophageal Varices Enlarged, tortuous veins
Esophageal Varices is often associated with what? Cirrhosis of Liver
What is the cause of Esophageal Varices Anything that leads to increased abdominal venous pressure-sneesing, coughing, vomiting Valsalva maneuver. (Valsalva is bearing down)
What are the treatments for Esophageal Varcies Sclerotherapy, ligatin, balloon tamponade, and shunt placement.
Pharmaology of Esophageal Varices No non-steroidal anti-inflammatory drugs (NSAIDS), aspirin, or anticoagulants
What is Sandostatin drip use for in Esophageal Varices? To decrease blood flow to gut, control bleeding.
What is Carafate use for in Esophageal Varices? To coat esophagus and protect from gastic acids.
What's another treatment for Esophageal Varices? IV fluid rehydration and blood transfusions.
What are some of the s/s you look for in Esophageal Varices. -Monitor vital signs and lab values (H&H) -Monitor for s/s of bleeeding! -Assess for Nausea and dizziness -Montior for hypotension, tachycardia -If bleeding: bedrest. -If no bleeding: may be ambulatory, no strenuous activity.
What is Gastroesophageal Reflu Disease (GERD) Gastic secretins flow upward into esophagus.
Damages tissues, acide regurgitation, intermittent dysphagia and bleeding are common. In GERD
What is the treatment of GERD? Diet, medication and weight loss, encourage client to avoid foods that increase symptoms.
When does GERD symptoms likely to occur? During physical activity that increases intra-abdominal pressues (Lifting, lying supine).
What pharmacology would you use for GERD H2 antagonists, prokinetic agents, proton pump inhibitors.
What type of method would use surgically in GERD. Fundoplication is meds unsuccessful.
What would you observe for in GERD? Melena and signs of discomfort and pain.
What type of food should avoid in GERDs. Food with caffeine, ETOH, milk products, fatty foods or any that increase symptoms.
Hydrochloric acid, histamine, pepsin cause tissues edema, increased capillary permeability and possible hemorrhage. Gastritis
What is the prime culprit in Gastritis? Helicobacter pylori.
What are the s/s of Gastritis? Nausea, vomiting, feeling of fullness, pain stomach area.
How do you diagnosis Gastritis? Gastroscopy and laboratory values.
What's the treatment for Gastritis NPO in acute phase - rest gut! IV fluids, meds to reduce gastric acidity and relieve nausea, analgesics for pain relief and antibiotics for H. pyori.
What are you going to monitor in Gastritis? Vital signs, observe for signs of bleeding, checking stools, dietary monitoring and teaching, skin tugor, dehydration, monitor abdominal distention and tenderness, bowel sounds: note any change in speed.
What is Diverticula? Saclike protrusions of intestional wall.
What is Diverticulosis? Presence of one or more diverticula.
What is Diverticulitis? Inflammation of one or more diverticula.
What do you treat Diverticulitis with? Analgesics, antibiotics, bed rest, NPO, IV fluids.
What would make surgery required in Diverticulitis or Diverticulosis. If perforation or abscess for colon resection with possible ostomy.
What are the risk factors for Diverticulosis? Lack of dietary residue, age, constiptation, obesity, emotional tension.
What are the s/s of Diverticulosis? asymptomatic at times. constipation, diarrhea or periodic bouts of each. Rectal bleeding,pain, in LLQ, N/V and urinary problems.
Diverticulitis-bleeding, obstruction, perforation, peritonitis and fistual formation. Complication of Diverticulosis.
What treatment of Diverticulosis. High-residue diet, no spicy foods. stool softeners or bulk-forming laxatives, antidiarrheals, broad-spectrum antibiotics, anticholingergics.
What are some nursing interventions Diverticulosis? Acute bouts of inflmmation - bedrest, NPO, IV fluids. Possible NG tube for decompression. Surgical intervention: temporary colostomy.
What is Inflammatory Bowel Disease Crohn's disease and ulcerative colitis.
What is inflammatory bowel disease characterized by? Inflammation and ulcerations of bowel.
What is the treatment of Inflammatory Bowel Disease? Control inflmmation, relieve symptoms, maintain fluid and electrolyte balance, provide adequate nutrition and prevent complications.
If you severe cases of ulcerative colitis may required what? Ileostomy
What are the symptoms of Irritable Bowel Syndrome? Cramping, abdominal pain, bloating, constipation, and diarrhea.
What are the treatment of Irritable Bowel Syndrome? Treatment symptomatic: diet and medications.
Contents cannot pass through intestine is called? Intestinal Obstruction
The cause/location of Intestinal Obstruction can require what? Surgery and routine post-operative care.
What are some of the cause for Intestinal Obstruction. Tumor, Fecal impaction, Hernia, strangulated hernia, Volvulus (twisting bowels) Intussusception (telescoping of the bowel), Adhesions.
What are some of complication in Intestinal Obstruction? fluids and electrolyte imbalances and metabolic alkalosis.
Gangrene and perforation of the bowel is related to what? Intestional Obstruction.
What are the treatments for Intestinal Obstruction? NPO,NGT- decompression, IV fluids, surgical intervention, bowel resectionn with colostomy (temporary or not) or reanastamosis.
What are the nursing interventions and assessments for Intestinal Obstruction? pain, nausea, onset and progression of symptoms, when was last bowel movement? Monitor VS, Tmp, skin moisture and tissue turgor. Monitor abdomen for visible peristalsis, high pitched raping tinkling bowel sounds.
What are you going to monitor in Intestinal Obstruction? VS, Temp, skin moisture and tissue turgor. Monitor abdoomen for visible peristalsis, high pitched raping tinkling bowel sounds.
What is the wall of muscle weakens and intestine protrudes through muscle wall. Hernias
What are the types of Hernias? Umbilical, abdominnnal, inguinal, femoral, and hiatal.
How can Hernais be reduced? Pushed back into place, or by physican or repaired with surgery.
Protrusion of lower esophagus and stomach up through diaphragm into chest. Hiatal Hernias
Were is the weakness of the Hiatal Hernias? Diaphragm muscles where the esophagus and stomach join.
What is the cause of Hiatal Hernias? Excessive intra-abdominal pressure, trauma, long-term bed rest in reclining position.
What the age group of people with Hiatal Hernias? Half the people over the 60 yr of age.
What are the s/s of Hiatal Hernias? feeling of fullness, dysphagia, eructation, regurgitation, heartburn.
What the medication for Hiatal Hernias? H2-antagonists, proton pump inhibitors
What would you have surgery for Hiatal Hernias? Severe bleeding and narrowing of esophagus
What is Inflammation of peritoneum? Peritonitis
What is the treatment of Peritonitis? Surgical with repair of cause and irrigation of abdominal cavity with saline and antibiotic solutions.
Swollen vascular tissues in rectal area is what? Hemorrhoids
Hemorrhoids may be what in the body? External or Internal
Sitz baths, warm compresses, creams and suppositories to decrease inflammation and swelling, fiber supplements, stool softeners, and surgery is the treatment for what? Hemorrhoids
Chronic, degenerative changes in liver cells and thickening of surrounding tissue is called what? Cirrhosis of the Liver
What is the form of end-stage liver disease with not cure Cirrhosis
What is the treatment for Cirrhosis. Paracentesis to remove fluid from abdomen, shunt, emdicatin and dietary changes.
What are some of the complication of Cirrhosis? protal hypertension, esophageal varices, hepatic encephalopathy, hepatorenal syndrome.
What are s/s of Cirrhosis? Early - slight weight loss, unexplained fever, fatigue, dull heaviness in RUQ
What are s/s of Progess Cirrhosis? anorexia, N/V, diarrhea or constipation, dyspepsia, esophageal varices.
What are s/s of Late Cirrhosis? testicular atrophy, impotence, amenorrhea, spider angiomas,confusion, drecreasing LOC, ascites.
What the types of Chirrhosis? Aloholic, Postnecrotic, Biliary, Cardiac
Hepatitic steatosis, fatty liver, chirrhosis Cirrhosis Alcoholic
Complication of hepatitis with massive liver cell necrosis. Cirrhosis Postnecrotic
Obstructive or idiopathic, develops as a result of obstruction of bile flow. Cirrhosis Biliary
Follows severe right-sided heart failure. Venous congestion and hypoxia lead to necrosis of the liver. Cirrhosis Cardiac
What is the cause of Hepatic encephalopathy? Constipation, GI bleeding,hypokalemia, infection, opiods, dehydration, renal failure.
What are the treatment of Cirrhosis T1 (Cirrhosis)- bed rest- liver will regenerate itself.
Treatment of Cirrhosis (2) T2 (Cirrhosis) - high carbohydrate diet and vitamins with moderate to high protein unless blood ammonia level elevated
Treatment of Cirrhosis (3) T3 (Cirrhosis) IV fluids
Treatment of Cirrhosis (4) T4 (Cirrhosis) Anemia may require blood transufions
Treatment of Cirrhosis (5) T5 (Cirrhosis) Waater an sodium restriction
Treatment of Cirrhosis (6) T6 (Cirrhosis) Cathartics an antibiotics for hepatic encephalopathy
Treatment of Cirrhosis (7) t7 (Cirrhosis) Goal to limit deterioration of liver function and prevent complications!
enlarggement and changes in liver cause backup of blood in portal system leading to increased protal pressure. portal hypertension
distended, engorged vessels in the esophagus, fragile and abdominal pressure can cause bleeding and rupture. esophageal varices
accumulation of fluid in peritoneal cavity ascites
liver unable to detoxify blood of ammonia. state of confusion related to build uo of ammonia, which is toxic to brain. Hepatic encephalopathy
What are some of the factors contributing to Hepatic encephalopathy? Infection, fluid and potassium depletion, GI bleed, constipation, some liver toxic meds.
Renal failure in cirrhosis pt. usually occurs after diuretic therapy, paracentesis, GI hemorrhage. Hepatorenal syndrome
Treatment for Hepatic encephalopathy? Lactulos, very low protein diet or protein free diet.
What is the goal of therapy for Hepatic encephalopathy. decrease the amount of ammonia being produced in GI tract.
What is the treatment for Ascites. Aimed to promote reabsorption and elimination of fluid. Sodium restriction and diuretics.
How do you treat Ascites Cirrhosis? acute bleeding with vasopressin - constricts blood vessels and lowers pressure in hepatic circulation.
What are the nursing assessments in Cirrhosis? daily weights, measue abdominal girth, I & O. Monitor S/s bleeding, ascites, encephalopathy and renal failure.
What are the nursing intervention of Cirrhosis? Imbalanced nutrition, acitivty intolerance, impaired skin, disturbed though process, infection, fear, ineffective breathing.
Chronic or acute inflammation of liver caused by cirus, bacteria, drugs, alcohol abuse, or other toxic substance. Hepatitis
What is the treat for Hepatitis? Rest liver and detect complications early.
Treatment for Chronic/Acute Hepatitis is also based on what? Signs, symptoms present, and prevention of transmission.
What is the treatment for Hepatitis? Medication, vaccines, immune globulin, dietary modification, bed rest, and standard precautions.
What are the disorder of gallbladder? Cholecystitis, Cholethiasis
What is Cholecystitis? Inflammation of gallbladder.
What is Cholethiasis? Presence of gallstones (calculi) in gallbladder.
What is the treatment for Cholecystitis and Cholelithiasis? Low-fat diet, analgesics, and surgery.
What is the cause of Cholecystitis? gallstones, bacteria, tosic chemicals, tumors, anesthesia, starvation and opiods.
When gallbladder becomes inflamed, it places, pressure and occludes cystic duct. Is Cholecystitis
What cause Cholelithiasis? Comprised of bile salts, bilirubin, calcium and protein.
Cholelithiasis is associated with what? High cholesterol. Can be found anywhere in biliary tract.
What are the s/s of Cholelithiasis and Cholecystitis? Mild to moderate indigestion, to severe pain, fever, jaundice, N/V chills, RUQ pain radiating to shoulder. Symptoms onset about 3 hours after eating a meal esp if the food has high fat content.
What color is the stool in Cholecystitis and Cholelithiasis? Gray
In Cholecystitis and Cholelithiasis what are you unable to absorb? Fat-soluble vitamins and may have S/S of vitamin deficiency.
What are the complication of Cholecystitis and Cholelithiasis? Pancreatitis, abscesses, rupture of gallbladder.
What is the medical treatment for CC? analgesccis, anticholinergics, antibiotics, IV fluids, NGT, cholecystectomy, lithotriipsy, drug therapy to dissovle stones (oral bile salts)+
What is Monooctanoin used to treat? Stones remaining in common bile duct after cholecystectomy.
How is Monooctanoin administered? Through nasobiliary for 2-10 days.
What is Extracorporeal Shock Wave Lithotripsy (ESWL) used for? sound waves to break up gallstones. Not popular therapy.
Ensoscopic Sphincterotomy endoscopic instruments under conscious sedation to remove stones from common bile duct.
What is the most frequent treatment gallbladder? Cholecystectomy, surgical removal of gallbladder via laparoscopy or open incision.
What is the pt teaching for disorders of gallblader? low fat diet, signs of bile obstruction-light stools, dark urine, jaundice, and itching, if taking bile salts - report gastric upset, blood draws to monitor liver function, bile salts interfere with effectiveness of oral contraceptives.
Acute or chronic inflammation of pancreas caused when pancreatic enzymes digest lining of pancreas Pancreatitis
Pancreatitis occurs with obstruction of what? Pancreatic duct as result of gallstones, tumors, or exposure tochemicals, alcohol, or injury.
Acute Pancreatitis caused by what? Biliary tract disorder, viral infections, peptic ulcer disease,cysts, metabolic d/o and trauman,external injry or surgery.
Chronic Pancreatitis caused by what? Alcohol Abuse.
What is the S/S of pancreatitis? Abdominal pain!!! Sudden onset, centered in ULQ or epigastric region and radiates to the back. Severe vomiting, flushing, cyanosis and dyspnea often acomppany pain. Low grade fever, tachypnea, and hypotension.
Pancreatitis treatment? NOP, TPN, NG tube. PAIN CONTROL IS PRIORITY. Dermerol is medication of choice due to morphine and other opiods can cause spasm of pshincter of Oddi.
What is the patient teaching for pancreatitis? Bland diet, high carbohydrate, low-fat avoids stimulating pancrease and promote healing.
Small frequent meals at first then advance as tolerated. Abstaining from alcohol!!! Alcoholics anonymous refeerrel is necessary. Patient teaching in Pancreatitis.
Were does cancer of pancrease spreads? quickly to duodenum, stomach, spleen and left adrenal glad. Very serious!! Must act quickly!
What are the risk factors of cancer of pancreas? smoking and chronic alcohol consumption. Tumors can affect the head, body or tail of pancreas.
Created by: BBrooks01