 Anatomy of the Accessory Organs
 Liver, Gallbadder and Pancreas (rev.5/08)
 Assessment of the patient with Liver Diseas
 Health History
 Past Medical History
 Review of Systems
 Functional Assessment
 PE
 Diagnostic Tests and Procedures
 For Lower GI
 System
 Stool Specimens
 O&P
 C&S
 OB( occult blood)
 Fecal Fat
 Imaging Studies
 HIDA scan
 CT
 MRI
 US
 Another Radiological Study..
 Barium Enema
 NPO after MN
 Cathartics and enemas (observe results)
 Assess abdomen
 Colonoscopy
 To visualize colon and obtain specimens
 NPO 6-8 hrs prior
 Bowel cleanse
 Sedation
 Sigmoidoscopy
 Visualize rectum and sigmoid colon
 Enema prior to exam
 Sedation optional
 Observe for bleeding after
 Lower GI Disorders and Related
 Nursing Interventions
 Diverticulosis
 Multiple Diverticula present in colon
 Cause: unknown
 Related factors: low fiber diet, age, constipation, obesity and emotional tension
 Signs & Symptoms
 Asymptomatic
 Change in bowel habits (Constipation/Diarrhea)
 Pain in left lower abdomen
 Tx. High fiber diet
 Diverticulitis
 Inflammation of diverticula
 Complication of diverticulosis
 Cause: stool impacted in diverticula
 Complications….
 Severe bleeding
 Obstruction
 Perforation (rupture)
 Peritonitis
 Fistula formation
 Medical Treatment
 Bedrest
 NPO and IV Fluids
 GI decompression
 Analgesics
 ABX
 Surgical Treatment
 Colon resection
 Colostomy
 Colostomy
 Surgical opening between the colon and the surface of the body; creation of a stoma
 Named for the part of colon where located
 Temporary or Permanent
 Ostomy Care
Assess:
 Stoma color Q shift
 Bowel function
 Bowel sounds, distention, tenderness
 Clean w/ H20, cover w/ ointment or paste (see pg. 407)
 Abdominal Hernia
 Muscle weakness resulting in intestine protruding through muscle
 Reducible
 Irreducible or incarcerated
 Incarcerated hernias have  obstructed peristaltic flow
 Strangulated hernia is deprived of blood flow
 Types of Hernias
 Inguinal
 Femoral
 Umbilical
 Incisional
 Cause…
 Congenital
 Acquired
 Signs & Symptoms
 Vary depending on location
 Some are asymptomatic
 Strangulated is a emergency
 Surgical Treatment
 Herniorrhaphy
 Hernioplasty
 Truss
 Post Op Nursing Interventions
 Assess bowel and bladder function
 Assess wound healing
 Teach to avoid stress on healing wound
 Intestinal Obstruction
 Adhesions
 Strangulated hernia
 Tumor
 Volvulus
 Intussuseption
 Signs & Symptoms
 Abdominal pain
 N/V ( possible projectile)
 Constipation
 Bloating
 Medical Treatment
 NGT for decompression
 IV hydration
 Surgery may be needed
 Medications…
 Non-narcotic analgesics
 Antibiotics
 THINK….
 What are 3 nursing diagnosis and related nursing interventions for the patient with an intestinal
obstruction???
 Irritable Bowel Syndrome
 AKA Spastic colon, spastic colitis, mucus colitis, irritable colon
 Most common GI complaint
 Unknown cause
 Signs & Symptoms
 Abdominal pain
 Cramping
 Flatulence
 Constipation/Diarrhea
 Diagnostic Tests
 UGI
 BE
 Sigmoidoscopy
 Treatment
 Reduce stress
 Counseling
 High fiber diet/Metamucil
 Lifestyle changes
 Adeq. Fluids & regular meal patterns
 Medications
 Sedatives
 Anti-spasmodic
 Anti-diarrheal
 Constipation
 Infrequent, hard, dry stools
 Tumors
 Frequent laxative use
 Inactivity
 low Fluid intake & low fiber diet
 Treatment
 Fiber supplements
 Laxatives
 Stool softeners
 Or a combination of above
 Nursing Interventions
Teach patient to Increase…
 Fiber
 Fluids
 Activity
 Diarrhea
 Loose stools with increased frequency
 S/S  pain, abdominal cramps, urgency, flatus
 Complications….
 Dehydration
 Electrolyte imbalances
 Metabolic acidosis
 Malabsorption leading to malnutrition and anemia
 Nursing Interventions
 NPO, IV, TPN if severe sx
 I&O, daily weight
 Record T-A-C of stool
 Motility reducers
 Monitor electrolytes
 Inflammatory Bowel Disease
( IBD )
 Crohn’s Disease
 Ulcerative Colitis
 Unknown cause
 ? Autoimmune reactions tx with steroids
 Crohn’s Disease
 Lesions affect the entire thickness of bowel; can occur anywhere in the colon or small
intestine
 Signs & Symptoms
 Variable depending upon areas affected
 N/V & epigastric pain
 Abdominal pain, tenderness and cramping
 Rectal bleeding & diarrhea
 S/S ( cont’d)
 Weight loss
 Steatorrhea
 Electrolyte imbalance
 Iron deficiency anemia
 Amino acid mal-absorption
 Long Term Complications
 Hemorrhage
 Bowel obstruction
 Fistulas
 Abscesses
 Perforation(rupture)
 Ulcerative Colitis
 Inflammation & ulceration of the mucous membrane in colon
S/S:
 Fever, anorexia, wt. loss
 Frequent, watery stools with mucous & blood
 Long Term Complications
 Fissures
 Abscesses
 Increased risk of colon CA
 Toxic megacolon
 Diagnostic Tests  IBD
 BE w/ small Bowel follow- through
 Colonoscopy w/ biopsy
 Ultrasound
 CAT
 Med/Surg. Management
 Control inflammation steroids
 Relieve symptoms
 Maintain fluid and electrolytes
 Provide adequate nutrition
 Prevent complications
 Limit milk products
 High cal, low residue, non-spicy, caffeine free diet
 Surgical Intervention
 Colectomy  curative for ulcerative colitis NOT for Crohn’s disease
 Medications used alone or in combination….
 Corticosteroids
 Immunosupressants
 Antidiarrheals
 Anticholinergics
 Antibiotics and others…
 Appendicitis
 Inflammation of the appendix
 If ruptured peritonitis develops which may be fatal
 Signs & Symptoms
 Pain at McBurney’s Point
 N/V
 Fever
 Rebound tenderness
 Treatment
 Appendectomy
Pre-op Orders:
 NPO
 IV fluids
 Appendectomy
Post-op Orders
 NPO until BS return then advance diet as tolerated
 V.S., TC & DB
 Assess wound for s/s infection
 OOB ASAP
 Peritonitis
 Inflammation of peritoneum
 Contamination of the peritoneal cavity
 Abscesses, septicemia, hypovolemic shock, paralytic ileus and organ failure.
 Signs & Symptoms
 Pain over affected area
 Fever
 Tachycardia
 N/V
 Tachypnea
 S/S (cont’d )
 Distended, board-like abdomen ( rigidity )
 Paralytic ileus
 Treatment
 Surgery to repair cause
 Abdominal cavity irrigation with NS and abx soln
 IV abx.
 Nursing Interventions
 NPO w/ NGT
 IV fluids
 Monitor drains
 Elevate HOB
 For abd. Distention and BS
 V.S.
 Activity as tolerated
 C&DB
 Analgesics
 Colorectal CA
 3rd most common CA in women
 Risk factors:
 Over 45
 Hx of polyps
 Hx of IBD
 Signs & Symptoms
 Change in bowel habits
 Wt loss
 Abd cramping
 Rectal bleeding
 Diagnostic Tests
 Colonoscopy
 BE
 CEA
 CBC
 Surgical Treatment
 Polypectomy
 Colon resection
 Chemo
 Radiation
 Post Op Nursing Care
 NPO w/ NGT
 C&DB
 Early ambulation
 Assess wound for infection
 Opioid analgesics
 Hemorrhoids
 Varicosed veins of rectum
 Internal or external
 Risk factor:
 Increased intra-abd pressure
 Signs & Symptoms
 Painful
 Puritis
 Bleeding
 Non surgical treatment
 Sitz baths
 Warm compresses or ice packs
 Stool softeners
 Creams
 Surgical Treatment
 Ligation
 Sclerotherapy
 Thermocoagulation
 Laser surgery
 hemorrhoidectomy
 Post op Nursing Interventions
 Pain control
 Assess for rectal bleeding, keep area clean
 Monitor stools passed after surgery, provide stool softeners
 VS
 Ambulate
 Anorectal Abscess
 Infection of tissue around the anus
 What are s/s…..?
 Treatment…?
 I&D
 Anal Fissure
 Laceration between the anal canal and perianal skin
 Usually heal spontaneously
 Anal Fistula
 Abnormal opening between anal canal and perianal skin
 S/S pruritus and discharge
 TX sitz baths, excision of fistula & surrounding skin
 Temporary colostomy PRN
 Pilonidal Cyst
 Cyst in sacrococcygeal area
 Easily infected
 Usually requires surgical excision
 Care similar to hemorrhoidectomy
 Disorders of the Accessory Organs
 Gallbladder, Pancreas and Liver
 Diagnostic Tests
 CT
 Liver Scan
 Ultrasonography
 MRI
 Biopsy ( liver, needle, open)
 ERCP
 Lab Tests
 PT, PTT, INR
 Bilirubin
 Serum protein
 Alk. Phosphatase
 AST, ALT,LDH
 Cirrhosis of the Liver
 Chronic, progressive disease of the liver
 40-60 yrs. highest incidence
 Related to alcoholic liver disease or chronic viral infection
 Signs & Symptoms
 Early weight loss, fever, fatigue, heaviness in rt. Upper abdomem
 Progimpaired metabolism, GI disturbances, congestion of bloodflow causes ^ pressure of
intestines, stomach, esophag.
 Later signs and symptoms…
 Jaundice
 Ascites
 Abd pain
 Peripheral neuropathy
 Dyspnea
 Bleeding disorders
 Dry puritic skin
 Confusion
 Clay colored stool
 Complications…
 Portal hypertension
 Esophageal varices
 Ascites
 Hepatic encephalopathy
 Esophageal Varices
 Distended esophageal blood vessels
 Caused by ^ pressure in portal system
 Bleed easily
 TX for Bleeding Varices
 Drug therapy
 Surgical ligation
 Esophageal – gastric balloon
 Sclerotherapy
 TX for Ascites
 Na+ restriction diet and diuretics
 Paracentesis
 Shunts
 Hepatic Encephalopathy
 Liver unable to detoxify ammonia
 Reduce ammonia by restricting protein
 Lactulose binds with ammonia  causes diarrhea
 Asterixis- most common sign
 Nursing Care for the patient with Cirrhosis
 Emollient baths( oatmeal or baking soda )
 Blood transfusions
 Low Na, high vitamin diet
 Small frequent meals
 Nrsg Care (cont’d)
 No ETOH
 Diuretics
 Vitamin K
 Daily weight
 Abd. girth measurements
 THINK….
 What are 3 nursing diagnosis and related nursing interventions when caring for the patient with
cirrhosis of the liver??/
 Liver Transplantation
 Only cure for end stage liver disease
 Patients ranked by acuity and need
 Nursing assessments focus on: neuro status, VS, respiratory status, and indicators of bleeding.
 Provide usual post op care
 Lifelong drug therapy is needed
 Hepatitis
 Inflammation & swelling of the liver
 Bile channels are compressed
 Blood flow through liver is impaired
 Signs & Symptoms
 Fatigue / lethargy
 Nausea
 Abd pain
 Joint and muscle aches
 Decreased appetite
 S/S ( cont’d)
 Jaundice
 Hepatomegaly
 Dark urine
 Puritis
 Treatment Goal…
 To promote healing and manage symptoms
 Allow liver to regenerate
 Prevent transmission
 Medications
 Alphainterferon
 Ribavirin
 Antipyretics
 Antiemetics
 Avoid hepatotoxic drugs
 Dietary Changes
 High cal, high carb, high pro
 Low fat
 Vitamin supplements
 No ETOH
 Liver Cancer
 Primary site  rare
 Frequent site metastasis
 Signs & Symptoms
 Liver enlargement
 Weight loss
 Anorexia / N&V
 URQ pain
 Treatments
 Lobectomy
 Chemo
 Radiation
 Gallbladder Disease
 Cholecystitis - inflammation of gallbladder
 Cholelithiasis – gallstones
 5 F’s
 Diagnostic Tests
 US
 ERCP
 Cholangiography
 Signs & Symptoms
 RUQ pain 2-4 hours after meals
 N/V
 Flatulence
 Indigestion, belching
 S/S ( cont’d)
 Steatorrhea
 Clay colored stools
 Increased WBC, serum and urinary bilirubin and enzymes
 Medical Treatment
 Low fat diet
 Demerol
 ABX
 UDCA, and MTBE
 Surgical Treatment
 Endoscopic Sphincterotomy
 Extracorporeal Shock Wave Lithotripsy
 Cholecystectomy
 Post Op Nursing Care
 T, C, & DB
 NGT
 Monitor T-tube
 IV’s
 Incentive spirometer
 Common Bile Duct Obstruction
 Stones block bile flow within common bile duct
 Signs & Symptoms
 Intense spasmotic pain (biliary colic)
 Fever
 Jaundice
 ^ WBC, ^enzymes
 Treatment
 ERCP with sphincterotomy to enlarge opening and facilitate passage of stone
 Nursing Care
 VS
 IV hydration
 ABX
 Analgesics
 Monitor lab results
 Pancreatitis
 Inflammation of the pancreas
 May be acute or chronic
 Causes:
 Backflow of bile into the pancreas
 Gallstone or tumor
 ETOH
 Trauma
 Signs & Symptoms
 Severe, sudden onset abdominal pain in ULQ
 Vomiting
 Flushing
 Fever
 S/S (cont’d)
 Tachypnea
 Tachycardia
 Tender, distended abdomen
 Bowel sounds may be absent
 Elevated serum amylase
 Medical Management
 Pain control Demerol
 Anticholinergics, Antispasmodics
 Assess for new onset DM
 Antacids
 Pancrease  to reduce steatorrhea
 Nursing Care
 NGT
 NPO
 IV
 TPN (in severe cases)
 No caffeine or ETOH
 No spicy foods
 High carb, high pro.
 Low fat/Low Na+
 Small frequent meals
 Pancreatic Cancer
 Tumors usually malignant
 Prognosis poor
 Metastasizes quickly
 Most die within 1 yr of diagnosis
 Signs & Symptoms
 Pain
 Jaundice
 Weight loss
 Glucose intolerance
 Surgical Procedures
 See page 831 Figure 39-13
 Most often procedures preformed are Side-to-side and the Whipple
 Nursing Care
 PCA for pain control
 Monitor I & O
 VS
 Monitor blood glucose
 Emollient lotions/Benadryl
 You’re done with
GI Unit 2…..
YIPPEEE !!!!