Chapter 34 & 35 Med-Surg PDF

Med-Surg ch: 34&35 CHAPTER 34 Lower gastrointestinal system:. small intestines. large intestines. rectum. anus - Most common problems: Constipation, Diarrhea Constipation:. Fecal becomes hard, dry. (Due to more water being absorbed) - Causes:. Medications. Narcotics, tranquiliz...

Med-Surg ch: 34&35 CHAPTER 34 Lower gastrointestinal system:. small intestines. large intestines. rectum. anus - Most common problems: Constipation, Diarrhea Constipation:. Fecal becomes hard, dry. (Due to more water being absorbed) - Causes:. Medications. Narcotics, tranquilizers, antacids with aluminum.. Hemorrhoids or Fissures. Low intake of fiber and fluids - Signs & Symptoms:. Abdominal pain. Distention. Indigestion. Intestinal rumbling. Rectal pressure. Incomplete emptying. Hard shit. Decreased appetite. Straining Prolonged Constipation is called OBSTIPATION - Complications:. Hemorrhoids. Impaction. Ulcers. Straining. Megacolon Diagnosed by Self-Diagnosis or History and physical with rectal examination. - Interventions:. High fiber Diet (Main prevention). 2-3 Liters of fluid daily. Exercise. Over The Counter bulk forming laxatives- Metamucil. Bulk Forming Agents. Shit softeners (colace) Laxatives are used for severe constipation  I know yall aint constipated I smell what demons yall release upstairs and downstairs at school!!!! Im prayin for yall stanky butts. Diarrhea:. Rapid Passing. Decreased absorption of water and nutrients.. Decreased Electrolytes & Nutrients - Causes:. Bacterial/Viral infection. Food Allergies - Prevention:. Proper handling. Storage. Refrigerate all fresh foods. Hand Hygiene Eternal feeds should be given using full strength formula rather than diluting the formula. It reduces the risk of contaminating the formula. - Signs & Symptoms:. Fever. Foul odor. Abdominal cramping. Distention. Anorexia. Intestinal rumbling - Dehydration:. Tachycardia. Hypotension. Decreased skin turgor. Weakness. Thready pulse. Dry membranes. oliguria - Diarrhea resulting from food poisoning usually has an explosive onset and may be accompanied by N/V. - Gerontological issues: Dehydration & Hypokalemia. Diarrhea can cause older people to quickly become dehydrated and hypokalemic because BOTH fluid & potassium are lost in stools.. Signs & Symptoms of Hypokalemia are muscle weakness, hypotension, anorexia, paresthesia, & drowsiness. - Hypokalemia can cause Cardiac arrythmias such as:. Atrial & Ventricular Tachycardia. Premature Ventricular Contraction. Ventricular Fibrillation Which can be fatal - Older population:. If an older person has decreased mobility QUICK access to the bathroom is important.. Poor muscle control (May cause patient to be incontinent). High Fall risk (Due to rushing to the bathroom). Older patients’ skin is more sensitive (Poor turgor & reduction of subcutaneous fat). Perirectal skin excoriation can occur secondary to the acidity & digestive enzyme content of diarrheal stools. - Interventions:. Identify cause.. Replace fluids/electrolytes.. Increase fiber/bulk.. Assess for dehydration - Medications:. Diphenoxylate (Lomotil), loperamide (Imodium). Probiotics (Lactinex) restore normal flora. Antimicrobial agents for infection Appendicitis: Inflammation of the appendix - Signs & Symptoms:. N/V. Anorexia. Pain in RLQ (McBurney point). Normal Bowel Sounds - Diagnostic test:. CBC (reveals elevated WBC count). Ultrasound/CT. MRI - Therapeutic Measures:. NPO. Surgery is performed immediately unless there is evidence of perforation or peritonitis.. Applying ICE to the site of pain. Placing patient in semi-fowlers position may help - Complications:. Abscess (usually treated with antibiotics & surgical drainage). Peritonitis - If the appendix ruptures-Maintain a Semi-fowlers position to allow purulent drainage to stay in the abdomen. - Keeping drainage below diaphragm promotes lung expansion. - If the appendix has ruptured, IV fluids and antibiotics are started to treat infection and peritonitis. Patient may have an Orogastric, or NG tube placed to decompress the stomach. Peritonitis: Inflammation of the peritoneum - Causes:. Peptic ulcer. Pancreatitis. Diverticulitis - Signs & Symptoms:. Abdominal pain. Abdominal rigidity. N/V. Fever - Diagnostic test:.  WBC count (predict infection). Abdominal X-Ray or CT. Exploratory surgery - Complication:. Intestinal obstruction. Hypovolemia is caused by the shift of fluid into the abdomen.. Sepsis from bacteria entering the bloodstream.. Shock - Therapeutic interventions:. NPO. Fluids to replace electrolytes. NG or Orogastric tube insertion to help with abdominal distension with LOW intermittent suction.. Surgery. Pain management Diverticulitis/Diverticulosis: Diverticulum- Herniation or outpouching of bowel mucous membrane (seen from inside of colon) Diverticulosis- Multiple diverticula without evidence of inflammation (outpouching without inflammation) Diverticulitis- Inflammation/infection of diverticulum Food and bacteria trapped in diverticulum (Inflammation and infection develops) - Causes:. Chronic Constipation. Increased pressure within the colon. Weakness in the bowel wall. Decreased intake of dietary fiber - Risk factors:. Low-fiber diet. High in animal fats diet. Obesity. Sedentary Lifestyle. Smoking. Medications (nonsteroidal, NSAIDs, opioids, steroids) - Signs & Symptoms:. Most people with diverticulosis never experience pain. Constipation. Cramping. Bleeding. Abdominal tenderness - Diagnostic tests:. Flexible sigmoidoscopy or colonoscopy. CT scan - Therapeutics:. can be treated at home for mild cases (OTC pain meds, antibiotics, liquid diet). prevent constipation. in severe cases pain control, NPO, IV antibiotics and fluids, surgery - Nursing knowledge:. Keep a look out for abdominal distention. Monitor VS. Monitor for signs of sepsis. Monitor for low BP, High heart rate. Monitor for reduced urinary output Crohn's Disease: - Inflammation of GI tract with alternate healthy and inflamed areas - Crohn's is an autoimmune disease - Can occur anywhere in the GI tract. End of ileum or first part of large intestine (most common) - As the disease progresses, obstruction occurs because the intestinal lumen narrows with inflamed mucosa and scar tissue. - Cause:. Unknown. More common in WOMEN than men. Hereditary. Smoking increases risk. MOST often diagnosed between ages 15 & 30. Stress may trigger exacerbation - Signs & Symptoms:. YOU IS GONNA BE SHITTIN YA BRAINS OUT!!. Crampy abdominal pains. Diarrhea (with blood possible). Weight loss. Fatigue. Mouth sores. Fluid and electrolyte balance - Diagnostic tests:. Endoscopy w/ biopsy. Barium enema. Lab testing looks for Anemia, infection, liver function, LOW albumin - Complications:. Malnutrition. Obstruction. Fissures. Abscess. Fistulas. Perforation. Bleeding - Therapeutics:. Avoid malnutrition - Medications:. Anti-inflammatories. Corticosteroids. Immunosuppressants. Biologic response modifiers. Antidiarrheals. Avoid offending foods. Avoid smoking. Surgery if needed. Enteral feedings or TPN if required. Support and education *Crohn's & Ulcerative colitis are more common in Caucasians Ulcerative Colitis: Inflammatory bowel disease affects the large intestine and rectum. Similar to Crohn's. Occurs in the LARRGE INTESTINE. Multiple ulcerations and inflammation in superficial mucosa and submucosa of colon. Remissions and exacerbations occur. Increases risk for colorectal cancer. Lesions spread in a continuous pattern. Infection, allergy, and autoimmune response are possible causes. Pesticides, tobacco, radiation, food additives may exacerbate.. Diet and psychological stress may trigger - Signs & Symptoms:. Abdominal pain. 5-10 liquid stools daily. Rectal bleeding or pus. Incontinence or poop urgency hehe. Anorexia. Weight loss. Cramping. Vomiting. Dehydration. Fever - Complications:. Hemorrhage. Toxic megacolon. Perforation. Peritonitis. Osteoporosis.  risk for colorectal cancer - Diagnostic Test:. Labs (CBC). Shit specimen. Electrolytes. Protein level. Colonoscopy w/ biopsy. Leukocyte Scintigraphy - Therapeutics:. Diet - Medications:. Anti-Inflammatory. Antidiarrheals. Biologic response modifiers. Corticosteroids. Immunosuppressants (A lot of same meds for Crohn's are used for ulcerative colitis). Surgery, if necessary. Enteral feedings or TPN if required Crohn's Disease: Ulcerative Colitis:. Involves ANY part of GI tract. Involves ONLY large intestine and rectum. Segmental. CONTINOUS. Involves ALL LAYERS of mucosa. Involves mucosa and submucosa. Steatorrhea frequent. Steatorrhea ABSENT. Strictures & Fistulas COMMON. Strictures & fistulas RARE. Slowly progressive. Remission & relapses. Malignancy RARE. Malignancy COMMON IBS (irritable bowel syndrome):. NOT a disease & is functional problem. It alters Intestinal motility. Bowel mucosa NOT changed. Colon muscle contracts more easily. Colon muscle contacts Disorderly & Violently. Leads to bowel changes. More common in WOMEN. Hereditary. Bowel nerves more sensitive. Psychological stress trigger. Infection. Menstruation - Signs & Symptoms:. Gas. Bloating. Constipation. Diarrhea. Abdominal Pain. Depression/anxiety - Testing:. Stool examination. Colonoscopy. IBS check (antibody test) - Interventions:. Low FODMAP diet. Diet High in Fiber & Bran. Small Frequent meals. Stress management. Exercise  Medications: - IBS w/ constipation:. Selective Serotonin Reuptake Inhibitors. Paroxetine Hydrochloride (Paxil). Fluoxetine (Prozac). Increase fluid secretion into bowel - IBS w/ Diarrhea:. Low-Dose tricyclic antidepressants. Antispasmodics. Antibiotics Hernias:. Umbilical. Inguinal: Direct, Indirect. Femoral - Signs & Symptoms:. None. Bulging - Complications:. Strangulated incarcerated hernia. Blood & intestinal flow cut off. Lead to an obstruction. Gangrene & bowel perforation - Abdominal Hernias Therapeutics:. Observe. Support devices. Surgery - Herniorrhaphy (small hernias): put sac content back, sew weal tissue, close incision - Hernioplasty: put hernia back into abdomen, reinforced weakened muscle wall with wire, facia, or mesh. - Nursing Care:. NO COUGHING OR LIFTING (including post-op). Support garments - Post-op nursing care:. Again, no coughing or lifting. Limit activity. MALE patients may experience swelling of the scrotum. Ice packs and elevation of the scrotum may be ordered to reduce swelling - Complications of Abdominal Hernias:. Strangulation (could cause pain at hernia site, abdominal pain, N/V) - Education:. Deep breathing to clear lungs (NO COUGHING BRO). Changing dressing. Report problems urinating, bleeding, signs of infection Absorption Disorders: related to malabsorption, weight loss, weakness and fatigue. Inability to absorb one or more major nutrients such as Carbs, fats, or proteins. - Causes:. Ileal dysfunction, Jejunal diverticula, Parasitic disease, Enzyme deficiency. - Types of disorders:. Celiac Disease . Gluten sensitivity . Malabsorption of protein in wheat, barley, and rye - Signs & Symptoms of Celiac Disease:. Frequent loose, bulky stools (Gray in color and foul smell). Increased fat content - Lactose intolerance: Lactase deficiency. Malabsorption of lactose in milk products - Signs & Symptoms:. Abdominal cramping. excessive gas. Loose stools after dairy products - Complications of Absorption disorders: - Nursing care for Absorption disorders:. Monitor fluids.. Monitor Electrolytes. Monitor nutritional status.. Daily weight. Strict I’s & O’s - For celiac disease educate your patient to eat a high protein, high calorie, GLUTEN FREE diet. - For Lactose intolerance educate your patients to avoid dairy products, and to take Lactaid when dairy cannot be avoided. Intestinal Obstruction: When flow of the intestinal contents is blocked. Could be PARTIAL or COMPLETE blockages - Mechanical Obstruction:. Blockage occurs within the intestine. Bowel sounds . HIGH PITCHED/TINKLING SOUNDS. Adhesions. Twisting of bowel. Strangulated hernia - Non- Mechanical Obstruction:. Peristalsis impaired. Bowel sounds ABSENT.. Abdominal surgeries. Trauma. Mesenteric ischemia. Infection Small Bowel Obstruction: Collection of intestinal contents, gas, fluids proximal to obstruction - Causes:. Post abdominal surgery due to loops of intestine adhere to areas in abdomen that are not healed. Adhesions or bands of scar tissue are most commonly acquired from previous surgeries or inflammation. Examples of Mechanical Bowel Obstructions: - Volvulus: Occurs when bowel twists, occluding the lumen of intestine. - Intussusception: Occurs when peristalsis causes the intestine to telescope into itself. Example of Non-Mechanical Bowel Obstruction: - Paralytic Ileus is an obstruction that occurs when intestinal peristalsis is decreased or stops because of neuromuscular condition. Intestinal Obstruction Signs & Symptoms:. Wave like abdominal pain. Blood & Mucus in stool. Feces & flatus cease. Fecal vomiting may occur (Stops as the obstruction becomes worse). Abdominal distention. Fluid and electrolyte imbalance - Therapeutics:. NPO with frequent oral care. NG tube to decompress bowel. Replace fluids and electrolytes. Medications (Antibiotics, antiemetics, Analgesics). Surgery Anorectal Problems: - Hemorrhoids:. Enlarged veins within the anal tissue - Causes:. Increased pressure in veins/intraabdominal pressure. Straining while shittin. Chronic Constipation. Pregnancy. Prolonged sitting or standing. Obesity. Portal hypertension related to liver disease - Internal Hemorrhoids:. Occur above internal sphincter. Usually NOT painful unless prolapse. May bleed during bowel movements - External Hemorrhoids:. Occur below anal sphincter. Inflammation & Edema occur with thrombosis. Severe pain and possible infarction of skin and mucosa over hemorrhoids - Prevention:. Try and refrain from straining and forcing your shit out… let it slide babbyyy. Increase fluids. Stool Softeners. SITZ baths increase circulation. Astringents (Which Hazel0. Steroid creams. Suppositories. Alternate ice & heat Anal fissures: Cracks or ulcers in lining of anal canal. - Cause:. Constipation/ stretching of anus with passage of hard stool. Crohn's Disease - Signs & Symptoms:. Bright red bleeding. Pain delay. Constipation - Therapeutic care:. Stool Softeners. Sitz baths. Anesthetic suppositories. Non- opioid analgesics. Surgical excision GI Bleeding: - Signs & Symptoms:. Occult blood, Melena, Bright red stools - Nursing care:. Monitor VS. Monitor stools for bleeding. Shock Signs. Diagnostic prep Colon Cancer:. Major cause is a lack of dietary fiber - Signs & Symptoms:. Blood & Mucous in stool. Abdominal or rectal pain. Weight loss. Anemia. Obstruction - Risk Factors:. Low fiber diet. History of colon polyps. History of ulcerative colitis. Smoking. obesity. Age. Low activity levels - Diagnostic testing:. Colonoscopy with biopsy/Sigmoidoscopy with biopsy. Proctosigmoidoscopy. C T scan. Abdominal and rectal examination. Immunological tests. Fecal occult blood. Carcinoembryonic antigen - Therapeutics:. Radiation. Chemo. Surgery. Colostomy. Abdominoperineal resection. Monoclonal antibody therapy. Analgesics. Parenteral nutrition as necessary  Patients with an Ostomy: - Ostomy: Surgically created opening diverts stool or urine to outside of body - Stoma: Position of bowel sutured onto abdomen - Abdominal ostomies:. Ileostomy. Colostomy. Urostomy Ileostomy: Terminal Ileum to abdominal wall after total colectomy - Conventional Ileostomy:. Small stoma in the RLQ. Continuous flow of liquid. Teach patients to drink 8-10 glasses of fluid per day to prevent dehydration - Continent Ileostomy: Knock Pouch. Internal Revisor with a nipple valve. Empty reservoir 3-4 times daily - Ileoanal Anastomosis: Called J pouch Colostomy: Stool becomes LESS liquid and MORE solid - Loc stoma:. PROXIMAL bowel end is brought to the abdominal wall - Loop Stoma:. Loop of bowel OUTSIDE of abdomen with bridge - Double- Barrel Stoma:. Temporary ostomy. Both ends of colon outside abdominal wall from TWO stomas. PROXIMAL stoma is functioning stoma. DISTAL stoma is mucous fistula - Preoperative Ostomy care:. Marks site. Emotional & Physical Support. Education. Bowel prep. Antibiotics - Postoperative Ostomy Care:. Ensure Stoma is PINK/RED = NORMAL. Bluish= Inadequate blood supply. Black= Necrosis. Monitor skin around the stoma for irritation. Stoma will shrink over weeks. Change appliances when needed. Ensure to find appropriate size of collection bag. TOO SMALL can cause edema at stoma - CHAPTER 35 > Liver Disease: - Hepatitis: Inflammation of the cells in the liver *IF damage involves the Bile Canaliculi obstructive jaundice will occur. - Causes:. Bacterial infection. Medications. Alcohol. Chemicals toxic to the liver. Often caused by a virus - Hepatitis Types:. Hepatitis A virus (HAV) – Fecal or Oral- vaccine- NO cure. Hepatitis B virus (HBV) – Body fluids-Blood, semen, vaginal fluid- vaccine- NO cure. Hepatitis C virus (HCV)- Circulation- Blood- NO vaccine- HCV meds to treat. Hepatitis D virus (HDV). Hepatitis E virus (HEV). HAV, HCV, and HBV most common in the United States - Hepatitis Prevention:. Transmission precautions. Standard precautions. Hand Hygiene. Immunoglobulin (IG). Vaccines:. HAV. HBV - Hepatitis Signs & Symptoms:. Could be asymptomatic.. Prodromal stage. Flu- like Symptoms. RUQ pain - Icteric stage:. Jaundice. Worsening symptoms - Convalescent:. Return to normal liver function - Hepatitis Complications:. Liver Failure. Fulminant (sudden with great intensity). Acute. Chronic. Chronic infection. Carrier of virus at risk of Liver Cancer - Diagnostic Testing:. Liver Biopsy - Lab Draws:. Serum testing. Liver Enzymes. Serum Bilirubin. Prothrombin. Serological - Therapeutics:. Relieve Symptoms. Prevent Cirrhosis. Educate on hydration & nutrition. Rest. Avoid Alcohol & liver toxic drugs. HAV or HEV Supportive care. HBV/HDV pegylated interferon therapy. HBV (Antivirals, pegylated interferon therapy, liver transplant). HCV new therapies are being developed - Direct-acting antiviral medications:. Elbasvir/Grazoprevir (Zepatier). Sofosbuvir/ledipasvir (Harvoni). Certain Genotypes. Interferon therapy - Nursing Diagnoses: Acute Pain related to liver enlargement: Monitor pain level using pain rating scale from 0-10  Give analgesics as ordered, around the clock and as needed (PRN) for intermittent breakthrough pain, recognizing that lower doses might be needed with liver dysfunction to control pain and prevent toxicity. Avoid use of acetaminophen (Tylenol) and combination drugs containing acetaminophen due to risk of liver toxicity Encourage non-drug pain relief, such as distraction, imagery, and relaxation to supplement and possibly decrease need for analgesics. - Nursing Process: imbalance nutrition, less than body requirements, related to anorexia, nausea or vomiting: Make dietitian referral for development of a nutritional plan. Monitor weight and nutritional intake, recording percentage of food eaten, to determine ongoing treatment needs. Administer antiemetic drugs as ordered to reduce nausea and increase appetite. Provide frequent, smaller meals because these may be better tolerated than larger meals. Teach the patient to avoid alcohol, herbal supplements and vitamin supplements unless specifically prescribed by the HCP to prevent further liver damage, as these can be toxic to the liver.. > Acute Liver Failure: Sudden massive loss of liver tissue. Acute liver failure is a rare but serious condition that can develop rapidly.. Sometimes I’m just 2 days. - Etiology: Drug toxicity Acetaminophen (Tylenol) is the most common cause of a cure liver failure. Acetaminophen intake should not exceed 3000 mg in a 24-hour period in a person with no liver disease. For overdose of acetaminophen activated charcoal is given to absorbs acetaminophen if it’s within one hour of ingestion and the patient is alert with an intact or protected airway. Acetylcysteine is the antidote for Acetaminophen. It is effective in preventing Hepatotoxicity, if given within eight hours of ingestion. Hepatitis can also cause acute liver failure - Signs & Symptoms of Acute Liver Failure: - Early signs: (vague & make detection difficult) Fatigue GI upset Diarrhea - Worsening Symptoms: Jaundice Hepatic Encephalopathy Bleeding Abdominal distention  Confusion Hepatic Coma - Diagnostic Tests: X-Ray ALT- will be elevated AST- will be elevated Bilirubin- will be elevated PTT- will be elevated Potassium- will decrease Blood Glucose – will decrease - Therapeutic Interventions: Dialysis may be ordered if Liver damage is present from an overdose of a hepatotoxic substance to filter the substance from the blood. Decrease stimulation and provide rest Eliminate ALL drugs (because most drugs are metabolized through the liver) High calorie, Low sodium, High protein diet Patient may need an NG tube Lactulose will be given to DECREASE ammonia level Patient need a liver transplant depending on severity > Liver Cirrhosis: (Chronic Liver Disease) Progressive disease Irreversible Replacement of healthy liver tissue with scar tissue. Often Irreversible unless the cause is treated early. - Causes: Chronic alcohol use Chronic HBV or HCV Non-alcoholic steatohepatitis (NASH) also known as “Fatty Liver Disease” Due to the buildup of fat in the liver it is common in those with diabetes, obesity, heart, disease, or elevated cholesterol levels - Pathophysiology: Healthy liver cells exposed to toxins become inflamed. Liver cells are infiltrated with fat and WBC are replaced by fibrotic tissue. As the liver makes repairs, scar tissue forms. The liver becomes enlarged and hardened and lumpy instead of soft. Impaired Liver Function (Can lead to liver failure) - Complications: Clotting Defects Portal Hypertension Ascites Varices Hepatic encephalopathy Hepatorenal syndrome Wernicke-Korsakoff Syndrome - Clotting Defects: blood clotting defects develop because of impaired prothrombin in fibrinogen production in the liver  the absence of bile salts prevents the absorption of fat-soluble vitamin K - Portal Hypertension: Portal hypertension is persistent, elevated blood pressure in the portal vein. The increase pressure causes the abdominal veins around the umbilicus to become enlarged and visible, as well as rectal hemorrhoids, spleen, enlargement, and esophageal varices. the most serious result of portal hypertension is bleeding, esophageal varices varices usually develop from the fundus of the stomach - Diagnostic Tests: Liver Enzymes (ALT, AST, ALP) Bilirubin Ammonia Levels PT Liver Biopsy CT, MRI - Therapeutics For Ascites: Diuretics (Spironolactone or Lasix) Sodium Restriction Fluid restriction (800-1000ml per day) Albumin Infusion (If severe) Paracentesis (Removes fluid from Peritoneal cavity) Transjugular intrahepatic portosystemic shunt (TIPS) (Non-surgical) - Therapeutics for Esophageal Varices: Beta Blockers (Inderal & Nadolol) Vasoconstrictor Endoscopic Varices Ligation using rubber bands Transfusion Antibiotic Prophylaxis (Given with Hemorrhage) - Therapeutics for Hepatic Encephalopathy: REDUCE AMMONIA LEVELS Lactulose (Lowers the PH of the colon by preventing ammonia from moving into the blood) Antibiotics (Rifaximin or Neomycin) are given to reduce bacteria in the gut that produce ammonia. Vitamins Albumin - Data Collection: - Be ALERT to subjective symptoms of liver dysfunction such as: Abdominal pain Anorexia Nausea Severe itching  RUQ PAIN - Objective Symptoms: Jaundice Light colored stools Ascites Ecchymosis GI bleed Confusion - Acute Liver Failure & Cirrhosis Education: Teach patients how these diseases affect their bodies and health Signs & Symptoms to report Adequate Rest & Nutrition Avoid narcotics, sedatives, tranquilizers, alcohol. > Liver Transplant: - Patients who would be candidates: End-Stage Liver failure Hepatitis Biliary Disease Metabolic Disorders Hepatic Vein Obstruction Anti-rejection meds - Signs of Rejection from transplant: Pulse than 100bpm Temperature than 101 degrees RUQ pain Jaundice - Liver Cancer: Usually metastasized from another site - Risk Factors: Chronic HBV or HCV Nutritional Deficiencies Exposure to Hepatotoxins - Signs & Symptoms: Encephalopathy Bleeding Jaundice Ascites - Diagnostic Tests: serum ALP (Alkaline Phosphate) MRI, CT (Show tumor growth) Biopsy - Therapeutic Interventions: - Surgery  - Chemotherapy drugs by injection into the affected lobe or hepatic artery called NEXAVAR. Radiation > Acute Pancreatitis: - Pathophysiology: Inflammation (Caused by a process called autodigestion) Elevated Enzymes Fluid Loss - Etiology: Most commonly associated with heavy alcohol consumption or cholelithiasis Gallstones Triglycerides ERCP (endoscopic retrograde cholangiopancreatography)(induced pancreatitis) Tumors Idiopathic (sometimes cause is unknown) - Signs & Symptoms: Severe pain (located in the Epigastric area or LUQ, with radiation to the chest and back & flanks) Rigid abdomen (board like) Hypotension Shock Respiratory destress (From fluid buildup in the retroperitoneal space) Guarding Shallow Respirations Low grade fever Tachycardia N/V Jaundice - Complications: Death from organ failure Systemic inflammatory response syndrome (SIRS) Cardiovascular failure Acute respiratory distress syndrome Acute kidney injury Hemorrhage Infection A purplish discoloration of the flanks (Turner Sign) Purplish discoloration around on the umbilicus (Cullens Sign) - Diagnostic Tests: CT MRI Ultrasound - Diagnosed with 2 tests. Serum Amylase > 3 times  (Normal= 100-300units). Serum Lipase > 3 times (Normal= 0-60units) - Therapeutic Interventions: Treat Pain Aggressive IV Fluids (For first 24hrs for Hypovolemia is recommended) Mild cases= Oral Nutrition Severe cases= Enteral feeds Analgesics Antibiotics are given if sepsis is present > Chronic Pancreatitis: - Pathophysiology: Progressive Fibro-inflammatory Disease Obstructed Ducts Ulceration & Tissue death Exocrine Insufficiency Pancreas becomes smaller and hardened. Progressively smaller amounts of pancreatic enzymes are produced (exocrine insufficiency). Later, islet tissue is lost, causing diabetes mellitus (endocrine insufficiency). - Etiology: Usually developed between ages 43-62 Occurs more in MEN Predominately found in Caucasians Alcohol Abuse/Cigarettes Smoking Obstructive Biliary disease Idiopathic, Genetic, & autoimmune Hyperlipidemia - Signs & Symptoms: May be Asymptomatic Epigastric pain or LUQ that worsens after eating N/V Weight Loss Steatorrhea (Greasy foul smelling loose stools) Intolerance of fatty foods *Patients history will show a pattern of exacerbations and remissions. - - Complications: Abscess & Fistulas may develop when Cyst filled with Pancreatic Enzymes burst into the abdominal cavity causing inflammation and necrosis. Pleural Effusion may develop from Inflammation Fatty stools & Diarrhea Risk for pancreatic cancer Malabsorption - Prevention: Alcohol abstinence Avoid Smoking Biliary Disease treatment - Diagnostic tests:  CT, MRI Endoscopic ultrasound Pancreatic Enzyme labs (Normal or Low) High Fecal fat level - Therapeutic Interventions: Stop alcohol use Small low-fat meals NSAIDs, analgesics, and PPIs Pancreatic Enzyme Replacement Stents Surgery > Ductal Adenocarcinoma of Exocrine Pancreas: - Risk Factors: Smoking Obesity Work exposure to chemicals Diabetes Mellitus Chronic Pancreatitis - Signs & Symptoms: No early signs most the time Usually has Metastasized Weight Loss Abdominal pain that radiates to back (worsens at night) Anorexia Nausea/Vomiting Pruritus Depression Fatigue Jaundice Recent Diagnosis of diabetes Mellitus - Preoperative Complications: Malnutrition Spread of Cancer Gastric or Duodenal Obstruction - Postoperative Complications: Infection Fistula Formation Malabsorption Thrombophlebitis - Diagnostic Tests: Serum Amylase/Lipase ALP Bilirubin Coagulation Studies Carcinoembryonic Antigen (CEA) Carbohydrate antigen 19-9  CT, MRI, Ultrasound, ERCP Biopsy - Therapeutic Measures: Surgical Treatment Whipple Procedure Total Pancreatectomy (rare) Stent or Bypass relieves biliary obstruction Chemotherapy Radiation - Patient Education: Management of hyperglycemia and Hypoglycemia Pancreatic enzyme replacement Dressing changes Complications to report hospice referral/social worker - Gallbladder Disease: - Gallstones and inflammation of the gallbladder and common bile duct are the MOST common disorders of the biliary system. - Pathophysiology: - Cholecystitis= Inflammation of the Gallbladder. Acute cholecystitis is a serious response to obstruction of the common bile duct by a stone. Resulting in edema and inflammation. Urgent medical treatment is required with surgery to prevent gallbladder rupture. - Cholelithiasis (Stones)= Formation of Gallstones in the Gallbladder. The most common reason of Gallstones is due to Cholesterol. - Choledocholithiasis = Gallstones within the Common Bile Duct. - Gallstones form when bile becomes saturated with Cholesterol. > Gallbladder Disorders: Risk of gallstones with age Family History Obesity Bile Stasis Cholesterol intake Fasting Sedentary Lifestyles More Common in women - Signs & Symptoms: Some Gallstones are Asymptomatic (SILENT STONES) White/Clay colored stool Elevated Vital Signs Vomiting Jaundice Epigastric Pain (Biliary Colic) Inflammation (Positive Murphy sign which is the inability to take a deep breath when the examiners fingers are pressed below the liver Margin)  Pain in RUQ that may radiate back to behind the right scapula or right shoulder. N/V Indigestion - Complications: Cholangitis (Inflammation of the bile ducts) Necrosis/perforation of gallbladder Fistulas Adenocarcinoma of gallbladder Acute pancreatitis - Diagnostic Tests: - Ultrasound (Classic test done to detect stones) Endoscopic ultrasound (can provide more detailed images of the gallbladder and brown ducts) CT MRCP HIDA scan Patient may have WBC count Elevated Direct Bilirubin - Therapeutic Interventions: Pain control (Analgesics) Infection prevention Maintain electrolyte and fluid balance Antiemetics Bile Acid Sequestrants NPO then advancing to Low fat diet - Treatment: Cholecystectomy Laparoscopic Surgery (Most common) Traditional Surgery (Open) (T-Tube may be inserted into the common bile duct to endure that bile drainage is not obstructed) Medication to dissolve Stones