Download Anatomy of the Accessory Organs

Anatomy of the Accessory Organs
Liver, Gallbadder and Pancreas
Diagnostic Tests and Procedures
For Lower GI
System
Stool Specimens
O&P
C&S
OB( occult blood)
Fecal Fat
Radiological Studies
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. 350)
Abdominal Hernia
Muscle weakness resulting in intestine protruding through muscle
Reducible
Irreducible
Incarcerated  obstructed peristaltic flow
Strangulated  hernia that is trapped and deprived of blood
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
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
Stool softeners
Nursing Interventions
Increase…
Fiber
Fluids
Activity
Diarrhea
Loose stools with increased frequency
S/S  pain, abdominal cramps, urgency, flatus
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….
1. Sulfasalazine
2. 5 ASA
3. Purinethol
4. Corticosteroids
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.
OOB ASAP
Peritonitis
Inflammation of peritoneum
Complications: 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 Ulcerative Colitis
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
Treatment
Sitz baths
Warm compresses or ice packs
Stool softeners
Creams
Hemorrhoidectomy
Anal Abscess
Infection of tissue around the anus
Treatment:
Antibiotics
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
IV vasopressin
Surgical ligation
Esophageal – gastric balloon
Sclerotherapy
TX for Ascites
Na+ restriction diet and diuretics
Paracentesis
Peritoneal-venous shunt
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
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
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
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
Fever
Jaundice
^ WBC, ^enzymes
(biliary colic)
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 746 Figure 37-13
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 !!!!