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GI/Hepato Disorders - Coggle Diagram

- - - - Motility disorder: Slow wave activity of colon
      - Alternating diarrhoea and constipation
      - Abdominal cramping in absence of identifiable GI tract pathology
      - Associated with stress
      - Mucus in stool present
    - - Drugs
        
        Anti-spasmodic medications
        
        Anti-diarrhoeal agents
      - Nursing management
        
        Adequate fluid and fiber
        
        Diet: avoid oily food, alcohol, milk products, coffee
        
        Stress management
        
        Seek medical attention if there is abrupt change
  - - - External
        
        Underlying skin becomes irritated and erodes
        
        Pain: severe, when blood clot forms
        
        Itchy, potential of being irritated
      - Internal
        
        Painless typically even when it bleeds
        
        Fresh bleeding --> hemorrhoids
        
        Ability to prolapse and extend beyond anus
        
        Irritate skin, make it very itchy
    - - Conservative + surgery
        
        Increase fiber in diet: softens stools, lowers pressure on herrmoids
        
        Exercise: stimulate motility of GI
        
        Sitz bath: warm bath for buttocks and hips -> relieve itching, spasms
        
        2-3 times a day
        
        After each bowel movement
        
        20min
        
        Haemorrhoid creams: anaesthetic creams that relieve pain of haemorrhoids
        
        Treat clot: surgically removed
        
        Surgery
        
        Rubber band ligation
        
        haemorrhoidectomy: inflammed blood vessels removed. (incision on internal and external haemorrhoid tissue)
        
        stapled haemorrhodopexy: anchor the haemorrhoids in normal position
      - Nursing management
        
        Assessment
        
        Elimination patterns
        
        Diet
        
        Exercise activity
        
        History
        
        Interventions
        
        Encourage at least 2L water
        
        Recommend high-fiber foods
        
        Bulk laxatives, stool softeners, topical medications
        
        Hygiene/sitz baths
        
        Monitor for complication
        
        Self care education
        
        Major goals include: reduction of anxiety, pain relief, adequate elimination patterns + promotion of urinary elimination
  - - - Due to: obstruction of appendiceal lumen/lymphoid hyperplasia/parasitic worms
      - Usually occurs in those 45 and below
      - Can lead to appendiceal necrosis: abscess formation = death
      - Sometimes obstruction removes by itself (RARE)
    - - Pain in the epigastric/periumbilical area -> becomes localised to lower right quadrant
        
        Vague pain then becomes colicky after 2 to 12 hours
        
        Rebound tenderness positive sign: due to spasm of overlying abdominal muscles
        
        Ultrasound/CT scan confirm diagnosis
    - - Surgery: removal of appendix
      - Nursing management
        
        Generic care before and after
        
        Supportive management
  - - - Causes: abdominal surgery with adhesions, congenital abnormalities in bowel, carcinoma
    - - Loss of electrolytes
      - Dehydration
      - Vomiting
    - - Peritonitis: redness and swelling (inflammation) of the tissue that lines your belly or abdomen.
      - Perforation
      - Ischemia from impaired bowel circulation
      - Blood escapes from engored veins: blood and plasma loss -> shock
      - Bacteria translocate to bloodstream -> fever and sepsis
    - - Surgery: Correct/removal of mechanical obstruction
      - Nursing management
        
        General before and after care
        
        Supportive measures
        
        Fluid and electrolyte replacement
        
        Decompression
- - - - Autoimmune disorders
      - Reactions to drugs/toxins
      - Hepatotrophic viruses: predisposition to go liver
      - Other infectious disorders
    - - Hep A
        
        Fecal-oral transmission
        
        Brief incubation period: 3-7 weeks
        
        Manifestations: non specific GI symptoms (children) + jaundice (adults)
        
        Presence of IgM: acute infection. IgG: previous infection
        
        Sometimes asymptomatic
      - Hep B
        
        Transmission through infected blood/sexual contact
        
        Longer incubation period than A
        
        More serious than Hep A
        
        HBcAg first then HBcAb
        
        HBsAg: active infection. HBsAb: resolved
        
        HBeAg: associated with viral replication and infectivity. HBeAb: hepatitis B antibody: minimal replication and infective potential
      - Hep C
        
        Most common cause of chronic hepatitis
        
        Incubation period: 2-26weeks, average 6-12 weeks
        
        May be asymptomatic, non-specific: malaise, fatigue, anorexia, weight loss
        
        Contaminated blood/blood products (similar to Hep B)
      - Hep D
        
        noncomitant infection with Hep B: Hep B should be present for Hep D virus to happen
        
        2 forms
        
        Coninfection: associated with more severe hepatitis
        
        Superinfection: hepatitis D is imposed on chronic Hep B patient/carrier state
        
        Transmission through blood/blood products (similar to B)
      - Hep E
        
        Does not cause chronic hepatitis or the carrier state
        
        Manifestations: similar to Hep A
        
        Transmitted through fecal-oral route (similar to A) but blood product transmission may also occur
        
        Incubation period: 2-9 weeks
    - - Drugs
        
        Vaccination
        
        Antiviral medications: Entecavir, Tenofovir, Lamivudine (Direct acting antivirals for Hep C)
      - Nursing management
        
        Sufficient rest
        
        Nutritious diet
  - - - Obstruction of gallbladder outlet due to gallstones
        
        Calculous
        
        Sepsis, severe trauma, infection of gall bladder
        
        Acalculous
        
        Ischemia rather than inflammation associated with stones
        
        Can rapidly progress to gangrene and perforation
    - - Severe right upper abdominal pain that may radiate to the back
      - Mild fever, anorexia, nausea, and vomiting
    - - Physical examination
        
        Murphy's sign: NOT RELIABLE TO ELDERLY POPULATION
      - Lab tests
        
        Increased WBC, mild increase in bilirubin
      - History
        
        Signs and symptoms
        
        Lifestyle factors
      - Hepatobiliary scintigraphy
        
        Nuclear medicine: uses radio tracers to evaluate bili resistance
      - Ultrasound
    - - Surgery: laproscopic cholecystectomy, open cholecystectomy
      - Drugs: Broad spectrum antibiotics
      - Diet: LOW FAT MEALS
      - Post op
        
        Optimal nutrition
        
        Relieve pain
        
        Fluid balance
        
        Skin integrity
        
        Biliary drainage
  - - - Linked to alcoholism, trauma, peptic ulcer(men)
      - Linked t o biliary tract disease (women)
      - Autodigestion of pancreas
      - Predisposing factors: hypertriglyceridemia, biliary tract disease, ethanol associated
    - - Abdominal tenderness
      - Nausea and vomiting
      - Steady, boring pain in the epigastrium/left upper quadrant radiating to the back
      - Reduced bowel sounds
      - Low grade fever
      - SEVERE: signs of circulatory instability, respiratory insufficiency, shock
    - - Diagnostic
        
        Serum aminotransferases level RISE
        
        Serum amylase and lipase levels RISE
        
        CT scan- gold standard
      - Nursing management
        
        Symptomatic and supportive care
        
        Comfort management
        
        Pain relief
        
        Nutritional support
      - Drugs
        
        Analgesics
        
        Antibiotics