GI Notes For Exam 3
GI Notes For Exam 3
GI Notes For Exam 3
BILIARY CIRRHOSIS
Associated with chronic biliary obstruction and infection
liver is fibrotic with presenting jaundice
CARDIAC CIRRHOSIS
Caused by rt sided heart failure
Cor pulmonale (enlargement of rt vent)
constrictive pericarditis (fiber thicken of pericardium caused by gradual scarring or fibrosis of the membrane) heart becomes very rigid
tricuspid insufficiency
Clinical manifestations
GI disturbances (anorexia, dyspepsia, flatulence, n&v, change in bowel habits)
abdominal pain RUQ or epigastrium
Enlargement of spleen and liver
Others:
Fever
lassitude (weakness; low energy)
weight loss
Key concept: as a result of the livers altered metabolism of carbs and proteins or fats, dull ache in the stomach and very
heavy feeling in RUQ due to stretching o swelling
Late s/s
Jaundice
peripheral edema
ascites
skin lesion
hematologic disorders
endocrine disturbances
peripheral neuropathies
Key concepts: s/s of sever liver dysfunction with accompanying jaundice include clay stools, peritis and dark urine. Later stages may result in portal
hypertension. Skin lesions include spider angiomas which are small dilate blood vessels, due to an increase circulation of estrogen as a result of the
damaged liver inability to metabolize steroid hormones.
HEPATIC ENCELAPATHY
Risk for a coma
s/s of impending coma
esticsis (flapping tremors)
ask the patient to extend there arms out in front of them if the client is unable to hold this position they are at risk
Increase ammonia causes Slow deep respirations and hyperactive reflexes mental changes.
Treatment includes lactolos which detracts the ammonia in the gut and causes diarrhea, explosive diarrhea which expels the ammonia thereby decreases the
levels. This help improve the nervous system.
PORTAL HYPERTENSION
Increased central venous pressure
splenomegaly
large collateral veins
ascites
systemic hypertension
esophageal varices
Key concept: structural damage in the liver cause this due to cirrhosis which compresses and destroys hepatic veins
Changes result in obstruction of the normal flow of blood to the portal system which is what supplies the liver with blood results in portal hypertension.
The goal is to reduce the risk for bleeding associated with portal hypertension, therefore the patients are often given stool softeners
Key concept: Esophageal varices are complexed veins at the end f the esophagus and they are enlarged and swollen as a result of portal hypertension.
Common in cirrhosis. Die within 6 weeks. The nurse must assess the client for hemorrhage. The patient will be txt with balloon tapanode to reduce
bleeding in the esophagus, 250ml of air inflate, x-ray confirm placement. NURSING: Deflate the balloon every 8-12 hrs to avoid necrosis. The most
common complication of balloon tampanode is aspiration pneumonia, therefore suction and frequent oral hygiene must be performed.
ASCITES
Due to decreased albumin and increase portal hypertension
peripheral edema
abdominal distension due to water and proteins in the abdominal area
accumulation of serous fluid in the abd, the lymp are unable to carry away excess proteins and water causing them to leak through the liver and into the
peritoneal cavity. Retention of sodium as well as increased antiduertic hormone causes additional water in the abd. Because of increase edema there is
decreased invascular volume and decreased renal blood flow, and decreased glumaular activity
Key concept: clients with severe ascites must be evaluated for respiratory changes, such as decreased lung expansion bc of diaphragm pressure place the
client in the fowler's position to relieve pressure on the diaphragm. Patients with ascites should never be in a flat position, the patient might also be more