1. Interference to Nutritional Needs Due to Degeneration and Inflammation

2. Biliary disorders Cholecystitis Pathophysiology Cholangitis Acute
Cholelithiasis
Acalculous cholecystitis
Calculous cholecystitis
Pathophysiology
Abnormal metabolism of cholesterol and bile salts
Decreased gallbladder-emptying rates
Changes in bile concentration or bile stasis w/in gallbladder
Cholangitis
Ascending
supporative

3. Chronic cholecystitis
Repeated episodes
Complications of pancreatitis and cholangitis
S/S: jaundice, pruritus, clay-colored stools, dark urine
Risk factors: Genetic relationship, cholesterol- lowering meds, age (>60), type I DM, rapid wgt loss, low-calorie or liquid protein diets, etoh abuse, white women, Native Americans, Mexican American, pregnancy (to name but a few-your book has more)
Assessment – see key features of cholecystitis chart 63-1
Lab tests: nothing specific for gallbladder disease, tests look for ruling out other diseases.

4. Interventions Diet therapy (see table 63-1)
Drug therapy – pain, antiemetics
Percutaneous Transhepatic Biliary Catherization
Under fluoroscopy
Used for inoperable situations or for unstable high risk surgical candidates
Surgery – laparoscopic most common now
Same day surgery
Short recovery period
Back to normal activities in 1-3 weeks
Traditional method for cholecystectomy
Far greater chance for complications
Need for T-tube, JP drains (see chart 63-2 and 3)
Slower recovery
May require home visits by RN
Risk for postcholecystectomy syndrome

5. Pancreatitis Acute Necrotizing form dangerous, high mortality
Understand endocrine and exocrine functions of the organ (great chart pg 1403, figure 63-2)
Complications
See table 63-2
Why might you see these problems occur? Understand the pathophysiology of what happens.
Risk factors – etoh most common followed by obstruction
Physical assessment
Jaundice
Cullen’s sign
Turner’s sign
No bowel sounds
Rigid abdomen = perforation, peritonitis

6. Labs Interventions Amylase – when is it helpful, accurate to dx?
Lipase – more specific, more accurate.
Other tests to dx biliary obstruction (note that these don’t indicate pancreatitis)
Tests done to identify fat necrosis
Interventions
Nonsurgical
Resting the bowel, TPN
Meds: pain control, give gi tract chance to rest
Comfort measures
ERCP – when is this done?
Surgical
Laparoscopic cholecystectomy

7. Chronic The acute form done over and over and over again
Type is defined by why the patient gets the attack
Calcifying pancreatitis – etoh
Obstructive pancreatitis – guess
Does the chronic form of the disease have the same manifestations as the acute form? What is the same, what is different?
How is your nursing care changed when dealing with the chronic form vs the acute form?
See chart 63-8 for prevention of exacerbations

8. Peptic Ulcer Disease Term includes both gastric and duodenal ulcers
Too much acid, violation in integrity of mucous coating over stomach wall, H. pylori
What are those things that cause acid to be secreted? These are the things you need to teach your patient about re: change in lifestyle.
Complications
Hemorrhage
How can you tell an upper gi bleed from a lower gi bleed? An old bleed from a fresh one?
Perforation
Pyloric obstruction – not common
Intractable disease

9. Physical assessment – see chart 59-4
Risk factors
Nsaid usage, theophylline (when is this used?), steroids (remember these pesky little buggers?)
Genetics
H. pylori
Caffeine products, lots and lots of them
Physical assessment – see chart 59-4
Dyspepsia (another word for your vocab.)
Pain: upper epigastrium with localization to L of midline relieved with food; R of epigastrium 90 min. to 3 hours after eating.
Exacerbating foods, meds.
Vomiting
Orthostatic bp changes
Labs
H&H

10. Interventions – see chart 59-5
Dx tests
EGD
IgG serologic testing
Urea breath test
Stool test
Interventions – see chart 59-5
Drug therapy – what are the differences btwn these?
Antibiotics
Proton pump inhibitors
H2 receptor antagonists
Prostaglandin analogues
Antacids
Mucosal barrier fortifiers
Diet therapy
Alternative medicine

11. Nonsurgical management
Endoscopic therapy
Acid suppression (didn’t we already cover this?)
Add somatostatin to your med list
NG tube (what’s the difference btwn using this for an ulcer vs to treat pancreatitis?)
Saline lavage
Management of perforation
Management of obstruction
Surgical management
Gastrectomy
Gastroenterostomy
Vagotomies
Dumping syndrome – see diet table 59-2
Reflux gastropathy
Delayed gastric emptying
Afferent loop syndrome
Recurrent ulceration

12. You had care of the surgical patient back in Nursing 2
You had care of the surgical patient back in Nursing 2. If you need to review that material to refresh it, you had best do so.
See chart 59-7 for home care assessment
What do you need to teach this person now that they have had surgery?
Can you figure out how all of these diseases are linked? If so, you will know how I will approach teaching this material in class.