Provide bed rest • Kidneys: acute tubular necrosis

• Provide high-calorie diet • Hemorrhage, DIC

• Monitor for signs of GI bleeding • Pancreatic abscess
• Monitor mental status: lethargy, • Pancreatic pseudocysts
somnolence, personality changes • Pancreas insufficiency
• Limit visitors / isolation procedures if ASSESSMENT
infectious • Nausea
MEDICATIONS: • Severe abdominal pain around umbilicus
• Antiemetics • Abdominal rigidity
• Antibiotics ( to decrease ammonia • Signs of shock
production by intestinal bacteria) • Dark urine, clay-colored stools if due to
• Vitamin K bile duct obstruction (stones)
CLIENT EDUCATION LAB:
• HAV: Good hand washing practice • Elevate amylase, lipase
• HBV: Avoid unprotected sexual • If serum calcium low> poorer prognosis
intercourse Avoid sharing of needles ANALYSIS:
GALLBLADDER • Fluid and electrolyte balance?
cholelithiasis = presence of gallstones in the • Adequate nutrition?
gallbladder IMPLEMENTATION
CHOLELITHIASIS • Keep client NPO
• Usually asymptomatic (70%) • Assist with nasogastric tube
• May cause biliary colic (20%) • Monitor vital signs
• May cause cholecystitis (10%) • Monitor input/output
BILIARY COLIC • Assess for respiratory difficulties and base
• Steady, cramplike pain in epigastrium of lungs.
• Murphy’s sign (inspiratory arrest during CLIENT EDUCATION
palpation of liver margin) • Strict avoidance of alcohol
• Pain does not subside spontaneously MALDIGESTION
ANALYSIS Dysfunction of pancreas
• Dehydration due to nausea and vomiting? • Chronic pancreatitis
• Risk of acute pancreatitis if stone • Cystic fibrosis
obstructs duct Lack of specific enzymes
IMPLEMENTATION • Lactase deficiency
• No oral food during acute cholecystitis Lack of bile salts
DIAGNOSIS: • Biliary cirrhosis
• X-ray, ultrasound, scan to visualize stones • Resected terminal ileum
• ERCP to visualize ducts • Bacterial overgrowth
MEDICATIONS: MALABSORPTION
• Analgesics Dysfunction of small bowel
• Antibiotics • Short bowel syndrome
• Ursodiol: (resolves small cholesterol • Bacterial overgrowth
stones, but does not help in acute attack) • Celiac disease
POSTOPERATIVE: • Tropical sprue
• Monitor T-tube drainage (up to 500ml in Note: Diarrhea often leads to transients
first 24h is normal) lactase deficiency: Teach client to avoid milk
CLIENT EDUCATION: when having diarrhea of any cause.
• Reduce dietary fat and cholesterol intake DIARRHEA
PANCREATITIS SECRETORY
ACUTE PANCREATITIS • Large volume watery stools
Causes – Alcohol abuse, cholelithiasis • Persists with fasting
Features – Elevate lipase, amylase (cholera, dysentery)
Mortality rate – 10% OSMOTIC
CHRONIC PANCREATITIS • Bulky, greasy stools
Causes – Alcohol abuse, rarely due to • Improves with fasting
cholelithiasis (lactase deficiency, pancreatic insufficiency,
Features – pancreatic calcifications short bowel syndrome)
COMPLICATIONS OF ACUTE PANCREATIS INFLAMMATORY
• Peritoneum: fat necrosis • Frequent but small stools
• Lungs: respiratory distress syndrome • Blood and/or pus
(inflammatory bowel disease, irradiation,
shigella, amebiasis)
DYSMOTILITY
• Diarrhea alternating with constipation
(irritable bowel syndrome, diabetes
mellitus)
LOWER ABDOMINAL PAIN
Appendicitis
• Vague periumbilical pain, nausea
• Later localizes to lower right quadrant
• Perforation: high fever and leukocytosis
Diverticulitis
• Elderly patients
• Steady pain
• Localized to lower left quadrant
• Left sided appendicitis
Inflammatory bowel disease
• Chronic, cramping pain
• Diarrhea, blood and pus in stool
Intestinal obstruction
• Hyperactive bowel sounds
Intestinal infraction
• Absent bowel sounds
• Gross or occult blood in stool
APPENDICITIS
ASSESSMENT
• Nausea, anorexia