• Antidiuretic Hormone (ADH)- Inc. H20 reabsorption & urine concentration
• Atrial Natriuretic Hormone (ANH)- Promotes loss of Na+ in urine
• Aldosterone- Increase Na+ absoprtion & Control K+ secretion
• Renin- Regulates Na+ Retention
• Erythropoietin- Stim. inc. RBC production in response to low O2

Renin-Angiotensin System

• (Angiotensin --> Angiotensin I --> Angiotensin II --> Aldosterone)

• Transferred through blood transfusion and sexual contact

Manifestations:

• Flulike Upper Resp. Tract Infection
• Low grade fever
• Anorexia- early sign
• Jaundice & Dark urine- Later
• Epigastric distress
• Taste of cigarettes

Management:

• Triple Therapy: Protease Inhibitor + Peginterferon + Ribavirin (Rebetol)

• Gallstones that occur anywhere in biliary tree
• Cholecystitis- acute/chronic inflammation of gallbladder

Manifestations:

• Severe/steady RUQ pain that may radiate to back, right scapula or shoulder
• Sudden onset, lasting up to 5hrs
• May occur after high fat meal
• Biliary colic or cramping-type pain occurs when stone is lodged in common bile duct
• Physical exam- Positive Murphy's sign- severe pain of RUQ w/inspiratory arrest

Management:

• Ursodiol (Actigall)- dissolve cholesterol stones
• Laparascopic cholecystectomy
• Cholecystectomy- open & traditional (T-tu...

Normal Values:

• ALT= 5-35 [Elev. w/acute hepatitis]
• Albumin= 3.5-5.0 [Edema & Ascites]
• ALP= 30-80 [Acute hepatitis]
• AST= 5-40 [Severe liver damage]
• Higher ALT/AST [Acute hep. & liver necrosis]
• Higher AST/ALT [Cirrhosis of liver]
• Ammonia= 15-45
• Bilirubin= 0.1-1.2
• Glucose= 60-100
• Inc. WBC [Cholecystitis- inflammation gallbladder]

• Inflammation of liver by virus (Hep. A,B,C,D, E) or alcohol/ drugs (acetaminophen)
• Hep. A + E = Fecal ral route
• Hep. B,C,D = Blood and body fluids

3 phases:

• Prodromal (preicteric) phase- most contagious; before jaundice; flulike symptoms
• Icteric phase- marked by onset of jaundice
• Recovery (posticteric) phase- resolution of jaundice

Management:

• Vaccines available for Hep. A + B
• Acetaminophen contraindicated
• Liver function compromised, protein, salt should be restricted
• Observe for blood in stool, urine, multiple ecchymosis, petechiae,oozing, blood fr...

• Diverticulum- saclike herniation of lining of bowel that extends through muscle layer
• Diverticulitis- when food & bacteria retained in diverticulum produce infection/inflammation --> abscess formation

Nursing Diagnoses:

• Constipation related to narrowing of the colon from thickened muscular segments & strictures
• Acute pain related to inflammation & infection

Management:

• Info on onset/duration
• Current and past elimination patterns
• Lifestyle info
• Past medical & surgical history
• Current meds
• Laxative and enema use
• Sensation of rectal pressure of fullness, ab pain, excessive straining & flatulence?

• Hollowed out area that forms in wall because of erosion of a circumscribed area of mucous membrane
• Occurs most in duodenum

Possible causes:

• Infection w/H.PYLORI
• Use of NSAIDs
• People w/blood type O
• Chronic pulmonary disease

Manifestations:

• Dull/Gnawing pain
• Burning sensation in midepigastrium or back
• Gastric- pain after eating
• Duodenal- pain 2-3hrs after meals, relief of pain after eating or after taking antacid
• Pyrsosi (Heartburn)

Diagnostic finding:

• BUN: 8-22 mg/dL
• Serum Creatinine: Male- 0.6-1.5 mg/dL / Female- 0.6-1.1 mg/dL
• GFR: 90-120 mL

Management:

• Surgical (Lobectomy)
• Liver transplant (Immunosuppresive therapy --> Infection- leading cause of death after surgery) STRICT ASEPSIS

• Disturbance in bilirubin- Hyperbilirubinemia
• (Normal: 2.5-3.0)

Types:

• Hepatic- disturbance of hepatocyte function caused by impaired liver cells
• Obstructive jaundice- common bile duct occluded by gallstones
• Hemolytic- excessive breakdown by RBCs

Clinical Manifestations:

• Yellow skin + mucous membranes
• Scleral icterus (yellow eyes)
• Pruritus (Severe itching)
• Dark urine
• Clay colored stools
• Infection- fever + chills

• Obstruction to flow of pancreatic enzymes resulting in inflammation of pancreas
• Alcoholic pancreatitis (Chronic)
• Self digestion by an enzyme- Trypsin

Manifestations:

• Severe abdominal pain and N/V!!
• Acute epigastric pain, steady & severe, umbilical area radiates to back
• Pain greater when lying supine
• Leukocytosis, hyperglycemia, elev. amylase & lipase
• Grey Turner- bluish discoloration over flank area (accum. of blood in that area)
• Cullen Sign- bluish discoloration around umbilicus (sign of bleeding)

Management:

• Semi-fowlers
• Freq. change in position= prevent atelectasis

• Chronic functional bowel disorder affects freq. of defecation and constancy
• Peristaltic waves affected

Management:

• Reinforce good dietary habits
• Eat at regular times
• chew food slowly
• Fluid should not be taken w/meals --> DISTENTION
• Stress management

• Overweight 25–30 kg/m2
• Mild 30–35 kg/m2
• Moderate 35–40 kg/m2
• Severe >40 kg/m2

Pharmacological:

• Orlistat (Xenical)- side effects: inc. freq. of bowels, gas w/ oily dishrag, dec. food absorption, dec. bile flow, dec. absorption of vitamins

Surgical:

• Bariatric surgery- 6 to 18 mo medically supervised diet fails to reach goal
• Roux-en Y- Restrictive + Malabsoprtive
• Sleeve Gastrectomy

Management:

• 6 small feedings (600-800 calories per day)
• Eat smaller but more freq. meals

• Chronic inflammation of GI mucosa (most often in terminal ileum)

Manifestations:

• Lesions=cobblestone w/sections of normal mucosa b/t lesions (skip lesions)
• Diarrhea (5-6 semiformed)
• Steatorrhea (fatty stool)
• Ab pain in RUQ relieved by defecation

Management:

• Diagnosed by colonoscopy
• High calorie, high protein, low fat
• Meds- antidiarrheals, salicylate containing compounds, corticosteroids

• Back flow of gastric contents into esophagus, incompetent lower esophageal sphincter

Manifestations:

• Pyrosis (Burning)
• Dyspepsia (Indigestion)
• Regurgitation
• Dysphagia
• Odynophagia

Management:

• LOW-FAT diet
• Avoid caffeine, tobacco, beer, milk, carbonated beverages
• Avoid drinking/eating 2hrs before bed
• Maintain normal body weight
• Avoid tight fitting clothes
• Elev. head of bed
• Antacids, H2 Receptors, PPI, Prokinetic agents

Rapid acting: Onset Peak Duration

• lispro (Humalog) 10–15 min 1 h 2–4 h
• aspart (NovoLog) 5–15 min 40–50 min 2–4 h
• glulisine (Apidra) 5–15 min 30–60 min 2 h

Short acting:

• regular (Humalog R, Novolin R, Iletin II Regular)

1½–1 h 2–3 h 4–6 h

Intermediate acting:

• NPH (neutral protamine Hagedorn)

2–4 h 4–12 h 16–20 h

(Humulin N, Iletin II Lente, Iletin II NPH, Novolin N

) 3–4 h 4–12 h 16–20 h

• Assoc. w/cigarette smoking

Manifestations:

• Early- anorexia, nausea, weight loss, flatulence, dull epigastric pain
• Fatal w/in 6 months regardless of treatment

(QUICK DEATH)

• Chronic liver disease by inflammation and fibrosis of liver tissue

3 classifications:

• Laennec's (Alcoholic) cirrhosis
• Biliary cirrhosis- obstruction of bile
• Posthepatic- postnecrotic; results from chronic liver disease such as hep. B & C

Manifestations:

• Protect form falls/injuries
• Electric razor- Risk for bleeding from abnm. clotting (Dec. PT production)
• Fluid Volume Excess
• Inc. Abdominal girth (from ascites)
• Muscle atrophy
• Asterixis- flapping tremor of hand (from inc. ammonia levels)
• Hepatic encephalopathy- lack of coordination, dec. memory, lack of orientation, coma (from inc. ammonia)

• Appendix becomes inflamed & edematous as result of kinked or occluded

Manifestations:

• Periumbilical pain (Right Lower Quad)
• Rebound tenderness
• Inflamed --> Pus --> Ischemic --> Gangrene

Manifestations:

• Pain relieved by antacids (Early)
• Dyspepsia (Indigestion)
• Early Satiety
• Weight loss
• Ab pain just above umbilicus
• Loss of appetite
• Bloating after meals
• Nausea & Vomiting

Management of Gastric Surgery:

• Asses nutritional status
• Assess complications (hemorrhage, infection, ab distention, atelectasis, impaired nutritional status, bile hemorrhage, dumping syndrome, dysphagia)

• Inflammation of gastric or stomach mucosa
• Gastric mucous membrane= edematous & hyperemic (Congested w/blood & fluid) & undergoes superficial erosion
• Lack of HCL

Manifestations:

• Ab discomfort
• Headache
• Nausea
• Anorexia
• vomiting
• Hiccuping
• Bleeding- blood in vomit or black tarry stools/ bright red stools

Management:

• Recovers in about 1 day

Complication:

• Motor disorder

Manifestations:

• Dysphagia (Diff. swallowing)
• Odynophagia (Pain swallowing)

Assessment/Diagnostic:

• Esophageal Monometry- measures motility & pressure= simultaneous contractions occur irreg.
• X-ray=barium swallow show sep. areas of spasm

Management:

• Sedatives & Nitrates= pain
• CCB= diffuse spasm
• Small freq. feedings + Soft diet
• Bougienage= Dilation
• Surgery (Laparascpic Modified Hellery Myotomy)

• Absent/ ineffective peristalsis

Manifestation:

• Difficulty w/ liquids and solids
• Food Regurgitation
• Chest pain/Pyrosis (Heartburn)

Management:

• Eat slowly
• Drink fluids w/meals
• CCB & Nitrates= Dec. esophageal pressure
• Pneumatic Dilation