Disease: Disease: Disease:

Cirrhosis Pancreatitis Celiac Disease

Description: Scarring of the Liver Description: inflammation of the pancreas leading to Description: autoimmune GI disorder, causes damage
digestion by its own enzymes and irreversible to the small intestine, specifically the intestinal villi.
structural damage to the organ

Cause: Cause: Cause:

Viral infections: Hep C and B Gallstone Genetics
Alcohol High alcohol consumption Ingestion of Barley, Rye, Oats, Grains,Wheat
Too much fat collecting tin the liver, obese, Cystic Fibrosis
hyperlipedimia, diabetics
Problem with bile duct
Autoimmune

Risk Factors: Risk Factors: Complications:

Malnourishment
Cancer (Lymphoma)
Refractory Celiac Disease

S/Sx: THE LIVER IS SCARRED S/Sx: S/Sx :MALNOURISHED

Tremors of hands (asterixis) Abdominal pain Mouth Ulcers
Hepatic foetor Pain worsth when lying flat Anemia
Eye and skin yellowing (jaundice) Pain after greasy or high fat meal or alcohol Lactose Intolerance
Loss of appetite Fever, increased HR, decreased BP Nausead and Vomiting
Increase BilirubinEdema in legs Nausea and Vomiting Osteo changes
Varices (esophageal and gastric) Hyperglycemia Unexplained slow growth, delay puberty, weight loss
Reduced platelets and WBCs Cullens sign( bluish discoloration in the belly button) Rashes
Itchy skin Turners sign(bluish discoloration in the flanks) Irregular periods, irritable,
Spider angiomas Steatorrhea Stools: greasy and odorous
Splenomegaly Weight Loss Hair loss
Confusion or Coma (high ammonia) Jaundice Enamel changes to the teeth
Ascites (low albumin, congestion) Dark urine d/t excessive bile in the body Diarrhea
Redness on the palms of hands S/Sx of DM d/t pancreas not working
Renal failure
Enlarged Breast in men
Deficient vitamins (ADEK, C and B12)

Nrsng Mgt: Nrsng Mgt: Nrsng Mgt:

Monitor for bleeding (PT and INR)
Monitor for Esophageal varices
Check mental status (confusion)
Monitor for hyper/hypoglycemia
Assess for sclera and skin color
NPO, (If sx subside reintroduce solids carefully) Assess for s/sx of celiac diease
IV hydation, TPN Instruct patien to keep a food diary log
NGT per MD order Educate to read food labels and avoid all food
Monitor CBG containing gluten.
Monitor stools: Steatorrhea? Implement gluten free diet and administer (foods to
Monitor nutrition avoid, WHEAT, BARLEY, MALT, BEER, PASTA
Pain meds but NO MORPHINE NOODLES, RYE, SEASONINGS, SOUP, CROUTONS,
Position: leaning forward or sitting CRACKERS, BREADS, DOUGH, MOST CEREALS AND
Avoid alcohol or greasy/ fatty food OATS)
Low Fat. Bland small meals Supplementations as per MD order
Limit sugar and refined carbs

Meds/Treatment: Meds/Treatment: Meds/Treatment:

Liver Transplant, Pancreati Enzymes: Creon/Pancreatin Bld test ( Tissue Transglutaminase Antibodies, IgA
Shunting surgery (helps with ascites) Administer drug to decrease acide secretions like serum, IgA Endomysial Antibody)
Diuretics PPIs, H2 blockers, antacids per MD order
Beta Blockers (slows the HR), Lactulose (ammonia)
Administer blood products and Vit. K
Paracentesis
Nitrates
Disease: Disease: Disease:
GERD Peptic Ulcer Disease Crohn’s Disease

Description: Stomach contents back flow d/t Description: Description: IBD that causes inflammation and ulcers
damaged/weak lower esophageal sphincter. Ulcer formation which affects the mucosal lining of formation in the GI, can be found in both large and
the stomach small intestines.
Cause: Cause: Cause: Genetics
Weak LES due to hiatal hernia, pregnancy, obesity, Bacterial infections Environment: (allergens to cow’s milk, stress, illness,
overeating, medications like antihistamins CA NSAIDs use – long term virus, bacteria, NSAIDs usage
channel blockers, antidepressants, sedatives and Zollinger-Ellison Syndrome
smking

Complications: Complications: Complications:

Inflammation of the esophagus G Bleed, Perforations, Peritonitis, Abscess
Narrowing of the esophagus, strictures Obstruction in Pylorus, Fistulas
Dumping Syndrome Malnourishments
Fissures- tears in anal area
Strictures: can lead to obstructions
S/Sx: S/Sx: S/Sx:
Gastric pain (upper) Mainly Indigestion and Epigastric Pain. Abdominal pain at RL side
Excess regurgitation of food (bitter taste in mouth) GASTRIC: (Pain worse with 1-2 hrs after eating, dull Ulcers in mouth and GI tract
Burning sensation in the chest and abdomen and aching, weight loss, vomit blood more common Diarrhea
Dry cough wost at night in severe cases) Loss of appetite and wight
Nausea Fissures in anus with bleeing
Problems swallowing DUODENAL: (pain when stomach is empty, about 3-4 Bloating of abdomen (inflammation)
Lung Infections hrs after eating, gnawing pain, wake in the middle of
the night pain, normal weight, tarry dark stool from
GI bleed in severe cases)

Nrsng Mgt: Nrsg Mgt: Nrsg Mgt: Goal: control flare up and maintain
Eat small meals Assess for bowel sounds, pain quality and medical hx. remission.
Avoid greasy, fatty, alcohol, soft drinks, coffee, Avoid spicy, acidic, foods with caffeine, chocolate, Smoking cessation, monitor weights and I&O,
peppermint/spearmint soft drinks, fried foods, alcohol, monitor for pain bloating, freq of BM.
Void eating right before bed LOW FIBER DIET that is bland. Educate patient to avoid, High Fiber Foods, Hard to
Sit up after eating for 1 hr. digest foods like nuts, raw veggies, for fruits.,
Weight Loss, Smoking cessation Allergen type of food like dairy, fish, spicy, high fat
WOF: citrus and tomatoes foods, gluten, gas causing foods like onions, beans.
Meds as per MD order DURING FLARE UP: Low fiber diet, High protein and
stay hydrated

Meds/Treatment: Meds/Treatment: Meds/Treatment:

Antacids: (neutralize acid) allow 1-2 hours before
administering other meds. (MAG. HYDROXIDE, CA.
CARBONATE)
H2 Receptors (decrease secretions of acid) ex.
RANITIDINE, ZANTAC, FAMOTIDINE. Don’t give with
antacid or Carafate.
PPI: decrease stomach acid (OMEPRAZOLE, PRILOSEC,
PANTOPRAZOLE, PROTONIX), No to long term use, it
can cause BONE FRACTURES
PROKINETICS: Prevent delayed gastric emptying
(BETHANECHOL URECHOLINE, REGLAN
METOCLOPRAMIDE)
Antacids- neutralizes stomach acid (MG. HYDROXIDE,
CA. CARBONATE) give alone, allow 1-2 hr a other
meds.
Mucosal Healing: SUCRALFATE- empty stomach.
Histamine Receptor- decrease gastric secretions.
RANITDINE, FAMOTIDINE
BISMUTH SUBSALICYLATES: Pepto-Bismol- Use for H.
pylori infections. Used with natibiotics, PPIs and H2
blockers
PPI- decrease gastric acide OMEPRAZOLE,
PANTOPRAZOLE
Antibiotics- Clarithromycin, Metronidazole,
Tetracyclines, Amoxicilline to treat H. pylori
infections.
Anti Inflammatory, Andiarrheals,
5-Aminosalicylates (5-ASA) Sulfasalazines-first line for
mild cases.
Steroids: Prednisone (S/E: hyperglycemia, thinning of
skin, easy bruising, osteoporosis, risk for infection
NO NSAIDS, Tylenol only
Antibiotics: Ciprofloxacin
IMMUNOSUPPRESSORS: “Azatioprine/Imuran- to
suppress immune system. Risk for infections and
cancer, no live vaccine like MMR, Varicella, Shingles
IMMUNO MODULATORS: Adalimumab/Humira or
Inflixmab/Remicade (Tumor Necrosis Factor Blocker)
MD will check pt for TB a starting meds) increase risk
for cancer, no live vaccines.
Disease: Disease: Disease:
Ulcerative Colitis Appendicitis Diverticulosis and Diverticulitis

Description: Inflammation and ulcers in the inner
lining of colon and rectum (large intestines)
Cause:
Description: inflammation of the appendix
Cause:
Obstruction of some form: fecalith, parasites, foreign
body that may have been ingested
Swollen lymph nodal tissue
Trauma
Description: Diverticulosis- formation of hollow sac
cavities throughout the intestinal wall. Outpouching
sac.
Complications of DIVERTICULOSIS
Diverticular Bleeding-painless bleeding and bright
blood in the stool.
Strictures/bowel obstructions
Fistula
Diverticulitis

Complications: Risk Factors: Complications of DIVERTICULITIS

Rupture of the Bowel- leads to peritonitis Abscess
Tosic Megacolon- Abd. Distention, fever, diarrhea, Rupture of Diverticulum which can lead to peritonitis
abd pain, dehydration, tachycardis, hypoactive bowel Obstruction due to inflammation of the tissues
sounds. Fistula formation
Lead Pipe Sign

S/Sx: ULCERS S/Sx: APPENDIX S/Sx: DIVERTICULITIS

Urgent/Frequent need to have bowel movements ABD. Pain
Loss of weight, low RBC Point of Mc Burney’s Pain in the abdomen in the LLQ
Cramps in abdomen, very painful Poor Apetite Observe abdominal bloating and blood in the stool
Electrolytes imbalances, Elevated temperature Elevated Temperature Unrelenting cramping type pain
Rectal Bleeding Nausea/Vomiting Constipation
Severe Diarrhea (Pus, Blood, Mucous) Desire to be in the fetal Position to relieve pain High temperature
Increased WBC
eXperiences rebound tenderness

Nrsng Mgt: Nrsng Mgt: Nrsg Mgt:

Monitor VS, pts bowel movements,
Keep pt hydrated, monitor daily weights,
WOF S/Sx of peritonitis (distentions or abnormal
bloating, increased HR, tachypnea, pain)
WOF S/Sx of Toxic megacolon
NPO with IV Hydration
Foods to be avoided during flare ups- high fiber
foods, foods that are hard to digest like nuts, raw
veggies, fruits,
Allergen type of foods like dairy or certain foods that
the person may be intolerant too like wheat, fish
Avoid spicy, high fat foods, gluten, gas forming, like
onions, beans.
Low fiber foods during flare ups
Monitor for appendix rupture (relief or pain after Monitor GI and Diet status closely.
which intense abd pain) Administer meds as order.
NPO, no pain meds, no heat, no enemas or laxatives NPO at first, but once recovered needs to consume
WOF S/SX of peritonitis: intense abd pain, increase high fiber foods.
RR and Temp, abd distention and bloating Drink 2-3L of water
POST APPENDECTOMY:
Monitor VS and Surgical Site for infection.
Ambulate, Incentive spirometer
IV antibiotics, Maintain NGT
Encourage high fiber diet
Monitor bowel sounds; (BM- 2 to 3 days post op)
If lap appendectomy: pt may experience shoulder
pain.

Meds/Treatment: Meds/Treatment: Meds/Treatment:

Regular Screening for Colon Cancer Diagnostic test: Colonoscopy MD may order TPN/IVF or fat emlusions
MEDS SAME AS WITH CROHNS Ba. Enema MD may prescribe Psyllium (Metamucil) mis in 80z of
Antidiarrheal-use sparingly to avoid toxic megacolon water.
PROCTOCOLECTOMY-complete removal o colon and Sx: Appendectomy
rectum. Goal: avoid constipation
ILEOANAL ANASTOMOSIS (J-POUCH)- Colon and Appendicitis not treated within 48 to 72 hours –
rectum removed and a pouch is created, attached there is a risk for rupture which will lead to abscess
ileum to anus. and peritonitis
Disease:

Description:

Cause:

Risk Factors:

S/Sx: THE LIVER IS SCARRED

Nrsng Mgt:
Meds/Treatment: