1. Hepatitis A
➢ Commonly found in shellfish caught in contaminated water
➢ Food handlers
a. Precautions
Transmitted via the fecal-oral route.
Use gloves and a gown when providing care to the client and having contact with the client’s
stool
2. Hepatitis B
➢ Most commonly transmitted mother to baby
➢ Sexual transmission
➢ Needles
a. Nursing action
Teach patients taking immunomodulators and antivirals to avoid large crowds and people that are sick
When on drug therapy for Hep B:
➢ Teach risk for falls to prevent fractures - Can cause bone demineralization
➢ Monitor Kidney function - Drug is excreted through kidneys
➢ Teach patient to not discontinue without consulting PCP - Discontinuation can cause a flareup
3. Pancreatitis
Acute:
➢ Can be life-threatening inflammation of pancreas
➢ Autodigestion and fibrosis of pancreas
➢ Complications of acute pancreatitis
Risk factors:
➢ Biliary tract disease (gallstones
➢ Trauma
Assessment findings:
➢ Severe acute abdominal pain
➢ Jaundice
➢ Nausea and/or vomiting
➢ Elevated serum amylase level
➢ Leukocytosis
➢ Dyspnea
➢ Weight loss
Chronic:
➢ Progressive destructive disease of pancreas characterized by remissions and exacerbations
, ➢ Inflammation and fibrosis of tissue contribute to pancreatic insufficiency
Assessment findings:
➢ Abdominal pain
➢ Ascites
➢ Respiratory compromise
➢ Steatorrhea
➢ Weight loss
➢ Jaundice (Yellow, itching skin)
➢ Dark urine
➢ Polyuria, polydipsia, polyphagia
a. Labs
➢ Amylase
➢ Lipase
➢ Serum bilirubin and alkaline phosphatase
➢ ALT (If elevated = infection)
➢ WBC
➢ ESR
If these levels are elevated - Indicates Pancreatitis
4. Cirrhosis
➢ Characterized by widespread fibrotic (scarred) bands of connective tissue
➢ Tissue become nodular
➢ Nodules block blood and lymph flow
○ backflow of blood can cause: HTN, edema, destruction of brain tumor, biliary
obstruction, jaundice, itching of skin, spider nevi, ascites, esophageal varices (enlarged
veins)
➢ Liver shrinks in size and hardens
Hepatitis C - Leading cause of cirrhosis and liver cancer in the U.S
Alcohol use - Another main cause of cirrhosis
Labs:
➢ AST - if elevated, caused by alcohol
➢ ALT - if elevated, caused by infection
➢ Ammonia - goes up as there is less filtration ability
➢ Prothrombin time - will be prolonged - diseased liver decreases prothrombin production
➢ Serum bilirubin - will be increase - inability of the liver to excrete bile
➢ Albumin - will be decreases - inability of the diseased liver to produce it
➢ LDH - will be elevated
a. Signs/symptoms
, ➢ Fatigue
➢ weight change
➢ GI symptoms
➢ abdominal pain
5. Cholecystitis
Inflammation of the gallbladder
Patients most at risk - the 4 F’s
➢ Female
➢ Fourty
➢ Fat
➢ Fertile
Key Features:
➢ Episodic or vague upper abdominal pain or discomfort that can radiate to the right shoulder
➢ Pain triggered by a high-fat or high-volume meal
➢ Anorexia
➢ Nausea and/or vomiting
➢ Dyspepsia
➢ Eructation - (burping)
➢ Flatulence
➢ Feeling of abdominal fullness
➢ Rebound tenderness (Blumberg sign)
➢ Fever
➢ Jaundice, clay-colored stools, dark urine
➢ Steatorrhea (most common with chronic cholecystitis)
Older adults & patients with diabetes mellitus - atypical symptoms including; absence of pain and
fever. Localized tenderness may be the only presenting sign.
The older patient may become acutely confused (delirium) as the first symptom
Older adults become dehydrated much more quickly than other age-groups, and they may not present
with a fever. Monitor for a new onset of disorientation or acute confusion
The severe pain of biliary colic is produced by obstruction of the cystic duct of the gallbladder or
movement of one or more gallstones.
➢ When a stone is moving through or is lodged within the duct, tissue spasm occurs in an effort to
get the stone through the small duct.
➢ May be so severe that it occurs with tachycardia, pallor, diaphoresis, and prostration (extreme
exhaus-tion).
➢ Assess the patient for possible shock
➢ Notify the health care provider or Rapid Response Team if these symptoms occur. Stay with the
patient and keep the head of the bed flat if shock occurs.
, a. Patient teaching
Teach patient to avoid losing weight too quickly and to keep weight under control
Encourage small frequent meals
Avoid excessive intake of fatty foods
6. Peptic ulcer
➢ Occurs when mucosal defenses become impaired; epithelium not protected from effects of acid
and pepsin
➢ Duodenal, gastric, and stress ulcers
➢ Many caused by H.pylori
➢ NSAIDs are also a common cause
a. Signs/symptoms
Potential for upper GI bleeding due to gastric and/or duodenal ulceration or perforation
➢ Epigastric tenderness and pain
➢ Rigid, board-like abdomen with rebound tenderness and pain = peritonitis
➢ Dyspepsia
Monitor for:
➢ Peritonitis - at risk for perforation in which GI contents enter the abdomen
➢ Anemia - Bleeding can occur and as a result causing decreased hematocrit
➢ Hypotension - Bleeding can occur and as a result causing decreased blood pressure
Esophagogastroduodenoscopy (EGD) is used to rule out peptic ulcer disease
➢ Commonly found in shellfish caught in contaminated water
➢ Food handlers
a. Precautions
Transmitted via the fecal-oral route.
Use gloves and a gown when providing care to the client and having contact with the client’s
stool
2. Hepatitis B
➢ Most commonly transmitted mother to baby
➢ Sexual transmission
➢ Needles
a. Nursing action
Teach patients taking immunomodulators and antivirals to avoid large crowds and people that are sick
When on drug therapy for Hep B:
➢ Teach risk for falls to prevent fractures - Can cause bone demineralization
➢ Monitor Kidney function - Drug is excreted through kidneys
➢ Teach patient to not discontinue without consulting PCP - Discontinuation can cause a flareup
3. Pancreatitis
Acute:
➢ Can be life-threatening inflammation of pancreas
➢ Autodigestion and fibrosis of pancreas
➢ Complications of acute pancreatitis
Risk factors:
➢ Biliary tract disease (gallstones
➢ Trauma
Assessment findings:
➢ Severe acute abdominal pain
➢ Jaundice
➢ Nausea and/or vomiting
➢ Elevated serum amylase level
➢ Leukocytosis
➢ Dyspnea
➢ Weight loss
Chronic:
➢ Progressive destructive disease of pancreas characterized by remissions and exacerbations
, ➢ Inflammation and fibrosis of tissue contribute to pancreatic insufficiency
Assessment findings:
➢ Abdominal pain
➢ Ascites
➢ Respiratory compromise
➢ Steatorrhea
➢ Weight loss
➢ Jaundice (Yellow, itching skin)
➢ Dark urine
➢ Polyuria, polydipsia, polyphagia
a. Labs
➢ Amylase
➢ Lipase
➢ Serum bilirubin and alkaline phosphatase
➢ ALT (If elevated = infection)
➢ WBC
➢ ESR
If these levels are elevated - Indicates Pancreatitis
4. Cirrhosis
➢ Characterized by widespread fibrotic (scarred) bands of connective tissue
➢ Tissue become nodular
➢ Nodules block blood and lymph flow
○ backflow of blood can cause: HTN, edema, destruction of brain tumor, biliary
obstruction, jaundice, itching of skin, spider nevi, ascites, esophageal varices (enlarged
veins)
➢ Liver shrinks in size and hardens
Hepatitis C - Leading cause of cirrhosis and liver cancer in the U.S
Alcohol use - Another main cause of cirrhosis
Labs:
➢ AST - if elevated, caused by alcohol
➢ ALT - if elevated, caused by infection
➢ Ammonia - goes up as there is less filtration ability
➢ Prothrombin time - will be prolonged - diseased liver decreases prothrombin production
➢ Serum bilirubin - will be increase - inability of the liver to excrete bile
➢ Albumin - will be decreases - inability of the diseased liver to produce it
➢ LDH - will be elevated
a. Signs/symptoms
, ➢ Fatigue
➢ weight change
➢ GI symptoms
➢ abdominal pain
5. Cholecystitis
Inflammation of the gallbladder
Patients most at risk - the 4 F’s
➢ Female
➢ Fourty
➢ Fat
➢ Fertile
Key Features:
➢ Episodic or vague upper abdominal pain or discomfort that can radiate to the right shoulder
➢ Pain triggered by a high-fat or high-volume meal
➢ Anorexia
➢ Nausea and/or vomiting
➢ Dyspepsia
➢ Eructation - (burping)
➢ Flatulence
➢ Feeling of abdominal fullness
➢ Rebound tenderness (Blumberg sign)
➢ Fever
➢ Jaundice, clay-colored stools, dark urine
➢ Steatorrhea (most common with chronic cholecystitis)
Older adults & patients with diabetes mellitus - atypical symptoms including; absence of pain and
fever. Localized tenderness may be the only presenting sign.
The older patient may become acutely confused (delirium) as the first symptom
Older adults become dehydrated much more quickly than other age-groups, and they may not present
with a fever. Monitor for a new onset of disorientation or acute confusion
The severe pain of biliary colic is produced by obstruction of the cystic duct of the gallbladder or
movement of one or more gallstones.
➢ When a stone is moving through or is lodged within the duct, tissue spasm occurs in an effort to
get the stone through the small duct.
➢ May be so severe that it occurs with tachycardia, pallor, diaphoresis, and prostration (extreme
exhaus-tion).
➢ Assess the patient for possible shock
➢ Notify the health care provider or Rapid Response Team if these symptoms occur. Stay with the
patient and keep the head of the bed flat if shock occurs.
, a. Patient teaching
Teach patient to avoid losing weight too quickly and to keep weight under control
Encourage small frequent meals
Avoid excessive intake of fatty foods
6. Peptic ulcer
➢ Occurs when mucosal defenses become impaired; epithelium not protected from effects of acid
and pepsin
➢ Duodenal, gastric, and stress ulcers
➢ Many caused by H.pylori
➢ NSAIDs are also a common cause
a. Signs/symptoms
Potential for upper GI bleeding due to gastric and/or duodenal ulceration or perforation
➢ Epigastric tenderness and pain
➢ Rigid, board-like abdomen with rebound tenderness and pain = peritonitis
➢ Dyspepsia
Monitor for:
➢ Peritonitis - at risk for perforation in which GI contents enter the abdomen
➢ Anemia - Bleeding can occur and as a result causing decreased hematocrit
➢ Hypotension - Bleeding can occur and as a result causing decreased blood pressure
Esophagogastroduodenoscopy (EGD) is used to rule out peptic ulcer disease
