Nursing care management of digestive system disorders for Nursing schools

## **Presentation Description**

**Title:** Gastrointestinal Disorders: Symptoms, Causes, and Management

**Overview:**

This comprehensive presentation provides a detailed overview of various gastrointestinal (GI) disorders, their associated symptoms, and potential causes. It covers a wide range of conditions, including upper and lower GI symptoms, hepatobiliary disorders, pancreatic issues, and other GI-related problems.

**Key Topics:**

* **Symptoms of GI Disorders:**
- Upper GI symptoms (mouth, dysphagia, reflux, nausea, vomiting)
- Lower GI symptoms (diarrhea, constipation, distension, bleeding)
- Hepatobiliary symptoms (pain, jaundice, hepatitis)
- Pancreatic symptoms (dyspepsia, pain, diabetes)
- Other GI symptoms (bloating, pain, dyspepsia)

* **Specific Conditions:**
- Vomiting: Causes, complications, and management.
- Diarrhea: Types, causes, and treatment.
- Abdominal pain: Localization and potential causes.
- Gastrointestinal bleeding: Upper and lower GI bleeding, causes, and management.
- Gastritis, gastroenteritis, and ulcers: Symptoms, causes, and treatment.
- Appendicitis, peritonitis, and hepatic encephalopathy: Overview, symptoms, and management.
- Other conditions: Cholecystitis, fatty liver disease, hepatitis, liver cirrhosis, and portal hypertension.

* **Investigations and Management:**
- Laboratory investigations (stool analysis, blood tests, imaging studies)
- Endoscopy procedures (EGD, colonoscopy)
- Treatment options (medications, surgery, lifestyle changes)

**Target Audience:**

This presentation is suitable for healthcare professionals, medical students, and individuals interested in understanding common GI disorders and their management.

**Purpose:**

To provide a comprehensive resource for understanding and managing various gastrointestinal disorders. The presentation aims to educate viewers on the symptoms, causes, and potential treatments for these conditions.

1. Nursing care of Digestive System Disorders
Dr. Mysara Mogahed
Professor of Internal
medicine.
Benha University

3. S ymptoms of the gas trointestinal
disorders 1- upper gas trointestinal symptoms:
a-Mouth symptoms: stomatitis, bleeding gums, dryness of
mouth, water brash(sudden filling of the mouth with tastless
secretion).
b-Dysphagia(difficulty of swallowing), Odynophagia(painful
swallowing).
c-Reflux, regurgitation, heartburn.
d-nausea, vomiting, hematemesis.

4. 2-Lower gastrointestinal symptoms:
a-Diarrhea, tenesmus, constipation.
b-Distension, flatulence, borborygmi(audible intestinal sounds).
c-Melena, bleeding per rectum.
d-passage of parasite from the anus.
3-Hepatobiliary symptoms:
a-Right hypochondrial pain.
b-biliary colic, biliary dyspepsia.
c-jaundice, change in urine color, change in stool color,
body itching.
d-symptoms suggesting hepatitis, symptoms of liver cell failure.
e-disturbed consciousness with hepatic encephalopathy.

5. 4-Pancreatic symptoms:
a-pancreatic dyspepsia, malabsorption, steatorrhea.
b-pancreatic pain, epigastric mass.
c-symptoms suggesting hypoglycemia, hypercalcemia, diabetes.
5-Other gastrointestinal symptoms:
a-abdominal bloating and distension.
b-abdominal pain.
c-dyspepsia.

6. Def:
Vomiting
Vomiting is a forceful explanation of gasteric contents through the mouth as a result
of retrograde Contraction of gasteric antrum.
Nausea is unpleasent feeling of impending to vomit.
Causea of vomiting:
1-gastrointestinal causes:
Nasopharynx : inflammation, mechanical stimulation.
Esophageal: esophagitis, esophageal irritation.
Gasteric : gasteritis, gasteric ulcer, cancer, pyloric obstruction.
Intestinal : intestinal colic, intestinal obstruction, parasitic infestation.
Hepatobiliary: cholecystitis, biliary colic, hepatitis, acute liver damage.
Peritoneal disease such as peritonitis.

7. 2-Non- gastrointestinal causes:
1.Renal causes: renal colic, pyelonephritis.
2.Cardiac causes: myocardial infarction, heart failure, tachycardia.
3.Respiratory causes: sever cough.
4.Central nervous system: migraine, increased interacranial tension.
5.Obstetric : hyperemesis gravidarum, ectopic pregnancy.
6.Gynecological causes:dysmenorrhea.
7.Ocular: glucoma.
8.Labyrinthine disorders: motion sickness, Meniere’s disease.
9.Metabolic disease: Uremia, hepatic failure.
10.Endocrinal :diabetic ketoacidosis, hyperthyrodism.
11.Electrolyte imbalance.
12.Allergic reaction.
13.Drug-induced vomiting.
14.Post operative nausea & vomiting.
15.Psychogenic.
16.Hysterical.

8. Complications of vomiting:
1.Loss of fluid: dehydration
2.Loss of HCL from the stomach leading to metabolic alkalosis.
3.Loss of diet: nutritional defficiency.
4.Aspiration of vomiting: aspiration pnumonia.
5.Precipitate hepatic encephalopathy.
6.Mallory-weiss syndrome: recurrent vomiting followed by hematemesis.

9. Diarrhea
Def:
Diarrhea is increased stool weight to more than
300gm/day, increase in stool frequency with increased
fluidity. The patient usually complains of frequent
motions more than 3 times/day
Diarrhea may be either;
Acute diarrhea: Diarrhea less than 3 wk duration
Chronic diarrhea: presist for more than 4 wks.

10. What causes diarrhea?
Diarrhea may be caused by many things, including:
•A bacterial infection
•A virus
•Trouble digesting certain things (food intolerance)
•Food allergy (such as celiac disease, gluten allergy)
•Parasites that enter the body through food or water
•A reaction to medicines
•An intestinal disease, such as inflammatory bowel disease
•(functional bowel disorder), such as irritable bowel syndrome
•A result of surgery on the stomach or gall bladder
•Metabolic conditions such as thyroid problems
•Other less common reasons such as damage from radiation treatments
tumors that make too many hormones

11. Abdominal pain
Abdominal pain , is frequent complaint of gastrointestinal disorder.
Causea of abdominal pain:
1-right upper quadrant pain:
•Pneumonia, basal pleurisy.
•Liver: hepatitis, liver abscess, congestion, neoplasm.
•Gall bladder: cholecystitis, gall bladder stone.
•Duodenum: perforated dudenal ulcer.
2-right flank pain:
•pyelonephritis, renal abscess, hydronephrosis.
•Renal/ureteric stone.
3-right lower quadrant pain:
•Appedicitis
•Terminal ileitis
•Mesentric adenitis

12. 4-epigasteric pain:
•Cardiac: ischaemia, myocardial infarction.
•Oesphagus: esopahgitis, Esophageal spasm
•Stomach/duodenum: gasteritis, peptic ulcer.
•Pancrease: pancreatitis, cancer.
•Irritable bowel syndrome
•Inflammatory bowel disease.
•Peritonitis.
•Systemic conditions: Rheumatic fever, diabetic ketoacidosis.
5-periumbilical pain:
•Gastroenteritis
•Appendecitis
•Intestinal obstruction
•Aortic aneurysm
6-suprapubic pain
•Colitis
•Irritable bowel syndrome
•Urinary bladder: cystitis, acute urine

13. 7-left upper qudrant pain:
•Basal pneumonia, basal pleurisy
•Cardiac: ischemia, infarction.
•Spleen: abscess, rupture, splenomegaly.
•Stomach: perforated ulcer.
8-left flank pain:
•Renal: pyelonephritis, renal abscess.
•Ureter: stones.
•Spleen: abscess, rupture, splenomegaly.
9-left lower quadrant pain:
•Left colon: diverticulosis, ischemic colitis, inflammatory bowel disease.
•Ectopic pregnancy
•Left salpingitis
•Left ovarian torsion.

14. Investigations for gastrointestinal disorders
1-Laboratory investigations :
•Stool analysis.
•Blood test: CBC, ESR, liver function test, serum electrolytes, pancreatic enzymes.
•Antibodies to H.pylori.
•Urea breath test to H.pylori.
•Antibodies for celiac disease.
•CA 19.9 a tumor marker in pancreaticobiliary malignancy.
2-Imaging studies:
•Plain X-ray
•Barium study.
•Ultrasonography
•Computed tomography(CT).
•Magnetic resonance imaging(MRI).

15. 3-Endoscopy:
•Esophagogastroduodenoscopy
•Enteroscopy
•Colonoscopy
•Sigmoidoscopy
•Proctoscopy
•Video capsule endoscopy
4-Other investigations:
•Manometeric studies: esophageal and anorectal
•Biopsy: from the affected tissues or organs

16. Gastrointestinal bleeding
Def:
Bleeding or hemorrhage from the gastrintestinal tract.
Which may be:
•Upper GIT bleeding : the source is proximal to ligament of Treitz.
•Lower GIT bleeding : the source is distal to ligament of Treitz.
Gastrointestinal bleeding may be : acute or chronic.
Gross or occult
Clinically patients with GIT bleeding can present with:
Hematemesisi : means vomiting of blood.
Melena : passage of digested black blood with stool( dark, black, tarry, liquid,
and metallic smell stool)
Bleeding per rectum: passage of bright red blood or clots per rectum.
Occult gastrointestinal bleeding : refres to gastrointestinal blood loss that is
small in volume and not apparent to the patient but is detectable by tests for fecal
occult blood.

17. Acute gastrointestinal bleeding.
Causes of gastrointestinal bleeding :
A. Upper gastrointestinal bleeding:
1- esophageal causes:
•Esophageal varices.
•Esophagitis, including reflux esophagitis.
•Esophageal ulcers, esophageal cancer.
•Mallory-Weiss tear.
2- stomach causes:
•Bleeding peptic ulcer.
•Acute gastric erosions, acute gastritis.
•Gastric carcinoma.
•Gastric fundal varices.
3- systemic causes: hemorrhagic disorders, anticoagulant therapy.

18. B- Lower gastrointestinal bleeding:
Lower gastrointestinal bleeding can be manifested by melena, bleeding per rectum, or occult blood loss in stool
A- Melena:
oCauses of melena include:
1.All causes of upper GIT bleeding.
2.Small intestine
•Small bowel tumor
•Tuberculosis, bleeding typhoid ulcer.
•Crohn’s disease.
3.Colon: include
•Right sided colonic tumor.
•Inflammatory bowel disease.
B- Bleeding per rectum:
1.Colon:
•Colonic cancer, colonic polyp.
•Diverticulosis.
•Ulcerative colitis.
•Vascular lesions such as angioma.

19. 2.Anus and rectum :
•Piles, anal fissure.
•Rectal ucer, rectal cancers
•Anal and rectal polyp.
•Bilharziasis
3-systemic disease : hemrrhagic diorders, anticoagulant therapy.
Diagnosis of acute gastrointestinal bleeding:
A- clinical assessment:
•Clinical presentation:: hematemesisi, melena, or occult blood loss.
•Rectal examination: (for piles, fissure)
•Clinical manifestation of the underlying etiology.
B- nasogastric tube insertion and aspiration :
•Determine wheather the source of bleeding is in the upper part of the GIT.
•Estimation of the severity of bleeding.
•Can determine the wheather the the bleeding is presistent or recurrent.
•Cleaning the the stomach prior to diagnostic endoscopy.

20. C- endoscopy in the upper GIT bleeding
1-upper GI endoscope :
•Detect the site of bleeding.
•Can obtain biopsy for diagnosis.
•TTT as sclerotherapy and/or band ligation.
2-Lower GI endoscope.
D- Other investigations :
•Barium swallow and barium meal.
•Barium enema.
•Angiography.
Management of acute upper GIT bleeding:
1- General treatment measures:
•Hospitalization.
•Insertion of one or more large bore cannulae.
•Send blood sample for typing and cross matching.
•Blood transfusion.
•Gastric acid supression.

21. 2- nasogastric tube
3- Endoscope.
4- Medical therapy : “ proton pump inhibitors”, discontinue aspirin, NSAID, Eradication of H. pylori.
5- Other TTT: Angiographic or surgical TTT.

22. GASTRITIS
– Acute gastritis is the irritation and inflammation
of the stomach's mucous lining.
–Gastritis may be caused by a chemical, thermal,
or bacterial insult. Eg: Drugs such as alcohol,
aspirin, and chemotherapeutic agents. Hot,
spicy, rough, or contaminated foods.
–Management involves symptomatic treatment
measures after removal of the causative agent.

23. Gastroenteritis
•It is inflammation of the stomach and intestines.
•It is caused by bacteria and viruses.
•Other causes include parasites, food allergens, drug reactions
to antibiotics, and ingestion of toxic plants.
•S&S: Pain, cramping, belching, nausea, and vomiting. Severe cases
may include hematemesis. Diarrhea may occur with
gastroenteritis.
•Treatment is the same as for gastritis, with the addition of
anti- microbial drugs for severe cases.

24. Nursing implications
(1)Stop all P.O. intakes until symptoms subside.
(2)medications such as antacids and antiemetics.
(3)Monitor intake and output closely. Excessive
vomiting or diarrhea may result in severe
electrolyte depletion that will require replacement
therapy.
(4)Administer and monitor IV therapy when ordered
to replace lost fluids.
(5)Weigh daily to monitor weight loss.
(6)Encourage the prescribed diet to maintain nutrition.

25. GASTROINTESTINAL ULCERS
A gastrointestinal ulcer is a break in the continuity of the mucous lining.
Ulcers commonly occur in the lower esophagus, the stomach, and the
duodenum.
Other factors implicated in the development of ulcers.
(1)Emotional stress.
(2)Prolonged physical stress associated with trauma, surgery, burns,
and so forth.
(3)Hereditary factors.
(4)Certain drugs and medications. Eg: alcohol, caffeine,
aspirin, corticosteroids, and chemotherapeutic agents.

26. The primary symptom of ulcers is
•Pain: (burning, cramping, aching, or gnawing pain in the
stomach area between the xiphoid process and the umbilicus.)
•The severity of the pain is generally an indication of the extent of
the ulceration.
•Pain is normally localized, the patient being able to indicate the
area of the pain by pointing one finger.
•Radiating pain indicates a severe or perforated (ruptured) ulcer.

27. Nursing implications:
The first objective is to promote gastric rest.
The second objective is prevention of further ulceration.
(1)Encourage physical and emotional rest by using relaxation
techniques and prescribed medications (such as sedatives and
tranquilizers) to reduce anxiety, restlessness, and insomnia.
(2)Practice prophylaxis (prevention) by use of antacids. Avoidance
of irritants such as aspirin, alcohol, caffeine, and spicy foods.
(3)Dietary management aids in control of pain and prevention of
ulcers. Meals should be frequent, regular, and small to moderate in size.
Foods not well tolerated should be eliminated. Daily intake should be of
sufficient caloric and nutritive value to maintain health. (4) When
ulceration is in the acute stage, diet should be modified to consist of
bland, low-fiber, non-gas-producing foods. Foods that are mechanically,
chemically, and thermally nonirritating to the stomach.

28. (5)Observe for signs and symptoms such as nausea, vomiting,
blood in emesis or stool, abdominal rigidity, or abdominal pain.
These symptoms may indicate the presence of bleeding,
rupture, or obstruction at the ulcer site.

29. APPENDICITIS
Appendicitis is the inflammation of the vermiform appendix.
The appendix fills with food and empties regularly.
Because its lumen is quite small, it empties irregularly and is
prone to obstruction.
The obstruction sets off an inflammatory process that may lead to
infection, necrosis, and perforation.

30. Signs and Symptoms.
(1)Generalized abdominal pain that localizes in
the right lower quadrant.
(2)Anorexia.
(3)Nausea and vomiting.
(4)Abdominal rigidity or guarding.
(5)Rebound tenderness.
(6)Fever.
(7)Elevated white blood cell count.

31. Nursing Implications.
(1)Administer IV fluids as ordered to
maintain hydration.
(2)Keep the patient NPO until symptoms
subside and/or surgery is ruled out.
(3)Position the patient in Fowler's or semi-
Fowler's position. This position relaxes the
abdominal muscles and reduces pain.
(4)Never apply heat to the abdomen, as this
may cause the appendix to rupture.
(5)Analgesics are normally withheld since they
mask symptoms.

32. Treatment.
Treatment of choice is surgical removal of the appendix,
especially if rupture is suspected or imminent.
(1)If the appendix can be removed before it ruptures, the
post- op course is generally uncomplicated. The wound is
closed and the patient is usually discharged within a week.
(2)If rupture has occurred, the wound is often left open to
drain. The patient must be observed for signs and symptoms of
obstruction, peritonitis, hemorrhage, or abscess.

33. PERITONITIS
•The peritoneum is the serous membrane that lines
the abdominal cavity and covers the visceral organs.
•Peritonitis is inflammation of the peritoneum.
•Inflammation may be generalized throughout the
peritoneum, affecting the visceral and parietal surfaces
of the abdominal cavity, or may be localized in one
area as an abscess.

34. •Peritonitis occurs as a result of leakage of contents
from an abdominal organ into the abdominal cavity.
•Results from perforation of the GI tract,
allowing bacterial contamination of the
peritoneum.
•Result of chemical irritation, and subsequent infection,
caused by rupture of an organ. (For example, the
ovaries, spleen, or urinary bladder.)

35. Signs and symptoms.
(1)Diffuse pain that eventually localizes in the area of
the underlying process.
(2)Abdominal tenderness.
(3)Abdominal muscle rigidity.
(4)Nausea and vomiting.
(5)Fever.
(6)Rapid pulse rate.
(7)Elevated WBC.

36. Nursing implications.
(1)Observe for signs of hypovolemia and shock. These
conditions may result from loss of fluids and
electrolytes into the abdominal cavity.
(2)Strictly monitor I&O and vital signs.
(3)Observe safety precautions, since fever and pain
may cause the patient to become disoriented.
(4)Administer prescribed medications and intravenous
fluid replacement.

37. Symptoms of Hepatobiliary disorders
Biliary disease refers to diseases affecting the liver, bile ducts, gallbladder
and other structures involved in the production and transportation of bile.
symptoms common to many of the disorders include:
•Jaundice (yellowing of the skin and whites of the eyes)
•Abdominal pain, especially in the upper right side of the abdomen under the rib cage
•Nausea or vomiting
•Loss of appetite, which may result in weight loss
•Fatigue
•Fever or chills
•Itching
•Light brown urine
•Greasy or clay-colored stools
Detection and diagnosis
The tests performed vary according to the suspected bile duct disorder. However, tests
commonly performed to diagnose many bile duct disorders may include:

38. •Blood tests
•Liver function tests
•Ultrasound
•Endoscopic ultrasound
•Computed tomography (CT) scan
•Magnetic Resonance Imaging (MRI)
•Endoscopic retrograde cholangiopancreatography (ERCP)
•Liver biopsy

39. Cholecystitis
Chronic cholecystitis: is usually due to long standing gall bladder
inflammation
Cholelithiasis: Formation of GALLSTONES in the biliary apparatus
Signs and symptoms :
1.Indigestion, belching and flatulence
2.Fatty food intolerance
3.Epigastric pain that radiates to the scapula
or localized at the RUQ
4.Mass at the RUQ
5.Jaundice
6.dark orange and foamy urine

40. NURSING INTERVENTIONS :
1.Maintain NPO in the active phase
2.Administer prescribed medications to relieve pain
3.Instruct patient to AVOID HIGH- fat diet and GAS-
forming foods
4.Assist in surgical and non-surgical measures
5.Surgical procedures- Cholecystectomy, laparoscopy

41. Post-operative nursing interventions:
1.Monitor for surgical complications
2.Post-operative position after recovery from anesthesia- LOW
FOWLER’s
3.Encourage early ambulation
4.Administer medication before coughing and deep breathing exercises
5.Advise client to splint the abdomen to prevent discomfort
during coughing
6.Administer analgesics, antiemetics, antacids
7.Care of the biliary drainage .
8.Fat restriction is only limited to 4-6 weeks. Normal diet is resumed

42. What is fatty liver disease?
Fatty liver disease
Fatty liver disease (steatosis) is a common condition caused by having too much fat
build up in your liver. A healthy liver contains a small amount of fat. It becomes a
problem when fat reaches 5% to 10% of your liver’s weight.
Why is fatty liver disease bad?
In most cases, fatty liver disease doesn’t cause any serious problems or prevent
your liver from functioning normally. But for 7% to 30% of people with the
condition, fatty liver disease gets worse over time. It progresses through three
stages:
1.Your liver becomes inflamed (swollen), which damages its tissue. This stage is
called steatohepatitis.
2.Scar tissue forms where your liver is damaged. This process is called fibrosis.
3.Extensive scar tissue replaces healthy tissue. At this point, you have cirrhosis
of the liver.

43. What causes fatty liver disease?
Some people get fatty liver disease without having any pre-existing conditions. But these
risk factors make you more likely to develop it:
•Having overweight/obesity.
•Having Type 2 diabetes or insulin resistance.
•Having metabolic syndrome (insulin resistance, high blood pressure,
high cholesterol and high triglyceride levels).
•Taking certain prescription medications, such
as amiodarone(Cordarone®), diltiazem (Cardizem®), tamoxifen (Nolvadex®) or
steroids.

44. What are the symptoms of fatty liver disease?
People with fatty liver disease often have no symptoms until the
disease progresses to cirrhosis of the liver. If you do have
symptoms, they may include:
•Abdominal pain or a feeling of fullness in the upper right side
of the abdomen (belly).
•Nausea , loss of appetite or weight loss .
•Yellowish skin and whites of the eyes (jaundice).
•Swollen abdomen and legs (edema).
•Extreme tiredness or mental confusion.

45. Diagnosis and Tests
How is fatty liver disease diagnosed?
Because fatty liver disease often has no symptoms, your doctor
may be the first one to spot it. Higher levels of liver enzymes
(elevated liver enzymes ) that turn up on a blood test for other
conditions may raise a red flag. Elevated liver enzymes are a sign
your liver is injured. To make a diagnosis, your doctor may order:
•Ultrasound or computed tomography (CT scan) to get a picture
of the liver.
•Liver biopsy (tissue sample) to determine how far advanced
liver disease has progressed.
•FibroScan ®, a specialized ultrasound sometimes used instead of
a liver biopsy to find out the amount of fat and scar tissue in the
liver.

46. Management and Treatment
How is fatty liver disease treated?
There’s no medication specifically for fatty liver disease.
Instead, doctors focus on helping you manage factors that
contribute to the condition. They also recommend making
lifestyle changes that can significantly improve your health.
Treatment includes:
•Avoiding alcohol.
•Losing weight.
•Taking medications to manage
diabetes, cholesterol and triglycerides (fat in the blood).
•Taking vitamin E and thiazolidinediones (drugs used to treat
diabetes such as Actos® and Avandia®) in specific instances .

47. What is hepatitis?
HEPATITIS
Hepatitis is inflammation of the liver. Inflammation is swelling that happens when
tissues of the body are injured or infected. It can damage your liver. This swelling
and damage can affect how well your liver functions.
Hepatitis can be an acute (short-term) infection or a chronic (long-term) infection.
Some types of hepatitis cause only acute infections. Other types can cause both
acute and chronic infections.
What causes hepatitis?
There are different types of hepatitis, with different causes:
•Viral hepatitis is the most common type. It is caused by one of several viruses
-- hepatitis viruses A, B, C, D, and E. In the United States, A, B, and C are the
most common.
•Alcoholic hepatitis is caused by heavy alcohol use
•Toxic hepatitis can be caused by certain poisons, chemicals, medicines,
or supplements
•Autoimmune hepatitis is a chronic type in which your body's immune system
attacks your liver. The cause is not known, but genetics and your environment

48. How is viral hepatitis spread?
Hepatitis A and hepatitis E usually spread through contact with food or water that was
contaminated with an infected person's stool. You can also get hepatitis E by eating
undercooked pork, deer, or shellfish.
Hepatitis B, hepatitis C, and hepatitis D spread through contact with the blood of someone
who has the disease. Hepatitis B and D may also spread through contact with other body
fluids. This can happen in many ways, such as sharing drug needles or having unprotected
sex.
Who is at risk for hepatitis?
The risks are different for the different types of hepatitis. For example, with most of the viral
types, your risk is higher if you have unprotected sex. People who drink a lot over long
periods of time are at risk for alcoholic hepatitis.

49. What are the symptoms of hepatitis?
Some people with hepatitis do not have symptoms and do not know they are
infected. If you do have symptoms, they may include:
•Fever
•Fatigue
•Loss of appetite
•Nausea and/or vomiting
•Abdominal pain
•Dark urine
•Clay-colored bowel movements
•Joint pain
•Jaundice , yellowing of your skin and eyes

50. If you have an acute infection, your symptoms can start anywhere
between 2 weeks to 6 months after you got infected. If you have a
chronic infection, you may not have symptoms until many years later.
What other problems can hepatitis cause?
Chronic hepatitis can lead to complications such as cirrhosis (scarring of
the liver), liver failure, and liver cancer. Early diagnosis and treatment of
chronic hepatitis may prevent these complications.
How is hepatitis diagnosed?
To diagnose hepatitis, your health care provider:
•Will ask about your symptoms and medical history
•Will do a physical exam
•Will likely do blood tests, including tests for viral hepatitis
•Might do imaging tests , such as an ultrasound, CT scan , or MRI
•May need to do a liver biopsy to get a clear diagnosis and check for
liver damage

51. What are the treatments for hepatitis?
Treatment for hepatitis depends on which type you have and whether it is acute or
chronic. Acute viral hepatitis often goes away on its own. To feel better, you may
just need to rest and get enough fluids. But in some cases, it may be more serious.
You might even need treatment in a hospital.
There are different medicines to treat the different chronic types of hepatitis.
Possible other treatments may include surgery and other medical procedures.
People who have alcoholic hepatitis need to stop drinking. If your chronic hepatitis
leads to liver failure or liver cancer, you may need a liver transplant.
Can hepatitis be prevented?
There are different ways to prevent or lower your risk for hepatitis, depending on
the type of hepatitis. For example, not drinking too much alcohol can prevent
alcoholic hepatitis. There are vaccines to prevent hepatitis A and B. Autoimmune
hepatitis cannot be prevented.

52. Liver Cirrhosis
A chronic, progressive disease characterized by a diffuse damage to
the hepatic cells The liver heals with scarring, fibrosis and nodular
regeneration
ETIOLOGY: Post-infection, Alcohol, Cardiac diseases, Schisostoma,
Biliary obstruction
ASSESSMENT FINDINGS :
1.Anorexia and weight loss
2.Jaundice
3.Fatigue
4.Early morning nausea and vomiting
5.RUQ abdominal pain
6.Ascites
7.Signs of Portal hypertension

53. Sequelae of liver
cirrhosis
1- portal
hypertensio
n

54. Portal hypertension is elevated pressure in your
portal venous system. The portal vein is a major
vein that leads to the liver. The most common
cause of portal hypertension is cirrhosis Portal
hypertension is elevated pressure in your portal
venous system. The portal vein is a major vein that
leads to the liver. The most common cause of
portal hypertension is cirrhosis

55. Symptoms and signs of portal hypertension include:
•Gastrointestinal bleeding: which may be hematemesis or melena, if any
large vessels around your stomach that developed due to portal
hypertension rupture.
•Ascites: When fluid accumulates in your abdomen, causing swelling
•Encephalopathy, or confusion and fogginess in thinking
•Jaundice, the yellowing of the skin and the whites of the eyes
•Edema, (swelling) of the legs
•Caput medusa, a visible network of dilated veins surrounding your
navel
Diagnostic procedures your doctor may order include:
•Imaging and blood tests
•Pressure measurement studies
•Endoscopic diagnosis

56. Hepatic encephalopathy
What is hepatic encephalopathy?
Hepatic encephalopathy is an often-temporary neurological (nervous system) disorder
due to chronic, severe liver disease . A diseased liver struggles to filter toxins (substances
created from the breakdown of food, alcohol, medications and even muscle) from the
bloodstream. These toxins build up in the body and travel to the brain. Toxicity affects
brain function and causes cognitive impairment.
People with hepatic encephalopathy.

57. What causes hepatic encephalopathy?
People with chronic liver disease are at risk for hepatic encephalopathy.
Something usually triggers the condition, such as:
• Alcohol use .
•Certain drugs that affect the nervous system, such as
sleeping pills and antidepressants.
• Constipation (being unable to pass stool, or poop, normally).
• Dehydration or electrolyte imbalance.
• Digestive tract bleeding .
•Infection.
• Kidney disease .
•Liver shunt.

58. What are the symptoms of hepatic encephalopathy?
People with hepatic encephalopathy experience impaired brain
function. Symptoms include:
• Anxiety or irritability.
•Cognitive impairment (confused thinking or judgment).
•Coordination or balance problems .
•Difficulty concentrating or short attention span.
•Flapping hand motion (asterixis).
•Mood or personality changes.
• Muscle twitches (myoclonus) .
•Reduced alertness.
• Sleep problems.
•Slurred speech,

59. How is hepatic encephalopathy diagnosed?
Generally, your doctor makes a diagnosis based on your:
•Medical history.
•Symptoms.
•Office exam.
How is hepatic encephalopathy managed or treated?
Treatment varies depending on your symptoms and overall health and
how severe the condition is. It’s important to take medications for hepatic
encephalopathy exactly as prescribed. With treatment, it’s possible to
slow, and sometimes stop, the disease from getting worse. Your doctor
may recommend one or both of these treatments:
•Antibiotics: Bacteria in your body make natural toxins from digested
foods. Antibiotics, such as rifaximin (Xifaxan®), stop bacterial growth. As
a result, the body produces fewer toxins.
•Laxatives: Lactulose oral solution , a laxative made from lactose
sugar, draws toxins into the colon. The laxative stimulates frequent
bowel movements that help remove toxins from the body.

60. How can I prevent hepatic encephalopathy?
Proper management and treatment of liver disease is key to lowering
the chances of developing hepatic encephalopathy. These steps can
lower your risk:
•Avoid alcohol, which damages liver cells.
•Avoid medications that affect the nervous system, such as sleeping pills
and antidepressants.
•Eat a nutritious diet, exercise and maintain a healthy weight (especially
important if you have fatty liver disease).
•Take your prescribed medications to treat liver disease.
•Undergo regular liver function tests .