GI Surgical & Hepatobiliary Comparison Study Notes

GI SURGICAL & HEPATOBILIARY COMPARISON

HIATAL HERNIA

  • Types of Hiatal Hernia:
    • Sliding Hiatal Hernia:
    • Associated with gastroesophageal reflux disease (GERD) symptoms.
    • Treatment:
      • Elevation of head of bed (HOB)
      • Small meal portions
      • Proton Pump Inhibitors (PPIs)
    • Paraesophageal Hiatal Hernia:
    • Higher risk for strangulation, which is a surgical emergency.

BARIATRIC SURGERIES

  • Roux-en-Y Gastric Bypass:
    • Risks include dumping syndrome and malabsorption of nutrients.
  • Sleeve Gastrectomy:
    • Considered a restrictive procedure leading to potential vitamin deficiencies.
  • Gastric Banding:
    • Risks include obstruction and slippage of the band.
  • Priority Considerations Post-Surgery:
    • Patients should consume small meals, maintain a low sugar intake, and monitor nutritional status.

ABDOMINAL HERNIAS

  • Types of Hernias:
    • Inguinal Hernia
    • Femoral Hernia: High risk for strangulation.
    • Umbilical Hernia
    • Incisional Hernia
  • Signs of Strangulation:
    • Severe abdominal pain
    • Firm abdominal mass
    • Nausea and vomiting (N/V)
    • Fever

BOWEL OBSTRUCTION

  • Types of Bowel Obstruction:
    • Mechanical Obstruction:
    • Causes include tumors, adhesions, or hernias, leading to severe pain and abdominal distention.
    • Non-mechanical Obstruction (Ileus):
    • Absent bowel sounds are characteristic.
  • Priority Management:
    • Maintain NPO status (nothing by mouth)
    • Insert a nasogastric (NG) tube
    • Administer intravenous (IV) fluids
    • Monitor for perforation of the bowel.

OSTOMIES

  • Ileostomy:
    • Produces liquid output and has a high risk for dehydration and electrolyte imbalance.
  • Colostomy:
    • Output is generally formed to semi-formed stool.
  • Healthy Stoma Assessment:
    • A healthy stoma should appear pink/red and moist.
    • A dusky or black stoma is a medical emergency indicating possible ischemia.

CIRRHOSIS

  • Complications of Cirrhosis:
    • Portal Hypertension leading to:
    • Ascites
    • Varices
    • Splenomegaly
    • Elevated ammonia levels can result in hepatic encephalopathy.
    • Increased International Normalized Ratio (INR) indicates a higher risk of bleeding.
    • Decreased albumin may lead to fluid accumulation.
  • Priority Nursing Actions:
    • Implement bleeding precautions
    • Conduct neurological checks
    • Enforce sodium restriction in diet.

GALLBLADDER & CHOLELITHIASIS

  • Symptoms of Gallbladder Problems:
    • Right upper quadrant (RUQ) pain after consuming fatty meals, which may radiate to the right shoulder.
  • Acute Cholecystitis Symptoms:
    • Fever and abdominal guarding in response to palpation.
  • Priority Management:
    • Maintain NPO status
    • Provide pain control
    • Administer antibiotics
    • Prepare for potential cholecystectomy (surgical removal of the gallbladder).

NCLEX MEMORY AID:

  • Important Reminders:
    • Hernias can strangulate.
    • Bariatric patients are at risk for dumping syndrome.
    • Patients with ostomies have high dehydration risks.
    • Cirrhosis patients are at risk for bleeding complications.
    • Gallbladder conditions emerge with specific symptoms like RUQ pain after meals.