DIGESTIVE SYSTEM DISEASES

AND
NURSING CARE
 General Symptoms of Digestive System Diseases
• Pain is one of the most important symptoms of digestive system diseases.
• It is important to know the location, severity, duration of pain, and factors that reduce or
Pain: increase pain.
• Other conditions that may be related to pain, such as eating, resting, defecation and
vascular disease, should be identified.

• It is a burning sensation that occurs in the substernal region as a result of reflux of

Retrosternal burning (pyrosis):
stomach contents to esophagus and sometimes spreads to the throat.

• It is a pain in the substernal region that limits oral intake during swallowing due to an
Odynophagia: organic disease of the esophagus. The pain disappears after the food leaves the
esophagus.

• Dysphagia is the sensation of attachment of nutrients at any point from pharynx to the
Dysphagia (difficulty swallowing):
stomach. Dysphagia may be of oropharynx or esophageal origin.

• Regurgitation is the spontaneous ingestion of stomach or esophageal contents. It can

occur when lying on your back at night, lifting heavily while leaning forward. It may occur
Regurgitation: in distal obstructions of the esophagus, achalasia or large diverticula.
 • Increased salivation in the esophagus due to foreign body and occlusive
Sialorrhoea:
diseases

• Esophageal diverticula, chronic esophagitis, atrophic gastritis, pyloric

Halitosis:
stenosis, and infections are seen in oral and throat diseases.

• Indigestion is a common discomfort in the upper abdomen and may be

Indigestion: caused by damage to the nervous system that controls the stomach or
any other disease in the digestive tract.

• Gas accumulated in the digestive tract is excreted by burping or out of the

rectum. The accumulation of excess gas in the intestine is called
Gas:
meteorism. The patient complains of swelling and tension. Excess gas is
seen in gallbladder diseases or food intolerance.
• Nausea is a subjective emotion and occurs in diseases other than
digestive system diseases. Vomiting is usually associated with nausea and
Nausea and vomiting:
the causes are very diverse. The content of vomit; blood, nutrient wastes,
mucus, bile and foreign bodies should be investigated.

• Changes in bowel habits are usually signs of colon diseases. May cause
Changes in intestinal habits:
diarrhea or constipation
Esophageal Diseases and
Nursing Care
 Achalasia

Definition Etiology Symptoms

• Achalasia; It is a condition that occurs as a • the reasons are certain, • Dysphagia, regurgitation,
result of impaired transmission of nutrients psychological factors may nighttime pulmonary
from the pharynx to the stomach as a result be stress or may be the aspiration develops
of lower esophageal sphincter relaxation result of destruction of • (The most common cause
disorder, which often works in accordance the myenteric plexus. of death in achalasia is
with peristalsis in 2/3 of the esophagus. aspiration pneumonia.)
• It is most commonly seen between the ages • Retrosternal pain and
of 30-50. fullness, weight loss,
• solid and liquid nutrients accumulate in the globus and hiccups are
lower part of the esophagus. other symptoms
• As a result, it loses its esophageal tone and
becomes wide. When the hydrostatic
pressure in this part increases, nutrients
slowly pass from the esophagus to the
stomach.
 Diagnosis Treatment

• barium esophageal radiography. • The aim of treatment is to enlarge or

• Endoscopy eliminate the functional congestion
• In suspected cases, esophageal present in the cardiovascular system.
monometry. • Mechanical dilatation or surgery.
• Surgery is the main treatment.
Surgical myotomy (Heller operation)
can be performed by laparotomic and
laparoscopic methods.
• Although it is an invasive procedure,
it is an extremely effective treatment.
 Kalazia
Definition
• Calacia, which is the • Regurgitation,
opposite of achalasia, is
insufficiency in the
cardio esophageal
sphincter and the
stomach contents
return to the
esophagus.
• Views, especially in
newborns following
feeding
• Continuous vomiting
makes people think of
calacia.
S’gns D’agnos’s
• Differential diagnosis is
heartburn, aspiration, made by barium
dysphagia (due to radiological examination
peptic esophagitis and esophagoscopy
Treatment and care
• the antacid medication
reduces stomach
acidity, can be used
temporarily.
• advise the patient to
avoid foods that
increase stomach acid
and to eat in small
portions at frequent
intervals.
• Explain to the patient
that the complaints will
increase when he lies
on his back after
feeding.
• Cigarettes, coffee and
tea are not
recommended
 Gastroesophageal Reflux (GERD)
Definition Reasons symptoms

• Gastroesophageal reflux (GER) is • Increased gastric acid, smoking • burning behind the rib cage,
the escape of gastric contents and alcohol use, gastric hernia painful and sour stomach fluid
back into the esophagus. (hiatal hernias), fast and coming back from the stomach to
• The most harmful substance in overfilling the habit of feeding, the mouth, long-term cough,
the stomach content escaping supine after meals, stomach hoarseness, bad mouth and
from the stomach to the ejaculation disorders, obesity, breath odor, difficult and painful
esophagus is stomach acid. disruption of the mechanism of swallowing of solid foods in
• However, the presence of bile and the valve between the stomach advanced cases
pancreatic enzymes together with and esophagus.
acid increases the severity of
esophageal damage.
• It is usually associated with
various degrees of damage to the
esophageal mucosa and various
symptoms. In this case,
gastroesophageal reflux disease is
mentioned.
 Diagnosis
• 24-hour pH monitoring is
performed by endoscopy,
barium esophagos
radiography, acid perfusion
test (Bernstein) and
gastroesophageal scintigraphy.
Complications
• Stricture, esophageal ulcers,
iron deficiency anemia,
aspiration pneumonia, peptic
ulcer, laryngitis, subglottic
stenosis, laryngeal carcinoma,
otitis, sinusitis, asthma,
idiopathic pulmonary fibrosis,
sleep apnea.
Treatment and care
• There are three treatment
options:
• Medical treatment,
• endoscopic treatment and
• surgical treatment.
• Not to eat before bedtime, not
to smoke, coffee and alcohol,
not to eat chocolate and
similar foods, to avoid
carbonated and acidic
beverages, 1 hour before
bedtime and 1 hour after
meals to use antacid, reduce
the amount of fat in the diet
and raise the head of the bed
 Possible Diagnoses
Difficulty swallowing / impaired swallowing

Nutritional imbalance; Less nutrition than the body needs (due to anorexia, burning sensation, dysphagia)

Pain

Comfort (Impaired Comfort) (due to burning behind the sternum, regurgitation, dysphagia)

Disrupted sleep pattern

Ineffectiveness in maintaining health

Managing the therapeutic regime ineffective

Stress

Lack of information (illness, diet regulation, pharmacological treatment)

Aspiration risk
Esophageal Varices
• Esophageal varices occur as a result of portal hypertension in liver cirrhosis.
• vital bleeding may occur.
• Causes such as cough, straining, vomiting, or physical exercise, such as increased
intraabdominal pressure, mechanical trauma to the veins during passage of an
irritating food through the esophagus, and ascites of the vein wall cause
perforation and bleeding.
 Diagnosis
• Diagnosis is made by laboratory and radiological
examinations.
• Laboratory findings;
• Liver tests were impaired, albumin increased,
globulin decreased, prothrombin time elongation,
elevated ammonium levels, bilirubin were elevated.
• The majority of esophageal varices are detected by
barium esophageal radiography.
Treatment
• In case of major bleeding, diagnostic methods and
emergency treatment are carried out together.
• The location and cause of bleeding should be
investigated.
• Methods used to control bleeding:
• Balloon tamponade: A gastric and esophageal
balloon is applied to the varices for tamponade.
• For this purpose, sengstaken-blakemore tube is
used.
• With this application, it is aimed to stop the
bleeding by applying pressure to the esophageal
wall and thus to the bleeding varicoid veins.
• Balloon administration has complications such as
aspiration pneumonia, esophageal ulcer,
esophageal rupture and asphyxia.
 Sclerotherapy: Vasopressin infusion: Surgical treatment:

• It is applied to patients • It is a method aimed at • Transesophageal

who have no response reducing the amount variceal ligation and
to balloon therapy or of blood going to the porta-caval shunt
have no bleeding, but portal system. surgery in uncontrolled
have varicose veins. esophageal bleeding.
• A sclerosing agent is
injected into the
varices by endoscopic
methods and the
patient is kept under
observation.
 Nursing care in esophageal diseases
The patient should be evaluated in terms of localization, duration and extent of pain

Patients should be rested during painful periods

Identify stressful factors and provide the necessary support to deal with them

Medications should be taken regularly according to the physician's request (usually antacids one hour
after meals, anticholinergics 30 minutes before meals)

Training should be given to avoid taking aspirin, steroids and anti-inflammatory drugs

In dietary regulation, the patient should avoid all foods that cause pain and be fed with small frequent
meals.

Caffeine, alcohol and smoking should be prevented.

Gastric and Duodenal Diseases and Nursing Care
 Gastritis

Definition Etiology Clinical symptoms Diagnosis

• Gastritis is defined as • Helicobacter pylori • Bloating after eating, • Radiological imaging

acute and chronic (most common), viral • epigastric pain, of the digestive
inflammation of the causes, chemical • tension, system,
gastric mucosa. causes (acid and alkali • belching, • endoscopy,
• It is usually seen as a substances), • urease test to
• loss of appetite,
regional or common autoimmune diseases, determine antibodies
drugs (aspirin, • nausea, vomiting,
redness of the against H. pylori
stomach mucosa. cortisone, etc.), • pernicious anemia, infection
nutritional disorders • fecal occult blood.
(protein deficiencies),
alcohol, cigarettes,
tea, spicy foods, very
hot and cold foods,
stress.
 Treatment and care
Patient should be taken to bed rest

Parenteral fluid should be given if the patient cannot get enough fluids.

Drugs should be given as recommended

Symptoms should be evaluated

If the patient can take orally, a non-irritating diet should be recommended and foods and beverages that
increase symptoms should be avoided.

Training on lifestyle regulation

Smoking, alcohol should not be consumed

Possible diagnosis

Impaired comfort; Acute pain

Nausea

Nutritional change (associated with pain, nausea, vomiting,

loss of appetite)

Liquid electrolyte imbalance

Lack of information (condition, treatment, diet,)

Managing the therapeutic regimen ineffectively (lack of

knowledge)
Peptic Ulcer
Definition

Peptic ulcer is tissue loss that occurs in the

stomach and duodenal mucosa due to the harmful
effects of acid and pepsin.
• Duodenal ulcer is more common between the
It is seen at the same rate in men and women,
ages of 30-55 and gastric ulcer between the
and the incidence increases with age.
ages of 55-70.
Ulcers can occur in every part of the
gastrointestinal tract. It is most commonly seen in
duodenum and stomach.
Peptic ulcer occurs as a result of disruption of the
balance between aggressive and protective
factors in the gastric and duodenal mucosa.
Protective factors for mucosal Aggressive factors that increase
continuity: the risk of ulcers:
• Mucus layer • Helicobacter pylori (H. Pylori)
• HCO3 • Increase in stomach acid
• Mucosal blood flow • NSAIS and aspirin
• Cell renewal • Cigaret
• Endogenous prostaglandins • Stress
• Delay in gastric emptying
• Genetic diseases, biliary reflux, blood
type 0 and systemic diseases (COPD, CRF,
cirrhosis, kidney stones) may increase the
risk of ulcers associated with aggressive
factors
 Clinical symptoms Diagnosis

• The symptoms of peptic ulcer vary from person to person. • The diagnosis of peptic ulcer is made by anamnesis.
• Most ulcer patients complain of mild indigestion, while some • A barium-filled gastric duodenal radiography is required for
have no symptoms. further examination.
• The most important symptom is pain. Nausea, vomiting, • Biopsy may be required in some cases
regurgitation, hypersalivation are other signs and symptoms.
• In the stomach ulcer;
• burning or gas pressure in the left upper epigastrium, back
and upper abdomen; 1-2 hours after meals, pain, penetration
ulcer food intake increase with discomfort, from time to time
nausea-vomiting, weight loss.
• Duodenal ulcer,
• burning in the middle epigastrium and upper abdomen,
cramping, pressure-related pain, back pain in posterior ulcers,
2-4 hours after meals and mid-day, late afternoon and
midnight pain, periodic and attacks pain, antacids and food,
pain reduction, occasional nausea - there is vomiting.
 Complications
Bleeding:
• It is the most common
complication.
• Bleeding is most common in the
first part of the duodenum.
• In case of excessive bleeding, there
may be fresh blood as well as coffee
grounds.
• The patient has signs of blood loss
such as sweating and orthostatic
hypotension.
• Bleeding stops spontaneously in
most cases.
• Cautery, heat or laser
photocoagulation can be applied
endoscopically in cases of excessive
bleeding.
• In some cases, arterial embolization
is performed.
Perforation:
• It is mostly seen in duodenal ulcers.
• Diaphragm irritation may cause
shoulder pain. The pain is
accompanied by the restriction of
diaphragm movements and
superficial breathing due to shock.
• There is widespread rigidity and
defender in the abdomen.
• Intestinal sounds have disappeared.
• Perforation is the most common
complication of peptic ulcer.
Penetration:
• Penetration, also called restricted
perforation, is the infiltration of the
ulcer into the surrounding tissue.
• Gastric ulcers most commonly
penetrate the left lobe of the liver
and duodenal ulcers penetrate the
pancreas.
• Pain should hit the waist and upper
right quadrant, and persistence of
anti-acids should be continuous.
 Complications

Fistula: Obstruction:

• Duodenal ulcers are most commonly • Gastric outflow obstruction may be

fistulated to the main biliary tract associated with scarring or spasm
and gastric ulcers to the colon. and inflammation.
• It is most commonly seen in pyloric
ulcers. It first tries to dilate
endoscopically with the balloon. If it
fails, surgical treatment is required
 Treatment:
• Medical and surgical treatment is used in the
treatment of peptic ulcer.
• In H. pylori-positive ulcer, only the removal of H.
pylori is sufficient for treatment.
• After antibiotic treatment, antacid drugs are
continued for 2-4 weeks for duodenal ulcers and
4-6 weeks for gastric ulcers to increase the
recovery rate and control symptoms of patients.
• Proton pump inhibitors or H2 receptor
antagonists are most commonly used for the
treatment of H. pylori negative ulcers.
• Peptic ulcer is chronic and recurrent. Treatment is
continued by trying to improve the patient's
quality of life with mucosal protective drugs.
Surgical treatment should be performed in cases
of bleeding where the ulcer is very severe.
Nursing care in peptic ulcer
• Patients should be rested during painful periods
• Identify stress factors and provide support to deal
with them
• Medications should be given regularly according
to the physician's request
• Training should be given to avoid taking aspirin,
steroids and anti-inflammatory drugs
• In the diet regulation, the patient should avoid all
foods that cause pain and be fed with small and
frequent meals.
• Caffeine, alcohol and smoking should be
prevented.
https://www.youtube.com/watch?
v=lnVjXuyM6xk
Nursing Diagnosis

Acute-Chronic pain (due to lesions caused by increased gastric secretions)

Diarrhea-constipation (associated with drug treatments)
Fluid-volume deficiency (associated with bleeding risk, nutritional deficiency)
Lack of information
Managing the therapeutic regimen ineffectively (regarding disease process,
condition, contraindications, complications, signs and symptoms)
Nutritional change, less nutritional needs

Disrupted sleep pattern

Crohn's Disease
• Crohn's disease is a chronic and inflammatory bowel disease. It is seen with
intermittent inflammation in any part of the digestive system from mouth to anus
or in several different parts at the same time.
• Crohn's disease is a systemic disease that is more common in both sexes at the
age of 10-30 years. The disease may involve any segment of the intestine. It most
commonly involves the iliocecal region.
• This is followed by colon, small intestine and stomach involvement.
• Crohn's disease can also cause extra-intestinal symptoms.
• The most common extra-intestinal symptom is arthritis without deformation.
• Skin, kidney and eye involvement are also common.
 Clinical symptoms
• It often starts with abdominal
pain and diarrhea.
• Clinically, slimming, diarrhea,
sweating, fever, abdominal
pain are seen.
• An abdominal mass may
present in the right lower
quadrant.
• Rarely, rectal bleeding may
occur.
• It has iron, B12 and folate
deficiency, vitamin D
deficiencies, hypocalcemia,
magnesium and zinc
deficiencies.
• Gall stones, osteomalacia,
vitamin deficiencies, calcium
oxalate type kidney stones are
specific to Crohn's disease.
Diagnosis
• A blood count is taken and the
blood hidden in the stool is
checked.
• Barium graphy can be done.
• It is diagnosed by colonoscopy
and biopsy.
Treatment
• Nutrition and medicine are the
basis of treatment.
• The aim of treatment; to
control the inflammatory
process, reduce symptoms,
eliminate metabolic and
nutritional problems and
provide healing.
• Long-term antibiotics are
effective in patients with mild
Crohn's disease.
• Supportive treatment is
preferred in severe cases. Oral
steroids are given.
Nursing diagnosis

• Pain
• Diarrhea (due to intestinal inflammatory process)
• Impaired gastrointestinal motility
• Fluid volume deficiency
• Fluid electrolyte imbalance (diarrhea, insufficient fluid intake)
• Tiredness
• Unbalanced diet (due to diarrhea, abdominal pain)
• Risk of bleeding
• Impaired comfort (chronic pain)
• Deterioration in skin integrity (perianal, due to persistent diarrhea)
• Weakness
• Lack of information
• Ineffective management of the therapeutic regimen
Nursing care in inflammatory bowel diseases

The patient's condition should be evaluated and his / her participation in care

Patient should be advised to avoid emotional stress and bed rest should be
recommended

Compliance with treatment and limitations should be ensured

Special skin care for patients with perianal abscess

Training on the importance of bed rest and diet management, perinatal care,
side effects of drugs and coping with stress
 Liver and Gall Bladder
Diseases and Nursing Care
 Common symptoms in liver diseases
Jaundice (icterus):
• This is due to the • In bile duct
increased amount of
bilirubin in the blood.
• Hepatic jaundice is
observed when liver
cells deteriorate.
• Hemolytic jaundice
develops when excess
bilirubin is released as a
result of excessive
erythrocyte destruction.
• Bilirubin is not
discharged from the
body and obstructive
jaundice is seen in the
case of a congestion in
the bile duct.
Acid and edema in the
Akolic stool: Ache:
abdomen:
• Acid is the collection of • Swelling of the liver due
obstructions, bile fluid in the peritoneal to inflammation causes
cannot be poured into cavity. pain in the right upper
the duodenum and • In liver diseases, fluid quadrant of the
stoolobiline does not accumulates in the abdomen
form in the intestine, abdomen with portal
and the stool appears hypotension, decreased
colorless. plasma colloid osmotic
pressure and sodium
retention.
 • As the phagocytosis performed by the liver (kupffer cells) is
Fever
disrupted, signs of infection are observed.

• In some liver diseases, especially in patients with cirrhosis, a

spider-like structure is noticed in the capillaries of the skin.
Spider angiomata: • Looking at the skin, it looks like a spider.
• However, it is attributed to the destruction of estrogen in the
liver.

• It is the prominent veins around the umbilicus.

Hood meduza:
• Portal hypertension is probably the cause of the hood medusa.

• Portal hypertension is the basis of the development of these

Esophageal varices and complications.
hemorrhoids: • Portal hypertension causes esophageal varices and
development of hemorrhoids
 Diagnostic tests in liver diseases

Magnetek
Liver function Ultrasonograph Computed
Liver biopsy resonance Laparoscopy
tests y tomography
imaging (MRI)
Cirrhosis
• Hepatitis plays an important role among the causes of cirrhosis of liver diseases.
• Necrosis, regeneration, nodular and fibrosis is a progressive disease caused by
disruption of the liver structure.
 • Hepatitis viruses, chronic • Weight loss, loss of • Ultrasonography,

Diagnosis
etology

Clinical symptoms
alcoholism, hepatotoxic appetite, • computed tomography,
drugs and chemicals, • darkening of urine color, • endoscopy,
congestive heart failure, • jaundice, • liver biopsy and
cholestasis, autoimmune • fever, weakness, laboratory findings are
diseases, genetic and used.
• spider angioma, purpura,
metabolic diseases, and in
gynecomastia, • In laboratory findings;
some cases the cause is
unclear. • white nail, clubbing, anemia,
• palmar erythema, thrombocytopenia,
• edema, coagulation disorder,
urinary urinogen and
• acid, parotid
bilirubin increase,
enlargement, albumin decrease, ALT,
• testicular atrophy, AST and GGT.
• fetus hepaticus, epistaxis,
hemorrhagic diathesis,
splenomegaly, flapping
tremor, cachexia, pruritus.
 Alcoholic Cirrhosis
(Laennec Cirrhosis)
• Alcoholic cirrhosis is the • There are fever, marked
last and irreversible
form of alcoholic liver
disease.
• It develops slowly and
often insidiously.
• Alcohol-induced liver
disease varies from
person to person.
• The first change in the
liver due to excessive • Alcoholic cirrhosis
alcohol intake is the
accumulation of fat in
the liver cells.
• The development of the
disease depends on the
amount of alcohol use,
duration, sex and
genetic factors.
Clinical symptoms Diagnosis Treatment
• The diagnosis is made • The patient should
jaundice, hepatomegaly, by anamnesis, clinical avoid alcohol.
hyperbilirubinemia, findings, endoscopic • B complex vitamins,
serum alkaline detection of esophageal vitamins C and K,
fostaphase, GGT, varices and liver biopsy. potassium, magnesium
aminotransferase and zinc are also useful.
elevations, • Drug treatment is
hypercholestrolemia applied.
and • In advanced liver
hypertriglyceridemia. cirrhosis, as in other
cirrhosis, treatment is
manifests itself in the liver transplantation.
clinic with signs of
portal hypertension.
Postnecrotic Cirrhosis
• Most cases develop as a result of hepatitis B and C.
• Poisonings such as phosphorus, chloroform, iproniazide and some infectious
diseases can also cause postnecrotic cirrhosis.
• When the liver is examined, it is seen that it has shrunk and its surface is not
smooth.
• In large areas, liver cells were lost and scar tissue was replaced.
• The disease usually occurs at a young age.
• The symptoms of postnecrotic cirrhosis do not differ from those of classical
cirrhosis.
• Treatment consists of treatment of symptoms and correction of the general
condition of the patient.
 Biliary Cirrhosis
Biliary cirrhosis is a type of cirrhosis that is associated with disorders of the biliary tract
and bile secretion. There are two types as primary and secondary.

Primary biliary cirrhosis: Secondary biliary cirrhosis:

• It develops due to intrahepatic bile duct damage. • It develops due to the failure of bile to be thrown out as
• Primary biliary cirrhosis; autoimmune disease. a result of obstruction of the bile ducts.
• 90% occur in women and middle ages. • Toxic substances that cannot be removed with bile start
• Cholestasis due to impaired biliary flow, the first finding to accumulate in bile ducts and damage liver cells.
is usually itching. Other findings; jaundice, weakness, • The best surgical intervention in secondary biliary
skin pigmentation, hepatosplenomegaly, bleeding, bone cirrhosis cases is to remove the biliary obstruction as
pain. Serum ALP, GGT and IgM are typically high. early as possible by surgical intervention.
• Bilirubin and cholesterol levels may increase.
• Absorption of fat-soluble vitamins is impaired and
prothrombin time is prolonged.
• Ursodeoxycholic acid is widely used because it slows the
progression of the disease.
• Medium chain fatty acids, vitamins K and D, calcium
replacement and cholestyramine for pruritus are given
as supportive treatment.
• The definitive treatment is liver transplantation.
 Wilson Cirrhosis

• It is a genetic disease characterized by toxic accumulation of

copper in many tissues and organs as a result of copper
metabolism disorder, especially liver, brain and eye. Liver
Medical
transplantatio
treatment
• Copper that cannot be excreted with bile accumulates in the n
liver.
• It initially presents with acute hepatitis.
The aim of treatment is to reduce the accumulation of copper
in the body. Hepatocyte
• For this purpose, copper absorption is reduced and urinary transplantatio Gene therapy.
excretion of copper is tried to be increased. n

• Treatment is life-long after Wilson is diagnosed.

• Patients should be checked at least twice a year and drug side
effects should be reviewed.
• Treatment is carried out in four ways:
 Treatment of cirrhosis and nursing care

Comprehensive, careful and continuous care is required to prevent serious complications such as acid accumulation,
portal hypertension, hepatic encephalopathy and esophageal variceal bleeding in patients with cirrhosis. These;
Prevention and treatment of cirrhosis are done according to the cause.
It is ensured that the patient avoids strenuous activities and rests.
Enough calories and vitamins are provided.
If there is respiratory distress, semi-fowler or fowler position is given.
Skin care is provided.
Diuretics are given to resolve the edema.
Follow-up, daily weight monitoring, measurement of extremities and abdominal waist circumference are measured.
Vitamin K is given as claimed.
If the patient has an esophageal variceal, hematemesis and bleeding symptoms of varicose veins such as melena are
observed.
The patient is allowed to express his / her feelings about self-esteem, body image change, deterioration in role
performance and sexual problems.
• Insufficient respiratory mode
• Fluid volume excess
• Pain
• Tiredness
• Deterioration of the oral mucous membrane
• Impairment of skin / tissue integrity
• Disrupted sleep pattern
• Lack of information
• Risk of bleeding
• Risk of infection
• Risk of thought disruption
 Imbalanced Nutrition: Less Than Body Requirements: The state in which an individual who is not on NPO,
experiences or is at risk for inadequate intake or metabolism of nutrients for metabolic needs with or without weight loss
.
May be related to
• inability to intake enough food because of reflux
• increased metabolism caused by disease process
• early satiety
• heartburn
• Possibly evidenced by
• inadequate food intake
• altered taste
• weight loss
• decreased peristalsis
• muscle mass loss
• nausea and vomiting
• abdominal pain or discomfort
• intolerance of fatty foods
• epigastric pain after eating
• heartburn
• regurgitation
• dysphagia
• Desired Outcomes
• Patient will ingest daily nutritional requirements in accordance to his activity level and metabolic needs.
Nursing Interventions Rationale
Accurately measure the patient’s weight and height. For baseline data.
Obtain a nutritional history. Determining the feeding habits of the client can provide a basis for establishing
a nutritional plan.
Encourage small frequent meals of high calories and high protein foods. Small and frequent meals are easier to digest.
Instruct to remain in upright position at least 2 hours after meals; avoiding Helps control reflux and causes less irritation from reflux action into
eating 3 hours before bedtime. esophagus.
Instruct patient to eat slowly and masticate foods well. Helps prevent reflux.
Prepare the patient for the following diagnostic procedures:
Complete blood count To identify the presence of anemia that must be ruled out
Cardiac enzymes To rule out myocardial pain related to the atypical pain felt with GERD
Serum iron To identify presence of iron-deficiency anemia
To identify toxicity of proton pump inhibitors or to diagnose Zollinger-Ellison
Gastrin levels syndrome
To determine if failure with pharmacologic agents is caused by inadequate 
Gastric acid secretory analysis suppression of gastric acid secretion, which may signify bile reflux or pill-
induced disease
Upper gastrointestinal endoscopy Used to identify the type and extent of tissue damage.
Barium swallow Can be used to identify structures and Hiatal hernias
Esophageal pH monitoring Used to document pathologic acid reflux, especially for patients who have
atypical symptoms.
 Acute Pain
• Acute Pain: The state in which an individual experiences and reports the presence of severe discomfort or an
uncomfortable sensation lasting from 1 seconds to <6 months.
• May be related to
• gastroesophageal reflux
• coughing
• aspiration
• irritated esophageal mucosa
• irritated oral cavity from reflux
• Possibly evidenced by
• verbalization of pain
• fever
• cough with or without production
• heartburn
• dysphagia
• regurgitation of acid
• atypical chest pain
• abdominal pain
• Desired Outcomes
• Client will report pain is relieved.
Nursing Interventions Rationale

Heartburn is the most common feature of GERD.

Assess for heartburn. This becomes more severe with vigorous exercise,
bending, or lying down.

Pain of esophageal spasm resulting from reflux

Carefully assess pain location and discern pain esophagitis tends to be chronic and may mimic 
from GERD and angina pectoris. angina pectoris: radiating to the neck, jaws, and
arms.

Please check out the nursing interventions in the

other nursing diagnoses. 
Imbalanced Nutrition: More Than Body Requirements
• Imbalanced Nutrition: More Than Body Requirements: The state in which an individual experiences
or is at risk of experiencing weight gain related to an intake in excess of metabolic requirements.
• May be related to
• decreased physical activity
• GERD
• eating to try to assuage pain
• decreased metabolic rate
• Possibly evidenced by
• body weight 10% or more over ideal weight
• triceps skin-fold measurement more than 15 mm in men and 25 mm in women
• eating in response to social situations, abdominal pain, or cues other than hunger
• pairing food with other activities
• sedentary lifestyle
• Desired Outcomes
• Client will achieve and maintain an adequate body weight.
• Client will carry out exercise program and weight reduction plan as devised.
Nursing Interventions Rationale

Assess patient for dietary history intake, eating patterns, the importance of eating, and Provides information regarding factors associated with being overweight or obesity problems
and assists in establishing a plan of care for weight reduction. Note: Elderly tend to gain
potentials for where dietary exercises can be limited.
weight faster and easily because of decreased activity and a lower metabolic rate.

Identify amount of weight loss needed for optimal body size and frame. Provides basis for dietary planning.

Provides goal achievement weight loss information, or lack of progress that may require
Weight patient every day, on same scale, same time if possible, same amount of clothing. changes or deviation in the plan of care. Weighing on same scale helps consistency of data.

Establish a dietary plan for weekly goals of weight loss of one pound. Encourage patient to Prevents frustration from lack of achieving goals. A reduction of approximately 500 calories
make gradual changes in dietary habits. per day will achieve the prescribed goal.

Provide activities for the patient that do not center around or are associated with meals or Utilize calories and provides diversion from eating; being overweight increases abdominal
snacks. pressure, which can then push stomach contents up into the esophagus.

Commend patient for his success and efforts in losing weight. Weight reduction may alleviate some of patient’s physical symptoms, and praise encourages
continued progress.

Assist patient and develop a modified exercise program, such as walking, or low-impact Increases utilization of calories, increases endurance, and maintains musculoskeletal
exercises. strength. Regularly scheduled exercise facilitates improvement of self-worth and self-esteem.

Instruct patient and/or family regarding dietary restrictions, modifying favorite foods to use
Promotes weight reduction plan by allowing the patient to use familiar foods that have had
lower calorie substitute ingredients, and to make choices that provide for adequate calories cut down.
nutritional intake.
Facilitates adeuqate nutritional intake and calorie reduction. Most patients are unaware of
Instruct patient to keep a dietary log of intake for calorie counting.
the “hidden” calories in food they ingest.

Instruct patient regarding community resources, weight reduction programs, or support Dietary requirements usually decrease with age by approximately 10-25%. Overeating,
groups. together with reduction in metabolic rate, continues obesity.

Consult with dietician for meal planning and food preparation. Provides meal planning and appropriate nutritional guidance.
Risk for Aspiration
• Risk for Aspiration: 
• The state in which a person is at risk for entry of secretions, solids, or
fluids into the tracheobronchial passages.
• May be related to
• esophageal compromise affecting the lower esophageal sphincter
• impaired swallowing
• Risk factors
• Depressed gag and cough reflex.
• Increased intragastric pressure.
• Impaired swallowing.
• Desired Outcomes
• Client will mantain patent airway
Nursing Interventions Rationale

Assess for pulmonary symptoms resulting from reflux of gastric content. These include subsequent aspiration, chronic pulmonary disease, or nocturnal
wheezing, bronchitis, asthma, morning hoarseness, and cough.

Assess for nocturnal regurgitation. This is a rare condition wherein the patient awakens with coughing, choking,
and and a mouthful of saliva.
Assess patient’s ability to swallow and the presence of gag reflex. Have the
patient swallow a sip of water. Loss of the gag reflex increases the risk of aspiration.

Avoid placing patient in supine position, have the patient sit upright after Supine position after meals can increase regurgitation of acid.
meals.

Instruct patient to avoid highly seasoned food, acidic juices, alcoholic drinks, These can reduce the lower esophageal sphincter pressure.
bedtime snacks, and foods high in fat.

To prevent aspiration by preventing the gastric acid to flow back in the

Elevate HOB while in bed. esophagus.
The tube interferes with sphincter integrity and allows reflux, especially when
Avoid nasogastric intubation for more than five (5) days. the patient lies flat.

Instruct the patient to chew food thoroughly and eat slowly. Well-masticated food is easier to swallow. Food should be cut into small
pieces.

If the patient has dysphagia, put the patient on NPO and notify physician. Patient at high risk for aspiration should be kept NPO until swallowing study
has been completed.
Deficient Knowledge

• Deficient Knowledge: 
• The state in which an individual or group experiences a deficiency in cognitive
knowledge or psychomotor skills concerning the condition or treatment plan.
• May be related to
• lack of information regarding condition/disease process.
• Possibly evidenced by
• request for information
• verbalization of problems
• presence of preventable complications
• Desired Outcomes
• Client will have increased knowledge of actions that reduce reflux.
Nursing Interventions Rationale
Assess patient for information needed and ability to perform actions
Provides a basis for teaching.
independently.
Assist with the reduction in caloric intake. Overweight increases intraabdominal pressure.
Provide patient with information regarding disease process, health practices
that can be changed, and medications to be utilized. Provides knowledge and facilitates compliance.

Instruct patient regarding eating small amounts of bland food followed by a

Gravity helps control reflux and causes less irritation from reflux action into
small amount of water. Instruct to remain in upright position at least 1–2 the esophagus.
hours after meals, and to avoid eating within 2–4 hours of bedtime.

Instruct patient to avoid bending over, coughing, straining at defecations, and Promotes comfort by the decrease in intra-abdominal pressure, which
other activities that increase reflux. reduces the reflux of gastric contents.
Instruct patients to eat slowly, chew foods well and maintain a high- Helps prevent reflux.
protein, low-fat diet.
Instruct patient to avoid temperature extremes of food, spicy foods, and These food items increase acid production that precipitates heartburn and
citrus, and gas forming foods. increased reflux.
Instruct patient regarding avoidance of alcohol, smoking, and caffeinated
beverages. Increases acid production and may cause esophageal spasms.

Instruct patient to raise both arms, fully extended towards the ceiling prior to Relieves spasms and allows for more comfort when eating.
eating.

Instruct patient in medications, effects, side effects, and to report to physician Promotes knowledge, facilitates compliance with treatment, and allows for
prompt identification of potential need for changes in medication regimen to
if symptoms persist despite medication treatment. prevent complications.
Administer medications as ordered
•Antacids and H2 receptor antagonists like famotidine (Pepcid), nizatidine (Axid), or Acts by neutralizing the acid in the stomach, therefore, helps relieve pain.
ranitidine (Zantac).

•Proton pump inhibitors such as lansoprazole (Prevacid), rabeprazole (AcipHex), Works by decreasing the release of gastric acid.
esomeprazole (Nexium), omeprazole (Prilosec), and pantoprazole (Protonix).

Helps hasten the gastric emptying time. Metoclopramide has extrapyramidal side effects
•Prokinetic agents such as bethanechol (Urecholine), domperidone (Motilium), and that are increased in certain neuromuscular disorders (e.g., Parkinson’s disease); it should
metoclopramide (Reglan). only be used if no other option exists.

•Sucralfate Helps ulcer healing by forming a protective barrier on the surface of the ulcer.

Used to replace gastric prostaglandins that have been depleted by the use of NSAIDs;
•Prostaglandin E1 analogues such as misoprostol (Cytotec) decreases basal gastric acid secretion and increases gastric mucus and bicarbonate
production.

Instruct the patient for correct preparation for diagnostic testing. No food intake for 6 to 8 hours prior to barium swallow or endoscopy.

Nicotine relaxes the esophageal sphincter and stimulates the production of stomach acid. It
can also injure the esophagus causing irritation making it more susceptible to damage from
Instruct the patient to avoid smoking. acid reflux. Lastly, smoking can decrease gastric motility and reduces the effectiveness of
digestion because the stomach takes longer to empty.

Alcohol can increase the production of stomach acid and can also lower the esophageal
Instruct the patient to avoid alcohol sphincter, which allows stomach acids to move up into the esophagus. Alcohol also makes
the esophagus more sensitive to stomach acid.
 Acute Pain

• May be related to
• Abdominal distention
• Abdominal muscle spasm
• Recent nonsteroidal anti-inflammatory drug (NSAID) or acetylsalicylic acid (ASA) use
• Possibly evidenced by
• Early satiety
• Nausea and vomiting
• Pain relieved by food or antacid
• Weight loss
• Desired Outcomes
• Client will report satisfactory pain control at a level less than 2 to 4 on a scale of 0 to 10.
• Client uses pharmacological and nonpharmacological pain relief measures.
• Client will exhibit increased comfort such as baseline levels for HR, BP, and respirations
and relaxed muscle tone for body posture.
Nursing Interventions Rationale

Clients with gastric ulcer typically demonstrate pain 1 to 2 hours after eating. The client with
Assess the client’s pain, including the location, characteristics, precipitating factors, onset, duration, duodenal ulcers demonstrate pain 2 to 4 hours after eating or in the middle of the night. With both
frequency, quality, intensity, and severity. gastric and duodenal ulcers, the pain is located in the upper abdomen and is intermittent. Client
may report relief after eating or taking an antacid.

Encourage the use of nonpharmacological pain relief measures: 

•Acupressure
•Biofeedback Nonpharmacological relaxation techniques will decrease the production of gastric acid, which in
•Distraction turn will reduce pain.
•Guided imagery
•Massage
•Music therapy
Instruct the client to avoid NSAIDs such as aspirin. These medications may cause irritation of the gastric mucosa.

Instruct the client that meals should be eaten ar regularly paced intervals in a relaxed setting. An irregular schedule of meals may interfere with the regular administration of medications.

Encourage the importance of smoking cessation. Smoking decreases the secretion of bicarbonate from the pancreas into the duodenum, resulting in
increased acidity of the duodenum.

Administer the prescribed drug therapy:  Antacids buffer gastric acid and prevent the formation of peptin. This mechanism of action
•Antacids promotes of healing of the ulcer. Antibiotics treat the Helicobacter pylori infection and promote
•Antibiotics such as amoxicillin, clarithromycin, metronidazole, tetracycline healing of the ulcer. As the ulcer heals, the client experience less pain. H2 receptor antagonists block
•Histamine receptor antagonists the secretion of gastric acid. Prostaglandin analogue reduces acid secretion and enhance the
•Prostaglandin analogues integrity of the gastric mucosa to resist injury. Proton pump inhibitors block the production and
•Proton pump inhibitor secretion of gastric acid and thereby reduce gastric pain. Sucralfate forms a barrier at the base of
•Sucralfate the ulcer crater to protect the healing ulcer from gastric acid.
Imbalanced Nutrition: Less Than Body Requirements
• May be related to
• Abdominal pain
• Alcohol intake
• Anorexia
• Diarrhea
• Gastrointestinal bleeding
• Nausea, vomiting
• Possibly evidenced by
• Inadequate dietary intake
• Malabsorption of irons, minerals, and vitamins
• Weight loss
• Desired Outcomes
• Client will verbalize and demonstrate selection of foods or meals that will achieve a
cessation of weight loss.
• Client will weigh within 10% of ideal body weight.
Nursing Interventions Rationale
Clients may often overestimate the amount of food eaten. The client may
not eat sufficient calories or essential nutrients as a way to reduce pain
Obtain a nutritional history.
episodes with peptic ulcer disease. Because of this, clients are at high risk
for malnutrition.
Weight loss is an indication of inadequate nutritional intake. Gastric ulcers
Assess for body weight changes. are more likely to be associated with vomiting, loss of appetite and weight
loss than duodenal ulcers.

Assist the client with identifying foods hat cause gastric irritation.
Clients need to learn what foods they can tolerate without gastric pain. Soft,
bland, non acidic foods cause less gastric irritation. The client is more likely
to increase food intake if the foods are not associated with pain. Foods that
may contribute to mucosal irritation include spicy foods, pepper, aNd raw
fruits and vegetables.

This test indicates the degree of protein depletion (2.5 g/dL indicates severe
Monitor laboratory values for serum albumin. depletion; 3.8 to 4.5 g/dL is normal).
Instruct in the importance of abstaining from excessive alcohol. Alcohol causes gastric irritation and increases gastric pain.

Encourage the client to limit the intake of caffeinated beverages such as tea Caffeine stimulates the secretion of gastric acid. Coffee, even if
and coffee. decaffeinated, contains a peptide that stimulates the release of gastrin and
increases acid production.

Specific dietary restrictions are no longer part of the treatment for PUD.
Teach about the importance of eating a balanced diet with meals at regular
intervals. During the symptomatic phase of an ulcer the client may find benefit from
eating small meals at more frequent intervals.
Anxiety
• May be related to
• Fear of the unknown
• Nature of the disease.
• Situational crisis
• Stress
• Possibly evidenced by
• Abdominal pain
• Apprehensive
• Expressed concerns about changes in life events
• Fatigue
• Irritability
• Desired Outcomes
• Client will demonstrate ways of reducing anxiety level.
Nursing Interventions Rationale
Assess client’s level of anxiety. Clients with peptic ulcers are anxious, but their anxiety level is not
visible.

Acknowledge awareness of the client’s anxiety. Acknowledgement of the client’s feelings validates the feelings and
communicates the acceptance of those feelings.

Open communication enable the client to develop a trusting

Encourage to express fears openly
relationship that aids in reducing anxiety and stress.

When experiencing moderate to severe anxiety, clients may be

Use simple language and brief statements when giving instructions unable to comprehend anything more than simple, clear, and brief
to the client.
instructions.

Decrease sensory stimuli by maintaining a quiet environment. Anxiety may escalate to a panic state with excessive conversation,
noise, and equipment around the client.

Providing emotional support will give a client calming and relaxing

Provide emotional support to client. mood that will lower anxiety, and stress related to the condition.

Assist the client in developing anxiety-reducing measures such as Learning these methods provides the client with a variety of ways to
biofeedback, positive imagery, and behavior modification. manage anxiety.
Deficient Knowledge
• May be related to
• Lack of recall of previously learned information
• New condition, treatment
• Recurrent episodes of GI bleeding
• Recurrent peptic ulcer disease
• Possibly evidenced by
• Incorrect responses to questions about peptic ulcer disease
• Inaccurate follow-through with treatment regimen and lifestyle modifications
• Lack of questions
• Multiple questions
• Desired Outcomes
• Client will verbalize understanding of the importance of compliance with medical
regimen, knowledge of peptic ulcer disease, and commitment to self-care
management.
Nursing Interventions Rationale

Clients may have inaccurate information about how lifestyle behaviors

Assess the client’s knowledge and misconceptions regarding peptic ulcer contribute to peptic ulcer disease. The client needs accurate knowledge to
disease, lifestyle behaviors, and the treatment regimen. make informed decisions about taking prescribed medications and modifying
behaviors that contribute to peptic ulcer disease or GI bleeding.

An understanding of the disease process helps to foster the willingness to

Explain the pathophysiology of disease and how it relates to the functioning follow the recommended treatment plan and modify behaviors to prevent
of the body.
recurrent episodes or related complications.

Instruct the client in what signs and symptoms to report to the health care Recognizing the signs and symptoms can help ensure the early initiation of
provider. treatment.

The correct use of antibiotics and acid suppression medications can promote

Discuss the therapy options and the rationales for using these options. rapid healing of an ulcer.

The modifications of lifestyle behaviors such as alcohol use, coffee, and

Discuss the lifestyle changes required to prevent further complications or other caffeinated beverages, and the overuse of aspirin or other
episodes of peptic ulcer disease. nonsteroidal anti-inflammatory drugs is necessary to prevent recurrent ulcer
development and prevent complications during the healing phase.
Risk for Deficient Fluid Volume
• May be related to
• Gastrointestinal (GI) bleeding
• Nausea, vomiting

• Desired Outcomes
• Client will be normovolemic as evidenced by systolic BP greater than or equal
to 90 mm Hg (or client’s baseline), absence of orthostasis, HR 60 to 100
beats/minute, urine output greater than 30 ml/hr, and normal skin turgor.
Nursing Interventions
Assess for the signs of hematemesis or melena.
Monitor the client’s fluid intake and urine output.
Monitor the client’s vital signs, and observes BP and HR for signs of
orthostatic changes.
Instruct the client to immediately report symptoms of nausea, vomiting,
dizziness, shortness of breath, or dark tarry stools.
Monitor hemoglobin and hematocrit levels.
Administer IV fluids, volume expanders, and blood products as ordered.
Rationale
The client with a bleeding ulcer may vomit bright red blood or coffee
grounds emesis. Melena occurs when there is bleeding in the upper GI tract.
The kidney will reabsorb water into circulation to support a decrease in
blood volume. This compensatory mechanism results in decreased urine
output. A decrease in circulatory blood volume leads to decreased renal
perfusion and decreased urine output
The erosion of an ulcer through the gastric or duodenal mucosal layer may
cause GI bleeding. The client may develop anemia. If bleeding is brisk,
changes in vital signs and physical symptoms of hypovolemia may develop
rapidly. A decrease in BP and an increase in HR with changes in position is an
early indicator of decreased circulatory volume.
These assessment findings are signs of GI bleeding and should be reported
immediately.
Erosion of the gastric mucosa by an ulcer results in GI bleeding. A decrease
in hemoglobin and hematocrit occurs with bleeding.
Isotonic fluids, volume expanders, and blood products can restore or expand
intravascular volume.
VIRAL HEPATITIS
HEPATITIS

• Hepatitis is a class of diseases that impact the liver.

• Hepatitis can cause inflammations of the liver and can
cause its function to diminish.
• When this Happens liver scarring can occur, which is known
as cirrhosis, and in severe cases, cancer can develop.
• Hepatitis can be attributed to certain types of medication,
toxins, alcohol, hereditary conditions, viruses, and
autoimmune disorders.
 HEPATITIS

• Hepatitis is a medical condition defined by the inflammation of the liver and

characterized by the presence of inflammatory cells in the tissue of the organ.
 CLASSIFICATION:

• Viral hepatitis may be divided into 5 types according to etiology, that is hepatitis
• A, B, C, D and E
 Hepatitis A virus (HAV)
Etiology

Is an acute liver disease

caused by the hepatitis A Transmission:
virus (HAV),
• lasting from a few weeks • Ingestion of fecal matter,
to several months. even in microscopic
• It does not lead to amounts, from close
chronic infection. person-to-person
contact or ingestion of
contaminated food or
drinks.
Vaccination:
• Hepatitis A vaccination is
recommended for all
children starting at age 1
year, travelers to certain
countries, and others at
risk.
 Signs & Symptoms

• Some persons, particularly young children, are asymptomatic. When symptoms are
present, they usually occur abruptly and can include the following:

• Fever

• Fatigue

• Loss of appetite Nausea

 Signs & Symptoms cont:

Vomiting
Abdominal pain
Dark urine
Clay-colored bowel movements

Joint pain Jaundice .

 Hepatitis B virus (HBV) "serum hepatitis,"

Is a liver disease caused • It ranges in severity from a mild illness, lasting a few weeks
by the hepatitis B virus (acute), to a serious long-term (chronic) illness that can lead to
liver disease or liver cancer.
(HBV).

• Contact with infectious blood, semen, and other body fluids from
Transmission: having sex with an infected person, sharing contaminated needles
to inject drugs, or from an infected mother to her newborn.

• Hepatitis B vaccination is recommended for all infants, older

Vaccination: children and adolescents who were not vaccinated previously, and
adults at risk for HBV infection.
 CONT:
• About 6% to 10% of patients with HBV hepatitis develop chronic HBV infection
(infection lasting at least six months and often years to decades) and can infect
others as long as they remain infected.

• Patients with chronic HBV infection also are at risk of developing cirrhosis, liver
failure, and liver cancer.
 Acute infection with hepatitis B virus
Is associated with acute viral hepatitis –

• an illness that begins with general ill-health, loss of appetite, nausea, vomiting, body
aches, mild fever, dark urine, and then progresses to development of jaundice.
• It has been noted that itchy skin has been an indication as a possible symptom of all
hepatitis virus types.
• The illness lasts for a few weeks and then gradually improves in most affected people.
• A few patients may have more severe liver disease (fulminant hepatic failure), and may
die as a result of it.
• The infection may be entirely asymptomatic and may go unrecognized
 CONT:

Chronic infection with Hepatitis B virus

• May be either asymptomatic or may be associated with a chronic inflammation of

the liver (chronic hepatitis), leading to cirrhosis over a period of several years.
• This type of infection dramatically increases the incidence of hepatocellular
carcinoma (liver cancer).
• Chronic carriers are encouraged to avoid consuming alcohol as it increases their
risk for cirrhosis and liver cancer.
• Hepatitis B virus has been linked to the development of Membranous
glomerulonephritis (MGN).
 Hepatitis C virus (HCV)
Is a liver disease caused by the hepatitis C virus
(HCV).
most n becomes
HCV infection a chronic
sometimes resultscondition thatillness,
in an acute can
ofte
cirrhosi
but of thetoliver and liver
lead
s infection
The cancer.
is often asymptomatic, but once
chronic fection can progress to scarring of the liver
established,
in
(fibrosis , and advanced scarring (cirrhosis).
)
I some ses, those with cirrhosis will go on to
failure develop liver other complications of cirrhosis,
n ca
or
cancer. including liver
Most people have few symptoms after the initial infection,
yetthe persists in the liver in about 80% of
virus
infected those
.
 Transmission: Vaccination:

• Contact with the blood • There is no vaccine for

of an infectedperson, hepatitis C.
primarily through
sharing contaminated
needles to inject drugs.
 Signs And Symptoms

• Acute hepatitis C refers to the first 6 months after infection with HCV.
• Symptoms of acute hepatitis C infection include decreased appetite, fatigue,
abdominal pain, jaundice, itching, and flu-like symptoms.
• The hepatitis C virus is usually detectable in the blood within one to three weeks
after infection, and antibodies to the virus are generally detectable within 3 to 12
weeks.
 Generalized signs and symptoms associated with
chronic hepatitis C include:

Fatigue
marked weight loss itching,
flu-like symptoms sleep disturbances
muscle pain abdominal pain (especially in the
joint pain right upper quadrant),
intermittent low-grade fevers appetite changes nausea,
depression, diarrhea,
headaches, dyspepsia, cognitive changes,
and mood swings.
Hepatitis D virus (HDV) Is a serious liver disease
caused by the hepatitis D virus (HDV) and relies
on HBV to replicate.

Transmission:

• Contact with infectious blood, similar to how HBV is spread.

Vaccination:

• There is no vaccine for hepatitis D.

 Hepatitis E virus (HEV)
Is a serious liver disease caused by the hepatitis E virus (HEV)
• that usually results in an acute infection.
• It does not lead to a chronic infection.

Hepatitis E virus (HEV) is similar to HAV

• in terms of disease, and mainly occurs in Asia
• it is transmitted by contaminated water.

Transmission:
• Ingestion of fecal matter, even in microscopic amounts; outbreaks are usually
associated with contaminated water supply in countries with poor sanitation.

Vaccination:
• There is currently no FDA- approved vaccine for hepatitis E.
INCUBATION PERIOD
 Incubation period

HA 15-45 days 30 days

HB 30-180 days 70 days
HC 15-150 days 50 days
HD similar to
HB 40 days
HE 10-70 days
Laboratory examination
 Laboratory examination
Liver function
 Serum transaminase
• ALT(alanine transferase) ↑
• AST(aspartase transferase) ↑
• ALP (Alkaline phosphatase) ↑
• in chronic hepatitis LDH (Lactate
dehydrogenase) ↑
 Serum protein
•• Albumin
In chronic↓ Ig ↑↑
• hepatitis
The ratio of A/G ↓
 Bilirubin
• Urobilinogen ↑in early stage
of AIH
 Detection of the markers of hepatitis
virus:

•Hepatitis A Hepatitis B
• Serologic marker • Sero-immunologic marker
– Anti-HAVIgM: recent – HBsAg anti-HBs
infection – HBcAg anti-HBc
– Anti-HAVIgG: past infection – HBeAg anti-Hbe
• Marker of feces
• Molecular biological marker
– HAV particles may be – DNAp
detected by RIA or IEM – HBV DNA
– Isolation of HAV may use – Immune tissue chemistry
tissue culture or animal examination
inoculation
CONT:

Ultra-sound
examination Liver
biopsy
Other laboratory
examination
– Blood routine
– Urine routine
Hepatitis
C • Serological
marker
Hepatitis
– Anti-
HCVIgM
– Anti- D anti-
HCVIgG •• HDAg
HDV HDV
• Molecular
biologic
marke RNA
r – HCV RNA may
bedetective by Hepatitis E
RT-
PCR 1-2 • Anti-HEVIgG,Anti-HEVIgm
after
weeks
• RT-PCR
infection of
HC
– V
Quality of • HEV particais: IF IEM
HCV
RNA
– Immune tissue
chemistry
method detect
HCAg within
liver cells
NURSING INTERVENTION
 CONT:

Observe standard precautions to prevent disease transmission.

Provide rest periods throughout the day.

Schedule treatments and tests so the patient can rest between activities.

To help the patient maintain an adequate diet, avoid overloading his tray.
 CONT:

• Administer supplemental vitamins and commercial feedings, as ordered.

• Provide adequate fluid intake atleast 4 liters of liquid daily.
• Observe the patient for desired and adverse effects of medication.
• Record the patient’s weight daily, and keep accurate intake and output records.
 CONT:

• Watch for signs of complications, such as changes in level of consciousness, ascites,

edema, dehydration, respiratory problems, myalgia, and arthalgia.
• Teach the patient about the diseases, its signs and symptoms, and recommended
treatments.
• Explain all the necessary diagnostic tests.
• Stress the importance of continued medical care.