Med-Surg - Gastrointestinal System, part 12: Hepatitis, Cholecystitis, Bariatric Surgery
by Cathy Parkes November 28, 2021 Updated: January 17, 2022 4 min read
Hi, I'm Cathy with Level Up RN. In this video, I am going to talk about hepatitis, cholecystitis, as well as bariatric surgery. At the end of the video, I'm going to give you guys a little quiz to test your knowledge of some of the key points I'll be covering in this video, so definitely stay tuned for that. And if you have our Level Up RN medical surgical nursing flashcards, definitely pull those out so you can follow along with me. Hepatitis is inflammation of the liver that is caused by a virus or a hepatotoxic medication or chemical. Let's first talk about the different types of viral hepatitis. So we have hepatitis A, B, C, D, and E. Hepatitis A and E are spread through the fecal-oral route; for example, contaminated water. Hepatitis B, C, and D are spread through blood and bodily fluids. We have vaccines for hepatitis A and B. There is no vaccine for hepatitis C. And of note, you can only get hepatitis D if you have hepatitis B. So if you get your vaccine to hepatitis B, then you won't get hepatitis D.
So if a patient has chronic hepatitis, that can lead to cirrhosis or liver cancer. Risk factors for viral hepatitis include IV drug use, body piercings, tattoos, high-risk sexual practices, as well as travel to underdeveloped countries. Signs and symptoms can include fever, lethargy, nausea and vomiting, jaundice, which is yellow discoloration of the skin and of the whites of the eyes. In addition, the patient may have clay-colored stools, dark urine, abdominal pain, as well as arthralgia, which is joint pain. Abnormal labs that may be present with hepatitis include an increase in ALT, AST, as well as bilirubin, and then diagnosis of viral hepatitis can be done with serological testing, which tests for the presence of antibodies for the different types of viral hepatitis.
And then, in terms of treatment, with hepatitis A and E, those types are usually self-resolving and don't really require much treatment, other than supportive care. We can use antiviral agents for chronic hepatitis B or acute or chronic hepatitis C. Next, let's talk about cholecystitis, which is inflammation of the gallbladder, and this is typically caused by cholelithiasis, which is a gallstone. So that gallstone will block the cystic duct or the common bile duct and cause inflammation of the gallbladder, impaired bile flow, and eventual necrosis of the cells in the gallbladder. So risk factors associated with cholecystitis include cholelithiasis, as I just described. Other risk factors include a high-fat diet, obesity, genetics, older age, and the female gender. In terms of signs and symptoms, the patient will likely have right-upper-quadrant pain that may radiate to the right shoulder. They will have pain upon ingestion of high-fat foods. They may also complain of nausea and vomiting, dyspepsia, which is a fancy name for indigestion, as well as gas and bloating. And if the liver becomes involved - for example, if the gallstone is in that common bile duct - then we may end up with symptoms such as jaundice, dark-colored urine, and clay-colored stools because of that liver involvement.
White blood cells are often elevated with cholelithiasis. If we have liver involvement, then liver enzymes such as AST and bilirubin may be elevated. And if we have pancreatic involvement because that pancreatic duct will join with the common bile duct before it reaches the small intestine, then we may have elevation in amylase and light pace. In terms of diagnosing cholecystitis, we would use an ultrasound. Treatment includes the use of analgesics. We can also do a lithotripsy, which uses shockwaves to break up those gallstones. The patient may ultimately require a cholecystectomy, which is removal of that gallbladder. In terms of nursing care, we're going to want to monitor for complications, which can include pancreatitis if the pancreas becomes involved. It can also include peritonitis, which can be caused by perforation of the gallbladder. So if the gallbladder perforates, then all of those contents are going to contaminate the abdominal cavity, that peritoneal cavity, which can result in peritonitis. In terms of patient teaching, we want to advise our patient to consume a low-fat diet, they should avoid gas-causing foods, and they should lose weight, if applicable.
The last topic I'm going to cover in this video and in this gastrointestinal playlist is bariatric surgery. So this is a surgical intervention aimed at reducing an individual's gastric capacity or absorption, and we perform this in morbidly obese patients, so typically with a BMI over 40 or with a BMI over 35 with other risk factors. So in terms of post-op nursing care, we're going to want to monitor the patient for dumping syndrome. Signs and symptoms of dumping syndrome include abdominal cramping, tachycardia, nausea, diarrhea, as well as diaphoresis. We also need to provide some important teaching to our patient who just had bariatric surgery.
So we need to advise them to chew their food slowly and thoroughly. We need to advise them to eat six small meals a day versus three large meals. They should not consume liquids with meals. They will need to have liquids between meals. They should recline after meals in order to slow gastric emptying and prevent dumping syndrome. And then they should avoid foods that are high in sugar, fat, and carbohydrates. All right, it's time for a quiz. I have four questions for you.
First question. What types of hepatitis are preventable through vaccination? The answer is hepatitis A and B. Question number two. What procedure uses shockwaves to break up gallstones? The answer is lithotripsy. Question number three. What type of diet would be recommended for a patient with cholecystitis? The answer is a low-fat diet. Question number four. What complication of bariatric surgery is characterized by abdominal cramping, tachycardia, diaphoresis, and diarrhea? The answer is dumping syndrome. All right. That is it for this video and for this gastrointestinal playlist. I hope you have found it super helpful. Take care, and good luck with studying.
Hepatitis is inflammation of the liver that can be caused due to-- hepatitis is inflammation of the liver that can be caused to-- that can be caused due to exposure to a virus or due to a.
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