University:
Texas Lutheran University
Course:
NURS 332 | Fundamental Nursing Concepts & Practice
Academic year:

2019
Views:

122

Pages:

4
Author:

FreestyleLava

Peptic ulcer It’s the only pain that is relieved by anti-acid drugs ( proton pump inhibitor (PPI) such as Pantoprazole) Endoscopy indication: when I suspect peptic ulcer and I excluded all other causes, especially if pain is relived by PPI . ( I will take a biopsy also) Treatment: anti-acid drugs Perforated peptic ulcer Diagnosis: 1. Guarding ( board like rigidity) indicate peritonitis 2. Difficult to hear bowel sounds 3. Air under diaphragm on X-ray (diagnostic) * Endoscopy is contraindicated Treatment: urgent surgery ( omentum patch) Difference between perforated gastric and duodenal ulcer is that in gastric I will take biopsy before closer ( to role out cancer) Gall stones Diagnosis : + Murphy’s sign: It is pain on taking a deep breath when the examiner’s hand is on the approximate location of the gallbladder. US: shadow of the stones + signs of Cholecystitis if it’s present Oral contract CT TT: Lapcholy Cholecystitis Acute : less than 2-3 days On US: 1- Thick wall 2- pericholecystic fluid 3- + Murphy’s sign by the probe 1 - Common bile duct 4-6 mm (normal) : dilated or not Treatment: 1- admission of patient , NPO , IV fluids, antibiotics, analgesic + surgery (lap cholecystectomy) Chronic: more than 3 days Conservative management: NPO, IV fluids, IV antibiotics, analgesia - If it’s improved, discharge continue the antibiotic course and elective surgery after 8 weeks. Why? Because first 48 hours it will be edematous (surgery is easy) After that edema will become fibrosis (easy bleed) more chance for complication - If it’s not improve we do surgery 2 Pancreatitis Lap: Amylase & Lipase (lipase more sensitive) Classify pancreatitis by Ranson criteria. First line of treatment is rehydration then analgesia & sometimes antibiotics Appendicitis Diagnosis: 80% clinically (rebound tenderness on right lilac fossa) + umbilical pain radiated to RIF + tenderness. US findings: one of them 1- Edematous appendix with fluid around it (can be seen in CT also) 2- Appendicular mass (after untreated inflammation the omentum come around the inflamed area) 3- Appendicular abscess (as a cystic) Treatment : ● In Acute appendicitis : * Surgery is the definitive treatment ● In Appendicular abscess: Drainage by US or CT guidance drainage done by a radiologist. If it’s failed, or we have multiple abscesses by surgery, either laparoscopic or open. ● In Appendicular mass: Conservative management: NPO, IV fluids, IV antibiotics, analgesia - If it’s improved, discharge, continue the antibiotic course and elective surgery after 8 weeks. Why? Because it has risk for recurrence. Signs of improvements? - Mass is regressed in size, no fever, decrease pain, decrease leukocytosis If it’s not improve surgery is done. 3 What are the most common bacteria in case of appendicitis? OR what are the antibiotics used in appendicitis? Answer: Antibiotics: against Gram – (E-coli) such as 3rd generation of cephalosporin & anaerobic bacteria (Enterobacter) flagyl 4

Perforated Peptic Ulcer

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