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Clinical Companion
MEDICALSURGICAL
NURSING
2nd edition
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Clinical Companion
MEDICALSURGICAL
NURSING
2nd edition
Gayle McKenzie
RN, BSocSc, GC ClinEd, GD CritCare,
MEd, RCNA
Tanya Porter
RN, BN, GDipAdvNsg (Emerg), MEd
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Mosby
is an imprint of Elsevier
Elsevier Australia. ACN 001 002 357
(a division of Reed International Books Australia Pty Ltd)
Tower 1, 475 Victoria Avenue, Chatswood, NSW 2067
2011 Elsevier Australia
This publication is copyright. Except as expressly provided in the Copyright Act 1968
and the Copyright Amendment (Digital Agenda) Act 2000, no part of this publication
may be reproduced, stored in any retrieval system or transmitted by any means (including
electronic, mechanical, microcopying, photocopying, recording or otherwise) without prior
written permission from the publisher.
Every attempt has been made to trace and acknowledge copyright, but in some cases
this may not have been possible. The publisher apologises for any accidental infringement
and would welcome any information to redress the situation.
This publication has been carefully reviewed and checked to ensure that the content is as
accurate and current as possible at time of publication. We would recommend, however, that
the reader verify any procedures, treatments, drug dosages or legal content described in this
book. Neither the author, the contributors, nor the publisher assume any liability for injury
and/or damage to persons or property arising from any error in or omission from this publication.
National Library of Australia Cataloguing-in-Publication Data
___________________________________________________________________
McKenzie, Gayle.
Clinical companion : medical-surgical nursing / Gayle McKenzie ; Tanya Porter.
2nd ed.
9780729539968 (pbk.)
Includes index.
NursingHandbooks, manuals, etc.
Surgical nursingHandbooks, manuals, etc.
Porter, Tanya.
610.73
___________________________________________________________________
Publisher: Libby Houston
Developmental Editors: Larissa Norrie and Elizabeth Coady
Publishing Services Manager: Helena Klijn
Editorial Coordinator: Natalie Hamad
Edited by Brenda Hamilton
Proofread by Sarah Newton-John
Indexed by Cynthia Swanson
Cover and internal design by Toni Darben
Typeset by Pindar New Zealand, Auckland
Printed in China by China Translation and Printing Services
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Contents
Preface
Acknowledgments
Reviewers
ix
x
xi
1 Medication administration
Medication errors
1
9
2 Documentation
10
19
19
21
25
29
33
51
53
56
58
58
62
64
66
74
83
86
91
95
98
98
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vi |
Contents
103
105
112
118
134
138
145
150
152
153
154
158
159
163
163
165
166
169
171
174
177
177
182
184
202
203
205
209
213
213
222
224
231
241
245
249
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Contents |
vii
252
252
253
257
268
269
271
273
276
286
286
286
288
288
291
298
298
299
299
303
306
308
311
311
11 Infectious diseases
Chain of infection
Prevention of infection
Infectious diseases
Pharmacology
313
315
317
320
357
360
362
363
365
367
369
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viii |
Contents
Fractures
Amputation
Shock
Burns
Complications of trauma
370
372
374
379
386
13 Operative care
Preoperative care
Intraoperative care
Postoperative care
On return to ward (RTW)
Wound care
Discharge from hospital
388
389
392
396
397
399
402
14 Survival tactics
Tips to assist with clinical placement
Workload management
What else do you need to know?
404
407
409
410
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420
428
429
430
432
433
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Preface
ix
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Acknowledgments
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Reviewers
Sonja Cleary RN, BN, MHlthSc, Grad Cert Tert Edn, MRCNA;
Lecturer/Course Coordinator, Discipline of Nursing and
Midwifery, School of Health Science, RMIT University, VIC
Trinity Farrell CCRN, Grad Dip Nursing (Critical Care);
Lecturer, La Trobe University, VIC
Penny Paliadelis RN, BNurs, MNurs(Hons), PhD, MRCNA,
MACCCN; Associate Professor, Deputy Head of School
(Teaching & Learning), School of Health, Faculty of the
Professions, University of New England, NSW
Lacey Smale BNurs, RN, MRCNA; Lecturer, University of
Canberra, ACT
xi
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gastrointestinal
7 | The
system
The main function of the gastrointestinal system is to provide
nutrients to the cells of the body. The four major functions
are ingestion (taking in food), digestion (breakdown of food),
absorption (transfer of food products into the circulation) and
elimination (excretion of waste products).
Mouth
Also known as buccal or oral cavity
Contains the salivary glands, which secrete saliva to
moisten food during chewing
Tongue (with cheeks) shapes food into a bolus (rounded
mass) and pushes it into the pharynx.
Pharynx
Oropharynx
Oesophagus
Cricopharyngeal sphincter relaxes so food can enter the
oesophagus.
Stomach
Has four main regions: cardia, fundus, body and pylorus
(includes the pyloric sphincter)
Lies just below the diaphragm
Size varies with distension
If too distended, may cause shortness of breath due to
pressure on the diaphragm
Function:
Temporary storage of food
177
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Mouth
179
Parotid
gland
Teeth
Epiglottis
Submandibular
gland
Pharynx
Sublingual
gland
Oesophagus
Hepatic
bile duct
Stomach
Cystic
duct
Pancreas
Liver
Splenic
flexure
Common
bile duct
Transverse
colon
Gallbladder
Hepatic
flexure
Descending
colon
Duodenum
Ascending
colon
Caecum
Jejunum
Vermiform
appendix
Ileum
Rectum
Sigmoid
colon
Large intestine
Consists of the caecum, appendix, ascending colon,
transverse colon, descending colon, sigmoid colon,
rectum and anus (including anal sphincter)
Function:
Water absorption
Mucus secretion (to aid faecal movement)
Bacteria, e.g. Escherichia coli, Lactobacillus bifidus
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181
The hepatic duct carries bile out of the liver, the cystic duct
takes bile to and from the gallbladder and the common bile
duct takes bile from the cystic and hepatic ducts to the small
intestine.
Bilirubin
Gallbladder
Collects, concentrates, acidifies and stores bile
Food and fat ingestion trigger the release of cholecystokinin
(CCK), which relaxes the valve at the common bile duct,
releasing bile into the small intestine
Bile is moved in and out through the cystic duct.
Pancreas
Lies behind the stomach (between the duodenum and the
spleen)
The pancreatic duct empties into the ampulla of Vater and
joins the common bile duct, allowing pancreatic juices to
empty into the small intestine, where they become activated
Exocrine function:
Releases digestion enzymes into pancreatic duct
Releases inactive pancreatic enzymes into the small
intestine
Endocrine function:
Releases hormonesinsulin, glucagon and
somatostatin.
Exocrine secretes into a duct.
Endocrine secretes into the blood or lymph.
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Assessment
Subjective
Ask the patient about:
What the symptoms are and what precipitates or relieves
them
Bowel characteristics (stool description), including altered
bowel habits
Diet and nutrition, including altered eating habits, e.g.
changes in appetite, difficulty eating or swallowing, weight
loss or gain
Dentures or any recent dental work
Lifestyle, e.g. stress, smoking, exercise, alcohol
Family history
Past history
Any recent travel (particularly overseas)
Past surgery or hospital admission
Any previous ulcers, GI bleeding etc
Medications (including OTCparticularly aspirin,
NSAIDs or laxatives)
Allergies to medications or foods.
Objective
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For adults:
BMI
Weight range
< 20.0
Underweight
20.025.0
Normal
25.030.0
Overweight
> 30.0
Obese
Nutrition
A healthy diet should consist of:
Carbohydratesgive energy, e.g. bread, pulses, grains
Fibreno nutritional value, but promotes bowel motility,
e.g. bran, cereals
Proteinsneeded for cell production and maintenance, e.g.
meat, fish, pulses
Fatsneeded for the everyday function of cells, the
hormone system and body temperature regulation, e.g. milk,
butter, cheese, fish
Vitamins and mineralse.g. vitamins A, B1 (thiamine),
B2 (riboflavin), B3 (niacin), B6 (pyridoxine), B12
(cyanocobalamin), C, D, E and K.
Medical disorders
Anorexia
Lack or loss of appetite. It can occur due to psychological issues
(e.g. anorexia nervosa, low self-esteem, stress) or be related to
disease processes, medications or other treatment regimes.
Appendicitis
Inflammation of the appendix. Occurs as a result of obstruction
of the mucous outflow from the appendix, causing the appendix
to distend and bacteria to multiply, leading to restricted blood
flow and eventual necrosis and perforation.
Causes
Faecal impaction
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Strictures
Viral infection
Ulceration of the mucosa.
Cholelithiasis (gallstones)
Occurs when bile is released that lacks the usual concentration of
bile salts, causing it to become less soluble. This leads to bilirubin,
calcium and cholesterol precipitation and the formation of
gallstones.
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Treatment
Depends on severity
Low-fat diet
Antibiotics (usually IV)
NGT (if vomiting)
Lithotripsy (the break-up of stones using ultrasonic waves)
Cholecystectomy.
Cirrhosis
Irreversible scarring of the liver that leads to the disruption of
blood flow through the liver.
Types
Post-necrotic
Characterised by the replacement of liver tissue with
nodules of fibrous tissue
Occurs due to viral hepatitis B or C, autoimmune disease,
or drug or chemical toxicity.
Biliary
Develops in the bile ducts with obstruction of the flow
of bile, and causes inflammation and scarring of the bile
ducts
Usually caused by autoimmune disorders, gallstones or
strictures
Signs and symptoms are pruritus, dark urine and pale stools
Treatment includes correction of the obstruction and
treating the symptoms.
Portal or alcoholic
Occurs in three stages:
Fatty changes
Alcohol replaces fat as a fuel for liver metabolism
Alcoholic hepatitis
Inflammation and necrosis of liver cells
Cirrhosis
Normal tissue is replaced by scar tissue and blood
flow through the liver is obstructed, causing the
formation of shunts that serve as alternative routes
for the return of portal blood to the heart.
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Liver failure.
Constipation
Infrequent and often difficult evacuation of faeces.
Causes
Inadequate fluid and food (particularly fibre) intake
Immobility or a sedentary lifestyle
Medications, e.g. opiates
Surgery.
Signs and symptoms
Hyperactive bowel sounds above the obstruction, with no
sounds below the obstruction
Bloating
Abdominal discomfort.
Treatment
Promote fluid intake
Promote fibre intake to improve muscle tone
Bowel chartnote colour, consistency and frequency
Encourage ambulation
Medications, e.g. laxatives.
Crohns disease
An inflammatory bowel disease that can affect any part of the
GIT, from the mouth to the anus, although the terminal ileum is
the most common. It affects all layers of the bowel (transmural
inflammation). It is painful and debilitating, and can lead to lifethreatening complications. There is no cure, however symptoms
can be relieved with treatment and some people can go into
remission for months or years.
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Diagnosis
Blood tests, e.g. WCC, ESR, FBE, U&E
Faecal occult blood test
Barium enema
X-Ray, CT or MRI
Colonoscopy
Sigmoidoscopy
Biopsy.
Treatment
Medications:
Anti-inflammatory medications, e.g. corticosteroids,
sulfasalazine, mesalamine
Antibiotics, e.g. metronidazole, ciprofloxacin
Immunosuppressants, e.g. azathioprine, infliximab
Aminosalicylates
To relieve symptoms, e.g. anti-diarrhoeals, laxatives, pain
relief
Vitamins and minerals, e.g. iron, calcium, vitamins B12, D
Diet restriction
If acute, may need total parenteral nutrition (TPN)
Colectomy and/or ileostomy (if recurrent).
Nursing considerations
Observe faeces for occult blood
Observe for malnutrition and dehydration.
Diarrhoea
An increase in the frequency and fluidity of faeces.
Causes
GIT disease, e.g. Crohns disease
Toxins
Medications, e.g. laxative overuse
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Causes
Increased transluminal pressure combined with a weakening
of the bowel wall (often due to straining during bowel
movements)
Food or faeces lodging in the diverticula
Note: In countries where the diet is high is fibre, this disease is
relatively unknown.
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Gallbladder cancer
A rare form of cancer that is usually only discovered when the
gallbladder is removed or when the cancer is very advanced.
Cause
Unknown but could be due to toxins.
Signs and symptoms
Often mimics other gallbladder problems such as gallstones
or infection
Right upper quadrant abdominal pain
Nausea and vomiting
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Treatment
Cholecystectomy
Radiation therapy.
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Nursing considerations
Ensure patient remains sitting upright and sleeps with head
of bed elevated.
Haemorrhoids
Congestion of the veins in the haemorrhoidal plexus, causing
varicose veins in the anal sphincter area. They can be internal or
external. Can be treated with OTC medications, minimally invasive
procedures, e.g. sclerotherapy, or surgery, e.g. haemorrhoidectomy.
Hepatitis
See Ch 11 Infectious diseases.
Causes
Stress
Ingestion of irritants, e.g. coffee, alcohol
Laxative abuse
Other illness, e.g. gastroenteritis.
Signs and symptoms
Abdominal pain relieved by flatulence or bowel actions
Diarrhoea or constipation
Mucus in stools
Bloating.
Diagnosis
Sigmoidoscopy
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Colonoscopy
CT
Lactose intolerance tests
Blood tests for other diseases, e.g. coeliac disease.
Treatment
Increase dietary fibre or fibre supplements, e.g. Metamucil
Eliminate high-gas foods from the diet
Medications
Anticholinergics (to relieve symptoms)
Antidiarrhoeal medication, e.g. loperamide.
Nursing considerations
Observe fluid status.
Jaundice
Yellowish discolouration of the sclera of the eye, skin and deep
tissues due to an abnormally high accumulation of bilirubin in
the blood.
Types
Intrahepatic
Caused by liver disease and drugs such as oral
contraceptives, anabolic steroids and chlorpromazine
Conjugated and unconjugated serum bilirubin levels are
abnormally high
Extrahepatic
Occurs due to obstruction of bile flow between the liver
and the intestine, caused by strictures of the bile duct,
gallstones and tumours of the bile duct or the pancreas
Conjugated levels of bilirubin are elevated.
Causes
Excessive destruction of red blood cells (haemolytic
jaundice)
Can occur following a blood transfusion or due to
hereditary diseases or haemolytic disease of the newborn
Decreased uptake of bilirubin by the liver cells
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Liver cancer
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Treatment
Surgical removal of the affected area of the liver
Radiation therapy
Chemotherapy
Alcohol injection
Radio frequency ablation
Cryoablation
Targetted drug therapy, e.g. Sorafenib
Liver transplant.
Complications
Liver failure
Renal failure
Metastases to other organs.
Pancreatic cancer
One of the most serious forms of cancer as it is seldom detected
in the early stages and spreads rapidly. The cause is unknown.
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Treatment
Whipple procedure
Total pancreatectomy
Distal pancreatectomy
Radiation therapy
Chemotherapy
Targeted therapy, e.g. erlotinib
Palliative care.
Complications
Diabetes
Pain
Metastasis to other vital organs.
Pancreatitis
Inflammation of the pancreas, resulting in exocrine dysfunction.
It can be acute or chronic, and occurs when digestive enzymes
attack the pancreas.
Causes
Common:
Biliary disease (gallstones) and long-term alcohol abuse
Less common:
Medications, abdominal surgery or trauma, infectious
disease, pancreatic cancer and genetic diseases.
Signs and symptoms
Increasing symptoms with alcohol and food consumption
Upper abdominal pain
Nausea and vomiting
Fever
Tachycardia
Swollen, tender abdomen on palpation
Flatulence
Weight loss despite normal eating
Dehydration
Hypotension
Bleeding
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Steatorrhea.
Diagnosis
Acute
Blood tests for:
Elevated pancreatic enzymes, amylase and lipase
Elevated white blood cell count
Elevated liver function tests, particularly bilirubin
Hyperglycaemia
Hypocalcaemia
Ultrasound, CT, MRI
Chronic
Blood tests as per acute pancreatitis
Faecal specimen
Ultrasound
Pancreatic and bile duct X-ray
Pancreatic function test.
Treatment
Intravenous fluid administration
Acute
Nil orally
Analgesia
Reduce or cease alcohol intake and smoking
Surgery to remove gallstones, if applicable
Chronic
Treatment to assist with the cessation of alcohol and drug
use
Analgesia
Enzyme supplements
Smaller, more frequent meals that are low-fat
Treat other conditions, e.g. diabetes, bleeding, infection.
Complications
Infection
Pseudocysts or abscess
Renal failure
Myocardial depression
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Nursing considerations
Frequent vital signs
Cardiac auscultation (third heart sound may be detectable)
Respiratory assessment
Blood tests as ordered
Arterial blood gases
Monitor neurological status
Monitor renal output
Gastrointestinal auscultation and palpation
Pain assessment.
Types
Simple
Blockage with no further complications
Strangulated
Blood supply to the obstructed section is cut off
Close-looped
Both ends of a bowel section are occluded.
Causes
Mechanical obstruction due to adhesions, carcinomas,
foreign bodies, stenosis or hernias
Non-mechanical obstruction due to electrolyte imbalances,
drug toxicity, thrombosis of a mesenteric vessel or a
paralytic ileus.
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Ulcerative colitis
An inflammatory bowel disease that causes chronic inflammation
of the mucosa of the colon and rectum. It can be debilitating
and may lead to life-threatening complications. There is no cure,
however with treatment, symptoms can be greatly reduced and
remission can occur.
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Barium enema
Colonoscopy
X-ray or CT.
Treatment
Medications:
Antibiotics, e.g. metronidazole
Immunosuppressants, e.g. azathioprine, cyclosporine
Antiinflammatories, e.g. corticosteroids, sulfasalazine
Antidiarrhoeals, e.g. metamucil, loperamide
Analgesia (not NSAIDs as these may exacerbate
symptoms)
Iron supplements
Bowel resection (of the diseased bowel).
Nursing considerations
Observe hydration and electrolyte status.
Ulcers
Open sores that develop in the lining of the oesophagus, stomach
or duodenum. They are usually caused by bacterial infection
(H. pylori), medications or gastric acid reflux.
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Medical interventions
Nasogastric tube (NGT)
Types
Wide bore (usually 2 lumens)
Indications:
Decompression
Gastric lavage
Aspiration of gastric contents, e.g. for testing
To give medication, e.g. charcoal
Example: Salem Sump
Small lumen for ventilationprevents the gastric
mucosa from damage if the tube adheres to the lining
during suctioning
Fine bore (usually only 1 lumen)
Indications:
Enteral feeding (short-term)
If need enteral feeding long-term, then a percutaneous
endoscopic gastrostomy (PEG) would be better
Example: Levin.
Nursing considerations
Check the tube placement:
After each new insertion by chest X-ray, before
commencement of enteral feeding
At the beginning of each shift, by aspirating the
stomach contents and testing with pH indicator strips,
not litmus paper. pH of 5.5 or less indicates correct
placement.
Contraindicated if patient has a base of skull fracture.
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Surgical interventions
Appendectomy
Surgical removal of the appendix to prevent rupture or
perforation, or to remove if already ruptured.
Cholecystectomy
Surgical removal of the gallbladder due to the presence of
gallstones or inflammation.
Can be either:
Open via a laparotomy, or
Laparoscopiccontraindicated in pregnancy, peritonitis
and bleeding disorders.
Liver transplant
The replacement of the patients liver with a donor liver. Used
for the treatment of chronic hepatitis B and C, bile duct disease,
alcoholic liver disease, autoimmune liver disease, fatty liver
disease, liver cancer and liver failure.
Indications
Infants with abnormalities of the mouth
Patients who cannot swallow correctly
Patients receiving long-term enteral feeds, e.g. cystic fibrosis
and HIV patients.
Complications
Complications of surgery and anaesthesia, e.g. bleeding,
infection.
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Nursing considerations
Always flush the tube well after giving a feed and at the
beginning of your shift
Contraindications for feeding include SBO, paralytic ileus,
severe diarrhoea, peritonitis, peritoneal dialysis, severe
pancreatitis and gastrointestinal ischaemia.
If the tube becomes dislodged and there is no
spare tube, a Foley catheter can be placed in
the opening (with the balloon blown up to stop it
falling out) to prevent the stoma from closing.
Indications
Crohns disease or ulcerative colitis
Bowel or rectal cancer
Trauma.
Nursing considerations
Observe the stomait should be pink and moist
A stoma has no pain receptors:
Take care when placing the pouch on the stoma
Constriction of the opening could cause skin damage
without the patient feeling pain
Never pierce the pouch to release gas, as this destroys
the odour-proof seal releasing the odour into the
environment.
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Tests
Liver function tests
Used to evaluate the functions of the liver.
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Bilirubin
Normal levels are:
Total bilirubin: < 20 mmol/L
Direct bilirubin: < 7 mmol/L
Used for the investigation and monitoring of hepatobiliary
disease and haemolysis
Total bilirubin
Comprises unconjugated, conjugated and delta bilirubin
Usually only required for diagnosis
Direct bilirubin
Comprises conjugated and delta bilirubin
Increased levels occur with hepatocellular disease or biliary
disease
May also be increased in anaemia, haemolysis and Gilberts
syndrome, jaundice of newborns
Levels may be normal in cirrhosis, liver failure or hepatic
metastases until the disease is advanced.
Gamma glutamyl transferase (GGT)
Normal levels are:
Female: < 30 U/L
Male: < 50 U/L
Used to assess liver disease
Increased levels occur in cholestatic liver disease and
hepatocellular disease with cholestasis
Increased levels are also seen in diabetic patients with
chronic alcohol and drug excess, pancreatitis and prostatitis.
Globulins
Normal levels are:
Neonate: 1236 g/L
Adult: 2535 g/L
Used to identify hypo- and hypergammaglobulinaemia
Increased levels occur with chronic inflammation, infection,
autoimmune disease, liver disease and paraproteinaemia
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Sigmoidoscopy
Purpose
To diagnose acute or chronic diarrhoea and rectal bleeding
Aids in the assessment of known ulcerative colitis.
Procedure
May need to fast prior
May need to take a laxative or have a bowel washout prior
Will probably have a light sedative
Takes about 1030 minutes.
Complications
Bleeding
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Bowel perforation
Vasovagal reaction (severe bradycardia and even cardiac
arrest).
Proctosigmoidoscopy
Endoscopic examination of the lining of the distal sigmoid colon,
rectum and rectal canal.
Purpose
Aids diagnosis of IBD, infections, polyps, fistulas and abscesses.
Colonoscopy
A visual examination of the large intestine.
Purpose
To detect and evaluate IBD
To locate lower GIT bleeding
To aid diagnosis of polyps.
Procedure
A light sedative will probably be given
Patient should have a pulse oximeter on at all times
Specimens or biopsies may be taken
Electrocautery may be used to remove polyps or stop
bleeding
Takes about 3060 minutes.
Complications
Bowel perforation
Bleedingfrom the biopsy/polyp removal.
Upperbarium meal
Examination of the pharynx and oesophagus to investigate
strictures, ulcers and GORD.
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Lowerbarium enema
To diagnose inflammatory disorders, colorectal cancer,
polyps and diverticulitis.
Endoscopic retrograde
cholangiopancreatography (ERCP)
A radiographic examination of the pancreatic ducts via an
endoscopic tube.
Purpose
To evaluate obstructive jaundice
To diagnose cancer of the duodenum, pancreas or biliary
ducts.
Procedure
A tube is swallowed and inserted until the common bile duct
is visualised
Patient will need a light anaesthetic
Contrast medium will be given.
Complications
Adverse drug reactionfrom the contrast
Bowel perforation
Pancreatitis.
Pharmacology
Alginates
Action:
Create a foam that lies on top of gastric contents,
preventing reflux
Example: Gaviscon.
Antacids
Action:
Weak bases
React with hydrochloride acid to form water-soluble salts
Neutralise the hydrochloric acid
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Antiemetics
All antiemetics work by blocking the dopamine or 5-hydroxytryptamine (5-HT3) receptors in the chemoreceptor trigger
zone in the brain.
Dopamine antagonists
Action:
Block dopamine receptors at low doses, and 5-HT3 at
high doses
Increase tone in the lower oesophagus
Increase gut motility
Stomach and duodenum empty more quickly
Example: metoclopramide.
5-hydroxytryptamine (5-HT3) antagonists
Action:
Selectively block the 5-HT3 receptors
Example: ondansetron.
Antiemetic-antipsychotics
Action:
Dopamine receptor antagonists
Example: prochlorperazine.
Antihistamines
Action:
Act on the H1 receptors
Block the vomiting centre in the brain
Example: promethazine.
Aminosalicylates
Action:
Unknown; thought to work by causing inhibition of
leucocyte chemotaxis
Have an antiinflammatory effect
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Anti-diarrhoeal agents
Action:
Reduce gastric motility, therefore water and electrolyte
absorption is increased
Example: loperamide.
Action:
Block the histamine H2 receptors
Decrease intracellular cyclic adenosine monophosphate
(cAMP)
Decrease proton pump activity
Therefore decrease acid secretion
Example: ranitidine.
Laxatives
Bulk-forming
Action:
Increase intestinal volume
Cause intestinal wall distension
Stimulate the emptying reflex
Example: ispaghula husk (Fybrogel).
Osmotic
Action:
Make the fluid in the bowel hypertonic
Water wont be reabsorbed, therefore there is more fluid
in the bowel
Intestinal wall distension
Defaecation reflex
Example: lactulose.
Softening
Action:
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Stimulant
Action:
Irritate the intestinal wall and stimulate peristalsis
Example: senna.
Action:
Inhibit the enzyme hydrogen/potassium ATPase
Lower the acidity of gastric juices
Take 35 days for full effect if used for prophylactic use
Example: omeprazole.
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