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Inflammatory Disorders of the Gastro Genitourinary and Reproductive System

APPENDICITIS
● Inflammation of the appendix occurring between 11 and 30 years of age
● Causes include: Obstruction of the lumen of the appendix by a fecalith (accumulation of the feces), foreign
body, tumor , or intramucal thickening as a result of lymphoid hyperplasia

Assessment
- Periumbilical pain that is continuous, persistent, and shift to the right lower quadrant , localizing at
mcburney's point (between umbilical and right iliac crest -signs of peritoneal irritation)
- Anorexia
- Nausea
- Vomiting
- Rebound tenderness - Pain felt after exertion of pressure on the affected area. (RLQ) - Muscle guarding
Diagnostics
- Increase in WBC count
- History and Physical assessments

Surgical Management
- Immediate appendectomy unless appendix has ruptured ; If appendix has ruptured but no peritonitis , IV
fluids and antibiotics for 6 to 8 hrs before surgery

PERITONITIS
● Acute or chronic inflammation of the peritoneum
● Bacterial causes : ruptured appendix , pancreatitis, peritoneal dialysis, obstruction in the GI tract, and
gunshot or stab wound
● Chemical causes : perforated peptic ulcer and ruptured of a fallopian tube from an ectopic pregnancy
● Complications : Hypovolemic shock, septicemia , paralytic ileus, intra-abdominal abscess and organ failure
Assessment
- Abdominal pain (Tenderness over the involved site)
- Rebound tenderness
- Muscle rigidity and spasm
- Abdominal distention and ascites
- Fever, tachycardia and tachypnea, nausea & vomiting
Diagnostic Tests
a. complete blood count CBC
b. abdominal paracentesis w/ culture
c. laparotomy
Medical Management Nursing Interventions
a. NPO and NG suction
b . Antibiotic therapy
c. IV fluid and electrolyte replacement
d. Analgesics
● Assist the client to flex the knees for increased comfort
● Accurate intake & output

Surgical Management
● Emergency surgery may be necessary to eliminate the source of infection
● Evacuate the abdominal cavity and insert drains if a perforation has occurred
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Inflammatory Disorders of the Gastro Genitourinary and Reproductive System

PANCREATITIS
● Inflammation of the pancreas (acute or chronic) ; ranges from mild edema to severe
hemorrhagic necrosis
● Common in middle-age men
● Causes:
- Biliary tract disease
- Alcoholism
- Surgical trauma
- Penetrating duodenal ulcer
- Hyperparathyroidism
- Hyperlipidemia
- Renal failure
- Certain drugs such as:
● Thiazide diuretics
● Oral contraceptives (pills)
● Corticosteroids
● NSAIDs
● Sulfonamides and following Endoscopic retrograde cholangiopancreatography (ERCP)

Acute Pancreatitis
Assessment
- Severe, continuous Left upper quadrant pain that radiates to the back , aggravated by eating, and not
relieved by vomiting
- Flexion of the spine - an attempt to relieve the pain
- Flushing , cyanosis and dyspnea
- Nausea & Vomiting
- Low grade fever & leukocytosis
- Hypotension & tachycardia
- Decreased or absent bowel sounds
Nursing Intervention
● Meperidine (Demerol) - was once thought to be the drug of choice because it doesn't cause spasms of the
sphincter of Oddi , all opioids cause some degree of spasms
● Normeperidine (toxic metabolite) - can result in seizures , no longer the preferred drug to be used in acute
pancreatitis
● Assist the client to assume pain relief positions - Flex the trunk and draw the knees up or side-lying with the
head elevated 45 degrees
● NPO and jejunostomy tube - to decrease gastric and pancreatic secretions
● IV fluid (lactated ringer's) and electrolyte replacement
● Monitor the client for fever and other signs of an infection
● Monitor serum glucose to assess the development of diabetes mellitus from damage to the b-cells islets of
langerhans
● Blood volume replacement if shock is present
● Administer H2 antagonists and antacids as ordered
● Restart food with small, frequent high-carbs , high protein and low-fat diet
● Instruct the client to avoid alcohol
Chronic Pancreatitis
Assessment
- Heavy, gnawing, occasional burning or crampy left upper quadrant abdominal pain
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Inflammatory Disorders of the Gastro Genitourinary and Reproductive System

- Malabsorption and weight loss
- Mild jaundice with dark urine and steatorrhea
- Diabetes mellitus
Nursing Interventions
- Same as acute pancreatitis
- Administer Pancreatin (Viokase) and Pancrelipase (Cotazym) which contain amylase , lipase, and trypsin ,
given to replace pancreatic enzymes
- May give bile salts to facilitate absorption of fat-soluble vitamins
- Surgery may be necessary to divert bile flow or relieve ductal obstruction
Diagnostic Tests
- Serum and urinary amylase , serum lipase (most specific) , serum bilirubin, alkaline phosphatase and
sedimentation rate
- White blood cell count
- Fecal fat determinations
- Blood and urine glucose
- Endoscopic Retrograde Cholangiopancreatography

CROHN'S DISEASE
● Chronic, nonspecific inflammatory bowel disorder that may occur in any part of the GI tract but frequently
seen in the terminal ileum , jejunum, and colon with an insidious onset
● Commonly affects ages of 15 and 30 years , with a slightly higher incidence in women , jewish population
upper-middle-class urban populations
● Complications include structures , obstruction , fistulas, fat malabsorption and gluten intolerance

Diagnostic Tests
- Barium enema (skip lesions)
- Sigmoidoscopy and colonoscopy with biopsy
- Complete blood count
- Serum chemistries
Nursing Interventions
- Monitor frequency and character of stools
- Daily weights
- Assess for signs of malnutrition
- Administer IV fluids and TPN as ordered
- Administer good skin care, cleaning the perineal area and providing sitz baths ( suob)
- Increase fluids
- High-protein , calories and vitamins ; Low in roughage , residue and fat and milk free
- Administer Sulfasalazine (Azulfidine) and corticosteroids or some immunosuppressants
Surgical Management
- Intestinal resection may be necessary when medical management fails
ULCERATIVE COLITIS
● Continuous Inflammation- beginning in the rectum and sigmoid colon extending upward into the colon but
rarely affecting the small intestine
● Most commonly occurs between the age of 15 and 25 years and less frequently between 50 and 80 years of
age with a slightly higher incidence in women , jewish population and upper-middle class urban populations
● Complications include : Hemorrhage , strictures , perforations, toxic megacolon , colonic dilation,
malabsorption, and a significantly increased risk of active colitis present for more than 10 years .
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Inflammatory Disorders of the Gastro Genitourinary and Reproductive System

● Ranges from mild localized disorder to an acute fulminating crisis that may result in a perforated colon , fatal
peritonitis , and toxemia .

Assessment
- Bloody diarrhea ranging from 2 to 20 stools per day depending on the extent of the disease
- Abdominal cramping
- Weight loss
- + Fever
- Anemia
- Tachycardia
- Dehydration
Diagnostic tests
- Blood studies including a complete blood count
- Serum electrolyte pane and serum protein
- Sigmoidoscopy
- Colonoscopy
- Barium enema
Nursing Interventions
- Provide for both physical and mental rest - Monitor and record the characteristics of the stools - Increase
fluids and maintain a strict Intake and output.
- Meticulous skin care, avoiding harsh soaps, and providing sitz baths
- NPO during acute exacerbation followed by a diet high in protein and calories, low in residue, and milk free -
Instruct the client to avoid smoking.
- Administer vitamin and Iron supplements as ordered.
- Administer Sulfasalazine (Azulfidine) and corticosteroids orally as prescribed (forms of each may be given
as retention enema depending on the severity of the disease).
- Administer Immunosuppressive drugs in severe cases when other drug regimens fall

Surgical Management
- Indicated if the client fails to respond to treatment with frequent debilitating exacerbations, massive
bleeding, perforation, strictures, obstruction, dysplasia, or carcinoma.
1. Total proctocolectomy with permanent ileostomy
- one-stage procedure that removes the colon, rectum, and anus with closure of the anus creating a
stoma in the right lower quadrant with the end of the terminal ileum * curative procedure
2. Total proctocolectomy with continent ileostomy
- creates an internal pouch (Kock's pouch) with a one-way nipple valve that is emptied at Intervals with
the Insertion of a catheter
> curative but has a high complication rate
3. Total colectomy and ileal reservoir
- consists of two procedures 8 to 12 weeks apart

● First procedure Includes a colectomy, rectal mucosectomy, construction of Ileal reservoir, and anastomosis
with temporary Ileostomy,

● Second procedure Involves closure of the ileostomy when the capacity of the reservoir is Increased.

- Goal is to gain control and decrease the number of stools daily.

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Inflammatory Disorders of the Gastro Genitourinary and Reproductive System

POSTOPERATIVE MANAGEMENT
- Measure drainage daily from ileostomy (1500 to 2000 ml) and from abdominal drain (100 to 150 ml).
- Reassure the client that Incontinence of mucus is a temporary result of the surgery.
- Instruct the client to begin kegel exercises several weeks postoperatively.
- Make a referral to an enterostomal therapy nurse.

Cholecystitis
- Inflammation of the gallbladder; usually associated with cholelithiasis.
- Generally caused by escherichia coli in the absence of gallstones
- Incidence higher In multiparous women over 40 years of age, postmenopausal women, sedentary lifestyle,
obesity, a familial tendency, and native american or caucasian populations
- Complications Include cholangitis, pancreatitis, biliary cirrhosis, carcinoma, and peritonitis.

Assessment
- Mild Indigestion to severe pain and tenderness in the right upper quadrant that may radiate to the right
shoulder and scapula
- Nausea, vomiting, dyspepsia, heartburn, fat Intolerance, and flatulence

Diagnostic Tests
- Ultrasonography
- Oral Cholecystogram
- IV cholangiogram
- Percutaneous transhepatic cholangiography
- Liver function tests
- White blood cell count
- Serum enzymes
Nursing Interventions
- NPO and NG tube to decompress stimulation of the gallbladder
- Administer prescribed anticholinergics to decrease secretions, biliary contractions, and spasms.
- Use baking soda, alpha Kerl Lotion, and lotions containing calamine, and administer Cholestyramine
(Questran) if ordered for pruritus.
- Instruct the client on a low-fat and low-calorie diet if weight reduction is needed.
Medical Management
● Methyl tert-butyl ether (MTBE) via a percutaneous catheter into the gallbladder to dissolve the stones.
● Extracorporeal shock wave lithotripsy (ESWL) Involves locating the stones with an ultrasound followed
by high-energy shock waves to dissolve the stones (usually occurs within 2 hours).
● Hydrocholeretic drugs such as Dehydrocholic acid (Decholin) may be administered postoperatively if there
is no obstruction to stimulate the production of bile with a low specific gravity
Surgical Management
● Endoscopic sphincterotomy (papillotomy) Involves passing the endoscope into the duodenum with an
Electrodiathermy knife attached to the endoscope to widen the sphincter of Oddi, removing the stone or
allowing it to pass

● Laparoscopic cholecystectomy Involves removing the gallbladder through one of four small punctures in
the abdomen through the use of a laparoscope allowing the client to return to normal activities within 2 to 3
days.
● Cholecystectomy involves removing the gallbladder through a right subcostal Incision with the insertion of
a t-tube to drain excess bile and ensure patency of the common bile duct
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Inflammatory Disorders of the Gastro Genitourinary and Reproductive System

Cystitis
● Infection of the lower urinary tract Involving the bladder
● More common In women, children, and older men

Cystitis (Assessment & Dx)

- Increased urgency and frequency of urination

- Dysuria
- Foul-smelling urine - Pyuria

- Urinalysis
- Urine culture and sensitivity
- Urine gram stain

Nursing Interventions
- Administer prescribed antibiotics such as Sulfamethoxazole, trimethoprim (Bactrim, Septra), Cephalexin
(Keflex), and Nitrofurantoin (Macrodantin), and Fluoroquinolones such as Ciprofloxacin (Opro) and
Ofloxacin (Floxin),
- Administer prescribed urinary analgesic such as phenazopyridine (Pyridium).
- Increase fluid intake to 2500-3000 ml per day unless contraindicated.
- Avoid caffeinated beverages, citrus juices, chocolate, alcohol and spices, which may irritate the bladder.
- Instruct female clients to wipe from front to back after elimination
- Instruct the client on the Importance of taking the prescribed antibiotics for the prescribed period of time.
- Instruct the client to avoid taking bubble baths and using perineal products.
- Encourage the client to urinate when the urge is present and to fully empty the bladder with each volding.

Urolithiasis (Renal Stones)

● Stones In the urinary tract that produce clinical manifestations when the flow of urine becomes
obstructed, the majority of stones are composed of calcium
● Most commonly affects Caucasians between the ages of 20 and 55 years with a familial history ●
Contributing factors Include a
- sedentary lifestyle
- high-protein dietary Intake
- decreased fluid Intake, decreased urinary output
- Increased perspiration during warm weather months, or
- Metabolic abnormalities resulting In Increased levels of calcium, uric acid, and citric or oxalic
acid
Calcium Oxalate Stones
● account for over 30% of the urinary calculi
● characteristically small stones that may become trapped In a ureter
● more common in men

Struvite (magnesium-ammonium phosphate stones)

● account for approximately 10% of the urinary calculi
● more common in women who experience frequent urinary tract Infections
● generally take on a staghorn appearance
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Inflammatory Disorders of the Gastro Genitourinary and Reproductive System

● contributing factors Include
- Proteus urinary tract Infection
Calcium Phosphate Stone
● account for only 8% of the urinary calculi
● most commonly are a combination struvite or oxalate mixed stone
Uric acid stones
● account for less than 5% of all urinary calculi
● more common in Jewish men who have a family history or an incidence of gout
Cystine stones
● account for less than 2% of all urinary calculi

Assessment
- Nausea
- Vomiting
- Pain that becomes colicky in nature when the stone passes into the ureter
- Cool, moist skin
- Chills
- Flank or abdominal pain that is generally severe

Diagnostic Tests
● Excretory urography
● Urinalysis
● Urine culture
● KUB x-ray
● Serum calcium, phosphorus, and protein
● 24-hour urine collection
● Ultrasound
● IVF or retrograde pyelogram
● Cystoscopy
● CT scan
● BUN and creatinine
● Urine ph

Nursing Interventions
● Administer prescribed analgesics.
● Reassure the client that most stones smaller than 4 mm pass spontaneously
● Provide education to prevent future stones
● Encourage Increased daily fluid intake,
● Instruct the client to avoid foods that contribute to the diagnosed type of urinary stone s

Pelvic Inflammatory Disease

- An Infectious process Involving the fallopian tubes, ovaries, pelvic peritoneum, pelvic veins, or pelvic
connective tissue
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Inflammatory Disorders of the Gastro Genitourinary and Reproductive System

- May be confined to one structure, or widespread and Involve all pelvic structures
- Usually caused by bacteria but could also be viral, fungal, or from parasites organisms from chlamydia and
gonorrhea are the most common causative agents. - Inflammation of the fallopian tubes is called
salpingitis - Inflammation of the ovary is called oophoritis.
- Pathogens are usually Introduced from outside the body and pass up the cervical canal Into the uterus.
- Pathogens invade the pelvic organs during sexual Intercourse, childbirth, or the postpartum period, or when
an abortion is done.
- FID is common in women who have IUDs. pathogens do not cause difficulty in the uterus but pass Into the
pelvis by way of the fallopian tubes through thrombosed uterine veins or through the lymphatics of the uterus
- Invaded structure develops an acute or chronic Inflammatory process
Complications
● generalized peritonitis
● abscess formation
● strictures or complete obstruction of the fallopian tubes, leading to Infertility.
Women at risk are those who have their
- first Intercourse at any early age
- have multiple sex partners
- have frequent intercourse
- do not use protection in sexual Intercourse
- have Intercourse with partners who have sexually transmitted diseases (STDs), and have a history of
previous STDs

Pelvic Inflammatory Disease (Assessment)

● Severe abdominal pain
● Feeling of pressure and fullness in the abdomen
● Lower abdominal cramps and tenderness
● Dyspareunia (pain during Intercourse)
● Spotting between menses
● Fever
● Chills
● Malaise
● Nausea and vomiting
● Foul-smelling purulent vaginal discharge

Diagnostics
● Smears from the vagina and cervix for culture and sensitivity
● Laparoscopy
● Hysterosalpingography
Surgical Management
● Salpingectomy if tubal abscess
● Total hysterectomy if severe case of chronic inflammation
Nursing Intervention
- Maintain bed rest in semi-fowler's position to facilitate dependent drainage during the acute phase (helps to
prevent abscesses from forming high in the abdomen, where they might rupture and cause generalized
peritonitis).
- Administer antibiotics and Intravenous fluids as ordered.
- Note the amount, color, consistency, and odor of any vaginal drainage - Monitor vital signs frequently to
detect changes in condition.
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Inflammatory Disorders of the Gastro Genitourinary and Reproductive System

- Apply heat to the abdomen to Increase circulation and promote comfort

Benign Prostatic Hyperplasia (BPH)

● Benign prostatic hypertrophy (benign prostatic hyperplasia; BPH) is a slow enlargement of the prostate
gland, with hypertrophy and hyperplasia of normal tissue.
● Enlargement compresses the urethra, resulting in partial or complete obstruction.
● Usually occurs in men older than 50 years

Assessment
● Diminished size and force of urinary stream (early sign of BPH)
● Urinary urgency and frequency
● Nocturia
● Inability to start (hesitancy) or continue a urinary stream
● Feelings of Incomplete bladder emptying
● Postvoid dribbling from overflow Incontinence (later sign)
● Urinary retention and bladder distention
● Hematuria
● Urinary stasis
● Dysuria and bladder pain

Surgical Management

● Laser prostatectomy
● Transurethral Electrovaporization of the Prostate: Placement of a special metal Instrument that emits a
high-frequency electrical current that cuts and vaporizes excess tissue and seals the remaining tissue to
prevent bleeding; this is especially useful for men on anticoagulants and those at risk for complications.
● Transurethral Incision of the Prostate (TUIP): Removal of prostatic tissue through an Incision made in
the bladder neck
● Transurethral Microwave Thermotherapy: Application of heat to destroy the hypertrophied tissue
● Transurethral Needle Ablation of the Prostate (TUNA): Placement of Interstitial radiofrequency needles
through the urethra and Into the lateral lobes of the prostate, causing heat Induced coagulation necrosis of
the prostate for treating benign hypertrophy (BPH)
● Transurethral Resection of the Prostate (TURP): Removal of benign prostatic tissue surrounding the
urethra with use of a resectoscope Introduced through the urethra; there is little risk of impotence and it is
most commonly used for BPH
● Urethral Stents: Application of stents or colls in the urethra where it is narrowed by the prostate