Pathophysiology
A weakness in the abdominal wall allows the bowel or omentum, along with peritoneal tissue,
to herniate outward. Weakened areas include the umbilical area, along the linea alba, incisional areas, and areas that have not completely closed after birth (the inguinal rings).
Umbilical hernias are caused by incomplete closure of the umbilical orifice and commonly occur in children and obese clients.
Ventral hernias are caused by weakness in the linea alba and are aggravated by obesity.
Inguinal hernias are caused in both males and females by incomplete closure of the inguinal rings.
Incisional hernias occur after underlying muscle is cut and scar tissue forms, weakening the area.

Assessment and Diagnostic Findings
May be reducible.
Straining causes the hernia to protrude.
Inguinal hernias may cause a dragging feeling or occasional discomfort.
May be present in newborn males with hydrocele.
Diagnosed through physical examination, computerized tomography (CT) scan, magnetic
resonance imaging (MRI), or direct endoscopy.

Complications
Incarcerated or strangulated hernia results in necrosis of the bowel or omentum, which is a
surgical emergency.

Medical Care and Surgical Treatment
Stool softeners or bulk laxatives to prevent straining at stool.
Herniorrhaphy or hernioplasty (open or closed surgical procedure).

Keep in Mind
Postsurgical care includes avoidance of coughing or straining.
Avoid lifting, driving, and sexual activity as prescribed.

Pathophysiology
Inflammation of the liver caused by direct cellular injury and secondary injury by the immune
response; those with a lesser immune response may become carriers rather than infected.
Hepatitis A (HAV): Spread by the oral-fecal route.
Hepatitis B (HBV; often coexistent with hepatitis D [HDV]): Spread by blood and body fluids.
Hepatitis C (HCV): Spread by contact with contaminated blood, IV drug use, unprotected sex.
Hepatitis E (HEV): Spread by contaminated water.

Assessment and Diagnostic Findings
Preicteric phase: Weeks to months depending on type; characterized by malaise, lethargy, nausea,
vomiting.
Icteric phase: Characterized by jaundice, pale stools, dark tea-colored urine, and rashes.
↑ ALT and AST, ↑ bilirubin, presence of virusspecific antigen, prothrombin time >11.6 seconds, ↑ ESR, ↑ serum ammonia levels, abnormal hepatocytes revealed through liver biopsy.

Complications
 Acute or chronic liver failure and encephalopathy.
 Hemorrhage; liver cancer.

Medical Care and Surgical Treatment
Avoid hepatotoxic medications like acetaminophen.
Bedrest; avoid injections to prevent hemorrhage.
Small, frequent meals that contain high calories,
high protein (titrate protein to ammonia levels),
low sodium, and moderate fluid intake.
Immunoglobulin therapy on exposure; hepatitis A and B vaccination for prevention.
Keep in Mind
Teach client dietary regimen, to rest, and avoid hepatotoxic substances.
Report confusion, asterixis, abdominal distention, or edema of legs/feet.

Pathophysiology
Behavioral, genetic, medication, or hormonal etiology.
Imbalance between food energy consumed and energy expended.

Assessment and Diagnostic Findings
Overweight is defined as a body mass index (BMI) of 25 to <30 kg/m2.
Obesity is defined as a BMI of >30 kg/m2.

Complications
Degenerative joint disease (DJD).
Cardiovascular, renal, and neural damage related to hypertriglyceridemia and hypercholesterolemia,
resulting in atherosclerosis.
Enlargement and infiltration of the liver with fat.
Type 2 diabetes mellitus.
Dumping syndrome related to bariatric surgery.
Intertriginous skin breakdown.
Dyspnea.

Medical Care and Surgical Treatment
Total hip, knee, and ankle replacement.
Angioplasty or coronary bypass surgery.
Oral antidiabetic agents or insulin therapy.
Dialysis.
Bariatric surgery:
Roux-en-Y.
Gastric banding.

Keep in Mind
Reduction of 500 kilocalories (kcal) per day results in weight loss of 1–2 lb/wk.
Walking for 30–60 minutes daily is the safest method of exercise.
Prevention of obesity is the goal. Eat a variety of colorful foods and exercise 35 minutes daily.

Gastrointestinal Disorders
Pathophysiology
Epithelial cells undergo mutation related to chronic irritation or exposure to carcinogens.
Cells that are damaged must be replaced. The chance of a mutation occurring is proportional to the rate of new cell growth.
Implicated causes are chronic or autoimmune gastritis; exposure to lead dust, grain dust, glycol ethers, or leaded gasoline; or a diet high in smoked fish or meats.

Assessment and Diagnostic Findings
Indigestion that responds to antacids.
Anorexia and weight loss, nausea and vomiting,
gastric distention.
Complete blood count (CBC) reveals anemia.
Stool is positive for occult blood.
Barium swallow with x-ray, gastric fluid analysis for cytology, serum gastrin levels.
Positive diagnosis is made by gastroscopy and biopsy.

Complications
Nutritional deficit.
Metastasis.
Bleeding, perforation, and peritonitis.
Death.

Medical Care and Surgical Treatment
Subtotal or total gastrectomy.
Dumping syndrome related to subtotal or total gastrectomy.
Chemotherapy and radiation, biological therapies.

Keep in Mind
Manage stress.
Pain medication should be taken before the pain is severe.
Teach pre- and postoperative therapies (nasogastric [NG] tube will be in place after gastrectomy).
Teach the side effects of chemotherapy and radiation and how to mitigate them.