NLE Gastrointestinal Nursing — Hepatic, Biliary & Pancreatic DisordersConcept Map

Concept

Viral Hepatitis

Sub Concepts

• Hepatitis A - Fecal-oral transmission, self-limiting, vaccine-preventable
• Hepatitis B - Blood/body fluids, sexual, perinatal; chronic; endemic in Philippines; vaccine-preventable
• Hepatitis C - Blood transmission; chronic; now curable with direct-acting antivirals
• Hepatitis D - Requires HBV co-infection; blood/body fluid transmission
• Hepatitis E - Fecal-oral transmission; dangerous in pregnancy
• Serologic markers and diagnostic interpretation
• Nursing management and isolation precautions

Relationship To Central

Major hepatic inflammatory condition affecting liver function and requiring specific transmission-based precautions

Concept

Cirrhosis

Sub Concepts

• Causes - chronic hepatitis B/C, alcohol, NAFLD
• Pathophysiology - fibrosis, nodular regeneration, portal hypertension
• Hepatic encephalopathy - ammonia accumulation, lactulose therapy
• Ascites - fluid management, sodium restriction, diuretics, paracentesis
• Esophageal varices - hemorrhage risk, band ligation, beta-blocker prophylaxis
• Laboratory abnormalities - albumin, bilirubin, PT/INR, ammonia, thrombocytopenia
• Bleeding precautions and coagulation monitoring

Relationship To Central

Irreversible hepatic fibrosis leading to portal hypertension and multi-system complications requiring intensive monitoring

Concept

Cholecystitis & Cholelithiasis

Sub Concepts

• Risk factors - 5 F's (Female, Fat, Forty, Fertile, Fair)
• Pathophysiology - stone obstruction, inflammatory response
• Clinical manifestations - RUQ pain after fatty meals, Murphy's sign
• Diagnostic methods - ultrasound, LFTs
• Medical management - dietary modification, pain control
• Surgical intervention - laparoscopic cholecystectomy
• Post-operative nursing care - T-tube management

Relationship To Central

Biliary disorders affecting gallbladder function and requiring dietary and surgical management

Concept

Acute Pancreatitis

Sub Concepts

• Causes - gallstones, alcohol
• Pathophysiology - premature enzyme activation
• Clinical presentation - epigastric pain radiating to back
• Diagnostic markers - elevated amylase and lipase
• Complications - hypocalcemia, hyperglycemia, hemorrhagic pancreatitis
• Grey Turner's and Cullen's signs
• NPO status and IV fluid management
• Pain management approach

Relationship To Central

Pancreatic autodigestion requiring aggressive fluid management and pain control

Concept

Nursing Process Application

Sub Concepts

• Focused health assessment and risk factor identification
• NANDA-I nursing diagnoses - Fluid volume excess, Impaired skin integrity, Risk for bleeding
• Priority setting using Maslow's hierarchy
• Evidence-based interventions
• Patient education and lifestyle modification
• Monitoring for complications

Relationship To Central

Systematic assessment, diagnosis, planning, implementation, and evaluation specific to hepato-biliary-pancreatic disorders

Concept

Philippine Healthcare Context

Sub Concepts

• Hepatitis B endemicity in Philippines - 10% chronic HBV prevalence
• Universal birth-dose HBV vaccination program
• RA 9173 - Nursing Practice Law and scope of practice
• Public health prevention strategies
• Health teaching for endemic conditions
• Blood supply safety and infection control standards

Relationship To Central

Epidemiological and regulatory framework specific to Philippine nursing practice and public health priorities

To

Cirrhosis

From

Viral Hepatitis

Strength

strong

Relationship

Chronic hepatitis B and C are the primary causes of cirrhosis, which develops over years of persistent inflammation and fibrosis

To

Hepatic Encephalopathy

From

Cirrhosis

Strength

strong

Relationship

Portal hypertension and hepatocyte failure in cirrhosis impair ammonia detoxification, leading to neurologic manifestations

To

Esophageal Varices

From

Cirrhosis

Strength

strong

Relationship

Portal hypertension from cirrhosis causes dilation of esophageal veins with hemorrhage risk; varices are a major complication requiring prevention and emergency management

To

Ascites

From

Cirrhosis

Strength

strong

Relationship

Portal hypertension combined with decreased albumin production in cirrhosis causes fluid sequestration in the peritoneum

To

Acute Pancreatitis

From

Cholecystitis

Strength

moderate

Relationship

Gallstone migration into the common bile duct obstructs pancreatic duct outflow, triggering acute pancreatitis in 5-10% of cholecystitis cases

To

Philippine Context

From

Hepatitis B

Strength

strong

Relationship

Hepatitis B is highly endemic in the Philippines (10% chronic prevalence), making universal vaccination and newborn HBIG prophylaxis major public health priorities

To

Nursing Process Application

From

Viral Hepatitis

Strength

strong

Relationship

Assessment of hepatitis type, transmission route, and stage guides nursing diagnosis selection, precaution implementation, and patient/family education

To

Hypocalcemia

From

Acute Pancreatitis

Strength

strong

Relationship

Pancreatic fat necrosis binds serum calcium, causing hypocalcemia with risk of seizures and cardiac dysrhythmias requiring monitoring and replacement

To

Lactulose Therapy

From

Hepatic Encephalopathy

Strength

strong

Relationship

Lactulose acidifies the colon to convert ammonia to ammonium, reducing neurologic symptoms; dosing must be titrated to 2-3 soft stools daily to avoid worsening dehydration

To

Beta-blockers

From

Esophageal Varices

Strength

strong

Relationship

Non-selective beta-blockers (propranolol, nadolol) reduce portal pressure and are used for primary and secondary prevention of variceal hemorrhage

To

Cholecystectomy

From

Cholelithiasis

Strength

strong

Relationship

Symptomatic gallstones are treated definitively with laparoscopic cholecystectomy, avoiding recurrent episodes and preventing complications like pancreatitis

To

Bleeding Precautions

From

Nursing Process Application

Strength

strong

Relationship

Cirrhotic patients with impaired clotting factor synthesis and thrombocytopenia require soft toothbrushes, electric razors, IM injection avoidance, and frequent monitoring for bleeding signs

To

Cirrhosis Complications

From

Fluid and Electrolyte Management

Strength

strong

Relationship

Ascites and diuretic therapy cause hyponatremia and hypokalemia; pancreatitis causes hypocalcemia; hepatic encephalopathy is worsened by hypokalemia, requiring careful replacement

To

Fecal-Oral Precautions

From

Hepatitis A and E

Strength

strong

Relationship

Both HAV and HEV are transmitted via contaminated food and water, requiring contact precautions and emphasis on handwashing, sanitation, and safe food handling

To

Blood-Borne Precautions

From

Hepatitis B, C, D

Strength

strong

Relationship

All three viruses are transmitted through blood and body fluids, requiring standard precautions plus additional measures for sexual contacts and perinatal exposure

To

Alcohol Avoidance

From

Patient Education

Strength

strong

Relationship

Alcohol is hepatotoxic and accelerates cirrhosis, is a trigger for acute pancreatitis, and is an absolute contraindication in any liver or pancreatic disease

To

NANDA Nursing Diagnoses

From

Nursing Assessment

Strength

strong

Relationship

Assessment findings guide selection of diagnoses such as Fluid Volume Excess, Impaired Skin Integrity, Risk for Bleeding, Acute Pain, and Imbalanced Nutrition appropriate to the specific disorder

To

Infection Control Standards

From

RA 9173 Scope of Practice

Strength

moderate

Relationship

The Nursing Practice Law (RA 9173) mandates that nurses implement infection prevention measures including isolation precautions specific to transmission routes

To

Pancreatic Rest

From

Acute Pancreatitis

Strength

strong

Relationship

NPO status and NG tube insertion allow the pancreas to rest by preventing stimulation of enzyme secretion, essential during acute inflammation to prevent further autodigestion

To

Newborn Vaccination Protocol

From

Hepatitis B Screening

Strength

strong

Relationship

Maternal HBsAg-positive status triggers newborn HBIG within 12 hours of birth plus hepatitis B vaccine series, preventing mother-to-child transmission