will suffer pain, nausea, and vomiting. Strangula-
tion (the intestinal loop becomes twisted or
severely pinched and the blood supply is cut off)
results in perforation and peritonitis.
TREATMENTFor a reducible hernia, these
measures include bed rest, Trendelenburgs posi-
tion, and moist heat. For incarcerated and
strangulated hernias, do not exert any pressure
on the mass at any time. Opiates may be
administered for pain. If perforation and
peritonitis have resulted, administer IV and
antibiotic therapy. Medically evacuate the patient
as soon as possible for surgical care.
Nonspecific Ulcerative Colitis
This is an inflammatory disease of the colon
of unknown etiology characterized by bloody
diarrhea and prostration. The patient may
experience 30 to 40 bowel movements per day.
Abdominal cramping, anorexia, malaise, and
fever are common.
TREATMENTGeneral measures consist of
bed rest, nutritious diet with no dairy products,
mild sedation, and steroids.
They are varices of the three hemorrhoid
Hemorrhoids are usually mild and
remittent. The patient complains of pruritus,
incontinence, and recurrent protrusion, rectal
bleeding, and sensation of discomfort and
TREATMENT-General measures consist of
a low roughage diet, regular bowel habits, sitz
baths, suppositories, and surgical treatment, if
This condition is the result of an inflamma-
tion of the liver. There are two types of viral
hepatitis: hepatitis A (infectious) and hepatitis B
(serum). A third type of hepatitis is alcoholic
hepatitis, which is induced only by alcoholic
ingestion. Hepatitis A is usually transmitted by
the fecal-oral route and occurs sporadically or in
epidemics. Hepatitis B is transmitted by in-
oculations of infected blood in most cases, but
may be transmitted by the common use of razors,
toothbrushes, and drug paraphernalia.
SYMPTOMSThey include general malaise,
myalgia, symptoms of URI, anorexia, distaste for
smoking, nausea, vomiting, fever, dark urine, and
an enlarged tender liver. Jaundice mayor may not
TREATMENTStrict isolation is not
necessary, but careful hand washing techniques
are essential. Bed rest should be at the patients
option during the acute initial phase of the
symptoms but is unwarranted thereafter. A
gradual return to normal activity and a high
protein diet is indicated.
This condition is an acute inflammation of the
gallbladder, usually associated with gallstones
(cholelithiasis). It occurs when calculus becomes
impacted in the cystic duct and inflammation
develops behind the obstruction.
SYMPTOMSAttacks are often precipitated
by a large fatty meal. The appearance is sudden
and pain may vary from minimal to severe. Pain
is localized in the epigastrium or right hypo-
chondrium, but may be referred to the
midscapular or intrascapular regions. The right
upper quadrant is tender with muscle guarding
and rebound tenderness. The gallbladder is
palpable and jaundice may be present due to
blockage of the common bile duct. There is
usually some nausea, vomiting, and fever.
TREATMENTTreat with analgesics, IV
therapy, and antibiotics as necessary. Diet should
be low fat as tolerated. With the above con-
servative regimen, mild acute attacks will usually
subside; however, reoccurrences are common and
cholecystectomy may be necessary. Complications
include perforation, peritonitis, and abscess.
NOTE: Cholelithiasis requires surgery and is more
common in women.
It is a severe abdominal disease for which
causes have not been completely determined.
About 40 percent of the cases are alcoholics; 40
percent have associated biliary tract disease,
usually with gallstones; and the remaining 20
percent have a variety of causes.
SYMPTOMSOnset is sudden with steady,
severe pain located in the epigastrium that may