Gastrointestinal Disorders

A client with extreme weakness, pallor, weak peripheral pulses, and disorientation is admitted to the emergency department. His wife reports that he has been "spitting up blood." A Mallory-Weiss tear is suspected, and the nurse begins taking a client history from the client's wife. The question by the nurse that demonstrates her understanding of Mallory-Weiss tearing is:

"Has your partner had recent forceful vomiting?" A Mallory-Weiss tear is associated with massive bleeding after a tear occurs in the mucous membrane at the junction of the esophagus and stomach. There is a strong relationship between forceful vomiting, and a Mallory-Weiss tear. The bleeding is coming from the stomach, not from the lungs as would be true in some cases of tuberculosis. A Mallory-Weiss tear does not occur from chest injuries or falls and isn't associated with eating spicy foods.

An enterostomy nurse is providing an in-service session on caring for colostomies. Which statement by a nurse indicates the need for further teaching?

"I can make a small pin hole in the bag to let the gas out, so I don't have to change the appliance frequently." The nurse requires additional teaching if she states that she can make a hole in the drainage bag to let gas out. Any hole in the drainage bag, no matter how small, will destroy the odor-proof seal. Removing or unclamping the bag is the only appropriate method for releasing the gas accumulated in the bag. Odor-relieving tablets, usually made of charcoal, can be placed in the bag to help with the odor.

The health care provider (HCP) recommends that a client have a partial bowel resection and an ileostomy. Later, the client says to the nurse, "That doctor of mine surely likes to play big. I will bet the more he can cut, the better he likes it." Which reply by the nurse is most therapeutic?

"What do you mean by that statement?" When the client seems to be questioning the HCP's goals, it is best for the nurse to present an open statement and ask the client what he means. This technique helps the client express his feelings. Telling the client about the surgery is less therapeutic when he is upset. While it is the client's right to get a second opinion, this suggestion does not address the client's feelings. Making assumptions can also interfere with communication, especially if the assumption is incorrect.

The nurse is teaching the client how to care for an ileostomy. The client asks the nurse how long to wear the pouch before changing it. The nurse should tell the client:

"You can wear the pouch for about 4 to 7 days." Unless the pouch leaks, the client can wear the ileostomy pouch for about 4 to 7 days. If leakage occurs, it is important to promptly change the pouch to avoid skin irritation. It is not necessary to change the pouch daily or in the evening. Diet and activity typically do not affect the schedule for changing the pouch.

A client has 4000 mL removed via paracentesis. When the nurse weighs the client after the procedure, how many kilograms is an expected weight loss? Record you answer in whole numbers.

4 A liter of water weighs one kilogram. Therefore, the client should have a weight of 4 kilograms less than preprocedure weight.

A client who has ulcerative colitis says to the nurse, "I cannot take this anymore; I am constantly in pain, and I cannot leave my room because I need to stay by the toilet. I do not know how to deal with this." Based on these comments, the nurse should determine the client is experiencing:

60 The following formula is used to calculate the correct dosage: 30 mL/1 oz = X/2 oz X = 2 x 30 mL = 60 mL.

The nurse is checking the client's chart for possible contraindications, before administering meperidine, 50 mg I.M., to a client with pain after an appendectomy. The nurse should hold the meperidine when she sees an order for what type of drug?

A monoamine oxidase (MAO) inhibitor The nurse should hold the meperidine if she sees an order for an MAO inhibitor because MAO inhibitors increase the effects of meperidine and can cause rigidity, hypotension, and excitation. The client shouldn't receive meperidine within 14 days after administration of an MAO inhibitor. Antibiotics, antiemetics, and loop diuretics don't cause significant drug interactions when administered concurrently with meperidine.

The nurse has an order to administer 2 oz of lactulose to a client who has cirrhosis. How many milliliters of lactulose should the nurse administer? Record your answer using a whole number.

Ascites related to portal hypertension The jaundice is a result of inability of the liver to break down the end products from red blood cells, resulting in elevated bilirubin levels. Small bowel ulcerations do not occur as a result of elevated bilirubin levels and are not problems commonly associated with cirrhosis. The remaining choices are all associated with advanced cirrhosis. Ascites presents because of portal hypertension; clear dilute urine is incorrect as it would be dark due to the inability to eliminate some of the bile byproducts. Confusion and disorientation would occur when the brain is inundated by high levels of circulating toxins because of a failing liver not mental alertness and increased perception.

The nurse is developing a care management plan with a client who has been diagnosed with gastroesophageal reflux disease (GERD). What should the nurse should instruct the client to do? Select all that apply.

Avoid a diet high in fatty foods. Avoid beverages that contain caffeine. Avoid all alcoholic beverages. No specific diet is necessary, but foods that cause reflux are avoided, including fatty foods (which decrease the rate of gastric emptying) and foods that decrease lower esophageal sphincter (LES) pressure such as chocolate, peppermint, coffee, and tea. The client should also avoid alcohol. The client should not lie down for 3 to 4 hours after eating. Antisecretory agents decrease the secretion of hydrochloric acid (HCI) by the stomach; some are available in both OTC and prescription formulations, but the OTC preparations have lower drug dosages compared with prescription drugs. Cimetidine, ranitidine, famotidine, and nizatidine are available in both formulations.

A physician orders morphine for a client who complains of postoperative abdominal pain. For maximum pain relief, when should the nurse anticipate administering morphine?

Before the pain becomes severe For greatest analgesic effectiveness, the nurse should administer an opioid agonist, such as morphine, before the client's pain becomes severe. If the nurse waits until the pain becomes severe, the medication will be less effective, taking longer to provide relief. Giving morphine every 3 hours whether or not the client has pain would be inappropriate because the client may need a larger dose if the pain worsens. Giving morphine as seldom as possible to avoid dependency would cause needless client suffering.

A client with Crohn's disease is scheduled for a barium enema. What should the plan of care include today to prepare for the test tomorrow?

Encourage plenty of fluids. The nurse should encourage plenty of fluids because adequate fluid intake is necessary to avoid dehydration that may be caused by the bowel preparation and to prevent fecal impaction after the procedure. The client may be placed on a low-residue diet 1 to 2 days before the procedure to reduce the contents in the GI tract. Fiber intake is limited in a low-residue diet. Because dairy products leave a residue, they aren't allowed the evening before the test. Clear liquids only are allowed the evening before the test.

When caring for a client with hepatitis B, the nurse should monitor closely for the development of which finding associated with a decrease in hepatic function?

Increased drowsiness Although all the options are associated with hepatitis B, the onset of drowsiness suggests a decrease in hepatic function. To detect signs and symptoms of disease progression, the nurse should observe for disorientation, behavioral changes, and a decreasing level of consciousness and should monitor the results of liver function tests, including the blood ammonia level. If hepatic function is decreased, the nurse should take safety precautions. Yellow sclera, pruritus, and fatigue are expected with hepatitis B infection and do not indicate worsening of liver function.

When planning care for a client with a small-bowel obstruction, which of the following should the nurse consider to be the primary goal?

Maintaining fluid balance Because a client with a small-bowel obstruction can't tolerate oral intake, fluid volume deficit may occur and can be life-threatening. Therefore, maintaining fluid balance is the primary goal. Pain relief and maintaining body weight don't reflect life-threatening conditions. Ambulation would not be the priority because of nasogastric suctioning and pain control.

While ambulating, a client who had an open cholecystectomy complains of feeling dizzy and then falls to the floor. After attending to the client, a nurse completes an incident report. Which action by the nurse should the charge nurse correct?

Making a copy of the incident report for the client A nurse shouldn't copy an incident report for anyone. An incident report is a confidential and privileged document available to agency personnel for risk-management activities. After completing the report, the nurse should submit it according to facility policy. The nurse should document the incident factually in the client's record and notify the physician of the incident and the client's condition.

A client seeks medical attention after developing acute abdominal pain. Which action by the nurse helps ensure accurate auscultation of the client's bowel sounds?

Making sure the client's bladder is empty before auscultating The nurse should make sure the client's bladder is empty before auscultating, because a full bladder may interfere with bowel sounds. To auscultate bowel sounds, the nurse uses the diaphragm of the stethoscope. (The nurse uses the bell to auscultate vascular sounds.) To confirm absence of bowel sounds, the nurse must listen in each quadrant for 1 minute. The nurse should press the stethoscope lightly, not deeply, on the abdominal wall in all four quadrants.

A nurse is caring for a client with active upper GI bleeding. What is the appropriate diet for this client during the first 24 hours after admission?

Nothing by mouth Bleeding must be controlled before oral intake, so the client should receive nothing by mouth. When the bleeding is controlled, the diet is gradually increased, starting with ice chips and then clear liquids. Dairy shouldn't be given because it increases gastric acid production, which could prolong bleeding. A clear liquid diet is the first diet offered after bleeding is controlled.

A client has been admitted to the emergency department with severe mid-epigastric, upper quadrant abdominal pain. Based on the signs and symptoms and laboratory data documented in the chart below, the nurse would anticipate preparing for which diagnosis?

Pancreatitis. The assessment findings combined with the laboratory results suggest pancreatitis. The pancreas is situated behind the stomach in the upper quadrant. Signs and symptoms of pancreatitis include severe mid-epigastric, upper quadrant abdominal pain, fever, nausea, and vomiting. Inflammation of the pancreas results in leukocytosis. Injured ?-cells are unable to produce insulin, leading to hyperglycemia, which may be as high as 500 to 900 mg/dl (27.75 mmol/L to 49.95 mmol/L). Lipase and amylase levels become elevated as the pancreatic enzymes leak from injured pancreatic cells. Calcium becomes trapped as fat necrosis occurs, leading to hypocalcemia. Peptic ulcer, Crohn's disease, and irritable bowel syndrome do not cause amylase or lipase levels to increase.

A nurse should expect to administer which vaccine to the client after a splenectomy?

Pneumococcal vaccine-injection Pneumococcal vaccine-injection, a polyvalent pneumococcal vaccine, is administered prophylactically to prevent the pneumococcal sepsis that sometimes occurs after splenectomy. Hepatitis B vaccine prevents hepatitis B. Measles virus vaccine-live is a live, attenuated virus vaccine for immunization against measles (rubeola). Tetanus toxoid is administered to prevent tetanus resulting from impaired skin integrity caused by traumatic injury.

The nurse is caring for a client that has undergone a colon resection. While turning him, wound dehiscence with evisceration occurs. What is the nurse's first response?

Place saline-soaked sterile dressings on the wound. The nurse should first place saline-soaked sterile dressings on the open wound to prevent tissue drying and possible infection. Then the nurse should call the physician and take the client's vital signs. The dehiscence needs to be surgically closed, so the nurse should never try to close it.

When providing care for a client hospitalized with acute pancreatitis who has acute abdominal pain, which nursing interventions would be most appropriate for this client? Select all that apply.

Place the client in a side-lying position. Monitor the client's respiratory status. Obtain daily weights. The client with acute pancreatitis usually experiences acute abdominal pain. Placing the client in a side-lying position relieves the tension on the abdominal area and promotes comfort. A semi-Fowler's position is also appropriate. The nurse should also monitor the client's respiratory status because clients with pancreatitis are prone to develop respiratory complications. Daily weights are obtained to monitor the client's nutritional and fluid volume status. While the client will likely need opioid analgesics to treat the pain, morphine sulfate is not appropriate as it stimulates spasm of the sphincter of Oddi, thus increasing the client's discomfort. During the acute phase of the illness while the client is experiencing pain, the pancreas is rested by withholding food and drink. When the diet is reintroduced, it is a high-carbohydrate, low-fat, bland diet.

When caring for a client with acute pancreatitis, the nurse should use which comfort measure?

Positioning the client on the side with the knees flexed The nurse should place the client with acute pancreatitis in a side-lying position with knees flexed; this position promotes comfort by decreasing pressure on the abdominal muscles. The nurse should administer an analgesic, as needed and ordered, before pain becomes severe, rather than once each shift. Because the client needs a quiet, restful environment during the acute disease stage, the nurse should discourage frequent visits from family and friends. Frequent oral feedings are contraindicated during the acute stage to allow the pancreas to rest.

A client who is legally blind must undergo a colonoscopy. The nurse is helping the physician obtain informed consent. When obtaining informed consent from a client who is visually impaired, the nurse should take which step?

Read the consent form to the client and ask him if he has any questions. The nurse should read the consent form to the client and make sure that he understands what was read to him. The physician and nurse should answer any questions the client has before he signs the consent form. The client's family doesn't need to be present. The legally blind client may sign the consent form.

After being admitted to the emergency department for severe lower right quadrant pain, a child states that the pain has suddenly resolved. Which of the following would the nurse suspect?

Ruptured appendix When a client with severe right lower quadrant pain has a sudden relief of pain, a ruptured appendix should be suspected. Although gastroenteritis, celiac disease, and food allergies may elicit a pain response, the specific presentation of right lower quadrant sudden pain is indicative of a ruptured appendix.

A client is to start on enteral tube feedings. What should a nurse do to make this as comfortable as possible for the client?

Start the tube feeding slowly. Administering the tube feeding too fast could upset the client's stomach causing diarrhea and putting the client at risk for aspiration. Elevation of the client's head prevents the risk of aspiration. Room temperature feeding is recommended when giving an enteric feeding. Enteric tubing and pumps should be used when giving an enteric feeding.

A graduate nurse and her preceptor are establishing priorities for their morning assessments. Which client should they assess first?

The newly admitted client with acute abdominal pain The graduate nurse and her preceptor should assess the new admission with acute abdominal pain first because he just arrived on the floor and might be unstable. Next, they should change the abdominal dressing for the postoperative client or measure feeding tube residual in the client with continuous tube feedings. These tasks are of equal importance. They should assess the sleeping client who received pain medication 1 hour ago last because he just received relief from his pain and is able to sleep.

The nurse assesses the client's stoma during the initial postoperative period. What observation should the nurse report to the health care provider (HCP) immediately?

The stoma is dark red to purple. A dark red to purple stoma indicates inadequate blood supply. Mild edema and slight oozing of blood are normal in the early postoperative period. The colostomy would typically not begin functioning until 2 to 4 days after surgery.

A client who has had ulcerative colitis for the past 5 years is admitted to the hospital with an exacerbation of the disease. Which factor is of greatest significance in causing an exacerbation of ulcerative colitis?

a demanding and stressful job Stressful and emotional events have been clearly linked to exacerbations of ulcerative colitis, although their role in the etiology of the disease has been disproved. A modified vegetarian diet or an exercise program is an unlikely cause of the exacerbation.

A client is scheduled for oral cholecystography. Prior to the test, the nurse should:

ask the client about possible allergies to iodine or shellfish. Explanation: Iodine compounds used as radiographic contrast agents, such as iopanoic acid),, should not be administered to the client with iodine and seafood allergies, because anaphylaxis may occur. Drinking large amounts of water is indicated for certain kidney or urinary bladder studies, not gallbladder studies. The contrast agent is administered orally 10 to 12 hours before the test. The client is NPO after administration of the contrast agent. Enemas are not required for cholecystography.

The client with an intestinal obstruction continues to have acute pain even though the nasoenteric tube is patent and draining. The nurse should first:

assess the client for signs of peritonitis. The client's pain may be indicative of peritonitis, and the nurse should assess for signs and symptoms, such as a rigid abdomen, elevated temperature, and increasing pain. Reassuring the client is important, but accurate assessment of the client is essential. The full assessment should occur before pain relief measures are employed. Repositioning the client to the left side will not resolve the pain.

A client had a nephrectomy 2 days ago and is now complaining of abdominal pressure and nausea. The first nursing action should be to:

auscultate bowel sounds. If abdominal distention is accompanied by nausea, the nurse must first auscultate bowel sounds. If bowel sounds are absent, the nurse should suspect gastric or small intestine dilation and these findings must be reported to the physician. Palpation should be avoided postoperatively with abdominal distention. If peristalsis is absent, changing positions and inserting a rectal tube won't relieve the client's discomfort.

A client is admitted with a diagnosis of ulcerative colitis. The nurse should assess the client for:

bloody, diarrheal stools. Diarrhea is the primary symptom of ulcerative colitis. It is profuse and severe; the client may pass as many as 15 to 20 watery stools per day. Stools may contain blood, mucus, and pus. The frequent diarrhea is often accompanied by anorexia and nausea. Constipation is not a sign or symptom of ulcerative colitis. Steatorrhea (fatty stools) is more typical of pancreatitis and cholecystitis. Alternating diarrhea and constipation is associated with irritable bowel syndrome.

A barium enema is not prescribed as a diagnostic test for a client with diverticulitis, because a barium enema:

can perforate an intestinal abscess. Barium enemas and colonoscopies are contraindicated in clients with acute diverticulitis because they can lead to perforation of the colon and peritonitis. A barium enema may be prescribed after the client has been treated with antibiotic therapy and the inflammation has subsided. A barium enema is diagnostic in diverticulitis. A barium enema could increase the client's pain; however, that is not a reason for excluding this test. The client may be able to tolerate the procedure, but the concern is the potential for perforation of the intestine.

A client with advanced cirrhosis of the liver is jaundiced and malnourished. Which of the following problems is associated with cirrhosis of the liver?

difficulty coping. It is not uncommon for clients with ulcerative colitis to become apprehensive and have difficulty coping with the frequency of stools and the presence of abdominal cramping. During these acute exacerbations, clients need emotional support and encouragement to verbalize their feelings about their chronic health concerns and assistance in developing effective coping methods. The client has not expressed feelings of fatigue or isolation or demonstrated disturbed thought processes.

Because of religious beliefs, a client, who is an Orthodox Jew, refuses to eat hospital food. Hospital policy discourages food from outside the hospital. The nurse should next:

discuss the situation and possible courses of action with the dietitian and the client. The best course of action when a client is not able to eat food that is contrary to religious beliefs is to discuss the situation with the client and the dietitian. Health team members may need to confer about this client's needs. Telling the client that it is important to eat what is served is unlikely to help; the client has already refused the food, and this approach does not address the client's concerns. Encouraging the family to bring suitable food to the hospital may be acceptable. However, the family should not bear sole responsibility for meeting the client's nutritional needs. Health care team members need to seek ways the hospital can address the client's concerns. Suggesting that foods may be replaced with intravenous fluids may be perceived as a threat and is not a realistic solution.

A nurse is caring for a client who underwent a subtotal gastrectomy. To manage dumping syndrome, the nurse should advise the client to:

drink liquids only between meals. A client who experiences dumping syndrome after a subtotal gastrectomy should be advised to ingest liquids between meals rather than with meals. Taking fluids between meals allows for adequate hydration, reduces the amount of bulk ingested with meals, and aids in the prevention of rapid gastric emptying. There is no need to restrict the amount of fluids, just the time when the client drinks fluids. Drinking liquids with meals increases the risk of dumping syndrome by increasing the amount of bulk and stimulating rapid gastric emptying. Small amounts of water are allowable before meals.

The client with a peptic ulcer is prescribed antibiotics and bismuth salts. The nurse explains that this combination of medications will:

eradicate the Helicobacter pylori bacteria. H. pylori is present in 70% of clients with peptic ulcers. Bacteriostatic or bacteriocidal antibiotics are given to eradicate the bacteria from the gastric mucosa. Bismuth salts suppress the H. pylori bacteria and help to heal the mucosa. Although sometimes indicated, surgery for peptic ulcer is much less common now that the role of H. pylori in the development of gastric ulcers is understood. The bowel preparation for gastric surgery does not include bismuth salts. While treatment for H. pylori drastically reduces the recurrence rate, 10% of clients treated for H. pylori will have a recurrence of peptic ulcer disease. While effective treatment will eliminate the possibility of complications, antibiotics and bismuth salts will not directly prevent bleeding.

A client with cancer of the stomach had a total gastrectomy 2 days earlier. Which indicates the client is ready to try a liquid diet? The client:

has frequent bowel sounds. The client can begin eating with a liquid diet when bowel sounds return, usually in 2 to 3 days. The client may be hungry but cannot have oral fluids or foods until intestinal motility has been established. The client may continue to have postoperative pain for several days; because receiving a liquid diet does not depend on the client being pain-free, the nurse can continue to offer pain medication. The client does not have to experience a bowel movement to receive fluids and food.

A client with a bleeding ulcer is vomiting bright red blood. The nurse should assess the client for which indicator of early shock?

heart rate above 100 beats/minute In early shock, the body attempts to meet its perfusion needs through tachycardia, vasoconstriction, and fluid conservation. The skin becomes cool and clammy. Urine output in early shock may be normal or slightly decreased. The client may experience increased restlessness and anxiety from hypoxia, but loss of consciousness is a late sign of shock.

A client who has been vomiting for 2 days has a nasogastric tube inserted. The nurse notes that over the past 10 hours the tube has drained 2 L of fluid. The nurse should further assess the client for:

hypokalemia. Loss of electrolytes from the gastrointestinal tract through vomiting, diarrhea, or nasogastric suction is a common cause of potassium loss, resulting in hypokalemia. Hypermagnesemia does not result from excessive loss of gastrointestinal fluids. Common causes of hypernatremia are water loss (as in diabetes insipidus or osmotic diuresis) and excessive sodium intake. Common causes of hypocalcemia include chronic renal failure, elevated phosphorus concentration, and primary hypoparathyroidism.

The client has had a gastric resection, and is having difficulty clearing the airway of mucus. The nurse should determine if the client has:

incisional pain. Breathing and coughing cause pain in clients with high abdominal incisions. Chest excursion decreases, which decreases coughing and deep-breathing efforts. Shallow breathing leads to hypoventilation and atelectasis, leading to ineffective airway clearance. Frequent ambulation helps decrease the likelihood of respiratory complications. The possibility of recurring nausea is not related to respiratory complications. Semi-Fowler's position facilitates drainage of the remaining stomach contents, thus decreasing the risk of regurgitation that could result in aspiration of gastric contents. The position also allows for greater chest wall expansion and diaphragm contraction.

Postoperative nursing care for a client after an appendectomy should include:

noting the first bowel movement after surgery. Noting the client's first bowel movement after surgery is important because this indicates that normal peristalsis has returned. Sitz baths are used after rectal surgery, not appendectomy. Ambulation is started the day of surgery and is not confined to bathroom privileges. The abdomen should be auscultated for bowel sounds and palpated for softness, but there is no need to measure the girth every 2 hours.

The nurse administers fat emulsion solution during TPN as prescribed based on the understanding that this type of solution:

provides essential fatty acids. The administration of fat emulsion solution provides additional calories and essential fatty acids to meet the body's energy needs. Fatty acids are lipids, not carbohydrates. Fatty acids do not aid in the metabolism of glucose. Although they are necessary for meeting the complete nutritional needs of the client, fatty acids do not necessarily help a client maintain normal body weight.

The nurse assesses a client with diverticulitis and suspects peritonitis when which of the following symptoms is noted?

rigid abdominal wall Diverticular rupture causes peritonitis from the release of intestinal contents (chemicals and bacteria) into the peritoneal cavity. A rigid abdominal wall results from a diverticular cavity. The inflammatory response of the peritoneal tissue produces severe abdominal rigidity and pain, diminished intestinal motility, and retention of intestinal contents (air, fluid, and stool). Hyperactive bowel sounds, explosive diarrhea, and excessive flatulence do not indicate peritonitis.

A nurse is teaching a client with malabsorption syndrome about the disorder and its treatment. The client asks which part of the GI tract absorbs food. The nurse tells the client that products of digestion are absorbed mainly in the:

small intestine. The small intestine absorbs products of digestion, completes food digestion, and secretes hormones that help control the secretion of bile, pancreatic juice, and intestinal secretions. The stomach stores, mixes, and liquefies the food bolus into chyme and controls food passage into the duodenum; it doesn't absorb products of digestion. Although the large intestine completes the absorption of water, chloride, and sodium, it plays no part in absorbing food. The rectum is the portion of the large intestine that forms and expels feces from the body; its functions don't include absorption.

After a nasogastric (NG) tube has been inserted, the nurse can most accurately determine that the tube is in the proper place when:

the pH of the aspirated fluid is measured. Measuring the pH of the aspirated gastric fluid is the most accurate determination of the placement of the NG tube. A pH lower than 4 indicates that the tube is in the stomach. Whether or not the client is gagging or coughing is not an accurate way to determine if the tube is placed correctly. No fluids should be inserted into the tube until the placement has been determined. Inserting air into the tube and listening for the resulting whoosh can be used, but this is not as accurate as pH measurement.

Which rationale best explains why the nurse should evaluate gastric residual before administering the client's next enteral feeding?

to prevent overdistention of the stomach The primary reason for evaluating gastric residual is to determine whether gastric emptying has been delayed and the stomach is becoming overdistended from the feeding. With delayed gastric emptying, the possibility of aspiration of the feeding into the lungs is increased. It is not possible to determine how well the client's body is absorbing nutrients or whether the client is receiving enough feeding by checking the gastric residual. It is not necessary to keep partially digested formula separate from undigested formula.

Which finding is normal for a client during the icteric phase of hepatitis A?

yellowed sclera Liver inflammation and obstruction block the normal flow of bile. Excess bilirubin turns the skin and sclera yellow and the urine dark and frothy. Profound anorexia is also common. Tarry stools are indicative of gastrointestinal bleeding and would not be expected in hepatitis. Light- or clay-colored stools may occur in hepatitis owing to bile duct obstruction. Shortness of breath would be unexpected.