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. TREATMENT—For a reducible hernia, these measures include bed rest, Trendelenburg’s 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. TREATMENT—General  measures  consist  of bed rest, nutritious diet with no dairy products, mild  sedation,  and  steroids. Hemorrhoids They   are   varices   of   the   three   hemorrhoid veins. Hemorrhoids   are   usually   mild   and remittent.   The   patient   complains   of   pruritus, incontinence,   and   recurrent   protrusion,   rectal bleeding,   and   sensation   of   discomfort   and pain. TREATMENT-General   measures   consist   of a  low  roughage  diet,  regular  bowel  habits,  sitz baths,  suppositories,  and  surgical  treatment,  if necessary. Hepatitis 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. SYMPTOMS—They 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 be present. TREATMENT—Strict   isolation   is   not necessary,  but  careful  hand  washing  techniques are essential. Bed rest should be at the patient’s 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. Cholecystitis 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. SYMPTOMS—Attacks 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. TREATMENT—Treat   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. Pancreatitis 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. SYMPTOMS—Onset  is  sudden  with  steady, severe pain located in the epigastrium that may 2-12