exam 4- gi/ hepatic Flashcards
(314 cards)
1
Q
Gastric Analysis- how does it work
A
gastric secretions by inserting ng tube into stomach and taking contents out-
2
Q
gastric analysis
npo how long
assess x2
A
npo for 8-12 hrs,
assess meds and baseline vitals
3
Q
PTC (Percutaneous Transhepatic Cholangiography)-
how does it work
assess what
A
evaluates filling of hepatic/biliary ducts- contrast medium is injected- a
assess allergy to iodine
4
Q
ERCP (Endoscopic Retrograde Cholangio-Pancreatography)-
vsiaulzes what
retrieves what
assess what
A
visaulzed gi structures to retrieve gallstones from common bile duct-
assess allergy to contrast medium
5
Q
Liver Biopsy-
rules out what
no what med
assess what
A
rules out metastic cancer-
no anticoagulants a week before-
assess baseline vitals
6
Q
Barium Enema-
what does it do
what w colon
what diet
A
identify structure abnomralites of colon and rectum-
colon needs to be free of fecal matter-
clear liquid
7
Q
Barium Swallow (Upper GI series)-
diagnosis what
drink what
A
diagnose conditions of esophagus and stomach-
pt drink 16-20 oz of chalky liquid-
8
Q
Barium Enema
npo how long
after test do what
A
go npo 8 hrs before,
after test make sure pt takes laxitves to remove it in bile
9
Q
Esophagogastroduodenoscopy (EGD)-
visualzes what
what time
A
directly visualizes the mucous membranes of esophagus, stomach-
2 days after barium swallow-
10
Q
Esophagogastroduodenoscopy (EGD)-
npo how long
may need what
A
npo 6-8 hrs-
may need sedative
11
Q
Esophageal Manometry –
what problems
how does it work
npo how long
assess what
A
esophageal motility ptoblems-
cath is inserted into mouth
- npo for 8-12 hrs,
assess meds
12
Q
Occult Blood – tests for what
A
test for hidden blood in stool
13
Q
Small Bowel Series (Lower GI series)-
diagnose what
what before
give what
A
dinaogse abnomralites of esophagus, sotmahc and small intestine-
npo before test-
give barium
14
Q
Sigmoidoscopy and Colonoscopy
what does it look at
what diet
what prep
A
– visual examination of colon –
liquid diet-
bowel prep
15
Q
Pyloric Stenosis-
affects what time
what does it do
A
Affects infants from first week through 8th week
Constriction of bottom part of stomach-
16
Q
Pyloric Stenosis-S/S:
main sign
wt
I
c
s
what type of stools
A
projectile vomiting-no bile, maybe blood,
lose weight,
irritable,
crying,
starving,
few small stools
17
Q
Pyloric Stenosis-Diagnosis
p e
s
what series
A
: physical exam
, sonogram,
upper GI series
18
Q
Pyloric Stenosis-Interventions:
main intervention
A
surgical correction (pyloromyotomy: cutting the pyloric muscle)
19
Q
Pyloric Stenosis- blood gases
what chloride
what k
met what
A
hypochloremic
hypokalemia
metabolic alkalosis
20
Q
Pyloromyotomy- surgery to correct pyloric stenosis- discharge teaching
s/s of what
additional what
come back if what
look for what
how often
A
s/s of infection
Complications-additional
n/v-come back
Look for baby in pain
How often can they feed
21
Q
Pediatric Gastroesophageal Reflux- patho
A
Backward flow of acidic GI contents into the esophagus ->irritation & inflammation ->erosion
22
Q
Pediatric Gastroesophageal Reflux-Manifestations
p
what type of spit up
crying when
what changes
A
: painful,
spit up in excessive amount-regurguation,
crying when spitting up ,
nuerochanges,
23
Q
Pediatric Gastroesophageal Reflux- Risk for
a
p
s
A
aspiration,
pneumonia
sepsis
24
Q
Pediatric Gastroesophageal Reflux-Diagnostics:
what series
e
what of stomach
A
upper gi series,
endoscopy,
ph of stomach(stomach will be more acidic then esophagus)
25
pediatric gastroesophagheal reflux solution- give what
give ppi 30-60 mins before feeding
26
Pediatric Gastroesophageal Reflux- Treatment -Modify feeding habits –
what feeds
waht volume
what before
frequent what
scheduled feeds,
smaller volume,
ppi before
Frequent burping
27
Pediatric Gastroesophageal Reflux- Treatment -
avoid what foods x2
Avoid fatty foods and citrus juice
28
Pediatric Gastroesophageal Reflux- Treatment - meds
p
a
h
Proton pump inhibitors,
antacids,
histamine antagonists
29
Surgery for adult and peds: Gerd
Surgery for adult and peds: laparoscopic Nissen
30
Gerd- what is it
backwards flowing of gastric contetns into esophagus
31
s/s-Gerd-
what/when
what pain
what throat
h
heartburn aftermeals, when bending over or when reclining,
chest pain,
sort throat
hoarsnes
32
Gerd-Complications x2
- esophagal strictures and barrets esophagus
33
Gerd-
Esophageal strictures can lead to
Barrets esophagus can lead to
Esophageal strictures can lead to dysphagia due to scar tissue
Barrets esophagus can lead to esophageal cancer
34
Gerd-Diangosed w
b s
upper
what test
barium swallow,
upper endoscopy,
Bernstein test
35
Gerd-Manage acute/chronic pain-
what meals
stop what
small frequent meals,
stop smoking
36
Gerd-Tx- antacids-
neutralizes what
neutralizes stomach acid,
37
Gerd-Ppi- omeprazole and lansoprazole-
reduce what
can cause what
monitor what
report
reduce gastric secretions-
can cause osteopniea and osteoporosis-
monitor lft
,report black tarry stools
38
Gerd-H2 receptor agonist- famotidine and rantidine-
how does it work
no what
report what
reduce acidity of secretions-
no smoking or nsaids,
report any alterations like rash
39
gerd- tx- Metoclopromide
how does it work
dont do what x2
-stimulates upper gastric moltility and gastric emptying-
do not drive, and no alcohol
40
Hitaital hernia-
what is it
what is tx
when stomach protrudes into diaphragm into thoracic cavity
tx is gerd tx
41
Hitaital hernia- s/s-
r
h
what feeling
what pain
d
what bleeding
reflux,
heartburn,
feeling of fullness,
chest pain,
dysphagia,
occult bleeding
42
Hitaital hernia- diagnosis
b s
upper
barium swallow
upper endoscopy
43
Pediatric Biliary Atresia-Cause:
what happens
leads to what if not treated
extra bile duct fails to close
->cholestasis, cirrhosis, portal hypertension, end-stage liver disease and if not treated –
child will not survive
44
Pediatric Biliary Atresia-Symptoms:
how long after
increasingly
I
failure
what urine
what stools
no interest in what
prolonged what
2-3 weeks after birth,
increasingly jaundiced,
irriabtle,
failure to thrive,
dark tea colored urine,
white clay colored stools,
no interest in feeding,
prolonged bleeding times, itching, bruising
45
Pediatric Biliary Atresia-Diagnosis
what test
b
what levels
what scan
u
: liver function tests,
bilirubin,
ammonia levels,
cat scan,
ultrasound
46
Pediatric Biliary Atresia
need to have what
what is only curative
Need to have surgery! (Kasai procedure) –
many also need liver transplant in the future-only treatment
47
Pediatric Biliary Atresia
prep w what after kasai
and what else
Prep w/ antibiotics and antibiotics used for 1-2 years after kasai procedure
, and vitamin K
48
Peptic Ulcer Disease-Gastric Ulcers & Duodenal ulcers- what are they
break in gastrointestinal mucosa
49
Peptic Ulcer Disease-Gastric Ulcers & Duodenal ulcers-
Causes
s
use what
what infection
: Common w/ people that smoke,
use NSAIDS / ASA,
H. pylori infection
50
Peptic Ulcer Disease-Gastric Ulcers & Duodenal ulcers-S/S:
what pain/radiated where
pain occurs when
releived by what
gnawing, burning, aching pain in the epi-gastric area, radiates to back.
Pain occurs when the stomach is empty.
Relieved by food
51
Peptic Ulcer Disease-Gastric Ulcers & Duodenal ulcers-Treatment:
waht w what
stop what
b c
a
m
2 antibiotics w PPI,
stop NSAIDS,
Bismuth compounds,
antacids,
misoprostol
52
duodenal ulcers
pain what w meal
occurs when
what stool
pain relieved by meal
occurs 2-3 hrs after meal
dark tarry stool
53
gastric ulcer
pain what w meal
occurs when
what occurs
risk for what
pain increased by meal
occurs30-1hr after meal
vomiting occurs
risk for gi bleed
54
Peptic Ulcer Disease->Complications-Hemorrhage
S/S?-
worry about what
h
what in stool
what skin
worry about shock-hypotension, tachycardia,
,hematemesis( coffee ground emesis w dark colored and fouls smelling)
, blood in stool,
pale and clammy,
55
Peptic Ulcer Disease->Complications-
Pyloric Obstruction-what is it
s/s- /, c what feeling
edema around sphincter
n/v,
cramping,
feeling full
56
Pyloric Obstruction-
tx
Peptic Ulcer Disease->Complications
Gastric decompression- ng tube, iv
57
Perforation-can be lethal- medical emergency
Risk for
b p
s s
h
Peptic Ulcer Disease->Complications
bacterial peritonitis,
septic shock
hypovolemia
58
Perforation-can be lethal- medical emergency-S/S?
what bp
what hr
what emesis
what bowel sounds
what abdomen
what pain
Peptic Ulcer Disease->Complications
drop in map,
increase hr,
mixture of coffee ground emesis and bright red,
absent bowel sounds,
distended abdomen
, sever upper abdominal pain
59
Perforation-can be lethal- medical emergency-For both and hemorrhage
want what
what for blood
get what
potentail what
Peptic Ulcer Disease->Complications
want large bore ivs,
type and cross match for blood,
get gi consult/ct of pelvis,
potential intubation, maybe ng
60
Perforation-can be lethal- medical emergency
how do you try and fix
if you cant - then what
Peptic Ulcer Disease->Complications
Get to or, try to fix with clipping,
if you cannot, need laparotomy
61
perforation -what is priority and why
priority is airway
-can choke on vomit
62
Gastrointestinal Bleeding-UGI bleeding ->
g
p
e v
gastritis, PUD, esophageal varices
63
Gastrointestinal Bleeding-At risk-
s
chronic what
smokers
chronic alchoholics
64
Gastrointestinal Bleeding-S/S:
h
what bs
what stools x2
what symptoms
Hematemesis- “coffee-ground”
, hyperactive BS,
melena(black tarry stools), hematochezia(frankly bloody stools),
Shock symptoms (tachycardia, hypotension, pallor, decreased urine output)
65
Gastrointestinal Bleeding- can lead to
what shock
a
what failure
b I
m I
c/d
hypovolemic shocks,
acidosis,
renal failure,
bowel infarction,
MI,
coma/ death
66
Gastrointestinal Bleeding: Interventions
what labs
what Diagnostic
Labs: CBC, Blood type & cross match, electrolytes, BUN, Liver function, coagulation profile
Diagnostic: Upper endoscopy
67
Gastrointestinal Bleeding: Interventions-If pt comes in and is vomiting blood-
what iv
put where
what blood
protect waht
large bore ivs,
get them laying down,
type and cross match blood,
protect airway (intubation/ng)
68
Gastrointestinal Bleeding: Interventions-Treatments
o
potential
replacing
what drip
what antidote
:oxygen,
potential antibiotics,
fluids/blood
put on ppi drip,
maybe antidote for their anticoag,
69
Gastrointestinal Bleeding:
Interventions- why a gastric lavage
needs what
Gastric Lavage: removes blood from GI system
needs or
70
Gastrointestinal Bleeding: Interventions- Watch for hypovolemic schock-
assess what
mintor what
insert what
2
replace
assess vs,
monitor change in skin,
insert indewelling catheter,
2 large bore iv,
replace fluids
71
Esophageal Cancer 2 types
Squamous Cell
Adenocarcinoma - Dysplastic columnar epithelium (associated with Barrett’s Esophagus)
72
why is upper gi bleed worse
why is lower gi bleed more common
upper gi becuase of airway
lower gi because warfarin and aspirin
73
Esophageal Cancer-Causes:
what use
untreated what
what factors
tobacco & alcohol use,
long-term untreated GERD,
congenital factors
74
Esophageal Cancer-Manifestations
what stuck
d
what wt
c
: choke/food stuck,
dysphagia,
wt loss,
cough
75
Esophageal Cancer -Diagnosis
Barium swallow
Tissue biopsy via endoscopy
Esophagogastroduodenoscopy with biopsies of the esophagus and tumor
CXR, CT scan, MRI
CBC, albumin, ALT, alkaline phosphatase, AST, bilirubin
76
Esophageal Cancer-Goal
control
maintain
: Control dysphagia, maintain nutritional status
77
Esophageal Cancer-Nonsurgical management:
what therapy x2
c
r
p
e d
e t
nutrition and swallowing therapy,
chemotherapy,
radiation therapy,
photodynamic therapy,
esophageal dilation,
endoscopic therapies
78
Esophageal Cancer-Surgical management:
is it a cure
what happens
palliative, not a cure,
removal of part or all of the esophagus (esophagectomy)
79
Esophageal Cancer-Post-op interventions:
manage what
who place ng- no
scheduled what
waht line
may need what
airway management,
doctor/surgeron place ng in-no suction- (preventing vomit),
scheduled antiemetics,
central line,
may need tpn, g tube
80
Esophageal Cancer-Health Promotion:
what diet
cannot do what
meds are how
maintain what
mechanical soft diet,
cannot eat post surgery for a while,
meds need to be crushed or liquid,
maintain activity
81
Esophagectomy Interventions-Discharge Teaching-
no what x2
what feeding
how to give meds where
preventing what
no smoking, no alchohol,
g tube feeding,
how to give meds in g tube
, preventing dvt/pe,
82
h pylori
from what
how tx
what is in stool
from contaminated water
treated with 2 antibiotics
fat is in the stool
83
h pylori- s/s
what pain
lack of what
what wt
buring pain
lack of appetite
losing wt
84
Stomach (Gastric) Cancer- adenocarcinomas-Causes
what water
what infection
chronic what
what diet
partial what
: contaminated water-low socioeconomical status
h pylori infection
chronic gastritis
smoked /processedfoods diet
partial gastric resection
85
Stomach (Gastric) Cancer-Manifestations
f
what in stomach
general
what labs
: fatigue-,
dull stomach ache,
general discomfort,
will have low rbc/h/h
86
Stomach (Gastric) Cancer0 diagnostics
what labs
what is definitive diagnostic
: CBC (anemia), upper GI x-ray with barium swallow, CT scan
Upper endoscopy with visualization and biopsy (definitive diagnosis)
87
Stomach (Gastric) Cancer-Interventions:
do what only when prior to metastasis
r/c
Surgical resection (only when diagnosed prior to metastasis)
Radiation / Chemotherapy
88
Stomach (Gastric) Cancer
-Palliative care
what is palliative
Gastrostomy/jejunostomy feeding tube
89
Stomach (Gastric) Cancer-Surgical Interventions:
p
t
t what
Partial gastrectomy
Total gastrectomy
Total gastrectomy with esophagojejunostomy
90
Gastric Cancer Surgery-Total gastrectomy with anastomosis of esophagus to jejunum
what happens
Stomach is completely out
91
Gastric Cancer Surgery-Total gastrectomy with anastomosis of esophagus to jejunum
priority
n
a
what issues
c
what shift
a
Nutritional,
airway
absoption issues
constipation
electrolyes shift,
anemia
92
Complications of Gastric Surgery- dumping syndrome
what is it
massive fluid shift from vascular system to gi system,
93
dumping syndrome
when pt does what
causes what
usually when
when pt eats a large amount of fluid and food together-
causes pressure-
usually 30 mins of meal-
94
Complications of Gastric Surgery- dumping syndrome
s/s
/
what bowel sounds
d /p
what bp
what hr
s
impending
n/v,
hyperactive bowel sounds
dizziness, pale
,hypotension,
tahcyardia,
sweating,
impending doom
95
Complications of Gastric Surgery- dumping syndrome-Diet
what w liquids/solid
what type of meals
high in 3x
- separate liquids and solids,
small frequent meals
high in b 12, carb and protein,
96
Complications of Gastric Surgery- dumping syndrome-Positioning
- semi recombant after eating,
97
- dumping syndrome
when is it concern
risk of what
Complications of Gastric Surgery
concern for 6-12 months after surgery
risk of fluid volume defeicit,
98
Malabsorption Syndromes: Celiac Disease-S/S
ab
d
chronic
ab cramping,
diahhrea,
chronic anemia,
99
Malabsorption Syndromes: Celiac Disease-Diagnosis
what panel
what draw
what w what
celiac panel-
venous draw ,
endoscopy w colonoscopy and bioposy,
100
Malabsorption Syndromes: Celiac Disease-Labs
c
b
what vit d
what calcium
cbc,
bmp,
low vit d, low calcium,
101
classical celiac
atypical celiac
Classical- gluten intolerance
Atypical- gi symtpms are mild
102
silent celiac
latent celiac
Silent- no symtpms
Latent- has genes, but doenst expiernce symtpms
103
Malabsorption Syndromes: Celiac Disease-Tx-
no what
maybe what
no gluten,
maybe vitamin and mineral suplementals
104
Malabsorption Syndromes: Celiac Disease
what allergy
what sensitivity
Wheat allergy- IgE antibodies increase when exposed to gluten
Gluten sensitivity:
105
Malabsorption Syndromes: Celiac Disease
no what foods
only use what if really sure
No wheat, rye, barley! Oats can be contaminated, so avoid unless absolutely sure.
106
Colon Polyps
what are they
can become what
what s/s
small growths attached to intestine
can become malignant
usually asytmomatic
107
Colon Polyps
diagnosed with
when are these done
Diagnosis: barium enema & sigmoid or colonoscopy, biopsy
First one at 45- then 10 years after unless polyps or underlying conditions
108
Colon Polyps-Interventions
: polypectomy or total colectomy for certain types (high malignancy potential)
109
Colorectal Cancer (CRC) (large bowel)-> most are adenocarnionmas
how does it happen
progressive, starts as polyps and leads to malgignancy
110
Colorectal Cancer (CRC) (large bowel)
why is this such a bad thing
Easily metastasizes to nearby organs (especially the liver) and through the vascular or lymphatic system
111
Colorectal Cancer (CRC) (large bowel)->Tumor can lead to complications such as
b
b o
p
bleeding,
bowel obstruction
perforation
112
Colorectal Cancer (CRC)-Risk factors:
g p
what factors
I
genetic predisposition,
personal & dietary factors,
Inflammatory Bowel Disease (IBD)
113
Colorectal Cancer (CRC)-Manifestations
b
what stools
what pain
what wt
bloating
, bloody stools,
rectal /abdominal pain or pressure ,
wt loss
114
Colorectal Cancer (CRC)- Diagnosis:
H & H, fecal occult blood, CT scan, sigmoidoscopy or colonoscopy, Carcinoembryonic antigen (CEA), CT/MRI/US, Biopsy
115
Colorectal Cancer (CRC)-Nonsurgical interventions:
Based on the staging of the disease
r
a c
L p
Radiation
Adjuvant chemotherapy
Laser photocoagulation – uses heat to destroy small tumors
116
Colorectal Cancer (CRC)-Surgical Interventions:
what w Early stage small tumors:
transanal approach (rare)
117
Colorectal Cancer (CRC)-Surgical Interventions:
Colon resection (removal of what and what
removal of tumor and regional lymph nodes)
118
Colorectal Cancer (CRC)-Surgical Interventions:
Colectomy -removal of what
(colon removal with colostomy)
119
Colorectal Cancer (CRC)-Surgical Interventions:-
Abdominoperineal (AP) resection -removal of what x3
removal of sigmoid colon, rectum, and anus)
120
Colorectal Cancer (CRC)-Surgical Interventions-May need Colostomy placed- management & care
keep what
provide what
asess s
asess o
–keep it clear of irritants
provide stoma care,
assess skin
, asses ouput
121
Differnce between colostomy and ileltomsy
colostomy- creates an incision in the colon-large intestine
ileostomy-creates an incision in ileum-small intestine
122
tpn administration
must have what
monitor what
change how often
must have a CVAD
Monitor electrolyte and protein levels
change tubing every 24 hrs
123
administration of blood
hand
open
all
spike/and
prime w
prepare/invert
spike
close
prime/ attach
regulate
monitor for
hand hygiene,
open y tubing,
all clamps in off,
spike ns bag and put on iv pole,
prime with ns,
prepare blood-invert2-3 times,
spike blood,
close ns,
prime with blood, attach to vad,
regulate blood flow,
montor for reaction
124
NG insertion
determine
2/e/p/c
perform/prepare
assess/stand
what position
apply
place
measure
prepare
apply
__tube
hand pt
gently
have pt/flex
encourage
check
temporarily
check placement-
connect
fasten
provide
determine order
identify/ explain/ provide privacy / cultural needs
perform hand hygiene and. prepare supplies
asses nares and stand on side of bed
high fowlers positions
apply pulse ox/ capnogrophy
place bath towel over pt
measure length of tube
prepare tape
apply clean gloves
lubricate tubing
hand pt cup of water/determain hand signal
gently insert tube in nostril
have pt take a deep breath and flex head toward chest
encourage small sips of water
check for position of tubing
temporarily anchor tube
check placement- X-ray,ph and air bolus
connect to suction
fasten end of gown
provide oral/nasal care
125
central venous management
use what
change
repsond
use sterile technique
change dressings
respond to any adverse events
126
Gastrititis- what is it
inflammation of stomach lining
127
what is acute gastritis
what is sever form of that
Acute- dispruption of mucosal barrier by irrirant like nsaids-
severe form of acute is erosive gastritis-
128
acute gastritis s/s
a
what releived by what
what pain
/
Anorexia,
disocomfort relieved by belching,
severe ab pain,
n/v
129
Chronic gastritis- s/s
vague discomfort after eating
130
Gastrititis- Diangnostc
testing for what
what analysis
/
- testing for h pylori,
gastric analysis
, h/h,
131
Gastrititis- Meds
p
h
s
- ppi,
h2 receptors,
sucralfate,
132
Gastrititis- Meds-if hpylori-
2 antibiotics w bismuth
133
gastritis tx-
how long npo
slow
replacing what
g l
6-12 hrs of npo,
slow introduction of food,
replacing electrolytes,
gastric lavage
134
IBS- what is it
spastic bowels
135
ibs s/s
what pain- releived by what
altered what
what abdominal
ab pain relieved by defecation,
altered defecation habits,
abdominal bloating,
136
IBS- spastic bowels-Diagnosis- focused on what
focused on ruling out other things, like testing for blood in stools, looking at colonoscopy and such
137
IBS treatment-
what laxatives
anti c
anti d
anti d
Bulk forming laxative-
Anticholinergic-
Anti-diarrhea-
Antidepressants-
138
IBS education- dietary habits-
additional what
avoid what
additional fiber ,
avoid trigger foods like dairy, caffine and soda
139
Peritonoitis-what is it
inflammation of peritoneum-
contamination from bacteria from some sort
140
s/s- peritonitis
what pain
what abdomen
p I
f
severe abdominal pain,
distedend abdomen,
paraytic ileus (bowel doesn’t go forward)
, fever
141
Peritonoitis-Needs prompt treatment to prevent septic shock- how identify
what wbc
p
b c
elevated wbc,
paracetnesis,
blood cultures
142
peritonitis tx
broad spectrum antibiotic like imipenem or meropenem, then get specific antibiotic
143
peritonitis tx plan
2 what
what for bp
what kills bacteria
what helps against stomach
what for decomp
2 ivs
vasopressors
antibiotics
antiemetics
ng decomp
144
Intestinal decompression- peritonitis
does what
what is inserted
what is maintained
until when
what is withheld
relieves abdominal distention-
ng tube is inserted
suction is maintained
until bowel sounds are present And passing flatus
fluids and foods are withheld
145
If cause of peritonitis is
perforation,
gangrous bowel,
or inflamed appendix-
need what
need laparotomy to remove damaged tissue
146
peritonitis
Also can get what
does what
return form surgery w what
perintoneal lavage-
washes out cavity w warm istonic fluid to remove contaminetnts
Return from surgery w jp drain
147
paralytic ileus
what is it
why can it happen
when the bowels stop moving
can be from anesthesia, or opioid useage
148
assess what before giving foods
b s
b b
b m
paralytic ileus
bowel sounds
butt burps (farts)
Bowel movements
149
what is opioid alternative for when in pain and bowel is paralytic ileus
make sure what organ works
also give what for pain
paralytic ileus
ketorolac
make sure kidneys work
also can give Tylenol
150
what drug promotes motility in bowel
also do what as well
paralytic ileus
metoclopramide
also move the patient around
151
Gastroenteritis
what is it
caused by what
- inflammation of the stomach
Caused by contaminated water or food- “food poisoning”
152
Gastroenteritis-s/s -
a
/
what pain
d
b
anorexia,
n/v,
ab pain,
, diahhrea,
Borborygmi, excessively loud and hyperactive bowel sounds
153
Gastroenteritis-Complications
what imbalances
vomiting leads to what
- electrolyte imabalanaces-
vomiting leads to metabolic alkolosis
154
Gastroenteritis-Tx
is doesn’t really need tx, maybe needs antibiotics, or antidiahhreals, and replacing fluids lost,
155
Gastroenteritis-If botusilsm is suspected-
gastric lavage
156
Gastroenteritis-If ecoli is suspected
plasmapheresis
157
Gastroenteritis-what if renal failure
Dialysis
158
Diverticular disease-Risk factors-
what diet
decreased what
low fiber diet
decreased activity levels
159
Diverticular disease-what are these
Diverticulosis
Diverticulitis
Diverticulosis- presence of diverticula- often asymtpmatic- can lead to hemorrhage and divertultiis
Diverticulitis- inflammation around diverticular sac- undigested food and bacteria collect in diverticula and allow bacteria to settle
160
Diverticular disease-s/s-
what pain
c
/
f
what abdomen
left sided pain,
constipation,
n/v,
fever,
distended abdomen
161
Diverticular disease-Complications
b o
f f
h
- bowel obstruction,
fistula formation
hemorrhage
162
Diverticular disease-Diangoseed w
c
c
colonoscopy,
ct scan
163
Diverticular disease-Meds
what med
s s
avoid what
- broad spectrum antibiotics- metronidazole and ciproflaxin,
stool softeners
avoid laxatives
164
Diverticular disease-Nutrition
increase what
avoid what
- increase fiber,
avoid seedy foods
165
Hernia- what is it
- abdominal wall protrudes out of abdominal cavity
166
Hernia-Inguinal herie-
in who
what is it
what looks like
males-
impropure closure of testes-
lump and swelling on groin
167
Hernia- Umbilical hernia-
when
what pain
pregnancy/obesity-
sharp pain on coughing or straining
168
Hernia- Incisional hernia
where is it
- on surgical incision- bulge at incisional site
169
Hernia- s/s
- sac covered by skin
170
Hernia-Tx-
modify what
anti
s s
last tx is
modify activity,
anti inflammatory meds,
stool softeners
last tx is surgery
171
Intestinal obstruction- what is it
failure of intestinal contents to move through bowel lumen
172
Small bowel obstruction- from what
a
h
t
adhesions,
hernias
tumors
173
Small bowel obstruction-
what pain
v
what bowel sounds
Cramping pain
vomiting(may contain bile
, hyperactive bowel sounds
174
Small bowel obstruction-Complications
what volume
organ
p
p v
hypovolemia
organ dysfunction,
perforation
pulmonary ventillation
175
Large bowel obstruction-
c
i
f i
cancer
inflammation,
fecal impaction
176
Large bowel obstruction-
c
what pain
constipation
severe ab pain
177
Large bowel obstruction-
complications- colon dilation can lead to
g
p
p
gangrene,
perforation,
peritonitis
178
Large bowel obstruction- dx
r s
a x
radiologic studies,
abdominal xray
179
Partial small bowel obstructions can be treated w
what using what
n
what meds x2
gastrointestional decompression using ng tube,
npo,
pain meds / antibiotcs
180
Complete mechanical obstruction tx
w what
what do prior
with surgical intervention-
prior to you give ng tube
181
Preoperative Nursing Care bowel surgery
marking where
what placement
perform what
Marking of stoma site
NG tube placement and management
Perform bowel prep as ordered
182
Postoperative Nursing Care- bowel surgery
monitor what
asess what
watching for what
Monitor bowel sounds
Assess surgical site dressing and drainage-CHECK bleeding
watching for peritonitis
183
cholesethiasis
what is it
made from what
what low kind of diet
stone in gall bladder
made form fat
low fat diet
184
when pt takes lots of antibiotics=
risk for what
treat w what
if that doesn't work->
risk for c diff
treat w metronidazole
if that doesn't work- give a stool replacement
185
Liver functions
m
s
d
p
s
Metabolism
Synthesizes
Detoxifies
Produces
Storage
186
Liver Function Tests
a
a
a
g
serum what
alt
ast
alp
ggt
serum bilirubin
187
what other lab values for liver
what factors
what markers
waht electrolytes-(na/k/ca)
Clotting factors,
inflammatory markers,
low (na/k/ca)
188
Abdominal ultrasound –non invasive-why used
used to look at abdominal organs
189
Cholangiography
uses what to see what
assess
used x ray to view bile ducts in gallbladder
assess coags
190
Endoscopic Retrograde Cholangiopancreatography (ERCP)-invasive
what does
discontinue what
uses x rays and endoscopy to see bile ducts and pancreatic duct
discontinue blood thinners
191
Magnetic Resonance Cholangiopancreatography (MRCP) -invasive
visualizes what
uses what
visualizes biliary and pancreatic ducts
uses contract dye
192
Liver biopsy
does what
performed how
what after
takes out small sample of liver for examination
performed under anesthesia
rest after
193
Hepatocellular Failure:
impaired p
disrupted g
reduced b
impaired s
impaired protein metabolism
disrupted glucose metabolism
reduced bile production
impaired steroid hormone metabolism
194
Jaundice (icterus):
accumulated what
due to what
accumulated bilirubin
due to disrupted metabolism and excretion
195
Anp=
where is glucose stored/metaobolzied,
196
foods to avoid in heptoceullular cancer
high in x2
p
a
food high in fat, sugar
processed
alchohol
197
Hepatitis
what is it
leads to what
leads to what s/s
Widespread inflammation of liver cells
leads to congestion w inflammatory cells
ruq pain
198
what hepatitis is transmitted fecal-oral
A
E
199
what hepatitis is transmitted in blood and body fluids
B
C
D
200
Complications of hepatitis
c h
c
d
: chronic hepatitis,
cirrhosis
death
201
Diagnosing Hepatitis-manifestations
what symptoms
what pain
flu like symtpms
ruq pain
202
diagnosing hepatitis
lab
presence of what
liver function tests
Presence of antigens and antibodies
203
Liver biopsy
need to know what
– need to know if they take anticoags, know s/s of bleeding
204
Hepatitis -Pre icteric phase- before jaundice
what symptoms
m
lack pf what
what pain
f
c
Flu-like symptoms- body aches,
mailaise,
lack of appetite,
mild RUQ pain,
fever,
chills,
205
hepatitis- Icteric Phase-jaundice-5-10 days after symtpoms-
j
p
what stools
what urine
Jaundice-present in sclera skin and mucous membranes ,
pruritus,
clay-colored stools,
dark brown urine
206
hepatitis- Post icteric / convalescent phase
what labs
less
what decreased
Bilirubin labs return to normal,
less fatigued
, pain decreased
207
Medications for Hepatitis- prevention-what 2 vaccines
Hepatitis A (2 doses 6 months apart)
Hepatitis B (3 doses; first vaccine after birth)
208
Medications for Hepatitis A-Post exposure prophylaxis
give what
when
Immune globulin (Ig)
within 2 weeks of exposure
209
Medications for Hepatitis
what if severe
severe ->antiretroviral drugs (enecavir)
210
what is hep c treated w
what can that cause
hep C tx w/ Interferon alpha
Can develop flu-like symptoms & depression
211
Medications for Hepatitis-Complementary Therapies
m t
l r
g
st
Milk thistle,
licorice root,
ginger,
St. John’s wort
212
Hepatitis nursing diagnosis- Transmission Issues
what precautions
what with fecal incontincene
encourage what
Standard precautions/Good hand washing
Contact isolation (with fecal incontinence)
Encourage prophylactic Tx of contacts
213
Hepatitis nursing diagnosis-Fatigue
what periods
monitor what
Rest periods/ Limitations of activities
Monitor fatigue in order to determine activity
214
hepatitis nursing diagnosis-Nutritional Deficits
what facilitates healing
what type of meals
avoid
use of what
High calorie, high carbs to facilitate healing
Small frequent meals/snacks / Low fat (↓ nausea)
Avoid alcohol
Use of nutritional supplements
215
Treatments for Acute Hepatitis -
physical what
avoid what
may take how long
Physical rest, avoid strenuous activities
avoid hepatic toxic drugs/alcohol,
may take 3-16 weeks
216
Treatments for Acute Hepatitis
increase c x2
what type of meals
increase carbs (pasta white bread, crackers)
calories,
small frequent meals.
217
what meds for acute hepatitis
supplemental
anti
supplemental vitamins
antiemetics
218
Fatty Liver (Steatohepatitis)
what is it
caused by what
Accumulation of fat in and around the hepatic cells
caused by DM, obesity, elevated lipid profile
219
Fatty Liver (Steatohepatitis)-Assessment
slight what
mild
potential what
: slight abdominal girth increased,
mild pain,
potential SOB,
220
Fatty Liver (Steatohepatitis)-Diagnosis
what panel
what issues
: elevated lipid/liver panel,
coag issues
221
Fatty Liver (Steatohepatitis)-Interventions:
control what
what controls diabetes x2
what controls lipid
appriopate
control carb intake,
metformin/ insulin to control diabetes,
statins to control lipids,
approtiate amount of excercise
222
Cirrhosis- what is it
replaced by what
Liver tissue destroyed and
replaced with fibrous scar tissue and metabolic function is lost.
223
cirrhosis-due to what
a
chronic what 2 hepatitis
due to alcohol
chronic hepatitis B and C.
224
what impacts the extent of problems and complications in liver
The degree of damage to the liver impacts the extent of problems and complications.
225
Cirrhosis Manifestations
a
j
what stools
d
what pain
ascites,
jaundice,
clay colored stools,
diarrhea,
ruq pain
226
cirrhosis diagnosis
what labs
u
what scan
what level
liver labs,
ultrasound,
ct scan
alc level
227
cirrhosis tx
what to reduce fluid
what to lower ammonia
what to lower hr
what for anemia
what for agitation
diuretics-reduce fluid,
lactulose- lower ammonia,
betablocker (nadolol, propranolol)- hr
ferrus sulfate, folic acid-anemia,
oxazepam- agitation
228
Loss of hepatic function leads to: Portal hypertension- manifestations
a
e v
prominent what
Ascites
Esophageal varices
Prominent abd. veins
229
Loss of hepatic function leads to: Portal hypertension-manifestations
h
s
p s e
Hemorrhoids
Splenomegaly (blood cell destruction)
Portal systemic encephalopathy
230
Loss of hepatic function leads to: Portal hypertension-manifestations
h s
b p
s j
Hepatorenal syndrome
Bacterial peritonitis
Severe jaundice
231
Portal Hypertension- increase of bp where
is an increase in the blood pressure within a system of veins called the portal venous system
232
portal hypertension
what merges into portal vein
then branches where
Vessels coming from the stomach, intestine, spleen, and pancreas merge into the portal vein,
which then branches into smaller vessels and travels through the liver.
233
Portal hypertension is an increase in the pressure in portal vein->
portal vein carries blood where
carries blood from the digestive organs to the liver.
234
why do alcoholics have digestive problems and gallbladder problems
Because it will cause portal hypertension, which then Cuts perfusion to esophagus and pancreas and all that
235
decreased proteins / increased aldosterone lead to:
Loss of hepatic function leads to: Portal hypertension
Ascites
236
Ascites-> Loss of hepatic function leads to: Portal hypertension
tx-
what med
how much na
how much fluid
p
Diuretics (spironolactone)
Na restricted 2g/day
Fluid restriction 1500 ml/day
Paracentesis
237
paracentesis
if large volume may need->
watch for what
(if large volume, may need albumin IV)
– watch for hypovolemia afterwards
238
fluid restriction management
suck on hard candy
239
Esophageal varices - what can happen
Loss of hepatic function leads to: Portal hypertension
(can rupture and cause hemorrhage death)
240
Esophageal varices -Prevention of bleeding:
what lower hr
what for anemia
Loss of hepatic function leads to: Portal hypertension
Beta-blocker (nadolol / propranolol)
Vitamin K / Ferrous sulfate / folic acid
241
Esophageal varices -waht if active bleed
v l
b
Loss of hepatic function leads to: Portal hypertension
Variceal ligation
/ banding
242
Esophageal varices -waht if active bleed
give what
b t
what inserted
Loss of hepatic function leads to: Portal hypertension
give RBCs, FFP, platelets
Balloon tamponade
Central line inserted
243
Esophageal varices -
treated w what
put in what
do what
varices are then what
Loss of hepatic function leads to: Portal hypertension
can be treated w endoscopy
put in ng tube-
do gastric lavage
varsices are then sclerosed
244
Esophageal varices -
Ballon tamponade- does what
Loss of hepatic function leads to: Portal hypertension
Balloon puts pressure on direct bleed so that they have enough time to get to surgery
245
esophageal varices- if coming in and bleeding
what from who
2 what
replace what
what med for bp
what drip
what in them
intubation from provider
2 large bore ivs
replace fluids/blood
dopamine for bp
ppi drip
catheter in them
246
prominent abdominal veins leads to what
Loss of hepatic function leads to: Portal hypertension
gi bleed
247
hemorrhoids
prevent what
could lead to what
Loss of hepatic function leads to: Portal hypertension
Prevent constipation
could lead to rectal bleeding
248
hemorrhoids
prevent constipation w what
what also happen In this med
Loss of hepatic function leads to: Portal hypertension
Laxative (lactulose)
– also given to lower ammonia levels
249
Splenomegaly-(blood cell destruction) ->
e
p
vit what deficiency
Loss of hepatic function leads to: Portal hypertension
ecchymotic
purpura
Vit. K deficiency
250
Portal systemic encephalopathy
from what
Loss of hepatic function leads to: Portal hypertension
from the accumulation of neurotoxins in blood
251
Portal systemic encephalopathy
what builds up
decrease what intake
Loss of hepatic function leads to: Portal hypertension
Ammonia build up (ammonia is byproduct of protein metabolism)
decrease protein intake
252
Portal systemic encephalopathy -s/s
a
what changes
c h
Loss of hepatic function leads to: Portal hypertension
Asterixis (liver flap),
LOC changes,
cerebral hypoxia
253
Portal systemic encephalopathy meds
L
n
m
e
Loss of hepatic function leads to: Portal hypertension
Lactulose /
neomycin /
metronidazole
Enemas
254
Portal systemic encephalopathy
pt may look how
from what
Loss of hepatic function leads to: Portal hypertension
Pt may look like stroke/ drunk,
but that is from elevated ammonia level being neurotoxic
255
Portal systemic encephalopathy
impaired what
give where
Loss of hepatic function leads to: Portal hypertension
Impaired speech and swallowing,
so give stuff recatlly
256
Hepatorenal syndrome-
what happens
Loss of hepatic function leads to: Portal hypertension
when liver puts all waste filtering into kindeys, and kindeys now don’t work
257
Hepatorenal syndrome- s/s
a
what level na
what bp
Loss of hepatic function leads to: Portal hypertension
Azotemia (excess nitrogenous waste products)
Na retention,(high)
Hypotension
258
Hepatorenal syndrome- tx
restrict what
Loss of hepatic function leads to: Portal hypertension
restrict fluids and sodium
259
why could bacterial peritonitis happen
Loss of hepatic function leads to: Portal hypertension
maybe from frequent pericardiocentesis, or just contaimination of cavity
260
bacterial peritonitis s/s
increased what
what temp
worsening what
e
overall what
Loss of hepatic function leads to: Portal hypertension
increased abdominal pain/discomfort,
little fever
, worsening ascites,
enceloplathy,
overall decline
261
Severe jaundice-
leads to what on skin
can show what
Loss of hepatic function leads to: Portal hypertension
Leads to bile salt deposit on skin
pruritus
262
Severe jaundice- what helps
what h20
L
m
what schedule
Loss of hepatic function leads to: Portal hypertension
Warm h20,
lotions,
mittens,
turning schedule
263
Severe jaundice-
what med
what for malnutrition
Loss of hepatic function leads to: Portal hypertension
Antihistamines
Vitamins to help w/ malnutrition
264
emergency measure to treat
portal hypertension, esophageal varacies and ascites
Transjugular intrahepatic portosystemic shunt (TIPS)-
265
Transjugular intrahepatic portosystemic shunt (TIPS)-
used for what
what type of treatment
Used for as a short term measure before a liver transplant can be done –
last chance treatment
266
General interventions for cirrhoisis-
what diet until ammonia levels are wnl
increase what
supplemental
low what
low protein diet until ammonia levels are wnl,
increase carbs,
supplemental vitamins,
low sodium diet
267
what do you do with fluids when gi bleed
in cirrhosis, always measure what
npo
measure abdominal girth
268
Liver Cancer
related to what x3
Hep b,
hep c,
cirrhosis
269
Liver Cancer Manifestations
often masked by cirrhosis or chronic hepatitis,
w
a
what pain
:weakness,
anorexia,
abdominal pain (RUQ
270
liver cancer interventions:
c
r
t
Chemo
radiation
transplant depending on severity
271
liver cancer
no I s
no f
check what levels
diet
no a
No impact sports,
no falls,
check coag levels,
diet that they can process,
no alcohol,
272
Liver Trauma
why can it happen
Commonly injured with penetrating trauma and blunt trauma resulting in lacerations, avulsions, and crush injuries
273
Liver Trauma Assessment
what pain
abdominal what
d
g
r
: RUQ pain,
abd tenderness,
distention
, guarding,
rigidity
274
Liver Trauma Diagnosis
signs of what
p l
c
u
: signs of shock related to excessive blood loss(large abdominal girth),
peritoneal lavage,
CT scan
ultrasound
275
Liver Trauma Interventions
e L
what interventions
what transfusions
: exploratory laparotomy,
surgical interventions to stop bleeding,
blood transfusions
276
Liver Trauma Meds-
iv
f
p
iv fluids,
ffp,
platelets- clotting factors
277
Liver Abscess Invading bacteria or protozoa leads to what
-destruction of liver tissue->
production of a necrotic cavity filled with infective agents, liquefied liver cells and tissue, and leukocytes.
278
liver abscess Diagnosis
c
u
b
a
: CT scan,
ultrasound,
biopsy,
aspirate
279
liver abscess what meds
- antibiotics-metronidazole, iodoquinol
280
liver abscess Prevention
- avoid contaminated food/water
281
liver abscess Supportive care
p
n
/
pharmacy,
nutrition,
pt/ot,
282
pancreas functions
h
d e
Hormones (alpha - glucagon, beta - insulin, detla, F)
Digestive enzymes
283
what labs are pancreas
a
l
amylase
lipase
284
Pancreatitis- inflammation of pancreas leads to what
release of what
h and n
→release of pancreatic enzymes→
hemorrhage and necrosis
285
PancreatitisCauses: _
what abuse
m
g
alc abuse,
malformation of pancrease,
gallstones,
286
acute Pancreatitis Manifestations
what pain
/
f
j
what bleeding
: sudden onset of severe LUQ pain,
N/V
, fever,
jaundice,
retroperitoneal bleeding
287
PancreatitisDiagnosis:
a
L
waht ultrasound
what scan
amylase,
lipase,
abdominal ultrasound,
ct scan,
288
Pancreatitis Complications
a
s
what shock
what failure
ARDS,
sepsis,
hypovolemic shock,
organ failure
289
Acute Pancreatitis
why npo
when can patient resume eating
NPO- decreases enzyme secretion.
Pt resume eating when Lipase WNL
290
acute pancreatitis interventions
what supplemental
treat what
balance what
what to feed
what diet
supplemental oxygen
treat pain
balance electrolytes
npo to feed
low fat diet
291
what meds to stay away from in pancreatitis
n
s
what diuretics
waht hormone
nsaids
steroids
thaiszide
estrogen
292
Acute Pancreatitis
what is placed
no what
r
NG tube usually placed.
no contact spot
rest
293
Acute Pancreatitis
diet
what type of diet
low what as well
no
Clear liquid diet ADAT to
low fat diet,
no alcohol
294
Chronic pancreatits s/s
what pain to where
wt
c
what stools
luq pain to back
wt loss,
constipation,
steatorrhea (fatty, foul smelling stools
295
chronic pancreatitis causes
e
m
what pancreas
abdominal what
etoh
malnutrition
malformed pancreas
abd truama
296
chronic pancreatitis nursing interventions
p
a
what envireomnt
what checks
ppi
analegesics
relaxing envireomnt
wt checks
297
Chronic pancreatits complicaitions
m
m
possible
malabsorption,
malnutrion,
possible pud
298
Pancreatitis interventions
what analgesics
a
what gastric ones
o
Opioid analgesics,
antibiotics,
H2 blockers, PPI,
octreotide
299
Pancreatitis interventions-Nutrition
what initially
what to feed pt
: NG initially,
IV fluids/TPN(bypass gi tract) –
300
Pancreatitis interventions-Nutrition
after tpn, start food when
what is present
what lab is normal\
BS present and slow,
amylase levels normal.
301
Pancreatitis interventions-Nutrition
after start food back up-what diet
low what
no what
low fat
no alchohol
302
Pancreatitis interventions
watch what functions x2
Watch respiratory and renal function
303
Pancreatic Cancer- Manifestations:
wt
f
what pain
j
what stools
what urine
weight loss,
flatulence,
dull epigastric pain,
jaundice,
clay colored stools,
dark urine
304
Pancreatic Cancer Diagnosis:
c
e
what study
CT scan
, ERCP,
cytologic study
305
Pancreatic Cancer Risk w
o a
s
hx of what
old age,
smoker,
hx of pancreatitis,
306
Pancreatic Cancer: Pancreatodueode-nectomy (Whipple)
how does it work
what is used as well
Removes part of pancreas and reattaches-
radiation and chemo are used as well
307
Pancreatic Cancer: Pancreatodueode-nectomy (Whipple)
risk for what
put where
assis w what
Risk for resp compromise in-
put in semi fowlers,
assist w cdb,
308
Pancreatic Cancer: Pancreatodueode-nectomy (Whipple)
needs what
Needs ng tube w low suction
309
Pancreatic Cancer: Pancreatodueode-nectomy (Whipple)
what helps drain secretions
Changing positions helps facilitate drainage of secretions
310
Pancreatic Cancer: Pancreatodueode-nectomy (Whipple)
maintain what
can give pt what
Maintain pain control
Can give pt diabetes
311
Pancreatic Cancer: Pancreatodueode-nectomy (Whipple)
monitor for what signs
Monitor for s/s of hypovolemic shock
312
reyes syndome
what causes it
what use
what viruses
aspirin use w viral illness
viruses- URI, gastroenteritis, influenza
313
reyes syndrome s/s
f
decreased
c
decreased what function
fever
decreased loc
coma
decreased liver function
314
reyes syndorme tx
what checks
maintain what
assess what
what precautions
nuero checks
maintain hydration + electrolytes
assess resp status
seizure precautions
