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Flashcards in gastrointestinal Deck (45)
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1

pancreatitis patho

autodigestion of the pancreas

function:
endocrine (insulin)
exocrine (digestive enzymes)

two types: acute and chronic

causes:
#1 gallbladder disease
#2 alcohol

****one system-- when one part gets sick it'll all get sick

2

pancreatitis s/s

pain (increases with eating)
abdominal distention/ascites (losing protein rich fluids like enzymes and blood in the abdomen)
abdominal mass (swollen pancreas)
rigid, board-like abdomen (bleeding that can lead to peritonitis)
bruising around umbilical area (Cullen's sign)
bruising in the flank area (Grey-Turner's sign)
fever (inflammation)
n/v
jaundice
hypotension (bleeding or ascites)

3

pancreatitis diagnosis

*****serum lipase and amylase (digestive enzymes)
high WBC
high blood sugar
ALT/AST high
longer PT & aPTT (risk for bleeding)
high serum bilirubin
high h&h (dehydration)
low h&h (bleeding)

4

amylase normal levels

30-220

5

lipase normal levels

0-160

6

normal AST

0-35

7

normal ALT

10-36

8

pancreatitis treatment

control pain
decrease gastric secretions (NPO, NGT to suction)
bedrest
*****want the stomach dry and empty *if anything gets in the body will want to make enzymes thats what is causing the pain*

pain meds:
PCA narcotics
fentanyl patches

anticholinergics to dry the stomach:
benztropine
diphenoxylate

GI protectants:
pantoprazole
famotidine
antacids

maintain fluid and electrolytes

maintain nutritional status

insulin (pancreas is sick, TNA/TPN)

daily weights

eliminate alcohol

AA if that's the cause

9

hemoglobin levels

male: 14-18
female: 12-16

10

hematocrit levels

male: 42-52
female: 37-37

11

***** if your liver is sick

***** worry about bleeding
***** decrease dose of meds
***** never give them acetaminophen (antidote is acetylcysteine)

12

4 major functions of the liver

detoxifying the body
helps the blood clot
liver helps metabolize (break down) drugs
synthesizes albumin

13

cirrhosis patho

liver cells destroyed and replaced with connective/scar tissue
alters circulation within the liver
BP in liver goes up (portal hypertension)

14

cirrhosis s/s

firm, nodular liver
jaundice
abdominal pain (liver stretched)
***not normal to be able to palpate liver
chronic dyspepsia (GI upset)
change in bowel habits
ascites
splenomegaly
fatigue
peripheral edema
anemia
can progress to hepatic encephalopathy/coma (ammonia build up)

15

cirrhosis diagnostics

low serum albumin
high ALT/AST
ultrasound
CT/MRI

liver biopsy--confirms diagnosis
pre-procedure:
clotting studies pre-procedure (PT, INR, aPTT)
VS pre-procedure
supine w/ R arm behind the head
exhale and hold breath to get diaphragm out of the way
post procedure:
lie on R side
VS (worried about hemorrhage)

***if unsure why they're swelling, ask for albumin levels

16

cirrhosis treatment

antacids
vitamins
diuretics
no more alcohol
i and o
weights
rest
bleeding precautions (no IM injections, no NSAIDs)
abdominal girth (ascites)
paracentesis:
remove fluid from the peritoneal cavity (ascites)
have them void
positing sitting up
VS (shocky clients BP goes down and pulse up)

monitor jaundice (good skin care)
***avoid narcotics (liver cannot metabolize drugs)
***diet (low protein, low Na)

17

hepatic coma patho

protein breaks down into ammonia
liver converts it to urea
urea is excreted through kidneys

when liver is impaired it cannot make the conversion, ammonia builds up in the blood and causes a decrease in LOC

18

hepatic coma s/s

mental changes
motor issues
difficult to awaken
asterixis (liver flap-hand tremors)
handwriting changes
reflexes will decrease
EEG will be slow
fetor (breath smells like ammonia)

19

hepatic coma treatment

lactulose (decrease serum ammonia)
enemas
decrease protein in diet
monitor serum ammonia

20

bleed esophageal varices patho

high bp in the liver (portal hypertension) forces collateral circulation to form in the stomach, esophagus, & rectum
no problem until it ruptures

21

bleeding esophageal varices treatment

replace blood
VS
monitor CVP
O2
Octreotide lowers BP in the liver
endoscopic sclerotherapy (banding)
esophageal variceal ligation (injects sclerosing agent into the varices)

balloon tamponade:
sengstaken-blakemore tube
used to stabilize severe hemorrhage
dont use more than 12 hours
used to hold pressure on bleeding varices
****if it gets caught, use scissors to cut the tube and pull out)

enemas to get rid of blood
lactulose (decreases ammonia)
saline lavage to get blood out of stomach

22

peptic ulcer patho

common cause of GI bleeding
can be in esophagus, stomach, or duodenum
erosion is present

23

peptic ulcer s/s

burning pain in mid-epigastric area/back
heartburn (dyspepsia)

24

peptic ulcer diagnosis

gastroscopy (EGD):
NPO pre procedure
sedated
NPO until gag reflex returns
watch for perforation by watching for pain, bleeding, or if they are having issues swallowing

upper GI:
looks at esophagus and stomach with dye
NPO past midnight
***no smoking, chewing gum, or mints (smoking increases stomach motility which will affect test and increases stomach secretions which will increase the chance of aspiration)
*** remove nicotine patches

25

peptic ulcer treatment

antacids (liquid to coat stomach) ****take when the stomach is empty and at bedtime. when the stomach is empty acid can get on the ulcer so take antacids to protect the ulcer

PPI "prazole"
H2 antagonist (famotidine)
GI cocktail (donnatal, viscous llidocaine, mylanta II)
antibiotics for H. pylori (clarithromycin, amoxicillin, tetracycline, metronidazole)
Sucralfate forms a barrier over the wound so acid can't get on the ulcer

26

peptic ulcer teaching

decrease stress
stop smoking
eat what you can tolerate
avoid temp extremes and spicy foods
avoid caffeine

27

two types of peptic ulcers

gastric:
malnourished
pain half hour to one hour after meals
food doesn't help
vomiting helps
vomits blood

duodenal:
appear well nourished
night time pain
pain 2-3hours after meals
food helps
blood in stools

28

histal hernia patho

hole in diaphragm is too large so the stomach moves up into the thoracic cavity

cause: large abdomen (lose weight), congenital abnormalities, trauma, straining

29

histal hernia s/s

heartburn
fullness after eating
regurgitation
dysphagia (difficulty swallowing)

30

histal hernia treatment

small frequent meals
sit up 1 hour after eating
elevate HOB
surgery
teach lifestyle changes
healthy diet