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HURST > GI > Flashcards

GI Flashcards

1
Q

Pancreatitis Patho

A

auto-digestion of pancreas

Pancreas has two separate functions:

 - endocrine - insulin
 - exocrine - digestive enzymes

Two types of pancreatitis: acute and chronic

 - #1 cause is gallbladder dz
 - #2 cause is alcohol
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2
Q

Pancreatitis S/sx

A

pain that increases w food
abdominal distention / ascites (losing protein rich fluids like enzymes and blood into abdomen)
abdominal mass = swollen pancreas
rigid, board-like abdomen (with guarding) = 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
jaundic
Hypotension from bleeding or ascites

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3
Q

Pancreatitis diagnosis

A

serum lipase and amylase increased (digestive enzymes)
- lipase is specific to pancreas
increased WBCs
increased blood sugar
increased or normal ALT, AST (liver enzymes)
longer PT and aPTT
- liver not making clotting factors
increased serum bilirubin
decreased hemoglobin and hematocrit due to dehydration

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4
Q

Amylase normal value

A

30-220 U/L

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5
Q

Lipase normal value

A

0-160 U/L

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6
Q

AST normal value

A

0-35 U/L

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7
Q

ALT normal value

A

10-36 U/L

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8
Q

Normal Hemoglobin Value

A

Male: 14-18 g/dl

Female: 12-16 g/dl

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9
Q

Normal Hematocrit Value

A

Male: 42-52%

Female: 37-47%

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10
Q

Pancreatitis Treatment

A

CONTROL PAIN

Decrease gastric secretions (NPO, NGT to suction, bed rest) (want stomach empty and dry)
Pain medication (PCA narcotics and fentanyl patches)
- morphine sulfate and hydromorphone
Anticholinergics to dry patient
- benztropine and diphenoxylate/atropine
GI Protectants
- pantoprazole
- famotidine and cimetadine - H2 receptor antagonists
- antacids
Maintain fluid and electrolyte balance and nutritional status (TPN or TNA)
Insulin (pancreas is sick and not producing)
Daily wts
Eliminate alcohol

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11
Q

Cirrhosis

A

don’t give Tylenol or narcotics

4 major functions of the liver

 - detoxify the body
 - helps your blood to clot
 - metabolizes drugs
 - synthesizes albumin

liver cells are destroyed and replaced with scar tissue. This alters the circulation and creates portal HTN

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12
Q

Cirrhosis S/sx

A 
firm, nodular liver; jaundice
abdominal pain
chronic dyspepsia (GI upset)
change in bowel habits
ascites
splenomegaly
fatigue
peripheral edema (ascites)
anemia
can progress to hepatic encephalopathy / coma (due to build up of ammonia that acts like sedative)
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13
Q

Cirrhosis Diagnosis

A

decreased serum albumin
increased ALT & AST
ultrasound
CT, MRI
Liver biopsy - confirms diagnosis
- make sure to do VS and clotting studies before
- position supine / flat w right arm up and behind head
- exhale and hold breath to get diaphram out of way
- post procedure = lie on right side for pressure to prevent bleeding

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14
Q

Cirrhosis Treatment

A 
antacids, vitamins, diuretics
no alcohol
I&O / daily wt
rest (toxins = tired)
prevent bleeding (No IM or aspirin)
measure abdominal girth (ascites)
Paracentesis (to help w breathing if ascites occurs)
    - void before so we don't poke bladder
    - position upright to keep fluid in front (where we're poking)
    - VS (BP goes down and HR goes up)
Monitor for jaundice
Avoid narcotics (liver can't metabolize)
Diet (decrease protein / low sodium)
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15
Q

Protein breaks down to ______ . The _______ converts it to ______ which is then excreted by the ______.

A

Protein breaks down to AMMONIA. The LIVER convers it to UREA which is then excreted by the KIDNEYS.

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16
Q

Hepatic Coma Patho

A

Protein breaks down into ammonia and the liver converts it to urea which is excreted through the kidneys.

When the liver stops working, ammonia builds up which leads to sedation.

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17
Q

Hepatic Coma S/sx

A 
minor mental changes / motor problems
difficult to arouse
asterixis (flapping, trembling hands)
handwriting changes
reflexes will decrease
EEG is slow
Fetor = breath smells like acetone / ammonia
LIver people = GI bleed likely
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18
Q

Treatment for Hepatic Coma

A

lactulose (decreases serum ammonia)
enemas (to get blood out of GI tract)
decrease protein in the diet
monitor serum ammonia

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19
Q

Bleeding Esophageal Varices Patho

A

high BP in liver (portal HTN) forces collateral circulation to form
- it forms in stomach, esophagus, and rectum

alcoholic client that is GI bleeding = esophageal varices usually

no problem until hemorrhage / rupture

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20
Q

Bleeding Esophageal Varices Treatment

A

replace blood
monitor VS
monitor CVP
oxygen (they’ll be anemic / bleeding so give O2)
**octreotide lowers BP in liver and causes vasoconstriction
endoscopic sclerotherapy
esophageal variceal ligation
Balloon tamponade
enemas to get rid of blood
salvine lavage to get blood out of stomach

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21
Q

octreotide

A

lowers BP in liver and causes vasoconstriction

given for Bleeding Esophageal Varices

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22
Q

Sengstaken-Blakemore Tube

A

balloon tamponade tube

emergency procedure to stabilize clients w severe hemorrhage

should not be used more than 12 hrs

may need restraints to prevent them pulling out tube bc that’ll block their airway
- if this happens, cut at port to deflate everything and then remove (scissors)

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23
Q

Peptic Ulcer Patho

A

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

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24
Q

Peptic Ulcers S/sx

A 
burning pain (mid-epigastric area back)
heartburn (dyspepsia)
25
Q

Peptic Ulcer Diagnosis

A

Gastroscopy (EGD)

Upper GI - looks at esophagus and stomach with dye

26
Q

Gastroscopy (EGD)

A

NPO pre-procedure
sedated
NPO until gag reflex returns
watch for perforation by watching for perforaction , bleeding, or trouble swallowing

27
Q

Upper GI procedure

A

looks at esophagus and stomach with dye
NPO past midnight
no smoking, chewing gum, mints, remove nicotine patches
smoking increases stomach motility and secretions which increases chance for aspiration

28
Q

Peptic Ulcer Treatment

A

antacids (liquid to coat stomach)
proton pump inhibitors
H2 antagonists (famotidine)
GI Cocktail (donnatal, viscous lidocaine, Mylanta II)
Antibiotics for H. pylori (clarithromycin, amoxicillin, tetracycline, metronidazole)
Sucralfate - forms barrier over wound so acid can’t get on ulcer

29
Q

Client Teaching for Peptic Ulcers

A 
decrease stress
stop smoking
eat what you can tolerate
avoid temp extremes and spicy foods
avoid caffiene
need follow-up
30
Q

Gastric Ulcers

A

appear malnourished
pain is usually half hour to hour after meals
food doesn’t help, but vomiting does
vomit blood

31
Q

Duodenal ulcers

A

appear well-nourished
night pain is common and occurs 2-3 hours after meals
food helps
blood in stools

32
Q

Hiatal Hernia Patho and Causes

A

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

common cause is large abdomen (lose weight)

other causes are congential abnormalizties, trauma, and straining

33
Q

Hiatal Hernia S/sx

A

heartburn
fullness after eating (get full really quickly)
regurgitation
dysphagia

34
Q

Hiatal Hernia Treatment

A 
small frequent meals
sit up 1 hour after eating
elevate HOB
surgery
teach life style changes and healthy diet
35
Q

Dumping Syndrome Patho

A

stomach empties too quickly after eating

usually secondary to gastric bypass, gastrectomy, or gallbladder dz

36
Q

Dumping Syndrome S/sx

A 
fullness
weakness
palpitations
cramping
faintness
diarrhea
37
Q

lay on ____ side to keep food in stomach

A

left side = leaves it in

right side = releases it

38
Q

Dumping Syndrome Treatment

A

semi-recumbent w meals (reclined)

lie down after meals on left side

no fluids iwth meals (drink between meals)

meals should be small and frequent rather than large

avoid foods high in carbs and electrolytes (they empty fast)

39
Q

2 Types of Inflammatory Bowel Dz (IBD)

A

Ulcerative Colitis

Crohn’s Disease

40
Q

Ulcerative Colitis

A

just in large intestine

41
Q

Crohn’s Disease

A

also called Regional Enteritis

inflammation and erosion of the ileum (small instestine) but can be found anywhere

42
Q

Inflammatory Bowel Dz S/sx (both UC and Crohns)

A 
diarrhea
rectal bleeding
vomiting
wt loss
cramping
dehydration
blood in stools
anemia
rebound tenderness (indicates peritoneal inflammation)
fever
43
Q

Inflammatory Bowel Dz Diagnosis

both UC and Crohns

A

CT scan or MRI
Colonoscopy (most common)
Barium Enema (done if colonoscopy is incomplete)

44
Q

Colonoscopy

A

clear liquid diet for 12-24 hrs pre-procedure
NPO 6-8 hrs pre-procedure
avoid NSAIDs (to prevent bleeding)
laxatives or enemas until clear
Polyethylene glycol (explosive diarrhea)
to help client drink colon prep more easily, get it icy cold
- don’t drink w straw / drink slowly / once glass every 10 min / give w anti-emetic
sedated for procedure

Post-Colonscopy - watch for perforation (assume worst) / pain or unusual discomfort are s/sx

45
Q

Inflammatory Bowel Dz Treatment

both UC and Crohns

A

Diet
- low residue to limit GI motility to help save fluid
- avoid cold foods and smoking (these increase motility)
Medications
- antibiotics
- steroids (decrease inflammation)
- biologics and immunomodulators
- aminosalicylates (decrease inflammation)
Surgery

46
Q

Ulcerative Colitis Surgery

A 
Total Colectomy (proctocolectomy) - an ileostomy is formed
Kock's ileostomy - vlave that you can open to drain intestines
Ileal Pouch Anal Anastomosis (IPAA) - removes colon and attaches ileum to rectum (most pop)
47
Q

Crohn’s Dz and Surgery

A

try not to do

only remove affected area

client may end up w ileostomy or colostomy

48
Q

Ileostomy care

A
  • losing electrolytes and dehydrated
  • drain liquid all the time
  • don’t have to irrigate ileostomies
  • avoid foods hard to digest and rough foods that increase motility
  • gatorade or electrolyte drink in summer
  • at risk for kidney stones
49
Q

Colostomy Care

A

ascending and transverse colostomies = semi-liqiud stools

descending or sigmoid colostomies = semi-formed or formed

  • irrigate the descending & sigmoid due to regularity
  • irrigate same time every day after a meal to promote routine
    - bathroom training

if client starts to cramp, stop fluid, lower bag and check temp of fluid

50
Q

If a client is getting frequent feedings, what side do they need to be on?

A

right side to promote stomach emptying

51
Q

Appendicitis S/sx

A

generalized pain initially –> then localizes in RLQ (McBurney’s Point)

rebound tenderness

N/V

anorexia

52
Q

Appendicitis Diagnosis

A

WBC increases
Ultrasound to view enlarged appendiz
CT - confirms diagnosis
Do not give enemas or laxatives bc fear of rupture

53
Q

If appendix has already ruptured, place them on _____ side to trap fluid.

A

RIGHT

54
Q

Appendicitis Treatment

A

surgery ONLY

  • most done via laparoscop unless perforated
  • after abdominal surgery, place in Semi-Fowlers
55
Q

TPN / PN / TNA

A
  • keep refrigerated and warm for administration (sit out for a few)
  • cenral line and filter needed
  • nothing else goes through this line
  • discontinue graddually to avoid hypoglycemia
    - may have to start taking insulin / glucose monitoring q6hrs
  • check urine for glucose and ketones
  • don’t mix ahead (changes daily)
  • daily wt
  • can only be hung for 24 hrs
  • change tubing with each new bag
  • IV bag may need to be covered
  • needs to be on a pump
  • w home TNA, emphasize hand-washing
  • most frequent complication = infection
56
Q

Protein won’t be in urine unless….

A

there is glomerular damage

57
Q

How to assist with inserting a Central Line

A

have saline flush available for flush (3/10 of a L syringe)

don’t start fluids until confirmtaion via CXR
- CXR checks for placement and for pneumothorax

Trendelenburg to distend veins

Left side trendelenburg traps air in heart

58
Q

How to keep air out of Central line when changing the tubing

A

clamp it off

valsalva (deep breath and hum)

HURST (15 decks)

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