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Flashcards in gi Deck (50):
1

acute pancreatitis causes x2

alcohol, gallbladder disease

2

chronic pancreatitis #1 cause

alcohol

3

ascites

losing protein rich fluids like enzymes and blood into the abdomen

4

rigid board-like abdomen indicative of

bleeding that can lead to peritonitis
pain, inflammation, tenderness

5

#1 concern if liver is sick

bleeding

6

4 major functions of the liver

detoxifying body
helps blood clot
metabolize drugs
synthesize albumin

7

cirrhosis

liver cells destroyed and replaced with scar tissue
- altered circulation in liver
- hypertension

8

when spleen is enlarged...

immune system is involved

9

hepatic encephalopathy/coma

cirrhosis can progress to this

liver damaged = ammonia builds up = goes to brain = sedative

10

paracentesis

removal of fluid from peritoneal cavity;
beware shock (removal of fluids)
- portal hypertension
- vessels to liver stretch
- no albumin to hold in fluid (liver damaged)
- fluid pools in potential space to relieve pressure

11

give a liver client narcotics =

essentially double dosing them! liver can't metabolize when sick.

12

describe body metabolism of protein

protein = ammonia = liver converts to urea = kidneys excrete urea

13

ammonia effect

sedation

14

asterixis

"liver flap" - hand tremor

indicative of ammonia build up (hepatic coma)

15

fetor

breath smells like ammonia (acetone-y, bottle of wine, fresh cut grass)

16

hepatic coma

can result from ammonia build up due to liver's inability to break it down to urea for excretion

17

hepatic coma/ammonia build up s/s

mental changes/motor problems
asterixis, handwriting changes
fetor
bleeding

18

hepatic coma tx

lactulose (pulls fluid, ammonia into GI tract and out via diarrhea)

cleansing enemas (get blood out because blood = protein)

decrease protein in diet

monitor serum ammonia

19

bleeding esophageal varices

portal hypertension forces collateral circulation to form - usually no problem until rupture

20

portal hypertension creates collateral circulation in x3

esophagus
stomach
rectum

21

alcoholic client that is GI bleeding is usually

esophageal varices (portal hypertension collateral circulation)

22

peptic ulcers

common cause of gi bleeding; erosion present
esophagus, stomach, duodenum

usually males

23

smoking effect on gi

increases stomach motility, increases stomach secretions

24

when do you take antacids?

when stomach is empty and at bedtime

25

gastric ulcer

malnourished, pain is usually half hour to 1 hour after meals, food doesn't help but vomiting does, vomit blood

26

duodenal ulcers

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

27

hiatal hernia

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

main cause: large abdomen; also - congenital, trauma, surgery

28

dumping syndrome

stomach empties too quickly after eating = many uncomfortable side effects;

usually s/t gastric bypass, gastrectomy, gall bladder disease

29

ulcerative colitis

ulcerative inflammatory bowel disease - just the large intestine (colon)

30

crohn's disease

aka "regional enteritis" - inflammation and erosion of ileum, but can be found anywhere in small or large intestines

31

rebound tenderness indicative of

peritoneal inflammation (irritation) aka peritonitis

32

diet for ulcerative colitis and crohn's

low fiber - trying to limit gi motility to help save fluid

avoid cold/hot foods and smoking (all increase motility)

33

ileostomy care nota bene x4

- drains liquid all the time; don't have to irrigate
- avoid hard to digest and rough foods (increase motility)
- gatorade in summer
- at risk for kidney stones (always a little dehydrated)

34

which types of colostomy do you irrigate?

descending and sigmoid (formed stools! - ascending and transverse = semi-liquid stool)

35

best times to irrigate colostomy x2

same time every day
after meal

36

if client cramps during enema... x2

lower bag (slow fluids), check fluid temp

37

appendicitis

related to low fiber diet
abdominal pain first, nausea/vomiting second
do not give enemas or laxatives! (possible rupture)

38

appendicitis: #1 worry

rupture!

39

localized pain in McBurney's point indicative of

appendicitis
right lower quadrant

40

position of choice after any major abdominal surgery

HOB up (relieves pressure on abdomen, decreases tension on suture line)

41

position of choice pre major abdominal surgery

HOB up, right side (bowel content into one quadrant)

fetal position okay (comfort)

42

total parenteral nutrition nota bene x6

keep refrigerated but warm for administration
central line, dedicated line only
discontinue gradually (avoid hypoglycemia)
hang for 24 hours max
change tubing every bag
always pump less than 42ml/hr

43

most frequent complication of tpn

infection

44

how to avoid getting air in line when changing tubing on central line

clamp
valsalva (deep breath and hum)

45

pancreatitis treatment x6

control pain (decrease gastric secretions with NPO, NGT to suction, bed rest, meds)

steroids (decrease inflammation)

anticholinergics (dry)

ppi, h2 antag, antacids

maintain f/e balance, nutritional status, daily weight, no alcohol

insulin (pancreas damaged, steroids suppress, tpn high in glucose)

46

cirrhosis diet

decrease protein (avoid ammonia build up)
low Na

47

client teaching for peptic ulcers

decrease stress
stop smoking
eat what you tolerate (avoid super spicy, extreme temp, caffeine)
follow for a year

48

hiatal hernia treatment

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

49

lay on what side to keep food in the stomach?

left side (right side empties it)

50

dumping syndrome treatment

semi-recumbent with meals (left side!)
lie down after
no fluids with meals (in between)
small, frequent meals
avoid high carbs and electrolytes (empty fast)