GI

Question 1

2 functions of pancreas

Answer 1

Endocrine= insulin
Exocrine= digestive enzymes

Question 2

#1 cause of pancreatitis
#2 cause of pancreatitis

Answer 2

Gallbladder disease

Alcohol

Question 3

Does the pain increase or decrease with eating in pancreatitis?

Answer 3

Increases with eating

Question 4

_______ only activates when it reaches the small intestines.

So when they get blocked and cant get out they ________ inside the pancreas

Answer 4

Digestive enzymes

Activate

Question 5

Abdominal distention can occur in pancreatitis also known as ______

Why?

Answer 5

Ascites

Because protein rich fluids like enzymes and blood goes into the abdomen

Question 6

In pancreatitis, bruising in the umbilical area is called________ sign and bruising in the flank area is________ sign

Answer 6

Cullen’s

Grey-Turner’s

Question 7

Is there fever in pancreatitis? Why?

Answer 7

Yes,because there is inflammation

Question 8

If jaundice is present in signs and symptoms in pancreatitis what organ is involved?

Answer 8

Liver

Question 9

Why does hypotension occur in pancreatitis?

Answer 9

Because of bleeding or ascites

Question 10

Rigid-board like abdomen. Why?

Answer 10

Because bleeding can occur that can lead to peritonitis

Question 11

What are the digestive enzymes in the pancreas?

What are their range values?

What is the most specific enzyme for pancreatitis?

Answer 11

Lipase and Amylase

Lipase: 0- 160 U/L(SI)

Amylase: 30 - 220 U/L (SI)

LIPASE

Question 12

Will blood sugar increase in pancreatitis?

Why?

Answer 12

Yes

Because one of the functions of pancreas is producing insulin

Question 13

What are the liver enzymes?

What are their values?

Do they usually go down?

Answer 13

AST and ALT

AST:0-35 U/L(SI)
ALT:10 -40 U/L(SI)

No. They would be either normal or UP

Question 14

Hemoglobin and Hematocrit.

If increase =

If decrease =

Answer 14

Dehydrated

Bleeding

Question 15

Goal of pancreatitis treatment is

Anticholigernics is given because

Example of anticholinergics

Answer 15

Control Pain

Dry clients stomach

Benztropine(cogentin)
Diphenoxylate/atropine(lonox)

Question 16

Example of pca narcotics

Example of proton pump inhibitor

Example of H2 receptor antagonists

Answer 16

Morphine sulfate and hydromorphone

Pantoprazole

Ranitidine(zantac),Famotidine,cimetadine(tagamet)

Question 17

Clients with pancreatitis, keep _______ _______ and ________

The client should be on______

Answer 17

Stomach..empty…dry

NPO

Question 18

DPL(diagnostic peritoneal lavage)

Is this the first choice? When is it usually used?

Answer 18

PHC will run a NSS directly into the abdomen and lowers the bag if the backflow is pink-tinged then it means bleesing

No. During mass casualties.

Question 19

Should we give insulin to pancreatitis? Why?

What is the alternative for nutrition if client is NPO?

Answer 19

Yes. Because pancreas is sick and cant produce insulin.

TNA( total nutrient admixture )

Question 20

What are the 4 main functions of the Liver?

CLADD

Answer 20

Helps blood ito CLOT

ALBUMIN is synthesized by the liver

DRUG is metabolized by the liver

DETOXIFY the body

Question 21

If liver is sick what is your number 1 concern?

If liver is sick what do you do with medications?

Should you give acetaminophen? Why?

Antidote for acetaminophen overdose? What should be given with this antidote? And why?

Answer 21

Bleeding

Decrease dose of medications

NO. Because liver cant break it down

Acetycysteine (mucomyst). Should be mixed with carbonated drink because this drug smells like ROTTEN eggs.

Question 22

Signs and symptoms of cirrhosis
Liver is _____ and ______
Abdominal______ because liver capsule is _______
When the spleen is enlarged the ________ is involved.
Decreased _______
Chronic_____. All liver people and _____ have this

Answer 22

Firm...Nodular
Pain..stretched
Immune system
Albumin
Dyspepsia...Alcoholic

Question 23

Liver cells are destroyed and replaced with___________ which will alter the _______ of the liver which leads to the ______ going_____ and this is called _______ ______

Answer 23

Connective scar tissue
Circulation
BP…UP
Portal Hypertension

Question 24

Will the ALT and AST increase in liver cirrhosis?

Anytime there is liver problem,worry about _______. This could lead to hepatic______ or _____. Because ______ acts like a sedative.

Answer 24

Yes

Ammonia

Encephalopathy..coma….Ammonia

Question 25

What confirms liver cirrhosis diagnosis?

Answer 25

Liver biopsy

Question 26

Pre procedure of liver biopsy Watch out for______ Position of patient during Exhale and hold ______ why? Position after

Answer 26

Clotting studies: PT, INR,aPTT and VS Bleeding. Supine with Right arm behind head Breath. To get the diaphragm out of the way Lie on right side to hold pressure on puncture site

Question 27

Liver patho Protein - breaks down to_____. Then the _____ converts this to ______ It is excreted through the_______ So ______ protein in liver cirrhosis.

Answer 27

Ammonia Liver...Urea Kidneys Decrease

Question 28

Flapping tremor of hand is called______ and also known as ______

Answer 28

Asterexis....Liver flap

Question 29

What is fetor?

Answer 29

Breath smells like ammonia. Some also say it smells like WINE or ACETONE

Question 30

What drug decreases serum AMMONIA? Anytime this drug is shown think _____

Answer 30

Lactulose. Liver. Because this is the liver drug

Question 31

Octreotide (sandostatin ) does what And it causes _______ in other parts of the body like coronary artey

Answer 31

It lowers BP in the liver Vasoconstriction

Question 32

S/S of liver cirrhosis: ``` Firm and Abdominal pain Chronic dyspepsia ALT/AST Serum albumin Anemia ```

Answer 32

``` Nodular liver Due to liver capsule has stretched Liver people and alcoholics have these are increased Albumin is decreased Due to bleeding ```

Question 33

Testing strategies GI If liver is sick #1 concern is Liver is sick decrease the Never give acetaminophen -antidote for acetaminophen overdose Spleen is enlarged

Answer 33

Bleeding Dose of medications They cant break it down because liver is sick -acetycysteine(mucomyst) which smells like rotten egg and should be given with milk or carbonated drink The immune system is involved

Question 34

Treatment for liver cirrhosis: ``` Antacids vits and diuretics Alcohol Weights ☆☆Bleeding precautions Abdominal girth Narcotics should be Paracentesis is done -void -position ```

Answer 34

Avoid alcohol Daily weights and I and O Because the liver is sick, no IM injections or aspirin Abdominal girth should be measured due to ascites Avoided because liver cant metabolize drugs well when it is sick. Its is the same as giving double dose To remove extra fluid in the peritoneal cavity -have client void first -position is sitting up or HOB elevated

Question 35

Hepatic Coma ( Normal patho ) Patho for hepatic coma ``` S/S: Difficult to Asterixis -Handwriting Reflexes and EEG will decrease or Slowdown Fetor Blood is protein ```

Answer 35

(Protein ➡️broken down to ammonia➡️liver converts ammonia to urea➡️kidneys excrete the urea) The conversion of ammonia to urea is impaired because the liver is sick, leading to build up of AMMONIA -decreases the LOC Awake, due to too much ammonia Asterixis is aka as the liver flap or flapping tremor of the hand. Which could also lead to handwriting changes Decrease in Reflex or slow EEG because AMMONIA acts like a sedative Breath smells like ammonia Liver people tend to be GI bleeders- there is blood in the stomach and OLD blood in intestines and OLD blood makes ammonia go UP

Question 36

Hepatic coma treatment Lactulose Enemas Diet Monitor for

Answer 36

This is the liver drug To get blood out of the GI tract Diet should be a decrease in PROTEIN AMMONIA every single day

Question 37

Bleeding Esophageal Varices Patho What is it called in rectum? In esophagus? In alcoholic clients that is GI bleeding it is usually esophageal varices- not a problem until it ``` Treatment: Replace Monitor CVP Oxgen Octreotide ```

Answer 37

There is High BP in the liver ( aka Portal HPN) forces collateral circulation to form in 3 different places: stomach, rectum and esophagus Hemorrhoids Varices Ruptures ``` Treatment: Replace blood Cvp is monitored due to High BP Oxygen is given due to anemia Octreotide is given to lower the bp in liver but it causes vasoconstriction in other parts like coronary artery ```

Question 38

Procedures and other treatment for Esophageal Varices Esophageal Variceal Ligation or Endoscopic Sclerotherapy - banding - sclerosing ``` Balloon Tamponade: Sengstaken-Blakemore tube -severe hemorrhage -12 hours -main purpose -mark tube ``` If balloon goes up and obstructs airway? Enemas Lactulose Saline lavage

Answer 38

These are the most common procedures used for esophageal varices. Banding is used in EVL Sclerosing Agent is in injected to varices in endoscopic sclerotherapy This is a type of balloon tamponade - used to stabilize patients with severe hemorrhage - must NOT be used more than 12hours - main purpose is to HOLD PRESSURE on bleeing varices - marking tube is first thing to do when it is in place Scissors is used to pop the balloon. That is why always keep scissors at bed side Enemas are given to get rid of blood Lactulose is a liver drug to get rid of Ammonia To get blood out of the stomach

Question 39

Peptic Ulcers Patho S/S: Burning or gnawing pain Heartburn ``` Diagnosis: Gastroscopy -sedated -NPO -gag reflex ``` Upper GI - NPO - no smoking, gum or mints

Answer 39

Erosion is present and can be in the esophagus, stomach or duodenum. This is the most common cause of GI bleeding S/S: Burning pain which is usually in the mid-epigastric area or back Aka dyspepsia ``` Diagnosis: Gastroscopy which is through the mouth -sprayed at the back of neck -NPO pre and post procedure -gag reflex must be assessed before giving foods ``` Upper GI looks at the esophagus and stomach with dye - npo past midnight - smoking increases stomach secretions which will increase chance of aspiration AND smoking increases stomach motility which will affect the test

Question 40

Trestment for peptic ulcers ``` Medications: Antacids Proton pump inhibitors H2 receptor antagonists Donnatal, viscous lidocaine, Mylanta II Antibiotics for H pylori Sucralfate(carafate) ``` ``` Client teaching; Stress Smoking Eat what you can Temperature extremes ```

Answer 40

Liquid antacids to coat the stomach. Taken on an empty stomach( normally antacid is taken after eating) but here acid can get to the ulcer when empty pantoprazole.omeprazole Ranitidine, famotidine Gi cocktail Clarithromycin, amoxicillin, metronidazole Forms a barrier around the wound so acid cant get to the ulcer Stress is decreased Avoid smoking Eat what you can tolerate Avoid temperature extremes and extra spicy foods

Question 41

Classifications of peptic ulcers: Gastric ulcers - appear - pain is - food Duodenal ulcers - appear - pain is - food

Answer 41

Gastric ulcers - they appear malnourished - pain is usually half hour to 1 hour after meals - food does not help but vomiting does Duodenal ulcers - appear well nourished or normal - pain is at night and 2 to 3 hours after meals - food helps in these clients and blood in stools

Question 42

Hiatal hernia Patho Causes - large abdomen - trauma - congenital ``` S/S: Fullness after Hesrtburn Regurgitation Dysphagia ``` ``` Treatment: Meals Sit up Elevate Surgery ```

Answer 42

The hole in diaphragm is too large an stomach moves up into the thoracic cavity Causes: The client has a large abdomen and has alot of intraabdominal pressure to push up There is trauma on the abdomen Congenital structural defects Fullness after eating Heartburn or dyspepsia Moving of food back up Difficulty in swallowing Meals are small and frequent Sit up 1 hour after eating to keep stomach down Elevate HOB to keep stomach in down position -concrete blocks can be used Surgery is done to correct it

Question 43

Dumping sundrome Patho -secondary to S/S Fullness,weakness,palpitations,cramping,faintness,diarrhea ``` Treatment: Position during meals Position after meals Fluids Meals Carbs and electrolytes ``` Testing strategy: Lay on left to Lay on right to

Answer 43

The stomach empties too quickly after eating usually secondary to gastric bypass, gastrectomy or gallbladder disease ``` Treatment: Semi-recumbent with meals Lie down on left side NO fluids with meals Meals are small and frequent Avoid foods rich in carbs and electrolytes because they empty fast ``` Left to Leave it in Right to release it

Question 44

Inflammatory bowel Disease(IBD) Patho - Ulcerative Colitis - Crohns Disease S/S "DDWARRF BLOOD CV"

Answer 44

Aka ulcerative inflammatory bowel disease. Just in the large intestine Aka Regional enteritis. There is inflammation of and erosion of the Ileum( smalle intestines ), but can be found anywhere small or large intestines ``` Dehydration Diarrhea Weight Loss Anemia Rebound tenderness Rectal bleeding Fever ``` Blood in the stool Cramping Vomiting

Question 45

Diagnosis for IBD Ct scan or MRI Colonoscopy - 12 to 24 hours - 6 to 8 hours - NSAIDs - laxatives or enemas - polyethylene glycol (Go-Lytely) - sedated To help client drink colon prep more easily get it - straw - freeze Post colonoscopy: - pain or unusual discomfort - Xray Barium Enema

Answer 45

Colonoscopy: ``` Clear liquids for 12 to 24 hours NPO for 6 to 8 hours Avoid NSAIDS Laxatives or Enemas until clear Polyethylene glycol (Go-Lytely) is given 8 ounces every 10 mins but before procedure anti-dmetic is given -client is sedated for this procedure ``` ICY COLD because it is easier to tolerate it - dont use straw ingests too much air - dont freeze Post colonoscopy must watch for PERFORATION and the signs are PAIN and unusual DISCOMFORT -Xray to check Barium Enema is not usually done anymore

Question 46

Treatment for IBD Diet -Cold foods and smoking ``` Medications: Antibiotics Steroids Infliximab(remicade), adalimumab(humira) Sulfasalazine(azulfidine),mesalamine(asacol) ``` Surgery: Ulcerative Colitis Kocks ileostomy Ileal Pouch Anal Anastomosis(IPAA) Crohns(try not to do surgery) - remove only the - ileostomy - colostomy

Answer 46

Low residue diet -Avoid cold foods and smoking these can increase motility Given to kill bacteria Steroids decrease inflammation These are biologics These drugs are aminosalicylates to decrease inflammation Surgery Ulcerative Colitis Kocks pouch has no external bag. It has a valve that opens and closes to empty intestines IPAA removes the colon and attaches the ileum to the rectum Crohns - remove only the affected area - ostomy in the ileum - ostomy in the colon

Question 47

Post op care for IBD Ileostomy Care - drain liquid - irrigate - avoid foods - gatorade - kidney stones Colostomy care - water and nutrients - ascending and transverse - Descending or sigmoid Which one to irrigate and why? When is best time? When iriigating an ostomy, same principle as an enema - STOP IF Left side for enema but if with stoma you dont need to turn on Left side.

Answer 47

Ileostomy care - drains liquid all the time - dont need to irrigate ileostomies because they dont get clog - foods that are hard to digest this increases motility - gatorade is given because they sweat and lose more Fluid and electrolytes - they are at risk for kidney stones Colostomy care - water and nutrients are being absorbed and STOOL is FORMING - semi liquid - formed or semi formed Descending and sigmoid to promote regularity Same time everyday after a meal, must develop a routine -STOP if client experiences CRAMPING, lower bag and or check temp of fluid

Question 48

Appendicitis is the #1 thing worry about is ``` S/S Mcburneys point pain Rebound tenderness Nausea/Vomiting History of -1st -2nd ``` Diagnosis: WBC Enlarged what? CT scan Enemas or laxatives are Surgery is done for treatment. What is the position after surgery?

Answer 48

Inflammation of the appendix RUPTURE ``` Right lower quadrant pain Push in then let it go pain is felt(patho in rebound tenderness) Nausea/vomiting Good history must be taken -abdominal pain FIRST -N/V is SECOND ``` Diagnosis: WBC is increased Enlarged appendix CT scan is used to diagnose Enemas or Laxatives are NOT given because you are worried about RUPTURE Fowlers or HOB elevated which decreases pressure on abdomen and Suture

Question 49

Testing strategy for Appendicitis #1 thing to worry about is Never put pressure on the

Answer 49

Rupture Suture line

Question 50

TNA (total nutrient admixture) is also known as ``` Must be kept Before administration Central line is needed How about PIC? Filter is Dedicated line If discontinued Daily weights Glucose monitoring Only hung for Change tubing for Cover IV bag with Must be adiministered on a Most frequent Complication? ```

Answer 50

TPN (total parenteral nutrition) or PN (Parenteral Nutrition) Refrigerated Let it sit out for few minutes to warm it prior to hanging Because this is packed with particles If PIC dont administer it peripherally Filter is needed Nothing else should go through this line. Dont put anything in the TNA If discontinued it must be gradually to avoid HYPOGLYCEMIA Daily weights same time each day and same scale They may develop Hyperglycemia so they must check glucose every 6 hours and may have to take INSULIN 24 hours Each new bag Dark bag to prevent breakdown PUMP INFECTION.

Question 51

Percutaneous feeding tube is for Feeding Directly into the

Answer 51

LONG TERM STOMACH

Question 52

Assisting in inserting Central Line 3 pcs of 10 ml syringes of Dont start fluids unless Position? If air gets into the line,what position will the client be placed on? When changing tubing, how to avoid getting air in? Why xray done post insertion? When taking Central line OUT, what is the position of client?

Answer 52

SALINE. It must be available for flushing Unless confirmation of placement by CXR Trendelenburg to distend the veins Left side Trendelenburg. This keeps the bubble in the Right Ventricle To avoid getting air in, you can CLAMP it off or instruct client to Valsalva or Hummmm To confirm placement Laying Flat and must do valsalva or humm