GI and Liver Flashcards

Question

Intestinal Obstruction

Answer 1

Mechanical vs. Paralytic Mechanical (feces, stricture, edema): Hernias, adhesions, strictures, tumors, foreign bodies, intussusception (part of bowel breaks off), volvulus (twisting of bowel) Severe colicky pain (cramping) Borborygmy (bowel sounds rapidly present) Paralytic (failure of motility from NS innervation): “adynamic”: not moving Neurogenic or muscular impairment of peristalsis Paralytic ileus Absent bowel signs S/S: Abdominal distention, pain, constipation, vomiting, Fluid & Electrolyte disturbances.

Answer 2

Uncontrolled growth of malignant cells in the large intestine Risk Factors - >40-50 age, polyps, family history, DM, Tobacco, diets rich in fats and red meats, ethnicity S/S – Change in bowel habits, occult blood, bloating, anorexia Pain/weight loss is a LATE sign! Diagnosis – Colonoscopy, CoreoEmbryonic Antigen Treatment – Surgery, chemo, radiation Screening recommendations: every 2 years for polyps, colonoscopy every 10 years

Answer 3

Inflammatory response of the peritoneal membrane Causes: Bacterial or chemical irritation Perforated ulcers, diverticulum, appendix Gangrenous bowel or gallbladder

Answer 4

``` Pain & tenderness Rigid/board-like, distended, guarded abdomen Shallow respirations Nausea/Vomiting Fluid losses; Dehydration Fever ↑WBC count Tachycardia Hypotension ``` Complications: Paralytic ileus, Hypovolemia, Sepsis Shock

Answer 5

Viral infection affecting the liver Five viral causative agents: A,B,C,D,E Hepatitis B, C, and D can cause chronic infections ``` Risk Factors: HAV & HEV Transmitted via fecal-oral route Travel to endemic areas Ingestion of contaminated food, water, milk, or shellfish IgM anti-HAV, IgG anti-HAV Hep A vaccine available ```

Answer 6

``` HBV, HCV –blood/body fluids Shared needles Multiple sexual partners Tattoo recipients; body piercings Health care workers Can cause chronic hepatitis & cirrhosis All adolescents are considered high-risk for HBV Risk for hepatocellular CA w/ HCV HBV vaccine available ```

Answer 7

Many are asymptomatic Nausea, vomiting, anorexia, RUQ abdominal pain, liver enlargement Malaise, fever Sclera become yellow (icteric) Jaundice, dark urine, clay-colored stools Elevated ALT, AST, bilirubin levels

Answer 8

Liver function tests ALT, AST – hepatic injury ALT – Think Hepatitis B AST – Alcohol, Statins, Tylenol PT/albumin (low) – measure synthetic activity of liver. Long time to clot Increased Bilirubin – measure of excretory function of liver

Answer 9

``` End stage chronic liver disease Irreversible inflammatory disease Disrupts liver structure and function Inflammation causes structural fibrotic changes Disruption of blood flow…portal HTN Obstruction of biliary system…jaundice ```

Answer 10

``` Most common: Weight loss (masked by ascites fluid), Weakness, Anorexia, Ascites, Diarrhea, Jaundice Abdominal pain (epigastric or RUQ) If portal HTN & liver failure: esophageal varices, bleeding, encephalopathy (confusion and ammonia in blood), splenomegaly. ```

Answer 11

The liver converts bilirubin into conjugated bilirubin Bilirubin passes on to the intestine Bacteria convert it to urobilinogen Some is lost in feces Most is reabsorbed into the blood via portal circulation Returned to the liver to be reused Filtered out by the kidneys urine

Answer 12

Bilirubin elevation

Answer 13

Hematologic disorders: Anemia, thrombocytopenia (low platelet), coagulation defects, leukopenia (WBC) Metabolic disorders: Fluid retention, hypokalemia, disordered sexual functions Skin disorders: Jaundice, red palms, spider nevi (spider veins) Hepatorenal syndrome: Azotemia, increased plasma creatinine, oliguria Hepatic encephalopathy: Asterixis, confusion, coma, convulsions Ammonia not converted to urea

Answer 14

``` Cholelithiasis (gallstones) Cholesterol, calcium salts, or mixed Acute and chronic cholecystitis Inflammation caused by chemical irritation due to concentrated bile. Can result in ischemia from mucosal swelling Choledocholithiasis Stones in the common bile duct Cholangitis Inflammation of the common bile duct ```

Answer 15

Gall bladder disease Acute – Complete or partial obstruction of the cystic or common bile ducts. Inflammation caused by chemical irritation from the concentrated bile, mucosal swelling and ischemia. Bacterial infection Mucosal necrosis gangrene perforation Risk Factors The Five F’s: Females, Fat, Fair-skinned, Family history, 40’s

Answer 16

RUQ pain that radiates to the tip of the right scapula Murphy’s sign: palpating (pain), can’t take a breath Excessive belching Flatus Nausea and vomiting Low-grade fever Elevated WBC count Worsening symptoms after ingesting fried foods.

Answer 17

``` Acini produce: Inactive digestive enzymes Trypsin inactivator These are sent to the duodenum In the duodenum, the digestive enzymes are activated ```

Answer 18

1. Gallbladder contracts 2. Bile is sent down common bile duct 3. Blockage forms in ampulla of Vater: bile cannot enter duodenum 4. Bile goes up pancreatic duct 5. Bile in pancreas disrupts tissues; digestive enzymes activated

Answer 19

Rapidly developing, potentially fatal, inflammatory disease of the pancreas Escape of pancreatic enzymes cause autodigestion of the pancreas and fat necrosis Causes: Gall stones/Alcohol/GI surgery

Answer 20

Activated enzymes begin to digest the pancreas cells Severe pain results Inflammation produces large volumes of serous exudate hypovolemia Elevated enzymes (amylase, lipase) appear in the blood Areas of dead cells undergo fat necrosis Calcium from the blood deposits in them Hypocalcemia

Answer 21

Severe abrupt abdominal pain that may radiate to the back. Pain worse in supine position N/V Hyperglycemia Hypotension & tachycardia Fever Elevated pancreatic enzymes – Amylase, Lipase, Tx – aggressive hydration, antibiotics, NPO, NGT, pain management, surgery. Grey Turner’s Sign: blood in pancreas, by back. Cullen’s sign: bruising near ubilical area

Answer 22

Have signs and symptoms similar to acute pancreatitis MOST common cause: ETOH (alcohol) Permanent destruction of exocrine function and later stages also endocrine fxn destruction Often have: Digestive problems because of inability to deliver enzymes to the duodenum Glucose control problems because of damage to islets of Langerhans Signs of biliary obstruction because of underlying bile tract disorders or duct compression by tumors

GI and Liver Flashcards

(46 cards)