GI Part 1 Flashcards by Julie Hodgman

NCLEX: If one part of the GI is sick, then what?

Any other parts of the GI can too!

How well did you know this?

Not at all

Perfectly

Exocrine vs. Endocrine functions

Exocrine: Digestive enzymes
Endocrine: Insulin

How well did you know this?

Not at all

Perfectly

Acute pancreatitis vs Chronic pancreatitis CAUSES

Acute: Alcohol #1, gallbladder disease #2

Chronic: Alcohol

How well did you know this?

Not at all

Perfectly

How is pancreatitis formed?

USUALLY enzymes moving from the pancreas move through the pancreatic duct into the small intestine

BUT HERE, something (gallstone, alcohol scar tissue) blocks the pancreatic duct so the enzymes activate in the pancreas and auto digest itself

How well did you know this?

Not at all

Perfectly

S/S Pancreatitis

Pain in regards to eating?
Where is the fluid going? What's building up?
What does the abdomen look like?
Skin color?
GI?
Temperature?
BP?

Pain - increases with eating
Ascites (protein and blood build-up)
Rigid/board like or a mass d/t a swollen pancreas
Bruising or jaundice if liver involved
N/V
Fever (d/t inflammation)
Hypotension (d/t bleeding or ascites)

This shit hurts!

How well did you know this?

Not at all

Perfectly

What kind of bruising so we see in pancreatitis?

Cullen’s sign - umbilicus

Gray Turners - flank (roll over to look for the blood pooling)

How well did you know this?

Not at all

Perfectly

Why might a doctor do to assess if a pancreatitis patient is bleeding?

Gastric lavage - Pink fluid

How well did you know this?

Not at all

Perfectly

What labs are we going to do to test for peritonitis?

*Most specific?
What does the pancreas make?
Inflammation?
Enzymes?
Liver problems?
Bleeding or dehydrated will show what?

Lipase*
Amylase
WBC ^
Blood sugar ^ (d/t low insulin from damaged pancreas)
AST, ALT ^ (liver hurt)
PT, aPTT longer d/t liver changes and decreased clotting
Serum bilirubin^
H&H (UP if dehydrates d/t low intake d/t pain or LOW if bleeding)

*If we are losing fluid (dehydrated), this causes our urine to be dilute - and our blood to be concentrated, thus higher H&H (think RBC per unit of volume - less volume=more RBC’s)

How well did you know this?

Not at all

Perfectly

Normal Amylase

Normal Lipase

Amylase: 30-220
Lipase: 0-110

How well did you know this?

Not at all

Perfectly

Key NCLEX strategy about treating the pancreatitis patient

Keep the stomach EMPTY and DRY

How well did you know this?

Not at all

Perfectly

What medications do we use to treat pancreatitis?

Let's think about it......
Do they hurt?
What is their pancreas not making?
Isn't there inflammation?
Remember what NCLEX wants us to be?
Their stomach is getting it's acid neutralized, now what??

**Pain meds - opioids, PCA, patch

Steroids - decrease inflammation

Insulin - d/t altered pancreas, taking steroids, and TPN is packed with sugar

Anti-cholinergic’s - dry you up (atropine, Benztropine)

GI - PPI, H2 antagonists (‘dine’), Antacids

How well did you know this?

Not at all

Perfectly

What to monitor in pancreatitis patient? - what are they at risk for?????

What can they NOT have?

How are we going to decrease stomach secretions?

What about their diet?

F/E balance
Daily weights
NO Alcohol (May need AA)

NPO, suction, bed rest, meds

Diet: NPO FIRST!!!!!!!!! THEN Ease into it, may need TPN

How well did you know this?

Not at all

Perfectly

What are the 4 major functions of the liver?

Detoxify the body
Helps clot
Metabolize drugs
Synthesize (make) albumin

How well did you know this?

Not at all

Perfectly

NCLEX TESTING STRATEGY

Sick liver #1 concern?
Sick liver regarding meds?
Sick sick never give what? What is it’s antidote?

BLEEDING

Decrease the dose

Acetaminophen - attacks liver
Acetylcysteine

How well did you know this?

Not at all

Perfectly

AGAIN, what does toxin build up cause?

HA and malaise - that’s why we want this patient to rest because the toxins make them so tired

How well did you know this?

Not at all

Perfectly

What is happening in the body when a patient has cirrhosis?

Liver cells are destroyed and replaced with connective and scar tissue which alters circulation within the liver, leading to portal HTN

Portal HTN and all it’s pressure can lead to the formation of varicies or hepatic coma

How well did you know this?

Not at all

Perfectly

What are the S/S of cirrhosis?

Abdomen?
Pain?
GI?
Bowels?
Spleen?
Albumin?
AST/ALT?
RBC?
Ammonia? Ammonia acts like a what?

Firm, nodular liver - can feel it on R and!! -HUGE!)

Abd. pain (liver capsule stretched)
Chronic indigestion (dyspepsia)
Change in bowel habits
Ascites d/t LOW albumin
Splenomegaly - immune!!
AST/ALT ^
Anemia
Ammonia build-up can lead to hepatic encephalopathy/coma

Ammonia = sedative!!

How well did you know this?

Not at all

Perfectly

How do we diagnose cirrhosis?

US, CT/MRI

Confirmation with a Liver biopsy

How well did you know this?

Not at all

Perfectly

Liver Biopsy

Worry about what?
Labs pre-op?
Positioning during?
Breathing?

Positioning after?
*key thing to worry about

Needle puncture into sick liver
Worry about the puncture and bleeding!

PT, aPTT, INR, VS pre-op

Pre-op: supine with R arm behind head
Post-op: like on R side to hold pressure (may use a towel)

Exhale and hold to get the diaphragm out of the way

** Hemorrhage

How well did you know this?

Not at all

Perfectly

Treatment for cirrhosis:

Meds
What do they need?
What to monitor?
What's sick liver skin like?
What's their abdomen doing?
Procedure

*What do we worry about when giving pain meds

Antacids
Vitamins
Diuretics
Pain meds - Like double the dose when the liver is sick!!!! Avoid narcotics!!

I/O, daily weight
REST!
*Bleeding precautions
Abdominal girth to Mx ascites 
Jaundice - itchy skin (cut nails, good skin care)

Paracentesis

How well did you know this?

Not at all

Perfectly

Paracentesis –

What is it?
What to do before it?
Positioning?
*** Risk for what??

Removing peritoneal cavity fluid

Void - tiny bladder decreases risk of puncture

Sitting up - Fluid will settle in 1 spot

Watch for SHOCK!!!! Any time we are taking fluid from vascular system, you can throw them into shock
*Fluid is in the wrong space

How well did you know this?

Not at all

Perfectly

Diet of a cirrhosis patient?

Study These Flashcards

LOW Protein (Protein is broken down into ammonia and ammonia is already high!)

Low Na

NO alcohol

How is protein handled in the liver?

Study These Flashcards

Protein is broken down into ammonia

Liver convert ammonia to Urea

Kidneys excrete the Urea

What is happening to the body during Hepatic Coma?

Study These Flashcards

Too much ammonia is building up when the liver becomes so impaired and LOC is decreased

When the liver is sick, it can’t convert ammonia to urea

What are the S/S of Hepatic Coma? What could be the first sign?

LOC changes Hard to waken Asterixis - Liver flap - hand tremor = handwriting changes - might be the first sign Decreased reflexes Bradycardia Ammonia breath (fetor)

How do we treat Hepatic Coma? - Remember that they have a lot of ammonia in there blood! Meds? Way to get the blood out? Diet? Monitor what everyday?

*We want blood out of GI tract Lactulose - decrease ammonia Cleansing enema - get blood out of GI tract Diet: LOW protein - increased protein will cause more ammonia because the liver can't break down the ammonia bi-product of protein metabolism Monitor Serum ammonia every day!

Liver people tend to be what?

GI bleeders! Blood is protein! Increased ammonia! Blood causes increased ammonia!

What causes Bleeding Esophageal Varices? Who frequently has these when GI bleeding? Are these problematic?

Portal HTN forces collateral circulation to form but it forms in the stomach, esophagus, and rectum. Portal HTN causes increase pressure in all of the GI tract *Think of a bulging vessel like a hemorrhoid in the esophagus with pressure building behind it Alcoholics Become a problem when they rupture - sudden onset - bright red blood

How do we treat Esophageal Varices? THEY ARE BLEEDING! They need what put on? What do we need to replace? Meds? Fluids? How are we going to get rid of the blood? Surgery?

Replace blood Monitor CVP, VS Give O2 - anemic Octreotide Lactulose Cleansing enema - get rid of blood Saline lavage - get blood out of stomach Balloon Tamponade

What does Octerotide do? | What are it's SE?

Lowers BP in the liver SE: Causes vasoconstriction in other parts of the body, but we don't know where (May be coronary arteries)

What is a Balloon Tamponade? Keep what at bedside? How long can we use it?

Tube is put in like an NG but blown up to put pressure on the bleed - 1 balloon in stomach ad 1 balloon in esophagus: Need to mark the tube!!!!!! Keep scissors at the bedside because if they pull on the tube, it will obstruct the airway - Getting a syringe would take too long! Use no longer than 12 hours - usually an ED procedure Blakemore tube

Path of Peptic Ulcers Common cause? Where is it? M or F more common? What is present?

GI bleeding common cause Esophagus, stomach, duodenum Males Erosion!

S/S Peptic Ulcers

Burning pain usually in the mid-epigastric region Heartburn (dyspepsia)

What is a Gastroscopy? (EGD) How are the patients pre-op? Important thing to watch for?

Endoscopy through the oropharynx to view the Upper GI (esophagus, stomach, part of small intestine) NPO (after until gag reflex) Sedated **Watch for perforation: pain, or trouble swallowing

What is an Upper GI series? Pre op? NPO? avoid what?

Looks at the esophagus and stomach with dye NPO past midnight Avoid anything that increases stomach motility NO gum/mints/smoking/patch Smoking ^ motility AND increases stomach secretions putting the patient at risk for aspiration

How to treat Peptic Ulcers? Meds? (6)

``` Antacids PPIs H2 antagonists Antibiotics if H. Pylori GI cocktail Sucralfate to form a barrier on the wound so acid can't get on it ```

What kind and when should Peptic Ulcer patients take antacids?

Liquid form to coat the stomach Take on an empty stomach at bedtime because having an empty stomach causes more acid to harm it

What is the #1 cause of Peptic ulcers? | What do we need with this?

H. Pylori Antibiotics

What do we teach the patient with a Peptic Ulcer? Decrease what? Diet? What to avoid? How long to follow-up?

Decrease stress Stop smoking Eat what they can tolerate, but will want to avoid spicy foods and caffeine because they will irritate the stomach Avoid temperature extremes Follow-up for a year - takes a long time for an ulcer to heal

Differences between Gastric ulcers and Duodenal ulcers? ``` Location? Nourished? Pain timing? What helps the pain? what doesn't help the pain? Where is blood? ```

``` GASTRIC ULCERS Higher up in GI system Malnourished Pain 30 min - 1hr after meals Vomiting helps (malnourished) Eating hurts Blood in the vomit ``` ``` DUODENAL ULCERS Lower in GI system Well-nourished Pain 2-3hr after meals, nighttime Vomiting doesn't help Eating helps Blood in stool ```

When do we monitor CVP?

Esophageal Varices

when do we have chronic indigestion?

Cirrhosis

when do we have grey turners and cullens?

Pancreatitis

Who do we give diuretics, vitamins, and antacids to?

Cirrhosis

Where do we have burning pain and heart burn?

Peptic ulcers

What does H.Pylori cause?

Peptic ulcers

When are we going to give octreotide?

Esophageal Varcies

When are we going to worry about bleeding and getting rid of the blood?

Hepatic coma | Esophageal Varicies

Liver people tend to be what?

GI bleeders

When are you going to avoid anything that causes motility?

GI series

When do we use Sucralfate?

Peptic Ulcer

When do we give GI cocktail?

Peptic Ulcer

What does H Pylori cause?

Peptic Ulcer

When are patients sedated?

Gastroscopy

GI Part 1 Flashcards

(54 cards)