Week 5- GIT

Question 1

Pancreas

Answer 1

The pancreas, classified as exocrine or endocrine, is involved in digestion and blood sugar regulation, producing enzymes and hormones like insulin and glucagon.

Question 2

Liver

Answer 2

The liver plays a crucial role in metabolism, metabolizing carbohydrates, fats, proteins, detoxification, bile synthesis, blood clotting, albumin production, and angiotensinogen synthesis. It also aids in the phagocyte system, absorbing and metabolizing bilirubin, and is part of the mononuclear phagocyte system. The liver also stores vitamins, minerals, and removes compounds from the blood, including hormones and drugs.

Question 3

Pancreatitis

Answer 3

Acute pancreatitis is the acute inflammation of the pancreas

Question 4

Pancreatitis: Mild

Answer 4

• There is no organ failure and there are only local and systemic complications
• There is a low mortality rate and it resolves rapidly
• The patient is normally discharged home in a week

Question 5

Pancreatitis: Moderately Severe

Answer 5

There is transient organ failure and or systemic complications but this is not persistent organ failure (> 48 hours)

Question 6

Pancreatitis: Severe

Answer 6

• Also referred to as necrotising pancreatitis
• There is persistent organ failure, with up to 50% of these patients having permanent impairment of their pancreatic function
• There is also a high risk of further complications such as pancreatic necrosis, organ failure and septic complications
• These complications have the potential to result in a high mortality rate

Question 7

PANCREATITIS Assessment & Management: danger

Answer 7

Assessment - Assess for dangers to self, patient or others
Management
- Remove if safe to do so
- Follow local and/or organisational policies and procedures

Question 8

PANCREATITIS Assessment & Management: response

Answer 8

Assessment - Assess for patient response (AVPUC)
Management
- Call for local and external help if indicated
- Do not leave the patient

Question 9

PANCREATITIS Assessment & Management: send for help

Answer 9

Management
- Call for local and external help if indicated
- Emergency buzzer, dial hospital emergency response number, call out for help
- Do not leave the patient

Question 10

PANCREATITIS Assessment & Management: airway

Answer 10

Assessment – Assess for airway patency and signs of obstruction
Management
- Nil if patent and no obstruction (patient talking)
- Sit up if vomiting, suction if indicated

Question 11

PANCREATITIS Assessment & Management: breathing

Answer 11

Assessment
- Potential Findings
- Sitting upright, tachypnoea, hypoxia and increased WOB, shortness of breath
- Patient may have pulmonary effusions/infiltrates and atelectasis
- Distended abdomen impeding breathing
Management
- Sit upright to facilitate chest expansion and adequate ventilation
- Apply supplemental oxygen to maintain adequate SpO2
- Review CXR
- Monitor and continually assess

Question 12

PANCREATITIS Assessment & Management: circulation

Answer 12

Assessment
- Potential Findings
- Warm, pink, perfused, weak & fast radial pulses
- Capillary refill time brisk-sluggish
- Tachycardia, hypotension & oliguria
- Elevated lipase, amylase and WCC
Management
- Ensure patent IV access insitu for early hydration
- Manage fluid losses (anti-emetics for vomiting)
- Review ECG and complete electrolyte replacement
- IDC and FBC
- Haemodynamic monitoring

Question 13

PANCREATITIS Assessment & Management: disability

Answer 13

Assessment
- Potential Findings
- ACS from cerebral hypoperfusion in severe cases
- Abdominal pain from oedema, chemical irritation & inflammation, & obstructed biliary tract
- Nausea & vomiting from hypermotility or paralytic ileus
- Hyperglycaemia as glucagon is released from damaged pancreas
Management
- Analgesia: multimodal analgesia, PCA, antacids/proton pump inhibitors, antispasmodics
- Anti-emetics
- Insulin to manage hyperglycaemia
- NBM initially
- Reorientation & reassurance
- Monitor and continually reassess above

Question 14

PANCREATITIS Assessment & Management: exposure

Answer 14

Assessment
- Potential Findings
- Fever from infective processes
- Cullens/Grey Turner Sign (discoloured abdomen)
- Abdominal distention
Management
- Antibiotics
- CT abdomen
- NGT and nutritional support when indicated
- May need surgery

Question 15

Complications of Pancreatitis

Answer 15

• Pancreatic fluid collection
• Abscess formation
• Pseudocysts
  *Necrosis
• Systemic Inflammatory Response Syndrome (SIRS)
• Organ failure,
• Disseminated Intravascular Coagulation (DIC)
• Acute Respiratory Distress Syndrome (ARDS)

Question 16

Liver Cirrhosis

Answer 16

Chronic progressive liver disease is characterized by extensive degeneration and destruction of the liver, resulting in abnormal blood vessel and bile duct formation, disorganized liver lobules, impeded blood flow, poor cellular nutrition, hypoxia, and decreased liver function due to poor cellular nutrition.

Question 17

Clinical Manifestations of Cirrhosis

Answer 17

Early symptoms
* Early symptoms can include fatigue, but most patients may not be aware of their liver condition.
* The diagnosis may not be discovered until later when other significant symptoms appear
Later symptoms
* Can be related to both liver failure and portal hypertension
* The patient can be jaundiced, have ascites and peripheral oedema
* Skin lesions, endocrine disturbances, haematological disorders and peripheral neuropathies are present

Question 18

LIVER CIRRHOSIS Assessment & Management: danger

Answer 18

Assessment - Assess for dangers to self, patient or others
Management
- Remove if safe to do so
- Follow local and/or organisational policies and procedures

Question 19

LIVER CIRRHOSIS Assessment & Management: response

Answer 19

Assessment - Assess for patient response (AVPUC)
Management
- Call for local and external help if indicated
- Do not leave the patient

Question 20

LIVER CIRRHOSIS Assessment & Management: send for help

Answer 20

Management
- Call for local and external help if indicated
- Emergency buzzer, dial hospital emergency response number, call out for help
- Do not leave the patient

Question 21

LIVER CIRRHOSIS Assessment & Management: airway

Answer 21

Assessment - Assess for airway patency and signs of obstruction
Management
- Nil if patent and no obstruction (patient talking)
- Sit up if vomiting or haematemesis, suction if indicated

Question 22

LIVER CIRRHOSIS Assessment & Management: breathing

Answer 22

Assessment
- Potential Findings
- Sitting upright, tachypnoea, hypoxia and increased WOB, shortness of breath
- Patient may have distended abdomen from ascites impeding breathing and causing pulmonary effusions
Management
- Sit upright to facilitate chest expansion and adequate ventilation
- Apply supplemental oxygen to maintain adequate SpO2
- Review CXR
- Monitor and continually assess

Question 23

LIVER CIRRHOSIS Assessment & Management: circulation

Answer 23

Assessment
- Potential Findings
- Warm, jaundice, perfused, weak & fast radial pulses
- Assess risk of and signs of bruising/bleeding (varices)
- Capillary refill time brisk-sluggish
- Distended collateral veins & oedema
- Hypotension, tachycardia, & arrythmias
- Assess coagulation factors, LFTs, UE, FBE, & ammonia level
Management
- Ensure patent IV access insitu for early hydration/blood transfusion
- Manage fluid losses (anti-emetics for vomiting)
- FWT to assess for haematuria
- Review ECG and complete electrolyte replacement
- IDC if indicated and FBC
- Haemodynamic monitoring

Question 24

LIVER CIRRHOSIS Assessment & Management: disability

Answer 24

Assessment
- Potential Findings
- ACS in severe cases
- Abdominal pain
- Nausea & vomiting
- Hyperglycaemia
Management
- Analgesia: multimodal analgesia
- Anti-emetics and lactulose
- Insulin to manage hyperglycaemia
- NBM initially
- Reorientation & reassurance
- Monitor and continually reassess above

Question 25

LIVER CIRRHOSIS Assessment & Management: exposure

Answer 25

Assessment - Potential Findings - Fever if infective processes - Abdominal distention - Jaundice and pruritis Management - Antibiotics if indicated - Reassessment of above

Question 26

Several complications can occur from liver cirrhosis. These include:

Answer 26

* Jaundice: develops due to the liver's reduced ability to remove (excrete) bilirubin * Ascites: this results from portal hypertension where proteins from blood vessels shift into the lymph space and the lymphatic system is unable to remove the excess proteins and water * Oesophageal Varices: this results from portal hypertension where veins at the lower end of the oesophagus are enlarged and swollen * Portal Hypertension: this develops from structural changes in the liver that cause compression and destruction of hepatic and portal veins * Hepatic encephalopathy: this is a complex side effect that results from the neurotoxic effects of ammonia

Question 27

GI BLEEDING Assessment & Management: danger

Answer 27

Assessment - Assess for dangers to self, patient or others Management - Remove if safe to do so - Follow local and/or organisational policies and procedures

Question 28

GI BLEEDING Assessment & Management: response

Answer 28

Assessment - Assess for patient response (AVPUC) Management - Call for local and external help if indicated - Do not leave the patient

Question 29

GI BLEEDING Assessment & Management: send for help

Answer 29

Management - Call for local and external help if indicated - Emergency buzzer, dial hospital emergency response number, call out for help - Do not leave the patient

Question 30

GI BLEEDING Assessment & Management: airway

Answer 30

Assessment - Assess for airway patency and signs of obstruction Management - Nil if patent & no obstruction (patient talking) - Sit up if vomiting or haematemesis, suction if indicated

Question 31

GI BLEEDING Assessment & Management: breathing

Answer 31

Assessment - Potential Findings - Sitting upright, tachypnoea, hypoxia and increased WOB, shortness of breath - Patient may have hypoxaemia from blood loss and distended abdomen from ascites impeding breathing & causing pulmonary effusions Management - Sit upright to facilitate chest expansion and adequate ventilation - Apply supplemental oxygen to maintain adequate SpO2 (consider risk to airway from face mask) - Review CXR - Monitor and continually assess

Question 32

GI BLEEDING Assessment & Management: circulation

Answer 32

Assessment - Potential Findings - Cool, clammy, pale, weak & fast radial pulses - Capillary refill time brisk-sluggish - Assess amount of blood loss (haematemesis & malena) - Hypotension, tachycardia (hypovolaemia) - Arrythmias (hypovolaemia, hypoxaemia & risk of ischaemia) - Assess coagulation factors, LFT, UE, FBE, & G&H Management - Ensure patent 2 x IV access insitu for early hydration/blood transfusion (fluid resuscitation) - NGT insertion if indicated - FWT to assess for haematuria - Review ECG and complete electrolyte replacement - IDC if indicated and FBC - Haemodynamic monitoring

Question 33

GI BLEEDING Assessment & Management: disability

Answer 33

Assessment - Potential Findings - ACS and/or confusion - Assess for pain - Nausea & vomiting - Hyperglycaemia Management - NBM initially - Analgesia: multimodal analgesia - Insulin to manage hyperglycaemia - PPI stat dose & infusion - Antacids, H2 antagonists - Reorientation & reassurance - Monitor and continually reassess above

Question 34

GI BLEEDING Assessment & Management: exposure

Answer 34

Assessment - Potential Findings - Fever if infective processes - Abdominal distention - Jaundice and pruritis - External signs of bleeding Management - Antibiotics if indicated - Reassessment of above