Complex Exam 3 - inflammation and digestion/metabolism Flashcards
Where is appendicitis pain?
- RLQ
- dull around navel
Where is pancreatitis pain?
- epigastric
- radiates to back, left flank, left shoulder
Where is perforation pain?
all over the abdomen
Where is diverticulitis pain?
LLQ
What type of diet will a patient with abdominal pain be on?
NPO
Does anything help appendicitis pain go away?
NO
What characterizes a ruptured appendix?
going from extreme pain to no pain at all
- increased HR, RR, temp
- abdominal distention/bloating
What tests for rebound tenderness?
Blumberg’s sign
If the appendix has ruptured, what should be done?
- washing out the abdominal cavity
- appendectomy
What cannot be given to someone with appendicitis due to causing rupture?
- laxatives
- enemas
- opioids
- heat
What can a ruptured appendix lead to?
peritonitis (rigid, boardlike abdomen)
What are the most common causes of drug-induced hepatitis?
acetaminophen and “statins”
What does combining drugs with alcoholic drinks do?
increases the risk of liver damage
What is given for acetaminophen OD?
acetylcysteine
What pooping problems can occur with acute hepatic failure?
- constipation or diarrhea
- steatorrhea
- chalky stool
AHF can have hepatic encephalopathy. What can this lead to?
coma
What labs are elevated from AHF?
- bilirubin
- PT
- AST/ALT
- ammonia
What AHF diagnostic can identify the size of the liver, the presence of ascites, tumors, and patency of blood vessels?
CT/MRI
What should be kept at the bedside of a patient with AHF?
ET tube and oral airway
What should be avoided to keep ICP WNL with AHF?
overstimulation
What should be done to help with ascites from AHF?
paracentesis
What is the only treatment for liver failure?
liver transplant
After ABC’s are stable, what is the priority with AHF?
new-onset restlessness, confusion, or deteriorating LOC
Why is lactulose given for AHF?
to decrease ammonia levels
Why are beta blockers or vasoconstrictors given for AHF?
esophageal varicies
Why is vitamin K given for AHF?
clotting
What medications cannot be given with AHF?
- nephrotoxic
- sedatives
What is the biggest complication with AHF?
portal HTN
What should be restricted in the diet of a patient with AHF?
sodium and fluids
What should be increased in the diet of a patient with AHF?
carbs and protein, vitamin supplements
When should protein be decreased in a patient with AHF?
if they have hepatic encephalopathy
What causes esophageal varices?
portal HTN
What happens to HR and BP with esophageal varices?
tachycardia and hypotension
What bleeding manifestations occur with esophageal varices?
- hematemesis
- melena
- decreased H&H
Why is it important to control bleeding with esophageal varices?
to prevent hemorrhage and hypovolemic shock
What medications are used for esophageal varices?
- BB (propranolol)
- octreotide
- vasoconstrictors and vasopressors
Where is banding done for esophageal varices?
at the base of the varices to stop bleeding
Where is the catheter placed during a TIPS procedure for esophageal varices?
in the liver between the portal and hepatic vein
What does a balloon tamponade do?
compress blood vessels in the esophagus and stomach with balloons and traction
What can cause hemorrhage in the upper GI tract?
- varices
- PUD
- gastritis
- tumors
- esophagitis
What can cause hemorrhage in the lower GI tract?
- diverticulosis
- cancer
- polyps
- IBD
- UC
Does hematemesis and melena characterize an upper or lower GI bleed?
upper
Does hematochezia characterize an upper or lower GI bleed?
lower
What happens to capillary refill with a GI bleed?
it is increased, >3 seconds
What does the skin feel like with a GI bleed?
- cool, clammy
- rigid abdomen
What is a symptom of hemodynamic compromise that occurs with GI bleed?
chest pain
Signs and symptoms of anemia can occur with a GI bleed. What can this include?
- fatigue
- SOB
- tachycardia
What type of GI bleed can H. pylori cause?
upper
What diagnostics should be done for GI bleed?
- H&H
- type and crossmatch
- stool sample
- BUN
- H. pylori
When would an endoscopy be done?
w/in 24 hours of identifying a GI bleed
What is given through the 2 large bore IV’s with a GI bleed?
- fluids (LR)
- PRBC’s
- meds (PPI)
What medication is given if H. pylori caused a GI bleed?
antibiotics (metronidazole)
What diet should a patient with a GI bleed be on?
NPO while bleeding, clear liquids after
Who can not be a candidate for liver transplant?
- severe cardiac/respiratory disease
- metastatic malignant liver cancer
- alcohol or substance use disorder
Who can be a candidate for liver transplant?
- end stage liver disease
- chronic liver disease
What type of shower should be done before a liver transplant?
shower with chlorhexidine soap
What type of medication will patients be on for life after a liver transplant?
immunosuppressants
What is important to monitor after a liver transplant?
- VS
- neuro status
- s/sx of rejection, acute renal failure, infection, and clotting issues
What happens to amylase and lipase levels with acute pancreatitis?
they increase
When does pancreatitis pain worsen?
when laying down
What helps pancreatitis pain?
- fetal position
- sitting still and up
- leaning forward
Do patients with pancreatitis gain or lose weight?
lose
What does hypocalcemia cause with acute pancreatitis?
- positive trousseau’s sign
- positive chvostek’s sign
What is trousseau’s sign?
hand spasm
What is chvostek’s sign?
facial twitching
Turner’s sign is ecchymoses on the flanks. What causes this?
pancreatitis
Where does Cullen’s sign cause bluish-gray discoloration? What causes this?
- around the belly button (periumbilical)
- acute pancreatitis
What diet should someone with pancreatitis be on?
NPO, possible TPN
What is an NG tube used for with pancreatitis?
to empty the stomach
What pain medication cannot be used for pancreatitis?
morphine
What is important to give with pancreatitis?
FLUIDS
If a patient with pancreatitis has unstable glucose levels what should be done?
give supplemental insulin
What causes hypovolemia with pancreatitis?
third spacing
What can hypovolemia from pancreatitis lead to?
shock
What causes a pancreatic infection leading to a pseudocyst or abcess?
leakage of fluid out of the damaged pancreatic duct
If pancreatitis is not treated, what can it lead to?
MODS
Where is a palpable mass found with pyloric stenosis/intestinal obstruction?
RUQ
What abdominal s/sx occur with pyloric stenosis/intestinal obstruction?
- pain
- distention
- rigidity
- hypoactive bowel sounds
- vomiting
Pyloric stenosis/intestinal obstruction can cause increased hgb, hct, BUN, and creatinine. What are these signs of?
dehydration
What diagnostic evaluates the presence of free air and gas patterns with pyloric stenosis/intestinal obstruction?
x-ray
What diagnostic determines the cause of intestinal obstruction?
endoscopy
What diagnostic determines the cause and exact location of intestinal obstruction?
CT
What develops with diverticulitis?
small pouches throughout the intestinal wall
How does diverticulitis develop?
diverticulosis pouches get inflamed/infected by bacteria/food/fecal matter
What can perforation of diverticulosis pouches cause?
- peritonitis (increased temp/HR/RR)
- severe bleeding
What medications can be given for diverticulosis/diverticulitis?
- fluids
- antibiotics
- opioids
- psyllium and probiotics
Patients with diverticulosis/diverticulitis will move from clear liquids to a low fiber diet. What can this include?
- white rice
- cooked/skinned fruits/veggies
- eggs
What should not be eaten with diverticulosis/diverticulitis?
- popcorn/seeds/nuts
- alcohol
What should you monitor for if bowel perforation occurs?
- peritonitis
- infection
- sepsis
What is the late symptom of dumping syndrome?
hypoglycemia
What happens to BP and HR with dumping syndrome?
hypotension and tachycardia
What should a patient experiencing dumping syndrome do?
lay down
What medication can be given SQ to manage s/sx of dumping syndrome?
octreotide
Should you have liquids with meals with dumping syndrome?
NO
What foods should be avoided with dumping syndrome?
milk and sugars
