Digestive (Saunders) Flashcards
cholecystitis is inflammation of what?
gallbladder
acute inflammation associated with gallstones is called what?
cholelithiasis
what is chronic cholecystitis
inefficient bile emptying and gallbladder muscle wall becomes fibrotic and contracts the gallbladder
S/S of cholecystitis
N/V
belching
flatulence
epigastric pain that radiates to right shoulder or scapula
guarding
rebound tenderness
murphy signs
high temp
tachycardia
jaundice
dark orange/foamy urine
steatorrhea/clay colored feces
pruritus
where do you feel the pain for cholecystitis
RUQ
interventions for cholecystitis
NPO until said so
antiemetics
analgesics
antispasmodic
SMALL, HIGH FIBER, LOW FAT MEALS
cirrhosis is a progressive disease to what organ?
liver
cholecystitis is to what organ?
gallbladder
early signs of cirrhosis
weight loss
n/v
abdominal pain
causes for cirrhosis
hepatitis c
alcoholism
NAFLD (nonalcoholic fatty liver)
NASH (nonalcoholic steatohepatitis)
complications for cirrhosis
ascites
portal HTN
bleeding problems
jaundice
encepalopathy
interventions for cirrhosis
elevate HOB
high protein and vitamins (if there’s no edema or coma)
vitamins (A,C,k,folic acid, thiamine)
restrict I and O/ fluids
daily weights
monitor for tremors/delirium
ASTERIXIS (duhhh hand)
give lactulose
what is esophageal varices
bleeding from the dilated veins
causes for esophageal varices
portal HTN
liver cirrhosis
s/s for esophageal varices
melena
hematemesis
jaundice
dilated abdominal veins
interventions for esophageal varices
elevate HOB
02
NPO
monitor LOC
give IVF
monitor hgb,htc
insert Ng tube/balloon
is hepatitis a treatable disease
yes
what hepatitis is most likely to cause liver dysfunction
Hep. B
what hepatitis has vaccines
A,B
how can you get hep C
through blood/paraneterally
complications of hep c
chronic liver disease
cirrhosis
how can you get Hep. D?
must need Hep. B
how can you get Hep E
waterborne virus
what is pancreatitis
inflammation of the pancreas
s/s of acute pancreatitis
cullens sign
turners sign
LUQ pain
N/V
weight loss
pain aggrevated by fatty meal,alcohol
tachycardia
HOTN
hyperthermia
dyspnea
pleural effusions
where do you feel pain/mass for pancreatitis
LUQ
interventions for acute pancreatitis
hold fluid, food
give opiates
NG tube feed
s/s of chronic pancreatitis
LUQ mass
jaundice
ascites
s/s of DM
s/s of respiratory distress
weight loss
steaorrhea
interventions for chronic pancreatitis
avoid alcohol, caffeine
give insulin
avoid heavy meals
complications of acute pancreatitis
HOTN
gi bleed
hyperglycemia
hypocalcemia
atelestasis, pneumonia, ards
anemia
causes of acute pancreatitis
opiates
steroids
BC
thiazides
sulfas
labs for acute pancreatitis
everything high except albumin and calcium and magnesium
tx for acute pancreatitis
opioids
famotidine
pantoprazole
antibiotics
pulmonary hygiene
surgical management
education for pancreatitis
low fat
high protein
moderate carbs
avoid spicy
educate s/s of jaundice, clay/pale poop, dark urine,
chronic pancreatitis complications
stearorrhea
muscle waste
pUD
pancreatic pseudocust
pancreatic CA
Tx for chronic pancreatitis
lifestyle diet/change
pain meds
PERT (pancreatic enzyme)
surgery PRN
what are surgeries for pancreatic cancer
partial pancreatectomy (3cm or smaller)
radical pancreaticoduodenectomy (whipple)
complications of whipple
MODS
ARDS
hemorrhage
DM
MI
deadly
clinical management for whipple
NGT for decompression
TPN
blood glucose watch
drain tube
what are the types of cirrhosis
post-necrotic (viral.toxins)
laennec (alcoholic)
biliary (obstructive)
what is the most common cause of cirrhosis worlwide
hep b and D
leading cause of cirrhosis in US
hep C
cirrhosis tx for meds
lactulose
moisturizer
corticosteroids
electrolyte replacement
Tx for esophageal
vasopressin
BB
somatostatin
elastic bands
pressure on varices
what is the name for esophageal varices tx
sengstaken-blakemore tube
sengstaken-blakemore tube three openings
gastric suction
inflating esophageal balloon
inflating esophageal balloon to compress vein
inflating gastric balloon applies pressure to fundul veins
what are health promotions for hepatitis
vaccines for A and B
healthcare workers
standard precautions
needleless systems
proper handwashing (especially after fish)
avoid contaminated food/water
hepatitis management
high carb, low fat
small frequent meals
increase kcal
tell women for extra BC because of drugs fo hepatitis
emotional support
s/s of hepatic encephalopathy
altered LOC
confusion
somnolence
insomnia
impaired mentation
how does hepatic encephalopathy happen
liver failure
what happens in stage 4 hepatic encepatholagy
accumulation of toxins in bloodstream (ammonia)
seizures
positive babinski sign
muscle rigidity
unresponsiveness
what med for hepatic encepathology
lactulose
side effects for lactulose
gas
bloating
burping
stomach pain
nausea
cramps
stage 1 hepatic encephalopathy
subtle manifestations
drowsy
inability to concentrate
slurred speach
sleep pattern disturbance
what worsens hepatic encephalopathy
high protein
infection
hypovolemia
hypokalemia
constipation
gi bleed
drugs
stage 2 hepatic encephalopathy
asterixis
disorientated
stage 3 hepatic encephalopathy
asterixis
more duhhhh
How does Hepatitis affect Metabolism of medications?
increases drug toxicity bc the liver is not working meaning the liver enzymes can’t break down shit
What are some hepatotoxic medication?
tylenol
nsaids
statins
antibiotics
antifungal
methotrexate
S&S of increase ammonia level in patients /management
mental status change
n/v
breath odor
management for hyperammonia
lactulose
antibiotics (rifaximin)
low protein
high carbs
Appropriate DIET for patients with Hepatitis A B C
diet high in veggies, fruits, whole grains (anything healthy)
limit fat and cholesterol
avoid alcohol
limit salt
stay hydrated
monitor protein intake be careful
modes of transmission of hepatitis
A,E: food and water
B,C,D,G: blood or bodily
C: sex or needle stick
Patient education for Hep. ABCDEG
modes of transmission
prevention tacts
s/s (jaundice, fatigue, n/v, clay colored stools
Medical management for chronic Hep
antiviral
regular liver function test (AST,ALT, INR, bilirubin,albumin)
antiviral meds for hepatitis B
entecavir, tenofovir
disoproxil
antiviral meds for hep c
direct acting antiviral (DAA)sofosbuvir
ledipasvir
glecaprevir
complications for pancreatic cancer
VTE (bc of thrombolytic factor)
rapid and difficult to treat
metastatic disease
associated factors for pancreatic cancer
dm
fat
old
cigs
male
cirrhosis
red meat
chronic pancreatitis
diagnosis for pancreatic cancer
amylase
lipase
cholesterol
ERCP
s/s for pancreatic cancer
DVT/VTE/PE
weight loss
weakness
fatigue
N/V
jaundice (dark urine, clay poop)
ascites
new onset of DM
surgery for Pancreatic cancer
partial pancreatectomy (3cm or smaller)
radical pancreaticofuodenectomy (whipple)
complications for whipple
infection
fistula
bowel obstruction
DM
MI
ARDS
MODS
hemorrhage
nurse care for post op pancreatic cancer surgery
NGT (decompression)
drainage
TPN (jtube)
strict i and o
fluid and electrolyte
emotional support
