Exam 4 Flashcards
Cirrhosis
Liver Failure
Portal Vein
The highway that brings stuff to the liver. If it becomes clogged, that stuff must find an alternative route.
Alternative Route
Overflow can back into the spleen and stomach. It can also go to the esophagus. The esophagus becomes dilated, makes the veins weak, causes rupture, leads to bleeding.
Esophageal Varices
Bleeding in the back of the throat. Number one complication of cirrhosis. MEDICAL EMERGENCY!
Signs and Symptoms of Esophageal Varices
Bloody emesis, black tarry stools (from blood being digested), low hemoglobin, low hematocrit (both from bleeding).
Management of Esophageal Varices
Can be fatal. Tell patient to sit up. Call the provider immediately. Surgery. A shunt to open up the portal vein (TIPS procedure). Balloon tamponade. Banding.
Ascites
Swelling caused by third spacing. Similar to edema. Caused by low albumin and portal hypertension. Give albumin with diuretic.
Low Sodium Diet
Salt draws fluid/water from the cells. This leads to 3rd spacing. A low sodium diet avoids this.
Causes of Cirrhosis
Alcohol, Hep. C, liver disease, and other viruses.
Complications of Cirrhosis
Ascites, portal hypertension, esophageal varices, edema, hepatic encephalopathy.
Hepatic Encephalopathy
Brain function loss due to lost liver function. Known for patients having musty breath. Give lactulose.
Crohn’s Disease
Inflammation of any segment of the GI tract from mouth to anus (multiple spots). Inflammation involves all layers of the bowel wall.
Skip lesions (can be anywhere).
Ulcerations are deep and longitudinal and penetrate between islands of inflamed edematous mucosa.
Signs and Symptoms of Crohn’s Disease
Diarrhea, cramps, dehydration, and electrolyte imbalances.
Less Common: Weight loss when the small intestine is involved, rectal bleeding, fever, or other systemic symptoms
Ulcerative Colitis
Inflammation and ulceration of the colon and rectum (only one spot). Tends to advance.
A disease of the mucosal layer of colon and rectum.
Usually starts in the rectum and moves in a continual manner toward the cecum.
Sometimes there is mild inflammation in the terminal ileum.
Signs and Symptoms of Ulcerative Colitis
Same as Crohn’s except diarrhea is bloody and there is more pain.
More Severe: Fever
Rapid weight loss of more than 10% of total body weight
Anemia
Tachycardia
Dehydration/ Electrolyte imbalances
Management of Crohn’s and Ulcerative Colitis
NPO, low residue, steroids to help with infection risk, low fiber diet if current, high fiber diet to prevent, and fluids.
Acute Pancreatitis
Pancreas usually makes insulin. Pancreas is leaking and inflamed. Increased amylase and lipase because the pancreas can no longer break it down.
Management of Acute Pancreatitis
Opioids, NPO, and NG tube. Lots of fluids and crystalloids. Control pain and nausea. Gall bladder may be removed (if caused by gall stones).
GI Perforation
Medical emergency! Inflammation leads to a burst. A hole in the large intestine causes stool to leak into the abdomen.
Causes of GI Perforation
Crohn’s, Ulcerative Colitis, Diverticulitis, Apendicitis, and ulcers.
Signs and Symptoms of GI Perforation (PERITONITIS)
BOARD-LIKE ABDOMEN! Firm, distention, low BP, high HR, and fever (shock symptoms).
Management of GI Perforation
Mainly surgery and antibiotics.
Signs and Symptoms of Esophageal Cancer
Pain is a LATE sign! Hoarseness, weight loss, choking, bloody emesis, blood flecked regurgitation, voice changes, sore throat, swallowing difficulty, and dysphagia.
GERD
Stomach contents flowing back up the esophagus. Essentially acid reflux.
Management of GERD
Sit up after meals, raise HOB, keep a food diary, avoid acidic foods = lemon and lime, no caffeine, no alcohol, no chocolate, no peppermint, no fatty foods, and small meals.
Abdominal Hernia
Protrusion of an internal organ through abnormal opening. Colon stuck in a loop. Hard circle pushing against the skin. Will likely be on NPO diet. Can be life threatening if the intestine is incarcerated causing bowel ischemia, this would be a medical emergency!
Inguinal most common.
Signs and Symptoms of Abdominal Hernia
Abdominal pain, distention, obstruction, constipation, bloating, emesis of stool, and hypoactive or absent bowel sounds.
Bariatric Surgery Management
Small meals, lifestyle changes, no liquids with meals (30 mins before/after), no carbonation, no sugar, no concentrated sweets, no straws, high protein, low carbohydrate, and B12 injection because stomach used to produce but is now lost.
Dumping Syndrome
Common complication of bariatric surgery. It is when food moves from stomach to the small intestine too fast. There is then build up in the small intestine, including excess fluid.
Signs and Symptoms of Cholecystitis
Jaundice, bile backup, clay stools, amber urine, itching, and steatorrhea = white specs in poop.
Risks for Oral Cancer
Smoking, alcohol, tobacco, genetics, sun exposure to lips, HPV, poor dentation, and environmental factors.
Signs and Symptoms of Oral Cancer
Sores, gum recession, and teeth falling out.
Management of Oral Cancer
Surgery. However, it is hard on patient’s self confidence.
Hepatitis C
Can cause both cirrhosis and liver cancer. It can be transmitted through blood, sexual intercourse, and parental.
Risks for Colorectal Cancer
Highly processed food, low fruits/vegetables, obesity, smoking, alcohol, genetics, history, and smoked/ charred meat.
Nutrition
Enteral feeding through the nose still goes through stomach. Do not give through IV (idk why anyone ever would).
Adverse Effects of Enteral Feeding
Dehydration, electrolyte imbalance, hypoglycemia, and aspiration. Take frequent blood sugars and make sure feed is not too slow or the wrong combination. Also, understand aspiration risk because the tube is close to the lungs (and may accidentally be put into the lungs. this is why we use XR to confirm location and draw back gastric contents).
Causes of Pancreatitis
Autodigestion, gall stones, occlusion, acute alcoholism, and acute cholecystitis.
Complications of Pancreatitis
Shock, sepsis, and acute respiratory distress.
Vitamin K
Decreased when loss of liver function because that is where it is made.
Drugs for Liver
Octreotide and PPI
Management for Portal Hypertension
Propranolol, give albumin, and parasentisis procedure.
Drugs for high ammonia
Lactulose and Rifaximin.
Liver Labs
Low vitamin K, bilirubin in urine, increased serum bilirubin, increased HR, decreased BP, increased protein INR/ATP, increased platelets, increased risk for bleeding, decreased CBC, decreased Hgb, decreased Hct, increased ammonia, and decreased albumin.
Complications of Crohn’s and Ulcerative Colitis
Weight loss
Anemias r/t bleeding
Pain
Diarrhea
Dehydration
Hypovolemia
Electrolyte imbalance
Arrythmias
Risk for Infection (lowered immune response)
Signs and Symptoms of Acute Pancreatitis
Cullen’s Sign, Gray Turner, PAIN RADIATES TO BACK, crackles in lungs, hypocalcemia, and tetany.
Signs and Symptoms of GIRD (GERD?)
Aspiration, dysphagia, hoarseness, swelling, chest pain, coughing, breathing issues. Can lead to barrett’s esophagus which can lead to cancer.
Causes of GERD
Increased ABD pressure (pregnancy) and weaker lower esophageal sphincter (alcohol and nicotine).
Barrett’s Esophagus (Metaplasia)
A pre-cancerous esophageal lesion caused by repeated damage r/t GERD
Sucralfate
Forms protective barrier over ulcerating, also known as “Band-aid”. Administer 2 hours before/after other medications
Causes of Peptic Ulcer Disease
H-Pylori Bacteria
Stress
Coffee
Alcohol
NSAID USE
Steroid use
What are the four medication classes for treating GERD/Hiatal Hernia?
Proton Pump Inhibitors
Antacids
H2 Blockers
Prokinetic Agents
How can we diagnose a hiatal hernia?
Barium Swallow
CT scan
Diagnostics for Colorectal Cancer
Occult blood test
Colonoscopy with biopsy
Carcinoembryonic antigen (CEA)
Signs and Symptoms of Colorectal Cancer
Narrow ribbon-like stool, rectal bleeding, alteration between constipation and diarrhea, sensation of incomplete evacuation, bowel obstruction, vague abd pain, and unexplained weight loss.
Important Things About IBS
Chronic Functional Disease.
Anxiety, Depression, Abuse, PTSD.
Antidepressants can help.
Back and forth between diarrhea and constipation.
Excessive flatulence!
Low FODMAP (sugar) diet, no gas-producing foods, increase fiber intake (20 g daily), yogurt better than milk, and probiotics.
Important Things About C-Diff
Gram Positive Spore Forming & Toxin Producing Bacillus.
Watery diarrhea with mucus.
Antibiotics kill off natural flora and can lead to c-diff bacteria overgrowth.
PPI Use increases risk for c-diff because it decreases acidity in the stomach which allows the bacteria entered orally to not be broken down by acid.
Inflammation opens you up for more infections.
Enteric Isolation.
Stool sample.
Disposable oral thermometer vs. Dynamap.
Can be given IV or per enema.
Fecal Transplant Microbiota.
Vancomycin
Management of Colorectal Cancer
Surgery most common.
May be chemotherapy and radiation.
Hernia Strangulation
Medical emergency! Blood supply is unable to reach the hernia. Can cause bowel ischemia.
Causes of a Hernia
Congenital, previous abdominal surgeries, muscle weakness, heavy lifting, straining with constipation, and pregnancy.
Reducible vs. Incarcerated
Hernias are classified as reducible when the hernia contents can be placed intra-abdominally through the layers of the abdominal wall. If the contents of the hernia cannot be reduced, the hernia is considered incarcerated.
Crohn’s Disease Complications
Nutritional problems, especially when the terminal ileum is involved.
Fat malabsorption and anemia occur.
Small intestinal cancer.
Causes of Inflammatory Bowel Disease
Diet
Hygiene
Stress
Smoking
Use of NSAIDs
Genetic is biggest thing!
Autoimmune disorder
Environmental triggers won’t give disease, but cause flareups
(May avoid food because everything hurts)
Signs and Symptoms of IBD
Diarrhea
Bloody stools
Weight loss
Abdominal pain
Fever
Fatigue
Complications of IBD
GI tract (local) complications
Hemorrhage
Strictures
Perforation
Fistulas
High risk for colorectal cancer
Colonic dilation
Toxic megacolon
Diagnostic Studies of Inflammatory Bowel Disease
Stool cultures – will probably present with general symptoms that can be many things but must be ruled out.
This would not show up on stool cultures, but this test would help narrow things down.
CT/MRI
Colonoscopy
Labs
CBC
Serum electrolyte levels
Serum protein levels
Nutritional Therapy of Inflammatory Bowel Disease
Lactose
High-fat foods
Cold foods
High-fiber foods – Fiber means bulk so peristalsis can push through
During acute exacerbations=Liquid enteral feedings are preferred
Severe Cases= parenteral nutrition
Ileostomy Care
Monitoring = Stoma viability and peristomal skin integrity.
Output may be as high as 1500–2000 mL per 24 hours.
Observe for complications:
Hemorrhage
Abdominal abscess
Small bowel obstruction
Dehydration
Diverticula
Bulging, pouch like herniation (diverticula) in GI wall
Diverticulosis
Diverticula present without symptoms.
May have:
Bowel irregularity
Intervals of diarrhea, Nausea, abdominal distention
Diagnostic:
Colonoscopy
Diverticulitis
Inflamed diverticula
Symptoms:
Mild to severe abdominal pain
N/V
Fever, chills, leukocytosis
Complications of Diverticulitis
Abscesses
Rupture-Peritonitis
Bleeding
Obstruction
Fistula development
Diagnostics of Diverticulitis
CT Scan
X-ray
Lab tests
CBC
Treatment for Diverticulitis
Bedrest
NPO
IV antibiotics
IV Fluids
Possible NG Suction
Possible Surgery
High fiber diet
Prevent ↑ intraluminal pressure= avoid straining, heavy lifting, tight clothing, bending
Weight reduction=↑ Physical activity
Not an infection but often treated like one
Give bowel time to rest
Iv fluids given for lots of diarrhea
Appendicitis
Inflammation of the appendix
Commonly caused by obstruction of lumen by fecalith
Leads to gangrene, perforation, peritonitis
Signs and Symptoms of Appendicitis
Pain starts with Dull periumbilical pain
Anorexia
N/V
Pain shifts to RLQ
Fever
Rebound tenderness- hurts more when you let go
McBurnees point
Do not deep palpate
Complications of Appendicitis
Abscess - treat with antibiotics but may be difficult if it is walled off
Rupture- Must get fever down
Peritonitis
Worry about sepsis
BRAIN Acronym for Peritonitis Symptoms
B- Board like abdominal rigidity
R- Retractive respirations
A- Anorexia
I- Increasingly severe abdominal and rebound spasms
N- Nausea and vomiting
