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.