Gastro-Intestinal Flashcards
What is affected by liver dysfunction
bile production, coagulation, blood glucose, protein production and metabolism
Liver inflammation caused by Sharing needles
(Hepatitis C)
more of a chronic disease, more common hepatitis
Liver inflammation caused by Unprotected sex with an infected individual
(Hepatitis B)
(RUQ pain)
Liver inflammation caused by Consuming tainted food or water
(Hepatitis A,E)
mild, flu-like symptoms
Signs of liver disease
clay-colored stools, hepatomegaly, decreased urine, dark urine , pruritus, bruising, spider angiomas, jaundice
lab values that indicate liver dysfunction
Serum total bilirubin (elevated)
Urinary bilirubin (elevated)
Surface antigen testing (positive)
Antibody testing (identify type)
INR (elevated)
CBC (elevated WBC, decreased Hgb)
Ammonia (elevated)
Folate (decreased)
Thiamine (decreased)
Vitamin B12 (decreased)
Albumin (decreased)
Hepatitis tx
Lactulose (PO, 6months or less, cures pts of hep c)
Sofosbuvir: oral only treatment that targets the reproduction of the virus
Antivirals: Interferon (body’s natural antiviral, suppresses virus but doesn’t get rid of it, infusions weekly can last a year)
Supportive treatment for symptom management of hepatitis
Vitamin supplementation
Possible support for elevated coagulation studies
how do you treat hepatic encephalopathy
Lactulose and rifaximin
diet for liver pts
Diet high in carbohydrates and calories as well as moderate to low fat and protein
Small frequent meals are more easily tolerated
Supplemental vitamins
how do you assess patient status for liver pts
CAGE screening
what is liver cirrhosis
Normal, healthy tissue is replaced by fibrotic, non-functional tissue
Often results from chronic hepatitis
how to you treat alcohol withdrawal sx
Will often give benzodiazepines to help wean the patient and ease symptoms
what hepatitis causes liver cirrhosis
hepatitis B and C
what is the flapping tremor from ammonia buildup associated with cirrhosis called
asterixis
what is caput medusae and fetor hepaticus associated with cirrhosis
appearance of enlarged or swollen veins across the front of your abdomen (belly)
a type of chronic bad breath that’s actually a symptom of liver disease. It has a distinctive smell — some say, like rotten eggs and garlic
what do labs for liver cirrhosis look like
elevated LFT, bili, clotting factors, ammonia, BUN/creatine
low blood count, protein/albumin, K, Na, and vitamins
how do you make diuretics effective if all the fluid isn’t in the intravascular space
Diuretics: only effective if fluid is in intravascular space so TAKEN WITH ALBUMIN
how do you tx portal vein HTN
Beta blockers, proton pump inhibitors
how do you get rid of ammonia buildup
Lactulose binds to ammonia in colon can causes frequent loose stools
Rifaximin is a antibiotic that binds to ammonia
How do you decrease GI bleed risk
proton pump inhibitors
How do you create clotting cascade
fresh frozen plasma and Vitamin K
What is a TIPS procedure
Scar tissue formed when the liver becomes cirrhotic can occlude the portal vein. TIPS is a minimally invasive procedure that creates a shunt to bypass the liver and reduce pressure in the portal vein.
blood through shunt isn’t cleaned by liver
How are esophageal varices caused
portal hypertension can cause rupture of vessels
Liver tx patients are at risk for
infection, formation of abscesses, and acute renal failure
what med would a liver transplant patient need to take the rest of their life
cyclosporine (immunosuppressant)
Liver diet
low-sodium diet—
high carbohydrate, moderate protein and moderate fat
Small, frequent meals
You must performa daily ____ on liver cirrhosis patients
weights
What is Hepatorenal syndrome:
fluid shift from decreased albumin from liver failure causes hypoperfusion to kidneys
A pt presents w/ hematemesis and is a known liver patient. What do you need to do
Will often be put on non-selective beta blocker in order to reduce pressure
Most often treated with endoscope with banding
If they rupture, pt will likely die
what is the difference between Cholelithiasis and Cholecystitis
Cholelithiasis—precipitation of bile salts to form gallstones
Cholecystitis—inflammation of the gallbladder—often associated with cholelithiasis, though can be linked to other causes
can occur separately or at the same time
Three major contributing factors to formation of gall stones are:
abnormalities in bile composition (too much cholesterol, too much bilirubin), bile stasis (gastric bypass), and cholecystitis (not using bile, hormone shifts)
estrogen affects concentration of ________.
bile salts, the more estrogen the more concentrated bile salt
difference between Calculous cholecystitis and Acalculous cholecystitis
Calculous cholecystitis-gallstone obstructs part of the path of flow for bile
Acalculous cholecystitis—can occur with ischemia or any other process which causes biliary stasis—can also be caused by anatomical obstructions (gall bladder hangs low which kinks flow of bile)
What is Murphy’s sign and Blumberg’s sign
Murphy: (push below liver, rebound tenderness indc peritonitis)
Blumberg: (pain underneath rib cage)
Sx of gallstones
RUQ pain
nausea, vomiting especially after eating a fatty meal
Murphy’s sign (push below liver, rebound tenderness indc peritonitis)
Blumberg’s sign (pain underneath rib cage)
steatorrhea ( Stools may be bulky and difficult to flush, have a pale and oily appearance, and can be especially foul-smelling. clay-colored)
Pruritis, jaundice
expected labs for gallstones
increased inflammation and high fat in blood
Amylase elevated
Lipase elevated
how do you officially dx gall stones
Ultrasound (only for calcified stones)
Endoscopic retrograde cholangiopancreatography (ERCP)
HIDA Scan (give radioactive component in so you see bile in liver, gall bladder, then small intestine)
how do you dissolve cholesterol-based stones
Bile acids-chenodiol, ursodiol
most common tx for gall stones is _____
removal
Alternative tx for gall stones
Endoscopic retrograde cholangiopancreatography (ERCP)
Extracorporeal shock wave lithotripsy (ESWL)
Transhepatic biliary catheter (t-tube)
stent placement
How do you manage a t tube
Drainage will initially be sanguineous and then transition to bile
There will be up to 400 ml in the first 24 hours, and then it will start to decrease
If no drainage, especially early on and with nausea/pain, could be an obstruction
Do not raise above the level of the gallbladder unless ordered
Clamp before and after meals (otherwise no bile can be used to digest with, it’ll all flow out)
Empty bag every 8 hours
gall stone diet
Low-fat diet—avoid dairy, fried foods, etc.)
Small, frequent meals
Avoid foods that cause flatulence
priority after lap-chole
Early ambulation after lap chole to help expel CO2
right shoulder pain from CO2 air from laparoscopic procedure alleviated by walking around
what causes pancreatitis
premature activation of pancreatic enzymes in the pancreases causes autodigestion (caused by obstructions, alcohol, autoimmune disease. Made worse by alcohol because it increases enzyme secretion)
Causes hypocalcemia, hyperglycemia, and decreased digestion of nutrients
what is the number one cause of pancreatitis
alcohol
Sx of pancreatitis
abdominal pain that radiates to back, flank or shoulder and is described as a “boring” pain;
polydipsia, polyphagia (little insulin production),
nausea, weight loss, vomiting
Turner’s sign (discoloration around hip/flank), Cullen’s sign (discoloration around belly button)
musculoskeletal tetany (involuntary contraction of muscles that usually results from low calcium levels in the blood)
labs of pancreatitis
Amylase-increases and clears faster than lipase (elevated)
Lipase (elevated)
Glucose (elevated)
Bilirubin (elevated if affecting common bile duct)
AST, ALT, LDH (elevated if affecting common bile duct)
Magnesium—impaired absorption (lower)
Calcium—precipitates as part of the disease process (lower)
how do you treat pancreatitis
prioritize pain management (PCA pump)
Antibiotics-for acute necrotizing pancreatitis (ANP)
Anticholinergics (dry everything up)
Proton Pump Inhibitors/H2 antagonists
Pancreatic enzymes (pancrelipase) help digest things
Insulin
Calcium replacement
Isotonic Fluids if polyuric
How do you manage acute pancreatitis
NPO, decompress, TPN
What do you do once the pt recovers from the initial insult of acute pancreatitis
slow start small frequent meals that are high protein, high carbohydrate, and low fat
Also give the patient bland food
Avoid caffeine and alcohol
Nutritional supplements are encouraged
No smoking (no nicotine)
What is a common complication from pancreatitis
pancreatic cancer. low survival rate
When treated with Whipple procedure at risk for:
Diabetes
Hemorrhage
Infection
Bowel obstruction
Abscess
Peritonitis
Which laboratory test result will the nurse monitor to evaluate the effects of therapy for a patient who has acute pancreatitis?
Lipase
Lipase is elevated in acute pancreatitis. Although changes in the other values may occur, they would not be useful in evaluating whether the prescribed therapies have been effective.
How should the nurse prepare a patient with ascites for paracentesis?
Ask the patient to empty the bladder.
