Gastrointestinal Flashcards
What does vasopressin do to the splanchnic arteriolar bed? And watch should you watch out for?
Constricts the splanchnic arteriolar bed and decreases portal venous pressures
Watch out for chest pain and ST elevation
What does octreotide reduce?
It reduces splanchnic blood flow, gastric secretions, and GI motility
Osmotic laxatives, such as lactulose, prevents ammonia conversion, how?
Osmotic laxatives remove nitrogenous materials out of the gut to prevent ammonia conversion
What do beta blockers do to the mesenteric arterioles?
It constricts them reducing venous flow
What is a common cause of portal HTN secondary to liver disease?
Esophageal varices
What are the exocrine functions of the pancreas?
Secretion of bicarbonate to neutralize stomach acid ( H2O, Na, K, digestive enzymes such as trypsin, amylase and lipase)
Secretion is increased by the parasympathetic stimulation and ingestion of food
What are the endocrine functions of the pancreas?
Alpha cells secrete glucagon
Beta cells secrete insulin
Delta cells inhibit the secretion of glucagon and insulin
What is acute pancreatitis?
It is the diffuse inflammation, destruction and auto digestion of the pancreas from premature activation of exocrine enzymes.
It is not usually caused by an infection
What are pulmonary complications of acute pancreatitis?
ARDS
atelectasis of LLL
Left sided pleural effusion
Bilateral crackles
What are signs and symptoms of acute pancreatitis?
- N/V, rigid abdomen, no rebound tenderness
- Elevated amylase ( peaks in 4 -24hrs, returns to normal in 4 days)
- Hypocalcemia (d/t calcium being used up for auto digestion which precipitates hypocalcemia leading to Trousseau’s sign, prolonged QT and sz)
- Elevated blood sugar
What is Trousseau’s sign?
During inflation of the blood pressure cuff the brachial artery is occluded. The absence of blood flow, the patient’s hypocalcemia and subsequent neuromuscular irritability will induce spasms of the muscles of the hand and forearm
Why is your blood sugar elevated in acute pancreatitis?
Because beta cells are injured thus unable to secrete insulin causing a rise in glucose, which could lead to HHS
How can you get a left pleural effusion or LLL atelectasis for acute pancreatitis?
Pancreatic inflammation and capillary leak block the pancreatic duct cause LLL atelectasis, diaphragmatic lifting and left pleural effusion
What two signs are indicative of hemorrhagic pancreatitis?
Cullen’s sign and Grey Turner’s sign
What is the treatment of acute pancreatitis?
Fluid replacement H2 Blockers to decrease gastric PH NGT suctioning Enter all tube feeding below the duodenum Monitor for plumonary complications
In hepatic failure what labs do you expect to be abnormal?
Decreased: serum protein, serum albumin, blood sugar, serum creatinine (BUN -late), wbc, rbc, platelets
Increased: ammonia, PT, PTT, AST, ALT, Bilirubin
What factors increase serum NH3 (ammonia)?
Hypokalemia
Increased BUN: breakdown nitrogen
Increase protein: breakdown nitrogen
Increase lactic acidosis
If a patient with hepatic failure is having a GI bleed, what happens to their ammonia levels?
The ammonia levels increase because of the protein breakdown in the gut
What is a TIPS procedure?
Transjugular intrahepatic portosystemic shunt
A procedure for select patients with cirrhosis to relieve esophageal varices or ascites
What is a TIPS procedure?
Transjugular intrahepatic portosystemic shunt
A procedure for select patients with cirrhosis to relieve esophageal varices or ascites
What are complications of a TIPS procedure?
Hepatic encephalopathy
Because the stent shunts blood directly from the hepatic vein to portal vein, which bypasses the liver. This decreases portal HTN but decreases the detoxification of blood
Spleen
- Hx of splenectomy means pt has reduced immune function since spleen is thought to filter the blood
- Signs of splenic rupture - Kehr’s sign ( diaphragmatic irritation that causes referred pain to left shoulder), abdominal distention with absent bowel sounds
What parameters would a patients intra-abdominal pressures be if a patient gas intra-abdominal HTN?
> 12-15 mmHg
An abdominal perfusion pressure is the difference between MAP and IAP. If an APP is less than 50 it is associated with increased mortality.
What pressure would a patient’s abdominal cavity be at if they were to have abdominal compartment syndrome?
Sustained pressure >20 mmHg with or without an APP of 60 and is associated with new organ dysfunction or failure
When evaluating whether a patient has abdominal compartment syndrome, what level should the transducer be at to get an accurate pressure?
Symphysis pubis
The following are complications related to the pathophysiological changes in acute pancreatitis EXCEPT:
A. hyperglycemia r/t beta cell injury
B. hypercalcemia d/t pancreatic auto-digestion
C. ARDS related to a Type II alveolar cell injury
D. left side atelectasis r/t left sided diaphragm lift
B
Hypocalcemia is a complication leading to prolonged QT and seizures, may have a positive Trousseau’s sign
A patient was admitted with generalized abdominal pain (that is dull in quality), diminished bowel sounds, and low-grade fever. The patient now complains more sever pain that is worse with movement. Upon examination, bowel sounds are absent, her abdomen is rigid to palpation, and her pain is less with palpation down than when released. Which of the following is a priority for that patient at this time?
A.increasing the opiate dose
B.surgery
C.insert NG tube
D. ABX therapy
B
This clinical picture is one of peritonitis. Addressing the problem surgically will prevent increased morbidity.
A patient with esophageal varices was admitted with hypovolemic shock secondary to upper GI bleeding. The follwing intervention related to the care of this patient are appropriate EXCEPT:
A.preparing the patient for emergent surgery
B. ensuring that scissors are at the bedside if the patient has an esophageal balloon in place (Sengstaken- Blakemore tube)
C. administering lactulose if the patient has a history of cirrhosis
D. closely monitoring the patient’s respiratory and neuro status
A
Surgery is not indicated for esophageal varices.
