Gastrointestinal Flashcards
What is the liver function? Read
- Metabolism: carbs, fats and proteins
- Clotting factor production
- Bile salts production
- Bilirubin metabolism
- Detox
- Vitamin and mineral storage
Liver dysfunction affects multiple bodily functions like : (4)
- Coagulation
- LOC
- Substrate metabolism
- Wound healing
Liver Function Tests involves:
Total Protein
Serum Albumin
Serum Globulins
Total Protein: 6-8 g:dL
Serum Albumin 3.5 -5 g/dL
Serum Globulins: 2.6-4.1 g/dL
What are the normal levels of Serum Ammonia?
19-60mcg/dL
Why does ammonia accumulate during liver disease?
The liver is unable to convert ammonia to urea, which is then excreted via the kidneys.
What will elevated NH3 levels lead to?
Hepatic encephalopathy and coma.
What are treatments for elevated ammonia?
Limit protein, give lactulose.
Potassium levels should be monitored since the body is less unable to handle NH3 during hypokalemic states.
What exactly is bilirubin?
Bilirubin is the waste product of RBCs being broken down.
The liver helps makes bilirubin from lipid soluble to water soluble.
If AST & ALT are elevated. What is the likely cause of liver damage if AST>ALT
Cirrhosis and metastatic cancer may be in the liver
*AST is more a sign of liver necrosis or other signs of failure
If AST & ALT are elevated. What is the likely cause of liver damage if ALT>AST
hepatitis, nonmalignant obstruction may be present in the liver.
What is the difference between cirrhosis and hepatitis?
Hepatitis is the inflammation of the liver.
Cirrhosis is non reversible damage, scarring of the liver.
Why is neomycin given in hepatic encephalopathy?
prophylatically prevent gut infection by killing the bacteria
What happens to NH3 levels at end stage liver disease?
It actually drops off because the liver is unable to break down protein anymore, thus not able to create by product of NH3
What are 7 clinical presentations of liver dysfunction?
- Hepatic encephalopathy
- Malnutrition
- Coagulopathy (bleeds more)
- Portal HTN
- Hepatorenal Syndrome
- Ascites
- Infection
Why does this clinical presentation happen? Coagulopathy
Liver can’t synthesize fibrinogen, prothrombin, vitamin K, fibrinolytic factors and other factors.
Why does this clinical presentation happen? Portal HTN
This occurs with increased pressure in the portal vein, secondary to flow obstruction from inflammation/bands/fibrotic hepatic tissue.
Retrograde pressure can lead to esophageal/stomach/rectal varices.
What is Caput Medusae?
dilated cutaneous veins radiating from the umbilical (spider angiomas). Seen in cirrhosis
How would you treat portal HTN?
Surgical shunting.
TIPSS - transjugular intrahepatic portosytemic stent shunt
Why does this clinical presentation happen? Hepatorenal Syndrome
It’s a form of pre-renal failure caused by liver dysfunction. High mortality.
Presents with kidney failure
Why does this clinical presentation happen? Ascites
Fluid accumulation in the peritoneal space, secondary to decreased albumin production.
Fluid accumulation impacts respiratory and cardiac system.
Why does this clinical presentation happen? Infection
A liver cell, Kuppfer cell, cleans the blood of bacteria. Liver failure means increased risk of infection.
Pt has poor wound healing as ar esult too.
Read pathophysiology of liver dysfunction and failure.
Liver tissues are destroyed and replaced by fibrotic tissues. Functions altered, organ changes shape and vascular flow is obstructed, leading to portal HTN.
What are some functions of the Pancreas? (3)
- Synthesis and release of Glycogen, Insulin and Gastrin
- Pancreatic enzymes to break down protein, starch and fat
- Produce bicarbonate
What are the 3 pancreatic enzymes?
- Lipase
- Amylase
- Trypsin
LAT
What does Trypsin help digest?
Protein
What does amylase help digest?
Carb digestion
What does lipase help digest?
Fat
What occurs during Acute Pancreatitis?
Auto digest (too many enzymes produced, before it could leave the pancreas), occurs from BLOCKED enzyme release
Necrotizing Pancreatitis is shown by what two classic signs?
- Cullen’s Sign
- Grey Turner’s Sign
What is Cullen’s Sign?
Bluish discoloration of umbilical
What is Grey Turner’s Sign?
Bluish discoloration of the flank
*TURN around to see flank Turners
Why does hypocalcemia occur in pancreatits?
autodigestion of fat causes fatty acid that forms Ca salts. This then pulls Ca from the bloodstream
What are notable dx labs for pancreatitis?
- Hypocalcemia
- Hyperglycemia
- Elevated amylase
- Elevated lipase
- Elevated WBC
- Increased BUN & Creatinine
Why does dehydration occur pancreatitis?
3rd spacing around pancreas could cause dehydration. There’s increased BUN & Creatinine.
What’s the treatment options for pancreatitis?
- Fluid resuscitation
- NPO NGT, rest pancreas
- Pain management
- Monitor and repalce electrolytes
- Nutritional support
- Surgery
What’s more life threatening? Upper GIB or lower GIB?
Upper GIB.
Peptic Ulcer Disease accounts for 50% bleeding episodes.
What is Mallory-Weiss Syndrome?
Rip occurs at the esophagus GI junction. Can occur from repeated vomiting.
What are meds that may be used for GIB?
- H2 blockers, antacids, PPI
- Sucralfate
- Vasopressin: constricts splanchinic inflow to reduce protal pressure
- Somatostatin & Octreotide:
- Vasoconstricts splanchnic vessels to decrease blood flow
What are non pharmacological ways to treat GIB?
- NG decompression
- Fluid resuscitation
- Blood Product admin
- Endoscopic sclerotherapy
What does TIPSS stand for?
Transjugular INtrahepatic Portosytemic Stent Shunt
What does TIPPS do?
Rescue intervention to help with bleeding esophageal varices. It shunts blood, and help relieve fluid backup and could help stop bleeding.
Bowel infarctions occurs from embolic/thrombotic sources and typically occurs where?
Superior Mesenteric Artery
What are clinical symptoms of bowel infarction?
- severe epigastric pain
- rebound tenderness
- guarding and rigidity
stimulated sympathetic response from pain
similar to MI symptoms, without EKG changes
What are 2 treatment options for bowel infarcts/ischemia?
- angiography to id/confirm occlusion
- surgery to removed occlusion & dead bowel
What are typical assessment findings of large bowel obstruction?
- lower abd pain
- distention
- no vomiting
What are symptoms of SMALL intestinal obstruction like? compared to large intestine
- acute pain and sudden onset
- n&v
- hyperactive high pitched bowel sounds
- may have some gas/feces cuz of soem movement
-distention (mild)
Symptoms of large intestinal obstruction?
- slow onset pain from mild to severe
- no N&V
- no stool
- LOW PITCH BOWEL SOUNDS
- large distention
Treatment options for bowel obstructions?
similar to bleeds.
Pain management
fluids
bowel rest
decompression
abx
What is the Cullen’s Sign?
Bruising around the umbilicus. C around belly button. Indicates pancreatitis, GI hemorrhage etc
What is the Grey Turner’s Sign?
Bruising around the flank area. Think TURN to see bruising around flank
What is the Kehr’s Sign?
Elicited when pt is lying flat or in trendelenburg position.
Spleenic rupture results in blood irritating the diaphragm and pain appears in L shoulder.
