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01 CCRN Exam > Gastrointestinal > Flashcards

Gastrointestinal Flashcards

1
Q

What is the liver function? Read

A
  • Metabolism: carbs, fats and proteins
  • Clotting factor production
  • Bile salts production
  • Bilirubin metabolism
  • Detox
  • Vitamin and mineral storage
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2
Q

Liver dysfunction affects multiple bodily functions like : (4)

A
  • Coagulation
  • LOC
  • Substrate metabolism
  • Wound healing
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3
Q

Liver Function Tests involves:
Total Protein
Serum Albumin
Serum Globulins

A

Total Protein: 6-8 g:dL
Serum Albumin 3.5 -5 g/dL
Serum Globulins: 2.6-4.1 g/dL

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4
Q

What are the normal levels of Serum Ammonia?

A

19-60mcg/dL

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5
Q

Why does ammonia accumulate during liver disease?

A

The liver is unable to convert ammonia to urea, which is then excreted via the kidneys.

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6
Q

What will elevated NH3 levels lead to?

A

Hepatic encephalopathy and coma.

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7
Q

What are treatments for elevated ammonia?

A

Limit protein, give lactulose.
Potassium levels should be monitored since the body is less unable to handle NH3 during hypokalemic states.

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8
Q

What exactly is bilirubin?

A

Bilirubin is the waste product of RBCs being broken down.
The liver helps makes bilirubin from lipid soluble to water soluble.

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9
Q

If AST & ALT are elevated. What is the likely cause of liver damage if AST>ALT

A

Cirrhosis and metastatic cancer may be in the liver

*AST is more a sign of liver necrosis or other signs of failure

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10
Q

If AST & ALT are elevated. What is the likely cause of liver damage if ALT>AST

A

hepatitis, nonmalignant obstruction may be present in the liver.

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11
Q

What is the difference between cirrhosis and hepatitis?

A

Hepatitis is the inflammation of the liver.
Cirrhosis is non reversible damage, scarring of the liver.

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12
Q

Why is neomycin given in hepatic encephalopathy?

A

prophylatically prevent gut infection by killing the bacteria

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13
Q

What happens to NH3 levels at end stage liver disease?

A

It actually drops off because the liver is unable to break down protein anymore, thus not able to create by product of NH3

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14
Q

What are 7 clinical presentations of liver dysfunction?

A
  1. Hepatic encephalopathy
  2. Malnutrition
  3. Coagulopathy (bleeds more)
  4. Portal HTN
  5. Hepatorenal Syndrome
  6. Ascites
  7. Infection
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15
Q

Why does this clinical presentation happen? Coagulopathy

A

Liver can’t synthesize fibrinogen, prothrombin, vitamin K, fibrinolytic factors and other factors.

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16
Q

Why does this clinical presentation happen? Portal HTN

A

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.

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17
Q

What is Caput Medusae?

A

dilated cutaneous veins radiating from the umbilical (spider angiomas). Seen in cirrhosis

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18
Q

How would you treat portal HTN?

A

Surgical shunting.
TIPSS - transjugular intrahepatic portosytemic stent shunt

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19
Q

Why does this clinical presentation happen? Hepatorenal Syndrome

A

It’s a form of pre-renal failure caused by liver dysfunction. High mortality.

Presents with kidney failure

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20
Q

Why does this clinical presentation happen? Ascites

A

Fluid accumulation in the peritoneal space, secondary to decreased albumin production.

Fluid accumulation impacts respiratory and cardiac system.

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21
Q

Why does this clinical presentation happen? Infection

A

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.

22
Q

Read pathophysiology of liver dysfunction and failure.

A

Liver tissues are destroyed and replaced by fibrotic tissues. Functions altered, organ changes shape and vascular flow is obstructed, leading to portal HTN.

23
Q

What are some functions of the Pancreas? (3)

A
  1. Synthesis and release of Glycogen, Insulin and Gastrin
  2. Pancreatic enzymes to break down protein, starch and fat
  3. Produce bicarbonate
24
Q

What are the 3 pancreatic enzymes?

A
  • Lipase
  • Amylase
  • Trypsin

LAT

25
Q

What does Trypsin help digest?

A

Protein

26
Q

What does amylase help digest?

A

Carb digestion

27
Q

What does lipase help digest?

A

Fat

28
Q

What occurs during Acute Pancreatitis?

A

Auto digest (too many enzymes produced, before it could leave the pancreas), occurs from BLOCKED enzyme release

29
Q

Necrotizing Pancreatitis is shown by what two classic signs?

A
  1. Cullen’s Sign
  2. Grey Turner’s Sign
30
Q

What is Cullen’s Sign?

A

Bluish discoloration of umbilical

31
Q

What is Grey Turner’s Sign?

A

Bluish discoloration of the flank

*TURN around to see flank Turners

32
Q

Why does hypocalcemia occur in pancreatits?

A

autodigestion of fat causes fatty acid that forms Ca salts. This then pulls Ca from the bloodstream

33
Q

What are notable dx labs for pancreatitis?

A
  1. Hypocalcemia
  2. Hyperglycemia
  3. Elevated amylase
  4. Elevated lipase
  5. Elevated WBC
  6. Increased BUN & Creatinine
34
Q

Why does dehydration occur pancreatitis?

A

3rd spacing around pancreas could cause dehydration. There’s increased BUN & Creatinine.

35
Q

What’s the treatment options for pancreatitis?

A
  1. Fluid resuscitation
  2. NPO NGT, rest pancreas
  3. Pain management
  4. Monitor and repalce electrolytes
  5. Nutritional support
  6. Surgery
36
Q

What’s more life threatening? Upper GIB or lower GIB?

A

Upper GIB.
Peptic Ulcer Disease accounts for 50% bleeding episodes.

37
Q

What is Mallory-Weiss Syndrome?

A

Rip occurs at the esophagus GI junction. Can occur from repeated vomiting.

38
Q

What are meds that may be used for GIB?

A
  • H2 blockers, antacids, PPI
  • Sucralfate
  • Vasopressin: constricts splanchinic inflow to reduce protal pressure
  • Somatostatin & Octreotide:
  • Vasoconstricts splanchnic vessels to decrease blood flow
39
Q

What are non pharmacological ways to treat GIB?

A
  • NG decompression
  • Fluid resuscitation
  • Blood Product admin
  • Endoscopic sclerotherapy
40
Q

What does TIPSS stand for?

A

Transjugular INtrahepatic Portosytemic Stent Shunt

41
Q

What does TIPPS do?

A

Rescue intervention to help with bleeding esophageal varices. It shunts blood, and help relieve fluid backup and could help stop bleeding.

42
Q

Bowel infarctions occurs from embolic/thrombotic sources and typically occurs where?

A

Superior Mesenteric Artery

43
Q

What are clinical symptoms of bowel infarction?

A
  • severe epigastric pain
  • rebound tenderness
  • guarding and rigidity
    stimulated sympathetic response from pain

similar to MI symptoms, without EKG changes

44
Q

What are 2 treatment options for bowel infarcts/ischemia?

A
  • angiography to id/confirm occlusion
  • surgery to removed occlusion & dead bowel
45
Q

What are typical assessment findings of large bowel obstruction?

A
  • lower abd pain
  • distention
  • no vomiting
46
Q

What are symptoms of SMALL intestinal obstruction like? compared to large intestine

A
  • acute pain and sudden onset
  • n&v
  • hyperactive high pitched bowel sounds
  • may have some gas/feces cuz of soem movement
    -distention (mild)
47
Q

Symptoms of large intestinal obstruction?

A
  • slow onset pain from mild to severe
  • no N&V
  • no stool
  • LOW PITCH BOWEL SOUNDS
  • large distention
48
Q

Treatment options for bowel obstructions?

A

similar to bleeds.
Pain management
fluids
bowel rest
decompression
abx

49
Q

What is the Cullen’s Sign?

A

Bruising around the umbilicus. C around belly button. Indicates pancreatitis, GI hemorrhage etc

50
Q

What is the Grey Turner’s Sign?

A

Bruising around the flank area. Think TURN to see bruising around flank

51
Q

What is the Kehr’s Sign?

A

Elicited when pt is lying flat or in trendelenburg position.
Spleenic rupture results in blood irritating the diaphragm and pain appears in L shoulder.

01 CCRN Exam (17 decks)

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