Gastrointestinal Flashcards
1
Q
Intestinal Infarction
A
- Occlusive: embolus or thrombosis to the superior mesenteric artery or major vessel; adequate CO
- Non-occlusive: associated with decreased CO or BPl ischemia secondary to low perfusion
- S/S: abdominal pain, vomiting, abdominal distention, diarrhea, fever
- Tx: adequate resuscitation
- Occlusive: angiogram - clot lysis, anticoagulation, thrombolytic therapy if present within 8 hours of symptoms
- non occlusive: vasodilator therapy to dilate the mesenteric arterial bed, surgery - resection, increase CO & perfusion to gut - (+) inotrope
- Both: manage pain, decompress stomach, gastric tube, resect infarcted bowel
2
Q
Bowel obstruction
A
- Causes: Adhesion from previous surgery, incarcerated hernia, tumors, ulcers, ileus, infections (abscesses, diverticulitis), opiates, volvulus (small intestines), intussusception
- Duodenal or proximal small bowel: vomiting, crampy, epigastric pain, dehydration, high-pitched bowel sounds, hypokalemia
- Distal small bowel or large bowel: vague abdominal pain, decreased passing of stool, constipation, vomiting (late) of fecal matter
- Both: decreased PO intake, fluid trapped in intestinal loops, early- BS increased, late - BS decreased
3
Q
Gastric perforation
A
- Rigid abdomen (guarding)
- Leakage of intestinal content into the peritoneum
- Systemic inflammatory response (SIRS) & infection: tachycardia, tachypnea, fever, leukocytosis & severe abdominal pain
- Elevated H&H - hemoconcentrated d/t dehydration
- Dx: free air in the abdomen
- Tx: surgery - abdominal wash out, adequate volume resuscitation, abx, gastric decompression, nutritional support
4
Q
Intra-Abdominal Hypertension (IAH)
A
- increased intra-abdominal pressure from 3rd spacing of fluids, capillary leak, associated with fluid resuscitation, inflammation
- S/S: abdominal distension, decreased UO, intra-abdominal pressure (IAP) >25 mmHg (normal 5-10), abdominal perfusion pressure (IAP-MAP) idealy >60
Respiratory compromise: SOB, increased RR, pressure on diaphragm, increased airway pressure, difficult ventilation
Hemodynamic effect: decreased venous return d/t pressure on IVC, decreased CO, increased afterload (SVR), increased preload (CVP/PAOP)
-Assess bladder pressure via bladder catheter, IAP>25 indication of Intra-abdominal compartment syndrome
- Decompressive laparotomy; the abdomen is left open for extreme cases
5
Q
Acute hepatic injury
A
- Inflammation, hepatic necrosis, no prior liver failure, encephalopathy & jaundice, no portal HTN
- # 1 DILI: acetaminophen OD
- S/S: Jaundice PLUS, increase in aminotransferases
6
Q
Chronic hepatic failure/advanced cirhosis
A
- Hepatic parenchymal cells destroyed, replaced with fibrotic tissue
- Constriction of blood flow leads to portal hypertension
- Encephalopathy, hepato-renal syndrome, high risk of developing liver carcinoma
- Causes: chronic ETOH, FAtty liver, advanced cirrhosis, hepatitis, hepatic tumors
- S/S: atrophied muscles, splenomegaly, distended abdomen (ascites), tissue paper-thin skin, hemorrhoids, jaundice, lower extremity edema, spider angiomas
- Labs:
Decreased - albumin, platelet & fibrinogen, Na, K, Mg, Ca, and glucose
Increased RBCs, varied WBC, hepatic transaminases, LFT, AST/ALT ratio >1, PTT/PT/INR, lactate, bilirubin, NH3, aldosterone & ADH - fluid retention - S/S: hypotension, GIB, weight loss, poor appetite, ascites (hydrostatic pressure pushes fluid into abdominal space), SOB (pressure from ascites pushes on diaphragm), portal HTN, poor renal perfusion, jaundice, neuro (lethargic, slow to respond, slurred speech, decreased LOC, asterixis - flapping hands, hepatic encephalopathy, cerebral edema, increased ICP, seizures, coma)
7
Q
Esophageal varices
A
- dilated, engorged submucosal veins in the mid to distal esophagus caused by chronic portal hypertension
- Elevated liver enzymes, bilirubin, coag times
- Quickly into hypovolemic, hemorrhagic shock
- Tx: difficult to control bleed, correct coag, airway protection, hemodynamic support, endoscopic banded ligation, sclerotherapy, octreotide, vasopressin to reduce portal HTN, beta blocker, nitrates, Transjugular Intrahepatic Portosystemic Shunting (TIPS), esophageal balloon for active bleeding
8
Q
Octreotide
A
- Long-acting
- Reduce portal venous pressure by inhibiting the release of glucagon, which is a splanchnic vasodilator
9
Q
Transjugular Intrahepatic Portosystemic Shunting (TIPS)
A
- Done in IR
- Blood directed from the portal vein to the hepatic vein to relieve pressure in the portal system
- Encephalopathy may develop or worsen
- For higher risk: uncontrolled bleeding
10
Q
Esophageal Balloon
A
- Minnesota or Blakemore tube
- 2 balloons: gastric & esophageal
- Tamponade bleeding area
- Placement verified via X-ray
- Airway protection: ET intubation, aspiration
- Safety: Scissors always at the bedside
- High incidence of re-bleed after removal
11
Q
Acute pancreatitis
A
- Digestive exocrine enzymes leak out and digest the pancreatic tissue –> triggers SIRS, capillary leak, vasodilation
- 2 most common causes of duct obstruction: chronic ETOH leads to structural changes to the pancreas, gall stones,
- S/S: Pain - upper abdomen that radiates to the back, tender & distended abdomen, decreased or absent bowel sounds, N/V, fever, tachycardia, hypotension, pleural effusion - Lt or BL d/t inflamed pancreas near the left diaphragm, elevated hemidiaphragm, atelectasis, phospholipase A release kills type II alveolar cells → ↓ surfactant → ARDS
- Lab: elevated amylase & lipase in blood and urine, hypocalcemia low albumin, hypokalemia, hypomagnesemia, leukocytosis, hypoxemia, hyperglycemia - likely need insulin, steatorrhea
-Tx: supportive, rest the pancreas, nutritional support (feed ASAP)
12
Q
Necrotizing pancreatitis
A
- Necrosis of the pancreas, peripancreatic tissue &fat
- Hemorrhage
- S/S hypovolemic shock
- Sequestration of fluids in the peritoneum
- Cullen’s sign - ecchymosis around umbilicus
- Grey-Turner - flank ecchymosis
- May appear within 1-2 weeks with hemorrhagic pancreatitis
13
Q
Kehr’s sign
A
- Left shoulder pain
- ruptured spleen
14
Q
Acute abdominal trauma
A
- Blunt abdominal trauma usually caused by MVA
- Spleen and liver are most commonly injured
- S/S: Kehr’s sign, seatbelt sign, Hypotension, abdominal distension, guarding/rebound tenderness
- Dx: Focused Assessment with Sonography for Trauma (FAST) to screen for abdominal hemorrhage, CT scan, H/H, UA
- Tx: severe - MTP, crystalloids, surgery - laparoscopy
15
Q
Abdominal compartment syndrome
A
- sustained intra-abdominal pressure >20 mmHg AND new organ dysfunction d/t intra-abdominal hypertension
- S/S: abdominal distension, progressive oliguria, increased ventilatory requirement, hypotension, tachycardia, increased JVD, peripheral edema, hypoperfusion - cool skin, restlessness, lactic acidosis
- Gold standard: urinary bladder pressure
record every 4 hours and if it is >20 mmHg, notify the provider
