Gastrointestinal Flashcards
Gastrointestinal Stress Ulcers
- Occur in critically ill patients
- take 5-7 days after hospitalization / critical illness to develop
- Prophylaxis: antacids, H2 blockers, PPIs
What are the main causes of peptic ulcer disease?
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- NSAIDs
- H. pylori
What is portal hypertension?
- narrowed portal vein
- leads to ↓ blood flow to the liver & ↑ pressure in the portal vein
What is the treatment for portal HTN & cirrhosis of the liver?
Trans jugular Intrahepatic Portosystemic Shunt (TIPS)
- connects the portal & hepatic veins
What is asterixis?
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Involuntary flapping of the hand
- found in encephalopathy
What is hematochezia?
Bright red, bloody stool
* lower GI bleed
What is melena?
dark, tarry stool
* upper GI bleed
What is fulminant hepatic failure (FHF)
Sudden onset of acute liver failure (1-3 weeks)
Hepatic encephalopathy (within 8 weeks)
impaired bilirubin conjugation
↓ production of clotting factors
* ↓ glucose synthesis
* ↓ lactate clearance
What are common symptoms of Fulminant Hepatic Failure (FHF)?
Similar to cirrhosis
- jaundice
- ascites
- confusion
- N/V
What is the treatment for Fulminant Hepatic Failure (FHF)?
- definitive tx = liver transplant
- Neomycin to ↓ bacterial flora
- Lactulose to ↓ bacterial growth (causes pt to excrete excess ammonia)
What is pancreatitis?
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loss of volume into retroperitoneal & peripancreatic spaces
Signs & Symptoms of Pancreatitis
HYPOCALCEMIA (↓ Ca+)
* + Chovsteck’s Sign (twitching facial nerve associated w/ hypocalcemia – chovsteck = cheek)
* + Trousseau Sign (tension of hand when BP cuff is inflated associated w/ hypocalcemia – trousseau =tension of hand)
- hypoxemia (↓ O2 in blood)
- hyperglycemia (↑ glucose)
- ARDS
- hypotension (↓ BP)
- acute tubular necrosis
Which two signs are associated with hypocalcemia due to acute pancreatitis?
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+ Chovsteck’s Sign
* twitching of facial nerve
* Covsteck = Cheek
+ Trousseau Sign
* carpel / pedal spasm when BP cuff is inflatted
* Troussea =Tension of hand
Which abnormal labs are associated wtih acute pancreatitis?
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- ↑ serum amylase
- ↑ serum lipase
Medical management of acute pancreatitis
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- Patient should be NPO (helps manage pain by minimizing pancreas stimulation & inhibiting autodigestion)
- Hypovolemic shock (due to ↓ volume into retroperitoneal & peripancreatic spaces)
What are the 2 most common types of injury secondary to blunt force trauma?
Spleen & liver injuries
What is the official way to diagnose a GI bleed?
Endoscopy
Which signs or symptoms are associated with splenic injuries?
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- Fractures at the 11th / 12th rib
- Kehr’s Sign (pain in L shoulder)
- LUQ Tenderness
What is Kehr’s Sign & what is it associated with?
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L shoulder pain
* associated with splenic injuries
What is the treatment for esophageal varicies?
TIPPS procedure
Management of a GI bleed
- 2 large bore IVs & fluid
- Monitor coagulation
- Intubate patient if they cannot maintain / protect their airway
Sign or Symptom associated with peritonitis
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Rigid board-like abdomen
What disease / disorder / complication is a rigid, board-like abdomen associated with?
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Peritonitis
Gastric contents in the peritoneum
What is Cullen’s sign & what is it associated with?
bluish / purple bruise / coloring around the umbilicus
- Sign of bleeding in the peritoneum
The nurse is monitoring a female patient with a diagnosis of peptic ulcer. Which assessment finding would most likely indicate perforation of the ulcer?
a.) Bradycardia
b.) Numbness in the legs
c.) Nausea & vomiting
d.) A rigid, board-like abdomen
d.) A rigid, board-like abdomen
