Gastrointestinal

Question 1

Gastrointestinal Stress Ulcers

Answer 1

• Occur in critically ill patients
• take 5-7 days after hospitalization / critical illness to develop
• Prophylaxis: antacids, H2 blockers, PPIs

Question 2

What are the main causes of peptic ulcer disease?

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Answer 2

• NSAIDs
• H. pylori

Question 3

What is portal hypertension?

Answer 3

• narrowed portal vein
• leads to ↓ blood flow to the liver & ↑ pressure in the portal vein

Question 4

What is the treatment for portal HTN & cirrhosis of the liver?

Answer 4

Trans jugular Intrahepatic Portosystemic Shunt (TIPS)

• connects the portal & hepatic veins

Question 5

What is asterixis?

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Answer 5

Involuntary flapping of the hand

• found in encephalopathy

Question 6

What is hematochezia?

Answer 6

Bright red, bloody stool
* lower GI bleed

Question 7

What is melena?

Answer 7

dark, tarry stool
* upper GI bleed

Question 8

What is fulminant hepatic failure (FHF)

Answer 8

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

Question 9

What are common symptoms of Fulminant Hepatic Failure (FHF)?

Answer 9

Similar to cirrhosis

• jaundice
• ascites
• confusion
• N/V

Question 10

What is the treatment for Fulminant Hepatic Failure (FHF)?

Answer 10

• definitive tx = liver transplant
• Neomycin to ↓ bacterial flora
• Lactulose to ↓ bacterial growth (causes pt to excrete excess ammonia)

Question 11

What is pancreatitis?

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Answer 11

loss of volume into retroperitoneal & peripancreatic spaces

Question 12

Signs & Symptoms of Pancreatitis

Answer 12

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

Question 13

Which two signs are associated with hypocalcemia due to acute pancreatitis?

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Answer 13

+ Chovsteck’s Sign
* twitching of facial nerve
* Covsteck = Cheek

+ Trousseau Sign
* carpel / pedal spasm when BP cuff is inflatted
* Troussea =Tension of hand

Question 14

Which abnormal labs are associated wtih acute pancreatitis?

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Answer 14

• ↑ serum amylase
• ↑ serum lipase

Question 15

Medical management of acute pancreatitis

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Answer 15

• Patient should be NPO (helps manage pain by minimizing pancreas stimulation & inhibiting autodigestion)
• Hypovolemic shock (due to ↓ volume into retroperitoneal & peripancreatic spaces)

Question 16

What are the 2 most common types of injury secondary to blunt force trauma?

Answer 16

Spleen & liver injuries

Question 17

What is the official way to diagnose a GI bleed?

Answer 17

Endoscopy

Question 18

Which signs or symptoms are associated with splenic injuries?

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Answer 18

• Fractures at the 11th / 12th rib
• Kehr’s Sign (pain in L shoulder)
• LUQ Tenderness

Question 19

What is Kehr’s Sign & what is it associated with?

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Answer 19

L shoulder pain
* associated with splenic injuries

Question 20

What is the treatment for esophageal varicies?

Answer 20

TIPPS procedure

Question 21

Management of a GI bleed

Answer 21

• 2 large bore IVs & fluid
• Monitor coagulation
• Intubate patient if they cannot maintain / protect their airway

Question 22

Sign or Symptom associated with peritonitis

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Answer 22

Rigid board-like abdomen

Question 23

What disease / disorder / complication is a rigid, board-like abdomen associated with?

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Answer 23

Peritonitis

Gastric contents in the peritoneum

Question 24

What is Cullen’s sign & what is it associated with?

Answer 24

bluish / purple bruise / coloring around the umbilicus

• Sign of bleeding in the peritoneum

Question 25

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

Answer 25

d.) A rigid, board-like abdomen