Gastrointestinal

Question 1

Two causes of acute pancreatitis

Answer 1

Alcohol and gallbladder disease

Question 2

What are you looking for with peritoneal lavage?

Answer 2

Pink tinged fluid (bleeding)

Question 3

Normal Amylase Level

Answer 3

45-200 U/L

Question 4

Normal Lipase Level

Answer 4

0-110 U/L

Question 5

Normal AST

Answer 5

8-40 U/L

Question 6

Normal ALT

Answer 6

10-30 U/L

Question 7

Normal Hgb males & females

Answer 7

14-18 males, 12-16 female

Question 8

Normal hct for males & females

Answer 8

40-54% males and 38-47% females

Question 9

Why would hgb go up

Answer 9

dehydrated

Question 10

Why would hgb go down

Answer 10

bleeding

Question 11

Treatment for acute pacreatitis

Answer 11

NPO, NGT to suction, bed rest, morphine or dilaudid, fentanyl patches, steroids for inflammation, anticholinergics like benzotropine or atropine, pantoprazole, tidines, antacids, F&E balance, TPN, insulin, no alcohol

Question 12

S/sx of cirrhosis

Answer 12

firm and nodular liver, abdominal pain, chronic dyspepsia, bowel changes, ascites, splenomegaly, decrease albumin, increase ALT & AST, anemia, hepatic encephalopathy, coma, ammonia buildup (sedative like).

Question 13

Worried about what with liver biopsy

Answer 13

Bleeding!

Question 14

Positioning patient for liver biopsy

Answer 14

Preop: supine flat, put right arm above head. Exhale and hold breath to get diaphragm out of way. Postop: lie on right side b/c it puts pressure for bleeding.

Question 15

Diet for liver people

Answer 15

decrease protein, low sodium.

Question 16

What is fetor

Answer 16

Breath smells like ammonia (acetone, fresh cut grass, glass of wine).

Question 17

Main concern with varices

Answer 17

Bleeding—airway management!!!

Question 18

What is octreotide used for and what does it do

Answer 18

Used for variceal bleeds. Lowers the BP in the liver. Causes vasoconstriction.

Question 19

S/sx of peptic ulcer

Answer 19

Burning pain that usually on the mid-epigatric area/back, heartburn (dyspepsia)

Question 20

Perforation of esophagus s/sx & what do you do

Answer 20

pain, bleeding or trouble swallowing. Call the doctor.

Question 21

Treatment of peptic ulcers

Answer 21

liquid antacids (taken when stomach empty and at bedtime); PPIs, H2 antagonist, Gi cocktail, anbx for h pylori, sucralfate forms barrier over wound so acid doesnt get on ulcer. Decrease stress, no smoking, avoid extreme temp changes and spicy foods, avoid caffeine,

Question 22

For gastric ulcers, what happens & what helps?

Answer 22

laboring person, malnourished, pain usually 1/2 to 1 hr after meals, food doesnt help, Throwing up helps, blood in vomit

Question 23

For duodenal ulcers, what happens & what helps?

Answer 23

Executives; well-nourished, night time pain is common and 2-3 hrs after meals, food helps, blood in stool;

Question 24

Treatment for hiatal hernia

Answer 24

small meals, sit up after eating for 1 hr, elevate HOB, surgery, lifestyle changes

Question 25

What is dumping syndrome

Answer 25

Stomach empties too quickly and experiences severe side effects (fullness, palpitations, faintness, weak, cramping, diarrhea)

Question 26

Treatmnt for dumping syndrome

Answer 26

Semi recumbant with meals, lie down after meals, no drinkis with foods, decrease caqrbs (empty fast)

Question 27

Ulcerative colitis

Answer 27

Just in the large intestine

Question 28

Chrons disease

Answer 28

inflammation and erosion of the ileum; can be found anywhere

Question 29

Colonoscopy pre and post op teaching

Answer 29

Clear liquid for 12-24 hrs, NPO 6-8 hrs preop, avoid nsaids, laxatives or enema until clear, go lytely (mixed and fridgerated, tolerate better cold, no straws), postop watch for perforation

Question 30

Ileostomy care

Answer 30

Drain fluids all the time, avoid foods hard to digest, rough foods increase motility, gatorade in summer (dehydrated), at risk for kidney stones

Question 31

Why would you irrigate a colostomy

Answer 31

For regularity. Do every day at the same time and after a meal.

Question 32

what do you do when patient has pain during irrigation of colostomy?

Answer 32

Slow down, stop it, check temp, and lower bag

Question 33

Appendicitis is related to what?

Answer 33

Low fiber diet

Question 34

What do you check urine for with TPN?

Answer 34

Glucose and ketones —give fat emulsions (lipids) for ketones, give insulin for glucose

Question 35

Central line technique

Answer 35

Have saline for flush, do not start fluids until have positive confirmation by CXR, Put in trendelenburg to distend veins, have help, sterile procedure

Question 36

If air gets in central line, what do you do?

Answer 36

Put on left side trendelenburg