Gastrointestinal

Question 1

What is pancreatitis?

Answer 1

Auto-digestion of the pancreas. Obstruction in the pancreatic ducts (scar tissue, stones) leads to occlusion. Digestive enzymes become trapped and activate, digesting the pancreas itself. Very painful!

Question 2

What is the #1 cause of pancreatitis?

Answer 2

Gallbladder disease. Second cause is alcoholism.

Question 3

S/S of pancreatitis?

Answer 3

• pain that increases with eating
• ascites
• abdominal mass (swollen pancreas)
• rigid, board-like abdomen with guarding (indicates bleeding that could lead to peritonitis)
• Cullen’s sign (bruising around umbilicus)
• Grey-Turner’s sign (bruising in the flank area)
• fever
• nausea/vomiting
• jaundice (liver is involved)
• hypotension from bleeding or ascites

Question 4

What procedure is used to determine causes of abdominal bleeding?

Answer 4

DPL “Diagnostic Peritoneal Lavage”

Question 5

Are digestive enzymes normally in the blood?

Answer 5

No. Elevated serum lipase and amylase indicate pancreatic problems.

Question 6

What is diagnostic for pancreatitis?

Answer 6

• elevated serum lipase and amylase
• elevated WBCs
• elevated blood sugar
• elevated liver enzymes (ALT, AST)
• prolonged PT, aPTT
• increased bilirubin
• increased hemoglobin and hematocrit with dehydration
• decreased hemoglobin and hematocrit with bleeding

Question 7

What is treatment for pancreatitis?

Answer 7

• fluid resuscitation for acute pancreatitis is first intervention
• NGT to suction to decrease gastric secretions
• PCA narcotics for pain
• anticholinergics to dry them up
• GI protectants
• insulin as needed
• TPN as needed
• daily weights and I/Os
• eliminate alcohol

Question 8

What organ synthesizes albumin?

Answer 8

The liver

Question 9

What is portal hypertension?

Answer 9

Elevated blood pressure in the liver. Occurs as a result scar tissue that alters liver circulation.

Question 10

What is the antidote for acetaminophen overdose?

Answer 10

acetylcysteine (Mucomyst)

Question 11

What builds up in the blood with liver problems?

Answer 11

Ammonia

Question 12

What is a major cause of ascites?

Answer 12

Decreased albumin. Fluid cannot remain in the vascular space without albumin, so it shifts into the tissues.

Question 13

Ammonia acts like a ___?

Answer 13

Sedative. Hepatic coma can result from ammonia buildup.

Question 14

How is cirrhosis of the liver diagnosed?

Answer 14

• Ultrasound
• CT, MRI
• labs (increased AST/ALT, decreased albumin)
• liver biopsy CONFIRMS diagnosis

Question 15

How is a patient positioned during and after a liver biopsy?

Answer 15

During: supine with right arm behind head
After: lateral on right side to hold pressure

Question 16

What medication decreases serum ammonia?

Answer 16

Lactulose

Question 17

What causes esophageal varices?

Answer 17

Portal hypertension.

Question 18

What are esophageal varices?

Answer 18

Basically internal hemorrhoids.

Question 19

What is a Sengstaken-Blakemore tube?

Answer 19

A type of balloon tamponade use infrequently as an emergency procedure to stabilize clients with hemorrhage from esophageal varices.

Question 20

How often is TPN adjusted?

Answer 20

Daily, according to electrolytes.

Question 21

What is the most common complication of TPN?

Answer 21

Infection due to high glucose levels.

Question 22

Is a filter needed with TPN?

Answer 22

Yes

Question 23

What is the FIRST intervention if a patient is suspected of having an air embolism caused by a displaced central line?

Answer 23

Clamp off the tube! Encourage valsava.

Question 24

What position do you place a patient suspected of air embolism?

Answer 24

Left side trendelenburg.

Question 25

How should a patient be positioned for removal of a central line?

Answer 25

Lie flat and valsalva, apply occlusive dressing for at least 24 hours.

Question 26

How long does it take serum amylase level to return to normal in a patient with acute pancreatitis?

Answer 26

3 - 4 days.

The serum amylase initially rises within 2-12 hours of onset, but with treatment it will take 3-4 days to return to baseline.