Gastrointestinal part 1

Question 1

anatomy of the abdomen

Answer 1

RUQ:
pylorus, duodenum, liver, R kidney and adrenal gland, hepatic lexure of the colon, head of the pancreas

RLQ:
cecum, appendix, R ovary and fallopian tube (F), R ureter and lower kidney pole, R spermatic cord (M)

LUQ:
Stomach, spleen, L kidney and adrenal gland, splenic flexure of the colon, body of the pancreas

LLQ:
Sigmoid colon, L ovary and fallopian tube (F), L ureter and lower kidney pole, L spermatic cord (M)

Question 2

Upper GI hemorrhage

Answer 2

accounts for 80% of acute GI bleeds;
HIGHER MORTALITY (lower GI rarely requires an ICU admission)

causes:
peptic ulcer disease, esophageal, stress ulcers, mallory-weiss tear, cancer

management includes:
address the cause
isotonic fluids (as for hypovolemic shock)
PRBCs
replace clotting factors (FFP, platelets)
medications:
-vasopressin constricts the splanchnic arteriolar bed decreasing portal venous pressure (watch for chest pain, ST elevation)
-octreotide (Sandostatin) reduces splanchnic blood flow, gastic acid secretion, and GI motility
-osmotic laxatives (latulose) remove nitrogenous materials (blood) out of the gut to prevent ammonia conversion (esp important with liver disease)
-beta blockers constrict mesenteric arterioles thus reducing portal venous flow

Question 3

Lower GI bleed

Answer 3

accounts for 20%; usually does not require an ICU stay

causes:
diverticulitis, angiodysplasia (AVMs), tumor, radiation, colitis, crohn’s disease, infections such as C. diff and E. coli

Question 4

Esophageal varices

Answer 4

common cause is portal hypertension s/t liver disease; liver cirrhosis prevents normal drainage through the liver. Pressure backs up into the esophageal vein, like “hemorrhoids of the esophagus”

Venous drainage of the GI tract:
GI venous drainage -> portal vein -> liver -> hepatic vein -> inferior vena cava

treatment:
~general management of an upper GI bleed
~endoscopy procedure (banding or sclerosing of varices)
~esophageal balloon tamponade (Sengstaken-Blakemore tube)
- a gastic balloon is attached to suction and empties the stomach;
an esophageal balloon is prescribed by physician to control bleeding; if balloon is displaced, it may occlude the airway so cut the balloon if there is respiratory distress