GI 1 Flashcards by Ally Frazier

what is appendicitis?

the inflammation of the vermiform appendix & classified as simple, gangrenous, or perforated.

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appendicitis is most common in who?

young adults, especially men

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what are some common s/sx of appendicitis?

RLQ pain
McBurneys point
rebound tenderness
low grade fever
high WBC (10,000)
shift to the left (increase in bands)
-rupture is peritonitis

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what is McBurney’s point?

halfway between the R anterior iliac crest & umbilicus

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what are some s/sx of peritonitis?

abdominal pain (generalized)
high temp
higher WBC (20,000)
infection/sepsis

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how do we treat appendicitis?

must be rapid, include antibiotics & may have drain in incision or open incision

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what nursing interventions can be done for someone with appendicitis?

Avoid laxatives, enemas, or heat as may cause rupture of appendix.
pt is NPO. I & O & IV fluids to prevent dehydration.
Monitor bowel movements & signs of return of peristalsis.
Ambulate ASAP after surgery; usually within 8 to 12 hours.
Semi-Fowler’s position to ↓ pain & promote drainage to prevent fluid accumulation.

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what is cholecystitis?

inflammation of the gallbladder, either calculous or acalculous

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what is calculous cholecystitis?

hemical irritation and inflammation from cholelithiasis (stones in the gallbladder, usually formed of cholesterol when bile becomes supersaturated with cholesterol) or choledocholithiasis (stones in the common bile duct)

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what is acalculous cholecystitis?

inflammation occurring without gallstones, typically associated with biliary stasis.

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cholecystitis is common in who?

4x more common in women (ages of 40-50):
-fair, fertile, overweight, forty or older

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what are some s/sx of cholecystitis?

RUQ pain/ rebound tenderness (Blumberg’s sign)
Murphy’s sign
steatorrhea (fatty stool)
may have a fever

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what is Blumberg’s sign?

RUQ - rebound tenderness – called Blumberg’s sign; may radiate to shoulder
-cholecystitis

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what is murphy’s sign?

patient stops breathing during palpation just below right costal margin.
-cholecystitis

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how do diagnose cholecystitis?

-Ultrasound determines gallstones and is best initial diagnostic test.

-HIDA (hepatobiliary) scan

-ERCP (endoscopic retrograde cholangiopancreatography) or MRCP

-Lab Values:
– WBC elevated - indicates inflammation.
–↑ amylase and/or lipase- indicates pancreatic involvement (stones in common bile duct).
– ALP (alkaline phosphatase), AST & bilirubin may be elevated (direct & indirect) if obstruction of the
common bile duct & liver involvement.

-Gallbladder X-ray test

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what is a HIDA?

(hepatobiliary) scan: visualizes gallbladder and determines patency of biliary system.

what is a ERCP? or MRCP?

(endoscopic retrograde cholangiopancreatography)
(magnetic resonance
cholangiopancreatography).

Pt. swallows a long, thick, lighted flexible tube connected to a computer and monitor. Dye is injected that stains the bile ducts. Stones can be removed. Assess gag reflex following test.

what does gallbladder x-ray test tell us?

radiopaque tablets are taken the evening before so that the gallbladder will be visible on x-
ray examination; this test may be done if the ultrasonography is inconclusive.

how do we differenciate between cholecystitis & biliary obstruction?

-cholecystitis/cholelithiasis
–Pain RUQ (2-4 hours after eating high-fat) that may radiate to the R shoulder or back. Discomfort is
experienced because bile flow into the intestine is obstructed.

-choledocholithiasis (stone in the common bile duct)
–pain
–Jaundice due to obstruction/hepatocellular damage. When the common bile duct is completely obstructed, the bile is unable to pass into the duodenum & is absorbed into the blood.
–lab values: amylase, ALP, bilirubin
–feces - clay colored
–pruritis – itching due to accumulation of bile salts under the skin

how do we treat cholecystitis?

surgery
–cholecystectomy
–choledochotomy (remove stones)

ABO

antispasmodics, anticholinergics
–reduce the contraction of the gallbladder

morphine or another opioid

lithotripsy (breaks up stones)

biliary catheter drain

what are some nursing interventions for cholecystitis?

-low fat healthy diet
-assess liver or pancreatic involvement
-assess bowel sounds
-NPO, NG, F & E balance, TCDB & IS
-semi-fowlers
-may have a t-tube

what is the patho of pancreatitis? how does this cause problems?

Auto-digestion: injury permits digestive enzymes to leak into pancreatic tissue, then break down
tissue & cell membranes in the organ & causes vascular damage, edema, hemorrhage, & necrosis → trypsin (initiates pancreatic digestion & activates lactase, which dissolve the elastic fibers of the blood vessels within the pancreas causing hemorrhage), kinins (causes vasodilation and ↑ capillary/vascular permeability), & phospholipase (causes necrosis of the pancreas).
As more cells are destroyed, more enzymes are released, causes ↑ inflammation of the peritoneum and the pancreas. Drainage may collect into abscesses, which can eat through the bowel & trigger sepsis.
In severe acute pancreatitis, total auto-digestion & pancreatic destruction may lead to diabetic ketoacidosis, shock, coma, & death.

what causes pancreatitis?

acute- Obstruction of pancreatic or common bile duct (e.g. biliary stones, stasis) and alcohol consumption

chronic- heavy alcohol consumption

what are some s/sx of pancreatitis?

-pain (mid-epigastric or LUQ)
-jaundice
-N/V
-fever
-hypotension, hypovolemia, respiratory distress & electrolyte imbalances.
-hyperglycemia
-steatorrhea

what is common result from chronic pancreatitis shown by grey turner's and cullen's sign? What are those?

pancreatic hemorrhage -Grey Turner’s sign: a gray-blue discoloration of the flank -Cullen’s sign: a gray-blue discoloration around the umbilicus

how do we diagnose pancreatitis?

1. Lab values --Pancreatic enzymes: amylase, lipase --Hyperglycemia --Calcium-forming complexes develop because fatty acids have been set free from retroperitoneal fat by lipase, which causes hypocalcemia. Pt may have s/sx of ↓ Ca++. --WBC elevation --Liver function tests (LDH, AST) may be elevated in alcoholic liver disease & acute pancreatitis 2. Imaging --Abdominal ultrasound --Contrast-enhanced CT – more reliable

how do we treat pancreatitis?

-NPO with gastric suction to suppress enzymes & ↓ pancreatic stimulation -Pancreatic enzyme supplement for pancreatic insufficiency -Low fat diet to reduce discomfort & steatorrhea -Meds a. Histamine blockers & antacids are used to ↓ gastric secretions b. Anti-emetics & analgesics such as morphine or other opioid c. Anticholinergic drugs to ↓ vagal stimulation, inhibit pancreatic enzyme secretion, & relieve spasms 6. Operative procedures - pancreatic resection of the head, body, tail, or total removal of the pancreas (pancreatotomy), which results in compromised pancreatic function.

what are some nursing interventions for pancreatitis?

-assess for fluid deficit, F+E imbalance -resp. assessment -assess bowel tones -Nutritional support - TPN (monitor glucose levels) or NG/Peg feedings. Clear liquids → small amts of CHO → bland low-fat/protein while gradually ↑ CHO. Avoid large meals, alcohol & caffeinated beverages. -rest periods -monitor for complications

what are the common complications from pancreatitis and or/ pancreatic surgery?

pancreatic abscess (most serious); the most common fatal complications of severe pancreatitis are hypovolemia & hyperglycemia.

what is diverticulosis and diverticulitis?

 diverticulosis: multiple diverticula.  diverticulitis: inflammation of diverticula.

who commonly has diverticulosis/itis?

common after age 65 2/3 of adults > 80 have diverticulosis

what are the s/sx of diverticulosis/itis?

no s/sx unless complications occur 1. Constipation, diarrhea, & flatulence. 2. Acute LLQ abd pain - may be relieved by a BM or passing flatus. 3. S/sx may ↑ after a meal or activities causing ↑ intra-abd pressure. 4. May see rectal bleeding or fever if infection present.

whata re common complications of Diverticulosis/Diverticulitis?

-retained, undigested food in diverticular sac, resulting in a hard mass, causing abscess, fistulas, bowel obstruction, peritonitis, & hemorrhage.

how do we disgnose Diverticulosis or Diverticulitis?

how do we treat Diverticulosis or Diverticulitis?

what are some nursing interventions for Diverticulosis Diverticulitis?

1. Treat & watch for s/sx of complications 2. Encourage:  A soft high fiber diet if a diagnosis of diverticulosis  NPO if a diagnosis of diverticulitis  Fluids (at least 8 glasses per day)  Maintenance: high vegetable fiber diet – seeds? 3. Teach importance of:  Avoid ↑ intra-abd pressure (e.g. constipation, tight belts, restrictive clothing & improper lifting techniques; however low-impact weight lifting is acceptable)  Encourage activities that ↑ peristalsis (e.g. walking & ↑ fluids)  Importance of having a daily BM & weight loss  Notifying the physician of changes in bowel elimination patterns or characteristics, fever, or abd pain.