GI 1 Flashcards
whenever there is pressure within the abdomen..
puts pressure on kidneys and gut which causes GI tract to stop working
when the GI tract stops working…
- decrease peristalsis (cause peritoneal ileus)
- fluid backs up, cannot be absorbed (fluid is dumped)
- no bowel sounds, hard/rigid abdomen, cannot get rid of back products
if no bowel sounds…
Emergency if NO bowel sounds (remove fluid and decompress it)
if gut dies…
you die (liver and kidneys will stop functioning)
what meds often cause GI bleeds
- *ulceration in stomach (aspirin and NSAIDS)
- NSAIDS will cause holes in stomach (decrease prostaglandins which are what line stomach to prevent acid from eating stomach)
- acid that is not contained causes holes in stomach and GI bleeding
why do esophageal problems cause GI bleeding
- normal stomach acid is 2
- if it is refluxed up to the esophagus (where it is normally only equipped for a pH of 5) will cause ulceration and eventual hole/bleeding
generalized first step if GI bleed suspected
where is it occuring and why??
how long does it take for food to get through the stomach
2 hrs
generalized causes of GI bleeds
esophageal, gastric, duodenal
describe dumping syndrome
- occurs from insulin, stomach empties food too quickly into small intestine
- Stomach is small and when you put food in it it triggers the pancreas to release insulin
- s/s: cold, clammy, drop in BP
common symptoms with GI bleed
Hematemesis, hematochezia and melena (black tarry)
Anemia
hematemesis is from what
is from source above ligament of Treitz
where does coffee ground emesis come from
- STOMACH
- comes from when gastric acid mixes with blood and causes partial decomposition
what does black blood mean
means that there is long transit through the GI tract
what does melena mean
black tarry stools
usually upper GI bleed
maroon or bright red means
means that there is little contact with gastric acid (small intestine or colon)
GI bleed s/s
- Tachycaardia, othrostatic hypotension
- Dizziness and orthostatic changes indicate 15% blood loss
- if 40% blood loss, have angina, cyanosis and altered mental status
- Check for rigid board like abdomen
what to watch for if GI bleed
Watch for hypokalemia and hypernatremia
treatment of GI bleed
- Fluid resuscitation
- O2
- Type and cross
- PRBC’s for Hgb 7 g/dl or less
- Foley to monitor output
- Platelets and clotting factors may be needed
- Ca replacement if large amounts of blood, citrate binds to Ca and causes hypocalcemia.
blood loss of what requires blood transfusion
blood loss of greater than 1500ml requires blood replacement
general treatment for GI bleed
find bleed (angiography) and stop it (surgery)
why is air in the colon bad
(no fluid, not moving)
diagnosis of abdominal obstruction
abd. x ray
mechanical causes of bowl obstructions
hernia, intussusceptions, volvulus
what is a hernia
abnormal protrusion through the abdominal wall
what is volvulus
torsion of a loop of intestine causing an obstruction (may also have strangulation)
intussusception
the prolapse of the intestine into the lumen of the immediate adjacent part
what to remember about intestinal obstructions
- Can occur in both the large and small bowel
- Recognizing the obstruction quickly is important, as the mortality rate with a strangulated obstruction is very high
- Location, Degree of obstruction and Presence of ischemia are all important factors
- remove obstruction, maybe with surgery
extrinsic lesions that cause bowel obstructions
hernia, adhesions, volvulus, tumors, abscesses and aneurysms
intrinsic lesions that cause bowel obstructions
Adenocarcinoma, lymphosarcomas, crohn’s disease, radiation injury, diverticulitis, gastroenteritis, pelvic inflammatory disease, intussusception, hemotoma from abdominal trauma
mechanical cuases of bowel obstruction
things in the gut (tumor/food. Backed up barium
nonmechanical causes of bowel obstruction
drugs or anesthesia
