GI Flashcards
Causes of upper GI bleed?
- Peptic ulcer
- Esophageal
- Stress ulcers
- Mallory-Weiss tear
- Cancer
*~80% of GI bleeds are upper and are more dangerous
Causes of lower GI bleed?
- Diverticulosis
- AVMs
- Tumors
- Radiation
- Colitis
- Inflammation (Crohn’s)
- Infection (c diff, ecoli)
Reduces splanchnic blood flow, gastric acid secretion, and GI mobility.
Octreotide (Sandostatin)
Removes nitrogenous materials (blood) out of gut to prevent ammonia conversion which is important in liver disease.
Osmotic laxatives (sorbitol)
Why might beta blockers be given for GI bleed?
They constrict mesenteric portal venous flow.
What do you do if esophageal balloon is causing respiratory distress?
Cut the balloon
What are the exocrine functions of the pancreas?
-Secretes bicarb (to neutralize stomach acid), H2O, Na, K, digestive enzymes (trypsin, amylase, lipase)
What are the endocrine functions of the pancreas?
- Alpha cells: recreate glucagon
- Beta cells: secrete insulin
- Delta cells: inhibit recreation of above
Diffuse inflammation, destruction, and auto-digestion of the pancreas from premature activation of exocrine enzymes.
- Up to 6L of fluid may be recreated into interstitial spaces.
- Results in SIRS
Pancreatitis
What are complications of acute pancreatitis?
Atelectasis left lower lobe, left pleural effusion, bilateral crackles, ARDS (phospholipase A released which kills type II alveolar cells -> decrease surfactant)
What are the signs and symptoms of acute pancreatitis?
- Pain radiates to all quadrants
- Rigid abdomen
- No rebound tenderness
- Increase WBC
- Increase amylase (peaks in 4-24 hours, returns to normal in 4 days)
- Increase lipase (stays elevated longer than amylase)
- Decrease calcium (used for autodigestion)
- Increase blood sugar (beta cell injury)
Bluish discoloration and ecchymosis of periumbilical area caused by intraperitoneal bleeding.
Cullen’s Sign
Forms from digested blood and tracks around the abdomen from the inflamed pancreas
Methemalbumin
-Happens in acute pancreatitis
Bluish discolaration of flanks
Turner’s Sign
-Present in hemorrhagic pancreatitis
The more criteria present, the more severe the acute pancreatitis and increased morbidity
Ranson’s Criteria
At admission: -Age >55 -WBC >16 -Glucose >200 -LDH >350 AST >250
During next 48 Horus:
- Hct decreases to >10
- BUN increases >5
- Fluid sequestion >6
- Ca <8
- PaO2 <60
- Base deficit >4
Treatment for pancreatitis:
- Fluid replacement
- Replace K, Mg, & Ca
- H2 blockers of PPI
- NG to suction
- Enteral feed PP
Flappy hand tremor seen in liver failure due to elevated ammonia (NH3)
Asterixis
Why does ascites happen in liver failure?
Low albumin and protein
Why does jaundice occur?
Elevated bilirubin
What factors increase ammonia?
- Low K (causes ammonia genesis in the kidneys)
- Increase BUN (breakdown of nitrogen)
- Increase protein (breakdown of nitrogen, restrict only if encephalopathy present)
- Increase lactic acidosis (may get worse with LR)
Kills bacteria in the gut that produces ammonia.
Neomycin
-Complications of giving: vitamin D deficiency
Procedure for select patient with cirrhosis to relieve esophageal varies or ascites.
Transjugular intrahepatic porto-system shunt (TIPS procedure)
How can a TIPS procedure cause encephalopathy?
The stent inserted during the procedure allows shunting of blood directly from hepatic veins into the portal vein thus bypassing the liver and not getting detoxified.
-May need to medically manage or decrease diameter of stent
Sharp pain in the left shoulder caused by splenic rupture.
Kehr’s Sign
-Will also have distended abdomen when the spleen ruptures
What is elevated intra-abdominal hypertension (IAP)?
IAP > 12-15 mmHg
Difference between MAP and IAP
Abdominal perfusion pressure (APP)
- APP 60 mmHg or > associated with improved survival
- APP 50 or < is associated with increased mortality
Is a sustained IAP of >20 mmHg with or without an APP of 60 mmHg and is associated with new organ dysfunction or failure.
Abdominal compartment syndrome (ACS)
Where do you level transducer for bladder pressures?
Symphysis pubis
What are some common complications from bariatric surgery?
- Malabsorption: vitamin supplements (protein, Ca, iron, B12, folate)
- Gallstones (~52% within 1 year)
- Bowel obstruction from scar tissue
What type of pain is associated with bowel infarction?
Severe cramping - periumbilical or diffuse.
Small bowel obstruction clinical picture:
- Sharp, episodic pain
- Vomiting (early)
- Low K
- High pitched bowel sounds (increase early, decrease late)
Large bowel obstruction clinical picture:
- Dull pain
- Change in bowel habits
- Vomiting (late)
- Abdominal distention
- Low-pitch bowel sounds if any
Clinical presentation with bowel perforation:
- Abdominal pain, tenderness that increases with coughing or hip flexion.
- Rigid abdomen, “boardlike”
- Rebound tenderness
- Fever
Treatment of bowel perforation:
- Surgery then temporary bowel diversion to allow for anastomosis to heal.
- Antibiotic lavage during surgery
