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CCRN > GI > Flashcards

GI Flashcards

1
Q

Causes of upper GI bleed?

A
  • Peptic ulcer
  • Esophageal
  • Stress ulcers
  • Mallory-Weiss tear
  • Cancer

*~80% of GI bleeds are upper and are more dangerous

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2
Q

Causes of lower GI bleed?

A
  • Diverticulosis
  • AVMs
  • Tumors
  • Radiation
  • Colitis
  • Inflammation (Crohn’s)
  • Infection (c diff, ecoli)
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3
Q

Reduces splanchnic blood flow, gastric acid secretion, and GI mobility.

A

Octreotide (Sandostatin)

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4
Q

Removes nitrogenous materials (blood) out of gut to prevent ammonia conversion which is important in liver disease.

A

Osmotic laxatives (sorbitol)

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5
Q

Why might beta blockers be given for GI bleed?

A

They constrict mesenteric portal venous flow.

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6
Q

What do you do if esophageal balloon is causing respiratory distress?

A

Cut the balloon

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7
Q

What are the exocrine functions of the pancreas?

A

-Secretes bicarb (to neutralize stomach acid), H2O, Na, K, digestive enzymes (trypsin, amylase, lipase)

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8
Q

What are the endocrine functions of the pancreas?

A
  • Alpha cells: recreate glucagon
  • Beta cells: secrete insulin
  • Delta cells: inhibit recreation of above
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9
Q

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
A

Pancreatitis

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10
Q

What are complications of acute pancreatitis?

A

Atelectasis left lower lobe, left pleural effusion, bilateral crackles, ARDS (phospholipase A released which kills type II alveolar cells -> decrease surfactant)

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11
Q

What are the signs and symptoms of acute pancreatitis?

A
  • 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)
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12
Q

Bluish discoloration and ecchymosis of periumbilical area caused by intraperitoneal bleeding.

A

Cullen’s Sign

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13
Q

Forms from digested blood and tracks around the abdomen from the inflamed pancreas

A

Methemalbumin

-Happens in acute pancreatitis

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14
Q

Bluish discolaration of flanks

A

Turner’s Sign

-Present in hemorrhagic pancreatitis

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15
Q

The more criteria present, the more severe the acute pancreatitis and increased morbidity

A

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
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16
Q

Treatment for pancreatitis:

A
  • Fluid replacement
  • Replace K, Mg, & Ca
  • H2 blockers of PPI
  • NG to suction
  • Enteral feed PP
17
Q

Flappy hand tremor seen in liver failure due to elevated ammonia (NH3)

A

Asterixis

18
Q

Why does ascites happen in liver failure?

A

Low albumin and protein

19
Q

Why does jaundice occur?

A

Elevated bilirubin

20
Q

What factors increase ammonia?

A
  • 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)
21
Q

Kills bacteria in the gut that produces ammonia.

A

Neomycin

-Complications of giving: vitamin D deficiency

22
Q

Procedure for select patient with cirrhosis to relieve esophageal varies or ascites.

A

Transjugular intrahepatic porto-system shunt (TIPS procedure)

23
Q

How can a TIPS procedure cause encephalopathy?

A

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

24
Q

Sharp pain in the left shoulder caused by splenic rupture.

A

Kehr’s Sign

-Will also have distended abdomen when the spleen ruptures

25
Q

What is elevated intra-abdominal hypertension (IAP)?

A

IAP > 12-15 mmHg

26
Q

Difference between MAP and IAP

A

Abdominal perfusion pressure (APP)

  • APP 60 mmHg or > associated with improved survival
  • APP 50 or < is associated with increased mortality
27
Q

Is a sustained IAP of >20 mmHg with or without an APP of 60 mmHg and is associated with new organ dysfunction or failure.

A

Abdominal compartment syndrome (ACS)

28
Q

Where do you level transducer for bladder pressures?

A

Symphysis pubis

29
Q

What are some common complications from bariatric surgery?

A
  • Malabsorption: vitamin supplements (protein, Ca, iron, B12, folate)
  • Gallstones (~52% within 1 year)
  • Bowel obstruction from scar tissue
30
Q

What type of pain is associated with bowel infarction?

A

Severe cramping - periumbilical or diffuse.

31
Q

Small bowel obstruction clinical picture:

A
  • Sharp, episodic pain
  • Vomiting (early)
  • Low K
  • High pitched bowel sounds (increase early, decrease late)
32
Q

Large bowel obstruction clinical picture:

A
  • Dull pain
  • Change in bowel habits
  • Vomiting (late)
  • Abdominal distention
  • Low-pitch bowel sounds if any
33
Q

Clinical presentation with bowel perforation:

A
  • Abdominal pain, tenderness that increases with coughing or hip flexion.
  • Rigid abdomen, “boardlike”
  • Rebound tenderness
  • Fever
34
Q

Treatment of bowel perforation:

A
  • Surgery then temporary bowel diversion to allow for anastomosis to heal.
  • Antibiotic lavage during surgery

CCRN (8 decks)

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