GI Flashcards
stoma colors rose to brick pink pale blanching, dark red to purple small blood
Rose- viable stoma mucosa
maybe anemia
inadequate blood supply
when touched is normal from high vascularity
post op wound care stoma 2 risks when will the edema resolve gas and time ileostomy drainage and one thing about it one thing to watch who is most at risk for developing obstruction stools teach 1 about anal teach about pain
fistula, delayed wound healing
6 weeks
2 weeks will go away
1500-1800ml/24 if small bowel is shortened may be more can decrease to 500ml a day
electrolytes na and k
corhns in 30 days
first0 4-6 then will lessen in 3-6 month
if manipulated- mucus-do kegals 4 weeks after
phantom pain
when do you empty a ostomy bag
1/3 full
how long does a drainable pouch last?
4-7 days
pouches for ostomy
transverse-dispose
sigmoid- drain or dispose
function after surgery
6-8 weeks normal no heavy lifting
illeostomy care 4
no regularity
drainable pouch
2-3 lt a day
susceptible obstruction
bile billy and ammonia
Bile salts aid in digestion by making cholesterol, fats, and fat-soluble vitamins easier to absorb from the intestine. Bilirubin is the main pigment in bile. Bilirubin is a waste product that is formed from hemoglobin (the protein that carries oxygen in the blood) and is excreted in bile.
Ammonia is protein breakdown that turns into urea in the liver and leaves
Acute liver failure causes
Acetaminophen and alcohol
Hep B
NSAIDS, Ionized TB drug, sulf drugs, anticonvulsants
ALD definition and Death complications
RAPID acute onset with hepatic encephalopathy without previous cirosis
Cerebral edema, herniation, brainstem compression
Manifestations of ALF
Rapid onset of severe dysfunction, Cognitive decline (FIRST), Jaundice, Ascites, Coag abnormalities-DIC and bleeding
GI bleeding, Fever with leukocytosis, thrombocytopenia, hypovolemia, Algeria, azotemia, increased urea and nitrogen in blood, edema, hypoglycemia, bacterial infection
respiratory failure
Metabolic acidosis, sepsis, organ failure
Treatment of ALF
Liver transplant, monitor hemodynamic status, tx amonia
HOB at 30, avoid stimulation, no pressure-valsalva
LAbs for ALF
Bilirubin, pt time, Enzymes, glucose, CBC. d dim, hand h platelet, tox levels, serum c, a antitryps, iron, ammonia, autoantibodies, acid base
Imaging for ALF
CT and MRI
Nursing care for ALF
Neuro Checks-ICP- Widening BP, Irregular respirations, bradycardia
Seizure precautions
avoid sedatives
skin and oral checks- fluids for kidneys
no aminoglycosides or NSAIDS
Hemodynamic, kid, glucose, electrolyes, acid base checks
Is and Os
Bleeding risks
Ducts order
Common bile duct, cystic duct, biliary duct, pancreatic duct
Acute pancreatitis def
women-
men-
Injury to pancreatic cells causes activation of the enzymes
W-gallstones M- Chronic alcohol use
BIl disease, trauma, infection, drugs, post op GI, surgery, smoking DM, hypertyglycerides
Mild-Edematous or interstital
Severe-necrotizing, dysfunction, necrosis, organ failure, sepsis
Manifestations of acute pancreatitis
Sudden inflam, edema, necrosis, hemorrhage, fat necrosis, vascular perm, smooth mm contractions, shock, ab pain in LUQ, and mid epi that radiates to shoulder and worse with food, N/V that dosent help pain, low fever, Hypotension, Jaundice, gry turners sign, cullens sign (eccymosis), Hyposctive or no bowel sounds, crackles,
Complications of acute pancreatitis
plural effusion, atelectasis, pneumonia, ARDS,
Emboli, DIC
Hypotension
hypocalcemia-Tetany
Pseudo cyst- from all the gunk
Ab pain, palpable mass, anorexia, NV, Perf, peritonitis
Abscess- infection of pseudocyst
S/S of peritonitis
Increased HR, BP, temp, stiff plap belly,
Labs for pancreatitis acute
Panc enzymes, hypoca+,
Liver, triglycerides, glucose, bilirubin,
Image for pancreatitis one consideration
Ultrasound, xray for lung changes, contrast, MRCP, ERCP-can make it worse
Care for pancreatitis acute
REST the pancreas
Agressive hydration for third spacing, pain management, decrease pan stimulation-NPO NGT, Tx shock, electrolytes, Watch rep for ARDS, watch hypogly, tetany,
SURG for pancreatitis acute
ERCP and choleystectomy
Drugs for pancreatitis acute
PPI, decrease acid to rest pancreas
Spasmolytics- hypoca
Anticholenergics- DONT DO WITH PER IL
Nutrition for acute pancreatitis
NPO initially, Entera-1st( If intestines are not used they get infected) or parenteral, watch Trigy if IV lipis were given Small frequent feedings high carbs-takes less energy No alcohol Fat sol vitamins Albumin- tx shock Gluconate and lactated ringers
Chronic pancreatitis and about the two types
Irreversible structural damage to the pancreas. This includes fibrotic tissue, strictures, and calcification, Scaring, dilation, stones pass.
Obstructive- Gallstones that cause inflam of sphincter or odi-cancer of amp, duodenum, pancreas, or cystic fibrosis,
Non-obstructive- Inflam and sclerosis in head of pancreases and duct, alcohol abuse
manifestations of chronic pancreatitis
Swelling, mass, chronic ab pain, or no pain, mal absorption, weight loss, constipation, DM!, increase in cholesterol, heavy burning not relieves by food or antacids, mild jaundice, dark urine-from bile, Steatorrhea
Diagnostic for Chronic pancreatitis labs and image
Panc enzymes, bilirubin, alkaline phosphate, ERCP/MRCP, CT
STOOL-fat
Care for chronic vs panc
Increase in WBC, pain-TD, bland low fat diet, no smoking, alcohol, caffeine, panc enzyme replacement, bile salts, insulin or hypo agents, acid inhibiting drugs, antidepressants,
Surgery for Pancreatitis chronic
look up
Education for chronic pan
diet control, pan enzymes, diabetes education, no alcohol, no smoking, watch for fat in poop, bland diet
Gallbladder disease two types and risks
Cholelith-Stones
Cholecys- Inflam of gallbladder usually from cholelith
Balance of chole, bile salts, ca+, and Na+=precipitation
Infections or alterations in metab or chole or stasis
immobility, pregnancy, inflam or obstruction, lesions-all cause obstruction
Manifestatons of choelith
Pain is severe-none, more pain when stone is moving or obstructing, may be in shoulder or scap, tachy, diaphoresis, tender RUQ pain,- 3-6 hours after meal or when laying down
Manifestations of chole sis
fat intol, dyspepsia, heart burn, flatulence, inflam with leuko and fever, ab regidity
Total gal stone obstruction symptoms
Jaundice, dark urine, clay stools, pruritus, intol of fat, bleeding tendencies, steatorrhea
Complications of gal bladder disease
Cholesis, gangrenous, subphrenic abcess, pancreatitis, cholangitis, billiary ducts, fistulas, bil cirrhosis, perionitis, choledocholithiasis.
Diagnostic for bil disease
Ultrasound, ERCP, Percutaneoustransoatichosdfkhjldf-Look that up
Labs for bil
Increase WBC, Serum bili/urin bil
Increase liver enzymes, amalase-pancreatic
Tx for bil
Conservative management, if gallstone symp-Cholecystectomy, ERCP with sphincterotomy, endocarp shock lithotrips-takes 1-2 hr and use salts,
Tx for cholecycsitis
Pain control, NSAIDS, anticholenergics, antibiotics, choleystestomy, Fluids and electrolytes, NG tube in severe N/V,
Surgical tx for choleitis
Laperascopic cholecystectomy- Removal through holes, minimal post pain, normal activity in 1 week, few complications, clear lq, same day discharge
or open- removal through right subcostal incision
t-tube-Inserted into the common bile duct,
ESWL
s/s of complete bil obstruction
Steatorrhea, jaundice, dark amber urine, puritis, bleeding, intol to fat foods, clay colored stools
esophageal cancer patho history and risks
Usually advanced disease by the time of diagnosis, it narrows the esophagus, Risks-Increase with age, BE, smoking, alcohol, Obestiy, abestos, cement dust, achalasia-delayed emtying, gerd, barrets
Manifestatons of Esoph cancer
Progressive dysphagia-meat, soft food, lq Pain is latep substernal epigastric, back that increases with swallowing-even spit, Weight loss Sore throat, choacking hoarseness\regur with blood tinged Hemmorrhage-if trach May cause obstruction common metastasis to lungs and liver
Diagnosis for esoph cancer
Endoscope biops
ultrasound
CT/MRI
Bronchoscopy
Tx for Esoph cancer
Surg-esophagectomy-removal
esophagastromy -resection to stomach
esophagoenterostomy-resection to colon- lap or open
Photodynamic lasor therapy- no sun 3-6 weeks
Chemo and radiation
Post of esoph cancer
Watch respiratory, pain control, Chest tube, TPN, Swallow study, HOB 30 and for 2hr after meal
Surg risk for esoph cancer
DysR, anastomatic leaks, fistulas, edema, respiratory distres, dysruption of medial sternal lymph nodes
Care for E cancer
Airway, respiratory, swallow B4 oral fluids, high fowlers, tube feeding tol, pain
Stomach cancer patho history
rt
and associations
Adenocarcinoma of stomach wall usually spread by diagnosis
RT mucosal injury-Hpylori, autoimmune disorders, NSAIDS, tobacco
Association-smoked meats, salted fish/meats, pickled veggies
Manifestations of stomach cancer
Weight loss, saticty- full fast, indigestion, ab pain, anemia-blood loss or pernicious , weak fatigue, SOB, OB positive stool, Acities=poor prognosis- seeding of cancer cells introperitoneal cavity and no cure
Diagnosis for stomach cancer
and labs
Upper endoscopy and biopsy
CT/PET
Anemia, liver function, pancreatic function
tx for stomach cancer
surgery
legions in fundus means full gastrectomy
biliroth 1 and 11 with vegotomy or pyloric re
monitor fluids, cuts vegas nerve so no acid, dumping syndrome-slow meals no sugar or fat
bile reflux gastritis- enzymes and acid go up too
chemo radiatin
HyperTN S/S
Lower GI obstruction types
Mechanical- Detectable, commonly found in sm intestine, surgical adhesion-small intest and colorectal cancer-Large intest
non mechanical- Paralytic illeus, pseudo- acting like theres an obstruction- critically ill, trauma, burns. vascular- no blood to intestines- a fib, art obstruction, clots, heart valve issues, heart attack, congestive fail
Types of lower gi obstruction
Adhesions, intessuseption, hernwas, tumors, volvus,
Steps of lower obs
1.obstruction- build up fluid, gas, intestial contents-prox
Collapse- distal
2. Increase in bowel distension- reabsorption of fluids
3. increase pressure- cap perm, fluids into 3rd space
4. loss of blood volume
5, ischemic bowel no blood supply
Sm in lower GI
Rapid onset
Early- Colckly, intermit ab pain, NV in large ammounts, projectile vom with bile, if long standing smells like poop
Lg in obstruction s/s
Gradual onset, vom it rare, ab pain present but low grade, ab distention increased new onset of constipation and no flatulus
diagnosis of bowel obstruction
Labs
x ray-ct scan
Sigmoidoscopy/colonoscopy
Increase in WBC, H and H, BUN and creatinine
Tx for lower GI obstruction
When do you need surgery
conservative, NPO, rest, NG tube, IV fluids-NS or lac ringers, Pain control
if strangulated or tx not effective, May need colonosctomy or illiostomy
What are the biggest concerns with Lrg bowel obstructions
Ischemia, peritinitous, sepsis
Ostomy 2 things
Fluid increase with all but sigmoid
bowel regulation- can only occur with sigmoid
Indications for the types of ostomys
ill-Ulcerative, chrons, injury, family polp, trauma, cancer
Assending and transverse- perf dive, trauma, rec-vag fistula, inop tumor
Sigmoid- Cancer at the rectom or seg, perf div, trauma.
What is the non perm end stom called
Hartmanns pouch
How long does the plastic place stay on the loop
7-10 days
Stoma after post op normal
Dark pink/ red swollen beefy
Hernias
Hiatal- stomach and esoph, gerd, reflux, end of sternum
Ventral-Below hiatal poke through ab wall
Umbilical-below ventrical from birht
Inguinal- crease below hip crease
Femoral-high up on femur
What can hernias cause
Peritonitis, sepsis, hyposhoich, bowel reconstrus, ostomy placement ARDS
Diverticulitis complications 1 to remember
Abcess
risks for diverticulitis
Obesity, inactivity, smoking, alcohol use, NSAIDS increased fiber decreased carbs constipation
Manifestations of dive losis
No symptoms, ab pain, bloating, flatulence, change in bowel, can lead to itis or bleeding.
Manifestations of deverticulitis
and can lead to-
Pain in LLQ, distention, decreased or no bowel sounds, NV, infection- fever leukocytosis-shift to the left,
erosin and perf into peritoneum, localized abcess, bleeding can be extensive but stops spontaneously, strictures
What is the gold standard for divertic test
ct with oral contrast
CBC, berium enema, cloonoscopy w. biopsy, blood culture, colonoscopy
Care for divertic
Increase fiber to prevent,
high activity-prevent
Clear lq, bed rest, pain
Severe- Hospitalization (For when you can’t have PO Fluids, symptomatic of infection, or immunosuppressed.
NPO, Bed rest, IV fluids, antibiotics, watch infection, strict I and O NG on low,
Surg for divertic indications
Reoccuring abcess or obstruction, resection , diverting colonostomy
Teaching for diver
Increase fiber, increase fluids to 2 lt a day, no interab pressure, lose weight, stool softeners, anticholinergics
