GI Flashcards by Liz Jarzembowski

Alpha cell

Secrete Glucagon

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Beta cell

Secrete insulin

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Delta cell

Inhibit alpha and beta cells from releasing glucagon and insulin

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Pancreas secretes

Bicarbonate for stomach acid
Water
Na and K
Digest enzymes trypsin, amylase, lipase

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Acute panc s/s

Boring abd pain, all quads and lumbar 
Rigid abd no rebound tenderness
BL crackles, L pleura effus L lobe collapse
Raised diaphragm
Amylase⬆️
Lipase⬆️
Calcium⬇️
Bg ⬆️
Surfactant⬇️from💀alveolar cells

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Cullen sign

Blue discolor and bruising of umbilicus from methylalbumin formation from acute panc, intraperitoneal bleed

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Grey Turner sign

Bruised flank, can be retro bleed, from acute panc

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Acute panc tx

Fluids
Ca++,K+,Mg++
H2 blocker or PPI
NG suct 
TF below duodenum
Monitor for ARDS, diaphragm elevation, atelectasis, and l sd plearual effus

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Upper GIB tx

Address cause
Fluids
PRBC
Clotting factor replacement
Vasopressin-constrict spleen art bed, ⬇️portal vein HTN
Octeotride -⬇️spleen blood flow GI motil
Lactulose-excrete nitrous content pvn ammonia
Bblocker -⬇️portal vein flow

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Hepatic failure labs

Protein⬇️
Albumin⬇️
Ascites
Ammonia⬆️
Pancytopenia
Coagulopathy
AST/ALT⬆️
Bilirubin⬆️
BG⬇️
RR⬆️
Creatinine⬆️

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Hepatic failure s/s

AMS
Asterixis (flapping hand tremor)
Ascites
Jaundice
Renal fail
Sepsis
Liver starts inflamed then shrinks

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Factors increasing serum ammonia

K⬇️
BUN⬆️
LA⬆️
Protein⬆️

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Manage Hepatic failure

K sparing diuretic(Aldactone)
Neomycin to kill NH3 gut bacteria
Lactulose for NH3
Prevent ⬆️BUN, GIB, acid buildup 
Tips procedure

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Spleen

Hx of splenectomy has poor immune fn, kehr sign, abdominal distention no bowel sounds, LUQ

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Kehr Sign

Sharp L shoulder pain associated with ruptured spleen

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Intrabdominal hypertension IAH

12-15mmHg

Abdominal perfusion pressure APP

MAP-IAP; >60 ideal

Abdominal compartment syndrome ACS

Sustained IAP >20, with or without APP of 60

IAH tx

If IAP >12 reverse trend, restrict fluid, NGT, rectal tube

IAP>20 decompressive surgery

Small intestine is perfumed by

Superior messnteric artery

SBO s/s

Sharp episodic pain
Early vomiting 
K⬇️
High pitch BS
dilated loops on KUB
Hypovolemia(3rd spacing)

LBO S/s

Dull pain
Bowel habit change
Vomiting (late)
Distention 
Low pitch BS
dilated loops KUB

Bowel perf causes

PUD
BO
appendicitis
UC
Wound

Bowel perf s/s

NV, temp, ⬆️HR, ⬆️RR
Abd tenderness c coughing hip flex
Rigid abd
Rebound tender
⬇️BS
air in peritoneum in KUB

Bowel perf tx

NGT fluids ABX Surgery and possible bowel diversion for healing

Gastritis pain

Epigastric, indigestion, NV

Peptic ulcer pain

Epigastric or RUQ burning Tenderness, Melena or BRB vomit

Pancreatitis pain

Epigastric or LUQ boring Temp, NV

Cholecystitis pain

Epigastric or RUQ Cramping NV tenderness

Appendicitis pain

Epigastric then RUQ periumbilical Dull or sharp NV anorrhexia, fever, leukocytosis rebound tenderness

SBO pain

Across abd in waves Cramping, sharp Abd distention, K⬇️, BS⬇️

Ruptured spleen pain

Kehr sign Sharp Abd distention no BS

Peritonitis pain

General pain Dull then sharp Rigid board like, rebound tenderness, BS⬇️