GI Flashcards
Pancreatitis Patho
auto-digestion of pancreas
Pancreas has two separate functions:
- endocrine - insulin - exocrine - digestive enzymes
Two types of pancreatitis: acute and chronic
- #1 cause is gallbladder dz - #2 cause is alcohol
Pancreatitis S/sx
pain that increases w food
abdominal distention / ascites (losing protein rich fluids like enzymes and blood into abdomen)
abdominal mass = swollen pancreas
rigid, board-like abdomen (with guarding) = bleeding that can lead to peritonitis
bruising around umbilical area = Cullen’s sign
bruising in the flank area = Grey-Turner’s sign
fever (inflammation)
N/V
jaundic
Hypotension from bleeding or ascites
Pancreatitis diagnosis
serum lipase and amylase increased (digestive enzymes)
- lipase is specific to pancreas
increased WBCs
increased blood sugar
increased or normal ALT, AST (liver enzymes)
longer PT and aPTT
- liver not making clotting factors
increased serum bilirubin
decreased hemoglobin and hematocrit due to dehydration
Amylase normal value
30-220 U/L
Lipase normal value
0-160 U/L
AST normal value
0-35 U/L
ALT normal value
10-36 U/L
Normal Hemoglobin Value
Male: 14-18 g/dl
Female: 12-16 g/dl
Normal Hematocrit Value
Male: 42-52%
Female: 37-47%
Pancreatitis Treatment
CONTROL PAIN
Decrease gastric secretions (NPO, NGT to suction, bed rest) (want stomach empty and dry)
Pain medication (PCA narcotics and fentanyl patches)
- morphine sulfate and hydromorphone
Anticholinergics to dry patient
- benztropine and diphenoxylate/atropine
GI Protectants
- pantoprazole
- famotidine and cimetadine - H2 receptor antagonists
- antacids
Maintain fluid and electrolyte balance and nutritional status (TPN or TNA)
Insulin (pancreas is sick and not producing)
Daily wts
Eliminate alcohol
Cirrhosis
don’t give Tylenol or narcotics
4 major functions of the liver
- detoxify the body - helps your blood to clot - metabolizes drugs - synthesizes albumin
liver cells are destroyed and replaced with scar tissue. This alters the circulation and creates portal HTN
Cirrhosis S/sx
firm, nodular liver; jaundice abdominal pain chronic dyspepsia (GI upset) change in bowel habits ascites splenomegaly fatigue peripheral edema (ascites) anemia can progress to hepatic encephalopathy / coma (due to build up of ammonia that acts like sedative)
Cirrhosis Diagnosis
decreased serum albumin
increased ALT & AST
ultrasound
CT, MRI
Liver biopsy - confirms diagnosis
- make sure to do VS and clotting studies before
- position supine / flat w right arm up and behind head
- exhale and hold breath to get diaphram out of way
- post procedure = lie on right side for pressure to prevent bleeding
Cirrhosis Treatment
antacids, vitamins, diuretics no alcohol I&O / daily wt rest (toxins = tired) prevent bleeding (No IM or aspirin) measure abdominal girth (ascites) Paracentesis (to help w breathing if ascites occurs) - void before so we don't poke bladder - position upright to keep fluid in front (where we're poking) - VS (BP goes down and HR goes up) Monitor for jaundice Avoid narcotics (liver can't metabolize) Diet (decrease protein / low sodium)
Protein breaks down to ______ . The _______ converts it to ______ which is then excreted by the ______.
Protein breaks down to AMMONIA. The LIVER convers it to UREA which is then excreted by the KIDNEYS.
Hepatic Coma Patho
Protein breaks down into ammonia and the liver converts it to urea which is excreted through the kidneys.
When the liver stops working, ammonia builds up which leads to sedation.
Hepatic Coma S/sx
minor mental changes / motor problems difficult to arouse asterixis (flapping, trembling hands) handwriting changes reflexes will decrease EEG is slow Fetor = breath smells like acetone / ammonia LIver people = GI bleed likely
Treatment for Hepatic Coma
lactulose (decreases serum ammonia)
enemas (to get blood out of GI tract)
decrease protein in the diet
monitor serum ammonia
Bleeding Esophageal Varices Patho
high BP in liver (portal HTN) forces collateral circulation to form
- it forms in stomach, esophagus, and rectum
alcoholic client that is GI bleeding = esophageal varices usually
no problem until hemorrhage / rupture
Bleeding Esophageal Varices Treatment
replace blood
monitor VS
monitor CVP
oxygen (they’ll be anemic / bleeding so give O2)
**octreotide lowers BP in liver and causes vasoconstriction
endoscopic sclerotherapy
esophageal variceal ligation
Balloon tamponade
enemas to get rid of blood
salvine lavage to get blood out of stomach
octreotide
lowers BP in liver and causes vasoconstriction
given for Bleeding Esophageal Varices
Sengstaken-Blakemore Tube
balloon tamponade tube
emergency procedure to stabilize clients w severe hemorrhage
should not be used more than 12 hrs
may need restraints to prevent them pulling out tube bc that’ll block their airway
- if this happens, cut at port to deflate everything and then remove (scissors)
Peptic Ulcer Patho
common cause of GI bleeding
can be in esophagus, stomach, or duodenum
erosion is present