GI Flashcards
Scarrrosis/ fibrosis of liver—liver hard like rock
CIRRHOSIS
CIRRHOSIS cause
- Alcohol
- Cystic fibrosis
- Hepa B C
CIRRHOSIS types
1. mc due to alcohol
2. dt hepa B C
3. dt gall stone obstruction
4. dt to RSHF
- LAENNEC’s
- POST NECROTIC
- BILIARY
- CARDIAC
LIVER 4 RESPONSIBILITIES
- produce Albumin, Bile, coagulation factors
- Detoxify AMMONIA
- Drugs metabolism
- Store GLYCOGEN
Liver is like __ bus that scoops ___ and bilirubin
Bile bus
Cholesterol
Fx ni albumin
Attracts water, drugs, binds with Ca
CIRRHOSIS hepa-j sx and ano sx under nila.
Hepatic Encepalopathy (ammonia)
* Asterixis
* LOC
* Constructional apraxia
Esophageal varices
Portal HPN
* Pre renal failure
* Hepatomegaly
* hemorrhoids
* Caput Medusae
* SPIDER ANGIOMA
Ascites
Jaundice
* Pruritus
CIRRHOSIS other sx
- Dec Ca and Platelet dt to albumin (trousseau and chvostek, bleeding)
- > 20 BUN
- Inc AST & ALT
CIRRHOSIS interventions for:
- Hepatic Encepalopathy (ammonia):
- Esophageal varices:
- Portal HPN:
- Ascites:
- Jaundice:
- Dec Ca and Platelet dt to albumin:
- Hepatic Encepalopathy (ammonia): LIMIT PROTEIN, no SEDATIVES, ✅NEOMYCIN & LACTULOSE
- Esophageal varices: no NGT/ STRAINING and coughing , and no NGT, ✅Balloon Tamponade
- Portal HPN: BETA BLOCKERS, TIPS/ transjugularhepatic portosystemic shunt
- Ascites: PARACENTESIS, low NA, ✅reverse trendelenburg, ALDACTONE
- Jaundice: cool moist skin, moisturizing cream, long sleeved cotton gloves, trim nails
- Dec Ca and Platelet dt to albumin: iron rich foods, Vitamin ADEK, bleeding prec, Spirinolactone, ALBUMIN IV (egg white)
CIRRHOSIS considerations of paracentesis
- Empty bladder
- Measure abd circumference/ wt
- High fowlers
CIRRHOSIS giving albumin effective if?
⬆️BP and pulse
CIRRHOSIS dx and considerations
Liver biopsy
- Before and during: supine c pillow sa head and R side
- After procedure: R side lying to prevent bleeding
CIRRHOSIS y insert balloon tamponade? What kind of tube? Ano prio at ilalagay sa bedside
- to apply pressure kasi nag rupture na, compress stomach dt bleeding, and decompress gastric/air
- Sengstaken Blakemore Tube (triple lumen)
- Airway. Scissor
CIRRHOSIS neomycin and lactulose is effective?
⬆️LOC
CIRRHOSIS lactulose’s stool na masasabi effective eto? Monitor for?
Soft stools c 2-3 bowel movt
HYPOKALEMIA
CIRRHOSIS Hepatic Encephalopathy stages
- Stage 1: confused
- Stage 2: lethargy
- Stage 3: stupor
- Stage 4: coma
CIRRHOSIS 3 complications
- Primary peritonitis: ANTIBIOTICS
- HEPATORENAL SYNDROME: dialysis
- HEPATIC ENCEPALOPATHY
Inflammatory cond of liver caused by viral or non viral (alcohol autoimmune)
HEPATITIS
HEPATITIS types
hepa TAE
BC- blood and body fluids
D- co-infection c B
HEPATITIS ABA sx
⬆️bilirubin
- Jaundice & pruritus
- Clay colored/ pale stools
- Dark or tea-colored urine
⬆️aPTT and PT
- bruising
⬇️Albumin
- edema
HEPATITIS mngt and DIET
- low PROTEIN (all liver dse)
- low FAT (kc my nausea)
- ❌acetaminophen (tylenol), alcohol
HEPATITIS pruritus mngt
- Moisturizer
- Cool compress
- Avoid sun
Enzymes begin to digest the pancreas (autodigestion)
PANCREATITIS
PANCREAS fxns
- Exocrine: produce digestive enzymes
- Endocrine: insulin & glucagon
3 digestive enzymes
- Trypsin/ protease: protein
- Lipase: fat (most destructive)
- Amylase: carbs
PANCREATITIS sx specially hallmark
- Turner’s sign- flank
- Cullen’s sign- umbiliCULL
- LUQ epigastric pain radiates to back aggravated by Flat position
- ⬆️bilirubin (jaundice)
- internal bleeding, Ascites (Internal Bleeding dito may lead to DHN, Hypotension)
- HypoCa
- NV indigestion
PANCREATITIS dx kung san lahat ⬆️
- Enzymes (best parameter)
- Glucose (hyperglycemia)
- WBC (fever)
- PT and aPTT
- Bilirubin, Alkaline Phosphatase
PANCREATITIS mngt
- LUQ epigastric pain radiates to back aggravated by Flat position: ❌MORPHINE/ HYDROMORPHONE/ DEMEROL or any NARCOTICS
- ⬆️bilirubin (jaundice): ✅pruritus care
- internal bleeding, Ascites (Internal Bleeding dito may lead to DHN, Hypotension)- ✅BLEEDING PREC
- Prio: REST THE GI/ NPO or ✅NGT
- hypergly: INSULIN
- ⬆️enzymes: PPI, H2 BLOCKERS, ANTACIDS
PANCREATITIS diet
Enzymes c meals
PANCREATITIS compli
- Steatorrhea
- HYPOCALCEMIA
- DM
- ARDS
- PERITONITIS
- HYPOVOLEMIC/HEMORRHAGIC SHOCK
Inflammation of gallbladder caused by gallstones (CHOLELITHIASIS) resulting to backup ng bile
CHOLECYSTITIS
CHOLECYSTITIS supersaturation of bile types
- Cholesterol (mc)- yellow color
- Bile/Pigment stone (hemolysis, dark green color)
- Calculous- gall stone (mc din)
- Acalculous- injury/surgery➡️infxn
- Water
CHOLECYSTITIS signs
- Murphy’s sign: hepatic subcoastal margin/last rib palpation while on supine gall bladder contrac/mamaga then pain + Rebound Tenderness
- Boas sign: pain after intake of fat, pain sa SCAPULA
- RUQ colic pain radiates to RIGHT shoulders
- Fever c chills
- ⬆️bilirubin (jaundice, pruritus, steatorrhea, dark tea colored urine)
- ⬇️Vit K (bleeding)
- Belching/indigestion of fats
CHOLECYSTITIS prio mngt
NPO/ REST THE GI
CHOLECYSTITIS
1. diet
2. meds
3. treatment/surgery
❌gas forming foods
- ursoDEOXYCHOLIC acid or chenoDEOXYCHOLIC acid
- PANTOLINE/ATROPINE (anti spasmodic/anticholinergic)
- NSAIDS for pain
- PPI & H2 blocker (⬇️secretion—⬇️contraction)
- Lithotripsy
- Laparoscopic cholecystectomy(stone lang tanggal)
- cholecystectomy (gall bladder)
cholecystectomy may bile parin?
Yes kasi may liver pa
Triad/peritad na naga septick shock na
CHARCOT’s triad or REYNOLD’s Peritad
1. RUQ pain
2. Jaundice
3. Fever
4. Confusion
5. Hypotension
CHOLECYSTITIS compli wherein gallstone bumababa sa common bile duct
CholeDOCHOlithiasis
CHOLECYSTITIS dx
UTZ
CHOLECYSTITIS heath educ
- ❌fatty fried foods
- Lose wt
cholecystectomy post op instruction
- early ambulation
- Prevent pneumonia (deep breath and cough)
- Prevent infection (❌baths✅shower, report redness/swelling sa incision site)
- 1 wk bago balik sa work
Dt fecalith causing inflammation in RLQ
APPENDICITIS
APPENDICITIS signs
1. pain upon release/ rebound tenderness
2. pain in umbilicus hanggang iliac crest
3. Rolling/paradoxical pain (sa LLQ nag palpate pero pain sa RLQ)
4. Pain triggered by coughing
5. Pain when R knee flexed 90 degrees tas inikot ikot or external rotaion
6. R leg flexed backward tas naga L lateral position pt
- BLUMBERG
- MCBURNEY
- ROVSING
- DUNPHY’S
- OBTURATOR
- PSOAS
APPENDICITIS other sx
- Low grade fever
- ⬇️bowel sound