gi Flashcards
What are the functions of the liver?
Glucose metabolism, ammonia conversion, protein metabolism
What is glucose metabolism?
Metabolism of glucose and regulation of blood sugar concentration
What is glucose?
Sugar in the blood that is released
Excess stored as glycogen and obtained from portal venous blood
What is gluconeogenesis?
The synthesization of glucose from amino acids from broken down proteins
What is happens in ammonia conversion?
Convert ammonia to urea that is excreted in the urine
What can form ammonia?
Amino acids from gluconeogenesis, bacteria in the intestines
What proteins does the liver synthesize?
Albumin, clotting factors
What is fat metabolism?
The breakdown of fatty acids into ketones when glucose metabolism is limited
What vitamins/ minerals are stored by the liver?
A, B, D, B complex, iron, and copper
What drugs does the liver metabolize?
Barbiturates, opioids, sedatives, anesthetics, amphetamines
Where is bile formed?
The liver
How does bilirubin get excreted?
The liver, bilirubin is the breakdown of hemoglobin
What causes esophageal varices?
Portal hypertension
What is the key sign of esophageal bleeding?
Lots of bleeding
What is the nursing management of someone with esophageal varices?
Gastric suction to keep the stomach empty, monitor blood pressure, anticipate vitamin k therapy and blood transfusion
What is hepatic encephalopathy?
Liver is not able to convert ammonia to urea causing fluid buildup in systemic circulation instead of the portal venous system
How can you reduce serum ammonia?
Eliminate protein from the diet, neomycin (antibiotic → reduces bacteria), lactulose
What are the early symptoms of hepatic encephalopathy?
Forgetful, confusion, sleeping during the day, insomnia at night
What are the advanced symptoms of hepatic encephalopathy?
Shaking of the hands or arms (asterixis), disorientation, slurred speech, sweet poopy breath
What is the treatment for hepatic encephalopathy?
Lactulose (Cephulac)
Trapping and expelling the ammonia in the feces
Can be dilated with fruit juice
Monitor for hypokalemia and dehydration
What should we encourage patients with hepatic encephalopathy to do?
Breathe deeply to prevent pulmonary complications
What are the risk factors for pancreatic cancer?
Cigarette smoking
Chronic pancreatitis
Family history of pancreatic or other cancers
Age 60 and over
Exposure to industrial chemicals
Toxins in the environment
Diet high in fat, meat, or both
Where do most pancreatic tumors emerge?
At the head
What are we worried about regarding the surrounding organs of the pancreas with a head tumor?
Obstruction
What do biliary duct obstructions cause?
Jaundice, clay colored stools and urine
How can we treat jaundice caused by an obstruction?
Biliary enteric shunt
What is associated with functioning islet cell tumors?
Hyperinsulinism
Why does pancreatic cancer have such a high mortality rate?
It is often caught when it is too late
What are the clinical manifestations of pancreatic cancer?
Pain (severe at night laying on back or by meals→ relieved sitting up)
Jaundice
Weight loss (unrelated to GI, up to 80%)
Ascites
DM (early)
When is pain most severe for a patient with pancreatic cancer?
Nighttime, accentuated when lying supine
Relief by sitting up and leaning forward
What is the most accurate assessment and diagnostic tool for pancreatic cancer?
Spiral CT → 85-90% accurate
How can we assess and diagnose pancreatic cancer?
Spiral CT
MRI
ERCP
Endoscopic ultrasound
Percutaneous fine needle aspiration biopsy of the pancreas
What is the medical management of pancreatic cancer?
Palliative bulk removal
What is the nursing management for pancreatic cancer?
Hospice, pain management
What do we ensure for a patient prior to a Whipple procedure?
Diet high in protein and pancreatic enzymes
Hydration
Adequate vitamin k (correction of prothrombin deficiency
Treatment of anemia
What is the Whipple’s Procedure?
Removal of the gallbladder, portion of the stomach, duodenum, proximal jejunum, head of the pancreas, distal common bile duct
Connection of the remaining stomach and jejunum
What is the result of Whipple’s procedure?
Removal of the tumor, bile flow in the jejunum
What should we give to the patient of a Whipple Procedure post op?
Pancreatic enzymes, low fat diet, vitamin supplements
What may a patient experience after Whipple’s procedure?
Malabsorption, hyperglycemia
