GI 2

Question 1

75% of all SBO are d/t _____

Answer 1

adhesions

Question 2

why do adhesions occur

Answer 2

• Adhesions can occur anywhere from a few days after surgery to 10-20 years
• Occur after laparatomies and other GI surgeries, radiation or foreign bodies

Question 3

why does distension occur in SBO

Answer 3

• Fluid and swallowed air accumulate in the small bowel, causing distention. Fluid keeps building up from saliva, fluids and gastric juices.
• Swallowed air has a high nitrogen content and is poorly absorbed in the bowel

Question 4

Increased pressure of SBO causes increased capillary permeability and…

Answer 4

movement of fluid and electrolytes into the abdominal cavity

Question 5

s/s of SBO

Answer 5

• Intermittent, crampy, periumbilical pain
• Borborygni above the obstruction cause pain, more severe closer to the obstruction
• Vomiting at first and then abdominal distention
• Tachycardia, orthostatic hypotension, poor skin turgor or dry mucous membranes
• Rebound tenderness and decreasing BP may be signs of perforation

Question 6

most small bowel obstructions _____

Answer 6

• *resolve SPONTANEOUSLY (fix themselves)
• 80% of SBO resolve spontaneously
• If doesn’t improve in 3-5 days need surgery

Question 7

management of SBO

Answer 7

NPO
NG intubation to decompress
Fluids and electrolytes
Foley, CVP catheter

Question 8

surgery of SBO if doesnt resolve on own

Answer 8

exploratory laparotomy, lysis of adhesions

Question 9

if colonic SBO…

Answer 9

may need a bowel resection, colostomy

Question 10

if paralytic ileus…

Answer 10

use neostigmine to stimulate peristalsis if not responsive to conservative treatment

Question 11

abdominal pressure should be what and how is it monitored

Answer 11

• less than 10

- Monitored with foleys (blow up balloon and push pressure against bladder, transduce to determine abdominal pressure)

Question 12

regions of left abdomen (from top to bottom)

Answer 12

1) Left Hypochondriac
2) Left Lumbar/Lateral
3) Left Iliac/Inguinal

Question 13

regions of middle abdomen (from top to bottom)

Answer 13

1) Epigastric
2) Umbilical
3) Hypogastric

Question 14

regions of right abdomen (from top to bottom)

Answer 14

1) Right Hypochondirac
2) Right Lumbar/Lateral
3) Right Iliac/Inguinal

Question 15

describe toxic megacolon

Answer 15

• Massive dilation of the colon that can lead to gangrene and peritonitis.
• Large colon
• d/t swelling within the colon and UC or Chron’s with leakage
• Colon stops working and swells up

Question 16

treatment of toxic megacolon

Answer 16

• Depends on the cause
• If inflammatory bowel: Infliximab (Remicade) & Adalimumab (Humira) immunomodulators to decrease inflammation
• Surgery for non-functioning bowel
• Antibiotics

Question 17

cause of toxic megacolon

Answer 17

inflammatory (UC or Chron’s) or infectious (bacterial or viral)

Question 18

what is hepatic encephalopathy

Answer 18

• Caused by elevated ammonia levels related to the inability of the liver to detoxify toxic agents from the GI tract, esp urea.
• Without the excretion of urea, ammonia levels rise

Question 19

grades of hepatic encephalopathy

Answer 19

Grade 1- mild confusion,
Grade 2-lethargy and moderate confusion,
Grade 3-stuporous, but arousable,
Grade 4- coma and unresponsive

Question 20

describe asterixis

Answer 20

• tremor of hand when wrist extended

- if Asterxis is present, ammonia level is elevated

Question 21

hepatic means what

Answer 21

liver

Question 22

chole means what

Answer 22

gallbladder

Question 23

treatment of hepatic encephalopathy

Answer 23

1) Decrease ammonia level
2) Lactulose- clears nitrogen products and decreases colonic pH to prevent absorption of ammonia
3) Decrease proteins
4) Antibiotics: Neomycin or metronidazole to clear to gut of bacteria

Question 24

renal means what

Answer 24

kidneys

Question 25

what to monitor if hepatic encephalopathy

Answer 25

Monitor neuro status
Extraventricular drain if ICP level increases
Assess for brain activity with EEG and ICP levels

Question 26

what is Spontaneous Bacterial Peritonitis

Answer 26

Ascitic fluid infection without an identifiable source.

Question 27

describe normal ascitic fluid

Answer 27

Ascites fluid has low levels of albumin, which protects against leakage of bacteria through the abdominal wall.

Question 28

s/s of spontaneous bacterial peritonitis

Answer 28

• fever, chills, abdominal pain

- renal impairment in 40% of the cases

Question 29

common causes of spontaneous bacterial peritonitis

Answer 29

E coli, Klebsiella, enterobacter and staphy aureus are most common

Question 30

if temp of 37.8 or 100 with spontaneous bacterial peritonitis need to do what

Answer 30

may need to do blood cultures

Question 31

treatment of spontaneous bacterial peritonitis

Answer 31

Treatment with intestinal antibiotics