GI 2 Flashcards
75% of all SBO are d/t _____
adhesions
why do adhesions occur
- 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
why does distension occur in SBO
- 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
Increased pressure of SBO causes increased capillary permeability and…
movement of fluid and electrolytes into the abdominal cavity
s/s of SBO
- 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
most small bowel obstructions _____
- *resolve SPONTANEOUSLY (fix themselves)
- 80% of SBO resolve spontaneously
- If doesn’t improve in 3-5 days need surgery
management of SBO
NPO
NG intubation to decompress
Fluids and electrolytes
Foley, CVP catheter
surgery of SBO if doesnt resolve on own
exploratory laparotomy, lysis of adhesions
if colonic SBO…
may need a bowel resection, colostomy
if paralytic ileus…
use neostigmine to stimulate peristalsis if not responsive to conservative treatment
abdominal pressure should be what and how is it monitored
- less than 10
- Monitored with foleys (blow up balloon and push pressure against bladder, transduce to determine abdominal pressure)
regions of left abdomen (from top to bottom)
1) Left Hypochondriac
2) Left Lumbar/Lateral
3) Left Iliac/Inguinal
regions of middle abdomen (from top to bottom)
1) Epigastric
2) Umbilical
3) Hypogastric
regions of right abdomen (from top to bottom)
1) Right Hypochondirac
2) Right Lumbar/Lateral
3) Right Iliac/Inguinal
describe toxic megacolon
- 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
treatment of toxic megacolon
- Depends on the cause
- If inflammatory bowel: Infliximab (Remicade) & Adalimumab (Humira) immunomodulators to decrease inflammation
- Surgery for non-functioning bowel
- Antibiotics
cause of toxic megacolon
inflammatory (UC or Chron’s) or infectious (bacterial or viral)
what is hepatic encephalopathy
- 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
grades of hepatic encephalopathy
Grade 1- mild confusion,
Grade 2-lethargy and moderate confusion,
Grade 3-stuporous, but arousable,
Grade 4- coma and unresponsive
describe asterixis
- tremor of hand when wrist extended
- if Asterxis is present, ammonia level is elevated
hepatic means what
liver
chole means what
gallbladder
treatment of hepatic encephalopathy
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
renal means what
kidneys
what to monitor if hepatic encephalopathy
Monitor neuro status
Extraventricular drain if ICP level increases
Assess for brain activity with EEG and ICP levels
what is Spontaneous Bacterial Peritonitis
Ascitic fluid infection without an identifiable source.
describe normal ascitic fluid
Ascites fluid has low levels of albumin, which protects against leakage of bacteria through the abdominal wall.
s/s of spontaneous bacterial peritonitis
- fever, chills, abdominal pain
- renal impairment in 40% of the cases
common causes of spontaneous bacterial peritonitis
E coli, Klebsiella, enterobacter and staphy aureus are most common
if temp of 37.8 or 100 with spontaneous bacterial peritonitis need to do what
may need to do blood cultures
treatment of spontaneous bacterial peritonitis
Treatment with intestinal antibiotics
