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GI Flashcards

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1
Q

Leading cause of acute and chronic pancreatitis

A

Alcohol

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2
Q

Two functions of pancreatitis

A

Endocrine-insulin

Exocrine-digestive enzymes

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3
Q

Second cause of acute pancreatitis

A

Gallbladder disease

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4
Q

S/S of pancreatitis

A 
Pain
Abdominal distention/ascites
Abdominal mass-swollen pancreatitis
Rigid board-like abdomen (guarding or bleeding)
Bruising around umbilical area (Cullen's sign)
Flank area bruising (Gray Turner's sign)
Fever
N/V
Jaundice
Hypotension=bleeding or ascites
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5
Q

Pancreatitis

A

Auto-digestion of pancreatitis-it’s eating itself

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6
Q

Does pain with pancreatitis increase or decrease with eating?

A

Increase

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7
Q

Diagnostic labs for pancreatitis

A 
Increased serum lipase and amylase
Increased WBCs
Increased BS
ALT, AST-liver enzymes increased
PT, PTT longer
Serum bilirubin increased
H/H increased or decreased
(Down with bleeding, up with dehydrated)
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8
Q

Normal amylase labs

A

30-220 U/L

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9
Q

Normal lipase labs

A

0-110 U/L

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10
Q

Normal AST labs

A

8-40 U/L

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11
Q

Normal ALT labs

A

10-30 U/L

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12
Q

Tx of pancreatitis

A

Control pain (Decrease gastric secretions: NPO to suction, bed rest. If anything gets in their stomach, they think they have to make digestive enzymes, increasing pain.)
Steroids to decrease inflammation
Anticholinergics to keep stomach dry and empty (Benztropine, atropine/diphenoxylate)
GI protectants (pantoprazole, ranitidine, famotidine, antacids)
Maintain nutrition status then ease into diet
Insulin-sick pancreas, not making insulin, on steroids which increase BS, on TPN

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13
Q

If you stay on steroids too long what could you get?

A

Cushing’s

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14
Q

4 major functions of liver

A
  1. Detoxify body
  2. Helps blood clot
  3. Metabolize drugs
  4. Synthesized albumin
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15
Q

If liver is sick, do what with meds?

A

Decrease dose

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16
Q

If liver is sick, #1 concern is what?

A

Bleeding

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17
Q

Antidote for acetaminophen

A

Acetylcysteine

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18
Q

Cirrhosis patho

A

Liver cells are destroyed and replaced with connective/scar tissue which alters the circulation within the liver, the BP in the liver goes up, called portal HTN

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19
Q

S/S of cirrhosis

A 
Firm, nodular liver
Abdominal pain-liver capsule stretched
Chronic dyspepsis
Change in bowel habits
Ascites
Splenomegaly
Decreased serum albumin
Increased ALT and AST
Anemia
Can progress to hepatic encephalopathy/coma
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20
Q

Are you suppose to be able to feel the liver normally?

A

No

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21
Q

Never give what to someone with liver problems?

A

Acetaminophen

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22
Q

Male hemoglobin

A

14-18

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23
Q

Female hemoglobin

A

12-16

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24
Q

Male hematocrit

A

42-52%

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25
Q

Female hematocrit

A

37-47%

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26
Q

Cirrhosis Dx

A

Ultrasound
CT, MRI
Liver biopsy

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27
Q

Liver biopsy procedure

A

Clotting studies pre procedure: PT, aPTT, INR
Vitals pre procedure
Position supine with right arm over head
Exhale and hold breath to keep diaphragm out of the way
Lie on right side post procedure, worried about bleeding so take vitals

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28
Q

Tx of cirrhosis

A

Antacids, vitamins, diuretics
No more alcohol
I&O, daily weights
Rest
Prevent bleeding, no IM injections or aspirin
Measure abdominal girth to see if ascites is increased
Paracentesis
Monitor jaundice-good skin care, short nails
Avoid narcotics-liver can’t metabolize drugs well when it’s sick
Decrease protein, low Na diet

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29
Q

Paracentesis

A

Removal of fluid form the peritoneal cavity
Have client void
Position sitting up
Vitals
With “shocky” clients, the BP goes down and pulse goes up

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30
Q

Why worry about shock with paracentesis?

A

Any time you pull fluids, you can throw them into shock

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31
Q

Protein breaks down to what?

A

Ammonia, then the liver converts ammonia to urea, then the kidneys excrete the urea

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32
Q

Patho of hepatic coma

A

When you eat protein, it transforms into ammonia, and the liver converts it to urea. Urea can be excreted through the kidneys without difficulty
When the liver becomes impaired, it can’t make this conversion, so ammonia builds up in the blood
Serum ammonia decreases LOC (acts like sedative)

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33
Q

S/S of hepatic coma

A 
Minor mental changes/motor problems
Difficult to awaken
Asterixix-flaping tremor of hand
Handwriting changes
Reflexes will decrease
EEG slow
Fetor-breath smells like ammonia (acetone, cut grass)
Anything that increases ammonia level aggravates the problem-protein
Liver people tend to be GI bleeders
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34
Q

Tx of hepatic coma

A

Lactulose to decrease serum ammonia
Cleansing enemas
Decrease ammonia in diet
Monitor serum ammonia

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35
Q

Patho of bleeding esophageal varices

A

High BP in the liver (portal HTN) forces collateral circulation to form in stomach, esophagus, rectum
Usually no problem until rupture
Protruding vessel, same thing as a hemorrhoid

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36
Q

When you see an alcoholic client that is GI bleeding it is usually what?

A

Esophageal varices

37
Q

Tx of esophageal varices

A 
Replace blood
VS, CVP
Oxygen (needed whenever someone is bleeding)
Octreotide to lower BP in liver
Balloon tamponade
Cleansing enema to get rid of old blood
Lactulose to decrease ammonia
Saline lavage to get blood out of stomach
38
Q

Type of balloon tamponade tube

A

Sengstaken-Blakemore

39
Q

Balloon tamponade

A

Infrequently used emergency procedure that may be used to stabilize clients with severe hemorrhage. Should not be used more than 12 hours. Many of the safety implications for the Blackemore tube can be applied to other oropharynx or nasopharynx tubes

40
Q

Purpose of balloon tamponade

A

To hold pressure on bleeding varices

41
Q

EVL or Endoscopic Sclerotherapy

A

More commonly used for esophageal varices. Uses a banding procedure and endoscopic sclerotherapy is when the physician injects a sclerosing agent into the varices via an endoscope

42
Q

Patho of peptic ulcers

A

Common cause of GI bleeds
Can be in esophagus, stomach or duodenum
Mainly in males, but increasing in females
Erosion is present

43
Q

S/S of peptic ulcers

A

Burning pain usually in the mid-epigastric area/back
Heartburn
Might point to a “hunger” region after they already ate

44
Q

Diagnosis of peptic ulcers

A

Gastroscopy (EGD, endoscopy)

  • NPO pre procedure
  • Sedated
  • NPO until gag reflex
  • Watch for perforation by watching for pain, bleeding, or if they are having trouble swallowing

OR

Upper GI:
-Looks at the esophagus and stomach with dye
NPO past midnight
No smoking, chewing gum, or mints. Remove nicotine patch. Smoking increases stomach motility, which will affect the test. Smoking also increases stomach secretions which will increase the chance of aspiration

45
Q

Tx of peptic ulcers

A

Antacids
Proton pump inhibitors
H2 antagonist

46
Q

What do you do if balloon tamponade is stuck in clients throat and they can’t breathe?

A

Deflate the balloon by keeping scissors at HOB and chop it in half for immediate deflation, reestablish airway

47
Q

Why antacids for peptic ulcers?

A

Liquids, coat stomach
Take when stomach is empty and at bedtime.
Acid can get on ulcer, take antacid to protect ulcer

48
Q

Why proton pump inhibitors for peptic ulcers?

A

To decrease acid secretions

Omeprazole, lansoprazole, pantoprazole, esomeprazole

49
Q

Why H2 antagonists for peptic ulcers?

A

Ranitidine, famotidine
GI cocktail (donnatal, siscous lidocaine, mylanta)
Antibiotics for H. Pylori
Sucralfate to form barrier over the wound so acid can’t get on the ulcer

50
Q

Client teaching for peptic ulcers

A

Decrease stress
Stop smoking
Eat what you can tolerate, avoid temp extremes and extra spicy foods, avoid caffeine
Need to be followed for one year

51
Q

Gastric ulcers

A

Malnourished (bc throwing up helps): pain is usually half hour to one hour after meals, food doesn’t help, vomiting helps, vomit blood

52
Q

Duodenal ulcers

A

Well nourished: night time pain is common and 2-3 hours after meals, food helps, blood in stools

53
Q

Hiatal hernia patho

A

When the hole in the diaphragm is too large so the stomach moves up into the thoracic cavity
Main cause is a large abdomen
Other causes are congenital abnormalities, trauma, sx

54
Q

S/S of hiatal hernia

A

Heartburn
Fullness after eating
Regurgitation
Dysphagia

55
Q

Tx of hiatal hernia

A

Small frequent meals, sit up 1 hour after eating, elevate HOB, sx, teach life style changes and healthy diet (keep stomach in down position)

56
Q

Dumping syndrome

A

The stomach empties too quickly after eating and the client experiences many uncomfortable to sever side effects. Usually secondary to gastric bypass, gastrectomy, or gall bladder disease

57
Q

S/S of dumping syndrome

A 
Fullness
Weakness
Palpitations
Cramping
Faintness
Diarrhea
58
Q

Tx of dumping syndrome

A

Semi recumbent with meals
Lie down after meals
No fluids with meals (drink in between meals)
Meals should be small and frequent rather than large
Avoid foods high in carbs and electrolytes, carbs and electrolytes empty fast

59
Q

Ulcerative colitis patho

A

Ulcerative inflammatory bowel disease, just in large intestine

60
Q

Crohn’s Dz

A

Also called regional enteritis, inflammation and erosion of the ileum but it can be found anywhere in the small or large intestines

61
Q

S/S of ulcerative colitis and crohn’s disease

A 
Diarrhea
Rectal bleeding
Weight loss
Vomiting
Cramping
Dehydration
Blood in stools
Anemia
Rebound tenderness
Fever
62
Q

Rebound tenderness

A

Push in, let go and hit hurts

Means peritoneal inflammation

63
Q

Diagnosis of ulcerative colitis and crohn’s disease

A

CT
Colonoscopy-best
Barium enema-Lower GI series, done if colonoscopy is incomplete

64
Q

Colonoscopy procedure

A

Clear liquid diet for 12-24 hours
NPO 6-8 hours pre procedure
Avoid NSAIDs to avoid GI bleeding
Laxatives or enemas until clear
Polyethylene glycol-don’t drink with straw, will swallow air
To help your client drink colon prep more easily, get it as cold as possible
Sedated for procedure
Post op: watch for perforation. We are going to assume the worst, signs of perf are pain or unusual discomfort

65
Q

Tx of ulcerative colitis and crohn’s

A

Low fiber diet, try to limit GI motility to help save fluid

Avoid cold foods, hot foods, smoking-these all increase motility

66
Q

Medications for ulcerative colitis and crohn’s

A

Antidiarrheals-only given with mildly symptomatic UC clients, doesn’t work well in severe cases
ABX
Steroids to decrease inflammation

67
Q

Sx for UC

A

Total colectomy with ileostomy formed

Koch’s ileostomy or a J pouch (no external bag)

68
Q

Koch Pouch

A

qNipple valve that opens and closes to empty intestines

69
Q

J pouch

A

Removes the colon and attaches the ileum to the rectum

70
Q

Sx for crohn’s

A

Try not to do sx
May remove only affected area
Client may end up with an ileostomy or colostomy, depends on area affected
An ostomy in the ileum is called an ileostomy and an osmotic in the colon is called a colostomy

71
Q

Post op ileostomy care

A

It’s going to drain liquid all the time. Don’t have to irrigate ileostomies
Avoid foods hard to digest and rough foods: increase motility
Gatorade or a similarly electrolyte replacement drunk in summer
At risk for kidney stones (always a little dehydrated

72
Q

Post op colostomy care

A

As waste moves through the colon, water and nutrients are being absorbed and the stool is forming
Irrigate for regularity. Same time every day, after a meal
The further down the colon the stoma is, the more formed the stool will be because water is being drawn out. The stool is more normal
When you’re irrigating an osmotic, use same principles as if you’re administering an enema

73
Q

Any time you’re giving an enema, what do you do if the client starts to cramp?

A

Stop fluids, lower bag and/or check the temp of the fluid

74
Q

Stools with ascending and transverse colostomy

A

Semi liquid

75
Q

Stools with descending or sigmoid colostomy

A

Semi formed for formed

76
Q

Which colostomies do you irrigate?

A

Descending and sigmoid

77
Q

Positioning of colons

A

Ascending, transverse, descending, sigmoid, rectum

78
Q

Patho of appendicitis

A

Related to a low fiber diet, number one thing to worry about it rupture

79
Q

S/S of appendicitis

A

Generalized pain initially: eventually localizes in the right lower quadrant (McBurney’s Point)
Rebound tenderness
N/V
Get good hx ( abdominal pain first then N/V)
Anorexia

80
Q

Which side do they lay on for enemas

A

Left, normal flow of GI tract

If irrigating a stoma, they don’t have to be on their side bc they don’t have a rectum, any position is okay

81
Q

Diagnosis of appendicitis

A

Increased WBC
Ultrasound
CT
Do not give enemas or laxatives because you are worried about ruptured appendix

82
Q

Tx of appendicitis

A

Sx
Most done via laparoscope unless perforated
After any major abdominal sx, the position of choice is sitting up, no tension on suture

83
Q

Why put client on right side with HOB elevated after ensure?

A

Stomach will empty quicker, if they vomit they won’t aspirate, it will come out

84
Q

TPN considerations

A 
Sometimes called hyperalimentation
Keep refrigerated, warm for administration, let sit out for a few minutes prior to hanging
Central line needed
Filter needed
Nothing else should go through this line (dedicated line)
D/C gradually to avoid hypoglycemia
Daily weights
May have to start taking insulin
BG monitoring q 6
Check urine for glucose and ketones
Do not mix ahead: mixture changes every day according to electrolytes
Can only be hung for 24 hours
Change tubing with each new bag
IV bag may be covered with dark bag to prevent chemical breakdown
Needs to be on a pump
Home TPN: emphasize hand washing
Most frequent complication: infection
85
Q

If appendix ruptures, what do you do?

A

Straight to sx, they’ll be leaking bowel contents into abdomen, they’ll get septic
Put on right side and sitting up so all bowel contents will settle in one spot

86
Q

Assisting physician with inserting a central line

A

Have saline available for flush, don’t start fluids until positive confirmation of placement with CXR
Trendelenburg to distend veins

87
Q

If air gets in central line, what position do you put the client in?

A

Left side trendelenburg

*When an air embolus is suspected in the heart, the client may be taken to the cath lab for removal of the air

88
Q

Han you are changing the central line tubing, how can you avoid getting air in the line?

A

Clamp it off, valsalva, take a deep breath and HUMMMM

89
Q

Why is an x-ray done on post insertion of central line

A

To check for placement and make sure they don’t have a pneumothorax

NCLEX (14 decks)

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