GI Flashcards
what are the functions of the pancreas?
endocrine- insulin
exocrine-disgestive enzymes
what is the causes for acute and chronic pancreatitis?
acute- 1. alcohol 2. gallbladder disease
chronic- alcohol
(alcohol destroys your gi tract!)
s/s of pancreatitis?
pain- increased with eating abdominal distention/ascites abdominal mass- swollen pancreas rigid broad-like abdomen (this is peritonitis) bleeding around the umbilical area (cullen's sign) fever (inflammation) N/V jaundice (liver is involved) hypotension (ascites or bleeding)
what lab value is most specific to pancreatitis?
amylase
normal lab value for amylase and lipase?
amylase= 30-220
lipase=0-110
Normal lab value for hemoglobin
male- 14-18
female 12-16
diagnosis for pancreatitis
- serum lipase and amylase UP
- WBCs UP
- Blood sugar UP
- ALT, AST-liver enzymes UP
- PT,PTT LONGER
- serum bilirubin UP
- hemoglobin could go UP or DOWN (up for bleeding and down for ascites)
patient with pancreatitis, keep the stomach ____.
empty and dry!!
tx for pancreatitis
- NPO (decrease GI secretions)
- pain meds
- steroids
- anticholinergics (to dry up)
- GI protectants
- maintain f&e imbalance
- maintain nutritional status—ease into diet
- insulin (pancreas is sick, TPN (full of sugar), steroids(makes blood sugar go up))
- daily weight
- eliminate alcohol
- refer to AA f this is the cause
anytime there is a liver problem, what chemical should you think of?!!
ammonia!
**if you liver is sick, your #1 concern is
bleeding
if you liver is sick, what should you do with the medication?
decrease the dose
never give ____ to people with liver problems. antidote?
acetaminophen
antidote is acetylcysteine
4 major functions of the liver
- detoxify the body
- helps the blood to clot
- the liver helps to metabolize (break down) drugs
- the liver synthesizes albumin
Cirrhosis:
liver cells are destroyed and are replaced with connective/scar tissue—alters the ____ within the liver—the BP in the liver goes ____, this is called ____.
circulation
UP
potal hypertension
s/s of cirrhosis
- firm, nodular liver
- abdominal pain -liver capsule has stretched
- chronic dyspepsia (gi upset)
- changes in bowel habits
- ascities
- splenomegaly (means immune has kicked in)
- decrease serum albumin
- increased ALT and AST
- anemia
- can progress to hepatic encephalopathy/ coma
when the spleen is involve, this mean
immune system is involved!!
what should you know with acetylcysteine
give with carb. drink
STINKS
come in a small vial
what does albumin do?
hold on to fluid in the vascular space. if NO albumin, fluid goes to peritoneal cavity as ascites
Liver biopsy:
- clotting studies pre-procedure: _____
- vital signs pre-procedure
- how do you position this client?
- exhale and hold ____. why?
- post-procedure: lie on ____ side. vital signs, worried about _____.
PT INR and aPTT
worried about hypotension
supine with right arm above bed
breath why? to get the diaphragm out of the way
lie on right side post op (to hold pressure!)
worry about hemorrage
ammonia can lead to ___. it acts as a ___.
COMA hepatic encephalopathy.
SEDATIVE
tx for cirrhosis
- antacids, vitamins, diuretics
- no alcohol
- i&o and daily weight
- rest (bc toxins are building in the body)
- prevent bleeding!
- measure abdominal girth (why? ascites)
- paracentesis
- monitor jaundice
- avoid narcotics
- diet
what diet should cirrhosis patient ?
decrease protein
low NA diet
Protein—-breaks down to ___—-the ___ converts ammonia to ___—-___excrete the urea
ammonia
liver
urea
kidneys
asterixis
hand tremor
liver flap
(s/s of hepatic coma)
what is fetor?
breath smells like ammonia
tx hepatic coma
lactulose (decrease ammonia)
cleansing enemas
decrease protein
monitor serum ammonia
s/s hepatic coma
- minor mental changes/motor problems
- difficult to awake
- asterixis
- handwriting changes
- reflexes will decrease
- eeg slow
- fetor
- anything that increase ammonia level will aggravate this problem
- liver people tend to be GI bleeders!
what is the liver drug to think of?
lactulose (decrease ammonia)
high BP in the liver
portal HTN
when you see an alcholic client that is GI bleeding it is usually esophageal varies. usually no problem until ____.
rupture
tx for bleeding esophageal varies
replace blood VS CVP Oxygen (any time someone is anemic, o2 is needed) octreotide (lowers bp in the liver) ballon tamponade cleansing enemia to get rid of blood lactulose saline lavage to get blood out of the stomach
what is balloon tamponade?
to hold pressure on bleeding varices
it is an infrequently used emergency procedure that may be used to stabilize client with severe hemorrhage. it should not be used more then 12 hrs. many of the safety implications for the blakemore tube can be applied to other oropharynx or nasopharync tubes.
peptic ulcers:
common cause of ___.
can be in the ____.
mainly in females or males?
GI bleeding
esophagus, stomach, or duodenum
males but increasing in females
(erosion is present)
s/s of peptic ulcers
burning pain usually in the mid-epigastric area/back.
heartburn (dyspepsia)
erosion can lead to PAin!
gastroscopy (EGD,endoscopy): Sedated
NPO until what returns?
watch for?
gag reflex returns
watch for perforation by watching for pain, bleeding, or if they are having trouble swallowing.
tx for peptic ulcers
–medications
1.antacids (liquid to coat stomach)
2. proton pump inhibitors (decrease acid secretion) “zole” at the end; omeprazole
3. h2 antagonist
—client teaching
decrease stress, stop smoking, eat what you can tolerate, need to be followed for one year
when should a client with a peptic ulcer take an antacid?
take when stomach is empty and at bedtime— when the stomach is empty. acid can get on ulcer… take antacid to protect ulcer
malnourished; pain is usually half hour to 1 hour after meals; food doesnt help, but vomitting does; vomit blood
what is this?
gastric ulcer
well-nourished; night time pain is common and 2-3hours after meals; food helps; blood is stools.
duodenal ulcer
pain with stomach empty
these are lower down than gastric
what is hiatal hernia?
this is when the hole in the diaphragm is too large so the stomach moves up into the thoracic cavity
- -main cause is large abdomen
- -other cause include- congenital abnormalities, surgery, trauma
s/s hiatal hernia?
heartburn
fullness after eating
regurgitation
dysphagia
tx hiatal hernia
small frequent meals sit up 1 hour after eating elevate HOB surgery teach lifestyle changes and healthy diet
the stomach empties too quickly after eating and the client experiences many uncomfortable to severe side effects…. usually secondary to _____.
dumping syndrome
gastric bypass
gastrectomy
gall bladder
lay on ____ to keep food in the stomach.
____= leaves in
____= releases it
left side
lying on left side
right side lying
tx for dumping syndome
- semi-recumbent with meals
- lie down after meals
- no fluid with meals
- meals should be small frequent rather than large
- avoid foods high in carbs and electrolyte( becuase they empty fast!)
ulcerative colitis is ulcerative inflammatory bowel disease that is just in___.
large intestines
post op for colonoscopy, you would watch for
perforation. we are going to assume the worst. the signs of perforation are pain or unusual discomfort
difference between koch’s ileostomy and a j pouch
koch’s - has a nipple valve that opens and closes to empty intestines
j pouch- removes the colon and attaches the ileum to the rectum ( no external bag)
if the colostomy is in the ascending and transverse you will have _____. if it is in the descending or sigmoid you will have _____.
which do you irrigate?
why?
best time to irrigate?
semi formed stools
semi formed or formed (because the fluid is almost gone)
descending and sigmoid
regularity
same time everyday, after a meal
anytime you are giving an enema, if the client starts to cramp, ____ the fluids, lower the bag and/or check the ___ of the fluid.
what side should the pt be on?
stop
temperature
turn the pt on the left side!!
what position should pt be in with feeding tube?
elevate the hob and always want them on their side.
appendicitis is related to a ____ fiber diet.
major symptom?
never give what to appendicitis client?
low
initially pain localizes in the right lower quadrant (mcburney’s point)
abdominal pain 1st!! then n/v
NEVER GET ENEMAS or LAXATIVES; worry about perforation
when a pt with appendicitis waiting for surgery, what position should the client be in?
right side with hob elevated. so all the bowel content will settle in one area.
hyperalinmentation is aka __.
(tpn) total parenteral nutrition
should anything else go through the line for tpn?
no
glucose in urine—- need ___
ketone in urine—- need ____
insulin
fat; you should change recipe
what position sould the client be in for placement of a central line?
trendenlenburg left side
