GI Flashcards
Pancreatitis is ___ of the pancreas.
auto-digestion
The #1 cause of both acute and chronic pancreatitis is ___.
The #2 cause of acute pancreatitis is ___.
ETOH
gallbladder disease
Pain with pancreatitis (increases/decreases) with eating.
Eating
Bruising around umbilicus: ___ ___
Bruising around flank area: ___ ___ ___
Cullen’s sign
Gray Turner’s sign (Remember: turn your back)
Pancreatitis…the labs all go UP except for H&H. Why?
can go up with 3rd spacing
can go down with bleeding
Normal pancreatic enzyme values:
Amylase & Lipase
Amylase: 30 - 220
Lipase: 0 - 110
(Remember: “L for Lipase is Less”)
Normal liver enzyme values:
AST & ALT
AST: 8 - 40 (M’boro highway)
ALT: 10 - 30 (I Lay down at 10:30)
If liver is sick, the #1 concern is ___. Why?
Bleeding
Decrease in clotting factors that are made in the liver!
Pt on BLEEDING PRECAUTIONS
If liver is sick, (increase/decrease) meds. Why?
Decrease
Liver can’t metabolize meds as efficiently
4 jobs of the liver:
1) DETOXIFY
2) CLOTTING factors
3) METABOLIZE
4) makes ALBUMIN
What causes ascites?
The liver isn’t making enough protein so fluid moves to the interstitium
Paracentesis is removal of fluid from the ___ cavity. Why position with HOB straight up?
Fluid drains down
What to remember about dosing narcotics to liver pts.
Cut dose in half…liver can’t metabolize efficiently. It’s like double dosing them.
Diet concerns for liver pts
Decrease protein
Low sodium
Liver pts can’t adequately convert ammonia to ___, so it builds up in the blood. This can decrease ___ & lead to ___ ___.
Urea
LOC
hepatic coma
Ammonia acts like a ___
sedative
Handwriting changes can be an early sign of ___ ___
liver disease
What med is given to decrease ammonia in the body? How does it work?
Lactulose
Eliminates ammonia through the GI tract. Pt has diarrhea…you want diarrhea here!
Portal HTN leads to the formation of ___ circulation. What 3 places do these form?
collateral
- stomach
- esophagus
- rectum
What med lowers BP in the liver? What should we watch out for when using it?
Octreotide
Causes vasoconstriction in other areas including the heart!
What 3 places do we commonly find peptic ulcers?
esophagus
stomach
duodenum
S/S of peptic ulcer
Burning pain in epigastric area and/or back
Hearburn
May also feel hungry
Meds for Peptic Ulcer Dz
- Antacid (empty stomach / at bedtime)
- PPI
- H2 blocker
- Antibiotic (clarithromycin, amoxicillin, tetracycline, metronidazole)
- Sucralfate (forms barrier over wound)
Watch with tetracycline admin…
photosensitivity
DON’T GIVE WITH CALCIUM PRODUCTS
stains teeth
Dumping syndrome symptoms
(Think, similar to stomach bug)
- fullness
- weakness
- palpitations
- cramping
- faintness
- diarrhea
What to avoid with dumping syndrome
Foods high in carbs and electrolytes
make GI empty fast
What does “rebound tenderness” indicate?
Inflammation
Pt ed for colonoscopy
- clear liquid diet 12-24 hrs preprocedure
- NPO 6-8 hrs before
- avoid NSAIDS several days before
- laxatives/enemas until cleared out
- polyethyline glycol (Golightly)…serve icy cold to help drink
Remember about an ileostomy…
Always a little dehydrated b/c poop is liquid
Restore electrolytes, esp in summer (Gatorade)
At risk for kidney stones (dehydrated)
Parts of colonoscopy that require irrigation:
When to irrigate?
descending and sigmoid
Same time each day
AFTER a meal (peristalsis is up and running)
Positioning for irrigating colonoscopy…
Positioning for enema…
Colonoscopy –> Doesn’t matter
Enema –> left side (“Left…Leave it in”)
Don’t give enemas or laxatives to appendicitis pt b/c…
worried about rupture
Positioning for appendicitis
sitting up, lay toward right side b/c if ruptured the contents will localize on that side
TPN…keep ___, but serve ___ ___. Why?
keep refrigerated, but serve room temp
B/c so much sugar, bacteria can grow
Admin TPN in a ___ ___
Use a filter
central line (helps dilute)
How to avoid hypoglycemia with TPN
Discontinue GRADUALLY
If out of TPN, admin D5W until more comes
TPN is selective to the pt. Only good for ___ hrs
24
When changing central line tubing, what are 3 ways that help avoid getting air in the line?
- clamp it off
- Valsalva
- take a deep breath and hum
