GI Flashcards
auto digestion of the pancreas
pancreatitis
endocrine function of the pancreas
insulin
exocrine function of the pancreas
digestive enzymes
1 cause of acute pancreatitis
alcohol
2 cause of acute pancreatitis
gallbladder disease
1 cause of chronic pancreatitis
alcohol
sx of pancreatitis
pain ascites abdominal mass rigid abdomen culler's sign fever N/V jaundice hypotension
bruising around umbilical area
cullen’s sign
bruising around flank area
grey-turner’s sign
how do you diagnose pancreatitis
elevated liver enzymes
elevated WBCs
increased blood sugar
increased serum bilirubin
with pancreatitis the PT and aPTT is _____.
longer
normal amylase
30-220
normal lipase
0-110
normal AST
8-40
normal ALT
10-30
treatment for pancreatitis
control pain
steroids
anticholinergics
GI protectants
with pancreatitis we want the stomach ____ and _____
empty and dry
male hemoglobin levels
14-18
female hemoglobin levels
12-16
male Hct levels
42-52%
female Hct levels
37-47%
why do we give anticholinergics with pancreatitis?
dry up secretions
examples of anticholinergics
benztropine
atropine
examples of GI protectants
pantoprazole
ranitifidine
famotidine
antacids
since we want the stomach empty and dry the client with pancreatitis needs
NPO
NGT to suction
bedrest
why will pancreatitis patients need insulin?
pancreas is sick
steroid use
TPN
4 major functions of the liver
detoxifying the body
helps blood clot
breaks down drugs
synthesizes albumin
with cirrhosis of the liver, liver cells are destroyed and replaced with scar tissue with alters the circulation within the liver, which in turn makes the BP in the liver go up….this is called?
portal HTN
if your liver is sick ____ is your #1 concern
bleeding
if your liver is sick ___ the dose of meds
decrease
never give ___ to people with liver problems
tylenol
antidote for tylenol
acetylcysteine (mucomyst)
sx of cirrhosis
firm, nodular liver abdominal pain chronic dyspepsia change in bowel habits ascites splenomegaly
serum albumin with cirrhosis
decreased
3rd spacing
ALT and AST in cirrhosis
increased
when the spleen is enlarged, the _____ system is involved
immune
dx of cirrhosis by?
liver biopsy
CT/MRI
ultrasound
which labs need to be viewed prior to liver biopsy
PT, INR, aPTT
how do you position client for liver biopsy
supine with R arm behind head
post liver biopsy position?
lie on R side
treatment for cirrhosis
antacids, vitamins, diuretics
no more alcohol
I/Os, daily weights
measure abdominal girth
removal of fluid from the peritoneal cavity
paracentesis
have the client ____ before paracentesis
void
position for paracentesis
sitting up
with “shocky” clients, the BP goes ____ and the pulse goes ____
down
up
anytime you are pulling fluids you can throw them into ____
shock
avoid ____ because the liver can’t metabolize drugs well when it’s sick
narcotics
if you give a liver client narcotics, it’s the same thing as doing what to them?
double dosing them
diet for cirrhosis
decrease protein
low sodium diet
protein breaks down to _____
ammonia
the liver converts ammonia to ____
urea
the kidneys excrete the ____
urea
when the liver is impaired, it can’t make the conversion to urea and _____ builds up in the blood
ammonia
what does the increase in ammonia do?
decrease LOC
ammonia acts as a ____
sedative
sx of hepatic coma
mental changes difficult to awake asterixis slow EEG fector
what is fector?
breath smells like ammonia
treatment for hepatic coma
lactulose
cleansing enema
decrease protein in the diet
lactulose decreases serum _____
ammonia
high BP in the liver known as ____ ___ forces collateral circulation to form
portal HTN
the collateral circulation forms in 3 different places?
stomach
esophagus
rectum
when you see an alcoholic client that is GI bleeding it is usually _____ _____
esophageal varices
esophageal varices are usually no problem until they _____
rupture
treatment for esophageal varices
replace blood
VS
CVP
Oxygen
_______ medication helps with esophageal varices by lowering BP in the liver
octreotide (sandostatin)
an infrequently used emergency procedure that may be used to stabilize clients with severe hemorrhage with esophageal varices
balloon tamponade
balloon tamponade should not be used more than _____ hrs
12
purpose of balloon tamponade
hold pressure on bleeding varices
common cause of GI bleeding
peptic ulcers
peptic ulcers are most common in ?
males
sx of Peptic ulcers
burning pain
heartburn
dx of peptic ulcers
gastroscopy
Upper GI
what’s important about gastroscopy
NPO before
they’re sedated
watch for perforation with gastroscopy by watching for what 3 things?
pain
bleeding
trouble swallowing
looks at the stomach with dye
upper GI study
NPO for how long for upper GI
NPO past midnight
education before upper GI
no smoking, gum, or mints
no smoking/nicotine patches
treatment of peptic ulcers
antacids
PPIs
H2 antagonist
client teaching with peptic ulcers
decrease stress
stop smoking
avoid spicy foods
malnourished
pani is usually half hour to 1 hr after meals
food doesn’t help, vomiting does
vomit blood
gastric ulcers
well-nourished
night time pain and 2-3 hrs after meals
eating helps
blood in stools
duodenal ulcers
when the hole in the diaphragm is too large so the stomach moves up into the thoracic cavity
hiatal hernia
main cause of hiatal hernia
large abdomen
other causes of hiatal hernia
congenital abnormalities
trauma
straining
sx of hiatal hernia
heartburn
fullness after eating
regurgitation
dysphagia
tx of hiatal hernia
small freq meals
sit up 1 hr after meals
elevate HOB
surgery
when the stomach empties too quickly after eating and the client experiences many uncomfortable to severe side effects…usually secondary to gastric bypass, gastrectomy, or gallbladder disease
dumping syndrome
sx of dumping syndrome
fullness weakness palpitations cramping faintness diarrhea
left side lying=
leaves it in
right side lying=
releases it
tx of dumping syndrome
semi-recumbent with meals lie down after meals no fluids with meals small freq. meals avoid food high in carbs and electrolytes
ulcerative inflammatory bowel disease
only in lg. intestine
ulcerative colitis
inflammation and erosion of the ileum but can be found anywhere in the small or large intestine
chron’s disease
sx of ulcerative colitis and chron’s disease
diarrhea rectal bleeding weight loss vomiting cramping dehydration blood in stools anemia rebound tenderness fever
what does rebound tenderness indicate?
peritoneal inflammation
dx of ulcerative colitis and chron’s disease
CT
colonoscopy
barium enema
clear liquids __-__hrs before colonoscopy
12-24
NPO __-__hrs before colonoscopy
6-8
they drink go-lytely before the colonoscopy. the other name for this is?
sodium polystyrene sulfonate
to help your client drink a colon prep more easily, get it _____
ice cold
post op colonoscopy watch for?
perforation
sx of perforation after colonoscopy
pain/unusual discomfort
treatment for ulcerative colitis and chron’s disease
diet
meds
surgery
diet for ulcerative colitis and chron’s disease
low fiber diet
avoid cold foods, hot foods, and smoking
meds for ulcerative colitis and chron’s disease
antidiarrheals
ATBs
steroids
surgery for ulcerative colitis
total colectomy
kock’s illeostomy
a kock’s pouch hav a nipple valve that opens and closes to ____ the intestines
empty
the J pouch procedure removes the colon and attaches the ____ to the ____
illeum to the rectum
with chron’s they try not to do ____
surgery
an ostomy in the ileum is called an ___
ileostomy
an ostomy in the colon is called a _____
colostomy
an ileostomy is going to drain _____ all the time
liquid
do you have to irrigate ileostomy?
NO
ileostomy patients are always at risk for ___ ___ because they are always a little dehydrated
kidney stones
a colostomy in the ascending and transverse colon have what type of stools
semi liquid
colostomy in the descending or sigmoid colon have what type of stools?
semi-formed or formed
which ostomys do you irrigate?
descending and sigmoid
sx of appendicitis
pain at mcburney’s point
rebound tenderness
N/V
anorexia
dx of appendicitis
increased WBCs
ultrasound
CT
do not give ___ or ___ with appendicitis because we are worried about perforation
enemas or laxatives
treatment for appendicitis
surgery
after appendectomy what position should they be in?
HOB up
keep TPN refrigerated but ___ for administration
warm
what 2 things are needed for TPN
filter and central line
BG monitoring q ___ hrs with TPN
6 hrs
TPN can only be hung for ___ hrs
24
check urine for ___ and ____ with TPN
glucose and ketones
position to put in a central ine
trendelenburg
if air gets in the central line what position do you put them in?
left side trendelenburg
when changing the tubing for central line, how do you avoid getting air in the line?
clamp it off
valsalva
take a deep breath and HUM
why is x-ray done post insertion of central line?
placement
and to make sure they don’t have pneumothorax
central lines go into the ___ ___
RA
