GI Flashcards
what are the 2 functions of the pancreas
endocrine - insulin
exocrine - digestion
what are the two types of pancreatitis
acute
chronic
what are the two causes of acute pancreatitis
alcohol
gallbladder disease
what is the main cause of chronic pancreatitis
alcohol
in pancreatitis does the pain increase or decrease with eating
increase
what happens with the abdomen in pancreatitis? why?
ascites - losing protein rich fluids like enzymes and blood into the abdomeq
what does a rigid board like abdomen incidcate
bleeding
what can a rigid board like abdomen lead to
bleeding leads to peritonitsi
What is Cullings sign
brusing around umbilical area (pancreattisi)
what is Gray Turner’s sign
burising on flank area seen with pancreatitis
is jaundice seen with pancreatitis
yes
are we worried about hypotension or hypertension with pancreatitis
hypotension - bleeding or ascities
what two lab values are most specific in digagnosing pancreatitis
serum lipase and amylase (digestive enzymes and shouldn;t be in blood
what happens to WBC in pancreatitis
increase
what happens to blood sugar with panrcreatitis
increases - can cause permanent diabetes
what happens to ALT, AST levels in pancreatitis?
increase
what happens to PT and aPTT in pancreatitis
prolonged
what is normal amylase values
30-220 U/L
what is the normal lipase range
0-110 U/L
what is the normal AST values
8-40 U/L
what is the normal ALT levles
10-30 U/L
what happens to serum bilirubin in pancreatitits
increased
what happens to hemoglobin and hematocrit in pancreatitis
low if bleeding
high if dehydrated
what are normal hemoglobin values in males and females
male 14-18
female 12-16
what are normal hematocrit values for males and females
m: 0.42-0.52
f: .37-.47
what is the goal with pancreatitis
control pain
true or false a patient with pancreatitis can still eat
false; should be npo don’t want to stimulate gastric secretions/
true or false pancreatitis patients should have NGT to suction and be on bedrest. Why or why not?
true; don’t want to stimulate pancrease to make digestive enzyemes
bed rest decrease stomach secretions
what pain medications are commonly used for pancreatitis
opioids including fentanyl pathces
what drug class is used to dry up secretions with pancreatitis
anticholergices
what types of medications are used for GI protection regarding patients with pancreatitis
PPI
H2 receptor antagonists - ranitidine
antacids
What is a good testing strategy to always think of for patients with pancreatitis
keep stomach dry and empty
why is insulin used for pancreattis pts.
TPN
damaged pancreas
steroids
if your liver is sick what is your #1 concern
bleeding
what are the 4 major fn of the liver
detoxifying
helps blood clot
metabolize drugs
synthesizies albumin
in cirrhosis what happens to the liver
liver cells are destoryed and replaced with connective or scar tissue –> alters liver circulation –> liver BP goes up
does the splenomegaly occur with cirrhosis
yes
what happens to serum albumin in cirrhosis? what does this lead to
decreased –> albumin helps hold onto water in the system –> acitites
what happens to ALT and AST in cirrhosis
increased (liver enzymes)
when your spleen in enlarged what does that mean
immune system is involved
what should never be given to people with liver problems
acetaminphen
what is the antidote for tylenol overdose
acetylcystien mucomyst
can anemia occur with cirrhosis
yes
why can cirrhosis progress to hepatic encephalophaty or coma
ammonia buildup –> acts like a sedatove
what 3 tests are used to diagnose cirrhosis
U/S
CT/MRI
liver biopsy
what lab values are important to check prior to a liver bx
PT
INR
aPTT –> scared of bleeding
how do you posistion a patient for a liver bx
supine with right arm behind head
what is important to tell a patient to do priro to the liver biopsy being taken? why?
take a deep breath and hold
get diaphragm out of the way
how shoulda patient be posistiioned following a liver bx
lie on right side to hold pressure
what should a client do prior to a parencetisis
void –>dont want to puncture bladder
how should a pt be posisitoned for a parcenteis
sitting up to have fluid settle in one spot
what should you worry about anytime you are pulling fluid from a pt.
shock
what drug class should be avoided with liver pts
narcotics —> liver can’t metabolize drugs when it is sick
what kind of diet should a liver pt have
low sodium and decrease protein (don’t want bulild up of ammonia)
what does protein break down to
ammonia
liver converts ammonia to urea
what causes hepatic coma
ammonia buildup
what are handwriting changes a sign of
liver problems
what is fetor
breath smells like ammonia –> wine, fresh cut grass, acetone smelling
what is the treatment for cirrhosis patients
lactulose
cleasing enemas
decraese protein
monitor serum ammonia
where are the 3 places varicies form
stomach
esophagus
rectum
what drug is used to lower liver BP
octreotide
what is a sengstaken blakemore tube used for
balloon tamponade with esophageal varicies
what is a saline lavage used for
to get blood out of stamch
what are the 3 places a peptic ulcer can be found
esophagus
stomach
duodenum
what are the signs and symptoms of peptic ulcers
burning pain usually in the mid-epigastric area/back
heartburn
how are peptic ulcers diagnosed
astroscopy
a pt who is undergoing gastroscopy should be NPO after the procedure till when
their gag reflex returns
what are 3 signs of perforation in a gastroscopy patient
pain
bleeding
trouble swallowing
wat is important to tell pts prior to having a gastroscopy
no smoking, chewing gum or mints, no nicotine patch stimulates stomach motility
smoking stimulates stomach secretions which will increase the chance of aspiration
are abx used for peptic ulcers
they can be to get rid of h. pylori
what are the two types of ulcers
gastric ulcers
duodenal ulcers
what are gastric ulcers charichterised by
malnoursihed pts. pain is usually half hour to 1 hour after mals food doesn't help vomiting does vomit blood
what are characteristics of duodenal ulcers
well noursihed patients
ngith time pain is common and occurs 2-3 hours after mals
food helps
blood in stool is common
what occurs in a hiatial hernia`
diaphragm is too large so stomach moves up into the thoracic cavity
what is the main cause of hiatial hernia
large abdomen
what are the 4 signs and symptoms of hiatial hernia
heartburn
fullness after eating
regurgititaion
dysphatia
should pts. with a hiatial hernia eat spaced out large meals or several small meals
several small
how should patients posisiton themselves after meals if they have a hitial hernia
sit up for 1 hr
what is dumping syndrome
stomach emptines to quick after eating
what side should you lye on to promote stomach emptying? keep stomch full?
right side - releases it
left side - leaves it in
should someone with dumping syndrome drink fluids with meals
no –> between meals
how should a person with dumping syndrome posisiton themselves
semi-recumbent while eating
lay down after meals
what ffoods should someone eat if they have dumping syndrome
avoid carbs and fats –> carbs and fats empty fast
where is ulcerative colitis
only in large intestine
where does chron’s disease affect
ileum usually but can be found anywhere in the samll or large intestines
how is chrons and ulcerative collitis diagnosed (3)
CT
colonscopy
barium enema
what kind of diet should someone have prior to a colonscopy? and for how long?
clear and liquid diet for 12-24 hours
how long should a client be NPO prior to a colonscopy
6-8 hours
what medications should be avoided prior to a coloscopy
NSAIDs
how long should laxitives and enemas be adminsitered
till clear
what helps with drinking colon prep
get it really cold
what should be avoided when drinking colon prep
straws
what are we watching for post op (same with any tube looking around procedure)
perforation
what are the signs of perforation following a colonscopy
pain or unsual discomfort
when is a barium enema done
if a colonscopy is incompete
what medications are vien for ulcerative cholitis and chron’s
abx
steroids
are antidiarrheals given for ulcerative colitis or chrons
only mild ulcerative colitis NOT SEVERE`
what are the newest class showing promise for ulcerative coitis and chrons
biologics such as adalimumab and infliximab
work by interfeing iwht the bodys immune response acting selectively unlike steroids which suppress entire immune system
is sx done for chrons or ulcerative colitis
UC
what sx is done for UC
total colectomy (entire colon)
kock’s ileostomy or a J Pouch (no external bag)
Kocks has nipple to empty
J pouch reatches ileeum to rectum
Can chrons have sx
yes, usually not but can remove only affectd area
what may the client end up with if tehy have chrons sx
ileostomy or cholestomy
what type of stool comes out of ileostomys? what foods should be avoided? what should be cincluded in diet
liquidy stools
hard to digest and rough foods should be avoided
gatroade should be drank ins ummer to replace electrolytes
are ileostomys prone to kidney stones? why or why not
yes, b/c always a little dehydrated
which type of colostoymy has formed stools
descending and sigmoid
ascending and trasnverse are semi-liquid stools
which type of colostomy is irrigted?
why are they are irrigated
descending and sigmoid
for regularity
when is the best time to irrigate a colosty
same time everyday
after a meal (more peristalsis)
why is the more down the colon the more formed the stool
b/c water is being removed
what should you do if a client starts to cramp following an enema
stop and check temp of fluid
what is appendicitis related to
a low fiber diet
how is appendicitis diagnosed
increased WBC
u/s
CT
do you give enemas or laxitives with suspected appendicitis
no, worried about rupture or perforation
how should a patient be posisitoned after an appendectomy
elevate HOB to decrease pressure on abdomen
Is a central line needed for TPN?
yes, particles eat up periipheral veins
can be TPN be abruptly disconcontined? why or why not
no, grdually to avoid hypoglycemia
how often should CBG be done for pts on tpn
every 6 hours
do tpn bags need to be mixed daily
yes, new electrolytes may need to be added
how long can tpn be held
24 horus
what is the most frequent complciation with TPN
infection
what should a nurse have ready for a a health care provider when they are inserting central lines
have saline flushes ready
have pt in trendelenberg
what posisiton do you put a client in if there is air in a central line
left side trendelenberg
