GI Flashcards
2 functions of pancreas
Endocrine= insulin Exocrine= digestive enzymes
#1 cause of pancreatitis #2 cause of pancreatitis
Gallbladder disease
Alcohol
Does the pain increase or decrease with eating in pancreatitis?
Increases with eating
_______ only activates when it reaches the small intestines.
So when they get blocked and cant get out they ________ inside the pancreas
Digestive enzymes
Activate
Abdominal distention can occur in pancreatitis also known as ______
Why?
Ascites
Because protein rich fluids like enzymes and blood goes into the abdomen
In pancreatitis, bruising in the umbilical area is called________ sign and bruising in the flank area is________ sign
Cullen’s
Grey-Turner’s
Is there fever in pancreatitis? Why?
Yes,because there is inflammation
If jaundice is present in signs and symptoms in pancreatitis what organ is involved?
Liver
Why does hypotension occur in pancreatitis?
Because of bleeding or ascites
Rigid-board like abdomen. Why?
Because bleeding can occur that can lead to peritonitis
What are the digestive enzymes in the pancreas?
What are their range values?
What is the most specific enzyme for pancreatitis?
Lipase and Amylase
Lipase: 0- 160 U/L(SI)
Amylase: 30 - 220 U/L (SI)
LIPASE
Will blood sugar increase in pancreatitis?
Why?
Yes
Because one of the functions of pancreas is producing insulin
What are the liver enzymes?
What are their values?
Do they usually go down?
AST and ALT
AST:0-35 U/L(SI)
ALT:10 -40 U/L(SI)
No. They would be either normal or UP
Hemoglobin and Hematocrit.
If increase =
If decrease =
Dehydrated
Bleeding
Goal of pancreatitis treatment is
Anticholigernics is given because
Example of anticholinergics
Control Pain
Dry clients stomach
Benztropine(cogentin)
Diphenoxylate/atropine(lonox)
Example of pca narcotics
Example of proton pump inhibitor
Example of H2 receptor antagonists
Morphine sulfate and hydromorphone
Pantoprazole
Ranitidine(zantac),Famotidine,cimetadine(tagamet)
Clients with pancreatitis, keep _______ _______ and ________
The client should be on______
Stomach..empty…dry
NPO
DPL(diagnostic peritoneal lavage)
Is this the first choice? When is it usually used?
PHC will run a NSS directly into the abdomen and lowers the bag if the backflow is pink-tinged then it means bleesing
No. During mass casualties.
Should we give insulin to pancreatitis? Why?
What is the alternative for nutrition if client is NPO?
Yes. Because pancreas is sick and cant produce insulin.
TNA( total nutrient admixture )
What are the 4 main functions of the Liver?
CLADD
Helps blood ito CLOT
ALBUMIN is synthesized by the liver
DRUG is metabolized by the liver
DETOXIFY the body
If liver is sick what is your number 1 concern?
If liver is sick what do you do with medications?
Should you give acetaminophen? Why?
Antidote for acetaminophen overdose? What should be given with this antidote? And why?
Bleeding
Decrease dose of medications
NO. Because liver cant break it down
Acetycysteine (mucomyst). Should be mixed with carbonated drink because this drug smells like ROTTEN eggs.
Signs and symptoms of cirrhosis
Liver is _____ and ______
Abdominal______ because liver capsule is _______
When the spleen is enlarged the ________ is involved.
Decreased _______
Chronic_____. All liver people and _____ have this
Firm...Nodular Pain..stretched Immune system Albumin Dyspepsia...Alcoholic
Liver cells are destroyed and replaced with___________ which will alter the _______ of the liver which leads to the ______ going_____ and this is called _______ ______
Connective scar tissue
Circulation
BP…UP
Portal Hypertension
Will the ALT and AST increase in liver cirrhosis?
Anytime there is liver problem,worry about _______. This could lead to hepatic______ or _____. Because ______ acts like a sedative.
Yes
Ammonia
Encephalopathy..coma….Ammonia
What confirms liver cirrhosis diagnosis?
Liver biopsy
Pre procedure of liver biopsy
Watch out for______
Position of patient during
Exhale and hold ______ why?
Position after
Clotting studies: PT, INR,aPTT and VS
Bleeding.
Supine with Right arm behind head
Breath. To get the diaphragm out of the way
Lie on right side to hold pressure on puncture site
Liver patho
Protein - breaks down to_____.
Then the _____ converts this to ______
It is excreted through the_______
So ______ protein in liver cirrhosis.
Ammonia
Liver…Urea
Kidneys
Decrease
Flapping tremor of hand is called______ and also known as ______
Asterexis….Liver flap
What is fetor?
Breath smells like ammonia. Some also say it smells like WINE or ACETONE
What drug decreases serum AMMONIA?
Anytime this drug is shown think _____
Lactulose.
Liver. Because this is the liver drug
Octreotide (sandostatin ) does what
And it causes _______ in other parts of the body like coronary artey
It lowers BP in the liver
Vasoconstriction
S/S of liver cirrhosis:
Firm and Abdominal pain Chronic dyspepsia ALT/AST Serum albumin Anemia
Nodular liver Due to liver capsule has stretched Liver people and alcoholics have these are increased Albumin is decreased Due to bleeding
Testing strategies GI
If liver is sick #1 concern is
Liver is sick decrease the
Never give acetaminophen
-antidote for acetaminophen overdose
Spleen is enlarged
Bleeding
Dose of medications
They cant break it down because liver is sick
-acetycysteine(mucomyst) which smells like rotten egg and should be given with milk or carbonated drink
The immune system is involved
Treatment for liver cirrhosis:
Antacids vits and diuretics Alcohol Weights ☆☆Bleeding precautions Abdominal girth Narcotics should be Paracentesis is done -void -position
Avoid alcohol
Daily weights and I and O
Because the liver is sick, no IM injections or aspirin
Abdominal girth should be measured due to ascites
Avoided because liver cant metabolize drugs well when it is sick. Its is the same as giving double dose
To remove extra fluid in the peritoneal cavity
-have client void first
-position is sitting up or HOB elevated
Hepatic Coma
( Normal patho )
Patho for hepatic coma
S/S: Difficult to Asterixis -Handwriting Reflexes and EEG will decrease or Slowdown Fetor Blood is protein
(Protein ➡️broken down to ammonia➡️liver converts ammonia to urea➡️kidneys excrete the urea)
The conversion of ammonia to urea is impaired because the liver is sick, leading to build up of AMMONIA -decreases the LOC
Awake, due to too much ammonia
Asterixis is aka as the liver flap or flapping tremor of the hand. Which could also lead to handwriting changes
Decrease in Reflex or slow EEG because AMMONIA acts like a sedative
Breath smells like ammonia
Liver people tend to be GI bleeders- there is blood in the stomach and OLD blood in intestines and OLD blood makes ammonia go UP
Hepatic coma treatment
Lactulose
Enemas
Diet
Monitor for
This is the liver drug
To get blood out of the GI tract
Diet should be a decrease in PROTEIN
AMMONIA every single day
Bleeding Esophageal Varices
Patho
What is it called in rectum?
In esophagus?
In alcoholic clients that is GI bleeding it is usually esophageal varices- not a problem until it
Treatment: Replace Monitor CVP Oxgen Octreotide
There is High BP in the liver ( aka Portal HPN) forces collateral circulation to form in 3 different places: stomach, rectum and esophagus
Hemorrhoids
Varices
Ruptures
Treatment: Replace blood Cvp is monitored due to High BP Oxygen is given due to anemia Octreotide is given to lower the bp in liver but it causes vasoconstriction in other parts like coronary artery
Procedures and other treatment for Esophageal Varices
Esophageal Variceal Ligation or Endoscopic Sclerotherapy
- banding
- sclerosing
Balloon Tamponade: Sengstaken-Blakemore tube -severe hemorrhage -12 hours -main purpose -mark tube
If balloon goes up and obstructs airway?
Enemas
Lactulose
Saline lavage
These are the most common procedures used for esophageal varices.
Banding is used in EVL
Sclerosing Agent is in injected to varices in endoscopic sclerotherapy
This is a type of balloon tamponade
- used to stabilize patients with severe hemorrhage
- must NOT be used more than 12hours
- main purpose is to HOLD PRESSURE on bleeing varices
- marking tube is first thing to do when it is in place
Scissors is used to pop the balloon. That is why always keep scissors at bed side
Enemas are given to get rid of blood
Lactulose is a liver drug to get rid of Ammonia
To get blood out of the stomach
Peptic Ulcers
Patho
S/S:
Burning or gnawing pain
Heartburn
Diagnosis: Gastroscopy -sedated -NPO -gag reflex
Upper GI
- NPO
- no smoking, gum or mints
Erosion is present and can be in the esophagus, stomach or duodenum. This is the most common cause of GI bleeding
S/S:
Burning pain which is usually in the mid-epigastric area or back
Aka dyspepsia
Diagnosis: Gastroscopy which is through the mouth -sprayed at the back of neck -NPO pre and post procedure -gag reflex must be assessed before giving foods
Upper GI looks at the esophagus and stomach with dye
- npo past midnight
- smoking increases stomach secretions which will increase chance of aspiration AND smoking increases stomach motility which will affect the test
Trestment for peptic ulcers
Medications: Antacids Proton pump inhibitors H2 receptor antagonists Donnatal, viscous lidocaine, Mylanta II Antibiotics for H pylori Sucralfate(carafate)
Client teaching; Stress Smoking Eat what you can Temperature extremes
Liquid antacids to coat the stomach. Taken on an empty stomach( normally antacid is taken after eating) but here acid can get to the ulcer when empty
pantoprazole.omeprazole
Ranitidine, famotidine
Gi cocktail
Clarithromycin, amoxicillin, metronidazole
Forms a barrier around the wound so acid cant get to the ulcer
Stress is decreased
Avoid smoking
Eat what you can tolerate
Avoid temperature extremes and extra spicy foods
Classifications of peptic ulcers:
Gastric ulcers
- appear
- pain is
- food
Duodenal ulcers
- appear
- pain is
- food
Gastric ulcers
- they appear malnourished
- pain is usually half hour to 1 hour after meals
- food does not help but vomiting does
Duodenal ulcers
- appear well nourished or normal
- pain is at night and 2 to 3 hours after meals
- food helps in these clients and blood in stools
Hiatal hernia
Patho
Causes
- large abdomen
- trauma
- congenital
S/S: Fullness after Hesrtburn Regurgitation Dysphagia
Treatment: Meals Sit up Elevate Surgery
The hole in diaphragm is too large an stomach moves up into the thoracic cavity
Causes:
The client has a large abdomen and has alot of intraabdominal pressure to push up
There is trauma on the abdomen
Congenital structural defects
Fullness after eating
Heartburn or dyspepsia
Moving of food back up
Difficulty in swallowing
Meals are small and frequent
Sit up 1 hour after eating to keep stomach down
Elevate HOB to keep stomach in down position
-concrete blocks can be used
Surgery is done to correct it
Dumping sundrome
Patho
-secondary to
S/S
Fullness,weakness,palpitations,cramping,faintness,diarrhea
Treatment: Position during meals Position after meals Fluids Meals Carbs and electrolytes
Testing strategy:
Lay on left to
Lay on right to
The stomach empties too quickly after eating usually secondary to gastric bypass, gastrectomy or gallbladder disease
Treatment: Semi-recumbent with meals Lie down on left side NO fluids with meals Meals are small and frequent Avoid foods rich in carbs and electrolytes because they empty fast
Left to Leave it in
Right to release it
Inflammatory bowel Disease(IBD)
Patho
- Ulcerative Colitis
- Crohns Disease
S/S
“DDWARRF BLOOD CV”
Aka ulcerative inflammatory bowel disease. Just in the large intestine
Aka Regional enteritis. There is inflammation of and erosion of the Ileum( smalle intestines ), but can be found anywhere small or large intestines
Dehydration Diarrhea Weight Loss Anemia Rebound tenderness Rectal bleeding Fever
Blood in the stool
Cramping
Vomiting
Diagnosis for IBD
Ct scan or MRI
Colonoscopy
- 12 to 24 hours
- 6 to 8 hours
- NSAIDs
- laxatives or enemas
- polyethylene glycol (Go-Lytely)
- sedated
To help client drink colon prep more easily get it
- straw
- freeze
Post colonoscopy:
- pain or unusual discomfort
- Xray
Barium Enema
Colonoscopy:
Clear liquids for 12 to 24 hours NPO for 6 to 8 hours Avoid NSAIDS Laxatives or Enemas until clear Polyethylene glycol (Go-Lytely) is given 8 ounces every 10 mins but before procedure anti-dmetic is given -client is sedated for this procedure
ICY COLD because it is easier to tolerate it
- dont use straw ingests too much air
- dont freeze
Post colonoscopy must watch for PERFORATION and the signs are PAIN and unusual DISCOMFORT
-Xray to check
Barium Enema is not usually done anymore
Treatment for IBD
Diet
-Cold foods and smoking
Medications: Antibiotics Steroids Infliximab(remicade), adalimumab(humira) Sulfasalazine(azulfidine),mesalamine(asacol)
Surgery:
Ulcerative Colitis
Kocks ileostomy
Ileal Pouch Anal Anastomosis(IPAA)
Crohns(try not to do surgery)
- remove only the
- ileostomy
- colostomy
Low residue diet
-Avoid cold foods and smoking these can increase motility
Given to kill bacteria
Steroids decrease inflammation
These are biologics
These drugs are aminosalicylates to decrease inflammation
Surgery
Ulcerative Colitis
Kocks pouch has no external bag. It has a valve that opens and closes to empty intestines
IPAA removes the colon and attaches the ileum to the rectum
Crohns
- remove only the affected area
- ostomy in the ileum
- ostomy in the colon
Post op care for IBD
Ileostomy Care
- drain liquid
- irrigate
- avoid foods
- gatorade
- kidney stones
Colostomy care
- water and nutrients
- ascending and transverse
- Descending or sigmoid
Which one to irrigate and why?
When is best time?
When iriigating an ostomy, same principle as an enema
- STOP IF
Left side for enema but if with stoma you dont need to turn on Left side.
Ileostomy care
- drains liquid all the time
- dont need to irrigate ileostomies because they dont get clog
- foods that are hard to digest this increases motility
- gatorade is given because they sweat and lose more Fluid and electrolytes
- they are at risk for kidney stones
Colostomy care
- water and nutrients are being absorbed and STOOL is FORMING
- semi liquid
- formed or semi formed
Descending and sigmoid to promote regularity
Same time everyday after a meal, must develop a routine
-STOP if client experiences CRAMPING, lower bag and or check temp of fluid
1 thing worry about is
Appendicitis is the
S/S Mcburneys point pain Rebound tenderness Nausea/Vomiting History of -1st -2nd
Diagnosis:
WBC
Enlarged what?
CT scan
Enemas or laxatives are
Surgery is done for treatment.
What is the position after surgery?
Inflammation of the appendix
RUPTURE
Right lower quadrant pain Push in then let it go pain is felt(patho in rebound tenderness) Nausea/vomiting Good history must be taken -abdominal pain FIRST -N/V is SECOND
Diagnosis:
WBC is increased
Enlarged appendix
CT scan is used to diagnose
Enemas or Laxatives are NOT given because you are worried about RUPTURE
Fowlers or HOB elevated which decreases pressure on abdomen and Suture
1 thing to worry about is
Testing strategy for Appendicitis
Never put pressure on the
Rupture
Suture line
TNA (total nutrient admixture) is also known as
Must be kept Before administration Central line is needed How about PIC? Filter is Dedicated line If discontinued Daily weights Glucose monitoring Only hung for Change tubing for Cover IV bag with Must be adiministered on a Most frequent Complication?
TPN (total parenteral nutrition) or PN (Parenteral Nutrition)
Refrigerated
Let it sit out for few minutes to warm it prior to hanging
Because this is packed with particles
If PIC dont administer it peripherally
Filter is needed
Nothing else should go through this line. Dont put anything in the TNA
If discontinued it must be gradually to avoid HYPOGLYCEMIA
Daily weights same time each day and same scale
They may develop Hyperglycemia so they must check glucose every 6 hours and may have to take INSULIN
24 hours
Each new bag
Dark bag to prevent breakdown
PUMP
INFECTION.
Percutaneous feeding tube is for
Feeding Directly into the
LONG TERM
STOMACH
Assisting in inserting Central Line
3 pcs of 10 ml syringes of
Dont start fluids unless
Position?
If air gets into the line,what position will the client be placed on?
When changing tubing, how to avoid getting air in?
Why xray done post insertion?
When taking Central line OUT, what is the position of client?
SALINE. It must be available for flushing
Unless confirmation of placement by CXR
Trendelenburg to distend the veins
Left side Trendelenburg. This keeps the bubble in the Right Ventricle
To avoid getting air in, you can CLAMP it off or instruct client to Valsalva or Hummmm
To confirm placement
Laying Flat and must do valsalva or humm
