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GI Flashcards

1
Q

2 functions of pancreas

A 
Endocrine= insulin
Exocrine= digestive enzymes
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2
Q 
#1 cause of pancreatitis
#2 cause of pancreatitis
A

Gallbladder disease

Alcohol

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3
Q

Does the pain increase or decrease with eating in pancreatitis?

A

Increases with eating

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4
Q

_______ only activates when it reaches the small intestines.

So when they get blocked and cant get out they ________ inside the pancreas

A

Digestive enzymes

Activate

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5
Q

Abdominal distention can occur in pancreatitis also known as ______

Why?

A

Ascites

Because protein rich fluids like enzymes and blood goes into the abdomen

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6
Q

In pancreatitis, bruising in the umbilical area is called________ sign and bruising in the flank area is________ sign

A

Cullen’s

Grey-Turner’s

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7
Q

Is there fever in pancreatitis? Why?

A

Yes,because there is inflammation

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8
Q

If jaundice is present in signs and symptoms in pancreatitis what organ is involved?

A

Liver

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9
Q

Why does hypotension occur in pancreatitis?

A

Because of bleeding or ascites

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10
Q

Rigid-board like abdomen. Why?

A

Because bleeding can occur that can lead to peritonitis

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11
Q

What are the digestive enzymes in the pancreas?

What are their range values?

What is the most specific enzyme for pancreatitis?

A

Lipase and Amylase

Lipase: 0- 160 U/L(SI)

Amylase: 30 - 220 U/L (SI)

LIPASE

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12
Q

Will blood sugar increase in pancreatitis?

Why?

A

Yes

Because one of the functions of pancreas is producing insulin

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13
Q

What are the liver enzymes?

What are their values?

Do they usually go down?

A

AST and ALT

AST:0-35 U/L(SI)
ALT:10 -40 U/L(SI)

No. They would be either normal or UP

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14
Q

Hemoglobin and Hematocrit.

If increase =

If decrease =

A

Dehydrated

Bleeding

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15
Q

Goal of pancreatitis treatment is

Anticholigernics is given because

Example of anticholinergics

A

Control Pain

Dry clients stomach

Benztropine(cogentin)
Diphenoxylate/atropine(lonox)

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16
Q

Example of pca narcotics

Example of proton pump inhibitor

Example of H2 receptor antagonists

A

Morphine sulfate and hydromorphone

Pantoprazole

Ranitidine(zantac),Famotidine,cimetadine(tagamet)

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17
Q

Clients with pancreatitis, keep _______ _______ and ________

The client should be on______

A

Stomach..empty…dry

NPO

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18
Q

DPL(diagnostic peritoneal lavage)

Is this the first choice? When is it usually used?

A

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.

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19
Q

Should we give insulin to pancreatitis? Why?

What is the alternative for nutrition if client is NPO?

A

Yes. Because pancreas is sick and cant produce insulin.

TNA( total nutrient admixture )

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20
Q

What are the 4 main functions of the Liver?

CLADD

A

Helps blood ito CLOT

ALBUMIN is synthesized by the liver

DRUG is metabolized by the liver

DETOXIFY the body

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21
Q

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?

A

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.

22
Q

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

A 
Firm...Nodular
Pain..stretched
Immune system
Albumin
Dyspepsia...Alcoholic
23
Q

Liver cells are destroyed and replaced with___________ which will alter the _______ of the liver which leads to the ______ going_____ and this is called _______ ______

A

Connective scar tissue
Circulation
BP…UP
Portal Hypertension

24
Q

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.

A

Yes

Ammonia

Encephalopathy..coma….Ammonia

25
Q

What confirms liver cirrhosis diagnosis?

A

Liver biopsy

26
Q

Pre procedure of liver biopsy

Watch out for______

Position of patient during

Exhale and hold ______ why?

Position after

A

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

27
Q

Liver patho
Protein - breaks down to_____.

Then the _____ converts this to ______

It is excreted through the_______

So ______ protein in liver cirrhosis.

A

Ammonia

Liver…Urea

Kidneys

Decrease

28
Q

Flapping tremor of hand is called______ and also known as ______

A

Asterexis….Liver flap

29
Q

What is fetor?

A

Breath smells like ammonia. Some also say it smells like WINE or ACETONE

30
Q

What drug decreases serum AMMONIA?

Anytime this drug is shown think _____

A

Lactulose.

Liver. Because this is the liver drug

31
Q

Octreotide (sandostatin ) does what

And it causes _______ in other parts of the body like coronary artey

A

It lowers BP in the liver

Vasoconstriction

32
Q

S/S of liver cirrhosis:

Firm and
Abdominal pain
Chronic dyspepsia
ALT/AST
Serum albumin
Anemia
A 
Nodular liver
Due to liver capsule has stretched
Liver people and alcoholics have these
are increased
Albumin is decreased
Due to bleeding
33
Q

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

A

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

34
Q

Treatment for liver cirrhosis:

Antacids vits and diuretics
Alcohol
Weights
☆☆Bleeding precautions
Abdominal girth
Narcotics should be
Paracentesis is done
-void
-position
A

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

35
Q

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
A

(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

36
Q

Hepatic coma treatment

Lactulose
Enemas
Diet
Monitor for

A

This is the liver drug
To get blood out of the GI tract
Diet should be a decrease in PROTEIN
AMMONIA every single day

37
Q

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
A

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
38
Q

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

A

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

39
Q

Peptic Ulcers

Patho

S/S:
Burning or gnawing pain
Heartburn

Diagnosis:
Gastroscopy
-sedated
-NPO
-gag reflex

Upper GI

  • NPO
  • no smoking, gum or mints
A

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
40
Q

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
A

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

41
Q

Classifications of peptic ulcers:

Gastric ulcers

  • appear
  • pain is
  • food

Duodenal ulcers

  • appear
  • pain is
  • food
A

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
42
Q

Hiatal hernia

Patho

Causes

  • large abdomen
  • trauma
  • congenital
S/S:
Fullness after
Hesrtburn
Regurgitation
Dysphagia
Treatment: 
Meals
Sit up
Elevate
Surgery
A

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

43
Q

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

A

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

44
Q

Inflammatory bowel Disease(IBD)

Patho

  • Ulcerative Colitis
  • Crohns Disease

S/S
“DDWARRF BLOOD CV”

A

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

45
Q

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

A

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

46
Q

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
A

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
47
Q

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.

A

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

48
Q

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?

A

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

49
Q

1 thing to worry about is

Testing strategy for Appendicitis

Never put pressure on the

A

Rupture

Suture line

50
Q

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?
A

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.

51
Q

Percutaneous feeding tube is for

Feeding Directly into the

A

LONG TERM

STOMACH

52
Q

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?

A

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

Thursss (17 decks)

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