GI and Nutrition Flashcards
Most common cause of hospitalization
GI bleed
Ligament of Treitz
Division of upper and lower GI
Upper GI Bleed Causes
Peptic Ulcer disease
Stress ulcers - caused by ischemia HF, sepsis etc.
Mallory Weiss tear - arterial hemorrhage (NSAID use)
Esophageal Varices - Develop w increase pressure in veins
Normal portal venous pressure
2-6 mm Hg
Peptic Ulcer disease
Most common cause of upper GI blled
In stomach and Duodenum
Breakdown of GI lining develops into muscle
RF - Smoking, H pylori, NSAID use, alcohol abuse
RUQ pain
Stress Ulcer
Occurs w increased acid production
Curling ulcer - Burn pt
Cushing’s Ulcers - head trauma
PPI - pantoprazole Enteral
H2 receptor Parenteral
GERD pain when swallowing
Cormorbidity
Esophageal Varices
Portal Hypertension
Veins become distended and varices develop
In esophagus and upper stomach
Jaundice, weakness, anorexia, abdominal distentiojn
Stool for upper GI bleed
BLACK TARRY Stool - Melena
Mallory Weiss Tear
Where esophagus meets stomach
After forceful vomiting
May need surgical repair. Often self resolvable
Could possibly cause bright red blood in stool. HEMATOCHESIA
Hematochezia in upper GI
Mallory Weiss Tear. RARE major bleed.
Priority for Upper GI
Blood loss
Hemodynamic stability
Fluid resuscitation
Hemodynamic Stability for GI bleed
Oxygen - NC
IV placement
Hemodynamic monitoring
Fluid Resuscitation
Blood Products
Gastric Lavage
Pharmacology Upper GI Bleed
Antacids - pH
PPI - inhibits gastric secretions
H2 - blocks HCl
Prokinetics - strengthens Lower esophageal sphincter
ABX - H pylori
Mucosal barrier - reduces acid secretion
Lower GI Bleed
Diverticulosis - Small outpouching
Angioectasias - Dilation of vessels
Post polypectomy bleeding - Bleeding after polyp is removed
Ischemic Colitis - reduced blood flow to colon
Acute Pancreatitis
Inflammation of pancreas
Causes - Alcoholism, Biliary Disease(Gallstones, Bile duct obstruction, ERCP procedure) Meds, Trauma
Acute Pancreatitis Patho
Autodigestion leads to edema, interstitial hemorrhage, necrosis
S/S pancreatitis
Pain - epigastric
N/V
Fever
Abdominal guarding - ascites
Retroperitoneal Hemorrhage (Grey Turner’s sign, Cullens Sign)
Jaundice
Pancreatitis can cause
pulmonary complications, DIV, abscess, renal failure, high glucose, hypovolemic shock
Lab Data Pancreatitis
Elevated - Serum urine, Serum lipase, WBC, GLucose, Liver function, Bilirubin, Triglycerides
Decreased- Calcium, Albumin, Potassium
Pancreatitis Nursing Care
Control Pain
Prevent shock
nutrition
minimize complications
Iv fluids
Parenteral Nutrition
Recommended who cannot meet caloric needs by mouth
Short Term Nutrition
NG or Og
Long term nutrition
PEG jejunostomy
Nursing Nutrition Management
Insertion of tube - verify placement Chest X ray, aspirate gastric content, 30 CC’s of air “whoosh”
Maintenance of tube
Adm of Feedings
Glucose Checks
Assess pt
Intermittent feeding evaluation when to flush w saline
Flushed 30mL q 4
before and after feedings
before and after med adm
Signs of intolerance
N/V
Absent bowel sounds
abdominal distention
cramping
diarrhea
Enteral Nutrition
PO
NGT
PEG T
Best form
Oral Supplements
Maintains gut health
HOB 30
Parenteral Nutrition
Directly to blood stream
Via central Line
TPN
Check blood glucose
Digestive Enzymes
Lipase fat
Amylase -carbs
Trypsin - protein
Test for polyps
SIgmoidoscopy
test for stomach ulcers
EGD
test for obstruction in biliary tract
fluoroscopy
test for air in abdomen
fluoroscopy / XRAY
Grey Turners Sign
Pancreatitis
Bruising on back
Cullens
Pancreatitis
Bruising on umbilicus
