GI CCRN REVIEW

Question 1

What are the percentages of G bleed in regards to upper versus lower?

Answer 1

80% upper, and 20% lower

Question 2

Which bleeding location is usually more concerning, upper or lower?

Answer 2

Upper, lower rarely requires ICU admission

Question 3

List 4 pharmacological treatments for GI bleed and their purpose?

Answer 3

1. Vasopressin - constrict splanchnic arterial bed- watch for chest pain & ST elevation
2. Sandostatin - reduces gastric blood flow
3. B-Blockers - reduces portal venous flow, constricts mesenteric arterioles
4. Osmotic Laxatives - decrease protein conversion to ammonia, dose increase needed in liver failure

Question 4

List the two main functional divisions of the pancreas?

Answer 4

exocrine and endocrine

Question 5

What are the exocrine functions of the pancreas?

Answer 5

Secretes:
bicarb- neutralizes stomach acids
digestive enzymes - trypsin, amylase, lipase

Question 6

What are the endocrine functions of the pancreas?

Answer 6

Secretes
glucagon from alpha cells
insulin from beta cells
inhibition of insulin and glucagon by delta cells.

Question 7

How many liters of fluid may be secreted into the interstitial space during a case of acute appendicitis?

Answer 7

6 liters

Question 8

How does acute pancreatitis affect calcium levels?

Answer 8

Decreased Ca levels d/t used up in autodigestion process
can cause trousseau and Chvostek’s sign
QT prolongation
sze

Question 9

What is trousseau sign

Answer 9

hand spasms with occlusion of brachial artery

Question 10

What can beta cell injury during acute pancreatitis cause?

Answer 10

increased blood glucose, hyperosmolar state

Question 11

What is the cause of ARDS in the setting of acute pancreatitis?

Answer 11

release of phospholipase A– it damages type II alveolar cells which decreases surfactant, leading to ARDS