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GI disorders Flashcards

1
Q

Upper GI bleed is caused by

A

Drugs, esophageal varies, stomach/duodenal ulcers/cancer, systemic diseases (leukemia)

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2
Q

Upper GI bleed assessment

A

Determines type of bleeding

  1. Hematoemesis bright red (no gastric acid) or coffee ground (with gastric acid)
  2. Melena: black tarry stool
  3. Bright red blood in stool: Hemorrhoid
  4. 5-10% w/ severe UGIB: hematochezia
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3
Q

Upper GI bleed diagnostics

A 
Endoscopy is primary 
Angiography is endoscopy not an option 
Test stool and vomitus 
Abnormal lab values: 
1. Increased: BUN, Na,
2. Decreased: H/H, UO, K, 
3. Increased or decreased: PT
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4
Q

What lab do you want to obtain for a patient with an UGIB in case of a transfusion?

A

Type and screen

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5
Q

UGIB care

A
  1. Bowel sounds and palpate (hard/rigid stomach)
  2. VS to ensure patient isn’t bleeding too much and going into hypotensive shock
  3. IV for fluid replacement
  4. Packed RBC or FFP
  5. UO
  6. Surgery depending on time, amount and size
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6
Q

Why do you want to measure OU in a patent that has an UGIB

A

It is the best way to ensure that vital organs are getting perfused

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7
Q

Functions of the liver

A
  1. Carb metabolism
  2. Protein metabolism
  3. Fat metabolism
  4. Steroid metabolism
  5. Immune system function
  6. Detoxification of drugs or harmful substances
  7. Bile synthesis
  8. Storage of glucose, fats, vitamins and amino acids
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8
Q

Cirrhosis

A

Chronic and progressive
The start of end stage liver disease when the liver can no longer heal itself and liver cells are being destroyed
Scarring and fibrosis of the liver

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9
Q

Causes of Cirrhosis

A
  1. Hep C (most common)
  2. Alcohol (most common)
  3. Non-alcoholic fatty liver disease
  4. Biliary
  5. Right sided HF
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10
Q

Patho of Cirrhosis

A
  1. Livers tries to regenerate
  2. abnormal blood vessels/bile duct architecture
  3. overgrowth and fibrous connective tissue changes liver structure
  4. Irregular and poor cellular nutrition and hypoxia —> decreased liver function
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11
Q

Early manifestations of liver cirrhosis

A

Usually GI due to inability to metabolize fats, proteins and carbs
Anorexia/weight loss, dyspepsia, N/V, change in bowel habits, abdominal pain, fever, enlarged liver or spleen, fatigue

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12
Q

Late manifestations of liver cirrhosis

A

Hepato cellular failure with portal hypertension, jaundice, Spider angioma, edema, ascites, anemia, thrombocytopenia

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13
Q

What do the labs for someone with cirrhosis look like?

A

Increased AST, ALT, ammonia
Decreases protein, albumin, globulin and cholesterol
Prolonged PT and PTT

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14
Q

What is the gold standard for a definitive diagnosis or cirrhosis?

A

Liver biopsy

Liver ultrasound can be done by it is not definitive

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15
Q

Cirrhosis complications: portal hypertension and varices

A

Due to increase pressure in the portal circulation that can lead to a rupture (more like an artery due to such high pressure)

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16
Q

What can portal hypertension lead to ?

A

Collateral circulation can develop and varices can form in the gastric and esophageal region which is common in pts. with cirrhosis

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17
Q

Care of patients with portal hypertension and varices

A
  1. Medications (b blocker, statin or vasopressin)
  2. Sclerotherapy or band ligation
  3. Balloon tamponade (compresses varices)
  4. Transjugular intrahepatic portosystemic shunt (TIPS)
  5. Education: avoid alcohol, aspirin, NSAIDS b/c they can irritate the varices
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18
Q

Ballon tamponade is used to

A

used to temporarily stabilize if bleed has or is likely to occur

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19
Q

How to care for pt. with balloon tamponade

A

NPO once balloon is inflated

Cut or deflate balloon if it becomes dislodged or blocks the airway

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20
Q

Band litigation

A

band around the varices so if it ruptures so it does not cause a problem

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21
Q

Sclerotherapy

A

injecting varices with glue

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22
Q

Transjugular intrahepatic portosystemic shunt (TIPS)

A

reroutes blood flow

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23
Q

Complications: peripheral edema

A

Due to hypoalbuminemia because the liver metabolizes less proteins

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24
Q

Cirrhosis complications: ascites

A

Serous fluid up in the peritoneal cavity due to

  1. increased protein in the lymph
  2. hypoalbuminemia in vascular space causing third spacing
  3. hyperaldosteronism causing fluid retention
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25
Care for edema and ascites
1. Sodium restriction 2. Diuretics 3. Paracentesis 4. TIPS 5. Monitor s/s of infection 6. Give albumin
26
What diuretics can you give a patient with liver cirrhosis?
Spironalactone, lasix, Tolvaptam (increase water excretion to increase serum sodium)
27
Why do you give albumin to a patient with liver cirrhosis?
to maintain vascular volume and increase colloid osmotic pressure
28
How do you diagnose peritonitis?
Obtain a sample of peritoneal fluid and culture it
29
When do you preform a paracentesis?
When the patient is having abdomen pain or difficulty breathing
30
Paracentesis procedure
1. Bedside or outpatient 2. Ultrasound for correct needle placement 3. Temporary fix because the fluid builds back up 4. less and less effective over time 5. ports can be placed for patients to remove fluid at home
31
Why should a patient void before a paracentesis?
While preforming the procedure, you do not want the needle to accidentally insert into a full bladder
32
Cirrhosis complications: hepatic encephalopathy
Reversible, impaired brain function due to increase ammonia or increased ammonia concentration
33
Grades or HE...
overlap and change rapidly | Grades range from mild confusion to non-arousable
34
Precipitating factors for HE: GI hemorrhage
increase ammonia in GI
35
Precipitating factors for HE: constipation
increase ammonia on feces
36
Precipitating factors for HE: hypokalemia
potassium is needed to metabolize ammonia
37
Precipitating factors for HE: hypovolemia
increase ammonia due to hepatic hypoxia
38
Precipitating factors for HE: infection
increase in catabolism and in cerebral sensitivity to toxins
39
Precipitating factors for HE: cerebral depressants
decrease metabolism by liver --> increased drug levels and cerebral depression
40
Precipitating factors for HE: metabolic alkalosis
Facilitation of ammonia across BBB and increase ammonia by renals
41
Precipitating factors for HE: Paracentesis
decrease sodium and potassium --> decreased blood volume
42
Precipitating factors for HE: dehydration
potentiates ammonia toxicity
43
Precipitating factors for HE: increased metabolism
increases workload of liver
44
Precipitating factors for HE: Uremia
AKA renal failure | retains nitrogenous metabolites
45
Care of HE
1. Reduce ammonia 2. Nutrition 3. Intregumentary jaundice 4. Daily weights and measure abdominal girth 5. Monitor labs for hypokalemia and hyponatermia 6. semi fowlers 7. skin care and ROM for edema 8. Coughing and deep breathing to dec respiratory issues
46
How do you reduce ammonia?
1. Give lactulose which decreases ammonia via stool 2. Rifaximin (antibiotic that is commonly given with lactulose) 3. Avoid constipation!
47
Nutrition of a patient with HE
1. Possible protein restriction but very rare 2. low sodium and fats 3. decrease alcohol 4. High calories
48
Home education for patient with HE
1. Rest 2. Vitamin B-complex 3. Avoid alcohol 4. avoid aspirin, acetaminophen and NSAIDS
49
Acute liver failure
rapid onset of liver dysfunction without history of liver disease associated with HE
50
What is a common cause of acute liver failure?
Drug like Tylenol in combination with alcohol
51
Lab for patient with acute liver failure
Increase AST and ALT
52
What is a common complication of acute liver failure?
Renal failure so care is focused on protecting the renals by providing fluids
53
Why should you avoid sedative with acute liver failure?
It can mask the symptoms and you need to monitor medications that are metabolized by the liver
54
What does the pancreas do?
1. secretes pancreatic juicers to control pH of intestine 2. Secrete hormone secretin which stimulates pancreas to secrete bicarb and water which increases intestinal pH to protect the mucous lining 3. Synthesis and secretion of digestive enzymes
55
Acute pancreatitis
inflammation of pancreas
56
What causes acute pancreatitis?
1. Gallbladder disease (most common) 2. Chronic alcohol intake 3. Smoking
57
What happens to the pancreas with acute pancreatitis?
Normally, the pancreas can protect itself, but during acute pancreatitis, the enzymes that the pancreas produces are prematurely activated and it starts damaging itself
58
Acute pancreatitis manifestations
1. Acute abdominal pain 2. N/V 3. Fever 4. Tachycardia 5. jaundice 6. abdominal distention 7. pancreatic ileus 8. grey turners or Cullens signs
59
What are the characteristics of abdominal pain r/t acute pancreatitis?
LUQ to mid epigastrium Sudden and severe Aggravated by eating Not relieved by vomiting
60
Why is shock a concern with acute pancreatitis?
there is massive fluid shifts that can lead to shock, toxemia or hypovolemia
61
Pancreatitis diagnostics
1. increase in amylase and lipase 2. increase in liver enzymes, triglycerides, glucose and bilirubin 3. Decrease in calcium —> positive chvostek and trousseaus
62
What might you see with a decrease in calcium?
Positive chvostek and trousseaus
63
Pancreatitis complications
1. Pancreatic abecess 2. Pseudocyst 3. Systemic complications including pleural effusion, atelectasis, PNA, ARDS, PE, DIC, MODs, hypotension
64
Pancreatitis care: Pain management
IV pain medications | Frequent position changes
65
Pancreatitis care: Prevention or alleviation of shock
monitor albumin | Give fluids if any s/s of shock
66
Pancreatitis care: Reduce pancreatic secretions
NG tube with NPO | Starts with a high carb diet that is low in fats
67
Pancreatitis care: correction fluid and electrolyte imbalances
IV calcium if tetany Hypokalemia so monitor heart glucose management
68
Pancreatitis care: Prevent or treat infection
antibiotics | Respiratory tract infections common so coughing and deep breathing
69
Pancreatitis care: removal of the cause
such as removing gallstones
70
Why do you want to avoid anticholinergic drugs if patient has pancreatitis?
to avoid a paralytic ileus
71
Home care for pancreatitis
1. no alcohol 2. no smoking 3. PT to increase lost muscle strength 4. Restrict fats (carbs are less stimulating to pancreas)
72
Can pancreatitis cause permanent damage?
50% with severe pancreatitis can have permanent decrease in endocrine/exocrine function
73
What are the precipitating factors for HE? (11)
1. GI hemorrhage 2. Constipation 3. Hypokalemia 4. Hypovolemia 5. Infection 6. Cerebral depressants 7. Metabolic alkalosis 8. Paracentesis 9. Dehydration 10. Increased metabolism 11. Uremia

Complex Care (22 decks)

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