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Complex Care > GI disorders > Flashcards

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
Q

Care for edema and ascites

A
  1. Sodium restriction
  2. Diuretics
  3. Paracentesis
  4. TIPS
  5. Monitor s/s of infection
  6. Give albumin
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26
Q

What diuretics can you give a patient with liver cirrhosis?

A

Spironalactone, lasix, Tolvaptam (increase water excretion to increase serum sodium)

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27
Q

Why do you give albumin to a patient with liver cirrhosis?

A

to maintain vascular volume and increase colloid osmotic pressure

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28
Q

How do you diagnose peritonitis?

A

Obtain a sample of peritoneal fluid and culture it

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29
Q

When do you preform a paracentesis?

A

When the patient is having abdomen pain or difficulty breathing

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30
Q

Paracentesis procedure

A
  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
Q

Why should a patient void before a paracentesis?

A

While preforming the procedure, you do not want the needle to accidentally insert into a full bladder

32
Q

Cirrhosis complications: hepatic encephalopathy

A

Reversible, impaired brain function due to increase ammonia or increased ammonia concentration

33
Q

Grades or HE…

A

overlap and change rapidly

Grades range from mild confusion to non-arousable

34
Q

Precipitating factors for HE: GI hemorrhage

A

increase ammonia in GI

35
Q

Precipitating factors for HE: constipation

A

increase ammonia on feces

36
Q

Precipitating factors for HE: hypokalemia

A

potassium is needed to metabolize ammonia

37
Q

Precipitating factors for HE: hypovolemia

A

increase ammonia due to hepatic hypoxia

38
Q

Precipitating factors for HE: infection

A

increase in catabolism and in cerebral sensitivity to toxins

39
Q

Precipitating factors for HE: cerebral depressants

A

decrease metabolism by liver –> increased drug levels and cerebral depression

40
Q

Precipitating factors for HE: metabolic alkalosis

A

Facilitation of ammonia across BBB and increase ammonia by renals

41
Q

Precipitating factors for HE: Paracentesis

A

decrease sodium and potassium –> decreased blood volume

42
Q

Precipitating factors for HE: dehydration

A

potentiates ammonia toxicity

43
Q

Precipitating factors for HE: increased metabolism

A

increases workload of liver

44
Q

Precipitating factors for HE: Uremia

A

AKA renal failure

retains nitrogenous metabolites

45
Q

Care of HE

A
  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
Q

How do you reduce ammonia?

A
  1. Give lactulose which decreases ammonia via stool
  2. Rifaximin (antibiotic that is commonly given with lactulose)
  3. Avoid constipation!
47
Q

Nutrition of a patient with HE

A
  1. Possible protein restriction but very rare
  2. low sodium and fats
  3. decrease alcohol
  4. High calories
48
Q

Home education for patient with HE

A
  1. Rest
  2. Vitamin B-complex
  3. Avoid alcohol
  4. avoid aspirin, acetaminophen and NSAIDS
49
Q

Acute liver failure

A

rapid onset of liver dysfunction without history of liver disease associated with HE

50
Q

What is a common cause of acute liver failure?

A

Drug like Tylenol in combination with alcohol

51
Q

Lab for patient with acute liver failure

A

Increase AST and ALT

52
Q

What is a common complication of acute liver failure?

A

Renal failure so care is focused on protecting the renals by providing fluids

53
Q

Why should you avoid sedative with acute liver failure?

A

It can mask the symptoms and you need to monitor medications that are metabolized by the liver

54
Q

What does the pancreas do?

A
  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
Q

Acute pancreatitis

A

inflammation of pancreas

56
Q

What causes acute pancreatitis?

A
  1. Gallbladder disease (most common)
  2. Chronic alcohol intake
  3. Smoking
57
Q

What happens to the pancreas with acute pancreatitis?

A

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
Q

Acute pancreatitis manifestations

A
  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
Q

What are the characteristics of abdominal pain r/t acute pancreatitis?

A

LUQ to mid epigastrium
Sudden and severe
Aggravated by eating
Not relieved by vomiting

60
Q

Why is shock a concern with acute pancreatitis?

A

there is massive fluid shifts that can lead to shock, toxemia or hypovolemia

61
Q

Pancreatitis diagnostics

A
  1. increase in amylase and lipase
  2. increase in liver enzymes, triglycerides, glucose and bilirubin
  3. Decrease in calcium —> positive chvostek and trousseaus
62
Q

What might you see with a decrease in calcium?

A

Positive chvostek and trousseaus

63
Q

Pancreatitis complications

A
  1. Pancreatic abecess
  2. Pseudocyst
  3. Systemic complications including pleural effusion, atelectasis, PNA, ARDS, PE, DIC, MODs, hypotension
64
Q

Pancreatitis care: Pain management

A

IV pain medications

Frequent position changes

65
Q

Pancreatitis care: Prevention or alleviation of shock

A

monitor albumin

Give fluids if any s/s of shock

66
Q

Pancreatitis care: Reduce pancreatic secretions

A

NG tube with NPO

Starts with a high carb diet that is low in fats

67
Q

Pancreatitis care: correction fluid and electrolyte imbalances

A

IV calcium if tetany
Hypokalemia so monitor heart
glucose management

68
Q

Pancreatitis care: Prevent or treat infection

A

antibiotics

Respiratory tract infections common so coughing and deep breathing

69
Q

Pancreatitis care: removal of the cause

A

such as removing gallstones

70
Q

Why do you want to avoid anticholinergic drugs if patient has pancreatitis?

A

to avoid a paralytic ileus

71
Q

Home care for pancreatitis

A
  1. no alcohol
  2. no smoking
  3. PT to increase lost muscle strength
  4. Restrict fats (carbs are less stimulating to pancreas)
72
Q

Can pancreatitis cause permanent damage?

A

50% with severe pancreatitis can have permanent decrease in endocrine/exocrine function

73
Q

What are the precipitating factors for HE? (11)

A
  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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