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CJA > GI emergencies > Flashcards

GI emergencies Flashcards

1
Q

when are you concerned about intestinal integrity?

A

-obstruction
-perforation
-ischemia

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2
Q

when are you concerned about infection?

A

-diverticulitis
-appendicitis
-peritonitis

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3
Q

what causes a bowel obstruction?

A

-functional (maybe it’s blood flow, twist, scar tissue)
-mechanical (intrinsic lesions & extrinsic lesions)

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4
Q

most commonly seen bowel obstructions

A

-adhesions
-tumor

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5
Q

functional bowel obstructions

A

(Ileus)
-inactive intestinal muscles producing blockage or obstruction of the intestine
-most often seen post abdominal surgeries
-can also be caused by medications, electrolyte abnormalities, infections

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6
Q

who’s at risk for an abdominal obstruction?

A

-prior abdominal surgery
-ischemia
-hernia
-abdominal cancer
-abdominal radiation
-IBS
-decreased gut motility
-decreased general mobility

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7
Q

obstructions - priority assessments

A

-failure to pass stool or flatus
-diarrhea
-abdominal pain
-abdominal distension
-nausea and vomiting (loosing bicarb & potassium)
-changes in bowel sounds
-tympany
-tachycardia
-hypotension
-fever
-localized tenderness, rebound, guarding (suggesting peritonitis)

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8
Q

obstructions - priority interventions

A

-NG tube insertion to decompress the gut
-antiemetic medications (metocloprmide for partial/functioning obstruction, halodol for complete/malignant obstructions)
-isotonic IV fluids to replace volume deficit
-replete electrolytes as necessary
-bowel rest
-consult surgery asap

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9
Q

NG tube management

A

-make them NPO
-do oral care
-double lumen w/ vent
-intermittent suction not high suction

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10
Q

gold standard for checking NG tube placement

A

pH check

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11
Q

obstructions - surgical management

A

-~25% of cases will require surgical intervention
-complete mechanical obstruction can cause strangulation and necrosis
-strangulation is surgical emergency
-may require diverting ileostomy or colostomy

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12
Q

GI ischemia

A

lack of perfusion to the gut is catastrophic for the patient, mortality is 50%

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13
Q

GI ischemia etiology

A

-compromise in blood flow to the intestine
-acute occlusion usually due to cardiogenic embolus
-results in tissue injury, death, and eventually necrosis

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14
Q

underlying causes for GI ischemia

A

-hypovolemia
-arrhythmias
-hypercoagulable states
-mechanical obstructions
-vascular diseases
-trauma
-vasoconstrictors

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15
Q

who’s at risk for ischemia

A

-obstruction
-DM
-dyslipidemia
-smoking
-heart failure
-aortic or coronary artery bypass surgery
-shock
-afib (watch for clots)
-atherosclerosis

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16
Q

ischemia signs and symptoms

A

-abdominal pain “out of proportion to the physical examination”
-peritoneal signs (abdominal guarding and rebound tenderness)
-acute onset colicky, severe left lower abdominal pain
-diarrhea
-abdominal distension
-decreased bowel sounds
-hematochezia (bloody stools)
-abdominal tenderness

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17
Q

order of assessing abdomen

A

inspect
auscultate
percuss
palpate

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18
Q

ischemia priority assessment

A

-strong physical assessment
-leukocytosis
-metabolic acidosis
-elevated lactate
-elevate LDH
-signs and symptoms of sepsis
-hemodynamic stability

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19
Q

ischemia priority interventions

A

-isotonic IV fluids to replace volume deficits
-broad spectrum antibiotics
-hemodynamic stability
-NG tube insertion to decompress the gut
-replete electrolytes as necessary
-bowel rest
-possibly consult vascular
-treat underlying cause fast

20
Q

intestinal perforation etiology

A

-ischemia (bowel obstruction, necrosis)
-infection (appendicitis, diverticulitis)
-erosion (malignancy, ulcerative disease)
-physical disruption (trauma, iatrogenic injury (accidentally hitting bowel during surgery))

20
Q

intestinal perforation

A

full-thickness injury of the bowel wall

21
Q

who’s at risk for intestinal perforation?

A

-recent abdominal procedures
-recent traumas
-foreign body ingestion
-violent vomiting
-IBDS
-cancer

22
Q

intestinal perforation priority assessments

A

-thorough abdominal history and examination
-imaging to look for intraperitoneal air
-signs & symptoms of sepsis
-nausea and vomiting
-perioneal signs (abdominal guarding & rebound tenderness)
-rigid abdomen

23
Q

intestinal perforation priority interventions

A

-hemodynamic stability
-broad spectrum antibiotics
-consult surgery
-possibly consult vascular surgery (aorta is in there)

24
Q

diverticulitis etiology

A

inflammation of one or more diverticula

25
Q

diverticulitis risk factors

A

-age
-low intake of dietary fiber
-slow colonic transit time
-obesity
-cigarette smoking
-history of frequent constipation
-regular use of NSAIDs
-family history

26
Q

diverticulitis priority assessment

A

-cramping pain in lower left quadrant (hallmark sign)
-constipation
-bloating
-nausea
-fever
-leukocytosis
-monitor for evolving signs and symptoms

27
Q

diverticulitis priority interventions

A

-spectrum of treatment depending on severity
-uncomplicated vs complicated

28
Q

uncomplicated diverticulitis priority interventions

A

-rest, oral fluids, analgesics medications
-high-fiber, low-fat diet
-selective antibiotic use

29
Q

complicated diverticulitis priority interventions

A

-hospitalization
-NPO
-IV fluids
-gastric decompression
-broad-spectrum antibiotics

30
Q

diverticulitis priority interventions

A

-abscess formation requires intervention (CT-guided percutaneous drainage, IV antibiotics)
-possible surgery after recovery to prevent recurrence

31
Q

appendicitis etiology

A

-appendix prone to obstruction and infection
-obstruction causes inflammation (increased pressure, edema, ischemia, bacterial growth)

32
Q

appendicitis priority assessments

A

-vague periumbilical pain progresses to right lower quadrant pain
-McBurney’s sign
-Rovsing’s sign
-monitoring for changes in signs and symptoms

33
Q

McBurney’s sign

A

RLQ pain

34
Q

Rovsing’s sign

A

LLQ pain

35
Q

appendicitis priority interventions

A

-pain relief (morphine)
-isotonic IV fluids to replace volume deficit
-antibiotics
-post surgical nursing interventions (prevent atelectasis, high fowler position, early ambulation, monitor for bowel sounds)

36
Q

Peritonitis

A

inflammation of the peritoneum

37
Q

primary peritonitis

A

spontaneous bacterial infection of ascitic fluid

38
Q

secondary peritonitis

A

perforation of abdominal organs with spillage that infects with serous peritoneum

39
Q

tertiary peritonitis

A

superinfection in a patient who is immunocompromised

40
Q

who’s at risk for primary peritonitis

A

liver failure

41
Q

who’s at risk for secondary peritonitis

A

-appendicitis
-ulcerative disease
-diverticulitis

42
Q

who’s at risk for tertiary peritonitis

A

HIV progressed to AIDS

43
Q

peritonitis priority assessments

A

-difficult to differentiate early signs (signs and symptoms of underlying cause)
-generalized, diffuse pain that becomes localized
-distended, rigid abdomen
-nausea and vomiting
-anorexia
-signs and symptoms of sepsis and septic shock
-monitor labs

44
Q

peritonitis priority interventions

A

-infection source control is priority
-antibiotics
-isotonic IV fluids to replace volume deficit
-replete electrolytes as necessary
-hemodynamic stability

45
Q

Nutrition for the critically ill patient

A

-Enteral nutrition (EN) is preferred
-Parenteral nutrition only is EN is not feasible
-beware of nutrition intolerances with gastric resections (dumping syndrome, refeeding syndrome)

CJA (31 decks)

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