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critical care > GI (liver) > Flashcards

GI (liver) Flashcards

1
Q

describe patho related to portal HTN

A

portal HTN results in venous congestion and dilation. pressure builds up in systemic venous circulation, causes congestion where portal and systemic venous system connect (esophagus, stomach, rectum)

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2
Q

important functions of the liver

A

synthesize albumin (maintains oncotic pressure)
eliminates bilirubin
coagualtion factors!! (impaired clotting is dysfxn)

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3
Q

what lab is most reflective of liver failure

A

high serum ammonia

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4
Q

inflammatation of the liver caused by virus, bacteria, drugs, alcohol, toxins

A

hepatits

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5
Q

treatment for hepatitis

A

supportive : rest, nutrition, avoid stress and hepatotoxic substances, treat cause

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6
Q

liver condition with chronic inflammation, circulationa dn structure changes, and alterations in metabolic processes

A

cirrhosis

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7
Q

what is cirrhosis caused by

A

chrinic active hepatitis, biliary obstruction, and unknown!

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8
Q

what is cirrhosis most commonly caused by?

A

chronic alcohol abuse

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9
Q

what does portal HTN result in poor metabolism of?

A

nutrients
drugs
toxins

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10
Q

where do vascular changes occur with portal HTN?

A

esophagus, stomach, rectum

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11
Q

assessment findings for impaired liver fxn

A

jaundice
edema
fatigue
bruising
ascites

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12
Q

importatn lab findings in impaired liver fxns

A

inc. ALT/AST
inc. ammonia

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13
Q

what is a reversible dec. in neuro fxn related to liver probs

A

hepatic encephalopathy

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14
Q

what causes hepatic encephalopathy

A

accumulation of ammonia and neurotoxins

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15
Q

what is an early sign of hepatic encephalopathy

A

asterixis (hand flapping, can not keep them up)

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16
Q

what meds are given for hepatic encephalopathy

A

lactulose, neomycin, rifaximin

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17
Q

accumulation of fluid in the peritoneum

A

ascites

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18
Q

what is retained with ascites

A

sodium and water

19
Q

what problem does ascites lead to

A

resp distress

20
Q

treatment for ascites

A

bedrest / low sodium diet / diuretics
paracentesis
LaVeen shunt
transjugular intrahepatic portosystem shunt (TIPS)

21
Q

complications of paracentesis for ascites

A

hypotension adn inc. risk of infection

22
Q

what method of ascites treatment is used when the ot is resistant to other treatment

A

LaVeen shunt

23
Q

which ascites treatment is a perforated intra-abdominal tube placed in peritoneal cavity which is tunneled to the superior vena cava

A

LaVeen shunt

24
Q

complications of LaVeen shunt

A

sepsis
peritonitis
occlusion

25
Q

which treatment is used to decompress the portal venous system, dec. portal HTN, prevent rebleed of varices, and stop/reduce ascites (palliative measure) (bypass flow in liver)

A

transjugular intrahepatic portosysten shunt (TIPS)

26
Q

contraindication for TIPS

A

CHF

27
Q

what causes varices to form in the esophageal, gastric, and hemorrhoidal veins

A

increased pressure in portal system

28
Q

major complication of varices

A

acute GI hemorrhage, suddenn hypovolemic loss of blood

29
Q

common causes of acute GI bleeds

A

PUD
stress related erosive syndrome
esophageal varices

30
Q

what are the 2 main causes of mucosal resistance in PUD (mucosal lining breakdown)

A

NSAIDS
bacterial action of h. pylori

31
Q

what puts patients at risk for stress related erosive syndrome

A

vent, shock, burns, trauma, surgery

32
Q

classic hallmarks of GI bleed

A

coffee ground
maroon color
hematemesis
hematochezia (bright red blood from GI bleed per rectum)
melena (tarry stool from old blood)

33
Q

what is an early sign of GI bleed

A

postural hypoTN / orthostatic vitals

34
Q

later signs of GI bleed

A

dec. H&H
tachycardia
pale, SOB
anxiety, fatigue, anorexia
elevated BUN, normal creatinine

35
Q

management of GI bleed

A

replace blood/fluid
endoscopy/sclerotherapy
surgery

36
Q

what are the 2 surgeries for GI bleed

A

biliroth I & biliroth II

37
Q

which GI bleed surgery includes a vagotomy and antrectomy with anastomosis of the stoamch to the duodenum

A

biliroth I

38
Q

which GI bleed surgery includes a vagotomy and antrectomy with anastomosis of the stoamch to the jejunum

A

biliroth II

39
Q

can band ligation be used for GI bleed

A

yes

40
Q

treatment for bleeding esophageal varices

A

BALLOON TAMPONADE (compresses bleeding vessels)

41
Q

complications of balloon tamponade for esophageal varices

A

aspiration
asphyxiation
esophageal erosion

42
Q

what is given IV to constrict splanchnic arteries which reduces blood flow to abdominal organs
-dec. portal hypoTN

A

vasopressin

43
Q

what does vasopressin cause other than restricted flow to abd organs

A

restricted flow to systemic circulation
-caridac / bowel ischemia
-coronary arteyr constriction (HTN)

44
Q

what 2 meds decrease portal venous pressure

A

somatostatin and octreotide

critical care (23 decks)

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