GI (liver) Flashcards
describe patho related to portal HTN
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)
important functions of the liver
synthesize albumin (maintains oncotic pressure)
eliminates bilirubin
coagualtion factors!! (impaired clotting is dysfxn)
what lab is most reflective of liver failure
high serum ammonia
inflammatation of the liver caused by virus, bacteria, drugs, alcohol, toxins
hepatits
treatment for hepatitis
supportive : rest, nutrition, avoid stress and hepatotoxic substances, treat cause
liver condition with chronic inflammation, circulationa dn structure changes, and alterations in metabolic processes
cirrhosis
what is cirrhosis caused by
chrinic active hepatitis, biliary obstruction, and unknown!
what is cirrhosis most commonly caused by?
chronic alcohol abuse
what does portal HTN result in poor metabolism of?
nutrients
drugs
toxins
where do vascular changes occur with portal HTN?
esophagus, stomach, rectum
assessment findings for impaired liver fxn
jaundice
edema
fatigue
bruising
ascites
importatn lab findings in impaired liver fxns
inc. ALT/AST
inc. ammonia
what is a reversible dec. in neuro fxn related to liver probs
hepatic encephalopathy
what causes hepatic encephalopathy
accumulation of ammonia and neurotoxins
what is an early sign of hepatic encephalopathy
asterixis (hand flapping, can not keep them up)
what meds are given for hepatic encephalopathy
lactulose, neomycin, rifaximin
accumulation of fluid in the peritoneum
ascites
what is retained with ascites
sodium and water
what problem does ascites lead to
resp distress
treatment for ascites
bedrest / low sodium diet / diuretics
paracentesis
LaVeen shunt
transjugular intrahepatic portosystem shunt (TIPS)
complications of paracentesis for ascites
hypotension adn inc. risk of infection
what method of ascites treatment is used when the ot is resistant to other treatment
LaVeen shunt
which ascites treatment is a perforated intra-abdominal tube placed in peritoneal cavity which is tunneled to the superior vena cava
LaVeen shunt
complications of LaVeen shunt
sepsis
peritonitis
occlusion
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)
transjugular intrahepatic portosysten shunt (TIPS)
contraindication for TIPS
CHF
what causes varices to form in the esophageal, gastric, and hemorrhoidal veins
increased pressure in portal system
major complication of varices
acute GI hemorrhage, suddenn hypovolemic loss of blood
common causes of acute GI bleeds
PUD
stress related erosive syndrome
esophageal varices
what are the 2 main causes of mucosal resistance in PUD (mucosal lining breakdown)
NSAIDS
bacterial action of h. pylori
what puts patients at risk for stress related erosive syndrome
vent, shock, burns, trauma, surgery
classic hallmarks of GI bleed
coffee ground
maroon color
hematemesis
hematochezia (bright red blood from GI bleed per rectum)
melena (tarry stool from old blood)
what is an early sign of GI bleed
postural hypoTN / orthostatic vitals
later signs of GI bleed
dec. H&H
tachycardia
pale, SOB
anxiety, fatigue, anorexia
elevated BUN, normal creatinine
management of GI bleed
replace blood/fluid
endoscopy/sclerotherapy
surgery
what are the 2 surgeries for GI bleed
biliroth I & biliroth II
which GI bleed surgery includes a vagotomy and antrectomy with anastomosis of the stoamch to the duodenum
biliroth I
which GI bleed surgery includes a vagotomy and antrectomy with anastomosis of the stoamch to the jejunum
biliroth II
can band ligation be used for GI bleed
yes
treatment for bleeding esophageal varices
BALLOON TAMPONADE (compresses bleeding vessels)
complications of balloon tamponade for esophageal varices
aspiration
asphyxiation
esophageal erosion
what is given IV to constrict splanchnic arteries which reduces blood flow to abdominal organs
-dec. portal hypoTN
vasopressin
what does vasopressin cause other than restricted flow to abd organs
restricted flow to systemic circulation
-caridac / bowel ischemia
-coronary arteyr constriction (HTN)
what 2 meds decrease portal venous pressure
somatostatin and octreotide
