GI Part 1 Flashcards
NCLEX: If one part of the GI is sick, then what?
Any other parts of the GI can too!
Exocrine vs. Endocrine functions
Exocrine: Digestive enzymes
Endocrine: Insulin
Acute pancreatitis vs Chronic pancreatitis CAUSES
Acute: Alcohol #1, gallbladder disease #2
Chronic: Alcohol
How is pancreatitis formed?
USUALLY enzymes moving from the pancreas move through the pancreatic duct into the small intestine
BUT HERE, something (gallstone, alcohol scar tissue) blocks the pancreatic duct so the enzymes activate in the pancreas and auto digest itself
S/S Pancreatitis
Pain in regards to eating? Where is the fluid going? What's building up? What does the abdomen look like? Skin color? GI? Temperature? BP?
Pain - increases with eating Ascites (protein and blood build-up) Rigid/board like or a mass d/t a swollen pancreas Bruising or jaundice if liver involved N/V Fever (d/t inflammation) Hypotension (d/t bleeding or ascites)
This shit hurts!
What kind of bruising so we see in pancreatitis?
Cullen’s sign - umbilicus
Gray Turners - flank (roll over to look for the blood pooling)
Why might a doctor do to assess if a pancreatitis patient is bleeding?
Gastric lavage - Pink fluid
What labs are we going to do to test for peritonitis?
*Most specific? What does the pancreas make? Inflammation? Enzymes? Liver problems? Bleeding or dehydrated will show what?
Lipase*
Amylase
WBC ^
Blood sugar ^ (d/t low insulin from damaged pancreas)
AST, ALT ^ (liver hurt)
PT, aPTT longer d/t liver changes and decreased clotting
Serum bilirubin^
H&H (UP if dehydrates d/t low intake d/t pain or LOW if bleeding)
*If we are losing fluid (dehydrated), this causes our urine to be dilute - and our blood to be concentrated, thus higher H&H (think RBC per unit of volume - less volume=more RBC’s)
Normal Amylase
Normal Lipase
Amylase: 30-220
Lipase: 0-110
Key NCLEX strategy about treating the pancreatitis patient
Keep the stomach EMPTY and DRY
What medications do we use to treat pancreatitis?
Let's think about it...... Do they hurt? What is their pancreas not making? Isn't there inflammation? Remember what NCLEX wants us to be? Their stomach is getting it's acid neutralized, now what??
**Pain meds - opioids, PCA, patch
Steroids - decrease inflammation
Insulin - d/t altered pancreas, taking steroids, and TPN is packed with sugar
Anti-cholinergic’s - dry you up (atropine, Benztropine)
GI - PPI, H2 antagonists (‘dine’), Antacids
What to monitor in pancreatitis patient? - what are they at risk for?????
What can they NOT have?
How are we going to decrease stomach secretions?
What about their diet?
F/E balance
Daily weights
NO Alcohol (May need AA)
NPO, suction, bed rest, meds
Diet: NPO FIRST!!!!!!!!! THEN Ease into it, may need TPN
What are the 4 major functions of the liver?
- Detoxify the body
- Helps clot
- Metabolize drugs
- Synthesize (make) albumin
NCLEX TESTING STRATEGY
Sick liver #1 concern?
Sick liver regarding meds?
Sick sick never give what? What is it’s antidote?
BLEEDING
Decrease the dose
Acetaminophen - attacks liver
Acetylcysteine
AGAIN, what does toxin build up cause?
HA and malaise - that’s why we want this patient to rest because the toxins make them so tired
What is happening in the body when a patient has cirrhosis?
Liver cells are destroyed and replaced with connective and scar tissue which alters circulation within the liver, leading to portal HTN
Portal HTN and all it’s pressure can lead to the formation of varicies or hepatic coma
What are the S/S of cirrhosis?
Abdomen? Pain? GI? Bowels? Spleen? Albumin? AST/ALT? RBC? Ammonia? Ammonia acts like a what?
Firm, nodular liver - can feel it on R and!! -HUGE!)
Abd. pain (liver capsule stretched) Chronic indigestion (dyspepsia) Change in bowel habits Ascites d/t LOW albumin Splenomegaly - immune!! AST/ALT ^ Anemia Ammonia build-up can lead to hepatic encephalopathy/coma
Ammonia = sedative!!
How do we diagnose cirrhosis?
US, CT/MRI
Confirmation with a Liver biopsy
Liver Biopsy
Worry about what?
Labs pre-op?
Positioning during?
Breathing?
Positioning after?
*key thing to worry about
Needle puncture into sick liver
Worry about the puncture and bleeding!
PT, aPTT, INR, VS pre-op
Pre-op: supine with R arm behind head
Post-op: like on R side to hold pressure (may use a towel)
Exhale and hold to get the diaphragm out of the way
** Hemorrhage
Treatment for cirrhosis:
Meds What do they need? What to monitor? What's sick liver skin like? What's their abdomen doing? Procedure
*What do we worry about when giving pain meds
Antacids
Vitamins
Diuretics
Pain meds - Like double the dose when the liver is sick!!!! Avoid narcotics!!
I/O, daily weight REST! *Bleeding precautions Abdominal girth to Mx ascites Jaundice - itchy skin (cut nails, good skin care)
Paracentesis
Paracentesis –
What is it?
What to do before it?
Positioning?
*** Risk for what??
Removing peritoneal cavity fluid
Void - tiny bladder decreases risk of puncture
Sitting up - Fluid will settle in 1 spot
Watch for SHOCK!!!! Any time we are taking fluid from vascular system, you can throw them into shock
*Fluid is in the wrong space
Diet of a cirrhosis patient?
LOW Protein (Protein is broken down into ammonia and ammonia is already high!)
Low Na
NO alcohol
How is protein handled in the liver?
Protein is broken down into ammonia
Liver convert ammonia to Urea
Kidneys excrete the Urea
What is happening to the body during Hepatic Coma?
Too much ammonia is building up when the liver becomes so impaired and LOC is decreased
When the liver is sick, it can’t convert ammonia to urea
What are the S/S of Hepatic Coma?
What could be the first sign?
LOC changes
Hard to waken
Asterixis - Liver flap - hand tremor = handwriting changes - might be the first sign
Decreased reflexes
Bradycardia
Ammonia breath (fetor)
How do we treat Hepatic Coma? - Remember that they have a lot of ammonia in there blood!
Meds?
Way to get the blood out?
Diet?
Monitor what everyday?
*We want blood out of GI tract
Lactulose - decrease ammonia
Cleansing enema - get blood out of GI tract
Diet: LOW protein - increased protein will cause more ammonia because the liver can’t break down the ammonia bi-product of protein metabolism
Monitor Serum ammonia every day!
Liver people tend to be what?
GI bleeders! Blood is protein! Increased ammonia! Blood causes increased ammonia!
What causes Bleeding Esophageal Varices?
Who frequently has these when GI bleeding?
Are these problematic?
Portal HTN forces collateral circulation to form but it forms in the stomach, esophagus, and rectum. Portal HTN causes increase pressure in all of the GI tract
*Think of a bulging vessel like a hemorrhoid in the esophagus with pressure building behind it
Alcoholics
Become a problem when they rupture - sudden onset - bright red blood
How do we treat Esophageal Varices?
THEY ARE BLEEDING!
They need what put on?
What do we need to replace?
Meds?
Fluids? How are we going to get rid of the blood?
Surgery?
Replace blood
Monitor CVP, VS
Give O2 - anemic
Octreotide
Lactulose
Cleansing enema - get rid of blood
Saline lavage - get blood out of stomach
Balloon Tamponade
What does Octerotide do?
What are it’s SE?
Lowers BP in the liver
SE: Causes vasoconstriction in other parts of the body, but we don’t know where (May be coronary arteries)
What is a Balloon Tamponade?
Keep what at bedside?
How long can we use it?
Tube is put in like an NG but blown up to put pressure on the bleed - 1 balloon in stomach ad 1 balloon in esophagus: Need to mark the tube!!!!!!
Keep scissors at the bedside because if they pull on the tube, it will obstruct the airway
- Getting a syringe would take too long!
Use no longer than 12 hours - usually an ED procedure
Blakemore tube
Path of Peptic Ulcers
Common cause?
Where is it?
M or F more common?
What is present?
GI bleeding common cause
Esophagus, stomach, duodenum
Males
Erosion!
S/S Peptic Ulcers
Burning pain usually in the mid-epigastric region
Heartburn (dyspepsia)
What is a Gastroscopy? (EGD)
How are the patients pre-op?
Important thing to watch for?
Endoscopy through the oropharynx to view the Upper GI (esophagus, stomach, part of small intestine)
NPO (after until gag reflex)
Sedated
**Watch for perforation: pain, or trouble swallowing
What is an Upper GI series?
Pre op?
NPO? avoid what?
Looks at the esophagus and stomach with dye
NPO past midnight
Avoid anything that increases stomach motility
NO gum/mints/smoking/patch
Smoking ^ motility AND increases stomach secretions putting the patient at risk for aspiration
How to treat Peptic Ulcers?
Meds? (6)
Antacids PPIs H2 antagonists Antibiotics if H. Pylori GI cocktail Sucralfate to form a barrier on the wound so acid can't get on it
What kind and when should Peptic Ulcer patients take antacids?
Liquid form to coat the stomach
Take on an empty stomach at bedtime because having an empty stomach causes more acid to harm it
What is the #1 cause of Peptic ulcers?
What do we need with this?
H. Pylori
Antibiotics
What do we teach the patient with a Peptic Ulcer?
Decrease what?
Diet?
What to avoid?
How long to follow-up?
Decrease stress
Stop smoking
Eat what they can tolerate, but will want to avoid spicy foods and caffeine because they will irritate the stomach
Avoid temperature extremes
Follow-up for a year - takes a long time for an ulcer to heal
Differences between Gastric ulcers and Duodenal ulcers?
Location? Nourished? Pain timing? What helps the pain? what doesn't help the pain? Where is blood?
GASTRIC ULCERS Higher up in GI system Malnourished Pain 30 min - 1hr after meals Vomiting helps (malnourished) Eating hurts Blood in the vomit
DUODENAL ULCERS Lower in GI system Well-nourished Pain 2-3hr after meals, nighttime Vomiting doesn't help Eating helps Blood in stool
When do we monitor CVP?
Esophageal Varices
when do we have chronic indigestion?
Cirrhosis
when do we have grey turners and cullens?
Pancreatitis
Who do we give diuretics, vitamins, and antacids to?
Cirrhosis
Where do we have burning pain and heart burn?
Peptic ulcers
What does H.Pylori cause?
Peptic ulcers
When are we going to give octreotide?
Esophageal Varcies
When are we going to worry about bleeding and getting rid of the blood?
Hepatic coma
Esophageal Varicies
Liver people tend to be what?
GI bleeders
When are you going to avoid anything that causes motility?
GI series
When do we use Sucralfate?
Peptic Ulcer
When do we give GI cocktail?
Peptic Ulcer
What does H Pylori cause?
Peptic Ulcer
When are patients sedated?
Gastroscopy
