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
