GIT conditions

Question 1

Define Pancreatitis

Answer 1

acute inflammation of the pancreas. most commonly caused by gall stones or gall bladder disease. The other common reason for the cause of pancreatitis is by chronic alcohol consumption

Question 2

How many levels of severity does pancreatitis have?

Answer 2

three
mild, moderately severe, and severe

Question 3

Define mild pancreatitis

Answer 3

There is no organ failure and there are only local and systemic complications
There is a low mortality rate and it resolves rapidly
The patient is normally discharged home in a week

Question 4

Define moderately severe pancreatitis

Answer 4

There is transient organ failure and or systemic complications but this is not persistent organ failure (> 48 hours)

Question 5

Define severe pancreatitis

Answer 5

Also referred to as necrotising pancreatitis
There is persistent organ failure, with up to 50% of these patients having permanent impairment of their pancreatic function
There is also a high risk of further complications such as pancreatic necrosis, organ failure and septic complications
These complications have the potential to result in a high mortality rate

Question 6

What are the phases of acute pancreatitis?

Answer 6

Early: lasts one week

Late: lasts weeks to months

Question 7

What is the main management goal of pancreatitis?

Answer 7

stop autodigestion and prevent systemic complications

Question 8

What are some potential Breathing findings for pancreatitis?

Answer 8

tachypnoea, hypoxia, increased WOB, SOB
may have pulmonary effusions/infiltrates
distended abdomen may impede breathing

Question 9

What are some potential circulatory findings for pancreatitis?

Answer 9

weak & fast radial pulses, tachycardia, hypotension, oliguria. elevated lipase, amylase and WCC
manage fluid losses (antimietucs for vomiting), IDC and FBC

Question 10

What are some potential disability findings for pancreatitis?

Answer 10

Acute coronary syndrome from cerebral hypoperfusion (severe), abdominal pain from oedema and inflammation and obstructed biliary tract, nausea and vomiting, hyperglycaemia as glucagon released from damaged pancreas
NBM initially, insluin, analgesia

Question 11

What pharmacological methods can be used to manage pancreatitis?

Answer 11

multimodal analgesia, PCA, antacids/proton pump
inhibitors, antispasmodics

Question 12

What are some potential exposure findings for pancreatitis?

Answer 12

fever from infection, cullens (bruising of the abdo)/grey turner sign (bruising of the flanks), abdominal distention
treat with ABs, CT for the abdo, NGT if indicated

Question 13

What are the clinical signs of pancreatitis?

Answer 13

pain and tenderness in abdo, nausea and vomiting, fever, tachycardia, SOB, jaundice

Question 14

What are the potential complications of pancreatitis?

Answer 14

Pancreatic fluid collection
Abscess formation
Pseudocysts
Necrosis

Question 15

What are the potential systemic complications that can occur in severe pancreatitis?

Answer 15

Systemic Inflammatory Response Syndrome (SIRS)
Organ failure,
Disseminated Intravascular Coagulation (DIC)
Acute Respiratory Distress Syndrome (ARDS)

Question 16

Outline Liver cirrhosis

Answer 16

a chronic progressive disease characterised by extensive degeneration and destruction of the liver. The liver cells attempt to regenerate but their regeneration process is disorganised, resulting in abnormal blood vessel and bile duct formation. The liver lobules become disorganised and irregular in size and shape. This results in impeded blood flow throughout the liver, resulting in poor cellular nutrition and hypoxia, which results in decreased function

Question 17

What is the function of the liver

Answer 17

removing toxins, processing food nutrients and regulating body metabolism

Question 18

What is the function of the pancreas

Answer 18

The exocrine pancreas produces enzymes that help to digest food, particularly protein. The endocrine pancreas makes the hormone insulin, which helps to control blood sugar

Question 19

What are early symptoms of liver cirrhosis?

Answer 19

can include fatigue, but most patients may not be aware of their liver condition. often not detected until more significant signs occur

Question 20

What are later symptoms of liver cirrhosis?

Answer 20

Can be related to both liver failure and portal hypertension (elevated BP in the portal vein (carries blood from GIT organs to liver))
The patient can be jaundiced, have ascites (swollen abdo) and peripheral oedema
Skin lesions, endocrine disturbances, haematological disorders and peripheral neuropathies (loss of feeling in peripheries)

Question 21

What are the potential breathing findings that can occur in liver cirrhosis?

Answer 21

tachypnoea, hypoxia, increased WOB, SOB, may have distended abdomen from ascites impeding breathing and causing pulmonary effusions

Question 22

What are potential circulatory findings in liver cirrhosis?

Answer 22

warm, jaundiced, weak & rapid pulse. signs of bruising, oesophageal varices (enlarged veins in throat), distended veins and oedema, hypotension
manage fluid loss (antimietics), FWT to assess for haematuria (blood in urine)

Question 23

What are potential disability findings in liver cirrhosis?

Answer 23

ACS (severe cases), abdo pain, nausea and vomiting, hyperglycaemia
analgesia, anti-mietics, insulin, NMB

Question 24

What are potential exposure findings in liver cirrhosis?

Answer 24

fever if infection is present, abdo distention, jaundice and pruritis
ABs if needed

Question 25

What are some common management considerations of liver cirrhosis?

Answer 25

CT of the abdo, low sodium diet if not NBM, paracentesis (drainage of fluid in abdo) if needed

Question 26

What are some pharmacology of liver cirrhosis?

Answer 26

PPI: decrease gastric acidity
Vit K: correct clotting abnormalities
Propanolol: Reduces venous portal pressure and bleeding from varices
Lactulose: traps ammonia in bowel for elimination
Diuretics: to decrease reabsorption of sodium & water, & block aldosterone
Vasopressin Octreotide: controls bleeding from oesophageal varices

Question 27

What complications can occur from liver cirrhosis?

Answer 27

jaundice, Ascites, Oesophageal varices, portal HTN, hepatic encephalopathy

Question 28

Define jaundice

Answer 28

develops due to the liver’s reduced ability to remove (excrete) bilirubin. turns the skin and eyes a yellow colour

Question 29

Define ascites

Answer 29

Causes swelling in the abdominal space via fluid
Results from portal hypertension, where proteins from blood vessels shift into the lymph space and the lymphatic system is unable to remove the excess proteins and water

Question 30

Define oesophageal varices

Answer 30

results from portal hypertension, where veins at the lower end of the oesophagus are enlarged and swollen

Question 31

Define portal hypertension

Answer 31

this develops from structural changes in the liver that cause compression and destruction of hepatic and portal veins: GIT and liver blood vessels
causes elevated blood pressure in these veins

Question 32

Define hepatic encephalopathy

Answer 32

a complex side effect that results from the neurotoxic effects of ammonia
due to liver damage, ammonia and other toxins can build up in your brain, causing you to lose brain function

Question 33

what are complications of ascites?

Answer 33

weight gain, abdominal distension and respiratory compromise due to the diaphragm being displaced. The patient is also at risk of developing bacterial peritonitis (an infection of abdominal fluid)

Question 34

Outline a paracentesis procedure

Answer 34

For the management of ascites
when the abdomen is drained (fluid is removed) by a needle puncture. Often 5L MAX at one time. It is only a temporary measure as fluid tends to re- accumulate. the pt will require special vitals monitoring during the procedure and strict FBC
Post procedure the patient may require fluid replacement such as albumin

Question 35

What are some pharmacological options for hepatic encephalopathy?

Answer 35

NBM initially
- Analgesia: multimodal analgesia
- Anti-emetics and lactulose
- Neomycin (antibiotic) to eradicate bacteria in the bowel & reduce
production of ammonia
- Insulin to manage hyperglycaemia

Question 36

What are some managements for precipitating causes of hepatic encephalopathy?

Answer 36

Renal failure: nitrogenous metabolites are retained
- Infection: the brain becomes more sensitive to toxins
- Hypovolaemia: increase in ammonia due to hepatic hypoxia &
impaired functioning of kidneys, brain & liver from hypoperfusion
- Constipation: increases ammonia level
- Hypokalaemia: the brain needs potassium to metabolise ammonia
- Metabolic alkalosis: this increases production of ammonia (by
kidneys) and facilitates transport of ammonia across the blood
brain barrier
- Dehydration: can cause ammonia toxicity

Question 37

Outline Gastrointestinal bleeding

Answer 37

A serious complication of various GIT disease states Patients can have an upper GI bleed or a lower GI bleed
patients with ascites, varices or coagulation issues significantly at risk

Question 38

What are some clinical manifestations of GI bleeding

Answer 38

paleness, cramps, fatigue, blood in stool

Question 39

What is the difference between bright red stools and black tarry stools?

Answer 39

bright red stools indicate lower GI bleed, while black tarry stools indicate older, upper GI bleeds

Question 40

What are some potential breathing findings for a GI bleed?

Answer 40

tachypnoea, hypoxia, increased WOB, SOB, may have hypoxaemia from blood loss, may have distended abdo from ascites casing pulmonary effusions

Question 41

What are some potential circulatory findings for a GI bleed?

Answer 41

clammy skin, assess amount of blood loss (haematemesis & malena), hypotension, tachycardia, arrhythmias
consider blood tranfusion or NGT insertion

Question 42

What are some potential disability findings for a GI bleed?

Answer 42

confusion, pain, vomiting/nausea, hyperglycaemia
NMB initially, analgesia, insulin, PPI stat dose and infusion (lower stomach acid), antacids

Question 43

What are some potential exposure findings for a GI bleed?

Answer 43

fever, abdo distention, jaundice and pruritis, external signs of bleeding

Question 44

What are some surgical considerations for a GI bleed?

Answer 44

Surgery or endoscopic therapies
Interventional radiology to stop bleeding
Balloon tamponade (Sengstaken-Blakemore tube)