Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Health Assessment > Liver and GI > Flashcards

Liver and GI Flashcards

1
Q

What do you want to find out about regarding the GI history?

A
  • Nutritional deficiency- wt loss greater than 10%
  • N/V
  • occult blood loss
  • overt GI bleeding
  • abd. pain/distension/masses
  • dysphagia
  • gastric hyperactivity with or without reflux
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Who is consdered an aspiration risk?

A
  • extreme ages
  • ascites
  • collagen vascular dx, metabolic disorders )DM, ESRD, hypothyroid)
  • hiatal hernia/GERD/esophageal surgery
  • mechanical obstruction
  • prematurity
  • pregnancy
  • neurologic diseases
  • morbid obesity
  • severe pain/anxiety
  • having eaten
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the aspiration prophylaxis med plan?

A
  • H2 antagonists
  • sodium citrate (bicitra)
  • metoclopramide
  • omeprazole
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is Mendelson syndrome?

What are the risk factors?

How does it manifest?

A
  • Chemical pneumonitis or aspiration pneumonitis caused by aspiration during anesthesia
  • characterized by pH, volume, and gastric material aspirated
  • Risk factors for aspiration sequelae:
    • Gastric volume of 0.4 ml/kg
    • pH <2.5
  • Manifests as
    • resp distress w/bronchospasm, cyanosis, dyspnea
    • tachycardia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is Barrett’s esophagus?

signs/symptoms

treatment

A
  • metaplastic disorder of the esophagus secondary to reflux
    • precursor to esophageal cancer
  • S/S
    • dysphagia
    • reflux esophagitis
    • retrosternal pain or heartbrn
    • LES dystonia
    • wt loss
  • Treatment
    • H2 blockers
    • PPIs
    • Nissen fundoplication
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is Schatzki Ring?

A
  • a narrowing of the lower esophagus caused by a ring of mucosal tissue or muscular tissue
  • causes dysphagia, food obstruction, vomiting
  • aspiration risk
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is Gastroparesis?

What causes it?

A
  • Partial paralysis of the stomach
  • Causes:
    • Vagus nerve injury
    • autonomic neuropathy- diabetes (most common cause)
    • Connective tissue dx (sclerderma, Ehlers-Danlos)
    • Opioids, anticholinergics
  • Will have prolonged food retention and up to 1 liter of fluid
  • RSI! Intubate if even for a minor procedure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q
A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is a hiatal hernia?

A
  • stomach protrudes up into diaphragm
    • sliding- food enters stomach from esophagus and gets caught in the pouch above the diaphragm
  • symptoms:
    • Heart burn
    • regurgitation
    • **can cause barrets esophagus and then cancer
  • increases with age
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are peptic ulcers?

A
  • Chronic lesions that can be anywhere in GI tract but 98% are in proximal duodenum and stomach (4:1)
    • most commonly the duodenal bulb or antrum of stomach
    • H. pylori is involved in 70-90% of duodenal ulcer and 70% of gastric ulcers
  • Only 10-20% of ppl w/ H. Pylori get ulcers
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What aggravates peptic ulcers?

A
  • Age 45-60
  • NSAIDS
  • smoking
  • alcohol
  • corticosteroids
  • high stress personality??
  • gastrinoma (zollinger-ellison syndrome)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What problems do peptic ulcers cause?

A
  • epigastric pain
  • nausea and vomiting
  • hemorrhage and perforation
  • generally do NOT progress to cancer
  • ** usually just impair quality of life rather than shorten it
    • 15,000 deaths/year attributed to complications of peptic ulcers
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Carcinoid tumors:

most common site

What is Carcinoid syndrome?

Symptoms of Carcinoid syndrome?

A
  • GI tract- mostly common in appendix
  • Carcinoid syndrome is caused when substances secreted in the GI tract enter systemic circulation
    • bradykinin, histamine, serotonin, dopamine
  • S/S of carcinoid syndrome
    • cutaneous flushing
    • diarrhea
    • palpitations
    • dyspnea, wheezing, bronchospasm
    • hypotension
    • HTN
    • orthostasis
    • right sided valvular heart dx
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is malnutrition often associated with?

A
  • prolonged hospital stay
  • wound infection
  • abscess
  • respiratory failure
  • death
  • Serum albumin <3.5
    • <2.1 major predictor of morbidity in veterans undergoing non-cardiac surgery
  • wt loss >10% in last 6 months
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What should you look for on the pts hands when assessing GI?

A
  • Koilonychia- brittle, thin nails that curve up
  • Leukonychia- nails that have big white spots
  • nail clubbing
  • palmar erythema
  • asterixis- can’t hold hand steady
  • Dupuytren’s Contracture- palmar fascia becomes thick, causing fingers to curl and limiting function
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

During a GI physical, how should you do the abdominal examination? (we don’t really do this)

A
  • auscultate bowel sounds
  • palpate- note guarding and pain, note organomegaly
  • percuss
19
Q

Besides hands and abdomen, what else do you want to look at during a GI physical?

A
  • Check sclera for jaundice or pallor
  • Examine chest for gynecomastia or spider nevi- signs of liver dx
  • skin color scratches, jaundice
  • skin turgor
20
Q

What are some general pre-op considerations for GI patients?

A
  • Airway management and prevention of aspiration
  • fluid and electrolyte balance
  • Skin
  • peripheral circulation
  • HR, BP
  • UOP
  • kidney function
  • orthostasis
21
Q

What labs and monitoring do you want for a GI patient?

A
  • Useful lab values:
    • hematocrit
    • serum electrolytes
    • BUN
    • serum albumin
  • Monitoring
    • +/- CVP, PAP
    • +/- Art line
22
Q

The liver does a lot of things. What are some of them?

A
  • Reservoir of blood (10-15% total blood volume)
  • maintains normal clotting
  • mediates endocrine functions
  • bilirubin excretion
  • metabolism
  • synthesis of proteins
  • immunologic function
  • pharmacokinetics
23
Q

What do you want to know about the history of a pt with liver problems?

A
  • easy bruising?
  • anorexia or wt changes
  • N/V or pain w/fatty meals
  • pruritis or fatigue
  • abdominal distension/ascites
  • GI bleed
  • scleral icterus, jaundice, or hx of it
  • hepatmegaly or splenomegaly
  • palmer erythema
  • gynecomastia
  • spider angiomata, petechiae, and ecchymosis
  • prior blood tx
  • recreational drugs/alcohol
  • travel history
  • occupational history
24
Q

What medications can increase Liver enzyme levels (CYP450)

A
  • antibiotics
  • antiepileptic
  • inhibitors of hydroxymethylglutaryl-coenzyme
  • NSAIDS
  • sulfonylureas for hyperflycemia
  • herbals
  • cocaine, ecstasy, angel dust, glues/solvents
25
Q

How do you do a physical assessment of a liver pt?

A

Look at everything you would look at for a GI patient

26
Q

What labs would be helpful with a liver pt?

A
  • albumin
  • CBC
  • coags
  • lytes and glucose levels
  • serum liver enzyme
  • serium ammonia levels
  • platelet counts >100,000
  • bilirubin
  • ABG
27
Q
  • Normal lab Values
    • albumin
    • bilirubin
    • unconjugated bili
    • conjugated bili
    • aspartate aminotransferase (SGOT)
    • alanin aminotransferase (SGPT)
    • alk phos
    • prothrombin time
A
  • Albumin 3.5-5.5 g/dl
  • bili 0.3-1.1 mg/dL
  • unconjugated bili 0.2-0.7 mg/dl
  • conjugated bili 0.1-0.4 mg/dl
  • SGOT 10-40 U/mL
  • SGPT 5-35 U/mL
  • alk phos 10-30 U/mL
  • PT 12-14 sec
28
Q

A currently non intoxicated alcoholic will require more/less anesthetic?

A

more

29
Q

How do you determine if you should check LFTs?

(chart)

A
30
Q

How do you determin what coags to look at?

(chart)

A
31
Q

Would you get a pre-op EKG in a liver pt?

Why or why not?

A
  • Yes
  • incresed levels of endogenous vasodilators such as vasoactive intestinal peptide
  • high CO
  • decreased SVR
  • hyperdynamic circulatory state
  • arteriovenous shunting
  • portal hypertension
32
Q

What does the Child-Pugh score use to calculate morbidity and mortality with liver insufficiency?

What are the scores?

A
  • encephalopathy
  • ascites
  • bilirubin
  • albumin
  • PT/INR
  • primary biliary cirrhosis
  • scored as A,B, and C- C being very severe
33
Q

How does cholestatic disease predispose Vit K deficiency?

What does this cause?

How is this treated?

A
  • Absorption of Vit K depends on bile salt excretion into GI tract
  • Vit K is required for coagulation factors to be made (II, VII, IX, X), without Vit K, pt will be deficient
  • treatment is to correct with parental Vit K
  • FFP is necessary for emergent surgery
34
Q

What are some findings you would expect to see in a pt with cholestatic disease?

A
  • increased peripheral vasodilation
  • increased CO
  • increased portal venous pressure
  • decreased portal venous blood flow
35
Q

Hep B treatment

Hep C?

Autoimmune hepatitis treatment?

A
  • Hep B Treatment-
    • based on age and severity
    • Interferon
  • Hep C treatment
    • interferon and ribavirin
  • Autoimmune hepatitis treatment
    • Corticosteroids and AZT
36
Q

What should your preop evaluation focus on for a pt with acute/chronic hepatitis?

A
  • signs and symptoms of encephalopathy
  • bleeding
  • jaundice
  • ascites
  • hemodynamics
  • labs
    • lytes, BUN/Cr, glucose, H&H, liver enzymes, bili, coags, ABG
37
Q

What is the most common cause of chronic liver disease?

risk factors?

signs/symptoms

A
  • Non-alcoholic fatty liver disease
  • fat accumulation in the liver exceeding 5%
  • Risk factors: NIDDM, obesity
  • signs/symptoms
    • asymptomatic, elevated AST/ALT
    • some degree of hepatocyte necrosis which promotes the accumulation of inflammatory cells in liver
    • leads to cirrhosis
  • weight loss (even 5 lbs) can reverse the elevated liver enzymes
38
Q

What are the 3 types of alcoholic liver disease?

How do you distiguish between?

S&S of all of them?

A
  • Steatosis, alcoholic hepatitis, cirrhosis
  • Clinical featureas do not distinugish, bust do liver biopsy for diagnosis
  • S&S
    • malaise
    • nausea
    • anorexia
    • weakness
    • abdominal discomfort
    • hepatomegaly
    • jaundice
39
Q

How long after alcohol will a pt in withdrawal become tremulous?

hallucinations and seizure?

DTs?

How is this treated?

A
  • tremulous within 6-8 hours
  • hallucinaitons and z within 24 hours
  • DTs within 72 hours
  • treatment: benzos
40
Q

How many ppl affected by cirrhosis?

most common causes of cirrhosis

S&S?

A
  • affects 3 million- 12th leading cause of death
  • most commonly due to Hep C and alcoholism
  • alters the function of ALL organs in advanced stages
    • anorexia, weakness, N/V, abd pain
    • jaundice, ascites
    • hyperdynamic circulation (High CO, low PVR, low SVR)
    • portal hypertenison and shunting
41
Q
A

Health Assessment (14 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions