Week 9 - GIT Flashcards
define pancreatitis
- inflammation of the pancreas
- severity varies from mild oedema to severe haemorrhagic necrosis of pancreas
pancreatitis - causes
- bilary disease (unable to break down bile)
- alchohol consumption (increased production of enzymes which pancreas produces = leads to them being activated in the pancreas)
- abdominal trauma
- infections (of pancreatitis or systemic)
- drugs (corticosteroids, NSAIDS)
Pathophysiology of pancreatitis
injury to pancreatic cells > activation of pancreatic enzymes
pancreatic enzymes leak into pancreatic tissue
pancreatic tissue & cell membrane breakdown (auto-digestion)
proteolytic enzymes activated
inflammation, oedema, vascular permability, heamorrhage, necrosis and fibrosis (due to hypoperfusion)
toxic enzymes and inflammatory mediators enter blood stream
^ injury to lungs, heart and kidneys
pancreatitis - 2 types
Oedematus:
- mild
- self limiting
Necrotising:
- severe
- necrosis of pancreatic tissue
- degree of damage relates to severity of symptoms
- can permanently affect function of pancreas (diabities)
- results in necrosis of pancreas, organ failure and sepsis
pancreatitis - clinical manifestations
!!!!!!!!!!!!!!! choose 7 to remember
- increased RR
- hypoxaemia
- decreased bp
- increased HR
- renal failure
- cogulation abnormalities (bleed more)
- low grade fever (due to inflammatory response)
- hyperglycaemia (due to stress response and dysfunction of the pancreas)
- nausea and vomiting
- hypoactive or absent bowel sounds
- jaundice (bilirubin not being broken down)
- cullens sign
- grey turner sign
- abdominal pain/ distension
- LUQ
- sudden onset
- severe, deep, piercing, continuous
- worse with eating
pancreatitis - Management goals (2)
- stop process of autodigestion (stop destroying pancreas)
- prevent systemic complications (prevent hypoperfusion, vasodilation and shock occurring)
pancreatitis - Management
DRSABCDE
Airway/ Breathing
- CXR (looking for APO)
- NGT (keep stomach empty)
Ciruclation:
- IV access anticipating will go into shock state
- IV naci and albium
- correct electrolyte imbalance (will be decreased calcium levels need extra)
- CVC, IDC (to monitor for renal failure)
Disability:
- NBM
- BGL (will be increased)
pancreatitis - Management (medications)
- morphine
- prophylactin IVAB
- diamex to manage increased BGL
- antacids
- proton pump inhibitors
- insulin (if BGL very high)
pancreatitis - Investigations
pathology:
- amalyse and lipase
- chest and abdo xray
- abdo CT
- ERCP
Cirrhosis of the liver - Define
irreversible inflammatory disease that distrupts liver function and structure
Cirrhosis of the liver - causes
- alchohol
- post necrotic cirrhosis (drugs (NSAIDS), viral infections)
- biliary cirrhosis
- metabolic cirrhosis
- cardiac cirrhosis
Cirrhosis of the liver - patho
cell necrosis ^ destroyed liver celss replaced by scar tissue (nodular irregular cells) ^ reduced blood flow (due to scar tissue) ^ poor nutrtion and hypoxia ^ cell death
Cirrhosis of the liver - clinical manifestations
EARLY:
- GI disturbance;
- anorexia, flactulence, nausea and vomiting, change in bowel habits
- abdominal pain
- fever
- enlargement of liver
LATE:
- jaundice (not breaking down bilirubin)
- puritis (itchy skin)
- skin lessions
- spider angiomas (small blood vessels dilated and pop)
- testicular atrophy (decreased testosterone)
Cirrhosis of the liver - management
liver transplant
- only definte treatment for end stage liver disease
management of complications is the key!
Cirrhosis of the liver - potential complications
- portal hypertension
- ascities
- hepatic encephalopathy
- oesophageal varices
