GI 1

Question 1

whenever there is pressure within the abdomen..

Answer 1

puts pressure on kidneys and gut which causes GI tract to stop working

Question 2

when the GI tract stops working…

Answer 2

• decrease peristalsis (cause peritoneal ileus)
• fluid backs up, cannot be absorbed (fluid is dumped)
• no bowel sounds, hard/rigid abdomen, cannot get rid of back products

Question 3

if no bowel sounds…

Answer 3

Emergency if NO bowel sounds (remove fluid and decompress it)

Question 4

if gut dies…

Answer 4

you die (liver and kidneys will stop functioning)

Question 5

what meds often cause GI bleeds

Answer 5

• *ulceration in stomach (aspirin and NSAIDS)
• NSAIDS will cause holes in stomach (decrease prostaglandins which are what line stomach to prevent acid from eating stomach)
• acid that is not contained causes holes in stomach and GI bleeding

Question 6

why do esophageal problems cause GI bleeding

Answer 6

• normal stomach acid is 2
• if it is refluxed up to the esophagus (where it is normally only equipped for a pH of 5) will cause ulceration and eventual hole/bleeding

Question 7

generalized first step if GI bleed suspected

Answer 7

where is it occuring and why??

Question 8

how long does it take for food to get through the stomach

Answer 8

2 hrs

Question 9

generalized causes of GI bleeds

Answer 9

esophageal, gastric, duodenal

Question 10

describe dumping syndrome

Answer 10

• occurs from insulin, stomach empties food too quickly into small intestine
• Stomach is small and when you put food in it it triggers the pancreas to release insulin
• s/s: cold, clammy, drop in BP

Question 11

common symptoms with GI bleed

Answer 11

Hematemesis, hematochezia and melena (black tarry)

Anemia

Question 12

hematemesis is from what

Answer 12

is from source above ligament of Treitz

Question 13

where does coffee ground emesis come from

Answer 13

• STOMACH

- comes from when gastric acid mixes with blood and causes partial decomposition

Question 14

what does black blood mean

Answer 14

means that there is long transit through the GI tract

Question 15

what does melena mean

Answer 15

black tarry stools

usually upper GI bleed

Question 16

maroon or bright red means

Answer 16

means that there is little contact with gastric acid (small intestine or colon)

Question 17

GI bleed s/s

Answer 17

• Tachycaardia, othrostatic hypotension
• Dizziness and orthostatic changes indicate 15% blood loss
• if 40% blood loss, have angina, cyanosis and altered mental status
• Check for rigid board like abdomen

Question 18

what to watch for if GI bleed

Answer 18

Watch for hypokalemia and hypernatremia

Question 19

treatment of GI bleed

Answer 19

• Fluid resuscitation
• O2
• Type and cross
• PRBC’s for Hgb 7 g/dl or less
• Foley to monitor output
• Platelets and clotting factors may be needed
• Ca replacement if large amounts of blood, citrate binds to Ca and causes hypocalcemia.

Question 20

blood loss of what requires blood transfusion

Answer 20

blood loss of greater than 1500ml requires blood replacement

Question 21

general treatment for GI bleed

Answer 21

find bleed (angiography) and stop it (surgery)

Question 22

why is air in the colon bad

Answer 22

(no fluid, not moving)

Question 23

diagnosis of abdominal obstruction

Answer 23

abd. x ray

Question 24

mechanical causes of bowl obstructions

Answer 24

hernia, intussusceptions, volvulus

Question 25

what is a hernia

Answer 25

abnormal protrusion through the abdominal wall

Question 26

what is volvulus

Answer 26

torsion of a loop of intestine causing an obstruction (may also have strangulation)

Question 27

intussusception

Answer 27

the prolapse of the intestine into the lumen of the immediate adjacent part

Question 28

what to remember about intestinal obstructions

Answer 28

- Can occur in both the large and small bowel - Recognizing the obstruction quickly is important, as the mortality rate with a strangulated obstruction is very high - Location, Degree of obstruction and Presence of ischemia are all important factors - remove obstruction, maybe with surgery

Question 29

extrinsic lesions that cause bowel obstructions

Answer 29

hernia, adhesions, volvulus, tumors, abscesses and aneurysms

Question 30

intrinsic lesions that cause bowel obstructions

Answer 30

Adenocarcinoma, lymphosarcomas, crohn’s disease, radiation injury, diverticulitis, gastroenteritis, pelvic inflammatory disease, intussusception, hemotoma from abdominal trauma

Question 31

mechanical cuases of bowel obstruction

Answer 31

things in the gut (tumor/food. Backed up barium

Question 32

nonmechanical causes of bowel obstruction

Answer 32

drugs or anesthesia