1
Q
Scarrrosis/ fibrosis of liver—liver hard like rock
A
CIRRHOSIS
2
Q
CIRRHOSIS cause
A
- Alcohol
- Cystic fibrosis
- Hepa B C
3
Q
CIRRHOSIS types
1. mc due to alcohol
2. dt hepa B C
3. dt gall stone obstruction
4. dt to RSHF
A
- LAENNEC’s
- POST NECROTIC
- BILIARY
- CARDIAC
4
Q
LIVER 4 RESPONSIBILITIES
A
- produce Albumin, Bile, coagulation factors
- Detoxify AMMONIA
- Drugs metabolism
- Store GLYCOGEN
5
Q
Liver is like __ bus that scoops ___ and bilirubin
A
Bile bus
Cholesterol
6
Q
Fx ni albumin
A
Attracts water, drugs, binds with Ca
7
Q
CIRRHOSIS hepa-j sx and ano sx under nila.
A
Hepatic Encepalopathy (ammonia)
* Asterixis
* LOC
* Constructional apraxia
Esophageal varices
Portal HPN
* Pre renal failure
* Hepatomegaly
* hemorrhoids
* Caput Medusae
* SPIDER ANGIOMA
Ascites
Jaundice
* Pruritus
8
Q
CIRRHOSIS other sx
A
- Dec Ca and Platelet dt to albumin (trousseau and chvostek, bleeding)
- > 20 BUN
- Inc AST & ALT
9
Q
CIRRHOSIS interventions for:
- Hepatic Encepalopathy (ammonia):
- Esophageal varices:
- Portal HPN:
- Ascites:
- Jaundice:
- Dec Ca and Platelet dt to albumin:
A
- Hepatic Encepalopathy (ammonia): LIMIT PROTEIN, no SEDATIVES, ✅NEOMYCIN & LACTULOSE
- Esophageal varices: no NGT/ STRAINING and coughing , and no NGT, ✅Balloon Tamponade
- Portal HPN: BETA BLOCKERS, TIPS/ transjugularhepatic portosystemic shunt
- Ascites: PARACENTESIS, low NA, ✅reverse trendelenburg, ALDACTONE
- Jaundice: cool moist skin, moisturizing cream, long sleeved cotton gloves, trim nails
- Dec Ca and Platelet dt to albumin: iron rich foods, Vitamin ADEK, bleeding prec, Spirinolactone, ALBUMIN IV (egg white)
10
Q
CIRRHOSIS considerations of paracentesis
A
- Empty bladder
- Measure abd circumference/ wt
- High fowlers
11
Q
CIRRHOSIS giving albumin effective if?
A
⬆️BP and pulse
12
Q
CIRRHOSIS dx and considerations
A
Liver biopsy
- Before and during: supine c pillow sa head and R side
- After procedure: R side lying to prevent bleeding
13
Q
CIRRHOSIS y insert balloon tamponade? What kind of tube? Ano prio at ilalagay sa bedside
A
- to apply pressure kasi nag rupture na, compress stomach dt bleeding, and decompress gastric/air
- Sengstaken Blakemore Tube (triple lumen)
- Airway. Scissor
14
Q
CIRRHOSIS neomycin and lactulose is effective?
A
⬆️LOC
15
Q
CIRRHOSIS lactulose’s stool na masasabi effective eto? Monitor for?
A
Soft stools c 2-3 bowel movt
HYPOKALEMIA
16
Q
CIRRHOSIS Hepatic Encephalopathy stages
A
- Stage 1: confused
- Stage 2: lethargy
- Stage 3: stupor
- Stage 4: coma
17
Q
CIRRHOSIS 3 complications
A
- Primary peritonitis: ANTIBIOTICS
- HEPATORENAL SYNDROME: dialysis
- HEPATIC ENCEPALOPATHY
18
Q
Inflammatory cond of liver caused by viral or non viral (alcohol autoimmune)
A
HEPATITIS
19
Q
HEPATITIS types
A
hepa TAE
BC- blood and body fluids
D- co-infection c B
20
Q
HEPATITIS ABA sx
A
⬆️bilirubin
- Jaundice & pruritus
- Clay colored/ pale stools
- Dark or tea-colored urine
⬆️aPTT and PT
- bruising
⬇️Albumin
- edema
21
Q
HEPATITIS mngt and DIET
A
- low PROTEIN (all liver dse)
- low FAT (kc my nausea)
- ❌acetaminophen (tylenol), alcohol
22
Q
HEPATITIS pruritus mngt
A
- Moisturizer
- Cool compress
- Avoid sun
23
Q
Enzymes begin to digest the pancreas (autodigestion)
A
PANCREATITIS
24
Q
PANCREAS fxns
A
- Exocrine: produce digestive enzymes
- Endocrine: insulin & glucagon
25
3 digestive enzymes
1. Trypsin/ protease: protein
2. Lipase: fat (most destructive)
3. Amylase: carbs
26
PANCREATITIS sx specially hallmark
- Turner’s sign- flank
- Cullen’s sign- umbiliCULL
- LUQ epigastric pain radiates to back aggravated by Flat position
- ⬆️bilirubin (jaundice)
- internal bleeding, Ascites (Internal Bleeding dito may lead to DHN, Hypotension)
- HypoCa
- NV indigestion
27
PANCREATITIS dx kung san lahat ⬆️
- Enzymes (best parameter)
- Glucose (hyperglycemia)
- WBC (fever)
- PT and aPTT
- Bilirubin, Alkaline Phosphatase
28
PANCREATITIS mngt
- LUQ epigastric pain radiates to back aggravated by Flat position: ❌MORPHINE/ HYDROMORPHONE/ DEMEROL or any NARCOTICS
- ⬆️bilirubin (jaundice): ✅pruritus care
- internal bleeding, Ascites (Internal Bleeding dito may lead to DHN, Hypotension)- ✅BLEEDING PREC
- Prio: REST THE GI/ NPO or ✅NGT
- hypergly: INSULIN
- ⬆️enzymes: PPI, H2 BLOCKERS, ANTACIDS
29
PANCREATITIS diet
Enzymes c meals
30
PANCREATITIS compli
- Steatorrhea
- HYPOCALCEMIA
- DM
- ARDS
- PERITONITIS
- HYPOVOLEMIC/HEMORRHAGIC SHOCK
31
Inflammation of gallbladder caused by gallstones (CHOLELITHIASIS) resulting to backup ng bile
CHOLECYSTITIS
32
CHOLECYSTITIS supersaturation of bile types
1. Cholesterol (mc)- yellow color
2. Bile/Pigment stone (hemolysis, dark green color)
3. Calculous- gall stone (mc din)
4. Acalculous- injury/surgery➡️infxn
5. Water
33
CHOLECYSTITIS signs
- Murphy’s sign: hepatic subcoastal margin/last rib palpation while on supine gall bladder contrac/mamaga then pain + Rebound Tenderness
- Boas sign: pain after intake of fat, pain sa SCAPULA
- RUQ colic pain radiates to RIGHT shoulders
- Fever c chills
- ⬆️bilirubin (jaundice, pruritus, steatorrhea, dark tea colored urine)
- ⬇️Vit K (bleeding)
- Belching/indigestion of fats
34
CHOLECYSTITIS prio mngt
NPO/ REST THE GI
35
CHOLECYSTITIS
1. diet
2. meds
3. treatment/surgery
❌gas forming foods
1. ursoDEOXYCHOLIC acid or chenoDEOXYCHOLIC acid
2. PANTOLINE/ATROPINE (anti spasmodic/anticholinergic)
3. NSAIDS for pain
4. PPI & H2 blocker (⬇️secretion—⬇️contraction)
1. Lithotripsy
2. Laparoscopic cholecystectomy(stone lang tanggal)
3. cholecystectomy (gall bladder)
36
cholecystectomy may bile parin?
Yes kasi may liver pa
37
Triad/peritad na naga septick shock na
CHARCOT’s triad or REYNOLD’s Peritad
1. RUQ pain
2. Jaundice
3. Fever
4. Confusion
5. Hypotension
38
CHOLECYSTITIS compli wherein gallstone bumababa sa common bile duct
CholeDOCHOlithiasis
39
CHOLECYSTITIS dx
UTZ
40
CHOLECYSTITIS heath educ
- ❌fatty fried foods
- Lose wt
41
cholecystectomy post op instruction
1. early ambulation
2. Prevent pneumonia (deep breath and cough)
3. Prevent infection (❌baths✅shower, report redness/swelling sa incision site)
4. 1 wk bago balik sa work
42
Dt fecalith causing inflammation in RLQ
APPENDICITIS
43
APPENDICITIS signs
1. pain upon release/ rebound tenderness
2. pain in umbilicus hanggang iliac crest
3. Rolling/paradoxical pain (sa LLQ nag palpate pero pain sa RLQ)
4. Pain triggered by coughing
5. Pain when R knee flexed 90 degrees tas inikot ikot or external rotaion
6. R leg flexed backward tas naga L lateral position pt
1. BLUMBERG
2. MCBURNEY
3. ROVSING
4. DUNPHY’S
5. OBTURATOR
6. PSOAS
44
APPENDICITIS other sx
- Low grade fever
- ⬇️bowel sound
45
APPENDICITIS mga bawal ❌
- Heat pads or blanket
- Laxative
- Enemas
- Colonoscopy
46
APPENDICITIS mngt
1. IV MORPHINE/HYDROMORPHONE
2. IV NS or LR
3. ✅cold compress
4. Appendectomy or Ex Lap (❌lifting obj, prevent pneumonia, prevent infxn)
47
PERITONITIS (nag rupture/perforate) vs and signs
- ⬆️HR, RR, Temp
- Rebound tenderness
- Rigid board like abd
48
Immune reaction to eating gluten dt absence og intestinal villi resulting to malabsorption
CELIAC DSE
49
CELIAC DSE foods na bawal
Lahat ng may GLUTEN (BROW)—barley, rye, oats, wheat) example is dinner roll, spag, beer, breaded meat
50
CELIAC DSE sx (SADEK)
- Steatorrhea
- Abd pain
- Diarrhea
- Vit ADEK (fat soluble) di absorbed
51
Grains like rice corn potatoes soy quinoa pede?
YES
52
1. Little pOuches of stress bubbles leading to CONSTIPATION
2. Dangerous Inflammation of diverticula
1. DIVERTICULOSIS
2. DIVERTICULITIS
53
DIVERTICULA DISORDERS cause and age affected
- LOW FIBER, popcorn, seeds, nuts
- ELDERLY
54
DIVERTICULA DISORDERS sx
- LLQ pain
- Fever, ⬆️WBC
- ⬇️Hct
- Abd sx c blood stool
55
DIVERTICULA DISORDERS prio during acute phase and dx
REST THE bowel/ NPO
CT scan
56
DIVERTICULITIS mngt
- NPO
- clear liquid diet (jello broth juices)
- LOW fiber
57
DIVERTICULOSIS mngt
- Avoid consti & STRAINING (HIGH fiber)
- ❌ popcorn, seeds, nuts (⬇️fiber mga to)
58
Other mngt na pang either sa dalawa
- MORPHINE/HYDROMORPHONE
- PANTOLINE/ ATROPINE
- ✅NGT decompression kasi naka NPO
- TPN lang if (+) malnutrition
- Antibiotics, antipyretics
- Diverticulectomy
59
Impending sign ng rupture (peritonitis)
Paralytic ileus (ABSENT BOWEL SOUND)
60
aka Dietary Compli, Resulting to massive fluid shift dt Stomach empties too quickly into duodenum (SI) 30 mins after eating seen any bariatric surgery
DUMPING SYNDROME
61
DUMPING SYNDROME goal
Delay gastric emptying
62
DUMPING SYNDROME sx is like __
Hypovolemic shock
- Hypotachytachy
- POST PRANDIAL HYPOGLY (rebound hypogly dt ⬆️insulin)
- SWEATING dizziness
- SEVERE ABD PAIN 30 mins after eating
- Diarrhea NV
63
DUMPING SYNDROME mngt
1. L SIDE LYING after eating
2. Recumbent DURING eating
3. Liquid IN BETWEEN meals (before and after kain)
4. ⬆️CHON for oncotic
5. ⬇️Carbs, ❌simple sugar milk caffeine salt
6. Atropine Pantoline (antispasmodic/ anticholinergic)
64
GI SURGERY post op mngt
- NPO until bowel sounds return
- ✅sequential compression devices or any Splinting specially during coughing
- Prevent infxn (shower), prevent pneumonia (coughing and DBE/incentive spirometer q hr), early ambulation
65
DEHISCENCE/EVISCERATION
1. Una gagawin
2. Position
3. Ilalagay
1. STAY c the client and CALL for help
2. LOW FOWLERS C KNEES BENT
3. Sterile gauze c saline
66
DEHISCENCE/EVISCERATION educ
- CARBS lang ⬇️ sa diet
- L SIDE LYING agad after eating
- Foods in bet meals
- SFF
- (**Dumping syndrome mngt din diba)
67
anong Vit imeasure after GI surgery to prevent compli
Serum VIT B12
68
Diff ng sx ng UPPER sa LOWER GI bleed
Upper (DARK)
- Hematemesis (coffee ground emesis)
- Melena (black tarry stool)
Lower (BRIGHT red bleeding)
69
GI BLEED common rx
Upper
- gastritis gerd PUD
- Esophageal varices
Lower
- Colorectal Cancer
- Hemorrhoids
- Diverticulosis
- Ulcerative colitis
70
GI BLEED dx
Guiac FOBT
71
how to perform Guiac FOBT
1. Nonsterile gloves
2. Lagay stool sa boxes
3. Sa likod, put 2 drops ng solution
4. Wait 1 min
5. Document
72
GI BLEED Compli
- HYPOVOLEMIC SHOCK
- hemorrhagic shock (Hgb <7 pt goes to Heaven)
73
GI BLEED Mngt
1. position
2. what IV sol to stabilize Bp
3. to increase Hgb
4. For upper GI bleed ano mngt
5. consideration if may esophageal varices
1. Low HOB
2. NS
3. BT
4. NGT lavage
5. ❌ NGT
74
surgery ng upper GI? low GI? post op mngt?
Upper GI: ENDOSCOPY
lower GI: COLONOSCOPY
Clear liquids like juice broth jello unsweetened tea
75
GERD cause
Anything nagpapa weaken/wide ng LES (lower esophageal sphincter) na nagpapa backflow ng hydrochloric acid and pepsin
76
GERD sx
- DYSPEPSIA “heartburn” aka PYROSIS after meal or lying down
- Globus (fullness in throat)
- Laryngitis (dry cough, hoarseness)
- Odynophagia (painful swallowing)
77
GERD rx
- Pyloric stenosis
- ⭐️Hiatal hernia
- ⬆️abd pressure
- Stress and obesity
- Slow motility
78
GERD mga ❌kainin
- Fried fatty
- Citrus/acidic like tomato spag ++ spicy
- Dairy (milk cheese)
- Chocolates
- Peppermint/spearmint
- Caffeine
- Tobacco and alcohol
79
GERD mngt
- ✅3 hr after meal saka pede humiga
- Fowlers sa gabi.. or L SIDE LYING
- SFF (6-10 meals)
- ❌inc ng abd pressure like compression
80
GERD meds
- antacid pang NEUTRALIZE (Al/Mg hydroxide, —carbonates)
- H2 blockers
- PPI
- DOMPERIDONE & METOCLOPROMIDE (prokinetics ⬆️motility)
81
GERD meds na bawal (ANAC)
- Aspirin
- NSAIDS
- anticholinergic/antispasmodic (atropine pantoline)
- Ca Channel Blockers
AN- ⬆️HCl
AC-⬇️motility
82
2 tests to determine LES competence
GERD 2 surgeries pampasikip ng LES
UPPER GASTROINTESTINAL ENDOSCOPY
ESOPHAGOGASTRODUODENOSCOPY (EGD)
STRETTA PROCEDURE (radio frequency waves)
FUNDOPLICATION
83
Happens when gastric acids erodes gastric lining creating holes/sores in stomach or duodenum
PUD
84
PUD gastric vs duodenal ulcer
Gastric
- sa STOMACH
- Poor man/ laborer’s ulcer
- ⬆️50 y.o
- pain after eating—wt loss
- HEMATEMESIS
- (ako to)😂
Duodenal (mas common)
- sa duodenum
- Executive ulcer
- 25-50 y.o
- nawawala lang sakit pag kumakain kaya worse sa gabi —wt gain
- MELENA
BOTH
- Dyspepsia/indigestion/Epigastric/Burning/Pain
85
PUD causes
- H. Pylori (raw meat)
- NSAIDs (Naproxen, Aspirin, Indomethacin, Ibuprofen)
- Stress and Vices
- Coffee
86
PUD dx
GUIAC FOBT
UPPER GI SERIES c BARIUM CONTRAST
- NPO 8h before
- expect abd cramping & chalky white stool
- OFI & laxatives
BIOPSY (tignan H pylori)
Gastric acid analysis
87
PUD
1. Diet
2. Avoid __
3. Report__
4. Tyoe of diet during active phase/painful
5. Educ
1. ❌spicy, fatty fried, acidic/citrus, caffeine, alcohol and cigars, peppermint/spearmint
2. NSAIDS and large amount milk (1 c per day lang or maga rebound hyperacidity), and stress
3. Black tarry stools
4. Bland diet
5. Chew slowly
88
PUD meds and med’s WOF
Antacids (neutralize, chewable 1-2 AFTER meal the 1 full glass water..eto lang after meal, the rest before)
1. Al Hydroxide (ala tae/consti, ⬇️phosphate/phosphorus)
2. Mg hydroxide (mag tae, ⬆️mg)
3. Ca carbonate (⬆️Ca)
4. Na bicarbonate (metabolic alkalosis)
5. Combined dalawang hydroxide—MgALOH (Maalox)
H2 blockers, PPI (before breakfast)— mga nagpapa ⬇️HCl
Sucralfate/Misoprostol
(Misoprostol is anti prostaglandin so ❌preg pang abort
Bismuth, Tetracycline, Metronidazole, Amoxicillin, Clarithromycin, Quinolones (H. Pylori)
89
3 types ng Histamine and their fxn
1. H1: allergy
2. H2: HCl
3. H3: drowsy
90
2 disease ng Inflammatory Bowel Dse (IBS) and difference
Ulcerative COLitis
- Colon
- LLQ
- 10-20 bloody stools
- ⬇️Hgb & Hct
- Rx: Colorectal Ca
- 16-25 and 55-65 y.o
CRohn’s Dse
- SI
- RLQ
- aka regional enteritis
- Rx: Irritable bowel Syndrome
- 5 soft loose stools/steatorrhea/mucus/pus (❌bleed)
- 35-55 y.o
BOTH
- tenesmus (urge to defecate but isn’t relieved by defecation)
91
IBS cause & triggers
AUTOIMMUNE
3 S- stress smoking sepsis
92
IBS dx and seen, surgery
UC- laceration inflammation
Crohns- cubble stone/ crown
Colostomy or Ileostomg
93
IBS mngt
1. Diet
2. Electrolytes
3. Avoid___
4. Meds (lodips)
1. ⬇️FIBER/ residue ⬆️CHON & Cal
2. 2 L water + more w diarrhea, ⬆️K, ⬆️ Ca vit, ✅oresol
3. Stress, alcohol, caffeine
4. Loperamide, Dicyclomine, Prednisone, Sulfasalazine
94
blockage in SI w rapid onset sx
SMALL BOWEL OBSTRUCTION
95
SBO sx
- COLICKY “intermittent” abd pain
- abd distention, NV
- HYPERactive bowel sounds (ABOVE obstruction)
- hypo (below)
96
SBO non mechanical & mechanical causes
Non mechanical: PARALYTIC ILEUS
Mechanical: anything nagpapa obstruct
- ADHESION From surgery
- Intussusception
- Hernia
- Volvulus (twisting ng bowel)
- Tumor
97
SBO mngt
1. NPO, ✅NGT
2. Semi FOWLER
3. NON OPOIDS
4. ❌ opoids (morphine, hydromorphone, hydrocodone)
5. Bowel resection
98
SBO mngt
1. NPO, ✅NGT
2. Semi FOWLER
3. NON OPOIDS
4. ❌ opoids (morphine, hydromorphone, hydrocodone)
5. Bowel resection
99
IRRITABLE BOWEL SYNDROME (IBS)
Affects LARGE INTESTINES either diarrhea or consti
100
IBS
1. type of stool
2. Cause
3. Rx factor
1. mucoid ❌bloody
2. Idiopathic
3. Stress, women, neuroendo dysfxn
101
IBS mngt
1. Diet
2. Dx
3. Position
4. Meds
5. Tell to avoid __
1. ⬆️FIBER ⬆️CHON❌gas forming (legumes/beans, eggs, dairy, FRUITS). If consti= low fat/low residue like rice ++lactulose (laxative)
2. Colonoscopy, Barium Enema
3. S LYING KNEES FLEXED
4. Loperamide
5. Stress
102
Potrusion ng part ng stomach thru diaphragm and now is stuck sa esophagus (SLIDING) or to the side ng esophagus (ROLLING) or MIXED
HIATAL HERNIA
103
HH cause & dx
- ⬆️abd pressure
- Obesity stress female
- Congenital
Endoscopy & Barium Swallow
104
HH sx & mngt
GERD sx + esophagitis
- ❌nagpapa⬆️abd pressure including tight clothing and girdle
- GERD mngt
- PPI (Pantoprazole)
- Fundoplication
105
ESOPHAGEAL CA rx factors (TOGA)
Tobacco
Obesity
Gerd
Alcohol
106
Cancer of large intestine + rectum
Colon Cancer
107
Colon & Colorectal Cancer
1. rx factor
2. dx
3. Educ
1. TOGA + DIVERTICULITIS + Ulcerative Colitis
2. Colonoscopy
3. Lose wt, no alcohol & tobacco, iwasan magka GERD, ⬆️FIBER
108
COLONOSCOPY before and after things to do
Before
- Clear liquid diet Laxatives
- NPO midnight
- Polyethylene Glycol
After
- WOF: peritonitis
109
Colostomy vs Ileostomy location
Colostomy- colon
Ileostomy- ileum (SI)
110
Colostomy & Ileostomy tell if ✅ or ❌
1. Red beefy after surgery then pink long term
2. Moist shiny
3. Pale grey dusky purple
4. Cold
5. Post op ⬆️fiber
6. Fluid electrolytes imbalance as compli
7. No gassy foods
8. No hard to digest like popcorn seeds nuts
1. ✅Red beefy after surgery then pink long term
2. ✅Moist shiny
3. ❌Pale grey dusky purple
4. ❌Cold
5. ❌Post op ⬆️fiber
6. ✅Fluid electrolytes imbalance as compli
7. ✅No gassy foods
8. ✅No hard to digest like popcorn seeds nuts
111
Colostomy & Ileostomy
1. How many ml fluid intake
2. Irrigation how many ml
3. warm or tap water?
4. place bag above__ (__height)
5. Cramping:
6. Empty pouch when __
7. Skin breakdown:
8. Nsg dx:
1. 3,000 ml
2. 500-1000
3. Warm
4. Ostomy, shoulder
5. STOP FLUID
6. 1/3–1/2 full
7. Clean periostomal skin meticulously
8. Disturbed body image
112
DOC diuretics of Ascites in Cirrhosis
Aldactone
