Upper GI bleeds can be from
peptic ulcers,
esophageal tears,
stress
mallory weiss tear
cancer
with a higher mortality
management of upper GI bleeds
hypotonic solutions,
Vasopressin which constricts the splanchnic arterial bed
ocreotide which reduced splanic blood floow and gi motility
blood flow of venous drainage of the GI tract
gi venous drainiage –> portal vein –> liver –> hepatin vein —-> inferior vena cava
acute pancreatitis
autodigestion of the pancreas usually not caused by infection from premature activation of exocrine enzmes
can results in 6L lost interstitially, activation of inflammatory mediators and can lead to SIRS
pulmonary complications of pancreatitis
LLL atelectasis/l sided pleural effusion/ b/l crackles/ards (bc phospholipase A released which kills type II alveolar cells –> decreases surfactant –> ARDs
the inflammation can cause capillary leak which may block pancreatic duct so left diaphargmatic lifting and left sides pleural effusion and atelectasis
s/s of pancreatisis and why
abdominal pain
n/v and rigid abdomen
increase WBC
increase amylase
increase lipase
decreased calcium - use for autodigestion monitor for trousseau’s sign and prolonged qt
increase blood sugar – beta cell injury (hyperglycemia)
whats a sign of hemorrhagic pancreatitis
cullen’s sign and grey turner’s sign wich is around the umbilic and back respectively which is a sign of retroperitoneal bleeding
tx for pancreatisi
fluids, calcium replacement, PPis to decrease the gastric pH, monitor for pulmonary complications!!!
lab abnormalities for hepatic failure
decreased serum albumin, ascites, increased ammonia, pancytopenia (decreased wbc, platelets, rbcs), coaglopathies, increase ast/alt, decreased blood sugar, increase lactate
what happens when your nh3 is super high
asterxis (flapping hand tremor)
and hepatic encepalopathy when toxins build
to treat hepatic failure treat high ammonia!!!
so make sure you’re not hypokalemic which worsens it, (use k sparing diuretic), lactulose for ammonia, restrict protein if encepalopathy is present. and NO LR
patients with splenectomy are severealy
immunocomprised
signs of a splenic rupture
kehr’s sign (diaphragmic irriation leading to referred pain in left shouldeR)
cullen’s sign is indicitave of what about grey turners
cullens is intraperitoneal
grey turners is retroperitoneal
and remember kehr’s is a ruptured spleen!
normal IAH
12-15
APP
abdominal perfusion pressureand measured by MAP -IAP
abdominal compartment syndrome is iap >20 or app of
60
you can check abdominal presure indirectly by getting a
bladder pressure
> 20 iap may need
decompression surgery
clinical presentation of a bowel obstruction
small bowel: hypokalemia, high pitched bowel sounds
large bowel: low pitched sounds abdominal distension
bowel perf
board like rigid abdomen
peritonitis
leaking of gi content into the peritoneal cavity, and the leakge of bacteria causes an infection and imflammation
