NURS 370 > GI Alterations > Flashcards

GI Alterations Flashcards

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1
Q

Upper gastrointestinal bleeds

A

Esophagus, stomach, duodenum

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2
Q

Esophageal varices

A

Abnormally enlarged veins, in submucosa of lower esophagus

Related to high pressure in liver causing dilation and ultimately rupturing

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3
Q

Esophageal varices: what do the red streaky marks indicate

A

Greater risk of rupture

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4
Q

Esophageal varices: warning signs

A

There aren’t really any until they rupture

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5
Q

Esophageal varices: risk factors: liver cirrhosis

A

-Increases pressure
-damage liver produces less clotting factors which increases the risk for bleeding

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6
Q

Esophageal varices: risk factors: alcohol

A

GI irritant

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7
Q

Esophageal varices: risk factors

A

-spicy food
-older age
-liver infection
-anticoagulants
-NSAIDs/ASA
-steroids

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8
Q

Esophageal varices: risk factors: anticoagulants

A

Increase risk of GI bleed x12

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9
Q

Esophageal varices: risk factors: NSAIDs/ASA

A

Cause ulcers/bleeding
-block COX 1 degrading the protectant layer in the GI and ulcers form

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10
Q

Esophageal varices: risk factors: steroids

A

Prednisone
-weakens the protective lining of the GI tract

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11
Q

Esophageal varices: clinical manifestations

A

-hematemesis
-Melina
-changes in LOC
-weak peripheral pulses
-tachycardia
-hypotension
-decreased urine output
-shock

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12
Q

Esophageal varices: clinical manifestations: shock

A

Very severe cases
-need to loose 25% or 1 L for any s/s

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13
Q

How much blood loss needs to occur for significant vital changes

A

2L

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14
Q

Mallory

A

GI bleed resulting from a tear at junction of gastroesophageal from forceful vomiting or binge drinking

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15
Q

Risk factors for Mallory

A

Eating disorders like bulimia or alcohol

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16
Q

Symptoms of upper GI bleeds

A

Dark black stools, bright red blood vomit with clots

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17
Q

Diagnosis of upper GI bleed: endoscopy

A

Scope down throat
-sedative or hypnotic

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18
Q

Diagnosis of upper GI bleed: barium swallow

A

Ingesting chalky mixture to coat intestines to observe abnormalities or bleeding
-X-RAY
-pt kept awake

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19
Q

Diagnosis of upper GI bleed: less likely alternatives

A

CT and MRI

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20
Q

Diagnosis of upper GI bleed: can a scope be a treatment as well

A

Yes, if they discover a problem they can treat it using banding technique

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21
Q

Laboratory tests for upper GI bleed: blood

A

Type and screen
-will most likely need blood
-packed RBC
-rare: whole blood

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22
Q

Laboratory tests for upper GI bleed: liver function

A

Test for liver damage and dysfunction

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23
Q

Liver damage lab results:

A

ALT, AST, ALP, bilirubin all increase

Albumin decreases

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24
Q

Laboratory tests for upper GI bleed: CBC

A

Comparing hemoglobin to other tests if possible

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25
Laboratory tests for upper GI bleed: electrolytes
Loss of blood and vomiting
26
Clinical management of upper GI bleeds: IV fluids
Isotonic such as NS or LR -easily accessible
27
Clinical management of upper GI bleeds: volume expander
Albumin: keeps fluid in the cells, therefore increases circulating blood volume
28
Clinical management of upper GI bleeds: blood transfusion
18 to 20 gauge IV -central line is even better
29
Clinical management of upper GI bleeds: electrolyte replacement
Along with IV fluids
30
Clinical management of upper GI bleeds: parental nutrition
Something is irritating their GI tract -might nto be able to digest or absorb -gives GI a rest
31
Clinical management of upper GI bleeds: oral hygiene
Post vomit and blood vomit.
32
Clinical management of upper GI bleeds: foley cath
Helps monitor urine output and kidney function
33
Clinical management of upper GI bleeds: reassurance and support
Very scary
34
Medications for upper GI bleed: somatostatin or octreotide
Lowers pressure within the hepatic system -slows blood flow through the gi tract
35
Medications for upper GI bleed: beta blocker
Hx of HTN or blood pressure is currently high = decreased bleeding and decrease pressure in the body
36
Surgical interventions of upper GI bleeds: esophageal banding therapy
During scope band up various bleed points
37
Surgical interventions of upper GI bleeds: Blake more tube
Puts pressure directly on the bleeding -tube down throat into stomach with inflatable balloon that puts pressure on walls of GI tract and bleeding vessels
38
Surgical interventions of upper GI bleeds: transjugular intrahepatic protosytemic shunting or TIPS
Diverts blood flow from the portal vein to reduce the high pressure -makes extra pathways
39
Outcome of the TIPS procedure
Not great, this is more of a last resort procedure
40
Surgical interventions of upper GI bleeds: liver transplant
Last effort
41
Nursing care of upper GI bleeds: activity
High loss of blood = intense fatigue -takes 3 months to replenish blood stores
42
Nursing care of upper GI bleeds: food/fluids
Avoid irritants, such as coffee, caffeine, chocolate and spicy foods
43
Nursing care of upper GI bleeds: elimination
Teach s/s of blood in stool, tar and blood clots
44
Nursing care of upper GI bleeds: psychological
Delving deeper into the cause -alcohol use and supports -stress levels
45
Nursing care of upper GI bleeds: pain management
Other options than NSAIDs or tylonal
46
Nursing care of upper GI bleeds: education
Signs and symptoms of bleeding
47
Hemorrhoids
Lower GI bleed typically not a large volume of blood loss
48
What are some lower GI bleeding conditions
-cancer or tumours -chronic bowel diseases: IBS, Crohns and colitis -diverticulitis
49
Diverticulitis is commonly caused by
Low fiber diet damaging the diverticulum
50
Symptoms of lower GI bleed
Coffe ground vomit, bright red blood in stool, maroon stool
51
How to diagnosis lower GI bleed
Colonoscopy
52
What are the functions of the liver
-clotting factors -metabolism -filters blood and toxins -activates medications -bile ducts
53
Hepatic cirrhosis
Replacement of normal liver tissue with diffuse scarring that interrupts function
54
What are leading causes of cirrhosis
Hep C and alcohol use
55
What gender is 2x more likely to have liver cirrhosis
Men
56
Ascities
Portal HTN where fluid leaks out of blood cells, and low albumin means the fluid is displaced -usually into abdomin
57
Hepatocelluar cirrhois
As a result of hepatitis, auto immune dysfunction and non alcoholic fatty liver disease
58
Metabolic cirrhosis
Genetically passed on
59
Cholestatitc cirrhosis
Obstruction of biliary system, may lead to permanent liver disease
60
Compensated cirrhosis
Asymptomatic for years -fatigue, and right upper quadrant pain
61
Decompenated cirrhosis
Ascities, jaundice, confusion, agitation, hepatic encephalopathy, excessive bleeding, dark urine, itchy skin
62
How to diagnosis cirrhosis
Liver labs: AST, ALT GGT, bilirubin and PTT increase Albumin decrease CT/MRI Biopsy
63
Complications of cirrhosis
-bleeding/coagulation -fluid volume excess or Ascities -hepatic encephalopathy -portal HTN
64
How to treat Ascities
Draining, fluid restriction, diuretics, paracentresis
65
How to treat hepatic encephalopathy
Lactulose -traps ammonia in GI and secretes into stool
66
How to treat portal HTN
Beta blockers and octiotide
67
Medical management of cirrhosis
Liver transplant
68
Pancreatitis simply is
Pancreas digesting itself
69
Pancreas function
Control blood sugar, digestive enzyme store/production (lipase, amalaze, tripsin)
70
What causes pancreatitis
Alcohol consumption, obstruction of bile duct, gallstones
71
Patho of pancreatitis
Pressure builds up, enzymes end up in the pancreas and begins digesting itself
72
How to diagnosis pancreatitis: blood
-amylase and lipase: increased dramatically -blood sugar could be high
73
Amylase and lipase timeframe in blood tests
Amylase is quick, whereas lipase takes 1 to 3 days
74
How to diagnosis pancreatitis: DI
Ultrasound, CT, MRI -full diagnosis
75
How to diagnosis pancreatitis: ERCP or ednoscpic retrograde cholangiopanreatography
Scope retrograde to find portal system up to pancreas, check for gallstones as well as remove them
76
Clinical management of acute pancreatitis
Nothing can be done to cure -pain medications -feed restrictions -TPN -NG tube with suction
77
Clinical management of chronic pancreatitis
May need insulin or monitoring of blood sugars
78
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