Week 5 GI (appendicitis & cholelithiasis & Cirrhosis & Hep & pancreatitis & pyloric stenosis)

Helpfulness: 0
Set Details Share
created 10 days ago by KijanaBackup
16 views
updated 8 days ago by KijanaBackup
show moreless
Page to share:
Embed this setcancel
COPY
code changes based on your size selection
Size:
X
Show:
1

First signs of appendicitis

-Bowel irregularity

-indigestion

-abdominal discomfort

2

Early appendicitis pain

umbilical or epigastric pain which is often vague, diffuse and/or associated with cramping

3

N/V in appendicitis do not always occur, but if they do, they follow

the onset of pain

4

As appendicitis progresses, pain localizes to:

McBurney's Point

(2 inches from anterior superior ileac spine on line from umbilicus

5

What symptoms may or may not appear with appendicitis?

-tachycardia

-diminished peristalsis

-gas pain

-anorexia

-diarrhea

-malaise

-muscle spasms

6

In appendicitis, if the appendix lies within the pelvis, what may be felt?

A palpable, tender mass

7

What may present in appendicitis with perforation?

-fever over 101.4/38.5

-rigid abdomen

-vomiting

-pt remains rigid w/ flexed knees

-palpable mass if abscess is present

8

How is appendicitis diagnosed most of the time?

-CT scan

-white cell/ C-reactive protein

9

What diagnostic test does a better job finding appendicitis in children?

(This method also rules out things like crohns disease and diverticulitis)

Abdominal ultrasound

10

What can be expected on a white cell count for pts with late appendicitis?

shift to the left-- 75% neutrophils

11

How are GU issues ruled out when appendicitis is suspected?

Urinalysis

(SHOULD BE NORMAL)

12

What is the biomarker found in stool sample that indicates acute appendicitis?

Calprotectin

13

What will be seen on an abdominal radiographic examination in cases of appendicitis?

-fecalith

-possibly localized air/ fluid levels increased

-possible increased soft tissue density in RLQ/localized ileus

14

Which vitals are expected to be within the normal range in the absence of sepsis?

-BP/HR

-Temp

-RR

15

What patient positioning indicates possible rupture of appendix?

supine or side lying with knees flexed

16

Sudden disappearance of appendix pain may indicate

rupture

17

What is a healthy bowel sound rate?

5-34/min in each quadrant

18

If an appendicitis pt, what does hip pain with hip extension or a limp indicate?

A possible retrocecal abscess irritating the psoas muscle

19

How does pain in appendix perforation present?

-generalized with recurrent vomiting

-abdominal rigidity

20

Why are opioids and sedatives avoided until a diagnosis of appendicitis is made?

They mask symptoms

21

What breathing exercises can be used to help pain?

Slow, diaphragmatic

22

What positions can help with appendicitis pain by decreasing traction on the abdomen?

supine with pillow under knees (NO PRESSURE ON POPLITEAL)

Side lying with knees bent

23

What kind of natural allergies can indicate allergies to contrast dye (ie CT scans for appendicitis)?

shellfish

24

How long does it usually take to see a reaction to contrast dye, and how long CAN it take?

2-6 hrs

7 days

25

Post appendectomy, the pt should not lift more than

10 lbs for 6 weeks

26

Cholelithiasis is

gallstones

27

Gallstones occur in women ______ as often as men

twice

28

gallstones may be found where?

Anywhere in the biliary system

29

What complications can be caused by gallstones in 10-20% of cases?

Cholangitis

Pancreatitis

Cholecystitis

30

What are gallstones made of?

cholesterol or pigment

31

Risk factors for cholesterol gall stones

-obesity/high cholesterol&lipids/Diabetes

-rapid weight loss

-multiparity

-certain meds

32

What are the two types of pigment gall stones?

black pigment (black tarry)

calcium bilirubinate (soft, brown, malodourous)

33

Risk factors for pigment gall stones

cirrhosis

ileal disease

hyperparathyroidism

truncal vagotomy

hemolytic anemia

bile duct infections

34

What typically make cholelithiasis become symptomatic?

Stone lodged in a duct

35

Which disease states is cholelithiasis typically seen in?

-diabetes

-regional enteritis

-certain blood dyscrasias

36

The incidence of gallstones in women increases after

age 40

37

What causes the sharp pains associated with biliary colic?

Contraction of gall bladder with stone in duct

38

What does biliary colic ultimately lead to?

Cholecystitis

39

What is choledocholelithiasis?

When a gall stone lodges in the common bile duct

40

Acute cholecystitis is typically a cystic duct obstruction, however, it can also be:

-stasis

-bacterial infection

-ischemia

41

What happens when the cystic tract becomes obstructed?

gallbladder distension

(possibly swelling and wall thickening)

42

What is the most serious complication of cholelithiasis?

acute cholangitis or ascending cholangitis

43

What are the conditions under which acute/ascending cholangitis occurs?

already infected bile duct becomes obstructed, and bacteria enter the duct from the duodenum

44

What can chronic bacteremia of the common bile duct cause?

Primary sclerosis cholangitis (biliary duct fibrosis (intra/extrahepatic) and inflammatory changes

(HIGH MORTALITY IF NOT CAUGHT EARLY)

45

What sort of pain does biliary colic cause?

aching midepigastric pain

46

What sort of pain does a "gall attack"/colic attack cause?

intense pain that may radiate to RUQ/ subscapular/R shoulder/back region lasting 1-4 hrs

47

Other than pain, what symptoms come with a colic/gall attack?

tachycardia

N/V

mild fever

diaphoresis

48

Patients who develop gallstone pancreatitis may be completely symptom free until:

they develop symptoms of pancreatitis

49

Pts with acute cholecystitis likely have a hx of which symptoms after eating?

-heaviness

-regurgitation/heartburn

-belching/gas

-nausea

50

What outward evidence may be present in biliary obstruction?

-clay colored stools/steatorrhea

-amber colored urine

-jaundice

-pruritis/fever

-bleeding tendencies

51

How long does acute cholecystitis usually last?

several hours, but possible 7-10 days

52

How does bacterial cholangitis typically present?

-fever

-jaundice

-chills

-mental confusion/lethargy

-abdominal pain

-leukocytosis/elevated bilirubin (80% of cases)

53

CHolelithiasis abdominal assessment, barring episodes of biliary colic are usually

normal

54

Where will pain and a globular mass be palpated during an abdominal assessment of someone with acute cholecystitis?

under and behind the anterior border of the liver in the RUQ

55

What is murphys sign?

Pt takes a deep breath, examiner presses on area, pt cannot inspire due to pain

(seen in acute cholecystitis along with rebound tenderness and guarding)

56

What is present in SEVERE cases of cholangitis?

HypoTN

Mental confusion

57

What is always necessary in cholangitis?

Surgical decompression of biliary tract

MEDICAL EMERGENCY

58

What is the preferred diagnostic test for cholelithiasis including details of stones, wall thickening, edema and sludge accumulation?

Ultrasound

59

Hydroxyliminodiacetic acid (HIDA) scan of cholescintigraphy is used when ultrasound fails, how does it work?

substance is injected IV, processed through the liver, and does not move into the gallbladder in cases of obstruction, so the gallbladder cannot be visualized

60

Why should HIDA scans/cholescintigraphy be avoided other than uncertain diagnoses in high risk surgical pts?

Extended exposure to radiation and can be false positive

61

Endoscopic retrograde cholangiopancreatography (ERCP) is a surgery to

Visualize and remove common bile duct gallstones

62

What is the downside of using ERCP?

may cause:

-pancreatitis

-hemorrhage

-perforation

-cholangitis

63

What is MRCP?

It's like an MRI for gallbladder shit

(expensive af, though)

64

Ultrasound is the gold standard for gallbladder imaging, so why might a CT be used?

Low risk and useful in assessing additional pathology or uncertain diagnosis

(CT has low sensitivity for gallstones)

65

What do WBCs higher than 18,000 indicate?

gangrene or gallbladder perforation (peritonitis)

66

What is done to differentiate between obstructive biliary disease and hemolytic disorders or hepatocellular disease?

Bilirubin and urobilinogen tests (bilirubin is typically increased in both in biliary disease)

67

What does elevated serum liver labs indicate in cholecystitis?

Worse outcomes and likely long standing cholecystitis/common duct stones

68

What causes bleeding issues in galbladder disease?

Shitty vit K absorption

(will lengthen PT)

69

Why is an EKG done in suspected cholecystitis?

cardiac issues may mimic gallbladder issues

70

What pt position is the most helpful for gall pain?

Low fowlers

takes tension off abdominal contents

71

What is the most effective pain management for acute gall pain?

PCA

72

Why should meperidine (demerol) be avoided in elderly?

Risk of seizures

73

What can be done to limit the use of opioid analgesics after gall surgery?

IV ketorolac (tramadol) every 6 hours for 4 or 5 doses

(do not use for more than 5 days!!)

74

Other than analgesics, what meds can help with gall pain?

H2 blockers (famotidine &cimetidine)

--antacids

(act as acid suppressors)

75

Diet during acute gall attack?

NPO w/ IV fluids in preparation for surgery

76

How much post gall surgery drainage should be seen?

less than 1000 ml of dark brown

77

When is clay colored stool normal?

If bile is being drained through a T-tube

78

Gall issues when bile is forced back into the bloodstream: Colors

Stool:

Urine:

Skin:

Clay

Amber

Yellow

79

How often should a t-tube and drainage be assessed post gall surgery?

Q2 on day of

Every shift after

80

How to prevent reflux into the common bile duct while ambulating with T-tube after gall surgery?

Ensure the tube is positioned lower than the common bile duct

81

What is a common problem for months after gall surgery?

Loose stools due to bile availability

82

What can drinking alcohol do to a gall pt?

Introduce pancreatic involvement

83

What is cirrhosis?

Irreversible replacement of healthy liver cells with fibrous tissue--leading to hepatomegaly

84

What does obstruction of blood flow to the liver resulting from cirrhosis impair?

-fluid electrolyte balance

-metabolism

-glycogen storage

-hormone metabolism

-protein synthesis

-coagulation

-digestion

-protein synthesis

-detoxification

85

How much of the body's blood supply does the liver hold?

13%

86

Where does blood back up when there is portal vein obstruction?

the GI tract and the spleen

87

Alcoholic cirrhosis is also called

Laennec

88

How long does it take for heavy drinking to become Laennec cirrhosis?

10-20 years

89

What increases the risk of developing Laennec cirrhosis?

-fatty liver disease

-hepatitis

90

How does cirrhosis progress?

fatty liver, which can be reversed

-then alcoholic hepatitis

-then chronic hepatitis w/ fibrosis and cirrhosis

91

How quickly can alcoholic liver damage be reversed with abstinence?

-fatty liver

-scarring and nodules

-weeks

-six months to show improvement

92

What can cause cirrhosis?

Any chronic liver disease

(hereditary hemochromatosis, Wilson's, hep b/c, nonalcoholic fatty liver, alpha-1 antitrypsin deficiency, autoimmune hep)

93

What are the very worst complications of Laennec cirrhosis?

-Primary liver cancer (hepatocellular carcinoma

-liver failure (decompensated liver disease)

94

What is biliary cirrhosis?

chronic retention of bile an inflammation of bile ducts that leads to 15% of cirrhosis cases

95

What is primary biliary cirrhosis?

Autoimmune mediated obstruction of the bile ducts due to small and medium bile duct destruction by CD4 and CD8 lymphocytes

96

What is typically the process of primary biliary cirrhosis?

pt notices fatigue, pruritis and RUQ pain that ultimately results in end stage liver disease due to bile build up

97

What is secondary biliary cirrhosis?

Bile duct obstruction leading to cirrhosis due to disease such as CF, chronic pancreatitis, idiopathic sclerosis cholangitis, biliary atresia, neoplasms, calculi or pericholangitis

98

Why is urine brown in liver failure?

Build up of urobilinogen

99

Why are stools pale and clay colored in liver failure?

Lack of bilirubin

100

WHat are th possible symptoms of cirrhosis/liver failure?

-Personality changes

-fatigability/impotence/lost libido/sterility

-menstrual irregularities

-weight loss/anorexia

-pruritis

-ab pain/n/v/diarrhea/hematemesis

101

What are the results of liver failure leading to lack of hormone processing?

-gynomastia

-pec and pit alopecia

-testicular atrophy

102

What might you find on a skin assessment in liver failure?

-spider nevi

-purpuric lesions

-palmar erythema

-jaundice

103

What might you find in a neuro assessment in liver failure?

-personality changes-----> coma

-asterixis (jerking of hands and wrists)

104

What is fetor hepaticus?

Sweet, musty smell on breath in liver failure

105

Fluid related signs of liver failure:

-periph edema

-ascites

-pleural effusion

106

Why might WBC, platelets and RBCs be decreased in liver failure?

Splenomegaly/hypersplenism

107

Why are consistently high or very high bilirubin labs evidence of a poor prognosis for cirrhosis?

The signify poor excretory function of liver

108

What is alkaline phosphatase at 2-3x normal levels indicative of?

-liver failure

-biliary tract dysfunction

biliary tracts dysfunction

109

Is ALT or AST more specific for hepatocellular damage?

ALT

110

What kind of liver failure is elevated (300 U) ALT/AST indicative of?

Acute

111

What can cause low levels of ambumin?

-poor liver function

-fluid issues

-malnutrition

112

What is gamma glutamyl transpeptidase indicative of?

toxic shit going through the liver or really poor liver clearance

113

what are globulins for?

forming antibodies, proteins and clotting factors

114

Which globulin level will be high in advanced cirrhosis?

Gamma

115

How does liver failure effect Na+ levels?

Normal to decreased

(except in laaate liver failure with tense ascites or hepatorenal syndrome--- dilutional hyponatremia)

116

What happens to K+ levels in chronic alcoholic liver disease?

chronic hypokalemic acidosis

117

K+ levels are ___________ in:

liver failure:

liver failure with renal insufficiency

slightly reduced

hyperkalemia

118

What does severe or terminal liver disease do to a pt's glucose metabolism?

Fucks it up

--hypoglycemia due to impaired gluconeogenesis, and glycogen depletion

119

How can a fucked up liver actually lower BUN?

It screws up the krebs cycle-- garbage enzymes

120

How can a fucked up liver increase BUN?

Causing renal insufficiency

causing bleeding

121

Why does a shitty liver cause ammonia to build up and wreak havoc?

it doesn't break it down into urea

it shunts intestinal blood to accessory vessels

122

What may be present in a urinalysis in liver failure?

-possible proteinuria

-bilirubin increased

-possible increased urobilinogen

123

What color is fluid drawn from abdomen of a cirrhosis case expected to be?

Straw colored or clear

124

What is the definitive test in determining the extent of liver disease?

liver biopsy

125

What is used as a "plug" in a plugged biopsy on a person with bleeding issues in liver disease?

collagen and thrombin

126

What can lead to sudden variceal bleeding?

Loss of patency of portal vein

127

What causes decreased gas exchange in liver disease?

Blood issues (anemia)

fluid in abdomen or pleura

mismatched vent-perfusion

128

PaCO2 is supposed to be

45mmHG or less

129

PaO2 is supposed to be

80 mmhg or more

130

How should one position a liver failure pt with dyspnea?

semi fowlers or high fowlers

131

What is the normal range for INR?

less than 2 seconds for pts not on coagulation therapy

132

What is the normal range for PT?

10.5-13.5 seconds

133

What actions must be avoided to prevent rupture of esophageal varices?

-vomiting

-sneezing

-lifting

-STRAINING (stool softeners)

-rough or caustic food

134

What dietary changes can increase PT?

-vit K

--spinach

--cauliflower

--liver

--cabbage

135

What complications can arise with cauterization/band ligation/sclerotherapy to treat esophageal varices?

-perforation leading to bleeding and shock

136

What must be done in the case of an esophageal perforation?

-NPO

-Gastric Suction prepared

-Provide antibiotics as prescribed

137

How is ascites monitored?

Abdominal girth and weight

-I&Os

(mark location of measurement on abdomen with indelible ink)

138

What pt position should be used for tracking abdominal girth?

supine

139

Barring major fluid overload and ascites, weight loss should not exceed:

0.5kg/ 1.1 lb per day

140

What can overly dramatic fluid loss from diuretic therapy cause?

electrolyte issues, especially hyponatremia

(can lead to encephalopathy and creatine build up)

141

How is edema staged?

1-4

142

What does the presence of edema signify in liver failure?

low albumin or high sodium

(persistently low albumin = poor prognosis)

143

What is optimal for sodium labs?

137-147 mEq/L

144

Which electrolyte abnormalities need to be watched especially closely in liver failure?

Na+ (hyponatremia is associated w/ tense ascites/hepatorenal syndrome and terminal disease)

K+ (renal insufficiency can result in hyperkalemia acidosis)

145

What causes pleural effusion in liver failure?

rapid diffusion of pressure during paracentesis

146

How is thirst handled in fluid overload?

ice chips and frequent mouth care

147

In liver failure related fluid overload, what may be prescribed to the pt as far as diet?

-Sodium restriction

-baking soda, certain mouthwashes, antacids

148

What can be used to mechanically decrease peripheral edema?

-antiembolism hose

-support stockings

-sequential compression devices

-pneumatic foot compression devices

149

What can rapid changes in intrathoracic pressure do to susceptible liver disease pts?

cause variceal hemorrhage

150

What can be done to treat weight loss in liver pts?

-I&Os and weight

-monitor glucose

-encourage eating in all the ways used in cancer pts

-small, frequent meals

-parenteral nutrition

-supplements

151

What herb has been shown to slightly diminish complications of cirrhosis?

Milk thistle

152

What pharmacologic therapies can be used to help a cirrhosis pt gain weight?

-cathartics

-acid suppression agents

-antiemetics

153

What effect of cirrhosis leads to nutritional deficiency due to an early sense of satiety and discomfort?

-ascites

154

What cirrhosis treatments can help relieve pressure on intrathoracic structures (leading to anorexia)?

-paracentesis

-colloid replacement

-diuretics

155

What is the PRIMARY intervention in alcoholic cirrhosis?

don't fucking drink

156

What may happen if cirrhosis related personality changes are left unchecked?

hepatic coma due to ammonia build up

157

What position triggers asterixis?

dorsiflexion of wrist and extension of fingers

158

GI bleeding can precipitate what?

Hepatic encephalopathy

159

How should a hepatic encephalopathy pt be treated as far as safety?

Like a dementia pt

-reorientation

-low bed

-side rails up

-etc

160

In alcohol withdrawal, which precautions must be kept in place

Seizure

161

Why are opioids, phenothiazines, sedatives, antihistamines and other meds affecting the CNS either not used or avoided in hepatic encephalopathy pts?

They are metabolized by the liver

(small dose benzos are okay if ABSOLUTELY necessary)

162

What is the general diet for cirrhosis pts?

Restricted:

-protein

-ammonia

-sodium

163

What must the pt be trained to do if ascites is present?

Deep breathing exercises

164

How many types of hepatitis are there?

5

165

What are the 5 types of hepatitis?

Hep A, B & C

Hep Delta/D/HDV

Hep E/HEV

166

What must already be present for a person to develop Hep delta/D/HDV?

Hep B (HBV)

167

What is the recently discovered and poorly understood "Sixth Hepatitis"?

Hep G

168

How is hep G transmitted?

Percutaneously

169

Symptomatology is similar in all hepatitis infections, but what is different?

-Epidemiology

-immunologic characteristics

170

What does hep G cause?

Acute hepatitis and viremia

171

What is the general disease process among all types of hepatitis?

Autolysis and necrosis occur secondary to hepatocyte damage leading to abnormal liver function

172

Typically hepatitis can be reversed. What happens in severe cases?

massive necrosis leads to acute liver failure and death

173

What qualifies as chronic hepatitis?

hepatic inflammation for more than 6 months

174

What can cause chronic hepatitis?

A, B & C

booze

CMV

IBD

Chronic active lupoid hepatitis (Autoimmune)

175

Which typically occurs first in alcoholic hep?

-cirrhosis

-hepatitis

hepatitis

(may occur together)

176

What causes jaundice?

An accumulation of RBC waste: bilirubin

(>2.5mg/dL)

177

Why does jaundice discolor the skin and sclera?

Bilirubin starts being excreted through the skin and the blood becomes filled with it

178

What causes dark brown or abnormally dark urine?

Excess urobilinogen and bilirubin trying to escape the body

179

What are the 3 classifications of jaundice?

prehepatic (hemolytic)

Hepatic (hepatocellular)

Posthepatic (obstructive)

180

How does prehepatic (hemolytic) jaundice present?

Unconjugated Bilirubin of >.8mg/dL

Bilirubin build up from RBC hemolysis

181

How does Hepatic (hepatocellular) jaundice present?

Demonstrated by indirect serum bilirubin

dysfunction of liver cells presents the breakdown and excretion of bilirubin through bile

(also associated w/ ACUTE hepatitis)

182

How does Posthepatic (obstructive) jaundice present?

biliary obstruction forces backflow of bile through the liver and back to the blood

Direct serum bilirubin >0.3ml/dL

183

The many signs of hepatitis include:

-epigastric discomfort

-malaise

-N/V

-anorexia

--aversion to smoking

-muscle/joint aches

-irritability

-pruritis

-low-to-mid grade fever

184

Objective signs of hepatitis

Jaundice

clay colored stools

brown urine

185

What subjective signs are often found with acute hepatic failure and not with basic bitch hepatitis?

-more severe N/V, ab pain and jaundice

-mental status changes/coma/seizures

186

What objective signs are often found with acute hepatic failure and not with basic bitch hepatitis?

-ascites

-sharp rise in temp and leukocytosis

-coffee ground emesis/GI hemorrhage

-shock

-purpura

-oliguria

-azotemia

187

WHat labs are elevated in azotemia?

BUN

(nitrogen is in the blood lol)

188

What might the nurse find in abdominal assessment of advanced hepatitis?

-splenomegaly

-hepatomegaly (UNLESS EXTREMELY SEVERE, THEN WE GET A BABY LIVER)

-lymphadenopathy

-ascites (duh)

189

Aside from the obvious, what are risk factors for hepatitis?

-multiple transfusions

-clotting disorders

-travel to developing countries

-men who have sex with men??

----all the sex and drugs stuff, obvs---

190

Immunoglobulins involved in hep B, C & D

IgG

191

What will you find in ALT and AST labs in the presence of hepatitis?

initial elevation then drop

192

What does GGT elevation indicate?

What does it mean if it persists?

Liver damage

cellular damage is ongoing

193

What will WBC labs look like in the presence of hepatitis?

leukocytosis, monocytosis and atypical lymphocytes will be found

194

What will a urinalysis show in the presence of hepatitis?

mild proteinuria and bilirubinuria

elevated urobilinogen

195

Definitive diagnosis of hepatitis is done by laparoscopic or percutaneous biopsy. What are the risks involved?

--BLEEDING

196

What are some ways a nurse can help treat hepatitis induced fatigue through diet?

-consult on increasing carbs or foods that the pt finds desirable

-encourage normal amounts of protein IF no mental status changes

-vitamins

-small frequent meals

197

What are some ways a nurse can help treat hepatitis induced fatigue through schedule adjustment?

Allow 90 minutes or more rest time before and after treatments

avoid exercise immediately after meals

198

What are some ways a nurse can help treat hepatitis induced fatigue regarding environment?

-keep frequently used objects in reach

-avoid excess environmental stimuli (especially w/ seizure risk)

199

What are some ways a nurse can help treat hepatitis induced fatigue pharmacologically?

-acid suppression therapy

-antiemetics

-antidiarrheal meds

-cathartics

(MINIMIZE GASTRIC DISTRESS AND NUTRIENT LOSS)

200

What should be avoided to reduce risk of hep A contraction?

Crowded conditions with poor sanitation

201

What can be done to prevent sexual partners from contracting hep B

VACCINEEEEE

202

What is the most common mode of contraction of both hep B and C?

Blood

(especially sexual transmission)

203

How can a nurse treat a hepatitis pt's pruritus to prevent skin lesions?

-Keep skin moist with tepid water

-avoid alkaline soaps (clear soaps like glycerin based are best)

-apply emollient lotions frequently

204

What should a hepatitis pt be taught about scratching in cases of pruritis?

-keep nails short

-use knuckles

(((-put wraps or gloves on comatose pts)))

205

Antihistamines can be used to treat hepatitis pruritis, however, what considerations must be in place?

--they are metabolized by the liver

-Low doses

-watch for excessive sedation

206

Environmental treatment of hepatitis induced pruritis?

-soft, cotton, loose clothing

-clean ass linins

-cool temp to avoid sweating

207

WHat is optimal PT?

10.5-13.5 seconds

208

What labs need to be monitored daily for hepatitis pts with bleeding issues due to decreased vit K absorption and decreased coagulation factors?

All dat blood stuff

-HCT/HBG

-platelets/PT

209

If an injection is ABSOLUTELY unavoidable in a hepatitis pt with bleeding risk, what needs to be done to manage after administration?

Hold moderate pressure but DO NOT massage

210

Pts with hepatic failure may not respond to vit K, what might they need?

fresh frozen plasma before invasive procedures

211

How long should a hepatitis pt rest after a meal?

30-60 minutes

212

What meds are especially hepatotoxic (other than acetaminophen)?

NSAIDS

aspirin

salicylates

vitamin A

213

What are some complications hepatitis patients should be made aware of?

-slow wound healing

-bleeding

-skin injury

214

Which function of the pancreas is hormonal?

Endocrine

215

Which function of the pancreas is nonhormonal?

Exocrine

216

WHich cells account for 98% of pancreatic mass?

exocrine/acini cells

217

What is the path of pancreatic exocrine secretions?

a series of lobular ducts-->main pancreatic duct--->duodenum

218

What digestive proteins are produced by the pancreas?

amylases

proteases

lipases

219

What are some examples of proteases?

trypsin

chymotrypsin

carboxypeptidase A & B

phospholipase A

elastase

220

What does the pancreas secrete to push back against the acidity of gastric acid?

bicarb, bitch

221

Why does the pancreas make stomach acid so alkaline (8.3) before dumping it's shit?

to allow for activation instead of destruction of pancreatic enzymes

222

What is pancreatitis?

acute or chronic inflammation with varying degrees of (pancreas inflicted) edema, necrosis and hemorrhage

223

What can persistent pancreatitis result in?

stricture

calcifications

fibrosis

224

What causes ACUTE pancreatitis?

duct blockage forces pancreatic digestive enzymes to escape into surrounding tissue

225

What body systems get fucked up from pancreatitis?

GI

renal

metabolic

cardiopulmonary

226

What illnesses are associated with pancreatitis?

-gallstones

-booze

-trauma/surgical manipulation/ERCP

-heavy metal poisoning

-vascular disease

-infectious agents

-meds

-allergies

-familial hyperlipidemia

227

What is the typical prognosis for acute pancreatitis?

short hospitalization, no long term effects

228

What accounts for 98% of acute pancreatitis deaths?

severe with multiple organ failure

229

What are the most common complications of acute pancreatitis?

-abscess or pseudocyst

-hemorrhage

-fistula formation

-transient hypoglycemia (duh)

230

What are the often fatal complications of acute pancreatitis?

-fucking everything can cause DIC

-shock

-renal failure

-septicemia

-hemorrhagic septicemia

-ARDS

231

Which nutrient is affected the most by pancreatitis?

lipids

232

WHat does high fat content in the bowels resulting from pancreatitis cause?

water and electrolyte excretion

(diarrhea)

233

What does bowel bacteria cause when presented with excessive fecal fat due to pancreatitis?

causes flatus

steatorrhea

cramps

234

DUe to beta cell involvement, what can result from pancreatitis?

DM

235

What should sudden onset of constant, severe epigastric pain after a large meal or alcohol intake make the nurse suspect?

pancreatitis

236

What is the typical location of pancreatic pain?

epigastric--radiating to back or left shoulder

(some relief with sitting with spine flexed)

237

What is pancreatitis pain caused by?

Enzymes irritating the biliary tree

238

What causes the N/V and persistent retching associated with acute pancreatitis?

bowel hypermotility or ileus

239

Why does pancreatitis pain increase after vomiting?

it increases pressure on the ducts, causing further secretion obstruction and tissue damage

240

What symptoms can be expected in pancreatitis beyond pain?

-tachycardia

-fever

-hypotension

241

What symptoms are sometimes, but not always seen in pancreatitis?

Extreme Malaise

restlessness

respiratory distress

diminished urinary output

242

What types of shock can result from acute pancreatitis?

-hypovolemic (duh)

-distributive (due to inflammatory response syndrome)

243

What is distributive shock?

Shitty blood distribution to the smallest vessels

244

What may be seen in an abdominal assessment in pancreatitis?

-mild-moderate ascites

-tenderness

-diminished sounds

245

What may be found in a respiratory/cardiac assessment in acute pancreatitis?

-tachypnea

-base crackles (due to atelectasis & interstitial fluid accumulation)

-diminished excursion related to pain response

246

How might a person with pancreatitis pain present?

-with splinting and/or guarding

247

What does a highish fever signify in pancreatitis pts?

sepsis or abscess

248

What needs to be looked for in agitation, confusion and mental status change seen in a pancreatitis pt?

-alcohol withdrawal

-electrolyte issues

-nutritional issues

249

What is the grey turner sign associated with pancreatic hemorrhage?

blue-gray discoloration of the flank

250

What is the cullen sign associated with pancreatic hemorrhage?

red-blue discoloration around the umbilicus

251

How does CHRONIC pancreatitis tend to present?

dull, constant epigastric pain

steatorrhea

weight loss

three Ps of diabetes

252

What does SIGNIFIGANTLY elevated serum amylase rule out in the suspicion of pancreatitis?

-cholecystitis

-appendicitis

-bowel obstruction/infarction

-perforated peptic ulcer

(confirms pancreatitis)

253

What qualifies as significantly elevated serum amylase?

higher than 500 units/dL

254

What conditions fuck up the sensitivity of serum amylase labs?

-hypertriglyceridemia

-alcoholic pancreatitis

255

What do serum amylase levels return to normal after an acute pancreatitis attack?

48-72 hrs after symptom onset

256

What is special about serum lipase labs compared to serum amylase in the process of diagnosing pancreatitis?

it is more sensitive and specific

it persists longer

257

What two labs determine the degree of necrotic pancreatic tissue?

serum amylase and lipase

258

Which type of pancreatitis is likely to cause DM as opposed to transient hyperglycemia?

Chronic

259

What might an ultrasound, MRI or CT be used to look for in pancreatitis?

-enlarged, edematous pancreatic head

-calcifications

-abscesses or pseudocysts

260

When assessing the common bile ducts, and pancreatic ducts in pancreatitis, what is used if the radiation exposure that comes with ERCP is not appropriate?

MRCP

261

What does ERCP do that MRCP cannot?

Distinguish cancer from calculi

can view duct stenosis and biliary stones

262

ERCP is NOT done until after what?

acute pancreatitis episode has subsided

263

Why might potassium levels be checked in a pancreatitis pt?

hyperkalemia can occur in metabolic acidosis, tissue damage and severe cases of renal failure

264

Which electrolytes might be lowered in pancreatitis?

Calcium and magnesium

265

What may be seen on an EKG in the presence of hypocalcemia in a pancreatitis pt?

QT prolongation w/ normal T wave

266

Why would WBCs be increased in pancreatitis?

The inflammatory process

267

What can pancreatitis do to a pt's HCT?

increase OR decrease

268

When a pancreatitis pt has glycosuria, what is the immediate concern?

Development of DM

269

When might an abdominal radiographic exam be necessary in pancreatitis?

when dilation of either bowel is suspected

when chronic pancreatitis is suspected to have caused calcification

270

What does NPO and limiting activity do for a pancreatitis attack?

It limits the stimulation of the pancreas, reducing pain

271

When is NG suctioning appropriate for a pancreatitis pt?

in severe attack when vomiting cannot be stopped

272

What pharmacological option exists to decrease pancreatitis inflammation?

Steroids

273

What pharmacological option exists to decrease pancreatic stimulation?

H2 receptor blockers

274

What analgesic should be used in pancreatitis?

-morphine?

-Demerol?

morphine (despite concerns for contraction of sphincter of oddi)

275

What positioning can assist with pancreatitis pain?

sitting or supine with knees flexed

--relaxes ab muscles--

276

What is a major downside of opioid analgesic pain meds treating pancreatitis?

gastric slow down may inhibit return to normal digestion

277

What O2 sat requires supplemental intervention when opioid analgesics are used?

92% or lower

278

What is the goal body temp of a pancreatitis pt?

under 100

279

WHat may precede hyperthermia in fever in older adults?

hypothermia

280

What is systemic inflammatory response syndrome (SIRS) a precursor to?

Sepsis

281

What temps does systemic inflammatory response syndrome (SIRS) manifest with?

higher than 38/101.4

OR

Lower than 36/98.6

282

What is a high white cell count?

Low?

higher than 12,000

Under 4000

283

What fluid replacement is preferred for electrolyte imbalances?

lactated ringers

284

What should central venous pressure (CVP) be?

2-6 mmHG

285

What does the chvostek sign (facial spasm) and & Trousseau (carpalpedal spasm) sign indicate?

Hypocalemia

286

Why can pancreatitis cause respiratory issues?

-pain

-decreased gas exchange

-fluid overload

287

If there is a pleural effusion or a defect in one lung (say, in a pancreatitis pt) how should they be positioned?

On their side with the unaffected lung dependent

288

What is the most significant reason for respiratory issues in pancreatitis?

Underproduction of surfactant

289

What is hypostatic pneumonia?

bedrest pneumonia

290

What is the cascade cough?

short forceful exhalations for those who cant forcefully cough

291

What pancreatitis related electrolyte imbalance can cause bowel dysfunction?

Hypokalemia

292

How does steatorrhea appear?

Foamy and foul smelling

293

If enteral nutrition is indicated, how far should they be infused to avoid pancreatic stimulation?

past the ligament of Treits

294

When are parenteral feedings instituted when pancreatitis calls for it?

When enteral doesn't work out for 5-7 days

295

Why does blood sugar need to be taken when pt is on parenteral nutrition?

high glucose content in fluid

296

What is the usual diet for pancreatitis?

High carb

low fat

protein as tolerated

297

When are pancreatic enzyme supplements used for pancreatitis pts?

Before reintroduction of fat into diet

298

What type of fats do not require pancreatic enzymes for absorption?

medium chain triglycerides (MTCs)

299

What happens if a nurse administers pancreatin with hot drinks?

deactivates enzyme activity

300

What do coffee, tea, nicotine and alcohol do to the pancreas?

Stimulate enzymes

301

After the pancreatitis pt recovers, what should they do every day to catch a recurrence?

weight daily to assess for weight loss

302

What does pyloric stenosis do?

Prevents food from leaving the stomach

303

Who most commonly develops pyloric stenosis?

Neonates

304

What does pyloric stenosis fuck up?

-digestion/absorption (like, yeah)

-hydration

305

What is pyloric stenosis pathophysiologically?

Hypertrophy of the pyloric orifice, narrowing it

306

What exposure is connected to the development of pyloric stenosis?

antibiotics during gestation and neonate period

307

Which gender is more likely to suffer pyloric stenosis?

male

308

What are the objective signs of pyloric stenosis?

projectile vomiting (possibly with blood)

weight loss

peristatic waves

changes in stool

malnutrition/dehydration

309

WHat are the subjective signs of pyloric stenosis?

persistent hunger

310

What diagnostic tests can be used when pyloric stenosis is suspected?

-ab ultrasound

-upper GI study

-blood tests

311

What surgery is used to repair pyloric stenosis?

open or laparoscopic pyloromyotomy

312

When can a pyloromyotomy be performed?

After fluid/electrolyte balance is handled

313

Is surgery for pyloric stenosis safe?

Yes, it has a very good prognosis

314

What is secondary pyloric stenosis?

The result of other GI issues (long standing)

occurs in adults

315

How often do adults develop pyloric stenosis?

Rarely

316

WHen adults DO develop pyloric stenosis, who is it typically?

Middle aged men

people who had it as neonates

317

How does adult pyloric stenosis differ from that of neonates?

Early satiety and loss of appetite instead of endless hunger

318

How is pyloric stenosis diagnosed in ADULTS?

barium xrays

blood and urine

endoscopy

319

What are the essential actions of a nurse treating pyloric stenosis?

-managing anxiety

-fluid electrolyte

-acid-base

320

What must be encouraged to prevent further energy reserve loss in pyloric stenosis pts?

REST

321

When changing the diaper of a pyloric stenosis baby, what must be done?

Slide diaper under buttocks, do not lift legs

322

Other than abdominal, what assessments need to be done on pyloric stenosis babies?

-respiratory (lung sounds, specifically)

-temp

323

What may occur post-surgery for a pyloric stenosis baby?

occasional vomiting

324

What might be necessary is pyloromyotomy is not effective in treating pyloric stenosis?

complete myotomy

325

What are two diseases that can occur due to pyloric stenosis?

GEEEEEEERD

malabsorption disorders

326

What is malabsorption?

Intestinal mucosa sucks and lets nutrients escape

327

What are the major malabsorption disorders?

(for this exam)

-short bowel

-celiac

-lactose intolerance

328

When do pyloric stenosis symptoms usually become evident?

3-6 weeks of age

329

When is an infant typically discharged after pyloromyotomy?

24 hrs

330

What primary diseases can lead to pyloric stenosis?

-,malignancy

-gastritis

-hernia

-ulcer

331

What is the difference between primary and secondary pyloric stenosis regarding tissue status?

Secondary does not typically involve increased muscle

332

How often should parents burp infant during feedings post pyloromyotomy?

Every 1-2 oz

or Q 5-10 minutes

333

How long should an infant remain upright after eating post-pyloromyotomy?

30 minutes

334

What are the common systemic manifestations of malabsorption?

bleeding issues/anemia

muscle/bone pain

weakness/malaise

335

Why does malabsorption cause abdominal distension?

undigested carbs fermenting and creating gas

336

What can happen to the face in malabsorption?

glossitis

cheilosis (scaling and fissures in the lips)

337

What are the other names for celiac?

nontropical sprue

celiac sprue

338

What part of gluten is involved in celiac?

gliadin fraction

339

what is gluten found in?

rye

wheat

barley

oats

fillers in meds

340

At it's core, what kind of illness is celiac?

immunologic

341

What are the high risk populations for celiac?

-1st degree relative

-iron deficiency anemia

-osteopenic bone disease

-T1 diabetes

-downs and turners

342

What illnesses are potential celiac complications?

-intestinal lymphoma

-GI malignancies

343

what is refractory celiac disease?

no longer responds to a gluten free diet

344

What is seen in barium examination of a celiac pt?

loss of "feathery" pattern in small bowel

345

WHich antibodies are found in celiac?

IgA

IgG

346

How is a gluten free diet supplemented?

high calorie

high protein

347

What determines the severity of celiac disease?

time

amount of mucosa involvement

348

Pharmacological treatment of celiac?

-steroids

-vit K

349

What is sometimes done for patients with extreme celiac?

parenteral nutrition

350

What kind of nutrient is lactose?

carb

351

Lactase deficiency is typically genetic, but it can also be secondary to what?

premature birth/aging

Celiac

crohns

GI mucosa illnesses in general

HX abdominal radiation therapy

352

How can lactase deficiency be diagnosed?

-lactose breath test

(hydrogen measured after 50 g of lactose given PO)

-lactose tolerance test

(blood sugar rises more than 20 if test negative)

353

Which bowel is involved in short bowel syndrome?

small

354

SHort bowel syndrome increases risk of

Kidney stones

gallstones

355

Removal of which parts of the bowel results in more severe short bowel syndrome?

duodenum

jejunum

proximal and distal ileum

356

Why might Prilosec/omeprazole be used for pts with short bowel?

gastric hypersecretion is sometimes developed

357

When is fluid volume loss THE MOST likely for short bowel pts?

Right after surgery

358

Which short bowel pts are at the most risk for vit D deficiency?

children and teens

359

What can vit D deficiency lead to?

rickets and garbage bones

360

What tends to happen to the appetite of minors with celiac?

appetite loss and possible failure to thrive

361

Primary lactase deficiency is

genetic and rare

362

What can cause secondary lactase deficiency?

crohns

gi mucosa damage (ie infections)

celiac

363

What losses are associated with female fertility issues in malabsorption?

folate

iron

364

Why can lactase deficiency disappear during pregnancy?

the body naturally improves its ability to absorb lactose

365

What are nondairy sources of calcium?

sardines

salmon

broccoli

spinacj

366

WHich malabsorption disorder seems to be unaffected one way or the other by pregancy?

Short bowel

367

Which age group tends to have milder symptoms of celiac despite having a higher rate of diagnosis?

older adults

368

What is acquired lactase deficiency?

the natural process of losing lactase production in old age