Week 5 GI (appendicitis & cholelithiasis & Cirrhosis & Hep & pancreatitis & pyloric stenosis)
First signs of appendicitis
Early appendicitis pain
umbilical or epigastric pain which is often vague, diffuse and/or associated with cramping
N/V in appendicitis do not always occur, but if they do, they follow
the onset of pain
As appendicitis progresses, pain localizes to:
(2 inches from anterior superior ileac spine on line from umbilicus
What symptoms may or may not appear with appendicitis?
In appendicitis, if the appendix lies within the pelvis, what may be felt?
A palpable, tender mass
What may present in appendicitis with perforation?
-fever over 101.4/38.5
-pt remains rigid w/ flexed knees
-palpable mass if abscess is present
How is appendicitis diagnosed most of the time?
-white cell/ C-reactive protein
What diagnostic test does a better job finding appendicitis in children?
(This method also rules out things like crohns disease and diverticulitis)
What can be expected on a white cell count for pts with late appendicitis?
shift to the left-- 75% neutrophils
How are GU issues ruled out when appendicitis is suspected?
(SHOULD BE NORMAL)
What is the biomarker found in stool sample that indicates acute appendicitis?
What will be seen on an abdominal radiographic examination in cases of appendicitis?
-possibly localized air/ fluid levels increased
-possible increased soft tissue density in RLQ/localized ileus
Which vitals are expected to be within the normal range in the absence of sepsis?
What patient positioning indicates possible rupture of appendix?
supine or side lying with knees flexed
Sudden disappearance of appendix pain may indicate
What is a healthy bowel sound rate?
5-34/min in each quadrant
If an appendicitis pt, what does hip pain with hip extension or a limp indicate?
A possible retrocecal abscess irritating the psoas muscle
How does pain in appendix perforation present?
-generalized with recurrent vomiting
Why are opioids and sedatives avoided until a diagnosis of appendicitis is made?
They mask symptoms
What breathing exercises can be used to help pain?
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
What kind of natural allergies can indicate allergies to contrast dye (ie CT scans for appendicitis)?
How long does it usually take to see a reaction to contrast dye, and how long CAN it take?
Post appendectomy, the pt should not lift more than
10 lbs for 6 weeks
Gallstones occur in women ______ as often as men
gallstones may be found where?
Anywhere in the biliary system
What complications can be caused by gallstones in 10-20% of cases?
What are gallstones made of?
cholesterol or pigment
Risk factors for cholesterol gall stones
-rapid weight loss
What are the two types of pigment gall stones?
black pigment (black tarry)
calcium bilirubinate (soft, brown, malodourous)
Risk factors for pigment gall stones
bile duct infections
What typically make cholelithiasis become symptomatic?
Stone lodged in a duct
Which disease states is cholelithiasis typically seen in?
-certain blood dyscrasias
The incidence of gallstones in women increases after
What causes the sharp pains associated with biliary colic?
Contraction of gall bladder with stone in duct
What does biliary colic ultimately lead to?
What is choledocholelithiasis?
When a gall stone lodges in the common bile duct
Acute cholecystitis is typically a cystic duct obstruction, however, it can also be:
What happens when the cystic tract becomes obstructed?
(possibly swelling and wall thickening)
What is the most serious complication of cholelithiasis?
acute cholangitis or ascending cholangitis
What are the conditions under which acute/ascending cholangitis occurs?
already infected bile duct becomes obstructed, and bacteria enter the duct from the duodenum
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)
What sort of pain does biliary colic cause?
aching midepigastric pain
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
Other than pain, what symptoms come with a colic/gall attack?
Patients who develop gallstone pancreatitis may be completely symptom free until:
they develop symptoms of pancreatitis
Pts with acute cholecystitis likely have a hx of which symptoms after eating?
What outward evidence may be present in biliary obstruction?
-clay colored stools/steatorrhea
-amber colored urine
How long does acute cholecystitis usually last?
several hours, but possible 7-10 days
How does bacterial cholangitis typically present?
-leukocytosis/elevated bilirubin (80% of cases)
CHolelithiasis abdominal assessment, barring episodes of biliary colic are usually
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
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)
What is present in SEVERE cases of cholangitis?
What is always necessary in cholangitis?
Surgical decompression of biliary tract
What is the preferred diagnostic test for cholelithiasis including details of stones, wall thickening, edema and sludge accumulation?
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
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
Endoscopic retrograde cholangiopancreatography (ERCP) is a surgery to
Visualize and remove common bile duct gallstones
What is the downside of using ERCP?
What is MRCP?
It's like an MRI for gallbladder shit
(expensive af, though)
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)
What do WBCs higher than 18,000 indicate?
gangrene or gallbladder perforation (peritonitis)
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)
What does elevated serum liver labs indicate in cholecystitis?
Worse outcomes and likely long standing cholecystitis/common duct stones
What causes bleeding issues in galbladder disease?
Shitty vit K absorption
(will lengthen PT)
Why is an EKG done in suspected cholecystitis?
cardiac issues may mimic gallbladder issues
What pt position is the most helpful for gall pain?
takes tension off abdominal contents
What is the most effective pain management for acute gall pain?
Why should meperidine (demerol) be avoided in elderly?
Risk of seizures
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!!)
Other than analgesics, what meds can help with gall pain?
H2 blockers (famotidine &cimetidine)
(act as acid suppressors)
Diet during acute gall attack?
NPO w/ IV fluids in preparation for surgery
How much post gall surgery drainage should be seen?
less than 1000 ml of dark brown
When is clay colored stool normal?
If bile is being drained through a T-tube
Gall issues when bile is forced back into the bloodstream: Colors
How often should a t-tube and drainage be assessed post gall surgery?
Q2 on day of
Every shift after
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
What is a common problem for months after gall surgery?
Loose stools due to bile availability
What can drinking alcohol do to a gall pt?
Introduce pancreatic involvement
What is cirrhosis?
Irreversible replacement of healthy liver cells with fibrous tissue--leading to hepatomegaly
What does obstruction of blood flow to the liver resulting from cirrhosis impair?
-fluid electrolyte balance
How much of the body's blood supply does the liver hold?
Where does blood back up when there is portal vein obstruction?
the GI tract and the spleen
Alcoholic cirrhosis is also called
How long does it take for heavy drinking to become Laennec cirrhosis?
What increases the risk of developing Laennec cirrhosis?
-fatty liver disease
How does cirrhosis progress?
fatty liver, which can be reversed
-then alcoholic hepatitis
-then chronic hepatitis w/ fibrosis and cirrhosis
How quickly can alcoholic liver damage be reversed with abstinence?
-scarring and nodules
-six months to show improvement
What can cause cirrhosis?
Any chronic liver disease
(hereditary hemochromatosis, Wilson's, hep b/c, nonalcoholic fatty liver, alpha-1 antitrypsin deficiency, autoimmune hep)
What are the very worst complications of Laennec cirrhosis?
-Primary liver cancer (hepatocellular carcinoma
-liver failure (decompensated liver disease)
What is biliary cirrhosis?
chronic retention of bile an inflammation of bile ducts that leads to 15% of cirrhosis cases
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
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
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
Why is urine brown in liver failure?
Build up of urobilinogen
Why are stools pale and clay colored in liver failure?
Lack of bilirubin
WHat are th possible symptoms of cirrhosis/liver failure?
What are the results of liver failure leading to lack of hormone processing?
-pec and pit alopecia
What might you find on a skin assessment in liver failure?
What might you find in a neuro assessment in liver failure?
-personality changes-----> coma
-asterixis (jerking of hands and wrists)
What is fetor hepaticus?
Sweet, musty smell on breath in liver failure
Fluid related signs of liver failure:
Why might WBC, platelets and RBCs be decreased in liver failure?
Why are consistently high or very high bilirubin labs evidence of a poor prognosis for cirrhosis?
The signify poor excretory function of liver
What is alkaline phosphatase at 2-3x normal levels indicative of?
-biliary tract dysfunction
biliary tracts dysfunction
Is ALT or AST more specific for hepatocellular damage?
What kind of liver failure is elevated (300 U) ALT/AST indicative of?
What can cause low levels of ambumin?
-poor liver function
What is gamma glutamyl transpeptidase indicative of?
toxic shit going through the liver or really poor liver clearance
what are globulins for?
forming antibodies, proteins and clotting factors
Which globulin level will be high in advanced cirrhosis?
How does liver failure effect Na+ levels?
Normal to decreased
(except in laaate liver failure with tense ascites or hepatorenal syndrome--- dilutional hyponatremia)
What happens to K+ levels in chronic alcoholic liver disease?
chronic hypokalemic acidosis
K+ levels are ___________ in:
liver failure with renal insufficiency
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
How can a fucked up liver actually lower BUN?
It screws up the krebs cycle-- garbage enzymes
How can a fucked up liver increase BUN?
Causing renal insufficiency
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
What may be present in a urinalysis in liver failure?
-possible increased urobilinogen
What color is fluid drawn from abdomen of a cirrhosis case expected to be?
Straw colored or clear
What is the definitive test in determining the extent of liver disease?
What is used as a "plug" in a plugged biopsy on a person with bleeding issues in liver disease?
collagen and thrombin
What can lead to sudden variceal bleeding?
Loss of patency of portal vein
What causes decreased gas exchange in liver disease?
Blood issues (anemia)
fluid in abdomen or pleura
PaCO2 is supposed to be
45mmHG or less
PaO2 is supposed to be
80 mmhg or more
How should one position a liver failure pt with dyspnea?
semi fowlers or high fowlers
What is the normal range for INR?
less than 2 seconds for pts not on coagulation therapy
What is the normal range for PT?
What actions must be avoided to prevent rupture of esophageal varices?
-STRAINING (stool softeners)
-rough or caustic food
What dietary changes can increase PT?
What complications can arise with cauterization/band ligation/sclerotherapy to treat esophageal varices?
-perforation leading to bleeding and shock
What must be done in the case of an esophageal perforation?
-Gastric Suction prepared
-Provide antibiotics as prescribed
How is ascites monitored?
Abdominal girth and weight
(mark location of measurement on abdomen with indelible ink)
What pt position should be used for tracking abdominal girth?
Barring major fluid overload and ascites, weight loss should not exceed:
0.5kg/ 1.1 lb per day
What can overly dramatic fluid loss from diuretic therapy cause?
electrolyte issues, especially hyponatremia
(can lead to encephalopathy and creatine build up)
How is edema staged?
What does the presence of edema signify in liver failure?
low albumin or high sodium
(persistently low albumin = poor prognosis)
What is optimal for sodium labs?
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)
What causes pleural effusion in liver failure?
rapid diffusion of pressure during paracentesis
How is thirst handled in fluid overload?
ice chips and frequent mouth care
In liver failure related fluid overload, what may be prescribed to the pt as far as diet?
-baking soda, certain mouthwashes, antacids
What can be used to mechanically decrease peripheral edema?
-sequential compression devices
-pneumatic foot compression devices
What can rapid changes in intrathoracic pressure do to susceptible liver disease pts?
cause variceal hemorrhage
What can be done to treat weight loss in liver pts?
-I&Os and weight
-encourage eating in all the ways used in cancer pts
-small, frequent meals
What herb has been shown to slightly diminish complications of cirrhosis?
What pharmacologic therapies can be used to help a cirrhosis pt gain weight?
-acid suppression agents
What effect of cirrhosis leads to nutritional deficiency due to an early sense of satiety and discomfort?
What cirrhosis treatments can help relieve pressure on intrathoracic structures (leading to anorexia)?
What is the PRIMARY intervention in alcoholic cirrhosis?
don't fucking drink
What may happen if cirrhosis related personality changes are left unchecked?
hepatic coma due to ammonia build up
What position triggers asterixis?
dorsiflexion of wrist and extension of fingers
GI bleeding can precipitate what?
How should a hepatic encephalopathy pt be treated as far as safety?
Like a dementia pt
-side rails up
In alcohol withdrawal, which precautions must be kept in place
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)
What is the general diet for cirrhosis pts?
What must the pt be trained to do if ascites is present?
Deep breathing exercises
How many types of hepatitis are there?
What are the 5 types of hepatitis?
Hep A, B & C
What must already be present for a person to develop Hep delta/D/HDV?
Hep B (HBV)
What is the recently discovered and poorly understood "Sixth Hepatitis"?
How is hep G transmitted?
Symptomatology is similar in all hepatitis infections, but what is different?
What does hep G cause?
Acute hepatitis and viremia
What is the general disease process among all types of hepatitis?
Autolysis and necrosis occur secondary to hepatocyte damage leading to abnormal liver function
Typically hepatitis can be reversed. What happens in severe cases?
massive necrosis leads to acute liver failure and death
What qualifies as chronic hepatitis?
hepatic inflammation for more than 6 months
What can cause chronic hepatitis?
A, B & C
Chronic active lupoid hepatitis (Autoimmune)
Which typically occurs first in alcoholic hep?
(may occur together)
What causes jaundice?
An accumulation of RBC waste: bilirubin
Why does jaundice discolor the skin and sclera?
Bilirubin starts being excreted through the skin and the blood becomes filled with it
What causes dark brown or abnormally dark urine?
Excess urobilinogen and bilirubin trying to escape the body
What are the 3 classifications of jaundice?
How does prehepatic (hemolytic) jaundice present?
Unconjugated Bilirubin of >.8mg/dL
Bilirubin build up from RBC hemolysis
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)
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
The many signs of hepatitis include:
--aversion to smoking
-low-to-mid grade fever
Objective signs of hepatitis
clay colored stools
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
What objective signs are often found with acute hepatic failure and not with basic bitch hepatitis?
-sharp rise in temp and leukocytosis
-coffee ground emesis/GI hemorrhage
WHat labs are elevated in azotemia?
(nitrogen is in the blood lol)
What might the nurse find in abdominal assessment of advanced hepatitis?
-hepatomegaly (UNLESS EXTREMELY SEVERE, THEN WE GET A BABY LIVER)
Aside from the obvious, what are risk factors for hepatitis?
-travel to developing countries
-men who have sex with men??
----all the sex and drugs stuff, obvs---
Immunoglobulins involved in hep B, C & D
What will you find in ALT and AST labs in the presence of hepatitis?
initial elevation then drop
What does GGT elevation indicate?
What does it mean if it persists?
cellular damage is ongoing
What will WBC labs look like in the presence of hepatitis?
leukocytosis, monocytosis and atypical lymphocytes will be found
What will a urinalysis show in the presence of hepatitis?
mild proteinuria and bilirubinuria
Definitive diagnosis of hepatitis is done by laparoscopic or percutaneous biopsy. What are the risks involved?
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
-small frequent meals
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
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)
What are some ways a nurse can help treat hepatitis induced fatigue pharmacologically?
-acid suppression therapy
(MINIMIZE GASTRIC DISTRESS AND NUTRIENT LOSS)
What should be avoided to reduce risk of hep A contraction?
Crowded conditions with poor sanitation
What can be done to prevent sexual partners from contracting hep B
What is the most common mode of contraction of both hep B and C?
(especially sexual transmission)
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
What should a hepatitis pt be taught about scratching in cases of pruritis?
-keep nails short
(((-put wraps or gloves on comatose pts)))
Antihistamines can be used to treat hepatitis pruritis, however, what considerations must be in place?
--they are metabolized by the liver
-watch for excessive sedation
Environmental treatment of hepatitis induced pruritis?
-soft, cotton, loose clothing
-clean ass linins
-cool temp to avoid sweating
WHat is optimal PT?
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
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
Pts with hepatic failure may not respond to vit K, what might they need?
fresh frozen plasma before invasive procedures
How long should a hepatitis pt rest after a meal?
What meds are especially hepatotoxic (other than acetaminophen)?
What are some complications hepatitis patients should be made aware of?
-slow wound healing
Which function of the pancreas is hormonal?
Which function of the pancreas is nonhormonal?
WHich cells account for 98% of pancreatic mass?
What is the path of pancreatic exocrine secretions?
a series of lobular ducts-->main pancreatic duct--->duodenum
What digestive proteins are produced by the pancreas?
What are some examples of proteases?
carboxypeptidase A & B
What does the pancreas secrete to push back against the acidity of gastric acid?
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
What is pancreatitis?
acute or chronic inflammation with varying degrees of (pancreas inflicted) edema, necrosis and hemorrhage
What can persistent pancreatitis result in?
What causes ACUTE pancreatitis?
duct blockage forces pancreatic digestive enzymes to escape into surrounding tissue
What body systems get fucked up from pancreatitis?
What illnesses are associated with pancreatitis?
-heavy metal poisoning
What is the typical prognosis for acute pancreatitis?
short hospitalization, no long term effects
What accounts for 98% of acute pancreatitis deaths?
severe with multiple organ failure
What are the most common complications of acute pancreatitis?
-abscess or pseudocyst
-transient hypoglycemia (duh)
What are the often fatal complications of acute pancreatitis?
-fucking everything can cause DIC
Which nutrient is affected the most by pancreatitis?
WHat does high fat content in the bowels resulting from pancreatitis cause?
water and electrolyte excretion
What does bowel bacteria cause when presented with excessive fecal fat due to pancreatitis?
DUe to beta cell involvement, what can result from pancreatitis?
What should sudden onset of constant, severe epigastric pain after a large meal or alcohol intake make the nurse suspect?
What is the typical location of pancreatic pain?
epigastric--radiating to back or left shoulder
(some relief with sitting with spine flexed)
What is pancreatitis pain caused by?
Enzymes irritating the biliary tree
What causes the N/V and persistent retching associated with acute pancreatitis?
bowel hypermotility or ileus
Why does pancreatitis pain increase after vomiting?
it increases pressure on the ducts, causing further secretion obstruction and tissue damage
What symptoms can be expected in pancreatitis beyond pain?
What symptoms are sometimes, but not always seen in pancreatitis?
diminished urinary output
What types of shock can result from acute pancreatitis?
-distributive (due to inflammatory response syndrome)
What is distributive shock?
Shitty blood distribution to the smallest vessels
What may be seen in an abdominal assessment in pancreatitis?
What may be found in a respiratory/cardiac assessment in acute pancreatitis?
-base crackles (due to atelectasis & interstitial fluid accumulation)
-diminished excursion related to pain response
How might a person with pancreatitis pain present?
-with splinting and/or guarding
What does a highish fever signify in pancreatitis pts?
sepsis or abscess
What needs to be looked for in agitation, confusion and mental status change seen in a pancreatitis pt?
What is the grey turner sign associated with pancreatic hemorrhage?
blue-gray discoloration of the flank
What is the cullen sign associated with pancreatic hemorrhage?
red-blue discoloration around the umbilicus
How does CHRONIC pancreatitis tend to present?
dull, constant epigastric pain
three Ps of diabetes
What does SIGNIFIGANTLY elevated serum amylase rule out in the suspicion of pancreatitis?
-perforated peptic ulcer
What qualifies as significantly elevated serum amylase?
higher than 500 units/dL
What conditions fuck up the sensitivity of serum amylase labs?
What do serum amylase levels return to normal after an acute pancreatitis attack?
48-72 hrs after symptom onset
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
What two labs determine the degree of necrotic pancreatic tissue?
serum amylase and lipase
Which type of pancreatitis is likely to cause DM as opposed to transient hyperglycemia?
What might an ultrasound, MRI or CT be used to look for in pancreatitis?
-enlarged, edematous pancreatic head
-abscesses or pseudocysts
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?
What does ERCP do that MRCP cannot?
Distinguish cancer from calculi
can view duct stenosis and biliary stones
ERCP is NOT done until after what?
acute pancreatitis episode has subsided
Why might potassium levels be checked in a pancreatitis pt?
hyperkalemia can occur in metabolic acidosis, tissue damage and severe cases of renal failure
Which electrolytes might be lowered in pancreatitis?
Calcium and magnesium
What may be seen on an EKG in the presence of hypocalcemia in a pancreatitis pt?
QT prolongation w/ normal T wave
Why would WBCs be increased in pancreatitis?
The inflammatory process
What can pancreatitis do to a pt's HCT?
increase OR decrease
When a pancreatitis pt has glycosuria, what is the immediate concern?
Development of DM
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
What does NPO and limiting activity do for a pancreatitis attack?
It limits the stimulation of the pancreas, reducing pain
When is NG suctioning appropriate for a pancreatitis pt?
in severe attack when vomiting cannot be stopped
What pharmacological option exists to decrease pancreatitis inflammation?
What pharmacological option exists to decrease pancreatic stimulation?
H2 receptor blockers
What analgesic should be used in pancreatitis?
morphine (despite concerns for contraction of sphincter of oddi)
What positioning can assist with pancreatitis pain?
sitting or supine with knees flexed
--relaxes ab muscles--
What is a major downside of opioid analgesic pain meds treating pancreatitis?
gastric slow down may inhibit return to normal digestion
What O2 sat requires supplemental intervention when opioid analgesics are used?
92% or lower
What is the goal body temp of a pancreatitis pt?
WHat may precede hyperthermia in fever in older adults?
What is systemic inflammatory response syndrome (SIRS) a precursor to?
What temps does systemic inflammatory response syndrome (SIRS) manifest with?
higher than 38/101.4
Lower than 36/98.6
What is a high white cell count?
higher than 12,000
What fluid replacement is preferred for electrolyte imbalances?
What should central venous pressure (CVP) be?
What does the chvostek sign (facial spasm) and & Trousseau (carpalpedal spasm) sign indicate?
Why can pancreatitis cause respiratory issues?
-decreased gas exchange
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
What is the most significant reason for respiratory issues in pancreatitis?
Underproduction of surfactant
What is hypostatic pneumonia?
What is the cascade cough?
short forceful exhalations for those who cant forcefully cough
What pancreatitis related electrolyte imbalance can cause bowel dysfunction?
How does steatorrhea appear?
Foamy and foul smelling
If enteral nutrition is indicated, how far should they be infused to avoid pancreatic stimulation?
past the ligament of Treits
When are parenteral feedings instituted when pancreatitis calls for it?
When enteral doesn't work out for 5-7 days
Why does blood sugar need to be taken when pt is on parenteral nutrition?
high glucose content in fluid
What is the usual diet for pancreatitis?
protein as tolerated
When are pancreatic enzyme supplements used for pancreatitis pts?
Before reintroduction of fat into diet
What type of fats do not require pancreatic enzymes for absorption?
medium chain triglycerides (MTCs)
What happens if a nurse administers pancreatin with hot drinks?
deactivates enzyme activity
What do coffee, tea, nicotine and alcohol do to the pancreas?
After the pancreatitis pt recovers, what should they do every day to catch a recurrence?
weight daily to assess for weight loss
What does pyloric stenosis do?
Prevents food from leaving the stomach
Who most commonly develops pyloric stenosis?
What does pyloric stenosis fuck up?
-digestion/absorption (like, yeah)
What is pyloric stenosis pathophysiologically?
Hypertrophy of the pyloric orifice, narrowing it
What exposure is connected to the development of pyloric stenosis?
antibiotics during gestation and neonate period
Which gender is more likely to suffer pyloric stenosis?
What are the objective signs of pyloric stenosis?
projectile vomiting (possibly with blood)
changes in stool
WHat are the subjective signs of pyloric stenosis?
What diagnostic tests can be used when pyloric stenosis is suspected?
-upper GI study
What surgery is used to repair pyloric stenosis?
open or laparoscopic pyloromyotomy
When can a pyloromyotomy be performed?
After fluid/electrolyte balance is handled
Is surgery for pyloric stenosis safe?
Yes, it has a very good prognosis
What is secondary pyloric stenosis?
The result of other GI issues (long standing)
occurs in adults
How often do adults develop pyloric stenosis?
WHen adults DO develop pyloric stenosis, who is it typically?
Middle aged men
people who had it as neonates
How does adult pyloric stenosis differ from that of neonates?
Early satiety and loss of appetite instead of endless hunger
How is pyloric stenosis diagnosed in ADULTS?
blood and urine
What are the essential actions of a nurse treating pyloric stenosis?
What must be encouraged to prevent further energy reserve loss in pyloric stenosis pts?
When changing the diaper of a pyloric stenosis baby, what must be done?
Slide diaper under buttocks, do not lift legs
Other than abdominal, what assessments need to be done on pyloric stenosis babies?
-respiratory (lung sounds, specifically)
What may occur post-surgery for a pyloric stenosis baby?
What might be necessary is pyloromyotomy is not effective in treating pyloric stenosis?
What are two diseases that can occur due to pyloric stenosis?
What is malabsorption?
Intestinal mucosa sucks and lets nutrients escape
What are the major malabsorption disorders?
(for this exam)
When do pyloric stenosis symptoms usually become evident?
3-6 weeks of age
When is an infant typically discharged after pyloromyotomy?
What primary diseases can lead to pyloric stenosis?
What is the difference between primary and secondary pyloric stenosis regarding tissue status?
Secondary does not typically involve increased muscle
How often should parents burp infant during feedings post pyloromyotomy?
Every 1-2 oz
or Q 5-10 minutes
How long should an infant remain upright after eating post-pyloromyotomy?
What are the common systemic manifestations of malabsorption?
Why does malabsorption cause abdominal distension?
undigested carbs fermenting and creating gas
What can happen to the face in malabsorption?
cheilosis (scaling and fissures in the lips)
What are the other names for celiac?
What part of gluten is involved in celiac?
what is gluten found in?
fillers in meds
At it's core, what kind of illness is celiac?
What are the high risk populations for celiac?
-1st degree relative
-iron deficiency anemia
-osteopenic bone disease
-downs and turners
What illnesses are potential celiac complications?
what is refractory celiac disease?
no longer responds to a gluten free diet
What is seen in barium examination of a celiac pt?
loss of "feathery" pattern in small bowel
WHich antibodies are found in celiac?
How is a gluten free diet supplemented?
What determines the severity of celiac disease?
amount of mucosa involvement
Pharmacological treatment of celiac?
What is sometimes done for patients with extreme celiac?
What kind of nutrient is lactose?
Lactase deficiency is typically genetic, but it can also be secondary to what?
GI mucosa illnesses in general
HX abdominal radiation therapy
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)
Which bowel is involved in short bowel syndrome?
SHort bowel syndrome increases risk of
Removal of which parts of the bowel results in more severe short bowel syndrome?
proximal and distal ileum
Why might Prilosec/omeprazole be used for pts with short bowel?
gastric hypersecretion is sometimes developed
When is fluid volume loss THE MOST likely for short bowel pts?
Right after surgery
Which short bowel pts are at the most risk for vit D deficiency?
children and teens
What can vit D deficiency lead to?
rickets and garbage bones
What tends to happen to the appetite of minors with celiac?
appetite loss and possible failure to thrive
Primary lactase deficiency is
genetic and rare
What can cause secondary lactase deficiency?
gi mucosa damage (ie infections)
What losses are associated with female fertility issues in malabsorption?
Why can lactase deficiency disappear during pregnancy?
the body naturally improves its ability to absorb lactose
What are nondairy sources of calcium?
WHich malabsorption disorder seems to be unaffected one way or the other by pregancy?
Which age group tends to have milder symptoms of celiac despite having a higher rate of diagnosis?
What is acquired lactase deficiency?
the natural process of losing lactase production in old age