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Unit 3 - GI

Gastrogafen Contrast used for perforations
Hepatobiliary Scentigraphy (HIDA) Dx study for liver biopsy. Nuke med test that checks integrity of ducts
Marasmus Very skinny, emaciated
Kwashiorkor Low protein, pot belly
Coumadin Vitamin K
Dilantin Folic Acid
Questran Fat Soluble Vitamins
Where does PEG tube come out ULQ
Fluids for NG/PEG tube Polymeric Formulas
Fluids for Jejunostomy Elemental Formulas
Signs of aspiration Crackles/Rhonchi on Right side
TPN 70% dextrose
PPN 10% dextrose, add lipids, watch triglycerides
Anorexia Nervosa Low Fe (anemia), electrolyte imbalance
Banding Restriction on stomach, removable
Malabsorptive Small intestine
Gastric Bypass On life long supplements (Fe, B12, folic acid)
Metabolic Syndrome (central obesity) High BP & Triglycerides, Low HDL cholesterol. Type II DM insulin resistant
Esophogeal = Mallory Weiss Tear From chronic GERD, ETOH, smoking, continuous vomit. Low BP, High heart rate
Esophogeal = Esophogeal Varices Massive bloody vomit / Veins engorge in esophagus from pressue on portal vein w/ cirrhosis
Rx: Esophogeal Varices Vasopressin/Sandostatin
Gastric Ulcer (PUD) Weight Loss, pain 1-2 hrs after eating, food aggrevates, massive blood loss, can result in obstruction, common women 50+
Duodenal Ulcer (PUD) pain 2-4 hrs after eating, hunger pain - relieved w/ food, anyone 35-45 yrs old
Complications of Peptic Ulcer Disease Acute exacerbation, perforation, Gastric Outlet Obstruction
Gastric Outlet Obstruction Swells shut w/ very small outlet. Abdominal pain worsens at end of day. Relief w/ belching/self induced vomit. Offensive odor to vomit/breath
Bill Roth II -- surgical treatment for PUD Remove portion of stomach and connect whats left to Jejunum
Complications of Bill Roth II Dumping Syndrome, Postprandial Hypoglycemia, Bile Reflux Gastritis
Postprandial Hypoglycemia Over production of insulin occurs 2 days after eating. s/s: sweating, weakness, confusion, tachy, anxiety
Bile Reflux Gastritis Bile in stomach, gastric distress, worsens after meals. Rx: Questran
Cullen Sign Bruise around umbilicus common in blunt trauma
Crohn's Disease (Inflammatory Bowel Disease) Diarrhea, weight loss, nutritional deficiencies/malabsorption, fistulas, strictures, anal abscess, recurs after surgery
Ulcerative Colitis (Inflammatory Bowel Disease) Bloody diarrhea, rectal bleeding, tenesmus, start in rectum -> colon, curable
Rx: for Inflammatory Bowel Disease Asacol, Imuran, Sulfasalazine, prednisone
Anal Fissure Skin ulcer or crack in lining of anal wall caused by trauma, infection or inflammation. Painful. Tx: Decrease straining, can heal on own
Anorectal Abscess Pus - drain, wet-dry leave open. Low fiber diet
Anal Fistula Complication of Crohn's. Abnormal tunnel leading from anus or rectum to outside of skin, buttocks, vagina
Pilonidal Sinus "Nest of Hair" pain/swelling at base of spine. Abscess or cysts requires drainage. Leave open, heal by 2ndary intention
Hemolytic Jaundice High breakdown in RBCs producing high unconjugated bilirubin in blood. Causes: blood transfusion, sickle cell, hemolytic anemia
Hepatocellular Jaundice Liver cannot conjugate or excrete bilirubin. Causes: Hepatic cirrhosis
Obstructive Jaundice Bilirubin not getting extcreted into intestines/stool causing it to turn gray
Hep A fecal->oral. Poor personal hygiene, daycares, contaminated food, milk, water, shellfish "wash hands"
Hep B Blood bourne - practice "safe sex" contracted like STD (semen, vaginal, blood), needles, tattoo/body piercing
Hep C Sharing needles, unprotected sex, linked to HIV "safe sex, clean needles"
Symptoms of Hepatitis Rash, fever, malaise, nausea, vomiting, clay colored stool
Lab for Hep C CD4 counts (WBC), >200 continue tx, <200 stop tx
Biliary Cirrhosis Chronic Inflammatory liver disease, T cells attack bile duct causing blockage. s/s: fatigue, pruritis
Rx: Biliary Cirrhosis Questran (itching), Actigall - dissolves bile clogging duct
Non-Alcoholic Fatty Liver Disease Major complication of obesity. s/s: asymptomatic unless goes to liver failure. Dx: High liver enzymes. Tx: Stable weight loss, not rapid
Oral & Esophogeal Cancer meds 5FU, methotrexate, platinol
GERD complications Esophagitis, Barretts esophagus (pre-cancerous lesions)
GERD Tx: Fundiplication - surgery if hiatal hernia or sphincter not working
Hiatal Hernia s/s Heartburn at night or when lying down
Hiatal Hernia Dx barium swallow (Upper GI series)
Esophogeal Cancer s/s Increased dysphagia, coarse foods (steak) gets stuck in throat then progress to soft foods. Pain late sign
Esophogeal Cancer complications Nutrition & Breathing is issue, will have NG Tube for suctioning but not a lot of residue will come out
Esophogeal Cancer Tx: Endoscopy w/ photofrin IV injected, a photo sensitizer, absorbed by cancerous tissue -- Esophagetctamy - Remove part of esophagus w/ other parts (stomach is in chest)
Irritable Bowel Syndrome Fluctuations between constipation, diarrhea and regularity
Irritable Bowel Syndrome s/s Excessive flatulance, bloating, urgency -- Avoid gassy foods
Irritable Bowel Syndrome meds Metamucil, imodium, Bentyl
Appendicitis Dx High WBC, ultrasound
Appendicitis s/s Rebound tenderness, pain at RLQ (Macburney's Point), guarding, fever, anorexia
Appendicitis complications Peritonitis, Abscess, perforation
Peritonitis Inflammation of peritoneum from rupture in bowel or foreign body (break in intestine/rupture appendix)
Peritonitis complications Hypovolemic shock, sepsis, intrabdominal abscess, paralytic ileus, acute respiratory distress
Peritonitis s/s Hypoactive/absent Bowel Sounds, rebound tenderness, distended abdomen
Upper GI Bleed (esophagus, stomach, duodenum) Dx: Hemoglobin, INR, stool for cult blood
Upper GI Bleed s/s Hematemesis, melana, Distention of stomach w/ blood
Hematemesis Vomiting blood (red, coffee ground)
Melana Black, tarry stool
Upper GI Bleed interventions Start IV normal saline, Type/cross blood, gets labs & blood drawn, lavage w/ cold ice water (acts as vasoconstrictive)
H-pylori Bacterial infection related to gastric/duodenum ulcers. Tx: Flagyl
Gastritis (treat like GERD patient) Stomach is raw, can have some blood loss
Gastritis Meds Pepcid & Protonix (decrease acid in stomach)
Gastritis s/s Apigastric tenderness, general malaise, upset stomach
Peptic Ulcer Disease teaching Decrease meal size, avoid simple carbs, drink less than 4 oz fluids
Perforation s/s Difuse abdominal pain, rigid board like abdomen, distention, ridgity, elevated WBC, fever
Stomach Cancer risks perniscious anemia (B12) and dumping syndrome
Intestinal Obstruction causes paralytic ileus, adhesion, tumors, hernias
Bowel sounds Distal to obstruction - no BS, proximal to obstruction - high pitched BS
Stoma Can be swollen up to 3 weeks, no output for couple days, may be mucousy or blood tinged initially post-op -- OKAY
Colon Cancer Want clean margins and remove lymph nodes
Colon Cancer Tx: Chemo/Radiation can be done before surgery to shrink cells and decrease vascular supply.
Diverticulitis Outpouching of mucosa in sigmoid colon
Diverticulitis s/s Abdominal pain in LLQ, high WBC, fever -- rest bowel, put on IV fluids
Diverticulitis prevention high fiber diet w/ fruits & veggies, low fat, no red meat, weight loss
Diverticulitis CT scan w/ oral contrast
Diverticululitis complications perforation, abscess, fistula, bleeding
Celiac Disease Immune response, allergic to gluten, test for antibodies, biopsy of bowel
Gluten Foods wheat, barley, rye, oats, flour, bread, pasta, pizza, bagels
Celiac Disease s/s malnutrition, osteoperosis, vitamin deficiencies
elevated ammonia levels Decrease protein in diet
New colostomy diet 4-6 weeks post-op Low fiber
Complete Proteins Derive from animal sources (meat, cheese, milk, eggs)
Created by: kristyd02