Nursing Care of Clients with Life-Threatening Conditions: Gastrointestinal Tract, Liver, and Pancreas

Comprehensive practice flashcards covering anatomy, subjective/objective assessment, diagnostic tests, GI bleeding, alcohol withdrawal syndrome, liver cirrhosis, and acute pancreatitis from Medical-Surgical Nursing 3.

What are the four primary functions of the digestive system?

1. PROCESS - Mechanically and chemically
2. ABSORB - Moves nutrients, water, vitamins, and minerals
3. ELIMINATE - Removes undigested material
4. SUPPORT - Provides an environment for microorganisms

What are the primary digestive roles of the mouth, esophagus, and stomach?

Mouth: Ingestion, chewing, saliva begins digestion (mechanical and chemical digestion begins). Esophagus: Transports food to the stomach using peristalsis. Stomach: Stores and mixes food; begins protein digestion using $HCl$ and pepsin.

What are the main functions of the small intestine, large intestine, rectum, and anus?

Small intestine: Major site of digestion and nutrient absorption. Large intestine: Absorbs water/electrolytes and forms feces. Rectum: Stores feces temporarily. Anus: Eliminates feces.

What are the main digestive and accessory functions of the liver and gallbladder?

Liver: Produces bile, processes absorbed nutrients, and performs detoxification. Gallbladder: Stores and concentrates bile.

What dual exocrine and endocrine functions are performed by the pancreas?

Exocrine function: Produces digestive enzymes and bicarbonate. Endocrine function: Produces insulin (decreases glucose) and glucagon (increases glucose).

In GIT subjective assessment, what condition does epigastric pain radiating to the back commonly suggest?

Pancreatic inflammation or dysfunction (pancreatitis).

What clinical conditions do melena and hematochezia typically indicate?

Melena (dark, tarry stool) indicates upper GI bleeding where blood has been oxidized by $HCl$. Hematochezia (bright-red or maroon blood per rectum) indicates lower GI bleeding or brisk upper GI bleeding.

What complication should be suspected when a client with liver dysfunction presents with confusion, altered behavior, or sleep disturbances?

Hepatic encephalopathy.

What does an abnormal elevation in serum ammonia indicate?

Hepatic encephalopathy, resulting from the impaired ability of the liver to detoxify ammonia into urea.

What do elevations in serum AST, ALT, and ALP typically indicate?

Elevated AST/ALT indicates hepatocellular injury, whereas elevated ALP indicates cholestasis or biliary obstruction.

How do serum albumin and PT/INR levels change in chronic liver disease or reduced hepatic synthetic function?

Albumin levels decrease (DEC), and PT/INR increases (INC) due to impaired synthesis of albumin and clotting factors.

What is the primary clinical purpose of FibroScan (elastography)?

Measures liver stiffness to help assess hepatic fibrosis and cirrhosis.

Which endoscopic procedure is depicted in this illustration, and what are its clinical uses?

Esophagogastroduodenoscopy (EGD). It visualizes the esophagus, stomach, and duodenum; detects ulcers, gastritis, tumors, varices, and upper GI bleeding; and can obtain biopsies or control bleeding.

Which diagnostic procedure is shown here, and what is its main function?

Colonoscopy. It examines the colon and rectum, detects polyps, tumors, inflammation, and sources of lower GI bleeding, and allows biopsy and polyp removal.

Which procedure is depicted in this diagram, and why is it considered therapeutic?

Endoscopic Retrograde Cholangiopancreatography (ERCP). It evaluates bile and pancreatic ducts and is primarily therapeutic because it can remove bile duct stones and relieve obstructions.

What pre-procedure checks, client positioning, and major complication are associated with this procedure?

Before: Check PT/INR and platelet count to assess bleeding risk. Position: Supine with the right arm raised. Major complication: Hemorrhage (warning signs: hypotension, tachycardia, increasing RUQ pain, pallor, falling Hgb/Hct).

What is the anatomical landmark shown here that distinguishes Upper GI Bleeding from Lower GI Bleeding?

The ligament of Treitz. Upper GI bleeding originates proximal to it (esophagus, stomach, duodenum), while lower GI bleeding originates distal to it (small bowel/mid-GI, colon, rectum, anus).

What are common causes and risk factors for Peptic Ulcer Disease (PUD)?

Causes/Risk factors include $H.\text{ pylori}$ infection, NSAID use, aspirin use, older age, and severe physiologic stress.

In which parts of the intestine do diverticula most commonly form?

The descending colon and sigmoid colon.

What is the sequence of events leading from portal hypertension to massive upper GI bleeding?

1. Portal hypertension
2. Collateral venous dilation
3. Esophageal varices formation
4. Possible rupture
5. Massive upper GI bleeding

What is a Mallory-Weiss tear and what mechanism precipitates it?

A tear in the esophageal mucosa near the gastroesophageal (GE) junction, caused by excessive vomiting or retching that physically strains the mucosa.

What are key nursing interventions for a client with acute, active gastrointestinal bleeding?

Assess ABCs immediately; position side-lying if vomiting blood to prevent aspiration; monitor vital signs frequently for shock; establish large-bore IV access; keep patient NPO; monitor strict I&O; and administer prescribed medications (PPI, octreotide, antibiotics).

What is the neurobiological mechanism underlying Alcohol Withdrawal Syndrome?

Chronic alcohol intake continuously depresses the CNS, prompting the brain to compensate by increasing excitatory activity. Sudden cessation removes CNS inhibition while excitatory activity remains high, producing CNS hyperactivity.

What is the clinical progression of alcohol withdrawal across standard timeframes?

$6\text{--}12\text{ hours}$: Tremors, anxiety, irritability, nausea, sweating, tachycardia. $12\text{--}24\text{ hours}$: Increasing autonomic hyperactivity, possible hallucinations. $24\text{--}48\text{ hours}$: More severe symptoms, seizure risk. $48\text{--}72+\text{ hours}$: Progression to Delirium Tremens (DTs) in severe cases.

What is the CIWA-Ar tool and what symptoms does it evaluate?

Clinical Institute Withdrawal Assessment for Alcohol, Revised. It assesses withdrawal severity to guide protocol treatment by evaluating: nausea/vomiting, tremor, sweating, anxiety, agitation, tactile disturbances, auditory disturbances, visual disturbances, headache, and orientation.

What electrolyte and metabolic abnormalities are key laboratory concerns during alcohol withdrawal?

Decreased magnesium, decreased potassium, decreased sodium, and decreased blood glucose.

What is Delirium Tremens (DTs) and what are its manifestations?

The most severe form of alcohol withdrawal, occurring approximately $48\text{--}72\text{ hours}$ after cessation. Manifestations include severe confusion/disorientation, agitation, hallucinations, severe tremors, profuse sweating, tachycardia, hypertension, fever, severe autonomic instability, and possible seizures.

What are the main medications prescribed in Alcohol Withdrawal Syndrome and their purposes?

Benzodiazepines: Control withdrawal and prevent seizures/DTs. Thiamine ($B_1$): Prevent Wernicke encephalopathy. Folate: Treat/prevent folate deficiency. Gabapentin/Carbamazepine: Manage selected withdrawal cases. Haloperidol: Adjunct for severe agitation/hallucinations.

What percentage of hepatocellular carcinomas (HCC) develop on the background of liver cirrhosis?

$$85\%$$

What pathophysiology causes ascites and peripheral edema in liver cirrhosis?

Portal hypertension elevates hydrostatic pressure in abdominal capillaries, promoting fluid exudation. Concurrently, impaired albumin synthesis reduces systemic oncotic pressure, driving fluid into interstitial tissues (edema) and the peritoneal cavity (ascites).

At what serum bilirubin threshold do jaundice and scleral icterus typically manifest?

When serum bilirubin exceeds $40\text{--}50\,\mu\text{mol/L}$.

What vascular skin lesion shown here is characteristic of advanced liver cirrhosis?

Spider nevi (spider naevus / spider angioma).

What medications are routinely used in cirrhosis management for ascites, ammonia reduction, and bleeding prevention?

Diuretics (spironolactone, furosemide) for ascites; Lactulose to lower ammonia levels; Beta-blockers to prevent variceal bleeding.

What essential nursing interventions must be carried out before, during, and after a paracentesis?

Before: Have the client void to prevent bladder puncture. During/After: Monitor vital signs closely for hypotension. Large-volume paracentesis: Anticipate IV albumin administration as prescribed.

What is acute pancreatitis and what are its two most common etiologies?

Inflammation of the pancreas caused by premature activation of pancreatic digestive enzymes (zymogens), leading to autodigestion of pancreatic tissue. The two most common causes are gallstones and alcohol use.

Which laboratory test is considered the gold standard and most specific diagnostic marker for acute pancreatitis?

Serum Lipase.

What do Cullen's sign and Grey-Turner's sign indicate in severe acute pancreatitis?

Intra-abdominal hemorrhage (occurring in $< 1\%$ of cases). Cullen's sign presents as periumbilical bruising; Grey-Turner's sign presents as bruising along both flanks.

What are the two main local complications of acute pancreatitis commonly visualized on CT?

1. Pancreatic pseudocyst (pancreatic enlargement caused by fluid accumulation)
2. Pancreatic necrosis/abscesses (death of pancreatic tissue)

What are the first-line management priorities for a client diagnosed with acute pancreatitis?

NPO (first priority) to suppress pancreatic enzyme stimulation, aggressive IV fluid resuscitation (typically Lactated Ringer's), and opioid analgesia (fentanyl or morphine) for pain control.