PAT 401-011 WEEK SEVEN (7) P2 GI DISORDERS OF THE ACCESSORY ORGANS

PAT 401-011 WK 7: GI Disorders of the Accessory Organs

Disorder #1: Appendicitis

What is appendicitis?

inflammation of the vermiform appendix

PAT 401-011 WK 7: GI Disorders of the Accessory Organs

Disorder #1: Appendicitis

CM of Appendicitis (5)

1. Epigastric and Periumbilical Pain

2. Rebound Tenderness

3. N/V

4. Fever

5. Anorexia

PAT 401-011 WK 7: GI Disorders of the Accessory Organs

Disorder #1: Appendicitis

Complication (3)

perforation

peritonitis

abscess formation

PAT 401-011 WK 7: GI Disorders of the Accessory Organs

Disorder #1: Appendicitis

Tx (3)

Antibitoics bs appendicitis is literally inflammation of the appendix usually due to infection

appendectomy removal not tht important

supportive care as needed like fluids/e replacement, pain relievers, etc

PAT 401-011 WK 7: GI Disorders of the Accessory Organs

Disorder #1: Appendicitis

Pharmacology for Appendicits: OPIODS

Opiods come in 2 categories which are

Opiods and Non-Opiods

PAT 401-011 WK 7: GI Disorders of the Accessory Organs

Disorder #1: Appendicitis

Pharmacology for Appendicits: OPIODS

opiods analgesics reduce severe apin and produce what other 2 symptoms

numbness

stupor like symptoms

stupor

a state of near-unconsciousness or insensibility

PAT 401-011 WK 7: GI Disorders of the Accessory Organs

Disorder #1: Appendicitis

Pharmacology for Appendicits: OPIODS

Opiods can be natural or?

synthetic

PAT 401-011 WK 7: GI Disorders of the Accessory Organs

Disorder #1: Appendicitis

Pharmacology for Appendicits: OPIODS

Opiods react with what receptors

mu or kappa receptors to exert their effects

PAT 401-011 WK 7: GI Disorders of the Accessory Organs

Disorder #1: Appendicitis

Pharmacology for Appendicits: OPIODS

Opiod and Opiate are often used interchangeably T or F

True

PAT 401-011 WK 7: GI Disorders of the Accessory Organs

Disorder #1: Appendicitis

Pharmacology for Appendicits: OPIODS

Mu and Kappa receptors activation produce what opiod effects (4)

analgesia

decreased GI motility

sedation

RD

PAT 401-011 WK 7: GI Disorders of the Accessory Organs

Disorder #1: Appendicitis

Pharmacology for Appendicits: OPIODS

A/E name some

RD

sedation

N/V

constipation

physical and psychological dependence

euphoria

intense relaxation leading to abuse potential

PAT 401-011 WK 7: GI Disorders of the Accessory Organs

Disorder #1: Appendicitis

Pharmacology for Appendicits: OPIODS

A: MORPHINE

Which of the following is true about morphine

a. it is a weak opiod

b. it is a potent opiod

c. it is a moderate opiod

b. it is a potent opiod

PAT 401-011 WK 7: GI Disorders of the Accessory Organs

Disorder #1: Appendicitis

Pharmacology for Appendicits: OPIODS

A: MORPHINE

Which is true about morphine

a. binds to kappa receptors only

b. binds to mu receptors only

c. binds to mu and kappa receptors

c. binds to mu and kappa receptors

PAT 401-011 WK 7: GI Disorders of the Accessory Organs

Disorder #1: Appendicitis

Pharmacology for Appendicits: OPIODS

A: MORPHINE

Which of the following is true about morphine?

A. produces analgesia

B. results in dilation of pupils

C. results in constriction of pupils

D. stimulates msk muscle

E. stimulates cardiac muscle

A

C

E

PAT 401-011 WK 7: GI Disorders of the Accessory Organs

Disorder #1: Appendicitis

Pharmacology for Appendicits: OPIODS

A: MORPHINE

Indication of use (3)

severe and acute chronic pain

pre-anesthetic medication

relief of sob and chest pain

PAT 401-011 WK 7: GI Disorders of the Accessory Organs

Disorder #1: Appendicitis

Pharmacology for Appendicits: IV THERAPY

Purpose

used to replace lost fluids

PAT 401-011 WK 7: GI Disorders of the Accessory Organs

Disorder #1: Appendicitis

Pharmacology for Appendicits: IV THERAPY

two main types of iv therapy used for appendicitis

crytalloids

colloids

PAT 401-011 WK 7: GI Disorders of the Accessory Organs

Disorder #1: Appendicitis

Pharmacology for Appendicits:

colloids due what

rapidly expand plasma volume

PAT 401-011 WK 7: GI Disorders of the Accessory Organs

Disorder #1: Appendicitis

Pharmacology for Appendicits:

Crystalloids do what?

promote urine output

PAT 401-011 WK 7: GI Disorders of the Accessory Organs

Disorder #1: Appendicitis

Pharmacology for Appendicits:

Crystalloids (Electrolyte Replacement and U/O Promotion)

What do crystalloids contain?

IV solutions that contain electrolytes and other agents

PAT 401-011 WK 7: GI Disorders of the Accessory Organs

Disorder #1: Appendicitis

Pharmacology for Appendicits:

Crystalloids (Electrolyte Replacement and U/O Promotion)

MOA

quickly diffuse across membranes entering intersitial fluid and intracellular fluid

PAT 401-011 WK 7: GI Disorders of the Accessory Organs

Disorder #1: Appendicitis

Pharmacology for Appendicits:

Crystalloids (Electrolyte Replacement and U/O Promotion)

osmolarity

come in isotonic, hypotonic, and hypertonic forms

PAT 401-011 WK 7: GI Disorders of the Accessory Organs

Disorder #1: Appendicitis

Pharmacology for Appendicits:

Crystalloids (Electrolyte Replacement and U/O Promotion)

Name some selected crystalloid solutions used in clinical settings (5) common ones

normal saline

hypertonic saline

hypotonic saline

LR

plasma-lyte

*have different tonicities and serve different purposes

PAT 401-011 WK 7: GI Disorders of the Accessory Organs

Disorder #1: Appendicitis

Pharmacology for Appendicits:

Crystalloids (Electrolyte Replacement and U/O Promotion)

MAIn nursing implications

worried about fluid overload and the effect this has on the heart and lungs

colloids

substances such as large protein molecules that do not readily dissolve into true solutions example dextrin and glucose and albumin and carbohydrates in the veins

PAT 401-011 WK 7: GI Disorders of the Accessory Organs

Disorder #1: Appendicitis

Pharmacology for Appendicits:

Colloids Plasma Volume Expanders

What are they?

Colloids are proteins or large molecules that remain in the blood for a long period of time

PAT 401-011 WK 7: GI Disorders of the Accessory Organs

Disorder #1: Appendicitis

Pharmacology for Appendicits:

Colloids Plasma Volume Expanders

MOA

They increase plasma osmolarity and osmotic pressure drawing water molecules into the plasma

osmolarity

total concentration of all solute particles in a solution

PAT 401-011 WK 7: GI Disorders of the Accessory Organs

Disorder #1: Appendicitis

Pharmacology for Appendicits:

Colloids Plasma Volume Expanders

tx for what 4 main conditions

hypovolemic shock

burns

hemmorhage

surgery

PAT 401-011 WK 7: GI Disorders of the Accessory Organs

Disorder #1: Appendicitis

Pharmacology for Appendicits:

Colloids Plasma Volume Expanders

What are some colloid examples (4)

albumin

dextran

plasma protein fraction

hetastarch

PAT 401-011 WK 7: GI Disorders of the Accessory Organs

Disorder #1: Appendicitis

Pharmacology for Appendicits:

Colloids Plasma Volume Expanders

colloids are

a. isotonic

b. hypertonic

c. hypotonic

a. isotonic = and act as plasma volume expanders

PAT 401-011 WK 7: GI Disorders of the Accessory Organs

Disorder #2: Cholelithiasis

What is it?

the formation of gallstones that are made up of so much cholesterol

*supersatured cholesterol

PAT 401-011 WK 7: GI Disorders of the Accessory Organs

Disorder #2: Cholelithiasis

What is it caused by?

There are many causes

Enzyme cause explain

Think about it

there is so much cholesterol it is forming stones

why is this excess cholesterol not breaking down and why is it accumulating?

cause: the body has an enzyme defect that causes EXCESS cholesterol synthesis

PAT 401-011 WK 7: GI Disorders of the Accessory Organs

Disorder #2: Cholelithiasis

What is it caused by?

There are many causes

Bile acid impairment (2)

decreased secretion of bile acids which emulfisy fats therefore cholesterol which is a fat builds up!

OR

decreased resorption of bile salts from the ileum

PAT 401-011 WK 7: GI Disorders of the Accessory Organs

Disorder #2: Cholelithiasis

What is it caused by?

What do bile salts do and why do they need to resorped from the ileum?

Briefly Explain

Bile salts are produced in the liver from cholesterol and stored in the gallbladder and released into the small intestine during digestion.

they emulsify fats such as cholesterol: by breaking down fat molecules via their hydrophobic/hydrophilic properties

now why do they need to be reasorbed from the ileum? the fat they engulf from the iluem is taken back to the liver for storage if it is not reabsorbed it can cause gallstones since the gallbladder is connected to the liver via the bile canalicuili forming the common hepatic duct

PAT 401-011 WK 7: GI Disorders of the Accessory Organs

Disorder #2: Cholelithiasis

What is it caused by?

There are many causes

Gallbladder motility cause

gallbladder smooth muscle hypomotility (not moving bile out when needed or excreting it)

accumulated bile becomes concentrated and hypersaturaed causing gallstones

PAT 401-011 WK 7: GI Disorders of the Accessory Organs

Disorder #2: Cholelithiasis

What is it caused by?

There are many causes

why is bile released from the gallbladder for what reason?

the gallbladder releases bile to aid in the digestion and absorption of dietary fats

unused bile is reabsorbed in the ileum and returned to the liver and secreted again into new bile or stored in the gallbladder for future use

PAT 401-011 WK 7: GI Disorders of the Accessory Organs

Disorder #2: Cholelithiasis

What is it caused by?

There are many causes

Gallbladder secretion cause

increased secretion of gallbladder mucin and biliary calcium

PAT 401-011 WK 7: GI Disorders of the Accessory Organs

Disorder #2: Cholelithiasis

What is it caused by?

There are many causes

how does increased secretion of gallbladder mucin and biliary calcium contribute to gallstones?

A: MUCIN = is a glycoprotein secreted by the gallbladder lining that thickens the bile, when mucin is increased it can trap the bile salts, cholesterol, and calcium creating a sticky gel like environment providing a perfect environment for cholesterol stones

B: Clalcium promotes the crystalization of cholesterol reducing its solubility making cholesterol stones more likely

PAT 401-011 WK 7: GI Disorders of the Accessory Organs

Disorder #2: Cholelithiasis

What is it caused by?

There are many causes

T or F cholelithiasis can also be caused by genetic predisposition?

True

PAT 401-011 WK 7: GI Disorders of the Accessory Organs

Disorder #2: Cholelithiasis

Pigmented Stones

What do they form?

form in the gallbladder

PAT 401-011 WK 7: GI Disorders of the Accessory Organs

Disorder #2: Cholelithiasis

Pigmented Stones

associated with what 2 diseases?

chronic liver disease and hemolytic disease

PAT 401-011 WK 7: GI Disorders of the Accessory Organs

Disorder #2: Cholelithiasis

Pigmented Stones

MADE UP OF?

composed of calcium bilirubinate with mucin glycoproteins

(ahh so this cause is the increased secretion of mucin and calcium from the gallbladder)

PAT 401-011 WK 7: GI Disorders of the Accessory Organs

Disorder #2: Cholelithiasis

Brown Stones

What are they associated with?

Associated with bacterial infection of bile ducts

PAT 401-011 WK 7: GI Disorders of the Accessory Organs

Disorder #2: Cholelithiasis

Brown Stones

formed of a multiple things including what 5 things

calcium soaps

uncojugated bilirubin

cholesterol

fatty acids

mucin

PAT 401-011 WK 7: GI Disorders of the Accessory Organs

Disorder #2: Cholelithiasis

Brown Stones

also associated with what 2 conditions

biliary stasis and biliary parasites

PAT 401-011 WK 7: GI Disorders of the Accessory Organs

Disorder #2: Cholelithiasis

CM of gallstones

Pain is located where and of what type

epigastric and right hypochrondrium pain that is intermittent comes and goes = called biliary colic

biliary colic

pain in the gallbladder caused by gallstones obstructing bile flow

PAT 401-011 WK 7: GI Disorders of the Accessory Organs

Disorder #2: Cholelithiasis

CM of gallstones

causes intolerance to?

intolerance to fatty foods

PAT 401-011 WK 7: GI Disorders of the Accessory Organs

Disorder #2: Cholelithiasis

CM of gallstones

biliary colic pain is directly caused by?

lodging of stones in the cytic or common duct

PAT 401-011 WK 7: GI Disorders of the Accessory Organs

Disorder #2: Cholelithiasis

CM of gallstones

jaundice is direcly caused by the stone being where?

in the common bile duct

PAT 401-011 WK 7: GI Disorders of the Accessory Organs

Disorder #2: Cholelithiasis

CM of gallstones

if the patient has gallstones PLUS fever and tenderness we should suspect?

cholecystitis

PAT 401-011 WK 7: GI Disorders of the Accessory Organs

Disorder #2: Cholelithiasis

TX of Gallstones

1) 1st preferred tx is?

Laparoscopic Cholecytesctomy

PAT 401-011 WK 7: GI Disorders of the Accessory Organs

Disorder #2: Cholelithiasis

TX of Gallstones

which tx is rapidly advancing?

Transluminal endoscopic surgery

PAT 401-011 WK 7: GI Disorders of the Accessory Organs

Disorder #2: Cholelithiasis

TX of Gallstones

For stone retrieval what do we use? (2)

endoscopic retrograde

chol-angio-prancreatography

sphincerotomy

PAT 401-011 WK 7: GI Disorders of the Accessory Organs

Disorder #2: Cholelithiasis

TX of Gallstones

for larger stones what do we use

lithotripsy

PAT 401-011 WK 7: GI Disorders of the Accessory Organs

Disorder #2: Cholelithiasis

TX of Gallstones

Alteranative Treatment (2 drugs)

Drugs that dissolve smaller stones such as bile acid (CDCA) chenodexoycholic acid

and

ursodexocyholic acid

PAT 401-011 WK 7: GI Disorders of the Accessory Organs

Disorder #2: Cholelithiasis

TX of Gallstones

acid drugs are given to the dissolve the stone but this only works if?

if the gallstone is small enough to be dissolved by the acidic drug otherwise need to use other procedures usually laproscopic!

PAT 401-011 WK 7: GI Disorders of the Accessory Organs

Disorder #3: Cholecystitis

What is it?

inflammation of the gallbladder

PAT 401-011 WK 7: GI Disorders of the Accessory Organs

Disorder #3: Cholecystitis

develops after cholelithiasis when?

develops after a gallstone becomes lodged in the cystic duct

PAT 401-011 WK 7: GI Disorders of the Accessory Organs

Disorder #3: Cholecystitis

CM (4)

Fever

leukocytosis

rebound tenderness

abdominal muscle guarding

leukocytosis

increase in the number of white blood cells

rebound tenderness

pain that increases when pressure (as from a hand) is removed

PAT 401-011 WK 7: GI Disorders of the Accessory Organs

Disorder #3: Cholecystitis

TX (5)

pain control

replacement of fluids and electrolytes

fasting

antibiotic administration

laprasopic cholecystectomy

cholecystectomy

surgical removal of the gallbladder

PAT 401-011 WK 7: GI Disorders of the Accessory Organs

Disorder #3: Cholecystitis

Pharmacotherapy

Cholecystitis is inflammation of the gallbladder that requires prompt treatment.

The main medication combo class used is?

NSAIDS + Antibiotics = offers comprehensive symptom relief and infection management

PAT 401-011 WK 7: GI Disorders of the Accessory Organs

Disorder #3: Cholecystitis

Pharmacotherapy

NSAIDS address?

Antibiotics address?

NSAIDS address pain and inflammation

Antibiotics target the underlying infectious agent

PAT 401-011 WK 7: GI Disorders of the Accessory Organs

Disorder #3: Cholecystitis

Pharmacotherapy: Non-Opiod Analgesics for Cholecystitis TX

non-opiod analgesic such as nsaids are used for what pain level?

mild to moderate pain

PAT 401-011 WK 7: GI Disorders of the Accessory Organs

Disorder #3: Cholecystitis

Pharmacotherapy: Non-Opiod Analgesics for Cholecystitis TX

NSAIDS such as advil are used for pain but also?

fever and inflammation

PAT 401-011 WK 7: GI Disorders of the Accessory Organs

Disorder #3: Cholecystitis

Pharmacotherapy: Non-Opiod Analgesics for Cholecystitis TX

NSAIDS inhibit what enzyme?

cyclooxygenase reducing inflammation and pain

PAT 401-011 WK 7: GI Disorders of the Accessory Organs

Disorder #3: Cholecystitis

Pharmacotherapy: Non-Opiod Analgesics for Cholecystitis TX

NSAID benefit over opiods main 2

available OTC

inexpensive

PAT 401-011 WK 7: GI Disorders of the Accessory Organs

Disorder #3: Cholecystitis

Pharmacotherapy: Non-Opiod Analgesics for Cholecystitis TX

Anti-inflammatories are drugs that

decrease the natural inflammatory response pretty straightforward

PAT 401-011 WK 7: GI Disorders of the Accessory Organs

Disorder #3: Cholecystitis

Pharmacotherapy: Non-Opiod Analgesics for Cholecystitis TX

most anti-inflammatory drugs are

a. specific

b. nonspecific

nonspecific

PAT 401-011 WK 7: GI Disorders of the Accessory Organs

Disorder #3: Cholecystitis

Pharmacotherapy: Non-Opiod Analgesics for Cholecystitis TX

what does cox enzyme do?

an enzyme responsible for the formation of prostaglandin --> resulting in the reduction of inflammation and pain

PAT 401-011 WK 7: GI Disorders of the Accessory Organs

Disorder #3: Cholecystitis

Pharmacotherapy: Non-Opiod Analgesics for Cholecystitis TX

NSAIDS have what 3 effects

analgesic

antipyretic

anti inflammatory

PAT 401-011 WK 7: GI Disorders of the Accessory Organs

Disorder #3: Cholecystitis

Pharmacotherapy: Non-Opiod Analgesics for Cholecystitis TX

special considerations for what groups

older adults

pregnancy and lactation

infants younger than 6 mo due to reyes syndrome

reyes syndrome

potentially serious or deadly disorder in children that is characterized by vomiting and confusion

Aspirin: Reye's Syndrome

Acute and potentially life-threatening condition involving progressive neurologic deficits that can lead to coma and may also involve liver damage.

Triggered by viral illnesses such as influenza as well as by salicylate therapy itself in the presence of a viral illness.

Survivors of this condition may or may not have permanent neurologic damage.

PAT 401-011 WK 7: GI Disorders of the Accessory Organs

Disorder #3: Cholecystitis

Pharmacotherapy: Non-Opiod Analgesics for Cholecystitis TX

non selective higher risk for losing gastric protection true or false

true

PAT 401-011 WK 7: GI Disorders of the Accessory Organs

Disorder #3: Cholecystitis

Pharmacotherapy: Non-Opiod Analgesics for Cholecystitis TX

A: Ibuprofen

Classication?

NSAID

PAT 401-011 WK 7: GI Disorders of the Accessory Organs

Disorder #3: Cholecystitis

Pharmacotherapy: Non-Opiod Analgesics for Cholecystitis TX

A: Ibuprofen

Indication for use 3

to relieve mild to moderate pain fever and inflammation

PAT 401-011 WK 7: GI Disorders of the Accessory Organs

Disorder #3: Cholecystitis

Pharmacotherapy: Non-Opiod Analgesics for Cholecystitis TX

A: Ibuprofen

MOA

inhibition of prostaglandin synthesis

PAT 401-011 WK 7: GI Disorders of the Accessory Organs

Disorder #3: Cholecystitis

Pharmacotherapy: Non-Opiod Analgesics for Cholecystitis TX

A: Ibuprofen

desired effects (2)

reduce pain

reduce fever

reduce inflammation

PAT 401-011 WK 7: GI Disorders of the Accessory Organs

Disorder #3: Cholecystitis

Pharmacotherapy: Non-Opiod Analgesics for Cholecystitis TX

A: Ibuprofen

A/E

nausea

epigastric pain

decrease plt function = Gi ulcers and occult bleeding

dizziness

heartburn

PAT 401-011 WK 7: GI Disorders of the Accessory Organs

Disorder #3: Cholecystitis

Pharmacotherapy: Non-Opiod Analgesics for Cholecystitis TX

A: Ibuprofen

a/e for bleeding and ulcers

can decrease plt function and GI ulceration with occult or gross bleeding

PAT 401-011 WK 7: GI Disorders of the Accessory Organs

Disorder #3: Cholecystitis

Pharmacotherapy: Non-Opiod Analgesics for Cholecystitis TX

B: Ketorolac

Classification

NSAID

PAT 401-011 WK 7: GI Disorders of the Accessory Organs

Disorder #3: Cholecystitis

Pharmacotherapy: Non-Opiod Analgesics for Cholecystitis TX

B: Ketorolac

indication (2)

mild to moderate pain and inflammation

PAT 401-011 WK 7: GI Disorders of the Accessory Organs

Disorder #3: Cholecystitis

Pharmacotherapy: Non-Opiod Analgesics for Cholecystitis TX

B: Ketorolac

MOA

inhibits cox enzyme reducing the production of prostaglandin responsible for pain and inflammation

PAT 401-011 WK 7: GI Disorders of the Accessory Organs

Disorder #3: Cholecystitis

Pharmacotherapy: Non-Opiod Analgesics for Cholecystitis TX

B: Ketorolac

desired effects

pain relief

inflammation relief

advil takes it one step further by also tackling fever anti-pyretic properties

PAT 401-011 WK 7: GI Disorders of the Accessory Organs

Disorder #3: Cholecystitis

Pharmacotherapy: Non-Opiod Analgesics for Cholecystitis TX

B: Ketorolac

adverse effect 4

gastric upset

bleeding disorders

renal impairment

hepatic impairment

PAT 401-011 WK 7: GI Disorders of the Accessory Organs

Disorder #3: Cholecystitis

Pharmacotherapy: Non-Opiod Analgesics for Cholecystitis TX

B: Ketorolac

advil is mostly PO but this medication can be

po

iv

IM

powdered

PAT 401-011 WK 7: GI Disorders of the Accessory Organs

Disorder #3: Cholecystitis

Pharmacotherapy: Non-Opiod Analgesics for Cholecystitis TX

B: Ketorolac

much higher risk for?

gastric ulcers and bleeding bc it is more potent

PAT 401-011 WK 7: GI Disorders of the Accessory Organs

Disorder #3: Cholecystitis

Pharmacotherapy: Non-Opiod Analgesics for Cholecystitis TX

B: Ketorolac

nsaids are cleared in the

kidney

PAT 401-011 WK 7: GI Disorders of the Accessory Organs

Disorder #3: Cholecystitis

Pharmacotherapy: Non-Opiod Analgesics for Cholecystitis TX

B: Ketorolac

tylenol is cleared in the

liver

PAT 401-011 WK 7: GI Disorders of the Accessory Organs

Disorder #3: Cholecystitis

Pharmacotherapy: Non-Opiod Analgesics for Cholecystitis TX

C: Cefotaxime

Classification:

cephalosprin antibiotic

PAT 401-011 WK 7: GI Disorders of the Accessory Organs

Disorder #3: Cholecystitis

Pharmacotherapy: Non-Opiod Analgesics for Cholecystitis TX

C: Cefotaxime

MOA

inhibits bacterial cell wall synthesis by binding to penicillin binding proteins leading to bacterial cell lysis

PAT 401-011 WK 7: GI Disorders of the Accessory Organs

Disorder #3: Cholecystitis

Pharmacotherapy: Non-Opiod Analgesics for Cholecystitis TX

C: Cefotaxime

indications (3)

tx of gram negative infections

clients allergic to penicillin

clients with penicillin resistant infections

PAT 401-011 WK 7: GI Disorders of the Accessory Organs

Disorder #3: Cholecystitis

Pharmacotherapy: Non-Opiod Analgesics for Cholecystitis TX

C: Cefotaxime

Desired Effects

bactercidal action against gram negative pathogens causing cholecystitis and appendicitis

PAT 401-011 WK 7: GI Disorders of the Accessory Organs

Disorder #3: Cholecystitis

Pharmacotherapy: Non-Opiod Analgesics for Cholecystitis TX

C: Cefotaxime

A/E (3)

possible cross sensitivity with penicillin

gastrointestinal upset

reduction in prothrombin levels