Exam 2 things to learn GI, Pancreas, Liver whater

wait im goated (no im not)

Abd US good for what organs

good for gallbladder/pancreas, ovaries, appendicitis-

ABD US prep

need to be NPO for 8-12 hours (gas or fluid affect good images)

CT good for what disorders

good for inflammatory -> diverticulitis, UC, gastritis/enteritis -> organ abnormalities liver, spleen, kidney, pancreas, intestines

MRI used for

diagnosis of disease -> cancer, soft tissue, vessels,

PET scan

radioactive – reserved for cancer diagnosis/treatment – EXPENSIVE

sulfonamides

Reduces inflammation of the intestinal mucosa – monitor for anemias, kidney/liver

Nonsulfonamides

- reduces bowel inflammation, diarrhea, rectal bleeding, and stomach pain. Less side effects than Sulfonamides.

(ex Mesalamine, Balsalazide)

corticosteroids

reduce inflammation. more acute mgm. monitor s/s cushings (moon face, buffalo hump, think gru dispicable me)

Immunosuppressants

– Traditionally cancer/leukemia drugs, useful in treating inflammatory bowel disorders

Cyclosporine

Methotrexate

Mercaptopurine

Immunomodulators

alters the immune response, used to treat other autoimmune disorders as well

Infliximab

Adalimumab

what are ESR and CRP

elevated in inflammation (ex IBD, divirticulitis, paralytic bowel caused by inflammation)

ESR and CRP values

ESR usually like less than 20 (dont quote me on that im lazy)

CRP less than like 1

Some BP meds can worsen liver damage

hydralazine

Thiamine deficiency is common in

many forms of cirrhosis particularly alcoholic liver disease

Rifaximin treats

hepatic encephalopathy by stopping the growth of bacteria that produce toxins and that may worsen liver disease

danger with Abx

Caution with many abx as they can worsen liver damage (especially the mycins) (could be taken daily)

meds for alchol withdrawl

Benzodiazapines, phenobarbital

metformin

Metformin - Metformin use was associated with higher risks of mortality and cirrhotic decompensation in patients with compensated liver cirrhosis. **However - often it has been found to be beneficial in patients with nonalcoholic fatty liver disease.

Portal HTN

r/t cirohsis

The scarring slows blood flow, causing it to back up

• Leads to:

  • Ascites – fluid accumulation in abdomen

  • Varices – enlarged veins (risk for bleeding)

hemolytic jaundice

• Hemolytic - increase breakdown of RBCs (hemolysis) → liver is overwhelmed by excessive bilirubin production → high levels of unconjugated bilirubin in the blood

hepatocellular jaundice

• → when liver cells are damaged / dysfunctional, reducing their ability to process and excrete bilirubin 

  • Results in conjugated and unconjugated bilirubin in the blood 

obstructive jaundice

• Obstructive - caused by a blockage that prevents bile from flowing from the liver to the same intestine → results in a buildup of conjugated bilirubin in the blood 

Liver fail nutritions deficiencies -

Zinc, BCAA, Folic Acid, Thiamine, Magnesium. Malabsorption of Vit A,B,D,E,K

Effects of Malnutrition in Cirrhosis

• Higher risk of infection

• Increased complications:

  • Portal hypertension

  • Variceal bleeding

  • Hepatic encephalopathy

  • Ascites

• More likely to require:

  • Blood transfusions

  • Mechanical ventilation

TIPS (Transjugular Intrahepatic Portosystemic Shunt)

Stent placed between portal vein and hepatic vein

• Reduces portal hypertension

• Peritoneovenous shunt

• Drains peritoneal fluid back into venous circulation

• PleurX catheter

• • Long-term catheter used for recurrent ascites drainage

alchol withdrawl can occur when

• can begin 4-12 hrs after last drink

alcohol withdrawl s/s

• Hand tremors, sweating, increase BP and HR, insomnia, anxiety, NV, hallucinations, seizures, delirum

• Symptoms peak around day 2 and usually last about 5 days, but can take two weeks 

• May need to be in ICU

• Benzodiazepines used to help

  • CIWA scale is used to determine dose 

  • Q4 hrs

low residue diet means

A low-residue diet limits high-fiber foods, like whole-grain breads and cereals, nuts, seeds, raw or dried fruits, and vegetables

signs of cirrohsis as it progresses

• lower exremtiy edema

muscle wasting

anorexia

low BP stimulating the RAAS system and decreasing urine output

increasing the risk of bruising and bleeding

when to monitor abd girth

 abdominal girth should be measured Qshift

atrophic gastritis is associated with

gastric ulcers due to the damage to the stomach lining, not typically seen with duodenal ulcers

hiatal hernia visible signs

NONE BEYOTCH

hiatal hernias can be associated with

gastric reflux. In order to decrease this the client should eat small bland meals and elevate HOB

how to prevent dumping syndrome

Limit the fluids taken with meals

the client should actually lay down after meals to delay gastric emptying

the client should decrease carbohydrates

the client should sit in a low fowler’s position during meals

When measuring the stoma for skin barrier placement, be sure the opening of the skin barrier is

1/8 inch larger than the stoma

paracentesis prep op

dont need to withhold meds or be NPO

empty bladder before

check labs and coags

Which nursing action is most appropriate to include in the pre-procedural plan of care to minimize risk of complications for ECRP

NPO

Administer rectal indomethacin immediately before or after the procure

UC presents with

ulcerative colitis presents with exdema and inflammation in the rectum and rectosigmoid colon. The mucosa and submucosa of the colon become hyperemic leading to edema and redness.

s/s include LLQ pain, wt loss, fever, 15-20 diarrhea stools per day that may contain mucus, blood or pus, abd distention abd tenderness, high pitched bowel sounds and rectal bleeding

pancreatitis nursing care

administer opioid pain medications to control the clients acute pain

monitor blood glucose levels as pancreastitis may impacte the endocrine abilities of the pancreas leading to hyperglycemia

encourage the client to abstain from alcohol entirely not just decreasing intake

NPO to prevent the secretion of pancreatic enzymes

clients with pancreatitis will be most comfortable in a side-lying or semi-fowlers position as it decreases abd pain

pt with obstruction should have what diet

NPO

NG tube care

irrigate the tube every 4 hours to keep it patent

maintain a semi-fowlers position

oral hygiene should be performed every 2 hours

acute treatment of bleeding varicies

treat for shock; administer O2

IV fluids, electrolytes, volume expanders, blood and blood products

balloon tampondade

chronic treatment of bleeding varicies

octreotide, somostatin, vasopressin to decrease bleeding

BB to decrease pressure

sound of ascites

dull on percussion

toxic megacolon

r/t UC

decrease BP

increase HR

electrolyte imabalnce

altered mental status

When is a cholecystectomy indicated?

Cholecystectomy (gallbladder removal) is primarily indicated for symptomatic gallstone disease, including biliary colic, acute/chronic cholecystitis, and complications like pancreatitis.

What is a T‑tube and what drainage is expected?

A T-tube is placed in the common bile duct after surgery (such as gallbladder removal) to drain bile externally while the duct heals. It drains thick, blood-tinged, to bright yellow-green bile into an external bag, with 300-500 mL expected in the first 24 hours, decreasing to <200 mL/day after 4 days

Small-bore Dobhoff

Typically inserted into the jejunum with a guidewire and manufactured for tube feedings, better tolerated up to 6 weeks, requires diligent monitoring and flushing 

This is the one with the weighted tip at the end, only for feedings or med admin but not for gastric decompression or suctoning 

triple treatment for h pylori ulcer

2 abx + PPI

bariatric surgery complications

• Hemorrhage

• Bowel leakage

• Bile reflux

• Dumping syndrome

• Dehydration/malnutrition

• Bowel/Gastric outlet obstruction

• low vit A and C

TPN complications

• Infection/sepsis

• Pneumothorax

• Air embolism

• Clotted catheter

• Hyperglycemaia

• Rebound hypoglycemia

• Fluid overload

antiemetics

• Ondansetron

• Prochlorperazine

• Promethazine

liver chanbe in age

less blood flow and smaller liver

risk prevention meaure for liver dysfunction pt

pad rails (in case seizure t/t encepholopathy)

glucose in liver damage

can be increased or decreased

what position can activate RAAS

upright

cholycystitis sign

rebound tenderness

position for paracentesis

Paracentesis is performed with the patient in a supine position (on their back) with the head of the bed slightly elevated (semi-recumbent)

what do u want to eat when u have dumping syndrome

protein with each meal

lactulose admin

like 3 times a day

stim lax instructions

habit forming need more to be effectivde

colostomy surgery and now has constiupation treatment

2L water per day

dumping syndrome special instruction

lie down after meals