Nurs 3366 - GI bleeding and Disorders of accessory organs

What is Upper GI bleeding?

bleeding from esophagus, stomach, duodenum

most common causes:

• acute hemorrhagic gastritis

• esophageal varices – large torturous veins in the esophagus caused by liver disease that can be easily irritated & caused to bleed

• peptic ulcers

What are the S&S of UGI bleeding?

hematemesis—sudden vomiting of blood

• visible, or “frank” hematemesis

• occult bleeding-- vomitus looks normal, but actually has small amt of

  hidden blood

blood in stools - occult bleeding - stool may look normal, but actually has small amt of hidden blood

melena - dark, tarry stools due to digested blood

What is Lower GI bleeding?

bleeding from jejunum, ileum, colon

• most common causes:

  a. IBD

  b. diverticulitis

  c. neoplasms

What are the S&S of LGI bleeding?

occult bleeding

• stool may look normal, but actually has small amt of hidden blood from a slower, chronic bleeding situation such as a cancer or diverticulitis.

• detected by using hemoccult test

frank bleeding

• hematochezia—red blood mixed with stool ( would NOT have melena because digestion occurs in upper GI areas, not lower GI.)

What is Jaundice?

alteration in the normal bilirubin cycle and it accumulates in the blood, the bilirubin is deposited in various pathological places in the body

• manifesting as a yellow-green pigment—this condition is called jaundice,

  AKA icterus (adj = icteric)

What is Prehepatic Jaundice?

increase in unconjugated bilirubin (AKA indirect bilirubin)

• most common causes are hemolytic conditions:

  • Autoimmune hemolytic anemia

  • erythroblastosis fetalis - mother is Rh neg & fetus is Rh pos

What is Posthepatic(AKA obstructive) Jaundice?

increase in conjugated bilirubin (AKA direct bilirubin)

• liver converts unconjugated bilirubin to conjugated just fine, but there is a problem with the flow of bilirubin actually making its way to the intestines due to an obstruction

• sign of obstructive jaundice is stool that is gray-colored (lack of pigment from bilirubin

What is Hepatic Jaundice?

because of increase in unconjugated bili

• hepatocytes are diseased, such as in hepatitis & cirrhosis, the liver cannot

  conjugate the unconjugated bilirubin that arrives→ remains in blood as

  unconjugated

• in addition since it cannot conjugate bili, the conjugated bili will be LOW

What are the blood test results that reflect Prehepatic jaundice?

• total serum bili - high

• serum indirect bilirubin (ie, unconjugated bili) — high

• serum direct bilirubin —normal

What are the blood test results that reflect Posthepatic jaundice?

• total serum bilirubin—high

• indirect bilirubin—normal

• direct bilirubin--—high

What are the blood test results that reflect Hepatic jaundice?

• total serum bili - high or normal

• serum indirect bilirubin (ie, unconjugated bili) —high

• serum direct bilirubin —low (because the diseased liver cannot conjugate

What is Cholecystitis?

inflammation of the gall bladder

• caused by irritation of stones inside the gall bladder itself (cholelithiasis)

• or in a nearby duct such as the common bile duct (choledocholithiasis)

What is the Patho of cholelithiasis/cholecystitis?

the stones are caused by situations in which either:

• cholesterol increases (cholesterol is normal part of bile)

• there is less water in the body, such as in dehydration

What are the S&S of Cholecystitis?

pain in the RUQ & epigastric area

• often manifested as painful spasms/ contractions of the GB & bile ducts called biliary colic

• if a large stone completely blocks common bile duct, may also cause obstructive jaundice

What are the Risk factors of Cholecystitis?

the 5 “F’s”—female, fat, forty, fertile, fair (statistically more typical in whites)

What is the dx & tx of Cholecystitis?

labs:

• often leukocytosis (from inflammation & sometimes infection)

• high direct bilirubin levels (an obstructive process)

if the GB is inflamed enough, the tx of choice is to remove it (cholecystectomy)

What is Acute pancreatitis?

escape of pancreatic enzymes into pancreas & surrounding tissues, causing autodigestion and hemorrhage

What are the S&S of Acute pancreatitis?

pain in epigastric area --abrupt onset of post-prandial or post-alcohol- ingestion epigastric pain that is severe and often radiates to the back

How do you diagnose Acute pancreatitis?

labs-- serum amylase & lipase will be elevated