hepato-pancreatic and gastro-intestinal

signs and symptoms of liver disease

bruising, increased bleeding, petechiae, spider angioma, hepatic encephalopathy (confusion)

not enough protein means fluids will third space (fluid shifts out of the blood vessels and into body spaces where they cannot be used) in abdominal wall which causes hypotension

pt will need IV albumin

what can liver disease cause?

bowel obstruction

blockage preventing movement of intestinal contents

signs and symptoms of bowl obstruction

abdominal distension, colicky abdominal pain, vomiting, constipation, absent or high-pitched bowel sounds

interventions for bowl obstruction

NPO, NG tube (for decompression), IV fluids, surgery

GERD

backflow of gastric contents into the esophagus due to weak lower esophageal sphincter that does not close properly

signs and symptoms of GERD

heartburn, esophageal irritation, regurgitation, burning chest pain after meals, worse when supine

interventions for GERD

avoid trigger foods (fat, spicy, caffeine, alcohol), elevate HOB, H2 blockers or PPI’s, weight loss, antacids

peptic ulcer disease

breakdown of gastric duodenal mucosa from acid and pepsini caused by H.pylori, NSAID’s, and stress

signs and symptoms of peptic ulcer disease

epigastric pain, melena (black/bloody and tarry stools), hematemesis (bloody vomit)

interventions for peptic ulcer disease

H2 blockers or PPIs, treat H. pylori, avoid use of NSAIDs

irritable bowel syndrome (IBS)

chronic functional bowel disorder where the intestines don’t move normally, causing abdominal pain and changes in bowl habits without structural damage

(lactose intolerance should be evaluated!)

signs and symptoms of IBS

abdominal pain, bloating, diarrhea, constipation, anxiety/depression

interventions for IBS

stress management, anticholinergics/antispasmotics (inhibits PNS), bulk fiber, antidiarrheals, antidepressants, TEGASEROD

histamine 2 receptors

famotidine

REDUCE acid production

proton pump inhibitors

omeprazole

BLOCKS acid secretion, can cause Mg deficit

ulcerative cholitis

chronic inflammation of colon starting at rectum, increase risk for colon cancer

pt will be on TPN

signs and symptoms of ulcerative cholitis

frequent bloody diarrhea, cramping pain, fever tachycardia

interventions for ulcerative cholitis

steroids, immunosupressants, colectomy

crohn’s disease

chronic inflammatory disease affecting any GI tract segment; key features include skip lesions and cobblestone mucosa

signs and symptoms of crohns disease

diarrhea, weight loss, fistulas, strictures, perianal abscesses

interventions for crohns disease

steroids, immunosupressants, surgery

gastric ulcer

pain worse with food

happens in stomach

weight loss (due to pt avoiding eating)

bleeding risk is higher

duodenal ulcer

pain relieved with food

happens in duodenum

weight gain (due to pt eating to relieve pain)

bleeding risk is lower

H. pylori

bacteria that damages gastric mucosa

famotidine (pepcid)

H2 receptor blocker that decreases stomach acid to help decrease irritation

used to treat GERD and peptic ulcer disease

given PO or IV

magnesium hydroxide (milk of mag)

osmotic laxative which increases fluid/speed stool release

treats constipation but can cause diarrhea and electrolyte imbalance

given PO

bisacodyl (ducolax)

stimulant laxative that adds water and electrolytes to increase motility

treats constipation and used for bowel prep but can cause diarrhea and electrolyte imbalance

given PO, suppository, enema and taken before bed

WORKS FAST

lactulose

osmotic laxitive that increased fluid and speeds stool release and is an ammonia reducer (pulls ammonia into stool so it is excreted)

treats constipation and hepatic encephalopathy

given PO or enema

sodium phosphate (fleet phospho-soda)

saline osmotic laxative that increased fluid and speeds stool release

treats severe constipation and used for bowel cleansing but at risk for fluid and electrolyte shifts

given PO or enema

docusate sodium (colace)

stool softener

treats constipation prevention to help prevent straining (post-op and cardiac pts)

given PO

plyethylene glycol (miralax)

osmotic laxitive that increases fluid and speeds stool release, gentle and safe for longer use

treats chronic constipatioon

given PO (mixed with liquids)

liver labs

ALT, AST, ALP, bilirubin, albumin, PT/INR

pancreas labs

amylase, lipase

gallbladder labs

ALP, bilirubin

hepatitis A

acute, usually mild, and transmitted via fecal or oral route (contaminated food/water)

S+S → flu-like symptoms, fever, jaundice

hepatitis B

chronic and more serious, transmitted via blood and sexually transmitted fluids

S+S → joint pain, fatigue, jaundice

hepatitis C

chronic and transmitted via blood, leads to cirrhosis and liver cancer, use direct acting anti-virals (entecavir or tenofovir)

S+S → often asymptomatic for years, mild fatigue, late jaundice

pancreatitis

inflamation of the pancrease

etiology → alcohol, gallstones

will have an increase in lipase and amylase

what happens if chronic pancreatitis sequela gets worse?

diabetes, malabsorption, weight loss, pancreatic cancer, chronic pain

portal hypertension

increase presure in portal vein (a vein conveying blood to the liver from the spleen, stomach, pancreas, and intestines)

esophageal varices

swollen, fragile, and dilated blood vessels in the esophagus (food pipe) that develop due to high blood pressure in the portal vein, usually from severe liver disease like cirrhosis. CAN CAUSE SEVERE BLEEDING

hepatic encephalopathy

increase ammonia which causes impaired brain function such as confusion

jaundice

increase in bilirubin which causes yellow skin and sclera

treatment for hepatic encephalopathy

lactulose (removes ammonia), antibiotics