Acute GI problems

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chell668
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105182
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Acute GI problems
Updated:
2011-09-29 11:25:34
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GI Issues
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GI
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  1. What consists of upper and lower GI tract?
    • Upper: esophagus, stomach, and duodenum
    • Lower: small intesting and large intestine
  2. Hematochezia
    Melena
    Occult Blood
    Hematemesis
    • Hematochezia: bright red or maroon stool from rectum
    • Melena: black tarry stool
    • Occult blood: somewhat visible blood, scant amount
    • Hematemesis: bloody vomit
  3. Common unmodifiable causes of PUD
    • Imbalance in protectors
    • Hostile factos in gut and duodemun
    • H pylori
    • family hx
    • genetic predisposition
  4. Common modifiable causes of PUD
    • NSAIDS
    • Smoking
    • Stress
  5. Diverticulitis
    • Inflammation Infection
    • Most common cause of lower GI bleeding
    • Risks: overcoagulants and chronic constipation
  6. Chrohn's Disease and ulcerative colitis
    • Both: dx by colonoscopy and biopsy; treated w/ coticosteroids; inflammatory bowel disease (IBD)
    • CD: extends through intestinal wall (mouth to anus), bloody diarrhea major feature
    • UC: confined to mucosa and submucosa, bloody diarrhea most common symptom, more bleeding than crohn's
  7. Neoplasyms and Polyps
    • Both: occult bleeding
    • Neo: bleeding is slow, chronic, and self-limiting, bowel resection and remove tumor
    • Polyps: bleeding common after removal
  8. What is RN's role w/ GI bleeds?
    • Assessment
    • Communication
    • Administer treatments correctly
    • Documentation
  9. Most common cause of upper GI bleed
    PUD
  10. PUD Location. Why?
    • Stomach and proximal duodenum
    • b/c of acid leak
  11. Biggest indicator of PUD
    • Pain; hallmark symptom
    • Location, timing, quality, severity, contibuting factors, alleviating factors
    • Analgesics do NOT work!
    • Pain usually shows 30mins in stomach or 1-2hrs in duodenum after eating; worsens at night
  12. PUD S/S
    • N/V
    • Anorexia/weight loss
    • Bloating w/ N/V (gas build up)
    • Hematemesis
    • Melena
    • Occult blood
  13. PUD Dx
    • Hx
    • S/S
    • Documentation
    • Communication
    • EGD (only thing that will show ulcer)
    • Contrast is contraindicated
  14. PUD Treatment
    • PPIs (not effective in duodenum, only in stomach): esmeprezole, omeprazole, pantoprazole
    • NG Suction
    • Nutrition
    • Antibiotics (H pyloric)
    • Histamine receptor antagonist: Rantidine, famotidine, cimetidine
    • Antisecretory agent (lessens amt of acid in environment): misoprostol
    • Cytoprotective agent (stops body thinking there's a wound and sending cytokins): sucralfate
    • Antacids
    • Famotidine can destroy platelets!
  15. Common causes of Acute erosive/hemorrhagic gastritis
    • NSAIDS (chronic, 20-30yrs)
    • ETOH
    • Stress
  16. S/S of acute erosive/hemmorhagic gastritis
    • Bleeding (Hematemesis, possible melena); usually not severe except in critically ill pts
    • Pain
    • N/V
    • Decreased H&H
  17. Gastritis Dx, Prevention, and Treatment
    • Dx: EGD
    • Prevention: PPIs, nutrition, eliminate risk factors
    • Treatment: Cauterize during EGD, Vasopressin therapy (antidiruretic therapy), surgical resection
    • NSAID induced: discontinue, reduce, or serve w/ meals
    • ETOH induced: alcohol withdrawal
  18. Ischemic bowel disease causes
    • Post-op: arteries are clamped to work on another vessel; no or low perfusion
    • Hypotension: no blood flow and perfusion to bowel
    • Athersclerosis
    • Obstruction
  19. Ischemic bowel disease S/S
    • Hemotachezia
    • Fever
    • Abd pain: doesn't go away, severe!
  20. Ischemic bowel disease Dx and Treatment
    • Dx: CT scan w/ contrast; KUB and Xrays not helpful
    • Treatment: restore circulation w/ fluids, antibiotics if infection present
  21. Small bowel obstruction causes
    • Surgery: post-op adhesions
    • Hernia
    • Tumor
  22. Small bowel obstruction S/S
    • Pain: visible peristalic waves, tinkles ausculated, rebound tenderness, tenderness on palpation; uncomfortable feeling not sharp
    • Nausea
    • Abd distention: gas and fluid accumulation, swallowed air most common, inflammation
    • Bowel sounds: watch for BMs; below distention will be hypoactive, above is hyperactive
  23. Small bowel obstruction Dx
    • Labs: CBC, BMP: WBCs b/c of inflammation, electrolyte changes (become trapped in small bowel)
    • Radiological exams: KUB, Flate panel X-ray, CT w/ contrast
  24. Small bowel obstruction treatment
    • Hydration
    • Abd decompression (for comfort)
    • Medication (Reglin will start moving gut; somewhat effective)
    • Surgery
  25. Acute paralytic ileus causes
    • Loss of peristalsis: trauma, surgery, meds
    • Extremely common in ICU
  26. Acute paralytic ileus Treatment
    • Bowel rest
    • Do not feed gut
    • Give Reglin
    • Get up and move
    • Will resolve on its own
  27. Ogilvie Syndrome
    • A severe form of paralytic ileus, people who are bedridden for a long time
    • Paraplegics, elderly in nursing homes
  28. Abdominal compartment syndrom causes
    • Abd surgery or trauma
    • Certain fractures
    • Burns
    • Ruptured abd aortic aneurysm
    • Bowel obstruction
    • Ascites
    • Pancreatitis
  29. Abd compartment syndrome S/S and treatment
    • S/S: acute pain
    • Treatment: surgery; immediately
  30. Abd compartment syndrome complication
    Compromises perfusion to intestinal mucosa, which becomes ischemic and translocates bacteria to blood stream, increasing risk of SIRS
  31. Varices causes
    • Backflow from liver dysfunction
    • Cirrhosis (most common)
    • Portal/splenic vein thrombosis
  32. Varices clinical course
    • Massive bleeding
    • Occurs w/o warning
    • Tubes, food, coughing, etc can cause them to rupture
  33. Varices risk factors
    • Liver patient
    • Hx of bleeding or varices
    • Scope down throat
    • Portal HTN
  34. Varices Treatment
    Cauterization
  35. Mallory Weiss Tears causes
    • Extreme vomiting (belimia)
    • ETTOH abus
  36. Mallory Weiss tears S/S
    Hemoptysis (coughing up blood): mild to moderate
  37. Mallory Weiss tears Dx and Treatment
    • Dx: EGD
    • Treatment: heals on on
  38. AV Malformation cause
    Unknown, possbile genetic
  39. AV Malformation Clinical course, Dx, and Treatment
    • CC: occult blood, possible melena; chronic slow bleed; recurrent bleeding, chronic anemia or severe acute GI bleeding
    • Dx: EGD (start in upper then lower)
    • Treatment: careful monitoring
  40. Assessment of GI bleeds
    • Vital signs (hemodynamic instability, should be assumed emergency until otherwise)
    • Mental status
    • I/O: urine, intake, NG tube
    • Bleeding: increased BUN suggests fluid vol. deficit or metabolism of blood w/in GI tract
  41. GI bleed Resusciation
    • IV fluids (LR or NS)
    • Blood: whole, plasma, or platelets (decreased H&H or anticoag)
    • Oxygenation
  42. GI Treatments
    • Endocscopy: PUD, Gastritis, Mallory Weiss tears, AV Malformations
    • Arterial angiotherapy: pts who are poor candidates, infusion of vasopressin into vessel; coag placed in vessel
    • Sclerotherapy: use of chemical to stop bleeding and harden vessel
    • Surgery: severe hemmorhage, rebleeding, invasive,acute intervention
  43. Sclerotherapy Post procedure
    • Monitoring of s/s of rebledding and complications
    • Monitor for aspiration pneuomonia
    • Monitor for esophageal scar tissue contraction; obstuction
    • Infection
    • Perforation

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