Adults GI III

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Adults GI III
2014-02-28 14:01:03

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  1. Cholelithiasis
    • gall stones
    • most common duct obstruction
    • abnl bile compostion
    • biliary stasis
  2. risk factors
    • women over men
    • 60 or older
    • overwt
    • fasting or rapid wt loss
    • Hx of stones
    • diabetes
    • cholesterol lowering drugs
  3. Sx of cholelitiasis
    blocked cystic or common bile duct
    early= epigastric fullness or distress periodically

    • Blocked= Biliary colic pain that can pass
    • -severe and steady, epigastric pain or RUQ
    • radiates, follows a meal, abrupt onest
  4. cholecystitis
    • complication of gall stones
    • inflamm of gallbladder

    • jaundice and liver damage
    • pancreatitis
  5. labs for Dx of cholecystitis
    CBC shows inflam/infection

    Bili INC if liver is affected

    Amylace and Lipase INC if pancreas is affected
  6. Tx of stones
    • non-surgical:
    • ERCP= mechanical crushing and removal of stone (video)

    • surgical:
    • lap chole
  7. post op care for lap chole
    • pain control
    • advance oral intake as tolerated
  8. Pancreatitis
    inflam of panc

    can be acute or chronic
  9. Acute pancreatitis

    associated factors
    self destruction of the pancreas by its own enzymes through autodigestion

    F= gall stones, alcoholism
  10. Sx of pancreatitis
    • pain:
    • -abrupt onset
    • -severe and continuous
    • -epigastric and LUQ
    • N/V
    • fever
  11. labs for Dx of pancreatitis
    • INC serum Amylase
    • INC serum Lipase
    • INC WBC's

    • **if both enzymes high, -itis is early
    • **if lipase is nl, and only Amylase is high, then it has been a few days
  12. Tx of pancratitis
    • PRIMARY= reduction of pancreatic secretion b/c the enzymes are causing the -itis
    •  = NPO status maintained b/c secretions caused by introduction of food into digestive system

    • reduce hypovolemia
    • prevent infection
    • NG suction
    • IV fluid replacement
    • TPN
    • Antibios
    • pain control w/ IV opioids
  13. Liver functions:
    1. metabs
    2. synthesizes
    3. detox's
    4. produces
    5. destroys
    6. stores
    • 1. proteins, carbs, fats, hormone and drug steroids
    • 2. albumin, clotting factors
    • 3. ETOH and toxic substances (acetaminophen is liver toxic)
    • 4. bile
    • 5. foreign cells and damaged RBC
    • 6. glycogen, minerals, fat-soluble vits
  14. Hepatitis

    • widespread inflamm of LIver
    • caused by viral, toxic, and drug induced (acetamin.)

    Patho= congestion of inflam cells and fluid --> normal lobal pattern distorted --> inc pressure w/m portal circulation disrupting bld flow --> Edema of bile chaneels results in obstructive Jaundice
  15. Lab for hepititis
    • ALT = only specific to liver
    • AST= less spcific but good indicator
    • ALP= same
    • LDH= not speccific
    • Bili= not specific

    You see all of theses RISE with liver damage
  16. Hep A:
    T= fecal-oral

    O= abrupt

    C= rare
  17. Hep B:
    T= blood, body fluids, perinatal

    O= slow

    C= chronic hep, cirrhosis
  18. Hep C:
    T= blood, body fluids

    O= slow

    C= chronis hep, cirrhosis

    **Common in IV drug users
  19. Hep D
    T= blood, body fluids, perinatal

    O= abrupt

    C= chronic hep, cirrhosis

    ** You can only get D if you already have B
  20. 3 stages of viral hepitits
    • preicteric phase
    • icteric phase
    • convalescent phase
  21. preicteric phase
    • pre-jaundice
    • flu like symptoms
    • mild RUQ pain
  22. icteric phase
    • 5-10 days after onset of symptoms
    • jaundice
    • itching
    • **stools light brown or clay colored
    • ** urine is brown
    • flu Sx disappear
  23. convalescent phase
    • serum bili and enzymes return to nl
    • pain decreases
  24. Tx of hep
    antivirals, bed rest, nutrition as tolerated

    avoid: strenuous exercise, ETOH, and liver toxins
  25. Chronic Hep

    • repeated infections
    • risk of cirrhosis and cancer

    Sx= fatigue, malaise, hepatomegaly
  26. cirrhosis
    • end stage liver disease
    • condition characterized by:
    • -chronic inflamm causing scarring
    • -alterations in circulation and metab processes

    caused by chronic hep, biliary obstruction, alcoholism
  27. Sx of cirrhosis
    • hepatomegaly
    • pain and tender in RUQ
    • wt loss / malnutrition
    • weak
    • anorexia
  28. complications of late cirrhosis
    • portal HTN
    • splenomegaly
    • ascites
    • esophageal varices
    • hepatic encephalopathy
  29. portal HTN
    scar tissue obstructs flow from portal vein to hepatic vein

    • INC pressure in portal vein system
    • INC pressure in GI tract, pancreas, and spleen
  30. portal HTN leads to what?
    • esophageal varices
    • splenomegaly
    • ascites
    • hepatic enceph
  31. Spleenomegaly
    • blood shunted into plenic vein
    • INC removal and destruciton of RBC, WBC, and platelets

    anemia, leuko and thrmbocytopenia
  32. ascites
    accumulation of plasma right fluid in abd cavity

    • results of portal HTN, which pushes fluid out of cappilaries  AND
    • hypoalbuminemia= lack of albumin mean the the fluid is able to be pulled out of vasculature
  33. esophageal varices
    • enlarged, thin walled veins int he esophagus
    • collateral vessel that may rupture easily, causing a massive hemorrhage risk

    this is BAD! b/c with liver danage, your clotting factors are already in shit shape
  34. hepatic encephalopathy

    • accumulation of neurotoxins in bld
    • cerebral edema
    • INC serum Amonia***

    • Sx= asterixis (liver flap hand tremor thing)
    • =change in mentation
    • =aggitation, restless, confusion, incoherence
  35. liver function tests of cirrhosis

    what 3 are increased?
    what 2 are decreased?
    which 2 are varient?
    • coag times
    • bilirubin
    • serum Amonia

    • CBC
    • serum Albumin

    • Elyte inbalance b/c of malnutrition
    • erratic glucose levels
  36. Tx of cirrhosis
    • Supportive, not curative
    • goal is to slow progression of liver failure and reduce complications
  37. meds for cirrhosis
    diuretics, beta blockers, and nitrates to decrease Portal HTN

    • lactulose and antibiotic to reduce Amonia levels produce by gastric bacteria
    •  =reduce encephalopathy
  38. Cirrhosis nutrition
    • NA and fluid restriction
    • reduce protein to reduce enceph b/c amonia is a byproduct of protein metab
    • vit and minerals
    • give Mag if cirrhosis is from alcohol