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What is Diverticulitis? #1
- Inflammation of an abnormal pouch (diverticulum) in the intestinal wall usually found
- in the large intestine.
What are the S/S of Diverticulitis?
- Left lower quadrant pain (or RLQ or abdominal pain)
- Leukocytosis (increased WBC)
What is the cause of Diverticulitis? #3
Lack of dietary fiber, particularly non-soluble fiber ("roughage").
- Small, protruding sacs when they become inflamed are thought to develop as a
- result of high pressure or abnormal pressure in the colon. High pressure
- against the colon wall causes pouches of the intestinal lining to bulge
- outward through small defects in the colon wall that surround blood
What is pathophysiology of diverticulitis?
Small, protruding sacs when they become inflamed are thought to develop as a result of high pressure or abnormal pressure in the colon. High pressure against the colon wall causes pouches of the intestinal lining to bulge outward through small defects in the colon wall that surround blood vessels.
Tests (3) to diagnose diverticulitis?
- Abdominal palpation
- CT scan with oral and IV contrast (98% accurate)
- High white blood cell count
How to prevent diverticulitis? #6
A high-fiber diet may prevent development of diverticulosis.
Some doctors tell patients with a history of diverticulitis to avoid nuts andseeds in the diet. However, there is no evidence that this is helpful to prevent the disease.
What will MD likly order for pt? #7
Broad-spectrum antibiotics which cover anaerobic bacteria and gram-negative rods.
What is broad-spectrum antibiotics?
it acts against both Gram-positive and Gram-negative bacteria
What are S/S of upper GI bleed? #11
- abdominal pain
- N/V coffee ground color, BBB, black
- melena/dark tarry stools/occult blood
- BRB per rectum
- decreased UO
usually present with pts who have hepatic cirrhosis becuase of dilation of esophageal varicies
What are S/S of lower GI bleed? #12
- usually slower and less massive than UGI bleed
- often bleeding stops on its own
What are common causes of lower GI bleed? #13
- ulcerative colitis
What are common causes of upper GI bleed? #14
- Poses greater risk for shock that lower GI bleed
- \Peptic ulcer (3 out of 4 patients)
- Esophageal varicies
- Inflammaory errosion on GI (slow minor capillary bleeding)
- peptic ulcer (ulcer stomach or duodenum, can cause significant blood loss)
- esophageal varicies or Mallory-Weiss tear (can cause massive blood loss)
- Mallory-Weiss tear-tear of esophagogastic junction
What are NSAID's and give examples? #14
- Most common are ASA, ibuprofen, and naproxen because they are available OTC in many areas.
- An estimated 10-20% of NSAID patients experience dyspepsia.
What is function of ASA?
Inhibition of platelet aggregation
What is dyspepsia? #16
- upset stomach or indigestion, impaired digestion.
- chronic or recurrent pain in the upper abdomen,
- upper abdominal fullness and feeling full earlier than expected when eating
- It can be accompanied by bloating, belching, nausea, or heartburn.
- Dyspepsia due to (GERD) or gastritis,
- may be the first symptom of peptic ulcer disease (an ulcer of the stomach or duodenum) and occasionally cancer.
What are adverse drug reactions associated with use of NSAIDs? #17
- Dual insult; direct and indirect irritation of the gi tract.
- 1) it's acidic irritates the gastric mucosa
- 2) Reduces protective prostaglandins which ^gastric acid secretion, diminished bicarbonate secretion, diminished mucous secretion and diminished trophic effects on epithelial mucosa.
What are MD orders for UGI bleed?
- CBC, PTT, PT/INR, hepatic panel, alylase. lipase, T&C, blood type
- prevent hypovolemia: PRBS's or LR/NACL
- Increase HOB (aspirarion precaustions)
- Continuos cardiac monitor/VS q 15-30 min
- Vitaman K required for blood coagulation
- Vasopressin or norepi- vasoavtive meds
- Proton pump inhibitors
- frequent small meals
- No ETOH, caffiene, tobacco
- PIV/Central line
- prep for endoscopy
What tests are included in a total hepatic panel? #19
- Bili direct & indirect
- Alk phos
- gamma transferase
What are 2 functions of Octreotide/Sandostatin. #20
Please spell this!
- Decreases splanchic blood flow, decreaseing amt of blood lost
- Reduce secretion of fluids by
- pancreas.Inhibit contraction of the
- natural somatostatin physiological activities.Inhibits secretion of many
- hormones, such as gastrin, CCK, glucagon, GH, insulin, secretin,
- pancreatic polypeptide, TSH, and vasoactive intestinal peptide.Reduce secretion of fluids
- by the intestine and pancreas.Reduce gastrointestinal
- motility and inhibit contraction of the gallbladder.Inhibit
- the action of certain hormones from the anterior pituitaryCause
- vasoconstriction in the blood vessels.Reduce portal vessel
- pressures in bleeding varices
- ABG: acidosis, hypoxemia
- hemeoccult positive
How to perform gastric Lavage
- flush NGT with cool saline 50 to 100 ml at at time
- let dwell for a short time
- then aspirate
- continued until drainage is light pink or clear without clots
What is endoscopy
- determine the source of bleeding
- NPO 8 hrs before
- If ER, then aspirate stomach contents via NGT if one is present
- lateral recumbant position
- supress gag reflex
- Can biopsy, photograph, remove polyps, foreing objects, treat bleeding vessels,
When is a saline enema adminitered and why?
Lower GI bleed to remove blood from the intestines and prevent dangerous ammonia buildup