MS 1 Final- Semester 1

• Esophageal trauma consider: etiology of trauma, severity/ location of trauma, early intervention, soft food/ NPO, swallow study
• Liver trauma/ laceration: bleeding, anticipate fluids with large bore IV; teach pt to take vitamins/supplements, activity restrictions, complications r/t s/sx of increased abdominal pain/ tenderness
• OR to PACU report includes: EBL, fluids in, meds, how they tolerated anesthesia, complications, drains
• History for any GI patient to include: family hx, previous surgeries, home meds, allergies, diet/ last PO intake, colonoscopies, history of malignant hyperthermia or reactions to anesthesia, BM habits
• Problems taking NSAIDs: upset stomach, changes in absorption, burning, bleeding, ulcers
• Lifestyle patterns: smoking, drinking, drug use, occupation, exposure to chemicals
• Suprapubic= above synthesis pubis
• Epigastric pain- rule out heart attack first, EKG
• Emergency s/sx of GI patients: vomiting blood, hypotension, pallor, sudden increased/ decreased pain, AMS
• Emergency s/sx in diarrhea or vomiting patient: coffee ground emesis, bright red blood present in stool
• Tarry stools, heavy/prolonged vomiting, very constipated= possible GI obstruction
• Other s/sx of GI problem: AMS, hypotension, tachycardia, diaphoretic, fever
• Diagnostic tests- check for ulcers, ulcerative colitis, cancers, polyps, varices
• Lab tests for GI: barium swallow test, barium enema, occult blood tests, AST/ALT, urea breath test (for H. pylori), abdominal x-ray, MRI, CT, ultrasound
• Urinalysis relates to GI: blood or protein in urine, abdominal pain, N/V
• Liver biopsy= diagnose cancer
• Ultrasound/ultrasonography= size of liver, spleen, can find tumors/cysts, diagnoses cholelithiasis
• Vagotomy= removing/killing the vagus nerve to decrease gastric secretions
• Cholecystectomy= gallbladder removal; can be laparoscopic or abdominal; uses abdominal approach if gangrenous/ scar tissue present, obese or large patient
• Signs of gallbladder attack: RUQ pain, steatorrhea; risk factors= Fertile, forty, female, flatulence, fat
• Gall stones= cholelithiasis; diagnosed with ultrasound
• Cirrhosis of liver: hand flapping tremors= asterixis; scarring of the liver, fatty liver (with or w/o alcohol use); caused by drugs, toxins, Hep C, or unknown reasons
• Portal HTN: increased pressure in portal vein that can lead to esophageal and gastric varices; can lead to upper GI bleeding, Mallory Weiss tears, or ascites
• Crohn‘s disease: can occur anywhere in GI tract (cobble stone); causes malabsorption, weight loss, may/may not have diarrhea
• Ulcerative colitis: frequent diarrhea/ bloody stools; different types and symptoms; cause is unknown but blamed on diet, immune disorders, allergies
• GERD meds: Proton pump inhibitors (PPIs), H2 receptor antagonists/blockers, antacids
• Lower esophageal sphincter (LES) gets loose and lets backflow occur= GERD; teach patients to take meds on empty stomach/1 hour before meals, sit up x30mins-1hour after meals, small/frequent meals, don’t eat late/before bed, avoid NSAIDs, alcohol and smoking
• Foods that trigger GERD: citrus, tomato, chocolate, onion, garlic, spicy foods, mints, alcohol, greasy food, large portions
• Complication of liver cirrhosis: hepatic encephalopathy= high ammonia levels= sweet/ fecal smelling breath (Fetor hepaticus); Give lactulose, restrict protein in diet, monitor LOC, avoid IM injections (increased risk of bleeding), monitor serum ammonia levels
• Hepatitis A: fecal or oral; from contaminated food/water; usually in overcrowded areas w/ poor sanitation- like daycares
• Hepatitis B: vaccine available; can be transmitted through blood or sexual contact
• Hepatitis C: viral or post- transfusion; contact with contaminated blood/ blood products (like used needles)
• Hepatitis D: exposure to blood/ blood products; occurs with people with Hep B; hemophiliacs or drug users high risk
• Hepatitis E: non A or B; from endemic areas (Asia, Africa, Central America) with dirty water
• 3 main electrolytes depleted from vomiting: sodium, potassium, and chloride
• Why would WBCs be elevated in a GI patient? peritonitis, necrosis of any GI areas, strangulation of hernia or bowel segment
• Increased serum amylase in GI patient= pancreatitis or something irritating the pancreas
• Increased risk of metabolic alkalosis: prolonged vomiting
• IBS irritating substances: coffee, raw food/veggies, stress, hormone changes
• Inflammatory bowel disease is an umbrella diagnosis for: Crohn's disease Ulcerative colitis