Acute GI problems

• Upper: esophagus, stomach, and duodenum
• Lower: small intesting and large intestine

• Hematochezia: bright red or maroon stool from rectum
• Melena: black tarry stool
• Occult blood: somewhat visible blood, scant amount
• Hematemesis: bloody vomit

• Imbalance in protectors
• Hostile factos in gut and duodemun
• H pylori
• family hx
• genetic predisposition

• NSAIDS
• Smoking
• Stress

• Inflammation Infection
• Most common cause of lower GI bleeding
• Risks: overcoagulants and chronic constipation

• 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

• Both: occult bleeding
• Neo: bleeding is slow, chronic, and self-limiting, bowel resection and remove tumor
• Polyps: bleeding common after removal

• Assessment
• Communication
• Administer treatments correctly
• Documentation

PUD

• Stomach and proximal duodenum
• b/c of acid leak

• 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

• N/V
• Anorexia/weight loss
• Bloating w/ N/V (gas build up)
• Hematemesis
• Melena
• Occult blood

• Hx
• S/S
• Documentation
• Communication
• EGD (only thing that will show ulcer)
• Contrast is contraindicated

• 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!

• NSAIDS (chronic, 20-30yrs)
• ETOH
• Stress

• Bleeding (Hematemesis, possible melena); usually not severe except in critically ill pts
• Pain
• N/V
• Decreased H&H

• 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

• Post-op: arteries are clamped to work on another vessel; no or low perfusion
• Hypotension: no blood flow and perfusion to bowel
• Athersclerosis
• Obstruction

• Hemotachezia
• Fever
• Abd pain: doesn't go away, severe!

• Dx: CT scan w/ contrast; KUB and Xrays not helpful
• Treatment: restore circulation w/ fluids, antibiotics if infection present

• Surgery: post-op adhesions
• Hernia
• Tumor

• 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

• 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

• Hydration
• Abd decompression (for comfort)
• Medication (Reglin will start moving gut; somewhat effective)
• Surgery

• Loss of peristalsis: trauma, surgery, meds
• Extremely common in ICU

• Bowel rest
• Do not feed gut
• Give Reglin
• Get up and move
• Will resolve on its own

• A severe form of paralytic ileus, people who are bedridden for a long time
• Paraplegics, elderly in nursing homes

• Abd surgery or trauma
• Certain fractures
• Burns
• Ruptured abd aortic aneurysm
• Bowel obstruction
• Ascites
• Pancreatitis

• S/S: acute pain
• Treatment: surgery; immediately

Compromises perfusion to intestinal mucosa, which becomes ischemic and translocates bacteria to blood stream, increasing risk of SIRS

• Backflow from liver dysfunction
• Cirrhosis (most common)
• Portal/splenic vein thrombosis

• Massive bleeding
• Occurs w/o warning
• Tubes, food, coughing, etc can cause them to rupture

• Liver patient
• Hx of bleeding or varices
• Scope down throat
• Portal HTN

Cauterization

• Extreme vomiting (belimia)
• ETTOH abus

Hemoptysis (coughing up blood): mild to moderate

• Dx: EGD
• Treatment: heals on on

Unknown, possbile genetic

• 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

• 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

• IV fluids (LR or NS)
• Blood: whole, plasma, or platelets (decreased H&H or anticoag)
• Oxygenation

• 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

• Monitoring of s/s of rebledding and complications
• Monitor for aspiration pneuomonia
• Monitor for esophageal scar tissue contraction; obstuction
• Infection
• Perforation