CEN, GI emergencies

  1. Why are peds more susceptible to dehydration with NVD?
    higher percentage of body water
  2. Peds kidney function consideration?
    immature kidney function = decreased ability to concentrate and dilute urine

    kidneys are more mobile - not well protected by fat
  3. Liver consideration in peds?
    more anterior and not as well protected by ribs as in adults
  4. GI S/S with peds?
    vague s/s when they have significant abd injury
  5. Peds pt can lose up to __ % of their circulating volume before they exhibit hypotension
    25-40%
  6. Stomach position in body?
    inferior to diaphragm with 80-85% L of midline
  7. HCl stimulated by what 3 chemicals?
    histamine, acetylcholine, gastrin
  8. Functions of HCl?
    denatures protein and break intermolecular bonds
  9. Functions of gallbladder?
    1. storage of bile, passageway for bile, bile release
  10. Pancreas functions?
    secretion of pancreatic juice for digestion of carbs, proteins, and fats

    - secreation of bicarb to neutralize chyme

     - secretion of insulin and glucagon
  11. Intrinsic factor?
    mucoprotein necessary for intestinal absorption of vit B12 in ileum

    deficiency of B12 causes pernicious anemia
  12. How long does food usually stay in stomach?
    2-6 hours after ingestion
  13. Kupffer cells?
    responsible for phagocytosis, line the sinusoids, destroy old or defective RBC and remove bacteria and foreign particles from the blood
  14. Bile is produced by the ____ and stored in the ____
    • liver
    • gallbladder
  15. The major bile pigment is ____, a breakdown product of ____
    • bilirubin
    • HgB
  16. Pancreas
    Alpha cells secrete ___
    Beta cells secrete ____
    Delta cells secrete ____
    • alpha - glucagon
    • beta - insulin
    • delta - somatostatin
  17. What triggers pancreatic secretions?
    food in small intestine
  18. Pancreatic secretions are controlled how?
    vagus nerve and parasympathetic NS

    hormonal:  secretin and cholecystokinin
  19. What arteries and veins supply liver?
    hepatic artery and vein
  20. ____ vein collects and delivers blood from entire venous drainage system of GI tract to liver
    portal
  21. Where does hepatic vein empty?
    inferior vena cava
  22. Parasympathetic NS effect on GI?

    What nerve is involved?
    increases activity of GI tract - innervated via vagus nerve
  23. Where in brain is hunger controlled?
    feeding center of hypothalamus

    sateity center also in hypothalamus
  24. Carbohydrate kcal/g?
    4
  25. Proteins kcal/g
    4
  26. Fats kcal/g
    9
  27. Where in the body is vitamin K produced?
    bacteria in lg intestine
  28. Are intestinal losses acidic or alkaline?

    What occurs with intestinal loss:  biliary losses, pancreatic fistula, intestinal suction, diarrhea?
    alkaline

    metabolic acidosis, hypokalemia, hyponatremia, hypovolemia
  29. S/S of gastritis?
    • 1. epigastric/L of midline pain
    • 2. "indigestion"
    • 3. NV
    • 4. may have hematemesis
  30. Peptic ulcer s/s?
    • 1. epigastric/RUQ burning/gnawing pain
    • 2. hematemesis/melena
  31. Pancreatitis s/s?
    • 1. epigastric/LUQ
    • 2. may radiate to back, flanks, or L shoulder
    • 3. boring/worsened by laying down
    • 4 NV
    • 5. mild fever
    • 6. Cullen sign - bluish discoloration at umbilicus indicatioing intraperitoneal bleeding
    • 7. Grey turner sign- bluish discoloration at flanks indicating retroperitoneal bleeding
  32. Cholecystitis s/s?
    • 1. epigastric/RUQ
    • 2. referred to below R scapula
    • 3. Murphy sign:  pain with deep breath while nurse palpates under R costal margin
    • 4. cramping
    • 5. NV
    • 6. tenderness RUQ
  33. Appendicitis?
    • 1. epigastric or periumbilical pain later lecalized to RLQ
    • 2. McBurney sign:  pain with palpation at McBurney point
    • 3. Rovsin sign:  pain in RLQ with palpation of LLQ indicates peritoneal irritation
    • 4. dull to sharp
    • 5. anorexia, NVD
    • 6. fever
    • 7. leukocytosis
    • 8. rebound tenderness indicates peritoneal irritation
  34. Intestinal obstruction s/s?
    • 1. epigastric or umbilical
    • 2. spastic to dull
    • 3. change in bowel habits
    • 4. melena or hematchezia
    • 5. hyperactive to hypoactive bowel sounds
  35. Flexing of knees to relieve abd tension frequently seen with _____
    periotonitis
  36. Leaning forward to relieve abd pain frequently seen with ____
    pancreatitis
  37. Jaundice?

    3 causes?
    seen with bilirubin >3.0

    liver disease, biliary obstruction excessive hemolysis
  38. Bluish abd discoloration?
    due infiltration of abd wall with blood
  39. Grey Turner sign?
    cchymosis to flanks indicative of retroperitoneal bleeding

    pancreas, duodenum, kidneys, vena cava, aorta
  40. Cullen sign?
    ecchymosis around umbilicus indicative of intraperitoneal bleeding:  liver spleen
  41. Spider angioma?
    caused by B12 deficiency, liver disease, and pregnancy
  42. Ascites causes?
    cirrhosis, intra-abd malignancy, or R ventricular failure
  43. Anasarca?
    end-stage heart failure or renal failure
  44. Seeing waves of peristalsis across abd generally associated with what condition?
    intestinal obstruction
  45. What is aortic pulsation indicative of?
    pulsatile swelling in the epigastrium suggests abd aortic aneurysm or an apigastric solid tumor overlying aorta
  46. High-pitched "rushing" bowel sounds indicate?
    early mechanical small intestine obstruction
  47. Low-pitched "rushing" bowel sounds?
    early mechanical large intestinal obstruction
  48. Bruit?
    if bruit noted check circulation to extremites:  if decreased BF is noted, aneurysm should be suspected
  49. Peritoneal friction rub?
    scratchy sound heard over inflamed spleen or neoplastic liver
  50. What does diffuse rigidity suggest?
    infectious, neoplastic, or inflammatory process in peritoneal cavity
  51. Rigid , boardlike abd is associated withwhat?
    acute perforation of viscus with spillage of GI contents into peritoneal cavity
  52. Consideration if palpate large, pulsating mass in abd?
    REFRAIN FROM ADDITIONAL ABD PALPATION AS THIS MAY BE AN ABD AORTIC ANEURYSM
  53. 4 situations in which deep palpation should not be used?
    • 1. polycystic kidneys
    • 2. after renal transplant
    • 3. malignant tumor - may cause seeding
    • 4. recent surgery
  54. Re bound tenderness is associated with
    peritoneal irritation
  55. When is the spleen palpable?
    when significantly enlarged:  injury, leukemia, mononucleosis, portal HTN
  56. When is chloride elevated/decreased?
    elevated in dehydration

    decreased in vomiting, diarrhea, or intestinal obstruction
  57. What happens to calcium in acute pancreatitis?
    decreases
  58. normal phosphorus level?

    When increased and decreased in GI probs?
    • normal 3-4.5
    • elefated in intestinal obstruction
    • decreased in malnutrition or malabsorption sysndromes
  59. When may magnesium be decreased with GI probs?
    diarrhea
  60. What happens to glucose with pancreatitis?
    elevated
  61. Normal bilirubin?
    0.3-1.3
  62. Total protein?
    6-8
  63. Albumin?
    3.5 - 5
  64. Cholesterol normal
    150-200
  65. Triglycerides?
    40-150
  66. When is alkaline phosphatase elevated?
    cirrhosis, RA, biliary obstruction, liver tumor, hyperparathyroidism
  67. Amylase normal?
    56-190
  68. What causes amylase to be elevated?
    • any pancreatic issues
    • perforated peptic ulcer
    • mesenteric thrombosis
    • ectopic pregnancy
    • renal failure
    • mumps
  69. Lipase normal?
    1.5
  70. ALT normal?
    5-36
  71. When is ALT elevated?
    • any liver issues
    • cholestasisinfectious mononucleosis
  72. AST normal?
    15-45
  73. When is AST elevated?
    liver issues, acute pancreatitis, dkeletal muscle disease or trauma
  74. LDH (lactate dehydrogenase) normal?
    90-200
  75. Elevated lactate dehydrogenase/LDH?
    liver issues, hemolytic anemia, pancreatitis, muscular dystrophy, pulmonary infarction, MI, pernidious anemia, renal disease
  76. ESR normal?
    15-20
  77. Clotting profiles in liver disease?
    may be abnormal
  78. Urobilinogen normal?
    • 0.3-2.1
    • lower in females
  79. When is urobilogen increase/decreased?
    • increased in hepatocellular disease
    • decreased in complete biliary obstruction
  80. ERCP?

    Contraindications?
    Dx biliary stones, ductal stricture, ductal compression, neoplasms of the pancreas and biliary system

    contraindicated if pt is uncooperative or if bilirubin is >3.5
  81. Considerations with endoscopy/colonoscopy?
    • 1. bowel prep with gastric irrigation and cathartics required before lower Gi
    • 2. NPO 4 to 8 hrs prior to study
    • 3. keep NPO until gag reflex returns if sedation used
    • 4. monitor for indications of perforation hemorrhage
  82. Neonatal appendicitis?
    extremely rare and mainly in preemies
  83. Precipitationg factors appendicitis?
    • most common in males age 10-30
    • 2. foreign bodies
    • 3. tumor of cecumor appendix
    • excessive lymphoid tissue growth
    • 5. recent barium enema
  84. Most common cause of appendicitis?
    hardened accumulated feces
  85. S/S of infant appendicitis?
    fussy and feeding poorly
  86. Child appenidicitis s/s?
    diarrhea and difficulty ambulating
  87. Rovsing sign?
    appendicitis - palpate LLQ cuases pain in RLQ
  88. McBurney point?
    2/3 way from umbilicus to anterior superior iliac spine
  89. Psoas sign?
    appendicitis - pain on extension of R thigh with patient on L side
  90. Position of comfort appendicitis?
    flex knees with pilows to help relax abd muscles
  91. Complications of appendicitis?
    perforation, sepsis, preterm labor in pregnanacy
  92. Mallory-Weiss tear?
    acute longitudinal tear of the esophagus caused by forceful retchin
  93. Boerhaave syndrome?
    spontaneous tear or rupturing of esophagus associated with vomiting
  94. Predisposing factors for upper GI hemorrhage?
    • 1. gastritis or peptic ulcer - genentic, substance abuse, diet, drugs/therapies:  NSAIDs, corticosteroids, drugs that increase acid production:  coffee, nicotine, hormones:  estrogen
    • 2. high physiologic stress situation:  COPD, recent Sx, MI
    • 3. Ingestion of strong acids or alkalis:
    • 4. esophageal varices
    • 5. cirrhoisis
    • 6. hepatitis
    • 7. chronic R ventricular failure
    • 8. Mallory-Weiss tear or Boerhaave syndrome:  forceful vomiting
  95. Patho of development of esophageal varices?
    fibrotic liver changes & resistance to normal venous drainage of liver to portabl vein -> portal htn -> pressure to collateral circulation -> dilation of submucosal veins of the distal esophagus & stomach -> predisposition to bleed
  96. Esophageal varices bleeding triggered by?
    • 1. increased intra-a bd pressure/valsalva maneuver
    • 2. mechanical trauma:  poorly chewed foods, insertion NG tube
    • 3. chemical trauma:  reflux
    • 4. coagulopathies
  97. S/S peptic ulcer?
    • gastic pain usually occurs 30 min to 1 hr after meals
    • duodenal pain usually occurs at night and 2-3 h after meals
  98. Use of vasopressin for GI bleed?
    1. slows blood loss by contricting arteries and decreasing portabl venous pressure
  99. Adverse effects of vasopressin?
    • 1. bradycardia
    • 2. htn
    • 3. water retention:  hyponatremia
    • 4. chest pain
    • 5. dysrhythmias
    • 6. abd cramping and pain
    • 7. oliguria
  100. Monitoring of vasopressin for GI bleed?
    htn can increase bleeding - monitor BP
  101. Medications that may be admin for GI bleed?
    • vasporessin
    • octreotide acetate/sandostatin
  102. Octreotide acetate/sandostatin for GI bleeding?
    reduces splanchnic BF, gastric acid secretion, GI mobility, and pacreatic exocrine function
  103. Tx of esophageal varices?
    • 1. sclerosing agent injected into varix and surrounding tissue - scar tissue
    • 2. esophageal variceal ligation:  rubber bands placed on target vessels
    • 3. stop bleeding through measures that lower venous pressure:  beta blockers, placement of tube for balloon tamponade
  104. Purpose of NG tube for GI bleed?
    • allows visulization during endoscopy
    • removes blood from GI tract to prevent digestion of protein causeing elevation of ammonia
  105. Pharmacologic therapy for H pylori?
    • 2 wk therapy with 3 drugs
    • 1. bismuth subsalicylate/pepto bismol or proton pump inhibitor AND
    • 2. metronidazole/flagyl and tetracycline OR
    • 3. clarithromycin/biaxin and amoxicillin
  106. What can occur r/t Gi bleeding -> blood in gut?
    elevated ammonia -> toxic to the brain
  107. GERD?
    reflux that occurs more than 2X per wk
  108. Achalasia?
    neurogenic impairment of esophageal motility that affects lower 2/3 of the esophagus
  109. Malfunction of LES?
    flux of acidic contents into esophagus
  110. S/S of GERD?
    • burning or discomfort up and down epigastric area
    • 1. worse bending over
    • 2 radiate to back, chest, neck
    • 3. worse 30 min after eating
    • 4. may feel like something stuck in upper chest area
    • 5. may c/o dyspnea and salivation
  111. Dx of GERD?
    • 1. upperGI/barium swallow:  eval motility and ID reflux
    • 2. endoscopy:  condition of esophageal and gastric mucosa
    • 3. esophageal manomotrey:  measure function of LES
  112. Predisposing factors cholecystitis?
    • 1. F, especially multiparous
    • 2. usually >40 years
    • 3. oral contraceptives/estrogen hormone replacment
    • 4. sedentary
    • 5. obesity
    • 6. familial tendency
    • 7. tumor
  113. Predisposing factors cholelithiasis?
    • 1. infection:  most common E coli
    • 2. cholesterol synthesis abnormalities
    • 3. pregnancy
    • 4. immobility
  114. What can cause cholelithiasis?
    any mechanism that alters body's ability to keep cholesterol, bile salts, and Ca in solution
  115. S/S of gallbladder probs?
    • typical s/s and
    • 1. jaundice
    • 2. Murphy sign:  inability to take deep breath while abd is palpated beneath R colstal arch below hepatic margin
    • 3. clay-colored stools, steatorrhea, dark amber urine if bile flow is obstructed
  116. Study of choice for Dx cholecystitis/cholelithiasis?
    HIDA scan
  117. Preciptitation factors for hepatic failure/encephalopathy?
    • 1. herpes simplex and herpes zoster
    • 2. epstein-barr
    • 3. adenovirus
    • 4. cytomegaloviurs
    • 5. hepatitis, hepatotoxic drugs/toxins
    • 6. ischemia and MODS
    • 7. trauma
    • 8. Reye syndrome
    • 9. acute fatty liver of pregnancy
    • 10. acute hepatic vein occlusion
  118. Reye syndrome?
    occurs in children recovering from a virus

    associated with aspirin use
  119. Fulminant hepatitis?
    liver cells fail to regenerate causing necrosis
  120. What occurs in portabl htn and impaired hepatic function?
    • Liver cannont:
    • 1. produce products:  proteins, carbs, bile - fat metabolism is impaired
    • 2. make plasma proteins and inactivate hormones:  aldosterone, estrogen

    - increased levels of aldosterone cause Na and water retention and excretion of K -> hypocalcemia, hypocalemia, etc

    - cumulative drug effects frequently occur

    - increased susceptibility to infection and sepsis
  121. Why does portal htn and liver failure cause increased susceptibilty to infection and sepsis?
    • 1. inability to store viitamins and manufacture clotting factor
    • 2. fat-soluable vitamin ADEK deficincies may occur
    • 3. clotting abnormalities occdur
  122. What may eventually occur in liver damage/failure?
    hepatic encephalopathy r/t neurotixics such as ammonia accumlating
  123. LP for in liver issues?
    may be done to r/o neurologic cause of altered LOC

    shows increase in glutamine
  124. Antidote to tylenol OD?

    When should it be admin?
    N-acetylcysteine/mucomyst

    must be admin within 24 h of acetaminophen ingestions
  125. Diverticulosis?
    multiple diverticular that are not inflamed
  126. Diverticulitis?
    infection of the diverticula
  127. Meckel diverticulum?
    true congenital diverticulum present at birth
  128. Early and late signs of alcohol withdrawal?
    • 1. mild tachycardia & htn
    • 2. NV
    • 3. diaphoresis
    • 4. pruritis
    • 5. visual disturbances
    • 6. time disoreientation
    • 7. tremors
    • 8. anxiety, agitation
    • 9. sleep disturbances

    • Late:
    • 1. marked tachycardia and hypertension
    • 2. hyperthermia
    • 3. dehydration
    • 4. delirium
    • 5. delusion
    • 6. hallucinations
    • 7. tonic-clonic seizures
  129. Predisposing factors diverticulitis?
    • 1. lowfiber/highfat diet
    • 2. increases with age
    • 3. chronic constipation
    • 4. previous spisodes of diverticulitis
    • 5. hereditary factors
  130. S/S of diverticulits?
    • 1. acute pain, constant, aching/cramping
    • 2. may be LLQ or generalized
    • 3. change in bowel habits
    • 4. anorexia
    • 5. low-grade temp
    • 6. abd tenderness LLQ
    • 7. palpable mass may be present
    • 8. bowel sounds:  decreased or nrmal
    • 9. peritoneal irritation
    • 10. older patients:  mayu be afebrile with normal WBC and no abd tenderness
  131. Preferred Dx tests for diverticulits?
    barium enema and colonoscopy - rarely done emergently - may cause perforation if done during acute episode
  132. Gastroenteritis?
    inflammation of the mucosal lining of the stomach and intestine
  133. Best position for patient if vomiting?
    side-lying
  134. Diet for pt with diverticulitis?
    initially NPO, fluids when vomiting stops

    clear liquids X24 h then bland foods after 24 h (BRAT) bananas rice applesauce toast/tea

    avoid carbonated, caffecinated, and high-sugar drinks
  135. Hernia?
    part of an internal organ bulges through and weakened area of a muscle
  136. Strangulated hernia?
    surgical emergency - cutting off blood supply and will result in necrosis if not relieved
  137. Bowel sounds that suggest strangulation of hernia?
    hypoactive
  138. Preparation of pt for procedures if hernia?
    • NPO
    • sedation if in ED
    • possible Sx
  139. Intussusception?
    mechanical bowel obstruction caused when a loop of bowel telescopes within itself
  140. Volbulbus?
    complete twisting of a loop of intestine around its mesenteric attachment site
  141. Classic s/s of intussception?
    classic red "currant jelly" stool

    caused by venous engorgement and ischemia of intestinal mucosa bleeding -> mixed mucus and blood
  142. S/S of intussusception?
    • 1. cries inconsolably
    • 2. crampy abd pain
    • 3. intermittent episodes of pain may be only s/s in older children
    • 4. lethargy
    • 5. facial grimacing, legs drawn up to chest
    • 6. vomiting
    • 7. sausage-shaped abd mass
    • 8. red currant jelly stools
  143. s/s of volvulus in infants?
    • 1.crying incosolably
    • 2. absence of stools
    • 3. failure to thrive
    • 4. severe pain and bloating
    • 5. abd distention
    • 5. perstaltic waves may be visible
    • 5. emesis may be bile in color
    • 6. clinical indications of shock
    • 7. bloody diarrhea
  144. Prepping pt for procedures for intussesception and volvulus?
    • NPO
    • for intusssception:
    • 1. hydrostatic reduction:   enema using barium or water-soluble contratst
    • 2. surgica correction

    • volvulus:
    • 1. Sx - emergent if symptomatic
    • 2. sigmoid volvulus:  endoscopic derotation of sigmoid colon may be done
  145. Predisposing factors for pyloric stenosis?
    • Neonates:  Dx within for 12 wks of life - occurs 4 X as often in males
    • 1 erythromycin use in first 2 wks of life
    • 2. turner syndrome - F with one of X chromosomes is defective or absent in some or all cells
    • 3. phenylketonuria - inability of body to utilize phenylalanine (amino acid)
    • 4. trisomy 18 - extra 18th chromosome

    Adults:  edema from PUD and scarring from PUD or carcinoma
  146. What will occur if pyloric stenosis goes unrecognized?
    stomach will become markedly dilated in response to near-complete obstruction
  147. S/S of pyloric stenosis infants/adults?
    • 1. no vomiting at birth - gradual onset
    • 2. fussy, hungry after feeding
    • 3. infrquent, hard stools
    • 4. weight loss
    • 5. decreased urination

    Adults:  abd bloating, vomiting

    • All: 
    • 1. tachycardia, hypotension
    • 2. projectile vomiting
    • 3. jaundice
    • 5. may have visible peristalsis noticeable prior to emesis
    • 6. palpable epigstric/RUQ mass hard and mobile:  olive shape
    • 7. bowel sounds hypoactive
    • 8. succussion splash:  splashing sound audible when pt is rocked from side to side
    • 9.  clinical s/s of dehydration
    • 10. restlessness/lethargy
  148. Dx studies for pyloric stenosis?
    • 1. electroltyes: hypokalemia, hypochloremia
    • 2. bilirubin elevated
    • 3. ABG metabolic alkalosis
    • 4. flat plate of abd:  air in stomac
    • 5. ultrasound:  dilated stomach and pyloric thickeingin
    • 6. upper GI:  gastric retention at 3-4 h - one or 2 thin bariu tracts and nonprogression of peristaltic wave from stomach to duodenum
  149. Med that may be used for pyloric stenosis?
    antispasmodics:  atropine may be used to shorten pyloric canal and decrease thickening over several weeks
  150. Prep for procedures for pyloric stenosis?
    NPO

    NG to decompress dilated stomach
  151. Who more affected by IBS?
    women more than men
  152. How is IBS Dx?
    rule out other problems
  153. What should be done for Dx in women with suspected IBS?
    pelvic exam - r/t ovarian tumors and cysts or endometriosis - mimic ibs
  154. Inflammatory bowel disease?

    2 types?
    chronic inflammation of GI tract

    ulcerative colitis, crohn's
  155. What areas of GI tract are affected by Crohn's?
    segmental areas of entire GI tract

    mouth to anus - most common is ileius
  156. What areas of GI tract are affected by ulcerative colitis?
    colon and rectum
  157. Differences b/t Crohn's and ulcerative colitis?
    • Crohn's                        Ulcerative colitis
    • anywhere in GI              only colon and rectum
    • R side of colon               L side of colon
    • bleeding rare               gross rectal bleeding
    • abscess/fistulas            no fistulas
    • perianal lesion maybe   no perianal lesion
    • patchy ulcerations         inflammation
    • separate from health     uniform/diffuse
    • areas
    • sarcoidlike granulomas    no sarcoid
    •                                      granulomas
  158. S/S of inflammatory bowel disease?
    • abd pain
    • UC - bloody diarrhea 15-20Xperday with or without pus
    • Crohn's:  diarrhea 3-5 Xperday - no blood but may have steatorrhea (fat in stool)
    • abd tenderness:  R side crohn's, L side UC
    • dehydration
    • infection/sepsis
    • acute abd if perforation occurs
  159. Meds for inflammatory bowel?
    corticosteroids, ABX, antipyretics
  160. Complications of inflammatory bowel diseases?
    • 1. anemia
    • 2. perforation
    • 3. toxic megacolon - dilation of colon >5cm
    • 4. abscess
    • 5. sepsis
  161. Why may hypovolemia occur with pancreatitis?
    fluid leak into peritoneal cavity
  162. Chronic pancreatitis?
    progressive and irreversible destruction of the pancreas - necrosis of pancreas erodes into tissues and blood vessels -> hemorrhage
  163. Predisposing factors pancreatitis
    • 1. obstruction of common bile duct
    • 2. alcoholism
    • 3. hypertriglyceridemia
    • 4. meds:  thiazides, estrogen, steroids, abx, opiates
    • 5. peptic ulcer with perforation
    • 6. cancer, especially of pancreas or lung
    • 7. injury to pancreas
    • 8. pregnancy - 34d trimester, ectopic
    • 9. ovarian cyst
    • 10. infections
  164. Patho of pancreatitis?
    • activation of pancreatic enzymes & pancreatic cell injury -> auto digestion of pancreas ->
    • edema, necrosis, hemorrhage

    inflammation causes necrosis of fat in pancreas and exudates with high albumin content -> hypoalbuminemia & ascites

    fat necrosis -> precipitation of calcium -> hypocalcemia

    may have sepsis and/or SIRS r/t necrotic toxins
  165. Clinical presentation pancreatitis?
    • 1. recent heavy meal or drinking binge
    • 2.epigastric pain:  aggravated by food, alcohol, walking, supine position
    • 3. anorexia
    • 4. dyspepsia, flatulence
    • 5. NV
    • 6. dyspnea
    • 7. weight loss
    • 8. weakness
    • 9. tachycardia, hypotension
    • 10. fever - usually low grade
    • 11. abd distention tenderness guarding
    • 12. grey turner sign:  ecchymosis over flank area
    • 13. Cullen sign- ecchymosis at umbilicas
    • 14. Chvostek sign- unilateral spasm of facial muscles when cheek tapped
    • 15. Trousseau sign:  carpal spasm occurs when upper arm compressed with tourniquet or BP cuff
    • 15. ascites
    • 16. rebound tenderness
    • 17. epigasric mass may be palpable
    • 18. steatorrhea
  166. Electrolyte imbalances that may occur with pancreatitis?
    decreased potassium, calcium, and magnesium
  167. Effect of pancreatitis on glucose?
    increased if endocrine function of pancreas is compromised
  168. CXR with pancreatitis?
    bilateral or only L pleural effusion, elevated L hemidiaphragm, L atelectasis
  169. Paralytic ileus?
    functional obstruction caused by loss of peristalsis
  170. Patho of bowel infarction?
    decrease BF to vessels that supply bowel  -> prolonged ischemia increases permeability of bowel and edema of intestinal wall -> normal bowel flora may penetrate bowel wall -> peritonitis

    necrosis and perforation may occur
  171. Patho of bowel obstruction?
    gas and fluids proximal to obstructions unable to move -> shifting of fluids from bowel into peritoneal cavity -> dehydration, hypovolemia, shock
  172. S/S of bowel obstruction/infarction?
    • 1. anorexia
    • 2. abd pain/distention/tenderness with perforation & peritoneal irritation
    • 3. weight loss
    • 4. urgency for BM
    • 5. tachycardia, tachypnea, hypotension
    • 6. hypoactive or absent bowel sounds
    • 7. vomiting - may be bloody
    • 8. urgent diarrhea - may be bloody
    • 9. dehydration s/s
    • 10. elevated temp
  173. Where is obstruction based on vomit contents?
    clear gastric fluid, gastric contents and bile, brown fecal
    clear gastric fluid:  obstruction at pyloris

    gastric contents and bile:  proximal small intestine, paralytic ileus

    brown fecal:  obstruction in distal small intestine
  174. S/S of large bowel obstruction?
    change in bowel habits - thin, ribbonlike preogressing to constipation
  175. Electrolyte issues that may occur with large bowel obstruction?
    Na high/low/normal, decreased potassium and chloride
  176. S/S of bowel perforation?
    • 1. tachycardia, tachypnea
    • 2. fever
    • 3. vomiting
    • 4. abd tenderness, rigid/boardlike abd, guarding, rebound tenderness
    • 5. diminished/absent bowel sounds
  177. Barium enema with obstruction?
    may show point of obstruction
  178. Test that may visualize bowel obstruction?
    endoscopy
  179. Drug that can enhance GI motility in partial intestinal obstruction?
    reglan/metoclopramide
  180. When is Sx needed with bowel obstruction?
    vascular obstruction, complete bowel obstruction, and perforations
  181. Considerations with high-velocity penetrating trauma to abd?
    blast effect on surrounding tissues

    liver most often affected by penetrating trauma
  182. Consideration with blunt trauma to abd?
    spleen most often affected by blunt trauma , pancreas frequently injured with spleen
  183. S/S of abd trauma?
    Kehr sign - L shoulder pain indicative of splenic rupture caused by blood below diaphragm tht irritates phrenic nerve

    Rovsing sign- RLQ pain with palpation of LLQ indicates peritoneal irritation

    seatbelt sign - ecchymosis across lower abd caused by seatbelt

    hematoma, entrance/exit wounds,

    Grey Turner or Cullen sign

    Coopernail sign - ecchymosis of scrotum or labia - indicates fractured pelvis

    • rigid abd - may indicate abd bleeding
    • - Balance sign - resonance over R flank with pt on L side - indicates ruptured spleen
    • - hypoperfusion or shock s/s
  184. Myoglobinuria indicates what?
    crush injury tor muscle breakdown occurring
  185. Why need CXR with abd injuries?
    r/o concurrenty thoracic injury

    ID free air under diaphragm
  186. What will abd Xray show with stomach or bowel perforation?
    free air in peritoneum
  187. What does FAST show?
    fluid/blood in pericardium, abd, or pelvis


    visualization of spleen and liver
  188. S/S  of liver injury?
    • 1. seatbelt sign
    • 2. hematoma or ecchymosis in RUQ
    • 3. lower R rib Fx
    • 4. blunt/penetrating trauma
    • 5. accel/decal MVA
    • 6. presence of other abd injuries
    • 7. RUQ pain/guarding - worse during inhalation
    • 8. referred pain to R shoulder
    • 9. increased abd girth/rigidity
    • 10. tachycardia, hypotension
    • 11. increased WBC
    • 12. elevated liver enzymes
    • 13. decreased Hgb and Hct
    • 14. abnormal clotting studies
    • 15. CXR - may show elevated diaphragm on R side
    • 16. injury evident on FAST
  189. S/S of spleen injury?
    • 1. seatbelt sign
    • 2. local sign of injury LUQ
    • 3. L pneumothorax
    • 4. blunt or penetrating trauma to abd
    • 5. accel/decal MVA
    • 6. presence of other abd injuries
    • 7. LUQ pain, tenderness, and guarding - increased with inspiration
    • 8. increased abd girth and rigidity
    • 9. Keher sign
    • 10. balance sign
    • 1. tachycardia, hypotension
    • 12. decreased Hgb and Hct
    • 13. injury evident on FAST
  190. s/s of pancreatic injury?
    • 1. seatbelt sign
    • 2. other abd injuries
    • 3. MVC
    • 4. blunt or penetrating injury to abd
    • 5. epigastric, back, or shoulder pain
    • 6. abd tenderness and guarding
    • 7. increased abd girth
    • 8. decreased bowel sounds
    • 9. electrolyte imbalances - hyperglycemia or hypoglycemia
    • 10. elevated serum lipase
    • 11. elevated WBC
    • 12.
  191. s/s of stomach injury?
    • 1. penetratring trauma to abd
    • 2. presence of other abd injuries
    • 3. epiastric or LUQ pain and tenderness
    • 4. hematemesis or bloody aspirate from NG tube
    • 5. rebound tenderness
    • 6. tachycardia, hypotension
    • 7. elevated WBC
    • 8. abd flat plate - free air
  192. s/s of intestinal injury?
    • 1. seatbelt sign
    • 2. presence of other abd injuries
    • 3. blunt trauma with decal
    • 4. penetrating injury
    • 5. local sign of injury
    • 6. NV
    • 7. abd pain, may be referred or rebound
    • 8. absent bowel sounds
    • 9. elevated WBC
    • 10. abd flat plate - free air
    • 11. positive fecal occult blood test
  193. s/s of abd vessel injury?
    • 1. other abd injuries
    • 2. blunt or penetrating abd injury
    • 3. sudden decal in MVC or fall
    • 4. abd distention and guarding
    • 5. increased abd girth and rigidity
    • 6. diminished femoral pulses if aorta or iliac injury
    • 7. mottled lower extremities
    • 8. Cullen sign
    • 9. decreased Hgb and Hct
    • 10. tachycardia, hypotension, shock
  194. Position of pt with peritoneal irritation?
    knees flexed while in supine position
  195. Considerations for children and orthopedic/wound emergencies?
    • 1. open epiphyses until after adolescence
    • 2. dislocations are rare  - if they occur there is usually a Fx involved
    • 3. limping in children is rare  - look for a possible hip disorder
  196. Bones are primary storage site for ___ and ___ and help with the regulation of these substances
    calcium and phosphate
  197. Osteoblasts, osteocytes, and osteoclasts?
    • osteoblasts:  build new bones
    • osteocytes:  maintain bone tissue
    • osteoclasts:  maintain bone reabsorption
  198. Parathyroid hormone effect on calcium and phosphate?
    increased parathyroid hormone -> calcium and phosphate absorbed and moved into blood stream
  199. Vitamin ___ affects bone deposition and absorption
    D
  200. Arthritis?
    breakdown of cartilage
  201. Systemic lupus erythematous?
    autoimmunie disorder that can affect joints and cause symptoms similar to those of arthritis
  202. Paget disease?
    alteration of the normal bone growth process of breakdown and rebuilding breaks down more quickly and grows back softer - bones bend and break more easily
  203. Sjogren syndrome?
    autoimmune disorder that causes chronic inflammation that can affect joints
  204. Osteopenia?
    low bone density
  205. Osteoporosis?
    brittle and weak bones
  206. Tobacco use affect on bones?
    smoking weakens bones
  207. Medications that can reduce bone density?
    corticosteroids
  208. Discoloration indication of wound age?
    • reddish blue to purple - 24-48 hours
    • greenish - 5 to 7 days
    • yellow - 7 to 10 days
    • brownish - 10-14 days
    • no injury evident - 2 to 4 wks
  209. Valgus?
    angle of part is away from midline of body to an abnormal degree
  210. Varus?
    deformity in which angle of part toward midline of body to abnormal degree
  211. Causes of increased calcium r/t bones?
    • prolonged immobility/immobilization
    • Paget disease
    • metastatic bone cancer
  212. When may troponin increase not r/t heart?
    skeletal muscle damage
  213. When may creatine kinase increase?
    muscle damage
  214. Lactate dehydrogenase increases with ?
    skeletal muscle damage
  215. Uric acid increses with ___ and ___
    • gout
    • acute tissue distruction
  216. What labs will be positive with RA?
    • CRP
    • antinuclear antibodies
    • serum rheumatoid factor
  217. Imaging studies for extremity injury?
    need 2 views of injured extremities with view of joint above and below
  218. Consideration of cervical injuries in pediatric patients <8 years old?
    spinal cord injury without radiographic abnormality common
  219. Tx of puncture wounds?
    soak puncture wounds for 10 to 15 minutes.  other wounds should not be soaked
  220. Removing sutures?
    pull across wound rather than away from wound
  221. Six P's of neurovascular assessment?
    • 1. pain
    • 2. paresthesia
    • 3. pallor
    • 4. polar - cold
    • 5. pulselessness
    • 6. paralysis
  222. Ice application to injuries?
    apply to injures <24to 48 hours

    20 to 30 min at a time for up to 48 hours after initial injury

    use for chronic injuries/pain after exercise
  223. Use of heat for injuries?
    chronic injuries or injuires that have no inflammation or swelling

    before exercising to increase elasticity of joint connective tissues and stimulate BF

    15 to 30 minutes at a time 

    do not place directly on skin
  224. When should sutures to face, scalp, neck, chest, abd, bac, joint surfaces, nonjoint surfaces of extremities, palm of hand/sole of foot be removed?
    • face 3-5
    • scalp 5-8
    • neck 3-5
    • chest 7-10
    • abd 7-10
    • back 10-12
    • joint surfaces 10-12
    • nonjoint surfaces 7-10
    • palm/sole 7-12
  225. Crutches:
    Should be ___ inches between axilla and top of crutches

    Elbows slightly bent _____ degrees of flexion.

    Cruthces should be ___ inches forward and ____ inches to the side of the body when walking.
    1 to 1/2 inches b/t axilla and crutches

    30 dgree flexion of elbow

    12 inches forward and 6 inches to side
  226. Up and down stairs with crutches?
    up stairs:  uninjured leg goes up on first step then followed by injured leg and crutches

    down stairs:  crutches placed down one step and then followed with injured leg and then the uninjured leg
  227. Walking with a cane?
    - cane should reach pt wrist - handgrip level with ulnar side of wrist

    - hold cane with elbow slightly bent in hand opposite injured side

     - cane and injured leg should move together - cane 4 to 5 inches forward

    - up stairs uninjured leg moved first and followed by cane and injured leg

    -= down stairs - cane placed on the step first and followed by injured leg then uninjured leg
  228. Walker walking?
    handgrips should be level with the wrist crease
Author
mbeklj
ID
344677
Card Set
CEN, GI emergencies
Description
CEN Gi Emergencies
Updated