2. GI Disorders

2. GI Disorders

1. Age related changes

   • poor dentures
   • decreased sense of taste
   • Atrophy of gastric mucosa
     • decreased production of hydrochloric acid
       • less absorption of iron and cobalamin (vitamin B12) and rise in bacterial growth
         • what does this lead to?
           • anemia
   • reduced GI motility
     • leads to constipation or impaction
   • loss of sphincter tone
     • may cause incontinence
   • change in structure/function of pancreatic duct
     • decreases in lipase level
       • lipase is the enzyme for digestion and absorption of fat
   • decrease in liver cells
     • interferes with protein synthesis

2. Diagnostics

   • Liver function panel
     • AST
     • ALT
       • more specific to the liver than AST
     • ALP
     • LDH
   • CBC
     • anemia and infection
   • PT/PTT & Fibrinogen
     • help with clotting abnormalities
   • Pancreatic enzymes
     • lipase
       • rises within 24-48 hours after disease onset
         • remains elevated longer than amylase
     • amylase
       • rises within 12-24 hours after disease onset
         • remains elevated for 5 days
   • serum ammonia
     • elevated levels seen with severe end stage cirrhosis of the liver
       • why does this elevate with cirrhosis?
         • inability to filter blood & poisons in the blood
     • used to monitor hepatic encephalopathy

3. Diagnostic imaging studies

   • Upper GI series
     • Gastrografin or barium sulfate
       • r/o suspected perforation
         • use Gastrografin over barium sulfate
       • pre care
         • NPO 8 hrs
         • contrast medium allergies
       • post care
         • fluids
         • laxative
   • lower GI series

4. Endoscopic procedures

   • EGD, ERCP, COLONOSCOPY
     • pre care
       • NPO 8 hours excluding certain medications
       • Establish IV access
       • allergies? contrast medium
         • ERCP, EGD
       • cleanse bowel, go lytly
         • colonoscopy
     • post care
       • VS q 15-30
         • assess sedation levels
         • rectal bleeding?
           • colonoscopy
       • NPO until gag reflex returns
       • assist out of bed
     • complications of ERCP
       • pancreatitis or gallbladder inflammation

5. GI Procedures

   • liver biopsy
     • pre care
       • NPO 8 hr
         • obtain coagulation studies and baseline CBC
           • instruct pt on procedure
     • post care
       • VS q 15x2
         • q 30x4
           • q 1hrx4
       • rt side for 2 hours to splint puncture site
         • then flat for 12 hrs
       • assess puncture site for bleeding, pneumothorax, or infection
   • FOBT
   • paracentesis
     • pre care
       • pt needs to empty bladder
       • measure abdominal girth
       • obtain weight
       • baseline VS
     • post care
       • observe puncture site for bleeding drainage or inflammation
       • measure abdominal girth, weight, and VS to compare to baseline
       • monitor for hypotension due to amount of fluid removed
       • monitor serum protein and electrolyte levels. transfusion may be ordered

6. TPN/PPN

   • check physicians order with TPN new order must be written daily
   • Keep solution refrigerated until ready for use
   • Assess daily labs, monitor weights, I&O
     • blood sugars q 6 h with insulin coverage
   • tubing changed q 24 h
     • start and stop times are very important
   • if next bag is unavailable?
     • hang 10% or 20% dextrose
       • never increase IV rate to catch up TPN