Mind map
2. GI Disorders
Map content
2. GI Disorders
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
- what does this lead to?
- less absorption of iron and cobalamin (vitamin B12) and rise in bacterial growth
- decreased production of hydrochloric acid
- 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
- decreases in lipase level
- decrease in liver cells
- interferes with protein synthesis
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
- rises within 24-48 hours after disease onset
- amylase
- rises within 12-24 hours after disease onset
- remains elevated for 5 days
- rises within 12-24 hours after disease onset
- lipase
- 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
- why does this elevate with cirrhosis?
- used to monitor hepatic encephalopathy
- elevated levels seen with severe end stage cirrhosis of the liver
- Liver function panel
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
- r/o suspected perforation
- Gastrografin or barium sulfate
- lower GI series
- Upper GI series
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
- VS q 15-30
- complications of ERCP
- pancreatitis or gallbladder inflammation
- pre care
- EGD, ERCP, COLONOSCOPY
GI Procedures
- liver biopsy
- pre care
- NPO 8 hr
- obtain coagulation studies and baseline CBC
- instruct pt on procedure
- obtain coagulation studies and baseline CBC
- NPO 8 hr
- post care
- VS q 15x2
- q 30x4
- q 1hrx4
- q 30x4
- rt side for 2 hours to splint puncture site
- then flat for 12 hrs
- assess puncture site for bleeding, pneumothorax, or infection
- VS q 15x2
- pre care
- 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
- pre care
- liver biopsy
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
- hang 10% or 20% dextrose