IX. GASTROINTESTINAL A. Pancreatitis: 1. Pathophysiology: a. The pancreas has two separate functions: 1) Endocrine-_____

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IX. GASTROINTESTINAL A. Pancreatitis: 1. Pathophysiology: a. The
pancreas has two separate functions: 1) Endocrine-_______________
2) Exocrine-_______________ enzymes b. Two types of pancreatitis:
1) Acute: #1 cause = ________________ #2 cause = gallbladder
disease 2) Chronic: #1 cause = ______________ 2. S/S: a. Pain- Does
the pain increase or decrease with eating? ___________________ b.
Abdominal distention/ascites (losing protein rich fluids like
enzymes and blood into the abdomen) → ascites c.
Abdominalmass-swollen___________________________ d. Rigid
board-like abdomen (guarding or bleeding)  What does it mean?
________________________________ e.
Bruisingaroundumbilicalarea____________sign;flankareaGrayTurner’ssign.
f. Fever (inflammation) g. N/V h. Jaundice i. Hypotension
=_______________or ________________ Hurst Review Services Copyright
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release by Hurst Review Services. 123 Gastrointestinal Normal Lab
Values Amylase: 45-200 U/L (dye) Lipase: 0-110 U/L Normal Lab
Values AST=8-40 U/L ALT= 10-30 U/L Normal Lab V alues Hemoglobin:
Male: 14-18 g/dl Female: 12-16 g/dl Hematocrit: Male: 40-54%
Female: 38-47% *TESTING STRATEGY* Pancreas client = Keep stomach
empty and dry. Copyright protected. Reproduction prohibited without
authorization and release by Hurst Review Services. Hurst Review
Services 124 3. Dx: a. Serum lipase and amylase _______ b. WBC’s
__________ c. Bloodsugar______________ d. ALT, AST-liver enzymes
_______ e. PT, PTT___________________ f. Serum bilirubin ______ g.
H/H (Hemoglobin & Hematocrit) ____________ or ___________  Why
down _________________, up ____________________. ***Please note
that all normal ranges for blood test depend on the lab performing
the test. The values listed in this book are only to be used as a
reference. 4. Tx: a. Goal: Control pain 1) Decrease gastric
secretions (___________, NGT to suction, bed rest)  Want the
stomach empty and dry 2) Pain Medications:  PCA narcotics morphine
sulfate(Morphine®), hydromorphone (Dilaudid®)  Fentanyl
patches(Duragesic®) 3) Steroids, why?
__________________________________ 4) Anticholinergics, why?
_____________________  Benztropine (Cogentin®),
Diphenoxylate/Atropine (Lonox®) 5) Pantoprazole (Protonix®) (proton
pump inhibitor) 6) Ranitidine HCI (Zantac®), Famotidine (Pepcid®)
(H2 receptor antagonist) 7) Antacids 8) Maintain fluid and
electrolyte balance 9) Maintain nutritional status → ease into a
diet 10) InsulinWHY?  __________________________ 
__________________________  __________________________
Gastrointestinal 11) Dailyweights 12) Eliminatealcohol 13)
RefertoAAifthisisthecause. B. Cirrhosis:  Liver ________________
the body.  Helps your blood to __________________  The liver
helps to metabolize (break down) ____________.  The liver
synthesizes __________________ 1. Pathophysiology:  Liver cells
are destroyed and are replaced with connective/scar tissue→ alters
the ______________within the liver→ the BP in the liver goes _____,
this is called portal ____________. 2. S/S: a. ___________, nodular
liver b. Abdominal pain – liver capsule has stretched c.
Chronicdyspepsia(GIupset) d. Change in _____________ habits e.
Ascites f. Splenomegaly g. _________________ serum albumin h.
_________________ ALT & AST i. Anemia j. Can progress to
hepatic encephalopathy/coma *TESTING STRATEGY* If your liver is
sick your #1 concern = Bleeding. *TESTING STRATEGY* Never give
Tylenol to liver people. *TESTING STRATEGY* When spleen is enlarged
the immune system is involved. Hurst Review Services Copyright
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release by Hurst Review Services. 125 Gastrointestinal *TESTING
STRATEGY* Anytime you are pulling fluids→ throw them into shock.
Copyright protected. Reproduction prohibited without authorization
and release by Hurst Review Services. Hurst Review Services 126 3.
Dx: a. Ultrasound b. CT, MRI c. Liver biopsy  Clotting studies
pre- PT and PTT  Vital signs pre-procedure  How do you position
this client? ________________________  Exhale and hold
_____________________ Why? To get the _________________out of the
way.  Post: Lie on _____________ side Vital signs, worried about
______________________________. 4. Tx: a. Antacids, vitamins,
diuretics b. No more ______________ (don’t need more damage) c.
I&Oanddaily____________(Anytimeyouhaveascitesyouhaveafluid
volume problem) d. Rest e. Preventbleeding(bleedingprecautions) f.
Measure abdominal girth, why? ___________________________________
g. Paracentesis:  Removal of fluid from the __________________
cavity (ascites)  Have client void  Position
____________________________  changes/motor problems b. Difficult
to ______________ c.