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GI DISORDERS Cheat Sheet (DRAFT) by

GI DISORDERS WITH CRITICALLY ILL PATIENTS

This is a draft cheat sheet. It is a work in progress and is not finished yet.

ACUTE LIVER FAILURE

Sudden and severe liver cell dysfun­ction, coagul­abi­lity, and hepatic enceph­alo­pathy
Causes: infect­ions, toxins, drug use, medication toxicity, poisoning, hypope­rfu­sion, metabolic disorders, surgery
High mortality
DIAGNOSING ACUTE LIVER FAILURE
EARLY RECOGN­ITION IS KEY!
Signs/­Sym­ptoms: headache, jaundi­ce,­changes in mental status, bruising, bleeding, palmar erythema, elevated bilirubin, ammonia, decreased albumin, prothr­ombin time is elevated and plasmin and platelets are decreased
HEPATIC ENCEPH­ALO­PATHY STAGES
I. Euphoria vs depres­sion, mild confusion, slurred speech, disordered sleep, slight asterixis, normal EEG
II.Let­hargy, moderate confusion, marked asterixis, abnormal EEG
III.Marked confusion, incoherent speech, sleepy but arousable, asterixis present, abnormal EEG
IV.Coma, responsive then nonres­ponsive to painful stimuli, asterixis absent, abnormal EEG
MANAGEMENT FOR ACUTE LIVER FAILURE
Antibi­otic: neomycin, metron­ida­zol­e,r­ifa­ximin Lactulose Prevent bleeding with vitamin K, FFP, platelets Monitor for infection Protect patient from injury Monitor for compli­cation Education
SURGICAL MANAGE­MENT: Esopha­gectomy Pancre­ati­cod­uod­ene­ctomy, Endoscopic variceal litiga­tion, Endoscopic injection therapy, Trans jugular intrah­epatic portos­ystemic shunt procedure
PHARMA­COL­OGICAL TREATMENT
Antacids, PPIs, H2 antago­nist, Sucral­fate, Vasopr­essin, Octreatide

ACUTE GI HEMORRHAGE

CLINICAL MANIFE­STA­TIONS
ASSESSMENT FINDINGS AND DIAGNOSIS FOR GI BLEED
MEDICAL MANAGEMENT FOR GI BLEED
Stress related mucosal disease: seen a lot because increase acid, decreased mucosal flow
Melena: digestion of blood from upper GI bleed (purplish red clotty blood)
Maintain Airway, Fluid Resusc­itation
Bleeding in upper or lower GI tract
Hemate­mesis: vomit blood(­coffee ground or bright red)
Any patients in ICU at risk
Peptic ulcer disease
Hemato­chezia: blood in the stool lower GI bleed
Administer prophy­lactic medica­tions: PPIs, Histamine 2 antagonist
Esophageal varices: blood vessels in esophagus increase in size and rupture (cirrh­osis)
Hbg and Hct is not going to determine bleeding, severity will based off patient
Determine cause of bleeding, control and stop bleeding

ABDOMINAL TRAUMA

Often associated with multisytem trauma
Blunt or penetr­ating
PHYSICAL ASSESSMENT AND DIAGNOSIS
Abdominal disten­tion, Cullen Sign, Grey-T­urner sign, hypoactive or absent bowel sounds, rebound tender­ness, Kerrs sign, entry/exit wounds
Focused assess­ment, CT scans, abdominal x-rays, peritoneal lavage
COMPLI­CATIONS
Abdominal compar­tment syndrome
Increased pressure causes decreased blood flow leading to ischemia and necrosis
Decreased CO, decreased UOP,hy­poxia
May need to leave abdomen open after surgery to prevent occurence
Live Injuries
Hemorrhage is very common
Often hemody­nam­ically unstable
Jaundice, coagul­opathy, acidosis, hypthermia contribute
Spleen Injuries
Sometimes hemody­nam­ically unstable
Often attempt to embolize instead of remove spleen
Patients with splene­ctomy at high risk for infection
Hollow viscus Injuries
Stomach, Small and Large Intestine
Often hard to see/di­agnosis
Can lead to perito­nitis
Kidney Injuries
May see flank ecchymosis
May see gross or micros­copic hematuria
Bladder Injuries
Usually because of pelvic fractures
Patients complain of difficulty or inability to void
Conser­vative treatment is cathet­eri­zation and antibi­otics
Pelvic Fractures
High mortality due to large area that is highly vascular
Can be stable or unstable
May indicate more severe injuries such as SCI

ACUTE PANCRE­ATITIS

CLINICAL MANIFE­STA­TIONS
ASSESSMENT FINDINGS
DIAGNO­STICS
MANAGEMENT
Acute Inflam­mation that produces exocrine and endocrine dysfun­ction that may also involve surrou­nding tissues
Pain, N/V, fever, guarding of abdomen
Labs:a­mylase, lipase­,c-­rea­ctive protein, WBC, decreased calciu­m,b­ili­rubin high, decreased albumin
Replace fluid volume loss/s­hifts, closely monitor electr­oly­tes­/gl­ucose levels
80% have edematous inters­titial pancre­atitis (less severe)
Hypovo­lemic shock, absent bowel sounds, grey turner's sign
Abdominal ultrasound of gallstones
Monitoring compli­cat­ions, using NGT only if patient has vomiting, obstru­ction, or severe gastric distention
20% have necrot­izing pancre­atitis (more severe)
Jaundice, ascites, Cullen's signs, abdominal mass
CT scan for inflam­mat­ory­/ne­crosis
Provide emotional support and education, Nutrit­ional support