2. GI Disorders

Age related changes
1. poor dentures
2. decreased sense of taste
3. Atrophy of gastric mucosa
  1. decreased production of hydrochloric acid
    1. less absorption of iron and cobalamin (vitamin B12) and rise in bacterial growth
      1. what does this lead to?
        anemia
4. reduced GI motility
  1. leads to constipation or impaction
5. loss of sphincter tone
  1. may cause incontinence
6. change in structure/function of pancreatic duct
  1. decreases in lipase level
    1. lipase is the enzyme for digestion and absorption of fat
7. decrease in liver cells
  1. interferes with protein synthesis
Diagnostics
1. Liver function panel
  1. AST
  2. ALT
    1. more specific to the liver than AST
  3. ALP
  4. LDH
2. CBC
  1. anemia and infection
3. PT/PTT & Fibrinogen
  1. help with clotting abnormalities
4. Pancreatic enzymes
  1. lipase
    1. rises within 24-48 hours after disease onset
      1. remains elevated longer than amylase
  2. amylase
    1. rises within 12-24 hours after disease onset
      1. remains elevated for 5 days
5. serum ammonia
  1. elevated levels seen with severe end stage cirrhosis of the liver
    1. why does this elevate with cirrhosis?
      1. inability to filter blood & poisons in the blood
  2. used to monitor hepatic encephalopathy
Diagnostic imaging studies
1. Upper GI series
  1. Gastrografin or barium sulfate
    1. r/o suspected perforation
      1. use Gastrografin over barium sulfate
    2. pre care
      1. NPO 8 hrs
      2. contrast medium allergies
    3. post care
      1. fluids
      2. laxative
2. lower GI series
Endoscopic procedures
1. EGD, ERCP, COLONOSCOPY
  1. pre care
    1. NPO 8 hours excluding certain medications
    2. Establish IV access
    3. allergies? contrast medium
      1. ERCP, EGD
    4. cleanse bowel, go lytly
      1. colonoscopy
  2. post care
    1. VS q 15-30
      1. assess sedation levels
      2. rectal bleeding?
        colonoscopy
    2. NPO until gag reflex returns
    3. assist out of bed
  3. complications of ERCP
    1. pancreatitis or gallbladder inflammation
GI Procedures
1. liver biopsy
  1. pre care
    1. NPO 8 hr
      1. obtain coagulation studies and baseline CBC
        instruct pt on procedure
  2. post care
    1. VS q 15x2
      1. q 30x4
        q 1hrx4
    2. rt side for 2 hours to splint puncture site
      1. then flat for 12 hrs
    3. assess puncture site for bleeding, pneumothorax, or infection
2. FOBT
3. paracentesis
  1. pre care
    1. pt needs to empty bladder
    2. measure abdominal girth
    3. obtain weight
    4. baseline VS
  2. post care
    1. observe puncture site for bleeding drainage or inflammation
    2. measure abdominal girth, weight, and VS to compare to baseline
    3. monitor for hypotension due to amount of fluid removed
    4. monitor serum protein and electrolyte levels. transfusion may be ordered
TPN/PPN
1. check physicians order with TPN new order must be written daily
2. Keep solution refrigerated until ready for use
3. Assess daily labs, monitor weights, I&O
  1. blood sugars q 6 h with insulin coverage
4. tubing changed q 24 h
  1. start and stop times are very important
5. if next bag is unavailable?
  1. hang 10% or 20% dextrose
    1. never increase IV rate to catch up TPN

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2. GI Disorders

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