IX.

GASTROINTESTINAL
A. Pancreatitis:
1. Pathophysiology:
a. The pancreas has two separate functions:
1) Endocrine- INSULIN
2) Exocrine- DIGESTIVE enzymes
b. Two types of pancreatitis:
1) Acute: #1 cause = ALCOHOL
#2 cause = gallbladder disease
2) Chronic: #1 cause = PANCREATITIS
2. S/S:
a. Pain- Does the pain increase or decrease with
eating? INCREASE
b. Abdominal distention/ascites (losing protein
rich fluids like enzymes and blood
into the abdomen) ascites
c. Abdominal mass- swollen PANCREAS
d. Rigid board-like abdomen (guarded)
What does it mean? PERITONITIS
e. Bruising around umbilical area CULLEN sign;
flank area GREY TURNERS sign.
f. Fever (inflammation)
g. N/V
h. Jaundice
i. Hypotension = BLEEDING or ASCITIS
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3. Dx:
a. Serum lipase and amylase INCREASE
b. WBCs INCREASE
c. Blood sugar INCREASE
d. ALT, AST-liver enzymes INCREASE
e. PT, PTT PROLONGED. (BLEEDING)
f. Serum bilirubin INCREASE
g. H/H (Hemoglobin & Hematocrit) UP or
DOWN
Why down BLEEDING , up
DEHYDRATED.
***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 (KEEP NPO, NGT
to suction, bed rest)
Want the stomach empty and dry
2) Pain Medications:
PCA narcotics morphine sulfate(Morphine),
hydromorphone
(Dilaudid)
Fentanyl patches
3) Steroids, why? DECREASE
INFLAMMATION
4) Anticholinergics, why? DRY UP THE
STOMACH ACIDS

Benzotropine
(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) Insulin WHY?
PANCREAS IS SICK
STEROIDS MAKE IT GO UP
GETTING A TPN
Normal Lab Values
AST=8-40 U/L
ALT= 10-30 U/L
Normal Lab
Values
Hemoglobin:
Male: 14-18 g/dl
Female: 12-16
g/dl
Hematocrit:
Male: 40-54%
Female: 38-47%
Normal Lab Values
Amylase: 45-200 U/L (dye)
Lipase: 0-110 U/L
*TESTING STRATEGY*
Pancreas client = Keep stomach empty and dry.
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11) Daily weights
12) Eliminate alcohol
13) Refer to AA if this is the cause.
B. Cirrhosis:
Liver DETOXIFYING the body.
Helps your blood to CLOT
The liver helps to metabolize (break down)
DRUGS, DECREASE THE DOSE. NEVER
GIVE ASPIRIN.
The liver synthesizes ALBUMIN
1. Pathophysiology:
Liver cells are destroyed and are replaced
with connective/scar tissue alters the
CIRCULATION within the liver the BP in the
liver goes UP, this is called
portal HYPERTENTION
2. S/S:
a. FIRM, nodular liver
b. Abdominal pain liver capsule has stretched
c. Chronic dyspepsia (GI upset)
d. Change in BOWEL habits
e. Ascites
f. Splenomegaly

g. DECREASED serum albumin HOLD ON

THE FLUID IN THE VASCULAR SPACE
h. INCREASED ALT & AST LIVER
ENZYMES
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 127
3. Dx:
a. Ultrasound
b. CT, MRI
c. Liver biopsy
Clotting studies pre- PT and PTT