10-day Course

GENITOURINARY &
GASTROINTESTINAL
SYSTEMS
TABLE OF CONTENTS:

I. GENITOURINARY SYSTEM
2 Functions of the Kidneys
3 Intravenous Pyelogram, Acute Renal Failure
4 Chronic Renal Failure, Dialysis
5 Disorders of the Nephrons, Nephritic Syndrome
6 Renal Calculi, ESWL, Benign Prostatic Hyperplasia
7 TURP, CBI, Stages of Burns
8 Burns, Fluid Resuscitation
9 Kidney Transplant, GUT Medications

II. GASTROINTESTINAL SYSTEM

9 Gastroesophageal Reflux Disease
10 Peptic Ulcer Disease, Gastric Surgery
11 Liver Cirrhosis
12 Cholelithiasis, Cholecystitis
13 Pancreatitis
14 Diverticular Disease, Liver Biopsy
15 Inflammatory Bowel Disease, Appendicitis
16 Gastrointestinal Medications

For any concerns you may have, please contact us:

Mobile: 323-866-0084 (9AM-5PM Central Time)

Scan this QR code with your
Email: contact@rachellallen.net
smartphone camera to go to the
Website live chat: www.rachellallen.com
Rachell Allen learning portal
Learning Portal: rachellallensuccess.com
 GUT-GIT

GENITOURINARY SYSTEM

FUNCTIONS OF THE KIDNEYS

B BP regulation – Renin Angiotensin Aldosterone System (RAAS)

BP REGULATION: THE Renin-Angiotensin-Aldosterone System (RAAS)

Bone formation – It synthesizes Vitamin D to maintain Calcium in the body

E Erythropoietin (hormone) – It stimulates bone marrow to produce RBC’s

Electrolytes – Potassium (K) and Sodium (Na)

A Acid Base balance “Homeostasis”

ACID – BASE BALANCE – to maintain homeostasis
The kidneys will EXCRETE H+ in response to a DECREASING blood pH
The kidneys will REABSORB H+ in response to an INCREASING blood pH

N Nitrogenous waste excretion

This Live Review Module and its content is a copyright of Rachell Allen - © RACHELL ALLEN PROFESSIONALS 2022. All rights reserved.
Any redistribution or reproduction of part or all of the contents in any form is prohibited. Serial No. 2022-GUT/GIT-Rachell Allen
2
 GUT-GIT
NEPHRONS – basic functional unit of the Kidney

INTRAVENOUS PYELOGRAM (IVP)

POSITION PRE POST COMPLICATION
SITE:
INCREASE ORAL FLUIDS
Consent (OFI)
- to eliminate dye or
Assess: contrast medium
(nephrotoxic)
NPO 6-8 hours
X-ray test which uses Iodine
Base contrast agent

DISORDERS OF THE KIDNEY

Causes of Renal Failure

Pre-Renal Intra-Renal Post-Renal
POOR PERFUSION WITHIN THE KIDNEYS OBSTRUCTION
Hypovolemia Acute glomerulonephritis(AGN) Prostate cancer
Dehydration/Shock/Burns Nephrotic syndrome BPH
Dysrhythmias Nephrotoxic drugs Renal calculi / stones

ACUTE RENAL FAILURE

OLIGURIC PHASE DIURETIC PHASE
Urine output: <400 ml/day = Inc USG
Normal Urine Output: 720 – 1500 ml/day

Diet: RECOVERY PHASE

___ Protein
Improvement in renal function
___ Potassium
Normal BUN & Creatinine
___ Sodium
Normal Urine output/hr : 30 cc/hr
___ Salt/Sodium substitute
Recovery can be achieved within 2 years

This Live Review Module and its content is a copyright of Rachell Allen - © RACHELL ALLEN PROFESSIONALS 2022. All rights reserved.
Any redistribution or reproduction of part or all of the contents in any form is prohibited. Serial No. 2022-GUT/GIT-Rachell Allen
3
 GUT-GIT
CHRONIC RENAL FAILURE

RENAL INSUFFICIENCY REDUCED RENAL RESERVE END STAGE RENAL DISEASE

Damage: 75% Damage: 75% -90% Damage: 90%-100%
Compensation: <25% Compensation: 10-25% Compensation: 0-10%
S/sx: ASYMPTOMATIC

MANIFESTATIONS MANAGEMENT
Blood pressure Fluid retention – Fluid overload Hypertension
Bones NO Vit D Decrease Calcium in the bone (brittle
bones) and Increase Phosphorus in the blood
Erythropoietin Dec. RBC production – Dec. Hemoglobin Anemia

Electrolytes Hyperkalemia ECG changes: Tall, peak T wave

Hypernatremia
Hypermagnesemia
Acid-base Hydrogen ion retention: Metabolic Acidosis
Nitrogenous waste Inc. BUN and Creatinine Azotemia
Uremic Frost

DIALYSIS – Removal of excessive fluid and waste products in the blood

HEMODIALYSIS PERITONEAL DIALYSIS

Permanent Access

AV Fistula AV Graft

PERFORMING THE EXCHANGE:

Temporary Access

INFUSION - 2L OF DIALYSATE SOLUTION (5-

Venous Catheter AV Shunt
10MINUTES)

DWELLING – TIME FOR THE SOLUTION TO STAY IN

THE PATIENTS PERITONEUM (30-45MINS)

DIALYSIS DISEQUILIBRIUM SYNDROME (DDS) TOO MUCH DWELLING:

- During the first few days of dialysis sessions
ANTIDOTE:
S/SX: Altered L.O.C. DRAINING - TIME FOR THE SOLUTION TO BE
Nausea & vomiting DRAINED OUT (10-30MINS)
Seizure
Restlessness TOO SLOW DRAINING:

If DDS happens:
This Live Review Module and its content is a copyright of Rachell Allen - © RACHELL ALLEN PROFESSIONALS 2022. All rights reserved.
Any redistribution or reproduction of part or all of the contents in any form is prohibited. Serial No. 2022-GUT/GIT-Rachell Allen
4
 GUT-GIT
DISORDERS OF THE NEPHRONS
NEPHROTIC Syndrome - Autoimmune
caused by damage to the clusters of small blood vessels in the kidneys that filter waste and excess water from the blood.

Damaged Glomerulus NOTE: Albumin promotes

oncotic pressure. Oncotic
pressure keeps the fluid
Loss of plasma proteins (Albumin) inside the vascular space.

Low Albumin
Medications:
Corticosteroids
Leads to the synthesis of Lipoproteins Atorvastatin
Diuretics
Decreased Oncotic Pressure
Albumin IV

NEPHRITIC Syndrome - Acute Glomerulonephritis

Common Causative Agent: Group A Beta Hemolytic Streptococcus (GABHS)
Inflammation of glomeruli due to an antigen-antibody reaction
Infection due to GABHS N – o urine

E – dema

Initial symptom: 2-3 weeks before the onset of other signs and symptoms P – allor

H – ypertension

Antigen – Antibody complexes – to initiate immune response R – ed brown urine

HEM(Hematuria)
Medications:
Corticosteroids I – ncreased USG
Trapped in the glomerulus
Antibiotics T – enderness in the flank
Diuretics
Antihypertensives I –increase BUN and Crea
Inflammation
S –ore throat

Calcium-oxalate stones Uric Acid Stones Struvite stones Cystine stones

Chocolate, Okra, Sweet potato Anchovies, Alcohol, Lentils, “Infection stones” Rare type
Spinach, Rhubarb, Rice bran, Legumes, Beer, Beans, Organ Associated with UTIs Due to excessively high
Almonds, Wheat berries, Corn meats, Yeast (Beer), Sardines, protein diet
grits (treated with alkali Salmon
process), Cocoa powder
Management: Management: Management: Management:
DIET DIET
Examples: Milk, green leafy Protein diet Protein diet
Examples: cranberry, corn, vegetables, and fruits EXCEPT Sodium diet Sodium diet
cheese, plums, prunes cranberry, corn, cheese plums,
prunes
This Live Review Module and its content is a copyright of Rachell Allen - © RACHELL ALLEN PROFESSIONALS 2022. All rights reserved.
Any redistribution or reproduction of part or all of the contents in any form is prohibited. Serial No. 2022-GUT/GIT-Rachell Allen
5
 GUT-GIT
RENAL CALCULI
NEPHROLITHIASIS UROLITHIASIS / URETEROLITHIASIS
Location: kidneys & renal pelvis Location: ureters

Stone formation

Calcium oxalate stones Obstruction Uric Acid stones

Flank pain – DOC: Weak urine stream COMPLICATIONS:

Decreased urine output

Strain to void
Hydronephrosis
- fluid stasis above the site of obstruction
Injury to the blood vessels
Urinary Tract Infection (UTI)

Hematuria

EXTRACORPOREAL SHOCKWAVE LITHOTRIPSY (ESWL)

- uses shockwave to break the stones in fragments
POSITION PRE POST COMPLICATION

Obstruction
NPO 6 – 8 hours
Supine Hydronephrosis
*Bright red urine
IV sedation *Bruising UTI

PAIN

BENIGN PROSTATIC HYPERPLASIA

RISK FACTORS: Enlarged prostate gland
MALE
AGE 50 Y.O AND ABOVE Obstructed urethra
DIHYDROTESTOSTERONE (DHT)
- male hormone which proliferates prostate cells Signs and Symptoms:

Dribbling urination
DIAGNOSTIC TEST:
1.Digital Rectal Exam (DRE)
Weak urine stream

LABORATORY CHECKS: Strain to void may cause injury to blood

1.Prostate Specific Antigen (PSA) – Normal: <4ng/ml vessels which can lead to hematuria
2.Erythrocyte Sedimentation Rate (ESR) Normal: 0-15mm/hr (male)
Urgency and Frequency

This Live Review Module and its content is a copyright of Rachell Allen - © RACHELL ALLEN PROFESSIONALS 2022. All rights reserved.
Any redistribution or reproduction of part or all of the contents in any form is prohibited. Serial No. 2022-GUT/GIT-Rachell Allen
6
 GUT-GIT
MANAGEMENT:

1. Saw Palmetto (herbal medication)

to improve urinary symptoms
2. Finasteride (Proscar)

3. Terazosin (Hytrin) – (Antihypertensive drug) to relax the muscles around the urethra
WOF: Hypotension
Check: Blood Pressure

4. Phenazopyridine (Pyridium) – Urinary Analgesic: to decrease pain upon urination

TRANSURETHRAL RESECTION OF THE PROSTATE (TURP)

- insertion of a resectoscope to remove obstructing prostate tissue
POSITION PRE POST COMPLICATIONS

NPO 6 – 8 hours CBI - Continuous Bladder Perforation

Irrigation
Lithotomy Gen. Anesthesia “Cystoclysis” Infection

Spinal Anesthesia Clot formation

CONTINUOUS BLADDER IRRIGATION (CBI) - is used to reduce the risk of clot formation and maintain indwelling urinary
catheter (IUC) patency by continuously irrigating the bladder via a 3-way catheter

INFLOW OUTFLOW BALLOON INFLATION

A specific rate is not prescribed, the nurse is

expected to adjust the irrigation flow so the urine
remains light pink, pinkish or amber

POINTS TO REMEMBER STAGES OF BURNS

ASSESSMENT
STAGE DEPTH

1 Epidermis
Dry, swelling, red
PARTIAL Superficial with pain
THICKNESS 2 Dermis
Deep most painful Red, white, with blister
Subcutaneous and
3
Adipose tissue Red, white, brown
Full thickness
FULL no pain
THICKNESS 4 Bones and muscles Black eschar, charred,
Deep thickness no pain no edema, dry

This Live Review Module and its content is a copyright of Rachell Allen - © RACHELL ALLEN PROFESSIONALS 2022. All rights reserved.
Any redistribution or reproduction of part or all of the contents in any form is prohibited. Serial No. 2022-GUT/GIT-Rachell Allen
7
 GUT-GIT
BURNS
PHASES OF BURNS
EMERGENT PHASE DIURETIC PHASE RECOVERY PHASE
“Shock Phase” Fluid shifts back to the blood PRIORITY: Wound care
Vital signs: vessels
Dec. Bp & Temp MANAGEMENT:
Inc. PR & RR 1. Analgesic: Morphine is
Hyponatremia INC KIDNEY
Narrowed pulse pressure given 30 mins prior
SODIUM EXCRETION & LOSS OF
Hyponatremia SODIUM 2. Prepare: sterile gloves and
SODIUM FROM WOUNDS
DEPLETION DUE TO sponge
DESTROYED TISSUES
3. Culture Sensitivity Test:
Hypokalemia DUE TO DIURESIS
Hyperkalemia MASSIVE TISSUE done to know the
NECROSIS & CELL LYSIS appropriate antibiotic to be
Hemodilution used
Hemoconcentration DUE TO
LOSS OF FLUID 4. Apply Silver sulfadiazine
ointment – to stop the
growth of bacteria

FLUID RESUSCITATION
BAXTER & PARKLAND METHOD

Total 24 hrs = TBSA X wt (Kg) X 4mL (constant)

First 8 hrs = 1/2 of the total
2nd 16 hrs = 1/2 of the total

Sample Computation:
Compute for the Total Fluid Requirement

Given: TBSA: 45%

Weight of the client: 50 kg
Computation: 45 x 50 x 4 = 9,000 Total 24 hours
4,500 First 8 hours
4, 500 2nd 16 hours

This Live Review Module and its content is a copyright of Rachell Allen - © RACHELL ALLEN PROFESSIONALS 2022. All rights reserved.
Any redistribution or reproduction of part or all of the contents in any form is prohibited. Serial No. 2022-GUT/GIT-Rachell Allen
8
 GUT-GIT

KIDNEY TRANSPLANT MEDICATIONS TO PREVENT REJECTION:

IMMUNOSUPPRESSANTS
SIGNS OF REJECTION:
G -raft tenderness (kidney) Cyclosporine (Sandimmune) – Do not take it with
R -ise in BP, BUN, Creatinine grapefruit juice (might cause toxicity) Chocolate milk
A -rapid weight gain due to fluid retention and orange juice okay
F -ever
T -emperature >37.8C / 100F Tacrolimus (Prograf)
Azathioprine (Imuran)
Prednisone (Deltasone)

GENITOURINARY MEDICATIONS
URINARY ANTI-INFECTIVES URINARY ANALGESIC ANTISPASMODIC CHOLINERGIC AGENTS
Methenamine (Hiprex, (PNS)
Mandelamine) Phenazopyridine Hyoscyamine (Cystospaz)
- Avoid milk (Pyridium) Tolterodine tartrate (Detrol) Bethanechol chloride
Oxybutynin chloride (Ditropan) (Urecholine)
Nalidixic acid (Negram -To decrease pain upon Flavoxate (Urispas)
Nitrofurantoin (Macrodantin) urination -Promotes urination
-Take it with meals -Increases bladder muscle tone
-Drug of choice for UTI -Turns the urine to red
-May cause red brown urine orange in color
Sulfisoxazole (Gantrisin)
-Avoid urine acidifying
substances
TMP-SMZ (Bactrim)

GASTROINTESTINAL SYSTEM
UPPER GI DISORDERS
GASTROESOPHAGEAL REFLUX DISEASE (GERD)
– Stomach contents leak toward the esophagus causing irritation
CAUSES: AGE, CAFFEINE, ALCOHOL, SMOKING, HOT AND SPICY FOODS and
HIATAL HERNIA - part of the stomach that sticks upward the hiatus (opening in the diaphragm)

Problems:
1. HCl acid back flow – Heart burn “Pyrosis” – burning sensation in the chest

2. Feeling of fullness – (bloated)

3. Nausea and vomiting – DOC: Antiemetics – Metoclopramide (Reglan)

Ondansetron (Zofran)

4. Dysphagia – (difficulty swallowing) Management: Thickened fluids

Assist the patient in flexing the neck to have control over
swallowing – to prevent aspiration
5. Ptyalism – excessive salivation Management: Oral care / chew sugarless gum or candy
This Live Review Module and its content is a copyright of Rachell Allen - © RACHELL ALLEN PROFESSIONALS 2022. All rights reserved.
Any redistribution or reproduction of part or all of the contents in any form is prohibited. Serial No. 2022-GUT/GIT-Rachell Allen
9
 GUT-GIT
PEPTIC ULCER DISEASE (PUD)
Commonly caused by: Helicobacter Pylori infection - Management: 2 Antibiotics

1 PPI
GASTRIC ULCER DUODENAL ULCER
Other causes: Long term use of NSAIDs Other causes: Zollinger Ellison syndrome (ZES)
- tumor in pancreas & small intestines

HCL acid production: normal or hyposecretion HCL acid production: hypersecretion

PAIN PAIN

RELIEVED: RELIEVED:

BLEEDING: BLEEDING:

Management: AVOID Caffeine - Chocolate

Alcohol – Antibiotic (E-mycin) Monitor: Hemoglobin & Hematocrit must be assessed
Smoking / Stress for bleeding tendencies.
Hot and spicy foods
Dairy products
(may worsen the patients the condition) Give: Antacids, H2 Receptor Blockers, Proton Pump
Inhibitors, Sucralfate, Cytotec (AHPSC)

COMPLICATION OF GASTRIC SURGERY

DUMPING SYNDROME PERNICIOUS ANEMIA
PROBLEM: Rapid gastric emptying – occurs when food PROBLEM: Lack of intrinsic factor resulting in Vitamin B12
moves from your stomach into your small bowel too deficiency
quickly.

Feeling of fullness – Give small frequent meals

Nausea and vomiting – DOC: Antiemetic
Increased peristalsis – Diarrhea may lead to dehydration

Undigested carbohydrate – Leads to an increased glucose

Pancreas releases insulin

Insulin causes Hypoglycemia

Diet: Fats and Proteins - longer to digest Clinical hallmark:

Carbohydrates - promotes rapid gastric emptying
Avoid: Diagnostic Test:

Position: During meals Management:

After meals

This Live Review Module and its content is a copyright of Rachell Allen - © RACHELL ALLEN PROFESSIONALS 2022. All rights reserved.
Any redistribution or reproduction of part or all of the contents in any form is prohibited. Serial No. 2022-GUT/GIT-Rachell Allen
10
 GUT-GIT
DISORDERS OF THE ACCESSORY ORGANS

LIVER CIRRHOSIS
Functions of the liver:
*Bile production Scarring of the liver tissues
-emulsification of fats
Liver tries to heal itself
*Vitamins A D E K absorption
*Synthesis of clotting factor Fibroids are formed (formation of connective tissues
*Making and storing glucose
leads to nodules, bumps and lumps in the liver)

Obstruction to the portal vein circulation

WHAT TO ASSESS: LIVER CIRRHOSIS
1. ALT – Alanine Transaminase Causing PORTAL HYPERTENSION
Men: 10-55 U/L
Women: 7-30 U/L COMPLICATIONS:
2. AST – Aspartate Transaminase Esophageal varices
Men: 10-40 U/L Ascites
Hepatic Encephalopathy
Women: 9-25 U/L
EARLY SIGNS AND SYMPTOMS:
Flu-like symptoms, Fever, Anorexia, Nausea, Vomiting

ESOPHAGEAL VARICES
Severe dilation of esophageal veins

Rupture

Bleeding

AVOID: straining, valsalva maneuver

coughing, sneezing,vomiting,
heavy weight lifting
wearing tight clothing

ASCITES
- Fluid accumulation in the peritoneum
PROCEDURE: Paracentesis – Removal of excessive fluid in the abdomen
Normal to drain at least 2-3 L/ doctor’s order
Before: Neomycin (Antibiotic prophylaxis) - to decrease GI bacteria to prevent infection
POSITION: Semi-fowler’s
During: Attach a BP cuff in the patients arm WOF: HYPOTENSION

GOAL: to relieve dyspnea

POST: Give Albumin IV (Plasma protein) to promote oncotic pressure (pulling force)

This Live Review Module and its content is a copyright of Rachell Allen - © RACHELL ALLEN PROFESSIONALS 2022. All rights reserved.
Any redistribution or reproduction of part or all of the contents in any form is prohibited. Serial No. 2022-GUT/GIT-Rachell Allen
11
 GUT-GIT
HEPATIC ENCEPHALOPATHY
- increased ammonia level in the blood
Hallmark sign: Asterixis (Liver flap) - is a neurological disorder that causes a person to lose motor
control of certain areas of the body. It commonly affects wrist and fingers.
Management:
1. Lactulose (Chronulac) - Osmotic Laxative
- To excrete ammonia via stool

2. Neomycin: Antibiotic prophylaxis – to decrease GI bacteria that produces ammonia

CHOLELITHIASIS

Obstruction in the

Bile obstruction Backflow of bile

__ serum bilirubin __ intestinal bile

____________ stool

urine

CHOLECYSTITIS

Inflamed Radiating pain NICE-TO-KNOW!

gallbladder Priority: Pain!
DOC:
• Meperidine (Demerol)
Fatty food BOAS sign Murphy’s sign • Ursodiol

SURGICAL MANAGEMENT:
_____ Pain CHOLECYSTECTOMY

- Laparotomy
- Open
Post-surgery: T-TUBE DRAIN
Normal: up to 1000 mL (24 hrs)

This Live Review Module and its content is a copyright of Rachell Allen - © RACHELL ALLEN PROFESSIONALS 2022. All rights reserved.
Any redistribution or reproduction of part or all of the contents in any form is prohibited. Serial No. 2022-GUT/GIT-Rachell Allen
12
 GUT-GIT
POINTS TO REMEMBER

Contrast
Procedure PRE- POST- COMPLICATION/S
Medium
“Radiographic”
x-ray examination which Anaphylactic reaction
uses a dye NPO 6-8
High Fowlers FOR BOTH:
UPPER GI SERIES Barium Upright
Esophagus Swallow Chalk-like stools due to use
Stomach 1-3 days: Bowel of Barium
Duodenum Preparation – clear fluids

LOWER GI SERIES Barium NPO 6-8 Management:

Colon Enema Left side lying 1. Increase Fluids
Sims position 2. Increase Fiber
3. Administer Laxative

“Scopy” Perforation
Direct visualization using
an endoscope
NPO 6-12 Wait for the gag reflex to
UPPER GI Local Anesthesia return
- Lidocaine (2-4 hours) – Avoid giving
EGD –Esophagogastro- Atropine -SNS food and fluids while Bleeding
duodenoscpy - Decreases mouth secretions waiting to prevent
Midazolam (Versed) aspiration.
- Anxiolytic/Sedative
- to calm the patient and
LOWER GI decrease anxiety
Colonoscopy
NPO 6 - 12 Shock
Cleansing enema 1 hour
Sigmoidoscopy before –for better
visualization

PANCREATITIS

Chronic pancreatitis – occurs after an episode of acute pancreatitis

Acute pancreatitis – sudden inflammation occurs over a short period of time
DOC FOR PAIN: Meperidine (Demerol)
• Steatorrhea due to malabsorption
• Hypocalcemia due to lipolysis (fat breakdown)
- leads to the production of calcium soap or immature Calcium
• Bleeding:
Cullen’s sign – bluish discoloration of the umbilicus
Turner’s sign – bluish discoloration of the flank
This Live Review Module and its content is a copyright of Rachell Allen - © RACHELL ALLEN PROFESSIONALS 2022. All rights reserved.
Any redistribution or reproduction of part or all of the contents in any form is prohibited. Serial No. 2022-GUT/GIT-Rachell Allen
13
 GUT-GIT
DIET: High carbohydrates, Low proteins, Low fats

PANCREATIC ENZYMES: SERUM LIPASE : 12-70 U/L SERUM AMYLASE: 25-125 U/L
SERUM TRYPSIN (has no known lab value)
Patients with pancreatitis will have elevated pancreatic enzymes in the blood.
Supply the patients with pancreatic enzymes since the pancreas does not produce sufficient enzymes needed to
break down food.
Examples:
Pancrealipase Note: Given with all meals and snacks
Pancreatin Do not hold the medication in the mouth for a length of time, it
may begin to digest the mucous membranes and cause irritation

DIAGNOSTIC TEST: Endoscopic Retrograde Cholangiopancreatography (ERCP)

- Visualization of the common bile duct, pancreas and gallbladder using an endoscope and contrast medium

DIVERTICULAR DISEASE
DIVERTICULOSIS DIVERTICULITIS
THERE IS AN OUTPOUCHING IN THE MUCOSA AND THE OUTPOUCHING MUCOSA (Diverticulosis)
SUBMUCOSAL LAYERS OF THE COLON WHICH CAUSES BECOMES IRRITATED WHICH CAUSES INFLAMMATION
HIGH INTRALUMINAL PRESSURE

CAUSES: Acute attack: NPO

Meat (increased intake)
Age (colon gets weak) Signs and symptoms:
Low fiber diet Cramps, LLQ pain, diarrhea, fever
Trapped foods (solid particles)
Treatment: Colostomy
Diet: High Fiber diet
Increase oral fluid intake Management: Bowel rest
Avoid milk TPN / NGT
Complete bed rest without bowel movement
Asymptomatic (CBC)
Goal: avoid constipation
Diagnostic test: Colonoscopy, Barium enema
CT-scan most accurate

LIVER BIOPSY

Removal of a small liver tissue to detect the presence of damage or a disease.

PRE-PROCEDURE: Assess Prothrombin Time (PT) (for bleeding)
DURING: Supine with the right hand under the head or
Left side lying
PROCEDURE: Inhale, Exhale and hold breath for 5-10 secs to prevent puncturing the lungs
AFTER: Right side lying
Put pressure to prevent bleeding

This Live Review Module and its content is a copyright of Rachell Allen - © RACHELL ALLEN PROFESSIONALS 2022. All rights reserved.
Any redistribution or reproduction of part or all of the contents in any form is prohibited. Serial No. 2022-GUT/GIT-Rachell Allen
14
 GUT-GIT
INFLAMMATORY BOWEL DISEASE (IBD)

CROHN’S DISEASE
Comparison ULCERATIVE COLITIS
(Regional Enteritis)

LOCATION SMALL & LARGE INTESTINES LARGE INTESTINES

Presenting s/sx FISTULA ULCERATION

Common Site ILEUM RECTAL

Stools per day 5-6 x per day 10-20 x per day

Cancer Potential COLON CANCER COLON CANCER

HEMATOCHEZIA
Bleeding NO BLEEDING
(Fresh blood in stool)
Avoid oily, fatty, hot and spicy foods
Diet for both:
Dec. fiber, low residue, BRAT

Management for Inflammatory Bowel Disease: Prone to: Dehydration

1. Corticosteroids 3. Antidiarrheals
2. Neomycin 4. Sulfasalazine
AVOID ATROPINE - may cause toxic megacolon

APPENDICITIS

Trapped fecalith

Infection

Fever, Increased WBC Inflammation

RLQ Pain Sudden relief of pain

Rebound tenderness Radiating pain Abdominal guarding Rupture

Assess for: Psoa’s sign Note: Avoid the use of heating pad
Rovsing’s sign Do not give pain medication
Markle’s sign Keep the patient on NPO
Management: Appendectomy WOF: Rupture

This Live Review Module and its content is a copyright of Rachell Allen - © RACHELL ALLEN PROFESSIONALS 2022. All rights reserved.
Any redistribution or reproduction of part or all of the contents in any form is prohibited. Serial No. 2022-GUT/GIT-Rachell Allen
15
 GUT-GIT

GASTROINTESTINAL MEDICATIONS

BEST TIME
MEDICATIONS ACTION EXAMPLES SIDE EFFECTS
TO TAKE
ANTACIDS
Neutralizes the 1-3 hours Aluminum Hydroxide Constipation
acid after meals (Amphojel)
Magnesium Hydroxide Diarrhea
A
(Milk of Magnesia)
Maalox and Mylanta (Al. H
and Mg. H)
H2 RECEPTOR
BLOCKERS Decreases the Cimetidine (Tagamet)

“TIDINE” acid production With meals - Crosses blood brain S/E:

barrier V. A. N. D. A.
- Gynecomastia
H - Dec. Libido A/E:
- Impotence Psychosis
Mental confusion
Ranitidine (Zantac)
Famotidine (Pepcid)

PROTON PUMP
INHIBITORS (PPI)
Decreases the Before meals Pantoprazole (Protonix)
acid production Omeprazole (Prilosec)
“PRAZOLE”
*Never crush Lansoprazole (Prevacid) V. A. N. D. A.
or chew the Esomeprazole (Nexium)
P
tablet
*applesauce
can be used
SUCRALFATE Sucralfate
S Coats the ulcer Before meals (Carafate) Constipation

CYTOTEC Increases Cytotec Abortion

C mucous lining With meals (Misoprostol) Birth defects
protection

This Live Review Module and its content is a copyright of Rachell Allen - © RACHELL ALLEN PROFESSIONALS 2022. All rights reserved.
Any redistribution or reproduction of part or all of the contents in any form is prohibited. Serial No. 2022-GUT/GIT-Rachell Allen
16