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Reviews common gastrointestinal diagnostic tests, including stool studies, barium enema, colonoscopy, and IV contrast precautions. Also explains when consent is needed and why kidney function and iodine allergies matter.
okay you seen my screen yeah all right so this is what we're focusing on gastrointestinal disorder now we did cover like i said all of these the diagnostic tests can just take a look at these and tell meif you have any question piccolo blood test this is this tool for guyak this is also what we call the fit test the ecole guard um this we use annually part of the annual physical to check for coloncancerand um the lower gi series the barium enema this is the one you just did the question for this one patient needs to be npo they need to have a clean bowel so they need to have bowel prepum they also needs to um after they the test they need to drink a lot of fluid and they're going to take laxative because we need the barium to come out because they don't get they need to have
a large amount of watery um stool they still need to look like the barrier the barium looks like chalk so they still need to for about a 24 hour day they need to be getting all that out becauseif it doesn't come out if they're not having bowel movement then they can get going to obstruction so they so we may give them a laxative um to help get that stool out and again stress the importance ofincreasing the fluid intake colonoscopy this one is usually um for colon cancer screening starting at age 50 and it's done every 10 years or we use it for you know to diagnose conditions where they patient may have likegi bleed uh history of irritable bowel syndrome colonoscopy requires a prep and it's invasive so they need consent oh question does the barium enema because i saw it in the in the question they're going to have chalky stools
yes okay it's like the barium that they're drinking looks like protein shake no the chalky protein shake like about the vanillas type one yeah and then it comes out like that just like just the same thing same wayyou drink it same way comes out any kind of shiny you know um but it comes out just like you just like the way it goes in and it's supposed to come out that way you want to seethat otherwise it can cause obstruction now the bad this barium enema this this type of um barium this type this does not affect the kidneys so you wouldn't you do not need it you do not need consent forbarium enema because they're drinking this thing and we're taking pictures so it's nothing invasive going on
colonoscopy and that's going to be sigmoidoscopy all those athletes require consent because it's invasive and you're going to be sedated in the patient and what did i say about when do we need consent do you remember the occasionswhen we need consent again um when it's invasive
was iv one of them invasive iv contrasts yes or you sedate in the patient yes very good now anytime you get these questions on ncx and they're asking you what is the test do what is it what arethey assessing for if you just read out this long drawn out stuff and then you go with that cholangio pancreatography so it's the colon and once you see collage we're talking about gallbladder pancreas the pancreas and the graffitiis you know we take taking pictures and we're using a dye so they're injecting once you see graphy grams and graphene means we're injecting a dye and we're taking pictures so these iv contrasts gonna be used graphic gramiv contrast so make sure your kidneys are working okay the u.n creatinine is okayand no allergies to iodine or shellfish
Covers peptic ulcer disease, its major risk factors, and treatment for H. pylori infection. Then shifts to GERD and related lifestyle changes such as meal timing, trigger avoidance, and head elevation.
okay so let's go into disorders of the stomach first um first thing let's look at the stomach so let's talk about peptic ulcer disease pud peptic ulcer disease um it could be stomach also or the one also nowwe're not in nursing school so we're just going to keep it on peptic also you don't need to know the difference with our stomach or duodenum peptic ulcer let's talk about the risk um what what are the causeswhat are the causes of peptic ulcer being overweightdrinking too much caffeine alcoholspicy food what about stress stress big one absolutely stress ulcer and the number one cause it's h pylori bacteria remember that hvalori stuff yeah so that thing exists and it's slayed dormant and most people don't even know they'reinfected with h pylori h pylori is from having eaten stale food and water most common in developing countries but they get it here in america too because people eat all food they go out and they buy food and
the food is there for a long time and they eat it and plus even at home you know especially like your older people are socioeconomically people they'll turn up their refrigerator to normal temperature and the food is youknow it's there in the refrigerator and they can grow bacteria so it's usually contaminated food or water can cause h pylori and h my lorry like i said you'll be infected and you have no idea until later onyou start having symptoms of gerd or incidentally you have in um a test for something else like an endoscopy or something and they found that you are positive for h pylori now h pylori must be treated because notonly is it or the number one cause of peptic ulcer disease it's also the number one cause of stomach cancer
besides when it comes to cancer the most common cause of cancer is old age but you know outside that is as you get older your risk of cancer goes up but h pylori can cause stomach cancer so itmust be treated now here's a must know for nclex how do you treat h pylori once diagnosed treatment is usually two antibiotics and one ppi or two antibiotics always or a one h2 receptor so clarity of icing amoxicillinwhatever they choose to use and omeprazole or the same claritum acid amoxicillin and the methadine which is pepcid but always to at least two antibiotics
you said two two antibiotics and one antagonist so the antacid could be a ppi proton pump inhibitor or h2 receptor blocker and there sometimes they even use um malox but it must be two antibiotics because of bacteria
and treatment lasts 14 days so they'll be on this foot for the so we do something called a prev pack the prep pack in there is stick it comes pre you know pre pre-packet with two antibiotics and usuallyif the uh is a ppi it's a meprazole that's in that prep pack it's a little bit more expensive but insurance covers it but if you don't have insurance and you're paying out of pocket the doctor will orderit separately because you can you know go to like walmart and buy medication cheaper 14 days and then after the 14 days they wait about a week or so and repeat the the test now we don't have todo a colonoscopy again to check for h pylori we can do what's called the breaths test but you can also check it in the stool the breath test is the patient goes to the lab and they give them
something citric to drink and they wait a few minutes and then they breathe into like a balloon little they blow something up it's because they need your breath and then they check it that way
if it's not negative then they'll continue the treatment a little longer because we want it to we want to eradicate it because if we don't eradicate it i told you it can lead to stomach cancer as far aspeptic ulcer disease skeptic ulcer disease it's an ulcer in the stomach and stress yes so the patient will have symptoms of gerd similar to birds so they'll complain of you know pain after they eat um they'll complain ofindigestion they'll complain of regurgitation um you know they bring in back up stuff some that sometimes they can say the pain it made epigastric like streak right there in their stomach and it could radiate to their back
so they you know your nursing intervention first you want to tell this patient to number one eat small frequent meal because uh a large meal is going to aggravate it and not eating at all is gonna make thehydrochloric acid bubble up more in your stomach and worsen the condition so eat you know six to eight little servants throughout the day just you know snack on something do not eat late stop your last meal should beif you go to bed at ten o'clock your last meal should be three hours before you go to bed so stop at seven so no late night eating no late night snacking avoid alcohol now avoid it because alcoholwill aggravate it smoking smoking is also another risk factor stop smoking
if they're overweight or i should say if they're obese lose weight
that will helpbut remember you're small and avoid your triggers they know they trigger so some people say i can't drink coffee because coffee is a trick i can't eat chocolate chocolate is my trigger anything that's spicy and irritating to thestomach avoid it so know your triggers and avoid your triggerssleep with the head of the bed elevated on several pillars or a six inch block so prop prop up your head because you you're less likely to regurgitate when you're sitting you sleep more in like a semi powerlessposition
bird is similar gastroesophageal reflux disease it's very similar to it except in this case they don't have a ulcer they just have reflux and this is usually um secondary to other things could be for myel hernia could bejust from being um from too much pressure in the stomach area and then obesity can cause that i'm certain food can trigger that so again know your triggers and avoid your triggers
Explains ulcer perforation warning signs and when shoulder pain is concerning versus expected after laparoscopic surgery. Then discusses partial gastrectomy, dumping syndrome, and vitamin B12 deficiency leading to pernicious anemia.
we'll go into the medications after we complete all of this the h2 receptor blockers and the ppis and the you know like just did the regular antacid like male ox mylanta caraphates and and so on and so forthany question on the stomach disorder no okay that's it now if there are some um you know cases where the patient with a situation may go on where they may develop ulcer and also may perforate perforation of theulcer these are the type of symptoms you will get a severe um piercing or abrupt mid epigastric pain that radiates to the back and the shoulder the shoulder yes scapular
now this is the must know this is the nclex moment pain radiating to the shoulder though with bad something bad is going on it's damage to the phrenic nerve and something perforated that's why we haven't pain to theshoulder the only time pain to the shoulder does not require you going oh my god this is bad is if they post up laparoscopic surgery like if they let's say they have laparoscopic cold cholecystectomy laparoscopic appendectomy exploratory labbecause usually for laparoscopic procedures they need to put poke holes and blow up the abdominal cavity with some carbon dioxide and then they need to in order to see what's going on in there and post and after thatall that gas that they put in your abdominal cavity have to go somewhere so that will radiate to the shoulder so that's the only time you wouldn't go oh oh this is not good i need to notify the
provider because the patient is out of shoulder pain if if they post laparoscopic procedure but any other time you don't want to see shoulder painpain radiating to the shoulder because remember even mi could radiate to the shoulder yeah yeah so anytime you see that you should go the bells should go off and go this is not good so if they you knowit's patient perforated it also is so bad they can't heal it medication can't fix it or a worst case scenario patient had gastric cancer and then we have to move to surgery we can do gastrectomy partial gastrectomy ortotal gastrectomy do you remember this thing called bill roth one and bill ward two in nursing school it's just it's basically what it is is um depending on this the situation we have the stomach and you're gonna cutoff um you know see if i can show you bill roth
all right this is what this is it right here so depending where the the um lesion is they'll just you know take off that area of the stomach and then anastomose it to the small intestine so now theyhave a tiny stomach just like a patient who had bariatric surgery okay so in this case this patient post-op they are you know they had increased risk for um dumping syndrome remember dumping syndrome yeah okay so now ifto prevent dumping syndrome they should not drink water when they eat because that's gonna make them feel full and the food is gonna move down too fast yeah i also should avoid like you know starchy high fructose foodso it's more like complex carbohydrate if and more protein had you know high protein diet small frequent meals because look they have a small stomach so small six to eight meals again spread them out
dumping syndrome is one is the only time you tell the patient to lay down after they eat so if they had the surgery and they had increased risk for dumping syndrome your intervention one of the things you shouldteach them to do is lay down after eating any other time you should sit up after eating for pepsico's a disease for gerd sit up but if it's we if it's dumping syndrome you're concerned about it should laydown after eating
so the bill roth one bill raw two that's just gastric to me different types of gastrectomy they look alike you know it's quite similar so they cut off part of the the the disease area of the stomach andthe anastomosis or anastomosis the same thing as a connected to part of the small intestine usually is the jejunum so food will go down fast so that's why they need to eat a void like uh they absolutely needto avoid like high fructose stuff but that will go to move too fast and give them that dumping syndrome and then you know they need to eat small frequent meals that they have a smaller stomach another big issuewith this too with this um surgery stomach surgery is that you know remember the intrinsic factor that's produced by the stomach the ruge of the stomach yeah if the stomach is not a hundred percent you're not gonna produce
enough intrinsic factor so now they're gonna be at increased risk because you need the intrinsic factor to absorb b12 so less stomach less function in stomach less intrinsic factor less intrinsic factor less b12 absorption now we have b12anemia or aka pernicious anemia
that's also one of the reason why older adults are at increased risk for pernicious anemia because as you get older everything shrinks and their stomach shrink stomach doesn't function as well if they get older size diminished doesn't meanthey eat less though size diminish function diminish and they also increase risk for anemia so your peptic ulcer patient has increased risk for anemia your surgery post-op gastrectomies patient has increased risk for anemia older adults and increased riskfor anemia and i'm talking about pernicious anemia b12 anemia so most likely your patient who had that surgery like bariatric surgery those gastric to me will be on b12 supplements
Introduces the biliary system and reviews anatomy-based pain locations, abdominal assessment order, and gallstone risk factors. Covers cholecystitis symptoms, Murphy sign, labs, imaging, surgery, and medications to dissolve stones.
that's all we're going to talk about for the stomach cancer is cancer so we'll when we do you know the goal live general we'll talk about that um so now let's go to the biliary system before we stepinto it any question on the gas trick
you know it's an english word that really means very bad yeah but it's pernicious anemia and it's a aka b12 anemia also common in people who in alcoholics because alcoholics um do not absorb b12 either so any conditionthat affects your b12 absorption can cause the pernicious media
okay all right so let's talk about the biliary system gallbladder kohli pancreas and a liver it's all the biliary system so let's go with the gallbladder first so where no um for gi i always want you to rememberthe anatomy you know if the stomach the abdomen is this you know it's your core and it's this everything is all squished up in there so you need to remember where things are located anatomically so if i sayto you and i'm going to say to you right now the patient is having right upper quadrant pain what could that be we
yes what else the gallbladder yes um let's take it over to the left left upper quadrant what could that be stomach stomach yes what else is over there
pancreas pancreas yes and the spleenokay now let's go back to the right and go to lower right lower quadrant what's there
the the part of the large intestine yeah there's a very annoying organist down there the appendix exactly appendix now and then remember if it's if they say female think about all the gyn stuff that's down there too likethey you know the patient ovaries the fallopian tube so because this is we're talking about abdominal pain so if it's a female it's not always a gi it could be a gu issue
got it yeah now let's talk about how do we assess the abdomen first give me the order again
when they're like escalating yeah what do you do first for the abdomen you inspect and then like you said auscultate i it's iapp it's the abdomen you want to listen to it before you touch it right so inspectyou look at it look at the contour to see if there's any bulging and it's trying anything moving around anything looks like it and you know it's good moving going on there but for any pulsating then you pulsateout the mask and then you listen and where do you start you start at the right lower and you move around like a clock now what if you don't hear any bowel sound when do you move how longshould you stay in the one quadrant before you consider i didn't hear anything
15 seconds and again is it 15 seconds oh five minutes oh it's five five minutes five minutes yep so the entire exam could take 20 minutes if there's no bowel sound because no battle sounds a big deal soif you listen so you should have vowel sound you don't count you really don't count it you just hear that little sound like okay or it may be mild to go we call it ipo active or it maybe that they have you know or um verbal jimmy because they have diarrhea or something else and it's hyperactivethat's hyperactive but you don't count it then you move to the next then you move up then you move to the next but if you don't hear anything it's silent it's nothing at all not even nothing just athe right answer is just stay there five full minutes when you move to the next one you move to the next one and move to the next one and wherever there is absent bounce on you need to notify
the provider if this is a post-op patient now shantae remember post-op abdominal surgery especially post-op any surgery anesthesia actually makes the bowel go to sleep so post-sub-patient in the first 24 hours you won't hear anything so don't golistening
what you need to do is ask them if they pass in gas yeah what that's the most important question are you passing gas first 24 hours you will hear nothing after 24 hours if you can the bowel soundswill start coming back slowly and it will be i proactivebut we don't keep them in the hospital waiting and bowel sounds if they pass in gas they go home yeah because bowel movement can take for gi surgery especially it could take up to a week to have abowel movement after gi surgery and that expected any other surgery could be a fourth five days too because this the anesthesia again put the bowels to sleep so what you're going to teach them is to move ambulate walkit out the more they move and drink fluids then you know and and if they're back to eating increase the fiber then you get things moving in your gi
so after you uh you inspect your auscultate then you percuss and palpate palpate is always the last p of the ippa palpate is always the last p
so for gallbladder remember i told you that once you see the word coley we're talking about gall bladder so um gallbladder disease like cholesterol colitis the word liophasis means tone stone so if you see nephroliphases it's stone inthe kidney urolithesis stone in the in the urinary system um stone in the gallbladder so we have risk factors for gallstone and it the risk factors are over 40 female menopausal obesity also rapid weight lossalso smoking also alcohol and by now you realize smoking and alcohol just wrong wrong wrong all over especially yeah everything smoking alcohol so and it's more common in female guys get gallstone too but it's more common in female
menopausal overweight rapid weight loss someone who was on this crash diet and they dropped 30 pounds in like two months increase the risk for gallstone and the stone is what's going to clog up the gallbladder because they uhthe gallbladder is tiny and cause cholecysteine is the itis let's go back for let's walk back for a minute what's the function of the gallbladder what are the gallbladder that little things right underneath the liver what does itdo
that's why we could live without it the store is the bio so when there's an idiot and it's inflamed the patient is going to come in with pain and we said their pain is going to be right upperquadrant and here's a hallmark sign this is the gallbladder it radiates to the shoulder so right upper quadrant pain radiate into the scapula gallbladder now we can just stop there they have fever chills any time you see generalizedmalay that just means i don't feel good that's all that means they couldn't have uh they will have anorexia anorexia just mean loss of appetite once there's an itis anorexia is a part of it so they get anorexianausea they could be vomiting
on physical exam they're gonna have an exquisitely tender right upper quadrant so i told you uh when you're assessing the abdomen you start with from the right lower and you move your way around but if they have anacute abdomen as we call it like something is going on in the abdomen you're going to change the order of operation you examine the painful area last
now another hallmark sign of gallbladder this problem is what we call a positive uh murphy sign you remember the murphy sign
let me show you what that is
positive murphy sign so murphy sign is usually let's say right when you palpate in between the rib cage right there the patient gets what's called an inspiratory arrest like soon as you touch it they go and that's apositive murphy sign and once you see murphy sign god ladder
any question those are the things you're looking for an assessment so you're going to score it around you know they have right upper quadrant pain you you're going to assess the lower part the here and here and hereand then you come here last and it's also if your patient uh is garden garden means that as soon as you go towards the area they pull up their leg and they like protecting themselves from you stop theexam don't touch anything once your patient is guarded
okay so we don't want to go to surgery right away for anything so with cholecystitis after the physical exam we're going to get labs so labs we're getting chemistry so you can you know we're getting cbc because wewant to look to see if the white cell is elevated which it will um we're going to the chemistry we need to see the electrolyteswe need to see what they um buin and creatinine is because most of you know further workup they may need a ct with iv contrast even if they do ultrasound most likely they do ultrasound and also ct wouldeven contrast and in order to you know to get iv contrast we must know what the kidneys are up to
and the ct scan will show you the stone will show you the inflammation and all that stuff depending on how severe the situation is um pain medication so definitely you'll need your iv access need iv fluids because they'regoing to be vomiting they have anorexia nausea vomiting once you have an array once i say anorexia nausea vomiting npo anyone who's vomiting should be npoand iv fluids
and we you may need to do an ng tube also if they're vomiting to decompress the stomach
pain
medication comfort and if they you know depend on how bad the situation is they may need to go to surgery and surgery they're going to get a cholecystectomy i'm going to remove the gallbladder most of the time nowthat's done laparoscopically called lab coli they go home they can go home the next day if it's done laparoscopically
and most of your patient can go back to work within two weeks and and this is within two to four weeks because it depends some patients are they have other underlying condition they may be morbidly obese and it'syou know a lot of stomach muscle being so it may take them a little longer but usually for laparoscopic surgery recovery is shorter time and they can go back to working sooner now if we choose not to goin and remove that stone or take out the gallbladder and they have stone we can use medication to break up the stone
and the medication that we use for this in this case is called ersodile i'm gonna spell it
that's it that's the um the trade name is acting gallbladder l a-c-t-i-g-a-l-l that's the trade name or the brand name that's not name and clicks is going to ask you so i have to give you the generic andit's your you're so u r s o d i o l
Describes acute pancreatitis with left upper quadrant pain, steatorrhea, dehydration, and characteristic lab findings. Reviews treatment priorities, complications, and pain control considerations for biliary system disorders.
and instead they can also use um this procedure called lipo trisp to break up the stone
now let's go to the pancreas so pancreatitis acute pancreatitis they have chronic and they have acute but let's focus on acute acute pancreatitis where would their pain be
they would be in thelike in the right right up upper or towards the back no the pancreas is more towards it's the the majority of the pancreas is on the left it's only a small little portion so it's left upper quadrant
left upper quadrant pain and pancreas and the gallbladder stomach pancreas stomach pancreas and spleen left upper stomach pancreas spleen left upper
so now they're gonna be in um pancreas pancreatitis they're in a lot of pain they're exquisitely tender typically their pain is for the most part always high 10 out of 10.then also because it's an iris so they're gonna also have anorexia nausea and they are vomiting they vomit pancreatitis patients are vomiting a lot a lot of bile bilius type of you know vomiters they also get um stiteriaremember steeloria
that fatty because the pancreas is um responsible for producing the enzyme lipase that makes you absorb the fat and if the pancreas is inflamed you're not absorbing fat so the fat is going to come out in the stoolso they can get theateria fatty stool
just like your cystic fibrosis patient
so normally the patient with pancreatitis they're in so much pain like i told you that they're so tender that they normally assume the fetal position they lay down their knees flex all pull all the way up and that'show they feel comfortable
so when they come in um and you get a set of vital signs um they're going to have of course you know they're going to be vomiting and they have a nastier and so they may have tachycardia andlow blood pressure because they're going to be in severe dehydration
so your intervention of course you're going to make them npo you need and they need an ng tube they're vomiting so much they need iv access they need iv fluids they need pain medication
and we need labs which lab do you remember in the marker that said that it's the pancreas for pancreatitis
remember serum amylase and lipase oh yes yes i'm sure you do yeah if you see it on paper you'll remember it yeah don't feel don't feel like don't feel if you don't know the answer that you know mygod i don't know because i'm asking you to regurgitate and that's not easy but if you see it on paper you'll know it yes amylase and my pace so and and um light paint is more specific for livepace is more specific for the pancreas because amylase breakdown carbohydrate and that could be anywhere in the gi tract but serum amylase interim lipase will be elevated in the patient with pancreatitis also something that's very unique that willthat it's going to be off and the labs with the patient with pancreatitis is the calcium the calcium level will be low they have hypocalcemia with pancreatitis please make a note of that because the hypocalcemia you can get
symptoms like you remember the chopstick sign and the trusox line and the technique yes so we may have to repeat the calcium levels they are also going to going to get um diagnostic tests they're also going to getlike the ct scan with the iv contrast or um ultrasound and basically the treatment for pancreatitis is rest fluids pain management prevent complicationsrest fluids pain management prevent complications complications with pancreatitis that they can actually develop um shock they can go into hypovolemic shock they can also get sepsis and they can also develop arts acute respiratory distress syndrome you said hyperbolemake or hypo i pull i provolinic shock
sepsis remember that i put calcium in sick they can get all the complications of hypocalcemia so let's try symptomatic management in other words now pancreatitis is very common in people who drink a lot so you want to tellthem to you know cut down when it comes to alcohol it's okay to say cut down when it comes to smoking stop
because they can develop chronic pancreatitis if they don't you know stop whatever is causing them to get the acute
and uh so and then we also may need to give them the pancreatic um the the enzymes the pancrealipas because remember i told you that you know they're going to be missing that they may need um to besupplemented with vitamins as well
but then a lot of pain so pain management
now just make a note of this the biliary system which include the gallbladder the pancreas and the liver the breast pain medication the best opioid for this patient is demerol the pyridine
wine pyridine because anything with morphine a morphine derivative can cause spasm inside the gallbladder biliary system there's something called a spinster of body that those um morphine or the pyridine can actually worsen their pain but that's a stretchbecause we still give it to them but if you ever see that on nclex and they give you which medication would be best go with the parody or gallbladder
pancreas and liver
that's pancreatitis any question of pancreatitis
Explains hepatitis A, B, and C transmission, vaccination, treatment, and screening recommendations. Then moves into cirrhosis complications such as encephalopathy, lactulose use, portal hypertension, and esophageal varices.
no i think i'm good okay let's go to liver hepatitis now we're only going to talk about a b and c okay and liver failure cirrhosis so hepatitis a pretty much so hepatitis is inflammation of the of theliver and it could be viral by the way or it could be chemical so it could be medication can do it chemicals um like you know overdose of ass tylenol could cause it overdose of certain medication any medicationthat's a part of toxic can cause hepatitis but for all intent and purpose we're going to focus on viral hepatitis here so um hepatitis a remember that's the one that's caused by fecal oral route
fecal oral route we start vaccination for so a and b have a vaccine c has no vaccine okay
and we normally start the vaccine for hepatitis a at age one twelve months
so most people are vaccinated against hepatitis aso it's fecal oral route if think you should get it so every type of a people get infected um from you know um eating out you know and so on and so forth when they get it they typicallyhave you know anorexia nausea vomiting and they write up a quadrant abdominal pain they don't go into full-fledged liver disease liver failure it's more like you know um mild that's the better word symptoms are more mild so yesthey have an itis because it's hepatitis so they'll have anorexia they'll feel nauseous they don't want to eat they could have some vomiting and the right upper quadrant abdominal pain so pretty much you will symptomatic management and letit run its course it's virus virus need to run the course so symptomatic management if they have pain they'll take care of the pain you know um if they're vomiting they're in the hospital we just hold all fluids
by amount and give them iv fluid if they're at home you can do rehydration so small little sips of water throughout the day and that it runs its course hepatitis b this one is caused by the blood bloodbornepathogen so you get this through anything where you get come in contact with bodily fluids and remember according to the cdc the only bodily fluid that we don't put we don't worry about is sweat anything else is yourstandard precaution if you're coming in contact with it saliva stool blood standard precaution so all these hepatitis gets standard precaution
b can actually turn into full-fledged liver failure hepatitis b
we have a vaccine for that and we start this that's the first vaccine babies get yeah before they leave the hospital remember that one the first one they get they get three shots one two and six months
if you should get in come in contact with epitaph someone who's as hepatitis b um you need the immunoglobulin first if you're not you're not vaccinated immune globulin and then the vaccine but don't give vaccine right away becausevaccine doesn't work right away immune globulin is immediate protection it's what we call the passive
protection and then the vaccine afterwardsso epithelius b has to be treated and we treat that we usually treat it with antiviral medication we don't even need to go into all of that is severe or anything with a very antiviral
it must be treated because hepatitis b can lead to um if we don't treat it and leave it there not only can it lead to full-fledged liver failure but it can also cause liver cancer
hepatitis c this one is very insidious and you don't even know that you have hepatitis c until it's discovered or you start to develop full-fledged liver failure which is like having had hepatitis c 20 years and now you'redeveloping full-fledged liver failure it's very insidious no symptoms really um people get it again to you know blood-borne pathogen so it can be sexually transmitted it could be transmitted from iv drug use sharing needles and so on andso forth here is the nclex moment for hepatitis c the generation which they call them the baby boomers that's the people who were born after 1945 between 1945 and 1965 are at the i'm the one that must bechecked for hepatitis c that's the age group that was sharing needles and experimenting and all that other stuff so that's the age group that they want you to stress it must be checked for hepatitis c now i'm going
to tell you according to the affordable care act everyone gets hepatitis c um check annually and if your doctor is not doing it if not following the guideline that's the new guideline hiv and hep c everyone gets itas part of your annual physical
pepsi once you find out that you have it they have different genotype you don't even need to know that for nplex just know we gotta treat it and we treat it with the various again
also use interferon to treat it we use interferon to treat hepatitis b also
so b and c or alcoholic hepatitis can lead to full-fledged liver failure which is called cirrhosis
so normally the patient with hepatitis symptoms are again going to be the anorexia nausea vomiting and all the biliary disorder disease like these everything here that i just talked about their stool um gallbladder they will have clay colorstoo because the bile is coming out now in the skin and in the urine instead of the stool so now the stool look gray and the urine look like coca-cola
and they john is looking the eyes gall bladder gets it kertitis can have it and liver disease definitely has it stool is the the gall the biliary system is backed up so the gallbladder is not coming out inthe stool because the god the bile is what gives the stool is brown color so now the stool looks whitish and now this the urine is where in the gallbladder the bile is coming out in the urine andnow the urine looks like coke that's for all the the hepatitis or just all the hepatitis and the gallbladder and the pancreatitis we call them the biliary system they're all part of the biliary system all of this righthere part of the billiard system
so jaundi's you know tea color urine clay color stool it's not only the gallbladder it could be pancreatitis could be liver so that's why we need tests labs and patient assessment to say and remember i told you hallmarksign of this hallmark sign of this remember you said the gallbladder and the murphy sign appropriate upper quadrant radiating to the shoulder and then we're going to get labs to confirm pancreatitis same thing the amylase like this willsay um that's in that direction um liver you're going to see elevated ast alt the liver enzymes and the build the bile the bilirubin would also be elevated in all three of this all the biliary disorder elevated bilirubin
so with um sclerosis when they advance the cirrhosis they of course you know this is the liver failure so now the liver is not really it's you know the liver is really the organ that metabolize everything and nowit's not working properly so metabolism has slowed down drastically it can go into medication medications are gonna floating around because not being metabolized by the liver so now when they have cirrhosis and liver disease you we need todecrease their protein because they're not high protein is going to turn into ammonia and they're not able to metabolize things so if you give them high protein diet the ammonia level is going to go up even higher andthey can go into encephalopathy or nicky encephalopathy this is where they get confused restless irritable confusion and they could even go into a coma so ncx moment liver failure low protein diet
we treat them with the lactolose to decrease the ammonia level the ammonia goes up and you know goes up in there we said we say it goes into the head and make them absolutely cuckoo and the cuckoo isone part but then they can get so the ammonia could get so high it could make them unconscious and that's a different story so you said the lactalos lowers the the amount of ammonia lactose lowers the amount ofammonia so the lactose goes in there and it binds to the ammonia and pulls it out in the form of diarrhea okay so you know it's working because the patient is more alert not that they're having a tonof diarrhea you know they need to but it's working because the patient is more alert as a matter of fact when they come in semi-unconscious or even unconscious and we know it and we get ammonia levels really high
we can give the lactulose at the enema or even via ng2
so advanced liver disease cirrhosis comes with a lot of other complications the encephalopathy is one of them um they can also get this thing called asterixis remember the flapping tremors yeah yeahso you know eventually they may need to get a new liver
they also get the um coral hypertension and esophageal viruses
as in advanced liver disease total hypertension esophageal and esophageal viruses
for esophageal viruses this is um the best way to describe it is um this this is what the the little blood vessels inside the esophagus get over distended because of the portal hypertension because of the portal vein righthere because of the liver see this cirrhosis this is a better picture so and then the various the little veins inside the esophagus get overly engorged and complication these can actually get so big they can burst and ifthey burst they can bleed the patient can bleed to death so with esophageal viruses we give them medication to kind of calm these things down so they don't get in they don't burst and we give medications like betablockers like propanolalso give they have newer medications now but those medications are not inflex ready so beta blockers calcium channel blockers to um to you know calm these they relax these varieties and if if here's my question the question said
you give him propanol or metropolo sorry go ahead huh did you say something no no yeah so if the question says you're giving um a beta blocker for the to the patient for the esophageal virus disease how doyou assess that the medication is working it's not their blood pressure it's not the pulse is that they have no blood in their stool because these things can bleed um discreetly and that's what the medication is for inthis case to you know calm them down relax them so they don't they don't bleed so remember when you get when you're answering questions about the medication your assessment should be what are you giving it for at thisparticular time it's not the general rule is what the medication is for us what is what it in this case what is the patient taking it for how do you know the medication is working if they if you're
giving it for viruses esophageal viruses you have no blood in your stool because usually with this if they bleed in they'll have positive quiet stool or they'll have curry stool but they're bleeding from upper
if we don't do that and just get further and get further and get further and they come in with this is bleeding then we have to put something in called a sangston blakemore tube this is now now i'mgoing into critical care the only thing i want you to know shantae regarding this tube this this is for the patient with the bleeding esophageal viruses the sanction blademore two is that when patient had this you could usuallythey're in the icu this is inflated with the dry ice and the ice is what's pressing on those those hap those varices that i showed you earlier and remember ice vasoconstrict yeah yes so it's that's what's calming itdown so occasionally you have to like deflate this because if you keep it in place but you know you can affect the patient airway so when they have this tube in airway is paramount and that's why they're in
the icu now what i want you to know is once they have one of these tube in what should you have at the bedside a pair of scissors why a pair of scissors because if you if they havethis in and the patient look like they have a difficulty breathing or they look cyanotic because this is in and it's occluding it's pressing down on the trachea cut this thing and take it out and that's why youneed a pair of scissors and that's all i want you to know as far as this is concerned it needs to be inflated and deflated periodically can't leave it inflated the entire time as you can see this isthe you know this is ice and it stops the bleeding stops the bleeding is going on inside there that's advanced liver disease but you may get question on that so i had to go there
any question on hepatitis b c a
Reviews appendicitis pain patterns, McBurney point, rebound tenderness, and typical symptoms. Also covers imaging, antibiotics, perforation risk, peritonitis, and when surgery becomes urgent.
no no i think i'm good so a is fecal oral oral route and if they have in diarrhea and a you could put them on contact per question b and c is standard
so a is only contact if they're having diarrhea yeah because you remember it's fecal oral you don't want no doubt on you because most of the time a get treated at home but if they're in the hospital we'llput them on contact precautionas a the symptoms are usually mild unless they have underlining out of medical condition usually they mild for their symptoms
now i'm gonna do appendicitis before i do the colon issues so let's talk about appendicitis um tell me what you know in your own words about appendicitis
i know it's information of the appendix and it's really hard yeah where would this where would this this uh would they have pain in the lower right lower right quadrant um would their pain radiate
i i don't think so mm-hmm remember um the mc bernie pointappendicitis mcburney point here we go you know i told you i love google
appendicitis
so it's right between see right see here this is where the the pain is and then between the the umbilicus midway between they have a pain we call it the radiator mcburnie point mcburney point for appendicitis
to write somewhere between here and there that's where the pain will radiate
okay what else do we see in appendicitis and and physical exam
they have they they don't want to rebound tenderness right okay yeah the rebound tenderness means that so they have right lower quadrant pain and when you press on the left side um they go that helps as soon asyou pull take your hand off the pain comes back even worse than before that's what we call it rebound tenderness
so for appendicitis so the synth it's just like the textbook typically when a person comes in with appendicitis everything we're talking about is how they present now it's tinnitus so remember they're still gonna they're also going to haveanorexia nausea and some vomiting too with the right low quadrant pain radiating to their belly to the umbilicus and the they you know the positive rough synthetic or the um rebound tenderness
now we of course we're gonna get iv in we're going to get pain medication and we're getting this patient to ct scan need a ct cd would contrast if they can tolerate contrast ct scan will show you thatinflamed appendix right here antibiotics
and you know start give them at least uh 24 hours of antibiotics and for the most part take this thing out because it's served no purpose and once it gets inflamed it's going to get inflamed again
so we worry about this still that when they have appendicitis we are concerned that they may perforate i think couldn't could be so inflamed that you know this is why when you're doing your physical exam i said stayaway from painful area class and don't put don't palpate too hard just you know gentle palpation because if you you know the appendix can perforate and if it perforates into the entire um personal cavity they can get peritonitisand that's a true medical emergency peritonitis now if the appendix perforate what would you typically see or what would the patient probably say to you that makes you think oh oh this is not good i think we justhad a perforation here if the pain suddenly stops the pain suddenly stop yep and then you look at you you touch the abdomen and they have a board like rigid abdomen now and that pain is only going to
stop momentarily because because it just perforated because once they they hit prayer tonight if the pain is going to come back and it's going to come back with a vengeance pain suddenly stop and they have bored like abdomenin physical exam now this is a or moment i gotta get them to the ore to clean up the puritanium because they can go into septic shock on this case we gotta get an uh ng tube in wegotta give some iv antibiotics to sterilize the bowel and get them to the or asap peritonites
most of the time appendicitis appendectomy is done laparoscopically and remember i told you post-op la post lap surgery it's normal to have shoulder pain that's the only time shoulder pain does not bother chante but any other time sheis not happy something's going on here shoulder pain expected lap post lab appendix that to me so again symptomatic management some patients will not go for surgery you know that you tell them that you know this is thisthing in flames that we blame again so surgeon usually they call the surgical team anyway as soon as the patient comes in with appendi appendicitis and surgery team that's what they trained to do operate so the first thingthey want to do is take it to the or and the patients are like not me you know so they will okay give me pain medication i'll go home and then i'll pray or whatever else they do and
you know but then if it happened once it'll happen again so eventually you should consider taking that appendix out because again it serves no purpose it's only there to cause problem now let's go to ibd
Compares ulcerative colitis and Crohn's disease, including symptoms, diet changes, autoimmune nature, and cancer risk. Then explains ostomy basics, stoma appearance, bag emptying, and supply replacement.
inflammatory bowel disease inflammatory bowel disease and under that comes prone and ulcerative colitis prones and you see now what's basically they you know we group them together in the nclex world you put them together we group them togetherin the medical world the only difference is that crohn's is the entire gi tract whereas ulcerative colitis is only in the colonso let's talk uc first ulcerative colitis so ulcerative colitis is in the colon so the lesions are in the colon and they're the one that gets like 10 to 12 bloody diarrhea
that goes with the territorynowadays because they're going so much they're going to be malnourished and have malabsorption syndrome severe malnutrition so they will need to have you know you'll need to make sure that you decrease the fiber in their diet so theyneed to be at roughage high you know low residue
no fiber dietso don't go don't tell them to do like brown rice
you also want them to avoid milk and milk product that's irritating too dairy
of the malabsorption they'll need um the fat cell of vitamin they'll need vitamin supplements
frequent small meals high protein diet fluids increase fluids
crohn's is the entire gi tract so crohn's is the thing interesting thing about crohn's is that the disease can be in um from the rectum all the way to the esophagus but they don't have lesions throughout they haveapache filter infiltrate so they have areas where it's normal no problem so here is a typical example they have lesion in the rectum and everything is okay until you get to the transverse colon and they have lesions thereand then everything is okay until you get to the ilium and they have lesion there so we call it cobblestone like it's you know it's patchy it's on and off but it's an entire gi tract so crohn's umthey get about they do get diarrhea too but they get about five to six loose tool a day and they don't have bloody diarrhea uc is bloody
now this is a disease crohn's and oscillative colitis is an autoimmune disorderand it's familial it runs in family
and the autoimmune disorder is familial it runs in family and it can actually cause cancer colon cancer they have an increased risk of colon cancer so it's autoimmune so like any autoimmune they have remission and exaggeration remission andexamination
some of them do very well and they could be in remission for years and some people have exaggeration like every three months stress of course will increase exacerbation
so when i go over the autoimmune does the immunosuppressive therapy then i'll talk about the medications that we use to treat ibd crohn's and uc and we can even use chemotherapy in some cases psychosporin sun the noondepending on especially in ulcerative colitis depending on how in you know disease the area of the colon they may need a colostomy or an ileostomy
now sometimes they could be it could be temporary the cholesterol or the ileostomy just to rest that area of the bowel that's so inflamed
they can reverse it now with colostomy let's talk colostory for a minute or ileostomy remember the stoma like that question you just took should always be beefy red pink it should be about one inch above the skin
shouldn't be bleeding shouldn't be dry it shouldn't be cracked it should be moist um initially when if they first get it it's going to be edematous and it could have some small amount of bleeding on it but thenthat should go away with time it should be moist um beefy red and one inch above about one inch above the the skin the stoma these patients need to be referred to the stoma nurse because the stoma umneeds to of course when they put the um stoma on you need to make sure they cut it wide enough so it doesn't you know occlude the ostomy what about the bag what do you remember when do theyempty the colostomy bag
is it three quarters one third or half yeah you don't let it get too too full if they will rip off one third or half full you empty it often do you change it
the bagthe whole setup oh the the whole thing yeah um
is it no the insurance is very strict on this they can they only get one bag a week oh yeah in the hospital we do it like you know we could change it like every two three days butat home it's only it's good for one week so they basically they they kind of clean that thing out wash it out and reuse it and that's heavy insurance that's not just the medicaid or medicare that's every insuranceonly one bag a week so they give them four for the month
Distinguishes IBS from IBD and describes its stress-related symptom pattern. Focuses on symptom-based management, trigger tracking, and adjusting fiber and fluids depending on diarrhea or constipation.
and so it's all about supplies and you know cost effectiveness and and all that because the the gi tract is not sterile so is you don't have to worry about the using the same bag over and over andover again the gi tract is not sterile nothing sterile the mouth is one of the dirtiest part of the body so you know nothing sterile about a gi tract urinary is a whole lot of system that's sterile sothat's it that's your you know and i also want you to review how do you you know um irrigate this the colostomy because they'll ask you that kind of question on the drug drop you know like what doyou do first what do you do next as far as irrigating the colostomy and changing the colostomy bag also when you take off the old bag you take it off you know cover that stoma please because that thing
has a mind of its own like a baby boy penis they just pee you know you go to change a diaper of a baby boy they just they pee right in your face so cover it you know andput a gauze on on it and then like make it one of those you know light chokes so that if it decides to shoot out it doesn't really you know mess up anything including your hair yeahso make sure you you cover that thing um as you get ready to change this now there is a condition called irritable bowel syndrome ibf you've heard of it yeah do not confuse it with ibd ibd inflammatory boweldisease is an autoimmune disease more common um in industrial countries like the united states more common in rich people very common in hollywood ibs in you know irrelevant bowel syndrome that people who that's this common in you know
people who tend to uh be a little bit more stressed um more depressed more anxious and they go between diarrhea and conservation and then that can be cured whereas this have no cure ibs is most doctor call itit's all in their head not really true because we actually use some some patients we give them ssris or snr and the depression and it it cure their ibs so it may be true but they go between diarrheaand conservation so your focus is on if they're having diarrhea you tell them to back off under fiber and you know drink a lot of fluids if they constipated increase the fiber so treat whatever symptoms they have infor ibs and they also need to journal their their symptoms and what food trigger or what condition will trigger their symptoms so they can avoid it like you know some people will say get clear um i i get
more problem i have more symptoms in the winter time um or i have more symptoms in the summer time or i have more symptoms when i eat certain food so they need to journal their triggers and avoid it
The speaker wraps up the lecture and transitions back to practice questions. This brief ending signals the close of the gastrointestinal review.
now i know i gave you a mouthful but i'm not gonna stop here we're gonna go back to your world and um you're gonna do another 10 questions okay
you