Absent sound: bad.

Paralytic ileus, obstruction nothing by mouth and NG decompress

Auscultating is really important for GI
Normal = 1 sound every 3-5 sec
Cirrhosis
-

Liver slowly deteriorates

Scar tissue
Fatty liver disease: pregnant women more in risk
Sign:
o Itchy: b/c of bile salt, one of earliest sign.
o GI bleed: clotting factor reduced
o Hepatic encephalopathy: b/c high ammonia level
When sending to lab, send on ice?
Banana bag for alc withdrawal has albumin and all electrolytes
1/3 die from hemorrhage
Treatment
o Cant cure but change lifestyle to extend life
o Diuretics for ascites
o MELD score transplant list, look at liver enzyme, etc.

Portal HTN
-

Cause doesnt have to be cirrhosis

GI bleed
-

Upper: coffee ground emesis (blood goes to stomach and vomit coffee ground) or can
poop out coffee ground too
o Mallory Weiss: prep lots of blood bags! Hard to fix b/c of location
o Localized below xiphoid process or RUQ usually
Lower GI: black tarry stool. Worst smell in the world
Goodies powder: aspirin powder. Risk for bleed
Hemodynamic stability high pulse, low BP, low urine output (<0.5ml/kg/hr) is bad
Massive blood transfusion protocol mainly for upper GI bleed
IV vasopressin is very effective first line!

Minnesota/Blakemore tube: last ditch effort to stop bleeding, balloon pushes on bleed to
tamponade
-

Helmet, and tape cus we want traction

Alcoholism and gallstones are most common causes
When in destress, cut, decompress and take it out
Too much pressure will cause necrosis of tissue around it
Can only keep it in for 24 hrs

Pancreatitis:

A lot of pain
Tachypnea usually from pain
Risk of DM onset monitor BG

*not all alc pt are stumbling street person

Practice question 1: D. vasopressin
2: Cirrhosis
3: Alcoholism