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GI Bleed

A GI bleed isnt a disease, but a symptom of a disease


- Types:
1) Upper GI bleed: from the esophagus to the duodenum
2) Lower GI bleed: from the jejunum to the anus
- Clinical Manifestations:
Dark, tarry stools (melena)
Blood on toilet paper or in streaks on stool
Vomiting blood (hematemesis)
Hypotension, compensated with tachycardia
- Causes:
Hemorrhoids
Cancer
Chrons disease
Gastric ulcers
Esophagitis
- Testing:
Fecal occult blood test
CBC
G-scope, C-scope
- Treatment:
Severe: IV Pantoloc (PPI) + fluids (to increase BP) + NPO (allow system to
rest)
Moderate: PO Pantoloc

A fib/Angina/MI
A fib: quivering/irregular heartbeat that can lead to blood clots in the atrium d/t
pooling of blood, stroke and heart failure.
- Symptoms: Palpitations, weakness, dizziness
- Types: Occasional, persistent, long-standing persistent, permanent
- Contributing factors: HTN, MI, CAD
- Treatment:
Clot prophylaxis = PO Coumadin
Pacemaker insertion
Medications: Anti-arrhythmic - Ca+ channel blockers, Beta blockers

Angina: result of ischemia to the heart muscle from obstruction of the coronary
arteries by atherosclerosis
- Types: stable vs unstable
- Treatment:
Prophylaxis: PO/Transdermal nitro
Acute: SL nitro, O2 2L
Ca+ channel blockers/Beta blockers
Balloon angioplasty: to widen arterial lumen
Coronary bypass graft: bypassing constricted arteries w/ venous graft

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MI: complete obstruction to an area of the heart d/t atherosclerosis
- Symptoms:
Chest pain, SOB, cold clammy skin
STEMI on EKG
- Treatment:
Acute phase: O2 2L, Aspirin, Nitro spray
STEMI: Angioplasty, Thrombolytic therapy to dissolve clot
NSTEMI: Heparin drip
Long term tx: Aspirin, B-Blockers, Statins

Pulmonary Embolism (PE)


Blockage in one of the pulmonary arteries by a clot that travels to the lungs
- Symptoms: SOB, chest pain, cough (w/ possible bloody sputum)
- Complications:
Pulmonary HTN: BP on R side of lungs increases, heart must work harder
to push blood through lungs R sided heart failure
- Diagnosis:
D dimmer: clot-dissolving substance high levels indicate an increased
likelihood of blood clots
Pulmonary angiogram
- Treatment:
Medications: Anticoagulants (Heparin), thrombolytic (Altepase)

Deep Vein Thrombosis (DVT)


Occurs when a blood blot forms in one of the deep veins in the body (mostly legs)
- Symptoms: Swelling/pain in the affected leg
- Risk Factors: Prolonged best rest/immobility, surgery
- Complications: PE
- Diagnosis:
Ultrasound
Blood test: D dimmer
Venography
- Treatment:
Anticoagulant (Heparin), then PO Coumadin (3 months +)
Thrombolytics (Altepase IV)
Compression stockings: prevent swelling r/t DVT

Peripheral Vascular Disease (PVD)


Narrowing of peripheral vessels caused by atherosclerosis
- Symptoms:
Claudication (intermittent pain when walking)
Critical limb ischemia: rest pain, ulcers, cyanosis
- Complications: Infections, tissue necrosis
- Risk Factors: smoking, diabetes, HTN, hyperlipidemia
- Diagnosis: Angiography

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- Treatment:
Medication: Statins, ACE inhibitors (decreased PVR)
Surgery: bypass grafting, angioplasty

ETOH Abuse
- Symptoms:
Inability to limit alcohol intake
Denying there is a problem
Craving for alcohol
- Alcohol intoxication:
Impaired judgment, slurred speech, impaired motor coordination
- Alcohol withdrawal:
Sweating, rapid pulse, hand tremors, restlessness
- Complications:
Liver cirrhosis
Heart problems: HTN, CHF, stroke
Diabetes
- Treatment:
- Medications: Antabuse (for withdrawal)

Urinary Tract Infection (UTI)


Infections of any part of the urinary system (urethra, bladder, kidneys)
- Symptoms:
Persistent urge to urinate, burning when urinating, frequent small
amounts of urine, cloudy urine
Inability to urinate
- Types:
Urethritis: burning when urinating, discharge
Cystitis: pelvic pressure, frequent painful urination, hematuria
Pyelonephritis: Upper back (flank) pain, fever, shaking/chills, n&v
- Complications: Sepsis
- Diagnosis: urinalysis, urine culture
- Treatment:
Antibiotics
Pain medication to numb bladder

Liver Cirrhosis
Late state of scarring (fibrosis) of the liver
- Symptoms (often no symptoms until damage is extensive):
Bleeding easily (decreased production of clotting factors)
Jaundice (decreased excretion of Bilirubin)
Ascites
Drowsiness, slurred speech (hepatic encephalopathy)
- Causes:
Chronic alcohol use
Hepatitis B, C

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Non-alcoholic fatty liver disease
- Complications:
Portal HTN
Peripheral edema
Splenomegaly
Esophageal varices
Hepatic encephalopathy
- Diagnosis:
Blood tests: LFTs, kidney function (creatinine), INR
- Treatment:
Alcohol withdrawal
Medications to control hepatitis
Liver transplant

Hepatitis
Inflammation of the liver with presence of inflammatory cells in the tissue
- Symptoms:
Acute: malaise, muscle + joint pain, fever, hepatomegaly, splenomegaly,
enlarged lymph nodes, jaundice
Chronic: malaise, weakness, peripheral edema, ascites, esophageal varices,
hepatic encephalopathy
- Types:
Viral hepatitis: Hep A, B, C, F, E
Alcoholic hepatitis
Drug-induced hepatitis (acetaminophen, antibiotics)
- Diagnosis:
Blood tests (LFTs)
Liver biopsy
- Treatment:
Antiviral medication
Liver transplant

Asthma
Respiratory condition marked by spasms in the bronchi, causing difficulty
breathing. The airways narrow + swell and produce mucus
- Symptoms: SOB, chest tightness, wheezing when exhaling
- Triggers:
Cold air
Airborne allergens
Respiratory infections
- Risk Factors:
Smoker/Secondhand smoke
Genetic predisposition
Being overweight

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- Diagnosis:
Spirometry: estimates narrowing of bronchial tubes by looking at how
much air you can exhale after a deep breath + how fast you can breathe it out.
Peak flow: measures how hard you can breathe out
- Treatment:
- Long-term control: inhaled corticosteroids (Flovent), long-acting beta
agonists (Ventolin), leukotriene modifiers
- Short-term control: anticholinergic bronchodilator (Atrovent)

Acute Kidney Injury (AKI)


Abrupt loss of kidney function that develops within 7 days - kidneys suddenly
become unable to filter waste products from your blood. Most common in critically
ill hospitalized patients
- Symptoms:
Decreased urine output
Fluid retention, leading to peripheral edema
SOB
- Causes:
Direct damage to kidneys (obstruction of renal veins/arteries,
glomerulonephritis)
Condition that decreased blood flow to kidneys (blood/fluid loss,
antihypertensives, liver failure, nephrotoxic drugs)
- Complications:
Fluid accumulation
Chest pain (r/t inflammation of pericardium)
Muscle weakness (d/t electrolyte imbalance)
- Diagnosis:
I&O measurement
Urinalysis
Blood tests (Creatinine, BUN)
- Treatment:
IV fluids
Diuretics
Kayexelate (to excrete K+)
Dialysis

Diabetes
Type 1: immune mediated destruction of Beta cells in the pancreas
Type 2 : non-insulin dependant diabetes
- Symptoms: Polyuria, polydipsia, polyphagia, blurred vision
- Complications: MI, stroke, amputations (diabetic neuropathy
hyperglycemia causes injury to nerve fibers= loss of sensation), blindness,
vascular dementia
- Diagnosis:
Fasting plasma glucose:
Glucose tolerance test

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Hgb A1C
- Treatment/Management:
Type 1: insulin
Type 2: Lifestyle modification diet, exercise
Oral antihyperglycemics: Diabeta, Metformin

Metabolic Acidosis
Condition that occurs when the body produces excessive quantities of acid or when
the kidneys are not removing enough acid from the body
- Acidemia: blood pH<7.35 + increased production of H+ ions by
body/inability to eliminate HCO3- in the kidneys.
- Causes:
Lactic acidosis
Ketoacidosis
CKD
- Compensatory mechanisms:
Respiratory compensation
Renal compensation
- Treatment:
If pH<7.1: IV HCO3-, dialysis

Anemia
Condition marked by a deficiency of red blood cells of hemoglobin in the blood,
resulting in pallor and weakness
- Symptoms: fatigue, weakness, pallor, tachycardia, SOB
- Types:
Iron deficiency anemia: bone marrow requires iron to produce hgb often
caused by hemorrhage (ulcers, menstrual bleeding, prolonged use of aspirin)
treatment: iron replacement
Vitamin B12 deficiency anemia: required for synthesis or RBC Vitamin
B12 supplements PO/IV
Anemia of chronic diseases: some diseases interfere with the production
of RBC, such as HIV, cancer, Chrons (decreases absorption of essential
nutrients), CKD treatment: treating underlying cause
Sickle cell anemia: caused by a defective form of hgb that causes
premature death of RBC treatment: O2 therapy, pain-relieving drugs, IV
fluids, blood transfusions prn
- Complications: severe fatigue
- Diagnosis: CBC

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Arthritis
Inflammation of a joint, causing pain and stiffness
- Types:
Osteoarthritis: involves wear-and-tear damage to joints cartilage
Rheumatoid arthritis: bodys immune system attacks the lining of the
synovial membrane (membrane that encloses joint parts) and it becomes
inflamed and swollen
- Diagnosis:
Blood test
Synovial fluid sample
X-ray
- Treatment:
- Medications:
o Analgesics: helps with pain, but not inflammation - Tylenol, Percocet,
Oxycontin)
o NSAIDS: help with inflammation - Advil
o Disease-modifying antirheumatics drugs (DMARDs): stop immune
system from attacking joints
o Corticosteroids: reduces inflammation and suppresses immune
system Prednisone

Fibromyalgia
Chronic disorder characterized by widespread musculoskeletal pain, fatigue,
tenderness in localized areas
- Causes:
Genetics
Infections
Physical/emotional trauma
- Complications: Pain/fatigue can interfere with ability to function
- Diagnosis: widespread pain > 3 months with no physiological cause
- Treatment:
Analgesics (Advil)
Antidepressants: ease pain + fatigue associated
Anti-seizure medications: help treat neuropathic pain (Neurontin)

Pancreatitis
Inflammation of the pancreas
Digestive enzymes of the pancreas become activated while still inside the pancreas,
causing damage to the organ.
- Symptoms:
Upper abdominal pain (may radiate to back + feel worse when eating)
N&V
- Causes:
Alcoholism
Gallstones
Abdominal surgery

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- Complications:
Pseudocyst (fluid collection in cyst-like pockets in the pancreas)
Infection (more vulnerable)
Diabetes (possible damage to beta cells)
Malnutrition
- Diagnosis:
Blood test
Stool test (to measure levels of fat that could suggest gi isnt absorbing
nutrients adequately)
CT scan

Multiple Sclerosis (MS)

Debilitating disease of the brain and spinal cord where the immune system attacks
the myelin sheath around the neurons, which slows/inhibits nerve signals
- Symptoms:
Numbness/weakness in one or more limbs
Tingling or pain
Partial/complete loss of vision
Tremor, lack of coordination, unsteady gait
- Complications:
Paralysis (legs)
Problems with bladder, bowel function
- Diagnosis:
Blood tests
Lumbar puncture
MRI
- Treatment: corticosteroids (decrease immune response)

Cancer
Group of disease involving abnormal cell growth with the potential to invade or
spread to other parts of the body, aka malignant tumor
- Symptoms:
New lump
Abnormal bleeding
Unexplained weight loss
Change in BMs
- Preventative factors:
Not smoking
Staying active
Eating healthy
- Management:
Chemotherapy
Radiation
Surgery
Palliative care

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