GI

Hepatic failure
Pancreatitis
Bowel obstruction
Abdominal trauma
7q

pancreatitis
caused by
1. obstruction of pancreatic ducts by gallstone or infection
2. alcoholism
3. drug toxicity – cyclosporine, steroids, thiazides, tetracyclines
what happens:
autodigestion of itself (fatty organ) needs calcium to do so
so you become
1. hypocalcemia
not right amount of insulin so 2. HHNK (high glucose level) (glucose not electrolyte)
3. left side pleural effusion
4. left side atelectasis
5. bilateral rales (the right side is called sympathetic rales)
6. die from ARDS – pancreas releases phosphatlapse A goes to lungs to kill type 2
aveoli cells ridding of surfactant
7. Cullen’s and Grey-Turners (black and blue belly button //and flank and side)
(eats through blood vessels)
8. Elevated amylase levels
---
Small bowel obstruction – small distention – diarrhea and vomiting
Large bowel obstruction – large distention – nothing coming out

Liver
Its job: 1. Kupper cells – detoxifies the blood (receive 1500cc of blood/min)
Backflow pressure into
2. makes Bile
3. Synthesis amino acids
4. makes Albumin //prothrombin, fibrinogen (don’t clot well if not enough)
If not enough albumin, then Fluid will third space out of it if not enough albumin
5. Converts glucose into glycogen and vice versa
6. Converts ammonia into urea (a good thing because high ammonia levels will
cause hepatic encephalopathy)

Liver disease – don’t want

1. Low potassium level because kidneys will hold into ammonia; careful with Lasix
2. High BUN because this breakdown becomes ammonia (dehydration cause high
BUN) (and acute infection)
3. High proteins – GI bleed (blood is protein), body breakdown into ammonia
4. High acid because metabolic acidosis (hypotension), ringers lactate (don’t give LR
to those with the liver disease because normally the liver converts LR into bicarb.
HOWEVER if you have liver disease then liver doesn’t work and it stays as lactate
and kidneys convert LR into lactic acid - – ammonia levels 500s! tx – lactulose and
neomycin

Alkalosis – vasoconstriction – placenta - uterine wall abrupt – left side on curve.

Cold, hang onto oxygen and doesn’t let go into peripheral. So when cold, lips turn
blue. Strong affinity for oxygen

High ammonia levels causing hepatic encephalopathy

19 yo, pregnant 4.5 months, vomit 40x a day. pH 7.62. Giving LR will make her more
alkalosis. (OB GYN always give D5 LR but – can’t give because LR is converted into
bicarb causing more metabolic alkalosis)

Complication of neomycin therapy

NOT Nephrotoxicity, ototoxicity – not neomycin is not absorbed systemic, however
Neomycin stays in gut, gut makes vitamins, bacteria releases ammonia, gets rid of
bacteria in bowel, causes vitamin deficiency (makes riboflavin, vit K) (a
complication)
Listen 2-5 minutes- 5-30 rumbles a minute in each quadrant

Jaundiced-
Liver failure vs gallbladder disease
Unconjugated or indirect bilirubin (if high, then liver disease)
Bilirubin and albumin goes to liver to become conjugated or direct bilirubin
Then goes to gallbladder as conjugated or direct bilirubin (if high, then gallbladder,
biliary tract disease)
Goes into gallbladder

Ruptured spleen (often occurs during abdominal trauma)

Kehr’s sign – left shoulder pain (55%); left under rib cage when pressed left
shoulder pain

Bowel infarct – hypoactive bowel sounds and leukocytosis, hyperresonance and

abdominal tenderness, absence of dullness in the liver area

Renal
6% 9 q; acute renal failure, chronic renal failure, electrolyte imbalances

ARF
Decrease UO, less than 400cc/24 h
Pre-renal – CHF, low BP, decrease urinary output due to a decreased blood supply to
the kidneys
Renal – ATN (acute tubular necrosis)– decrease in urinary output due to kidney
damage to tissues or nephrons; kidney damage from ischemia or nephrotoxicity
Ischemia – hemorrhage, burns, sepsis, heart failure, transfusion reactions
Nephrotoxicity substance– heavy metals, meds, street radiocontrast, rhabdomylosis

Oliguric stage – lasts 10-17 days – increased BUN, creatinine, potassium, fluid
overload, CHF, peritoneal dialysis

Polyuric stage – lasts 2 weeks to 3 months – increased BUN, creatinine, low

potassium, fluid depleted, water is leaking out peeing a lot

Recovery stage – lasts 3 months to 1 year – pray the kidneys regenerates

normal Pre-renal Renal

Urinary sodium 20-200 20 40-100 (leaking out na
BUN: Creatinine 20:1 10:1
Lasix/Fluid +urine No urine
challenge

Chronic renal failure

Diminished renal reserve 50% NEPHRON loss
Renal insufficiency 75% loss
ESRD 90% loss
Uremic syndrome – complete nephron loss
Inverse relationship exist between serum creatinine levels and GFR and the stage of
CRF

CRRT – continuous renal replacement therapy

CRRT is a 24 hour continueous dialysis therapy provided to patients who are
medically unstable. CRRT is not as aggressive as hemodialysis tx, delivered via
Prisma Dialysis Machine. It removes volume and solutes slowly, corrects electrolyte
and metabolic abnormalities associated with renal dysfunction, maintain optimal
fluid balance. FOR Fluid overload, ARF, CRF, electrolyte imbalances, drug overdose

2 ways
arteriovenous vs – force of the patient BP is used to pump blood from an artery into
the circuit and hemofiler
venovenous – blood pump is used to force blood from patient to the filer. This
ensures a consistent pressure in the circuit and hemofilter
4 ways
**SCUF – slow continuous ultrafiltration (exam) – takes off fluid removal
CVVH – continuous venovenous hemofiltration – fluid volume management and
moderal solute removal
CVVHD - continuous venovenous hemodialysis - +greater more
CVVDHF - continuous venovenous hemodiafiltration – takes off max fluid& solute
removal

Hyperkalemia
Muscle weakness, EKG changes, losing P wave, sine. Calcium chloride given works
immediately (by stopping to take steroids)
Calcium chloride – conduction of heart
Insulin – hides potassium in cell, and given glucose – to not pass out
Sodium bicarb – pushes potassium into cells
K-excelate - moves K from cell into stool

Calcium and phosphate have a reciprocal relationship (Low Ca, Hi Phosphate and
vice versa)

If with renal disease, always have a low calcium level because kidneys finalizes
vitamin D, and if kidneys aren’t working then it’s not making vitamin D that can’t
absorb calcium levels. Twitch, seize.

Hyperphosphtamia – same as hypocalemia – twitch, seize, Chvostek’s sign,

Trousseau’s (high phosphate – green leafy veggies)

If low phosphate and high calcium – muscle weakness, apathy

A weight gain of 1kg in 24 hours may indicate fluid retention of at least 1000cc
Signs of rapidly developing alkalosis – drop calcium so nervous irritability, muscle
tremors, seizures, not obtunded

What drug removes potassium from body in ARF? Kayexalate and sorbital

U wave (ST depression) and ventricular irritability is hypokalemia

Hyperkalemia – prolonged PR interval, absence of P wave, widened QRS complexes
NOT ventricular irritability

GFR – creatinine clearance

UO of 1000 in 24 hours; urine sodium level 25. On a salt free diet

Ischemia injury to kidneys commences when MAP flows before 60mmHg for 40
minutes