Primary manifestations of SRMD
GI bleeding
Cushing Ulcers
Stress ulcers that occur as a result of TBI or brain surgery
Upper GI bleed
any
... [Show More] source of bleeding which occurs in the esophagus, stomach or the duodenum.
Upper GI bleed is characterized by...
frank, bright red or "coffee ground" emesis
Upper GI bleed causes
bleeding varices (varicose veins) in the esophagus or stomach
peptic ulcers
gastritis
Mallory-Weiss tear (tearing of the esophagus from the stomach)
Lower GI bleed is found in the ...
jejunum, ileum, colon, or rectum
Lower GI bleed causes
inflammatory bowel disease, cancer, diverticula or hemorrhoids
Type of bleed commonly associated with colon cancer
occult GI bleed
Blood loss of 1000ml or greater will cause...
hypotension, tachycardia and if severe enough may lead to hypovolemic shock
Indicator of an upper GI bleed
Hematemesis
Hematemesis
bright red, bloody emesis
Coffee ground emesis
indicator of upper GI bleed but is not necessarily emergent
Hematochezia
presence of bright red blood in the stools
Presence of hematochezia
suggests that the bleed is in the lower GI tract, usually in the rectum, sigmoid colon or the descending colon
Diarrhea is characterized by...
loose, watery stools
Acute diarrhea
presence of 3 loose stools that develops within 24 hours and lasts no longer than 14 days
persistent diarrhea
Diarrhea which lasts 14-30 days
Chronic diarrhea
present for longer than 30 days
Osmotic diarrhea
caused by the presence of a nonabsorbable substance in the intestines
how the laxatives mag citrate, lactulose and MiraLAX work
pulls water by osmosis into the intestinal lumen and results in large volume diarrhea
causes of osmotic diarrhea
tube feedings, dumping syndrome, malabsorption, pancreatic enzyme deficiency, bile salt deficiency, small intestine bacterial overgrowth, or celiac disease.
Secretory diarrhea
large volume losses secondary to infectious causes such as the rotavirus, bacterial enterotoxins, or C-diff
These infections trigger enteroendocrine cells to secrete 5HT and the activation of afferent neurons that stimulate submucosal secretomotor neurons and alter sodium chloride transport resulting in decreased water 2 absorption
How does Secretory diarrhea result in large volume losses secondary to infectious causes
Motility diarrhea
AKA as short bowel syndrome and results from the resection of the small intestine or a surgical bypass of the small intestine or a portion of it, IBS, diabetic neuropathy, hyperthyroidism, and laxative abuse
Complications of diarrhea
dehydration, electrolyte imbalances, metabolic acidosis, weight loss, and malabsorption
Chronic diarrhea
Fever, cramping and bloody stools; caused by inflammatory bowel disease and dysentry
AST (aspartate aminotransferase)
intracellular protein which regulates metabolism. It is a marker of hepatic injury. When it is elevated it indicates that there is hepatocellular injury occurring. It does not tell you what is causing the injury, only that the injury is happening.
ALT (alanine aminotransferase, SGPT)
intracellular enzyme which helps to regulate metabolism and a marker of hepatocellular injury
ALP (alkaline phosphate)
intracellular enzyme found in bone cells, liver, the intestines and placenta. Elevations are seen in pregnant women, bone and liver disease, and obstruction of the biliary tract.
GGT (gamma-glutamyl transferase)
enzyme that helps with transmembrane transports of amino acids. Elevations are seen in obstruction of the biliary tract.
Albumin
plasma protein which is produced by the liver. It is a marker of the liver's synthetic function, its ability to produce albumin. A decreased level of albumin may indicate liver failure or malnutrition [Show Less]