The risk for peritonitis from perforation or penetration.
The risk of ascites.
The risk of pyloric obstruction
He risk of bleeding.
Clinical indicators of ascites and encephalopathy
They are often associated with weight loss because eating worsens pain
They are more likely to perforate than bleed.
They are relieved by eating
They are associated with increased acid secretion.
Patient remains unresponsive
Patient's serum Na and CL- levels are normalizing.
Patient has a positive fluid balance.
Patient is increasingly combative and trying to climb out of bed.
Both are cured by colostomy.
Neither are cured by colostomy.
Hematocrit and hemoglobin.
Coagulation (PT/INR and PTT) times.
Monitoring of his CIWA score at least q 4 hours (with vital sign checks)
IV benzodiazepine therapy.
TC oral benzodiazapines starting NOW.
Administration of Clonipine and Haldol in the early hours of potential withdrawal.
Will he be able to eat in the next 2 days?
What was his albumin on admission.
Has his albumin improved or gone down since admission?
Is he febrile, tachycardic or healing from a major wound?
Does he have diabetes mellitus?
D5 Normal Saline
Increased pain in the knee chest position.
A WBC count >20,000/mm3 and >5% bands
Increased pain when bending forward.
Right lower quadrant pain and rebound tenderness.
IV administration of Bumex or Lasix AND Paracentesis.
Sodium restriction and Spirolactone (Aldactone), possibly followed by loop diuretics
Paracentesis (tapping the belly to remove fluid)
IV administration of salt poor albumin.(SPA)
It is often associated with weight loss
It is often associated with pyloric obstruction.
Sympathetic nervous system suppressants
Alterations in Sodium, Potassium and calcium
Alterations in BUN, creatinine, K+ and magnesium.
Alterations in BUN (not creatinine), Na+ and Cl- and possibly in Bicarb
Alterations in BUN, creatinine, sodium and calcium
Potassium, magnesium and phosphorous.
Protein and sodium.
Green leafy vegetables
Low serum sodium levels.
Low serum Ca+ levels
Elevated serum K+ levels
Low serum glucose levels
Changes in Hematacrit (HCT)or Hemoglobin (Hgb) levels are early indicators
Earliest indication is changes in capillary refill.
Changes in vital signs (increased HR and narrowed pulse pressure) are often the early indicators
Changes in serum chemistries are often the first indication of a bleed.
It represents an approach to preventing only the most complex of alcohol withdrawal complications-delirium tremons. It should be initiated within 24 hours of the last drink.
A patient with a CIWA score of 8-10 is considered at VERY HIGH RISK for AWS.
CIWA scores are not useful in patients who are actively withdrawing from alcohol, but can be used to prevent alcohol withdrawal if initiated on admission
CIWA scores >10 indicate a need for symptom triggered response in the form of short or long acting benzodiazapines, with continued assessment of CIWA to assess effect.
Treatment of jaundice
Treatment of ammonia levels.
Treatment of nutritional deficiencies.
Treatment of electrolyte abnormalities
PT and INR.
Serum potassium and magnesium levels
Hematocrit and hemoglobin.
Conjugated Bilirubin levels
Hematocrit and Hemoglobin
Elevated unconjugated bilirubin
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