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Nursing 202 - Midterm > Biliary & Hepatic > Flashcards

Biliary & Hepatic Flashcards

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1
Q

Pancreas exocrine excretions

A

Amylase, trypsin, lipase, secretin

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2
Q

Pancreas endocrine excretions

A

Insulin, glucagon, somatostatin

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3
Q

Pancreatitis

MOA acute

A

Pancreatic duct becomes obstructed and enzymes back up, causing auto-digestion and inflammation of the pancreas

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4
Q

Pancreatitis

MOA chronic

A

Progressive inflammatory D/O w/ destruction of the pancreas; cells are replaced by fibrous tissue; pressure w/in pancreas increases, obstructing the pancreatic and common bile ducts

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5
Q

Pancreatitis

Complications

A
  • F&E disturbances
  • Necrosis of pancreas
  • Shock
  • MODS
  • DIC
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6
Q

Metabolic function of liver

A
  • Glucose metabolism
  • Ammonia conversion
  • Protein metabolism
  • Fat metabolism
  • Vitamin and iron storage
  • Bile formation
  • Bilirubin excretion
  • Drug metabolism
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7
Q

LFTs

A
  • Serum aminotransferase: AST, ALT, GGT, GGTP, LDH
  • Serum protein studies
  • Direct & indirect serum bilirubin, urine bilirubin, urine urobilinogen
  • Clotting factors
  • Serum alk phos
  • Lipids
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8
Q

Serum aminotransferases

A

Indicators of injury to liver cells

Helpful in detecting hepatitis

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9
Q

Alanine aminotransferase (ALT)

A

Levels increase primarily in liver D/O

Used to monitor course of hepatitis, cirrhosis, effects of TX that may be toxic to liver

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10
Q

Aspirate aminotransferase (AST)

A

Not specific to liver disease

May be increased in cirrhosis, hepatitis, liver cancer

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11
Q

Gamma-glutamyl transferase (GGT)

A

Levels associated w/cholestasis, alcoholic liver disease

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12
Q

Additional DX studies for liver disease

A

Liver biopsy, US, CT, MRI

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13
Q

Manifestations of hepatic dysfunction

A

Jaundice, portal HTN, ascites, varices, hepatic encephalopathy, coma, nutritional deficiencies

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14
Q

Bilirubin level to cause jaundice

A

> 2

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15
Q

S/S associated w/hepatocellular jaundice

A
  • Lack of appetite, N/V, weight loss
  • Malaise, fatigue, weakness
  • HA, chills, fever, infection
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16
Q

S/S associated w/obstructive jaundice

A
  • Dark orange-brown urine, clay-colored stools
  • Dyspepsia & intolerance of fats, impaired digestion
  • Pruritus
17
Q

Consequences of portal HTN

A

Ascites

Varices

18
Q

Ascites

Causes

A
  • Portal HTN —> increased capillary pressure —> obstruction of venous blood flow
  • Vasodilation of splanchnic circulation
  • Changes in ability to metabolize aldosterone, increasing fluid retention
  • Decreased synthesis of albumin, decreasing serum osmotic pressure
  • Movement of albumin into peritoneal cavity
19
Q

Ascites

Assessment

A
  • Abdominal girth, daily weights
  • May have striae, distended veins, umbilical hernia
  • Percussion shows shifting dullness or fluid wave
  • Monitor for F&E imbalances
20
Q

Ascites

Treatment

A
  • Low Na diet
  • Diuretics
  • Bed rest
  • Paracentesis
  • Admin of salt-poor albumin
  • Transjugular intrahepatic portosystem shunt (TIPS)
21
Q

Hepatic encephalopathy

Management

A
  • Lactulose
  • IV glucose to minimize protein catabolism
  • Protein restriction
  • Reduction of ammonia from GI tract by gastric suction, enemas, PO ABX
  • D/C sedatives, analgesics, tranquilizers
  • Monitor/Tx complications and infections
22
Q

Esophageal varices

Management/Tx

A
  • Treat for shock, admin O2
  • IVF, lytes, volume expanders, blood/blood products
  • Vasopressin, somatostatin, octreotide to decrease bleeding
  • Nitroglycerin in combo w/ vasopressin to decrease coronary vasoconstriction
  • Propranolol, nadolol to decrease portal pressure (combo Tx)
  • Balloon tamponade, endoscopic sclerotherapy, endoscopic variceal ligation, TIPS, surgical bypass, devascularization/transaction
23
Q

Hepatitis A & E spread

A

Fecal-oral

24
Q

Hepatitis B & C spread

A

Bloodborne

25
Q

Hepatitis D spread

A

Only people w/B can get D

26
Q

Hep A incubation

A

2-6 wks, may last 4-8 wks

27
Q

Hep A S/S

A

Mild flu-like S/S, low-grade fever, anorexia, jaundice/dark urine, indigestion, epigastric distress, enlargement of liver/spleen

28
Q

Hep A management

A
  • Prevention: hand hygiene, safe water, proper sewage disposal, vaccine
  • Bed rest during acute stage, nutritional support
29
Q

Hep B incubation

A

1-6 months

30
Q

Hep B S/S

A

Insidious and variable - similar to HAV, loss of appetite, dyspepsia, abdominal pain, generalized aching, malaise, weakness

Jaundice may/may not be evident

31
Q

Hep B management

A
  • Meds: alpha interferon, antiviral agents (entevavir, tenofovir)
  • Best rest, nutritional support
  • Vaccine for high risk
32
Q

Hep C incubation

A

15-160 days

33
Q

Hep C management

A
  • Antiviral meds

- Alcohol worsens disease - AVOID

34
Q

Cirrhosis

S/S

A

Liver enlargement, portal obstruction, ascites, infection/peritonitis, varices, edema, vitamin deficiency, anemia, mental deterioration

35
Q

Cirrhosis

Nutrition

A
  • Small, frequent meals
  • I&O
  • High-calorie diet, Na restriction
  • Protein modified or restricted if patient is @ risk of encephalopathy
  • Supplemental vitamins
36
Q

Liver cancer

S/S

A
  • Dull, persistent pain - RUQ, back, epigastrium
  • Weight loss, anemia, anorexia, weakness
  • Jaundice, bile ducts occluded, ascites, obstructed portal veins

Nursing 202 - Midterm (12 decks)

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