Ch 6 LGBP Flashcards
1
Q
ascites
A
an accumulation of fluid and albumin in the peritoneal cavity
2
Q
asterixis
A
hand flapping tremor usually induced by extending the arm and dorsiflexing the wrist frequently seen in hepatic coma
3
Q
esophageal varices
A
a complex of longitudinal tortuous veins at the lower end of the esophagus. they enlarge and become edematous as the result of portal hypertension
4
Q
flatulence
A
excessive formation of gases in the stomach or intestine
5
Q
hepatic encephalopathy
A
a type of brain damage caused by a liver disease and consequent ammonia intoxication
6
Q
hepatitis
A
inflammation of the liver resulting from several causes including several types of viral agents or exposure to toxic substances
7
Q
jaundice
A
yellowish discoloration of the skin mucous membranes and sclera od the eyes caused by greater than normal amounts of bilirubin in the blood. exceeds 2.5mg/dL of total serum bilirubin.
8
Q
occlusion
A
an obstruction or closing off in a canal vessel or passage of the body
9
Q
paracentesis
A
a procedure which fluid is withdrawn from the abdominal cavity
10
Q
parenchyma
A
tissue of an organ as distinguished from supporting or connective tissue
11
Q
spider telangiectases
A
dilated superficial arterioles
12
Q
steatorrhea
A
excessive fat in the feces
13
Q
Serum Bilirubin test normal values
A
Direct bilirubin : 0.1 to 0.3 mg/dL
Indirect bilirubin: 0.2 to 0.8 mg/dL
Total bilirubin: 0.3 to 1 mg/dL
14
Q
Serum Bilirubin test rationale
A
Testing for bilirubin in the blood provides valuable information for diagnosis and evaluation of liver disease biliary obstruction and hemolytic anemia.
15
Q
Nursing intervention serum bilirubin test
A
NPO until after the blood is drawn.
16
Q
Liver enzyme tests AST Normal levels
A
AKA. (Aspartate aminotransferase formerly serum glutamic oxaloacetic transaminase)
Adult 0 to 35 units/L
17
Q
Liver enzyme tests ALT Normal levels
A
AKA (alanine aminotransferase formerly serum glutamic pyruvic transaminase SGPT)
Adult or Child 4 to 36 units L
18
Q
Liver enzyme tests Alkaline phosphatase Normal level
A
Adult 30 to 12 units/L
19
Q
AST levels are elevated in the following conditions
A
MI, Hepatitis, cirrhosis, hepatic necrosis, hepatic tumor, acute pancreatitis and acute hemolytic anemia
20
Q
ALT levels are elevated in the following conditions
A
hepatitis, cirrhosis, hepatic necrosis and hepatic tumors and by hepatotoxic drugs
21
Q
Alkaline phosphatase level is elevated in the following conditions
A
obstructive disorders of the biliary tract, hepatic tumors, cirrhosis, hepatitis, primary and metastatic tumors, hyperparathyroidism, metastatic tumor in bones and healing fractures.
22
Q
Serum protein test normal values
A
Total protein: 6.4 to 8.3 g/dL
Albumin: 3.5 to 5g/dL
Globulin: 2.3 to 3.4 g/dL
Albumin/globulin (A/G ratio) 1.2 to 2.2 g/dL
23
Q
Serum protein test rational
A
Is to assess the livers functional status is to measure the products it synthesizes.
One of these products is protein, especially albumin.
24
Q
Cause of low serum albumin levels
A
excessive loss of albumin into urine as in nephrotic syndrome or third space volumes as in ascites liver disease, increased capillary permeability or protein caloric malnutrition.
25
What does the OCG do?
Provides roentgenographic visualization of the gallbladder after the oral ingestion of a raid opaque, iodinated dye
26
Adequate dye concentration depends on the following.
Ingestion of the correct number of dye tablets the evening before.
Adequate absorption of the dye in GI Tract.(vomiting and diarrhea inhibit absorption)
No fatty foods on morning of test.
uptake of the portal system and excretion of the dye by the liver.
27
Primary liver cancer
Is the 7th most common cancer in men & the 9th most common in women
28
High-risk factors in primary liver cancer
Cirrhosis of the liver & infection with hep-C or hep-B
29
Metastatic carcinoma of the liver
Occurs more often than primary liver cancer liver because of the portal vein circulation with its high rate of blood flow and extensive capillary structure
30
Carcinoma of the liver: side effects
Hepatomegaly, weight loss, peripheral edema, ascites, portal HTN, dull abd pain in the epigastric or RUQ, jaundice, anorexia, nausea et vomiting, and extreme weakness. Palpation may reveal an enlarged liver.
31
Hepatitis
An inflammation of the liver resulting from several types of viral agents or exposure to toxic substances. Rarely, hepatitis is caused by bacteria, such as steptococci, salmonellae, or Escherichia coli.
32
Hepatitis A
"Fecal-oral transmission" & is most common & lasts 10-40 days
33
Hepatitis B
Transmitted by contaminated serum via blood transfusion, contaminated needles, needle sticks, IV drug use, dialysis, breast milk, et sexual contact (bad sex)
34
Hepatitis C
Transmitted through needle sticks, blood transfusions, IVdrugs, et unidentified means, sharing straws used for snorting cocaine (cocaine)
35
Hepatitis s/s
Abd pain, dyspepsia, nausea, diarrhea, et constipation. May c/o pruritus from bile on the skin, c/o tenderness in the liver et remains fatigued for several weeks. Jaundice appears because of the damaged liver's inability to metabolize bilirubin.
36
Hepatitis diagnostics
PT & INR
37
If the hepatitis patient is dehydrated......
IV fluids are given with addition of vitamin C for healing, vitamin B complex to assist the damaged liver's inability to absorb fat-soluble vitamins, and vitamin K to combat prolonged coagulation time. Avoid sedatives!
38
When was the 1st human liver transplant performed?
1963
39
What is the leading indication for liver transplantation?
Liver disease related to chronic viral hepatitis
40
What are the major post-op complications of liver transplant?
Rejection & infection
41
What has been a major factor in the success rates of liver transplantation?
The use of cyclosporine, an effective immunosuppressant drug
42
Patients who have liver disease secondary to viral hepatitis often experience......
Reinfection of the transplanted liver with Hep B or C.
43
Mortality rates for Hep A & Hep B
Hep A is 0.5% mortality rate; Hep B is 10% mortality rate
44
Liver abscesses
If an infection develops anywhere along the GI tract, there is danger of the infecting organisms reaching the liver through the biliary system, portal venous system, or hepatic arterial or lymphatic systems
45
Liver abscesses: S/S
Nausea, chills, c/o dull abd pain, abd tenderness, and discomfort, fever, hepatomegaly, jaundice, and anemia
46
The two most common conditions of the biliary system are.....
Cholecystitis & cholelithiasis
47
Cholecystitis & cholelithiasis s/s
RUQ, anorexia, nausea, vomiting, and farts ;-) pts may experience increased HR & resp. rates & become diaphoretic (covered in sweat), leading them to think they are having a heart attack, low-grade fever, an elevated leukocyte count, mild jaundice, stools that contain fat (steatorrhea), and clay-colored stools
48
The 5 F's for gallbladder
Fat, female, fertile, fair, forty
49
Cholecystitis & cholelithiasis: med surg interventions
Bed rest is prescribed, an NG tube is inserted and connected to low suction, and the pt is placed on NPO status, Demerol is used
50
The two surgical procedures for gallbladder
A laparoscopic cholecystectomy et open abdominal cholecystectomy
51
If the stones are in the common bile duct and edema is present a _____ is inserted to keep the duct open and allow drainage of the bile until the edema resolves.
T-tube
52
Chole-
Pertaining to bile
53
Cholang-
Pertaining to bile ducts
54
Cholangiography
Radiographic exam of bile ducts
55
Cholangitis
Inflammation of bile duct
56
Cholecyst-
Pertaining to gallbladder
57
Cholecystectomy
Removal of gallbladder
58
Cholecystitis
Inflammation of gallbladder
59
Cholecystography
Radiographic exam of gallbladder
60
Cholecystostomy
Incision into the gallbladder (usually for drainage)
61
Choledocho-
Pertaining to common bile duct
62
Choledocholithiasis
Stones in common bile duct
63
Choledochostomy
Exploration of common bile duct
64
Cholelith-
Gallstone
65
Cholelithiasis
Presence of gallstones
66
During surgery, the abdominal cavity is inflated with ________ of carbon dioxide to Improve visibility
3 to 4 L
67
Laparoscopic cholecystectomy advantages over open abdominal cholecystectomy are:
It is less invasive (and thus there is less chance of wound infection or resp. impairment) and has a shorter healing time and a shorter recuperative time
68
Meal post op for laparoscopic cholecystectomy:
Oral liquids and a light meal are given the first night after surgery
69
Cholecystectomy pt teaching
Before discharge, pts should be able to eat without difficulty and walk and should have no abd distention, evidence of bleeding, or bile leakage. Instruct pt to report any severe pain, tenderness in the RUQ, increase in abd girth
70
While the T-tube is clamped, the pt may show signs of....
Distress, including abd pain, nausea/vomiting, light brown urine, and clay-colored stools
71
Diet for post op cholecystectomy
A clear liquid diet is usually ordered within first 24 hrs post op and increased as tolerated. When solid food is started, it will usually be low in fat. Flatulence or nausea after eating certain foods may persist after surgery; instruct pt to experiment with different foods.
72
Complications of cholecystectomy
Jaundice, and hemorrhage
73
Pancreatitis
An inflammatory condition of the pancreas that may be acute or chronic.
74
Pancreatitis: clinical manifestations
Severe abd pain radiating to the back; the pain is usually located in the LUQ; the pain is sometimes relieved by leaning forward. Jaundice may be noted if the common bile duct is obstructed
75
Pancreatitis: s/s
Low-grade fever, leukocytosis, hypotension, vomiting, jaundice, weight loss, steatorrhea, and tachycardia. Bowel sounds may be decreased or absent.
76
Pancreatitis: diagnostics
Abd CT scan and ultrasound of the pancreas, endoscopy, and lab analysis of the pancreatic enzymes in the serum and urine. Lab tests reveal an increased level of serum amylase and lipase during the first few days and increased urine amylase thereafter
77
Pancreatitis: the level of lipase
Rises in 4 to 8 hrs, peaks at 24 hrs, and may remain elevated for 14 days. Amylase and lipase levels may be elevated to 5 to 40 times normal
78
Pancreatitis: med surg interventions
Treatment is medical unless the precipitating cause is biliary tract disease, then surgery may be indicated. Food and fluids are withheld; NPO; NG tube is inserted. Parenteral anticholinergic medication, such as atropine or propantheline , helps decrease pancreatic activity
79
Pancreatitis: diet
A clear liquid diet with gradual progression may be started once the pt's pain is under control for at least 24 hrs. The diet must be free of alcohol and gastric stimulants, such as coffee. Low-fat, high-calorie, high-carb diet after discharge.
80
Cancer of the pancreas
The 4th leading cause of cancer death in the US & Canada
81
Cachexia
Wasting away
82
Pancreatic cancer: causes
Is unknown, but it is diagnosed more often in cigarette smokers, people exposed to chemical carcinogens, and people with DM, cirrhosis, and pancreatitis. Diets high in red meat and pork, fat, and coffee are also linked to pancreatic cancer.
83
Pancreatic cancer: clinical manifestations
About half the pts develop DM if islet cell are involved
84
Pancreatic cancer: S/S
Anorexia, fatigue, nausea, farts ;), a change in stools, and steady, dull, and aching pain in the epigastrium or referred to the back. Pain usually worse at night; weight loss, jaundice
85
Pancreatic cancer: diagnostics
ERCP (the gold standard); CA 19-9 can be elevated in other diseases such as cancer of the gallbladder or in no malignant conditions such as acute and chronic pancreatitis, hepatitis, and biliary duct obstruction
86
Pancreatic cancer: med-surg interventions
Cancer of the head of the pancreas is usually treated by pancreatoduodenectomy; the Whipple procedure involves resection of the Antrum of the stomach, the gallbladder, the duodenum, and varying amounts of the pancreas.
Combinations of drugs such as fluorouracil and gemcitabine may produce a better response than a single chemotherapeutic agent.
87
Pancreatic cancer: pt teaching
Post op care focuses on maintaining fluid and electrolyte balance, preventing hemorrhage, preventing resp. complications, and monitoring endocrine and exocrine functions of the pancreas.
88
T-Tube Cholangiography rationale
performed to diagnose retained ductal stones post op in pt who has had a cholecystectomy and common bile duct (CBD) exploration to demonstrate good flow into the duodenum
89
T-Tube Cholangiography Nursing interventions
protect pt from sepsis (if t-tube is left in place) by attaching to a CDU
If t-tube removed cover the t-tube tract site with a sterile dressing to prevent bacteria from entering the ductal system
Prior to the procedure pt should be NPO
90
Needle Liver biopsy procedure
The pt lies supine with the right arm over the head. Pt is instructed to exhale fully and not breathe while the needle is inserted. Done usually using ultrasound or CT guidance
91
What you make the pt do prior to a needle liver biopsy.
GO POTTY:)
92
Needle Liver biopsy nursing interventions
Monitor VS every 15 mins (2 times) then every 30 mins (4 times) then every hour (4 times)
93
What to do if there is a leakage of a large quantity of blood or bile from the needle biopsy causing severe pain.
Assess the pt for pneumothorax (collapsed lung) caused by improper placement of the biopsy needle into the adjacent chest cavity or for the bile peritonitis.
94
If pt has pneumothorax(collapsed lung) due to needle liver biopsy what do you do?
Inform doctor of symptoms. Keep pt lying on right side for at least 2 hours to splinting the puncture site.
95
Serum Ammonia Test normal values
10 to 80 mcg/dL
96
Ammonia is a by product of?
protein metabolism
97
What is most of the ammonia made by?
bacteria acting on proteins in the intestine
98
What happens when the pt has severe liver dysfunction or altered blood flow to the liver?
ammonia cannot be catabolized(metabolic process of breaking down complex into simple molecules)
serum ammonia level rises
BUN level decreases
99
What is the primary diagnosis's that the serum ammonia level is used for?
hepatic encephalopathy
| hepatic coma
100
Hepatitis
inflammation of the liver caused by viruses, bacteria and noninfectious causes of liver inflammation
101
Serum amylase test normal values
60 to 120 somogyi units/dL or
| 30 to 220 units/L (si units)
102
Serum amylase test rationale
performed for test of pancreatitis due to damage of the pancreatic cells or obstruction to the pancreatic ductal flow.
103
Urine amylase test normal value
up to 5000 somogyi units / 24 hr or 6.5 to 48.1 units/hr
104
Urine amylase level rationale
levels of amylase in the urine remain elevated for 7 to 10 days after the onset of the disease.
105
serum lipase test normal value
10 to 140 units/L
106
serum lipase test rationale
the lipase levels rise a little later than amylase levels(4 to 48 hrs after the onset of pancreatitis) peak around 24 hrs and remain elevated for 14 days
107
Endoscopic retrograde cholangiopancreatography (ERCP)
enables visualization mot only of the biliary system but also of the pancreatic duct
108
Endoscopic retrograde cholangiopancreatography (ERCP) nursing interventions
tell pt that the test will take 1 to 2 hrs and they have to lay motionless on a hard table which may be uncomfortable.
Must stay NPO until gag reflex comes back
assess for s/s of pancreatitis
109
Cirrhosis
is a chronic degenerative disease of the liver in which the lobes are covered with fibrous tissue of the parenchyma degenerates and the lobules are infiltrated
110
Alcoholic Cirrhosis
AKA Laennec's cirrhosis is most commonly found in the western world
111
Post necrotic cirrhosis
caused by viral hepatitis exposure to hepatotoxins or infections
112
Cardiac cirrhosis
results form longstanding severe right sided heart failure in patients with cor pulmonale, constrictive pericarditis and tricuspid insufficiency
113
Hypoalbuminemia
reduced protein or albumin level in the blood
114
Cirrhosis clinical maifestations
later stages of the disease are characterized by dyspepsia, changes in bowel habits, gradual weight loss, ascites, enlarged spleen, malaise, nausea, jaundice, ecchymosis and spider telangiectases.
115
Spider telangiectases occur on the....
nose, cheeks, upper trunk, neck, and shoulders
116
Anemia occurs....
because of the body's decreased ability to produce RBCs
117
The cirrhotic liver cannot absorb.....
Vit. K or produce clotting factors VII, IX, X thus the pt develops bleeding tendencies
118
Cirrhosis objective data early stages
Jaundice and weight loss
119
Cirrhosis objective data later stages
epistaxis, purpura, hematuria, spider angiomas and bleeding gums. Late symptoms are ascites, hematoligic disorders splenic enlargement and hemorrhage from esophageal varices or other distended GI veins.
120
Cirrhosis diagnostic tests
AST, ALT, LDH, and gamma GT decreased total protein and serum albumin elevated ammonia, hypoglycemia from impaired gluconeogenesis, PPT, INR decreased cholesterol levels
121
Paracentesis
a procedure in which fluid is withdrawn from the abd cavity. Done by either gravity or a vacuum. It is only a temporary method. Relieves ascites and also provides fluid for lab exam. Warning can go into shock from procedure
122
Cirrhosis Medical mgmt
Eliminating alcohol, hepatotoxins(Tylenol)
Well balanced diet high in calories (2500 to 3000 calories / day) moderately high in protein (75g of high quality protein), low in at and sodium ( 1000 to 2000 mg /day ) and with additional vitamins and folic acid will usually meet the needs of the pt and improve deficiencies
123
Antiemetics
may be prescribed to control nausea or vomiting caused by cirrhosis
124
Later manifestations of cirrhosis
jaundice, peripheral edema esophageal varices hepatic encephalopathy and ascites
125
Ascites complications and treatment
initially pt is on bed rest with accurate monitoring of I&O, Fluid restrictions are in place of 500 to 1000mL and sodium of 1000 to 2000 mg.
Diuretic therapy may be added and Spironolactone (aldactone) 300 to 1000 mg / day may be used to obtain the desired diuresis
Vitamin supplements and salt poor albumin my be administered to attempt to restore plasma volume
126
LeVeen continuous peritoneal shunt
This procedure allows the continuous shunting of ascetic fluid from the abd cavity through a none way pressure sensitive valve into a silicone tube that empties into the superior vena cava. This is another treatment for edema and ascites
127
Hormone Vasopressin (VP) administered by IV or directly into the vena cava is used to?
Decrease or stop the hemorrhaging. VP produces vasoconstriction of the vessels and decreases portal blood flow and decreases portal hypertension
128
Sengstaken-Blakemore tube
Is a triple lumen tube that has a lumen for inflating the esophageal balloon, one for inflating the gastric balloon and one for gastric lavage
129
How to care for a pt who has hemorrhaged from an esophageal varix.
Maintenance of oxygen content levels within the blood and administration of fresh frozen plasma and packed RBC's, Vitamin K, histamine receptor blockers such as cimetidine (tagament) and electrolyte replacement. AVOID ammonia buildup with use of cathartics(lactulose)
130
In the past a low protein diet
was often prescribed for patients with cirrhosis it was thought it would decrease the amount of ammonia in the intestine
131
Lactulose decreases
The bowels pH from 7 to 5 thus decreasing the production of ammonia by bacteria within the bowel. Lactulose may be administered orally, retention enema, or via NG tube.
132
Nursing interventions Cirrhosis
Observe for GI hemorrhage as evidenced by hematemesis, melena, anxiety and restlessness
133
Due to pruritus, malnutrition and edema a patient with cirrhosis is prone to....
skin lesions, and pressure sores. Initiate preventive nursing interventions such as alternating air pressure mattress, frequent turning and back rubs. apply soothing lotion to relieve pruritus
observe the patients mental status and report changes such as disorientation, headache or lethargy
134
Patient with cirrhosis should be instructed that they need to prevent bleeding when doing daily personal care.
Instruct to use a soft bristled toothbrush, use an electric razor, blow nose cautiously, avoid straining at stools. Also avoid soap, perfumed lotion and rubbing alcohol as that will further dry the skin
135
The prognosis for cirrhosis of the liver....
is related to the cause of the disease the patients general health status and the extent of the involvement
