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Nursing of Adults I > Chapter 48: Liver, Biliary Tract, and Pancreas Problems (Part 1- Liver) > Flashcards

Chapter 48: Liver, Biliary Tract, and Pancreas Problems (Part 1- Liver) Flashcards

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1
Q

younger women with cirrhosis may develop _______________, while older women may have ________________

A

amenorrhea, vaginal bleeding

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2
Q

this complication of cirrhosis causes blood to be rerouted to adjoining lower pressure vessels

A

portal hypertension

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3
Q

cirrhosis patients should have upper endoscopy to screen for _________

A

varices

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4
Q

if exposed to hepatitis A, ________________________ is given within __________ after exposure

A

single immunoglobulin, 2 weeks

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5
Q

immunoglobulin seen in acute phase of hepatitis A that begins to decline about 3 months after exposure

A

IgM

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6
Q

immunoglobulin seen in hepatitis A in which levels are slower to peak but remain elevated years after exposure, conferring immunity against further infection

A

IgG

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7
Q

(primary, metastatic) liver carcinoma is more common

A

metastatic

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8
Q

hepatitis B infection can lead to increased risk of developing ______________

A

liver cancer

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9
Q

this treatment method for esophageal varices uses a small rubber band around the base of a large vein

A

banding

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10
Q

type of hepatitis (A-C): prognosis: chronic carriers rate high; generally, a full recovery in others

A

hepatitis C

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11
Q

type of hepatitis (A-C): post-exposure management: in the un-immunized person exposed, give this type of hepatitis vaccine and high titer immune globulin to reduce the risk of infection

A

hepatitis B

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12
Q

type of hepatitis (A-C): post-exposure management: immune globulin within 2 weeks of exposure; if given early in incubation period, has 80-90% effectiveness

A

hepatitis A

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13
Q

type of hepatitis (A-C): complications: rare, but can be fatal if fulminant hepatitis develops; protracted cholestasis can occur

A

hepatitis A

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14
Q

hepatitis: in addition to liver enzymes, lab tests may also be done to test for ______________

A

viral antigens

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15
Q

hepatitis C (does, does not) have a current vaccine

A

does not

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16
Q

liver is a common site of metastatic growth because of these two things

A
  1. high rate of blood flow
  2. extensive capillary network
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17
Q

teach those at high risk of hepatitis B these four methods of how to decrease risk of contracting it

A
  1. good hygiene
  2. use gloves with expected contact with blood
  3. do not share razors, toothbrushes, other personal items
  4. use condoms for intercourse
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18
Q

treatment for acute hepatitis B is indicated only in patients with ______________ and ______________

A

severe hepatitis, liver failure

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19
Q

in treating cirrhosis, adequate calories including protein are needed except in cases where ___________ levels are high

A

ammonia

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20
Q

type of hepatitis (A-C): prevention: hand washing prior to food preparation; proper personal hygiene; environmental sanitation measures; food and water sanitation; immune globulin for travelers into areas where this type is common; this type vaccine (not yet licensed in US)

A

hepatitis A

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21
Q

treat any bleeding with esophageal varices with this

A

blood products

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22
Q

accumulation of protein-rich fluid in the abdominal cavity

A

ascites

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23
Q

to reduce pressure in the portal circulation, the body develops alternative circulatory pathways, called this

A

collateral circulation

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24
Q

two skin lesions that can occur with cirrhosis

A

spider angioma, palmar erythema

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25
Q

manifestation of hepatic encephalopathy in which the patient’s wrists and fingers are observed to “flap” because of a brief, rapid relaxation of wrist dorsiflexion

A

asterixis

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26
Q

hepatitis: ALT and AST increase in the _______ phase (due to ________________) and decrease as _____________________

A

acute, liver cell injury, jaundice disappears

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27
Q

presence of bilirubin in urine changes its color to this

A

dark brown or brownish-red

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28
Q

this can occur when portal hypertension increases hydrostatic pressure in vessels of portal system

A

ascites

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29
Q

_______________ cirrhosis is the most common type in North America, but cirrhosis can also result from __________________, prolonged ___________ of the biliary system, and long-term severe ______________________

A

Alcoholic, chronic hepatitis B or C, obstruction, right-sided heart failure

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30
Q

surgical procedure that is used to treat ascites that does not respond to pressure; involves a peritoneovenous shunt that provides continuous reinfusion of ascitic fluid into venous system

A

transjugular intrahepatic portosystemic shunt (TIPS)

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31
Q

type of hepatitis (A-C): post-exposure management: the value of immune globulin is unclear; no other treatment is presently available

A

hepatitis C

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32
Q

these two groups of patients may need a larger or more doses of the hepatitis B vaccine

A

hemodialysis
immunocompromised

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33
Q

after liver surgery, such as liver resection, place patient on ________ side

A

right

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34
Q

this procedure is performed when diuretics are not effective in reducing fluid with ascites

A

paracentesis

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35
Q

hepatitis: ALP: moderately increased from impaired _______________ function of liver

A

excretory

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36
Q

nutritional therapy for hepatitis: emphasis on a(n) _____________ diet with adequate ___________

A

well-balanced, calories

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37
Q

complementary therapy for hepatitis that may help by protecting and promoting growth of liver cells and inhibiting inflammation

A

milk thistle

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38
Q

hematologic problems of cirrhosis, such as thrombocytopenia, leukopenia, anemia, and coagulation problems may occur due to this

A

splenomegaly

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39
Q

when assessing a patient with hepatitis, assess for __________, __________ color, and ___________

A

jaundice, urine, pruritis

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40
Q

peripheral neuropathy is a common finding in ________________ cirrhosis, probably due to diet deficiency of _____________, _______________, and _______________.

A

alcoholic, thiamine, folic acid, cobalamin

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41
Q

isolation (is, is not) required for hepatitis A

A

is not

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42
Q

chronic active state of hepatitis B infection can lead to ___________ and __________ thus requiring ______________

A

cirrhosis, liver failure, liver transplantation

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43
Q

if patient with cirrhosis is unable to take lactulose PO for hepatic encephalopathy, this alternative treatment will be used

A

retention enema

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44
Q

type of hepatitis (A-C): prevention includes pre/post-exposure immunization

A

hepatitis A, hepatitis B

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45
Q

complication that may occur when esophageal varices rupture

A

hemorrhage

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46
Q

liver cancer patients typically have this survival period

A

less than 6 months

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47
Q

this treatment is an option for small liver tumors without evidence of spread

A

liver transplant

48
Q

type of hepatitis (A-C): source of virus is in blood/blood-derived body fluids

A

hepatitis B, hepatitis C

49
Q

this complication of cirrhosis occurs due to portal hypertension causing blood to be shunted into the splenic vein

A

splenomegaly

50
Q

primary liver tumors usually metastasize to the ________

A

lungs

51
Q

drug therapy for hepatitis C is directed toward _______________ and ___________________

A

eradicating virus, preventing complications

52
Q

enlarged thin-walled veins that form in the submucosa of the esophagus

A

esophageal varices

53
Q

hepatitis A virus can be found as long as _________ in feces and is the most ___________ at this time

A

3 months, contagious

54
Q

five risk factors for hepatitis C virus

A

multiple sex partners
drug use
tattooing
body piercing
barbering

55
Q

type of hepatitis (A-C): prognosis: good, generally, a full recovery, except for chronic carriers

A

hepatitis B

56
Q

type of hepatitis (A-C): prevention includes risk behavior modification

A

hepatitis C

57
Q

increased estrogen levels in men with cirrhosis may cause these four manifestations

A

gynecomastia
loss of axillary/pubic hair
testicular atrophy
impotence with loss of libido

58
Q

rings of varices in umbilicus area

A

caput medusae

59
Q

treatment of acute hepatitis C with _________________ in the first _________ weeks of infection (or _____________) decreases development of chronic hepatitis C

A

pegylated interferon, 12-24 weeks, antivirals

60
Q

prevention of hepatitis C is centered on these three measures

A
  1. screening of blood, organ, and tissue donors
  2. infection control
  3. modifying high-risk behaviors
61
Q

nutrition therapy for cirrhosis includes a(n) ____-calorie diet (______/day) with ______ carbohydrates and _____________ fat, supplemented with ___________ and ____________. _________ and possibly ____________ are restricted.

A

high, 3000, high, moderate to low, vitamins, minerals, sodium, fluids

62
Q

type of hepatitis (A-C): prevention includes blood donor screening

A

hepatitis C

63
Q

to treat acute phases of hepatitis, put patient on __________, provide adequate _________ as tolerated, avoid _________________, and avoid __________ for 3-16 weeks

A

bed rest, nutrition, strenuous activity, alcohol

64
Q

type of hepatitis (A-C): source of virus is in feces

A

hepatitis A

65
Q

these four groups are considered at high risk for contracting hepatitis B

A

healthcare workers (lab, blood bank, hemodialysis)
multiple sex partners
homosexual men
mom to fetus in third trimester

66
Q

nutritional therapy for hepatitis: vitamin supplements include these two vitamins

A

vitamin B-complex, vitamin K

67
Q

type of hepatitis (A-C): prognosis: good, generally full recovery, no chronic carrier state

A

hepatitis A

68
Q

type of hepatitis (A-C): prevention: this type vaccine for all infants, health care professionals, and others at risk; condom use; screening donated blood; devices to minimize risk to health care professionals (needleless IV access devices); personal protective devices for health care professionals (apron, eye and mucous membrane protection gloves, gowns)

A

hepatitis B

69
Q

management of hepatitis focuses on determining the ________, providing appropriate ____________ and _________, and _______________________ to prevent further liver damage

A

cause, treatment, support, teaching strategies

70
Q

if no active bleeding present with esophageal varices, this is the preferred treatment method

A

banding (band ligation)

71
Q

type of hepatitis (A-C): route of transmission is fecal-oral

A

hepatitis A

72
Q

nursing care for liver cancer includes education about _______________, controlling __________, and referring to ______________

A

risk factors, pain, hospice

73
Q

in caring for a patient with gastric lavage in place, never leave alone due to risk for _____________

A

aspiration

74
Q

drug therapy for chronic hepatitis B is focused on decreasing __________ and ____________ and _______________ of liver progression

A

viral load, liver enzymes, slowing rate

75
Q

health promotion for hepatitis includes prevention measures, including good _________, dangers of _________________ and _____________, safe ______, getting _____________, and ___________________ if known exposure.

A

hygiene, injectable drugs, sharing needles, sex, vaccinated, post-exposure prophylaxis

76
Q

main goal of treatment for esophageal varices

A

prevent bleeding and hemorrhage

77
Q

most common cause of hepatitis

A

viral

78
Q

type of hepatitis (A-C): no chronic infection

A

hepatitis A

79
Q

complementary therapy that helps treat nausea (hepatitis)

A

ginger

80
Q

telaprevir, boceprevir, or HCV-protease inhibitors are used for this type of hepatitis

A

hepatitis C genotype 1

81
Q

clinical manifestations of hepatitis are similar regardless of the _________

A

cause

82
Q

four places in which collateral circulation forms due to portal hypertension

A

lower esophagus
anterior abdominal wall
parietal peritoneum
rectum

83
Q

this may be done to evaluate for chronic hepatitis B or C

A

liver biopsy

84
Q

these two measures can help prevent hepatitis A

A

good hand washing, standard precautions

85
Q

complementary therapy that helps treat depression (hepatitis)

A

St. John’s wort

86
Q

if exposed to hepatitis B, these two measures are given

A

immunoglobulins (for short-term immunity) with concurrent vaccine

87
Q

therapies for hepatitis B suppress ________________, preventing complications

A

viral replication

88
Q

hepatitis A virus is usually resolved in ______ weeks but can take up to ____ weeks

A

9-10, 16

89
Q

primary liver cancer is _____, but _______________ increase risk for primary liver cancer

A

rare, hepatitis B and C

90
Q

hepatitis: serum bilirubin is increased to ______ mg/dL because of _____________

A

8-15, liver damage

91
Q

late manifestation of cirrhosis that results from decreased ability to conjugate and excrete bilirubin into small intestines for excretion

A

jaundice

92
Q

nutritional therapy for hepatitis: if patient has decreased bile production, reduce ______ intake

A

fat

93
Q

type of hepatitis (A-C): complications: chronic carrier state in as many as 50% of those infected via blood transfusions or IV drug abuse; chronic liver disease; cirrhosis; liver cancer; death

A

hepatitis C

94
Q

in most cases of acute viral hepatitis, pharmacologic treatment (is, is not) indicated

A

is not

95
Q

type of hepatitis (A-C): chronic infection possible

A

hepatitis B, hepatitis C

96
Q

these, produced by plasma cells and lymphocytes, function as antibodies (hepatitis B)

A

immunoglobulin-protein

97
Q

intact hepatitis B virus is sometimes called this

A

Dane Particle

98
Q

three places where liver tumors can infiltrate or move to

A

gallbladder, peritoneum, diaphragm

99
Q

improper metabolism of aldosterone can lead to __________________ with ___________ and ___________ retention and _____________ loss

A

hyperaldosteronism, sodium, water, potassium

100
Q

nutritional therapy for hepatitis: if severe nausea, vomiting, and anorexia is present, these two measures may be taken to maintain fluid and electrolyte balance

A

IV glucose
enteral nutrition (possible)

101
Q

type of hepatitis (A-C): complications: with acute infection, death from fulminant hepatitis is possible; up to 10% become chronic carriers and may be at risk for cirrhosis, liver cancer, and death; anyone with this type is at risk for HDV infection

A

hepatitis B

102
Q

best method of prevention for hepatitis A and B

A

vaccination

103
Q

hepatitis B: genotype ___ has the poorest response to treatment (50%) as compared to 70-80% for the other two

A

1

104
Q

this treatment method for esophageal varices is used when an acute esophageal/gastric hemorrhage cannot be controlled on initial endoscopy; controls the bleeding by mechanical compression of varices

A

balloon tamponade

105
Q

complementary therapy that is an antiviral and antiinflammatory (hepatitis)

A

licorice root

106
Q

two early manifestations of cirrhosis

A

fatigue, hepatomegaly

107
Q

clinical manifestations of liver cancer are similar to those of _____________

A

cirrhosis

108
Q

this treatment method for esophageal varices involves injection of a solution into varices

A

sclerotherapy

109
Q

surgical resection of the liver is possible only if the tumor is _____________ and in a lobe that can be ___________

A

localized, removed

110
Q

type of hepatitis (A-C); route of transmission is percutaneous permucosal

A

hepatitis B, hepatitis C

111
Q

complication of cirrhosis characterized by the accumulation of toxins (ammonia) in the blood and cerebral edema

A

hepatic encephalopathy (or portal systemic encephalopathy)

112
Q

hepatitis: in addition to ALT, AST, ALP, GGT, and serum bilirubin, ______ levels are also increased

A

LDH

113
Q

main goal of drug therapy for varices is to stop bleeding by producing _______________ of splenic arterial bed to _____________ portal blood flow and portal hypertension

A

vasoconstriction, decrease

114
Q

type of hepatitis (A-C): prevention: screening donated blood; avoidance of blood-to-blood exposure for at-risk individuals and health care professionals

A

hepatitis C

115
Q

this procedure involves inserting an esophageal or gastric balloon to apply direct pressure along with a tube

A

gastric lavage

116
Q

hepatitis: GGT: increased from _________________

A

liver cell injury

117
Q

when treating liver cancer, chemotherapy can be given in these two places

A

directly in liver
systemically

Nursing of Adults I (21 decks)

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