Chapter 48: Liver, Biliary Tract, and Pancreas Problems (Part 1- Liver) Flashcards
younger women with cirrhosis may develop _______________, while older women may have ________________
amenorrhea, vaginal bleeding
this complication of cirrhosis causes blood to be rerouted to adjoining lower pressure vessels
portal hypertension
cirrhosis patients should have upper endoscopy to screen for _________
varices
if exposed to hepatitis A, ________________________ is given within __________ after exposure
single immunoglobulin, 2 weeks
immunoglobulin seen in acute phase of hepatitis A that begins to decline about 3 months after exposure
IgM
immunoglobulin seen in hepatitis A in which levels are slower to peak but remain elevated years after exposure, conferring immunity against further infection
IgG
(primary, metastatic) liver carcinoma is more common
metastatic
hepatitis B infection can lead to increased risk of developing ______________
liver cancer
this treatment method for esophageal varices uses a small rubber band around the base of a large vein
banding
type of hepatitis (A-C): prognosis: chronic carriers rate high; generally, a full recovery in others
hepatitis C
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
hepatitis B
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
hepatitis A
type of hepatitis (A-C): complications: rare, but can be fatal if fulminant hepatitis develops; protracted cholestasis can occur
hepatitis A
hepatitis: in addition to liver enzymes, lab tests may also be done to test for ______________
viral antigens
hepatitis C (does, does not) have a current vaccine
does not
liver is a common site of metastatic growth because of these two things
- high rate of blood flow
- extensive capillary network
teach those at high risk of hepatitis B these four methods of how to decrease risk of contracting it
- good hygiene
- use gloves with expected contact with blood
- do not share razors, toothbrushes, other personal items
- use condoms for intercourse
treatment for acute hepatitis B is indicated only in patients with ______________ and ______________
severe hepatitis, liver failure
in treating cirrhosis, adequate calories including protein are needed except in cases where ___________ levels are high
ammonia
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)
hepatitis A
treat any bleeding with esophageal varices with this
blood products
accumulation of protein-rich fluid in the abdominal cavity
ascites
to reduce pressure in the portal circulation, the body develops alternative circulatory pathways, called this
collateral circulation
two skin lesions that can occur with cirrhosis
spider angioma, palmar erythema
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
asterixis
hepatitis: ALT and AST increase in the _______ phase (due to ________________) and decrease as _____________________
acute, liver cell injury, jaundice disappears
presence of bilirubin in urine changes its color to this
dark brown or brownish-red
this can occur when portal hypertension increases hydrostatic pressure in vessels of portal system
ascites
_______________ cirrhosis is the most common type in North America, but cirrhosis can also result from __________________, prolonged ___________ of the biliary system, and long-term severe ______________________
Alcoholic, chronic hepatitis B or C, obstruction, right-sided heart failure
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
transjugular intrahepatic portosystemic shunt (TIPS)
type of hepatitis (A-C): post-exposure management: the value of immune globulin is unclear; no other treatment is presently available
hepatitis C
these two groups of patients may need a larger or more doses of the hepatitis B vaccine
hemodialysis
immunocompromised
after liver surgery, such as liver resection, place patient on ________ side
right
this procedure is performed when diuretics are not effective in reducing fluid with ascites
paracentesis
hepatitis: ALP: moderately increased from impaired _______________ function of liver
excretory
nutritional therapy for hepatitis: emphasis on a(n) _____________ diet with adequate ___________
well-balanced, calories
complementary therapy for hepatitis that may help by protecting and promoting growth of liver cells and inhibiting inflammation
milk thistle
hematologic problems of cirrhosis, such as thrombocytopenia, leukopenia, anemia, and coagulation problems may occur due to this
splenomegaly
when assessing a patient with hepatitis, assess for __________, __________ color, and ___________
jaundice, urine, pruritis
peripheral neuropathy is a common finding in ________________ cirrhosis, probably due to diet deficiency of _____________, _______________, and _______________.
alcoholic, thiamine, folic acid, cobalamin
isolation (is, is not) required for hepatitis A
is not
chronic active state of hepatitis B infection can lead to ___________ and __________ thus requiring ______________
cirrhosis, liver failure, liver transplantation
if patient with cirrhosis is unable to take lactulose PO for hepatic encephalopathy, this alternative treatment will be used
retention enema
type of hepatitis (A-C): prevention includes pre/post-exposure immunization
hepatitis A, hepatitis B
complication that may occur when esophageal varices rupture
hemorrhage
liver cancer patients typically have this survival period
less than 6 months
this treatment is an option for small liver tumors without evidence of spread
liver transplant
type of hepatitis (A-C): source of virus is in blood/blood-derived body fluids
hepatitis B, hepatitis C
this complication of cirrhosis occurs due to portal hypertension causing blood to be shunted into the splenic vein
splenomegaly
primary liver tumors usually metastasize to the ________
lungs
drug therapy for hepatitis C is directed toward _______________ and ___________________
eradicating virus, preventing complications
enlarged thin-walled veins that form in the submucosa of the esophagus
esophageal varices
hepatitis A virus can be found as long as _________ in feces and is the most ___________ at this time
3 months, contagious
five risk factors for hepatitis C virus
multiple sex partners
drug use
tattooing
body piercing
barbering
type of hepatitis (A-C): prognosis: good, generally, a full recovery, except for chronic carriers
hepatitis B
type of hepatitis (A-C): prevention includes risk behavior modification
hepatitis C
increased estrogen levels in men with cirrhosis may cause these four manifestations
gynecomastia
loss of axillary/pubic hair
testicular atrophy
impotence with loss of libido
rings of varices in umbilicus area
caput medusae
treatment of acute hepatitis C with _________________ in the first _________ weeks of infection (or _____________) decreases development of chronic hepatitis C
pegylated interferon, 12-24 weeks, antivirals
prevention of hepatitis C is centered on these three measures
- screening of blood, organ, and tissue donors
- infection control
- modifying high-risk behaviors
nutrition therapy for cirrhosis includes a(n) ____-calorie diet (______/day) with ______ carbohydrates and _____________ fat, supplemented with ___________ and ____________. _________ and possibly ____________ are restricted.
high, 3000, high, moderate to low, vitamins, minerals, sodium, fluids
type of hepatitis (A-C): prevention includes blood donor screening
hepatitis C
to treat acute phases of hepatitis, put patient on __________, provide adequate _________ as tolerated, avoid _________________, and avoid __________ for 3-16 weeks
bed rest, nutrition, strenuous activity, alcohol
type of hepatitis (A-C): source of virus is in feces
hepatitis A
these four groups are considered at high risk for contracting hepatitis B
healthcare workers (lab, blood bank, hemodialysis)
multiple sex partners
homosexual men
mom to fetus in third trimester
nutritional therapy for hepatitis: vitamin supplements include these two vitamins
vitamin B-complex, vitamin K
type of hepatitis (A-C): prognosis: good, generally full recovery, no chronic carrier state
hepatitis A
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)
hepatitis B
management of hepatitis focuses on determining the ________, providing appropriate ____________ and _________, and _______________________ to prevent further liver damage
cause, treatment, support, teaching strategies
if no active bleeding present with esophageal varices, this is the preferred treatment method
banding (band ligation)
type of hepatitis (A-C): route of transmission is fecal-oral
hepatitis A
nursing care for liver cancer includes education about _______________, controlling __________, and referring to ______________
risk factors, pain, hospice
in caring for a patient with gastric lavage in place, never leave alone due to risk for _____________
aspiration
drug therapy for chronic hepatitis B is focused on decreasing __________ and ____________ and _______________ of liver progression
viral load, liver enzymes, slowing rate
health promotion for hepatitis includes prevention measures, including good _________, dangers of _________________ and _____________, safe ______, getting _____________, and ___________________ if known exposure.
hygiene, injectable drugs, sharing needles, sex, vaccinated, post-exposure prophylaxis
main goal of treatment for esophageal varices
prevent bleeding and hemorrhage
most common cause of hepatitis
viral
type of hepatitis (A-C): no chronic infection
hepatitis A
complementary therapy that helps treat nausea (hepatitis)
ginger
telaprevir, boceprevir, or HCV-protease inhibitors are used for this type of hepatitis
hepatitis C genotype 1
clinical manifestations of hepatitis are similar regardless of the _________
cause
four places in which collateral circulation forms due to portal hypertension
lower esophagus
anterior abdominal wall
parietal peritoneum
rectum
this may be done to evaluate for chronic hepatitis B or C
liver biopsy
these two measures can help prevent hepatitis A
good hand washing, standard precautions
complementary therapy that helps treat depression (hepatitis)
St. John’s wort
if exposed to hepatitis B, these two measures are given
immunoglobulins (for short-term immunity) with concurrent vaccine
therapies for hepatitis B suppress ________________, preventing complications
viral replication
hepatitis A virus is usually resolved in ______ weeks but can take up to ____ weeks
9-10, 16
primary liver cancer is _____, but _______________ increase risk for primary liver cancer
rare, hepatitis B and C
hepatitis: serum bilirubin is increased to ______ mg/dL because of _____________
8-15, liver damage
late manifestation of cirrhosis that results from decreased ability to conjugate and excrete bilirubin into small intestines for excretion
jaundice
nutritional therapy for hepatitis: if patient has decreased bile production, reduce ______ intake
fat
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
hepatitis C
in most cases of acute viral hepatitis, pharmacologic treatment (is, is not) indicated
is not
type of hepatitis (A-C): chronic infection possible
hepatitis B, hepatitis C
these, produced by plasma cells and lymphocytes, function as antibodies (hepatitis B)
immunoglobulin-protein
intact hepatitis B virus is sometimes called this
Dane Particle
three places where liver tumors can infiltrate or move to
gallbladder, peritoneum, diaphragm
improper metabolism of aldosterone can lead to __________________ with ___________ and ___________ retention and _____________ loss
hyperaldosteronism, sodium, water, potassium
nutritional therapy for hepatitis: if severe nausea, vomiting, and anorexia is present, these two measures may be taken to maintain fluid and electrolyte balance
IV glucose
enteral nutrition (possible)
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
hepatitis B
best method of prevention for hepatitis A and B
vaccination
hepatitis B: genotype ___ has the poorest response to treatment (50%) as compared to 70-80% for the other two
1
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
balloon tamponade
complementary therapy that is an antiviral and antiinflammatory (hepatitis)
licorice root
two early manifestations of cirrhosis
fatigue, hepatomegaly
clinical manifestations of liver cancer are similar to those of _____________
cirrhosis
this treatment method for esophageal varices involves injection of a solution into varices
sclerotherapy
surgical resection of the liver is possible only if the tumor is _____________ and in a lobe that can be ___________
localized, removed
type of hepatitis (A-C); route of transmission is percutaneous permucosal
hepatitis B, hepatitis C
complication of cirrhosis characterized by the accumulation of toxins (ammonia) in the blood and cerebral edema
hepatic encephalopathy (or portal systemic encephalopathy)
hepatitis: in addition to ALT, AST, ALP, GGT, and serum bilirubin, ______ levels are also increased
LDH
main goal of drug therapy for varices is to stop bleeding by producing _______________ of splenic arterial bed to _____________ portal blood flow and portal hypertension
vasoconstriction, decrease
type of hepatitis (A-C): prevention: screening donated blood; avoidance of blood-to-blood exposure for at-risk individuals and health care professionals
hepatitis C
this procedure involves inserting an esophageal or gastric balloon to apply direct pressure along with a tube
gastric lavage
hepatitis: GGT: increased from _________________
liver cell injury
when treating liver cancer, chemotherapy can be given in these two places
directly in liver
systemically
