Chapter 48: Liver, Biliary Tract, and Pancreas Problems (Part 1- Liver) Flashcards
1
Q
younger women with cirrhosis may develop _______________, while older women may have ________________
A
amenorrhea, vaginal bleeding
2
Q
this complication of cirrhosis causes blood to be rerouted to adjoining lower pressure vessels
A
portal hypertension
3
Q
cirrhosis patients should have upper endoscopy to screen for _________
A
varices
4
Q
if exposed to hepatitis A, ________________________ is given within __________ after exposure
A
single immunoglobulin, 2 weeks
5
Q
immunoglobulin seen in acute phase of hepatitis A that begins to decline about 3 months after exposure
A
IgM
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
7
Q
(primary, metastatic) liver carcinoma is more common
A
metastatic
8
Q
hepatitis B infection can lead to increased risk of developing ______________
A
liver cancer
9
Q
this treatment method for esophageal varices uses a small rubber band around the base of a large vein
A
banding
10
Q
type of hepatitis (A-C): prognosis: chronic carriers rate high; generally, a full recovery in others
A
hepatitis C
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
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
13
Q
type of hepatitis (A-C): complications: rare, but can be fatal if fulminant hepatitis develops; protracted cholestasis can occur
A
hepatitis A
14
Q
hepatitis: in addition to liver enzymes, lab tests may also be done to test for ______________
A
viral antigens
15
Q
hepatitis C (does, does not) have a current vaccine
A
does not
16
Q
liver is a common site of metastatic growth because of these two things
A
- high rate of blood flow
- extensive capillary network
17
Q
teach those at high risk of hepatitis B these four methods of how to decrease risk of contracting it
A
- good hygiene
- use gloves with expected contact with blood
- do not share razors, toothbrushes, other personal items
- use condoms for intercourse
18
Q
treatment for acute hepatitis B is indicated only in patients with ______________ and ______________
A
severe hepatitis, liver failure
19
Q
in treating cirrhosis, adequate calories including protein are needed except in cases where ___________ levels are high
A
ammonia
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
21
Q
treat any bleeding with esophageal varices with this
A
blood products
22
Q
accumulation of protein-rich fluid in the abdominal cavity
A
ascites
23
Q
to reduce pressure in the portal circulation, the body develops alternative circulatory pathways, called this
A
collateral circulation
24
Q
two skin lesions that can occur with cirrhosis
A
spider angioma, palmar erythema
25
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
26
hepatitis: ALT and AST increase in the _______ phase (due to ________________) and decrease as _____________________
acute, liver cell injury, jaundice disappears
27
presence of bilirubin in urine changes its color to this
dark brown or brownish-red
28
this can occur when portal hypertension increases hydrostatic pressure in vessels of portal system
ascites
29
_______________ 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
30
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)
31
type of hepatitis (A-C): post-exposure management: the value of immune globulin is unclear; no other treatment is presently available
hepatitis C
32
these two groups of patients may need a larger or more doses of the hepatitis B vaccine
hemodialysis
immunocompromised
33
after liver surgery, such as liver resection, place patient on ________ side
right
34
this procedure is performed when diuretics are not effective in reducing fluid with ascites
paracentesis
35
hepatitis: ALP: moderately increased from impaired _______________ function of liver
excretory
36
nutritional therapy for hepatitis: emphasis on a(n) _____________ diet with adequate ___________
well-balanced, calories
37
complementary therapy for hepatitis that may help by protecting and promoting growth of liver cells and inhibiting inflammation
milk thistle
38
hematologic problems of cirrhosis, such as thrombocytopenia, leukopenia, anemia, and coagulation problems may occur due to this
splenomegaly
39
when assessing a patient with hepatitis, assess for __________, __________ color, and ___________
jaundice, urine, pruritis
40
peripheral neuropathy is a common finding in ________________ cirrhosis, probably due to diet deficiency of _____________, _______________, and _______________.
alcoholic, thiamine, folic acid, cobalamin
41
isolation (is, is not) required for hepatitis A
is not
42
chronic active state of hepatitis B infection can lead to ___________ and __________ thus requiring ______________
cirrhosis, liver failure, liver transplantation
43
if patient with cirrhosis is unable to take lactulose PO for hepatic encephalopathy, this alternative treatment will be used
retention enema
44
type of hepatitis (A-C): prevention includes pre/post-exposure immunization
hepatitis A, hepatitis B
45
complication that may occur when esophageal varices rupture
hemorrhage
46
liver cancer patients typically have this survival period
less than 6 months
47
this treatment is an option for small liver tumors without evidence of spread
liver transplant
48
type of hepatitis (A-C): source of virus is in blood/blood-derived body fluids
hepatitis B, hepatitis C
49
this complication of cirrhosis occurs due to portal hypertension causing blood to be shunted into the splenic vein
splenomegaly
50
primary liver tumors usually metastasize to the ________
lungs
51
drug therapy for hepatitis C is directed toward _______________ and ___________________
eradicating virus, preventing complications
52
enlarged thin-walled veins that form in the submucosa of the esophagus
esophageal varices
53
hepatitis A virus can be found as long as _________ in feces and is the most ___________ at this time
3 months, contagious
54
five risk factors for hepatitis C virus
multiple sex partners
drug use
tattooing
body piercing
barbering
55
type of hepatitis (A-C): prognosis: good, generally, a full recovery, except for chronic carriers
hepatitis B
56
type of hepatitis (A-C): prevention includes risk behavior modification
hepatitis C
57
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
58
rings of varices in umbilicus area
caput medusae
59
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
60
prevention of hepatitis C is centered on these three measures
1. screening of blood, organ, and tissue donors
2. infection control
3. modifying high-risk behaviors
61
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
62
type of hepatitis (A-C): prevention includes blood donor screening
hepatitis C
63
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
64
type of hepatitis (A-C): source of virus is in feces
hepatitis A
65
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
66
nutritional therapy for hepatitis: vitamin supplements include these two vitamins
vitamin B-complex, vitamin K
67
type of hepatitis (A-C): prognosis: good, generally full recovery, no chronic carrier state
hepatitis A
68
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
69
management of hepatitis focuses on determining the ________, providing appropriate ____________ and _________, and _______________________ to prevent further liver damage
cause, treatment, support, teaching strategies
70
if no active bleeding present with esophageal varices, this is the preferred treatment method
banding (band ligation)
71
type of hepatitis (A-C): route of transmission is fecal-oral
hepatitis A
72
nursing care for liver cancer includes education about _______________, controlling __________, and referring to ______________
risk factors, pain, hospice
73
in caring for a patient with gastric lavage in place, never leave alone due to risk for _____________
aspiration
74
drug therapy for chronic hepatitis B is focused on decreasing __________ and ____________ and _______________ of liver progression
viral load, liver enzymes, slowing rate
75
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
76
main goal of treatment for esophageal varices
prevent bleeding and hemorrhage
77
most common cause of hepatitis
viral
78
type of hepatitis (A-C): no chronic infection
hepatitis A
79
complementary therapy that helps treat nausea (hepatitis)
ginger
80
telaprevir, boceprevir, or HCV-protease inhibitors are used for this type of hepatitis
hepatitis C genotype 1
81
clinical manifestations of hepatitis are similar regardless of the _________
cause
82
four places in which collateral circulation forms due to portal hypertension
lower esophagus
anterior abdominal wall
parietal peritoneum
rectum
83
this may be done to evaluate for chronic hepatitis B or C
liver biopsy
84
these two measures can help prevent hepatitis A
good hand washing, standard precautions
85
complementary therapy that helps treat depression (hepatitis)
St. John's wort
86
if exposed to hepatitis B, these two measures are given
immunoglobulins (for short-term immunity) with concurrent vaccine
87
therapies for hepatitis B suppress ________________, preventing complications
viral replication
88
hepatitis A virus is usually resolved in ______ weeks but can take up to ____ weeks
9-10, 16
89
primary liver cancer is _____, but _______________ increase risk for primary liver cancer
rare, hepatitis B and C
90
hepatitis: serum bilirubin is increased to ______ mg/dL because of _____________
8-15, liver damage
91
late manifestation of cirrhosis that results from decreased ability to conjugate and excrete bilirubin into small intestines for excretion
jaundice
92
nutritional therapy for hepatitis: if patient has decreased bile production, reduce ______ intake
fat
93
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
94
in most cases of acute viral hepatitis, pharmacologic treatment (is, is not) indicated
is not
95
type of hepatitis (A-C): chronic infection possible
hepatitis B, hepatitis C
96
these, produced by plasma cells and lymphocytes, function as antibodies (hepatitis B)
immunoglobulin-protein
97
intact hepatitis B virus is sometimes called this
Dane Particle
98
three places where liver tumors can infiltrate or move to
gallbladder, peritoneum, diaphragm
99
improper metabolism of aldosterone can lead to __________________ with ___________ and ___________ retention and _____________ loss
hyperaldosteronism, sodium, water, potassium
100
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)
101
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
102
best method of prevention for hepatitis A and B
vaccination
103
hepatitis B: genotype ___ has the poorest response to treatment (50%) as compared to 70-80% for the other two
1
104
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
105
complementary therapy that is an antiviral and antiinflammatory (hepatitis)
licorice root
106
two early manifestations of cirrhosis
fatigue, hepatomegaly
107
clinical manifestations of liver cancer are similar to those of _____________
cirrhosis
108
this treatment method for esophageal varices involves injection of a solution into varices
sclerotherapy
109
surgical resection of the liver is possible only if the tumor is _____________ and in a lobe that can be ___________
localized, removed
110
type of hepatitis (A-C); route of transmission is percutaneous permucosal
hepatitis B, hepatitis C
111
complication of cirrhosis characterized by the accumulation of toxins (ammonia) in the blood and cerebral edema
hepatic encephalopathy (or portal systemic encephalopathy)
112
hepatitis: in addition to ALT, AST, ALP, GGT, and serum bilirubin, ______ levels are also increased
LDH
113
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
114
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
115
this procedure involves inserting an esophageal or gastric balloon to apply direct pressure along with a tube
gastric lavage
116
hepatitis: GGT: increased from _________________
liver cell injury
117
when treating liver cancer, chemotherapy can be given in these two places
directly in liver
systemically
