Cirrosis/Pancreatitis/Liver Ca/Pancreatic Ca Flashcards

1
Q

Two causes of pancreatits

A

Gallstones/Alcohol use

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2
Q

Acute pancreatitis

A

Release of pancreatic enzymes that “audodigest” the pancreas.
It is reversible

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3
Q

Symptoms of Acute Pancreatitis

A
LUQ epigastric pain** that is deep and sharp, it intensifies when eating fatty foods **
Abdominal fullness
Gas bloating 
Hiccups and indigestion
Fever/Tachy/Hypotension
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4
Q

Diagnosis of Acute Pancreatits

A

Physical exam: Guarding, rebound tenderness, brusing around umbilicus/flank (indicate bleeding)

Lab tests: Metabolic panel, hemotological, Specific Pancreatic tests (amylase & lipase Most important) elevated BUN (renal function, in sever pancreatitis, indicator of mortality/shock) , Liver enzymes, WBC

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5
Q

Acute pancreatitis management

A

NPO-prevent release of pancreatic enzymes
IV Fluid-Several L followed by high maintenance fluid to maintain Intravascular volume (lactated ringers/ colloids)
IC level of care if organs involved
Treat cause of pancreatitis
necrotic (IV) vs inflammed (no IV)
Gall bladder vs alcohol

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6
Q

Medications used for patients with Acute pancreatitis

A
Opiod analgesics
Anticholinergics
Histamine blockers
Pancreatic enzymes
Antibiotic therapy
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7
Q

Complication acute pancreatitis

A

Necrotizing pancreatitis
High rate of complications/mortality
Caused by the pancreatic enzymes that eat through the pancreas and surrounding tissues. Can also cause hemorrhaging from rupture of surround BV

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8
Q

Two types of necrotizing pancreatitis

A

sterile areas free of bacteria

infected caused by bacteria

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9
Q

Nursing: How would a patient with acute pancreatitis present in hospital (ie vitals, pain level, labs)

A

Sudden onset of acute unbearable abdominal pain
Elevated heart rate and respiratory rate & low BP
Pain
Elevated serum lipase, amylase, glucose values
Hypocalcemia
Steatorrhea: clay colored stools
MODS: ARDS, PE, Hypoxia, Hypovolemia

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10
Q

What would you assess in a patient with acute pancreatitis

A
Vital signs
O2 status
Pain location intensity & duration
Abdominal assessment
Grey Turners+/o cullens signs
Serum lipase & amylase
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11
Q

Serum calcium in acute pancreatitis

A

Trosseau sign & Chvostek sign
NM irritability bc of the low calcium levels and the the accumulation of fatty acids which cheleate with calcium salts causing deposits in the abd

Trosseau: Hand spasms
Chvostek: :Facial spasms

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12
Q

Why is stool clay colored in acute pancreatits

A

Obstruction of the bile flow

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13
Q

Nutritional intake acute pancreatits

A

Loss of appetite because of the pain, or NPO monitor length of NPO and how well they tolerate feedings

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14
Q

Nursing interventions & MEDS acute pancreatits

A

NPO status
NGT low suction as ordered prevent abd distension
Administer meds: Analgesics, antiemetics, histamine blockers, sedatives/antianxiety meds

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15
Q

What position should acute pancreatits be in bed

A

Semi fowlers position or fetal position

Encourage coughing and deep breathing

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16
Q

Nurisng teaching acute pancreatitis

A

Appropiate diet and intake of small freq meals (carbs due to less pancreatic stimulation) and vitamin supplements
abstain from alcohol
abstain from smoking
Disease symptoms, progression, diagnostic procedures and interventions

17
Q

Patients are progressing well during acute pancreatitis when they have

A

Stable vitals, weight
Electrolytes w/in normal limits
Decreased pain**
Decreased liver enzymes

18
Q

Chronic pancreatitis cause

A

Most common cause is prolonged alcohol use, not reversible (acute is), exocrine and endocrine is altered.

19
Q

Chronic pancreatitis patho

A

Inflammation of pancreas
pancreatic enzymes auto-digest pancreas for a long period of time
Scarring occurs resulting in enzyme imbalances

20
Q

Chronic pancreatitis symptoms

A
Upper abd pain that can spread to back, worse after eating and drinking (LUQ pain)
N/V
Weight loss 
Diarrhea
Pale or clay colored stools
Steatorrhea (oily stools)
21
Q

Diagnostic work up of chronic pancreatitis

A

Abd CT
US
ERCP
Lab analysis (amylase & lipase levels)

22
Q

Managment of Chronic pancreatitis

A
Pain mngmnt 
IV fluid replacement
Electrolyte management
Nutritional support (significant weight loss)
Insulin therapy
23
Q

Chronic pancreatitis surgical managemnt

A

Surgical resection

Puestow Procedure

24
Q

Chronic pancreatitis nursing assessments

A

Vital signs
Serum BGC levels
Amylase and lipase levels
Serum bilirubin & alkaline phosphatase
Weight, pain, abd
Skin color (jaundice due to obstruction of bile ducts)
Stool

25
Q

Nursing actions in Chronic pancreatitis

A
Administer pancreatic enzymes
Provide GI prophylaxis (histamine/PPI)
Rest and calm environment
Implement pain relief measures
collaborate with dietician
26
Q

Nurse teaching Chronic pancreatitis

A
Avoid alcohol
DONT chew pancreatic enzymes bc slow release is needed
Limit fat in diet
avoid intake of irritating food/bev
Referral to support groups
27
Q

Well managed Chronic pancreatitis

A

Pain management
Minimize weight loss
Decrease steatorrhea

28
Q

Risk factors of liver cancer

A
45-60 yrs
Hx of heavy alcohol/smoking
Chronic viral hep B or C 
Enviormental exposure
Cirrosis
29
Q

Liver cancer pathophysiology

A

Primary hepatocellular carcinoma HCC
Secondary: High blood flow rate/extensive capillary network (cancer components travel via blood to the liver)
Liver cells enlarge and proliferate
Leads to necrosis