Cirrosis/Pancreatitis/Liver Ca/Pancreatic Ca

Question 1

Two causes of pancreatits

Answer 1

Gallstones/Alcohol use

Question 2

Acute pancreatitis

Answer 2

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

Question 3

Symptoms of Acute Pancreatitis

Answer 3

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

Question 4

Diagnosis of Acute Pancreatits

Answer 4

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

Question 5

Acute pancreatitis management

Answer 5

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

Question 6

Medications used for patients with Acute pancreatitis

Answer 6

Opiod analgesics
Anticholinergics
Histamine blockers
Pancreatic enzymes
Antibiotic therapy

Question 7

Complication acute pancreatitis

Answer 7

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

Question 8

Two types of necrotizing pancreatitis

Answer 8

sterile areas free of bacteria

infected caused by bacteria

Question 9

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

Answer 9

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

Question 10

What would you assess in a patient with acute pancreatitis

Answer 10

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

Question 11

Serum calcium in acute pancreatitis

Answer 11

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

Question 12

Why is stool clay colored in acute pancreatits

Answer 12

Obstruction of the bile flow

Question 13

Nutritional intake acute pancreatits

Answer 13

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

Question 14

Nursing interventions & MEDS acute pancreatits

Answer 14

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

Question 15

What position should acute pancreatits be in bed

Answer 15

Semi fowlers position or fetal position

Encourage coughing and deep breathing

Question 16

Nurisng teaching acute pancreatitis

Answer 16

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

Question 17

Patients are progressing well during acute pancreatitis when they have

Answer 17

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

Question 18

Chronic pancreatitis cause

Answer 18

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

Question 19

Chronic pancreatitis patho

Answer 19

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

Question 20

Chronic pancreatitis symptoms

Answer 20

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)

Question 21

Diagnostic work up of chronic pancreatitis

Answer 21

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

Question 22

Managment of Chronic pancreatitis

Answer 22

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

Question 23

Chronic pancreatitis surgical managemnt

Answer 23

Surgical resection

Puestow Procedure

Question 24

Chronic pancreatitis nursing assessments

Answer 24

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

Question 25

Nursing actions in Chronic pancreatitis

Answer 25

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

Question 26

Nurse teaching Chronic pancreatitis

Answer 26

``` 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 ```

Question 27

Well managed Chronic pancreatitis

Answer 27

Pain management Minimize weight loss Decrease steatorrhea

Question 28

Risk factors of liver cancer

Answer 28

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

Question 29

Liver cancer pathophysiology

Answer 29

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