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NURS 313R > Exam 3: Hepatobilliary Disorders > Flashcards

Exam 3: Hepatobilliary Disorders Flashcards

1
Q

Liver

A

The largest internal organ in the body.

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2
Q

The functional unit of the liver is

A

Lobules

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3
Q

Liver Cancer

A

Characterized by rapid tumor growth and metastasis

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4
Q

Causes of Liver Cancer include

A
  • Chronic Liver Disease
  • Hepatitis B and C
  • Cirrhosis of the Liver (Review - Will be included in the exam!)
  • Exposure to chemical and toxins
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5
Q

What are risk factors for liver cancer?

A
  • Cigarette Smoking
  • Alcohol
  • Aflatoxin
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6
Q

What are clinical manifestations of liver cancer?

A
  • Pain
  • Weight Loss
  • Loss of Strength
  • Anorexia
  • Anemia
  • Hepatomegaly
  • Jaundice
  • Ascites
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7
Q

What assessments and diagnostics are used to observe a patient for liver cancer?

A
  • H&P
  • X-ray
  • Laboratory Findings
  • Liver Scan
  • CT Scan
  • Ultrasound
  • PET Scan
  • Biopsy
  • Laparotomy
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8
Q

Metastasis Sites

A
  • Lung
  • Regional Lymph Nodes
  • Adrenal
  • Bone
  • Kidneys
  • Heart
  • Pancreas
  • Stomach
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9
Q

Medical Management for Liver Cancer

A

Radiation Therapy
Chemotherapy
Percutaneous Biliary Drainage

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10
Q

Complications of Liver Cancer

A
  • Sepsis
  • Leakage of Bile
  • Hemorrhage
  • Reobstruction
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11
Q

What is included in non surgical management of Liver Cancer?

A
  • Laser Hyperthermia
  • Radiofrequency thermal ablation
  • Transcatheter Arterial Embolization
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12
Q

What is included of surgical management of liver cancer?

A
  • Surgical resection
  • Lobectomy
  • Cryosurgery
  • Liver transplantation
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13
Q

Nursing Management of Liver Cancer includes

A
  • Glucose infusion
  • Blood Transfusion
  • Monitoring for hypothermia, hemorrhage and bile leak
  • Self care
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14
Q

Cholecystitis

A

Inflammation of the gallbladder

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15
Q

Cholethiasis

A

Stones in the gallbladder

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16
Q

Precipitating Factors of Cholelithiasis/Cholecystitis

A
  • Cause is unknown
  • Extensive burns
  • Recent surgery
  • Prolong fasting, TPN
  • Infection: E. Choli
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17
Q

What are clinical manifestations of Cholelithiasis/Cholecystitis?

A
  • Pain (RUQ referee to the right shoulder/scapula)
  • Fever
  • Jaundice
  • Indigestion, pain, tenderness in RUQ
  • N/V, restlessness, diaphoresis
  • Increased WBC
  • Fat intolerance
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18
Q

What is the collaborative care/nursing therapeutics indicated for cholecystitis and cholelithiasis?

A
  • Pain Management (Demerol)
  • Gastric Decompression(used if N/V is severe to prevent further gallbladder stimulation)
  • Biliary Stone Removal
  • Cholecystectomy: T-placement
  • Questran (tx of pruritus)
  • Low fat diet (decreases stimulation of the gallbladder)
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19
Q

Acute pancreatitis

A

Is an acute inflammatory process of the pancreas

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20
Q

What are causes of acute pancreatitis?

A
  • Biliary Tract Disease (obstruction)
  • Alcoholism (increases the production of digestive enzymes in the pancreas)
  • Trauma (post surgical, abdominal)
  • Viral Infection
  • Duodenal ulcer, abscess, Kapasi’s Sarcoma
  • Drugs (corticosteroids, thiazide diuretics, oral contraceptives, sulfonamides, NSAIDs)
  • Auto digestion of pancreas (bile back flow into the pancreatic ducts)
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21
Q

Clinical Manifestations of Acute Pancreatitis

A
  • Abdominal Pain located in LUQ
  • N/V
  • Hypotension, tachycardia
  • Jaundice
  • Decreased bowel sound, abdominal distention
  • Grey Turner’s Sign
  • Cullen Sign
  • Low grade fever, leukocytosis
  • Shock (may be d/t hemorrhage into the pancreas, toxemia from the activate pancreas enzymes or Hypovolemia as a result of fluid shift into the retroperitoneal space)
22
Q

What is the goal for treatment fo acute pancreatitis?

A
  • Relief of pain
  • Prevention or alleviation of shock
  • Reduction of pancreatic secretion
  • Control of F&E imbalance
  • Prevention and treatment of infection
23
Q

What are the nursing therapeutics for patients with acute pancreatitis?

A
  • Hydration
  • Pain Management
  • Demerol (decreases pain and acts as antispasmatic)
  • IV MS (longer effect)
  • Shock (give plasma expander - albumin, LR and dextran)
  • NPO (suppresses pancreatic enzymes to decrease stimulation of the pancreas and allow it to rest)
  • NGT (decrease gastric distention, reduce vomiting and prevent gastric acidic contents from entering the duodenum)
  • Small frequent feeding (bland diet)
  • High Carbohydrate Diet (least stimulating to already inflamed pancreas)
24
Q

Pathophysiology for Cholelithiasis

A

CHECK STUDY GUIDE

25
Q

Pathophysiology of Cholecystitis

A

Associated with obstruction cased by gallstones or biliary sludge.

26
Q

Acute cholecystitis

A

Acute attacks -> sudden, severe pain in RUQ

27
Q

Chronic Cholecystitis

A

Repeated attacks of pain d/t gallstones periodically blocking cystic duct.
Inflammation -> scarring/thickening of gallbladder wall.

28
Q

Acaclulus Cholecystitis

A

Cholecystitis in the absence of a stone.
High mortality rate.
Main cause is bile stasis. (Bile can’t escape and causes increased bile viscosity)

29
Q

Clinical manifestations of Cholelithiasis

A

..

30
Q

Clinical Manifestations of Cholecystitis

A

..

31
Q

Gangrenous Cholecystitis

A

Death of gallbladder tissue

Serious infection throughout the body

32
Q

Subphrenic Abscess

A

Infection of fluid b/w the diaphragm and liver

Usually associate with peritonitis

33
Q

How can cholelithiasis lead to pancreatitis?

A

Stone blockage backs up enzymes back into the pancreas.

Causes flatulence

34
Q

Cholangitis

A

Inflammation of biliary ducts

35
Q

Biliary cirrhosis

A

Tissue replaced with scar tissue d/t damage to the biliary duct

36
Q

Fistula

A

Any abnormal connection between organs.

Usually between gallbladder and portion of duct.

37
Q

Choledocholithiasis

A

Presence of gallstone in common bile duct - total obstruction.

38
Q

Diagnostic studies for Cholelithiasis and Cholecystitis

A

..

39
Q

Conservative Therapy for Cholelithiasis

A
  • Usodiol and Chenodiol (bile acids) - dissolve stones ***
  • ERCP with endoscopic sphincterectomy
  • extracorporeal shock-wave lithotripsy (disintegrates gallstones)
40
Q

Conservative Therapy for Cholecystitis

A
  • Focus on control of pain and infection and maintenance of F&E balance
  • NG tube insertion (for severe N/V, prevents gallbladder stimulation)
  • Cholecystostomy (drains purulent material from obstructed gallbladder)
  • Ketorlac/Demerol (NSAIDS) - for pain***
  • Anticholinergics (decrease secretion and counteract SM spasms **
41
Q

Surgical Therapy for Cholelithiasis and Cholecystitis

A

NOT SURE IF NEED TO KNOW BUT REVIEW IT

42
Q

Drug therapy for Cholelithiasis and Cholecystitis

A
  • Analgesics: morphine
  • Anticholinergics: atropine
  • Fat soluble vitamins: ADEK
  • Bile Salts
  • Cholestyramine: binds bile salts in intestine
43
Q

Nutritional Therapy for Cholecystitis and Cholelithiasis

A
  • Smaller and more frequent meals with some fat to promote some gallbladder emptying
  • Reduce calorie diet if obese (low saturated fats, high fiber and Ca)
44
Q

Cholecystectomy

A

Removal of gallbladder.

READ MORE ON STUDYGUIDE

45
Q

T-PLACEMENT

A

Connected to a bag; drains bile when there is an obstruction and prevents further obstruction.
READ MORE ON STUDY GUIDE

46
Q

Questran

A

Binds with bile salts in intestine and increases their excretion in the feces to prevent pruritus.

47
Q

Describe pancreatitis pain

A
  • Located in LUQ but may be midepigastrum
  • Commonly radiates to the back because of the retroperitoneal location of the pancreas.
  • Sudden onset
  • Severe, deep and piercing
  • Continuous or steady
  • Aggravated by eating frequently
  • Onset when patient is in recumbent position
  • Not relieved by vomiting
48
Q

Grey Turner’s Sign

A

Bluish flank discoloration, especially with rupture or bleeding

49
Q

Cullen’s Sign

A

Bluish periumbilical discoloration typically resulting from seepage of blood-stained exudate from the pancreas

50
Q

Goals for Collaborative Care of Pancreatitis

A
  1. Relief of Pain
  2. Prevention or Alleviation of Shock
  3. Reduction of Pancreatic Secretions (causes pain)
  4. Control of F&E imbalances
  5. Prevention and treatment of infection

NURS 313R (18 decks)

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