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M/S 3 > Exam 4 - Liver > Flashcards

Exam 4 - Liver Flashcards

1
Q

what vitamins and minerals are stored in the liver

A

A
B12
several B complex
D
Fe
copper

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2
Q

functions of the liver

A

bile formation, excretion
drug metabolism (first pass effect)
vitamin, iron storage

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3
Q

how long to auscultate before determining absent bowel sounds

A

5 minutes

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4
Q

is damage done before you see a rise in liver enzymes

A

Yes

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5
Q

what are the liver enzymes

A

AST (10-30)
ALT (10-40)
ALP (38-126)

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6
Q

what should be done before liver biopsy

A

check coag studies
informed consent
NPO 4-6 hours prior
void prior

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7
Q

what to instruct pt to do during liver biopsy

A

hold breath after a full expiration during needle insert

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8
Q

post liver bx instruction

A

lay on R side x2 hours
strict bedrest x24 hours
pillow under costal margin
monitor VS at 10-20 minute intervals
monitor bx site hourly

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9
Q

where to assess for internal bleeding re: liver bx

A

costovertebral angle

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10
Q

danger signs post liver bx

A

abdominal distention
rigidity
pain
rebound tenderness
absent bowel sounds

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11
Q

when to caution liver bx

A

plt < 100000
PT > 3
liver tumor with large # of veins
ascites
infection
angiomas of liver
biliary obstruction

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12
Q

destruction of liver parenchyma and replacement by scar tissue

A

Cirrhosis

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13
Q

4 types of cirrhosis

A

laennec’s (alcoholic; portal)
biliary
cardiac
postnecrotic

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14
Q

describe alcoholic cirrhosis-laennec’s

A

fatty infiltration of liver d/t increase fatty acid and triglyceride synthesis, decrease of lipoproteins

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15
Q

T or F. if etoh intake ceases, the liver can heal itself

A

true

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16
Q

alcohol WD s/sx

A

tremors
N/V
psychosis
elevated HR, BP

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17
Q

posthepatic/necrotic cirrhosis occurs from advanced progression from which liver diseases

A

hepatitis B, C

or unknown cause

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18
Q

what occurs with biliary cirrhosis

A

retained bile damages and destroys liver cels

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19
Q

cirrhosis is twice as common in ___

A

men

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20
Q

nonalcoholic fatty liver disease (NAFLD) is ___

A

genetic

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21
Q

cardiac cirrhosis occurs from what

A

R sided heart failure

blood isn’t pumping so it backs up into the liver

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22
Q

complications of cirrhosis

A

portal HTN
impaired metabolism
impaired bile formation and flow

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23
Q

jaundice will form when bilirubin is > ___

A

> 3

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24
Q

early s/sx of cirrhosis: GI

A

anorexia
dyspepsia
flatulence
N/V
change in bowel habits
abdominal pain
fever
lassitude
weight loss
enlarged liver, spleen
dull percussion

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25
Q

parathesia occurs d/t a lack of which vitamin

A

b12

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26
Q

what is asterixis

A

can’t hold hands out without flapping them

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27
Q

what is fector hepaticus

A

malodorous breath

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28
Q

alcohol intake increases which hormone

A

estrogen, decreases progesterone

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29
Q

why is there pruritus with cirrhosis

A

bile salts are excreted through the skin

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30
Q

will K, Na, and ammonia levels be high or low?

A

low

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31
Q

what is palmer erythema

A

red are on the palms of hands that blanches with pressure

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32
Q

where are spider angiomas found

A

nose
cheeks
upper trunk
neck
shoulders

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33
Q

why does splenomegaly occur

A

blood backs up from the portal vein

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34
Q

why does bleeding occur

A

decrease production of hepatic clotting factors

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35
Q

is jaundice a late or early sign of cirrhosis

A

late

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36
Q

complications of cirrhosis

A

portal HTN
esophageal, gastric varices
peripheral edema
ascites
hepatic encephalopathy
hepatorenal syndrome

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37
Q

portal HTN is characterized by…

A

increase venous pressure in portal circulation
splenomegaly
ascites
large collateral veins
esophageal varices
systemic HTN

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38
Q

what are esophageal varices

A

complex veins at lower end of esophagus

very fragile
most life threatening complication of cirrhosis

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39
Q

where are gastric varices occur

A

upper portion of the stomach

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40
Q

why does edema occur with cirrhosis

A

bc albumin cannot be synthesized

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41
Q

is hypo or hyperglycemia common with liver failure

A

hypoglycemia

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42
Q

which hormone is increased with ascites

A

aldosterone

Na, water retention

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43
Q

where is girth measured for ascites

A

level of umbilicus
pt lies flat
done while exhaling

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44
Q

after administering albumin, what indicates it is working

A

increased UOP

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45
Q

what is common after variceal hemorrhage

A

bacterial peritonitis

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46
Q

what is given for elevated ammonia

A

lactulose

PO, NGT, enema

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47
Q

ammonia lab tube color and instruction

A

green tube, place on ice

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48
Q

hepatic encephalopathy mental responsiveness can range from ___ ___ to ___ to ___ ___

A

sleep disturbance; lethargy; deep coma

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49
Q

stages of hepatic encephalopathy range from __ - __

A

0-4

4 is most advanced

50
Q

hepatic encephalopathy stage 1

A

slight confusion
reversal of day-night sleep pattern
asterixis
impaired writing
normal EEG

51
Q

hepatic encephalopathy stage 2

A

disoriented
sleep most of time
easily aroused
agitation
mood swings
asterixis
fector hepaticus
abnormal EEG

52
Q

hepatic encephalopathy stage 3

A

deep sleep
difficult to arouse
incoherent speech
increase deep tendon reflex
rigidity of extremities
markedly abnormal EEG

53
Q

hepatic encephalopathy stage 4

A

comatose
cerebral edem IICP
cerebral hypoxia - death

54
Q

goal of hepatic encephalopathy

A

decrease ammonia formation

55
Q

what to monitor after administering lactulose

A

F/E balance

56
Q

how does lactulose work

A

draws water into the gut to excrete ammonia

57
Q

other drugs for hepatic encephalopathy

A

aldactone
corgard (BB)
nitrates
Fe
folic acid
vit K
serax (benzo not metabolized in liver)

58
Q

what is azothemia

A

BUN, Crt build up

59
Q

what is hepatorenal syndrome

A

function renal failure with azotemia, oliguria, intractable ascites

60
Q

what should be avoided with any liver issues

A

alcohol
ASA
acetaminophen
NSAIDs

61
Q

long term management of ascites

A

peritonevenous shunt (LaVeen, Denver)

62
Q

ascites fluid and Na restriction

A

1500cc
2G

63
Q

pt positioning for paracentesis

A

MD preference

64
Q

what may occur with BP with a shunt and why

A

HTN; increase fluid in the vascular system

65
Q

ascites diet

A

high calorie, high carb, low Na

possible restricted to 60 G protein
want to prevent hypoglycemia and catabolism

66
Q

hypokalemia s/sx

A

cardiac dysrhythmias
hypotension
tachycardia
muscle weakness

67
Q

what are bleeding varices treated with

A

balloon tamponade

68
Q

how is balloon tamponade placement verified

A

XR

69
Q

balloon tamponade complications

A

regurgitation
aspiration
balloon, varices rupture

70
Q

what is a normal CVP range

A

2-6

varcies will begin to bleed when it reaches 12

71
Q

procedure of choice for dx and treatment of upper GI bleeds

A

endoscopy

72
Q

h. pylori treatment

A

2 abx & a PPI x 14 days

retest in 30 days; if +, retreat

73
Q

an gastric lavage is like an

A

NGT

74
Q

NGT increases secretion of what in the stomach

A

HCl

75
Q

what is sclerotherapy

A

injection into bleeding ulcer or varices

76
Q

post sclerotherapy interventions

A

noncardiac CP 24-72 hours after
monitor, ensure its non-cardiac
administer analgesics

77
Q

transjugular intrahepatic portosystemic shunt (TIPS) is performed under what

A

fluoroscopy

78
Q

vasopressin is what type of hormone

A

ADH

79
Q

vasopressin can cause what

A

midsternal CP, MI

80
Q

education measure to prevent bleeding variceal

A

soft tooth brush
avoid high acidic, spicy foods
avoid blowing nose
avoid ASA, NSAIDs
no coughing, straining

81
Q

how does somatostatin or octreotide work

A

decrease splanchnic blood flow
reduce portal pressure

82
Q

must review slide 111 and 112

A

must review slide 111 and 112

83
Q

what does a portacaval shunt do

A

improve survival rate

84
Q

what to do if abdominal girth becomes larger after a shunt placement

A

notify HCP

85
Q

what are 4 causes of liver failure

A

hepatitis
decreased perfusion
cirrhosis
fatty liver disease

86
Q

acute vs. chronic liver failure onset

A

a: rapidly (as little as 48 hours)

c: gradually over many years

87
Q

what are some causes of acute liver failure

A

acetaminophen OD
viruses (hep A, B, C)
reaction to Rx and herbals
ingestion of poisonous wild mushrooms

88
Q

causes of chronic liver failure

A

cirrhosis - MC cause
hep A, C
long term alcohol consumption
hemochromatosis
malnutrition

89
Q

early s/sx of acute liver failure

A

N/D
loss of appetite
fatigue

90
Q

progressive s/sx of acute liver failure

A

jaundice
bleeds easily
swollen abdomen
disorientation/confusion
–hepatic encephalopathy
sleepiness
coma

91
Q

most definitive treatment for liver failure

A

liver transplant

92
Q

therapeutic dose of acetaminophen

A

1-4 G daily

only 2 G daily if consumes alcohol daily

93
Q

acetaminophen is absorbed from the ___ tract, metabolized in the ___ with a half life of __ to __ hours

A

GI tract; liver; 2-4 hours

94
Q

where is acetaminophen excreted

A

urine

95
Q

toxic single dose of acetaminophen

A

7-10 grams

96
Q

acetaminophen antidote

A

n-acetylcysteine (mucomyst)

must be within 12 hours to eliminate hepatic injury

97
Q

what occurs during phase 1 of acetaminophen toxicity

A

0-24 hours

anorexia
N/V
lethargy
pallor
asymptomatic

98
Q

what occurs during phase 2 of acetaminophen toxicity

A

24-72 hours

RUQ pain
AST/ALT elevation
PT, bilirubin, renal - may be elevated

99
Q

what occurs during phase 3 of acetaminophen toxicity

A

abdominal pain
N/V
acute liver failure:
–jaundice, encephalopathy, cerebral edema, MODS

death is common in this stage

100
Q

stage 4 of acetaminophen toxicity

A

recovery phase
chronic liver impairment does not follow

101
Q

goal of care re: acetaminophen toxicity

A

promptly administer antidote

102
Q

who is a liver transplant for

A

those with progressive irreversible liver diease

103
Q

who would NOT be a candidate for a liver transplant

A

cancer
active etoh or drug use
poor surgical risk

104
Q

symptoms of a GI bleed

A

bright red blood coating stool
dark blood mixed with stool
black, tarry stool*
bright red emesis*
coffee ground emesis*
weakness
SOB
faintness

105
Q

what 2 meds can turn stool black

A

Fe
bismuth (Pepto Bismol)

106
Q

1 cause of GI ulcers

A

H. pylori

107
Q

cause of upper GIB

A

PUD
stress ulcer
mallory-weiss tear
esophageal varices

108
Q

this is a break in mucosal lining where it comes in contact with gastric juices

A

PUD

109
Q

PUD risk factors

A

ASA, ibuprofen, naproxen use
excessive alcohol
smoking, tobacco

110
Q

what can indicate perforation from PUD

A

severe abdominal pain with or without evidence of bleeding

111
Q

s/sx of PUD

A

abdominal pain
N/V
weight loss
anorexia
fatigue
heartburn/indigestion
belching
chest pain
vomiting blood
bloody, dark tarry stools

112
Q

what is Zollinger-Ellision syndrome

A

PUD caused by gastrinoma, a gastrin-secreting tumor of the pancreas, stomach or intestines causing hypersecretion of gastric acid

> 60% are malginant

113
Q

where does Zollinger-Ellison syndrome occur

A

stomach
duodenum
esophagus
jejunum

114
Q

Zollinger-Ellison syndrome can lead to….

A

diarrhea
steatorrhea

cause by impaired fat and protein metabolism

115
Q

Zollinger-Ellison Syndrome syndrome

A

bleeding
perforation
F/E imbalances

116
Q

PUD dx test

A

EGD

thin tube inserted through the mouth into the GI tract to look at the stomach and small intestine

117
Q

4 H. Pylori abxs

A

amoxicillin (Amoxil)
clarithromycin (Baxin)
metronidazole (Flagyl)
tetracycline HCl (achromycin)

118
Q

what are the 3 H2 antagonist and PPI of choice for h. pylori

A

H2:
cimetidine (tagamet)
ranitidine (zantac)
ramotidine (pepcid)

PPI: omeprazole (prilosec)

119
Q

misc PUD treatment

A

carafate
bismuth
antacids
Fe preps
DC NSAIDS

120
Q

how often to do a Gi assessment with PUD

A

q4h

121
Q

PUD education

A

abstinence from all caffeine and alcohol
avoid cigarettes
balance meals are regular intervals
avoid spicy foods

122
Q

review types of gastric resection, Billroth I and II - slide 157

A

slide 157

M/S 3 (17 decks)

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