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Question 1

What are the functions of the liver?

Answer 1

Glucose metabolism, ammonia conversion, protein metabolism

Question 2

What is glucose metabolism?

Answer 2

Metabolism of glucose and regulation of blood sugar concentration

Question 3

What is glucose?

Answer 3

Sugar in the blood that is released
Excess stored as glycogen and obtained from portal venous blood

Question 4

What is gluconeogenesis?

Answer 4

The synthesization of glucose from amino acids from broken down proteins

Question 5

What is happens in ammonia conversion?

Answer 5

Convert ammonia to urea that is excreted in the urine

Question 6

What can form ammonia?

Answer 6

Amino acids from gluconeogenesis, bacteria in the intestines

Question 7

What proteins does the liver synthesize?

Answer 7

Albumin, clotting factors

Question 8

What is fat metabolism?

Answer 8

The breakdown of fatty acids into ketones when glucose metabolism is limited

Question 9

What vitamins/ minerals are stored by the liver?

Answer 9

A, B, D, B complex, iron, and copper

Question 10

What drugs does the liver metabolize?

Answer 10

Barbiturates, opioids, sedatives, anesthetics, amphetamines

Question 11

Where is bile formed?

Answer 11

The liver

Question 12

How does bilirubin get excreted?

Answer 12

The liver, bilirubin is the breakdown of hemoglobin

Question 13

What causes esophageal varices?

Answer 13

Portal hypertension

Question 14

What is the key sign of esophageal bleeding?

Answer 14

Lots of bleeding

Question 15

What is the nursing management of someone with esophageal varices?

Answer 15

Gastric suction to keep the stomach empty, monitor blood pressure, anticipate vitamin k therapy and blood transfusion

Question 16

What is hepatic encephalopathy?

Answer 16

Liver is not able to convert ammonia to urea causing fluid buildup in systemic circulation instead of the portal venous system

Question 17

How can you reduce serum ammonia?

Answer 17

Eliminate protein from the diet, neomycin (antibiotic → reduces bacteria), lactulose

Question 18

What are the early symptoms of hepatic encephalopathy?

Answer 18

Forgetful, confusion, sleeping during the day, insomnia at night

Question 19

What are the advanced symptoms of hepatic encephalopathy?

Answer 19

Shaking of the hands or arms (asterixis), disorientation, slurred speech, sweet poopy breath

Question 20

What is the treatment for hepatic encephalopathy?

Answer 20

Lactulose (Cephulac)
Trapping and expelling the ammonia in the feces
Can be dilated with fruit juice
Monitor for hypokalemia and dehydration

Question 21

What should we encourage patients with hepatic encephalopathy to do?

Answer 21

Breathe deeply to prevent pulmonary complications

Question 22

What are the risk factors for pancreatic cancer?

Answer 22

Cigarette smoking
Chronic pancreatitis
Family history of pancreatic or other cancers
Age 60 and over
Exposure to industrial chemicals
Toxins in the environment
Diet high in fat, meat, or both

Question 23

Where do most pancreatic tumors emerge?

Answer 23

At the head

Question 24

What are we worried about regarding the surrounding organs of the pancreas with a head tumor?

Answer 24

Obstruction

Question 25

What do biliary duct obstructions cause?

Answer 25

Jaundice, clay colored stools and urine

Question 26

How can we treat jaundice caused by an obstruction?

Answer 26

Biliary enteric shunt

Question 27

What is associated with functioning islet cell tumors?

Answer 27

Hyperinsulinism

Question 28

Why does pancreatic cancer have such a high mortality rate?

Answer 28

It is often caught when it is too late

Question 29

What are the clinical manifestations of pancreatic cancer?

Answer 29

Pain (severe at night laying on back or by meals→ relieved sitting up) Jaundice Weight loss (unrelated to GI, up to 80%) Ascites DM (early)

Question 30

When is pain most severe for a patient with pancreatic cancer?

Answer 30

Nighttime, accentuated when lying supine Relief by sitting up and leaning forward

Question 31

What is the most accurate assessment and diagnostic tool for pancreatic cancer?

Answer 31

Spiral CT → 85-90% accurate

Question 32

How can we assess and diagnose pancreatic cancer?

Answer 32

Spiral CT MRI ERCP Endoscopic ultrasound Percutaneous fine needle aspiration biopsy of the pancreas

Question 33

What is the medical management of pancreatic cancer?

Answer 33

Palliative bulk removal

Question 34

What is the nursing management for pancreatic cancer?

Answer 34

Hospice, pain management

Question 35

What do we ensure for a patient prior to a Whipple procedure?

Answer 35

Diet high in protein and pancreatic enzymes Hydration Adequate vitamin k (correction of prothrombin deficiency Treatment of anemia

Question 36

What is the Whipple's Procedure?

Answer 36

Removal of the gallbladder, portion of the stomach, duodenum, proximal jejunum, head of the pancreas, distal common bile duct Connection of the remaining stomach and jejunum

Question 37

What is the result of Whipple's procedure?

Answer 37

Removal of the tumor, bile flow in the jejunum

Question 38

What should we give to the patient of a Whipple Procedure post op?

Answer 38

Pancreatic enzymes, low fat diet, vitamin supplements

Question 39

What may a patient experience after Whipple’s procedure?

Answer 39

Malabsorption, hyperglycemia