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GI 3 Flashcards

1
Q

Functions of liver

A

carb, fat, steroid, protein metabolism

detoxification

prodution & excretion of bile

storage iron, vit K, minerals blood

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2
Q

yellow pigmentation of sclera, skin, deeper tissues

A

jaundice

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3
Q

why does jaundice happen

A

due to a concentration of bilirubin in blood, becomes abnormally increased

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4
Q

how is bilirubin formed

A

from the breakdown of hemoglobin of old RBC’s

(unconjugated bilirubin released into blood, bound to albumin, not water soluable (cannot be excreted) cannot be filitered by kidneys, builds up in blood)

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5
Q

what does the bilirubin level have to be for jaundice to occur

A

3 times greater than normal

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6
Q

is jaundice a disease

A

NO, its a symptom

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7
Q

what is the most common cause of jandice

A

excessive breakdown of RBC’s or bile excretion obstruction

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8
Q

babies become jaundice because

A

of excessive destruction of RBC’s

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9
Q

results from excessive RBC destruction, occurs before the liver, has excess unconjugated bilirubin

A

pre-hepatic jaundice (hemolytic)

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10
Q

causes of hemolytic jaundice

A

hemolytic anemia, sickle cell, severe burns, newborns

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11
Q

defective uptake, conjugation or excretion of bilirubin within liver, both unconjugated and conjugated bilirubin elevated

A

hepatic jaundice (hepatocellular)

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12
Q

causes of hepatocellular jaundice

A

cirrhosis, hepatitis, hepatic carcinoma

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13
Q

what is the major problem in hepatocellular jaundice

A

conjufation and excretion of bilirubin

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14
Q

decreased or obstructed flow of bile thru liver or biliary duct system, blocks outward flow of bile from liver

A

post hepatic jaundice (obstructive)

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15
Q

obstruction of bile into the duodenum, clay colored stools with complete obstruction

A

extrahepatic

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16
Q

pruritis

A

itching

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17
Q

who would you have a pt come in with a bleeding problem who has a Hx of liver disease

A

lack of vit K, bile is necessary for absorption of vit k from GI

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18
Q

what Rx do you want to avoid if you have problems with jaundice

A

ASA, risk of bleeding

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19
Q

any type of inflammation in the liver

A

hepatitis

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20
Q

what kind of hepatitis is most common

A

viral hepatitis

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21
Q

wide spread inflmmation of liver, liver cell damage, degeneration and necrosis, bile flow interruption

A

viral hepatitis

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22
Q

what are causes of hepatitis

A

viral

alcohol

drugs

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23
Q

Hepatitis A

A

transmitted thru fecal oral route

occurs in small outbreaks

contagious for 2 weeks prior to symptoms

due to poor hygine, contaminated food, water, poor sanitary conditions

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24
Q

detection of IgM anti-HAV indicates

A

acute hepatitis

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25
Q

presence of IgG antibody does what

A

provides lifelong immunity

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26
Q

Hepatitis B

A

can live up to 7 days on a dry surface, 100x’s more infectious than HIV

transimission by body fluids, blood

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27
Q

HBV Window phase

A

have a 3 month delay between disapperance HB-antigen & apperance Anti-HB

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28
Q

a positive HBAb or anti-HBs indiciates

A

recovery, no longer contagious

immunity from HBV vaccine or past HBV infection

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29
Q

Hepatitis C

A

transmission is blood & blody fluids

HCV damages liver over decades

leading indication for liver transplant

chronic, asymptamatic

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30
Q

only way for survival of hepatitis c is

A

liver transplant

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31
Q

hepatitis D

A

also called delta virus

HDV only occurs as co-infection with HBV

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32
Q

Hepatitis E

A

waterborne infection in india, asia, africa

fecal oral route

causes epidemics after heavy rains and flooding

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33
Q

hepatitis G

A

blood & bldy fluids

often coexists with other hepatitis viruses (B, C, HIV)

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34
Q

Toxic & drug induced hepatitis

A

liver damage occurs after exposure to hepatotoxins

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35
Q

autoimmune hepatitis

A

chronic, autoimmune reaction against normal hepatocytes

treated with corticosteroids, or liver transplant

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36
Q

Hepatitis DX

A

biopsy, elevated ALT, AST, WBC, increased eosinophils

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37
Q

acute phast of hepatitis

A

lasts 1-21 days

period of maximal infectivity for hepatitis A

Sx: fatigue, constippation, diarrhea, malaise, RUQ pain, HA photophobia, low grade fever

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38
Q

Icteric phase (jaundice phase)

A

lasts 2-4 weeks, characterized by jaundice

dark urine

clay colored stools

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39
Q

posticteric phase

(convalescent phase)

A

begins when jaundicedisappears

lasts weeks to months

hepatomegaly

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40
Q

resulsts in severe impairment or necrosis of liver cells and potential liver failure

A

fulminant hepatitis

(Hep B &D)

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41
Q

Tx for hepatitis

A

no specfic Tx, emphasis on rest and adequate nutrition

antiviral Rx: epivir, baraclude, tyzeka, hepsera

antiemetics: zofran, tigan, reglan

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42
Q

prevention for hepatitis A

A

vaccine can be fiven for pre exposure prophylaxis, immune globulin can be given before or after exposure (1-2 weeks)

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43
Q

prevention hepatitis B

A

immunization is most effective, HB immune globulin given post exposure provides passive immunity

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44
Q

Preventino of Hepatitis C

A

no products to prevent HCV

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45
Q

what are the three A’s when preventing accidental exposure

A

awareness attentivness, anticipation

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46
Q

nutritional therapy for hepatitis

A

vitamin supplements b-complex vitamins, vitamin K

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47
Q

what needs to be done after diagnosis of Heptitis

A

follow up for at least one year after diagnosis, avoid alcohol

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48
Q

wilsons disease

A

increase of copper in liver, develop kayser-fleicher rings, leads to liver failure, Tx is chelating agents to promote exretion of exess copper

genetic

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49
Q

hemochromatosis

A

increase absorption of iron leads to cirrhosis, unTx can lead to death

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50
Q

a chronic progressive disease of the liver with irreversible scarring of the liver, tissue becomes nodular and fibrotic

A

cirrhosis

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51
Q

what is the most common cause of cirrhosis

A

alcohol

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52
Q

is cirrhosis fatal

A

yes

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53
Q

cirrhosis caused by alcohol use, proceded by fatty infiltration of the liver cells, widespread scar formation

A

alcoholic (laennec’s) cirrhosis

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54
Q

cirrhosis caused by a complication of tocix, viral or autoimmune hepatitis, liver becomes small and distorted

A

postnecrotic cirrhosis

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55
Q

cirrhosis associated with chronic biliary obstruction and infection, liver enlarges, firm and green

A

biliary cirrhosis

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56
Q

cirrhosis caused by longterm severe right sided heart failure

A

cardiac cirrhosis

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57
Q

when do S/Sx of cirrhosis begin

A

when about 80% of liver damage has occured

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58
Q

when do jaundice and peripheral edema occur in cirrhosis

A

last stages

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59
Q

small dilated vessels, bright red center and spider like branches

A

spider angiomas

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60
Q

red area palm of hand blanches with pressure

A

palmar erythema

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61
Q

how is splenomegaly caused

A

backup of blood from portal vein

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62
Q

why do people with cirrhosis have bleeding tendencies

A

decreased production of hepatic clotting factors

(II, VII, IX, X)

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63
Q

what dietary deficiencies occur with cirrhosis

A

thiamine, floic acid, vit B12

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64
Q

increased resitance to blood flow through the liver, portal vein pressure increases

A

portal HTN

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65
Q

complex tortuous veins at lower end of esophagus

A

esophageal varices

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66
Q

colalrteral circulation which involves the superficial veins of the abd wall leading tothe development of dilated veins around the umbilicus

A

caput medusae

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67
Q

shift of fluid in abd bc of lack of protein bc the liver isnt functioning properly

abd distention and weigh tgain

A

ascites

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68
Q

liver damage causs blood to enter systemic circutaion without liver detozification, liver is unable to convert ammonia to urea or blood shunted past liver so ammonia stays in systemic circulation

A

hepatic encephlopaty

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69
Q

what are S/Sx of hepatic encephalopaty

A

inapproptiate behavior to coma

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70
Q

flapping tremor invovles arms and hands

A

asterixis

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71
Q

musty, sweetish odor detected on the pts breath

A

fetor hepaticus

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72
Q

toes curl when touch bottom of feet

A

babinski sign

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73
Q

4 stages of hepatic encephalopaty

A

prodromal

impending (asterixis)

stuporous

comatose (+ babinski)

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74
Q

functional renal failure without structural abnormality of kidneys, decreased arterial volume which leads to renal vasoconstriction with renal failure

A

hepatorenal syndrome

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75
Q

what is the most specific lab test done for liver

A

ALT

76
Q

what kind of nursing care should be done for someone with chirrohsis

A

rest, admin of B12, management of ascites, prevent variceal bleeding, avoid alcohol

77
Q

provides for continuous reinfusion of ascitic fluid fromthe abd to the vena cava or jugular

A

peritoneovenous shunt

78
Q

wjat RX can be given to help prevent bleeding in espohageal varices

A

vasopressin

decreaes portal pressure by constriction

79
Q

3 lumens to apply pressure to bleeding areas, gastic aspiration, gastric balloon, esophageal balloon

A

sengstaken-blakemore tube

80
Q

what is important with a sengstaken-blakemore tube

A

monitor airway, syringe at bedside to deflate balloon

81
Q

which shunt is used to decrease incidence of hepatic encephalopathy

A

warren shunt (distal spenorenal shunt)

82
Q

what should the nurse do for a esophafeal varices

A

administer FFP & PRBC

vit K

H2 receptor blockers/PPI

83
Q

what should be given for a pt with hepatic encephalopathy

A

lactulose

(forms lactic acid in bowel, so bacteria cant grow so traps ammonia in the gut and expels it)

84
Q

what special diet should someone with ascite/edema follow

A

low sodium diet

85
Q

paracentesis

A

have pt void prior to to avoid knicking the bladder

86
Q

what is the most common complication of balloon tamponade

A

aspiration pneumoina

87
Q

what surgical procedure can be done for varices

A

balloon tamponade

88
Q

where does liver Ca usually metastazise from

A

lun, breast colon

89
Q

elevated serum alpha-fetoprotein

A

tumor marker

90
Q

used to treat inoperable cancer of liver, pancreatic & bile ducts & tumor obstructions

A

percutaneous biliary drainage

91
Q

what is used in end-stage liver disease, acute liver failure, primary liver tumors

A

liver transplant

92
Q

who is not a candidate for transplant

A

advanced cardiac disease, respiratory disease, alcohol abuse, metastatic tumors

93
Q

what complications can a pt have with a liver transplant

A

graft rejection, infection

94
Q

an acute inflammatory process of the pancreas

A

pancreatitis

95
Q

what is the most common reason for pancreatitis

A

biliary tract disease

96
Q

what enzymes aid with autodigestion

A

trypsinogen, elastase, phospholipase A

97
Q

causes hemorrhage by producing dissolution of the elastic fibers of blood vessels

A

elastase

98
Q

activated by trypsin and bile acids, plays a major role in autodigestion

A

phospholipase A

99
Q

activated by trypsin by enterokinase, enzyme can digest the pancreas and can activate other proteolytic enzymes

A

trypsinogen

100
Q

what can stimulate the production of digestive enzymes

A

alcohol

101
Q

S/Sx of pancreatitis

A

LUQ or epigastric pain, aggrivated by eating high fat meals or alcohol intake

102
Q

bluish periumbilical discoloration

A

cullens sign

103
Q

bluish color in flank

A

turners sign

104
Q

cullen or turners sign

A

sign of pancreatitis

105
Q

a psecavity surrounding outside of pancreas filled with necrotic products and liquid secretions

A

pseudocyst

106
Q

if a pseudocyst perforates it causes

A

peritonitis

107
Q

a large fluid containing cavity within pancreasresults from necrosis in pancreas, requires surgical drainage

A

pancreatic abscess

108
Q

tetany is caused by

A

hypocalcemia

109
Q

serum amylase & lipase that is elevated could be what

A

pancreatitis

110
Q

as a nurse what should you look for with pancreatitis

A

VS, hemmorrhage, fluid/electrolyte balance, NPO, LR

DO NOT use D5W bc you dont want the pancreas to have to work harder to make insulin

111
Q

endoscopic sphincterotomy

A

used when stone blocking Oddi duct

112
Q

ERCP is used when

A

gallstone blocking

113
Q

diet for pancreatitis

A

high carb, low fat, high protein

114
Q

what position should a pt lay with pancreatitis

A

side lying, with HOB elevated 45 degrees, knees up to abdomen

115
Q

signs of hypocalcemia

A

tetany, numbness around lips/fingers, positive chvostek or trousseau signs

116
Q

signs of hyperglycemia

A

polyuria, polyphagia, polydipsia

117
Q

continuous prolonged, inflammaroty and fibrosing process of the pancreas

A

chronic pancreatitis

118
Q

inflammation of sphincter of Oddi associated with cholelithiasis

A

chronic obstructive pancreatits

119
Q

causes of chronic obstructive pancreatitis

A

cancer of ampulla of Vater

cancer of duodenum, or pancreas

inflammation of sphincer of Oddi

120
Q

chronic calcifying pancreatitis happens where

A

head of the pancrea and around the pancreatic duct

121
Q

S/Sx of chronic pancreatitis

A

heavy, gnawing feeling, burning cramp like

122
Q

chronic pancreastitis is a precursor to what

A

pancreatic cancer

123
Q

in pancreatic cancer what will the serum amylase/lipase be

A

may be increaed slightly or not at all

124
Q

elevated sedimentation rate

A

indicates inflammation

125
Q

choledochojejunostomy

A

CBD anastomosed into jejunum

bypasses obstruction of tumor

126
Q

Roux-en-Y pancreaticjejunostomy

A

pancreatic duct opened & anastomosed to jejunum

127
Q

all surgery for chronic pancreatitis is

A

palliative

128
Q

cholecystojejumonstomy

A

connect GB to jejunum to go around obstruction

129
Q

whipple procedure

A

radical pancraticoduodenectomy

130
Q

S/Sx of carcinoma of pancreas

A

asymptamatic @ 1st, then rapid weight loss, abd pain radiates to back, pain related to eating

131
Q

what does the gallbladder do

A

collects and concentrates and stores bile

132
Q

inflammation of gallbladder

A

cholecystitis

133
Q

calculous

A

acute cholecystitis, with cholelithiasis (stones)

134
Q

acalculous

A

cholecystitis without cholelithiasis

135
Q

who is at highest risk for cholecystitis

A

over age 40, females, multiparous women (mult pregnancy)

136
Q

5 F’s of risk factors

A

Fourty

Female

Fertile

Family Hx

Fat

137
Q

calculous is mostly commonly associated with

A

obstruction

138
Q

acalculous occurs in older adults and those who have what hx

A

trauma, extensive burns, or recent surgery

139
Q

what are stones made of

A

bile salts, cholestrole

140
Q

what is the most common factor for cholecystitis

A

e. Coli (bacteria)

141
Q

develops when balance that keeps cholesterol, bile salts, and calcium in solution is altered

A

cholelithiasis

142
Q

what is the most common form of stone

A

cholesterol

143
Q

spasm of biliary duct trying to push stone through

A

biliary colic

144
Q

S/Sx of cholelithiasis

A

pain in RUQ, and R shoulder

145
Q

if your pt has pain triggered by a high fat meal, and blumbergs sign

A

acute cholecystitis

146
Q

rebound tenderness

A

blumbergs sign

147
Q

S/Sx when you have a total obstruction of GB

A

jaundice

dark amber foamy urine

clay colored stools

pruritus

bleeding tendencies

steatorrhea

148
Q

when a stone is lodged in ducts or moving may cause spasm what is this called

A

biliary colic

149
Q

why would a person have pruitis with cholelithiasis

A

bc of bile salts

150
Q

why would a pt have bleeding tendencies with cholelithiasis

A

bc vit k is not being absorbed

151
Q

steatorrhea

A

fatty stools

152
Q

murphys sign

A

pain with inspiration

(cholelithiais)

153
Q

subphrenic abcess

A

found under diaphragm, pocket of pus (infection)

154
Q

labs with cholecystitis

A

WBC, amalyse, lipase, AST, ALT

155
Q

visualization of gall bladder & cystic, common hepatic, common bile ducts, pancreatic duct, can retrieve gallstone from distal CBD, dilate strictures, obtain biopsy, diagnoise pseudocysts

A

endoscopic retrograde cholangiopancreatography

(ERCP)

156
Q

percutaneous transhepatic cholangiography

A

inject dye in bile duct, used to diagnose obstructive jaundice & locate stones within bile ducts, filling of hepatic and biliary ducts

157
Q

what is the gold standard that shows gallstones in the GB and ducts

A

ultrasound

158
Q

Labs for gallstone obstruction

A

increase of all the below:

ALT, AST, alkaline phosphaase

WBC

serum bilirubin (indirect, direct, urinary bilirubin)

serum amylase, lipase (if pancreastic involvement)

159
Q

Tx for gallstones

A

pain management

antibiotic Tx

fluid electrolyte balance

anticholinergics (counteract smooth muscle spasms)

160
Q

endoscopic spincterotomy

A

removes common bile duct stones, sphincter of Oddi widened, basket is used to retrieve stone

161
Q

Sphincter of Oddi

A

where bile duct opens to duodenum

162
Q

laparoscopic cholecystectomy

A

4 puncture holes, injury to common bile duct is main complication, discharged in 1-2 days

163
Q

when is t-tube used

A

for open cholecysectomy, allows excess bile to drain

164
Q

T-tube nursing Care

A

maintain semi fowlers position

keep drainage below level of GB

immediately post op have bloody drainage, then will change to greenish-brown

never irrigate aspirate or clamp without MD order

if pt is allowed to eat clamp tube for 1-2 hours before and after meals

stools will return to brown color (7-10 days)

165
Q

what Rx can be given for pruritus

A

questran (cholestyramine)

gets rid of bile salts

166
Q

if a pt eats too much fat they will have what kind of stools

A

steatorrhea

167
Q

cholelithiasis disease is more common in what ethnic background

A

native americans

168
Q

what signs of obstruction for GB stones

A

jaundice, caly colored stools, dark, foamy urine, fever, increased WBC, steatorrhea

169
Q

post of for laparoscopic cholecystectomy

A

shoulder pain from irritation of phrenic nerve and diaphargm due to retained CO2, place pt in Sims position, deep breathing

170
Q

when giving your pt narcotics what do you need to assess

A

RR

171
Q

post cholecystectomy syndrome

A

abd pain with Vomiting following cholecystectomy

jaundice may occur several weeks to months after surgery, ERCP used to find problem

172
Q

causes of post cholecystectomy syndrome

A

pseudocyst, common bile leak, bile duct stricture, retained stone, sphincter of Oddi dysfunction

173
Q

gallbladder cancer

A

begins in inner layer and grows outward, rare, metastasizes to adjacent organ (liver)

174
Q

CT and MRI is used for what

A

staging cancer

175
Q

ERCP & MRCP

A

looks at ducts

176
Q

CEA/CA 19-9

A

tumor markers

177
Q

if surgery is not an option what can be done for GB cancer

A

endoscopic stenting of biliary tree to reduce jaundice

178
Q

if pt who has gallbladder removed has bruising and bleeding could be bc of what

A

Vit K deficiency

179
Q

ALT lab is used for what

A

enzyme found in liver cells, is a more specific measure of liver damage than AST, some drugs can falsely increase the level of ALT (acetaminophen, salicytates, codeine, oral contraceptives)

180
Q

AST lab is used for what

A

non specific marker of hepatic injury found in brain, cardiac, skeletal muscle, kidney, and liver

the level can be falsely decreased in diabetic ketoacidosis, severe liver disease, uremia, pregnancy

181
Q

GTT lab is used for what

A

enzyme produced in bile ducts that may be increased with bile duct dieases

useful in determining the source of increased ALP

182
Q

ALP lab is used for what

A

relects bile formation and flow, produced in the bile ducts

can be falsely increased due to pregnancy, salicylates, antibiotics, oral DM rxs, oral contraceptives

183
Q

LDH (lactic dyhydrogenase)

A

if elevated indicates tissue damage, decreased in radiation and cancer tx, increase in alcoholism, anemia, burns,

184
Q

prothrombin

A

used to screen for hemostatic dysfunction involving coagulation system

185
Q

ammonia

A

wast product produced during protein digestion, if liver doesnt convert to ammonia into urea ammonia levels rise in blood

186
Q

bilirubin

A

byproduct of old red blood vell destruction removed by the liver from blood then secreted into bile, then absorped in intestine

187
Q

urobilinogen

A

produced in intestines, some is reabsorbed and returns to liver rest excreted in feces, a banana before test may affect results, also wine, drugs, ascorbic acid, ammonium chloride and antibx, drugs containing sodium bicarb may yield a false positive test

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