Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Nurs 2514 final > GI Accessory organs > Flashcards

GI Accessory organs Flashcards

1
Q

Prehepatic Jaundice

A

Overproduction of unconjugated bilirubin from excess RBC breakdown and the liver cannot keep up

  • High unconjugated (indirect)
  • Decreased hct
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Hepatic jaundice

A

Liver inability to take, conjugate and conjugae bilirubin. Conjugated will leak out of hepatocytes.
Occurs in hepatitis and Cirrhosis

  • High unconjugated + conjugated
  • High LFT
  • Dark urine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Post hepatic jaundice

A

Failure to reach duodenum
- Intrahepatic - swelling or fibrosis
- Extrahepatic - cholestitis, gallstones, pancreatic cancer

  • High conjugated (direct) bilirubin
  • Dark urine
  • Steatorrhea - pale coloured stool
  • High cholesterol
  • Accumulation of bile salts in skin = pruritis
  • Vit K deficiency
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Viral hepatitis

A

Infection of liver causing damage from cytotoxic cytokines and NK cells that destroy the infected hepatocytes. Chronic infection leads to scarring then cirrhosis

1) Hepatitis A
- Fecal oral route
- Poor hygiene, handling of food, sanitation, crowded places
- Diagnosed by HAV-specific antibodies, PCR test

2) Hepatitis B
- Higher pravelence
- Blood and body fluids

3) Hepatitic C
- Liver damage, through blood
- No vaccination

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Viral hepatitis clinical manifestations

A
  • RUQ pain = liver enlargement
  • Fatigue, myalgia, arthralgia, malaise, anorexia, fever
  • Jaundice

Chronic can lead to liver scarring, cirrhosis and failure, with more risk to develop cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

NAFLD = non alcoholic fatty liver disease

A

Ranges from simple to severe cirrhosis
Accumulation of fat in the liver cells without alcohol, usually in obesity or DM2
Often adymptomatic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Toxic/Drug induced hepatitis

A

Symetic posison (e.g. gold, carbon tetrachloride) or those converted in liver to toxic live Tylenol or alcohol

Liver necrosis can occur in 2-3 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Liver Cirrhosis

A

Irreversible fibrosis and conversion of liver to abnormal nodules - caused by viral hepatitis B&C, NAFLD, toxic/drug, autoimmune

Excessive alcohol is leading cause

Hepatocyte dyfunction as inadequate blood flow occurs

Complication - portal HTN, varices, ascites/edema, HE, coaguabulity, billary obstruction, hepatorenal syndrome, bacterial peritonitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Portal hypertension

A

Structural change where the hepatic portal vein becomes obstructed, causing backup of blood into spleen = Splenomegaly, thombocytopenia due to trapping plateltys and WBC

  • Signs of bleeding/bruising

Varices made as collateral circulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Varices

A

Created to bypass the liver.
Distended and tortuous collateral veins that are fragile, commonly in esophagus, abdomen or hemorrhoidal

  • Cause hematemesis or melena
  • Esophageal burst commonly causing life threatening GI bleeds
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Ascites/edema

A

Accumulation of fluid in abdomen due to portal HTNN, more hepatic lymph, less albumin (liver makes albumin!! so less oncotic pressure), hyperaldosteronism (liver breaks down aldosterone)

= Abdomen distention, dependent edema, weight gain, hypokalemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Hepatic Encephalopathy

A

i) Ammonia rich blood shunted past liver due to collateral veins/varices
ii) Dysfunctional hepatocytes cannot convert it into urea

= sleep disturbances, coma, asterixis, fetor hepaticus (neurotoxic)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Coagulopathy/anemia

A

Pancytopenia due to
- Portal HTN causing splenomegaly and trapping it
- Clotting factor not produced in liver
- Unable to excrete bile for vitamin K absorption
- Esophageal varices = bleeding/hemorrhage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Other manifestations of cirhosis

A

i) Jaundice - Hepatic jaundice as intrahepatic damage - mix of conjugated and unconjugated
ii) Infections - portal HTN so bypass filtering ingested bacteria
iii) Hepatorenal syndrome - sudden decrease in urine, high BUN/creatinine
iv) Hormonal - steroid hormones not broken (aldosterone, estrogen, etc)= water retention, testiculat atrophy, gynecomastia, amonrrhea, spider angioma, palmar erythema, abnormal hair growth
iv) Drug toxicity - elevated levels of drugs = toxic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Gallbladder

A

RUQ - Concentrates bile products by liver
- Bile made up water, bile salts, cholesterol and bilirubin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Cholelithiasis (calculi) risk factors

A

4 F
1) Female - estrogen increases biliary cholesterol. Pregnancy, birth control pills and replacement esp
2) Fetile
3) Forty
4) Fat (drastic weight loss also as it increases blood cholestrole)

Stone created when there is too much cholesterol or too much bilirubin

17
Q

Acute cholecystitis

A

1) Calculus
- Gallbladder lodges in cystic stone
- Pressure builds up and reduce blood flow = ischemia, necrosis, scarring and perforation

2) Acalculous (no stone)
- Biliary statis
- Starvation, hypovolemia, less blood glor = pancreatic enzyme build up and lead to inflammation

18
Q

Cholecystitis clinical manifestation

A

1) Pain - triggered after high fat meal in RUQ
- Pain can radiate to right shoulder/scalpula
- Biliary colic - when stone moves, spasm causes pain

2) Murphy sign
- Palpate to feel inflamed gallbladder

3) Rebound tenderness

4) Indigestion, N/V

5) Fever

6) Post-hepatic jaundice = blocks bilirubin from exiting

7) Fatty stool

19
Q

Pancreas

A

Endocrine
- Alpha makes glucagon, beta makes insulin
- Enzymes trypsinogen for protein, amylase for carb, lipase for fat

Retroperitoneal to stomach

20
Q

Acute pancreatitis

A

Acute inflammation of pancreas from abnormal activation of pancreatic enzymes that self-digest the pancreases

Causes
i) Gallstones - Block common bile duct, pancreatic juice and bile
ii) Alcohol
iii) Genetics, meds, virus, hypercalcemia, high triglyceride, surgery. Trauma

What occurs
1) Lipolysis = fat necrosis
2) Proteolysis = protein breakdown causing thrombosis and gangrene
3) Necrosis of blood vessels = bleeding!
4) Release of more enzymes = vasodilation
5) Inflammatory mediators

21
Q

Acute pancreatitis clinical manifestation

A

Pain - LUQ, mid gastric area that can radiate to back, left shoulder

N/V

Jaundice

Hemorrhage from breakdown of blood vessels
- Cullens sign and grey turner
- Tachycardia, hypovolemic shock

Fever from inflammation

Pancreatic enzymes in blood - high amylase and lipase

Hypocalcemia as FA bind to calcium

Hypovolemia - vasodilation, bleeding

Pulmonary - inflammatory cytokines

Hyperkalemia - cell death spills potassium

22
Q

Propranolol (Indrel)

A

Non-selective beta blocks

MOA
- Block cardiac beta 1/d + renal beta 1
- Reduce HR, dorce of contraction, renin and CO

Indication = PORTAL HYPERTENSION

AE
- Bradycardia, AV heart block, arrthymia
- Bronchoconstriction

NC
- HR before administer
- HF - SOB, edema, weight gain
- Do NOT abruptly stop
- RR, O2, WOB - CI in COPD or asthma

Precaution!!!
- Severe allergies - epi activates beta 1 in heart and 2 in lungs, which is blocks so epi wont work!!
- Hypoglycemic unawareness
- Cardiac/resp - exacerbates HF

23
Q

Lactulose (Enulose)

A

Osmotic laxative

MOA - Metabolizes into acid, lowering colon pH and inhibiting ammonia from entering blood

indication = HEPATIC ENCEPHALOPATHY

AE
- Diarrhea, crmaping, bloating
- Hyperglycema
- dehydration/electrolyte

NC
- CVS - Hydration/electrolyte
- GI and neurological

24
Q

Albumin 25% (HSA)

A

IV injection to restore oncotic pressure by withdrawing fluid from interstitial places
- Administered AFTER ascites removed

AE
- Hypervolemia - circulatory overload
- Hypersensitivity

CI - renal insufficiency, HF, anemia

NC -
- Stop in signs of hypersensitised immediately
- Monitor blood work for electrolyte
- Fluid overload - HF, pulmonary edema, HTN
= VS, HA, edema, JVD, crackles, S3/S4, urine ouput, WOB

25
Q

Spironolactone (Aldactone)

A

Potassium sparing diuretic

MOA
- Block aldosterone to prevent H20/Na reuptake to excrete sodium and keep potassium

Indication - ascites/peripheral edema

AE
- Hyperkalemia - paresthesia, muscle weakness, fatigue, bradycardia, arrythmias
- Hypotension
- Diarrhea/Abdominal cramping

NC
- Fluid statis - weigh, I&O, edema, lung, skin turgor, mucous membranes
- Electrolyte imbalance for sodium - anorexia, muscle weakness, confusion, thirst, seizure
- VS, serum electrolyte, BUN/CR

26
Q

Liver assessment

A
  • HE - Asterixis, drowsy, insomnia, fetor hepaticus - check LOC
  • CVS - BP, pulse

Findings
- Caput medusa - snake shape on adomen
- Spider angioma - red spidery skin marks
- Protuberant belly from ascites
- Palmary erythma - redness in palm
- Abdominal striae
- Gynecomastia/testicular atrophy

27
Q

Lab tests for liver

A
  • Bilirubin = high due to inability to conjugate
  • Hypokalemia = aldosterone
  • Hypoglycemia = liver cannot glycogenolysis
  • Less albumin
  • Low RBC, platelet, EBC = Portal HTN causing splenomegaly and blocking
  • High cholesterol - less bile to digest fat
  • High LFT
  • High INR - no vitamin K and clotting factors produced
  • High ammonia - breakdown of protein that cant become urea
28
Q

Gallpladder

A

Phrenic nerve causes referred pain to the right shoulder/back
- 30 min after fatty meal
- Monitor BP, pulse, RR, O2, post-hepatic jaundice, sweating

  • Murphy sign
  • Melena? steatorrhea?

LAB WORK
- INR/aPTT due to no vitamin K
- WBC - Inflammation
- Cholestrol - obstruction of bile means no digestion of fat (post-hepatic jaundice)
- High bilirubin - conjugated
- High LFT

29
Q

Endoscopic retrograde cholangiopancreatography (ERCP)

A

Specialiased technique of endoscope inserted into pancreatic duct
Risk of perforation, infection and pancreatitis

30
Q

Pancrease

A
  • Pain in LUQ, radiate to back as retroperitoneal
  • Leaning forward helps with pain
  • Hypovolemia esp in bleeding, sepsis or inflammatory
  • Jaundice
  • Hyperglycemia - beta cells destroyed
  • Cullen sign and Grey turner

LAB WORK
- High WBC - inflammation
- Low HgB - Pancreatic enzymes breakdown blood vessels and cause hemorrhage
- High glucose
- Low calcium - free FA from lipolysis bind to blood calcium
- Hyperkalemia - cells break and spill potassium
- High blood amylase and lipase

Nurs 2514 final (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions