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Nursing 102 > GI exam #3 > Flashcards

GI exam #3 Flashcards

1
Q

What are the 5 major functions of the liver?

A
  1. Metabolism
  2. Bile Synthesis
  3. Storage
  4. Mononuclear Phagocyte System
  5. Production of coagulation factors
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2
Q

What are the 3 metabolic functions of the liver?

A
  1. Carbohydrate, fat & protein metabolism
  2. Detoxification
  3. Steroid metabolism
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3
Q

What is jaundice?

A

yellow pigmentation of the skin, sclera & deeper tissues, results from abnormally high levels of bilirubin circulating in the blood.

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4
Q

How is bilirubin formed?

A

From breakdown of hemoglobin of old RBC’s

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5
Q

Which kind of bilirubin is not water soluble?

A

Unconjugated bilirubin (bound to albumin)

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6
Q

Where does bilirubin become conjugated?

A

in the liver, by attaching to glucuronic acid. Now it is water soluble

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7
Q

Liver secretes conjugated bilirubin into ____

A

bile, where it travels to the lg intestine

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8
Q

How is bilirubin excreted from the body?

A

It is converted into bilinogen in large intestines & excreted in urine & feces.

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9
Q

What are the 2 most common causes of jaundice?

A

excessive destruction of RBC’s OR bile excretion obstruction.

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10
Q

What are the 3 types of jaundice?

A
  1. Hemolytic (pre-hepatic)
  2. Hepatocellular (within the liver)
  3. Obstructive (most common)
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11
Q

What causes Hemolytic Jaundice?

A

excessive RBC destruction. leads to excess unconjugated bilirubin in the blood, liver is unable to handle increased load.

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12
Q

What causes hepatocellular jaundice?

A

defective conjugation or excretion within the liver. Hepatocytes are damaged & leak bilirubin, increasing conjugated bilirubin levels.

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13
Q

What causes Obstructive Jaundice?

A

decreased or obstructed flow of bile thru liver or biliary duct system

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14
Q

2 Types of obstructive jaundice?

A
  1. intrahepatic- outward flow of bile blocked

2. extrahepatic- flow of bile into duodenum blocked

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15
Q

What do stools look like with complete obstruction of bile flow?

A

clay colored

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16
Q

Clinical manifestations of jaundice:

A

yellowish discoloration, pruritis,, bruising & bleeding of skin, brown foamy urine, H/A & confusion (if unconjugated bilirubin crosses blood-brain barrier & irritates the brain)

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17
Q

What is hepatitis?

A

any type of inflammation of the liver

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18
Q

Types of viral hepatitis?

A

Hep A, Hep B, Hep C, Hep D, Hep E, Hep G

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19
Q

How is Hep A transmitted?

A

fecal-oral route

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20
Q

How can you get immunity from Hep A?

A

Hepatitis A vaccine or after infection develop IgG antibodies = lifelong immunity

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21
Q

Hepatitis B: RNA or DNA virus?

A

DNA

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22
Q

How is Hep B transmitted?

A

blood & body fluids

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23
Q

Can Hepatitis B live on a dry surface?

A

Yes! for up to 7 days

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24
Q

What is the HBV window phase?

A

3 month period where serological markers for hep b are negative but pt is infectious

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25
What is a chronic carrier?
someone who no longer has symptoms but remains contagious. high risk of developing cirrohosis and liver cancer
26
How can you get immunity from Hep B?
vaccine or past HBV infection
27
How is Hep C transmitted?
Blood to blood
28
What is the leading indication for liver transplant?
Hepatitis C
29
Hepatisis D can not survive on its own. What co-infection does it require to survive?
Hepatitis B
30
How is hepatitis E transmitted?
fecal-oral. usually self-limiting & resolves on its own
31
How do you acquire non-viral hepatitis?
liver damage after exposure to hepatotoxins
32
How do you diagnose Hepatitis?
Liver biopsy, elevated serum ALT & AST, elevated total serum bilirubin levels, elevated ALP, elevated WBC's
33
What are the phases of acute Hepatitis and how long do they last?
preicteric phase: 1-21 days icteric phase (jaundice phase): 2-4 weeks post icteric phase: weeks to months
34
What does icteric mean?
jaundice
35
What are symptoms of preicteric hepatitis?
splenomegaly, hepatomegaly, lymphadenopathy, fatigue, constipation/diarrhea, H/A, low-grade fever, RUQ pain
36
What are symptoms of icteric phase of hepatitis?
jaundice, dark urine, clay colored stools, GI symptoms, pruritis, increased indirect & direct serum bilirubin, increased stool bilirubin
37
Symptoms of post icteric phase of hepatits?
begins when jaundice disappears, malaise, fatigue, indigestion, flatulence, abd pain, hepatomegaly
38
What is anicteric Hepatitis?
viral hepatitis w o the presence of jaundice
39
Hepatitis C clinical manifestations:
majority asymptomatic! leads to chronic liver disease
40
What is the primary nursing intervention for acute hepatitis?
rest & adequate nutrition
41
When can IgG be given for Hep A?
1-2 weeks before or after exposure
42
What is cirrhosis of the liver?
progressive, irreversible scarring of the liver
43
What is the most common cause of cirrhosis?
Alcohol
44
What are the 4 types of cirrhosis of the liver?
1. alcoholic cirrhosis 2. postnecrotic cirrhosis 3. biliary cirrhosis 4. cardiac cirrhosis
45
What does a liver affected by alcoholic cirrhosis look like?
initially becomes fatty bc of infiltration of the liver cells, can be reversed at this point. Later becomes covered in scar tissue, permanent.
46
What does a liver affected by postnecrotic cirrhosis look like?
small & distorted bc of hepatitis
47
What does a liver affected by biliary cirrhosis look like?
enlarged, firm & green
48
What causes cardiac cirrhosis?
longstanding severe right-sided HF (portal HTN)
49
Early manifestations of cirrhosis?
vague & mild. Weight loss, malaise, GI disturbances: anorexia, dyspepsia, flatulence, N&V.
50
Late manifestations of cirrhosis:
Jaundice & peripheral edema, ascites, pruritis, spider angiomas, splenomegaly, bleeding tendencies, portal HTN, hepatocellular failure
51
What is caput medusae?
dilated veins around the umbilicus
52
what is ascites?
osmotic shift of fluid in to peritoneum = abd distention & weight gain
53
What is hepatic encephalopathy?
liver damage = liver not able to detoxify blood adequately = ammonia unable to convert to urea, builds up in blood. Ammonia crosses blood-brain barrier results in neuro s/sx, coma & death.
54
Clinical manifestations of hepatic encephalopathy?
range from inappropriate behavior to coma. apathy, memory loss, agitation, confusion
55
What is asterixis?
flapping tremor involves arms & hands
56
What is the most common characteristic of hepatic encephalopathy?
asterixis
57
What is fetor Hepaticus?
musty, sweetish odor on breath
58
Diagnostic studies for cirrhosis of the liver:
Liver function tests (ALT), liver biopsy, liver scan, liver U/S
59
Collaborative care Cirrhosis:
REST, avoid ETOH & anticoagulants
60
Collaborative care Ascites:
high carb, low protein, low Na+ diet avoid ETOH diuretics paracentesis
61
Collaborative care Esophageal Varicies:
manage airway, prevent bleeding, vasopressin
62
Collaborative care Hepatic Encephalopathy:
Goal = reduce ammonia formation ABX- decrease bacterial flora Lactulose- forms lactic acid in the bowel, bacteria can't grow, lots of POOP :( Monitor ammonia levels, watch for changes in LOC, Limit physical activity (increased ammonia)
63
Nutritional therapy for Cirrhosis:
High calorie, high carbohydrate, low fat
64
What is the most common complication of bleeding esophageal varicies?
aspiration pneumonia
65
What are the 2 major risk factors for Primary Hepatic CA?
Cirrhosis & Hepatitis
66
Diagnosing Liver CA:
biopsy | U/S, CAT scan
67
Clinical Manifestations liver CA:
weakness, anorexia, N&V, abd pain, jaundice, weight loss, liver enlargement
68
What type of liver CA would be appropriate for liver transplant?
primary
69
What are functions of the gallbladder?
collects, concentrates & stores bile | Releases bile into duodenum (stimulated by high fat ingestion)
70
What is cholecystitis?
inflammation of the gallbladder
71
2 types of acute cholecystitis?
calculous (stones) | noncalculous (no stones)
72
What are 5 F's of risk factors for cholecystitis?
1. Female 2. Forty + 3. Family Hx 4. Fertile 5. Fat
73
Most common component of gall stones?
cholesterol
74
What is biliary colic?
spasms/contractions of bile ducts trying to move stones, painful!!
75
Symptoms of cholecystitis:
indigestion, moderate to severe pain triggered by high fat meal, blumberg's sign, fever, jaundice.
76
symptoms of chronic cholecystitis:
fat intolerance, dyspepsia, heartburn, flatulence
77
What is choledocholithiasis?
gallstone lodged in CBD
78
Diagnosing Cholecystitis:
Pain in relation to eating? murphy's sign (pain w deep inspiration), ERCP, Percutaneous transhepatic cholangiography, *U/S*, AST, ALT, WBC, Serum Bilirubin,
79
Tx of cholecystitis:
pain control, ABX, gastric decompression, anticholinergics
80
Tx of cholelithiasis:
lap chole = tx of choice
81
What are signs of biliary obstruction?
clay-colored stools, jaundice, dark/foamy urine, fever, steatorrhea
82
What are 2 main causes of pancreatitis?
1. Biliary tract disease (MOST COMMON) | 2. Alcoholism
83
Etiology/Patho of pancreatitis:
premature activation of excessive pancreatic enzymes = autodigestion & fibrosis of pancreas
84
Which pancreatic enzyme leads to hemorrhagic pancreatitis?
elastase
85
S/Sx acute pancreatitis:
``` abd pain (LUQ or epigastric) aggravated by fat & ETOH jaundice cullen's sign turner's sign (bluish discoloration on flank) decreased or absent bowel sounds abd rigidity ```
86
What is a pseudocyst?
cavity surrounding OUTSIDE of pancreas filled with necrotic products & liquid secretions. Potential to perforate
87
What is a pancreatic abscess?
a large fluid-filled cavity WITHIN the pancreas
88
Lab tests for pancreatitis:
Amylase and Lipase!! WBC, blood glucose
89
Tx pancreatitis:
aggressive hydration, relieve pain, fluid/electrolyte balance, NPO
90
What is purpose of ERCP?
visualization, removal of gallstones, dilate strictures, biopsy, diagnose pseudocysts
91
What are signs of hypocalcemia?
tetany, + chvostek or trosseau sign
92
What is chronic pancreatitis?
continuous, prolonged, inflammatory & fibrosing process of pancreas
93
What are 2 major types of chronic pancreatitis?
1. chronic obstructive pancreatitis | 2. chronic calcifying pancreatitis
94
Which is the most common form of chronic pancreatitis?
calcifying AKA alcohol-induced pancreatitis | inflammation leads to sclerosis in head of pancreas around the pancreatic duct
95
S/Sx of chronic pancreatitis:
abd pain (heavy, gnawing, burning) malabsorption with weight loss jaundice frothy urine/stool
96
Chronic pancreatitis is a risk factor for _______
pancreatic CA
97
Diagnosing chronic pancreatitis:
serum amylase/lipase ( may be slightly elevated, or not) | ERCP
98
Tx chronic pancreatitis:
prevent attacks (low fat diet, NO ETOH) pain relief bile salts
99
Where do most pancreatic tumors occur?
in the head of pancreas, obstructing CBD
100
Risk factors for pancreatic CA:
chronic pancreatitis & diabetes heavy smoking family Hx
101
S/Sx of pancreatic CA:
anorexia with rapid weight loss abd pain pain progressively worsens, R/T eating

Nursing 102 (9 decks)

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