GI (liver)

Question 1

describe patho related to portal HTN

Answer 1

portal HTN results in venous congestion and dilation. pressure builds up in systemic venous circulation, causes congestion where portal and systemic venous system connect (esophagus, stomach, rectum)

Question 2

important functions of the liver

Answer 2

synthesize albumin (maintains oncotic pressure)
eliminates bilirubin
coagualtion factors!! (impaired clotting is dysfxn)

Question 3

what lab is most reflective of liver failure

Answer 3

high serum ammonia

Question 4

inflammatation of the liver caused by virus, bacteria, drugs, alcohol, toxins

Answer 4

hepatits

Question 5

treatment for hepatitis

Answer 5

supportive : rest, nutrition, avoid stress and hepatotoxic substances, treat cause

Question 6

liver condition with chronic inflammation, circulationa dn structure changes, and alterations in metabolic processes

Answer 6

cirrhosis

Question 7

what is cirrhosis caused by

Answer 7

chrinic active hepatitis, biliary obstruction, and unknown!

Question 8

what is cirrhosis most commonly caused by?

Answer 8

chronic alcohol abuse

Question 9

what does portal HTN result in poor metabolism of?

Answer 9

nutrients
drugs
toxins

Question 10

where do vascular changes occur with portal HTN?

Answer 10

esophagus, stomach, rectum

Question 11

assessment findings for impaired liver fxn

Answer 11

jaundice
edema
fatigue
bruising
ascites

Question 12

importatn lab findings in impaired liver fxns

Answer 12

inc. ALT/AST
inc. ammonia

Question 13

what is a reversible dec. in neuro fxn related to liver probs

Answer 13

hepatic encephalopathy

Question 14

what causes hepatic encephalopathy

Answer 14

accumulation of ammonia and neurotoxins

Question 15

what is an early sign of hepatic encephalopathy

Answer 15

asterixis (hand flapping, can not keep them up)

Question 16

what meds are given for hepatic encephalopathy

Answer 16

lactulose, neomycin, rifaximin

Question 17

accumulation of fluid in the peritoneum

Answer 17

ascites

Question 18

what is retained with ascites

Answer 18

sodium and water

Question 19

what problem does ascites lead to

Answer 19

resp distress

Question 20

treatment for ascites

Answer 20

bedrest / low sodium diet / diuretics
paracentesis
LaVeen shunt
transjugular intrahepatic portosystem shunt (TIPS)

Question 21

complications of paracentesis for ascites

Answer 21

hypotension adn inc. risk of infection

Question 22

what method of ascites treatment is used when the ot is resistant to other treatment

Answer 22

LaVeen shunt

Question 23

which ascites treatment is a perforated intra-abdominal tube placed in peritoneal cavity which is tunneled to the superior vena cava

Answer 23

LaVeen shunt

Question 24

complications of LaVeen shunt

Answer 24

sepsis
peritonitis
occlusion

Question 25

which treatment is used to decompress the portal venous system, dec. portal HTN, prevent rebleed of varices, and stop/reduce ascites (palliative measure) (bypass flow in liver)

Answer 25

transjugular intrahepatic portosysten shunt (TIPS)

Question 26

contraindication for TIPS

Answer 26

CHF

Question 27

what causes varices to form in the esophageal, gastric, and hemorrhoidal veins

Answer 27

increased pressure in portal system

Question 28

major complication of varices

Answer 28

acute GI hemorrhage, suddenn hypovolemic loss of blood

Question 29

common causes of acute GI bleeds

Answer 29

PUD stress related erosive syndrome esophageal varices

Question 30

what are the 2 main causes of mucosal resistance in PUD (mucosal lining breakdown)

Answer 30

NSAIDS bacterial action of h. pylori

Question 31

what puts patients at risk for stress related erosive syndrome

Answer 31

vent, shock, burns, trauma, surgery

Question 32

classic hallmarks of GI bleed

Answer 32

coffee ground maroon color hematemesis hematochezia (bright red blood from GI bleed per rectum) melena (tarry stool from old blood)

Question 33

what is an early sign of GI bleed

Answer 33

postural hypoTN / orthostatic vitals

Question 34

later signs of GI bleed

Answer 34

dec. H&H tachycardia pale, SOB anxiety, fatigue, anorexia elevated BUN, normal creatinine

Question 35

management of GI bleed

Answer 35

replace blood/fluid endoscopy/sclerotherapy surgery

Question 36

what are the 2 surgeries for GI bleed

Answer 36

biliroth I & biliroth II

Question 37

which GI bleed surgery includes a vagotomy and antrectomy with anastomosis of the stoamch to the duodenum

Answer 37

biliroth I

Question 38

which GI bleed surgery includes a vagotomy and antrectomy with anastomosis of the stoamch to the jejunum

Answer 38

biliroth II

Question 39

can band ligation be used for GI bleed

Answer 39

yes

Question 40

treatment for bleeding esophageal varices

Answer 40

BALLOON TAMPONADE (compresses bleeding vessels)

Question 41

complications of balloon tamponade for esophageal varices

Answer 41

aspiration asphyxiation esophageal erosion

Question 42

what is given IV to constrict splanchnic arteries which reduces blood flow to abdominal organs -dec. portal hypoTN

Answer 42

vasopressin

Question 43

what does vasopressin cause other than restricted flow to abd organs

Answer 43

restricted flow to systemic circulation -caridac / bowel ischemia -coronary arteyr constriction (HTN)

Question 44

what 2 meds decrease portal venous pressure

Answer 44

somatostatin and ***octreotide***