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Nur 336 > GI - Unit 1 - Hepatic/Biliary Disorders > Flashcards

GI - Unit 1 - Hepatic/Biliary Disorders Flashcards

1
Q

What does the liver do?

A

Storage, protection, metabolism - over 400 things!

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2
Q

What does liver metabolism do?

A

Breaks down amino acids to remove ammonia –> converted to urea –> excreted by kidney’s.

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3
Q

Liver - what plasma proteins does it synthesize?

A

Albumin, prothrombin, fibrinogen

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4
Q

Does the liver store and release glycogen for energy?

A

YES

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5
Q

What does the liver do for fat metabolism?

A

Synthesizes, breaks down and stores fatty acids and triglycerides.

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6
Q

Liver - forms and continually secretes _____.

A

Bile.

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7
Q

Bile - non-essential for the emulsification of fat. T/F?

A

FALSE - IT IS ESSENTIAL!

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8
Q

Gallbladder - joins with the hepatic duct to form the ___ ___ ___.

A

Common Bile Duct

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9
Q

What are some assessment things for the liver?

A

History, GI problems, lifestyle (diet, food, alcohol, etc.), occupation, travel, etc.

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10
Q

What is jaundice?

A

Yellowish discoloration of body tissues.

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11
Q

Where do we first see jaundice?

A

Sclera of the eye.

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12
Q

How does jaundice occur?

A

Excessive accumulation of bile pigments leak from blood onto the skin surface!

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13
Q

If no bile is getting into the stool, what color will it be?

A

Clay-colored.

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14
Q

Bilirubin - what does it test for?

A

How well is the bile being secreted or retained, etc.

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15
Q

Does blood ammonia elevate with liver dysfunction?

A

Yes, and this is typically what causes the mental problems.

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16
Q

What are some diagnostic tests for the liver?

A

MRI/CT, Ultrasound (structure + function!), cholecystography (dye), cholangiography (looks at common bile duct), paracentesis, liver biopsy, etc.

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17
Q

Paracentesis - what happens? What should we look for?

A

Extract ascitic fluid - we need to do vitals, assessments, etc. Complications can be hemorrhage, infection, fluid shifts - so WATCH FOR SHOCK!

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18
Q

What are cholelithiasis?

A

Gall stones

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19
Q

What is cholecystitis?

A

Gallbladder inflammation.

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20
Q

What are the 5 risk factors for cholecystitis?

A

Female, fair, fat, forty & family history.

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21
Q

Lap. choley - benefits?

A
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22
Q

What kind of tube is needed if the common bile duct is explored?

A

T-tube!

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23
Q

T-Tube - drains ___. How much should we expect?

A

2-300 ml around the first few hours, then less.

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24
Q

What are some other treatments for gallstones?

A

ERCP (small stones), cholendoscopic (removes via endoscopy), lithotripsy (uses shock waves), percutaneous stone dilution - for high risk surgical candidates!

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25
Q

T-Tube - how often should it be emptied?

A

Every shift.

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26
Q

Which nursing diagnosis is of highest priority for a client with acute jaundice?

A

Altered Skin Integrity

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27
Q

For cholecystitis patients, which diet is best?

A

A low fat, low cholesterol diet!

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28
Q

What is hepatitis?

A

Inflammation of the liver.

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29
Q

What causes hepatitis?

A

Virus, alcohol, toxins, gallstones, etc.

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30
Q

What are some symptoms of hepatitis?

A

Early = non-specific, vague - jaundice, fatigue, loss of appetite, n/v, dark urine (C,D,E), diarrhea (A only!!), joint pain (B, D).

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31
Q

Hepatitis A (HAV) - how is it transmitted?

A

Fecal-oral through water and food contamination.

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32
Q

Hep A - What’s the incubation period? Infection time? Immunity?

A

2-6 weeks incubation.
2 weeks before to 1 week after = infectious.
Lifetime immunity after exposure.

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33
Q

How do we treat Hep A?

A

Care for the symptoms, prevent spread. Symptoms include fatigue, NV, etc.

34
Q

How is Hep B transmitted?

A

Blood/body fluid exposure - through skin and mucous membranes with contaminated needles, sex, prenatal, etc.

35
Q

What’s the Hep B incubation/infectious/immunity timeline.

A

Incubation - 4 weeks - 6 months.
Infectious - from exposure to until enzymes return to normal limits.
Immunity - ONLY with the 3-dose vaccine.

36
Q

What are some complications of HBV?

A

Chronic HBV, liver cirrhosis, liver cancer, death.

37
Q

How do we treat HBV? Treatment for chronic?

A

Care related to symptoms. If it’s chronic, treat with the anti-viral hepseral.

38
Q

Hep C - how is it transmitted?

A

Contaminated needles, sex, prenatal, dialysis.

39
Q

What is the incubation/infection/immunity timeline for Hep C?

A

5-10 weeks = incubation.
Infection - when live HBV is present.
Immunity - NO VACCINE. OH fuck.

40
Q

What are some complications of HCV?

A

Chronic HVC, liver cirrhosis, liver cancer, death, etc.

41
Q

How do we treat HCV?

A

treat symptoms, prevent spread, etc.

42
Q

What is HDV?

A

Hepatitis Delta - complication of HBV, super infection, NO VACCINE - infectious for 3-weeks to 3 months.

43
Q

HEV - what is it?

A

Fecal-Oral Transmission Hepatitis.

Less infectious than A, no vaccine, uncommon in US.

44
Q

What is HGV?

A

Blood/body fluids hepatitis.

45
Q

Drug Induced Hepatitis and Toxic Hepatitis - what’s the diff?

A

Pretty much the same, except that drugs cause DIH and chemicals from the environment cause Toxic Hep.

46
Q

What is chronic hepatitis?

A

Persistent form of HBV, HCV and HDV. Comes with malaise, fatigue, hepatomegaly.

47
Q

What is fulminant hepatitis?

A

severe and often fatal form of massive hepatic necrosis - it is rare.

48
Q

What are some labs we look for with hepatitis patients?

A

Increased liver enzymes, increased s. bilirubin, specific hepatitis antibodies like anti-hav and anti-hbv, a PROLONGED THROMBIN TIME, etc.

49
Q

What’s the pre-icteric phase of hepatitis?

A

1-21 days - flu-like symptoms, N/V, diarrhea, anorexia, headache, muscle aches, polyarthritis.

50
Q

What’s the icteric phase of hepatitis?

A

2-6 weeks - jaundice, hepatomegaly, liver tenderness, pruritis, light stools, brown urine, improved pre-icteric symptoms, etc.

51
Q

What’s the post-icteric/convalescent phase of hepatitis?

A

6-weeks-4 months, everything returns to as close as normal as it possibly can. :)

52
Q

How do we treat hepatitis?

A

Rest the liver, promote cellular regeneration, prevent spread of infection, etc. Give meds to relieve symptoms, etc.

53
Q

What kind of diet should a patient with hepatitis have?

A

HIGH IN CARBS AND CALORIES, moderate fat - all in small, frequent meals.

54
Q

What nursing diagnoses should we focus on with a hepatitis patient?

A

Avoid intimate contact, rest, small high carb meals, body image issues, etc.

55
Q

What is cirrhosis?

A

Chronic liver disease that results in liver damage and eventually system failure. :(

56
Q

Cirrhosis - is it reversible?

A

No, it is not. :(

57
Q

What are some early symptoms of cirrhosis?

A

Generalized weakness, N/V, weight loss, anorexia, gas, changes in bowel habits, etc.

58
Q

What are some late symptoms of cirrhosis?

A

GI Bleed, jaundice, ascites, malnutrition, encephalopathy, petechiae, ecchymosis, warm & bright red palms, flapping tremors, fruity or musty breath, ammenhorea, testicular atrophy, etc.

59
Q

What is asterixis?

A

Flapping tremor!

60
Q

How do we diagnose cirrhosis?

A

Increased liver enzymes & s. protein and albumin, increased PT, low h&h, increasing s. ammonia, enlarged liver, upper endoscopy, liver biopsy, etc.

61
Q

What are the treatment goals for cirrhosis?

A

Maximize liver function, prevent infection, control disabling symptoms and complications.

62
Q

What are some complications of cirrhosis?

A

Portal hypertension, ascites, esophageal varices (enlarged veins in esophagus), coagulation problems, jaundice and hepatorenal syndrome.

63
Q

What is portal systemic encephalopathy?

A

End-stage, decreased loc - personality/behavior changes. Brought on my high-ammonia level - this is end stage cirrhosis. :(

64
Q

What is the LeVeen Shunt?

A

shunt fluid from abdominal cavity to general circulation via vena cava catheter.

65
Q

Cirrhosis diet - what is it?

A

High carb, high calorie, low protein, may be NPO with TPN.

66
Q

What are some meds for cirrhosis treatment?

A

Lactulose, Neomycin, stool softeners, sedatives, mild pain meds.

67
Q

Liver Cancer - simliar to cirrhosis?

A

Yes - many things are the same.

68
Q

What is pancreatitis?

A

Inflammation of the pancreas.

69
Q

What causes pancreatitis?

A

Most common is alcohol, chronic hepatitis, biliary surgery, infections, pregnancy, etc.

70
Q

What’s the patho of pancreatitis?

A

Autodigestion, necrosis of blood vessels, inflammation.

71
Q

What are some symptoms of pancreatitis?

A

Severe pain in LUQ/Epigastric/Back, vomiting, anorexia, abd. distention, weight loss, gray/blue discolortion of the abdomen, hypo/absent bowel sounds, hypotension, jaundice, elevated glucose.

72
Q

What are some diagnostic tests for pancreatitis?

A

Elevated glucose, amylase, lipase, bilirubin, low calcium, imaging, etc.

73
Q

How do we treat pancreatitis?

A

Eliminate what causes it, improve comfort, etc.

74
Q

Pancreatitis - should we check their sugar often?

A

YES!

75
Q

Pancreatic Cancer - high risk if….

A

diabetic or have had pancreatitis.

76
Q

What are some symptoms of pancreatic cancer?

A

Vague, jaundice (initially), clay colored stool, fatigue, abd pain, referred back pain, weight loss, NV, etc.

77
Q

How do we diagnose pancreatic cancer?

A

Elevated serum amylase, lipase, alkaline phosphate and bilirubin, CT/MRI/ERCP.

78
Q

How do we treat pancreatic cancer?

A

Pain control, chemo, radiation, biliary stent, surgery, etc.

79
Q

What is a cholecystojejunostomy?

A

Lap procedure - relieves obstruction and sends bile to the jejenun.

80
Q

What is a pancreaticoduodenectomy?

A

Whipple Procedure - removes parts of pancreas, duodenum, etc. MOST PREFERRED.

Nur 336 (26 decks)

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