GI - Unit 1 - Hepatic/Biliary Disorders Flashcards
What does the liver do?
Storage, protection, metabolism - over 400 things!
What does liver metabolism do?
Breaks down amino acids to remove ammonia –> converted to urea –> excreted by kidney’s.
Liver - what plasma proteins does it synthesize?
Albumin, prothrombin, fibrinogen
Does the liver store and release glycogen for energy?
YES
What does the liver do for fat metabolism?
Synthesizes, breaks down and stores fatty acids and triglycerides.
Liver - forms and continually secretes _____.
Bile.
Bile - non-essential for the emulsification of fat. T/F?
FALSE - IT IS ESSENTIAL!
Gallbladder - joins with the hepatic duct to form the ___ ___ ___.
Common Bile Duct
What are some assessment things for the liver?
History, GI problems, lifestyle (diet, food, alcohol, etc.), occupation, travel, etc.
What is jaundice?
Yellowish discoloration of body tissues.
Where do we first see jaundice?
Sclera of the eye.
How does jaundice occur?
Excessive accumulation of bile pigments leak from blood onto the skin surface!
If no bile is getting into the stool, what color will it be?
Clay-colored.
Bilirubin - what does it test for?
How well is the bile being secreted or retained, etc.
Does blood ammonia elevate with liver dysfunction?
Yes, and this is typically what causes the mental problems.
What are some diagnostic tests for the liver?
MRI/CT, Ultrasound (structure + function!), cholecystography (dye), cholangiography (looks at common bile duct), paracentesis, liver biopsy, etc.
Paracentesis - what happens? What should we look for?
Extract ascitic fluid - we need to do vitals, assessments, etc. Complications can be hemorrhage, infection, fluid shifts - so WATCH FOR SHOCK!
What are cholelithiasis?
Gall stones
What is cholecystitis?
Gallbladder inflammation.
What are the 5 risk factors for cholecystitis?
Female, fair, fat, forty & family history.
Lap. choley - benefits?
What kind of tube is needed if the common bile duct is explored?
T-tube!
T-Tube - drains ___. How much should we expect?
2-300 ml around the first few hours, then less.
What are some other treatments for gallstones?
ERCP (small stones), cholendoscopic (removes via endoscopy), lithotripsy (uses shock waves), percutaneous stone dilution - for high risk surgical candidates!
T-Tube - how often should it be emptied?
Every shift.
Which nursing diagnosis is of highest priority for a client with acute jaundice?
Altered Skin Integrity
For cholecystitis patients, which diet is best?
A low fat, low cholesterol diet!
What is hepatitis?
Inflammation of the liver.
What causes hepatitis?
Virus, alcohol, toxins, gallstones, etc.
What are some symptoms of hepatitis?
Early = non-specific, vague - jaundice, fatigue, loss of appetite, n/v, dark urine (C,D,E), diarrhea (A only!!), joint pain (B, D).
Hepatitis A (HAV) - how is it transmitted?
Fecal-oral through water and food contamination.
Hep A - What’s the incubation period? Infection time? Immunity?
2-6 weeks incubation.
2 weeks before to 1 week after = infectious.
Lifetime immunity after exposure.
How do we treat Hep A?
Care for the symptoms, prevent spread. Symptoms include fatigue, NV, etc.
How is Hep B transmitted?
Blood/body fluid exposure - through skin and mucous membranes with contaminated needles, sex, prenatal, etc.
What’s the Hep B incubation/infectious/immunity timeline.
Incubation - 4 weeks - 6 months.
Infectious - from exposure to until enzymes return to normal limits.
Immunity - ONLY with the 3-dose vaccine.
What are some complications of HBV?
Chronic HBV, liver cirrhosis, liver cancer, death.
How do we treat HBV? Treatment for chronic?
Care related to symptoms. If it’s chronic, treat with the anti-viral hepseral.
Hep C - how is it transmitted?
Contaminated needles, sex, prenatal, dialysis.
What is the incubation/infection/immunity timeline for Hep C?
5-10 weeks = incubation.
Infection - when live HBV is present.
Immunity - NO VACCINE. OH fuck.
What are some complications of HCV?
Chronic HVC, liver cirrhosis, liver cancer, death, etc.
How do we treat HCV?
treat symptoms, prevent spread, etc.
What is HDV?
Hepatitis Delta - complication of HBV, super infection, NO VACCINE - infectious for 3-weeks to 3 months.
HEV - what is it?
Fecal-Oral Transmission Hepatitis.
Less infectious than A, no vaccine, uncommon in US.
What is HGV?
Blood/body fluids hepatitis.
Drug Induced Hepatitis and Toxic Hepatitis - what’s the diff?
Pretty much the same, except that drugs cause DIH and chemicals from the environment cause Toxic Hep.
What is chronic hepatitis?
Persistent form of HBV, HCV and HDV. Comes with malaise, fatigue, hepatomegaly.
What is fulminant hepatitis?
severe and often fatal form of massive hepatic necrosis - it is rare.
What are some labs we look for with hepatitis patients?
Increased liver enzymes, increased s. bilirubin, specific hepatitis antibodies like anti-hav and anti-hbv, a PROLONGED THROMBIN TIME, etc.
What’s the pre-icteric phase of hepatitis?
1-21 days - flu-like symptoms, N/V, diarrhea, anorexia, headache, muscle aches, polyarthritis.
What’s the icteric phase of hepatitis?
2-6 weeks - jaundice, hepatomegaly, liver tenderness, pruritis, light stools, brown urine, improved pre-icteric symptoms, etc.
What’s the post-icteric/convalescent phase of hepatitis?
6-weeks-4 months, everything returns to as close as normal as it possibly can. :)
How do we treat hepatitis?
Rest the liver, promote cellular regeneration, prevent spread of infection, etc. Give meds to relieve symptoms, etc.
What kind of diet should a patient with hepatitis have?
HIGH IN CARBS AND CALORIES, moderate fat - all in small, frequent meals.
What nursing diagnoses should we focus on with a hepatitis patient?
Avoid intimate contact, rest, small high carb meals, body image issues, etc.
What is cirrhosis?
Chronic liver disease that results in liver damage and eventually system failure. :(
Cirrhosis - is it reversible?
No, it is not. :(
What are some early symptoms of cirrhosis?
Generalized weakness, N/V, weight loss, anorexia, gas, changes in bowel habits, etc.
What are some late symptoms of cirrhosis?
GI Bleed, jaundice, ascites, malnutrition, encephalopathy, petechiae, ecchymosis, warm & bright red palms, flapping tremors, fruity or musty breath, ammenhorea, testicular atrophy, etc.
What is asterixis?
Flapping tremor!
How do we diagnose cirrhosis?
Increased liver enzymes & s. protein and albumin, increased PT, low h&h, increasing s. ammonia, enlarged liver, upper endoscopy, liver biopsy, etc.
What are the treatment goals for cirrhosis?
Maximize liver function, prevent infection, control disabling symptoms and complications.
What are some complications of cirrhosis?
Portal hypertension, ascites, esophageal varices (enlarged veins in esophagus), coagulation problems, jaundice and hepatorenal syndrome.
What is portal systemic encephalopathy?
End-stage, decreased loc - personality/behavior changes. Brought on my high-ammonia level - this is end stage cirrhosis. :(
What is the LeVeen Shunt?
shunt fluid from abdominal cavity to general circulation via vena cava catheter.
Cirrhosis diet - what is it?
High carb, high calorie, low protein, may be NPO with TPN.
What are some meds for cirrhosis treatment?
Lactulose, Neomycin, stool softeners, sedatives, mild pain meds.
Liver Cancer - simliar to cirrhosis?
Yes - many things are the same.
What is pancreatitis?
Inflammation of the pancreas.
What causes pancreatitis?
Most common is alcohol, chronic hepatitis, biliary surgery, infections, pregnancy, etc.
What’s the patho of pancreatitis?
Autodigestion, necrosis of blood vessels, inflammation.
What are some symptoms of pancreatitis?
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.
What are some diagnostic tests for pancreatitis?
Elevated glucose, amylase, lipase, bilirubin, low calcium, imaging, etc.
How do we treat pancreatitis?
Eliminate what causes it, improve comfort, etc.
Pancreatitis - should we check their sugar often?
YES!
Pancreatic Cancer - high risk if….
diabetic or have had pancreatitis.
What are some symptoms of pancreatic cancer?
Vague, jaundice (initially), clay colored stool, fatigue, abd pain, referred back pain, weight loss, NV, etc.
How do we diagnose pancreatic cancer?
Elevated serum amylase, lipase, alkaline phosphate and bilirubin, CT/MRI/ERCP.
How do we treat pancreatic cancer?
Pain control, chemo, radiation, biliary stent, surgery, etc.
What is a cholecystojejunostomy?
Lap procedure - relieves obstruction and sends bile to the jejenun.
What is a pancreaticoduodenectomy?
Whipple Procedure - removes parts of pancreas, duodenum, etc. MOST PREFERRED.
