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Adults 1 > Hepatic > Flashcards

Hepatic Flashcards

1
Q

Cholelithiasis: definition

A

presence of gallstones in the CBD

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2
Q

Cholelithiasis: Types

A
  • cholestorl: made of undissolved cholesterol and other parts
  • pigment: dark brown/black caused by too much bilirubin in bile
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3
Q

Cholelithiasis: Mild clinical manifestations

A
  • sometimes asymptomatic
  • feeling of fullness
  • abd. distention
  • no guarding/ rebound/ fever
  • vague RUQ pain; not localized
  • pain after fatty meal
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4
Q

Cholelithiasis: Acute biliary colic clinical manifestations

A
  • N/V with heavy meal
  • localized pain in RUQ
  • guarding/rebounding/ fever
  • severe right side abd pain and, radiates to back and right shoulder
  • tachycardia/ diaphoresis
  • no/hypoactive BS if severe
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5
Q

Cholelithiasis: mild

A

not completely obstructed, but full contraction is not permitted

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6
Q

Cholelithiasis:: acute biliary colic

A

complete obstruction of biliary flow

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7
Q

Cholangitis: definition

A

infection of the biliary duct

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8
Q

Cholangitis: acute

A

responds to antibiotic treatment

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9
Q

Cholangitis: toxic

A

may not respond too antibiotics and may require emergency drainage

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10
Q

Cholangitis: open cholecystectomy: definition

A

removal of the gallbladder

-emptying fo bile into the duodenum directly from liver

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11
Q

Cholangitis: open cholecystectomy: indications

A
  • severe inflammation, infection, necrosis of gallbladder
  • blood disorders
  • scar tissue from previous surgery
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12
Q

Cholangitis: open cholecystectomy: procedure

A
  • 1-2 hours

- 2-4 days recovery in hospital

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13
Q

Cholangitis: open cholecystectomy: complications

A
  • surgical site pain
  • gas, bloating, constipation
  • referred shoulder pain
  • bile leakage: occur 1-2 after procedure: anorexia, abd pain, N/V, fever
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14
Q

Sphincter of Oddi

A
  • controls flow of pancreatic juices and bile
  • morphine causes it to have spasms, should be used in acute pancreatitis of CBD
  • meperidine drug of choice
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15
Q

Acute pancreatitis: definition

A

-inflammation of the pancreas

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16
Q

Acute pancreatitis: clinical manifestations

A
  • severe abd. pain
  • back pain
  • tenderness
  • N/V
  • onset of symptoms 24-48 after heavy meal or ETOH
  • grey turner’s sign: bleeding in peritoneal cavity
  • cullen’s sign: edema around umbilicus
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17
Q

Acute pancreatitis: treatment

A
  • supportive care
  • prevent complications
  • monitor for sepsis and organ failure
  • surgery too risky
  • might use gastric decompression
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18
Q

Acute pancreatitis: nursing care

A
  • medications: IV opioids: meperidine
  • nonpharmacologic care
  • emotional status
  • drugs first
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19
Q

Chronic Pancreatitis: definition

A
  • inflammatory disease that is progressive destruction of pancreas
  • healthy tissue is replaced by scarred tissue causing pressure in the pancreas to increase
  • often seen in ETOH abuse
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20
Q

Chronic Pancreatitis: Clinical manifestations

A
  • recurrent severe abd. and back pain
  • vomiting
  • weight loss
  • steatorrhea
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21
Q

Chronic Pancreatitis: treatment

A
  • pain management with opioids
  • avoid ETOH
  • surgery if indicated is risky
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22
Q

Liver Age related changes

A
  • reduced drug metabolism along with other age related factors, cause normal drug dosage to be come toxic and require lower dosing
  • increased presence of gallstones and decreased gallbladder contract lead to decreased tolerance for fatty food
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23
Q

Hepatic Dysfunction: definition

A

-damage to hepatocytes decrease ability to respond to injury with healthy tissue

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24
Q

Hepatic Dysfunction: types

A
  • acute
  • chronic
  • compensated
  • decompensated
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25
Q

Hepatic Dysfunction: causes

A
  • cirrhosis: scarring of tissue
  • hepatitis: inflammation related to viral hepatiits
  • exposure to toxin: environmental, meds, ETOH
  • metabolic disorder
  • indirectly from CBD obstruction: PHTN
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26
Q

Hepatic Dysfunction: compensated/early clinical manifestations

A
  • mild insufficient clotting: spider angiomas, palmar erythema, unexplained epistaxis (nose bleed)
  • visible ascites
  • enlarged liver/ abd. pain, edema
  • dyspepsia: decreased ability to digest fat
  • vitamin deficit/ malnutrition
  • portal HTN: splenomegaly
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27
Q

Hepatic Dysfunction: late/decompensated clinical manifestations

A
  • Jaundice
  • esophageal varices
  • ascites
  • splenomegaly
  • changes in responsiveness/ hepatic encephalopathy
  • spider angiomas
  • anemia: coagulation disorders
  • palmar erythema
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28
Q

Hepatic Cirrhosis: definition

A
  • chronic and progressive scarification of the lung

- this shrinks lung size and decreases lug functioning

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29
Q

Hepatic Cirrhosis: types

A
  • alcoholic: scarring around portal areas
  • post-necrotic: scarring after viral hepatitis
  • biliary: scarring after CBD obstruction or cholelangitis
30
Q

liver function test

A
  • AST/ALT: increase with abnormal liver function
  • GGT: increase with ETOH liver disease
  • Serum bilirubin/urobilnogen or fecal/urine urobilnogen: associated with jaundice
  • Alk phos. measure biliary obstruction
  • PT: increase with time to clot
  • ammonia
  • serum albumin and protein
31
Q

Major complication of liver disease

A
  • jaundice
  • Portal HTN
  • hepatic encephalopathy
  • ascites
  • esophageal varices
32
Q

Hepatic Encephalopathy: definition

A

life threatening consequence of advanced liver disease
-liver’s decreased ability to detoxify by products of metabolism like ammonia cause ammonia build up. Ammonia gets pushed out into blood circulation

33
Q

Hepatic Encephalopathy: early/compensated clinical manifestations

A
  • mild mental status changes: slight confusion, sleeping patterns, restless
  • spider angiomas
  • motor disturbances: asterixis, deep tendon reflex, difficulty writing,
  • hepaticas: sweet breath
34
Q

Hepatic Encephalopathy: end/ decompensated clinical manifestations

A
  • severe failure to make protein, clotting factors, and increase portal hypotension
  • insuffienct clotting factors: purpura, bruising, epistaxis, anemia
  • malnutrition: muscle wasting, sparse body hair, wight loss
  • Portal HTN: splenomegaly, esophageal varies
  • ascites
  • grey stool
  • mental deterioration
  • dyspepsia: decreased ability to digest fatty food
35
Q

Hepatic Encephalopathy: progressive worsening

A

Mental status: sleepier, somnolent, coma

-motor: flaccid extremities, no deep tendon reflex

36
Q

Hepatic Encephalopathy: treatment

A
  • lactulose (chronulac): decrease pH of bowel and ammonia production to increase BM.
  • Neomycin: inhibit protein synthesis in bowl and decrease ammonia production
  • avoid: narcotics, sedatives, barbiturates
  • protein restriction and nutritional support
  • prevent complications of immobility
  • symptom management
  • promote rest: decreased demon and give liver more blood
  • No ETOH or raw shellfish: Hep A risk
  • early detection of bleeding: prevent hemorrhage
  • skin care: itching
  • early detection of decreasing mental jsatuts: reduce risk of injury
37
Q

Hepatic Encephalopathy: diagnosis

A
  • Labs: decrease albumin and increase in: globulin, all. phos., AST/ALT, GGT, bilirubin, PT
  • UGI x ray
  • CT scan
  • Liver US
  • EGD
  • Liver biopsy: confirmation
38
Q

Liver biopsy considerations

A
  • remove piece of liver
  • pre: take PPT
  • during: hold breath at end of expiration
  • post: lay on right side with pillow under to tamponade bleeding and bile leakage and frequent VS for bleeding risk
39
Q

Jaundice: definition

A

yellowing of sclera, skin, mucous membranes when bilirubin exceed 2.5 mg/dL

40
Q

Jaundice: Types

A
  • Hemolytic: increased destruction of RBC
  • Hepatocellular: hepatocytes can not get rid of bilirubin fast enough
  • Obstructive: bilirubin does not enter small intestine
41
Q

Jaundice: Hepatocellular clinical manifestations

A
  • N/V
  • loss of appetite
  • headaches
  • chills
  • fever: if infection
  • fatigue
  • increased bilirubin, AST/ALT, urine urobilinogen
42
Q

Jaundice: Obstructive clinical manifestations

A
  • dark, orange, foamy urine
  • clay colored stools
  • dyspepsia
  • pruritis
  • increase bilirubin and all. phos.
43
Q

Portal HTN: definition

A

-liver damaged cause high blood pressure in the portal system. this causes albumin to leak out of the system leading to ascites. It also leads to enlarged veins around the body

44
Q

Portal HTN: clinical manifestation

A
  • esophageal varices
  • caput medusae
  • ascites marked
  • hemorrhoid
  • hypersplenism: moderate anemia, neutropenia, thrombocytopenia
  • mechanical obstruction
45
Q

Ascites: definition

A

increased portal HTN causes vasodilation of the abdominal circulation that leads to decreases in ECF and appears of ascites. Lier function decline leads to decreased metabolism of aldosterone which stimulates the RAAS system to increase sodium and water retention to intravascular systemic, which is then pushed back out of the ECF

46
Q

Ascites: clinical manifestation

A

increased abdominal firth: measure daily

  • weight gain
  • dyspnea
  • striae and distended viens
  • fluid electrolyte imbalance
47
Q

Ascites: treatment

A

goal: reduce fluid retention
- low sodium diet
- diuretics: aldactone
- daily weights: should not lose 1-2kg/day
- bedrest: upright too much pressure on renal system
- paracentesis
- IV salt porr albumin
- TIPS

48
Q

paracentesis

A

removed 5-6L

  • pre: empty bladder
  • during: VS and tolerance, upright
  • post: infection, hypovolemia (changes in MS), Hematuria, leaking at puncture sire
49
Q

Esophagael varices: definition

A

increase pressure of portal system leads to blood back up in the esophagus veins

50
Q

Esophagael varices: factors related to

A
  • exertion
  • coughing/sneezing
  • straining to defecate
  • reflux and vomiting
  • salicylate
51
Q

Esophagael varices: symptoms

A
  • hematemesis
  • melena
  • hemorrhoids
52
Q

Esophagael varices: complications

A
  • hemorrhage: if ruptured

- made worse by liver inability to clot

53
Q

Esophagael varices: treatment

A
  • endoscopic sclerotherapy: inject scarring agent to vein to constrict or eliminate vien
  • esophageal banding: stop use of vein
54
Q

Hepatitis: definition

A
  • toxin or drug induced has better recovery (Tylenol)

- systemic viral infection that causes necrosis and inflammation of liver

55
Q

Hepatitis: types

A

-A, B, C, D, E, G

56
Q

Hepatitis: Stages: prodromal/preicteric

A
  • nonspecific flu like symptoms
  • malaise
  • fatigue
  • headache
  • myaglis
  • anorexia
  • N/V/D
57
Q

Hepatitis : Stages: icteric

A
  • jaundice
  • dark urine
  • clay stools
  • steatorrhea
  • pruritus
  • large tender liver
  • increased liver enzymes
58
Q

Hepatitis: stages: posticteric

A
  • convasclent stage
  • decrease of fatigue
  • decrease jaundice
  • increase appetite
59
Q

Hepatitis: acute

A

-History of Iv drug use, Hepatitis, HIV
-poor appetite
-N/V
fever
-sever RUQ pain
-GI baled
-confusion
-bruising
-dizziness
-dark urine, clay colored stools
-steatorrhea
-flu like

60
Q

Hepatitis A: defintion

A
  • non chronic
  • fecal-oral route
  • poor sanitation/ contaminated water
61
Q

Hepatitis A: clinical manifestation

A

flu like

  • malaise
  • fever
  • jaundice
  • urine
  • indigestion
  • enlarged liver and spleen
62
Q

Hepatitis A: prevention

A
  • hand-washing

- Hep A vaccine or globulin 2 weeks after exposure

63
Q

Hepatitis A: diagnosis

A

stool specimen

64
Q

Hepatitis A: treatment

A
  • bedrest during acute stage

- nutritional support

65
Q

Hepatitis B: definition

A
  • chronic

- parenteral/sexual

66
Q

Hepatitis B: clinical manifestations

A

flu like

  • malaise
  • fever
  • jaundice
  • urine
  • indigestion
  • enlarged liver and spleen
67
Q

Hepatitis B: prevention

A
  • Hep B vaccine

- Globulin is allegory to vaccine: cannot take right after Hep B vaccine, will cancer out effects

68
Q

Hepatitis B: treatment

A
  • Meds
  • bedrest
  • nutrition
69
Q

Hepatic C: definition

A
  • usually chronic
  • parenteral /sexual
  • blood transfusions
70
Q

Hepatic C: treatment

A
  • remission is goal

- combination therapy: interferon and ribavirin

Adults 1 (3 decks)

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