Hepatic And billiary disorders Flashcards
What are the 3 main factors that can precipitate the hemorrhaging of Esophageal Varices?
1) Alcohol intake
2) Physical exercise
3) ⬆ Abdominal pressure (i.e., lifting, straining at stool,, Vomitting and coughing).
What is Jaundice? At what serum levels does it become apparent?
Jaundice is the liver’s inability to metabolize and secrete bilirubin, so it causes yellowing of the sclera of the eyes. Jaundice becomes apparent when serum bilirubin levels exceed 3 mg/dL.
Explain the indication for the 3 following types of medications in a patient with Esophageal Varices:
1) Vassopressin
2) Nitroglycerin
3) Antibiotics (Ciprofloxacin or Ceftriaxone)
4) Beta-Blockers
1) Vassopressin - Produces constriction of the splanchnic arterial bed and decreases portal hypertention.
2) Nitroglycerin - used in conjunction with vassopressors to prevent the side effects of vassopressors such as cardiac ischemia and hypertension.
3) Antibiotics (Ciprofloxacin or Ceftriaxone) - Prevents infection
4) Beta-Blockers - Slows down the heart and slows down hemorrhaging through Varices.
How do Antibiotics help to treat Hepatic Encephalopathy?
Hepatic Encephalopathy is caused by a build up of serum ammonia. A large source of ammonia is the bacterial digestion of blood in the GI tract (from Variceal bleeding). Antibiotics kill the bacteria and decrease this production of ammonia.
Explain the following Clinical Manifestations of Hepatic Encephalopathy:
1) Asterixis
2) Constructional Apraxia
3) Fetor Hepaticus
1) Asterixis - Flapping tremor of the hands
2) Constructional Apraxia - The inability to reproduce a simple figure.
3) Fetor Hepaticus - A sweet, slightly fecal odor to the breath.
Why would Lactulose (Cephulac) be prescribed to a patient with Hepatic Encephalopathy?
1) Lactulaose (Cephulac) is administered because it reduces serum ammonia levels by ⬇ the amount of ammonia that is being absorbed in the colon (you poop it out).
What are the 6 major Risk Factors for Hepatitis C?
1) Receiving blood products or organ transplant before 1992.
2) Being a healthcare worker (needle sticks)
3) Being a child born to a mother with HCV
4) IV drug use
5) Past Tx with chronic hemodialysis
6) Multiple sex partners, Hx os STD, and unprotected sex
What is Murphy’s Sign?
Murphy’s Sign is a clinical manifestation of Cholecystitis or liver inflammation in which the patient cannot take a deep breath when the examiners fingers are passed below the hepatic margin because of pain.
What are the 5 major Clinical Manifestations of of Cholecystitis/Cholelithiasis?
1) Upper Abd pain (with rebound tenderness and radiation of pain to right shoulder that appears after eating fatty foods)
2) Anorexia
3) N & V
4) Fever
5) Murphy’s Sign
What are the 5 major Risk Factors for Cholecystitis/Cholelithiasis?
1) Fat (sedentary lifestyle and high cholesterol)
2) Fertile (estrogen and birth control pill use)
3) Female
4) Forty years old and above
5) Caucasion
What are the 4 major clinical manifestations of Biliary obstruction?
1) Jaundice
2) Dark orange and foamy urine
3) Steatorrhea and clay colored feces
4) Pruritus
What is the difference between a Cholecystectomy and Choledocholithotomy?
1) Cholecystectomy - The re,oval of the gallbladder.
2) Choledocholithotomy - An incision into the common bile duct to remove stones.
Describe the 3 stages of Viral Hepatitis?
1) Preicteric Stage - Includes flu like symptoms, anorexia, N & V, diarrhea, pain and ⬆ serum bilirubin and enzyme levels.
2) Icteric Stage - Includes jaundice, pruritus, dark or tea-colored urine, clay-colored stool, ⬇ in preicteric symptoms.
3) Posticteric stage - Includes ⬆ energy levels, ⬇ pain, ⬇ GI symptoms, decreasing serum bilirubin and enzyme levels.
What are the 5 early clinical manifestations of Hepatic Cirrhosis?
1) Fatigue
2) Weight changes
3) GI symptoms
4) Abd pain and liver tenderness
5) Pruritus
What are the 5 late clinical manifestations of Hepatic Cirrhosis?
1) Jaundice/Icterus
2) Dry skin
3) Rashes
4) Petechiae/Ecchymosis
5) Edema
