Hepatic, Pancreatic & Biliary- PT 2

Question 1

Cirrhosis:: what is it?

Answer 1

• Destruction of liver tissue, replaced by fibrous bands, impairing blood and lymph flow
• Nonalcoholic fatty liver disease (NAFLD) - ~25% of Americans develop it
  
  • Usually associated with metabolic syndrome, obesity, DM Fatigue and ↓blood flow with heavy exercise – major precautions for patients with liver disease

Question 2

Cirrhosis- Nonalcoholic fatty liver disease (NAFLD)

Answer 2

~25% of Americans develop it – usually associated with metabolic syndrome, obesity, DM

Fatigue and ↓blood flow with heavy exercise – major precautions for patients with liver disease

Question 3

Clinical presentation and laboratory findings of Cirrhosis (R side of Picture)

Answer 3

1. Encephalopathy
2. Esophageal Varices (stomach)
3. GI Bleeding (stomach)
4. Splenomegaly (spleen)
5. Asctes,
6. Peritonitis
7. Internal hemorrhoids (Rectum)

laboratory findings Increased ALT, AST, LDH Increased PT Decreased BSP Dye excretion Decreased Albumin

Question 4

Clinical presentation and laboratory findings of Cirrhosis (L side of picture)

Answer 4

1. Jaundace
2. Emaciation
3. Spider Angiomas
4. Vascular changes
5. Gynecomastia (man boobs)
6. Scarred nodal liver
7. Hepatomegaly
8. Hepatoma
9. Portal Hypertension
10. Hepatocellular carcinoma
11. Caput medusae
12. Palmar Erythema
13. altered hair distribution & Testicular atrophy
14. Purpura, Ecchymosis (Thrombocytopenia)
15. Lower leg Edema

16- Infections (leukemia, Anemia)

Question 5

Cirrhosis Progression

Answer 5

• As liver fails, person develop portal hypertension -↑pressure in portal vein from the GI tract and spleen – backs up into esophagus, stomach, spleen
• Ascites – protein/electrolyte filled fluid in abdomen due to portal backup; may cause groin/lumbar pain
• Esophageal varices – dilated veins in lower esophagus, result of portal vein backup; can rupture

Question 6

Hepatic Coma

Answer 6

As liver fails, cannot detoxify ammonia from the intestine

• Stage 1: confusion and disorientation (might be at home)
• Stage 2: tremors (start seeing them). If we start to see acute tremors in someone with a liver problem that will be problematic. We should get them to the hospital.
• Stage 3: incoherent, combative, flap
• Stage 4: coma, impending total body failure

**I think this is the same as heptic encephalopathy

Question 7

Newborn Jaundice

Answer 7

Liver in 60% of newborns takes a few days to kick in – can’t process bilirubin, become jaundiced

Question 8

Treatment of Newborn Jaundice

Answer 8

UV phototherapy

Question 9

Gallbladder Disorders, Obstruction & Inflammation

Answer 9

Cholelithiasis- Cholesterol gallstones & Pigmented gallstones G&S Table 9-4, p. 372

Risks- Fat, Female, Forty, and Fertile- 4Fs

Cholecystitis - inflammation

Gallbladder Cancer- rare

Question 10

Surgical procedure used to remove gall bladder if stones persist

Answer 10

Open or Laparoscopic Cholecystectomy

Question 11

Risks of Gallbladder disorder- 4Fs

Answer 11

1. Fat
2. Female
3. Forty
4. Fertile

Question 12

Disorders of the Pancreas

Answer 12

Pancreatitis- Acute or Chronic

Pancreatic cancer- 4th leading cause of cancer death

Question 13

Whipple procedure

Answer 13

• Most common procedure to remove pancreatic tumors
• Removes head of the pancreas, gallbladder, upper duodenum, small portion of stomach, and lymph nodes near the head of the pancreas
• Post-op, pancreatic digestive enzymes, bile, and stomach contents flow into the small intestine
• May eat small, easily digestible food, and may need pancreatic enzyme supplements
• 2-3 month recovery
• May induce diabetes, depending on extent of surgery

Question 14

Pancreatic cancer

Answer 14

• Poor prognosis, with 6% 5-year survival rate
• Whipple procedure has ↑ 5-year rate to 25%
• Only 20% of patients are eligible for the procedure, due to location/extent of cancer

Question 15

Guidelines for physician Referral

Answer 15

• Pain referral pattern
• History of cancer or risk factors for hepatitis (Box 9-2)
• Arthralgias of unknown origin coupled with previous history of hepatitis or risk factors
• Bilateral carpal or tarsal tunnel syndrome
• Sensory neuropathy of unknown cause

Question 16

4 stages of hepatic encephalopathy

Answer 16

1. Prodromal
2. Impending
3. Stuporous
4. Comatose

Question 17

Stages of hepatic encephalopathy- Prodromal (5)

Answer 17

Subtle symptoms may be overlooked

Slight personality changes:

1. Forgetfulness
2. Euphoria or depression
3. Disorientation
4. Slurred speech
5. Confusion

Question 18

Stages of hepatic encephalopathy- Stage II- Impending Stage (7)

Answer 18

1. Facial grimacing and blinking
2. Lethargy
3. Aberrant behavior
4. Apraxia
5. Ataxia
6. Tremor progresses to asterixis (liver flap)
7. Resistance to passive movement (inc muscle tone)

Question 19

Stages of hepathic encepathology- Stage III- Stuporous Stage (9)

Answer 19

1. Client can still be aroused
2. Hyperventilation
3. Marked confusion
4. Abusive and violent
5. Noisey, incoherent speech
6. Asterixis (liver flap)
7. Muscle rigidity
8. Positive Babinski reflex
9. Hyperactive deep tendon reflexes

Question 20

Stages of hepathic encepathology- Stage IV- Comotose

Answer 20

• Client cannot be aroused, responds only to painful stimuli
• No asterixis
• Positive Babinski reflex
• Hepatic fetor (musty, sweet odor to the breath caused by the liver’s inability to metabolize the amino acid methionine.

Question 21

Additional risk factors for Gallstones from G&S

Answer 21

• Age- incidence inc with age
• Sex women affected more than men before age 60
• Elevated estrogen levels
  
  • Pregnancy
  • Oral contraceptives
  • Hormone therapy
  • Multiparity (women who hs had two or more pregnancies resulting in viable offsprings)
• Obesity
• Diet: High cholesterol, low fiber
• DM
• Liver disease
• Rapid weight loss or fasting
• Taking cholesterol-loading drugs (statin)
• Ethnicity, Stronger genetic predisposition in Native Americans, Mexican Americans
• Genetics (family hx of gallstones)