Hepatobiliary Disorders 2

Question 1

high mortality rate

not good treatment for

Answer 1

pancreatic cancer

Question 2

when is pancreatic cancer typically found

Answer 2

in late stage (too late to help)

Question 3

describe pancreatic cancer

Answer 3

highly METASTATIC -travels to other parts of body

bad screening methods for this cancer

Question 4

where is the cancer typically found on pancreas

Answer 4

typically on head of pancreas

body and tail spread faster than head (too late if on this part)

Question 5

S/S of pancreatic cancer

Answer 5

jaundice, pruitus, steatorrhea, abdominal pain, wt loss, fatigue, elevated amylase, elevated lipase, elevated CEA, ascites, loss of appetite

Question 6

you are AT RISK for pancreatic cancer IF

Answer 6

SMOKE
maybe alcohol(unsure of link- no direct evidence)

Question 7

treatment for pancreatic cancer

Answer 7

• referral to hospice (terminal diagnosis)
• chemo will extend life somewhat
• surgery

Question 8

what type of surgery is sometimes done for pancreatic cancer

Answer 8

*WHIPPLE:
removes head of pancreas (can only be done if on head of pancreas)
outlook is GOOD with this procedure

Question 9

what is albumin

Answer 9

PROTEIN

Question 10

liver has over ____ functions

Answer 10

400

Question 11

some functions of liver include

Answer 11

storage of vitamins
protective organ (keeper cells engulf bacteria)
metabolize
synthesize albumin
breaks down proteins (ie/ ammonia to urea)

Question 12

a lot of blood moves through ______

Answer 12

portal vein

Question 13

high pressure system

Answer 13

ARTERIES

Question 14

NOT high pressure system

Answer 14

VEINS

Question 15

hardening and destruction of liver cells

Answer 15

cirrhosis and liver failure

Question 16

what happens during cirrhosis and liver failure

Answer 16

normal blood volume cant get in (blocks up)
veins become large and weak (can burst easily)
small symptoms that are not noticeable occur

Question 17

complications of cirrhosis and liver failure

Answer 17

portal HTN, ascites, esophageal varices (bleeding: blakemore tube), jaundice, hepatic encephalopathy

Question 18

describe why portal HTN occurs with cirrhosis and liver failure

Answer 18

high pressure system in the portal vein

Question 19

explain why ascites occurs with cirrhosis and liver failure

Answer 19

fluid shift, attempt to be isotonic

test for fluid wave

Question 20

describe why esophageal varices occurs with cirrhosis and liver failure

Answer 20

bleeding**

eventually high pressure leads to rupture (pressure blows veins)

Question 21

what is given if esophageal varices

Answer 21

Balloon Tamponade- AKA Blakemore Tube to hold pressure on the bleeding varices

Question 22

describe why jaundice occurs with cirrhosis and liver failure

Answer 22

bilirubin back in skin

Question 23

describe what hepatic encephalopathy is

Answer 23

*coma
worst symptom of cirrhosis and liver failure
can be toxic (ammonia) and eventually cause death

Question 24

S/S of cirrhosis and Liver failure

Answer 24

vague symptoms

fatigue, wt change, random GI symptoms

Question 25

late stage S/S of cirrhosis and liver failure

Answer 25

GI bleeding, jaundice, ascites, bruising, palpable nodular liver, pain (abdominal), dyspepsia, GERD

Question 26

a sick liver CANNOT make _______

Answer 26

ALBUMIN | so serum albumin goes down

Question 27

what enzymes increase with liver failure

Answer 27

serum liver enzymes

Question 28

what decreases with liver failure

Answer 28

platelet test

Question 29

what tests are done to determine cirrhosis/liver failure

Answer 29

CT scan or ultrasound of liver

Question 30

what are you at risk for if have liver failure

Answer 30

THROMBOCYTOPENIA (decrease in platelets so risk for bleeding)

Question 31

what CONFIRMS cirrhosis

Answer 31

liver biopsy

Question 32

liver biopsy precautions

Answer 32

watch for *bleeding watch VS changes lay on LEFT side (expose right side) take deep breaths and exhale

Question 33

what side do you lay on immediately after procedure of liver biopsy

Answer 33

right side

Question 34

priority liver biopsy interventions

Answer 34

1) manage FLUID VOLUME 2) manage/prevent hemorrhage 3) manage hepatic encephalopathy

Question 35

other liver biopsy interventions

Answer 35

watch Na intake, take multivitamin/follate, diuretic(for fluid volume)

Question 36

Paracentesis

Answer 36

management of fluid volume | MD inserts a catheter into the abdomen to remove and drain ascitic fluid from peritoneal cavity

Question 37

nursing priorities for paracentesis

Answer 37

watch vital signs and drain SLOWLY | position SITTING UP

Question 38

track is made between the portal vein, hepatic veins and systemic circulation. The shunts are kept open with stents that are inserted and this increases the systemic circulation and decreases the portal hypertension

Answer 38

TIPS

Question 39

shunts fluid from parietal cavity to heart

Answer 39

TIPS

Question 40

what are common bleeding precautions

Answer 40

soft bristle brush and electric shaver

Question 41

increased ammonia because it is not broken down | extra ammonia causes cognition changes

Answer 41

hepatic encephalopathy

Question 42

S/S of hepatic encephalopathy

Answer 42

asterixis, mental/motor change, decrease in reflexes, fetor

Question 43

asterixis

Answer 43

hand flapping tremor

Question 44

fetor

Answer 44

bad breath

Question 45

anything that increases ammonia will...

Answer 45

make symptoms worse (ie/ GI bleed)

Question 46

what must be decreased in diet if hepatic encephalopathy

Answer 46

ammonia (protein)

Question 47

aka "cleansing enema" | causes diarrhea and cramping

Answer 47

lactulose

Question 48

teaching for pt with hepatic encephalopathy

Answer 48

no alcohol, increase in fat/carb, decrease in protein, bed rest, bleeding precautions

Question 49

80% of people with this will have an acute infection and develop antibodies

Answer 49

Hep B

Question 50

what happens to the other 20% of Hep B pts

Answer 50

will carry the antigen, never makes antibodies | ***we vaccinate AGAINST these people

Question 51

this is possibly sexually transmitted, blood borne

Answer 51

Hep C

Question 52

this is the primary cause of liver cancer

Answer 52

Hep C

Question 53

is there a vaccine for Hep C

Answer 53

no vaccine but good cures/treatments

Question 54

this is oftentimes just the "stomach bug"

Answer 54

Hep A

Question 55

this ONLY affects pts with Hep B

Answer 55

Hep D