Hepatobiliary Labs & Diagnostics Flashcards
Abdominal ultrasound detects ____, _____, and ____
tumor, cysts, and stones
True or False? Abdominal ultrasound is invasive.
False. Abdominal ultrasounds are non invasive.
What is used for an abdominal ultrasound?
Conductive gel
What is an important nursing intervention that the nurse should teach the patient about before getting the abdominal ultrasound?
Instruct to be NPO 8 hrs. beforehand 2’ food causing gallbladder contraction (altering results). Keep the gut quiet.
How accurate is the abdominal ultrasound in finding gallstones?
95% accurate in finding gallstones
A computed tomography allows for exposure at _____ ______
different exposures
What is used to see different depths in a computed tomography (CT)?
Use of oral and IV contrast medium accentuates density differences.
What is an important nursing intervention that you should assess before doing a computed tomography (CT) if contrast is being used?
Assess renal function if using contrast. Always assess BUN and creatinine because contrast can be nephrotoxic.
Also, assess for iodine or shellfish allergies.
What is important for the nurse to teach to the patient about feeling during the CT scan?
Warn about “flushed” feeling
If contrast is being used during a CT scan, what should the nurse promote afterwards?
Force fluids to get dye out of the body.
A magnetic resonance imaging (MRI) is used to detect _____, _____, and ____ __ __ _____.
disease, lesions, and sources of GI bleed
A magnetic resonance image (MRI) is ______ and uses _____ ____ and a ______ _____.
non-invasive
radio-frequency waves and a magnetic field
What may be used for an MRI?
IV contrast (gadolinium)
_____ _____ and _____ are contradicted for MRI’s.
Metal implants and pregnancy
A ________ is done if diagnosis of cholecystitis remains uncertain following ultrasound.
Hepatobiliary Scintigraphy (HIDA) scan
Hepatobiliary Scintigraphy (HIDA) scan is a _____ _____ study.
Nuclear medicene
How does the HIDA scan work?
It is injected IV and is taken up by hepatocytes and excreted into bile.
The HIDA scan demonstrates patency of _____ _____ _____ and _____
common bile duct and ampulla
An endoscopic retrograde cholangiopancreatography (ERCP) visualizes and assess the _____, _____, and ____ ____ ____
pancreatic, hepatic, and common bile duct
What are 3 things that should be done before and ERCP and all endoscopies?
- NPO x 8 hrs
- Consent form signed
- Administer sedation
What is the most common complication of an ERCP?
pancreatitis
What are 2 things nurses should do after an ERCP?
- Check VS (looking for manifestations of perforation or infection)
- Check for return of gag reflex (usually returns in 2-4 hours. Do this before giving fluid intake)
Before a liver biopsy procedure:
- Check ____
- Ensure patient’s blood is ____ and ______
- _____ is signed
- Baseline ____ _____
- Explain- ___ ____ ____ ______ ___ ____ ____
- coags (INR and PT)
- typed and cross-matched
- consent
- vital signs
- hold breath after expiration when needle inserted
After liver biopsy procedure:
- Frequent _____
- Keep on __ __ x ___ hrs.
- HOB ____ _____ hrs.
- Asses for ______
- VS (assessing for internal bleeding)
- right side x 2 hrs
- flat 12-24 hrs.
- complications (pneumothorax, peritonitis, shock)
What is the most specific liver enzyme to the liver?
ALT
Liver Function Tests (LFTs) Test: Abnormal trend Liver enzymes \_\_\_\_\_\_\_\_\_ ALT AST Alk Phos
Bilirubin (total) _________
conjugated (direct)
unconjugated (indirect)
Serum Ammonia (NH3) _________
Serum Protein (total) _________
Serum albumin __________
Prothrombin time (PT) _________
Liver Function Tests (LFTs)
Test: Abnormal trend
Liver enzymes increase
ALT
AST
Alk Phos
Bilirubin (total) increase
conjugated (direct)
unconjugated (indirect)
Serum Ammonia (NH3) increase
Serum Protein (total) decrease
Serum albumin decrease
Prothrombin time (PT) prolonged
What is the product of RBC breakdown?
Serum bilirubin
Total bilirubin is made up of _____ _____ and _____ ____.
Conjugated bilirubin and unconjugated bilirubin
Bilirubin that has been conjugated by the liver; water soluble and can be found in urine found in obstructive jaundice is ____ _____.
Conjugated bilirubin
Bilirubin that has not been conjugated by the liver; it is not water soluble so won’t be found in urine; elevated in hepatocellular and hemolytic conditions is ____ ____.
Unconjugated bilirubin
What happens when bilirubin is in excess?
It is deposited in skin/urine; if obstruction is blocking flow of bile into intestine, stool will be clay-colored stools.
When it comes to serum ammonia to urea it usually occurs in the ____.
Liver
True or False? A decrease in serum ammonia can result in hepatic encephalopathy r/t cirrhosis.
False. An increase in serum ammonia can result in hepatic encephalopathy r/t cirrhosis.
Ammonia crosses the blood-brain-barrier (BBB), altering what 3 things?
- LOC
- Intellectual function
- Neurological function
What test is the only way to distinguish among the various forms of viral hepatitis?
Antigen/Antibody Testing (viral hepatitis)
Viral genotype is done for both Hepatitis __ & __.
B & C
What are the 2 pancreatic enzymes?
- serum amylase
2. serum lipase
Which pancreatic enzyme digests carbohydrates?
amylase
Which pancreatic enzyme digests fats?
lipase
If a patient has acute pancreatitis, amylase will be elevated within __ of acute insult; peaks in __ hrs.
12 hrs
24 hrs
If a patient has acute pancreatitis, lipase will be elevated within _____ hrs. of acute insult and remains ____ for ____ days.
24-48 hrs
increased
5-7 days
