Laboratory and Diagnostic Tests for Hepatobiliary and Pancreatic Disorders Flashcards
Increases primarily in liver disorders
Alanine Aminotransferase (ALT)
-Used to monitor the course of illness in hepatitis or cirrhosis
-Used to monitor effects of treatments that may be toxic to the liver
Alanine Aminotransferase (ALT)
Present in tissues with high metabolic activity (i.e., heart, liver, skeletal muscle, kidneys)
Aspartate aminotransferase (AST)
-Determines hepatocyte dysfunction
-A sensitive indicator of cholestasis
Gamma-glutamyl transferase (GGT)
Secreted by liver (80%), bones, intestines, and kidneys and elevated in the presence of biliary obstruction
Alkaline phosphatase
-An enzyme present in almost all body tissues
-Released by cells into the bloodstream upon tissue damage
Lactate Dehydrogenase (LDH)
Most abundant protein in the blood
Serum Albumin
It maintains the colloid oncotic pressure
Serum Albumin
It synthesized in the liver and rapidly excreted into the blood stream
Serum Albumin
Elevation in Serum Albumin can only be caused by
Dehydration
Pressure that pushes plasma out of the blood
Hydrostatic Pressure
Pressure that maintains plasma inside the blood vessel
Osmotic Pressure
Subtype of osmotic pressure
Oncotic Pressure
A yellowish pigment that is a metabolite of heme and is a potentially toxic substance
Bilirubin
It is an actual energy of the cell
ATP
What is ATA
Adenosine Triphosphate
It maintains osmotic pressure
Albumin
Other term of unconjugated bilirubin
Indirect
Other term for conjugated bilirubin
Direct
-A by- product of protein metabolism
-A potent neurotoxin
-Elevation is attributed to liver diseases
Serum Ammonia
Is synthesized in the lover with the help of vitamin K
Prothrombin
What are the factors that are also produced in the liver?
Factors VII, IX, and X
2 types of Lipids
- Triglycerides
- Cholesterol
The most common type of fat in the blood and is obtained through dietary sources
Triglycerides
T/F Excess calories are stored as triglycerides in adipose tissues
TRUE
A waxy, fat-like substance
Cholesterol
Cell membrane synthesis, steroid hormone synthesis, bile acid synthesis, vitamin D (cholecalciferol) synthesis
Cholesterol
What are the 2 types of cholesterol?
- High-density lipopproteins (HDL)
- Low-density lipoproteins (LDL)
Removes LDL and VDL from the arteries
High- density lipoproteins (HDL)
Facilitates build-up of cholesterol in the arteries
VLDL
What is VLDL?
Very Low Density Lipoproteins
The meaning of TB-DB-IB
Total Direct, Indirect, Bilirubin
How many hours does the patient need to fast when having a lipoprotein fractionation testing
6 to 12 hours
Known as bad cholesterol
LDL
Known as Good Cholesterol
HDL
Enzyme for CHO digestion
Amylase
It is secreted by pancreatic acinar cells
Amylase
Enzyme for fat digestion
Lipase
Means ductless
Endocrine
Means ducts
Exocrine
It produces enzyme
Acinar Cell
It consists primarily of triglycerides (neutral fats), fatty acids, and fatty acid salts.
Fecal Fat
High fecal fat content
Steatorrhea
T/F High fat diet 5 days before test.
FALSE. High fat diet is 3 days before test
The time of fecal fat analysis
72-hour collection (3 days)
Stones within the gallbadder
Cholelithiasis
Stones in the common bile duct (CBD)
Choledocholithiasis
Made up of calcium bilirubinate
Pigment Stones
Form in infected bile
Brown pigment stones
Form in sterile gallbladder
Black pigment stones
Made up of cholesterol crystals
Cholesterol stones
Risk Factor of Gall Bladder Stones
5 F
f-female
f- fat
f-forty
f- fertile
f-fregnant
Clinical Manifestations of Gall Bladder Stones
A-Abdominal Pain, RUQ (Biliary Colic)
F- Fever
A- Acholic Stools
M- Murphy’s Sign
J- Jaundice
U- Unable to absorb fat-soluble vitamins
D- Dark colored stools
What is the diagnostic procedure of choice for Gall Bladder Stones?
Abdominal Ultrasound
What is the meaning of ERCP?
Endoscopic Retrograde Cholangiopancreatography (ERCP)
It permits the direct visualization of the hepatobiliary system using a flexible fiberoptic endoscope
Endoscopic Retrograde Cholangiopancreatography (ERCP)
What is the inital position of ERCP?
Left semi-prone
Drug of choice for acute cholecystitis
Meperidine (demerol)
Small, radiolucent cholesterol stones
Ursodeoxycholic Acid (UDCA)
This is for patient who refuse surgery
UDSA (Ursodeoxycholic Acid)
This is a preferred method if surgery
Laparoscopic Cholecystectomy
Intraoperative ppositioning of Laparoscopic Cholecystectomy
-Supine (initially)
- Reverse Trendelenburg (after insufflation)
Incision for Laparoscopic Cholecystectomy
is
Three to four small incisions
Immediate post op of Cholecystectomy
Low fat, high protein and high carbohydrate diet
Removal of gallbladder
Cholecystectomy
Its mechanism of action inhibits cholesterol synthesis and secretion, thereby desaturating bile
Ursodeoxycholic Acid (UDCA)
It means stone
Lithiasis
What is Lithiasis in plural?
Lithiases
Gold standard surgical procedure for gall stones
Laparoscopic Cholecystectomy
A same day procedure, minimally invasive and better surgical outcomes
Laparoscopic Cholecystectomy
Longer hospital stay and higher risk for post-op complications
Open cholecystectomy
Open cholecystectomy incision is only one, what does one incision means?
Kocher incision (right subcostal)
Pre-operative nursing care of cholecystectomy
- Facilitate signing of consent form
-Alley anxiety and fears - Teach patient about breathing exercises, splinting, getting out of bed, and assisted ambulation
- Administer medications , as ordered (anxiolytics and antibiotics (as prophylaxis) )
- Remove jewelries, dentures, nail polish, cosmetics
- Facilitate NPO, as ordered
Post-Operative Nursing Care of Cholecystectomy
- Monitor V/S and I&O
- Monitor incision site for presence of signs of infection
- Provide regular, meticulous wound care
- Facilitate performance of post- operative exercises (deep breathing exercises, turning, and splinting (esp. for open)
- Early ambulation (post-op day 0- for laparoscopic
What’s the immediate post-op diet for laparoscopic cholecystectomy?
Low fat, high protein, high carbohydrate diet
What’s the diet for Open Cholecystectomy?
- NPO until return of bowel sounds
- Progressive diet until able to tolerate pre-operative diet
