LIVER

Question 1

CIRRHOSIS

Answer 1

SCAR TIISSUE OF THE LIVER

Question 2

ETIOLOY OF CIRRHOSIS

Answer 2

alcohol, virus, nonalcoholic fatty liver, biliary duct obstruction, autoimmunine, toxins, metabolic

Question 3

alcoholic cirrhosi

Answer 3

etoh is toxic to the liver cells
fatty liver
tissue chanes
inflammation

Question 4

Alcoholic Cirrhosis

Answer 4

Compensated

Uncompensated:

Question 5

Compensated

Answer 5

asymptomatic, 
intermittent mild fever, 
vascular spider, 
palmar erythema, 
unexplained epistaxis,
alkel edema, 
vaue morning indiestion, 
flatulent dyspepsia, 
abdominal pain, 
firm enlarged liver, 
splenomegaly.

Question 6

epistaxis

Answer 6

NOSE BLEEDING

Question 7

Uncompensated

Answer 7

Ascites, 
Jaundice, 
Weakness,
muscle wasting, 
weight loss, 
continuous mild fever, 
clubbing of fingers,
purpura, 
spontaneous bruising, 
epistasis, 
hypotension, 
sparse body hair, 
white nails, 
gonadal atrophy,

Question 8

liver function

Answer 8

Bile: Secreted by liver, temporarily stored by gallbladder
coomon bile duct
Glucose: Glycogenesis, glycogenolysis, and storage of glycogen; and gluconeogenesis.
protein: protein synthesis and degradation, AA synthesis
Clotting-factor synthesis:coagulation factorsI (fibrinogen), II(prothrombin),V,VII,VIII,IX,X,XI,XIII, as well asprotein C,protein Sandantithrombin.
Lipid: cholesterol, triglycerol, lipoprotein

Question 9

bile

Answer 9

Secreted by liver, temporarily stored by gallbladder
coomon bile duct
sphinctor of oddi

Question 10

Glucose

Answer 10

Glycogenesis, glycogenolysis, and storage of glycogen; and gluconeogenesis.

Question 11

protein

Answer 11

protein: protein synthesis and degradation, AA synthesis
Clotting-factor synthesis:coagulation factorsI (fibrinogen), II(prothrombin),V,VII,VIII,IX,X,XI,XIII, as well asprotein C,protein Sandantithrombin.

Question 12

Albumin synthesis

Answer 12

the most abundant protein inblood serum. It is essential in the maintenance ofoncotic pressure, and acts as a transport forfatty acidsandsteroid hormones.

Question 13

angiotentionogen

Answer 13

produced in liver and transformed into angiotension 1 in liver by renin?

Question 14

s/s Cirrhosis

Answer 14

Palmar erythema
Spider nevi
Gynecomastia
Jaundice
Caput medusa

Question 15

Spider nevi

Answer 15

superior vena cava: The central red dot is the dilated arteriole and the red “spider legs” are small veins carrying away the freely flowing blood.

Question 16

Palmar erythema

Answer 16

estrogen increase

Question 17

Ascites develop dilutional hyponatremia

Answer 17

Diuretic should stop

Restrict fluid

Question 18

paracentesis

Answer 18

diagnostic

in combination with IV infusion of salt-poor albumin or other colloid

Question 19

spontaneous bacterial peritonitis

Answer 19

result of decreased immune function
bacteria from the fut reach the ascitic fluid via lymphatics causing inflammation
fever, chills abdominal pain and tenderness
fluid from paracentesis will show incresed WBC in fluid and the culture willl show bacterial growth
treated with IV antibiotics

Question 20

lactulose

Answer 20

oral, NGT, rectally enema,

Question 21

lactulose

Answer 21

ph, flora intestinal, intestinal movement,

Question 22

lactulose

Answer 22

monitor dehydration, hypokalemia, watery stool

Question 23

monitor hepatic encepholopathy

Answer 23

neurologic, 
mental by handwriting,
 I/0, VS Q4H,
monitor Infection,
monitor serum ammonia,
 protein restriction, 
decrease  GI absorption by suction enema,
 monitor eletrolytes, 
stop sedatives, tranquilizers, and analgesic medications; benzo antagonist flumazenil.

Question 24

cholelithiasis -risk factors

Answer 24

obesity
female: multipregnancy; native american or hispani
big weigt loss or frequent weight changes
estrogen treatment
gastric bypass
ileal disease or resection
Diabetes Mellitus
Total parental nutrition
cystic fibrosis
Family history

Question 25

cholelithiasis –symptoms

Answer 25

Nausea and vomiting
Indigestion
Belching
Flatulence
Epigastric pain that radiates to the scapula 2-4 hour after eating fatty foods and may persist for 4 to 6 hours
Pain localized in right upper quadrant
Guarding rigidity and rebound tenderness
Mass palpated in the RUQ
Murphy’s sign
Elevated temperature
Tachycardia
Signs of dehydration

Question 26

CHOLECYSTITIS-RISK FACTORS

Answer 26

Gallstone 90%
After major surgery, severe trauma or burns; cystic duct obstruction, infection of gallbladder, mutiorgarn failure, renal failure

Question 27

diagnostic/therapeutic tests associated with gallbladder disease.

Answer 27

A. Ultrasound
B. ERCP/MRCP
C. HIDA Scan (Nuclear)
D. Cholangiogram

Question 28

Cholesystitis–ERCP/MRCP

Answer 28

endoscopic retrograde cholangiopancreatography
Iv sleepy and relax
Spay the mount numbness
Lie Left side or stomach side
Mouth piece, chin against chest, swallow when tube in, spray more to numb the throat,
Side-viewing tube into the ampulla of voter to inject contrast to view the pancreatic and hepatic tube, and common bile tube.
X-ray
Stretch narrow area, remove the stone,

Question 29

Acute pancreatitis — assessment

Answer 29

Abdominal pain, sudden onset, midepigastric or Luq, radiating to the back
Pain is aggravated by fatty meal, alcohol, lying in a supine and flat position
Abdominal tenderness and guarding
Nausea and vomiting(emesis)
Weight loss
Absent or decreased bowel sounds
Elevated white blood cell count, glucose, bilirubin, alkaline phosphatase, or urinary amylase
Elevated serum lipase and amylase
Elevated glycaemia, glycosuria, elevated bilirubin, hypocalcemia
Hypotension: tachycardia, cyanosis, and cold clumsy skin
Respiratory distress
Peritonitis
Ecchymosis in the flank(Grey-Turner sign) or around the umbilicus(Cullen sign) indicating retroperitoneal the hemorrhage