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Medsurg 2: Exam 1 > Liver, Biliary, and Pancreas > Flashcards

Liver, Biliary, and Pancreas Flashcards

1
Q

What organ is responsible for converting glucose to glycogen?

A

Liver

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2
Q

What organ is responsible for lipid and protein metabolism?

A

Liver

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3
Q

What organ is responsible for the synthesis of prothrombin? (and other clotting factors)

A

Liver

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4
Q

What organ is responsible for production and storage of vitamin A and D?

A

Liver

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5
Q

What organ is responsible for storing vitamin B12 and iron?

A

Liver

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6
Q

What organ is responsible for metabolizing drugs and alcohol?

A

Liver

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7
Q

What organ is responsible for producing bile and bile salts?

A

Liver

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8
Q

What organ is responsible for excreting bilirubin?

A

Liver

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9
Q

What is bilirubin made from?

A

Break down of hemoglobin

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10
Q

Unconjugated bilirubin travels to the liver to become what?

A

Conjugated

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11
Q

After bilirubin is conjugated what happens?

A

It is excreted into the intestine where it aids in digestion

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12
Q

Do liver dysfunction and a prolonged INR go hand and hand?

A

Yes

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13
Q

What is the largest internal organ and is also essential?

A

Liver

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14
Q

Where does the liver get its rich blood supply from?

A

Hepatic artery and femoral vein

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15
Q

What types of jaundice are there?

A
  • Hemolytic
  • Hepatocellular
  • Obstructive
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16
Q

Which type of jaundice has a breakdown of RBCs which causes an increase in bilirubin in the blood?

A

Hemolytic

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17
Q

-Transfusion reactions
-Sickle Cell Crisis (SCC)
-Hemolytic anemia
… are all situations in which what kind of jaundice may be seen?

A

Hemolytic

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18
Q

The altered ability of the liver to take up bilirubin from blood, conjugate or excrete is the cause of what type of jaundice?

A

Hepatocellular

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19
Q

-Hepatitis
-Cirrhosis
-Hepatic carcinoma
… are all situations in which what kind of jaundice may be seen?

A

Hepatocellular

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20
Q

The obstructed flow of bile through liver or biliary duct system, is the cause of what type of juandice?

A

Obstructive

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21
Q

-Intrahepatic
-Extrahepatic
(Ex: gallstones, swelling, etc)
… are instances in which what type of jaundice may be seen?

A

Obstructive

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22
Q

What is it called when there is yellowing of the skin, sclera (eyes), dark urine (bilirubin was never conjugated), chalky-grey stool, and itching (accumulation of bile salts beneath the skin) ?

A

Juandice

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23
Q

What is used to treat itching caused by jaundice?

A
  • Benadryl (antihistamine)
  • Hydroxyzine/Vistaril
  • Steroid creams
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24
Q

What liver function tests are there?

A
  • Serum bilirubin (will be elevated with liver problems)
  • Alkaline phosphatase (ALP)
  • Aspartate aminotransferase (AST)
  • Alanine aminotransferase (ALT)
  • Liver biopsy
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25
Q

When will ALP be elevated?

A

with biliary obstruction

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26
Q

When will ALT be elevated?

A

with liver damage or inflammation

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27
Q

Because there is risk of bleeding with a liver biopsy, what techniques helps to stop the bleeding?

A

Lie flat or on R side to splint site

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28
Q

In what disease is there widespread inflammation of liver tissue causing hepatic cell degeneration and necrosis?

A

Hepatitis

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29
Q

Can hepatitis have several types and acute or chronic?

A

Yes

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30
Q

What form of Hep is transmitted through the fecal-oral route generally through contaminated food?

A

Hep A

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31
Q

How long are you infectious with Hep A?

A

2 weeks before s/s and 1-2 weeks after

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32
Q

Are immunoglobulins produced in response to a Hep A infection?

A

Yes

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33
Q

IgM anti-HAV indicates what type of Hep A infection?

A

Acute

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34
Q

IgG anti-HAV indicates what type of Hep A infection?

A

Chronic

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35
Q

What forms of immunoglobulins are associated with Hep A?

A

IgM and IgG

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36
Q

is there a Hep A vaccine?

A

Yes

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37
Q

Is the Hep A vaccine effective if given up to 2 weeks after exposure?

A

yes

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38
Q

What are the symptoms of Hep A?

A
  • Flu-like

- Juandice

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39
Q

What is important to teach in the prevention of Hep A?

A

Good hand washing

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40
Q

Is Hep B a blood Bourne pathogen?

A

yes

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41
Q

What type of Hepatitis is transmitted through

percutaneous/mucosal exposure/ sexual contact/ prenatal?

A

Hep B

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42
Q

How long are you infectious with a Hep B infection?

A

Before and after s/s, for about 4-6 months

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43
Q

Can Hep B be transmitted through all body fluids?

A

Yes

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44
Q

What type of Hepatitis is spread through percutaneous/ mucosal exposure/ high-risk sexual contact (anal)/ and perinatal?

A

Hep C

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45
Q

How long are you infectious with a Hep C infection?

A

1-2 weeks before s/s and continuous during clinical course, indefinite with carriers

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46
Q

How is Hep C treated?

A

Combination antivirals

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47
Q

The use of combination antivirals for the treatment of Hep C depends on what?

A

Genotype

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48
Q

Can Hep C be curative?

A

Yes

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49
Q

Can Hep C treatment be expensive?

A

Yes

50
Q

What are s/s of Hep C?

A
  • may be asymptomatic
  • body aches
  • flu-like
  • anorexia
51
Q

Is it possible to be a lifetime carrier of Hep B?

A

Yes

52
Q

Is there a Hep B vaccine?

A

Yes (95% effective)

53
Q

How is Hep B treated?

A

Post exposure prophylaxis

  • Hep B vaccine
  • HBIG (immune globulin)
54
Q

-H and P
-Liver function studies
-Hepatitis testing
-genotype testing
… are diagnostics done to diagnose what?

A

Hepatitis infections

55
Q

-Well-balanced diet
-Vitamins
-Rest (essential in promoting hepatocyte regeneration)
-Avoid alcohol
-Drug therapy (antivirals)
… are forms of acute and chronic care for what?

A

Hepatitis infections

56
Q

If someones albumin is low what is common to see?

A
  • Edema

- Ascites

57
Q

What disease has irreversible fibrosis and degeneration of the liver?

A

Cirrhosis

58
Q

What types of causes are there for cirrhosis?

A
  • Alcohol
  • Post-necrotic
  • Biliary
  • Cardiac
59
Q

Can long tern right-sided heart failure cause cardiac cirrhosis?

A

Yes

60
Q

Can chronic biliary obstruction and infection cause biliary cirrhosis?

A

yes

61
Q

Can Hepatitis B, C, and industrial chemical exposure cause post-necrotic cirrhosis?

A

Yes

62
Q

Why does long-term right sided heart failure cause cirrhosis?

A

Liver becomes congested with extra fluid which damages the liver cells

63
Q

Can some liver cells regenerate?

A

Yes

64
Q

What liver cells can not regenerate?

A

Fibrotic

65
Q

Does cirrhosis have multi system manifestations?

A

Yes

66
Q

-Portal hypertension
-Esophageal varices
-Peripheral edema
-Ascites
-Hepatic encephalopathy
-Hepatorenal Syndrome
… are all potential complications of what?

A

Cirrhosis

67
Q

-increased BP in portal vein
-Collateral circulation or shunting
-Increase hydrostatic pressure
… are characteristics of what?

A

Portal hypertension

68
Q

What is esophageal varices due to?

A

Portal HTN

69
Q

Is esophageal varices life-threatening?

A

Yes

70
Q

Can esophageal varies bleed by a slow ooze or a massive hemorrhage?

A

Yes

71
Q

-Enlarged blood vessels on the nose
-Red palms due to increase in circulating estrogen which liver normal metabolizes
… are visible manifestations of what?

A

Cirrhosis

72
Q

What is caused due to a decrease in colloidal osmotic pressure/ impaired synthesis of albumin?

A

Peripheral edema

73
Q

Where is edema typically seen in peripheral edema?

A

Anke and pre sacral (edema up to groin sometimes)

74
Q

What is the accumulation of fluid in the peritoneal or and cavity?

A

Ascites

75
Q

What is caused due to portal hypertension and the increased flow of hepatic lymph?

A

Ascites

76
Q

When is a decrease in serum colloidal oncotic pressure, hyperaldosteronism, and impaired water excretion seen?

A

In ascites

77
Q

Impaired ammonia metabolism is the cause of what?

A

Hepatic encephalopathy

78
Q

Are there neurological status changes seen with hepatic encephalopathy?

A

yes

79
Q

Can hepatic encephalopathy cause someone to be lethargic or even a deep coma?

A

Yes

80
Q

Ammonia which accumulates in hepatic encephalopathy is toxic to the brain, how are ammonia levels commonly reduced?

A

With use of lactulose

81
Q

-Disorientation
-asterixis * (flapping tremor)
-hyperventialtion
-hypothermia
-grimacing and grasping reflex
-fetor hepaticas (sweet breath odor)
… are signs of what cause by hepatic encephalopathy?

A

an impending coma

82
Q

what does the liver usually convert ammonia to?

A

Urea

83
Q

What does abdtunded mean?

A

slow to respond

84
Q

-Rest
-B-complex vitamins
-Avoid alcohol, ASA, acetaminophen, and NSAIDs
… are ways conservative therapy is used to treat what?

A

Cirrhosis

85
Q

How is ascites managed?

A
  • Low sodium diet
  • Diuretic
  • Paracentesis (if indicated)
86
Q

What drugs are used to manage varices?

A
  • Non selective beta blockers (to lower BP and HR)
  • Octreotide (lower portal HTN pressure)
  • Vasopressin (can decrease active bleeding/vasoconstricts)
87
Q

Band ligation or sclerotherapy, ballon tamponade or shunting is used to manage what?

A

Varices

88
Q

How is hepatic encephalopathy managed?

A

Antibiotics (Rifaximin) and lactulose

89
Q

Can patients with ascites be dehydrated if they have ascites?

A

Yes fluid in abdomen is taking fluid needed elsewhere away

90
Q

Is spironolactone (a potassium sparing diuretic) used to help with ascites?

A

Yes

91
Q

Should you monitor daily weights, Intake and output, and abdominal girth for someone with cirrhosis?

A

Yes

92
Q

What is the Blakemore-Sengstaken Tube used for?

A

To stop or slow bleeding in esophagus or stomach from varices

93
Q

Inflammation of the pancreas which can be acute or chronic is called what?

A

Pancreatitis

94
Q

Can acute pancreatitis be life-threatening and range from mild edema to severe hemorrhage from pancreatic vessels?

A

Yes

95
Q

Where do people with pancreatitis have pain?

A

LUQ

96
Q

-Sever abdominal pain in back or flank that is increased with eating
-N/v, Fever, Leukocytosis, hypocalcemia
- Juandice
-Crackles
-Decreased or absent bowel sounds
-Increased serum amylase and lipase**
-Abdominal wall with areas or cyanosis or greenish or yellow discoloration
-Ecchymosis
… Are manifestations of what disease?

A

Acute pancreatitis

97
Q

Where is ecchymosis seen in people with acute pancreatitis?

A
  • Cullen’s (periumbilical)

- Grey Turner’s (Flank)

98
Q

-Pleural effusion
-Atelectasis
-Pneumonia
… can be pulmonary complications from what?

A

Acute pancreatitis

99
Q

Tetany/hypocalcemia can be a complication from acute pancreatitis, what signs should you assess for?

A
  • Chvostek’s

- Trousseau’s

100
Q

Can gullstones cause pancreatitis?

A

yes

101
Q

What do you give a patient with acute pancreatitis who is is symptomatic to tetany?

A

Calcium gluconate

102
Q

Why should you watch for hyperglycemia in patient s with acute pancreatitis?

A

If beta cells of pancreas are injured, may see difficulty in insulin production

103
Q

Is a raised level of serum amylase and lipase seen in pancreatitis?

A

Yes

104
Q

Is there a poor prognosis with a pancreatic cancer diagnosis?

A

Yes

105
Q

What is removed during a Whipple procedure for pancreatic cancer?

A
  • Head of pancreas
  • The first part of the small intestine (duodenum)
  • Gallbladder
  • Bile duct
106
Q

If there is a tumor in the tail of the pancreas will you see jaundice right away?

A

No, you will as it progresses

107
Q

Is staging important in the treatment plan of pancreatitis?

A

yes

108
Q

Are chemo and radiation often used for pancreatic cancer?

A

Yes

109
Q

Inflammation of the gallbladder is called what?

A

Cholecystitis

110
Q

Stones in the gallbladder is called what?

A

Cholelithiasis

111
Q

Bile is overly saturated (usually with cholesterol) and it precipitates out in what disease?

A

cholelithiasis (gallstones)

112
Q

-RUQ pain: usually after eating
-N/V
-Juandice
-Intolerance of fatty foods
-Itching
-Steatorrhea
-Clay-colored stools
-Bleeding tendencies
… are manifestations of what?

A

Cholelithiasis and Cholecystitis

113
Q

Do cholelithiasis symptoms depend on if the gallstones have moved?

A

yes

114
Q

Why are there bleeding tendencies associated with cholelithiasis and cholecystitis?

A

Decrease absorption of vitamin K from diet

115
Q

A laparoscopic cholecystectomy is the gold standard for the treatment of what?

A

Cholecystitis (and cholelithiasis?)

116
Q

Can a cholecystectomy also be done through and open incision?

A

Yes

117
Q

Is a T-tube commonly placed after a open cholecystectomy to drain bile?

A

Yes

118
Q

What is a ERCP (short for endoscopic retrograde cholangiopancreatography)?

A

is a procedure used to diagnose diseases of the gallbladder, biliary system, pancreas, and liver

119
Q

What is it called when shock waves are use to break up stones in the gallbladder to be passed?

A

Lithotripsy

120
Q

Can people who have had a laparoscopic cholecystectomy return to work in 1 week and resume a usual diet (sometimes after a few weeks of a low-fat diet)?

A

Yes

121
Q

-Obesity
-People who have had multiple children
-Oral contraceptives
… put people at higher risk for what?

A

Gallbladder disease

Medsurg 2: Exam 1 (2 decks)

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