Liver, Biliary, and Pancreas Flashcards
1
Q
What organ is responsible for converting glucose to glycogen?
A
Liver
2
Q
What organ is responsible for lipid and protein metabolism?
A
Liver
3
Q
What organ is responsible for the synthesis of prothrombin? (and other clotting factors)
A
Liver
4
Q
What organ is responsible for production and storage of vitamin A and D?
A
Liver
5
Q
What organ is responsible for storing vitamin B12 and iron?
A
Liver
6
Q
What organ is responsible for metabolizing drugs and alcohol?
A
Liver
7
Q
What organ is responsible for producing bile and bile salts?
A
Liver
8
Q
What organ is responsible for excreting bilirubin?
A
Liver
9
Q
What is bilirubin made from?
A
Break down of hemoglobin
10
Q
Unconjugated bilirubin travels to the liver to become what?
A
Conjugated
11
Q
After bilirubin is conjugated what happens?
A
It is excreted into the intestine where it aids in digestion
12
Q
Do liver dysfunction and a prolonged INR go hand and hand?
A
Yes
13
Q
What is the largest internal organ and is also essential?
A
Liver
14
Q
Where does the liver get its rich blood supply from?
A
Hepatic artery and femoral vein
15
Q
What types of jaundice are there?
A
- Hemolytic
- Hepatocellular
- Obstructive
16
Q
Which type of jaundice has a breakdown of RBCs which causes an increase in bilirubin in the blood?
A
Hemolytic
17
Q
-Transfusion reactions
-Sickle Cell Crisis (SCC)
-Hemolytic anemia
… are all situations in which what kind of jaundice may be seen?
A
Hemolytic
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
19
Q
-Hepatitis
-Cirrhosis
-Hepatic carcinoma
… are all situations in which what kind of jaundice may be seen?
A
Hepatocellular
20
Q
The obstructed flow of bile through liver or biliary duct system, is the cause of what type of juandice?
A
Obstructive
21
Q
-Intrahepatic
-Extrahepatic
(Ex: gallstones, swelling, etc)
… are instances in which what type of jaundice may be seen?
A
Obstructive
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
23
Q
What is used to treat itching caused by jaundice?
A
- Benadryl (antihistamine)
- Hydroxyzine/Vistaril
- Steroid creams
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
25
When will ALP be elevated?
with biliary obstruction
26
When will ALT be elevated?
with liver damage or inflammation
27
Because there is risk of bleeding with a liver biopsy, what techniques helps to stop the bleeding?
Lie flat or on R side to splint site
28
In what disease is there widespread inflammation of liver tissue causing hepatic cell degeneration and necrosis?
Hepatitis
29
Can hepatitis have several types and acute or chronic?
Yes
30
What form of Hep is transmitted through the fecal-oral route generally through contaminated food?
Hep A
31
How long are you infectious with Hep A?
2 weeks before s/s and 1-2 weeks after
32
Are immunoglobulins produced in response to a Hep A infection?
Yes
33
IgM anti-HAV indicates what type of Hep A infection?
Acute
34
IgG anti-HAV indicates what type of Hep A infection?
Chronic
35
What forms of immunoglobulins are associated with Hep A?
IgM and IgG
36
is there a Hep A vaccine?
Yes
37
Is the Hep A vaccine effective if given up to 2 weeks after exposure?
yes
38
What are the symptoms of Hep A?
- Flu-like
| - Juandice
39
What is important to teach in the prevention of Hep A?
Good hand washing
40
Is Hep B a blood Bourne pathogen?
yes
41
What type of Hepatitis is transmitted through
| percutaneous/mucosal exposure/ sexual contact/ prenatal?
Hep B
42
How long are you infectious with a Hep B infection?
Before and after s/s, for about 4-6 months
43
Can Hep B be transmitted through all body fluids?
Yes
44
What type of Hepatitis is spread through percutaneous/ mucosal exposure/ high-risk sexual contact (anal)/ and perinatal?
Hep C
45
How long are you infectious with a Hep C infection?
1-2 weeks before s/s and continuous during clinical course, indefinite with carriers
46
How is Hep C treated?
Combination antivirals
47
The use of combination antivirals for the treatment of Hep C depends on what?
Genotype
48
Can Hep C be curative?
Yes
49
Can Hep C treatment be expensive?
Yes
50
What are s/s of Hep C?
- may be asymptomatic
- body aches
- flu-like
- anorexia
51
Is it possible to be a lifetime carrier of Hep B?
Yes
52
Is there a Hep B vaccine?
Yes (95% effective)
53
How is Hep B treated?
Post exposure prophylaxis
- Hep B vaccine
- HBIG (immune globulin)
54
-H and P
-Liver function studies
-Hepatitis testing
-genotype testing
... are diagnostics done to diagnose what?
Hepatitis infections
55
-Well-balanced diet
-Vitamins
-Rest (essential in promoting hepatocyte regeneration)
-Avoid alcohol
-Drug therapy (antivirals)
... are forms of acute and chronic care for what?
Hepatitis infections
56
If someones albumin is low what is common to see?
- Edema
| - Ascites
57
What disease has irreversible fibrosis and degeneration of the liver?
Cirrhosis
58
What types of causes are there for cirrhosis?
- Alcohol
- Post-necrotic
- Biliary
- Cardiac
59
Can long tern right-sided heart failure cause cardiac cirrhosis?
Yes
60
Can chronic biliary obstruction and infection cause biliary cirrhosis?
yes
61
Can Hepatitis B, C, and industrial chemical exposure cause post-necrotic cirrhosis?
Yes
62
Why does long-term right sided heart failure cause cirrhosis?
Liver becomes congested with extra fluid which damages the liver cells
63
Can some liver cells regenerate?
Yes
64
What liver cells can not regenerate?
Fibrotic
65
Does cirrhosis have multi system manifestations?
Yes
66
-Portal hypertension
-Esophageal varices
-Peripheral edema
-Ascites
-Hepatic encephalopathy
-Hepatorenal Syndrome
... are all potential complications of what?
Cirrhosis
67
-increased BP in portal vein
-Collateral circulation or shunting
-Increase hydrostatic pressure
... are characteristics of what?
Portal hypertension
68
What is esophageal varices due to?
Portal HTN
69
Is esophageal varices life-threatening?
Yes
70
Can esophageal varies bleed by a slow ooze or a massive hemorrhage?
Yes
71
-Enlarged blood vessels on the nose
-Red palms due to increase in circulating estrogen which liver normal metabolizes
... are visible manifestations of what?
Cirrhosis
72
What is caused due to a decrease in colloidal osmotic pressure/ impaired synthesis of albumin?
Peripheral edema
73
Where is edema typically seen in peripheral edema?
Anke and pre sacral (edema up to groin sometimes)
74
What is the accumulation of fluid in the peritoneal or and cavity?
Ascites
75
What is caused due to portal hypertension and the increased flow of hepatic lymph?
Ascites
76
When is a decrease in serum colloidal oncotic pressure, hyperaldosteronism, and impaired water excretion seen?
In ascites
77
Impaired ammonia metabolism is the cause of what?
Hepatic encephalopathy
78
Are there neurological status changes seen with hepatic encephalopathy?
yes
79
Can hepatic encephalopathy cause someone to be lethargic or even a deep coma?
Yes
80
Ammonia which accumulates in hepatic encephalopathy is toxic to the brain, how are ammonia levels commonly reduced?
With use of lactulose
81
-Disorientation
-asterixis * (flapping tremor)
-hyperventialtion
-hypothermia
-grimacing and grasping reflex
-fetor hepaticas (sweet breath odor)
... are signs of what cause by hepatic encephalopathy?
an impending coma
82
what does the liver usually convert ammonia to?
Urea
83
What does abdtunded mean?
slow to respond
84
-Rest
-B-complex vitamins
-Avoid alcohol, ASA, acetaminophen, and NSAIDs
... are ways conservative therapy is used to treat what?
Cirrhosis
85
How is ascites managed?
- Low sodium diet
- Diuretic
- Paracentesis (if indicated)
86
What drugs are used to manage varices?
- Non selective beta blockers (to lower BP and HR)
- Octreotide (lower portal HTN pressure)
- Vasopressin (can decrease active bleeding/vasoconstricts)
87
Band ligation or sclerotherapy, ballon tamponade or shunting is used to manage what?
Varices
88
How is hepatic encephalopathy managed?
Antibiotics (Rifaximin) and lactulose
89
Can patients with ascites be dehydrated if they have ascites?
Yes fluid in abdomen is taking fluid needed elsewhere away
90
Is spironolactone (a potassium sparing diuretic) used to help with ascites?
Yes
91
Should you monitor daily weights, Intake and output, and abdominal girth for someone with cirrhosis?
Yes
92
What is the Blakemore-Sengstaken Tube used for?
To stop or slow bleeding in esophagus or stomach from varices
93
Inflammation of the pancreas which can be acute or chronic is called what?
Pancreatitis
94
Can acute pancreatitis be life-threatening and range from mild edema to severe hemorrhage from pancreatic vessels?
Yes
95
Where do people with pancreatitis have pain?
LUQ
96
-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?
Acute pancreatitis
97
Where is ecchymosis seen in people with acute pancreatitis?
- Cullen's (periumbilical)
| - Grey Turner's (Flank)
98
-Pleural effusion
-Atelectasis
-Pneumonia
... can be pulmonary complications from what?
Acute pancreatitis
99
Tetany/hypocalcemia can be a complication from acute pancreatitis, what signs should you assess for?
- Chvostek's
| - Trousseau's
100
Can gullstones cause pancreatitis?
yes
101
What do you give a patient with acute pancreatitis who is is symptomatic to tetany?
Calcium gluconate
102
Why should you watch for hyperglycemia in patient s with acute pancreatitis?
If beta cells of pancreas are injured, may see difficulty in insulin production
103
Is a raised level of serum amylase and lipase seen in pancreatitis?
Yes
104
Is there a poor prognosis with a pancreatic cancer diagnosis?
Yes
105
What is removed during a Whipple procedure for pancreatic cancer?
- Head of pancreas
- The first part of the small intestine (duodenum)
- Gallbladder
- Bile duct
106
If there is a tumor in the tail of the pancreas will you see jaundice right away?
No, you will as it progresses
107
Is staging important in the treatment plan of pancreatitis?
yes
108
Are chemo and radiation often used for pancreatic cancer?
Yes
109
Inflammation of the gallbladder is called what?
Cholecystitis
110
Stones in the gallbladder is called what?
Cholelithiasis
111
Bile is overly saturated (usually with cholesterol) and it precipitates out in what disease?
cholelithiasis (gallstones)
112
-RUQ pain: usually after eating
-N/V
-Juandice
-Intolerance of fatty foods
-Itching
-Steatorrhea
-Clay-colored stools
-Bleeding tendencies
... are manifestations of what?
Cholelithiasis and Cholecystitis
113
Do cholelithiasis symptoms depend on if the gallstones have moved?
yes
114
Why are there bleeding tendencies associated with cholelithiasis and cholecystitis?
Decrease absorption of vitamin K from diet
115
A laparoscopic cholecystectomy is the gold standard for the treatment of what?
Cholecystitis (and cholelithiasis?)
116
Can a cholecystectomy also be done through and open incision?
Yes
117
Is a T-tube commonly placed after a open cholecystectomy to drain bile?
Yes
118
What is a ERCP (short for endoscopic retrograde cholangiopancreatography)?
is a procedure used to diagnose diseases of the gallbladder, biliary system, pancreas, and liver
119
What is it called when shock waves are use to break up stones in the gallbladder to be passed?
Lithotripsy
120
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)?
Yes
121
-Obesity
-People who have had multiple children
-Oral contraceptives
... put people at higher risk for what?
Gallbladder disease
