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Med/Surg > Liver, Biliary, and Pancreatic Disorders > Flashcards

Liver, Biliary, and Pancreatic Disorders Flashcards

1
Q

right lobe of the liver is separated from the right lung and pleura by the

A

right dome of the diaphragm

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2
Q

80% of the blood to the liver comes from the

A

portal veins

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3
Q

20% of the blood (oxygen-rich) to the liver comes from the

A

hepatic artery

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4
Q

hepatic artery supplies liver with

A

oxygenated blood

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5
Q

portal vein drains the viscera (abdomen and spleen) and delivers blood to

A

the liver

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6
Q

central veins in the liver join to form the _________ which drains into the inferior vena cava

A

hepatic vein

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7
Q

small bile ducts throughout the liver join to form the ________ which carries bile formed in the liver and other secretions

A

hepatic duct

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8
Q

the cystic duct comes from the gallbladder to release bile and combines with the hepatic duct to then form the _________ which empties into the small intestine

A

common bile duct

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9
Q

Functions of the liver

A

Glucose Metabolism
Protein Metabolism
Fat Metabolism
Conversion of Ammonia
Bile Formation
Bilirubin Excretion
Drug Metabolism
Vitamin and Iron Storage

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10
Q

The liver stores what vitamins?

A

vitamins A,D,E,K, and B12

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11
Q

up to ___% of the liver can be damaged before you see a change in lab values

A

70%

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12
Q

Portal Vein brings glucose to liver to

A

store as glycogen

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13
Q

When the liver converts glycogen to glucose when needed

A

Glycogenolysis

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14
Q

glucose synthesized from non-carbs (proteins or lactate)

A

Gluconeogenesis

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15
Q

The liver breaks down fatty acids for production of energy into

A

ketone bodies and cholesterol/lipids

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16
Q

the liver synthesizes which plasma proteins?

A

albumin, clotting factors, fibrinogen

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17
Q

Vit K is required for

A

clotting factor synthesis

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18
Q

provides colloidal osmotic pressure within vascular system

A

Albumin

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19
Q

Vit K needs ____ to be absorbed

A

bile

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20
Q

Prothrombin cannot be made without

A

Vit K

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21
Q

Function of bile

A

to digest fats

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22
Q

Function of Kupffer cells :

A

Remove bacteria, debris , RBC

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23
Q

formed by hepatocytes, collected in bile ducts

A

Bile

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24
Q

Made of water, electrolytes, fatty acids, cholesterol, bilirubin, bile salts

A

bile

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25
Q

Pigment from breakdown of hemoglobin

A

bilirubin

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26
Q

Colors feces brown

A

bilirubin

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27
Q

A byproduct of gluconeogenesis that is converted to urea then excreted in urine (also a byproduct of bleeding)

A

Ammonia

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28
Q

the liver metabolizes these hormones

A

estrogen and aldosterone

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29
Q

refers to black stools that occur as a result of gastrointestinal bleeding.

A

Melena

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30
Q

A neurological disorder that causes a person to lose motor control of certain areas of the body.

A

Asterixis

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31
Q

Liver function tests:

specific to liver, elevated with liver disease;
hepatitis, cirrhosis

A

ALT (alanine aminotransferase)

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32
Q

Liver function tests:

increased with damage to the heart, liver,
muscle, kidney

A

AST (aspartate aminotransferase)

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33
Q

Liver function tests:

increased with alcohol abuse

A

GGT (gamma glutamyl transferase)

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34
Q

Liver function tests:

found in bones, liver and intestines (an increase is seen with biliary obstruction w/o bone disease)

A

ALP ((alkaline phosphatase)

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35
Q

cholestasis

A

bile is stasis

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36
Q

Liver function tests:

elevated in ischemic hepatitis

A

LDH

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37
Q

chemical elevated in liver failure

A

Ammonia

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38
Q

Elevated if bile duct obstruction, decreased in parenchymal liver disease

A

Cholesterol

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39
Q

For biopsy coagulation studies, must have consent and have

A

patient void prior

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40
Q

Post-Op biopsy care:

A

Right side position for 2-4 hours, apply pressure dressing

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41
Q

Stages of liver damage:

stage 1

A

healthy liver

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42
Q

Stages of liver damage:

stage 2 (reversible)

A

fatty liver

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43
Q

Stages of liver damage:

stage 3 (thickening/hardening)

A

liver fibrosis

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44
Q

Stages of liver damage:

stage 4

A

cirrhosis

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45
Q

Replacement of normal liver tissue with fibrosis/scar tissue

A

cirrhosis

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46
Q

Type of cirrhosis:

chronic alcoholism, most common cirrhosis

A

Alcoholic

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47
Q

Type of cirrhosis:

scarring after viral hepatitis

A

Post necrotic

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48
Q

Type of cirrhosis:

scarring to liver around the bile ducts, less common cirrhosis

A

Biliary

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49
Q

Type of cirrhosis:

from Right sided heart failure

A

Cardiac

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50
Q

80% of patients diagnosed _________ remain asymptomatic for the next 10 years (may have vague symptoms only)

A

compensate

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51
Q

Early signs of compensate are subtle:

A

GI, anorexia, nausea, vomiting , changes in bowel

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52
Q

symptoms advanced from portal HTN

A

Decompensated

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53
Q

Late signs of decompensate:

A

Portal Hypertension, ascites, edema, varices, encephalopathy

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54
Q

Late cirrhosis

A

decompensated

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55
Q

Scarred liver cells can not process the blood returning from GI, blood backs up in these organs causing high pressure

A

Portal Hypertension

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56
Q

Obstruction of venous blood flow through liver – increased capillary pressure
Increased intravascular volume
Decreased production of albumin
-FLUIDS SHIFT into PERITONEAL CAVITY
Liver can’t metabolize aldosterone – kidneys then retain Sodium and H2O

A

ASCITES

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57
Q

Collateral blood vessels -
Esophagus, stomach, lower rectum (hemorrhoids) develop new blood vessels to drain blood

A

VARICES

58
Q

Blood with ammonia can not be metabolized in liver – gets circulated
Hepatic encephalopathy (in brain)

A

Shunting of blood

59
Q

The obstructed spleen from the portal HTN: thrombocytopenia/anemia

A

Splenomegaly

60
Q

keeps fluid where it belongs

A

albumin

61
Q

spleen destroys

A

platelets and RBC’s

62
Q

large veins on abdomen

A

caput medusae

63
Q

Nursing interventions for Cirrhosis Patients

A

high carb, limited protein, low sodium diet
Smaller more frequent meals
Assess: abdominal percussion
Daily weights

64
Q

Treating Ascites

A

Spironolactone
Fluid restrictions
Sodium Restrictions
Albumin
Daily weights, measure abdominal girth
Assess rate and effectiveness of respirations

65
Q

blocks aldosterone and spares potassium

A

Spironolactone

66
Q

keep fluid in intracellular space

A

Albumin

67
Q

In ascites, respiratory issues are caused by

A

large abdomen

68
Q

Catheter inserted to drain fluid
Often will give Albumin after procedure
Have patient void prior
Have patient sitting up in chair/bed

A

PARACENTESIS

69
Q

Stent inserted from portal vein to hepatic to decrease pressure / divert blood

A

TIPS

70
Q

TIPS

A

Transjugular Intrahepatic Portosystemic Shunt

71
Q

The nurse assess pt with ascites. VSS BP: 128/78, P: 118, RR 28, Temp 98.9 Pulse ox 89% on room air. What is first thing to do?
a. Assess heart sounds
b. Prepare for paracentesis
c. Raise HOB
d. Assess lung sounds

A

c. Raise HOB

72
Q

Life threatening condition from dilated, thin walled veins in submucosa of lower esophagus

A

Esophageal Varices

73
Q

due to portal HTN - may rupture when chemically or mechanically irritated or when pressure is increased due to sneezing, coughing, Valsalva maneuver or excessive exercise

A

Esophageal Varices

74
Q

Bleeding esophageal varies is an

A

EMERGENCY

75
Q

Same process of esophageal varices causes veins in rectum to bulge

A

hemorrhoids

76
Q

Medication that constricts esophageal veins to stop bleeding

A

Octreotide

77
Q

Med given ASAP, before endoscopy

A

octreotide

78
Q

med injected to cause inflammation & sclerosis

A

Endoscopic Sclerotherapy

79
Q

after endoscopy, Pt remains NPO after until

A

return of GAG reflex

80
Q

NGT with balloon inflated in esophagus to stop bleeding

A

Sengstaken Blakemore Tube

81
Q

Risks of balloon tamponade

A

Tube dislodges, airway obstruction, (cut port for balloon to deflate ASAP)

82
Q

Esophageal Varices is a risk factor for any patient admitted with

A

advanced cirrhosis

83
Q

Hepatic Encephalopathy =

A

END STATE CIRRHOSIS

84
Q

Portal HTN shunting of unfiltered blood (ammonia) to circulation

A

Hepatic Encephalopathy

85
Q

Causes of high ammonia in hepatic encephalopathy:

A

GI bleeding (varices, melena) increase levels of Ammonia
High Protein diet, bacterial infection
Hypokalemia & alkalosis

86
Q

Signs & Symptoms of hepatic encephalopathy:

A

Mental changes, motor disturbance, asterixis
Sleep….to COMA

87
Q

Hepatic Encephalopathy Treatment

A

Lactulose
Antibiotic (neomycin)
Diet : monitored protein, high carb

88
Q

laxative that traps and expels ammonia in feces (enema or oral)

A

Lactulose

89
Q

Hepatic Encephalopathy can be reversible if

A

treated promptly

90
Q

The nurse is giving lactulose to patient with hepatic encephalopathy. What effect should be seen
a. Increase urine output
b. Impaired level of consciousness
c. Increased bowel movements
d. Nausea and vomiting

A

c. Increased bowel movements

91
Q

jaundice is seen with serum bilirubin levels

A

> 2.0 mg/dL

92
Q

Type of Jaundice:

increase in destruction of RBC pigments in blood, cannot be excreted fast enough. Not
dangerous unless it gets very high

A

hemolytic

93
Q

Type of Jaundice:

occlusion of the bile duct, can be intra or extrahepatic. Bilirubin cannot flow into the
intestines and “backs up” and is then reabsorbed into the blood

A

obstructive

94
Q

Type of Jaundice:

seen with damaged liver cells that cannot clear bilirubin - seen with alcoholic damage and with medications that can cause hepatotoxicity

A

hepatocellular

95
Q

Bile can’t flow into intestines causing

A

clay colored stool

96
Q

Excess bile yellows skin/sclera and urine becomes

A

orange & frothy

97
Q

Icteric

A

yellow sclera

98
Q

Prolonged Jaundice predisposes pt to

A

stones and CNS damage

99
Q

Manifestations of Liver Disease:

Edema from

A

hypalbuminemia

100
Q

Manifestations of Liver Disease:

Thrombocytopenia causing

A

large spleen

101
Q

Manifestations of Liver Disease:

Vitamin Deficiency

A

Vit A, D, E, K, Thiamin

102
Q

Manifestations of Liver Disease:

Large belly BUT

A

Malnourished

103
Q

Manifestations of Liver Disease:

Pruritus from retention of bile salts from

A

biliary obstruction / cholestasis

104
Q

Manifestations of Liver Disease:

Gynecomastia, amenorrhea, testicular atrophy from

A

liver’s inability to metabolize hormones

105
Q

Manifestations of Liver Disease:

Elevated Respiratory rate r/t

A

ascites

106
Q

Common virus with symptoms similar to mono

A

Cytomegalovirus

107
Q

Hepatitis by mode of transmission:

fecal/oral route; poor sanitation, person to person contact
- waterborne/foodborne

A

Hep A

108
Q

Hepatitis by mode of transmission:

  • by intimate contact with carriers or those w/acute disease; sexual and oral-oral contact
  • perinatal transmission from mothers to infants
A

Hep B

109
Q

Hepatitis by mode of transmission:

transfusion of blood and blood products; exposure to contaminated blood through equipment or drug paraphernalia

A

Hep C

110
Q

Hepatitis by mode of transmission:

Contact with infected blood (occurs only in people already infected with Hep B)

A

Hep D

111
Q

Hepatitis by mode of transmission:

Eating contaminated food or drink. Dangerous to pregnant women

A

Hep E

112
Q

HCV antibodies testing basic info

A

If test is reactive its is most likely positive and RNA test is needed. both test confirm diagnosis

113
Q

the 3 hepatitis antigens

A

surface antigen
E antigen
Core antigen

114
Q

Blood born Heps

A

B/D and C

115
Q

Food borne Heps

A

A and E

116
Q

Liver cancer is usually caused by

A

another cancer in the body

117
Q

Primary liver cancer is usually caused by

A

Hep B, C or cirrhosis

118
Q

Hepatic Encephalopathy assessment requires

A

neuro checks

119
Q

Bile made in liver travels via the common hepatic duct to the

A

common bile duct to the duodenum

120
Q

Not all bile goes straight to the common bile duct, some is stored in

A

GB via the cystic duct

121
Q

Liver makes up to ___cc of bile daily

A

700cc

122
Q

GB can hold _____cc of bile

A

30-50cc

123
Q

What does the gallbladder do?

A

Digest fats via the bile salts and cholesterol
Alkalize intestinal contents to aide in digestion

124
Q

Inflammation of GB

A

Cholecystitis

125
Q

90% of Acute cholecystitis from

A

Stones

126
Q

Calculous in common duct:

A

choledocholithiasis

127
Q

Calculous (stone) in GB:

A

cholelithiasis

128
Q

GB condition caused by burns, severe trauma, major surgery, obstruction of cystic duct, or bacterial

A

Acalculous

129
Q

More common in women older than 40, multiparous, increase weight

A

Chronic Cholecystitis

130
Q

Older person with cholecystitis and comorbidities may have no symptoms until

A

septic

131
Q

stone blocks bile flow – GB distends becomes inflamed and infected. Fever, possible palpable mass

A

Acute Cholecystitis

132
Q

after heavy meal GB contracts b/c can not release bile – the GB can become gangrene!!

A

Biliary colic

133
Q

tenderness in RUQ on deep inspiration or when GB palpated

A

Murphy’s sign

134
Q

Vitamin Deficiency with cholelithiasis why??

A

Can not absorb fat sol vitamins w/o BILE!

135
Q

Diagnostic test where tube goes down toward the duodenum then curves up into gallbladder

A

ERCP - Endoscopic Retrograde cholangiopancreatography

136
Q

Can treat confirmed choledocholithiasis- CBD stone can be extracted with

A

ERCP

137
Q

80% of patients with acute GB inflammation will achieve remission with:

A

IV Fluids
NG suction
Pain relievers * treat pain!!!
Antibiotic
Rest

138
Q

Medication – For non obstructing stones taken for up to a year

A

UDCA (Agtigall)

139
Q

Non surgical GB stone treatment:

Laser pulse directed under endoscopy/fluoroscopic guidance directly to stone

A

Intracorporeal Lithotripsy

140
Q

Non surgical GB stone treatment:

Shock waves directed at gallstones to fragment stones. Fragmented stones are then either spontaneously passed or removed via endoscope.

A

ESWL - Extracorporeal Shock Wave Lithotripsy:

Med/Surg (17 decks)

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