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Critical Care Gastrointestinal > Liver Cirrhosis > Flashcards

Liver Cirrhosis Flashcards

1
Q

Venous blood from the GI tract organs empties into what

A

portal vein

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2
Q

What perfuses the liver

A

Portal vein

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3
Q

Where is the liver located

A

right upper quadrant

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4
Q

What is the liver enclosed in

A

peritoneum

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5
Q

Functional units of the liver are the

A

lobules

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6
Q

Kupffer cells

A

carry out phagocytic activity / Removal of bacteria and toxins from the blood

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7
Q

Liver has two types of cells

A

hepatocytes and phagocytics

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8
Q

What does the portal circulatory system (enterophatic) do

A

Brings blood to the liver from the stomach, intestines, spleen and pancreas

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9
Q

Portal vein carries what

A

absorbed products of digestion directly to the liver

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10
Q

Why is the liver essential for life

A

functions in the manufacture, storage, transformation, and excretion of a number of substances involved in metabolism

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11
Q

The liver removes what from the portal blood

A

glucose and amino acids

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12
Q

The liver aids in the synthesize of what

A

glucose, amino acids and fats

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13
Q

What does the liver store

A

blood up to one 1L

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14
Q

What does the liver secrete to emulsify fat

A

bile

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15
Q

Past medical history data you should obtain regarding the GI system

A
  • history of abdominal pain
  • distention
  • jaundice
  • anemia
  • heartburn
  • dyspepsia (upset stomach)
  • changes in appetite
  • hemataemesis (blood vomit)
  • food intolerance
  • melena (black sticky bloody stool)
  • trouble swallowing
  • hemorrhoids
  • rectal bleeding
  • reflux, gastritis, hepatitis, colitis, gallstones, peptic ulcer disease, cancer, diverticuli, or hernias
  • any unexplained weight loss or gain in the past 6-12 months
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16
Q

Medication History to obtain for the GI system

A
  • medications past and present
  • Name of all drugs, frequency of use, duration of use
  • OTC medications, herbals, vitamins and nutritional supplements
  • Chemical exposure
  • Drug use
  • NSAID use
  • Antibiotics
  • Antacids and laxatives
17
Q

Surgical history to obtain for GI system

A
  • Any GI related hospitalizations

- Any history of abdominal or rectal surgery (year, reason, postoperative course and if any blood was received)

18
Q

Health Pattern questions to ask for the GI system

A
  • Normal body weight
  • Adequate nutrition
  • Elimination habits
  • Foreign travel
  • RIsky behaviors
  • Alcohol usage
  • Smoking history
  • Family history
19
Q

Upper GI or barium swallow

A

Fluoroscopic x-ray study using a contrast medium. Used to diagnoses structural abnormalities of esophagus, stomach, and duodenum. Used to identify disorders such as esophageal strictures, polyps, tumors, hiatal hernias, foreign bodies, and peptic ulcers

20
Q

Nursing responsibilities for Upper GI or barium swallow

A

Explain procedure to the patient including the need to drink contrast medium and assume various positions on an x-ray table. Keep the patient NPO for 8-12 hours before the procedure. Tell the patient to avoid smoking after midnight before study. After x-ray take measures to prevent contrast medium impaction (fluids and laxatives) . Tell patient that stool may be white for up to 72 hours after test

21
Q

Esophagogastroduodenscopy (EGD)

A

Directly visualizes mucosal lining of esophagus, stomach, and duodenum with flexible endoscope. Test may use video imagine to visualize stomach motility. Inflammations, ulcerations, tumors, varices or mallory weiss tears may be detected. Biopsies may be taken and varices can be treated with band ligation or sclerotherapy

22
Q

Nursing Responsibilities for EGD

A

Before procedure: Keep patient NPO for 8hours. Make sure signed consent is in chart. Give preoperative medication if ordered. Explain to patient that local anesthesia may be sprayed on throat before insertion of scope and that patient will be sedated during the procedure.
After procedure: Keep patient NPO until gag reflex returns. Use warm saline gargles for relief of sore throat. Check temperature q15-30min for 1-2hours (sudden temperature spike is a sign of perforation.)

23
Q

Liver Biopsy

A

Precutaneous procedure uses needle inserted between 6th or 7th and 8th or 9th intercostal spaces on the right side to obtain specimen of hepatic tissue. Often done using ultrasound or CT guidance

24
Q

Nursing responsibilities for liver biopsy

A

Before procedure: Check patients coagulation studies. Ensure the patients blood has been typed and crossmatched. Take vital signs as baseline data. Explain that informed consent has been signed and in chart.
After procedure: Check vital signs to detect internal bleeding q15minx2, q30x4, q1hrx4. Keep patient laying on right side for a minimum of 2 hours to splint puncture site. Keep patient in bed flat position for 12-14hours. Assess patient for complications such as bile peritonitis, shock, pneumothorax

25
Q

Serum bilirubin

A

measurement of liver’s ability to conjugated and excrete bilirubin, allowing differentiation between unconjugated and conjugated bilirubin in plasma

26
Q

Total bilirubin

A

measurement of conjugated and unconjugated total bilirubin

27
Q

Conjugated (direct) Billirubin

A

Measurement of conjugated bilirubin

- elevated in obstructive jaundice

28
Q

Unconjugated (indirect) bilirubin

A

measurement of unconjugated bilirubin

- Elevated in hepatocellular and hemolytic conditions

29
Q

Urinary bilirubin

A

measurement of urinary excretion of conjugated billirubin

30
Q

Serum protein

A

measurement of serum proteins manufactured by the liver

albumin, globulin, total proteins, A/G ratio

31
Q

Albumin labs

A

3.5-5.0g (35-50mg)

32
Q

Globulin labs

A

2.5-3.5g (25-35mg)

33
Q

Total protein labs

A

6.4-8.3g (64-83mg)

34
Q

Prothrombin Time (PT)

A

determination of prothrombin activity

35
Q

Normal PT

A

11-16 seconds

36
Q

International normalized ration (INR)

A

standardized system of reporting PT based on a reference calibration model and calculated by comparing the patients PT with a control value (warfarin/coumadin)

37
Q

Normal INR

A

2-3 is considered therapeutic

38
Q

Vitamin K

A

essential cofactor for many clotting actors

39
Q

Normal Vitamin K levels

A

0.1-2.2

Critical Care Gastrointestinal (1 decks)

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