Liver Cirrhosis, Gallbladder, Pancreatitis Flashcards
severe SCARRING OF THE LIVER, presence of diffuse fibrosis
Liver cirrhosis
Common cause of Liver cirrhosis
Alcoholism also cause of Laennec’s Cirrhosis
can cause also post necrotic cirrhosis (hepa A-E)
-post billiary cirrhosis (biliary obstruction)
-CHON malnutrition- Liver parenchymal damage
-Schistosomiasis (Bilharzia) also called Snail fever and katayama fever
what type of hepa by eating food or drinking water contaminated
Hepa A
Most people with hepatitis A usually get better on their own without treatment. In rare cases, hepatitis A infection can be very serious and a person may require treatment to support their body’s recovery in the hospital. There is no specific treatment targeted at the HAV.
spreads from person to person through contact with blood, semen, and other bodily fluids. Sexual contact is a common way people get type hepatitis. Needle-sharing and exposure to blood are other ways you can get exposed. Healthcare workers can get this from unintentional needle sticks. can also pass the virus to an unborn child during pregnancy.
Hepa B
There is no cure for hepatitis B. There are medications that help slow liver damage. People with hepatitis B should avoid alcohol and medications that cause liver damage.There is a vaccine for hepatitis B. It is a three-dose series. It is part of the childhood immunization schedule. Children should get the vaccine because they are at high risk for chronic infection. If you don’t know if you got the vaccine as a child, your healthcare provider can order a blood test to see if you are immune.
passed to someone when they come in contact with blood that contains the virus. Most people get. Needle-sharing, Sharing items that could contain blood (like razors), Unregulated tattooing ,Accidental needle sticks,Sexual contact (though less likely)
Hepa C
Hepatitis C is treated with direct-acting antivirals (DAAs). DAAs are pills. A person with hepatitis C takes DAAs for 8 to 12 weeks. Over 90% of people with HCV are cured. Most people do not need to see a specialist to get hepatitis C treatment. You should not drink alcohol or use any medications or supplements that can harm the liver while taking DAAs.
spreads through blood and bodily fluids like the hepatitis B virus. Only people who already have hepatitis B can get hepatitis _. People can get hepatitis B and _ at the same time (called co-infection). Or they can get hepatitis _ after first getting hepatitis B (called superinfection).
Hepa D
spreads through blood and bodily fluids like the hepatitis B virus. Only people who already have hepatitis B can get hepatitis D. People can get hepatitis B and D at the same time (called co-infection). Or they can get hepatitis D after first getting hepatitis B (called superinfection).
spreads through infected stool. Raw or undercooked pork, Shellfish, Undercooked wild game
Hepa E
Most of the time, people get better on their own. An important exception to this is people who are pregnant. Hepatitis E infection during pregnancy can be very serious and even fatal.
commonly referred to as “swimmer’s itch”, due to irritation at the point of entrance. The rash that may develop can mimic scabies and other types of rashes a disease caused by parasitic flatworms.
Schistosomiasis, Bilharzia, Snail fever or katayama fever
Q: parenchymal damage*
CHON malnutrition
Dx test for liver cirrhosis
Increased Alt, Ast, Alp and bilirubin
-bilirubin= jaundice
-prolong PPT
-Liver Biopsy (FNA)
what is the position preprocedure of FNA biopsy and post procedure?
pre procedure= Supine Left side lying
post procedure= Right side lying to direct apply pressure because liver is known to be a bleeder full of viscosity
2 types of s/sx of liver cirhosis
- Compensated “early symptom”
(+) functional liver
- ankle edema
-abdominal pain
-Angioma (spider blood vessels)
-epistaxis (nosebleeding)
-enlargement of the liver
-erythema - Decompensated “late”
- jaundice, icteric sclera, pruritus, steatorrhea, vit ADEK deficiency, edema (ascites)
complication of Liver Cirrhosis
- scarring- portal to HTN
- hemorrhoids
- Caput medusae- varicose in the abdomen
- esophageal varices- very fragile, asymptomatic not unless it is already rupture= risk for bleeding
Mgt for bleeding
1.Drugs: Vasopressin
C/I CAD
- Balloon tamponade - 3 way of NGT/ Sengstaken blakemore tube
Bed side: scissor
WOF: airway obstruction
abnormal build-up of fluid in the abdomen. (-) albumin (-) oncotic pressure
ascites
s/sx of ascites
- increased abdominal girth
nc: tape measure - Dyspnea
nc: positioning elevate the head - wgt gain
nc: weight daily
every 1kg= 1L of water
mgt for ascites
Drug: diuretics= potassium sparring
diet decreased NA
Draw out fluid (paracentesis)
note: potassium is high in Prutas!
where is the puncture sight of the paracentesis, position during the procedure and how many L will be withdrawn?
below the umbilicus
upright/ high fowlers position
withdraw about 5-6L
n/c of ascites
- ask consent
-ask to empty the bladder- might the bladder will be punctured
-wof: hypotension - IV albumin-liver cannot produce albumin
- splenomegaly
s/sx of hepatic encepalopathy
- alteration of day and night sleep “early sign”
- altered level of consciousness
- asterixis- flapping tremors*
- constructional apraxia- inability to draw to write simple figure
- fector hepaticus (halitosis)- ammonia breath
- coma
mgt for hepatic encephalopathy
1.lactulose
expected: 2-3 soft stools/ day
effective: improve LOC
- antibiotics- to kill ammonia forming bacteria
R-rifaximin
M-metronidazole
N- neomycin - decrease CHON
below in the liver storage of the bile
Gallbladder- composed of bile salts and bilirubin
yellow-green fluid produced by the liver of most vertebrates that aids the digestion of lipids in the small intestine. contract the fats lead to cholecystitis
Bile
hardened deposits of digestive fluid that can form in your gallbladder
cholelithiasis (gallstone)
risk factor of cholelithasis
female, forty and above, fertile, fair skin at or obese
inflammation of the Gallbladder
Cholecystitis
Gallstones obstruction
calculus
absence of gallstones
acalculous
s/sx of cholecystitis
- biliary colic- severe RUQ pain radiates Right shoulder- pain after fatty meal
- n/, anorexia& fever
- Murphy sign-RUQ pain during inspiration hand below subcoastal pain
4.steatorrhea - vit ADEK
- jaundice
- pruritus
- Tea colored urine*
- acolic stool (gray/clay)
dx test of cholecystitis
- ultrasound
- ERCP- it is to Dx and Tx gallbladder
- increased all wbc, serum bilirubin and ALP
mgt of cholecystitis
- NPO
- IVF
- NGT
- pain meds= opioid analgesics
NOT morphine SO4- because can caus spasm in the sphincter of oddi - anti-emitics= blocking vomitting
- anti spasmodic/ anticholinergic= atrophine so4
- non surgical mgt= ESWL extra caoporpeal shockwave lithotripsy
- drugs to dissolve gallstone
-ursodeoxycholic acid
-chenodeoxycholic acid
-ursodiol
(3-6 moths dissolve for small gallbladder
surgery for cholecystitis
cholecystectomy= laparoscopic open cholecystectomy
organ of the digestive system and endocrine system of vertebrates.
pancreas
d/t autodigestion, reversible and mild to severe
acute pancreas
cause of acute pancreatitis
- gallstones
- alcohol
s/sx of acute pancreatitis
- severe mid epigastric pain that radiate at the back within 24-48hrs d/t heavy meals or alcohol intake
- n/v anorexia fever
- retroperitoneal bleeding= ecchymosis- bleeding discoloration (cullen sign and flank sign)
Diagnostic test of acute pancreatitis
- Increased amylase and increased lipase
- hypocalcemia= spasm, tetany, Chvostek and trousseaus sign
- hyperglycemia
- increased wbc
mgt for acute pancreatitis
- npo
- Ivf
- tpn administration
4NGT insertion - Pain medication= no morphine so4
Repeated/ recurrent inflammation of acute pancreatitis, to irreversible damage to fibrosis to pancreatic insufficiency
chronic pancreatits
severe mid epigastric pain that radiate at the back within 24-48hrs d/t heavy meals or alcohol intake (+) steatorrhea
acute pancreatitis
recurrent mid epigastric pain radiates to the back (-) streatorrhea
chronic epigastric pain
what is the cause of chronic pancreatitis
- alcohol
- cystic fibrosis
Mgt of Chronic pancreatitis
- pain= opoid
- PERT Therapy ( pancreatic enzyme replacement therapy)
EX. pancrea lipase, pancreatin, creon
what is the best time to take PERT
before meal
