Liver, Pancreas, Biliary System

Question 1

Causes of chronic liver disease

Answer 1

-hepatitis
-anoxia
-metabolic dx
-nutritional deficiencies
-hypersensitivity
-malnutrition R/T alcoholism

Question 2

Causes of cirrhosis

Answer 2

-alcohol #1 cause
-drug tox (acetaminophen)
-severe R sided HF
-hepatitis B&C

Question 3

Portal HTN

Answer 3

-results in ascites**, systemic HTN, large collateral veins, splenomegaly, increased venous pressure

Question 4

Esophageal/gastric varices

Answer 4

-veins enlarged and swollen
-easily ruptured, causing slow oozing or massive hemorrhage
-assess for bleeding (dark tarry = upper, bright red = lower)

Question 5

Complications of cirrhosis

Answer 5

-peripheral edema (ankle or presacral; hypoalbuminemia)

-ascites (rapid weight gain, SOB,inverted umbilicus, distend abd veins, dehydration, decreased UOP)

-hepatic encephalopathy and coma (gradual or sudden, mild sleep disturbance to sev coma, earliest sign: minor mental changes and motor disturbance)

Question 6

Interventions for cirrhosis

Answer 6

-hemorrhage
-hepatic encephalopathy
-ascites
-jaundice
-vit deficiency
-metabolic abnormal
-diet
-addiction

Question 7

Hepatic failure

Answer 7

-rapid onset of severe liver dysfunction with no hx
-common cause: drug overdose
-common drug: acetaminophen with ETOH, NSAIDS, sulfa
-first clinical sign: MS changes
-Tx: liver transplant

Question 8

Bile duct obstruction

Answer 8

-jaundice skin causing pruritis
-dark urine
-grayish or clay colored stool

Question 9

Gallbladder dx diagnosis

Answer 9

-cholescintigraphy

-liver functions, amylase (high), WBC (high), bilirubin (high)

-ERCP: for stones, NPO after MN, potential for aspiration post, risk for pancreatitis post

-MRCP: after incomplete or unsuccessful ERCP, non-invasive, safe

Question 10

Post op care for gallbladder

Answer 10

-low fowler’s
-NG tube
-NPO until BS return then soft, low fat high carb diet
-pain mgmt
-ambulation, TCDB
-splint
-T-tube

Question 11

Local pancreatitis complications

Answer 11

-pseudocyst (resolve on its own or rupture into peritoneal cavity)

-pancreatic abscess

Question 12

Systemic pancreatitis complications

Answer 12

-resp distress/hypoxia (watch ABG)

-cardiovascular (hypotension, tachycardia)

-F/E imbalance (hypocalcemia, + trousseau, tetany)

-hemorrhage, septic shock, MODS, death

Question 13

Pancreatitis diagnosis

Answer 13

-elevated amylase and lipase

-elevated WBC, triglycerides, glucose, bilirubin, liver enzyme

-hypocalemia

-CT scan

-Xray

Question 14

Pancreatitis management

Answer 14

-pain mgmt
-hydration
-decrease pancreatic stimulation (decrease enzymes)
-resp care (hypoxemia)
-infection prevention
-correct pancreatic drainage (stents)

Question 15

Chronic pancreatitis

Answer 15

-prolonged, recurrent atk leading to progressive destruct

-exclusive to people who abuse ETOH