pancreas liver gallbladder

Question 1

After a meal, excess glucose molecules are taken up by the liver, combined, and then stored as glycogen

Answer 1

Glycogenesis (gli-co- genesis)

Question 2

When blood glucose level falls, the process is reversed, and the glucose molecules are returned to the blood

Answer 2

Glycogenolysis (gli-co-geno-lysis)

Question 3

Fats and protein broken down in response to low blood glucose levels, and molecules are used to make new glucose

Answer 3

Gluconeogenesis (glu-co-neo-genesis)

Question 4

Primary palmar erythema

Answer 4

Heredity.
Pregnancy (due to alterations in skin function and vasculature).
Idiopathic.

Question 5

Secondary palmar erythema

Answer 5

Livercirrhosisand its many causes includingalcohol abuse.[(Palmar erythema develops as a result of abnormal oestradiol levels.)
Hereditary liver disease such asWilson’s diseaseandhereditary haemochromatosis.

Question 6

Locally, inflammatory process causes the liver to swell
Bile channels compressed; damage the cells that produce bile
Then blood flow through the liver is impaired, causing pressure to
rise in the portal circulation
Systemic effects related to altered metabolic functions performed by
the liver and to the infectious response in viral

Answer 6

Hepatitis

Question 7

Signs and symptoms

Hepatitis

Answer 7

Signs and symptoms of systemic effects: rash, arthritis, fever,
malaise and angioedema, (the rapid swelling [edema] of
thedermis,subcutaneous tissue,mucosa and submucosal
tissues.)

Question 8

: caused by exposure to toxic chemicals; drugs

Answer 8

Noninfectious: Hepatitis

Question 9

Exposure to fecal contaminated water, food or
medical equipment. Most common type of viral
hepatitis

Answer 9

hep A

Question 10

Blood borne, found in all body fluids of infected….
Transmit by intimate contact with carriers, exposure to
infected blood

Answer 10

hep B

Question 11

Becomes “C”hronic and a “C” arrier of Hep.

Increases risk of chronic liver infections

Answer 11

Hep C

Question 12

Caused by delta agent… RNA virus that can only
survive in the presence of Hep B..therefore blood
borne

Answer 12

hep D

Question 13

Similar to Hep A.. Trasmit via water or food… rare in

US. No long term effects

Answer 13

Hep E

Question 14

: Identified in some blood donors and transmits by
blood transfusion… does not cause chronic hepatitis..
But effects not fully known

Answer 14

Hep G

Question 15

Signs and symptoms regardless of cause are similar
Preicteric phase
Hepatitis

Answer 15

Malaise, severe headache, right upper quadrant abdominal pain, anorexia, nausea, vomiting, fever, arthralgia (joint pain), rash, enlarged lymph nodes, urticaria, liver enlargement and tenderness

Question 16

Icteric phase

Hepatitis

Answer 16

Jaundice, light or clay-colored stools, dark urine

Question 17

Posticteric phase

Hepatitis

Answer 17

Fatigue, malaise, and liver enlargement

Question 18

Medical diagnosis

Hepatitis

Answer 18

Elevated levels of serum enzymes (AST, ALT, GGT), serum and urinary bilirubin, and urinary urobilinogen

Question 19

Medical treatment

Hepatitis

Answer 19

No cure: treat to promote healing and manage symptoms
Antipyretics, corticosteroids, and antiemetics
Diet: high calorie, high carbohydrate, moderate to high protein, and moderate to low fat with supplementary vitamins

Question 20

Prevention

Hepatitis

Answer 20

Vaccines; immune globulin (IG); hepatitis B immune globulin (HBIG)

Question 21

Nursing Assessment

Hepatitis

Answer 21

General health state, drug and alcohol use, chemical exposure, dietary habits, blood transfusions, recent travel, gastrointestinal disturbances, and changes in skin, urine, or stools
Vital signs, skin, weight changes, and mental status

Question 22

Chronic, progressive disease
Degeneration and destruction of liver cells
Fibrotic bands of connective tissue impair the flow of blood and lymph and distort the normal liver structure

Answer 22

Cirrhosis

Question 23

Incidence

Cirrhosis

Answer 23

Fifth leading cause of death in ages 40 to 60 in the United States
More common in men than in women
Related to alcoholic liver disease or chronic viral infection

Question 24

Types

Cirrhosis

Answer 24

Alcoholic
Postnecrotic
Biliary
Cardiac (severe and longstanding, hepatic congestion can lead to fibrosis; if congestion is due to right heart failure, it is calledcardiac cirrhosis)

Question 25

s/s | Cirrhosis

Answer 25

Early: slight weight loss, unexplained fever, fatigue, and dull heaviness in the right upper abdomen Progresses: anorexia, nausea, vomiting, diarrhea or constipation, flatulence, dyspepsia, esophageal varices, infections, and epistaxis Later: jaundice; testicular atrophy, impotence, and gynecomastia; ascites; amenorrhea; palmar erythema and spider angiomas; confusion and decreasing consciousness; peripheral neuropathy

Question 26

Complications | Cirrhosis

Answer 26

Portal hypertension, esophageal varices, ascites, hepatic encephalopathy, and hepatorenal syndrome

Question 27

Medical Treatment | Cirrhosis

Answer 27

Bed rest Diet high in carbohydrates and vitamins with moderate to high protein unless blood ammonia level is elevated Intravenous fluids Anemia may require blood transfusions Water and sodium likely to be restricted Cathartics and antibiotics for hepatic encephalopathy

Question 28

Medical diagnosis | Cirrhosis

Answer 28

Liver function tests, CBC, prothrombin time, protein, electrolytes, albumin, bilirubin, urine bilirubin, urobilinogen, liver biopsy, liver scan, ultrasonography, angiography, CT, and MRI Liver biopsy

Question 29

Medical Treatment continued Ascites Cirrhosis

Answer 29

``` Various types of diuretics Salt-poor albumin may be given intravenously Paracentesis Peritoneal-venous shunt of the transjugular intrahepatic portosystemic shunt ```

Question 30

Bleeding esophageal varices Medical Treatment continued Cirrhosis

Answer 30

``` Drug therapy, sclerotherapy (inj. of med), surgical ligation, and placement of an esophageal-gastric balloon tube ```

Question 31

Rarely begins in the liver but frequent site of metastasis Cirrhosis is a predisposing factor As disease progresses, signs and symptoms are essentially the same as those of cirrhosis

Answer 31

Cancer of the Liver

Question 32

Signs/symptoms | Cancer of the Liver

Answer 32

Signs/symptoms: liver enlargement, weight loss, anorexia, nausea, vomiting, dull pain in upper right quadrant of abdomen Because early signs and symptoms of liver cancer are vague, the condition often not diagnosed until advanced

Question 33

test | Cancer of the Liver

Answer 33

Tests: liver scan and biopsy, hepatic arteriography, endoscopy, and measurement of alpha-fetoprotein levels If the cancer is confined to one area, a lobectomy may be done; otherwise chemotherapy is the primary treatment

Question 34

Cholecystitis

Answer 34

Inflammation of the gallbladder Caused by gallstones but can be due to bacteria, toxic chemicals, tumors, anesthesia, starvation, and opioids When gallstones present, called Cholelithiasis. Stones may be found anywhere in the biliary tract: gallbladder, cystic duct, or the common bile duct

Question 35

Signs and symptoms | Cholecystitis and Cholelithiasis

Answer 35

From mild indigestion to severe pain, fever, jaundice Also nausea, eructation, fever, chills, and right upper quadrant pain that radiates to the shoulder If bile flow obstructed, bile production decreases and serum bilirubin rises; leads to obstructive jaundice Some excess bilirubin is excreted in the urine, creating a dark, amber color Digestion of fats is impaired, causing intolerance of fatty foods and steatorrhea

Question 36

Complications | Cholecystitis and Cholelithiasis

Answer 36

Pancreatitis, abscesses, cholangitis, and rupture of the gallbladder

Question 37

Medical diagnosis | Cholecystitis and Cholelithiasis

Answer 37

History and physical examination Fluoroscopy using contrast medium injected directly into the biliary tree Radiographs, radionuclide imaging, ultrasonography, and oral or intravenous cholangiography White blood cell count, serum and urinary bilirubin, and serum enzymes

Question 38

Medical treatment | Cholecystitis and Cholelithiasis

Answer 38

``` Analgesics, anticholinergics, and antibiotics Intravenous fluids Nasogastric tube Drug therapy Shockwave lithotripsy Endoscopic sphincterotomy Cholecystectomy ```

Question 39

Islets of Langerhans

Answer 39

Alpha cells produce and secrete glucagon Beta cells produce and secrete insulin Delta cells produce somatostatin, which inhibits the release of glucagon and insulin Glucagon is secreted when BG level drops and Insulin is secreted when BG rises

Question 40

Pancreatitis

Answer 40

Inflammation of the pancreas May be acute or chronic Caused by biliary tract disorders or alcoholism Also viral infections; peptic ulcer disease; cysts; metabolic disorders; trauma from external injury, surgery, or endoscopy Digestive enzymes activated by unknown mechanism begin to digest pancreatic tissue, fat, and elastic tissue in blood vessels Chronic pancreatitis related to alcohol abuse

Question 41

Signs and symptoms | Pancreatitis

Answer 41

Abdominal pain Severe, with a sudden onset; centered in the upper left quadrant or the epigastric region and radiates to the back Severe vomiting, flushing, cyanosis, and dyspnea often accompany the pain Low-grade fever, tachypnea, tachycardia, hypotension Abdomen may be tender and distended Bowel sounds may be absent Bleeding and shifting of fluid may lead to shock

Question 42

Complications | Pancreatitis

Answer 42

Pseudocyst, abscess, hypocalcemia, and pulmonary, cardiac, and renal complications

Question 43

Medical diagnosis Pancreatitis

Answer 43

Elevated serum amylase, serum lipase, and urinary amylase levels Elevated WBC count, elevated serum lipid and glucose level, and decreased serum calcium level Ultrasonography and ERCP Secretin stimulation test and fecal studies

Question 44

Medical treatment Pancreatitis

Answer 44

Nothing by mouth Nasogastric tube Intravenous fluids Blood or plasma expanders Urine output should be at least 40 mL/hour Jejunal feeding tube or total parenteral nutrition Once food permitted, usually bland, low-fat, high-carbohydrate diet divided into frequent, small meals Prophylactic antibiotics

Question 45

Nursing Assessment | Pancreatitis

Answer 45

Abdomen should be inspected for discoloration, distention, tenderness, and diminished bowel sounds

Question 46

Quickly spreads to the duodenum, stomach, spleen, and left adrenal gland Risk factors: chronic pancreatitis and smoking Also high-fat diet, exposure to toxic chemicals

Answer 46

Cancer of the Pancreas

Question 47

Signs and symptoms | Cancer of the Pancreas

Answer 47

Pain, jaundice with or without liver enlargement, weight loss, and glucose intolerance Other signs and symptoms may be weight loss, upper abdominal pain, anorexia, vomiting, weakness, and diarrhea

Question 48

Medical diagnosis | Cancer of the Pancreas

Answer 48

Transabdominal ultrasound, computed tomography, ERCP, and endoscopic ultrasonography Serum amylase, lipase, bilirubin, and enzyme levels; carcinoembryonic antigen and CA 19-9 titers

Question 49

Assessment | Cancer of the Pancreas

Answer 49

Assess gastrointestinal function, pain, and emotional state | If surgery planned, determine the patient’s knowledge about pre- and postoperative care

Question 50

Cancer of the liver is usually

Answer 50

Secondary

Question 51

Liver usually has pain to the what extremity

Answer 51

Right shoulder