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2024DM Med Surg > pancreas liver gallbladder > Flashcards

pancreas liver gallbladder Flashcards

1
Q

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

A

Glycogenesis (gli-co- genesis)

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2
Q

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

A

Glycogenolysis (gli-co-geno-lysis)

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3
Q

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

A

Gluconeogenesis (glu-co-neo-genesis)

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4
Q

Primary palmar erythema

A

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

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5
Q

Secondary palmar erythema

A

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

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6
Q

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

A

Hepatitis

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7
Q

Signs and symptoms

Hepatitis

A

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

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8
Q

: caused by exposure to toxic chemicals; drugs

A

Noninfectious: Hepatitis

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9
Q

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

A

hep A

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10
Q

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

A

hep B

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11
Q

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

Increases risk of chronic liver infections

A

Hep C

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12
Q

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

A

hep D

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13
Q

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

US. No long term effects

A

Hep E

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14
Q

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

A

Hep G

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15
Q

Signs and symptoms regardless of cause are similar
Preicteric phase
Hepatitis

A

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

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16
Q

Icteric phase

Hepatitis

A

Jaundice, light or clay-colored stools, dark urine

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17
Q

Posticteric phase

Hepatitis

A

Fatigue, malaise, and liver enlargement

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18
Q

Medical diagnosis

Hepatitis

A

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

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19
Q

Medical treatment

Hepatitis

A

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

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20
Q

Prevention

Hepatitis

A

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

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21
Q

Nursing Assessment

Hepatitis

A

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

22
Q

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

A

Cirrhosis

23
Q

Incidence

Cirrhosis

A

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

24
Q

Types

Cirrhosis

A

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)

25
Q

s/s

Cirrhosis

A

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

26
Q

Complications

Cirrhosis

A

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

27
Q

Medical Treatment

Cirrhosis

A

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

28
Q

Medical diagnosis

Cirrhosis

A

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

29
Q

Medical Treatment continued
Ascites
Cirrhosis

A 
Various types of diuretics
Salt-poor albumin may be given intravenously
Paracentesis 
Peritoneal-venous shunt of 
   the transjugular intrahepatic 
   portosystemic shunt
30
Q

Bleeding esophageal varices
Medical Treatment continued
Cirrhosis

A 
Drug therapy, 
    sclerotherapy (inj. of med), 
   surgical ligation, and 
    placement of an 
    esophageal-gastric 
    balloon tube
31
Q

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

A

Cancer of the Liver

32
Q

Signs/symptoms

Cancer of the Liver

A

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

33
Q

test

Cancer of the Liver

A

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

34
Q

Cholecystitis

A

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

35
Q

Signs and symptoms

Cholecystitis and Cholelithiasis

A

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

36
Q

Complications

Cholecystitis and Cholelithiasis

A

Pancreatitis, abscesses, cholangitis, and rupture of the gallbladder

37
Q

Medical diagnosis

Cholecystitis and Cholelithiasis

A

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

38
Q

Medical treatment

Cholecystitis and Cholelithiasis

A 
Analgesics, anticholinergics, and antibiotics
Intravenous fluids 
Nasogastric tube 
Drug therapy
Shockwave lithotripsy
Endoscopic sphincterotomy
Cholecystectomy
39
Q

Islets of Langerhans

A

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

40
Q

Pancreatitis

A

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

41
Q

Signs and symptoms

Pancreatitis

A

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

42
Q

Complications

Pancreatitis

A

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

43
Q

Medical diagnosis

Pancreatitis

A

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

44
Q

Medical treatment

Pancreatitis

A

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

45
Q

Nursing Assessment

Pancreatitis

A

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

46
Q

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

A

Cancer of the Pancreas

47
Q

Signs and symptoms

Cancer of the Pancreas

A

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

48
Q

Medical diagnosis

Cancer of the Pancreas

A

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

49
Q

Assessment

Cancer of the Pancreas

A

Assess gastrointestinal function, pain, and emotional state

If surgery planned, determine the patient’s knowledge about pre- and postoperative care

50
Q

Cancer of the liver is usually

A

Secondary

51
Q

Liver usually has pain to the what extremity

A

Right shoulder

2024DM Med Surg (35 decks)

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