Quiz #3 (hepatic) prep

Question 1

If a patient has hepatic disease, what skin changes would you expect?

Answer 1

Jaundice
Bruising
Spider angioma
Palmar erythema
Purpura (rash and purple spots)
Caput medusa (epigastric viens radiate from umbilicus)

Question 2

If a patient has hepatic disease, what neurological changes would you expects?

Answer 2

confusion
sleep disturbances
muscle tremors
asterixis (flapping tremor)

Question 3

What common sign/symptom could you see in a hepatic disease patients urine and stools?

Answer 3

dark urine

light or clay-colored stools

Question 4

What common sign/symptom could you see in a hepatic disease patients abdomen?

Answer 4

Edema/ascites

Right upper quadrant abdominal pain

Question 5

What common sign/symptom or condition could you expect a hepatic disease patient to have in their bones?

Answer 5

Hepatic osteodystrophy

Question 6

What, why and when would a person with liver disease become jaundice (icterus)?

Answer 6

what - defects in bilirubin metabolism, liver disease or obstruction of bile flow.
why - due to liver damage (AST/ALT), decreases albumin
when - normal bilirubin 0.3-1.0 mg/dL; seen in eyes at 3.0 mg/dL and seen in the skin at 5-6 mg/dL.

Question 7

What are some special implications for the PT when working with patients with viral hepatitis?

Answer 7

• use universal precautions
• don’t wear clothes out of building
• 1/3 of patients c/o joint pain
• teach energy conservation for ADL’s
• Watch for signs of “fluid” shifting
• Watch for adverse drug reactions

Question 8

Prehepatic hyperbilirubinemia caused by excess bilirubin formation secondary to hemolysis is called?

Answer 8

unconjugated

Question 9

Hyperbilirubinemia caused by liver cell necrosis is called?

Answer 9

mixed or unconjugated

Question 10

Hyperbilirubinemia caused by an obstruction of bile flow is called?

Answer 10

conjugated

Question 11

What body system become involved when a patient had cirrhosis of the liver?

Answer 11

all systems become involved including cardiopulmonary, renal, endocrine and hematopoietic

Question 12

What are 3 clinical features of cirrhosis?

Answer 12

• large increase in serum liver enzyme ALT and AST
• loss of liver functions
• consequences of portal hypertension

Question 13

If liver inflammation leads to necrosis what clinical manifestations will result?

Answer 13

• decreased bilirubin metabolism (jaundice)
• decreased bile in GI tract (light-color stools)
• decreased vitamin K absobption (bleeding)
• decreased metabolism of proteins/carbs/fats (hypoglycemia)
• decreased plasma proteins (ascites & edema)
• decreased hormone metabolism
• increased urobilinogen (dark urine)

Question 14

What 3 things are associated with hepatic disorders and portal hypertension?

Answer 14

• Ascites (d/t portal hypertension & hypoproteninemia
• Splenomegaly
• Anastomoses between portal and systemic circulation (varies and is very serious)

Question 15

Special implications for working with patients with ascites?

Answer 15

• Fowler’s position (head of bed raised 18-20in above level with knees elevated)
• Breathing techniques (prevent atelectasis and pneumonia)
• Monitor vital signs (incr oxygen saturation)
• Monitor for bacterial peritonitis (fever, chills, abdomen pain & tenderness)
• Monitor fluid intake/outake (daily weights, 5-10 lbs/day)
• decreased SERUM ALBUMIN (incr edema, decr healing/clotting factors, drugs attach to albumin)

Question 16

What do you suspect when your patient has shape abdomen pain and they vomit after eating high fat foods?

Answer 16

an obstructed bile duct or cystic.

Question 17

What treatments are available for patients with obstructed bile ducts (cystic)?

Answer 17

• surgery (laparoscopy)
• extracorporeal shock waves (lithotripsy)
• drugs