Test 4 GI part 2 Flashcards
which type of etoh liver dz is a precursor to cirrhosis and is associated with a 2-3 fold increase in perioperative M&M?
alcoholic hepatitis
non-alcoholic steatohepatitis is due to ______________ accumulating in the liver causing ________________
fat; scar tissue
non-alcoholic steatohepatitis is associated with ?
DM
protein malnutrition
obesity
CAD
corticosteroids
how do you dx non-alcoholic steatohepatitis
biopsy
what are the characteristic laboratory abnormalities seen in alcoholic hepatitis?
- moderate elevation in LFTs typically 2:1 pattern AST to ALT
- elevated bilrubin and INR
- increased Cr if volume depleted
pt with acute alcoholic hepatitis presents for elective surgery, how should you proceed?
- delay for at least 12-weeks from onset of acute etoh hepatitis
- supportive care provided in the interim/counseling
emergency surgery in those with alcoholic hepatitis greatly increases ________________
morbidity and mortality
____________________ is chronic hepatocyte damage leading to progressive fibrosis, distortion of hepatic architecture and formation of fibrotic nodules
cirrhosis
most common causes of liver cirrhosis
hepatitis C and etoh
causes of cirrhosis
hepatitis
toxins
inherited d/o
most common symptoms with cirrhosis
N/V
abdominal pain
weakness
anorexia (malnourishment)
most common signs of cirrhosis
- hepatomegaly
- ascites
- jaundice
- spider nevi
- encephalopathy
T/F: cirrhosis affects all major organ systems
true
Review of Systems for cirrhosis
- neuro: encephalopathy?
- CV: hyperdynamic circ, increased HR & CO, low PVR
- pulm: V/Q mismatch
- GI: risk for aspiration
- GU: hepatorenal syndrome
- hepatic: ascites, alt’d drug metabolism, portal HTN
- hematologic: risk for bleeding, anemia
- immunologic: risk for infection/sepsis
Laboratory assessment with cirrhosis
CBC
CMP
bilirubin
INR for MELD calculation
LFTs
if someone has cirrhosis and presents for surgery what type of imaging should you do an why?
abdominal imaging to evaluate portal HTN
if pt presents for surgery with cirrhosis, what assesments could you do to predict morbidity and mortality in this patient?`
model for end-stage liver dz (MELD)
child-turcotte-pugh score
decompensated cirrhotic patients may have significant _____________
anemia
T/F: in a decompensated cirrhotic pt, you should transfuse for a hgb less than 8
false; the decision is NOT based off a number, it is based off other factors like: cardiac comorbidity/sx
if patient with cirrhosis comes in and during surgery, has a variceal hemorrhage; you know this is a complication of what?
portal vein htn
if pt with cirrhosis comes in for surgery, and during the procedure has a variceal hemorrhage; what should you do?
- intubate
- resuscitate
- TIPS should be performed
- if significant anemia ensues –> transfuse
what are the different types of viral hepatitis
A, B, C, D, E
acute hepatitis is often associated with what lab abnormality
elevated hepatic transaminases, AST, and ALT
pt with abnormalities in bilirubin, INR, fibrinogen, plt, or albumin due to hepatitis may suggest
undx advanced liver dz requiring further investigation
most common type of viral hepatitis
B
which viral hepatitis is transmitted via fecal/oral route and is “self limiting.” will have Hepatitis AV IGM on serology
A
hepatitis A, the pt is not infectious after _________ days, and the mean incubation time is _________ weeks
21; 4
how is Hepatitis B transmitted
sexual and blood borne
on serology what will you find with hepatitis B
major HBV surface ag (HBsAg)
which hepatitis typically occurs concurrently with hepatitis B
D
viral load of hepatitis B
HBV DNA PCR
which hepatitis may be acute or chronic and can progress to cirrhosis
B and C
detectable HBsAg for > 6 months indicates
chronic hepatitis B
mean incubation time of hepatitis B
12 weeks
mean incubation time of Hepatitis C
7 weeks
what hepatitis type is the acute phase often asymptomatic
C
IV drug use is a major risk factor with hepatitis _______
D
which hepatitis types are transmitted via blood only
C and D
which hepatitis types are transmitted via fecal/oral route
A and
E
you are doing CRNA charity work in thailand, and a pt presents with hepatitis type sx; you know that hepatitis ________ is not common in the US but is common in underdeveloped countries
E
What is the treatment for Hepatitis C that has a 94-99% cure rate in those infected with HCV genotype 1?
harvoni (ledispasvir/sofosbuvir)
how do you take harvoni for hep C?
po daily for 8-24 weeks
what are the complications/SE with harvoni ?
- may cause hepatitis B reactivation in those co-infected with B and C
- causes bradycardia
if someone has a tumor in the head or tail of the pancreas what type of procedure may they have?
whipple (pancreaticoduodenectomy)
what are the risks with a whipple procedure
significant blood loss and fluid shifts during surgery
if pt is presenting for a whipple surgery, what preoperative labs are warranted?
hgb and blood typing
pts presenting for whipple due to tumor in the head of the pancreas or if they present with jaundice what additional labs should be obtained other than hgb and blood typing?
coagulation studies
what are risk factors of liver disease?
- ETOH hx
- sexual activity hx (hep B)
- IV drug hx
- transfusion hx
- tattoo and body piercing hx
- travel hx
- obesity: NASH?
- family hx: hemochromatosis, A-1 antitrypsin def
why is transfusion hx important in determining if someone may have unknown liver dz?
no screening for hep B in blood donors prior to 1986
no screening for Hep C in blood donors prior to 1992
pt presents and has no hx of liver dz; what are some signs and sx that may indicate unknown liver dz?
- fatigue, weakness, malaise - increasingly tired as day progresses
- weight loss
- anorexia
- generalized abd pain or RUQ pain/bloating
- jaundice
- dark urine
