Week 2 (exam 1) Flashcards
Symptoms of ovarian cancer
Palpable ovaries
Pelvic pressure
Abdominal pain
Treatment of ovarian cancer
Hysterectomy
Chemo & Radiation
Breast cancer risk factors
Early period and late menopause
Alcohol consumption
Obesity
Genetics (BRCA 1 & 2)
Diagnostics of breast cancer
Blood tests
Brest exam (best performed if done 5-7 days after bleeding)
Mammogram
Ultrasound
MRI
Biopsy
Treatment of Breast cancer
Targeted therapy (meds that can help stop the growth of breast cancer)
Lymphoid removal
Mastectomy
Radiation and chemo
no blood pressure on the side of mastectomy or lobe ectomy)- they will have a limb alert bracelet
Testicular cancer risk factors
Cryptorchidism (undescended testicles)
Family or personal hx
Caucasian Americans
HIV positive men
Exposure to chemicals
Diagnostics of testicular cancer
Testicular exam
Alpha-fetoprotein (AFP) and beta-human chorionic gonadotropin (beta-hCG), may be elevated in patients with testicular cancer
Prostate cancer is common in men
50 + years
Prostate cancer symptoms
Asymptomatic in early stages
Nodule felt within the gland
Hardening in the posterior lobe of the prostate
Urinary hesitancy
Decreased urine output
Sexual dysfunction
Diagnostic of prostate cancer
Prostate specific antigen
Digital Rectal Examination
Transrectal Ultrasound
MRI
Biopsy (TURP)
Treatment of prostate cancer
Prostatectomy via TURP
Radical Prostatectomy
External Beam Radiation Therapy
Brachytherapy
Following a TURP or a prostatectomy side effects include
sexual impotence, urinary incontinence, bladder spasms, bleeding
- they will require continuous bladder irrigation*
Things to teach when they come off of continuous bladder irrigation
- they will have urinary incontinence
- teach them to do Kegel exercises
- discourage sitting for long periods of time
Bone cancer
typically a secondary cancer that has metastasized from another.
Bone cancer symptoms
Bone pain
Weakening (be careful of bone fractures)
Hypercalcemia
- fatigue
- weakness
give fluids and bisphosphonate
Skin cancer risk factors
Sun exposure
Genetics
Fair skin
Lots of moles
Skin cancer treatment
Removal w wide excision (dr will check the boarders of excision to make sure they got all of the cancer)
Types of skin cancer
Squamous Cell Carcinoma
Basel Cell Carcinoma
Markel Cell
Melanoma
Functions of the Liver
- metabolism of protein, fat, glucose, and drugs
- bile FORMATION
- amonia CONVERSION
- biliruben EXCRETION
- storage of Vitamins A, B, and D
- Coagulation factors
Liver function studies
Serum aminotransferases - AST, ALT, GGT, LDH
Serum protein studies
Pigment studies
PT/INR
Serum alkaline Phosphatase (increases with biliary duct obstruction causing gallstones)
Serum ammonia
Renal Function
Diagnostic Tests for liver cancer
Ultrasound
CT
MRI
PET scans
Biopsy (most definitive)
Liver failure symptoms
Dull pain in RUQ
Jaundice
Large Liver
Loss of strength
Anorexia/weight loss
Ascites
Anemia
DJ Loves Looking At Amazing Animals
Process of liver biopsy
- assess PT/INR, platelets
- have provider explain procedure
- Pt will be NPO, sitting supine
- provider will puncture the right upper quadrant between the ribs
- have the pt take a deep breath in and hold pressure on the site
- place pt on right side and monitor for bleeding
- monitor for difficulty breathing
Cirrhosis, what is it and what can cause it
a chronic liver disease in which normal liver tissue is replaced by fibrosis that disrupts the structure and function of the liver.
Cirrhosis is caused by
- alcohol → fatty liver disease
- hepatitis (post necrotic)
- chronic biliary obstruction
Manifestations of Cirrhosis
- liver enlargement
- portal hypertension
- ascites
- edema
- jaundice → itchy skin
- Vi deficiency
- anemia
- itchy skin
- confused
- esophageal varices
- spleenomegly
Down fall of the liver stages
- Healthy liver
- Fatty
- Fibrosis
- Cirrhosis
- Cancer
Ascites is a result of
portal hypertension or not enough albumin
Patho of ascites
Cirrhosis with portal hypertension → Splanchnic arterial hypertension → Decrease in circulating arterial blood flow → Activates the RAAS, SNS, and the antidiuretic hormone → Kidneys retain Na and water causing hypervolemia → Persistent activation of systems for Na and water retention = ascites and edema
Things to access with ascites
- abdominal girth
- daily weight
- see if pt has striae, distended veins, umbilical hernia
- percuss for dullness or fluid wave
- assess for fluid and electrolyte imbalance
Treat ascites with
low Na diet (2/3g) (no salt substitutes)
diuretics
bed rest
paracentesis
adminiter albumin
TIPS to bypass portal vein
Bleeding of Esophageal varies
- occurs in 1/3 of cirrhosis pts
- hematemesis, melena, deterioration, and shock
- pts with cirrhosis need endoscope every 2 years
if vessels ruptures theycould hemorrhage and aspirate on blood
Treatment of Esophageal Varies
- O2, IV fluids, electrolytes
- Blood and blood products
- Vasopressin, Somostatin, Octreotidie to decrease bleeding
- Nitroglycerin
- Propranolol and Hadolol to decrease portal pressure
- ballon tamponade to put pressure
- intubate
- endoscopic sclerotherapy (to promote clotting)
- Banding around varicose to necrosis and fall off
Vasopressin
Antiduretic hormone that caused the conservation of water and constricts blood vessels
Somostatin
a peptide hormone used to treat variceal bleed, it reduces blood flow to the portal system, which decreases the pressure in the veins and reduces bleeding.
Octreotidie
a synthetic drug used to treat acute esophageal variceal bleeding. It’s a somatostatin analog that reduces portal blood flow and pressure, which can help control bleeding
drug type: octapeptides
Propranolol
a beta blocker that is given to reduce the incidence of first variceal bleeding
Nadolol
a nonselective beta-blocker that can help prevent and treat variceal bleeding in people with cirrhosis
Beta blockers to prevent from rupture
Propranolol, Metoprolol, Sotalol, Atenolol
blocking the effects of the hormones (epinephrine) and (norepinephrine) slowing down the heart rate and reducing the force of cardiac contractions, thereby lowering blood pressure
What is Hepatic encephalopathy and coma and it’s (4 stages)
Life threatening complication of liver disease from the accumulation of ammonia and other toxins in the blood
1. Normal MS
2. Drowsy
3. Stuporous
4. Coma
Hepatic encephalopathy problems are increased by…
- GI bleed
- Hypovolemia
- Infection
- Hypokalemia
- Constipation
- Opioid meds
Treatment of Hepatic encephalopathy
- lactulose
- protein intake 1.2-1.5g.kg.day
- Discontinue any meds that can cause change in MS
- Neuro exams, fluid and electrolytes, Is and Os
- Antibiotics (to help ↓ ammonia levels)
Neomycin/Flaygal
Neomycin: antibiotic used to prevent and treat infection and can also be used for hepatic liver failure
Flaygal: antibiotic used to treat bacteria infections
Rifaximin
antibiotic used to diarrhea but in this case it is being used to decrease ammonia levels
Hepatitis
Inflammation of the liver
Viral Hepatitis (types)
systemic viral infection that causes necrosis and inflammation of the liver cells
- A&E = Vowels that come from the bowel aka fecal oral transmission (wash yo hands) (in order to have E you have to have A)
- B = Bodily flids (blood, seamen, saliva (long incubation period)
- C = sharing of needles or sexual contact (could be chronic carrier)
- D = only get of you’ve had hep B, transmitted through blood
only a vaccine for A and B
Signs and symptoms of hepatitis
RUQ pain
Jaundice
Dark urine
Flu like symptoms
Clay colored stools
Labs to dx Hepatitis
- ALT
- AST
- ALP
- Total bilirubin
- Presence of specific antibody/antigen
Treatment of Hepatitis
- Rest and Fluids (especially for Hep A)
- Nutrition
- Activity as tolerated
- Antivirals for Hep B and C
- Interferons for Hep B
