Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Nursing, LPN, Year 2 > X GI: Accessory Organs (Ms Si, Burke Chp 27) > Flashcards

X GI: Accessory Organs (Ms Si, Burke Chp 27) Flashcards

You may prefer our related Brainscape-certified flashcards:
Nursing Pharmacology flashcards NCLEX-RN® flashcards Nursing Mental Health flashcards Nursing Fundamentals flashcards Nursing Safety & Infection flashcards Nursing Adult Health flashcards NCLEX-PN® flashcards Nursing Management of Care flashcards Nursing Pediatrics flashcards Nursing Maternity flashcards
1
Q

Digestive Track

A

Mouth - Esophagus - Sm Intestines (DJI) - Lg Intestines - Rectum - Anus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Is the liver a part of the digestive tract?

A

No, it’s an accessory organ

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Accessory Organs to digestion

A
  • Liver
  • Gall Bladder
  • Pancreas
  • Biliary Tract (made of biliary ducts)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

biliary tree

A

a system of vessels that directs Bile from the liver, gallbladder and pancreas through a series of ducts into the duodenum. The exit hole into the duodenum is called the papilla of Vater. (hepatic duct, cystic duct, common bile duct)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Liver facts

A
  • largest glandular organ
  • located - RUQ below diaphragm, over Gall Bladder. RT lobe larger than L.
  • can NOT palpate from outside body. If you can, there is a problem.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the largest organ?

A

The Skin. Liver is the largest GLANDULAR organ

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Construction of Liver

A
  • 2 Lobes
  • thousands of lobules per Lobe
  • lobules made of hepatic cells.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Functions of the Liver

A
  • Metabolic
  • Hematologic
  • Digestive
  • Produces: Bile/Cholesterol
  • Converts: Glucose –> Glycogen
  • Regulates: BG
  • Filters: blood; remove drugs/ETOH
  • Stores: Glucose, ADEK (fat sol vits)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Function of Liver (Michael Linares, Simplenursing.com)

A 
(People Drink So Much)
Produce: (Albumin, Bile, Clot Fac)
Detox
Storage (glycogen)
Metabolize (NH3 --> Urea)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How does liver react to BG? Hi or Lo

A

BG UP - liver stores glucose

BG LO - liver converts glycogen to glucose when pancreas secretes Glucagon to stimulate liver to do so.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is BILE? Where made and stored?

A
  • fluid made by liver, stored in GB.

- It emulsifies fat

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Bile made of

A

H20, E, cholesterol, bile pigments, bile salts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are bile pigments?

A

they give stool color. from breakdown of RBCs.

  • Bilirubin
  • Biliverdin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How much Bile does Liver secrete?

A

700 - 1200ml/day

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Bile salts are made from?

A

Cholesterol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the digestive Fx of Bile

A
  • fat digestion

- absorption of fat soluble vits

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Statins stimulate the liver’s production of what? What is the overall effect?

A

Bile salts,
LO cholesterol, by using up cholesterol

Lipitor
Zocor
Pravachol (pravastin)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How much bile does the Gall Blader store?

How much bile does the Liver produce?

A
  • 50ml

- 700 - 1200ml

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Rhabdomyolysis

A

muscle cramping. s/e of taking statins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Gall Bladder, Def and Fx

A

sac that stores bile

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

The Biliary Tract ducts connect what?

A

Liver, GB, Duodenum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What bile ducts are in the Biliary Tract?

A

Hepatic bile duct, Cystic duct, Common Bile Duct (CBD)

see pic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Fx of Hepatic Bile Duct

A

receives bile from liver lobules

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Fx of Cystic Duct

A

carries bile from GB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Fx of Common Bile Duct (CBD)

A

Hepatic duct merged w Cystic duct into CBD, to empty into duodenum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What type of gland is the Pancreas?

A

Endocrine and Exocrine

  • Exocrine - secrete into ducts (Amylase, Lipase, Protease digestive enzymes)
  • Endocrine - secreted into blood (i.e. insulin)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

where is Pancreas located?

A

behind stomach

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What does the pancreas secrete?

A

ENZYMES for digestion (Amylase, lipase, Protease)
HORMONES to reg BG (Glucagon (+BG), Insulin (-BG))
GASTRIN (stim secretion of gastric acid)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

***Where do the CBD and Pancreatic Duct meet?

A

Ampulla of Vater (see pic)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

***What does the Spinchter of Oddi do, where is it?

A

at base of CBD and pancreatic duct. It regulates the amount of bile released into the duodenum (see pic)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Cholecystitis

A

(GB) (Bladder) (inflam)
Chole cyst itis

  • Inflammation of the GB
  • 90% caused by cholelithiasis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Cholelithiasis

A

Presence of gallstones, in ductal system or in GB itself.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What are most cases of Cholecystitis caused by?

A

Cholelithiasis (Gall Stones)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Types of Gallstones

A
  • Cholesterol (75% of stones)

- Pigment (Black and Brown)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What secretes Cholesterol?

A

Cholesterol is secreted by the liver into Bile.

Detergents secreted by liver to dissolve the cholesterol in bile

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Why does the liver secrete detergents?

A

to dissolve the cholesterol in bile.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What ‘detergent’ does the liver produce?

A

Bile Acids, Lecithin.

to dissolve cholesterol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Causes of Cholesterol Gall stones

A

1) UP Cholesterol, normal detergent
2) Lo detergent, normal cholesterol

Undissolved chol in GB becomes fat, sticky, forms into stones.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What does the Spleen do?

A

breaks down RBC and filters blood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

BILE PIGMENT: process of forming bile

A

RBC broken down in Spleen (Hemoglobin) –> Globin (protein) + Heme (iron) –> Biliverdin (pigment) –> Indirect Bilirubin (unconjugated) –> Indirect Billirubin travel to Liver –> joins w Glucuronide molecules –> forms Direct Bilirubin (conjugated)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

If you have problems with Indirect Biliruben, where does the problem lie?

A

Spleen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

If you have problems with direct Biliruben, where does the problem lie?

A

Liver

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

2 types of Pigment Gall Stones?

A

Black pigment

Brown pigment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

How are Black Pigment GS formed?

A

excessive bilirubin in Bile. w UP destruction of RBCs, more bilirubin is produced.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

How are Brown Pigment GS formed?

A

bile stasis in GB combines w bacteria and calcium d/t

1) blockage in cystic duct or
2) stenosis of duct

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Stenosis

A

an abnormal narrowing of blood vessel or other tubular organ or structure. aka stricture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Stricture

A

aka Stenosis. Abnormal narrowing of blood vessel

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Risk factors for Gall Stones

A
  • sedentary lifestyles
  • sex (female, 25% by 60yrs/50% by 75yrs)(estrogen)
  • race (native/Hispanic American)
  • Family Hx
  • DM, Obesity, Pregnancy
  • HRT (hormone replacement therapy)
  • Angina
  • Diet
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Estrogen has what affect on the liver?

A

causes liver to remove cholesterol from blood and deposit into bile

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

SS of Cholecystitis/Cholelithiasis

A
  • biliary colic (PRIMARY SYMPTOM, 80% pts)
  • RUQ abd pain triggered by fatty meals
  • referred R shoulder pain
  • severe N/V
  • Fever
  • Leukocytosis
  • Jaundice
  • severe
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

What is the primary symptom of Cholelithiasis and Cholecystitis?

A

Biliary Colic
in 80% of pts.
-Steady or intermittent pain, sever 15min - 5hr, severe N, RUQ Abd pain.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Cholelithiasis/Cholecystitis: Dx Tests

A
  • Fecal study
  • US/CT scan
  • HIDA Scan
  • ERCP
  • Oral Cholecystogram
  • IV Cholangiography
  • Liver Enzymes
  • WBC
  • Serum Bilirubin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Fecal Study produces what kind of stool?

A

Clay Colored Floaters, stool without bile. No bile means you wont digest fat. Clay color means no bile. Float because of HI fat content

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

Cholelithiasis and Cholecystitis: Complications

A
  • Necrosis/Gangrene (inflamed GB can develop abcess. Can lead to..)
  • Fistula
  • Pancreatitis
  • Perforated GB (Peritonitis)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Fistula

A

Tunnel formed btwn 2 structures. Inflamed GB sticks to nearby organs. i.e. SI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

Pancreatitis

A

Inflamed pancreas d/t stone in CBD, The digestive enzymes back up into pancreas and eats away at it

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

Peritonitis

A

r/t Perforated GB
-inflammation of the peritoneum, which is the membrane that lines
the wall of the abdomen and covers the abdominal organs.
-main cause of secondary peritonitis is the escape of pus from infected abdominal organ, including
.Perforated gall bladder – this small sac stores bile from the liver. A severe infection (cholecystitis) can cause the gall bladder to burst.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

Cholelithiasis/Cholecystitis: Rx

A
  • Cholecystectomy w T-tube (GB removal)
  • MED: Ursodiol (oral dissolution therapy)
  • Lithotripsy (sound waves to break up stones)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

Cholelithiasis/Cholecystitis: Cholecystectomy

A

Removal of the Gall Bladder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

Cholelithiasis/Cholecystitis: MED: Ursodiol

A

.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

Cholelithiasis/Cholecystitis: Lithostripsy

A

sound waves to break up stones

-GS fragmentation (

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

Cholelithiasis/Cholecystitis: Oral Dissolution Therapy

A
  • med Ursodiol, a naturally occurring bile acid (detergent) to dissolve sm cholesterol gall stones (1-1.5cm).
  • Lowers cholesterol secreted into the bile
  • 1-2yrs to take effect
  • still will return after stopping Ursodiol
    (i. e. 102 yrs old pt took this instead of sx.)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

Cholesystectomy w T-tube

A
  • purpose is to keep the CBD (common bile duct) open. Get rid of residual gall stones
  • promotws flow of bile
  • 4-6wks, external tube
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

Cirrhosis

A
  • Scarring of Liver
  • chronic degenerative disease
  • –> End Stage Liver Disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

Cirrhosis: Pathos

A
  • destruction of liver tissue
  • separation of lobules by fibrous tissue
  • dev of abnormal nodules
  • abnormal vasculature
  • repeated liver damage, r/t disease/chemicals
  • repairs w Fibrous tissue –> nodular shape
  • scar tissue restricts blood flow
  • leads to UP pressure in Portal Venus System
  • leads to port HTN
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

Portal HTN

A

?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

Splenic + Sup Mesenteric veins dump into

A

Hepatic Portal Vein –> liver for purification –> thru hepatic vein to Inferior Vena Cava to Rt. Atrium of Heart. (SEE PIC)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

Liver makes Clotting Factor to…

A

clot blood when injured.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

Liver uses what to make Clotting Factor?

A

proteins (amino acids) from the digestive tract through Portal System.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

Portal HTN

A

complication of cirrhosis

  • blood backs up in portal vein –> UP pressure in vein
  • affects all veins draining into Portal Vein
  • veins not designed for hight pressure. Arteries are.
  • vein w rupture –> massive hemorrhaging
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

Complications of Impaired blood flow

A
  • Portal HTN –> though liver
  • Ascites
  • Esophageal Varices (like hemorrhoids)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

Na+ follows H2O

A

Na+ follows H2O

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

Portal HTN –> Ascites. How?

Cirrhosis complications

A

altered vessel permeability + fluid leakage into abdomen

fluid follow protein

Liver CAN’T make Albumin –> fluid exits blood–> decrease in circulating volume (water is collecting in interstitial spaces) –> UP in Aldosterone (secreted by Adrenal gland r/t LO blood volume) –> kidneys retain Na + H2O –> UP press in vessels –> more Portal HTN –> upper body vein distension –> Esophageal Varices

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

Complications of Cirrhosis, Portal HTN (again)

A
  • Portal HTN
  • liver not making albumin
  • fluid leakage into abdomen
  • ascites
  • body senses LO blood volume
  • kidney retains fluid
  • UP Blood Volume AND Interstitial fluid
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

Type of Cirrhosis

A
  • Alchoholic Cirrhosis (Laennec’s)
  • Post necrotic Cirrhosis
  • Biliary Cirrhosis
  • Cardiac Cirrhosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

Achoholic Cirrhosis

A
  • PRIMARY cause of Cirrhosis in US
  • results after 10yrs heavy drinking
  • liver breaks down ETOH to Toxic substances –> inflammation –> liver cell destruction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

Postnecrotic Cirrhosis

A
  • necrosis of whole hepatic nodules w scarring

- cause: acute hepatitis, infections, hepatotoxins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

Secondary Biliary Cirrhosis

A
  • bile building up in liver
  • liver bile duct destruction
  • cause: unknown, gall stones, tumor
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

Cardiac Cirrhosis

A
  • chronic R sided HF from Cor pulmonale

- hepatic congestion –> fibrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

Cor Pulmanale

A

abnormal enlargement of the right side of the heart as a result of disease of the lungs or the pulmonary blood vessels.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

Fibrosis

A

,

82
Q

If R Atrium is blocked, blood backs up in the head –>

A

Distended Vein –Back up in Liver. (review heart)

83
Q

Hepatomegly

A

Enlarged liver and Edema in lower extremeties

84
Q

If L atrium blocks, where would backup be?

A

Lungs, pulmonary edema (review heart)

85
Q

Causes of Cirrhosis

A
  • ETOH
  • chronic Hep B/C
  • Autoimmune disease
  • Non ETOH fatty liver disease
  • Prolonged exposure to toxic material
  • OTC (tylenol), Rx Drugs
86
Q

Nonalchoholic fatty liver disease (Steatosis)

A

Fat accumulating in liver

  • Obese
  • lobules separate, scarring
  • build up of extra fat in liver cells not caused by alcohol. It is normal for the liver to contain some fat. However, if more than 5% - 10% percent of liver’s weight is fat, then it is called a fatty liver (steatosis).
87
Q

Cirrhosis: Early SS

A
  • N/V/Constip/Diar
  • loss appetite
  • flatulence
  • abd discomfort
  • hepatomegaly
  • LO Hgb
  • Jaundice
  • Fever (pyrexia)
88
Q

Hepatomegaly: Early SS

A
  • sharp edge on palpation (normally you can’t palpate liver)

- cells filled w fat

89
Q

Hepatomegaly: Late SS

A
  • Dyspnea
  • Pruritis/Jaundice (d/t liver not breaking down bilirubin. Bilirubin collecting in skin causes itching)
  • Collateral Blood vessels (vessels in GI system that w shunt blood away from portal venus system (PVS)
  • Spider Telangiectasia (spider veins)(dilated BV. cheecks, nose, neck, chin, tongue sometimes, purple/red
  • Gall Stones
90
Q

Collateral Blood Vessels

A

abnormal blood vessels that connect the aorta with the pulmonary arteries. The aorta is a blood vessel that carries blood from the heart to arteries throughout the body.

91
Q

Portal Venus System

A

refers to the vessels involved in the drainage of the capillary beds of the GI tract and spleen into the capillary bed of the liver. Blood flow to the liver is unique in that it receives both oxygenated and deoxygenated blood.

92
Q

Hepatomegaly: more Late SS

A
  • Ascites/Edema
  • Esophageal Varices
  • Caput Medusae (distended abd veins)
  • ***confusion (hepatic encelopathy)
  • Vit LO, anemia (b/c can’t store vitamins)
93
Q

Hepatic Encelopathy

A
  • Liver –>produces ammonia with filtering (toxic to body esp brain) –> out in URINE.
  • when system fails, ammonia builds up in body affecting brain.
94
Q

Cirrhosis: Dx tests

A
  • Liver biopsy (scarring?)
  • liver enzymes (UP blood)
  • UP Bilirubin in blood b/c liver can’t process it
  • UP NH3 in blood b/c liver can’t convert it.
95
Q

Cirrhosis: more Dx tests

A
  • UP coagulation times (liver no making enough CF, longer to clot)
  • LO serum albumin, total protein
  • US, CT scan, MRI, ERCP
96
Q

ERCP (Endoscopic Retrograde Cholangio-Pancreatography)

A

procedure that enables your physician to examine the pancreatic and bile ducts. A bendable, lighted tube (endoscope) about the thickness of your index finger is placed through your mouth and into your stomach and first part of the small intestine (duodenum).

97
Q

Hepatomegaly: Med Mgt Goal

A

-Goal to prevent further damage

98
Q

Hepatomegaly: Med Mgt Diet

A
  • eliminate ETOH, Hepatotoxins (tylenol)
  • Diet: UP calorie/protein, LO fat/Na+, take vitamins (b/c liver can’t store)
  • If Hepatic Encelopathy present? LO protein because liver not breaking down anything well and protein will result in NH3 in body.
99
Q

Hepatomegaly Diet if Hepatic Encelopathy present?

A

LO protein because liver not breaking down anything well and protein will result in NH3 in body.

100
Q

Hepatomegaly: more Med Mgt

A
  • Antiemetics (N)
  • Diuretics (fluid mgmt)
  • Anti HTN (treat Portal HTN)
  • Antihistamines (for pruritis)
  • Cholesterol binding meds
  • Treatment of varices
101
Q

Hepatomegaly: Complications

A
  • Ascites
  • Esophageal Varices
  • Hepatic Encelopathy
102
Q

Ascites

A

-excess fluid in peritoneal cavity (portal HTN, backup of blood flow)

103
Q

Ascites Rx

A

depends on severity

  • 1st:
  • BR, I+O, fluid/Na+ restriction
  • Vit supp (liver can’t store vits)
  • Diuretics (take away fluids)
  • Albumin (draw fluids into blood)
104
Q

Ascites Rx (agressive)

A

LAST RESORT
-LeVeen Continuous Peritoneal Jugular Shunt (redirects Ascitic fluid from abd cavity to SVC - to R atrium.
(learn heart)

105
Q

Ascites: Surgical Shunting

A

-Divert blood from Venus portal system - venus system
-portacaval shunt: portal vein (base of liver) connected to IVC
(learn heart)

106
Q

Portacaval shunt

A

Portal vein attached to IVC and cut off from liver. (See pic)

107
Q

Ascites: Paracentesis

A
  • removal of fluid from peritoneal cavity
  • Rx for massive ascites
  • remove 2-6L of fluid
108
Q

Varisces

A

Varices are dilated veins in the distal esophagus or proximal stomach caused by elevated pressure in the portal venous system, typically from cirrhosis.

109
Q

Gastrointestinal Varices

A

Gastric varices are dilated submucosal veins in the stomach, which can be a life- threatening cause of bleeding in the upper gastrointestinal tract.

110
Q

Esophageal Varices

A

Dilated, tortuous veins in Esophagus d/t portal HTN

  • HI mortality rate
  • caused by straining (bm, cough, sneeze) result in rupture
111
Q

Esophageal Varices S/S

A

Usually none until massive hemorrhaging

112
Q

Esophageal Varices Mortality Rate

A
  • Hi mortality rate
  • pts who bleed 1ce, have 70% rebleed rate. (50% survival)
  • 1/3 of rebleeds are fatal
113
Q

Bleeding Esophageal Varices: Dx

A

Dx: endoscopy

114
Q

Bleeding Esophageal Varices: Rx

A
  • Endoscopy (2 types)
  • Med
  • Balloon tamponade
115
Q

Bleeding Esophageal Varices:

Types of Endoscopy

A
  • Sclerotherapy: inject irritant into Varices causing it to clot
  • Ligation of Varices: rubber band around Varices and cut off
116
Q

Bleeding Esophageal Varices: Med?

A

Vasopressin (vasoconstrictor)

117
Q

Bleeding Esophageal Varices: Balloon Tamponade (Sengstaken-Blakemore Tube)

A

use of balloons inserted into the esophagus, stomach or uterus, and inflated to alleviate or stop refractory bleeding.

118
Q

Hepatic Encephalopathy

A

-Ammonia accumulating in brain, impairs brain cell function.

119
Q

Hepatic Encephalopathy: SS

A
  • changes in MS (mental status)
  • Motor disturbances (i.e. Asterixis)
  • Hepatic Coma
120
Q

Asterixis

A

Asterixis (also called the flapping tremor, or liver flap) is a tremor of the hand when the wrist is extended, sometimes said to resemble a bird flapping its wings.
-liver in trouble, affecting brain

121
Q

How is ammonia processed in body?

A

(NH3) Ammonia –>broken down in LIVER –> into UREA –> excreted in URINE

NH3 –> crosses BBB (blood, brain barrier) –> damages neurons (change in MS, LOC) and astrocytes (motor problems)

122
Q

Recommended diet w or w/out Hepatic Encephalopathy

A
  • Ammonia by product of protein metabolism
  • w Hepatic Enc: NO PROTEIN (because it will increase NH3 in body)
  • w out Hep Enc: HIGH PROTEIN to build up body from sickness, prevent ascites
123
Q

Hepatic Encephalopathy MM/NI

A
  • monitor neuro status (Orientation, LOC, Gain, Speech, PERRLA, MAE)
  • daily NH3 levels
  • I/O
  • diet: no protein
  • MED: Neomycin (LO bacteria in colon)
  • MED: Lactulose (LO NH3 by causing diarrhea, bacteria out to reduce NH3)
124
Q

Hepatic Encephalopathy MEDS

A
  • Neomycin (antibiotic)

- Lactulose (lower NH3 by causing diarrhea, bacteria out to reduce NH3)

125
Q

Lactulose

A
  • CLASS: Laxative, NH3 detoxicant
  • ACTION: prevents absorption of NH3 in colon
  • USE: Hepatic Encephalopathy
  • ADMIN: oral, rectal (solution via PO, NGT, Enema)
  • S/E: N/V/D
  • NI: monitor NH3 levels
126
Q

Cirrhosis: NI

A
  • monitor VS
  • SS: hemorrhage, LO prod of clotting factors, varices d/t portal HTN
  • precautions: bleeding since no CF
  • report changes: monitor MS
  • Diet/Nutrition: educate patient
  • skin care: pruritis d/t bilirubin in skin
  • I+O, abd, girth measurement, daily weight
  • counseling/support in alcoholism
127
Q

If on bleeding precautions: RANDI

A 
R: razor, electric
A: aspirin, NO
N: needles,small gauge 
D: decrease needle sticks 
I: injury, protect from

Observe for:

  • Hematuria, Melena
  • Nose bleeds
  • Gingivital bleeding
  • Bruising
128
Q

Carcinoma of Liver

A
  • rare

- Secondary carcinoma more common than primary. Secondary means it metastasized to liver and didn’t originate there.

129
Q

Liver CA Risk Factors

A
  • Hep B/C (genetic makeup of hep b found in genetic makeup of CA cells. Hep C known to cause Cirrohsis)
  • Cirrhosis
  • ETOH abuse
  • Aflatoxin BI (chem from mold in food: peanuts, rice, wheat, soy, corn)
  • drugs; bcp, hormone replacement
  • chem; bpa etc
130
Q

Liver CA S/S

A
  • hepatomegaly
  • weight loss
  • edema/ascites
  • portal HTN
  • abd pain
  • N/V
131
Q

Liver CA: Dx Tests

A
  • Liver enzymes
  • AFP (alpha-fetoprotein, usually LO in adults, HI in fetus’, in Live CA, it’s HI)
  • CT Scan/MRI/US
  • ERCP
  • Hepatic Arteriography
  • Liver Biopsy
132
Q

ERCP

A

Endoscopic retrograde cholangiopancreatography, or ERCP, is a specialized technique used to study the bile ducts, pancreatic duct and gallbladder. Ducts are drainage routes; the drainage channels from the liver are called bile or biliary ducts. The pancreatic duct is the drainage channel from the pancreas.

133
Q

Hepatic Arteriography

A
  • local anesthetic
  • needle in arm artery
  • catheter fed thru needle into hepatic artery
  • contrast dye injected
  • xrays display hepatic artery
134
Q

Liver CA: MM

A
  • lobectomy - removal of a lobe
  • systemic chemo
  • hepatic artery perfusion of chemo
  • tumor ablation
  • liver transplant
135
Q

Hepatic Artery Perfusion of Chemo

A
  • LIver CA gets blood from hepatic artery
  • Chemo administered thru Hepatic Artery directly to Tumor
  • Higher concentration of chemo delivered to tumors

Theoretically: won’t get systemic effects on effect straight to liver tumor. In actuality it does have systemic effects

136
Q

What does CA need to live?

A

a blood supply

137
Q

Liver CA: NI, Nursing Interventions

A
  • monitor VS
  • monitor S/S hemorrhage
  • Precautions: bleeding
  • Monitor MS/ report changes
138
Q

VS is ALWAYS an expected

A

Nursing Intervention

139
Q

Liver CA: NI (same as Cirrhosis)

A
  • diet/nutrition education
  • skin care
  • I/O, abd girth measurements, daily weight
  • MEDS education
  • counseling/support on Alchoholism
140
Q

Liver CA: Prognosis

A

Poor, death 1yr post dx

141
Q

Pancreatitis

A
  • Inflammation of Pancreas
  • Acute/Chronic
  • Cause: *Gall stones, *ETOH, auto immune, virus, trauma, ERCP, drugs (Tylenol, Estrogen, Chemo, HIV med, Hep AB Vaccine
142
Q

Pancreatitis Causes

A
  • *Gall stones,
  • *ETOH,
  • auto immune
  • virus
  • trauma
  • ERCP
  • drugs (Tylenol, Estrogen, Chemo, HIV med, Hep AB Vaccine)
143
Q

Pancreatitis: Pathos

A
  • Enzymes activated in pancreas
  • auto digestion
  • -> necrosis, pseudocysts, abcesses
144
Q

Pancreatitis: Enymes activated in Pancreas

A

{Amylase, protease, lipase}

enzymes released through pancreatic duct

145
Q

Pancreatitis: Auto Digestion

A

enzymes start breaking down pancreas, not food outside

146
Q

Pancreatitis: Pseudocysts

A

sac of enzymatic pancreatic exudate that forms on or around pancreas. if ruptures, can lease to hemorrhage.
–> abcess

147
Q

Pancreatitis: S/S - ACUTE

A
  • upper Abd Pn radiating to back
  • swollen, tender abd
  • N/V
  • Fever
  • Tachycardia
148
Q

Pancreatitis: S/S - CHRONIC

A
  • Chronic upper Abd Pn
  • N/V
  • Anorexia/Weight Loss (d/t food not digesting because enzymes stay in pancreas)
  • Steatorrhea (fatty stool b/c all fat still there, not digested)
149
Q

Pancreatitis: Dx Tests

A
  • Amylase/Lipase (serum/urine, UP b/c not going to cystic duct, spilling into blood (Endo/Exocrine)
  • Hyperglycemia (no insulin from Pancreas)
  • CT Scan/US
150
Q

Chronic Inflammation causes ?

A

Scarring

151
Q

Pancreatitis: Acute Rx

A
  • Eliminate causes(ETOH, remove GS)
  • minimize damage to pancreas/rest pancr
  • hydrate (IV not oral b/c that will stimulate pancreas to make more enzymes.)
  • Pain Mgmt (very painful)
152
Q

Pancreatitis: more Rx

A
  • NPO
  • IV fluid
  • Abx
  • Abcess/Cyst drainage
  • PCA (pt controlled analgesic)
153
Q

Pancreatitis: Chronic Rx

A

-Pain mgmt (NSAIDs, not narcotic or opiods b/c w cause more problems)
-Diet (lofat, sm meals)
-No ETOH
-Pancreatic Enzymes
MED Pancrelipase w 1st bite of food,tab
MED: Octreotide( Sandostatin), hormone suppresses Gh secreation (used in Gigantism to supress GH secretion)

154
Q

Hepatitis

A
  • 5 types, viral that cause physical problems
  • 1 type (Hep G) is asymtomatic
  • all types almost identical in Incubation, mode of transmission, prognosis
155
Q

How is Hepatitis transmitted?

A
  • cont food, H2O via fecesd (hand to mouth)

- body fluid/blood

156
Q

How does Hepatitis affect liver cells

A

cells become damaged and can lead to necrosis

157
Q

Hepatitis: Can liver cells regenerate?

A

YES

158
Q

Hepatitis: How are Liver cells affected w severe inflammation

A

scar tissue forms. Obstructing normal blook/bile flow, causing further damage –> eschemia

159
Q

Hepatitis A

A
  • most common type
  • oral fecal trans
  • often spread by food workers
  • mollusk shellfish (clam, scallops, muscles, cont. H2O)
  • Incubatino - 15 - 50 days
160
Q

Hep A: Incubation

A

15 - 50 days

161
Q

Hepatitis B

A
  • transmitted parental (veins/needles)
  • cont blood
  • transfusion
  • Dialyisis
  • direct contact w body fluids (semen, vaginal, saliva)
  • *** Healthcare workers most at risk (OR/ED/ICU/Phlebotomists, lab techs)
  • Incubation 60-90days
162
Q

Hep B Incubation time

A

60 - 90days

163
Q

Hep B, C, D similarities

A
  • pt can be asymptomatic
  • can carry virus in liver cells
  • can have it and not even know
164
Q

Hep C

A
  • trns thru cont needles
  • blood transfusion
  • Hemodyalisis
  • maternal fetal trans
  • multiple/infected sex partners
165
Q

Hep C Incubation time

A

2wks - 6mos

166
Q

What are the most serious types of HEP?

A
  • Hep B and C

- can progress –> chronic hepatities –> cirrhosis –> liver CA –> death

167
Q

Hep D

A
  • always associated w current Hep B infection (co-infection)
  • trans prenatally, sexually
  • incubation 2-8wks
168
Q

Hep D incubation time

A

2-8wks

169
Q

Hep E

A
  • fecal cont of H2O
  • rarely seen in US (Asia, Mid East, Mex)
  • fecal oral trans
  • China recently released vaccine for Hep E
  • Incubation 26 - 42 days
170
Q

Hep E Incubation time

A

26-42 days

171
Q

What strains of Hepatitis are there vaccines for?

A

only A/B

172
Q

Hep G

A
  • usually co-infection w Hep C
  • blood bourne exposure
  • Europe/Australia/Asia
173
Q

General Hepatitis S/S

A
  • pruritis (d/t bile under skin)
  • Hepatomegaly
  • enlarged lymph nodes
  • weight loss
  • general malaise
  • aching muscles
  • photo phobia
  • dyspepsia (indigestion)
  • H/N
  • chills
  • abd pain
  • Diarrhea
  • Constipatin

d/t liver not able to process bilirubin

  • jaundice
  • dark amber urine
  • clay colored stool
174
Q

Hepatitis MM

A
  • treat symptoms
  • small frequent meals
  • LO fat, HI carb
  • IV fluids
  • Vit C, K, B complex
  • avoid unnecessary meds so liver doesn’t work so hard
  • prevent transmission
  • pt education
  • bed rest for several weeks
175
Q

Drugs w Hepatotoxic effects

A
  • Phenothiazines (thorazine, stelazine, compazine, NAUSEA)
  • Sedatives
  • Hiv meds,estrogen ,Tylenol,TB meds
176
Q

Hep A: Tx

A
  • HAV (Hep A Vaccine), 2 doses, 6 mos apart
  • can be giving from 12mos old
  • well balanced diet to help Liver heal
  • 4-6 sm meals/day
177
Q

What do you administer to pt exposed to Hep A?

A

IG, Immune Serum Globulin (Gamma globulin)

178
Q

immune serum globulin (gamma globulin)

A

A sterile solution of globulins derived from pooled human blood that contains antibodies that are normally present in the blood of adults, used as a passive immunizing agent against rubella, measles, and hepatitis A and as treatment for hypogammaglobulinemia.

179
Q

Hep B Tx

A
  • VAC: HBV (Hep B vaccine)
  • MED: Epivir, Hepsera, Interferon\
  • MED: HBIG (hep B immune globulin)
  • VAC: RECOMBIVAX HB (3 doses, IM, protect up to 15yrs, produces immunity in 95% of vaccinated)
  • VAC: TwinRix
180
Q

MED: Lamivudine (Epivir)

A

Treats hepatitis B infection and human immunodeficiency virus (HIV) infection. HIV causes acquired immune deficiency syndrome (AIDS). This medicine does not cure hepatitis B, HIV, or AIDS, but it may help slow the disease progress.

181
Q

?????? Interferon

A

Interferons are a group of signaling proteins made and released by host cells in response to the presence of several pathogens, such as viruses, bacteria, parasites, and also tumor cells.

182
Q

MED: HBIG, Hepatitis B immune globulin

A

Prevents hepatitis B from occurring again in HBsAg-positive patients after a liver transplant. It is also used preventatively after exposed to hepatitis B virus.

183
Q

VAC: RECOMBIVAX HB

A

is a vaccine indicated for prevention of infection. caused by all known subtypes of hepatitis B virus.
-3 doses, IM, protect up to 15yrs, produces immunity in 95% of vaccinated)

184
Q

VAC: Twinrix

A

is a vaccine against hepatitis A and hepatitis B, manufactured by GlaxoSmithKline. Twinrix is administered over 3 doses.

The name was created because it is a mixture of two earlier vaccines — Havrix, an inactivated-virus Hepatitis A vaccine, and ENGERIX-B, a recombinant Hepatitis B vaccine. TWINRIX, HAVRIX and ENGERIX-B are registered trademarks of GlaxoSmithKline; if the same vaccine is available from others, it will have another name.

Twinrix first entered the market in early 1997.

185
Q

Hep C Tx

A
  • no vaccine
  • drug Tx
  • MED: Rebetol, Intron A Pegasys. (use combo to get rid of virus)
  • Liver transplant
  • 50% ppl w liver trans are HepC+
186
Q

MED:Ribavirin (Rebetol)

A

Treats hepatitis C. Used together with an interferon medicine, such as Intron® A, Peg-Intron®, or Pegasys®.

187
Q

Hepatitis Nutrition Mgmt

A
  • collect data
  • Hx of previous contact
  • if test +, have to notify people w possible exposure
  • must be reported to state dept of public health by law
  • assess pt for respiratory distress
188
Q

If liver not metabolizing drugs, what can result?

A

-mental confusion –> coma

189
Q

Hepatitis Education

A
  • hand washing
  • limit contact
  • proper handling of body secretions
  • after recovery, NO ETOH for 1 yr
  • long slow convalescence
  • emotional/psych support
  • develop new hobby. Long convalescence
190
Q

Hepatitis can cause massive necrosis of liver cell in small amount of patients resulting in death of 75% of ppl

A

.

191
Q

Asictes/Edema is a sign of ?

A

Liver failure

192
Q

Major post op concern for Liver transplant recipients?

A
  • Rejection and Infection
  • monitor for hemorrhage and drainage
  • I/O
  • preventing PNA ( re-positioning, coughing w splint)
193
Q

Why drug is given to aid in successful liver transplant?

A

-Cyclosporine.
An effective immunosuppressant to help lower rejection rate
-major reason for success of transplants

194
Q

What causes Liver abscesses?

A

Bacteria

-can have 1 or multiple accesses

195
Q

Liver Abscess S/S

A
  • Fever
  • Chills
  • Abd pn/tenderness, URQ
  • hepatomegaly
  • jaundice
  • Anemia
196
Q

Liver Abscess M/M

A
  • IV Abx
  • per cutaneous drainage of Liver abscess
  • open surgical drainage if abscess ruptures
197
Q

Liver Enzymes

A

Inflamed or injured liver cells leak higher than normal amounts of certain chemicals, including liver enzymes, into the bloodstream, which can result in elevated liver enzymes on blood tests. The specific elevated liver enzymes most commonly found are:

  • Alanine transaminase (ALT)
  • Aspartate transaminase (AST)
198
Q

*** Dx Tests: T-Tube Cholangiogram

A

Done post op to diagnose retained ductal stones for pts who have had cholecytectomy and to demonstrate good flow of bile –> duodenum

T-shaped rubber tube placed in bile duct where dye injected and xrays taken.Tube can stay temp to keep duct open and allow drainage of bile

199
Q

*** Dx Tests: T-Tube Cholangiogram: NI

A
  • ***Bag should be left at level of abdomen
  • If tube left temp, protect from sepsis by connecting to closed drainage system
  • if tube removed, site should stay covered w sterile dressing
  • ensure no Iodine allergy
  • NPO after midnight
200
Q

*** Dx Tests: Liver Biopsy

A

Safe simple method to Dx pathologic liver conditions. Special long needle inserted thru skin btwn 6/7 or 8/9 intercostal spaces and into liver.

  • Pt supine w RT arm over head and instructed to exhale fully. DONT BREATH while needle inserted. Used via US or CT guidance.
  • look at platelets
  • INR ordered (bleeding time) to ensure you will clot
201
Q

*** Dx Tests: Liver Biopsy: Post Op

A
  • monitor VS q 15min x 2
  • q30min x 4
  • q1hr x 4
  • some pain common
  • severe pn w leakage of bile
  • ensure pneumothorax (collapsed lung) doesn’t happen d/t improper needle placement.
  • pt on RT side min 2 hrs after. Splint puncture side to help compress liver to prevent bleeding.
  • monitor for hemmorhage

Nursing, LPN, Year 2 (27 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions