Advanced GI: Hepatic & Pancreatic Disorders Flashcards
What are the vascular functions of the liver?
blood storage and filtrations
What are the secretory functions of the liver?
bile productions and bilirubin metabolism
What are the metabolic functions of the liver?
digests carbs/ fat/ protein, synthesizes all clotting except for Von Willebrands, aids in synthesis of albumin, prothombin, and fibrogen, detoxification, vitamin and mineral storage (A, D, E, K, iron, copper)
Liver ________ in size with aging.
decreases
decreased synthesis of enzymes which help metabolize drugs
liver aging
- Ask ?s in nonjudgmental manner
- Always ask about family hx of liver disease
- Any hx of drug use (IV or intranasal?)
- Hx of tattoos?
- Been in military?
- In prison? County jail? Healthcare worker?
- Hx of Hepatitis?
- Ask about employment hx (exposure to toxins?)
- Sexual Hx?
Assessment Questions for Liver Function
growth of the breast tissue in men related to hormonal changes during liver disease
gynecomastia
7 F’s for Abdominal Distention
fat, fetus, fluid, flatulence, feces, fibroid, fatal tumor
skin abnormality in liver disease in which red, spider-like clusters appear on chest, back or umbilicus…they blanche
spider angiomas
What should the nurse inspect on a patient with liver disease?
skin color (everywhere, look for jaundice), surface characteristics, surface movements
What is shifting dullness?
When the patient lies on their side, the top of abdomen will have tympany (high-pitched sound) because of gas rising up and the bottom of abdomen will have dullness b/c fluid will shift down
What is a fluid wave?
When the patient’s side is tapped, the abdominal fluid will cause a wave across the abdomen.
Liver patients are at a high risk for _________.
bleeding
hernia surrounding the umbilicus in which the blood vessels pop out
caput medusa
vascular changes in the hand that cause the palms to be red
palmar erythema
What do ultrasounds of the liver check for?
patency of blood vessels in liver, gallstones, cysts, tumors & fat
What can CT scans pick up on the liver?
exact size of the liver, small lesions, look at bile ducts closely
What is an MRCP?
MRI of the pancreas and bile ducts
Is the MRCP or the ERCP more invasive?
the ERCP is more invasive
What does liver nuclear testing check?
cystic duct disease
AST Normal Level
10-35 units/L
In acute liver injury, AST is __________.
elevated
In chronic liver disease, AST is ________ or _________.
decreased or normal
ALT Normal Level
4-36 units/L
In acute liver injury, ALT is __________.
elevated
In chronic liver disease, ALT is ________ or _________.
decreased or normal
AP Normal Level
30-120 units/ L
GGT Normal Level
8-38 units/ L
In acute liver injury, AP and GGT are __________.
elevated
Bilirubin Normal Level
0.3-1.0 mg/ dL
In chronic liver disease, bilirubin is ________.
elevated
Albumin Normal Level
3.5- 5 g/ dL
Total Protein Normal Level
6.4-8.3 g/ dL
In chronic liver disease, albumin and total protein are _______.
decreased
PTT Normal Level
11-12.5 seconds
LDH Normal Level
??
In chronic liver disease, PTT is ________.
prolonged
In acute liver disease or liver tumors, LDH is ________.
elevated
80% of liver function is gone once __________.
albumin is decreased and PTT is prolonged
Normal Bleeding Time/ Platelet Closure Time
64-120 seconds
Ammonia Normal Level
6-47 µmol/L
In chronic liver disease, bleeding time is ________.
increased
In chronic liver disease, ammonia is ________.
elevated
In chronic liver disease patient, CBC will show _________.
B12, Folic Acid and Iron Deficiencies Anemias
In chronic liver disease, platelets are ________.
low (thrombocytopenia)
Before a liver biopsy, _________ is tested.
bleeding time
Elevated ammonia causes _________ and __________.
agitation and confusion
The gold standard test for liver disease.
liver biopsy
liver biopsy obtained by cutting the abdomen
open liver biopsy
liver biopsy obtained by going through the jugular vein
closed liver biopsy
The labs prior to a liver biopsy are __________.
H&H, bleeding time, platelets, and PT
If PT is high or platelets are low prior to liver biopsy, what does the nurse do?
notify the surgeon
What does the nurse give if PT is high or platelets are low prior to liver biopsy?
Vitamin K or fresh frozen plasma
Patients are NPO how long prior to liver biopsy?
6 hours
What must the nurse check prior to liver biopsy?
vital signs, labs, and signed informed consent
During a liver biopsy needle insertion, the patient must __________ and ___________.
lie completely still and hold breath on exhalation
Post-liver biopsy, the patient must be on complete bed rest and right side-lying for _____ hours.
6-8 hours
For an open liver biopsy, the nurse must apply _________.
direct pressure
How long must a patient remain right side-lying after liver biopsy?
2 hours
accumulation of bilirubin in the skin and mucous membranes that causes a yellow-orange discoloration and icterus of the sclera
jaundice
Bilirubin is formed by the breakdown of ______.
hemoglobin
jaundice that comes from the liver itself due damage of the liver
hepatocellular jaundice
jaundice that results from impaired bilirubin transport and excretion in the biliary system and is caused by a tumor
intrahepatic obstructive jaundice
jaundice that results from impaired bilirubin transport and excretion in the biliary system and is caused by gallstones stuck in the bile duct or pancreatic mass
extrahepatic obstructive jaundice
type of jaundice that is the most dangerous and caused by transfusion of the wrong type of blood
hemolytic jaundice
A patient that is very jaundiced but has no pain most likely has _________.
pancreatic cancer
Why is stool clay-colored and urine dark tea-like colored in jaundiced patients?
because bilirubin is being excreted in the urine instead of the stool like it should
What are the symptoms of jaundice?
scleral icterus, tea-colored urine, clay-colored stool, pruritus, elevated conjugated bilirubin, fatigue, anorexia
What are the expected outcomes for impaired skin integrity?
regain integrity of the skin, report any altered sensation or pain, describe measures to protect and heal the skin
Jaundice usually starts to fade after _____ weeks.
4-6 weeks
What is the first sign that jaundice is improving?
urine will return to yellow and stool will return to brown
The liver will heal itself if the problem is ___________.
hepatitis or gallstones and not cirrhosis
Acute liver failure is also called ________.
fulminate hepatic failure
In acute liver failure, 75% of patients die within ______.
days of the symptoms
What is the main cause of acute liver failure?
acetaminophen overdose
What causes acute liver failure?
infection, acetaminophen overdose, mushroom poisoning, or heat stroke
What happens to the liver in acute liver failure?
massive destruction of hepatocytes
What are the signs of acute liver failure?
headache, jaundice, LOC change (ammonia), bruising (bleeding)
What is the characteristic lab test of acute liver failure?
elevated PT
Every patient that is jaundice needs what lab test?
PT
What is the treatment for acute liver failure?
decrease ammonia levels, prevent bleeding, liver transplant and life support
What should the nurse do for a patient in acute liver failure?
protect from injury, monitor neurological status, give blood products, continuous pulse ox, ABG’s, cardio fxn, renal fxn, coagulation fxn, monitor ICP, watch for sepsis and shock
benign liver tumor made up of a collection of blood vessels
hemangioma
What are the benign liver tumors?
hemangiomas, cysts, lesions, adenoma
What are the malignant liver tumors usually caused by?
viral hepatitis or metastatic disease
Why are mets common in the liver?
because it is highly vascular
Primary cancers of the liver can arise in ___________ or ________.
liver cell or bile duct cell
How is primary liver cancer diagnosed?
CT or alpha feto protien (AFP) in bloodwork
After liver resection, the nurse should do what?
monitor closely for bleeding, V/S q15 min, check dressings, I & O, continuously monitor cardiac and respiratory function, control pain
What is the major risk for liver resection?
bleeding
What herbs can cause toxic hepatitis?
Kava Kava and Ephedra
What supportive nursing care is needed for toxic hepatitis?
give fluids and watch for bleeding
acute inflammation of hepatocytes caused by a virus
viral hepatitis
What are the modes of transmission of viral hepatitis?
contact w/ blood, blood products, semen, saliva, percutaneously or direct contact
What is the most common type of Hepatitis?
Hepatitis A
Hepatitis A is eliminated in the _______.
feces
Hepatitis A is spread through the ingestion of __________.
contaminated food, water, or shellfish
Hepatitis A is a ___________ disease.
self-limiting
Recovery from Hep A occurs in about ____ weeks.
9
Hepatitis B is spread through contact with ___________.
blood, blood products, and body fluids (like semen)
Recovery from Hep B occurs in about ____ weeks.
16
Hep B may progress to __________ infection.
chronic
Groups at risk for Hep B infection are?
IV drug users, people who have unprotected sex, infants born to infected mothers, immigrants
Hepatitis C is spread through contact with ___________.
blood and bodily fluids
80% of Hep C+ patients have ________.
no symptoms
85% of Hep C+ patients have __________ infections.
chronic
The most common genotypes of Hep C are _______.
1, 2, 3, and 4
What is the leading indicator for liver transplant?
Hepatitis C
What are the causes of Hep C infection?
IV drug use, intranasal drug use, tattoos, needle-stick injuries, and blood transfusions prior to 1992
Hep C can survive on surfaces for ____ weeks.
6
Hep D always occurs in the presence of Hep ____.
B
Hep E is similar to Hep ____. It is caught the same way.
A
Hep F and G are similar to Hep ____.
C
Symptoms of Hepatitis C include?
anorexia, N/V, abdominal pain, fatigue, low grade fever, enlarged/ tender liver, joint pain, and jaundice in the icteric phase
What should the nurse include in the plan of care for a Hepatitis patient?
bed rest, control of nausea, and frequent rest periods
What medication should a Hepatitis patient avoid?
acetiminophen
What kind of diet should the Hepatitis patient eat?
high carb, high calorie, moderate protein and fat
What precautions should the nurse enact with a Hepatitis patient?
disposable patient care items, gloves, universal precautions
Who can a Hep C patient donate a liver to?
another Hep C patient
Can Hep C patients donate blood or body fluids?
No
Liver enzymes are _______ in Hep A and B.
elevated
Liver enzymes are ________ in Hep C.
slightly elevated
Hep A test that checks for acute infection
IgM anti-HAV
Hep A test that checks for immunity
IgG
Hep B test that, if positive, means the patient has chronic infection and is contagious
HBsAg antigen
Hep B test that, if positive, means the patient is immune to Hep B
HBsAb antibody
How is a patient tested for Hep C?
Hep C viral load and genotype
What is the treatment for Hep A?
none because it is self-limiting
What is the treatment for Hep B?
Lamivudine QD x 1 year and Interferon
What are the horrible side effects of Interferon?
flu-like symptoms, N/V/D, joint pain, severe psychiatric problems
What is the treatment for Hep C?
Interferon Pegs, Ribavirin, and Direct-Acting Antiviral
What is the bad side effect of Ribavirin?
bone marrow depression – severe anemia
Viekira Pak for Hep C is a combo drug of what 4 drugs?
Ombitasvir, Paritaprevir, Dasabuvir, and Ritonavir
Ombitasvir, Paritaprevir, Dasabuvir, and Ritonavir are ____________ anti-virals.
direct-acting
Ombitasvir, Paritaprevir, Dasabuvir of the Viekira Pak are taken when?
once daily in the morning
Ritonavir of the Viekira Pak is taken when?
twice daily in the morning and evening
How many weeks does a patient take Viekira Pak?
12- 24 weeks depending on sub-genotype
What are the minimal side effects of Viekira Pak?
pruritus, nausea, and fatigue
Viekira Pak has multiple ________.
drug interactions
Viekira Pak is _____% effective in Hep C genotype 1b without cirrhosis.
100%
For a co-infected HIV patient, Viekira Pak is 100% effective if they have Hep C genotype ____.
1b
Viekira Pak is _____% effective in Hep C genotype 1b with cirrhosis.
99%
Viekira Pak is _____% effective in Hep C genotype 1a without cirrhosis.
87-96%
Viekira Pak is _____% effective in Hep C genotype 1a with cirrhosis.
95%
For a co-infected HIV patient, Viekira Pak is 91% effective if they have Hep C genotype ____.
1a
