Advanced GI: Hepatic & Pancreatic Disorders Flashcards Preview

Advanced Med/Surg > Advanced GI: Hepatic & Pancreatic Disorders > Flashcards

Flashcards in Advanced GI: Hepatic & Pancreatic Disorders Deck (364):
1

What are the vascular functions of the liver?

blood storage and filtrations

2

What are the secretory functions of the liver?

bile productions and bilirubin metabolism

3

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)

4

Liver ________ in size with aging.

decreases

5

decreased synthesis of enzymes which help metabolize drugs

liver aging

6

-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

7

growth of the breast tissue in men related to hormonal changes during liver disease

gynecomastia

8

7 F's for Abdominal Distention

fat, fetus, fluid, flatulence, feces, fibroid, fatal tumor

9

skin abnormality in liver disease in which red, spider-like clusters appear on chest, back or umbilicus...they blanche

spider angiomas

10

What should the nurse inspect on a patient with liver disease?

skin color (everywhere, look for jaundice), surface characteristics, surface movements

11

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

12

What is a fluid wave?

When the patient's side is tapped, the abdominal fluid will cause a wave across the abdomen.

13

Liver patients are at a high risk for _________.

bleeding

14

hernia surrounding the umbilicus in which the blood vessels pop out

caput medusa

15

vascular changes in the hand that cause the palms to be red

palmar erythema

16

What do ultrasounds of the liver check for?

patency of blood vessels in liver, gallstones, cysts, tumors & fat

17

What can CT scans pick up on the liver?

exact size of the liver, small lesions, look at bile ducts closely

18

What is an MRCP?

MRI of the pancreas and bile ducts

19

Is the MRCP or the ERCP more invasive?

the ERCP is more invasive

20

What does liver nuclear testing check?

cystic duct disease

21

AST Normal Level

10-35 units/L

22

In acute liver injury, AST is __________.

elevated

23

In chronic liver disease, AST is ________ or _________.

decreased or normal

24

ALT Normal Level

4-36 units/L

25

In acute liver injury, ALT is __________.

elevated

26

In chronic liver disease, ALT is ________ or _________.

decreased or normal

27

AP Normal Level

30-120 units/ L

28

GGT Normal Level

8-38 units/ L

29

In acute liver injury, AP and GGT are __________.

elevated

30

Bilirubin Normal Level

0.3-1.0 mg/ dL

31

In chronic liver disease, bilirubin is ________.

elevated

32

Albumin Normal Level

3.5- 5 g/ dL

33

Total Protein Normal Level

6.4-8.3 g/ dL

34

In chronic liver disease, albumin and total protein are _______.

decreased

35

PTT Normal Level

11-12.5 seconds

36

LDH Normal Level

??

37

In chronic liver disease, PTT is ________.

prolonged

38

In acute liver disease or liver tumors, LDH is ________.

elevated

39

80% of liver function is gone once __________.

albumin is decreased and PTT is prolonged

40

Normal Bleeding Time/ Platelet Closure Time

64-120 seconds

41

Ammonia Normal Level

6-47 µmol/L

42

In chronic liver disease, bleeding time is ________.

increased

43

In chronic liver disease, ammonia is ________.

elevated

44

In chronic liver disease patient, CBC will show _________.

B12, Folic Acid and Iron Deficiencies Anemias

45

In chronic liver disease, platelets are ________.

low (thrombocytopenia)

46

Before a liver biopsy, _________ is tested.

bleeding time

47

Elevated ammonia causes _________ and __________.

agitation and confusion

48

The gold standard test for liver disease.

liver biopsy

49

liver biopsy obtained by cutting the abdomen

open liver biopsy

50

liver biopsy obtained by going through the jugular vein

closed liver biopsy

51

The labs prior to a liver biopsy are __________.

H&H, bleeding time, platelets, and PT

52

If PT is high or platelets are low prior to liver biopsy, what does the nurse do?

notify the surgeon

53

What does the nurse give if PT is high or platelets are low prior to liver biopsy?

Vitamin K or fresh frozen plasma

54

Patients are NPO how long prior to liver biopsy?

6 hours

55

What must the nurse check prior to liver biopsy?

vital signs, labs, and signed informed consent

56

During a liver biopsy needle insertion, the patient must __________ and ___________.

lie completely still and hold breath on exhalation

57

Post-liver biopsy, the patient must be on complete bed rest and right side-lying for _____ hours.

6-8 hours

58

For an open liver biopsy, the nurse must apply _________.

direct pressure

59

How long must a patient remain right side-lying after liver biopsy?

2 hours

60

accumulation of bilirubin in the skin and mucous membranes that causes a yellow-orange discoloration and icterus of the sclera

jaundice

61

Bilirubin is formed by the breakdown of ______.

hemoglobin

62

jaundice that comes from the liver itself due damage of the liver

hepatocellular jaundice

63

jaundice that results from impaired bilirubin transport and excretion in the biliary system and is caused by a tumor

intrahepatic obstructive jaundice

64

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

65

type of jaundice that is the most dangerous and caused by transfusion of the wrong type of blood

hemolytic jaundice

66

A patient that is very jaundiced but has no pain most likely has _________.

pancreatic cancer

67

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

68

What are the symptoms of jaundice?

scleral icterus, tea-colored urine, clay-colored stool, pruritus, elevated conjugated bilirubin, fatigue, anorexia

69

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

70

Jaundice usually starts to fade after _____ weeks.

4-6 weeks

71

What is the first sign that jaundice is improving?

urine will return to yellow and stool will return to brown

72

The liver will heal itself if the problem is ___________.

hepatitis or gallstones and not cirrhosis

73

Acute liver failure is also called ________.

fulminate hepatic failure

74

In acute liver failure, 75% of patients die within ______.

days of the symptoms

75

What is the main cause of acute liver failure?

acetaminophen overdose

76

What causes acute liver failure?

infection, acetaminophen overdose, mushroom poisoning, or heat stroke

77

What happens to the liver in acute liver failure?

massive destruction of hepatocytes

78

What are the signs of acute liver failure?

headache, jaundice, LOC change (ammonia), bruising (bleeding)

79

What is the characteristic lab test of acute liver failure?

elevated PT

80

Every patient that is jaundice needs what lab test?

PT

81

What is the treatment for acute liver failure?

decrease ammonia levels, prevent bleeding, liver transplant and life support

82

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

83

benign liver tumor made up of a collection of blood vessels

hemangioma

84

What are the benign liver tumors?

hemangiomas, cysts, lesions, adenoma

85

What are the malignant liver tumors usually caused by?

viral hepatitis or metastatic disease

86

Why are mets common in the liver?

because it is highly vascular

87

Primary cancers of the liver can arise in ___________ or ________.

liver cell or bile duct cell

88

How is primary liver cancer diagnosed?

CT or alpha feto protien (AFP) in bloodwork

89

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

90

What is the major risk for liver resection?

bleeding

91

What herbs can cause toxic hepatitis?

Kava Kava and Ephedra

92

What supportive nursing care is needed for toxic hepatitis?

give fluids and watch for bleeding

93

acute inflammation of hepatocytes caused by a virus

viral hepatitis

94

What are the modes of transmission of viral hepatitis?

contact w/ blood, blood products, semen, saliva, percutaneously or direct contact

95

What is the most common type of Hepatitis?

Hepatitis A

96

Hepatitis A is eliminated in the _______.

feces

97

Hepatitis A is spread through the ingestion of __________.

contaminated food, water, or shellfish

98

Hepatitis A is a ___________ disease.

self-limiting

99

Recovery from Hep A occurs in about ____ weeks.

9

100

Hepatitis B is spread through contact with ___________.

blood, blood products, and body fluids (like semen)

101

Recovery from Hep B occurs in about ____ weeks.

16

102

Hep B may progress to __________ infection.

chronic

103

Groups at risk for Hep B infection are?

IV drug users, people who have unprotected sex, infants born to infected mothers, immigrants

104

Hepatitis C is spread through contact with ___________.

blood and bodily fluids

105

80% of Hep C+ patients have ________.

no symptoms

106

85% of Hep C+ patients have __________ infections.

chronic

107

The most common genotypes of Hep C are _______.

1, 2, 3, and 4

108

What is the leading indicator for liver transplant?

Hepatitis C

109

What are the causes of Hep C infection?

IV drug use, intranasal drug use, tattoos, needle-stick injuries, and blood transfusions prior to 1992

110

Hep C can survive on surfaces for ____ weeks.

6

111

Hep D always occurs in the presence of Hep ____.

B

112

Hep E is similar to Hep ____. It is caught the same way.

A

113

Hep F and G are similar to Hep ____.

C

114

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

115

What should the nurse include in the plan of care for a Hepatitis patient?

bed rest, control of nausea, and frequent rest periods

116

What medication should a Hepatitis patient avoid?

acetiminophen

117

What kind of diet should the Hepatitis patient eat?

high carb, high calorie, moderate protein and fat

118

What precautions should the nurse enact with a Hepatitis patient?

disposable patient care items, gloves, universal precautions

119

Who can a Hep C patient donate a liver to?

another Hep C patient

120

Can Hep C patients donate blood or body fluids?

No

121

Liver enzymes are _______ in Hep A and B.

elevated

122

Liver enzymes are ________ in Hep C.

slightly elevated

123

Hep A test that checks for acute infection

IgM anti-HAV

124

Hep A test that checks for immunity

IgG

125

Hep B test that, if positive, means the patient has chronic infection and is contagious

HBsAg antigen

126

Hep B test that, if positive, means the patient is immune to Hep B

HBsAb antibody

127

How is a patient tested for Hep C?

Hep C viral load and genotype

128

What is the treatment for Hep A?

none because it is self-limiting

129

What is the treatment for Hep B?

Lamivudine QD x 1 year and Interferon

130

What are the horrible side effects of Interferon?

flu-like symptoms, N/V/D, joint pain, severe psychiatric problems

131

What is the treatment for Hep C?

Interferon Pegs, Ribavirin, and Direct-Acting Antiviral

132

What is the bad side effect of Ribavirin?

bone marrow depression -- severe anemia

133

Viekira Pak for Hep C is a combo drug of what 4 drugs?

Ombitasvir, Paritaprevir, Dasabuvir, and Ritonavir

134

Ombitasvir, Paritaprevir, Dasabuvir, and Ritonavir are ____________ anti-virals.

direct-acting

135

Ombitasvir, Paritaprevir, Dasabuvir of the Viekira Pak are taken when?

once daily in the morning

136

Ritonavir of the Viekira Pak is taken when?

twice daily in the morning and evening

137

How many weeks does a patient take Viekira Pak?

12- 24 weeks depending on sub-genotype

138

What are the minimal side effects of Viekira Pak?

pruritus, nausea, and fatigue

139

Viekira Pak has multiple ________.

drug interactions

140

Viekira Pak is _____% effective in Hep C genotype 1b without cirrhosis.

100%

141

For a co-infected HIV patient, Viekira Pak is 100% effective if they have Hep C genotype ____.

1b

142

Viekira Pak is _____% effective in Hep C genotype 1b with cirrhosis.

99%

143

Viekira Pak is _____% effective in Hep C genotype 1a without cirrhosis.

87-96%

144

Viekira Pak is _____% effective in Hep C genotype 1a with cirrhosis.

95%

145

For a co-infected HIV patient, Viekira Pak is 91% effective if they have Hep C genotype ____.

1a

146

What is the dose of Sovaldi (sofosbuvir)?

One 400 mg tablet once daily

147

What are the side effects of Sovaldi (sofosbuvir)?

fatigue and headache

148

Sovaldi (sofosbuvir) is used in combination with _________ and ________.

interferon alfa and ribavirin

149

For Hep C genotype 1 and 4, Sovaldi (sofosbuvir) is used with ________ and _________.

peg interferon and ribavirin

150

For Hep C genotype 1, 2 and 4, Sovaldi (sofosbuvir) is given for ______ weeks.

12

151

For Hep C genotype 2, Sovaldi (sofosbuvir) is used in combination with ________.

ribavirin

152

For Hep C genotype 3, Sovaldi (sofosbuvir) is used in combination with _________.

ribavirin

153

For Hep C genotype 3, Sovaldi (sofosbuvir) is given for ______ weeks.

24 weeks

154

The cost of Sovaldi (sofosbuvir) is $_____/ pill.

$1,000

155

What is the dose of Harvoni (ledipasvir/ sofosbuvir)?

one pill once daily

156

Harvoni (Ledipasvir/sofosbuvir) is given for _____ weeks.

12

157

Side effects of Harvoni (Ledipasvir/sofosbuvir) are?

fatigue and headache

158

Is Harvoni (Ledipasvir/sofosbuvir) given with any other drugs?

No

159

Hepatitis A vaccines

Havrix or Vaqta

160

Havrix or Vaqta is given as a 2 injection series ___ to ___ months apart

6 to 12

161

Havrix or Vaqta is given to what groups of people?

people w/ Hep B or C, people who travel to 3rd world countries, military, and illicit drug users

162

Havrix or Vaqta is not a ______ virus.

live

163

Why is Hep A pre-vaccination screening needed in certain populations?

because some people might already have immunity because they already contracted Hep A (common in southwest US)

164

Hepatitis B vaccine

HBV

165

HBV is recommended for what groups?

infants born to Hep B+ mothers, people who have unprotected sex, people w/ chronic liver disease, people exposed to blood or body fluids, people who live in close-quarters

166

combination Hep A and B vaccine given at 0, 1 and 6 months

Twin-Rix

167

Twin-Rix is contraindicated in people allergic to _____.

alum

168

Immunoglobulin is only effective as post-exposure treatment for Hep A if given within ____ weeks of exposure.

2

169

Immunoglobulin _____ or ______ be effective post-exposure treatment for Hep C.

may or may not

170

Hep B post-exposure treatment for un-vaccinated people is _____.

HBIG (Hep B Immunoglobulin) then initiate HBV vaccine series

171

Hep B post-exposure treatment for a previously vaccinated known responder is _____.

no treatment

172

Hep B post-exposure treatment for a previously vaccinated known non-responder is _____.

HBIG x 1 then revaccinate OR HBIG x 2 separated by 4 weeks

173

Hep B post-exposure treatment for a previously vaccinated person whose antibody response is unknown is _____.

If HBsAb are adequate, don't treat. If HBsAb are inadequate, give HBIG x 1 and vaccine booster.

174

If HBsAb is inadequate prior to HBIG, what needs to be done?

Recheck titer in 3-4 months. If still inadequate, complete full second series of vaccine.

175

condition that occurs when the liver is damaged beyond its capacity to regenerate new cells

cirrhosis

176

Cirrhosis leads to _______.

fibrosis and nodule formation in the liver

177

In cirrhosis, the liver lobes become covered with _____.

fibrous tissue

178

In cirrhosis, ________ deteriorates in the liver.

parenchyma

179

In cirrhosis, the liver lobules are infiltrated with _____.

fat

180

Alcholic cirrhosis is also known as ______.

Laennec's cirrhosis

181

type of cirrhosis induced by toxins that leads to necrosis of liver tissue

post-necrotic cirrhosis

182

type of cirrhosis that is auto-immune

biliary cirrhosis

183

type of cirrhosis that is fairly rare and caused by right-sided heart failure

cardiac cirrhosis

184

What is the #1 cause of cirrhosis?

alcohol

185

abnormal accumulation of iron in the blood that can lead to cirrhosis

hemachromatosis

186

abnormal accumulation of copper in the blood that can lead to cirrhosis

Wilson's disease

187

type of cirrhosis that comes from the biliary system (bile ducts)

primary biliary cirrhosis

188

the stage of cirrhosis in which the liver is damaged but there are few, if any, symptoms

compensated disease

189

the stage of cirrhosis in which the liver can no longer perform vital functions and multiple manifestations occur throughout all body systems

decompensated disease

190

In early cirrhosis, liver enzymes are ______.

high or low

191

In advanced cirrhosis, liver enzymes are ________.

normal or low

192

In cirrhosis, bilirubin is _______.

elevated

193

In cirrhosis, protein and albumin are _________.

decreased

194

In cirrhosis, a patient is deficient in what vitamins?

Vitamin K, thiamine, and folic acid

195

In cirrhosis, what blood disorder is common?

anemia

196

In cirrhosis, PT will be _________.

elevated

197

What is the only definitive test for cirrhosis?

liver biopsy

198

Can blood work show cirrhosis?

Yes

199

How can cirrhosis be diagnosed?

X-ray, abdominal CT, blood work, and liver biopsy

200

Cirrhosis patient should avoid what hepatotoxic drugs?

acetaminophen, phenobarbital and alcohol

201

The cirrhosis patient should eat what kind of diet?

high protein (if compensated), low fat, low sodium, 2500-3000 cals/day, and small, frequent meals

202

What nursing interventions should be completed with the cirrhosis patient?

daily weights, strict I & O, antacids, anti-emetics, and vitamin supplements like thiamine (banana bags or IM QD x 3 days)

203

obstruction of the portal blood flow that increases portal venous pressure

portal hypertension

204

What can portal hypertension cause?

splenomegaly, ascites, esophageal varices, caput medusa, and severe hemorrhoids

205

What is the main risk of portal hypertension?

bleeding

206

If collateral circulation develops in portal hypertension, what is the patient at massive risk for?

upper GI bleed

207

What should the portal hypertension patient be taught?

no heavy lifting, avoid vigorous nose-blowing, no straining to have bowel movement, use a soft toothbrush/ foam toothbrush, and report any sign of bleeding ASAP

208

What medications are given to reduce portal vein pressure?

beta blockers like propranolol (Inderal)...even if the patient has asthma

209

High ammonia levels cause _______.

mental status changes

210

hepatic encephalopathy or hepatic coma

portal-system encephalopathy

211

What factors lead to portal-system encephalopathy?

high protein diet, infection, hypovolemia, hyperkalemia, constipation, GI bleeding, and medications like opiods, diuretics and hypnotics

212

How does a high protein diet lead to portal-system encephalopathy?

It leads to constipation and stool in the colon produces ammonia which circulates back into system to the liver.

213

first stage of portal-system encephalopathy in which driving could be impaired

sub-clinical stage

214

stage of portal-system encephalopathy in which behavior and handwriting changes

Stage 1- Prodomal

215

stage of portal-system encephalopathy including disorientation, confusion, and asterixis (flapping of hands “liver flap”)

Stage 2- Impending

216

stage of portal-system encephalopathy in which the patient becomes greatly confused, falls asleep, is hard to arouse, and has muscle twitching

Stage 3- Stuporous

217

stage of portal-system encephalopathy in which seizures and death occurs

Stage 4- Comatose

218

flapping of the hands often called the "liver flap"

asterixis

219

What is the dietary management of a patient with portal-system encephalopathy?

low protein

220

What medication is used in portal-system encephalopathy that decreases ammonia?

Lactulose

221

How does Lactulose decrease ammonia in the body?

It alters the acidity of the stool preventing the absorption of ammonia by the colon and also increases the number of stools per day.

222

How many stools per day should a patient have on lactulose?

3-4 loose stools/ day

223

How can Lactulose be given?

orally or by retention enema mixed w/ 75 mL of saline

224

How long must the lactulose retention enema be held in?

30 minutes

225

What is the first sign of altered mental status in portal-system encephalopathy?

changes in handwriting

226

For a patient with portal-system encephalopathy, the nurse should encourage _______.

fluids

227

The patient with portal-system encephalopathy should limit _______ until ammonia is decreased.

activity

228

sudden kidney failure for no reason in people with liver failure resulting from complete intrarenal vasoconstriction of normal kidneys

Hepatorenal Syndrome

229

A patient with Hepatorenal Syndrome will develop _____ and ______.

oliguria and azotemia

230

increase in BUN and creatinine

azotemia

231

What is the treatment for Hepatorenal Syndrome?

fluid administration, diuretic therapy, and hemodialysis

232

Nurses should address __________ decisions with Hepatorenal Syndrome patient and family.

end-of-life

233

accumulation of plasma-rich fluid within the peritoneal cavity secondary to portal hypertension, increased aldosterone, and decreased oncotic pressure

ascites

234

What happens to the kidneys in ascites?

Kidneys retain sodium and water increasing third-spaced fluid and anasarca

235

What is the most common cause of ascites?

cirrhosis

236

What are the treatment options for ascites?

Paracentesis, TIPS, or Peritoneal venous shunts

237

The two types of Peritoneal venous shunts are?

Denver and Leveen

238

What medications are given for ascites?

Aldactone (K+ sparing), Lasix (K+ depleting), and Bumex (K+ depleting)

239

If giving Lasix or Bumex, what needs to be checked?

potassium levels

240

What diet should a person with ascites follow?

low-sodium

241

What is given with a paracentesis to prevent shock?

albumin infusion

242

How much fluid can a patient with ascites have?

1 L/day or less

243

What should be done by the nurse prior to a paracentesis?

check weight and V/S, have patient void, position the patient upright, give albumin infusion

244

What should be done by the nurse during a paracentisis?

describe amount and appearance of fluid obtained

245

What should be done by the nurse after a paracentisis?

send specimen to the lab, check weight and V/S, put ostomy bag over site

246

Enlargement of collateral blood vessels in the esophagus that occurs due to portal hypertension

esophogeal varices

247

_____% of esophogeal varices patients will die the first time they bleed

50%

248

sign of a massive bleed in a patient with esophogeal varices

Hematochezia (bright red blood in stool)

249

What is the risk with Hematochezia?

shock

250

How often should the nurse monitor V/S in patient with bleeding esophogeal varices?

q 15 minutes

251

What should the nurse monitor in patient with bleeding esophogeal varices?

urinary output (foley), V/S, LOC, abdomen, labs

252

What procedure is done in patient with bleeding esophogeal varices?

endoscopy

253

What procedure is done in patient with non-bleeding esophogeal varices?

barium study

254

What medications are given to control hemorrhage in patient with esophogeal varices?

Vasopressin, Somatostatin/Octreotide, PPI's, coagulants (FFP, platelets, clotting factors), or beta-blockers

255

hormonal peptide given subQ or on a drip to control hemorrhage that is much safer than vasopressin

Somatostatin/Octreotide

256

What are the bad side effects of Vasopressin?

systemic vasoconstriction including the heart which can cause dysrythmias and chest pain

257

What kind of monitoring needs to be done with a patient on vasopressin?

cardiac monitoring

258

temporary measure to stop bleeding in esophogeal varices that applies direct pressure to varices to control bleeding

Esophageal Varices Treatment Balloon Tamponade

259

Esophageal tamponade tube with 3 lumens

Sengstaken-Blakemore or Linton-Nachlas

260

Esophageal tamponade tube with 4 lumens and 2 ports

Minnesota

261

How long will a patient have a balloon tamponade tube?

24-48 hours

262

How often does the nurse deflate a balloon tamponade tube?

for 15 minutes every 4 hours

263

What is the biggest risk with a balloon tamponade tube?

aspiration

264

What should be monitored while a patient has a balloon tamponade tube?

aspiration, nasal necrosis, tube position

265

What should be kept at the bedside while a patient has a balloon tamponade tube?

scissors to cut the tube if needed

266

Medication that is inserted during endoscopy that has an inflammatory reaction producing fibrous bands to form around vessels

Ethanolamine

267

Medication that is inserted during endoscopy that causes localized vasoconstriction

Epinephrine

268

endoscopic procedure in which mall bands or metal clips are placed around base of varices

band ligation

269

endoscopic procedure done when a patient is actively bleeding in which the vessels are washed out with saline to see which one is bleeding and epinephrine or ethanolamine is shot into the vessel

sclerotherapy

270

procedure in which a shunt is placed into the internal jugular vein

Transjugular intrahepatic portosystemic shunting (TIPS)

271

TIPS has a high rate of _________.

re-occlusion

272

What is the nursing care for a patient post-TIPS procedure?

monitor for bleeding and hypovolemic shock

273

TIPS worsens encephalopathy in ___% of patients.

20%

274

type of shunt that is threaded down abdomen to collect fluid and shunt back into inferior vena cava

Le Veen Shunt

275

type of shunt that has hand-held pump that pt. pumps to get fluid back into circulation

Denver Shunt

276

What are porto-caval shunts used for?

malignant and nonmalignant ascites, alternative to paracentesis, for patients awaiting liver transplant

277

1 unit of PRBC will increase hemoglobin by _____ g/dL

1

278

liver transplant surgery lasts between ______ hours

8 to 18 hours

279

The most common conditions for liver transplant are?

Viral Hepatitis (C), Cirrhosis, Primary sclerosing cholangitis, and Genetic conditions

280

What are the contraindications for liver transplant?

Systemic disease (cancer), Uncontrolled extrahepatic bacterial or fungal infection, Advanced cardio or pulmonary disease, and Active alcoholism or drug abuse

281

What are the potential complications of liver transplant?

Infection, Rejection, Hemorrhage

282

Liver transplant patients are discharged within _____.

1 week

283

Liver transplant patients can resume normal life within _____.

3-4 months

284

Liver transplant survival rate is greater than ______% with close follow up and medication compliance.

85%

285

What should the nurse do post-liver transplant?

Monitor for signs of rejection and infection, Continue immuno-suppressive therapy (might be for life), Monitor labs, assess for Volume Overload, Monitor wound drains and bile drains, and Assess needs of family and significant others

286

What are the exocrine functions of the pancreas?

secretion of pancreatic enzymes

287

What are the endocrine functions of the pancreas?

secretion of insulin, glucagon, and somatostatin

288

What enzymes does the pancreas secrete that are essential in breaking down nutrients?

amylase, lipase, trypsin, chrymotripsin

289

What is ordered to best view the pancreas?

a spiral CT

290

Inflammation of the pancreas resulting in premature release of pancreatic enzymes causing auto-digestion of the pancreatic tissues

pancreatitis

291

In pancreatitis, usually enzymes are released into the __________ which is extremely painful.

small bowel

292

fat necrosis caused by premature release of lipase

Lipolysis

293

edema, necrosis & gangrene of the pancreas due to premature release of trypsin

Proteolysis

294

in pancreatitis, this is caused by release of elastase which dissolves fibers in blood vessels causing the patient to hemorrhage

Necrosis of the blood vessels

295

Early release of pancreatic causes what 4 pathologic conditions?

lipolysis, proteolysis, necrosis of blood vessels and profuse inflammation

296

What is the #1 cause of pancreatitis?

alcohol

297

What can cause pancreatitis?

alcohol, gallstones, opiates, sulfa drugs, birth control, and bacterial or viral infections

298

Discoloration around umbilicus (blue/gray color) in pancreatitis

Cullen's sign

299

Discoloration on the flanks in pancreatitis

Turner's sign

300

What position helps with the pain of pancreatits?

fetal position

301

What makes pancreatitis pain much worse?

eating

302

Pancreatitis pain is described as ______ and _______.

intense and radiating to the back

303

What are the symptoms of pancreatitis?

abdominal pain, N/V, diaphoresis, weakness, tachycardia, and steatorrhea

304

What are Ranson's Criteria upon admission?

age > 55, WBC > 16,000, glucose > 200, LDH > 350, and AST > 250

305

What are Ranson's Criteria 48 hours post-admission?

hematocrit decreased > 10%, fluid sequestreation > 6 L, hypocalcemia (Ca+ 5 after IV fluids, and base deficit > 4 mmol/L

306

Ranson's Criteria score of 0 - 2 means _____% mortality.

2%

307

Ranson's Criteria score of 3 - 4 means _____% mortality.

15%

308

Ranson's Criteria score of 5 -6 means _____% mortality.

40%

309

Ranson's Criteria score of 7 - 8 means _____% mortality.

100%

310

What are the systemic complications of pancreatitis?

massive hemorrhage (hypovolemic shock), pulmonary complications, and renal complications (acute renal failure)

311

What is the most definitive lab test for pancreatitis?

lipase

312

Normal Lipase Level

1 - 160

313

Pancreatitis Lipase Level

6,000 - 7,000

314

Normal Amylase Level

30 - 220

315

In pancreatitis, bilirubin is _______.

elevated

316

In pancreatitis, a CBC will show signs of _______.

bleeding

317

How is pain controlled in pancreatitis?

opiods (Dilaudid or Morphine) and Anticholinergics (dicyclomine)

318

How will pancreatitis patient receive nutrition?

J tube, feeding tube that bypasses the pancreas, or TPN

319

What does dicyclomine do in pancreatitis?

decreases vagal stimulation, motility and pancreatic flow

320

When is dicyclomine contraindicated?

in patients with a paralytic ileus

321

What should be checked prior to administration of dicyclomine?

bowel sounds

322

drugs that decrease gastric secretions given to patients with pancreatitis

Octreotides, H2 blockers and PPI’s

323

As pancreatitis patient begins to eat again, what diet should they follow?

bland food, moderate to high carb, high protein, low fat, no caffeine or alcohol

324

Chronic Calcifying Pancreatitis (CCP) is caused by _______.

alcoholism

325

Chronic Obstructive Pancreatitis is caused by ________.

gallstones

326

The key symptom in chronic panreatitis is _________.

abdominal pain

327

In chronic panreatitis, there may be a palpable mass in the ____.

LUQ

328

Chronic pancreatitis can cause possible manifestations of __________.

diabetes

329

What general symptoms can Chronic pancreatitis cause?

Weight loss, muscle wasting, and ascites

330

What GI symptoms can Chronic pancreatitis cause?

Nausea/Vomiting, Diarrhea, Steatorrhea

331

In chronic panreatitis, stool will be ______ colored and urine will be _______ colored.

clay; tea

332

What is the definitive test for In chronic panreatitis?

biopsy done through ERCP

333

What diagnostic tests are done for chronic panreatitis?

CT, MRCP, labs (lipase and amylase), and biopsy

334

What is the dietary management for pancreatitis?

low fat diet

335

What are the surgical management options for chronic panreatitis?

Roux-en-Y or Celiac plexus nerve block (pain control)

336

What can be given for pain control of chronic panreatitis?

NSAIDS, Tricyclics, and Opioids (must go to pain managment)

337

enzyme replacement that contains lipase, amylase and protease to aid in digestion of fats, proteins and starches

Pancrelipase

338

What is the dose of Pancrelipase?

oral 4,000 to 50,000 Units with each meal and snacks
(everytime they eat)

339

What are the adverse effects of Pancrelipase?

nausea, abdominal cramping, diarrhea (in large doses)

340

Pancreatic enzymes are made from ________.

pork

341

Pancreatic enzymes cannot be mixed with __________.

protein-containing foods

342

Pancreatic enzymes cannot be _______ or ________.

chewed

343

Do not _______ the Pancreatic enzyme capsule as it could cause asthma exacerbations.

open

344

When taking Pancreatic enzymes, avoid contact with the _____.

lips

345

What is the first sign that Pancreatic enzymes are working?

decrease in frequency of stools

346

condition of the pancreas in which an abscess arises from necrotic tissue that is bacterial in nature and can erode into surrounding tissue

pancreatic abscess

347

pancreatic abscess has a _____% mortality rate.

60%

348

What are the risk factors for pancreatic cancer?

People older than 60, History of smoking, Chronic pancreatitis, Diabetes mellitus, Cirrhosis, High intake of red meat ** Study released 1/13/12, Long term exposure to chemicals, Obesity, African American, Heavy alcohol use, Male gender, family history

349

What is the usual first sign of pancreatic cancer?

painless jaundice

350

What are the symptoms of pancreatic cancer?

Dull discomfort in RUQ, Fatigue, Rapid Weight loss, Nonspecific GI disturbances, Clay colored stool

351

How is pancreatic cancer diagnosed?

CEA and CA19-9 (tumor markers), spiral CT, ultrasound, ERCP w/ biopsy

352

What is the most useful test for pancreatic cancer?

spiral CT

353

What is the most definitive test for pancreatic cancer?

ERCP w/ biopsy

354

What is the treatment for pancreatic cancer?

palliative, internal or external radiation, chemotherapy (5-Fluorouracil (5-FU) and Gemcitabine)

355

What medication is given for pancreatic cancer symptoms?

Morphine, Hydromorphone, Fentanyl

356

What is surgical treatment is used to remove small pancreatic tumors?

Partial pancreatecotomy

357

What is a Radical pancreaticoduodenectomy?

Whipple procedure

358

What are the potential complications of the Whipple procedure?

Cardiovascular- MI, hemorrhage, heart failure, thrombophlebitis, Pulmonary- atelectasis, pneumonia, PE, ARDS, pulmonary edema, GI- paralytic ileus, gastric retention, bowel obstruction, pancreatitis, hepatic failure, thrombosis, Wound- infection, dehiscence, fistulas, Metabolic- diabetes, renal failure

359

After pancreatic surgery, how is pain controlled?

PCA pump

360

What position should the pancreatic surgery patient be placed after surgery?

Semi-fowlers

361

GI drainage from a wound should be _________.

sero-sanginous

362

Immediately report GI drainage fluid that appears _______, ________, ________, or ________.

Clear, Colorless, Bile-tinged, Bloody (bright red)

363

After pancreatic surgery, the nurse should monitor what levels?

fluid/ electrolytes, protein, albumin, and blood glucose

364

Protein and albumin losses after pancreatic surgery occur due to_________, _________, or __________.

blood loss, NGT, or drainage tubes