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314 Exam 3 > Gallbladder, Pancreas, Liver > Flashcards

Gallbladder, Pancreas, Liver Flashcards

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1
Q

Problems with Gallbladder

A

Cholecystitis
- Inflammation of the gall bladder wall
- Most often caused by gallstone

Cholelithiasis
- Presence of stones in the gallbladder
- Can be acute or chronic

Compliations: pancreatitis, Peritonitis (If gallbladder ruptures)

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2
Q

Risk factors contributing to gallbladder problems

A
  • Female (r/t hormone therapy, or Birth control0
  • High fat diet
  • Obesity
  • T2DM
  • Rapid weight loss
  • Pregnancy
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3
Q

Diagnosis for gallbladder problems

A

Imagine
- US, Abdominal XR, CT

Hepatobiliary scan (HIDA)
- Shows function of liver, bile ducts, and gallbladder

Endocscopic retrograde cholangiopancreatography (ERCP)
- Allows visualization of common bile ducts
- Diagnostic and Interventions

Magnetic resonance cholangiopancreatography (MRCP)
- A special MRI scan to help visualize the hepatobiliary and pancreatic systems

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3
Q

Expected findings of Gallbladder problems

A

KEY FINDINGS
- Sharp pain in RUQ radiating to R shoulder
- Murphys signs: Pain with deep inspiration during R subcostal palpation
- Intense pain, N/V, after eating a high fat diet

  • Jaundice
  • Clay colored stools, steatorrhea
  • Dark urine
  • Pruritus

Labs
- WBC, Increased bilirubin
- If impacting liver: Elevated liver enzymes
- If impacting the pancreas: Elevated amylase and lipase

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4
Q

Interventions for Gallbladder problems

A

Pain management

Cholecystectomy
- Removal of gallbladder
- encourage pt ambulation
- Diet education: Low fat diet

Gallbladder draining
- JP or T tube may be placed in the common bile duct

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5
Q

Acute Pancreatitis

A

Acute inflammation of the pancreas
- Spillage of pancreatic enzymes into surrounding pancreatic tissue causes autodigestion and severe pain

Causes
- Gallbladder disease
- Chronic alcohol intake
- ERCP procedure
- Idiopathic

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6
Q

Expected findings of Acute pancreatitis

A

Sudden onset of epigastric or ULQ “knife like” pain
- May radiate to the back, left flank, left shoulder
- Relieved by fetal position
- Pain is aggravated by eating

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7
Q

S/S of Acute Pancreatitis

A

N/V
Weight loss
Jaundice
Ascites
Turners/Cullens Sign

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8
Q

Diagnostic and Monitoring for acute pancreatitis

A

Diagnostics
- CT scan, Lab values

Labs
- Serum amylase: Increase in 12-24 hrs (remains elevated for 2-3 days)
- Serum glucose increased
- Serume lipase: Slowly increased
- inflammation: WBC, ESR elevated

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9
Q

Complications of acute pancreatitis

A
  • Pleural effusion, atelectasis, pneumonia, ARDs
  • Paralytic illeus
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10
Q

Interventions for acute pancreatitis

A

Conservative management
- NPO
- May need TPN
- Resume diet very slowly -> Advanced to bland, low fat diet
- Fluid and electrolyte replacement

Possible NG decompression
Administer pain meds
Monitor blood sugars
Other options
- ERCP, Surgery

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11
Q

Chronic Pancreatitis / Causes

A

A continuous, prolonged, inflammatory and fibrosing process of the pancreas (Pancreas is progressively destroyed and replaced by fibrotic tissue)

  • Often due to chronic alcohol use
  • Other causes: Gall stones, Systemic disease (Lupus)
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12
Q

Chronic pancreatitis Treatment

A

Pain management
Pancreatic enzymes with meals
Possible steroids
High protein diet

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13
Q

Pancreatic Cancer / tx

A

Most cancer is undiagnosed in the early stages
- Usually metastatized by diagnosis

Surgery is the most effective treatment
- Only 15-20% eligable for surgery at time of diagnosis
- Chemo/radiation

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14
Q

Signs of liver dysfunction - Presentation/labs

A

General Presentations
- Jaundice
- Dark Urine
- Pruritis
- Clay colored stools/ Steatorrhea
- Ascites
- Peripheral edema
- Confusion
- Asterixis: Tremor

Labs
- ALT Elevated
- AST Elevated
- ALP Elevated
- Total Bilirubin Elevated

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14
Q

Diagnostic procedure: Liver Biopsy - Nursing interventions

A

Most definitive appraoch to diagnose most liver conditions

Nursing interventions
- Assist patient with positioning: Suppine with RUQ exposed
- Apply pressure to punture site when needle in removed
- Position R-Side laying after procedure

Other diagnostics
- US, MRI, XR, CT, ERCP, EGD

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15
Q

Hepatitis / Labs

A

Viral is the most common kind (Hep A, B, C, D, E

Patho:
- Liver becomes enlarged r/t inflammation eventually can lead to liver failure
- Many patients are asymptomatic in the early phases of the disease

Labs
- Liver enzymes
- Immunoglobulins studies may be done to confirm which type of hep virus

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16
Q

Hepatitis A

A

Self- Limiting infection
- Presents with mild flu-like symptoms and jaundice

Transmission
- Fecal oral

Tx
- Hep A immunization post-exposure
- Immunoglobulins for post-exposure protection

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17
Q

Hepatitis B

A

Blood borne pathogen that can cause either acute or chronic hepatitis

Transmission
- Blood/Bodily fluids

Prevention
- Hep B vaccine

Tx
- Supportive care
- Antiviral meds
- Immunoglobulins
- Energy conservation
- High carb diet

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18
Q

Hepatitis C

A

Can cause acute infection
- Most will develop chronic infection

Transmission
- Blood and body fluids
- Minimally sexually transmitted
- Needle sticks/sharing

Interventions
- Hep C can be cured
- New antiviral drug can cure certain variations

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19
Q

Hepatitis D

A

Not common in developed countries
- Coinfection with HBV
- Blood and body fluids

TX
- Supportive Care, Antivirals

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20
Q

Hepatitis E

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A

Not common in developed countries

Transmission
- Fecal oral

Tx
- Supportive care

21
Q

Expected findings of viral hepatitis

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A

Influenze like manifestations with initial infection - Can last 1-6 months

Fatigue, myalgias, abdominal pain, joint pain, fever
- Signs of liver dysfunction

Resolution
- After an acute infection, liver cells can regenerate
- If no complications occur, liver can resume normal function and appearance

22
Q

Complications of viral hepatitis

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A

Chronic Hepatitis

  • Ongoing inflammation of the liver from Hep B, C, D
  • increased risk of liver cancer
  • Fulminant hepatitis (Acute liver failure)
  • Extremely severe and potentially fatal form of viral hepatitis

Cirrhosis
Permanent scarring of the liver usually caused by chronic inflammation

Liver Failure
- Irreversible damage to liver cells with decreased ability to function adequately to meet the bodies needs

23
Drug and chemical induced liver injury
Acute alcoholic Hepatitis - Abstinence can result in significant reversal in some patients - If patients dont recover after 6 months of abstinence, transplant may be considered Chemical hepatotoxcity - Liver injury related to exposure to certain chemicals - Not common Drug induced liver injury - Acetaminophen
24
Nonalcoholic fatty liver disease
Accumulation of fatty infiltration in the hepatocytes - This causes inflammation (Steatohepatitis) and fibrosis of the liver NASH - Nonalcoholic steatohepatitis - If left untreated this can progress to cirrhosis, liver failure and cancer
25
Risk factors for Nonalcoholic fatty liver disease
Risk factors - Obesity, Diabetes, Hyperlipidemia and Hypertenison Elevated liver enzymes are often the first sign
26
Cirrhosis
End stage liver disease - Extensive scarring of the liver due to chronic inflammation - Normal liver tissue is replaced with fibrotic tissue that lacks function - Portal and periportal areas are affected -> Decreased ability to handle bile and blood flow - Most common causes are Hep C, and alcohol use
27
Types of Cirrhosis
Postnecrotic - Caused by viral hepatitis, medications, or toxins Leanne's: - Chronic alcohol use Biliary - Chronic biliary obstruction
28
Cirrhosis Expected findings
Fatigue, Weight loss Neuro - Confusion, personality changes, Asterixis Splenomegaly: blood backs up into the spleen causing platelet desctruction (bleeding, bruising, petechiae) Edema - Ascites - Dependent Edema Skin alterations - Jaundice - Spider angiomas - Pruritis Fetor Hepaticus (liver breath) Endocrine problems
29
Hepatic Encephalopathy
Due to the inability to convery ammonia to urea - Ammonia builds up and causes neurological manifestations
30
Hepatic Encephalopathy Treatment
Treatment - Lactulose: reduces ammonia through intestinal excretion - Titrate bowel movements to 3-4 loose stools per day - Reduce intake of protein
31
Esophageal Varicies
Portal hypertension = High pressure in the portal vein Varicose: veins in the upper stomach and esophagus that have become engorged - Varicies can rupture and cause extensive bleeding
32
Esophageal Varicies Treatment
TIPS procedure Esophageal banding Balloon tamponade
33
TIPS procedure
Performed in intervention radiology - A tract (shunt) between the systemic and portal venous system is created to redirect portal blood flow - Reduces portal venous pressure - Used for esophageal varicies
34
Ascites - Liver complications
Excessive fluid in peritoneal cavity - Administer albumin Paracentesis: used to relieve ascites - Position patient supine with HOB elevated - Apply pressure to puncture site when procedure is complete - Bed rest as ordered - Measure and document fluid - Up to 15L can be removed at one time
35
Detoxing / Interventions
Many patients admitted wtih liver failure and while in the hospital go through withdrawls due to alcohol use Interventions - WAS or CIWA scoring (Vitals, tremor, hallucinations, restlessness, diaphoresis) - Q2H benzodiazepines (Ativan, Haldol, valium) - Gabapentin, Clonidine therapy - Seizure precautions - Plan for discharge
36
Alcohol withdrawl Timeline
Stage 1 (8hrs) - Anxiety, insomnia, nausea, abdominal pain Stage 2 (1-3 Days) - High blood pressure, increased body temp Stage 3 (1 week) - Hallucinations, fever, seizures, and agitations
37
Liver transplant
Portions of heallthy livers from deceased or live donors are transported MELD score - Used to assess if a patient is a candidate for liver transplant - Ranges from 1-40 (seriously il) - Most patients will recieve a liver with a MELD score of 20 After transplant - Life long immunosuppressants - Monitor for s/s of rejection - Patients must be conscious of any OTC meds
38
Instant Reflux
Spitting up ins common (~50% of infants) Most are happy spitters - No discomfort - Normal weight gain - No need to treat - Improves with age
39
Management strategies for instant reflux
- Smaller more frequent feeds - Upright position during and after meals - Loose diapers (dont press on tummy) - Acid reducers are not helpful Concerns - FTT/Low weight gain
40
Pyloric Stenosis / Risk factors
Stenosis of pyloric sphincter -> Gastric outlet obstruction - Unknown cause Risk Factor - Male - White - Family history - 3-6 weeks old
41
Pyloric stenosis Clinical manifestations /Dx/ Tx
Clinicical manifestations - Projectile vomit, usually after feeds - Metabolic alkalosis, hypochloremia, hypokalemia Dx - US Tx - Rehydration with 5% dextrose w/ KCl - Pyloromyotomy
42
Intussuseption / Clinical manifestations
Intestine (usually small bowel) folds on itself Clinical manifestations - Abdmonial pain (may come and go) - N/V - Abdominal distention - Bloody stool (Red currant jelly)
43
Intussusception complications/Dx/Tx
Complications - SBO - Peritonitis - Bowel perforation Dx - US Tx - Enema
44
Hirschsprungs Disease
Aka: Congenital megacolon - Birth defect of colon - Results in intestinal blockage Requires surgery - May have temporary ostomy
45
Hirschsprungs Disease manifestations
- No BM withing first 48 hours of life - Abdominal distention - Vomiting - FTT, Malnutrition, Feeding problems
46
Omphalocele/ Manifestations
During fetal development: Abdominal contents herniate into the umbilical cords, covered in a sac Manifestations - Born with midline abdominal mass covered by a thin sac - Umbilical cord is inserted at the apex of the defect
47
Omphalocele Complications/Treatment
Complications - Infection risk - Rupture of sac - Pulmonary hypoplasia and GI dysfunction Tx - Initial stabilization: Temperature regulation, fluid resuscitation, protection of sac with sterile dressing Surgical options - Small defect: Primary closure - Large Defect: Ozver time the organs are moved back into the abdomen using a protective covering and a paint and wait technique
48
Gastroschisis / manifestation
Intestines protrude through an opening in the abdominal wall, without a protective sac Manifestations - Born with exposed, edematous, and possibly thickened bowel loops - Umbilical cord is normal
49
Gastroschisis Complications/Tx
Complications - Infection - Prolonged ileus and feeding intolerance - Short bowel syndrome Tx - Immediate: Temp regulation, fluid resuscitation, and pplacing exposed bowel in a sterile plastic bag Surgical - Primary closure if small, use a silo if too big or swollen
50
Neonatal Jaundice
Elevated serum bilirubin - Yellow discoloration of the skin, eyes, mucous membranes - Common in first 2 weeks of life Usually mild, self resolves (Physiological jaundice)
51
Neonatal pathological jaundice / Tx
Can cause kernicterus = brain damage monitor - Signs of bleeding - Hepatosplenmegaly - Weight loss - Dehydration - Lethargy, abnormal tone, seizures Tx - Phototherapy (cover eyes)

314 Exam 3 (3 decks)

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