Gastro-Intestinal

Question 1

What is affected by liver dysfunction

Answer 1

bile production, coagulation, blood glucose, protein production and metabolism

Question 2

Liver inflammation caused by Sharing needles

Answer 2

(Hepatitis C)
more of a chronic disease, more common hepatitis

Question 3

Liver inflammation caused by Unprotected sex with an infected individual

Answer 3

(Hepatitis B)
(RUQ pain)

Question 4

Liver inflammation caused by Consuming tainted food or water

Answer 4

(Hepatitis A,E)
mild, flu-like symptoms

Question 5

Signs of liver disease

Answer 5

clay-colored stools, hepatomegaly, decreased urine, dark urine , pruritus, bruising, spider angiomas, jaundice

Question 6

lab values that indicate liver dysfunction

Answer 6

Serum total bilirubin (elevated)
Urinary bilirubin (elevated)
Surface antigen testing (positive)
Antibody testing (identify type)
INR (elevated)
CBC (elevated WBC, decreased Hgb)
Ammonia (elevated)
Folate (decreased)
Thiamine (decreased)
Vitamin B12 (decreased)
Albumin (decreased)

Question 7

Hepatitis tx

Answer 7

Lactulose (PO, 6months or less, cures pts of hep c)

Sofosbuvir: oral only treatment that targets the reproduction of the virus

Antivirals: Interferon (body’s natural antiviral, suppresses virus but doesn’t get rid of it, infusions weekly can last a year)

Question 8

Supportive treatment for symptom management of hepatitis

Answer 8

Vitamin supplementation
Possible support for elevated coagulation studies

Question 9

how do you treat hepatic encephalopathy

Answer 9

Lactulose and rifaximin

Question 10

diet for liver pts

Answer 10

Diet high in carbohydrates and calories as well as moderate to low fat and protein
Small frequent meals are more easily tolerated
Supplemental vitamins

Question 11

how do you assess patient status for liver pts

Answer 11

CAGE screening

Question 11

what is liver cirrhosis

Answer 11

Normal, healthy tissue is replaced by fibrotic, non-functional tissue
Often results from chronic hepatitis

Question 12

how to you treat alcohol withdrawal sx

Answer 12

Will often give benzodiazepines to help wean the patient and ease symptoms

Question 13

what hepatitis causes liver cirrhosis

Answer 13

hepatitis B and C

Question 14

what is the flapping tremor from ammonia buildup associated with cirrhosis called

Answer 14

asterixis

Question 15

what is caput medusae and fetor hepaticus associated with cirrhosis

Answer 15

appearance of enlarged or swollen veins across the front of your abdomen (belly)

a type of chronic bad breath that’s actually a symptom of liver disease. It has a distinctive smell — some say, like rotten eggs and garlic

Question 16

what do labs for liver cirrhosis look like

Answer 16

elevated LFT, bili, clotting factors, ammonia, BUN/creatine

low blood count, protein/albumin, K, Na, and vitamins

Question 17

how do you make diuretics effective if all the fluid isn’t in the intravascular space

Answer 17

Diuretics: only effective if fluid is in intravascular space so TAKEN WITH ALBUMIN

Question 18

how do you tx portal vein HTN

Answer 18

Beta blockers, proton pump inhibitors

Question 19

how do you get rid of ammonia buildup

Answer 19

Lactulose binds to ammonia in colon can causes frequent loose stools

Rifaximin is a antibiotic that binds to ammonia

Question 20

How do you decrease GI bleed risk

Answer 20

proton pump inhibitors

Question 21

How do you create clotting cascade

Answer 21

fresh frozen plasma and Vitamin K

Question 22

What is a TIPS procedure

Answer 22

Scar tissue formed when the liver becomes cirrhotic can occlude the portal vein. TIPS is a minimally invasive procedure that creates a shunt to bypass the liver and reduce pressure in the portal vein.

blood through shunt isn’t cleaned by liver

Question 23

How are esophageal varices caused

Answer 23

portal hypertension can cause rupture of vessels

Question 24

Liver tx patients are at risk for

Answer 24

infection, formation of abscesses, and acute renal failure

Question 24

what med would a liver transplant patient need to take the rest of their life

Answer 24

cyclosporine (immunosuppressant)

Question 25

Liver diet

Answer 25

low-sodium diet— high carbohydrate, moderate protein and moderate fat Small, frequent meals

Question 26

You must performa daily ____ on liver cirrhosis patients

Answer 26

weights

Question 27

What is Hepatorenal syndrome:

Answer 27

fluid shift from decreased albumin from liver failure causes hypoperfusion to kidneys

Question 28

A pt presents w/ hematemesis and is a known liver patient. What do you need to do

Answer 28

Will often be put on non-selective beta blocker in order to reduce pressure Most often treated with endoscope with banding If they rupture, pt will likely die

Question 29

what is the difference between Cholelithiasis and Cholecystitis

Answer 29

Cholelithiasis—precipitation of bile salts to form gallstones Cholecystitis—inflammation of the gallbladder—often associated with cholelithiasis, though can be linked to other causes can occur separately or at the same time

Question 30

Three major contributing factors to formation of gall stones are:

Answer 30

abnormalities in bile composition (too much cholesterol, too much bilirubin), bile stasis (gastric bypass), and cholecystitis (not using bile, hormone shifts)

Question 31

estrogen affects concentration of ________.

Answer 31

bile salts, the more estrogen the more concentrated bile salt

Question 32

difference between Calculous cholecystitis and Acalculous cholecystitis

Answer 32

Calculous cholecystitis-gallstone obstructs part of the path of flow for bile Acalculous cholecystitis—can occur with ischemia or any other process which causes biliary stasis—can also be caused by anatomical obstructions (gall bladder hangs low which kinks flow of bile)

Question 33

What is Murphy’s sign and Blumberg’s sign

Answer 33

Murphy: (push below liver, rebound tenderness indc peritonitis) Blumberg: (pain underneath rib cage)

Question 34

Sx of gallstones

Answer 34

RUQ pain nausea, vomiting especially after eating a fatty meal Murphy’s sign (push below liver, rebound tenderness indc peritonitis) Blumberg’s sign (pain underneath rib cage) steatorrhea ( Stools may be bulky and difficult to flush, have a pale and oily appearance, and can be especially foul-smelling. clay-colored) Pruritis, jaundice

Question 35

expected labs for gallstones

Answer 35

increased inflammation and high fat in blood Amylase elevated Lipase elevated

Question 36

how do you officially dx gall stones

Answer 36

Ultrasound (only for calcified stones) Endoscopic retrograde cholangiopancreatography (ERCP) HIDA Scan (give radioactive component in so you see bile in liver, gall bladder, then small intestine)

Question 37

how do you dissolve cholesterol-based stones

Answer 37

Bile acids-chenodiol, ursodiol

Question 38

most common tx for gall stones is _____

Answer 38

removal

Question 39

Alternative tx for gall stones

Answer 39

Endoscopic retrograde cholangiopancreatography (ERCP) Extracorporeal shock wave lithotripsy (ESWL) Transhepatic biliary catheter (t-tube) stent placement

Question 40

How do you manage a t tube

Answer 40

Drainage will initially be sanguineous and then transition to bile There will be up to 400 ml in the first 24 hours, and then it will start to decrease If no drainage, especially early on and with nausea/pain, could be an obstruction Do not raise above the level of the gallbladder unless ordered Clamp before and after meals (otherwise no bile can be used to digest with, it’ll all flow out) Empty bag every 8 hours

Question 41

gall stone diet

Answer 41

Low-fat diet—avoid dairy, fried foods, etc.) Small, frequent meals Avoid foods that cause flatulence

Question 42

priority after lap-chole

Answer 42

Early ambulation after lap chole to help expel CO2 right shoulder pain from CO2 air from laparoscopic procedure alleviated by walking around

Question 43

what causes pancreatitis

Answer 43

premature activation of pancreatic enzymes in the pancreases causes autodigestion (caused by obstructions, alcohol, autoimmune disease. Made worse by alcohol because it increases enzyme secretion) Causes hypocalcemia, hyperglycemia, and decreased digestion of nutrients

Question 44

what is the number one cause of pancreatitis

Answer 44

alcohol

Question 45

Sx of pancreatitis

Answer 45

abdominal pain that radiates to back, flank or shoulder and is described as a “boring” pain; polydipsia, polyphagia (little insulin production), nausea, weight loss, vomiting Turner’s sign (discoloration around hip/flank), Cullen’s sign (discoloration around belly button) musculoskeletal tetany (involuntary contraction of muscles that usually results from low calcium levels in the blood)

Question 46

labs of pancreatitis

Answer 46

Amylase-increases and clears faster than lipase (elevated) Lipase (elevated) Glucose (elevated) Bilirubin (elevated if affecting common bile duct) AST, ALT, LDH (elevated if affecting common bile duct) Magnesium—impaired absorption (lower) Calcium—precipitates as part of the disease process (lower)

Question 47

how do you treat pancreatitis

Answer 47

prioritize pain management (PCA pump) Antibiotics-for acute necrotizing pancreatitis (ANP) Anticholinergics (dry everything up) Proton Pump Inhibitors/H2 antagonists Pancreatic enzymes (pancrelipase) help digest things Insulin Calcium replacement Isotonic Fluids if polyuric

Question 48

How do you manage acute pancreatitis

Answer 48

NPO, decompress, TPN

Question 49

What do you do once the pt recovers from the initial insult of acute pancreatitis

Answer 49

slow start small frequent meals that are high protein, high carbohydrate, and low fat Also give the patient bland food Avoid caffeine and alcohol Nutritional supplements are encouraged No smoking (no nicotine)

Question 50

What is a common complication from pancreatitis

Answer 50

pancreatic cancer. low survival rate When treated with Whipple procedure at risk for: Diabetes Hemorrhage Infection Bowel obstruction Abscess Peritonitis

Question 51

Which laboratory test result will the nurse monitor to evaluate the effects of therapy for a patient who has acute pancreatitis?

Answer 51

Lipase Lipase is elevated in acute pancreatitis. Although changes in the other values may occur, they would not be useful in evaluating whether the prescribed therapies have been effective.

Question 52

How should the nurse prepare a patient with ascites for paracentesis?

Answer 52

Ask the patient to empty the bladder.