GI 3 Flashcards
(187 cards)
1
Q
Functions of liver
A
carb, fat, steroid, protein metabolism
detoxification
prodution & excretion of bile
storage iron, vit K, minerals blood
2
Q
yellow pigmentation of sclera, skin, deeper tissues
A
jaundice
3
Q
why does jaundice happen
A
due to a concentration of bilirubin in blood, becomes abnormally increased
4
Q
how is bilirubin formed
A
from the breakdown of hemoglobin of old RBC’s
(unconjugated bilirubin released into blood, bound to albumin, not water soluable (cannot be excreted) cannot be filitered by kidneys, builds up in blood)
5
Q
what does the bilirubin level have to be for jaundice to occur
A
3 times greater than normal
6
Q
is jaundice a disease
A
NO, its a symptom
7
Q
what is the most common cause of jandice
A
excessive breakdown of RBC’s or bile excretion obstruction
8
Q
babies become jaundice because
A
of excessive destruction of RBC’s
9
Q
results from excessive RBC destruction, occurs before the liver, has excess unconjugated bilirubin
A
pre-hepatic jaundice (hemolytic)
10
Q
causes of hemolytic jaundice
A
hemolytic anemia, sickle cell, severe burns, newborns
11
Q
defective uptake, conjugation or excretion of bilirubin within liver, both unconjugated and conjugated bilirubin elevated
A
hepatic jaundice (hepatocellular)
12
Q
causes of hepatocellular jaundice
A
cirrhosis, hepatitis, hepatic carcinoma
13
Q
what is the major problem in hepatocellular jaundice
A
conjufation and excretion of bilirubin
14
Q
decreased or obstructed flow of bile thru liver or biliary duct system, blocks outward flow of bile from liver
A
post hepatic jaundice (obstructive)
15
Q
obstruction of bile into the duodenum, clay colored stools with complete obstruction
A
extrahepatic
16
Q
pruritis
A
itching
17
Q
who would you have a pt come in with a bleeding problem who has a Hx of liver disease
A
lack of vit K, bile is necessary for absorption of vit k from GI
18
Q
what Rx do you want to avoid if you have problems with jaundice
A
ASA, risk of bleeding
19
Q
any type of inflammation in the liver
A
hepatitis
20
Q
what kind of hepatitis is most common
A
viral hepatitis
21
Q
wide spread inflmmation of liver, liver cell damage, degeneration and necrosis, bile flow interruption
A
viral hepatitis
22
Q
what are causes of hepatitis
A
viral
alcohol
drugs
23
Q
Hepatitis A
A
transmitted thru fecal oral route
occurs in small outbreaks
contagious for 2 weeks prior to symptoms
due to poor hygine, contaminated food, water, poor sanitary conditions
24
Q
detection of IgM anti-HAV indicates
A
acute hepatitis
25
presence of IgG antibody does what
provides lifelong immunity
26
Hepatitis B
can live up to 7 days on a dry surface, 100x's more infectious than HIV
transimission by body fluids, blood
27
HBV Window phase
have a 3 month delay between disapperance HB-antigen & apperance Anti-HB
28
a positive HBAb or anti-HBs indiciates
recovery, no longer contagious
immunity from HBV vaccine or past HBV infection
29
Hepatitis C
transmission is blood & blody fluids
HCV damages liver over decades
leading indication for liver transplant
chronic, asymptamatic
30
only way for survival of hepatitis c is
liver transplant
31
hepatitis D
also called delta virus
HDV only occurs as co-infection with HBV
32
Hepatitis E
waterborne infection in india, asia, africa
fecal oral route
causes epidemics after heavy rains and flooding
33
hepatitis G
blood & bldy fluids
often coexists with other hepatitis viruses (B, C, HIV)
34
Toxic & drug induced hepatitis
liver damage occurs after exposure to hepatotoxins
35
autoimmune hepatitis
chronic, autoimmune reaction against normal hepatocytes
treated with corticosteroids, or liver transplant
36
Hepatitis DX
biopsy, elevated ALT, AST, WBC, increased eosinophils
37
acute phast of hepatitis
lasts 1-21 days
period of maximal infectivity for hepatitis A
Sx: fatigue, constippation, diarrhea, malaise, RUQ pain, HA photophobia, low grade fever
38
Icteric phase (jaundice phase)
lasts 2-4 weeks, characterized by jaundice
dark urine
clay colored stools
39
posticteric phase
| (convalescent phase)
begins when jaundicedisappears
lasts weeks to months
hepatomegaly
40
resulsts in severe impairment or necrosis of liver cells and potential liver failure
fulminant hepatitis
| (Hep B &D)
41
Tx for hepatitis
no specfic Tx, emphasis on rest and adequate nutrition
antiviral Rx: epivir, baraclude, tyzeka, hepsera
antiemetics: zofran, tigan, reglan
42
prevention for hepatitis A
vaccine can be fiven for pre exposure prophylaxis, immune globulin can be given before or after exposure (1-2 weeks)
43
prevention hepatitis B
immunization is most effective, HB immune globulin given post exposure provides passive immunity
44
Preventino of Hepatitis C
no products to prevent HCV
45
what are the three A's when preventing accidental exposure
awareness attentivness, anticipation
46
nutritional therapy for hepatitis
vitamin supplements b-complex vitamins, vitamin K
47
what needs to be done after diagnosis of Heptitis
follow up for at least one year after diagnosis, avoid alcohol
48
wilsons disease
increase of copper in liver, develop kayser-fleicher rings, leads to liver failure, Tx is chelating agents to promote exretion of exess copper
genetic
49
hemochromatosis
increase absorption of iron leads to cirrhosis, unTx can lead to death
50
a chronic progressive disease of the liver with irreversible scarring of the liver, tissue becomes nodular and fibrotic
cirrhosis
51
what is the most common cause of cirrhosis
alcohol
52
is cirrhosis fatal
yes
53
cirrhosis caused by alcohol use, proceded by fatty infiltration of the liver cells, widespread scar formation
alcoholic (laennec's) cirrhosis
54
cirrhosis caused by a complication of tocix, viral or autoimmune hepatitis, liver becomes small and distorted
postnecrotic cirrhosis
55
cirrhosis associated with chronic biliary obstruction and infection, liver enlarges, firm and green
biliary cirrhosis
56
cirrhosis caused by longterm severe right sided heart failure
cardiac cirrhosis
57
when do S/Sx of cirrhosis begin
when about 80% of liver damage has occured
58
when do jaundice and peripheral edema occur in cirrhosis
last stages
59
small dilated vessels, bright red center and spider like branches
spider angiomas
60
red area palm of hand blanches with pressure
palmar erythema
61
how is splenomegaly caused
backup of blood from portal vein
62
why do people with cirrhosis have bleeding tendencies
decreased production of hepatic clotting factors
(II, VII, IX, X)
63
what dietary deficiencies occur with cirrhosis
thiamine, floic acid, vit B12
64
increased resitance to blood flow through the liver, portal vein pressure increases
portal HTN
65
complex tortuous veins at lower end of esophagus
esophageal varices
66
colalrteral circulation which involves the superficial veins of the abd wall leading tothe development of dilated veins around the umbilicus
caput medusae
67
shift of fluid in abd bc of lack of protein bc the liver isnt functioning properly
abd distention and weigh tgain
ascites
68
liver damage causs blood to enter systemic circutaion without liver detozification, liver is unable to convert ammonia to urea or blood shunted past liver so ammonia stays in systemic circulation
hepatic encephlopaty
69
what are S/Sx of hepatic encephalopaty
inapproptiate behavior to coma
70
flapping tremor invovles arms and hands
asterixis
71
musty, sweetish odor detected on the pts breath
fetor hepaticus
72
toes curl when touch bottom of feet
babinski sign
73
4 stages of hepatic encephalopaty
prodromal
impending (asterixis)
stuporous
comatose (+ babinski)
74
functional renal failure without structural abnormality of kidneys, decreased arterial volume which leads to renal vasoconstriction with renal failure
hepatorenal syndrome
75
what is the most specific lab test done for liver
ALT
76
what kind of nursing care should be done for someone with chirrohsis
rest, admin of B12, management of ascites, prevent variceal bleeding, avoid alcohol
77
provides for continuous reinfusion of ascitic fluid fromthe abd to the vena cava or jugular
peritoneovenous shunt
78
wjat RX can be given to help prevent bleeding in espohageal varices
vasopressin
decreaes portal pressure by constriction
79
3 lumens to apply pressure to bleeding areas, gastic aspiration, gastric balloon, esophageal balloon
sengstaken-blakemore tube
80
what is important with a sengstaken-blakemore tube
monitor airway, syringe at bedside to deflate balloon
81
which shunt is used to decrease incidence of hepatic encephalopathy
warren shunt (distal spenorenal shunt)
82
what should the nurse do for a esophafeal varices
administer FFP & PRBC
vit K
H2 receptor blockers/PPI
83
what should be given for a pt with hepatic encephalopathy
lactulose
(forms lactic acid in bowel, so bacteria cant grow so traps ammonia in the gut and expels it)
84
what special diet should someone with ascite/edema follow
low sodium diet
85
paracentesis
have pt void prior to to avoid knicking the bladder
86
what is the most common complication of balloon tamponade
aspiration pneumoina
87
what surgical procedure can be done for varices
balloon tamponade
88
where does liver Ca usually metastazise from
lun, breast colon
89
elevated serum alpha-fetoprotein
tumor marker
90
used to treat inoperable cancer of liver, pancreatic & bile ducts & tumor obstructions
percutaneous biliary drainage
91
what is used in end-stage liver disease, acute liver failure, primary liver tumors
liver transplant
92
who is not a candidate for transplant
advanced cardiac disease, respiratory disease, alcohol abuse, metastatic tumors
93
what complications can a pt have with a liver transplant
graft rejection, infection
94
an acute inflammatory process of the pancreas
pancreatitis
95
what is the most common reason for pancreatitis
biliary tract disease
96
what enzymes aid with autodigestion
trypsinogen, elastase, phospholipase A
97
causes hemorrhage by producing dissolution of the elastic fibers of blood vessels
elastase
98
activated by trypsin and bile acids, plays a major role in autodigestion
phospholipase A
99
activated by trypsin by enterokinase, enzyme can digest the pancreas and can activate other proteolytic enzymes
trypsinogen
100
what can stimulate the production of digestive enzymes
alcohol
101
S/Sx of pancreatitis
LUQ or epigastric pain, aggrivated by eating high fat meals or alcohol intake
102
bluish periumbilical discoloration
cullens sign
103
bluish color in flank
turners sign
104
cullen or turners sign
sign of pancreatitis
105
a psecavity surrounding outside of pancreas filled with necrotic products and liquid secretions
pseudocyst
106
if a pseudocyst perforates it causes
peritonitis
107
a large fluid containing cavity within pancreasresults from necrosis in pancreas, requires surgical drainage
pancreatic abscess
108
tetany is caused by
hypocalcemia
109
serum amylase & lipase that is elevated could be what
pancreatitis
110
as a nurse what should you look for with pancreatitis
VS, hemmorrhage, fluid/electrolyte balance, NPO, LR
DO NOT use D5W bc you dont want the pancreas to have to work harder to make insulin
111
endoscopic sphincterotomy
used when stone blocking Oddi duct
112
ERCP is used when
gallstone blocking
113
diet for pancreatitis
high carb, low fat, high protein
114
what position should a pt lay with pancreatitis
side lying, with HOB elevated 45 degrees, knees up to abdomen
115
signs of hypocalcemia
tetany, numbness around lips/fingers, positive chvostek or trousseau signs
116
signs of hyperglycemia
polyuria, polyphagia, polydipsia
117
continuous prolonged, inflammaroty and fibrosing process of the pancreas
chronic pancreatitis
118
inflammation of sphincter of Oddi associated with cholelithiasis
chronic obstructive pancreatits
119
causes of chronic obstructive pancreatitis
cancer of ampulla of Vater
cancer of duodenum, or pancreas
inflammation of sphincer of Oddi
120
chronic calcifying pancreatitis happens where
head of the pancrea and around the pancreatic duct
121
S/Sx of chronic pancreatitis
heavy, gnawing feeling, burning cramp like
122
chronic pancreastitis is a precursor to what
pancreatic cancer
123
in pancreatic cancer what will the serum amylase/lipase be
may be increaed slightly or not at all
124
elevated sedimentation rate
indicates inflammation
125
choledochojejunostomy
CBD anastomosed into jejunum
bypasses obstruction of tumor
126
Roux-en-Y pancreaticjejunostomy
pancreatic duct opened & anastomosed to jejunum
127
all surgery for chronic pancreatitis is
palliative
128
cholecystojejumonstomy
connect GB to jejunum to go around obstruction
129
whipple procedure
radical pancraticoduodenectomy
130
S/Sx of carcinoma of pancreas
asymptamatic @ 1st, then rapid weight loss, abd pain radiates to back, pain related to eating
131
what does the gallbladder do
collects and concentrates and stores bile
132
inflammation of gallbladder
cholecystitis
133
calculous
acute cholecystitis, with cholelithiasis (stones)
134
acalculous
cholecystitis without cholelithiasis
135
who is at highest risk for cholecystitis
over age 40, females, multiparous women (mult pregnancy)
136
5 F's of risk factors
Fourty
Female
Fertile
Family Hx
Fat
137
calculous is mostly commonly associated with
obstruction
138
acalculous occurs in older adults and those who have what hx
trauma, extensive burns, or recent surgery
139
what are stones made of
bile salts, cholestrole
140
what is the most common factor for cholecystitis
e. Coli (bacteria)
141
develops when balance that keeps cholesterol, bile salts, and calcium in solution is altered
cholelithiasis
142
what is the most common form of stone
cholesterol
143
spasm of biliary duct trying to push stone through
biliary colic
144
S/Sx of cholelithiasis
pain in RUQ, and R shoulder
145
if your pt has pain triggered by a high fat meal, and blumbergs sign
acute cholecystitis
146
rebound tenderness
blumbergs sign
147
S/Sx when you have a total obstruction of GB
jaundice
dark amber foamy urine
clay colored stools
pruritus
bleeding tendencies
steatorrhea
148
when a stone is lodged in ducts or moving may cause spasm what is this called
biliary colic
149
why would a person have pruitis with cholelithiasis
bc of bile salts
150
why would a pt have bleeding tendencies with cholelithiasis
bc vit k is not being absorbed
151
steatorrhea
fatty stools
152
murphys sign
pain with inspiration
| (cholelithiais)
153
subphrenic abcess
found under diaphragm, pocket of pus (infection)
154
labs with cholecystitis
WBC, amalyse, lipase, AST, ALT
155
visualization of gall bladder & cystic, common hepatic, common bile ducts, pancreatic duct, can retrieve gallstone from distal CBD, dilate strictures, obtain biopsy, diagnoise pseudocysts
endoscopic retrograde cholangiopancreatography
(ERCP)
156
percutaneous transhepatic cholangiography
inject dye in bile duct, used to diagnose obstructive jaundice & locate stones within bile ducts, filling of hepatic and biliary ducts
157
what is the gold standard that shows gallstones in the GB and ducts
ultrasound
158
Labs for gallstone obstruction
increase of all the below:
ALT, AST, alkaline phosphaase
WBC
serum bilirubin (indirect, direct, urinary bilirubin)
serum amylase, lipase (if pancreastic involvement)
159
Tx for gallstones
pain management
antibiotic Tx
fluid electrolyte balance
anticholinergics (counteract smooth muscle spasms)
160
endoscopic spincterotomy
removes common bile duct stones, sphincter of Oddi widened, basket is used to retrieve stone
161
Sphincter of Oddi
where bile duct opens to duodenum
162
laparoscopic cholecystectomy
4 puncture holes, injury to common bile duct is main complication, discharged in 1-2 days
163
when is t-tube used
for open cholecysectomy, allows excess bile to drain
164
T-tube nursing Care
maintain semi fowlers position
keep drainage below level of GB
immediately post op have bloody drainage, then will change to greenish-brown
never irrigate aspirate or clamp without MD order
if pt is allowed to eat clamp tube for 1-2 hours before and after meals
stools will return to brown color (7-10 days)
165
what Rx can be given for pruritus
questran (cholestyramine)
gets rid of bile salts
166
if a pt eats too much fat they will have what kind of stools
steatorrhea
167
cholelithiasis disease is more common in what ethnic background
native americans
168
what signs of obstruction for GB stones
jaundice, caly colored stools, dark, foamy urine, fever, increased WBC, steatorrhea
169
post of for laparoscopic cholecystectomy
shoulder pain from irritation of phrenic nerve and diaphargm due to retained CO2, place pt in Sims position, deep breathing
170
when giving your pt narcotics what do you need to assess
RR
171
post cholecystectomy syndrome
abd pain with Vomiting following cholecystectomy
jaundice may occur several weeks to months after surgery, ERCP used to find problem
172
causes of post cholecystectomy syndrome
pseudocyst, common bile leak, bile duct stricture, retained stone, sphincter of Oddi dysfunction
173
gallbladder cancer
begins in inner layer and grows outward, rare, metastasizes to adjacent organ (liver)
174
CT and MRI is used for what
staging cancer
175
ERCP & MRCP
looks at ducts
176
CEA/CA 19-9
tumor markers
177
if surgery is not an option what can be done for GB cancer
endoscopic stenting of biliary tree to reduce jaundice
178
if pt who has gallbladder removed has bruising and bleeding could be bc of what
Vit K deficiency
179
ALT lab is used for what
enzyme found in liver cells, is a more specific measure of liver damage than AST, some drugs can falsely increase the level of ALT (acetaminophen, salicytates, codeine, oral contraceptives)
180
AST lab is used for what
non specific marker of hepatic injury found in brain, cardiac, skeletal muscle, kidney, and liver
the level can be falsely decreased in diabetic ketoacidosis, severe liver disease, uremia, pregnancy
181
GTT lab is used for what
enzyme produced in bile ducts that may be increased with bile duct dieases
useful in determining the source of increased ALP
182
ALP lab is used for what
relects bile formation and flow, produced in the bile ducts
can be falsely increased due to pregnancy, salicylates, antibiotics, oral DM rxs, oral contraceptives
183
LDH (lactic dyhydrogenase)
if elevated indicates tissue damage, decreased in radiation and cancer tx, increase in alcoholism, anemia, burns,
184
prothrombin
used to screen for hemostatic dysfunction involving coagulation system
185
ammonia
wast product produced during protein digestion, if liver doesnt convert to ammonia into urea ammonia levels rise in blood
186
bilirubin
byproduct of old red blood vell destruction removed by the liver from blood then secreted into bile, then absorped in intestine
187
urobilinogen
produced in intestines, some is reabsorbed and returns to liver rest excreted in feces, a banana before test may affect results, also wine, drugs, ascorbic acid, ammonium chloride and antibx, drugs containing sodium bicarb may yield a false positive test
