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From Flashcardlet > GI part 3 > Flashcards

GI part 3 Flashcards

1
Q

What are the functions of the liver?

A 
Create bile
Produce and release glucose when needed (stored as glycogen)
Fat metabolism
Protein metabolism (essential for life) 
Albumin synthesis
Blood clotting mechanisms
Detoxifies hormones, chemicals and drugs
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2
Q

What is the liver’s role in protein metabolism

A

degrades AA and uses as energy or stores –>by product is ammonia –> converted to urea & excreted in stool and urine

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3
Q

What is the liver’s role in albumin synthesis?

A

-maintains plasma oncotic pressure

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4
Q

What is the role of the hepatic artery?

A

Brings nutrients into liver

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5
Q

What is the role of the portal vein?

A

drains waste products from GI tract

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6
Q

What is another term for jaundice?

A

icterus

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7
Q

What type of HTN contributes to ascites?

A

Portal hypertension (blood blocked from going through the sinusoids of the liver)

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8
Q

How does hypoalbuminemia help cause ascites?

A

causes decreased oncotic pressure and 3rd spacing of fluid

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9
Q

How does hyperaldosteronism contribute to ascites?

A

body recognizes decreased vascular volume and tries to retain water and sodium

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10
Q

What drugs and diet treat ascites?

A

Low sodium diet, fluid restrictions

Diuretics

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11
Q

What interventions are there for treating ascites?

A

Paracentesis
Positioning, skin care
Abdominal girth, daily weight
Peritoneojugular shunt (LeVeen shunt)

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12
Q

What is acute hepatitis and what are the two types?

A

It is inflammation of the liver and it is either toxic (caused by chemicals) or viral

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13
Q

How do you diagnose viral hepatitis?

A

serologic tests

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14
Q

Is viral hepatitis a reportable disease?

A

yes

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15
Q

What ethnic groups have a high rate of the disease?

A

Native americans and native alaskans

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16
Q

What percentage of hepatitis is type A?

A

40%

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17
Q

What is the incidence of Hep B in the world?

A

5%

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18
Q

What percentage of US cases of HBV are related to multiple sexual partners, homosexual men, and IV drug users?

A

60%

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19
Q

What percentage of HBV in US involve healthcare workers?

A

3%

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20
Q

What is the percentage of Hep in US are Hep C?

A

20%

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21
Q

How much percent of Hep C cases will develop into chronic hepatitis?

A

50%

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22
Q

Where is HDV seen?

A

not US, Middle East and Mediterranean countries

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23
Q

Is Hep E, G, or G seen often in US?

A

no, it is rare

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24
Q

How is HAV transmitted?

A

fecal-oral route

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25
Q

How long is the incubation of HAV?

A

2-6 weeks

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26
Q

What is mortality percentage of HAV?

A

< 1%

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27
Q

What is post exposure prophylaxis for HAV and how soon should it be given?

A

immune globulin and given within 2 weeks

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28
Q

Prevention of HAV

A

hand washing

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29
Q

How long can HAV live outside the body and what kills it?

A

It can live for months and chlorination kills it.

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30
Q

Once you get HAV, can you get it again?

A

no

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31
Q

Who is at risk of getting HAV?

A

travelers to developing countries, staff and clients in custodial care situations (prisons, daycare, nursing homes)
Or having sex with someone who has Hep A

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32
Q

Is a vaccine available for HAV?

A

yes

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33
Q

How is HBV transmitted?

A

Parenteral, sexual, perinatal transmission

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34
Q

What is the incubation period of HBV?

A

4-24 week

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35
Q

Mortality rate of HBV

A

1-2%

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36
Q

Who is at high risk of getting HBV?

A

household and sexual partners of HBV carriers, IV drug users, sexually active gay men, health care workers in frequent contact with blood multiple sexual partners; infants born to infected mothers;

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37
Q

Is a vaccine available?

A

Yes and is best protection

38
Q

What can help decrease risk of getting HBV?

A

Latex condoms and don’t share razors, toothbrushes (blood)

39
Q

What should infants be given to prevent Hep B and how soon after birth?

A

immune globulin given within 12 hours

40
Q

How many in US are affected by chronic Hep B and how many die a year from it?

A

Over 1 million in US affected with chronic Hep B—about 5000 persons per year die from chronic Hep B

41
Q

How is HCV transmitted?

A

Parenteral, sexual, perinatal transmission

42
Q

Incubation period of HCV?

A

2-20 weeks

43
Q

Mortality rate of HCV?

A

1-2%

44
Q

How long can HCV live on surfaces?

A

up to 4 days

45
Q

Can you have HCV with no signs or symptoms?

A

yes

46
Q

Who is at high risk of getting HCV?

A

travelers to endemic countries, people receiving frequent blood transfusions, IV drug users, tattoos, but 40% have no risk factors

47
Q

Is there a vaccine for HCV?

A

no

48
Q

If you have Hep C what do you need to be evaluated for?

A

liver disease, leading indication for liver transplant

49
Q

Hepatitis Patho

A

Diffuse inflammatory infiltration of hepatic tissue
Liver cells may be very swollen
Inflammation, degeneration, and regeneration of tissues occur
Pressure on portal vein
Bile ducts can become obstructed

50
Q

Do most patients recover normal liver function after hepatitis?

A

yes

51
Q

What symptoms are shown during preicteric phase of hep?

A

flu-like symptoms, malaise, GI complaints, N/V/D, RUQ pain,

52
Q

What symptoms develop during icteric phase of hep?

A

jaundice, pruritis, clay-colored stools, dark urine

53
Q

What is characteristic during posticteric phase of hep?

A

lasts several weeks, liver enzymes return to normal, pain and weakness subside

54
Q

What nursing care is provided to prevent hep transmission?

A

Standard precautions, teach patient and family

55
Q

What nursing care is provided for activity intolerance with hep?

A

REST, gradually increase activities, progressive ambulation

56
Q

What is the nursing care for altered nutrition from hep?

A

very anorexic so need high calorie, low fat diet, eat most of calories in AM because tend to be more nauseated in PM, NO ALCOHOL

57
Q

Why may someone with hep have body image disturbance?

A

jaundice

58
Q

What is the “orange-yellow” condition?

A

Cirrosis

59
Q

What is the extensive destruction of liver parenchymal cells, then disorganized regeneration of liver tissue?

A

Cirrhosis

60
Q

What does Cirrhosis alter?

A

the flow of bile, blood and hepatic metabolites

61
Q

What does Cirrhosis usually start with?

A

fatty infiltration of the liver

62
Q

What can predispose a person to Cirrhosis?

A

Any chem. or organism that causes liver destruction and patchy

63
Q

What is Laenec’s cirrhosis?

A

alcohol cirrhosis

64
Q

What is 75% of all cirrhosis from?

A

toxic alcohol and poor nutrition

65
Q

What is is Post Necrotic Cirrhosis usually from?

A

hepatitis

66
Q

What are two main problems with cirrhosis?

A

decreased liver function

portal hypertension

67
Q

What does Portal HTN cause in the blood flow?

A

Reverses blood flow and enlarges esophageal, umbilical, and rectal veins

68
Q

What does Portal HTN form?

A

ascites

69
Q

What does portal HTN and a decreased liver function cause a decrease in?

A

causes a decreased clearing of metabolic wastes

70
Q

What are the clinical manifestations of Cirrhosis?

A 
Emaciation and ascites
Lower leg edema
Prominent ABD wall veins
Esophageal varices
Hormonal changes 
Bleeding tendencies
Anemia
Increased infection risk
71
Q

What causes the bleeding tendencies in Cirrhosis?

A

decreased Vit. K

72
Q

What is Hepatic Encephalopathy?

A

end-stage cirrhosis

73
Q

What is the main culprit of end-stage cirrhosis?

A

Ammonia**

74
Q

What produces Ammonia?

A

bacterial breakdown of amino acid in the intestines

75
Q

Where does ammonia go after its produced?

A

to the liver via vein

76
Q

What does ammonia do once it’s in the liver?

A

converted to urea in and excreted in kidneys

77
Q

What happens with Ammonia when a patient has Cirrhosis?

A

blood is shunted past the liver OR the liver is unable to convert ammonia to urea = increase in ammonia

78
Q

What happens when ammonia crosses blood-brain barrier?

A

causes neurologic manifestations

79
Q

What increases ammonia levels?

A

anything that increases proteins in the intestines (blood/diet)

80
Q

What is a manifestation when Ammonia levels are increased?

A

Change in mental status may progress from lethargy → deep coma
Disoriented to PPT
Asterixsis
fetor hepaticus

81
Q

What is Asterixsis?

A

Liver flap - hands will flap, cant keep them still

82
Q

What is fetor hepatiucs?

A

also known as “breath of the dead” sweet, fecal breath smell

83
Q

What is the treatment of Cirrhosis with the diet?

A

decrease protein in diet

84
Q

In the treatment of Cirrhosis, how is the bacterial production of ammonia decreased?

A

giving intestinal antiseptic such as Neomycin and Lactulose

85
Q

What does Neomycin do in decreasing ammonia?

A

powerful affect on nitrogen forming bacteria and helpful preventing ammonia accumulation

86
Q

What does Lactulose do in decreases ammonia in the intestine?

A

pulls ammonia into bowel and causes loose BMS

87
Q

How many bowel movements do you want a patient to have a day when taking Lactulose?

A

3-4/day

88
Q

What needs to be watched for closely with Cirrhosis?

A

sedative administration

increase drug effect since liver is not metabolizing correctly

89
Q

If a patient has ascites with Cirrhosis, what needs to be restricted?

A

fluid

90
Q

What needs to be prevented when caring for a patient with cirrhosis?

A

infection - watch for skin breakdown

91
Q

What needs to be given to help increase nutrition and help anemia?

A 
Thiamin
MVI
Folate supplements
Vit. K
Rest

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