Hepatic and Pancreatic Disorders Flashcards
(42 cards)
1
Q
What is cirrhosis?
A
irreversible scarring of liver due to hepatic inflammation and necrosis
2
Q
What are some complications of cirrhosis?
A
– complications depend of amount of damage
- portal hypertension – major complication
- development of nodular tissue – blocks bile ducts and blood flow
- hepatomegaly – due to blockage of bile and blood, causing fluid to accumulate
- ascites – free fluid accumulation in abdominal cavity –> hypoperfusion of kidneys –> renal failure –> more ascites
- bleeding esophageal varices
- coagulation defects – clotting factors 2, 7, 9, 10
- jaundice – due to inability to excrete bilirubin
-
hepatic encephalopathy – toxins that cannot be cleared by the liver accumulate in the blood and travel to the brain, impacting brain function
- end-stage liver failure
- ALOC – from elevated ammonia
- elevated ammonia
- hepatorenal syndrome – impaired kidney function due to liver disease
-
bacterial peritonitis
- presents as increased leukocytes
3
Q
What are the 3 types of cirrhosis?
A
- Laennec’s: alcoholic
-
postnecrotic: viral hepatitis or drugs
- usually caused by hep C
- biliary: biliary obstruction in gallbladder or autoimmune disease
4
Q
What are some causes of liver disease?
A
- hepatitis C – leading cause of cirrhosis
- alcohol
- drugs and toxins
- IV drug use can cause liver disease
- acetaminophen
- gallbladder disease – obstruction in common bile duct –> enlarged liver and liver damage
- metabolic / genetic causes
- cardiovascular disease
5
Q
What are the early and late signs and symptoms of liver disease?
A
– early:
- fatigue
- weight changes
- GI symptoms
- N/V
- anorexia
- abdominal pain
- liver tenderness
- pruritis
– late:
- jaundice and icterus (jaundice sclera)
- dry skin
- rashes
- petechiae
- ecchymoses
- warm, bright red palms
- spider angioimas
- peripheral dependent edema
- extremities
- sacrum
6
Q
What are some assessments that might indicate liver disease?
A
- ascites
- protrusion of umbilicus
- caput medusae (dilated abdominal veins) – AKA medusa veins in abdomen
- hepatomegaly
- bloody stools
- fector hepaticus (fruity/musty breath)
- amenorrhea
- genital changes
- asterixis (inability to sustain posture, resulting in rapid, jerking movements)
7
Q
What are the lab values to look out for with liver disease?
A
- increased ALT
- specific to liver
- increased AST
- specific to cardiac, muscle, kidney, brain
- increased lactate dehydrogenase (LDH)
- due to destruction of liver cells
- increased alkaline phosphatase
- due to biliary obstruction
- increased total bilirubin
- increased total urobilinogen
- increased prothrombin time
- damaged liver cannot produce enough prothrombin, decreasing clotting time
- increased ammonia
- increased creatinine
- decreased total protein
- decreased albumin
- decreased platelets
- decreased H&H
8
Q
What are some interventions for ascites?
A
- nutrition
- low sodium
- fluid restrictions
- vitamin supplements and electrolyte replacements
- banana bags = thiamine, folic acid, magnesium sulfate
- drugs
- diuretics
- paracentesis
- important to assess for hypovolemia since body has become accustomed to excess fluid
- elevate HOB to minimize SOB
- sit in chair
- surgical
- shunting fluid out of venous system
- peritoneovenous
- portocaval
- transjugular intrahepatic portosystemic shunt (TIPS) – controls long-term ascites; reduces variceal bleeding
- shunting fluid out of venous system
9
Q
How are pts assessed for hemorrhage?
A
endoscopy – screen pts early, especially UGIB
10
Q
What are some interventions for esophageal bleeds?
A
- drugs
- non-selective beta blockers
- sandostatin
- vasopressin
- endural
- coreguard
- non-selective beta blockers
- gastric intubation
- esophagogastric tamponade – short-term control of bleeds
- blood transfusion
- vasoactive therapy
- endoscopic procedures
- magnet at base of esophagus
- esophageal variceal ligation
- sclerotherapy
- TIPS
11
Q
What are some interventions for hepatic encephalopathy?
A
- control elevated ammonia levels
- ammonia is toxic to brain
- liver filters out
- produced from protein breakdown
- restricted protein diet
- drugs
- lactulose – promotes ammonia excretion
- neomycin sulfate
- intestinal antiseptic – eliminates good bacteria to decrease ammonia production
- metronidazole – intestinal antiseptic
12
Q
What is hepatits? Why are they important?
A
– hepatitis: viral inflammation of liver cells by
- hepatitis A
- hepatitis B
- hepatitis C
- hepatitis D
- hepatitis E
– important because hepatitis cases must be reported to local health department who will then notify the CDC
13
Q
Describe hepatitis A (HAV).
A
- typical viral syndrome – flu-like symptoms
- often goes unrecognized
- non-specific GI symptoms
- spread via fecal-oral route
- contaminated water, shellfish, foods
- spread via oral-anal sexual activity
- susceptible to chlorine bleach
- incubation = 15 - 50 days
- not life-threatening
- more severe in pts 40+
14
Q
Describe hepatitis B (HBV).
A
- spread via
- unprotected sex
- sharing needles/needle sticks
- blood transfusions
- hemodialysis
- maternal-fetal route
- healthcare works often get this type
- incubation = 25 - 180 days
- symptoms:
- anorexia
- N/V
- fever
- fatigue
- RUQ pain
- dark urine
- light stool
- joint pain
- jaundice
- carriers can infect others even without symptoms
15
Q
Describe hepatitis C (HCV).
A
- spread via
- sharing needles/needle sticks
- blood/blood products
- organ transplants prior to 1992
- tattoos
- intranasal cocaine
- incubation = 21 - 140 days
- pts are often asymptomatic
- damage occurs slowly over decades
- can be a carrier without symptoms
- leading cause for liver transplants in US
16
Q
Describe hepatitis D (HDV).
A
- spread via
- parenteral route
- sexual contact
- incubation = 14 - 56 days
17
Q
Describe hepatitis E (HEV).
A
- endemic areas
- waterborne epidemics
- travelers to endemic areas
- spread via fecal-oral route
- similar symptoms to HAV
- incubation = 15 - 64 days
18
Q
What are important labs to assess for hepatitis infections?
A
liver panels and liver enzymes
19
Q
What are some interventions for hepatitis?
A
– decrease demands of liver
- physical rest
- psychological rest
- nutrition
- restrict proteins
- restrict fats
- high carbs
- drugs
- use medications sparingly to decrease liver damage
- antiemetics
- antivirals
- immunomodulators
20
Q
What is steatosis?
A
fatty liver – caused by accumulation of fats in and around liver cells
21
Q
What causes steatosis?
A
- DM
- obesity – most common cause
- elevated lipid profile
- alcohol abuse
22
Q
How does steatosis present?
A
many pts are asymptomatic and may only present with an elevated liver profile
23
Q
What are hepatic abscesses? Which pathogens cause hepatic abscesses? How is it diagnosed?
A
– hepatic abscess: liver invaded by bacteria or protozoa, causing an abscess
– pathogens:
- E. coli
- Staph
- Salmonella
- gallstones – not a pathogen, but you know…
– diagnosed with CT or ultrasound
24
Q
What are some interventions for hepatic abscesses?
A
- drainage
- antibiotics
25
What are some clinical manifestations of liver trauma? What are some interventions for liver trauma?
-- clinical manifestations:
* abdominal tenderness
* distention
* guarding
* rigidity
-- interventions:
* surgery
* blood products
26
What is the most common complaint in pts with liver cancer?
-- common complaint = abdominal discomfort
* liver cancer is one of the most common tumors in the world
* prognosis is not very good
27
What are some interventions for liver cancer?
* chemotherapy
* hepatic artery embolization -- block blood to tumor
* hepatic arterial infusion (HAI) -- chemo drug pumped directly into liver supply to damage tumor
* surgery
-- liver cannot tolerate high levels of chemo, so treatments are limited
28
When is liver transplantation used?
to treat end-stage liver disease
29
What are some complications of liver transplantation?
* graft rejection
* infection
* hemorrhage
* hepatic artery thrombosis
* fluid and electrolyte imbalance
* pulmonary atelectasis (lung collapse)
* acute renal failure
30
What is acute cholecystitis? What are the 2 types? What commonly accompanies cholecystitis?
-- **acute cholecystitis:** inflammation of gallbladder
* **calculous:** inflammation with gallstone
* **acalculous:** inflammation without gallstone
-- cholelithiasis (gallstones) often accompany cholecystitis
* may be accumulation of cholesterol, bile salts, and pigments
31
What is chronic cholecystitis? What are some signs and symptoms?
-- **chronic cholecystitis:** repeat episodes of cystic duct obstruction resulting in chronic inflammation with calculi almost always present
-- s/s
* pancreatitis
* cholangitis -- infection of common bile duct
* jaundice
* icterus
* obstructive jaundice
* pruritis
* flatulence
* dyspepsia
* eructation (belching)
* anorexia
* N/V
* abdominal pain -- usually after fatty meals
* biliary colic -- pain and spasms
* Murphy's sign -- pain on R side that increases with inspiration
* Blumberg's sign -- rebound tenderness
* steatorrhea -- due to impaired urobilinogen production
* McBurney's point pain
32
What are some interventions for cholecystitis?
* nutrition
* low fat
* fat-soluble vitamins and bile salts
* drugs
* opioids -- morphine or hydromorphone
* anticholinergics
* antiemetics
* extracorporeal shock wave therapy -- shock waves to reduce pain and help healing
* biliary catheter insertion
* surgery -- most common treatment
* cholecystectomy
* laparoscopic = gold standard
* most important postop intervention = pain management
* referred shoulder pain
* free air pain -- CO2 retention in abdomen
* traditional open cholecystectomy
* very rarely done anymore
* only doen with severe biliary obstruction
33
Which population most commonly experiences gallbladder cancer? What are some signs and symptoms of gallbladder cancer? What are some interventions?
-- women experience gallbladder cancer more than men
* poor prognosis
-- s/s
* anorexia
* weight loss
* N/V
* malaise
* jaundice
* hepatosplenomegaly
* chronic, progressive, severe epigastric pain or RUQ pain
-- interventions:
* surgery
* radiation
* chemo -- not very effective due to proximity to liver
34
What is acute pancreatitis?
serious, potentially life-threatening inflammation of pancreas causing autodigestion and fibrosis
35
What are some complications of acute pancreatitis?
* pleural effusion, respiratory distress, pneumonia
* L lung due to pancreatic exudate
* multi-organ failure
* hypercoagulation
* DM
36
What are some signs and symptoms of acute pancreatitis?
* LUQ pain radiates to back or shoulder
* abdominal tenderness
* rigidity
* guarding
* jaundice
* Cullen's sign -- belly button discoloration
* Turner's sign -- flank and sides discoloration
* decreased bowel sounds
* pancreatic ascites
* vital sign changes -- resembles septic shock
* tachycardia
* hypoxia
* hypotension
37
What are some lab assessments for acute pancreatitis?
* amylase -- elevated for a few days
* lipase -- elevated for weeks
* trypsin -- elevated
* alkaline phosphatase -- elevated if biliary involvement accompanies pancreatitis
* WBC -- elevated
* glucose -- elevated from beta cell damage
* calcium -- decreased
38
What is chronic pancreatitis? What are some interventions?
-- **chronic pancreatitis:** progressive, destructive disease of the pancreas characterized by remissions and exacerbations
* pain is most common symptom
-- interventions
* drugs
* opioids
* PPIs
* analgescis
* enzyme replacements to help with digestion
* insulin
* nutrition
39
Why are pancreatic abscesses dangerous? What is the main symptom of pancreatic abscess? What is the main diagnostic test? What are some interventions?
-- can be fatal if untreated; most serious complication of necrotizing pancreatitis
-- main symptom = high fever (104 F)
-- diagnostic = blood cultures to determine if pt is septic
-- interventions:
* drainage
* percutaneous
* laparoscopy
* antibiotics
40
What is a pancreatic pseudocyst? What are some complications? What are some interventions?
-- **pancreatic pseudocyst:** cyst encapsulated on pancreas
-- complications
* hemorrhage from rupture
* infection
* bowel obstruction
* abscess
* fistula
* pancreatic ascites
* epigastric pain that moves to back
-- interventions
* surgery
* percutaneous
* endoscopy
* surgical drainage
* may resolve spontaneously
41
Where is the most common location for a pancreatic carcinoma? Discuss pancreatic carcinoma prognosis and progression.
-- head of pancreas most common location
-- 5 year survival rates -- poor prognosis
-- metastasis spreads rapidly through lymph and venous systems
42
What are some interventions for pancreatic carcinomas?
* drugs -- palliative
* radiation
* decrease size and pain
* helps with food absorption
* biliary stent to keep ducts open
* Whipple procedure -- removal of multiple portions of pancreas
* success rate is not very good
* radical pancreatectomy
