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NURSING 2 > liver and pancreas > Flashcards

liver and pancreas Flashcards

1
Q

Stages of liver damage:

A 
Health liver
Fatty liver (increase liver due to fat deposits)
Fibrosis liver (formation of scar tissue)
Cirrhosis liver (liver cell destruction)
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2
Q

What is total bilirubin

A

The direct and indirect bilirubin (total is combined direct and indirect)

– waist product from breakdown of blood cells

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3
Q

Total bili range

A

0.3-1.0

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4
Q

ALT

A

helps metabolize proteins

8-40

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5
Q

AST

A

Helps metabolize protein and ALT

10-40

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6
Q

GGT

A

0-30

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7
Q

LDH (lactic acid dehydrogenase)

A

shows erythrocyte damage

100-225

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8
Q

Alk phos

A

Breaks down proteins and elevares in bone cancer or problems
30-120

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9
Q

Amylase

A

23-85

pancreatic enzyme - elevates with not working well

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10
Q

lipase

A

0-160

elevates with not working well

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11
Q

Jaundice: patho

A

impairment of bodies ability to metabolize and secrete bilirubin

serum bilirubin levels > 3

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12
Q

Jaudice: cause –> hepatocellular

A

Hepatitis, hepatotoxins

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13
Q

Jaundice: cause –> obstructive process

A

Cholelithiasis
Cancer
pancreatitis

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14
Q

Hemolytic jaundice

A

Increased production of bilirubin due to hemolysis

Multiple transfusions

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15
Q

Hereditary hyperbilirubinemia

A

Impaired bilirubin metabolism

May require transplant

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16
Q

portal HTN

A

Increased resistance to blood flow through the liver and increased blood flow due to vasodilation in the splanchnic circulation

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17
Q

Portal HTN: complications

A

Ascites

Gastroesophageal varices

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18
Q

Esophageal varices: endoscopic therapies

A

Esophageal banding
Sclerotherapy
Balloon tamponade

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19
Q

Esophageal varices: sclerotherpy

A

used for acute bleed to promote thrombosis

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20
Q

Ascites

A

Loss of fluid into the peritoneal space causes further sodium and water retention by the kidneys

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21
Q

Ascites: dietary modification

A

decrease Na

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22
Q

Ascites: diuretics

A 
Spironolactone and furosemide
Daily weight (may have weight loss daily limit)
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23
Q

Ascites: paracentesis

A

temporary removal

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24
Q

Ascites: TIPS

A

Diverts blood flow from high pressure hepatic bed to low pressure vascular bed
Increases risk of hepatic encephalopathy

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25
Q

Ascites: complications

A

Fluid overload
E coli
peritonitis – spontaneous from all the pressure changes
Long term antibiotic therapy after diagnostic paracentesis

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26
Q

Cirrhosis: patho

A

normal liver tissue is replaced by fibrotic tissue in response to damage to liver cells

more prone to ulcers

Focused assessment changes

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27
Q

Hepatic encephalopathy: assessment

A 
Anorexia
NV
muscle waisting 
urine for presence of bilirubin
stool tan or gray with jaundice
resp. status
itching
hepatorenal
encephalopathy
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28
Q

Hepatic encephalopathy: labs/diagnostics

A 
EGD   
Liver Biopsy  
liver labs   
increased bili 
low albumin
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29
Q

Hepatic encephalopathy: interventions

A 
Oral hygiene - promote intake and high calories 
Manange skin integrity
I&O and daily weight
BP (hypotension from varices)
HR
IV fluids
Balloon tamponade for varices
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30
Q

Hepatic encephalopathy: complications

A 
Ascites
jaundice
hepatorenal syndrome 
Bleeding varices  
coagulation defects 
Encephalopathy
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31
Q

Hepatic encephalopathy: albumin

A

Get it if they’re exceedingly low or if we are trying to minimize effect of its loss after paracentesis

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32
Q

Hepatic encephalopathy: education

A
  • skin care
  • medications
  • no ETOH
  • bowel maintenance
  • Na restriction and food selections
  • nutritional supplements
  • NSAID acetaminophen safety
  • follow ups
  • check with provider pharmacist for OTC
  • ascites
  • weigh and log
  • support groups
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33
Q

What is alcoholic liver disease

A

Excessive consumption of alcohol

AST/ALT > 2

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34
Q

How do we ID someone of having alcoholic liver disease?

A

CAGE questions

Supportive groups

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35
Q

Hepatitis A B and C

A

Inflammation of the liver from a viral source

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36
Q

Hepatitis: vaccines

A

only for A and B

37
Q

Hepatitis: prevention

A

follow up to minimize the complication of cirrhosis and liver cancer

38
Q

What are general s/s of hepatitis

A 
fatigue
loss of appetite
abdominal pain
diarrhea
vomiting
joint pain
jaundice
39
Q

Hepatitis: labs and dx

A 
liver enzymes
specific immunoglobulin tests
serum and urine bili
coags 
ultrasound 
liver biopsy
40
Q

Hepatitis interventions

A 
rest
balanced diet
small, frequent means
IV nutrition if needed
fluids - oral or IV if needed
I&O
fluid/electrolyte balance
41
Q

Hepatitis meds

A
  • -antipruitics
    • antiemetics
    • anti virals
42
Q

hepatitis education

A
    • treatment recommendations
    • transmission and prevention
    • complications relapse follow up care
    • B C- cannot donate blood
43
Q

Hepatitis A

A 
Fecal oral
person to person
infected food if the food maker is a carrier
positive forever
immunizations available (2 doses)
44
Q

Hepatitis B: transmission

A

Blood, sexual secretions transmission

Mother to baby (biggest transmission)

45
Q

Hepatitis B: incubation

A

long incubation period

46
Q

Hep B: prevention transmission

A

sexual protection

vaccine

47
Q

Hep B: antiviral therapy depending on viral levels

A

The higher the viral load

48
Q

What is important to keep in mind for hepatitis vaccines

A

Just because you’ve been vaccinated doesn’t mean you carry the correct antibodies

49
Q

What is the primary cause of liver cancer?

A

Hepatitis B

50
Q

Hepatitis C: transmission

A

Primarily drug IV use

- blood to blood

51
Q

Hep C: s/s

A

may have no s/s

52
Q

Hepatitis C: prognosis

A

20-50% clear infection spontaneously
Antiviral therapy can cure it

Majority develop chronic infection. it can progress to cirrhosis if untreated - slow to develop

53
Q

What is the leading cause of drug induced liver disease?

A

Acetaminophen - should not exceed 3-4,000 mg a day

other causes: abx, NSAIDS, TB meds

54
Q

Why are medications that have a “first pass effect” a leading causing to drug induced liver disease?

A

Medications that have a “first pass” effect (large amount is metabolized by the liver before reaching systemic circulation…..liver disease increases bioavailability of these medications

55
Q

Hepatocellular carcinoma: risk factors

A

Cirrhosis and chronic B & C hepatitis put you at higher risk for developing this

56
Q

Hepatocellular carcinoma: hemochromatosis

A

Excessive retained iron in body. If this value is high, the patient will get blood taken out of the body to decrease this value. The client should also eat a low iron diet

57
Q

Hepatocellular carcinoma: diagnosis and treatment

A

Dx: liver biopsy
Tx: liver transplant

58
Q

What is the Treatment of choice for acute liver failure and ESLD (end stage)

A

liver transplant

59
Q

liver transplant: complications

A

Primary graft non-function
Bleeding
Infection
Rejection

60
Q

Why is a liver transplant easier than a kidney transplant?

A

you only need to match the blood type

61
Q

Cholethiasis

A

Calculi or gall stone form in gall bladder

62
Q

Cholelithiasis: s/s

A

Largely asymptomatic or RUQ pain with referral pain to right shoulder often associated after a fatty meal

Pain associated with obstruction of duct may cause abscess, necrosis and perforation

Usually the pain stimulates after a fatty meal because GB can’t excrete bile (n/v, diarrhea)
Stone can obstruct – peritonitis

63
Q

Cholecystitis

A

Acute inflammation of gall bladder

    • Repeated obstruction of cystic duct by gallstones
    • Empyema of gallbladder causes gallbladder to fill with purulent fluid
    • Bile can not leave the gall bladder initiating a chemical reaction causing autolysis and edema, gall bladder becomes distended due to increased pressure and vascular compromise
64
Q

Cholecystitis: assessment

A

Pain – severe, steady, colicky. May go away in an hour and just an achy feeling.

Radiation – epigastric, chest, right shoulder

What brought it in

NV
Belching
Flatulence
Fever
Jaundice
Steatorrhea
Bleeding (may impact liver)
65
Q

Cholecystitis: labs/dx

A
    • Ultrasound
      • ERCP
    • PercutaneousCholangiography
    • CBC
    • liver enzymes
    • bili
66
Q

Cholecystitis: interventions

A
    • pain meds &antiemetics
    • NPO
  • -NG
  • -IV fluids
    • I & O
    • low fat diet
    • fat soluble vitamins
    • pre and post op care
    • T-tube care if open choley
67
Q

Cholecystitis: meds

A
    • NSAIDS
    • morphine / fentanyl
    • ursodeoxycholic acid
    • cholestyramine
68
Q

Cholecystitis: education

A
    • medications
    • follow up care incision recognize fever
    • avoid fatty foods
    • increase high fiber
    • small meals
    • increase diet gradually
69
Q

Pancreatitis:

A

inflammation of the pancreas
– Pancreatic duct becomes temporarily obstructed, accompanied by hypersecretion of the exocrine enzymes of the pancreas

– These enzymes enter the bile duct where they are activated and with bile reflux into the pancreatic duct

70
Q

Pancreatitis: common cause

A

alcohol

gallstones

71
Q

Acute pancreatitis: patho

A

Self digestion of the pancreas by its own proteolytic enzymes (tripsin)

72
Q

Acute pancreatitis can lead to…

A

Causes inflammation, necrosis, erosion, hemorrhage

Multiorgan failure

73
Q

Acute pancreatitis: assess

A

– pain- LUQ radiates to back - sudden onset piercing
– when last ate
– ETOH intake - can make it worse
- fatty foods - can make it worse
– fever
– N/V
– guarding
– distention
– ileus
– Cullens
– Grey Turners
– tachy
– hypotensive
– pleural effusion, atelectasis, ARDS

74
Q

Acute pancreatitis: labs/dx

A 
Amylase lipase (both going to be high)
glucose gonna be high 
triglycerides gonna be high
Calcium = low 
Stool – changes 
Ultrasound 
MRI
75
Q

Acute pancreatitis: causes

A 
Idiopathic
Gallstones
ETOH
Trauma 
Steroids
Mumps virus 
Autoimmune diseases
Scorpion stings
Hypertriglycermia/hypercalcemia 
Endoscopic retrograde cholangiopancreatigraphy (ERCP)
Drugs

“I GET SMASHED”

76
Q

Acute pancreatitis: interventions

A

– NPO
– IV fluids
– NG Tube
– TPN
– Oxygen sat > 95%
– morphine for pain
– HOB 45 deg
– glucose
– hyperglycemia
– PPI / H2 blocker to reduce HCL secretions = prevent pancreatic enzyme secretion
– HR, BP, RR, sat
– vasoactive meds if significant hypotension
– may need surgery (not go to) or ERCP

77
Q

Acute pancreatitis: Complications

A
    • pseudocyst –rupture= bleeding and infection
    • kidney failure
    • dev. diabetes
    • pancreatic cancer
    • respiratory problems
78
Q

Acute pancreatitis: meds

A
    • pancrelipase
    • morphine
    • PPI
    • antispasmodics
    • diyclomine
79
Q

Acute pancreatitis: education

A
    • triggers to avoid
    • avoid fatty foods
    • how to take pancreatic enzymes
    • signs and symptoms of diabetes
80
Q

Chronic pancreatitis: patho

A

Recurrent attacks of severe upper abdominal and back pain accompanied by vomiting

81
Q

Chronic pancreatitis: nonsurgical management

A

Pain management
Pancreatic enzyme replacement
PPI to reduce gastric acid inactivation of enzymes
Fat soluble vitamin supplementation

82
Q

Chronic pancreatitis may develop what

A

DM

83
Q

Chronic pancreatitis: surgical management –> Pancreaticojejunostomy

A

Drainage of pancreatic enzymes into the jejunum

84
Q

Chronic pancreatitis: surgical management –> Pancreaticoduodenectomy

A

Relieves pain

85
Q

Causes of chronic pancreatitis:

A

Longstanding heavy alc use
smoking

chronic pancreatitis develops slow over time

86
Q

Pancreatic cancer: s/s

A

present with pain or jaundice
Rapid and profound weight loss
DM
Diarrhea and steatorrhea

87
Q

pancreatic cancer: pain management

A

huge because this is very painful

88
Q

pancreatic cancer: end of life care

A

Palliative care in early in this diagnosis to help patient become comfortable because this IS terminal

89
Q

what percent of people benefit from surgical resection of pancreatic cancer?

A

only 10-20%

NURSING 2 (12 decks)

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