liver and pancreas Flashcards
(89 cards)
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)
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
3
Q
Total bili range
A
0.3-1.0
4
Q
ALT
A
helps metabolize proteins
8-40
5
Q
AST
A
Helps metabolize protein and ALT
10-40
6
Q
GGT
A
0-30
7
Q
LDH (lactic acid dehydrogenase)
A
shows erythrocyte damage
100-225
8
Q
Alk phos
A
Breaks down proteins and elevares in bone cancer or problems
30-120
9
Q
Amylase
A
23-85
pancreatic enzyme - elevates with not working well
10
Q
lipase
A
0-160
elevates with not working well
11
Q
Jaundice: patho
A
impairment of bodies ability to metabolize and secrete bilirubin
serum bilirubin levels > 3
12
Q
Jaudice: cause –> hepatocellular
A
Hepatitis, hepatotoxins
13
Q
Jaundice: cause –> obstructive process
A
Cholelithiasis
Cancer
pancreatitis
14
Q
Hemolytic jaundice
A
Increased production of bilirubin due to hemolysis
Multiple transfusions
15
Q
Hereditary hyperbilirubinemia
A
Impaired bilirubin metabolism
May require transplant
16
Q
portal HTN
A
Increased resistance to blood flow through the liver and increased blood flow due to vasodilation in the splanchnic circulation
17
Q
Portal HTN: complications
A
Ascites
Gastroesophageal varices
18
Q
Esophageal varices: endoscopic therapies
A
Esophageal banding
Sclerotherapy
Balloon tamponade
19
Q
Esophageal varices: sclerotherpy
A
used for acute bleed to promote thrombosis
20
Q
Ascites
A
Loss of fluid into the peritoneal space causes further sodium and water retention by the kidneys
21
Q
Ascites: dietary modification
A
decrease Na
22
Q
Ascites: diuretics
A
Spironolactone and furosemide Daily weight (may have weight loss daily limit)
23
Q
Ascites: paracentesis
A
temporary removal
24
Q
Ascites: TIPS
A
Diverts blood flow from high pressure hepatic bed to low pressure vascular bed
Increases risk of hepatic encephalopathy
25
Ascites: complications
Fluid overload
E coli
peritonitis – spontaneous from all the pressure changes
Long term antibiotic therapy after diagnostic paracentesis
26
Cirrhosis: patho
normal liver tissue is replaced by fibrotic tissue in response to damage to liver cells
more prone to ulcers
Focused assessment changes
27
Hepatic encephalopathy: assessment
```
Anorexia
NV
muscle waisting
urine for presence of bilirubin
stool tan or gray with jaundice
resp. status
itching
hepatorenal
encephalopathy
```
28
Hepatic encephalopathy: labs/diagnostics
```
EGD
Liver Biopsy
liver labs
increased bili
low albumin
```
29
Hepatic encephalopathy: interventions
```
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
```
30
Hepatic encephalopathy: complications
```
Ascites
jaundice
hepatorenal syndrome
Bleeding varices
coagulation defects
Encephalopathy
```
31
Hepatic encephalopathy: albumin
Get it if they’re exceedingly low or if we are trying to minimize effect of its loss after paracentesis
32
Hepatic encephalopathy: education
- 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
33
What is alcoholic liver disease
Excessive consumption of alcohol
| AST/ALT > 2
34
How do we ID someone of having alcoholic liver disease?
CAGE questions
| Supportive groups
35
Hepatitis A B and C
Inflammation of the liver from a viral source
36
Hepatitis: vaccines
only for A and B
37
Hepatitis: prevention
follow up to minimize the complication of cirrhosis and liver cancer
38
What are general s/s of hepatitis
```
fatigue
loss of appetite
abdominal pain
diarrhea
vomiting
joint pain
jaundice
```
39
Hepatitis: labs and dx
```
liver enzymes
specific immunoglobulin tests
serum and urine bili
coags
ultrasound
liver biopsy
```
40
Hepatitis interventions
```
rest
balanced diet
small, frequent means
IV nutrition if needed
fluids - oral or IV if needed
I&O
fluid/electrolyte balance
```
41
Hepatitis meds
- -antipruitics
- - antiemetics
- - anti virals
42
hepatitis education
- - treatment recommendations
- - transmission and prevention
- - complications relapse follow up care
- - B C- cannot donate blood
43
Hepatitis A
```
Fecal oral
person to person
infected food if the food maker is a carrier
positive forever
immunizations available (2 doses)
```
44
Hepatitis B: transmission
Blood, sexual secretions transmission
| Mother to baby (biggest transmission)
45
Hepatitis B: incubation
long incubation period
46
Hep B: prevention transmission
sexual protection
| vaccine
47
Hep B: antiviral therapy depending on viral levels
The higher the viral load
48
What is important to keep in mind for hepatitis vaccines
Just because you’ve been vaccinated doesn’t mean you carry the correct antibodies
49
What is the primary cause of liver cancer?
Hepatitis B
50
Hepatitis C: transmission
Primarily drug IV use
| - blood to blood
51
Hep C: s/s
may have no s/s
52
Hepatitis C: prognosis
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
What is the leading cause of drug induced liver disease?
Acetaminophen - should not exceed 3-4,000 mg a day
other causes: abx, NSAIDS, TB meds
54
Why are medications that have a "first pass effect" a leading causing to drug induced liver disease?
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
Hepatocellular carcinoma: risk factors
Cirrhosis and chronic B & C hepatitis put you at higher risk for developing this
56
Hepatocellular carcinoma: hemochromatosis
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
Hepatocellular carcinoma: diagnosis and treatment
Dx: liver biopsy
Tx: liver transplant
58
What is the Treatment of choice for acute liver failure and ESLD (end stage)
liver transplant
59
liver transplant: complications
Primary graft non-function
Bleeding
Infection
Rejection
60
Why is a liver transplant easier than a kidney transplant?
you only need to match the blood type
61
Cholethiasis
Calculi or gall stone form in gall bladder
62
Cholelithiasis: s/s
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
Cholecystitis
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
Cholecystitis: assessment
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
Cholecystitis: labs/dx
- - Ultrasound
- - ERCP
- - PercutaneousCholangiography
- - CBC
- - liver enzymes
- - bili
66
Cholecystitis: interventions
- - 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
Cholecystitis: meds
- - NSAIDS
- - morphine / fentanyl
- - ursodeoxycholic acid
- - cholestyramine
68
Cholecystitis: education
- - medications
- - follow up care incision recognize fever
- - avoid fatty foods
- - increase high fiber
- - small meals
- - increase diet gradually
69
Pancreatitis:
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
Pancreatitis: common cause
alcohol
| gallstones
71
Acute pancreatitis: patho
Self digestion of the pancreas by its own proteolytic enzymes (tripsin)
72
Acute pancreatitis can lead to...
Causes inflammation, necrosis, erosion, hemorrhage
| Multiorgan failure
73
Acute pancreatitis: assess
-- 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
Acute pancreatitis: labs/dx
```
Amylase lipase (both going to be high)
glucose gonna be high
triglycerides gonna be high
Calcium = low
Stool – changes
Ultrasound
MRI
```
75
Acute pancreatitis: causes
```
Idiopathic
Gallstones
ETOH
Trauma
Steroids
Mumps virus
Autoimmune diseases
Scorpion stings
Hypertriglycermia/hypercalcemia
Endoscopic retrograde cholangiopancreatigraphy (ERCP)
Drugs
```
"I GET SMASHED"
76
Acute pancreatitis: interventions
-- 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
Acute pancreatitis: Complications
- - pseudocyst –rupture= bleeding and infection
- - kidney failure
- - dev. diabetes
- - pancreatic cancer
- - respiratory problems
78
Acute pancreatitis: meds
- - pancrelipase
- - morphine
- - PPI
- - antispasmodics
- - diyclomine
79
Acute pancreatitis: education
- - triggers to avoid
- - avoid fatty foods
- - how to take pancreatic enzymes
- - signs and symptoms of diabetes
80
Chronic pancreatitis: patho
Recurrent attacks of severe upper abdominal and back pain accompanied by vomiting
81
Chronic pancreatitis: nonsurgical management
Pain management
Pancreatic enzyme replacement
PPI to reduce gastric acid inactivation of enzymes
Fat soluble vitamin supplementation
82
Chronic pancreatitis may develop what
DM
83
Chronic pancreatitis: surgical management --> Pancreaticojejunostomy
Drainage of pancreatic enzymes into the jejunum
84
Chronic pancreatitis: surgical management --> Pancreaticoduodenectomy
Relieves pain
85
Causes of chronic pancreatitis:
Longstanding heavy alc use
smoking
chronic pancreatitis develops slow over time
86
Pancreatic cancer: s/s
present with pain or jaundice
Rapid and profound weight loss
DM
Diarrhea and steatorrhea
87
pancreatic cancer: pain management
huge because this is very painful
88
pancreatic cancer: end of life care
Palliative care in early in this diagnosis to help patient become comfortable because this IS terminal
89
what percent of people benefit from surgical resection of pancreatic cancer?
only 10-20%
