Liver/Gallbladder Disorders

Question 1

Name the routes of transmission for:
-Hep A
-Hep B
-Hep C
-Hep D
-Hep E

Answer 1

A: fecal-oral
B: blood to blood/sexual
C: blood to blood/sexual
D: hep B
E: fecal-oral

Question 2

Which types of viral hepatitis have a preventative vaccine?

Answer 2

Hep A + B

Question 3

Hep __ and __ are more common types of hepatitis in crowded living situations because they spread through the fecal-oral route

Answer 3

A, E

Question 4

Pathophysiology of Hepatitis

Answer 4

Infection (most common), alcohol, drugs (tylenol), autoimmune disease –> direct damage to liver cells (hepatocytes)

Question 5

Care for hepatitis?

Answer 5

-outpatient symptom management, rest, nutrition
-avoid drugs and alcohol
-if due to drugs, take N-Acetylcysteine

Question 6

Why/when would a patient take N-Acetylcysteine?

Answer 6

If they had drug-induced hepatitis (ex: tylenol overdose)

Question 7

Name the 5 non-hepatic viruses that can cause viral hepatitis

Answer 7

CMV, EBV, HSV, coxsackievirus, rubella

Question 8

S/S general liver dysfunction

Answer 8

-jaundice
-dark urine, light stool
-pruritis
-hepatomegaly
-asterixis (hand flapping)

Question 9

S/S specific to hepatitis

Answer 9

-flu-like (arthralgia–joint pain, malaise/fatigue, fever)
-N/V, anorexia
-RUQ tenderness
-lymphadenopathy

Question 10

Hepatitis ___ is self limiting

Answer 10

A

Question 11

Causes and pathophysiology of cirrhosis

Answer 11

cause: chronic liver disease
-chronic hep C, B
-alcoholism, malnutrition
–> hepatocytes unable to regenerate –> fibrous growth
–> scarred/fibrotic liver –> decreased function

Question 12

Describe the patho of portal hypertension, a complication of _______

Answer 12

cirrhosis –> blocked blood flow –> increased pressure in liver
(portal hypertension) –>
-ascites
-gastric and esophageal varices
-splenomegaly –> RBC/platelet depletion

Question 13

Hypoalbuminia in cirrhosis leads to _______. Describe how.

Answer 13

-ascites
-low albumin –> decreased oncotic pressure –> ‘leaky’ capillaries –> edema/ascites

Question 14

Encephalopathy can be caused by cirrhosis through what mechanism?

Answer 14

Reduced liver function –> toxin (ammonia) build up

Question 15

List 4 main complications of cirrhosis

Answer 15

-ascites, edema
-gastric/esophageal ulcer and bleeding
-splenomegaly –> decreased clotting factors (anemia, thrombocytopenia, leukopenia) and bleeding
-hepatic encephalopathy

Question 16

S/S of cirrhosis by system:
-GI
-heme
-skin
-CV
-metabolic

Answer 16

-GI: N/V, anorexia, abdominal pain, esophageal/gastric varices & bleeding
-heme: thrombocytopenia, leukopenia, coagulation issues
-skin: jaundice (general liver dysfunction s/s), spider angiomas, petechiae/purpura, palmar erythema
-CV: fluid retention, peripheral edema, ascites
-metabolic: hypo-issues: low K, low Na, low albumin, dehydration

Question 17

Cirrhosis Rx - general

Answer 17

-restrict Na (2g/day)
-restrict fluids (1L/day)
-vit k supplementation
-TIPS (shunt that reduces hypertension)

Question 18

Cirrhosis Rx - ascites

Answer 18

-paracentesis
-meds: albumin, diuretics, antibiotics

Question 19

Cirrhosis Rx - Varices

Answer 19

-non selective beta blockers (‘-lols’) ASAP to reduce variceal rupture risk
-endoscopy: banding, clipping, balloon tamponade
-PPIs

Question 20

Cirrhosis Rx - hepatic encephalopathy

Answer 20

-med: lactulose

Question 21

When variceal bleeding occurs, the first step is to:

Answer 21

stabilize the patient and manage the airway

Question 22

Asterixis is a sign of:

Answer 22

advanced cirrhosis with hepatic encephalopathy

Question 23

________ ________ the gold standard for a definitive diagnosis of cirrhosis

Answer 23

liver biopsy

Question 24

Nursing management for cirrhosis

Answer 24

-Constant assessment (daily weights, I/Os, skin, GI/GU, neuro)
-Restrict Na (2g/day) and fluids (1L/day)
-encourage nutrition–small meals, oral care
-monitor labs, bleeding…

Question 25

Describe the patho of cholelithiasis, aka _________

Answer 25

Gallstones -idiopathic (infection? cholesterol issues?) --> super cholesterol-ly bile from liver into gallbladder --> stone formation

Question 26

Describe the patho of cholecystitis

Answer 26

gallbladder obstruction --> inflammation (often d/t cholelithiasis)

Question 27

Risk factors for cholelithiasis and cholcystitis

Answer 27

-F sex -multiparity -over 40 -HRT and BC -sedentary lifestyle, obesity

Question 28

Cholecystitis in the absence of obstruction (acalculous cholecystitis) occurs most often in:

Answer 28

older adults and in patients who are critically ill.

Question 29

S/S cholelithiasis and cholecystitis

Answer 29

-SEVERE pain: biliary colic -indigestion, fever, chills, jaundice, N/V -elevated WBCs

Question 30

Dx for cholelithiasis

Answer 30

-ultrasound -endoscopic retrograde cholangiopancreatography: ECRP for visualization and bile sampling

Question 31

Once gallstones become symptomatic, ___________ is usually needed.

Answer 31

cholecystectomy (gallbladder removal)

Question 32

Nursing management - gallbladder disease

Answer 32

-pain management!! -NPO if ordered for severe pain/surgery -I/Os -post-op wound care -teach low-fat diet

Question 33

Signs of choledocholithiasis (obstruction of common bile duct by gallstones):

Answer 33

-RUQ pain -jaundice -clay-colored stools -dark, foamy urine -fever -increased WBC count.

Question 34

A 49 y/o mother of three presents with a low grade fever, diaphoresis, nausea, right shoulder and scapular pain. Upon examination, she notes some pain in her abdomen (epigastric, RUQ) as well. What might she be diagnosed with? With what diagnostic tool?

Answer 34

-likely, cholecystitis d/t cholelithiasis -will likely receive ultrasound

Question 35

When a gallstone is stuck in the ampulla of vader between the common bile duct and small intestine, this is called:

Answer 35

choledocholithiasis