Liver, Pancreas, & Biliary System

Question 1

chronic liver disease

Answer 1

damage to liver’s parenchymal cells

Question 2

causes of chronic liver disease

Answer 2

• bacteria/virus (hepatitis)
• anoxia
• metabolic disorders
• toxins
• medications
• nutritional deficiencies
• hypersensitivity
• malnutrition r/t alcoholism (primary cause)
• diet (non-alcoholic fatty liver disease)

Question 3

types of jaundice

Answer 3

• hemolytic: due to increased lysis of RBCs; excess bilirubin produced overwhelms normal liver function
• hepatocellular: damaged liver cells can’t clear normal amounts of bilirubin from the blood
• obstructive: bile doesn’t flow normally through the liver or bile duct system to the intestine

Question 4

cirrhosis

Answer 4

• chronic, progressive disease of liver involving degeneration and destruction of liver parenchymal cells
• acute or chronic

Question 5

types of cirrhosis

Answer 5

• alcoholic
• postnecrotic
• biliary

Question 6

etiology of cirrhosis

Answer 6

• alcohol #1 cause
• exposure to certain chemicals
• drug toxicity… acetaminophen
• severe R-sided heart failure (cardiac cirrhosis)
• hepatits B&C

Question 7

assessment of cirrhosis

Answer 7

• palpation of RUQ
• cirrhosis: liver enlarged, and later small/hard, nontender
• acute hepatitis: liver soft, tender, easily movable

Question 8

cirrhosis labs

Answer 8

• clotting studies: PTT, PT, INR
• AST or SGOT; ALT or SGPT; GGT and GGT and GGTP
• serum pigment studies: bilirubin, total & direct, urine bilirubin, urine and fecal urobilinogen
• serum ammonia
• serum proteins: total protein, serum albumin, serum globulin, serum electrophoresis

Question 9

radiologic tests for cirrhosis

Answer 9

• CT/US
• abdominal x-ray
• liver scan
• barium study of esophagus

Question 10

post-op nursing interventions for liver biopsy

Answer 10

• assist pt to lie on right side with pillow under costal margin
• immobilize for several hours in this position
• discourage coughing or straining
• VS q 15 minutes for first hour; then q 30 minutes for the next 2 hours
• watch for s/s of hemorrhage

Question 11

laparascopy

Answer 11

direct visualization by scope of the liver surface and gallbladder

Question 12

manifestations of early stages (compensated) of cirrhosis

Answer 12

• GI disturbances: anorexia, dyspepsia, flatulence, N/V
• RUQ dull abdominal pain
• lassitude
• slight weight loss
• hepatomegaly and splenomegaly
• abdominal pain
• ankle edema
• firm, enlarged liver
• intermittent mild fever
• palmar erythema (reddened palms)
• unexplained epistaxis
• vague morning indigestion
• vascular spiders

Question 13

manifestations of later stages (decompensated) of cirrhosis

Answer 13

• Ascites
• Clubbing of fingers
• Continuous mild fever
• Epistaxis
• Gonadal atrophy
• Hypotension
• Jaundice
• Muscle wasting
• Purpura (due to decreased platelet count)
• Sparse body hair
• Spontaneous bruising
• Weakness
• Weight loss
• White nails

Question 14

complications of cirrhosis

Answer 14

• portal htn
• esophageal/gastric varices
• peripheral edema (usually ankle)
• ascites
• hepatic encephalopathy and coma

Question 15

portal htn

Answer 15

• portal/hepatic veins damaged causing obstruction of blood flow in portal system resulting htn
• results in: increased venous pressure in portal circulation, splenomegaly, large collateral veins, ascites, systemic htn, gastric/esophageal varices

Question 16

esophageal/gastric varices

Answer 16

• tortuous veins that are enlarged and swollen due to portal htn
• quite fragile and intolerant high pressure
• easily ruptured, causing slow oozing or massive hemorrhage
• must assess for bleeding- melena, hematemesis

Question 17

treatment of esophageal/gastric varices

Answer 17

• avoid ETOH, ASA, NSAIDS, irritating foods
• control coughing
• IV fluids, blood replacement prn

Question 18

treatment of esophageal/gastric varices if bleeding

Answer 18

• stabilize patient/maintain airway
• iv fluids/blood products
• drug therapy
• endoscopic sclerotherapy
• endoscopic ligation
• ballon tamponade
• shunting procedures

Question 19

treatment of ascites

Answer 19

• sodium restriction (depends on degree of ascites, watch for malnutrition)
• diuretics
• fluid removal (paracentesis, TIPS procedure)

Question 20

hepatic encephalopathy and coma

Answer 20

• life threatening complication of liver disease r/t accumulation of ammonia and other toxic metabolytes in the blood
• liver is unable to convert ammonia to urea to be excreted by the kidneys
• ammonia crosses blood-brain barrier and causes neurotoxic effects
• can have gradual or sudden onset and can range from mild sleep disturbances to severe coma
• earliest sign: minor mental changes and motor disturbances

Question 21

treatment of hepatic encephalopathy and coma

Answer 21

• lactulose (cephulac): prevents ammonia from passing from colon to blood
• metronidazole, vancomycin, rifaximin: reduce bacterial flora of colon
• diet for cirrhosis: high CHO, high calories, low fat, normal protein intake, low Na

Question 22

cirrhosis nursing interventions

Answer 22

• hemorrhage
• hepatic encephalopathy
• ascites/ anasacra
• jaundice/pruritis
• vitamin deficiency
• metabolic abnormalities (drug metabolism)
• diet
• addiction

Question 23

fulminant hepatic failure

Answer 23

• acute liver failure
• rapid onset of severe liver dsyfunction with no prior history of liver disease
• associated with hepatic encephalopathy

Question 24

common causes of fulminant hepatic failure

Answer 24

• acetaminophen with ETOH
• nsaids
• sulfa drugs

Question 25

first sign of fulminant hepatic failure

Answer 25

-MS changes

Question 26

treatment of fulminant hepatic failure

Answer 26

liver transplant

Question 27

biliary conditions

Answer 27

- any disorder that affects the flow of bile into the duodenum - gallbladder disease - cholecystitis - cholelithiasis

Question 28

cholelithiasis

Answer 28

formation of stones in the gallbladder

Question 29

risk factors of cholelithiasis

Answer 29

- women - obesity - use of oral contraceptives and estrogen - over 40 - rapid weight loss - hypercholesterolemia; lipid lowering drugs - native american, hispanic

Question 30

types of stones in cholelithiasis

Answer 30

- pigment | - cholesterol

Question 31

cholecystitis

Answer 31

- inflammation/infection of the gallbladder - gallbladder becomes edematous, distended with bile or pus - acute or chronic

Question 32

calculous cholecystitis

Answer 32

- stones obstructs bile outflow | - most common

Question 33

acalculous cholecystitis

Answer 33

-acute inflammation of GB due to stones without stone obstruction

Question 34

s/s of cholecystitis

Answer 34

- pain in RUQ may radiate to sternum/R shoulder/back | - may see biliary colic

Question 35

manifestations of cholecystitis

Answer 35

- asymptomatic - fever, leukocytosis, abdominal rigidity - biliary colic: excruciating RUQ pain and n/v, usually 3-4 hours after a heavy high fat meal - stone can dislodge and sx resolve or can stay and lead to abscess, necrosis, or perforation - elderly may present atypically: sever sepsis, olgiguria, hypotension, mental changes

Question 36

bile duct obstruction

Answer 36

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