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Flashcards in pancreas liver gallbladder Deck (51):
1

After a meal, excess glucose molecules are taken up by the liver, combined, and then stored as glycogen

Glycogenesis (gli-co- genesis)

2

When blood glucose level falls, the process is reversed, and the glucose molecules are returned to the blood

Glycogenolysis (gli-co-geno-lysis)

3


Fats and protein broken down in response to low blood glucose levels, and molecules are used to make new glucose

Gluconeogenesis (glu-co-neo-genesis)

4

Primary palmar erythema

Heredity.
Pregnancy (due to alterations in skin function and vasculature).
Idiopathic.

5

Secondary palmar erythema

Liver cirrhosis and its many causes including alcohol abuse.[ (Palmar erythema develops as a result of abnormal oestradiol levels.) 
Hereditary liver disease such as Wilson's disease and hereditary haemochromatosis.

6

Locally, inflammatory process causes the liver to swell
Bile channels compressed; damage the cells that produce bile
Then blood flow through the liver is impaired, causing pressure to
rise in the portal circulation
Systemic effects related to altered metabolic functions performed by
the liver and to the infectious response in viral

Hepatitis

7

Signs and symptoms
Hepatitis

Signs and symptoms of systemic effects: rash, arthritis, fever,
malaise and angioedema, (the rapid swelling [edema] of
the dermis, subcutaneous tissue, mucosa and submucosal
tissues.)

8

: caused by exposure to toxic chemicals; drugs

Noninfectious: Hepatitis

9

Exposure to fecal contaminated water, food or
medical equipment. Most common type of viral
hepatitis

hep A

10

Blood borne, found in all body fluids of infected….
Transmit by intimate contact with carriers, exposure to
infected blood

hep B

11

Becomes “C”hronic and a “C” arrier of Hep.
Increases risk of chronic liver infections

Hep C

12

Caused by delta agent… RNA virus that can only
survive in the presence of Hep B..therefore blood
borne

hep D

13

Similar to Hep A.. Trasmit via water or food… rare in
US. No long term effects

Hep E

14

: Identified in some blood donors and transmits by
blood transfusion… does not cause chronic hepatitis..
But effects not fully known

Hep G

15

Signs and symptoms regardless of cause are similar
Preicteric phase
Hepatitis

Malaise, severe headache, right upper quadrant abdominal pain, anorexia, nausea, vomiting, fever, arthralgia (joint pain), rash, enlarged lymph nodes, urticaria, liver enlargement and tenderness

16

Icteric phase
Hepatitis

Jaundice, light or clay-colored stools, dark urine

17

Posticteric phase
Hepatitis

Fatigue, malaise, and liver enlargement

18

Medical diagnosis
Hepatitis

Elevated levels of serum enzymes (AST, ALT, GGT), serum and urinary bilirubin, and urinary urobilinogen

19

Medical treatment
Hepatitis

No cure: treat to promote healing and manage symptoms
Antipyretics, corticosteroids, and antiemetics
Diet: high calorie, high carbohydrate, moderate to high protein, and moderate to low fat with supplementary vitamins

20

Prevention
Hepatitis

Vaccines; immune globulin (IG); hepatitis B immune globulin (HBIG)

21

Nursing Assessment
Hepatitis

General health state, drug and alcohol use, chemical exposure, dietary habits, blood transfusions, recent travel, gastrointestinal disturbances, and changes in skin, urine, or stools
Vital signs, skin, weight changes, and mental status

22

Chronic, progressive disease
Degeneration and destruction of liver cells
Fibrotic bands of connective tissue impair the flow of blood and lymph and distort the normal liver structure

Cirrhosis

23

Incidence
Cirrhosis

Fifth leading cause of death in ages 40 to 60 in the United States
More common in men than in women
Related to alcoholic liver disease or chronic viral infection

24

Types
Cirrhosis

Alcoholic
Postnecrotic
Biliary
Cardiac (severe and longstanding, hepatic congestion can lead to fibrosis; if congestion is due to right heart failure, it is called cardiac cirrhosis)

25

s/s
Cirrhosis

Early: slight weight loss, unexplained fever, fatigue, and dull heaviness in the right upper abdomen
Progresses: anorexia, nausea, vomiting, diarrhea or constipation, flatulence, dyspepsia, esophageal varices, infections, and epistaxis
Later: jaundice; testicular atrophy, impotence, and gynecomastia; ascites; amenorrhea; palmar erythema and spider angiomas; confusion and decreasing consciousness; peripheral neuropathy

26

Complications
Cirrhosis

Portal hypertension, esophageal varices, ascites, hepatic encephalopathy, and hepatorenal syndrome

27

Medical Treatment
Cirrhosis

Bed rest
Diet high in carbohydrates and vitamins with moderate to high protein unless blood ammonia level is elevated
Intravenous fluids
Anemia may require blood transfusions
Water and sodium likely to be restricted
Cathartics and antibiotics for hepatic encephalopathy

28

Medical diagnosis
Cirrhosis

Liver function tests, CBC, prothrombin time, protein, electrolytes, albumin, bilirubin, urine bilirubin, urobilinogen, liver biopsy, liver scan, ultrasonography, angiography, CT, and MRI
Liver biopsy

29

Medical Treatment continued
Ascites
Cirrhosis

Various types of diuretics
Salt-poor albumin may be given intravenously
Paracentesis
Peritoneal-venous shunt of
the transjugular intrahepatic
portosystemic shunt

30

Bleeding esophageal varices
Medical Treatment continued
Cirrhosis

Drug therapy,
sclerotherapy (inj. of med),
surgical ligation, and
placement of an
esophageal-gastric
balloon tube

31

Rarely begins in the liver but frequent site of metastasis
Cirrhosis is a predisposing factor
As disease progresses, signs and symptoms are essentially the same as those of cirrhosis

Cancer of the Liver

32

Signs/symptoms
Cancer of the Liver

Signs/symptoms: liver enlargement, weight loss, anorexia, nausea, vomiting, dull pain in upper right quadrant of abdomen
Because early signs and symptoms of liver cancer are vague, the condition often not diagnosed until advanced

33

test
Cancer of the Liver

Tests: liver scan and biopsy, hepatic arteriography, endoscopy, and measurement of alpha-fetoprotein levels
If the cancer is confined to one area, a lobectomy may be done; otherwise chemotherapy is the primary treatment

34

Cholecystitis

Inflammation of the gallbladder
Caused by gallstones but can be due to bacteria, toxic
chemicals, tumors, anesthesia, starvation, and opioids

When gallstones present, called Cholelithiasis.
Stones may be found anywhere in the biliary tract: gallbladder, cystic duct, or the common bile duct

35

Signs and symptoms
Cholecystitis and Cholelithiasis

From mild indigestion to severe pain, fever, jaundice
Also nausea, eructation, fever, chills, and right upper quadrant pain that radiates to the shoulder
If bile flow obstructed, bile production decreases and serum bilirubin rises; leads to obstructive jaundice
Some excess bilirubin is excreted in the urine, creating a dark, amber color
Digestion of fats is impaired, causing intolerance of fatty foods and steatorrhea

36

Complications
Cholecystitis and Cholelithiasis

Pancreatitis, abscesses, cholangitis, and rupture of the gallbladder

37

Medical diagnosis
Cholecystitis and Cholelithiasis

History and physical examination
Fluoroscopy using contrast medium injected directly into the biliary tree
Radiographs, radionuclide imaging, ultrasonography, and oral or intravenous cholangiography
White blood cell count, serum and urinary bilirubin, and serum enzymes

38

Medical treatment
Cholecystitis and Cholelithiasis

Analgesics, anticholinergics, and antibiotics
Intravenous fluids
Nasogastric tube
Drug therapy
Shockwave lithotripsy
Endoscopic sphincterotomy
Cholecystectomy

39

Islets of Langerhans

Alpha cells produce and secrete glucagon
Beta cells produce and secrete insulin
Delta cells produce somatostatin, which inhibits the release of glucagon and insulin

Glucagon is secreted when BG level drops and Insulin is secreted when BG rises

40

Pancreatitis

Inflammation of the pancreas
May be acute or chronic
Caused by biliary tract disorders or alcoholism Also viral infections; peptic ulcer disease; cysts; metabolic disorders; trauma from external injury, surgery, or endoscopy
Digestive enzymes activated by unknown mechanism begin to digest pancreatic tissue, fat, and elastic tissue in blood vessels
Chronic pancreatitis related to alcohol abuse

41

Signs and symptoms
Pancreatitis

Abdominal pain
Severe, with a sudden onset; centered in the upper left quadrant or the epigastric region and radiates to the back
Severe vomiting, flushing, cyanosis, and dyspnea often accompany the pain
Low-grade fever, tachypnea, tachycardia, hypotension
Abdomen may be tender and distended
Bowel sounds may be absent
Bleeding and shifting of fluid may lead to shock

42

Complications
Pancreatitis

Pseudocyst, abscess, hypocalcemia, and pulmonary, cardiac, and renal complications

43

Medical diagnosis

Pancreatitis

Elevated serum amylase, serum lipase, and urinary amylase levels
Elevated WBC count, elevated serum lipid and glucose level, and decreased serum calcium level
Ultrasonography and ERCP
Secretin stimulation test and fecal studies

44

Medical treatment

Pancreatitis

Nothing by mouth
Nasogastric tube
Intravenous fluids
Blood or plasma expanders
Urine output should be at least 40 mL/hour
Jejunal feeding tube or total parenteral nutrition
Once food permitted, usually bland, low-fat, high-carbohydrate diet divided into frequent, small meals
Prophylactic antibiotics

45

Nursing Assessment
Pancreatitis

Abdomen should be inspected for discoloration, distention, tenderness, and diminished bowel sounds

46

Quickly spreads to the duodenum, stomach, spleen, and left adrenal gland
Risk factors: chronic pancreatitis and smoking
Also high-fat diet, exposure to toxic chemicals

Cancer of the Pancreas

47

Signs and symptoms
Cancer of the Pancreas

Pain, jaundice with or without liver enlargement, weight loss, and glucose intolerance
Other signs and symptoms may be weight loss, upper abdominal pain, anorexia, vomiting, weakness, and diarrhea

48

Medical diagnosis
Cancer of the Pancreas

Transabdominal ultrasound, computed tomography, ERCP, and endoscopic ultrasonography
Serum amylase, lipase, bilirubin, and enzyme levels; carcinoembryonic antigen and CA 19-9 titers

49

Assessment
Cancer of the Pancreas

Assess gastrointestinal function, pain, and emotional state
If surgery planned, determine the patient’s knowledge about pre- and postoperative care

50

Cancer of the liver is usually

Secondary

51

Liver usually has pain to the what extremity

Right shoulder