Week 7 - Assessment, Study Questions, Meds Flashcards
(90 cards)
1
Q
define ascites
A
- increased amt of fluid in the peritoneal cavity
2
Q
define bile
A
- fluid responsible for digestion of food, absorption of fats & fat soluble vitamins, and stimulation of peristalsis
3
Q
define cholecystitis
A
- inflammation of the gall bladder
4
Q
define cholelithiasis
A
condition in which there are stones present in the gall bladder
5
Q
define cirrhosis
A
- scarring of liver tissue which interferes w normal liver function & results in structural changes within the liver
6
Q
define hepatic encephalopathy
A
complication of liver cirrhosis caused by ammonia in the brain
7
Q
define splenomegaly
A
enlarged spleen
8
Q
define hepatitis
A
- inflammation of the liver
9
Q
define portal HTN
A
- increase in pressure in the portal vein caused by obstruction or congestion
10
Q
define steatorrhea
A
- fatty stools
11
Q
define varices
A
- dilation of a vein that is tortuous
12
Q
what is the fnxn of the hepatic portal vein
A
- moves blood from the spleen & GI tract to the liver
13
Q
how is bilirubin formed
A
- from the breakdown of hgb
14
Q
conjugated bilirubin is called…
A
- direct
15
Q
unconjugated bilirubin is called..
A
- indirect
16
Q
what causes jaundice
A
- increase in bilirubin lvls
17
Q
what causes prehepatic jaundice? is direct or indirect high
A
- when RBC are destroyed at high rates & the liver cannot conjugate fast enough
= high unconjugated bilirubin
18
Q
what causes hepatic jaundice? what is elevated
A
- when bilirubin cannot be conjugated due to liver disease
- high unconj & conj
19
Q
what should we ask during PMHx for a liver assessment (3)
A
about anything that can damage the liver
- alcohol
- meds (such as tyenol)
- fatty foods
20
Q
what assessment findings will we find in a pt with prehepatic jaundice (3)
A
- elevated unconj
- amber urine
- normal stool
21
Q
what assessment findings will we find in a pt with hepatic jaundice
A
- elevated unconj & conj
- elevated liver enzymes
- dark urine
- pale or N stool
22
Q
what assessment findings will we find in a pt with post hepatic jaundice
A
- elevated unconj & conj
- elevated liver enzymes
- dark urine
- pale stool
23
Q
what should we assess during inspection of a liver assessment
A
- skin, mucous membranes, and eyes for jaundice
- color of the urine
- color of the stool
- fat in the stool
- melena (due to varices, bleeding disorders)
24
Q
what is the normal liver span
A
6-12 cm
25
is the liver typically palpable?
- no
26
what kind of palpation is used for liver palpation?
- deep
27
what quadrant is the liver found? spleen?
- liver = RUQ
| - spleen = LUQ
28
what are 3 types of diagnostics for hepatitis
- viral serological tests
- serum liver enzymes
- liver function tests
29
what is included under viral serological tests
- measures the viral antibodies & antigens
30
what is included under liver enzymes tests
- AST & ALT
| - ALP (or ALK) and GGT
31
what do liver enzyme tests tell us
- do not differentiate between different types of hepatitis
| - but can determine the type of liver injury
32
what does elevated ALT and AST indicate
- liver cell injury
33
what does elevated ALP and GGT indicate
- bile duct injury
34
what is included under liver function tests
- serum albumin
- serum bilirubin
- prothrombine time
35
deteriorating liver function is demonstrated by which liver function test findings
- increased bilirubin
- increased bleeding time
- decreased albumin
36
what liver function test findings is present during mild acute viral hep? viral hep with detectable jaundice?
- mild acute = normal albumin, bilirubin, and INR
| - jaundice = elevated bilirubin
37
what viral serological tests are used for hep A
anti HAV IgM = indicates acute infection
| anti HAV IgG = indicates past infection
38
what viral serological tests are used for hep B (4)
- HBsAg = hep B surface antigen
- anti HBs = antibody towards HBsAG = indicates immunity
- anti HBc = indicated infection
HBV DNA
39
what viral serological tests are used for hep C
- anti HCV = indicates either past OR current exposure
| - HCV RNA = will confirm if the disease is active or not
40
list 4 causes of hepatitis
- drugs
- chemicals
- viral infections
- autoimmune diseases
41
what are the 3 phases of hepatitis
- pre-icterus or incubation period
- icteric
- convalescent or post icterus
42
which 2 types of hep can cause chronic injury
hep B & C
43
list causes of hep A (5)
- contaminated water
- contaiminated food
- poor sanitation
- pooor hygeine
- crowded conditions
44
list 5 causes of hep B and C
- blood products
- tattoos/body piercings
- contaminated needles
- IV drug users
- sexual intercourse
45
which 2 types of hep have a vaccine
A & B
46
what is NAFLD
- non alcoholic fatty liver disease
47
what is NAFLD characterized by? what can it lead to?
- characterized by hepatic steatosis
| - can progress to inflammation & scarring = NASH
48
list 3 complications of NAFLD
- cirrhosis
- cancer
- liver failure
49
list symptoms of NAFLD
- most have none
- fatigue, malaise
- abdominal discomfort in RUQ
- enlarged liver & spleen
50
what are 4 complications of hepatitis
- inflammation
- fibrosis
- cirrhosis
- liver failure
51
what labs might you order for cirrhosis
- K, Na
- INR/PT
- liver enzymes
- total bili
- glucose
- ammonia
52
why might a pt with cirrhosis be on a low sodium diet
- to prevent worsening of edema
53
why might a pt with cirrhosis be on a high protein, high cal diet
- damage to the liver = stops storing glucose
= if dont eat for few hours, body will start using ur muscle for energy
= muscle wasting & malnourishment
= high protein & cal to avoid
54
why might a pt with cirrhosis be SOB
- due to ascites = decreased expansion of lungs
55
what is a paracentesis
- removal of fluid from the abdomin
56
what is a risk associated with paracentesis in someone who has cirrhosis
- risk of bleeding
57
why is an endoscopy used for for someone w cirrhossi
- to detect varices
58
what are ways to assess for ascites
- fluid wave
- "outie" belly buttin
- striae
- inspect for distension
59
describe how fluid wave works
- firmly strike the left flank
| - and then with ascites, you will feel a distinct tap on the right hand (on the other side of the stomach)
60
what are signs of hepatic encephalopathy
- starts w insomnia & confusion
- progress to lethargy
- then coma
61
what is the function of the gall bladder
- to concentrate & store bile
| - then release it to the duodenom when needed
62
what is the gall bladder & bile important for
- fat breakdown
63
what are 2 diagnostic studies for cholelithiasis
- US
| - ERCP
64
what are the benefits of US for cholelithiasis diagnossi
- 90-95% accurate
| - useful for those allergic to contrast medium
65
what is ERCP
Endoscopic Retrograde Cholangiopancreatography
| - a specialized endoscopic technique
66
what is ERCP good for
allows visualization of:
- gallbladder
- cystic duct
- common hepatic duct
- common bile duct
67
what are signs of cholelithliasis (4)
- RUQ
- steatorrhea
- NV
- shoulder discomfort (due to referred pain)
68
what sign indicated cholelithiasis
- murphy's sign
69
what is murphy's sign
- ask pt to axhale
- place hand below costal margin on R side at mid clavicular line
- ask pt to inspire
70
what indicates a positive murphy's sign
- if the pt stops breathing in & winces with a "catch" in breath
71
what blood work findings might you find in a pt with cholelithiasis
- increased WBC due to inflammation
- increased bili (direct and indirect)
- increased liver enzymes
72
describe how an ERCP works
- fibre-optic endoscope is inserted thru the mouth to the descending duodenom
- then CBD and pancreatic ducts are cannulated
73
what are risk associated with ERCP
- perforation & bleeding
- infection
- pancreatitis (abdom pain, NV)
74
what is tetany
- a condition that is due to low blood calcium
| - characterized by spasms of the hands & feet, cramps, spasm of the voicebox (larynx) and overactive neuro reflexes
75
what 2 signs indicate hypocalcemia
- Trousseau sign
| - Chvosek sign
76
what is trousseau's sign
- when a blood pressure cuff is inflated & it causes the flexion of the hand
77
what is Chvosek's sign
- tapping of the cheek causes abnormal rxn of the facial nerve
78
what 2 signs indicate pancreatitis
grey turner's & cullen's
79
what is grey turner's sign
- bruising of the flank
80
what is cullen's signm
- bruising around the belly button
81
what type of pain is present in pancreatitis
- LUQ or mid epigastric that radiates to the back
| - sudden, deep, piercing, continuous
82
what causes aggravation of pancreatitis pain
- eating
| - recumbent position
83
why would you want to manage / avoid constipation in a pt with liver cirrhossi
- want to prevent build up of ammonia
84
what is palmar eythema ? what causes it?
- redness of the palms
| - rt estrogen
85
what kind of laxative may be used for hepatic encephalopagthy?
lactulose
86
what does lactulose do?
- enhances intestinal excretion of ammonia
87
what are 2 side effects of lactulose
- cramping & flatulence
88
what is propanolol
- nonselective beta blockers
89
what can propanolol be used for?
- liver cirrhosis
90
what are some side effects of propanolol
- bronchospasms
| - hypotension
