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157 Cards in this Set
- Front
- Back
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____ is the formation of stones within the gallbladder or biliary duct system.
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Cholelithiasis
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Gallstones are usually made up of ____ or ____.
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bile pigments or cholesterol
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Stones form when ____ crystalizes.
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bile
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Risk factors for cholelithiasis include:
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age
family history race or ethnicity (Native Am. or Northern European) obesity, hyperlipidemia rapid wt. loss female (oral bc) biliary stasis (preggo, fasting, TPN) other diseases (DM, cirrhosis, ileal disease or resection, sickle cell |
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Bile is made in the _____ and stored in the _____.
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liver
gallbladder |
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Cholecystitis is inflammation of the _____.
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gallbladder
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Cholecystitis is associated with stones in the ____ of ___.
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cystic or common bile duct.
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Manifestations of gallstones include:
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- epigastric fullness, mild gastric distress after fatty meal
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Acute cholecystitis manifestations are
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RUQ pain radiating to right shoulder, SEVERE pain that is colicky or cramping, NV
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Chronic cholecystitis manifestations are
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long term intolerance to fatty foods, possible fever, high WBCs, acute symptoms, high serum bilirubin and fatty stools
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Cholelithiasis and cholecystitis both have ____ onset of pain that is ____ and ____.
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abrupt
severe and steady |
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Acute cholelithiasis lasts ____ whereas cholecystitis may last _____.
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30 minutes to 5 hours
12 to 18 hours |
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Cholecystitis causes NV like cholelithiasis, but also manifests as
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anorexia
RUQ tenderness chills and fever |
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Complications of cholelithiasis include:
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cholecystitis
common bile duct obstruction with possible liver damage and jaundice common duct obstruction with pancreatitis |
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Complications of cholecystitis are:
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gangrene and perforation with peritonitis
chronic cholecystitis empyema fistula formation gallstone ileus |
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If direct bilirubin is up and indirect bilirubin is down, the problem is with the ____.
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liver or biliary system
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If the indirect bilirubin is up and the direct is down, the problem is with the _____.
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spleen or RBCs
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If the ____ and ___ are elevated we know that the pancreas is involved with the cholecystitis.
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serum amylase and serum lipase
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If on a CBC neutrophils are elevated we know that ____ are present.
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bacteria
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The diagnostic test that is 90% accurate for identifying cholelithiasis is ______.
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ultrasound
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An _____ injects dye into the veins and shows how well the gallbladder is working. It outlines the biliary ducts and looks for stones.
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Oral cholangiogram
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An ____ is used to go after stones at the pancreatic duct or lower.
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ERCP- endoscopic retrograde cholangiopancreatogram
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Elevated ____ bilirubin may indicate obstructed bile flow in the biliary duct system.
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direct
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Ursodiol and chenodiol are drugs used to dissolve _____. They reduce ____ production in the liver.
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gallstones
cholesterol |
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_____ may be given to patients with pruritis due to severe obstructive jaundice and an accumulation of bile salts on skin.
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Cholestyramine
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After an acute episode of cholesystitis is over, the patient may have a _____.
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laparoscopic cholecystectomy
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Post lap cholecystectomy, the patient should avoid ____ because...
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fatty foods because they cause discomfort and fatty stools. There is no storage tank anymore.
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If open cholecystectomy is performed a penrose or T-tube may be placed. Nsg care for a t tube is
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-keep it below level of insertion
-monitor drainage -Fowler's position -assess skin and avoid pulling tube -report early signs of infection |
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A stent in the common bile duct is called a _____.
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t tube
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Nursing care for cholecystitis patients
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-pain management with opioids
-abdominal assessment- ileus (decreased bowel sounds) -respiratory management- atelectasis -T tube management -monitor fluids and electrolytes -diet management (limit fatty foods) |
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Post op a cholecystectomy the nurse can expect to administer
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NS with K because patient may be hypokalemic d/t NV and this can cause an ileus.
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Drainage from a t tube may be ____ initially but then turns ____.
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blood tinged
green-brown |
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A diet that may reduce incidence of gallstones includes:
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-high fiber
-low CHO -unsaturated fats but low amounts -high protein |
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Functions of the liver include:
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-metabolism of fats, CHO, proteins
-metabolism of steroid hormones and drugs -synthesizes albumin and clotting factors -detoxifies alcohol and other toxic substances -converts ammonia to urea and sends to kidneys -produces bile -stores iron, fat soluble vitamins, glycogen -cleanses blood with kupffer cells -makes erythrocytes -conjugates bilirubin -promotes absorption of vitamins A D E and K |
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Sources of vitamin A include:
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-fish liver oils
-egg yolk -liver -fortified milk -margarine |
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Vitamin A is important for
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vision, skin and mucous membranes, cell membrane function and reproductive function
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Sources of vitamin D include:
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sunshine combined with cholesterol on skin.
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Vitamin D is important for
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blood calcium homeostasis
bone formation neuromuscular function |
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Sources of vitamin E include:
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vegetable oils
margarine whole grains dark green leafys |
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Vitamin E is important for
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antioxidant
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Sources of vitamin K include
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coliform bacteria in LI
green, leafy veggies cabbage cauliflower pork |
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Vitamin K is important for
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clotting proteins in liver
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___ is inflammation of the liver.
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Hepatitis
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Hepatitis ___ and ___ have vaccines.
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A and B
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Hepatitis ___ and ___ are transmitted oral-fecal.
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A and E
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Hepatitis ___ and ___ are the major cause of primary liver cancer and liver transplants because they cause cirrhosis.
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B and C
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Hepatitis B, C, and D are all transmitted ____ and often lead to chronic hepatitis
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IV drug use
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Hepatitis B can also be transmitted ____.
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sexually
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S/Sx of hepatitis include:
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-RUQ discomfort
-NV, anorexia, weight loss -fever, chills -jaundice, dark urine -h/o potential exposure |
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Treatment of hepatitis includes:
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-rest
-activity as tolerated -nutrition -hydration |
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The preicteric phase of hepatitis is characterized by
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general malaise, fatigue, NV, anorexia, "Flu-like" symptoms
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The icteric phase of hepatitis is characterized by
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jaundice, pruritis, light or clay colored stools, tea colored urine, some anorexia still
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The posticteric phase of hepatitis is characterized by
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decrease in LFTs
decrease in bilirubin increased energy and appetite pain subsides |
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The post icteric phase is also called the _____ and can last several weeks.
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convalescent
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Hepatitis ___ and ___ have a slow onset whereas the other forms of the virus have an abrupt onset.
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B and C
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The lab test which looks for antibodies to the different strains of Hepatitis and tells whether you have been exposed at some time is the _____.
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Anti-H_V
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The lab test that indicates an active hepatitis case is the _____.
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H__sAG (surface antigen)
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The two lab tests that tell specifically how the liver is doing are the ___.
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ALT and bilirubin
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Tests for liver functioning are
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LFT, ALT, AST, ALP, and bilirubin
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ALP is released by liver and _____.
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bone
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If a hepatocyte is damaged it will release ____.
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ALT
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If the liver is not working properly, bilirubin cannot be conjugated and the direct bilirubin levels will be ____.
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high
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HAV vaccine is a series of 2-3 shots that provide protection for about _____.
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20 years
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If exposed to HAV you should try to get the _____ within 7 days.
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Immune globulin
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The HBV vaccine is a series of 3 shots that provides protection for ____. The immune globulin provides passive immunity post exposure.
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5-10 years
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Treatment for HAV includes
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bed rest and diet management (high CHO and complete proteins)
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Tx for HBV includes
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bedrest
avoid hepatotoxic meds diet (high CHO and complete proteins) daily injections of alpha interferon (don't wait for LFTs to go up) |
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Only Tx for HCV is
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interferon and ribavirin (anti-viral agents)- 4 years only
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_______ (Interferons/Antivirals) block the virus from entering host cells.
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Interferons
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_______ (Interferons/Antivirals) inhibit synthesis of viral DNA.
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Antivirals
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Nsg care for a patient with Hepatitis includes:
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-teach modes of transmission
-teach to wear condom -teach cleaning syringes -teach abt disease -build day around rest periods -6-8 small meals/day |
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______ is a chronic disease that is characterized by the replacement of normal liver tissue with fibrotic scar tissue that disrupts the structure and function.
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Cirrhosis
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4 types of cirrhosis are
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-alcoholic
-Hepatitis (B/C) -Tylenol use -biliary stenosis |
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A patient with cirrhosis doesn't usually have shunt surgery because
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they usually won't survive it.
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Complications of cirrhosis are:
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-jaundice, pruritis
-portal HTN and ascites -encephalopathy -splenomegaly -esophageal varices -peritonitis -vitamin deficiency (b/c liver cant store A, D, E, K) -anemia (d/t anorexia and RBC issues) |
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____ and ____ are related to bile not flowing out of the liver.
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Jaundice and pruritis
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_____ is a result of structural abnormalities of the liver from tissue necrosis that impedes the normal emptying of bile out of the liver.
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Jaundice
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When jaundice occurs there will be high bilirubin levels in the blood >__mg/dl.
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2.5
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____ results from bile salts being deposited on the skin.
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Pruritis
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EArly signs of cirrhosis include:
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-dull, aching epigastric or RUQ pain
-wt loss -weakness -anorexia |
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_____ is abnormally elevated BP within the portal vein that eventually causes shunting of blood to smaller vessels that have lower pressure (collateral circulation).
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Portal HTN
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Portal HTN increases the hydrostatic pressure in vessels of the portal system. This increase hydrostatic pressure in the capillaries pushes fluid out causing low albumin and ____.
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ascites formation
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_____ creates pull in the vascular space to keep plasma in. If the hydrostatic pressure is greater than the pull there will be leaking of fluid in the interstitial spaces (ascites)
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Albumin
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____ occurs when increased pressure from portal HTN forces fluid out of the blood vessels and into the ABD cavity.
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Ascites
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Other causes of ascites are
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hypoalbuminemia and increased aldosterone
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____ is edema all over.
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Anasarca
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Aldosterone causes the body to
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retain Na and water therefore increasing ascites problem if albumin is low.
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Tx for Ascites and portal HTN includes
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-2gm NA diet
-Aldactone (aldosterone antagonist diuretic) -1800cc fld restriction -paracentesis |
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Nsg care for Paracentesis includes
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-have pt pee 1st- deflate bladder
-sit pt up -keep BP cuff on to monitor BP and P |
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______ occurs with profound liver failure as a result of the accumulation of ammonia and other toxic metabolites in the blood.
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Encephalopathy
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Many patients with ____ become restrained for their safety.
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encephalopathy
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S/Sx of encephalopathy include:
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-changes in LOC
-lethargy -coordination -disoriented, confused, combative -asterixis |
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Asterixis is a flapping tremor of the hand caused by ______.
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hyperactive DTRs
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Tx of encephalopathy includes administration of _____ to reduce ammonia.
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lactulose
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The recommended diet for a person with encephalopathy is
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low proteins (complete) and high CHO
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If a person has encephalopathy the nurse will need to D/c or lower doses of ____, ____, and ____ but may give ____ if needed.
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sedatives, tranquilizers, and analgesics
benzos |
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For encephalopathy pt, monitor neuro status ___ and monitor ____ levels.
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q2h
ammonia |
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The spleen is on the ____ side of the ABD.
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left
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Splenomegaly happens with ____ and is enlargement of the spleen.
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ESLD
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Splenomegaly is a result of ____ shunting blood into the splenic vein.
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portal HTN
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Splenomegaly may result in ____, _____ or _____.
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anemia, thrombocytopenia, or leukopenia
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Low platelets are called ______.
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thrombocytopenia
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Low WBCs are called ______.
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leukopenia
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The main job of the spleen is to...
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clean the blood of foreign substances.
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Splenomegaly presents as
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RUQ, LUQ, mid-epigastric pain.
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______ are enlarged over distended veins as a result of portal HTN.
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Esophageal varices
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A person with esophageal varices should be on a ____ diet.
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mechanical soft
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Esophageal varices are the main cause of _____ and ____ in cirrhotics.
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upper GI bleeds and hemorrhage
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Tx for esophageal varices includes:
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Vasopressin (vasoconstrictor)
gastric lavage sclerotic therapy (burn them) esophageal banding of vessels |
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The main goal of Tx for esophageal varices is
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stop you from bleeding.
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The inability of the liver to store or synthesize fat soluble vitamins results in ____ and ____.
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vitamin deficiency and anemia
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Vitamin K deficiency leads to decreased production of _____. Therefore, it is important to monitor PT times.
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clotting factors
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Tx for vitamin deficiency and anemia includes:
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replace vitamin K
use TPN until stable MVI in IV fluids (Rally pack) |
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A liver pt is at risk for impaired skin integrity d/t ____.
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low albumin levels.
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A liver pt is at risk for injury d/t
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confusion.
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____ is the only hope for a person with cirrhosis.
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Liver transplant
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The key to a successful liver transplant is
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post-op successful immunosuppression
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The immunosuppression medication for liver transplant is ____. It is however nephrotoxic.
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Prograf
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The main complications from liver transplant are
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technical complications and/or infection
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People with liver transplants are susceptible to pulmonary and fungal infections because they are on
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immunosuppressants
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Primary liver cancer usually results from one of 3 things
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-Hep C and cirrhosis
-bile duct cancer -not-alcoholic fatty liver |
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Tx for liver cancer includes:
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chemo
radiation surgery |
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Inflammation of the pancreas is called ____ and it can result from other problems in the biliary system.
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pancreatitis
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Manifestations of primary liver cancer include:
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-malaise, lethargy
-anorexia, wt. loss -fever, jaundice -ABD fullness -painful RUQ mass -S/Sx of liver failure |
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____ levels usually rise in most patients with HCC (hepatocellular carcinoma).
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Alpha-fetoprotein
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Pancreatitis is characterized by the release of pancreatic enzymes into the tissue of the pancreas itself leading to ____ and _____.
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hemorrhage and necrosis
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The pancreas and an endocrine and exocrine function. The exocrine portion of the pancreas dump into ______.
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another organ
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Acute pancreatitis is often due to something wrong in the ____ that causes ____.
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biliary tract
back up |
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Risk factors for acute pancreatitis include:
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-trauma
-surgery -pancreatic tumors -pregnancy -infection -meds (antirerovirals- HIV) |
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Meds linked with acute pancreatitis include:
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thiazide diuretics, estrogen, steroids, salicylates, and NSAIDS
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Acute pancreatitis usually follows ____ or ____ ingestion.
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heavy fat or heavy alcohol
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S/Sx of acute pancreatitis are:
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-SEVERE PAIN (mid- epi area radiating to back, w/ ABD tenderness)
-NV -ABD distention and rigidity -decreased bowel sounds -tachycardia -hypotension -elevated T, cold, clammy skin -ECCHYMOSIS in flank area |
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Abnormal lab results associated with acute pancreatitis are:
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-elevated serum amylase (1st 24 hours)
-elevated lipase (rises after 48 hrs, stays 5-7 days) -hypocalcemia |
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Acute pancreatitis could also cause complications such as
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-ARF
-ARDS -hypovolemic shock -tetany (hypocalcemia) -pseudocysts, abscesses |
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A ____ is located outside the pancreas connected by a duct to the pancreas and increases in size as the inflammation continues. It is filled with fluid and necrotic tissue.
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Pseudocyst
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A ____ is located inside the pancreas and can be fatal.
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abscess
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When there is almost total destruction of pancreas (usually chronic pancreatitis) ____ may occur.
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T1 DM
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Tx for acute pancreatitis includes:
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-PAIN management (Dilaudid best)
-TPN/PPN -NPO -Bedrest -Monitor IV flds, electrolytes, output -Assess abdomen, respiratory, VS |
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TPN/PPN may be used with acute pancreatitis patients because we need to
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feed them straight into the vein and bypass the pancreas.
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Patients with acute pancreatitis have trouble deep breathing because of the pain and often get ______.
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atelectasis
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_____ is a progressive disease that replaces normal tissue with fibrous tissue resulting in irreversible damage to the pancreas.
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Chronic pancreatitis
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The most common cause of chronic pancreatitis is _____.
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alcohol abuse
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S/Sx of chronic pancreatitis are
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-SEVERE pain
-fat, stinky stools -wt loss, malabsorption |
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Patients with chronic pancreatitis should be on a ____ diet.
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low fat
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Acute flare ups for a person with chronic pancreatitis are usually associated with
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-high stress
-alcohol binge -high fat consumption |
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Complications of chronic pancreatitis include:
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-T1DM
-pseudocysts, abscesses -PUD -malnutrition -stricture of common bile duct -pancreatic cancer |
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Tx for acute pancreatitis often focuses on
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reducing pancreatic secretions and providing supportive care.
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Tx for chronic pancreatitis includes:
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-Pain meds
-oral pancreatic enzymes -NPO with TPN -bedrest -NO alcohol -insulin or hypoglycemics |
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The surgical option for chronic pancreatitis is
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ductal stent placed in pancreatic duct so enzymes can come out.
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Pancreatic cancer risk factors are
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-smoking
-chronic pancreatitis -DM -genetics -high fat diet -Hepatitis A, B, or C |
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S/Sx of pancreatic cancer include a slow onset of symptoms of ____, ____ and ____.
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pain
weight loss jaundice |
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Tx of pancreatic cancer is usually
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palliative care.
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The surgical resection of the head of the pancreas is called a
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whipple procedure
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Patients who undergo the whipple procedure for pancreatic cancer often end up with
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dumping syndrome (diarrhea, malnutrition and severe hypoglycemia)
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____ and ____ may be given for pancreatic cancer to manage tumor size, pain and symptoms.
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Chemo and radiation
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Pancreatic cancer is confirmed with a
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biopsy.
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____ can be done when confirming pancreatic cancer to make sure things are not blocked.
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ERCP
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