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126 Cards in this Set

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What is the largest internal organ in the body weighing approximately 3lbs. in an adult and is essential for life?
The liver
About one-fourth of the liver's blood supply comes from the...
Hepatic artery
Three-fourths of the liver's blood supply comes from the...
Portal vein
The portal circulatory system brings blood to the liver from the...
Stomach
Intestines
Spleen
Pancreas
Where does blood enter the liver?
through the portal vein
What are the functions of the liver?
Metabolic functions
Bile synthesis
Storage
Mononuclear phagocyte system
Metabolic functions of the liver includes...
Carbohydrate metabolism
Protein metabolism
Fat metabolism
Detoxification
Steroid metabolism
Bile synthesis of the liver includes...
Bile production
Bile excretion
What does the liver store?
Glucose in the form of glycogen
Vitamins (fat and water soluble)
Fatty acids
Minerals
Amino acids (albumin/B-globulins)
What is the lab value for ammonia?
15-45mcg N/dl
What is the lab value for Alkaline phosphatase (ALP)?
38-126 U/L
What is the lab value for Aspartate amino-transferase (AST)?
10-30 U/L
What is the lab value for Alanine aminotransferase (ALT)?
10-40 U/L
What is the lab value for Cholesterol?
140-200 mg/dl
What procedure is used to obatin a specimen of liver tissue?
Liver biopsy
What type of patient shouldnt get a liver biopsy?
One who has a bleeding disorder
What are some complications of a liver biopsy?
Pneumothorax
Peritonitis
Hemorrhage
What are some goals for a patient that undergone a liver biopsy?
Bilateral breath sounds
No respiratory distress
Stable vitals
No bleeding
what is a chronic progressive disease of the liver, that causes extensive degeneration and destruction of liver cells?
Cirrhosis
What is cirrhosis of the liver caused by?
Long term liver disease
Excessive alcohol intake
Alcohol vs. malnutrition
Nonalcoholic fatty liver disease
Primary biliary cirrhosis
Primary sclerosing cholangitis
Cardiac cirrhosis
What are some early signs and symptoms of cirrhosis?
Nausea and vomiting
Anorexia
Dyspepsia
Flatulence
Diarrhea or constipation
Abdominal pain
Fever
Slight weight loss
Enlargement of liver and spleen
What are some late signs and symptoms of cirrhosis?
Jaundice
Perpherial edema
Ascites
Skin lesions
Hematologic disorders
Endocrine disturbances
Perpherial neuropathies
Liver size decreased and nodular
The compression of bile ducts by connective tissue overgrowth causes?
Jaundice
What color stools does a person with jaundice have?
Light or clay colored
What are the two kinds of skin lesions associated with cirrhosis?
Spider angiomas
Palmar erythema
What are small dilated blood vessels with a bright red center point and spider like branches?
Spider angiomas
What is a reddened area that blanches with pressure?
Palmar erythema
What are some hemtologic problems thats are associated with cirrhosis?
Thrombocytopenia
Leukopenia
Anemia
Coagulation disorders
Splenomegly
What are some endocrine problems associated with cirrhosis?
Hyperaldosteronism
What are some signs and symptoms of hyperaldosteronism in men?
Gynecomastia
Loss of axillary and pubic hair
Testicular atrophy
Impotence
Loss if libido
What are some signs and symptoms of hyperaldosteronism in women?
Younger women: amenorrhea
Older women: vaginal bleeding
What are enlarged and swollen veins at the end of the esophagus as a result in portal hypertension?
Esophageal varies
What kind of varies are located in the upper portion of the stomach?
Gastric varies
What are some factors that produce ulcerations such as Esophageal and gastric varies?
Alcohol ingested
Swallowing of poorly masticated food
Ingested or coarse food
Acid regurgitation from the stomach
Straining at stool
Coughing or sneezing
Lifting heavy objects
What results from collodial pressure from impaired liver synthesis of albumin and portcaval pressure from portal hypertension?
Peripheral edema
What is the most common manifestation of cirrhosis?
Ascites
What is the accumulation of serous fluid in the peritoneal or abdominal cavity?
Ascites
Due to ascites, the lymphatic system is not able to...
Carry off the excess protein and water
What position should a person with ascites be in?
High-folwers
What signs and symptoms will a person have with ascites?
Dehydration:
Dry tongue and skin
Sucken eyeballs
Muscle weakness
Decrease in urinary output
Hypokalemia
Abdominal distention
What is hepatic encephalopathy?
When ammonia crosses the blood brain barrier and produces neurotoxic manifestation.
In hepatic encephalopathy the liver is unable to convert ammonia into...
Urea
What are some signs and symptoms of hepatic encephalopathy?
Changes in neurologic and mental responsiveness
Sleep disturbances
Lethargy
Coma
Asterixis (Flapping tremors)
Fetor hepaticus (musty, sweet, odor of the patient's breath)
What is functional renal failure with azotemia, obliguria, and intractable ascites?
Hepatorenal syndrome
What type of renal failure can be reversed by a liver transplantation?
Hepatorenal syndrome
What happens to liver enzymes (alkaline phosphatase, AST, ALT, and GGT) when it is cirrhosis?
They all increase
In compensated or end stage liver disease what happens to the liver enzymes AST and ALT?
They may be normal
In compensated or end stage liver disease what happens to the protein, albumin, serum billirubin, globulin and cholesterol levels? and What happens to the prothrombin time?
Protein, albumin, and cholesterol levels are decreases
Billirubin and globulin levels are increased
Prothrombin time is prolonged
What are some nursing interventions for a person with ascites?
Sodium restriction
Diuretics (spironolactone, amiloride, triamterene, furosemide, and hydrochlorothiazide)
Fluid removal (paracentesis and perioneovenous shunt)
What are some interventions for a person with varices?
Endoscopic ligation (banding of varices, fewer complications than sclerotherapy)
Balloon tamponade (controls hemorrhage by compression of varices and uses Sengstaken-Blakemore tube)
What should someone with esophageal and gastric varices avoid?
Alcohol
Asprin
Irritating foods
What is the main goal for a person with esophageal and gastric varices?
Airway
Avoid bleeding/Hemorrhage

Treat respiratory infections promptly
What is the most common type of hepatitis?
Viral Hepatitis
What is inflammation and necrosis of hepatic cells?
Viral hepatitis
What are types of viral hepatitis?
Hepatitis A,B,C,D, and E
What is also known as "infectious hepatitis"?
Hepatitis A
What is the mode of transmisson for hepatitis A?
Fecal- oral route, poor sanitation
How long is the incubation period for hepatitis A?
15-50 days
The preicteric phase of hepatitis A includes what signs and symptoms?
Headache
Anorexia
Fever
The icteric phase of hepatitis A includes what signs and symptoms?
Dark urine
Jaundice of skin and sclera
(TRUE OR FALSE)
Hepatitis A is not a chronic carrier
True
Nursing management for hepatitis A includes:
Stressing good hygiene
Environmental sanitation
What is also known as "serum hepatitis"
Hepatitis B
Nursing management for hepatitis A includes:
Stressing good hygiene
Environmental sanitation
What is the mode of transmission of hepatitis B?
Blood and body fluids
Through mucous membranes and breaks in the skin.
What is also known as "serum hepatitis"
Hepatitis B
Who are at the greatest risk for contracting hepatitis B?
Health care workers (#1)
IV drug abusers
Homosexual activity
What is the mode of transmission of hepatitis B?
Blood and body fluids
Through mucous membranes and breaks in the skin.
How long is the incubation period of hepatitis B?
1-6 months
Who are at the greatest risk for contracting hepatitis B?
Health care workers (#1)
IV drug abusers
Homosexual activity
How long is the incubation period of hepatitis B?
1-6 months
How long can hepatitis B live on dry surfaces?
7 days
This vaccine provides active immuinty...
Hepatitis B
How does one recieve passive immunity for hepatitis B?
Through hepatitis B immune globulin
Nursing considerations for hepatitis B includes:
Teaching patient proper nutrition
Rest
Prevention of spread
(TRUE OF FALSE)
HBV can be a carrier state
TRUE
People who have hepatitis B are at and increased risk for
Cirrhosis
Chronic hepatitis
Hepatic cancer
How is hepatitis C transmitted?
Blood transfusion
Exposure to blood Contaminated equiptment or drug paraphernalia
Sexual contact
What is the incubation period hepatitis C?
15-160 day
(TRUE OR FALSE)
Chronic carrier state is usually occurs with hepatitis C?
TRUE
What medications are used to treat hepatitis C?
Interferon
Ribavirin
Who are at risk for getting hepatitis D?
only people who have hepatitis b
How is hepatitis D transmitted?
Sexual contact
IV drug use
Which hepatitis will likely progress to chronic hepatitis and cirrhosis?
hepatitis D
How is hepatitis E transmitted?
Fecal-oral route
What is the incubation peroid for hepatitis E?
15-65 days
What symptom is usually present with hepatitis E?
Jaundice
Does hepatitis E have a chronic state?
NO
What is an inflammatory condition caused by ingestion or inhalation of certian substances?
Toxic hepatitis
Inhalation or ingesting what substances can cause toxic hepatitis?
Dry cleaning fluid
Glue
Insecticides
Pesticides
Poisonous mushrooms
Rat poison
What medications can cause toxic hepatitis?
Tylenol
Asprin
Thorazine
INH
Valium
What are some symptoms of toxic and drug induced hepatitis?
GI and flu type symptoms
Jaundice
Hepatomegaly
(may take days to months for symptoms to appear)
What are twos kinds of gallbladder diseases?
Cholelithiasis
Cholecystitis
What is Cholelithiasis?
Stones in the gallbladder
What is the most common disorder of the biliary system?
Cholelithiasis
What is Cholecystitis?
Inflammation of the gallbladder
What are some risk factors of Cholelithiasis?
Estrogen therapy
Sedentary lifestyle
Familial tendency
Obesity
What gall bladder disease is most commonly associated with obstruction(gallstones or biliary sludge)?
Cholecystitis
What are the initial symptoms of acute cholecystitis?
Indigestion
Pain
Tenderness in right upper quadrant
What are some clincal manifestations on cholecystitis?
Pain
Inflammation
Right upper quadrant tenderness
Abdominal rigidity
What are some symptoms of chronic cholecystitis?
History of:
Fat intolerance
Dyspepsia
Heartburn
Flatulence
Severity of cholelithiasis symptoms depends on...
Presence of obstruction
Whether stones move or not
What are some symptoms of Cholelithiasis total obstruction?
Jaundice
Dark amber urine
Clay-colored stools
Pruritus
Intolerance to fatty foods
Bleeding tendencies
Steatorrhea
No urobilinogen in urine
What are some complications of cholecystitis?
Gangrenous cholecysitis
Subphernic abscess
Pancreatitis
Cholangitis
Biliary cirrhosis
Fistulas
Gallbladder rupture (bile peritonitis)
What are some complications of cholelithiasis?
Cholangitis
Biliary cirrhosis
Carcinoma
Peritonitis
Choledocholithiasis
What type of Conservative therapy is used for cholelithiasis?
Mechanical Lithotripsy
What is Mechanical Lithotripsy used for?
It is used when gallstones are to large to pass, the endoscopist crushes the stones.
What are surgical therapy for cholelithiasis?
Laparoscopic cholecystectomy
Open cholecystectomy
What is the treatment of choice for cholelithiasis?
Laparoscopic cholecystectomy
What is a Laparoscopic cholecystectomy?
Removal of the gallbladder through four puncture holes, minial postoperative pain with discharge for the next day or two.
What is the main complication with Laparoscopic cholecystectomy?
Injury to the common bile duct
What is an Open cholecystectomy?
Removal of the gallbladder through the right subcostal incision.
In an open cholecystectomy a T- tube is inserted into the common bile duct to...
Ensure patency of the bile duct
Allows excess bile to drain
What are some clinical manifestations of gallbladder disease?
Indigestion
Moderate to severe pain
Fever
Jaundice
What are some complications of cirrhosis?
Portal hypertension
Esophageal and gastric varices
Ascites
Peripheral neuropathy
Hepatic encephalopathy
Hepatorenal syndrome
What is obstruction of normal blood flow to the liver?
Portal hypertension
Nursing Care for hepatic encephalopathy include...
Treatment
Restrict protein intake in early stages
Lactulose (reduce serum ammonia through the bowel evacuation)
D/C sedatives, tranquillzers, analgesics
What are nursing interventions for hepatic encephalopathy?
Maintain safe enviornment
Assess (LOC, sensory and motor abnormalities, fluid and electrolytes imbalances, acid-base balance)
Neurologic status q2h
Prevention of constipation
Limit physical activity
Control hypokalemia
Ensure proper nutrition
What are some components of bile that precipitate into stones are?
Bile salts
Bilirubin
Calcium
Protein
(TRUE OR FALSE)
The cause of gallstones in cholelithiasis is unknown.
TRUE
Bile that is in the gallbladder is supersaturated with....
Cholesterol
What are the most common type of gallstones in cholelithiasis?
Cholesterol
What factors decrease bile flow?
Immobility
Pregnancey
Inflammatory or obstructive lesions of biliary system
Cholelithiasis gallstones stay in the gallbladder but may migrate to the...
Cystic or common bile duct
What is the most life threatening complication of cirrhosis?
Bleeding esophagel varices
With fluid removal from ascites you need to watch for...
A decrease in blood pressure and anticipate giving albumin