Med Surg Chapters 48 And 49

Front 1

Inflammation of the pancreas

Back 1

Acute Pancreatitis

Front 2

What is the major cause of Acute Pancreatitis?

Back 2

Alcohol abuse
Thought to be due to inappropriate activation of protease resulting in autodigestion of the pancrease

Front 3

What is the 2nd most common cause of acute pancreatitis?

Back 3

Gallstones
Biliary pancreatitis occurs when the ampulla of Vater is blocked; reflux of bile into pancreatic ducts cause direct injury to the acinar cells.

Front 4

Name three other causes of Acute Pancreatitis

Back 4

Abdomninal trauma
Metabolic factors
Hyperlipidemia, hypercalcemia, pancreatic ischemia, certain meds

Front 5

How would you predict the severity of an acute pancreatic attack?

Back 5

#2 or fewer sx, mortality 1%
#3-4 sx, mortality 16%
#5-6 sx, mortality 40%
#7 or more, even higher!

Front 6

Name six signs in dx of acute pancreatitis

Back 6

>55 years old
>16,000/mm3 WBC
>11 mmol/L(>200 mg/dl)Blood glucose
>400 i.u./L Serum LDH
>250 i.u./L Serum AST
Fall in HCT by >10%

Front 7

Name five more lab tests in dx of acute pancreatitis

Back 7

Fluid deficit of >4000 ml
Serum calcium <1.9 mmol/L
Hypoxemia (Po2 <60 mmHg)
BUN elevation to >1.8 mmol/L
Albumin level <32g/L 3.2g/dl

Front 8

Name six clinical manifestations of acute pancreatitis

Back 8

1. Abdominal pain 12-48 hrs after inebriation or large meal
2. Nausea & vomiting
3. Abdominal distention
4. Fever
5. Transient hyperglycemia
6. Hypocalcemia

Front 9

Bluish discoloration of left flank; result of tissue catabolism in acute pancreatitis

Back 9

Turner's Sign

Front 10

Bluish-yellow discoloration of periumbilical region; blood stained retroperitoneal fluid

Back 10

Cullen's Sign

Front 11

Value of Serum amylase in acute pancreatitis

Back 11

60-120 somogyi u/dl or 30-220 u/L
Starts to elevate in 24 hrs; resolves in 7-14 days

Front 12

Value of Urinary amylase in acute pancreatitis

Back 12

Up to 5000 somgyi u/24 hr or 6.5-48.1 units/hr

Front 13

Value of Serum lipase in acute pancreatitis

Back 13

0-160 units/L
Most specific indicator of a.p. as lipase is solely of pancreatic origin

Front 14

Result of Chest film in acute pancreatitis

Back 14

Left basilar atelectasis, elevated left diaphragm, left pleural effusion

Front 15

Result of WBC in acute pancreatitis

Back 15

WBC above 10,000 cells/mm3

Front 16

Progressive, inflammatory, destructive disease of the pancreas

Back 16

Chronic Pancreatitis

Front 17

Fatty Stools

Back 17

Steatorrhea

Front 18

What position may a patient assume to alleviate pain with chronic pancreatitis?

Back 18

Sit with knees flexed & press pillow to abdomen.

Front 19

A patient with chronic pancreatitis may experience more pain is lying supine.
True or False

Back 19

True

Front 20

What is the most common cause of Chronic Pancreatitis

Back 20

Chronic alcoholism

Front 21

A gene for hereditary pancreatitis has been located on chromosome 9
True or False

Back 21

False
Chromosome 7

Front 22

Crystalline structures formed by concretion (hardening) or accretion (adherence of particles) of normal or abnormal bile constituents

Back 22

Cholelithiasis
(Gallstones)

Front 23

Name 4 possible explanations of Cholelithiasis

Back 23

1. Change in bile composition
2. Bile stasis
3. Infection
4. Genetics & demography

Front 24

Name 3 locations gallstones might be found

Back 24

1. Gallbladder
2. Common duct
3. Hepatic duct

Front 25

Name the 3 types of gallstones

Back 25

1. Cholesterol
2. Pigment
3. Mixed

Front 26

What is the most common type of gallstones?

Back 26

Cholesterol

Front 27

How are gallstones formed?

Back 27

Bile must become supersaturated with cholesterol or calcium.
Solute must precipitate from solution as solid crystals

Front 28

Name some diagnostic tests for chronic pancreatitis

Back 28

Enzyme studies may be normal
Mild leukocytosis
Glycosuria
X-ray, ultrasound, CT

Front 29

Acute inflammation of gallbladder wall

Back 29

Acute Cholecystitis

Front 30

Etiology of Acute Cholecystitis

Back 30

Gallstones & obstruction of cystic duct

Front 31

What is acalculous cholecystitis?

Back 31

Cholecystitis without stones

Front 32

Name some possible factors or triggers of Acute Cholecystitis

Back 32

1. Multiple blood transfusion
2. Gram - bacterial sepsis
3. Tissue damage
4. Hyperalimentation
5. Prolonged fasting

Front 33

Name six clinical manifestations of acute cholecystitis

Back 33

1. Tenderness rt upper quad
2. Pain, lasting several days
3. Murphy's sign
4. Biliary colic
5. Nausea & vomiting
6. Low grade fever

Front 34

Inflammation of the liver

Back 34

Hepatitis

Front 35

Name the four types of hepatitis

Back 35

1. Viral
2. Toxic
3. Chronic
4. Alcoholic

Front 36

Most common cause of cirrhosis

Back 36

Alcoholic hepatitis

Front 37

Liver inflammation persists beyond a period of 3 to 6 months

Back 37

Chronic hepatitis

Front 38

________ hepatitis occurs worldwide; most common blood borne infection in the U.S.

Back 38

Viral

Front 39

Infectious hepatitis. Contaminated food & water. Poor sanitation. Children under 15 at most risk

Back 39

Hepatitis A

Front 40

Contact with blood or body fluids of carriers & persons in acute phase of disease
Hepatitis ______

Back 40

Hepatitis B

Front 41

IV drug use; tattooing & body piercing; same as Hep B

Back 41

Hepatitis C

Front 42

Hepatitis only through blood contact. Defective virus that needs B virus to exist

Back 42

Hepatitis D

Front 43

Rare in US Short incubation does not become chronic
Poor sanitation

Back 43

Hepatitis E

Front 44

How many strains of Hepatitis?

Back 44

Seven
Hepatitis A, B, C, D, E, F, & G

Front 45

Name eight clinical manifestations of Viral Hepatitis

Back 45

1. Jaundice 2. Lethargy
3. Irritability 4. Myalgia
5. Arthralgia 6. Anorexia
7. N/V 8. Fever, Flu-like

Front 46

Without Jaundice

Back 46

Anicteric

Front 47

Chronic; progressive disease; widespread fibrosis (scarring) & nodule formation

Back 47

Cirrhosis

Front 48

List four causes of Cirrhosis

Back 48

1. Excessive ETOH intake
2. Genetic predisposition
3. Improper nutrition
4. Viral hepatitis

Front 49

Diagnostic tests that determine Cirrhosis

Back 49

1. Elevated LFT's
2. Prolonged PTT
3. Hgb & hct low

Front 50

Persistent increase in BP in the portal venous system due to resistence or obstruction of blood flow thru the portal venous system into the liver

Back 50

Portal Hypertension

Front 51

In Portal Hypertension how much higher than the inferior vena cava is the pressure?

Back 51

5 mm Hg

Front 52

What is the etiology of Portal Hypertension?

Back 52

Most often due to cirrhosis; thrombus, or tumor

Front 53

List five clinical manifestations of Portal Hypertension

Back 53

1. Caput medusa
2. Enlarged palpable spleen

Front 54

Name five clinical manifestations of portal hypertension

Back 54

1. Caput Medusa
2. Enlarged palpable spleen
3. Internal hemorrhoids
4. Bruits
5. Ascites

Front 55

Accumulation of fluid in the peritoneal cavity that results from the interaction of several pathophysiologic changes

Back 55

Ascites

Front 56

Name 3 conditions that contribute to Ascites

Back 56

1. Portal hypertension
2. Lowered plasma colloidal osmotic pressure
3. Sodium retention

Front 57

Name 5 disease processes of Ascites

Back 57

1. Cirrohis of the liver
2. Right-sided heart failure
3. Tuberculosis peritonitis
4. Cancer
5. Pancreatitis

Front 58

Name 3 clinical manifestations of Ascites

Back 58

1. Abdominal distention
2. Bulging flanks
3. Downward protruding abdomen

Front 59

Name 4 diagnostic tests to determine Ascites

Back 59

1. Paracentesis
2. Abdominal x-ray
3. Ultrasonography
4. CT Scan

Front 60

Pathophysiology of Ascites
Name 4 of them

Back 60

1. Increase in hydrostatic pressure
2. Plasma leaks
3. Loss of plasma proteins
4. Aldosterone secretions increases

Front 61

Lipid infiltration of liver. Liver enlargement, increased firmness, decreased function

Back 61

Fatty Liver (Hepatic Stenosis)

Front 62

List seven causes of Fatty Liver (hepatic stenosis)

Back 62

1. Chronic alcoholism
2. Protein malnutrition in early age
3. Diabetes
4. Obesity
5. Cushing's syndrome
6. Jejunoileal bypass
7. Prolonged hyperalimentation

Front 63

Diagnostic test for fatty liver (hepatic stenosis)

Back 63

Elevated alkaline phosphatase & bilirubin levels