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91 Cards in this Set

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What is compensated cirrhosis?
when the liver is heavily scarred, but it can still perform many important fxns
What is compensated cirrhosis?
when the liver is heavily scarred, but it can still perform many important fxns
S&S of compensated cirrhosis?
1. vascular spiders
2. ankle edema
3. indigestion
4. flatulence
5. ab pain
6. enlarged liver
What is decompensated cirrhosis?
liver is extensively scarred and unable to fxn properly
S&S of decompensated cirrhosis?
1. ascites
2. jaundice
3. weight LOSS
4. purpura
5. epistaxis
Which biliary changes occur w/ cirrhosis? (3)
1. jaundice, pruritis
2. DARK URINE, CLAY-COLORED STOOLS
3. increased ab girth
3 circulatory changes that occur w/ cirrhosis?
1. esophageal varices
2. hematemesis
3. hemorrhage
List the digestive disturbances that occur w/ cirrhosis
1. indigestion, dyspepsia
2. flatulence, C, D
3. anorexia, weight LOSS
4. N, V
What is the phys of cirrhosis?
the replacement of normal liver tissue w/ widespread fibrosis and NODULE formation
3 types of cirrhosis?
1. alcoholic cirrhosis
2. biliary cirrhosis
3. postnecrotic cirrhosis
What is the cause of alcoholic cirrhosis?
alcoholism & poor nutrition
What is the cause of biliary cirrhosis?
chronic biliary obstruction and infection
What is the cause of postnecrotic cirrhosis?
result of previous viral hepatitis
List 4 complications a/w cirrhosis.
1. portal HTN w/ esophageal varices
2. peripheral edema & ascites
3. hepatic encephalopathy (coma)
4. hepatorenal syndrome
Where is the impact of portal HTN most likely found?
dilated tortuous veins usually in the submucosa of the lower esophagus
What is the leading cause of death in pt w/ cirrhosis?
hemorrhage from rupture of the esophageal varices r/t portal HTN
What is ascites/?
accumulation of serous fluid in peritoneal and abdominal cavity
What is peripheral edema and ascites a/w?
1. dehydration
2. HYPOkalemia
What is the cause of hepatic encephalopathy?
accumulation of AMMONIA and other toxic metabolites in the blood
S&S of hepatic encephalopathy?
1. change in level of consciousness
2. jaundice
**may lead to COMA
Signs of impending coma? (3)
1. not AxO x3
2. asterixis (flapping of hand when arm extended and hand held upward (dorsiflexed)
What is the cause of postnecrotic cirrhosis?
result of previous viral hepatitis
What is hepatorenal syndrome and what are S&S? 2
functional renal failure-

1. azotemia
2. ascites
List 4 complications a/w cirrhosis.
1. portal HTN w/ esophageal varices
2. peripheral edema & ascites
3. hepatic encephalopathy (coma)
4. hepatorenal syndrome
Where is the impact of portal HTN most likely found?
dilated tortuous veins usually in the submucosa of the lower esophagus
What is the leading cause of death in pt w/ cirrhosis?
hemorrhage from rupture of the esophageal varices r/t portal HTN
What is ascites/?
accumulation of serous fluid in peritoneal and abdominal cavity
What is peripheral edema and ascites a/w?
1. dehydration
2. HYPOkalemia
What is the cause of hepatic encephalopathy?
accumulation of AMMONIA and other toxic metabolites in the blood
S&S of hepatic encephalopathy?
1. change in level of consciousness
2. jaundice
**may lead to COMA
Signs of impending coma? (3)
1. not AxO x3
2. asterixis (flapping of hand when arm extended and hand held upward (dorsiflexed)
What is hepatorenal syndrome and what are S&S? 2
functional renal failure-

1. azotemia
2. ascites
How to relieve portal HTN?
shunts
Nutrition for pt w/ early stages of cirrhosis?
HIGH PROTEIN
HIGH CARB
VIT B COMPLEX SUPPLEMENT
Nutrition for pt/ w/ advanced cirrhosis?
FIBER, PROTEIN, FAT AND SODIUM RESTRICTIONS!!!

HIGH CALORIE
HIGH PROTEIN (W/ GOOD BIO VALUE)
3 additional nutrition requirements for cirrhosis pts?
1. small, frequent feedings
2. fluid restriction
3. avoid alcohol
What should you monitor for in pt w/ cirrhosis?
1. signs of bleeding (give blood products if necessary)
2. VS (for shock)
3. ab girth
4. daily wt
5. skin integrity (AVOID strong soaps)
6. assess degree of jaundice
7. promote REST
8. promote resp fxn
3 ways to prevent bleeding in a pt w/ cirrhosis?
1. electric razor
2. soft toothbrush
3. P to site after venipuncture
How do you reduce ascites?
1. sodium & fluid restrictions
2. diuretics
6 invasive tx for bleeding esophageal varices?
1. balloon tamponade
2. endoscopic sclerotherapy
3. room temp saline lavage
4. esophageal banding therapy
5. TIPS: transjugular intrahepatic postsystemic shunting
6. surgical bypass
What tubes can you use for balloon tamponade?
1. Sengstaken-Blakemore tube
2. Minnesota tube
What are the 3 fxns of the 3 lumens of the Sengstaken-Blakemore tube?
1. gastric inflation balloon
2. gastric aspiration (cxt to sxn)
3. esophageal inflation balloon

*deflate these sequentially, beginning w/ the esophageal one
Complications a/w balloon tamponade? 4
1. necrosis of nose, stomach mucosa, or esophagus
2. asphyxiation
What is endoscopic sclerotherapy?
injection of sclerosing agent into the esophagus, causing varices to become fibrotic
Which meds can be given to tx bleeding esophageal varices?
vasopressin
propanolol IV or interarterial
IV octreotide (sandostatin)

fxn: temp lowers the portal pressure by constricting the splenic artery
What is esophageal banding therapy?
modified endoscope w/ rubber band passed into the esophagus, varices are banded
How do you tx hepatic encephalopathy?
1. bedrest
2. meds:
Lactulose
Neomycin
S&S of Jaundice? (4)
Jaundice:
1. yellow or greenish-yellow skin & sclerae r/t high bilirubin conc in blood
2. DARK URINE
3. CLAY-COLORED stool
4. pruritis
What is hemolytic jaundice?
jaundice caused by destruction of great number of blood cells, which leads to high conc of bilirubin that exceeds liver's ability to excrete it
3 causes of hemolytic jaundice?
hemolytic jaundice:
1. hemolytic transfusion rxns
2. hemolytic anemia
3. sickle-cell crisis
What is intrahepatic jaundice?
jaundice due to obstructed flow of bile through the liver or biliary duct system
2 causes of intrahepatic jaundice?
1. cirrhosis
2. hepatitis
What is extrahepatic jaundice?
jaundice due to obstructed flow of bile through the liver or biliary duct system
3 causes of extrahepatic jaundice?
1. cholelithiasis
2. tumors
3. med side effects
-phenothiazine
-antithyroids
-sulfonamides
-TCAs
-androgens, estrogens
How do you relieve jaundice?
tx the underlying cause
How do you tx pruritis? (5)
1. antihistamines
2. baking soda or Keri baths
3. keep nails trimmed and clean (teach to rub w/ knuckles, not nails)
4. soft, old linen
5. moderate T
What is Reye's Syndrome (RS)?
acute metabolic encephalopathy of childhood that causes hepatic dysfxn
What are the causes of RS? (2)
1. asprin w/ a viral illness
2. a/w viruses (esp URI, gastroenteritis)
S&S of RS? 3
1. fever
2. increased ICP
3. decreased LOC, coma
4. decreased hepatic fxn
How do you dx RS?
liver biopsy
What should you monitor in a pt w/ RS?
1. neuro checks
2. hydration and electrolytes w/ IV
3. ET tube and respirator may be needed
4. CVP or Swan-Ganz catheter
What is cholecytitis?
inflammation of the gallbladder
What is cholelithiasis?
presence of STONES in the gallbladder
Risk factors for cholelithiasis/cholecystitis? 8
1. obesity
2. sedentary life
3. women (esp multips)
4. 40+ y/o
5. preg
6. family hx
7. hypothyroidism
8. increased serum cholesterol
Where is pain located in pt w/ cholecystitis/cholelithiasis?
severe pain in the upper right quadrant of badomen, radiating to back and right shoulder (biliary colic)
S&S of cholecystitis/cholelithiasis? 7)
1. intolerance to fatty foods
2. indigestion
3. N,V,flatus, eructation
4. high T
5. leukocytosis
6. diaphoresis
7. DARK URINE & CLAY COLORED STOOLS
4 interventions for cholecystitis/cholelithiasis?
1. rest
2. IVF
3. NG suction
4. meds: Ab, analgesics
What type of diet should a pt w/ cholecystitis/cholelithiasis be on?
LOW FAT LIQUIDS: powdered supplements high in protein, carbs stirred into skim milk

NO fried foods, pork, cheese, alcohol
2 types of surgeries to remove the gallbladder?
1. laparoscopic laser cholecystectomy
2. traditional cholecystectomy
What is a laparoscopic laser cholecystectomy?
removal of the gallbladder by a laser through a laparoscope

4 small puncture holes made in ab
Pre-op care before a laparoscopic laser cholecystectomy?
NPO
Postop care for pt s/p laparoscopic laser cholecystectomy? 3
1. monitor for bleeding
2. resume normal activity in 1 wk
3. low-fat diet for several wks
What is a traditional cholecystectomy?
removal of gallbladder through high abdom incision
What should you give if prothrombin time is low before a traditional cholecystectomy?
1. Vitamin K
2. blood transfusions
Which supplements would aid in healing and prevent liver damage?
1. glucose
2. protein hydrolysates
What must you insert prior to a traditional cholecystectomy?
NGT
Which tube must you monitor s/p traditional cholecystectomy?
T tube (inserted to ensure drainage of bile from common bile duct until edema in area diminishes)

*keep T-tube drainage bag below the level of the gallbladder
Which position should a pt s/p a traditional cholecystectomy be in?
semi-fowler's
How should you monitor for jaundice s/p a traditional cholecystectomy?
1. yellow sclerae
2. stools that don't change from light to dark after removal of T tube
What type of diet should a pt be on s/p a traditional cholecystectomy?
HIGH CARB
HIGH PROTEIN

LOW fat
What is acute pancreatitis?
acute inflammation of pancrease, brought about by digestion of the organ by ENZYMES IT PRODUCES, esp TRYPSIN
What is chronic pancreatitis?
progressive, chronic fibrosis and inflammation of the pancreas, w/ obstruction of its ducts and destruction of its secreting cells
Risk factors for pancreatitis? (5)
1. alcoholism
2. infection
3. trauma
4. mumps complication
5. meds
-BCPs
-corticosteroids
-thiazide diuretics
Describe the pain in r/t pancreatitis?
ab pain, N, V 24-48 hr after a heavy meal or alcohol

pain is relieved w/ position change
3 S&S of pancreatitis?
1. hypOtension
2. acute renal failure
3. GREY-BLUE discoloration in FLANK and around umbilicus
Meds to tx pancreatitis? 4
1. abs
2. opioids (avoid meperidine r/t tox)
3. his-blockers
4. PPIs
Which position should a pt w/ pancreatitis be in?
semi-fowler's
Resp care for a pt w/ pancreatitis?
1. ABG
2. humidified oxygen
3. intubation
4. ventilaiton
5. C&DB q2h
Goals for pt w/ pancreatitis?
1. NPO, gastric decompression
2. F&E
3. monitor for shock and HYPERglycemia
Diet for pt w/ pancreatitis?
TPN
long term tx for pancreatitis?
1. avoid alcohol and caffeine
2. low fat, bland diet
3. small, frequent meals