Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
108 Cards in this Set
- Front
- Back
|
escape of pancreatic enzymes into pancreas & surrounding tissues
|
Acute pancreatitis
|
|
|
leads to fat necrosis & autodigestion
|
acute pancreatitis
|
|
|
causes of acute pancreatitis
|
biliary tract disease leads to reflux of bile from gallstones blocking entrance to gallbladder
alcoholism leads to increase enzyme production |
|
|
60% of cases associated with alcoholism
|
acute pancreatitis
|
|
|
s/s of acute pancreatitis
|
abrupt onset after big meal or alcohol binge
severe steady "boring" pain in epigastric area or upper abd N/V fever cool clammy skin (fluid loss to abd cavity > hypovolemic shock increased pulse decrease blood pressure elevated WBC serum amylase 600 times normal (normal is < 300) |
|
|
from edema & inflammation as pancreas digest itself
|
acute pancreatitis
|
|
|
worse in supine, better sitting or leaning foward
|
acute pancreatitis
|
|
|
treatment for acute pancreatitis
|
pain relief w/ narcotics (but not w/ morphine because it causes spasms)
fluid restoration w/ colloids to pull fluid back to vascular system NPO Gastric scutioning H2 inbhibitors/proton pump inhibitors (decreased pancreatic stimulation if less acid production) |
|
|
Janudice (icterus)
|
increased accumulation of bilirubin in blood (aka hyperbilirubinemia) leading to staining of the skin
|
|
|
s/s jaundice
|
yellow skin
yellow sclera dark urine pale stools |
|
|
bilirubin makes stools
|
brown color
|
|
|
what is bilirubin
|
a yellow substance
waste product of normal RBC breakdown Normally excreted in stool and urine |
|
|
prehepatic causees of jaundice
|
hemolysis/rupture of RBC
|
|
|
example of a prehaptic cause of jaundice
|
sickle cell anemia
|
|
|
example of hepatic cause of jaundice
|
hepatitis
cirrhosis |
|
|
example of posthepatic cuases of jaundice
|
common bile duct blocked w/ a gallstone leading to bleeding
|
|
|
hepatic causes of jaundice
|
liver disease (inability to metabolize bilirubin)
|
|
|
posthepatic causes of jaundice
|
obstruction of bile ducts exiting the liver
|
|
|
define portal hypertension
|
abnormal blood flow in the portal blood vessel system
(blood vessels from GI, pancreas and spleen to liver) |
|
|
cause of portal hypertension
|
anything that impedes blood flow in portal system
|
|
|
common causes of portal hypertension
|
fibrosis
scarring inflammation liver tissue damage fibrous tissue & nodules constrict & increase portal vein pressure |
|
|
Reaction of the body to portal HTN
|
reroute blood flow
ascitites hepatic encephalopathy splenomegaly |
|
|
reroute blood flow creates
|
collateral channel (new pathway for blood) between portal & systemic veins to by pass obstruction
new blood vessels are fragile |
|
|
locations for collateral channels
|
esophagus (esophageal varices) leads to vomiting of blood
abd. wall leads to pattern on abd rectum leads to rectal bleeding |
|
|
treatment for esophagel varices
|
volume and blood replacement
meds to dilate collateral channels & provide more blood flow ensoscopic sclerosis mechanical pressure surgical procedures to shunt blood around the injured/scarred liver |
|
|
endoscopic sclerosis
|
injection to cause fibrosis of bleeding blood vessel
|
|
|
meachanical pressure
|
balloon tamponade with Stenstaken-Blakemore tube
|
|
|
ascitites & it's AKA
|
fluid in the abd cavity
aka third-spacing |
|
|
______ is due to
decreased albumin from the liver leading to decreased osmotic pressure obstruction of blood flow through the liver leading to fluid leaks out into tissues |
ascities
|
|
|
tx ascities
|
decrease sodium diet
diuretics decrease H20 paracentesis |
|
|
paracentesis
|
use needle to pull fluid out of abd.
have pt sit up so fluid drains down |
|
|
hepatic encephalopathy
|
CNS disturbances from ammonia not removed
|
|
|
splenomegaly
|
from excess blood flow
splen naturally holds excessive blood |
|
|
hepatitis
|
inflammation of the liver
usually applied to viral hepatitis |
|
|
causes of hepatitis
|
drugs
toxins infections virus |
|
|
viral hepatitis variations
|
Hepatitis A
Hepatitis B Hepatitis C Hepatitis D Hepatitis E |
|
|
lives in intestine
|
Hepatitis A
|
|
|
not as blood related
|
Hepatitis A
|
|
|
Hepatitis A incubation
|
brief - 30 days average
|
|
|
Hepatitis B incubation
|
long - 2-6 months
|
|
|
Hepatitis A Transmission
|
fecal/oral route
contaminated food/water, milk, shelfish Infected food preparers flooding of sewer poor bathroom handwashing |
|
|
Hepatitis B transmission
|
blood & body fluids
just like AIDS Many believe it to be a STD mothers to fetus |
|
|
people of risk for Hepatitis A
|
children & institionalized people
people who eat in restraunts travel out of western world flood zones |
|
|
people of risk for Hepatitis B
|
IV drugs users
hemodialysis unit health care workers |
|
|
Which hepatitis's can be carriers
|
Hepatitis B & D
|
|
|
patho of Hep A & B
|
infection can damage liver cells > necrosis & scarring
Immune reaction can damage cells & obstruct bile making liver function worse most damage w/ Hep B & C can cause liver failure |
|
|
infection hepatitis
|
Hep A
|
|
|
serum hepatitis
|
Hep B
|
|
|
stages of symptoms hep A & B
|
1. prodromal stage
2. icteric phase 3. recovery phase |
|
|
prodromal stage
|
highly contagious state
starts about 2 weeks after exposure and ends when jaundice occurs last about 1-2wk for A & B lasts longer |
|
|
S/s of prodromal stage
|
anorexia
malaise n/v low grade fever RUQ pain |
|
|
icteric phase
|
jaundice stage
lasts 2-6 weeks (hep B) occurs after prodromal stage |
|
|
s/s of icteric phase
|
dark urine
clay colored stools enlarged liver abd pain & fatigue elevated bilirubin levels & liver enzymes |
|
|
Recovery phase
|
6-8 weeks after exposure with Hep A
16+ weeks for Hep B Resolution of jaundice & liver function tests return to normal |
|
|
if hepatitis is to become chronic it would start
|
before recovery phase
There would be no recovery phase |
|
|
prevention of hep A
|
careful where u eat
cook suspicious food well boil suspicious water |
|
|
prevention hep B
|
avoid contact w/ blood & Body Fluids
wear gloves screen blood donors |
|
|
vaccine for hep A
|
mostly recommended for travelers
2 doses for full immunity takes 4 weeks to develop immunity 1st injection believed to last 20yrs |
|
|
vaccine for hep B
|
3 doses spaced over 8 months
should have antibody after series cannot get hep B from vaccines If not immune after 4 injections probably won't be. |
|
|
prevention of hep A once exposed
IgG IgM |
gamma globulin
|
|
|
gamma globulin
|
immune serum injection given before or just after contact (7days) w/ hep A, can prevent illness
|
|
|
prevention once exposed hep B
|
Hep B immune globulin injection within 10 days of exposure can prevent Hep B
|
|
|
Treatment of Hepatitis
|
Symptomatic
rest no alcohol no tylenol no strenuous exercise increase fluids low fat high carbohydrates diets |
|
|
treatment for hep B
|
interferon-alpha 2b
daily injection for 16 weeks to boost the immune system & prevent further viral replication Not a "cure" |
|
|
formerly called non-A/non-B
|
hepatits C
|
|
|
hep C transmitted by
|
blood & body fluids - just like Hep B
|
|
|
can now detect the virus in blood, but work toward vaccine is not going well because the virus mutates in the body
|
Hep C
|
|
|
15 different strains known
|
hep C
|
|
|
Chronic illnes, but is treated with interferon-alpha 2b with a 40% response rate
|
Hep C
|
|
|
Hep D occurs
|
with hep B > increased severity of illness
can catch at same time Hep B or can be superinfection Prevent hep D by preventing hep B No treatment, but can detect it |
|
|
Hepatitis E
|
fecal/oral tramsmission & possible parenterl too
clinically much like Hep A but shorter course of illness Mostly contracted from contaminated H20 (flooding related) No carrier state increase mortalitiy if pregnant found in developing countries - Not in USA |
|
|
irreversible destruction of the liver
|
cirrhosis
|
|
|
cirrhosis disrupts ______ and leads to
|
liver structure & function
leads to fibrosis Jaundice Portal hypertension necrosis atrophy |
|
|
various types of cirrhosis
|
alcoholic cirrhois
billary cirrhoiss post-necrotic cirrhosis |
|
|
8th leading cause of death in USA
|
alcoholic cirrhosis
|
|
|
laennec's cirrhosis
|
alcoholic cirrhosis
|
|
|
3rd leading death in men
|
alcohol cirrhosis
|
|
|
cause of alcoholic cirrhosis
|
excesive alcohol (increase of 20yrs)
50% of alcoholics get full blown cirrhosis some get only fatty liver changes some don't get anything directly related to amount of alcohol consumed |
|
|
alcohol leads to
|
chemical attack on membranes of liver
disrupts the mitochondria enzyme & protein is decreased decreased breakdown of hormone & ammonia > malnutrition alters metabolism of vitamins stimulates autoantibodies against the liver |
|
|
alcoholic cirrhosis stages
|
fatty changes
alcholic hepatitis cirrhosis |
|
|
S/S of fatty changes
|
fatigue
n/v dull pain decreased wt OFTEN asymptomatic |
|
|
fatty changes
liver enlargment because of excessive accumulation in liver cells due to alcohol as food for liver metabolism causes decreased ability to oxidize fat |
fatty changes
|
|
|
alcoholic hepatitis
|
inflammed & necrosis of liver cells
often occurs with spree drinkers (weekend bingers) |
|
|
S/S of alcoholic hepatitis
|
decreased bilirubin metabolism > jaundice & SGOT
decreased vit K absorption > bleeding tendencies Decreased metabolism of food > hypoglycemia decreased plasma proteins > ascities (fluid) patchy lesions of lobular involvement > fibrosis (scaring) |
|
|
may be fatal 33% mortaility rate
80% of patients with this will eventually get cirrhosis |
alcoholic hepatitis
|
|
|
cirrhosis
|
liver injury from fatty changes and alcoholic hepatitis
|
|
|
yellow-orange
fatty scarred liver bands of fibrotic tissue > shrinks the liver > increased scar tissue replaces normal tissue leading to portal HTN & ascities |
Cirrhosis
|
|
|
s/s of cirrhosis
|
dull ache
wt. loss anorexia weakness jaundice palpable hard liver anemia malnurition diarrhea/constipation hepatomegaly |
|
|
choletithiasis
|
gall stones
|
|
|
75% of all gall stones are made up of
|
cholestrol
|
|
|
25% of all gall stones are made of
|
pigment
|
|
|
formation of gallstones:
|
supersaturation of bile with cholesterol
cholesterol crystal form in the center of the stone bile stasis makes stone grow |
|
|
risk factors for cholelithiasis (gallstones)
|
female
fat fertile fortyish fair complexion flatulent |
|
|
gallstones often asymptomatic until stone lodges in
|
the common bile duct; becoming inflamed
|
|
|
cholecystitis
|
inflammation of the gallblader
gallstones got out and got lodged making inflammation |
|
|
etiology of cholecystitis
|
from complete or partial obstruction of bile flow,
usually from gallstones chemical irritation from bile mucosal swelling and ischemia may lead to gangrene |
|
|
s/s of cholecystitis
|
AFTER A FATTY MEAL, carbs)
gallbladder SPASMS to try and push stones out colicky pain - BILLARY COLICK pain also RADIATES TO BACK indigestion, vomiting, fever, increased WBC DOESN'T RESPOND WELL TO ANALGESICS |
|
|
treatment of cholecystitis if symptomatic
|
cholecystectomy (not when s/s are acute)
lithotripsy (sound waves break stones) laproscopic vs traditional open cholecystectomy |
|
|
traditional surgery for cholecytitis
|
incision in UQ; liver, lungs, diaphgram in jeopardy
|
|
|
Liver cancer most often due to
|
metasis
|
|
|
rare liver cancer is often due to
|
the liver being the primary cite
|
|
|
prognosis for liver cancer
|
very poor
|
|
|
3/4 of all people with liver cancer (primary cite) had
|
cirrhosis first
|
|
|
Hep B C D are associated with what cancer
|
liver
|
|
|
liver cancer patho
|
may be diffuse
nodular or massive growth in hepatocytes or bile ducts |
|
|
s/s of liver cancer
|
N/V
fullness jaundice pressure/dull ache |
|
|
treatment for liver cancer
|
removal of tumor if localized
poor survival rate liver transplant - |
|
|
liver cancer transplant is not a good option if
|
cancer started some where else or alcoholic
|
