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47 Cards in this Set

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hepatitis
inflammation of cells of liver

usually caused by virus but may also be caused by drugs or bacteria

S/S: malaise - headache - anorexia - fever - RUQ pain - fatigue - vomiting - jaundice
hepatotoxic
substance that is damaging to the liver

includes: Tylenol - aspirin - oral contraceptives - industrial chemicals
fulminant liver failure
AKA acute liver failure

uncommon but serious complication of liver disease

up to 50% mortality rate

S/S: CNS dysfunction - rapid reduction in liver size - marked elevation in prothrombin time
encephalopathy
central nervous system dysfunction
cirrhosis
chronic dx of liver associated w/fat infiltration & fibrotic tissue

S/S: malaise - anorexia - diarrhea - RUQ pain - icterus - jaundice
hepatorenal syndrome
complication of liver failure

S/S: oliguria w/o detectable kidney damage - reduced GFR - urine output 200 mL or less daily - nearly total sodium retention
postnecrotic liver failure
results from massive exposure to hepatotoxins or viral hepatitis
biliary liver failure
caused by chronic inflammation & obstruction of the gallbladder & bile ducts
cardiac liver failure
caused by chronic severe congestion of liver from heart failure

liver congestion causes death of liver cells from lack of nutrients & oxygen
ascites
accumulation of serous fluid in abdominal cavity

accumulates primarily due to low production of albumin by failing liver
portal hypertension
persistent BP elevation in portal circulation of abd

most serious result is bleeding esophageal varices (dilated veins)
varices
dilated veins that tear easily from excessive pressure (coughing, lifting, etc)
hepatic encephalopathy
caused by accumulation of noxious substances in circulation

failing liver unable to make toxic substances water soluble for excretion

S/S: progressive confusion - asterixis - fetor hepaticus - fatigue - handwriting changes
asterixis
flapping tremors in hands caused by toxins at peripheral nerves
fetor hepaticus
foul breath caused by metabolic end products related to sulfur
transjugular intrahepatic portosystemic shunt (TIPS)
shunt placed between portal and systemic venous systems

diverts venous blood around liver to vena cava
What are the medical goals for managing bleeding from esophageal varices? (four listed)
1 Stop bleeding

2 Treat fluid volume deficit caused by bleeding

3 Prevent further fluid loss

4 Maintain fluid & electrolyte balance
What types of drugs are used to treat bleeding varices?
vasoconstrictors
List some dietary considerations for a pt w/liver failure.
1 restrict protein intake

2 homogenized milk & eggs recommended

3 adequate carb intake necessary

4 fluid & sodium restricted if ascites present
The pt w/chronic liver failure is at risk for 1_____ from bleeding esophageal varices, gastrointestinal bleeding, & lack of 2_____ 2_____ 2_____.
1 hemorrhage
2 blood clotting factors
Signs of possible organ transplant rejection include: (five)
1 pulse greater than 100 bpm

2 temp greater than 101F

3 c/o of RUQ pain

4 increased jaundice

5 decrease in bile from T-tube or change in bile color
Symptoms of acute tissue rejection usually develop between the 1_____ and 2_____ postoperative days.
1 fourth
2 tenth
cancer of the liver
usually result of metastasis from primary cancer at distant location

increased risk for pts w/hx of chronic HBV, nutrional deficiencies, or exposure to hepatotoxins

S/S: encphalopathy - abnormal bleeding - jaundice - ascites - elevated serum alkaline phosphatase
pancreatitis
inflammation of the pancreas

may be mild or severe - acute or chronic
acute pancreatitis
caused by autodigestion

most commonly associated w/excessive alcohol consumption

S/S: dull abd pain - rigid abd - hypotension - respiratory distress - fever - dry mucous membranes - tachycardia
chronic pancreatitis
chronic dx that replaces functioning pancreatic tissue w/fibrotic tissue due to inflammation

S/S: pattern of remissions /exacerbations over years - epigastric or LUQ pain - weight loss - anorexia
Dry, scaly skin or changes in skin pigment may indicate a deficiency in:
vitamin A
A pt complaining of bone pain may have a _____ _____ deficiency.
vitamin D
_____ _____ deficiency may be associated with anemia.
Vitamin E
Abnormal bruising or bleeding & prolonged clotting time indicate a deficiency of _____ _____.
vitamin K
cancer of the pancreas
spread rapidly by direct extension to stomach, gallbladder, & duodenum

associated w/hi-fat diets, cigarettes, diabetes, alcohol, & chronic pancreatitis

S/S: weight loss - abdominal pain (worse at night) - anorexia - vomiting - weakness - feeling bloated after eating
pancreatectomy
surgical removal of all or part of pancreas
Relief of biliary obstruction can sometimes be accomplished by implanting a _____ or plastic tube in the common bile duct.
stent
cholecystitis
inflammation of the gallbladder
cholelithiasis
gallstones
cholangitis
inflammation of the bile ducts
choledocholithiasis
gallstones in the common bile duct

S/S: sudden biliary colic onset - lasts 1 to 3 hrs - fever - nausea/vomiting
Medical management for an acute episode of cholecystitis centers on 1____ 1_____, prevention of 2_____, and maintenance of fluid and electrolyte balance. The analgesic agent most often ordered is meperidine hydrochloride because 3_____ 3_____ is believed to cause spasms of the gallbladder, biliary ducts, and the sphincter of Oddi.
1 pain control
2 infection
3 morphine sulfate
choledochoscopy
use of endoscope to explore common bile duct & possibly remove stones found
extracorporeal shock-wave lithotripsy (ESWL)
use of shock waves as a noninvasive method to destroy stones in gallbladder or biliary ducts

usually used w/pts considered poor surgical candidates
The pt w/altered thought processes r/t liver failure most likely has which of the following laboratory findings?
a. Low bilirubin
b. Low amylase
c. High hematocrit
d. High ammonia
d. High ammonia
Jack, a pt w/chronic liver failure, has an episode of bleeding. Which of the following conditions placed Jack at risk for bleeding?
a. Portal hypertension
b. Low vitamin K
c. Elevated liver enzymes
d. High-fiber diet
b. Low vitamin K
Most gallstones are composed of which of the following?
a. Lipase
b. Cholesterol
c. Sodium
d. Potassium
b. Cholesterol
John develops jaundice & dark, amber-colored urine. Which of the following is the most likely cause?
a. Encephalopathy
b. Pancreatitis
c. Bile duct obstruction
d. Cholecystitis
c. Bile duct obstruction
Jeff is a 26-yr-old health care worker who is diagnosed w/HCV. Which of the following questionis is most important to ask Jeff?
a. "Have you eaten any raw seafood recently?"
b. "Have you experienced a needle stick?"
c. "Have you made beds or handled clothing such as slippers w/o gloving?"
d. Has anyone coughed into your face whe you weren't wearing a mask?"
b. "Have you experienced a needle stick?"
Jim, age 43, is admitted to your unit w/chronic pancreatitis. You recognize that an elevation in which diagnostic test indicates chronic pancreatitis?
a. Serum bilirubin
b. Serum calcium
c. Serum albumin
d. Serum amylase
d. Serum amylase
In planning care for the newly admitted pt w/acute pancreatitis, you assign the highest priority to which pt outcome?
a. Pt expresses satisfaction w/pain control
b. Pt verbalizes understanding of meds for home
c. Pt increases activity tolerance
d. Pt maintains normal bowel functions
a. Pt expresses satisfaction w/pain control