Chapter 35 Med Surg

Front 1

chronic liver failure
CHEAP

Back 1

C=clotting disorders
H=hepatorenal syndrome
E=Encephalopathy
A=Ascites
P=Portal Hypertension

Front 2

Hepatitis

Back 2

inflammation of the liver

Front 3

What is hapatitis caused from?

Back 3

from infection by viral agents or exposure to drugs toxic to the liver or occasionally bacterial infection

Front 4

What are the symptoms of Hepatitis?

Back 4

range from nearly none to life-threatening symptoms due to death of liver cells

Front 5

Hepatitis is usually caused by 6 viruses:

Back 5

Heaptitis A=infectious hepatitis
Hepatitis B=serum heapatitis
Hepatitis C=Non-A , Non B,(NANB)
Hepatitis D
Hepatitis E
Hepatitis G

Front 6

Hepatitis A
Mode of transmission
Incubation period symptoms
Diagnostic tests
Preventative vaccine
Groups at risk

Back 6

Mode of transmission=Oral-Fecal contamination of water, oysters, eating utensils or equipment
Incubation period symptoms= 3-7 weeks
early (prodromal): fatique, anorexia, malaise, nausea or vomitting
Later: Icteric-Jaundice, pale stools, amber or dark urine, RUQ pain,
Diagnostic tests=Elevated serum liver enzymes(ALT, AST), elevated serum Bilirubin,
Hepatitis Panel-HAV Antigen
Preventative vaccine=Immune Globulin-temp.passive, gives antibodies to fight with
Groups at risk=military and day care

Front 7

Heapatitis B
Mode of transmission
Incubation period symptoms
Diagnostic tests
Preventative vaccine
Groups at risk

Back 7

Mode of transmission=Blood or body fluids, such as: saliva, semem and breast milk; equipment contaminated by blood
Incubation period symptoms= 2-5 months
Early-Prodromal: 1-2 months of fatique, malaise, anorexia, low grade fever, nausea, headache, abdominal pain, muscle aches
may have no early symptoms
later:
Icteric-Jaundice, rashes
Diagnostic tests=elevated serum liver enzymes(ALT, AST), elevated serum bilirubin, HBV antigen
Preventative vaccine=immune globulin, or HBIG
Groups at risk=IV drug abusers, homosexuals, health care workers, transplant, and hemodialysis patients

Front 8

Hepatitis C
Mode of transmission
Incubation period symptoms
Diagnostic tests
Preventative vaccine
Groups at risk

Back 8

Mode of transmission=blood transfusions, IV drug users, unprotected sex
Incubation period symptoms=1 week to months: same as HBV, usually less severe
Diagnostic tests=elevated liver enzymes (AST, ALT), serum bilirubin, HCV antigen
Preventative vaccine=none
Groups at risk=same as HBV

Front 9

Hepatitis D
Mode of transmission
Incubation period symptoms
Diagnostic tests
Preventative vaccine
Groups at risk

Back 9

Mode of transmission=blood or body fluids as with HBV, strongly linked as a confection with HBV
Incubation period =same as HBV and HAV but more severesymptoms=same as HBV
Diagnostic tests=same as HAV, HBV but HDV antigen
Preventative vaccine=HBIG
Groups at risk=same as HBV

Front 10

Neurotransmitters pass through the synaptic knob's membrane into the ____ ___

Back 10

Synaptic Cleft

Front 11

Pancreas-Lab values
serum glucose >150mg%

Back 11

abnormal-elevated because damage to the islets Langerhans causes decreased insulin production

Front 12

Pancreas-Lab values
serum amylase>500 IU/L

Back 12

the digestive enzyme amylase is released in large quantities by inflammed pancreas

Front 13

Pancreas-Lab values
serum Lipase >15 IU/L

Back 13

normal 0-160 IU/L

Front 14

Pancreas-Lab values
pleural effusion

Back 14

abnormal
is caused by a local inflammatory reaction to the irritation from pancreatic enzymes

Front 15

Pancreas-Lab values
blood pressure and pulse 15 % from Pt.'s baseline

Back 15

normal

Front 16

Pancreas-Lab values
serum albumin<3.2 g/dl
normal-3.5 to 5.5 g/dl

Back 16

abnormal because albumin is decresed usually from decresed protein metabolism

Front 17

Pancreas-Lab values
positive Cullens sign

Back 17

abnormal
a positve Cullens sign indicates hemorrhage from pancreatic destruction

Front 18

Pancreas-Lab values
urinary output <30 ml/hr

Back 18

abnormal
can indicate hepatorenal syndrome or shock from circulatory collapse

Front 19

Pancreas-Lab values
positive Chvosteks sign

Back 19

indicates neuromuscular irritability from decreased serum calcium levels

Front 20

Pancreas-Lab values
foul smelling, fatty stools

Back 20

abnormal
indicates malabsorption of dietary fats from decreased lipase

Front 21

what is important with a esophageal tamponade with a Senstaken-Blakemore tube?

Back 21

keeping a pair of scissors by the bedside
having oral suction available
maintaining traction on the tube, if ordered

Front 22

instructions to Pt. with portal hypertension?

Back 22

avoid straining to have a bowel movement

Front 23

Fulminant liver failure is most often caused by?

Back 23

Hepatitis B virus

Front 24

Pt with chronic liver failure has asterixis and fetor hepaticus and is confused...these symptoms are related to?

Back 24

Hepatic Encephalopathy

Front 25

risk factors for gallbladder disease?

Back 25

obese
multiple pregancies
age 40 or older
fasting

Front 26

Pt. with biliary colic...nurse nonsurgical intervention?

Back 26

administering probantheline(Pro-Banthine)

Front 27

Pt. with pancreatic disease usually has a history of?

Back 27

alcohol abuse

Front 28

Pt with pancreatitis describe pain as?

Back 28

dull, boring, begining in mid epigastrium and radiating to the back

Front 29

ascites

Back 29

fluid in the abdomen from decreased albumin

Front 30

asterixis

Back 30

liver flaps

Front 31

Cirrhosis

Back 31

scarring and hardening of the liver from inflammation

Front 32

Encephalopathy

Back 32

neurological changes from excess ammonia

Front 33

Fetor Hapaticus

Back 33

foul breath

Front 34

Hepatorenal syndrome

Back 34

Oliguria and sodium retention without kisney defects

Front 35

Hepatitis

Back 35

inflammation of liver cells

Front 36

Jaundice

Back 36

yellowing of the sclerae and skin from excess bilirubin

Front 37

Portal hypertension

Back 37

increased pressure in the portal circulation

Front 38

Pancreatectomy

Back 38

removal of all or part of the pancreas

Front 39

Steatorrhea

Back 39

fatty, foul smelling stools

Front 40

Varices

Back 40

weakened, swollen veins

Front 41

cholecytisis

Back 41

inflammation of the gallbladder

Front 42

cholesterol

Back 42

composition of gallstones

Front 43

Flatulence

Back 43

intestinal gas expelled via the rectum

Front 44

Murphys sign

Back 44

inability to take a deep breath when fingers are pressed under liver margin

Front 45

Bilirubin

Back 45

pigment from the breakdown of red blood cells

Front 46

Extrcorporeal shock wave lithotripsy(ESWL)

Back 46

a procedure that shatters gall stones using sound waves

Front 47

T-Tube

Back 47

a surgical drain used to ensure that bile drains from gallbladder after surgery

Front 48

Laparscopic cholecystectomy

Back 48

removal of the gallbladder through a small abdominal incision

Front 49

Choledochoscopy

Back 49

use of an endoscope to explore the common bile duct

Front 50

visible veins around the umbilicus

Back 50

caput medusae

Front 51

liver shunt

Back 51

abreviations
TIPS

Front 52

liver flaps

Back 52

Asterixes

Front 53

Abreviations for infectious hepatitis

Back 53

HAV

Front 54

confusion and coma are symptoms

Back 54

encephalopathy

Front 55

this syndrome causes anuria

Back 55

hepatorenal syndrome

Front 56

liver location

Back 56

Right Upper Quadrant

Front 57

chronic liver failure is?

Back 57

Laennec's Cirrhosis

Front 58

collection of fluid in peritoneal cavity

Back 58

ascites

Front 59

dilated esophageal veins

Back 59

varices

Front 60

low vitamin K places Pt. with chronic liver failure at risk for?

Back 60

bleeding

Front 61

IN Chronic liver disease, Lactulose gives Pt diarrhea to?

Back 61

keep ammonia levels controled

Front 62

Pt with jaundice and dark amber urine...what is most likely the cause?

Back 62

bile duct obstruction

Front 63

intervetntion that will help a Pt that has had and open cholecystectomy 24 hours ago?

Back 63

provide analgesics for pain relief
encourage coughing and deep breathing
assist with splinting during coughing

Front 64

serum amylase normal level

Back 64

59-160 IU/L

Front 65

white blood cell normal count

Back 65

5000 to 10,000 cells per mm