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108 Cards in this Set
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escape of pancreatic enzymes into pancreas & surrounding tissues
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Acute pancreatitis
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leads to fat necrosis & autodigestion
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acute pancreatitis
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causes of acute pancreatitis
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biliary tract disease leads to reflux of bile from gallstones blocking entrance to gallbladder
alcoholism leads to increase enzyme production |
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60% of cases associated with alcoholism
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acute pancreatitis
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s/s of acute pancreatitis
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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) |
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from edema & inflammation as pancreas digest itself
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acute pancreatitis
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worse in supine, better sitting or leaning foward
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acute pancreatitis
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treatment for acute pancreatitis
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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) |
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Janudice (icterus)
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increased accumulation of bilirubin in blood (aka hyperbilirubinemia) leading to staining of the skin
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s/s jaundice
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yellow skin
yellow sclera dark urine pale stools |
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bilirubin makes stools
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brown color
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what is bilirubin
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a yellow substance
waste product of normal RBC breakdown Normally excreted in stool and urine |
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prehepatic causees of jaundice
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hemolysis/rupture of RBC
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example of a prehaptic cause of jaundice
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sickle cell anemia
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example of hepatic cause of jaundice
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hepatitis
cirrhosis |
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example of posthepatic cuases of jaundice
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common bile duct blocked w/ a gallstone leading to bleeding
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hepatic causes of jaundice
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liver disease (inability to metabolize bilirubin)
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posthepatic causes of jaundice
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obstruction of bile ducts exiting the liver
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define portal hypertension
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abnormal blood flow in the portal blood vessel system
(blood vessels from GI, pancreas and spleen to liver) |
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cause of portal hypertension
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anything that impedes blood flow in portal system
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common causes of portal hypertension
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fibrosis
scarring inflammation liver tissue damage fibrous tissue & nodules constrict & increase portal vein pressure |
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Reaction of the body to portal HTN
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reroute blood flow
ascitites hepatic encephalopathy splenomegaly |
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reroute blood flow creates
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collateral channel (new pathway for blood) between portal & systemic veins to by pass obstruction
new blood vessels are fragile |
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locations for collateral channels
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esophagus (esophageal varices) leads to vomiting of blood
abd. wall leads to pattern on abd rectum leads to rectal bleeding |
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treatment for esophagel varices
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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 |
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endoscopic sclerosis
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injection to cause fibrosis of bleeding blood vessel
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meachanical pressure
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balloon tamponade with Stenstaken-Blakemore tube
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ascitites & it's AKA
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fluid in the abd cavity
aka third-spacing |
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______ 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
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tx ascities
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decrease sodium diet
diuretics decrease H20 paracentesis |
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paracentesis
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use needle to pull fluid out of abd.
have pt sit up so fluid drains down |
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hepatic encephalopathy
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CNS disturbances from ammonia not removed
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splenomegaly
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from excess blood flow
splen naturally holds excessive blood |
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hepatitis
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inflammation of the liver
usually applied to viral hepatitis |
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causes of hepatitis
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drugs
toxins infections virus |
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viral hepatitis variations
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Hepatitis A
Hepatitis B Hepatitis C Hepatitis D Hepatitis E |
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lives in intestine
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Hepatitis A
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not as blood related
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Hepatitis A
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Hepatitis A incubation
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brief - 30 days average
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Hepatitis B incubation
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long - 2-6 months
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Hepatitis A Transmission
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fecal/oral route
contaminated food/water, milk, shelfish Infected food preparers flooding of sewer poor bathroom handwashing |
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Hepatitis B transmission
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blood & body fluids
just like AIDS Many believe it to be a STD mothers to fetus |
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people of risk for Hepatitis A
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children & institionalized people
people who eat in restraunts travel out of western world flood zones |
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people of risk for Hepatitis B
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IV drugs users
hemodialysis unit health care workers |
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Which hepatitis's can be carriers
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Hepatitis B & D
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patho of Hep A & B
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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 |
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infection hepatitis
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Hep A
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serum hepatitis
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Hep B
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stages of symptoms hep A & B
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1. prodromal stage
2. icteric phase 3. recovery phase |
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prodromal stage
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highly contagious state
starts about 2 weeks after exposure and ends when jaundice occurs last about 1-2wk for A & B lasts longer |
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S/s of prodromal stage
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anorexia
malaise n/v low grade fever RUQ pain |
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icteric phase
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jaundice stage
lasts 2-6 weeks (hep B) occurs after prodromal stage |
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s/s of icteric phase
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dark urine
clay colored stools enlarged liver abd pain & fatigue elevated bilirubin levels & liver enzymes |
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Recovery phase
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6-8 weeks after exposure with Hep A
16+ weeks for Hep B Resolution of jaundice & liver function tests return to normal |
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if hepatitis is to become chronic it would start
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before recovery phase
There would be no recovery phase |
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prevention of hep A
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careful where u eat
cook suspicious food well boil suspicious water |
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prevention hep B
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avoid contact w/ blood & Body Fluids
wear gloves screen blood donors |
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vaccine for hep A
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mostly recommended for travelers
2 doses for full immunity takes 4 weeks to develop immunity 1st injection believed to last 20yrs |
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vaccine for hep B
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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. |
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prevention of hep A once exposed
IgG IgM |
gamma globulin
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gamma globulin
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immune serum injection given before or just after contact (7days) w/ hep A, can prevent illness
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prevention once exposed hep B
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Hep B immune globulin injection within 10 days of exposure can prevent Hep B
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Treatment of Hepatitis
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Symptomatic
rest no alcohol no tylenol no strenuous exercise increase fluids low fat high carbohydrates diets |
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treatment for hep B
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interferon-alpha 2b
daily injection for 16 weeks to boost the immune system & prevent further viral replication Not a "cure" |
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formerly called non-A/non-B
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hepatits C
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hep C transmitted by
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blood & body fluids - just like Hep B
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can now detect the virus in blood, but work toward vaccine is not going well because the virus mutates in the body
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Hep C
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15 different strains known
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hep C
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Chronic illnes, but is treated with interferon-alpha 2b with a 40% response rate
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Hep C
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Hep D occurs
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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 |
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Hepatitis E
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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 |
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irreversible destruction of the liver
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cirrhosis
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cirrhosis disrupts ______ and leads to
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liver structure & function
leads to fibrosis Jaundice Portal hypertension necrosis atrophy |
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various types of cirrhosis
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alcoholic cirrhois
billary cirrhoiss post-necrotic cirrhosis |
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8th leading cause of death in USA
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alcoholic cirrhosis
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laennec's cirrhosis
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alcoholic cirrhosis
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3rd leading death in men
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alcohol cirrhosis
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cause of alcoholic cirrhosis
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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 |
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alcohol leads to
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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 |
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alcoholic cirrhosis stages
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fatty changes
alcholic hepatitis cirrhosis |
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S/S of fatty changes
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fatigue
n/v dull pain decreased wt OFTEN asymptomatic |
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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
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alcoholic hepatitis
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inflammed & necrosis of liver cells
often occurs with spree drinkers (weekend bingers) |
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S/S of alcoholic hepatitis
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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) |
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may be fatal 33% mortaility rate
80% of patients with this will eventually get cirrhosis |
alcoholic hepatitis
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cirrhosis
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liver injury from fatty changes and alcoholic hepatitis
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yellow-orange
fatty scarred liver bands of fibrotic tissue > shrinks the liver > increased scar tissue replaces normal tissue leading to portal HTN & ascities |
Cirrhosis
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s/s of cirrhosis
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dull ache
wt. loss anorexia weakness jaundice palpable hard liver anemia malnurition diarrhea/constipation hepatomegaly |
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choletithiasis
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gall stones
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75% of all gall stones are made up of
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cholestrol
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25% of all gall stones are made of
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pigment
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formation of gallstones:
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supersaturation of bile with cholesterol
cholesterol crystal form in the center of the stone bile stasis makes stone grow |
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risk factors for cholelithiasis (gallstones)
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female
fat fertile fortyish fair complexion flatulent |
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gallstones often asymptomatic until stone lodges in
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the common bile duct; becoming inflamed
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cholecystitis
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inflammation of the gallblader
gallstones got out and got lodged making inflammation |
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etiology of cholecystitis
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from complete or partial obstruction of bile flow,
usually from gallstones chemical irritation from bile mucosal swelling and ischemia may lead to gangrene |
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s/s of cholecystitis
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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 |
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treatment of cholecystitis if symptomatic
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cholecystectomy (not when s/s are acute)
lithotripsy (sound waves break stones) laproscopic vs traditional open cholecystectomy |
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traditional surgery for cholecytitis
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incision in UQ; liver, lungs, diaphgram in jeopardy
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Liver cancer most often due to
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metasis
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rare liver cancer is often due to
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the liver being the primary cite
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prognosis for liver cancer
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very poor
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3/4 of all people with liver cancer (primary cite) had
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cirrhosis first
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Hep B C D are associated with what cancer
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liver
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liver cancer patho
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may be diffuse
nodular or massive growth in hepatocytes or bile ducts |
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s/s of liver cancer
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N/V
fullness jaundice pressure/dull ache |
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treatment for liver cancer
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removal of tumor if localized
poor survival rate liver transplant - |
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liver cancer transplant is not a good option if
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cancer started some where else or alcoholic
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