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M6 13-005

Exam 6: GI (Liver, Gallbladder, Pancreas, Hernia, Hemorrhoids)

How does cirrhosis differ from hepatitis? Hepatitis=Inflammation & destruction of hepatocytes R/T virus/toxins. Cirrhosis=Destruction of hepatocytes w/ scarring R/T ETOH or other (can be a result of Hepatitis)
With Hepatitis/Cirrosis what 3 types of Rx do you want to avoid (Hepatoxic) besides ETOH? Aspirin, Acetaminophen, Sedatives
Abnormal Labs in Liver Dysfunction include elevated ammonia and prolonged PT/INR. Why? Liver produces clotting factors, liver unable to breakdown protein, intestines produce ammonia as a byproduct.
Meds for pain of Pancreatitis? Avoid what because they cause sphincter spasm? Demerol. Avoid opioids (morphine) if possible.
What is the sphincter of Oddi? Goes from pancreas and gall bladder to duodenum to deliver bile & pancreatic juice.
Nutrition for Pancreatitis IV or TPN; NPO status until pain free for 24 hours.
To relieve tight stretch of peritoneum in pancreatitis, the Pt can (3)? Sit up, lean forward, fetal position.
Signs of Jaundice= yellow skin/sclera. What does urine and stool look like? Dark urine (billirubin) Chalky/clay stool (No billirubin)
Complications of cirrhosis= esophageal varices, ascites, portal HTN and what else? Hepatic encephalopathy, hepatorenal syndrome (kidney fails)
The obstruction to blood flow from Portal HTN (result of cirrhosis) leads to what 3 things? Hepatomegaly, Splenomegaly, Esophageal-gastric-rectal varices.
How does Ascites lead to increased hydrostatic pressure and lymph formation? Ascites (extra fluid in the ABD)- reduced intravascular pressure -> Renin-angiotensin response -> Increased Na/h20 retention -> Increased hydrostatic pressure... Worse Ascites.
Fluid wave, shiftness of dullness & protruding umbilicus = S/S of what? Ascites
Diffuse fibrosis of liver Cirrhosis
Cirrhosis obstructs flow of what? (3) Blood, lymph, bile
3 Causes of cirrhosis Toxins (ETOH), Infections, R sided HF
Laennec;s Cirrhosis caused by Liver Damage (ETOH)
Biliary Cirrhosis caused by Biliary (Obstruction, bile stasis, inflammation
3 early signs of cirrhosis Malaise, RUQ discomfort, GI disturbance (bowel changes, anorexia, indigestion)
Esophageal varices, spider angiomas, changes in mental status are late signs of what? Cirrhosis
Jaundice, anemia, gynecomastia, edema occur with what? Late cirrhosis
Besides 5 Hepatitis Viruses, what 3 inflammatory causes lead to hepatitis? Drugs (INH, OD, dilantin, halothan, aldomet), Toxins (ETOH, Mushrooms, carbon tetrachloride), hepatobiliary disease.
Main types of Hepatitis Virus & Transmission? Hep A (Fecal-oral), B (Blood/body), C (BID-Body), D (with B), E (Like A), G (Like C)
Which Hepatitis Viruses have fecal-oral transmission? Hepatitis A & E
Hepatitis D usually is with which for of Hepatitis? Hepatitis B
Early symptoms of hepatitis Flu-like symptoms
Late symptoms of hepatitis Jaundice, hepatomegaly, ascites, cirrhosis
What causes hepatic encphalopathy (altered conscious from liver problems) Impaired ammonia metabolism after protein breakdown (ammonia result of protein breakdown)
Rx Tx for hepatic encephalopathy Lactulose (ammonia binder)
3 types of intestinal obstruction (partial/complete blockage) Mechanical (adhesions, hernia, tumors, intuss, volvulus), Neurogenic (paralytic, spinal cord lesion), Vascular (Artery occlusion in the gut)
Do you give fiber/stool softeners to Pt w/ intestinal obstruction? Why? No- Could collect above obstruction and cause perforation
Kinking of a portion of the intestines Volvulus
Telescoping of one part of the intestine into an adjacent part Intussusecption
Fibrous bands that constrict tissue, loops of intestine adhere to areas that heal slowly or scar after ABD surgery Adhesions
A blockage interferes with the normal progression of intestinal contents through the intestinal tract Intestinal Obstruction
Protrusion of any organ from the cavity that normally confines it; mist commonly used to describe the protrusion of the intestine through a defect in ABD wall Hernia
Protruding structures can be replaced in the ABD cavity Reducible Hernia
One in which the intestine cannot be replaced in the ABD cavity b/c of edema of the protruding segment and constriction of the muscle opening thru which it has emerged Irreducible or incarcerated hernia
Protrusion of the hernial sac contains the intestine at the inguinal opening Inguinal Hernia
Surgical repair of the hernia Herniorrhaphy
Surgical procedure in which the weakened area of a hernia is reinforced with wire, fascia, or mesh to prevent recurrence Hernioplasty
Dilated veins outside or inside the anal sphincter Hemorrhoids
AN infection with a collection of pus in an area between the internal and external sphincters anorectal abscess
Linear tear in the anal canal tissue Anal Fissure
A tract that forms in the anal canal Anal fistula
Surgical procedure involving incision of a fistula Fistulotomy
Surgical procedure in which a fiatulous tract is excised Fistulectomy
Protrusion of stomach through diaphragm hiatus, occurs in 40% of the population; often asymptomatic; surgical Tx: fundoplication or gastroplexy Hiatal Hernia
Hand flapping tremor usually induced by extending the arm and dorsiflexing the wrist; frequently seen in severe cirrhosis Asterixis
Faint, irregular bluish discoloration around the umbilicus; seen in severe pancreatitis Cullen's Sign
Gray-blue discoloration of the flanks, sometimes seen in acute hemorragic pancreatitis Turner's Sign
Spasm in facial muscles elicited by tapping the facial nerve; seen in tetany/hypocalcemia Chvostek's Sign
Carpal spasm is induced by inflating BP cuff on upper arm; + sign= hypocalcemia and/or mypomagnesemia Trousseau's Sign
Created by: jtzuetrong