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Diseases & Meds

Nur 270 Final Exam Material

Cirrhosis s/sy R?T stage disease anorexia GI Upset, wt loss abd fullness, abd pain weakness, fatigue, malaise anemia, bleeding low grade fever, infection jaundice, pruritis, hepatomegaly hypoglycemia, hypokalemia, edema
Portal HTN s/sy varices, altered LOC, dyspnea encephalopathy, hepatomegaly, ascities caput medusa hyperplenism palmar erythema jaundice, spider telangiectasia gynocomastia varices
Hepatic Encephalopathy: Stage 1 inappropriate behavior personality changes euphoria depression confusion slurred speech
Hepatic Encephalopathy: Stage 2 drowsiness lethargy incontinence asterixes (hand flapping)
Hepatic Encephalopathy: Stage 3 supor disoriented incoherent speech
Hepatic Encephalopathy: Stage 4 coma
Cirrhosis: Stage A compensated--not too sick
Cirrhosis: Stage B beginning to decompensated; complications beginning to appear
Cirrhosis: Stage C decompensated--end stage
Cirrhosis: Diagnostic Testing Lab Liver Bx CT Scan Hepatobillliary Scan Hepatoportography MRI NH3 15-45 mg/dl conventional
Cirrhosis: Lab Variances low WBC low RBC low platelet counts elevated serum billirubin elevated liver enzymes low serum albumin prolonged clotting time low clotting factors
Liver Biopsy Consent check PT/PTT bleeding time platelet count position w/ right side down after post procedure: s/s of bleeding/shock, Vitals, H/H
Corticosteroids +/- azathioprine for autoimmune
Interferon w/ viral hepatitis
Lactulose lowers pH of colon inhibits diffusion of ammonia from colon to blood increases water content of stools laxative effect
Neomycin 2nd line drug destroys intestinal floral that breakdown protein to ammonia risk of nephrotoxicity and ototoxicity w/ longterm use
Metronidazole (flagyl) 2nd line drug avoid alcohol (antabuse effect)
Aldactone potassium-sparing dieuretic
Ritalin used for chronic fatigue
Esophageal Varices: RX life threatening--ABCs bleeding soft diet pharmacological rx temp. balloon tamponade of varices endoscopic sclerotherapy variceal ligation or banding Transjugular intrahepaticportacaval shut surgery (TIPS) portal systemic shunt surgery blood tran
Vasoactive agents safer than ballon tamponade Examples: glypressin, samatostatin, octreotide, vasopressin w/NTG reduces azygos blood flow Bolus of 50 mcg followed by 50 mcg/hr infusion x 5 days
Octreotide used in place of vasopression & NTG; safer and fewer SEs
Vasopressin "Vascular-press" SE: chest pain, stimulate severe clotting factors anti-deuretic effects monitor for increased clotting
Hepatic Coma: RX safety protein--no aggressive protein restriction pt can tolerate 1 to 1.5g of protein/day remove nitrogenous load from intestine lactulose, neomycin (short term, flagyl don't stop lactulose bc pt is having diarrhea
Colorectal Cancer: RIsk Factors age, family hx, ethnic background (Jews) IBD or polyps high fat &/or low fiber diet inadequate fruits and veggies smoking high etoh consumption obesity physical inactivity long-term insulin use night shift work
Hereditary Nonpolyposiscolorectal Cancer (HNPCC): Amsterdam Criteria At least 3 relatives have CRC 2 successive generations are involved 1 of these relatives had CA younger than 50 at least 2 of the people are 1st degree relatives
Bethesda Criteria determines if pt with CRC should have CA tested for microsatelite instability (MSI)
Hereditary Nonpolyposiscolorectal Cancer (HNPCC): Bethesda Criteria person younger than 50 person with another CA asso. w. HNPCC 1st degree rel. not dx with Pt younger than 60 & CA has certain charac. w/ MSI 1st degree relative dx w. non-CRC often seen w. HNPCC pt has >2 2nd degree relatives who have HNPCC related t
Familial Adenomatous polyposis (FAP) 1% of all polyps 100s-1000 of polyps avg age of onset 15 100% lifetime risk of CRC Segmoidoscopy q2yrs from 10-40, q 3-5 yrs if polyps: subottal colectomy w/ IAA FAP associated CAs--thyroid, brain, liver
Created by: cmunchaquita04