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M6 13-005
Exam 6: GI (Liver, Gallbladder, Pancreas, Hernia, Hemorrhoids)
| Question | Answer |
|---|---|
| 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
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