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Adult Exam 3

Hepatobiliary Disorders

GERD? chroic symptom of mucosal damage caused by reflux of stomach acid into the LES.
Dyspepsia? pain centered in upper abdomen
Rule of patient coming in with chest pain? always cardiac until proven otherwise.
Esophagitis? inflammation of the esophagus
Esophageal Stricture? narrowing of the esophagus.
Barrett's Esophagus? replacement of squamous epithelium with columnar epithelium.
Motility Diagnostic Studies? measure the pressure in the esophagus
Acute vs Chronic S/S of GERD? Acute: symptoms occur once a week of heartburn Chronic: symptoms occur twice a week of heartburn, esophageal strictures.
Esophageal Diverticula? sac like out pouching of one or more layers of the esophagus.
Achalasia? absent peristalsis of the lower 2/3 of esophagus.
Nutritional Therapy of GERD? avoid foods that decrease LES pressure like alcohol, chocolate, peppermint, tea, coffee and fatty foods. Take fluid between rather than with meals. avoid late evening meals.
Histamine H2-Receptor Blockers for GERD? blocks secreation of HCL acid and promotes healing.
Proton Pump Inhibitors for GERD? inhibits gastric HCL acid. it can affect calcium absorption.
Antacids for GERD? quick neutralizing of HCL acid while coating the stomach. cannot help with healing lesions.
Prokinetic Agents for GERD? promote gastric emptying
Cholinergic for GERD? Increase LES pressure, but stimulates HCL acid secretion.
Cholecystitis? inflammation of the gallbladder
Cholelithiasis? stones in the gallbladder
Choledocholithiasis? gall stones in the common bile duct. medical emergency.
Positive Murphy's Sign? pain with deep inspiration
Blum Berg Sign? pain on deep palpation of the RUQ.
Eructation? belching
Steatorrhea? clay-colored stools.
Cholangitis? inflammation of the biliary ducts
Empyema? collection of pus in GB
Fistula? abnormal connection between organs.
Peritonitis? inflammation of the thin tissues that line the inner wall of abdomen
Ultrasound for Gallbladder? best diagnosis of cholecystitis
Unconjugated? broken down hgb combined with albumin
Conjugated? albumin combines with glucuronic acid.
Analgesics for GB? morphine for pain management
Anticholinergics for GB? for antispasmodics which control decreases spams of GB which is the true cause of the pain.
Antiemetics for GB? for nauseated patients.
Nutritional Therapy for GB? eat smaller frequent meals, decrease fat consumption.
T-Tubes? keeps flow between CBD. Never raise bag, irrigate, aspirate or clamp with out orders.
main GB Nursing Diagnosis? Acute pain r/t Surgical Procedure.
Acute Pancreatitis? Reversible, acute inflammation of the pancreas.
ERCP in Pancreatitis? can cause trauma to the pancreatic ducts.
Turner's Sign? discoloration of the flanks
Cullen's Sign? discoloration of the periumbilical
Types of Pancreatic Enzymes? 1.Amylase: rise 2-3 hrs after inflammation and returns to normal in 24-48hrs later. 2.Lipase: elevates in the late stages, can remain elevated for two weeks. late stage. 3.Trypsin: is inactive while in the pancreas until it reaches sm. intest.
The two types of Pancreatic Juice? Exocrine: Enzymes. Endocrine: Insulin.
Nursing Diagnosis for Acute Pancreatitis? Acute pain r/t distension of pancreas
Abscess? accumulation of pus in the pancrease
Pseudocysts? accumulation of fluid, pancreatic enzymes, tissues debris and inflammatory exudates surrounded by the wall
Atelectasis? complete/partial collapse of lung or lobe
CT Scan in Acute Pancreatitis? Most valuable test for diagnosis of acute pancreatitis.
Morphine for Acute Pancreatitis? relive pain.
Antispasmodics for Acute Pancreatitis? decreases motility and pancreatic outflow
Carbonic Anhydrase Inhibitor for Acute Pancreatitis? decrease volume of pancreatic secretions
Antacids for Acute Pancreatitis? neutralize gastric HCL acid
Protein Pump Inhibitors for Acute Pancreatitis? inhibits HCL acid secretion
Nutritional Therapy for Acute Pancreatitis? NPO status, NG-Tube to suction vomit, small frequent meals, high protein, high cholesterol, low fat, TPN,TEN for electrolytes imbalance.
Chronic Pancreatitis? Irreversible progressive destructive cellular damage that leads to fibrotic tissue with decrease exocrine function.
Pain management for Chronic Pancreatitis? start with non-narcotics and later Demerol and Talwin.
Drug Therapy for Chronic Pancreatitis? 1.Pancreatic Enzyme Replacement: pancreatic lipase for increase absorption. 2.Insulin: for treatment of Diabetes and hyperglycemia.
Sphincterotomy? enlargement of the pancreatic duct.
Acute Pancreatitis vs Chronic Pancreatitis? Acute: N/V, low grade fever, tachycardia, decrease BP, decreased BS, dehydration, 3rd spacing. Chronic: weight loss, malabsorption, steatorrhea, and DM.
Pancreatic Cancer? more than half occur in the head of the pancreas causing the CBD to be obstructed.
Clinical Manifestation of Pancreatic Cancer? abdominal pain, anorexia, rapid weight loss, jaundice, N/V, and pus.
Ranson's Criteria for Severity of Acute Pancreatitis? Age>55. WBC>1600. BS>200. LDH>350. AST>250. CA<8. Hct<10. BUN>5. O2<60. Fluid<60. The points adding >3is deadly.
Intestinal Obstruction? when intestinal contents cannot pass though the GI tract.
Mechanical? detectable occlusion
Nonmechanical? caused by neuromuscular or vascular disorder
Paralytic Ileus? common cause, lack of intestinal peristalsis and bowel sounds
Sigmoidoscopy and Colonoscopy for Intestinal Obstruction? direct visualization of intestines.
Care of NG-Tube with Intestinal Obstruction? oral care and NG patency.
Polyps of Large Intestines? projection of lumen, either cancerous or noncancerous.
Colorectal Cancer? cancer in the colon, risk are family hx, inflammatory bowel disease, hx of cancer, obesity, red meat, smoking and alcohol.
Early signs of Colorectal Cancer? fatigue, weight loss or none
Late signs of Colorectal Cancer? abdominal tenderness, palpable abdominal mass, hepatomegaly and ascites.
Diagnostics for Colorectal Cancer? Colonoscopy
Metastasis? cancer staging.
Diverticulosis? sac-like out pouching's of the mucosa that develop in the colon.
Diverticulitis? inflammation of diverticula
Acute Diverticulitis Therapy? antibiotics, NPO status, IV fluids, NG suction and Surgery
Diverticulosis is discovered during? sigmoid/colonoscopy
Hernia? Protrusion of internal organ through abdominal opening or weakened area in the wall.
Sliding Hernia? bowel will sit in sac but moves in and out.
Reducible Hernia? intestines are pouched but by pressing it will manually get put back into the place.
Incarcerated Hernia? Intestines cannot be retuned in normal position but blood flow is normal.
Strangulated Hernia? incarcerated so tightly constricted the blood flow is cute off killing the bowel causing Ischemia. this is a medical emergency.
Locations of Hernia? 1.Femoral. 2.Indirect. 3.Direct. 4.Periumbilical.
Diagnosis of Hernia? history and physical exam
Complications of Hernia? Scrotal edema(indirect)
Cirrhosis? chronic progressive disease of the liver
Biliary Cirrhosis? obstruction from stones in the biliary
Cardiac Cirrhosis? severe heart failure due to cirrhosis
Early s/s of Cirrhosis? asymptomatic, GI, abdominal pain, fever, weakness, hepatosplenomegaly and swelling.
Late s/s of Cirrhosis? jaundice, skin lesion, endocrine disorders, hematologic disorders, and peripheral neuropathy
Spider Angiomas? dilated blood vessels common on th
Palmer Erythema? red areas on the palms
Portal Hypertension? increase in venous pressure in the portal system
Esophageal Varices? veins that are twisted, enlarged and swollen due to portal hypertension
Gastric Varices? located in the upper portion of the stomach.
Ascites? accumulation of serous fluid in the peritoneal or abdominal cavity
Hepatic Encephalopathy? neuropsychiatric manifestation of liver disease, a neurotoxic effect of ammonia.
Neurologic Toxic symptoms? changes in mental responsiveness, impaired consciousness, inappropriate behavior and lethargy to deep coma.
Asterixis? side effect of hepatic encephalopathy, flapping of arms and hands involuntarily.
Hepatorenal System? occurs in decompensated cirrhosis. type of renal failure
Compensated Cirrhosis? shows no complications, will have a normal AST and ALT
Decompensated Cirrhosis? one or more complications, will have elevated AST and ALT
Paracentesis? remove fluid
Peritoneovenous Shunt? surgical procedure to provide continuous reinfusion of ascites fluid into the venous system.
Transjugular Intrahepatic Portosystemic Shunt(TIPS)? shunt between the systemic and portal venous system to direct portal blood flow by decompressing portal venous pressure to decompress varices.
Endoscopic Sclerotherapy? a med is injected to create hardness of the vein to decrease fragility.
Endoscopic Litigation? bonding of varices with fewer complications than sclerotherapy
Balloon Tamponade? blow a balloon to press vessels to stop bleeding with the use of Senstaken-Blakemore tube.
Vasopressin for Cirrhosis? control bleeding in varcies.
Propanolol for Cirrhosis? reduce portal venous pressure
Lactulose for Cirrhosis? trap ammonia in the gut to be eliminated through the feces.
Vitamin K for Cirrhosis? corrects clotting abnormalities
PPI for Cirrhosis? inhibits gastric activity
Diuretics for Cirrhosis? blocks aldosterone and retention of sodium and water.
Nutritional Therapy for Compensated Cirrhosis? high calories, high carbohydrates, protein restriction and moderate to low fat.
Nutritional Therapy for Decompensated Cirrhosis? Enteral formula supplements, and low sodium
Ecchymoses? bruise
Gynecomastia? development of breast in men
Nursing Diagnosis of Cirrhosis? Imbalanced Nutrition: les than requirements r/t anorexia and nausea. Impaired Skin Integrity r/t edema, ascites and pruritus
Liver Transplant? end-stage liver disease related to chronic viral hepatitis.
Liver Transplant is Contraindicated for? advanced hepatocellular carcinoma, ongoing drug and alcohol abuse.
Created by: aneshia
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