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Adult Exam 3
Hepatobiliary Disorders
| Question | Answer |
|---|---|
| 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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