Nur 270 Final Exam Material
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| 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
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| Portal HTN s/sy | varices, altered LOC, dyspnea
encephalopathy, hepatomegaly, ascities
caput medusa
hyperplenism
palmar erythema
jaundice, spider telangiectasia
gynocomastia
varices
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| Hepatic Encephalopathy: Stage 1 | inappropriate behavior
personality changes
euphoria
depression
confusion
slurred speech
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| Hepatic Encephalopathy: Stage 2 | drowsiness
lethargy
incontinence
asterixes (hand flapping)
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| Hepatic Encephalopathy: Stage 3 | supor
disoriented
incoherent
speech
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| Hepatic Encephalopathy: Stage 4 | coma
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| Cirrhosis: Stage A | compensated--not too sick
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| Cirrhosis: Stage B | beginning to decompensated; complications beginning to appear
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| Cirrhosis: Stage C | decompensated--end stage
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| Cirrhosis: Diagnostic Testing | Lab
Liver Bx
CT Scan
Hepatobillliary Scan
Hepatoportography
MRI
NH3 15-45 mg/dl conventional
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| 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
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| 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
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| Corticosteroids | +/- azathioprine for autoimmune
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| Interferon | w/ viral hepatitis
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| Lactulose | lowers pH of colon
inhibits diffusion of ammonia from colon to blood
increases water content of stools
laxative effect
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| Neomycin | 2nd line drug
destroys intestinal floral that breakdown protein to ammonia
risk of nephrotoxicity and ototoxicity w/ longterm use
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| Metronidazole (flagyl) | 2nd line drug
avoid alcohol (antabuse effect)
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| Aldactone | potassium-sparing dieuretic
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| Ritalin | used for chronic fatigue
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| 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
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| 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
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| Octreotide | used in place of vasopression & NTG; safer and fewer SEs
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| Vasopressin | "Vascular-press"
SE: chest pain, stimulate severe clotting factors
anti-deuretic effects
monitor for increased clotting
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| 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
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| 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
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| 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
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| Bethesda Criteria | determines if pt with CRC should have CA tested for microsatelite instability (MSI)
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| 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
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| 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
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