Exam 6: GI (Liver, Gallbladder, Pancreas, Hernia, Hemorrhoids)
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| 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)
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| With Hepatitis/Cirrosis what 3 types of Rx do you want to avoid (Hepatoxic) besides ETOH? | Aspirin, Acetaminophen, Sedatives
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| 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.
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| Meds for pain of Pancreatitis? Avoid what because they cause sphincter spasm? | Demerol. Avoid opioids (morphine) if possible.
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| What is the sphincter of Oddi? | Goes from pancreas and gall bladder to duodenum to deliver bile & pancreatic juice.
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| Nutrition for Pancreatitis | IV or TPN; NPO status until pain free for 24 hours.
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| To relieve tight stretch of peritoneum in pancreatitis, the Pt can (3)? | Sit up, lean forward, fetal position.
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| Signs of Jaundice= yellow skin/sclera. What does urine and stool look like? | Dark urine (billirubin) Chalky/clay stool (No billirubin)
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| Complications of cirrhosis= esophageal varices, ascites, portal HTN and what else? | Hepatic encephalopathy, hepatorenal syndrome (kidney fails)
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| The obstruction to blood flow from Portal HTN (result of cirrhosis) leads to what 3 things? | Hepatomegaly, Splenomegaly, Esophageal-gastric-rectal varices.
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| 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.
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| Fluid wave, shiftness of dullness & protruding umbilicus = S/S of what? | Ascites
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| Diffuse fibrosis of liver | Cirrhosis
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| Cirrhosis obstructs flow of what? (3) | Blood, lymph, bile
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| 3 Causes of cirrhosis | Toxins (ETOH), Infections, R sided HF
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| Laennec;s Cirrhosis caused by | Liver Damage (ETOH)
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| Biliary Cirrhosis caused by | Biliary (Obstruction, bile stasis, inflammation
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| 3 early signs of cirrhosis | Malaise, RUQ discomfort, GI disturbance (bowel changes, anorexia, indigestion)
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| Esophageal varices, spider angiomas, changes in mental status are late signs of what? | Cirrhosis
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| Jaundice, anemia, gynecomastia, edema occur with what? | Late cirrhosis
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| Besides 5 Hepatitis Viruses, what 3 inflammatory causes lead to hepatitis? | Drugs (INH, OD, dilantin, halothan, aldomet), Toxins (ETOH, Mushrooms, carbon tetrachloride), hepatobiliary disease.
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| 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)
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| Which Hepatitis Viruses have fecal-oral transmission? | Hepatitis A & E
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| Hepatitis D usually is with which for of Hepatitis? | Hepatitis B
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| Early symptoms of hepatitis | Flu-like symptoms
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| Late symptoms of hepatitis | Jaundice, hepatomegaly, ascites, cirrhosis
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| What causes hepatic encphalopathy (altered conscious from liver problems) | Impaired ammonia metabolism after protein breakdown (ammonia result of protein breakdown)
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| Rx Tx for hepatic encephalopathy | Lactulose (ammonia binder)
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| 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)
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| Do you give fiber/stool softeners to Pt w/ intestinal obstruction? Why? | No- Could collect above obstruction and cause perforation
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| Kinking of a portion of the intestines | Volvulus
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| Telescoping of one part of the intestine into an adjacent part | Intussusecption
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| Fibrous bands that constrict tissue, loops of intestine adhere to areas that heal slowly or scar after ABD surgery | Adhesions
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| A blockage interferes with the normal progression of intestinal contents through the intestinal tract | Intestinal Obstruction
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| 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
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| Protruding structures can be replaced in the ABD cavity | Reducible Hernia
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| 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
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| Protrusion of the hernial sac contains the intestine at the inguinal opening | Inguinal Hernia
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| Surgical repair of the hernia | Herniorrhaphy
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| Surgical procedure in which the weakened area of a hernia is reinforced with wire, fascia, or mesh to prevent recurrence | Hernioplasty
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| Dilated veins outside or inside the anal sphincter | Hemorrhoids
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| AN infection with a collection of pus in an area between the internal and external sphincters | anorectal abscess
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| Linear tear in the anal canal tissue | Anal Fissure
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| A tract that forms in the anal canal | Anal fistula
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| Surgical procedure involving incision of a fistula | Fistulotomy
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| Surgical procedure in which a fiatulous tract is excised | Fistulectomy
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| Protrusion of stomach through diaphragm hiatus, occurs in 40% of the population; often asymptomatic; surgical Tx: fundoplication or gastroplexy | Hiatal Hernia
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| Hand flapping tremor usually induced by extending the arm and dorsiflexing the wrist; frequently seen in severe cirrhosis | Asterixis
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| Faint, irregular bluish discoloration around the umbilicus; seen in severe pancreatitis | Cullen's Sign
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| Gray-blue discoloration of the flanks, sometimes seen in acute hemorragic pancreatitis | Turner's Sign
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| Spasm in facial muscles elicited by tapping the facial nerve; seen in tetany/hypocalcemia | Chvostek's Sign
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| Carpal spasm is induced by inflating BP cuff on upper arm; + sign= hypocalcemia and/or mypomagnesemia | Trousseau's Sign
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