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Hepatobiliary Disorders

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