Hepatitis/Cirrhosis/Pancreatitis/Renal/Endocrine
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| show | asymptomatic
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| show | mild flu-like symptoms, malaise, body aches, N&V
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| show | Jaundice, dry, itchy skin, RUQ pain, N&V, fatigue
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| Hepatitis Convalescent phase | show 🗑
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| show | Acute Hepatitis; oral-fecal route caused by contaminated food/water
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| Hepatitis B | show 🗑
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| Hepatitis C | show 🗑
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| show | occurs ONLY concurrently with Hepatitis B; spread via blood/body fluids
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| show | Acute Hepatitis; oral-fecal route; primarily spread from contaminated water
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| Chronic Hepatitis | show 🗑
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| Fulminant Hepatitis | show 🗑
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| Toxic Hepatitis | show 🗑
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| Hepatobiliary Hepatitis | show 🗑
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| Manifestations of Hepatitis | show 🗑
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| Diagnosing Hepatitis | show 🗑
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| show | 2-6 weeks
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| show | Antiemetics, Antivirals, Immunomodulators, and Corticosteroids
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| show | Epivir-HBV & Hepsera: RENAL TOXIC: monitor I&O's and risk of infection
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| show | Interferon & Ribavirin: Interferon is ONLY given IM or SQ
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| Diet considerations with Hepatitis | show 🗑
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| show | Education on prevention & Vaccines for Hep A & B
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| Causes of liver cirrhosis | show 🗑
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| Pathophysiology of Cirrhosis | show 🗑
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| show | hepatomegaly, fever, weight loss, RUQ pain, N,V
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| show | Jaundice, altered mental status, edema, leukocytopenia, esophageal varices
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| show | Increased pressure in the portal vein due to reduced perfusion in the liver
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| Esophageal Varices | show 🗑
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| Cause of peripheral edema and ascites in cirrhosis patients | show 🗑
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| Hepatic encephalopathy | show 🗑
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| Diet considerations for cirrhosis patients | show 🗑
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| show | euphoria, depression, memory loss, and slowed speach
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| show | hyperventilation, hypothermia, asterixis (fine tremors of hands), coma
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| show | decreased perfusion to the kidneys commonly following diuretics, bleeding, or pancreatitis leads to acute renal failure and oliguria
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| Diagnosing cirrhosis | show 🗑
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| show | elevated liver function tests (AST, ALT), watch albumin & protein levels, monitor ammonia levels, perform coagulation study (low clotting factors)
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| Meds for treating Cirrhosis | show 🗑
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| show | Low protein diet & Lactulose & Neomycin
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| show | Diet (low salt & protein), medications (HTN, edema, ammonia), prevent bleeding; symptom management (paracentesis to decrease ascites)
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| Treating Esophageal Varices | show 🗑
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| Esophageal Tamponade | show 🗑
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| show | secrete digestive enzymes & produce insulin
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| show | pancreatic duct obstruction (gall stone or inflammation) causes enzyme reflux and cell damage
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| show | Acute form; enzyme reflux causing necrosis of the blood vessels and inflammation. Risk of rupture & bleeding. Life-threatening
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| show | sudden onset, severe RUQ pain radiating to back; N&V, decreased bowel sounds, tachycardia, jaundice, Turner's sign, & Cullen's sign
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| Turner's Sign | show 🗑
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| show | bruising around the umbilicus (Pancreatitis)
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| show | ERCP (scope of GI system), Xray, ultrasound (gall stones), CT, biopsy
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| show | elevated liver enzymes, elevated ESR (inflammation), CBC (anemia)
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| show | dehydration, inflammation, jaundice, edema, Hypoactive or Absent Bowel Sounds, abdominal pain (RUQ to back)
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| show | progressive destruction of pancreas; common causes include alcoholism and cystic fibrosis; occurs with remission and exacerbations
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| Manifestations of Chronic Pancreatitis | show 🗑
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| show | High protein, High calorie, Low fat diet
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| Treating Chronic Pancreatitis | show 🗑
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| Pancreatic Abscess | show 🗑
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| Whipple procedure | show 🗑
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| show | NPO, NG to suction, TPN started
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| Renal Labs | show 🗑
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| show | CT contrast dye is renal toxic and can send the patient into renal failure.
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| show | rapid decline in renal function commonly caused by Ischemia.
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| show | nitrogen waste products present in the blood (measured with BUN)
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| show | Hyperkalemia (peaked T wave, muscle spasms, fatigue), Hypocalcemia (tetany, trusseu's, chektevak's), Hyponatremia (confusion)
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| Pre-Renal Acute Renal Failure | show 🗑
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| show | Damage within the kidney causing decreased function (infection, injury, glomerulonephritis)
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| Post-Renal Acute Renal Failure | show 🗑
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| show | destruction of renal tube epithelial cells causing decline in renal function; caused from ischemia (dead cells clog the kidneys)
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| Stages of Acute Renal Failure | show 🗑
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| show | decreased GFR, Metabolic acidosis, Hyperkalemia, Hypocalcemia, Hyponatremia, confusion, peaked T waves, tetany, edema, oliguria, anemia, fluid retention
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| Diagnosing Acute Renal Failure | show 🗑
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| show | Fluid challenge, Dopamine (small doses causing renal dilation), ACE-inhibitors (vasodilation), Dextrose & Insulin or Kayelxelate (tx hyperkalemia), Calcium, Aluminum Hydroxide (binds phosphorous)
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| Diet considerations for renal patients | show 🗑
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| show | kidneys cannot excrete wastes lasting more than 3 months; common causes: diabetes, HTN, nephron damage
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| show | uremia, fatigue, confusion, hematuria, proteinuria, hyperkalemia, hypocalcemia, chronic metabolic acidosis, HTN, edema, and anemia
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| show | UA, BUN/Cr, GFR, BMP, ultrasound & biopsy
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| Treating Chronic Kidney Disease | show 🗑
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| show | dialysis cannot pull off phosphorous. Use Phosflo to bind phosphorous in the blood. Dialysis will be 3-4 times a week lasting 3-4 hours each time.
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| Hemodialysis | show 🗑
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| Continuous Renal Replacement therapy (CRRT) | show 🗑
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| show | they are loaded with anticoagulants (Do Not Flush), No BP or IV on affected arm.
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| show | Patient does at home by instilling fluid into abdominal cavity and draining off waste later. Complications: fluid is high in dextrose (risk of hyperglycemia and INFECTION)
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| show | ambulatory: fluid in the morning and drain about 6 hours later; cyclic: fluid before bed, machine drains off through the night.
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| show | increased appetite, weight loss, heat intolerance, insomnia, palpations, hair loss, sweating, goiter, blurred vision
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| Labs with Hyperthyroidism & Graves Disease | show 🗑
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| Graves Disease | show 🗑
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| show | Goiter, Proptosis (bulging eyes), exophthalmos (fluid around eyes), pretibial myxedema (nodules on tibia)
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| Causes of Hyperthyroidism | show 🗑
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| show | High fever, Tachycardia, Systolic HTN, N&V, Confusion (altered mental status), and Cardiac Complications
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| show | TSH will be low; T3/T4 will be high
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| show | Medications (antithyroid meds), radioactive iodine, surgery
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| show | destroys partial thyroid cells; pre-medicate with potassium iodine to slow thyroid function. (Potassium Iodine: no shellfish allergy, increases bleeding)
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| show | Tapazole & PTU: increases risk of bleeding; takes 12 weeks to kick in
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| Thyroidectomy | show 🗑
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| show | cool environment, protect eyes (sunglasses and eye drops), daily weight, high protein and carb diet
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| Primary vs Secondary Hypothyroidism | show 🗑
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| Manifestations of Hypothyroidism | show 🗑
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| Causes of Hypothyroidism | show 🗑
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| Hashimoto's Thyroiditis | show 🗑
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| show | life threatening complication of untreated hypothyroidism. Hypoglycemia, Hyponatremia, Metabolic acidosis, cardiovascular problems leading to coma
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| show | thyroid hormone replacement: Synthroid (take on empty stomach with glass of water)
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| show | increased PTH disorder primarily affecting bones and kidneys and causing high calcium levels
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| Primary, Secondary, Tertiary Hyperparathyroidism | show 🗑
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| Manifestations of Hyperparathyroidism | show 🗑
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| show | rule out other causes of Hypercalcemia
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| show | GOAL: decrease calcium; Aredia, Fosamax & Zometa (reduces calcium reabsorption), Calcitonin (given IM/SQ to reduce plasma calcium) fluids, and staying active
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| Hypoparathyroidism | show 🗑
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| Manifestations of Hypoparathyroidism | show 🗑
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| show | IV calcium gluconate, supplemental calcium and vitamin D
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| Cushing's Syndrome | show 🗑
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| show | weakness, osteoporosis, thin skin, striae, mood swings, HTN, peptic ulcers, Hypokalemia, Hypernatremia, slow wound healing, moon face, easy bruising, buffalo hump, hyperglycemia
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| show | Plasma cortisol levels, plasma ACTH, 24h urine
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| Medications for treating Cushing's Disease | show 🗑
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| show | surgery to remove adrenals, pituitary, or tumors, radiation if cancerous, medications for management
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| show | Results from Adrenal Insufficiency; caused from pituitary tumors, trauma, sepsis, sudden stopping of cortisol medications, or autoimmune process
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| show | slow wound healing, postural HTN, lethargy, confusion, mood swings, N,V&D, Hyperkalemia, Hypoglycemia, Hyponatremia, loss of blood volume due to aldosterone deficiency causing excess sodium and water loss
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| Diagnosing Addison's Disease | show 🗑
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| Addison's Crisis | show 🗑
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| show | Coritcosteroid and Mineralcorticoid replacement therapy (Cortef & Florinef)
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| show | Posterior Pituitary Disorder caused by tumor, head trauma or water retention causing excessive release of ADH
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| Manifestations of SIADH | show 🗑
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| show | Diuretics, Sodium replacement, treat hyperkalemia (insulin & dextrose or kaylexelate), fluid restriction, *Declomycin (creates urine flow)
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| show | Low ADH levels & renal system becomes insensitive to ADH absorption
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| Manifestations of Diabetes Insipidus | show 🗑
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| Treating Diabetes Insipidus | show 🗑
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