TEST3.3

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Question

Answer

The majority of blood supply to the liver, which is rich in nutrients from the gastrointestinal tract, comes from the:

portal vein

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The liver plays a major role in glucose metabolism by:

participating in glucogenisis

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The liver synthesizes prothrombin only if there is enough:

vitamin K

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The substance necessary for the manufacture of bile salts by hepatocytes is:

cholesterol.

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The main function of bile salts is:

fat emulsification in the intestines.

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Hepatocellular dysfunction results in all of the following

decreased serum albumin, elevated serum bilirubin, increased blood ammonia levels.

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Jaundice becomes evident when serum bilirubin levels exceed:

2.5 mg/dL

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The liver converts ammonia to urea. What level of ammonia would suggest liver failure?

300 mg/dL

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The most common cause of parenchymal cell damage and hepatocellular dysfunction is:

malnutrition

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Negative sodium balance is important for a patient with ascites. An example of food permitted on a low-sodium diet is

one cup of powdered milk

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The nurse expects that the diuretic of choice for a patient with ascites would be

Aldactone

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An indicator of probable esophageal varices is

hematemesis, a positive guaiac test, melena

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The mortality rate from the first bleeding episode for esophageal varices is about

30% to 50%

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Bleeding esophageal varices result in a decrease in:

renal perfusion

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The initial model of therapy to treat variceal hemorrhage that decreases portal pressure and produces costriction is:

Pitressin.

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A person who consumes contaminated shellfish would probably develop:

hepatitis E.

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The hepatitis virus that is transmitted via the fecal-oral route is:

hepatitis A virus

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Immune serum globulin provides passive immunity against type A hepatitis in those not vaccinated if it is administered within 2 weeks of exposure. Immunity is effective for about:

2 months.

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Choose the correct statement about hepatitis B vaccine

All persons at risk should receive active immunization

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Indications for postexposure vaccination with hepatitis B immune globulin include:

accidental exposure to HbAg-positive blood, perinatal exposure, sexual contact with those who are positive for HbAg

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The chemical most commonly implicated in toxic hepatitis is

chloroform, gold compounds, phosphorus

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Fulminant hepatic failure may progress to hepatic encephalopathy about how many weeks after disease onset?

8 weeks

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Late symptoms of hepatic cirrhosis include all of the following except

edema, hypoalbuminemia, hypokalemia

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Cirrhosis results in shunting of portal system blood into collateral blood vessels in the gastrointestinal tract. The most common site is:

the esophagus, the lower rectum, the stomach

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Signs of advanced liver disease include:

ascites, jaundice, portal hypertension

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The most common single cause of death in patients with cirrhosis is:

ruptured esophageal varices.

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Hepatic lobectomy for cancer can be successful when the primary site is localized. Because of the regenerative capacity of the liver, a surgeon can remove up to what percentage of liver tissue?

90%

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What percentage of the liver needs to be damaged before liver function tests are abnormal?

70%

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The two major complications of a liver biopsy are:____ and____.

bleeding and bile peritinitis

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The mortality rate for hepatitis B can be as high as what percent?

10%

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The most common reason for liver transplantation is exposure to _

hepatitis c

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Hepatocellular carcinoma is caused by:__, __, __, and __

chronic liver disease, hepatitis b, hepititis c, and cirrhosis

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The leading cause of death after liver transplantation is

infection

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hypoprothrombinemia

Vit K

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beriberi and polyneuritis

thiamine

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hemorrhagic lessions of scurvey

vit. c

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night blindness

vit. a

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macrocytic anemia

folic acid

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skin and neurologic changes

pyridoxine

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mucous membrane lesions

riboflavin

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Before a liver biopsy, the nurse should check to see that

a compatible donor blood is available, coagulation studies have been completed, vital signs have been assessed

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The nurse knows that the biopsy needle will be inserted into the liver between the:

sixth and seventh ribs

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The nurse is aware that postoperatively the most common complication after liver transplantation is:

bleeding.

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The nurse knows that a patient receiving cyclosporine to prevent rejection of a transplanted liver may develop a drug side effect of:

nephrotoxicity.

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Bile is stored in the:

gallbladder

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A patient is diagnosed with gallstones in the bile ducts. The nurse knows to review the results of blood work for a:

serum bilirubin level greater than 1.0 mg/dL.

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The major stimulus for increased bicarbonate secretion from the pancreas is

secretin

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An action not associated with insulin is the

conversion of glycogen to glucose in the liver

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The nurse knows that a patient with low blood sugar would have a blood glucose level of:

55 to 75 mg/dL

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A patient with calculi in the gallbladder is said to have:

cholelithiasis

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The obstruction of bile flow due to cholelithiasis can interfere with the absorption of

vitimin a

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Clinical manifestations of common bile duct obstruction include all of the following

clay-colored feces, pruritus, jaundice.

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The diagnostic procedure of choice for cholelithiasis is

ultrasonography

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Pharmacologic therapy is frequently used to dissolve small gallstones. It takes about how many months of medication with UDCA or CDCA for stones to dissolve?

6 to 12 months

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Chronic pancreatitis, commonly described as autodigestion of the pancreas, is often not detected until what percentage of the exocrine and endocrine tissue is destroyed?

80% to 90%

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Mild acute pancreatitis is characterized by

edema and inflammation

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A major symptom of pancreatitis that brings the patient to medical care is:

severe abdominal pain

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The nurse should assess for an important early indicator of acute pancreatitis, which is a prolonged and elevated level of:

serum lipase

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Nursing measures for pain relief for acute pancreatitis include

encouraging bed rest to decrease the metabolic rate, teaching the patient about the correlation between alcohol intake and pain, withholding oral feedings to limit the release of secretin

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The risk for pancreatic cancer is directly proportional to

smoking

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With pancreatic carcinoma, insulin deficiency is suspected when the patient evidences

an abnormal glucose tolerance, glucosuria, hyperglycemia

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Clinical manifestations associated with a tumor of the head of the pancreas include:

clay-colored stools, dark urine, jaundice.

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A nurse should monitor blood glucose levels for a patient who is diagnosed as having hyperinsulinism. A value inadequate to sustain normal brain function is:

30 mg/dL.

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Zollinger-Ellison tumors are associated with hypersecretion of

gastric acid.

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The capacity of the gallbladder for bile storage is:_____ mL.

30-50 mL

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Digestive enzymes are secreted by the pancreas;______ aids in the digestion of carbohydrates,_______aids protein digestion, and_____ aids the digestion of fats.

amylase, trypsin, and lypase

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The endocrine secretions of the pancreas are:____ ,_______ , and___ .

insulin, glucagon, and somatostatin

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The primary cause of acute cholecystitis is

calculous cholesistitis

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The most serious complication after a laparoscopic cholecystectomy is

bile duct injury

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A major cause of morbidity and mortality in patients with acute pancreatitis is

pancreatic necrosis

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asaterixes

involuntery flapping movement of the hands associated with metabolic liver dysfunction

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Budd-Chiarri Syndrome

hepatic vein thrombosis resulting in non-cirrhotic portal hypertension

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constructional apraxia

inability to draw figures in two or three dimensions

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fetor hepaticus

sweet, slightly fecal odor to the breath. presumed to be of intestinal origin, prevalent with the extensive collateral portal circulation in chronic liver disease

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fulminant hepatic failure

sudden severe onset of acute liver failure that occurs within 8 weeks after the first symptoms of jaundice

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hepatic encephalopathy

cns dysfunction resulting from liver disease associated with high ammonia levels that produce changes in mental status, altered loc and coma

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orthotopic liver transplantation (OLT)

grafting of a donor liver into the normal anatomic location with the removal of the diseased native liver

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portal hyertension

elevated pressure in the portal circulationresulting from obstruction of venous flow into and through the liver

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sclerotherapy

injection of substance to esophageal varices to cause constrioction, thickening, and hardening of the vesel to stop bleeding

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variceal bleeding

involves endoscopic placement of a rubber band like device over esophageal varices to ligate the area and stop bleeding.

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xenograft

transplantation from one species to another

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dissolution therapy

use of meds to break up or disolve gallstones

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endocrine

secreteing internally; hormonal secretion of a ductless gland

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endoscopic retrograde cholangiopancreatography (ERCP)

endoscopic procedure using fiberoptic technology to visualize the biliary system

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exocrine

secreting externally; hormonal secretion from excretory ducts

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lipase

pancreatic enzyme; helps with the digestion of fats

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panceaticojejunostomy

joing of the pancreatic duct to the jejunum by side to side anastomosis; allows drainage of the pancreatic secretion into the jejunum

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secretin

responsible for stimulating secretion of pancreatic juice; also used to aid in diagnosing pancreatic exocrine disease and in obtaining desquamated pancreatic cells for cytologic exam

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steatorrhea

frothy foul smelling stools with high fat content; results from inpaired digestion of proteins & fats due to lack of pancreatic juice in the intestines

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trypsin

pancreatic enzyme that aids in digestion of proteins

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Zollinger-Ellison tumor

hypersecretion of gastric acidthat produces peptic ulcersas a result of a non-beta cellor tumor of the pancreatic islets

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Glycogenesis

formation of glycogen from glucose

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Glycogenolysis

conversion of glycogen into glucose for energy

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Gluconeogenesis

formation of glycogen from amino-acids Occurs in the liver when there are excess amino-acids & decreased carbohydrate-intake

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for the process of Gluconeogenesis

the liver uses amino-acids from protein-breakdown or lactate produced by exercising muscles (from fats and proteins).

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Ammonia, a potential-toxin,

metabolically-generated as a by-product of gluconeogenesis (results from protein-breakdown).

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Ammonia is converted-into-urea

This is how liver rids the blood of toxic-ammonia. Urea is excreted in urine

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Hormone-Metabolism

> Aldosterone - sodium (Na) and water (hhO) retention o Is secreted by adrenal-cortex > Estrogen - secondary sexual-characteristics in women > Testosterone - secondary sexual-characteristics in men

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ADH — antidiuretic-hormone, decreases urine-secretion

o secreted by hypothalamus o naturally occurring ADH is vasopressin o pharmaceutically-prepared ADH is Pitressin

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Albumin decreases with

ascites and cirrhosis

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Vit. K = necessary for

prothrombin-synthesis & some of the other clotting-factors.

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Created by: sandjlambert1