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Nursing 210: Module IV, Unit A
Patient with Metabolic Disorders
59
Nursing
Undergraduate 2
12/11/2009

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Cards

Term
What are the blood tests that look for liver damage?
Definition

- liver enzymes: ALT, AST, GGT, ALP

- cholesterol (made in liver, often low with liver disease)

- serum proteins: total, albumin, globulin, A/G ratio

- serum ammonia

- PT/PTT (often prolonged in liver disease)

Term
How does a liver biopsy help dx liver disease?
Definition
liver tissue will be hypertrophies, cirrhotic
Term
What are nursing measures during a liver biopsy?
Definition

- position pt

- have patient exhale and hold breath while biopsy is taken

- offte psychological support

Term
What are nursing measures after a liver biopsy?
Definition

- position on R side

- VS q 15 minutes x 1 hour, q 30 minutes until stable

- assess for complications

Term
Explain the process of bilirubin metabolism.
Definition

- RBCs are composed of globin and heme

- glob in re-used

- heme becomes biliverdin

- biliverdin becomes bilirubin, which is unconjuguated, indirect, not water-soluble, and bound to albumin)

- in liver, joined with glucuronic acid, becomes conjugated, direct, and water soluble

Term
How is bilirubin excreted?
Definition

- conjugated bilirubin excreted in bile via bile ducts

- bile empties into small intestine

- bacteria in gut convert bilirubin to urobilinogen

- most urobilinogen excreted in feces

- some excreted in urine

Term
What are diagnostic measures of bilirubin?
Definition

- bilirubin: serum direct, serum indirect, serum total

- urine bilirubin

- fecal urobilinogen

Term
What is jaundice?
Definition

- a condition in which the bilirubin concentration in the blood increases (3x normal levels)

- icterus

- all body tissues become yellow tinged: skin, sclera, mucous membranes

- a symptom, not a disease

Term
What is hemolytic jaundice and what are some examples?
Definition

- hemolytic: increased destruction of RBCs, increased unconjugated bilirubin, liver cannot handle all of it

- examples: hemolytic anemia, blood toxicity reaction, Rh incompatiblity, physiologic jaundice of newborn

Term
What is hepatocellular jaundice and what are some examples?
Definition

- hepatocellular: inability of diseased liver to clear normal amounts of bilirubin

causes: cirrhosis, hepatitis, cancer, chemical toxicity, trauma

Term
What is obstructive jaundice and what are some causes?
Definition

- obstructive: obstruciton of bile flow, bile dammed in liver

- causes: liver tumors, hepatitis, cirrhosis, bile duct stones, cancer head of pancreas

Term
What is hepatitis?
Definition
inflammation of liver
Term
What are causes of hepatitis?
Definition

- viral: A, B, C, D, E, G

- drugs

- chemicals

Term
What is the pathophysiology of hepatitis?
Definition

- viral invasion

- inflammation and destruction

- enzymes released

- decreased liver function

- liver may regenerate

Term
What are the pre-icteric s and sx of hepatitis?
Definition

- starts with infection

- last 1-3 weeks

- flu- like symptoms: a/n/v, fatigue, malaise, fever, h/a, arthralgias

- dull pain RUQ

- increased liver size

- lymphadenopathy

Term
What are the icteric s and sx of hepatitis?
Definition

- starts with onset of jaundice

- lasts 2-6 weeks

- GI symptoms remain

- juandice

- liver increased in size, tender

- dark urine, clay stool with biliary obstruction

- pruritis

Term
What are the post-icteric s and sx of hepatitis?
Definition

- convalescence

- lasts 2-4 months

- jaundice disappears

- fatigue remains

- liver size decreases

- appetite returns

- may have relapse

- complete recovery by 6 months

Term
What are the characterisitics of Hepatitis A?
Definition

- fecal-oral transmission

- crowded conditions, poor sanitation

- contaminated food or water

- 37% of hepatitis cases in USA

- is an acute disease

Term
What are the charactertistics of Hepatitis E?
Definition

- fecal-oral transmission

- seen in Asia, Africa, and Mexico

Term
What are the characteristics of Hep B?
Definition

- pareneteral transmission: contaminated needles

- sexual transmission: sex with infected partners

- perinatal transmission

- 6 % become chronic

Term
What are the characteristics of Hepatitis C?
Definition

- parenteral and sexual transmission

- co-infection with HIV is increasing

- 75% of patients develop chronic form

Term
What are teh characterisitics of Hep D?
Definition

- transmitted same as HBV

- can only infect in presence of HBV

Term
What are varices?
Definition

- collateral veins that form to try and decrease portal hypertension

- occur in: distal espohagus, upper stomach, peri-umbilical, rectum

Term
What incidence/mortaility of esophageal varices?
Definition

- occur in 2/3 pts with cirrhosis

- bleeding varices are most life threatening complicatino of cirrhosis

- bleeding r/t irritatino, ulceration

- 30-50% mortality with first bleed

Term
How is esophageal varices assessed?
Definition

- melena

- hematemesis

- oozing vs. hemorrhage

- increased encephalopathy

Term
What are diagnostic studies for esophageal varices?
Definition

- barium swallow

- EGD

Term
What are endoscopic therapy options for managment of esophageal varices?
Definition

- ligation/banding of varices

-sclerotherapy

-shunt therapy: Tips/Surgical shunting

Term
How are bleeding esophageal varices managed?
Definition

- maintain airway; deflate esophageal balloon

- stabilize pt

- fluid resuscitation

- balloon tamponade

Term
What is ascites?
Definition

- edema: excess fluid in interstitial spaces, in peritoneal space

- not a disease

Term
What is the pathophysiology of ascites?
Definition

- increased capillary hydrostatic pressure

- increased capillary permeability

- decreased colloid osmotic pressure

- increased ADH and increased aldosterone r/t circulating volume

Term
What are the clinical manifestatinos of ascites?
Definition

- abdominal distention

- everted umbilicus

- abdominal striae

- + fluid wave

- looks dehydrated

- decreased urine output

- abdominal pain

- dyspnea

Term
What is a paracentesis and what are nursing managment actions?
Definition

- empty of ascites

- have pt empty bladder

- possibly 7-8 L of fluid

Term
What is medical managment of ascites?
Definition

- bedrest

- sodium restricted diet

- possible fluid restriction

- diuretics: aldactone

- salt poor albumin

Term
What is hepatic encephalopathy?
Definition

- neuropsychiatrtic manifestation of liver failure

- protein digestion produces ammonia, liver converts ammonia to urea

- diseased liver cannot convert, ammonia builds up

Term
What are the stages of hepatic encephalopathy?
Definition

- promdromal: personality changes, blank stares

- impending: lethargic, flapping tremors, muscle twitching, electrolyte imbalance

- stupourous: verbally abuse, may try to get out of bed

- comatose: coma

Term
What is collaborative managment of hepatic encephalopathy?
Definition

- goal: decrease ammonia formation

- treat causes

- restrict dietary protein

- administer neomycin PO

- administer lactulose

Term
What is nursing managment of hepatic encephalopathy?
Definition

- assess: neurologic status, vital signs

- monitor ammonia levels

- monitor fluid/electrolyte status

- keep pt safe

- avoid sedatives, narcotics

Term
Describe caloric intake in acute illness and maintenace of liver disease.
Definition

acute: normal as tolerated

maintenance: increased if malnourished

Term
Describe protein intake in acute illness and maintenace of liver disease.
Definition

- acute: none to low with encephalopathy

- maintenace: normal to increased

Term
Describe fat intake in acute illness and maintenace of liver disease.
Definition

acute: restricted with steatorrhea

maintenance: normal as tolerated

Term
Describe carbohydrate intake in acute illness and maintenace of liver disease.
Definition

acute: not restricted

maintenace: increased

Term
Describe sodium intake in acute illness and maintenace of liver disease.
Definition

acute: limit if ascites, FVE

maintenance: limit if ascites, FVE

Term
What are indications for liver transplant?
Definition

- chronic viral hepatitis

- congenital biliary atresia

- cancer confined to liver

- fulminant liver failure

- chronic end-stage liver disease

Term
What are contraindications for liver transplant?
Definition

- severe pulmonary hypertension

- morbin obesity

Term
What is acute pancreatitis?
Definition
acute inflammation caused by digestion of the pancreas by the enzymes it produces, primarily trypsin
Term
What are causes of acute pancreatitis?
Definition

- gallstones

- long term alcohol use

- other: trauma, infection, drugs, post-op GI surgery

Term
What are the clinical manifestations of acute pancreatitis?
Definition

- pain

- n/v

- change in VS

- respiratory distress

- Grey-Turner's sign

- Cullen's sign

- fever

- jaundice

Term
What tools are used to diagnose acute pancreatitis?
Definition

- serum amylase

- serum lipase

- urine amylase

- CBC: WBC, H&H

- Chest x-ray

- CT, Ultrasound of abdomen

- MRCP

Term
How is acute pancreatitis managed?
Definition

- pain control

- fluid resuscitation

- decrease pancreatic secretions

- prevent/treat infection

- bedrest

Term
What is chronic pancreatitis?
Definition

- inflammatory disease characterized by progressive destruction of pancrease

- cells replaced by fibrous tissue

- increased pressure in pancreas leads obstruction

- organ is digested by own enzymes

Term
What are causes of chronic pancreatitis?
Definition

- long term ETOH consumption

- biliary disease

- cancer

Term
What are clinical manifestations of chronic pancreatitis?
Definition

- pain

- n/v, weight loss

- jaundice, dark urine, steatorrhea

- diabetes

- psudeocyst formation

Term
How is chronic pancreatitis diagnosed?
Definition

- as acute pancreatitis

- ERCP

Term
How is chronic pancreatitis managed?
Definition

- as for acute pancreatitis

- prevention

- medications

- surgery

Term
What are medications for pancreatitis?
Definition

- analgesics: morphine, Dilaudid

- pancreatic enzymes: Viokase

- insulin/oral hypoglycemics

- GI prophylaxis: H2 block, PPI

- hormone: Sandostatin

Term
What is Grey-Turner's sign?
Definition
- bleeding in flank
Term
What is Cullen's sign?
Definition
- bluish/purplish discoloration in umbilicus
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