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Liver, Gallbladder, and Pancreatic Disorders
Lintion Ch. 40
210
Nursing
Undergraduate 1
05/30/2023
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Term
when referring to the liver the term hepatic is commonly used in
 Definition
hepatic circulation, hepatic enlargement, or hepatic pathology
Term
inflammation of the liver
 Definition
hepattitis
Term
if swelling r/t hepatitis is severe, two important effects occur
 Definition
the bile channels are compressed, blood flow through the liver is impaired
Term
systemic s&S of hepatitis include
 Definition
rash, angioedema, arthritis, fever and malaise
Term
hepatitis can be classified as
 Definition
infectious or noninfections
Term
viruses known to cause infectious hepatitis are classified as type
 Definition
A, B, C, D and E
Term
othe viruses that may cause acute inflammatory liver disease include
 Definition
human cytomegalovirus, epseitn barr virus, herpes simplex virus
Term
noninfectious hepatitis is caused by exposure ot
 Definition
toxic chemicals including drugs
Term
hep a has been caolled
 Definition
infectious hepatitis and epidemic hepatitis
Term
hep a can be transmitted by way of
 Definition
water, food, or medical equipment that has been contaminated with infected fecal matter
Term
the most common type of viral hepatitis
 Definition
hep a
Term
Transmission modes of Hep b
 Definition
intimate contact with carriers and contact with contaminate blood or medical equipment
Term
chronic hep b also increases the risk of
 Definition
cirrhosis, liver failure and lvier cancer
Term
hep c is trasmitted by contact with
 Definition
contaminated blood or medical equipment by contact with infected body fluids
Term
many people with hep c will develop
 Definition
cirrhosis or cancer of the liver
Term
hep d is caused by a virus knonw as the
 Definition
delta agent
Term
a defective ribonucleic acid virus that can survive only in the company of hbv
 Definition
delta agent
Term
hep d is trasmitted _ with or following HBV
 Definition
percutaneously
Term
hep e is transmitted via
 Definition
water or food contaminated with infected fecal matter
Term
noninfectious hepatitis can be the result of exposure to toxins such as
 Definition
mercury and arsenic and drugs such as alcohol and acetaminophen
Term
for those with symptomatic hepatitis the course of the disease is marked by three phases
 Definition
preicteric, icteric and posticteric
Term
common findings in the preicteric phase
 Definition
malaise, sever headache, right upper quadrant abdominal pain, anorexia, nausea, vomiting, fever, arthralgia, rash, enlarged lymph nodes, urticaria, enlargment and tenderness of the liver
Term
the preicteric phase lasts
 Definition
1 to 21 days
Term
the most infectious phase of hepatitis
 Definition
preicteric
Term
the icteric phase is characterized by
 Definition
jaundice, light or clay colored stools and dark urine, pruritus may occur, gi symptoms from the preicteric phase often persist
Term
the icteric phase lasts
 Definition
2 to 4 wks
Term
hepatitis patients who do not develop jaundice are said ot have
 Definition
anicteric hepatitis
Term
s&s in the posticteric phase
 Definition
fatigue, malaise and liver nelargment persist for several months
Term
complications of hepatitis
 Definition
chronic hepatitis, fulminant hepatitis, cirrhosis of the lvier, liver cnacer
Term
chronic hepatitis is characterized by a prolonged recovery with contiuning _ that eventually resolves
 Definition
fatigue and liver enlargment
Term
a diagnossis of hepatitis is based on the presence of _ specific to each type of hepatitis
 Definition
viral antigens and antibodies
Term
typical finding sconsistent with hepatitis
 Definition
elevated levels of serum enzymes, serum and urinary bilirubin and urinary urobilinogen, PT may be prolonged, albumin may be normal or low, gamma globulin may be normal or high
Term
serum enzymes r/t hepatitis
 Definition
aspartat aminotransferase, alanin aminotransferase, gamma glutamyl transpeptidase,
Term
acute hepatitis A uusally requires no treamtn as it typically resolves _ and does not become chronic
 Definition
spontaneously
Term
most patients with acute hepatitis b spontaneously clear the virus althought treatment with _ may be given
 Definition
lamivudine, tenofovir or entecavir
Term
chronic hep b can usually be controlled with an _ and a combination of _
 Definition
alphainterferon, nucleoside anlog antiviral drugs
Term
acute hep c is treated with an _ for _, in some cases _ is added
 Definition
interferon, 12 to 24wks, ribarirn
Term
if the initial treatment for hep c does not clear the virus a course of _ may be prescribed for _
 Definition
interferon and ribavirin, 48wks
Term
two of the combination drugs marketed that treat hep c
 Definition
harvoni and vosevi
Term
the cdc recommends that dults up to 40 years jof age who are exposed to hep a be given the HAV vaccine within _ of exposer to prevent infection
 Definition
2wks
Term
in adults over 40 years, if exposure to hep a occurs, _ should be givein rather than the HAV vaccin
 Definition
immunoglobulin
Term
active disease may be prevented in paitents who have been exposed to HBV by administering the _ within _ after exposure
 Definition
hbv vaccin and hep b immune globulin, 24hrs
Term
unless the patient has sever complications r/t hepatiits, complete bed rest is usally
 Definition
not necessary
Term
a common symptom of hepatitis
 Definition
anorexia
Term
four types of cirrhosis are classified base on cause:
 Definition
alcholic, postnecrotic, biliary and cardiac cirrhosis
Term
the liver enlarges and becomes knobby and then shrics
 Definition
alcoholic cirrhosis
Term
can be a complication of hepatitis in which massive liver cell necrosis occurs
 Definition
postnecrotic cirhosis
Term
develops as a result of obstruction to bile flow
 Definition
bilaiary cirrhosis
Term
follows severe right sided heart failure
 Definition
cardiac cirrhosis
Term
venous congestion and hypoxia r/t cardiac cirrhosis lead to
 Definition
necrosis of liver cells
Term
in the early stage s&s of cirhosis are usually subtle, the pt may report
 Definition
slight weight loss, unexplained fever, fatigue,and dull heaviness in the right upper quadrant of the abdomen, liver may be palpable below the right rib margin
Term
as cirrhosis progresses impaired _ causes GI disturbances such as _
 Definition
carbohydrates, fats and proteins
anorexia, n/v, diarrhea or constipation, flatulenc, dyspepsia
Term
elevated pressure in the veins in the gi tract r/t cirrhosis causes them to
 Definition
dilate and bulge
Term
dilated veins in the esophagus are called
 Definition
esophageal varices
Term
dilated veins in the rectum are called
 Definition
hemorrhoids
Term
hematologic disorders associate with cirrhosis
 Definition
anemia, leukocytopenia, thrombocytopenia, prothrombin deifciency
Term
as a result of hematologic disorders r/t cirrhosis pt tend to
 Definition
tire quickly, bruise easily and ar more susceptible ot infection, epistaxi is common
Term
two factors that contribute to jaundic in the pt with cirrhosis
 Definition
disease liver cells may be unable to conjugate and extrete bilirubin, structural changes in the liver prevent the normal flow of bile out of the lvier
Term
the pt with cirrhosis may exhibit signs of hormone excess because the diseased liver is unable to metabolize
 Definition
estrogen, testosterone, aldosterone, adrnocortical hormones
Term
with cirrhosis _ may be noted in men and _ may be noted in women
 Definition

testicular atrophy, impotnece, gynecomastia

amenorrhea
Term
_are also attributed to hromone excess r/t cirrhosis
 Definition
palmar erythema, spider angiomas
Term
cirrhosis impairs th elivers ability to manufactor
 Definition
albumin
Term
_ common with cirrhosis
 Definition
peripheral neuropathy
Term
peripheral neuropath is characterized by
 Definition
tingling or numbness in the extremities
Term
peripheral neuropathy r/t cirrhosis is thought to be caused by dietary deficiencies of
 Definition
vitamin b12, thiamine and folic acid
Term
complications of cirrhosis
 Definition
esophageal varices, ascites, hepatic encephalopathy, hepatorenal syndrome, spontaneous bacterial peritonitis
Term
delivers blood from the intestines to the lvier
 Definition
the portal vein
Term
portal hypertension causes
 Definition
collateral vessels to develop
Term
collateral vessels commonly form in the
 Definition
esophagus, anterior abdominal wall and the rectum
Term
the accumulation of fluid in the peritoneal cavity
 Definition
ascites
Term
excessiv ammonia in the blood causes neurologic sympoms including
 Definition
congintive disturbances, declining level of consciousness and changes in neuromuscular function
Term
the failing liver is unable to detoxify ammonia
 Definition
hapatic encephalopathy
Term
if hepatic encphalopathy is not reversed, the patient lapses into unconsciousness refferred to as
 Definition
hepatic coma
Term
factors that may precipitate hepatic encephalopathy are
 Definition
infection, fluid and potassium depletion, gi bleeding, constipation and some drugs
Term
hepatorenal syndrome renal failure in the patien with cirrhosis that often follows excessive
 Definition
diuresis, paracentiesis without albumin infusion, or GI hemorrhage
Term
vasodilation associated with portalhypertension triggers a physiologic repsose that
 Definition
constricts blood vessels
Term
although some patients have no symptoms of spontaneous bacteria peritonitis others have
 Definition
fever, jaundice and abdominal pain
Term
results of lab tests that are consistent with cirrhoiss include
 Definition
elevated serum and urine bilirubin, elevated serum enzymes, decreased total serum protein, decreased cholesterol, prologned PT
Term
in relation to cirrhosis, the CBC may reveal deficiences of
 Definition
red blood cells, white blood cells and platelts
Term
before liver biopsy _ should be studied
 Definition
vital signs and blood coagualtion
Term
after a liver biopsy a dressing is applied and the pt is positioned
 Definition
on the right side for 1 to 2 hours
Term
the goals of medical treatment for cirrhosis are to
 Definition
limit deterioration of the liver function and to prevent complications
Term
compensated cirrhosis is managed with treatment of
 Definition
any underlying disease, avoidance of liver toxins, monitoring for varices and liver cancer
Term
if the patient is in liver failure _ is usually ordered
 Definition
bed rest
Term
a diet high in _ is typically ordered when treating cirrhosis
 Definition
calories, carbohydrates and vitamins
Term
the most important advancement in the care of patients with liver failure
 Definition
albumin dialyis s
Term
the medical managment of ascites aimes to promote _ of the fluid by means of _ and diuretics usually _
 Definition
reabsorption and elimination, sodium restriction and diuretics
spironolactone, furosemid or both
Term
if ascites does not respond to conservative treatment fluid can be removed wiht a needle, a procedure called
 Definition
paracentiesis
Term
the removal of ascitic fluid from the peritoneal cavity
 Definition
paracentesis
Term
provide a mechanism to collect ascitic fluid and return it to the circulation
 Definition
shunts
Term
advantages to shunting ascitic fluid rather than remvoing it are
 Definition
protein rich serum is retained and returned to the vascular compartment, urine output increases which eliminates excess sodium and water
Term
a catheter is threaded through thejugular vein and the inferior vena cava to the hepatic vein
 Definition
TIPS shunt
Term
one problem with TIPS is that toxins in the blood bypass the liver and may cause
 Definition
encephalopathy
Term
two other types of shunts r/t ascites are the
 Definition
protacaval and distal splenorenal shunt (both require surgical procedures)
Term
involves anatomosing the portal vein to the inferior vena cava to diver blood form the portal vein to the systemic circulation
 Definition
the portacaval shunt
Term
the pt with a portacaval shunt is at risk for _ because ammonia accumulates in the blood
 Definition
hepatic encephalopathy
Term
anastomoses the splenic vein to the renal vein
 Definition
distal splenoral shunt
Term
the incidence of hepatic encephalopathy is lower with
 Definition
distal splenoral shunts
Term
techniques used to control bleeding esophageal varices
 Definition
drug therapy, sclerotherapy and endoscopic ligation
Term
delivers blood from the intestines to the lvier
 Definition
the portal vein
Term
portal hypertension causes
 Definition
collateral vessels to develop
Term
collateral vessels commonly form in the
 Definition
esophagus, anterior abdominal wall and the rectum
Term
the accumulation of fluid in the peritoneal cavity
 Definition
ascites
Term
excessiv ammonia in the blood causes neurologic sympoms including
 Definition
congintive disturbances, declining level of consciousness and changes in neuromuscular function
Term
the failing liver is unable to detoxify ammonia
 Definition
hapatic encephalopathy
Term
if hepatic encphalopathy is not reversed, the patient lapses into unconsciousness refferred to as
 Definition
hepatic coma
Term
factors that may precipitate hepatic encephalopathy are
 Definition
infection, fluid and potassium depletion, gi bleeding, constipation and some drugs
Term
hepatorenal syndrome is renal failure in the patien with cirrhosis that often follows excessive
 Definition
diuresis, paracentiesis without albumin infusion, or GI hemorrhage
Term
vasodilation associated with portalhypertension triggers a physiologic repsose that
 Definition
constricts blood vessels
Term
although some patients have no symptoms of spontaneous bacteria peritonitis others have
 Definition
fever, jaundice and abdominal pain
Term
results of lab tests that are consistent with cirrhoiss include
 Definition
elevated serum and urin bilirubin, elevated serum enzymes, decreased total serum protein, decreased cholesterol, prologned PT
Term
in relation to cirrhosis, the CBC may reveal deficiences of
 Definition
red blood cells, white blood cells and platelts
Term
before liver biopsy _ should be studied
 Definition
vital signs and blood coagualtion
Term
after a liver biopsy a dressing is applied and the pt is positioned
 Definition
on the right side for 1 to 2 hours
Term
the goals of medical treatment for cirrhosis are to
 Definition
limit deterioration of the liver function and to prevent complications
Term
compensated cirrhosis is managed with treatment of
 Definition
any underlying disease, avoidance of liver toxins, monitoring for varices and liver cancer
Term
if the patient is in liver failure _ is usually ordered
 Definition
bed rest
Term
a diet high in _ is typically ordered to treat cirrhosis
 Definition
calories, carbohydrates and vitamins
Term
the most important advancement in the care of patients with liver failure
 Definition
albumin dialyis s
Term
the medical managment of ascites aimes to promote _ of the fluid by means of _ and diuretics usually _
 Definition
reabsorption and elimination, sodium restriction, spironolactone, furosemid or both
Term
if ascites does not respond to conservative treatment fluid can be removed wiht a needle, a procedure called
 Definition
paracentiesis
Term
the removal of ascitic fluid from the peritoneal cavity
 Definition
paracentesis
Term
provide a mechanism to collect ascitic fluid and return it to the circulation
 Definition
shunts
Term
advantages to shunting ascitic fluid rather than remvoing it are
 Definition
protein rich serum is retained and returned to the vascular compartment, urine outpud increase, which eliminates excess sodium and water
Term
a catheter is threaded through thejugular vein and the inferior vena cava to the hepatic vein
 Definition
TIPS shunt
Term
one problem with TIPS is that toxins in the blood bypass the liver and may cause
 Definition
encephalopathy
Term
two other types of shunts r/t ascites are the
 Definition
protacaval and distal splenorenal shunt (both require surgical procedures)
Term
involves anatomosing the portal vein to the inferior vena cava to diver blood form the portal vein to the systemic circulation
 Definition
the portacaval shunt
Term
the pt with a portacaval shunt is at risk for _ because ammonia accumulates in the blood
 Definition
hepatic encephalopathy
Term
anastomoses the splenic vein to the renal vein
 Definition
distal splenoral shunt
Term
the incidnece of hepatic encephalopath is lower with
 Definition
distal splenoral shunts
Term
techniques used to control bleeding esophageal varices
 Definition
drug therapy, sclerotherapy and endoscopic ligation
Term
uses rubber rings to tie off varices
 Definition
ligation
Term
acute bleeding episodes r/t esophogeal varices may be treated with
 Definition
iv ctreotide, which constricts blood vessels and lowers pressure in hepatic circulaiton
Term
may be ordered in addition to blood transfuions to treat esophogeal varices
 Definition
vitamin ka and proton pum inhibotors such as pantoprazole
Term
may be ordered for bleeding esophogeal varices to prevent the breakdown of blood in the intestines that would release ammonia
 Definition
lactulose
Term
antibiotics are given for bleeding esophogeal varices to
 Definition
prevent bacterial infection and decrease bleeding
Term
antibiotis usually prescribed for bleeding esophogeal varices
 Definition
IV ceftriazone or oral norfloxacin
Term
may be used to reduce BP in the long term managment of patients after accute bleeding episodes r/t esophogeal varices
 Definition
beta-adrenergic blockers
Term
a procedure in which a solution is injected into the varices or into the veins that supply them, causing the varices to harde and close
 Definition
slerotherapy
Term
after sclerotherapy patients often report
 Definition
chest disocomfort for several days
Term
if pain persists after schlerotherapy it may indicate
 Definition
perforation of the esophagus
Term
deterioration in neurologic function asssociated with excess ammmonia in the body
 Definition
hepatic encephalopathy
Term
a product of protein metabolism that is normally borken down by th elvier
 Definition
ammonia
Term
manifestations of hepatic encephalopathy
 Definition
hand tremor, personality changes, hyperventilatio and lethargy progressing to coma
Term
factors that can precipate hepatic encephalopathy including
 Definition
constipation,GI bleeding, hypokalemia, infectino, opioids, dehydration and renal failure
Term
treatment of hepatic encephalopathy is aimed at _ and reducing the amount of ammonia being produced in the _ this reduction may be achieved with _
 Definition
correcting the cause, digestive tract, lactulose
Term
a cathartic that promotes elimation of ammonia from the colon and discourages bacterial growth by making the intestinal contents more acidic
 Definition
lactulose
Term
renal failure accompanying cirrhosis
 Definition
hepatorenal syndrome
Term
precipitating factors of hepatorenal syndrome
 Definition
paracentesis, diuresis, and GI hemorrhage
Term
HRS MAY BE TREATED IWHT A
 Definition
vasoconstrictor, albumin and a TIPS, or extracorporeal albumin dialysis
Term
Pts with HRS should not recieve
 Definition
NSAIDS
Term
Spontaneous bacterial peritonitis is treated with
 Definition
antiboitcs
Term
IV albumin is given for spontaeous bacterial peritonitis to prevent _ associated with this infection
 Definition
renal dysfunction
Term
Inflammation of the gallbladder
 Definition
cholecystitis
Term
cholecystitis is mosto often caused by the presence of _ but can be ther result of _
 Definition
gallstones
bacteria, toxicc chemicals, tumors, anesthesia, starvation and opioids
Term
in cholecystitis the inflamed galladder and cystic duct become
 Definition
swollen and congested with blood
Term
when gallstones are present, the patient is said to have
 Definition
cholelithiasis
Term
Most gallstones are composed of
 Definition
cholesterol mixed with bile salts, bilirubin, calcium and protein
Term
gallstones may be found anywhere in the biliary tract such as:
 Definition
the gallbladder, the cysic duct or the common bile duct
Term
when a gallstone causes an obstruction, duct respon to obstruction with spasms to move the stone, this is responsible for an intense spasmodic pain called
 Definition
bilairy colic
Term
some patients with cholecystitis may only have _ while others have _
 Definition
mild indigestion
severe pain, fever and jaundice
Term
other symptoms of cholecystitis
 Definition
nausea, eructation, fever, chills and right upper quadrant pain that radiats to the shoulder
Term
symptoms of cholecystitis typically occur about _ especially if that meal had high _
 Definition
3hrs after a meal, fat content
Term
most serious complicationsn of cholecytiitis and cholelithiasis are
 Definition
pancreatitis, abscesses, cholangitis, ruptur of the gallbladder
Term
sonservative treatment of cholecystitis includes _ to relieve pain and muscle spasms
 Definition
analgesics and anticholinergic agents
Term
among the options available for the treatment of cholelithiasis ro choledocholithiasis are
 Definition
drug therapy, shock wave lithotripsy, endoscopic sphincterotomy and cholecystectomy
Term
the standard of care for cholelithiasis
 Definition
cholecystectomy
Term
tow pocedures that may be used for cholecystectomy
 Definition
laparoscopy or a right subcostal incision
Term
the most seirous complication of laparoscopy altho rare is
 Definition
injury to the bile duct
Term
after laparoscopy patients can resume regular activities within a
 Definition
week
Term
a _ may be placed after classic cholecystectomy procedure to maintain _ until sweeling in the duct subsides
 Definition
t-tube, bile flow
Term
when using a t-tube notify the physician if drainage exceeds _ in 24 hrs
 Definition
1000mL
Term
the T-tube should be unclamped if the pt begins to experience
 Definition
pain, fever, chills, nausea or distentions
Term
the physician removes the t-tube when:
 Definition
the patient tolerates clapping for a prolonged period of time
Term
_ may be ordered for cholecystitis because morphine causes _ in the common bile duct which would increase pt's pain
 Definition
meperidine, spasms
Term
some believe that the spasms r/t cholecystitis caused by morphine can be controlled with
 Definition
atropine
Term
type of diet recommeded to decrease the incidence of acute symptoms of cholecystitis
 Definition
low fat diet
Term
signs of bile duct obstruction
 Definition
light stools, dark urin, jaundice and itching
Term
bile salts interfere with the effectiveness of
 Definition
oral contraceptives
Term
inflammations of the pancrease
 Definition
pancreatitis
Term
pancreatitis is most often associate with
 Definition
alcholisms or obstruction of the pancreatic duct by a gallstone
Term
other causes of pancreatitis include
 Definition
viral infections, peptic ulcer disease, cysts, metabolic disorders, trauma from external injury, surgery or endoscopic procedures
Term
the most prominent symptom of pancreatitis
 Definition
abdominal pain
Term
the pain r/t pacreatitis is typically severe with a _, is centered in the _ and radiates to the _
 Definition
sudden onset, left upper quadrant or the epigastric region, back
Term
sever _ often accopany the pain caused by pancreatitis
 Definition
vomitting, flushing, cyanosis and dyspnea
Term
other s&s of pancreatitis
 Definition
low grade fever, tachypnea, tachycardia, hypotension, abdomen may be tender and distended, bowel sounds absent suggesting ileus
Term
in pancreatitis cyanosis or greenish discoloration may be present around
 Definition
the abdominal wall, the flanks and arear around the ubilicus
Term
early s&s of shock r/t pancreatitis are
 Definition
restlessness and tachycardia
Term
late sign of shock
 Definition
hypotension
Term
symptoms of chronic pacreatitis are similar to those of the acute diseas but usually appear as
 Definition
periodic attacks that become more and more frequent
Term
pt with chronic pancreatitis may develop
 Definition
DM, and malabsorption with steatorrhea
Term
complications of pancreatitis include
 Definition
pseudocyst, abscess, hypocalcemia and pulmonary, cardiac and renal complications
Term
a fluid filled pouch attached to the pancreas
 Definition
pseudocyst
Term
a pseudocyst contains products of
 Definition
tissue destruciton and pancreatic enzmes
Term
sympoms of pseudocyst include
 Definition
abdominal pain, n/v, and anorexia, sometimes a mass can be palpated in the epigastric area
Term
necrosis within the pancreas can lead to
 Definition
pancreatic abscess
Term
symptoms of pancreatic abscess are similar to those of
 Definition
pseudocyst, pt usually run high fever
Term
pulmonary complications of pancreatitis are
 Definition
pneumonia and atelectasis
Term
most important diagnostic findings in actue pancreatitis are
 Definition
elevated serum amylase, serum lipas and urinary amylase levles
Term
when the kidneys clear amylase more rapidly than they cleare _ acute pancreatitis is strongly suspected
 Definition
creatinine
Term
other findings iwht acute pancreatitis are
 Definition
elevated WBC, elevated serum lipid and glucose levels and decreased serum calcium level
Term
tests for chronic pancreatitis include the
 Definition
secretin stiumlation test and fecal studdis
Term
findings consistent with chronic pancreatis are
 Definition
decreased volume and bicrabonat concentration of pancreatic fluid, low serum trypsinogen and high fecal fat content
Term
the pt with acute pancreatitis is usually
 Definition
NPO status
Term
drug therapy for pancreatitis commmonly includes
 Definition
analgesics, antispamodic agents, anticholinergic agents and gastric acid inhibitors
Term
morphine is gaining favor because the pain relief lasts longer and spasms can be managed with the antispasmodic drugs such as
 Definition
nitroglycerin
Term
dry up secretions which can also rduce spasms and pain
 Definition
anticholinergic
Term
with chronic pancreatitis _ is tried intially for pain control
 Definition
acetominopen, ibuprofen, tramadol
Term
when assessing pancreatitis the abdomen should be inspected for
 Definition
discoloration, distention, and diminished bowel sounds
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