Term
|
Definition
| Formation of stones within the gallbladder or biliary duct system. |
|
|
Term
| Formation of bile occurs here |
|
Definition
|
|
Term
| Gallbladder releases bile through these sites into the intestines |
|
Definition
Common bile duct
Sphincter of Oddi |
|
|
Term
|
Definition
| Increase the solubility and absorption of dietary fats |
|
|
Term
| Factors leading to the formation of gallstones |
|
Definition
Abnormal bile composition
Biliary stasis
Inflammation of the gallbladder |
|
|
Term
|
Definition
Severe steady pain in RUQ
Sudden onset following a meal
May last as long as 5 hours |
|
|
Term
| Medical Management of Biliary Tract Disorders |
|
Definition
FPAIN
F - Fluid/electrolyte assessment
P - Pain reduction
A - Antiemetics to treat N/V
I - Infection control: antibiotics
N - Nutrition
*Reduce fat intake
*Ensure protein intake
*Allow some carbs, but not a lot |
|
|
Term
| Medications to treat Biliary Tract Disorders |
|
Definition
Actigall (ursodiol)
Chenix (chenodiol) |
|
|
Term
| Actions of Actigall and Chenix |
|
Definition
Reduce cholesterol content of gallstones
Slowly dissolve gallstones
May take 2 years or more to work |
|
|
Term
|
Definition
Treatment for dissolving large gallstones.
Patient sits in large tub of water and ultrasound is used to align the stones with the source of shock waves. |
|
|
Term
Laparoscopic Cholecystectomy
"Lap Choley" |
|
Definition
| Removal of gallbladder using a minimally invasive procedure. |
|
|
Term
| Cholecystectomy: Laparotomy |
|
Definition
Open procedure for removal of gallbladder.
Used in more critical cases.
Can also remove stones from the common bile duct.
T-Tube is inserted and left in place while edema decreases. |
|
|
Term
|
Definition
Maintain patency
Promote bile passage
Nurse will change dressing periodically
Position of comfort: 45 degrees, semi-Fowler's
Pin drainage bag and tubing off to the side
Bag will drain by gravity
Removal: 1-2 weeks post-op |
|
|
Term
|
Definition
Small incisions
Short surgery
Might be outpatient
Return to work in 2-3 days |
|
|
Term
| Complications of Open Cholecystectomy |
|
Definition
Hemorrhage
Atelectasis
Thrombophlebitis
Paralytic ileus
Bile leakage
Peritonitis |
|
|
Term
|
Definition
| Inflammation of the gallbladder |
|
|
Term
|
Definition
"I BOIL"
I - Impaired drainage
B - Bacterial proliferation
O - Obstruction of biliary ducts with distention
I - Ischemia: necrosis/perforation of gallbladder wall
L - Localized chemical irritation due to retained bile |
|
|
Term
|
Definition
*Pain: may be entire RUQ, tender to palpation, may radiate to back, right scapula, shoulder
*Movement/deep breathing may make pain worse
*Pain lasts longer than biliary colic (8-12 hours)
*Anorexia
*N/V
*Fever and chills may be present |
|
|
Term
|
Definition
Slowed emptying of gallbladder:
Gallbladder empties in response to hormonal stimulation
When gallbladder empties completely as it should, stones do NOT form! |
|
|
Term
| Inflammation of gallbladder |
|
Definition
| Allows excess water and bile salt reabsorption which increases the risk of lithiasis |
|
|
Term
| Composition of gallstones |
|
Definition
80% consist mainly of cholesterol
20% contain a mixture of bile componenets |
|
|
Term
| Obstruction of Common Bile Duct Leads to: |
|
Definition
Bile reflux into the liver which causes
*Pain
*Jaundice
*Possible liver damage
Pancreatitis: inability of pancreatic enzymes to enter small intestine. |
|
|
Term
|
Definition
Glycogenesis
Glycogenolysis
Gluconeogenesis
Fat metabolism
Protein metabolism
Vitamin and Iron storage
Metabolism and detoxification of drugs and chemicals
Bile formation
Elimination of foreign/damaged cells |
|
|
Term
|
Definition
| Formation of glycogen from glucose |
|
|
Term
|
Definition
| Glycogen (stored in liver and muscles) is converted to glucose |
|
|
Term
|
Definition
| Process of synthesizing glucose from non-carbohydrate sources: starting point is pyruvic acid. |
|
|
Term
|
Definition
Fatty acids broken down into ketones
Fatty acids used for synthesis of:
*Cholesterol
*Triglycerides
*Lipoproteins |
|
|
Term
| Protein metabolism in Liver |
|
Definition
Proteins are first catbolized (broken down)
Ammonia is converted to urea
Plasma proteins are synthesized: albumin and clotting factors |
|
|
Term
| Vitamin and Iron Storage in Liver |
|
Definition
Vitamins A, B12, D, E, and K
Iron and copper |
|
|
Term
| Metabolism and Detoxification of drugs and chemicals in Liver |
|
Definition
Conjugated or bound with chemicals
Metabolized by certain pathways |
|
|
Term
| Bile: Formed in Liver and Accomplishes This |
|
Definition
*Absorbs fat
*Metabolized bilirubin by converting it from unconjugated to conjugated
*Eliminate bilirubin from the body. |
|
|
Term
|
Definition
By way of Kupffer cell phagocytosis:
*Foreign cells
*Damaged blood cells |
|
|
Term
Bilirubin Levels
Expected Value: Total Serum Bilirubin |
|
Definition
|
|
Term
Bilirubin Levels
Expected Value: Direct (conjugated) |
|
Definition
|
|
Term
Bilirubin Levels
Expected Value: Indirect (unconjugated) |
|
Definition
|
|
Term
| Reasons for elevated bilirubin levels |
|
Definition
1. Liver disease
2. Flow of bile is obstructed
3. Excessive destruction of RBCs |
|
|
Term
| Aging changes in the LIver |
|
Definition
Decrease in size and weight.
Decrease in hepatic blood flow.
Increase in incidence of Hep B
Increase in severity of Hep B
Increase in incidence of liver abscesses |
|
|
Term
|
Definition
| Remain the SAME even though the size/weight/flow have decreased. |
|
|
Term
|
Definition
| Accumulation of fluid in the abdomen r/t low albumin levels which reflect poor protein metabolism |
|
|
Term
| Additional S/S of Liver disease in Males |
|
Definition
Gynecomastia
Testicular atrophy |
|
|
Term
Liver Disease Assessment:
Inspection |
|
Definition
Skin - dilated veins/vessels that pop up around umbilicus
Ascites
Abdominal girth
Males: gynecomastia, testicular atrophy |
|
|
Term
Liver Disease Assessment:
Auscultation |
|
Definition
Bowel sounds: may be absent
RUQ - may hear a "hum" r/t collateral circulation
Friction rub - in lungs r/t inflammation of the liver in proximity to lungs. |
|
|
Term
Liver Disease Assessment:
LFTs |
|
Definition
Serum enzymes
Serum proteins: albumin (3.5-5 normal) and total serum protein
Prothrombin time: 10-15 seconds (normal)
Ammonia level
Cholesterol
Bilirubin |
|
|
Term
| Post-procedure care: Liver Biopsy |
|
Definition
Turn patient on RIGHT side: this creates pressure on the wound.
Monitor VS
Check site for hematoma
Check site for crepitus
Assess pain
No heavy lifting or strenuous activity for ONE week |
|
|
Term
|
Definition
| Rice Krispy crackling sound r/t air in the subcutaneous tissues. |
|
|
Term
|
Definition
| Inflammation of the liver |
|
|
Term
| Fulminant Hepatic Failure |
|
Definition
| Sudden and severely impaired liver function in a previously healthy person: may be related to a traumatic injury |
|
|
Term
| Development of Fulminant Hepatic Failure |
|
Definition
Within 2-3 weeks of the first symptoms
One thing leads to another: all happens quickly
Can lead to multi-organ system failure |
|
|
Term
| Fulminant Hepatic Failure: First symptoms |
|
Definition
|
|
Term
|
Definition
Illness characterized by fibrosis of the liver tissue leading to
*Decreased mass
*Impaired liver function
*Altered blood flow |
|
|
Term
| Cirrhosis: Pathophysiology |
|
Definition
1. Functional liver tissue is gradually destroyed and replaced by fibrous scar tissue
2. As hepatocytes and liver lobules are destroyed, metabolic functions of the liver are lost
3. Amount of scar tissue exceeds that of functional tissue
4. Flow of blood, lymphatic fluid and bile is impeded. |
|
|
Term
|
Definition
1. Fatty liver
2. Liver fibrosis
3. Full cirrhosis |
|
|
Term
|
Definition
*Deposits of fat cause liver enlargement
*Strict abstinence can lead to a full recovery
Reversible stage if patient abstains from alcohol |
|
|
Term
| Liver Fibrosis: Prognosis |
|
Definition
Scar tissue forms
Recovery is possible but scar tissue remains |
|
|
Term
|
Definition
Growth of connective tissue destroys liver cells
Damage is irreversible |
|
|
Term
|
Definition
Increased pressure in the portal system causes blood to be re-routed to adjoining lower pressure vessels.
This is a shunting of blood that involves collateral vessels. |
|
|
Term
| Result of Portal Hypertension |
|
Definition
Affected veins engorge and congest:
Esophageal varices
Umbilical vein varices: caput medusae
Hemorrhoids
Enlarged superior rectus veins |
|
|
Term
| Portal Hypertension: Pathophysiology |
|
Definition
Hydrostatic pressure in the vessels of the portal system increases:
Capillary pressure pushes fluid out: it has to go somewhere
Ascites formation occurs (fluid shifts) |
|
|
Term
|
Definition
| Beginning stages when body is still trying to compensate for fibrotic blockages (probably not reversible at this point) |
|
|
Term
| Compensated Cirrhosis: S/S |
|
Definition
VAGUE
I FEEL A PISS (*my apologies for using this language!)
I - Indigestion
F - Flatulent dyspepsia
E - Edema: peripheral
E - Erythema: palmar
L - Liver enlargement upon exam
A - Altered bowel function
P - Pain: abdominal
I - Intermittent fevers
S - Spider veins: vascular
S - Splenomegaly |
|
|
Term
|
Definition
Patient is very sick.
Low survival rate: poor prognosis |
|
|
Term
| Decompensated Cirrhosis: S/S |
|
Definition
*Clotting issues: purpura, spontaneous bruising, epistaxis
*Jaundice
*Ascites
*Nutritionally compromised: weight loss, weakness, muscle wasting
*Circulation issues: clubbing of fingers, white nails
*Mild fevers
*Hypotension
*Liver decreases in size
*Gonadal atrophy
*Sparse body hair
*Fetor hepaticus
*LOC changes
*Renal failure |
|
|
Term
|
Definition
Liver flap
Can't control hands |
|
|
Term
|
Definition
| The inability to draw or construct simple configurations |
|
|
Term
| Cirrhosis: Diagnostic Findings |
|
Definition
Elevated labs:
*Alkaline phosphatase
*LFTs
*Bilirubin
*Ammonia
*Prolonged prothrombin time (elevated)
Blood dyscrasias
Electrolyte imbalances |
|
|
Term
|
Definition
Breath of the dead
Foul-smelling breath r/t high ammonia levels |
|
|
Term
|
Definition
| Aspiration of fluid from abdominal cavity |
|
|
Term
| Therapeutic benefit of paracentesis |
|
Definition
Relieves ascites that doesn't respond to diuretic therapy
May withdraw fluid in moderate amounts
Large volume withdrawal: be careful, if you take off more than 4-6 liters at one time you may get hypovolemia
(May administer albumin by IV during a large-volume procedure) |
|
|
Term
|
Definition
1. Verify informed consent (invasive procedure)
2. Describe procedure
3. Weight and measure abdominal girth prior to procedure
4. Assess baseline VS
5. Have patient VOID immediately prior to procedure
6. Position: seated, either on side of bed or in a chair with feet supported. |
|
|
Term
| Liver Trauma Clinical Manifestations |
|
Definition
METER BATHH
M - muscle rigidity/spasms
E - elevated temp
T - tachycardia
E - elevated leukocytes
R - rebound tenderness
B - bowel sounds: absent or decreased
A - Abdominal pain
T - tachypnea
H - Hypotension
H - hemoglobin/hematocrit: decreased |
|
|
Term
| Pancreas Endocrine Function |
|
Definition
Secrete glucagon
Secrete insulin |
|
|
Term
| Pancreas Exocrine Function |
|
Definition
Produce digestive enzymes
Produce alkaline fluid
Produce fluid rich in proteins and electrolytes |
|
|
Term
|
Definition
| Inflammation of the pancreas with auto-digestion |
|
|
Term
| Auto-digestion of pancreas |
|
Definition
Release of pancreatic enzymes into the tissue of the pancreas itself leading to:
Hemorrhage
Necrosis |
|
|
Term
|
Definition
Spontaneous and more correctable
Milder form of acute:
* Inflammation
* Edema of pancreatic tissue
* Self-limiting |
|
|
Term
|
Definition
More severe form of acute:
Inflammation
Hemorrhage
Death of tissue |
|
|
Term
|
Definition
Pain
N/V
Fever
Jaundice
Turner's sign
Cullen's sign
Left pleural effusion
Respiratory distress
Hypotension
Shock
DIC
Renal failure |
|
|
Term
|
Definition
Longer illness; patient is sicker
Continual inflammation
Fibrosis
Gradual destruction of functional pancreatic tissue
Irreversible process leading to pancreatic insufficiency |
|
|
Term
| Chronic pancreatitis: Clinical Manifestations |
|
Definition
Severe upper abdominal pain
** May be left upper pain that radiates to the back
N/V
Weight loss
Steatorrhea |
|
|
Term
| Chronic pancreatitis: Labs/Diagnostics |
|
Definition
Serum amylase and WBC may NOT be significantly elevated
Hyperglycemia
ERCP most useful diagnostic study
CT scan
Ultrasound |
|
|
Term
| Chronic pancreatitis: Treatment |
|
Definition
NO alcohol
Pain control
Low-fat diet
Insulin therapy
Consistent calorie diet
Exogenous pancreatic enzymes
Surgery |
|
|
Term
Common causes of pancreatitis
(www.acutepancreatitis.org) |
|
Definition
GET SMASHHHED
G - gallstones
E - ethanol (ETOH)
T - Trauma to pancreas
S - Steroid use
M - mumps
A - autoimmune
S - scorpion sting (venom)
H - hypercalcemia
H - hyperlipidemia
H - hypothermia
E - ERCP
D - Drugs |
|
|
Term
Pancreatitis: Etiology and Risk Factors
(Ms. Moorman's List) |
|
Definition
Alcoholism
Bacteria
Cystic fibrosis
Drugs
Gallstones
Hereditary pancreatitis
Hypercalcemia
Hyperlipidemia
Ischemia of pancreas
Parasites
Trauma
Viruses |
|
|
Term
| Treatment for acute pancreatitis |
|
Definition
No alcohol
Choleycystectomy: remove the gallbladder
NPO
NG tube: if there is a lot of drainage
Suppress pancreatic exocrine function
Re-introduce clear liquids after pain is resolved
Bed rest |
|
|
Term
| Patient support for pancreatitis |
|
Definition
Pain relief: IV morphine
F/E balance
Nutritional support: possibly TPN
Insulin administration for hyperglycemia
Pancrease: pancreatic enzyme replacement |
|
|
Term
| Hepatitis strains caused by an RNA virus |
|
Definition
|
|
Term
| Hepatitis strains caused by a DNA virus |
|
Definition
|
|
Term
|
Definition
15-50 days (average 30)
[Text says 2-6 weeks] |
|
|
Term
|
Definition
1-6 months
[Text says 6-24 weeks] |
|
|
Term
|
Definition
15-160 days
[Text says 5-12 weeks] |
|
|
Term
|
Definition
|
|
Term
| Hepatitis B and C: Duration |
|
Definition
|
|
Term
|
Definition
Usually a full recovery
Active immunity |
|
|
Term
|
Definition
1-10% mortality
Increased risk:
Liver cancer
Cirrhosis
Active immunity OR may become a carrier |
|
|
Term
|
Definition
Only 15% resolve
Most become chronic active hepatitis state
Increased risk:
Liver cancer
Cirrhosis
NO immunity: increased chronic carrier state |
|
|
Term
|
Definition
Vaccine
Immune globulins
HANDWASHING |
|
|
Term
|
Definition
Vaccine
Immune globulins
Universal precautions
NO sharing: personal hygiene items
Condom use
Autologous blood use (in transfusions, blood products)
Donor screening |
|
|
Term
|
Definition
Latex condoms may reduce transmission
Get vaccines for other two strains |
|
|
Term
| Hepatitis A: Manifestations |
|
Definition
Anorexia: often the first symptom
Vague: mild, flu-like
Low-grade fever
Fatigue, malaise
Dyspepsia
Headache
Aversion to strong odors
Jaundice
Hepatomegaly/splenomegaly with tenderness |
|
|
Term
| Hepatitis B: Manifestations |
|
Definition
Prodromal period:
Urticaria/rashes
Arthralgias
Serum sickness
Glomerularnephritis
Actual disease may be asymptomatic |
|
|
Term
| Hepatitis C: Manifestations |
|
Definition
Usually asymptomatic
If symptoms: mild and nonspecific
Often recognized long after exposure |
|
|
Term
| Hepatitis A: Medical management |
|
Definition
Reduce: fatigue and pruritis, and N/V
Lots of rest!!
Light, frequent meals: maintain nutrition
F/E balance
AVOID tylenol, ETOH |
|
|
Term
| Hepatitis B: Medical management |
|
Definition
Evaluation for liver disease every 6-12 months
Antiviral medications, Alpha interferon
Avoid tylenol, ETOH |
|
|
Term
| Hepatitis C: Medical management |
|
Definition
NO benefits from rest/diet
*Ribavirin
*Interferon
Avoid tylenol, ETOH |
|
|
Term
| Hepatitis A: Transmission |
|
Definition
|
|
Term
| Hepatitis B: Transmission |
|
Definition
Blood
Body fluids
High risk:
*IV drug users
*Multiple sexual partners
*Male/male sexual activity
*Healthcare workers |
|
|
Term
| Hepatitis C: Transmission |
|
Definition
Blood/body fluids
Primary risk factor: IV drug use (50% of ALL new infections)
Tattoos, piercings
Not usually transmitted through sexual activity |
|
|
Term
|
Definition
Given for Hepatic Encephalopathy
Binds with excess ammonia and can be excreted in the stool |
|
|
