Term
What is the maximum volume that should be removed during a paracentesis of ascites? How much weight loss does that yield?
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Definition
| Not to exceed 1 L/day, weight loss of 0.5 to 1 kg. |
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Term
How much albumin is lost with 1L of ascites?
How much albumin do we replace? |
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Definition
1L of ascites contains 10 grams of albumin.
Each liter of ascites removed must be replaced by 50 ml of 25% albumin. |
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Term
| What is hepatobiliary disease usually associated with? |
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Definition
| Stones that block the flow of bile. Blockage can result in bile backup into the liver producing jaundice. Other causes are strictures and tumors. |
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Term
| What are the presenting s/s of patients with hepaobiliary disease? |
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Definition
| Jaundice, dark urine, pale stools, and pruritis. |
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Term
What is the treatment for hepatobiliary disease if the cause is stones?
What is the obstruction is in the liver? |
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Definition
| Surgical, unless the obstruction is in the liver, then it is usually medically managed. |
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Term
| What are the symptoms of gallstones? |
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Definition
| Sudden RUQ pain, fever, elevated WBC. |
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Term
| If gallstones pass out of the gall badder, where might they end up? |
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Definition
| They may pass through the common duct, producing jaundice, or they can obstruct the pancreatic duct. |
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Term
Acalculus cholecystitis can also occur. In what pt populations is this common?
Is this type more or less severe? |
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Definition
Common in ICU pts and preggers.
This is more severe. |
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Term
| A patient that has stones preventing the passage of bile into the guts may have an elevated PT. Why? |
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Definition
| The inability of bile to pass into the intestines results in a vitamin K deficiency. |
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Term
| What types of drugs cause sphincter of Oddi spasms? How do you treat it? |
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Definition
Narcotics, with morphine maybe being the worst.
Treatment: Narcan, glucagon, nitroglycerine, atropin/glycopyrolate |
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Term
| If a drug is excreted through the bile, what impact will biliary obstruction have? |
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Definition
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Term
| What type of pain is protopathic, and what nerve fibers carry it? |
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Definition
| Noxious, transmitted by high-threshold receptors and conducted by smaller, lightly myelinated (alpha delta) and unmyelinated C fibers. |
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Term
| What stimulates epicritic pain? |
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Definition
| Non-noxious stimuli--touch, pressure, proprioception, and temperature discrimination. LOW THRESHOLD receptors, conducted by large myelinated nerve fibers. |
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Term
True or false:
Nociceptive pain is due to activation or sensitization of peripheral nociceptors which are specialized receptors that transduce noxious stimuli. |
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Definition
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Term
| Pain as a result of injury or acquired abnormality of peripheral or central neural structures is call ________? |
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Definition
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Term
What is the purpose of nociceptive pain?
What type of pain is acute pain? |
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Definition
To detect, localize, and limit tissue damage.
Acute pain is always nociceptive. |
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Term
| What are the 4 physiologic processes involved in nociceptive pain? |
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Definition
1. Transduction
2. Transmission
3. Modulation
4. Perception |
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Term
| Modulation can either inhibit or facilitate pain. Where can this occur? |
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Definition
| Peripherally at the nociceptor, in the spinal cord, or in the supraspinal structures. |
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Term
| What results in the perception of pain? Where does this occur? |
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Definition
| Third order neurons located in the thalamus, that project to somatosensory areas I and II in the post-central gyrus and superior wall of the sylvian fissure? |
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Term
| What are the 2 types of acute nociceptive pain? |
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Definition
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Term
| Differentiate between superficial and deep somatic pain. |
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Definition
| Superficial comes from the skin, mucous membranes, SQ. Deep is from muscle, tendons, joints, or bones. |
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Term
What causes visceral pain?
How is visceral pain divided? |
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Definition
Visceral pain is due to disease or abnormal function of an organ or its covering, such as pleura, pericardium, or peritoneum.
1. True visceral, driven by the ANS. dull, diffuse, and midline
2. Localized parietal--localized sharp or stabbing
3. Referred parietal--sharp or stabbing pain referred to another site
4. Referred visceral--dull, diffuse pain referred to another site. |
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Term
For each characteristic, state whether this primarily refers to acute or chronic pain.
1. Dependence and tolerance to medication
2. Psychological component
3. Organic cause
4. Environmental contributions and family involvement
5. Insomnia
6. Treatment goal is cure
7. Depression |
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Definition
1. Chronic
2. Chronic
3. Acute
4. Chronic
5. Chronic
6. Acute
7. Chronic |
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Term
| What do many patients consider to be the most frightening aspect of surgery? |
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Definition
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