Term
| What does Cholestasis represent? |
|
Definition
| A decrease in bile flow through intrahepatic canaliculi and a decreased secretion of water, bilirubin and bile acids by the hepatocytes. |
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|
Term
| Cholestasis caused by intrinsic liver disease is called what? |
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Definition
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Term
| Cholestasis caused by obstruction of the large bile ducts is called what? |
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Definition
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Term
| What is common to all types of cholestasis? |
|
Definition
| accumulation of bile pigment in the liver (goes out to blood). |
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Term
| What is the most common symptom of cholestasis and what is it caused by? |
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Definition
| Pruritis (itching) b/c of increased bile acids in blood |
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Term
| Jaundice is also called _________ and results from what? |
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Definition
| Icterus, an abnormally HIGH accumulation of bilirubin in the blood causes the yellowing |
|
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Term
| What is usually the first structure in which jaundice can be seen? |
|
Definition
| the eye (see yellow sclera) |
|
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Term
| List the 4 major causes of jaundice: |
|
Definition
1. Excessive destruction of RBC's (sickle cell, hemolytic disease of newborn)
2. Impaired Uptake of bilirubin by the liver cells (Hepatitis, Cirrhosis, Cancer of the Liver)
3. Decreased conjugation of bilirubin
4. Obstruction of bile flow in hepatic lobules or bile ducts |
|
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Term
| What is the major cause of prehepatic jaundice? |
|
Definition
| Excessive Hemolysis of RBC's |
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Term
| What causes intrahepatic jaundice? |
|
Definition
Inability of the liver to remove bilirubin from blood or conjugate it for removal of bile.
Hepatitis, Cirrhosis & Cancer are common causes of this type. |
|
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Term
| What causes posthepatic jaundice? |
|
Definition
Obstruction of bile flow between liver & intestine.
Cholelithiasis is a common cause of this type. |
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Term
| What is the incubation period for Hepatitis A? |
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Definition
|
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Term
| Think back to the "infection" content - Can a person with Hep A transmit it during the incubation period? |
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Definition
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Term
| The longer the incubation period is, the more likely the disease is to be transmitted because the person doesn't know he/she has the disease. True or False? |
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Definition
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Term
| If you were reviewing a patient's lab work and found that htere was IgM-anti HAV in the blood, what would this mean? |
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Definition
| Onset is less then 6 months previous |
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Term
| List the signs & symptoms of HAV infection: |
|
Definition
| Jaundice, fatigue, abdominal pain, loss of appetite, nausea, diarrhea, fever |
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Term
|
Definition
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Term
| List 5 groups of persons who are at increased risk of HAV infection: |
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Definition
| household contacts (children who are asymptomatic & spread it to home from daycare), traveling abroad in Hep A countries, sex partners, M2M sex, IV and non IV drug users |
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Term
| An 18 mont old child, who goes to a daycare center daily, is diagnosed with Hep A. You are the nurse at the day care center. What records would you check for each child? If a child or staff hadn't been immunized, what would you recommend and why? What education would you provide to the staff and parents of other children? |
|
Definition
Immunization for all d/t liklihood of transmission from that environment. Kids: wash hands often, esp. after bathroom. Don't put toys in your mouth.
Staff: help ensure kids are clean, disinfect play surfaces, report symptoms in kids or themselves |
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Term
| The incubation period for Hep B is what? |
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Definition
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Term
| This patient is tested 3 months after the initial diagnosis and HBsAg, total anti-HBc & HBeAg are present. The results are the same 6 months later. This indicates the patient has ___________ . |
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Definition
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Term
If the patient's lab results were positive for the presence of Anti HBsAg, this would indicate the patient has ____________ immunity to HBV.
This patient should be immunized for HBV? |
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Definition
protective (long lasting)
False |
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Term
| Many of the s & s are the same for HAV & HBV. In addition to those you listed for HAV, what are the signs of HBV? |
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Definition
| vomiting, joint pain, may or may not have fever |
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Term
| Describe how HBV is transmitted: |
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Definition
| unprotected sex, sharing needles, needlestick or job-related exposeure. Also, from mother to infant. |
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Term
| What groups of persons are at high risk for contracting HBV? |
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Definition
| persons w/ multiple sex partners or STD, M2M sex, IV drug users, household contacts, infants with HBV positive mothers, infants from overseas high areas of infection, health care and public safety, hemodialysis patients |
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Term
| A person with HBV infection might also be at risk for what? |
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Definition
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Term
| What is the best protection against HBV? |
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Definition
|
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Term
| What precautions should health care workers take to prevent infection? |
|
Definition
| HBV vaccination, barrier precautions, safe sharp's handling |
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Term
| What is the incubation period for Hep C? |
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Definition
|
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Term
|
Definition
| presence of anti-HCV in blood AND acute rise in Alanine Amino Transferase (ALT) |
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Term
| Does the presence of antibodies to HCV indicate that the person is now immune to HCV? |
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Definition
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Term
| The S & S for HCV are the same as Hep A, but include ______________. |
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Definition
|
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Term
| Do 55-85% of persons infected with HCV develop chronic HCV? |
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Definition
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|
Term
| HCV is transmitted in the same way as _________ . |
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Definition
| HBV (unprotected sex, sharing needles, needle stick or job-related exposure, mother to infant) |
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Term
| The persons at high risk for HCV are the same as those at risk for ______. |
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Definition
| HBV (persons with multiple sex partners or STD, M2M sex, IV drug users, household contacts, infants with HBV positive moms, infants from overseas high areas of infection, health care and public safety, hemodialysis patients) |
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Term
| What precautions should health care workers take to protect themselves from HCV? |
|
Definition
| HBV Vaccine, barrier precautions |
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Term
| Hep D has the same S & S as Hep A. There are a couple to add, what are they? |
|
Definition
| vomiting, joint pain, dark urine |
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Term
| In what ways can HDV be acquired? |
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Definition
| Unprotected sex, sharing needles |
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Term
| What are the effects of HBV - HDV co-infection? |
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Definition
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Term
| What are the effects of HBV - HDV superinfection? |
|
Definition
| Cirrhosis (final stage in chronic liver failure) |
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Term
| HDV is transmitted the same way as _____. |
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Definition
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Term
| Hep B vaccination is recommended to prevent Hep D. This seems a little strange until you think about it some. If a person is immune to HBV, they won't get HBD b/c it only occurs as a coinfection or superinfection with Hep B. Would it also be true that person who has adequate levels of anti HBsAg wouldn't get HDV? |
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Definition
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Term
| Hep E (HEV) are the same as HAV with the addition of what? |
|
Definition
| vomiting, dark (tea colored) urine |
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Term
| HEV is transmitted in the same way as ________ . |
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Definition
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Term
| Is Hep E uncommon in the U.S.? |
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Definition
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Term
| In cirrhosis (end stage of chronic liver disease) much of the functional liver tissue has been replaced by ______________. |
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Definition
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Term
| Normal Liver architecture has been converted into ___________________________ . |
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Definition
| Structurally abnormal nodules |
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Term
| Fibrous bands resulting in cirrhosis disrupt flow in ________________ channels and _____________systems of the liver. |
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Definition
| vascular channels & biliary duct systems |
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Term
| The disruption of flow happening in cirrhosis to the liver will predispose the body to what? |
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Definition
| portal hypertension -> obstruction of biliary channels + exposure to bilestasis & loss of liver cells -> liver failure |
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Term
| What are the manifestations of cirrhosis? |
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Definition
| wt. loss, weakness, anorexia, constipation, abdominal pain (dull and aching epigastric or upper rt. quadrant) and jaundice (usually happens in late stages) |
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Term
| Portal Hypertension is characterized by: |
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Definition
| Increased resistance to flow in portal venous system and sustained portal vein pressure about 22 mmHg. |
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Term
| Prehepatic obstruction is caused by conditions such as: _______________, ______________ and ___________________ that produce obstruction of portal vein when? |
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Definition
| portal veinthrombosis, cancer (causing external compression) & enlarged lymph nodes. These are make obstructions of portal vein before it enters the LIVER! |
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Term
| Posthepatic obstruction is obstruction of hepatic veins beyond the liver & can be caused by what? |
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Definition
| thrombosis of hepatic veins, veno occlusive disease, severe right sided heart failure |
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Term
| Intrahepatic obstruction occurs within the liver & is most commonly caused by _____________. |
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Definition
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Term
|
Definition
| Increased peritoneal cavity fluid |
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Term
| Factors that seem to contribute to ascites are INCREASED capillary pressure due to portal hypertension & obstruction of venous flow through the liver and ________ & ________ retention by the kidney. |
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Definition
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Term
| Though ascites (increased peritoneal fluid) increases capillary pressure. What do they do to colloidal osmotic pressure which limits reabsorption of fluid? |
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Definition
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|
Term
| Why does the spleen enlarge? |
|
Definition
| shunting of blood into the splenic vein |
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Term
| Hypersplenism leads to... ? |
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Definition
| anemia, throbocytopenia, leukopenia (decreases the lifespan of all formed elements of blood) |
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Term
| Increased pressure in the portal vein causes large channels to develop between the portal & systemic veins. Dilation of veins that supply the lower rectum cause _____________ . |
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Definition
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Term
| Cirrhosis causes Portostemic Shunts. Inspection of the abdomen would reveal _______________ around the umbilicus. Channels develop that reverse the flow between the portal & coronary veins that causes the development of ______________________ that can rupture, producing massive hemorrhage (this is the most important). |
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Definition
| dilated veins (caput medusae), esophageal varices |
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Term
| The liver regulates blood glucose levels. If the liver cannot metabolize nutrients, _____________ will occur. Impaired protein matebolism leads to hypoalbuminemia causing _________ & ________. |
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Definition
hypoglycemia
edema & ascites |
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Term
| Clotting factors, prothrombonin & fibrinogen are synthesized in the liver & Vitamin K is absorbed. Deficiencies of these (happens during liver failure) lead to ____________ that causes bruising, hematuria & GI bleeding. |
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Definition
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|
Term
| Ammonia is a neurotoxin. It is the by product of protein & amino acid metabolism. If the liver cannot convert ammonia to urea, hepatic ____________ may result with neural disturbances ranging from lack of alertness to confusion, coma & convulsions. |
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Definition
encephalopathy
basically, toxic substances normally removed by the liver accumulate in the blood and impair the function of brain cells. |
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Term
| The liver metabolizes steroid hormones (aldosterone, androgens & estrogens). Increased levels of aldosterone promote sodium retention by the kidney & increase urinary loss of potassium cuasing ________ & _________. |
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Definition
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|
Term
| What do increased androgens produce in men? and in women? |
|
Definition
gynecomastia & testicular atrophy in men
menstrual irregularities in women |
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Term
| because of the liver's descreased ability to metabolize drugs, nurses administering medications to patients in liver failure must be aware of the potential for what? |
|
Definition
| drug interactions & toxicities are a risk to a patient with liver failure |
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Term
| Jaundice is often a late manifestation of chronic liver failure and is caused by what? |
|
Definition
| hyperbilirubinea (too much bilirubin excreted by bile causes yellowing) -> is jaundice |
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Term
| What etiologic agents have been identified as causes of primary liver cancer? |
|
Definition
| chronic viral hepatitis (B,C & D) cirrhosis, long-term exposure to aflatoxin in environment & drinking water with arsenic. |
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Term
| What are the most common site (sources) of metastatic liver cancer? |
|
Definition
| lungs & portal lymph nodes |
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|
Term
| What is Cholelithiasis and what is it caused by? |
|
Definition
the presence gallstones in the bladder
precipitation of substances in bile, usually cholesterol & bile |
|
|
Term
| What 3 factors contribute to the formation of gallstones & what do they cause the liver to do? |
|
Definition
gallstones form b/c of: abnormalities in the composition of bile, stasis of bile & inflammation of the gallbladder.
They cause excess excretion of cholesterol into the bile. |
|
|
Term
| What are the risk factors for Cholelithiasis (gallstones)? |
|
Definition
Sex: FEMALE
Weight: OBESE
Pregnancies: MULTIPLE
Contraception: ORAL
Medications: CHOLESTEROL LOWERING (Clofibrate) |
|
|
Term
| What are the symptoms of gallstones & when do they occur? |
|
Definition
| Indigestion & pain in UR quadrant. Abrupt 30-60 min peak, 2-8 hour duration |
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|
Term
| Both acute & chronic cholecystitis (inflammation of the gallbladder) are associated with _________________ . |
|
Definition
| cholelithiasis (gallstones) |
|
|
Term
| What can precipitate the manifestations of Choleystitis (inflammation of the gallbladder) and Cholelithiasis (gallstones)? |
|
Definition
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|
Term
Severe pain is a symptom of acute cholecystitis. Where is the pain located?
What are 2 other common manifestations? |
|
Definition
UR quadrant, rt subcostal region
vomiting (75%) and jaundice (25%) |
|
|
Term
| What are the manifestations of chronic cholecystitis? (inflammation of the gallbladder) |
|
Definition
| Intolerance of fatty foods, belching, colicy pain |
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|
Term
| Acute pancreatitis is associated with escape of __________________________ into the _________ & ________________. |
|
Definition
| ACTIVATED PANCREATIC ENZYMES escape into the PANCREAS & SURROUNDING TISSUES. |
|
|
Term
| What does the escape of pancreatic enzymes cause? |
|
Definition
| fat necrosis or auto digestion of pancreas, abdominal fatty deposits d/t hemorrhage of necrotic vessels |
|
|
Term
| What are the 2 most common causes of acute pancreatitis? |
|
Definition
| gallstones or alcohol abuse |
|
|
Term
| The onset of acute pancreatitis is usually abrupt & may follow a __________ or ___________. |
|
Definition
| heavy meal or alcoholic binge |
|
|
Term
| What are some of the manifestations and symptoms you will see with acute pancreatitis? |
|
Definition
Most common initial symptom is PAIN. It RADIATES TO THE BACK.
will be ABDOMEN DISTENSION & HYPOACTIVE (underactive) BOWELS
Loss of large amounts of fluid too. will discuss more on the next card... |
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|
Term
| An important disturbance related to acute pancreatitis is the loss of large volumes of fluid. Where does the fluid go & what does it cause? |
|
Definition
| Large amounts of fluid lost go to the retroperitoneal & peripancreatic spaces, causes tachycardia, hypotension & cool/clammy skin. |
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|
Term
| Chronic pancreatitis is characterized by what? |
|
Definition
| progressive destruction of the pancreas |
|
|
Term
| Chronic calcifying pancreatitis is seen most often in _____________ . |
|
Definition
|
|
Term
| What are the manifestations of chronic pancreatitis? |
|
Definition
| persistent, recurring UL quadrant pain following alcohol abuse or overeating |
|
|
Term
| Eventually, chronic pancreatitis progresses to the extent that both endocrine & exocrine functions in the pancreas become impaired. What are the manifestations when this occurs? |
|
Definition
| Diabetes Mellitus and the Malabsorption Syndrome (wt. loss & fatty stools) |
|
|
Term
| Why does cancer of the pancreas have such a poor prognosis for survival? |
|
Definition
| Most have metastasized prior to diagnosis |
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