Hepatic and Endoscopic Procedures Overview
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Questions and Answers

A patient with cirrhosis develops ascites. What dietary modification is most appropriate for managing this condition?

  • Low-carbohydrate, high-sodium diet
  • Low-protein, high-sodium diet
  • High-carbohydrate, low-sodium diet (correct)
  • High-protein, high-sodium diet

    • Which intervention is most important to include in the plan of care for a patient undergoing paracentesis to treat ascites?

  • Administer a Fleet enema prior to the procedure.
  • Ensure the patient voids immediately before the procedure. (correct)
  • Restrict fluids for 24 hours post-procedure.
  • Position the patient supine during the procedure.

    • A patient with hepatic encephalopathy is prescribed lactulose. What indicates that the medication is having the desired therapeutic effect?

  • Increased serum ammonia levels and increased bowel movements.
  • Increased serum ammonia levels and decreased bowel movements.
  • Decreased serum ammonia levels and increased bowel movements. (correct)
  • Decreased serum ammonia levels and decreased bowel movements.

    • A nurse is caring for a patient with bleeding esophageal varices. Which intervention is the priority?

    <p>Managing the patient's airway (D)</p> Signup and view all the answers

    What assessment finding is most indicative of hepatic encephalopathy?

    <p>Asterixis. (B)</p> Signup and view all the answers

    Which laboratory finding is most consistent with a diagnosis of hepatorenal syndrome?

    <p>Elevated urea and creatinine. (D)</p> Signup and view all the answers

    A patient in the acute phase of hepatitis reports loss of appetite and fatigue. What nursing intervention is most appropriate?

    <p>Provide frequent rest periods and antiemetics as needed. (C)</p> Signup and view all the answers

    A patient with cirrhosis is at risk for developing esophageal varices. What should the nurse include in the patient's education to prevent this complication?

    <p>Avoid alcohol and NSAIDs. (D)</p> Signup and view all the answers

    A patient with cirrhosis presents with increased abdominal girth, dyspnea, and lower extremity edema. Which of the following interventions would be most appropriate?

    <p>Elevating the head of the bed and administering diuretics. (C)</p> Signup and view all the answers

    A patient with a history of cirrhosis is admitted with hematemesis and melena. Which of the following interventions is the highest priority?

    <p>Monitoring vital signs and initiating intravenous access. (C)</p> Signup and view all the answers

    Which laboratory finding is most indicative of acute pancreatitis?

    <p>Increased serum lipase (D)</p> Signup and view all the answers

    A patient with cirrhosis develops ascites. What is the primary pathophysiological mechanism contributing to this condition?

    <p>Decreased oncotic pressure due to impaired albumin synthesis (A)</p> Signup and view all the answers

    Following a laparoscopic cholecystectomy, a patient reports shoulder pain. What is the most likely cause of this pain?

    <p>Referred pain from gas used to inflate the abdomen during surgery (A)</p> Signup and view all the answers

    Which dietary modification is most appropriate for a patient with chronic pancreatitis to manage steatorrhea?

    <p>Low-fat diet (C)</p> Signup and view all the answers

    A patient with advanced cirrhosis exhibits asterixis. What physiological process explains this manifestation?

    <p>Accumulation of toxins in the brain due to liver dysfunction (A)</p> Signup and view all the answers

    Which of the following instructions is most important to include in the discharge teaching for a patient following a cholecystectomy?

    <p>Report any signs of infection at the incision site. (C)</p> Signup and view all the answers

    What is the primary rationale for placing a patient with acute pancreatitis on NPO status?

    <p>To reduce stimulation of pancreatic enzyme secretion (D)</p> Signup and view all the answers

    A patient with cirrhosis has developed esophageal varices. Which medication is typically prescribed to reduce the risk of variceal bleeding?

    <p>Octreotide (D)</p> Signup and view all the answers

    What is the significance of Cullen’s sign in a patient with acute pancreatitis?

    <p>Suggests retroperitoneal hemorrhage (B)</p> Signup and view all the answers

    Which of the following is a key difference between acute and chronic pancreatitis?

    <p>Acute pancreatitis is a reversible process, while chronic pancreatitis results in permanent damage. (C)</p> Signup and view all the answers

    A patient is scheduled for an ERCP. Which allergy is most important for the nurse to assess prior to the procedure?

    <p>Iodine (D)</p> Signup and view all the answers

    In the management of hepatic encephalopathy, what is the primary purpose of administering lactulose?

    <p>To decrease ammonia levels in the blood (A)</p> Signup and view all the answers

    A patient with cholelithiasis presents with jaundice and dark, tea-colored urine. What does this indicate?

    <p>Gallstone obstruction of the common bile duct (B)</p> Signup and view all the answers

    What is the most appropriate initial intervention for a patient experiencing biliary colic due to cholelithiasis?

    <p>Administer an opioid analgesic for pain relief (B)</p> Signup and view all the answers

    Why are patients with cirrhosis at increased risk for bleeding?

    <p>Impaired synthesis of clotting factors by the liver (C)</p> Signup and view all the answers

    Flashcards

    Portal Hypertension

    Increased venous pressure in portal circulation, leading to complications like varices.

    Esophageal Varices

    Dilated veins in the lower esophagus, risking life-threatening bleeding.

    Hepatic Encephalopathy

    Neuropsychiatric changes due to elevated ammonia levels in the blood.

    Ascites

    Fluid accumulation in the abdominal cavity, often due to liver disease.

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    Lactulose

    A medication that reduces serum ammonia by increasing bowel movements.

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    Hepatorenal Syndrome

    A serious complication of liver cirrhosis causing functional renal failure.

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    Diet for Ascites

    Low sodium, high carb diet to manage fluid retention.

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    Asterixis

    A flapping tremor in hands indicating liver disease or metabolic issues.

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    Hepatitis Symptoms

    Include malaise, fatigue, nausea, and abdominal discomfort during the acute phase.

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    Diagnostic Studies for Hepatitis

    Utilize blood tests to check liver enzymes and bilirubin levels.

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    Comprehensive Metabolic Panel

    A blood test measuring various substances, including electrolytes and liver enzymes.

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    Liver Function Tests

    Tests to assess liver health, measuring substances like AST and bilirubin.

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    Cholelithiasis

    The presence of stones in the gallbladder, often asymptomatic.

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    Cholecystectomy

    Surgical removal of the gallbladder, performed laparoscopically or open.

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    Pancreatitis

    Inflammation of the pancreas, often due to alcohol or gallstones.

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    Acute Pancreatitis Symptoms

    Severe abdominal pain, jaundice, and signs of shock.

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    Chronic Pancreatitis Management

    Requires dietary changes, enzyme replacement, and pain management.

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    Cirrhosis

    Chronic liver disease characterized by extensive scarring and loss of function.

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    Cirrhosis Early Manifestations

    Symptoms include GI disturbances, abdominal pain, and fatigue.

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    Gallbladder Disease Risk Factors

    Includes obesity, female gender, and a high-fat diet.

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    Liver Biopsy

    Procedure to obtain liver tissue for examination.

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    ERCP

    Endoscopic procedure to diagnose and treat biliary and pancreatic disorders.

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    Post-Procedure Care

    Monitoring vital signs and complications after a procedure.

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    Pancrelipase

    Pancreatic enzyme replacement therapy for digestion.

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    Jaundice

    Yellowing of the skin and eyes due to high bilirubin levels.

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    Study Notes

    Hepatic Diagnostic Tests

    • Comprehensive metabolic panel: Albumin, Total Bilirubin, Chloride, Potassium, Alkaline phosphatase, Creatinine/BUN, Sodium, ALT/AST, CO2, Glucose, Total Protein
    • Liver function tests: Total bilirubin, AST, A/G ratio, LDH, GGT, Albumin
    • Hepatitis panel: Hepatitis A, AB, Hepatitis B antibody, IgM, Hepatitis B surface antigen, Hepatitis C, AB

    Endoscopic Procedures

    • ERCP: Endoscopic retrograde cholangiopancreatography
    • Liver biopsy: Examination of liver tissue

    Pre-procedure Care

    • Bowel prep: NPO (nothing by mouth), cleansing laxative, enema
    • Allergies/sensitivities: Iodine
    • Consent form
    • IV access

    Post-procedure Care

    • NPO until gag reflex returns (or bowel sounds return, up to 24 hours)
    • Monitor vital signs (every 15 minutes for first hour, every 30 minutes for next hour, then hourly for 2 hours)
    • Assess for complications: Bleeding, infection, respiratory depression

    Cholelithiasis (Gallstones)

    • Stones in the gallbladder
    • Most common biliary disorder
    • Stones not always requiring removal
    • Types: Pigment stones (10-25%), Cholesterol stones
    • Risk factors: Obesity, female gender, high-fat diet, genetics, age, diabetes ("Fat, Forty, Female")
    • Symptoms: Pain, biliary colic, jaundice, itching (pruritis), dark urine, light-colored stools, vitamin deficiencies, pain under rib cage, referred scapular pain
    • Diagnostics: Ultrasound (rapid and accurate), abdominal X-ray (rarely shows stones), ERCP
    • Blood tests: Increased WBCs, bilirubin, AST, LDH, ALP, cholesterol (>200 mg/dL)
    • Treatment: Cholecystectomy (gallbladder removal), dietary modifications (low-fat, low-cholesterol)
    • Nursing care: Encourage ambulation to reduce gas, cough/deep breathing exercises, monitor and teach patient about potential complications after surgery.

    Cholecystitis

    • Inflammation of the gallbladder
    • Often associated with cholelithiasis
    • Possible medication/diet-induced
    • Treatment: Cholecystectomy

    Acute Pancreatitis

    • Inflammation of the pancreas
    • Common causes: Alcohol abuse (men), gallstones (women)
    • Self-digestion of the pancreas
    • Other causes: Alcohol abuse, biliary tract disease, bacterial/viral infection, trauma, drug toxicity, smoking, idiopathic (unknown cause)
    • Symptoms: Abdominal pain (severe, deep, piercing, epigastric/LUQ, radiating to back), fever, jaundice, hypotension, tachycardia, dyspnea, increased respiratory rate, crackles, Turner's sign (flank discoloration), Cullen's sign (periumbilical discoloration), worsened by food, dry skin, intravascular damage, decreased/absent bowel sounds, shock
    • Management: Prevent shock, reduce pancreatic secretions (NG tube, NPO), correct fluid/electrolyte imbalances, treat underlying cause, IV fluids/antibiotics, NPO initially then clear liquids/bland foods, small frequent meals (5-6x/day), high-carb, low-fat diet, no medications by mouth (PO)
    • Diagnostics: Increased serum/urine amylase, increased serum lipase, decreased serum calcium, increased serum bilirubin, increased WBCs, increased blood glucose
    • Procedures: CT scan, ERCP, abdominal ultrasound

    Chronic Pancreatitis

    • Progressive, inflammatory damage to the pancreas
    • Causes: Alcohol abuse, gallstones, pseudocysts, previous acute pancreatitis
    • Symptoms: Abdominal pain (dull, achy), steatorrhea (fatty stools), distinct stool odor, episodic nausea/vomiting, weight loss
    • Diagnostics: ERCP, MRI, CT, ultrasound
    • Management: Non-opioid pain relievers, pancreatic enzyme replacement, H2 or PPI (proton pump inhibitors), dietary modifications (no alcohol/smoking, bland low-fat diet, small frequent meals), surgical intervention if biliary disease/obstruction/pseudocyst
    • Pancreatic enzyme products: Pancrelipase (e.g., Pancreas, Riqase) - replace pancreatic enzymes, take with meals/snacks
    • Potential side effects: Nausea, diarrhea, abdominal cramps
    • Nursing management: Chronic care and health management, antacids, no alcohol, report symptom changes, maintain diet diary

    Cirrhosis

    • Chronic, progressive liver disease with extensive parenchymal cell destruction and scarring
    • Causes: Alcohol abuse, non-alcoholic fatty liver disease, malnutrition, hepatitis
    • Early symptoms: GI disturbances, abdominal pain, fatigue, enlarged liver/spleen
    • Advanced symptoms: Hepatic encephalopathy, peripheral neuropathy, asterixis (flapping tremor), jaundice, spider angiomas, palmar erythema, purpura, petechiae, caput medusae (veins on abdomen), anemia, thrombocytopenia, coagulation disorders, splenomegaly, hypokalemia, hyponatremia, hypoalbuminemia, fluid retention, ascites, anorexia, dyspepsia, nausea/vomiting, bowel changes, esophageal/gastric varices, hematemesis, hemorrhoidal varices, amenorrhea, testicular atrophy, gynecomastia, impotence
    • Common complications: Portal hypertension, esophageal/gastric varices, peripheral edema, ascites, splenomegaly, hepatic encephalopathy, hepatorenal syndrome
    • Collaborative care: B-complex vitamins, avoid alcohol/aspirin/NSAIDs, manage ascites (diuretics, paracentesis), prevent/manage esophageal varices/encephalopathy
    • Nutrition (no complications): High calorie, high carbohydrate, low-fat, moderate protein diet
    • Nutrition (ascites/edema): Low sodium

    Lactulose

    • Action: Inhibits intestinal ammonia production
    • Expected outcome: Decreased serum ammonia, improved mentation, increased bowel movements
    • Side effects: Diarrhea, increased bowel sounds, flatulence, bloating
    • Note: Ammonia excretion in stool, do not stop dose.

    Esophageal Varices

    • Dilated veins in the lower esophagus
    • Life-threatening complication of cirrhosis, leading to bleeding if rupture
    • Treatment: Stabilize patient, airway management, IV fluids, 1:1 care, balloon tamponade (NG suction, semi-Fowler's position)

    Ascites

    • Fluid accumulation in the abdomen
    • Management: Daily weights, abdominal girth measurements, high carbohydrate, low sodium diet (<2 g/day), diuretics, paracentesis, peritoneovenous shunt (less common)

    Hepatorenal Syndrome

    • Serious cirrhosis complication leading to functional renal failure (azotemia and oliguria)
    • Difficult to treat

    Hepatic Encephalopathy

    • Neuropsychiatric condition from elevated serum ammonia levels, can result in: Asterixis and Fector hepaticus (musty breath)
    • Management: Ammonia-lowering therapies (e.g., lactulose, antibiotics, cathartics/enema), patient monitoring

    Hepatitis

    • Inflammation of the liver, often viral (A, B, C, D, E, G)
    • Other causes: Drugs, alcohol, chemicals, autoimmune liver disease, metabolic abnormalities, bacteria
    • Acute phase: Asymptomatic or mild malaise, anorexia, fatigue, nausea, vomiting, abdominal discomfort, headache, low-grade fever, arthralgia, skin rashes
    • Physical exam may reveal: Hepatomegaly, lymphadenopathy, splenomegaly
    • Convalescent phase: Begins as jaundice resolves, lasts weeks to months
    • Chronic phase: Asymptomatic until significant liver disease develops
    • Diagnostics: Physical assessment (tenderness, hepatomegaly, splenomegaly), lab tests (AST, ALT, bilirubin, prothrombin time, hepatitis panel)

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    Description

    This quiz covers essential hepatic diagnostic tests, including metabolic panels and liver function tests, as well as endoscopic procedures like ERCP and liver biopsies. It also addresses pre- and post-procedure care, focusing on patient preparation and monitoring for complications. Test your knowledge of these important medical procedures.

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