Hepatic Diagnostic Tests and Biliary Disorders
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Questions and Answers

Which of the following is most commonly associated with inflammation of the gallbladder?

  • Dietary factors
  • Infection
  • Stones (correct)
  • Alcohol abuse

    • What is a potential consequence of chronic pancreatitis?

  • Increased insulin production
  • Increased pancreatic enzyme production
  • Decreased ability to absorb fats (correct)
  • Improved digestive function

    • What is the primary treatment for cholecystitis?

  • Surgical removal of the gallbladder (correct)
  • Pain medication
  • Antibiotics
  • Dietary changes

    • Which of these is a potential risk factor for developing cholelithiasis (gallstones)?

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

    Which of the following is a typical symptom of cholecystitis?

    <p>Sudden onset of abdominal pain (B)</p> Signup and view all the answers

    What is the primary function of the pancreas?

    <p>Producing hormones and digestive enzymes (D)</p> Signup and view all the answers

    Which of the following is a potential complication of chronic pancreatitis?

    <p>Development of pancreatic pseudocysts (C)</p> Signup and view all the answers

    Which of the following is a potential sign of liver disease?

    <p>Jaundice (A)</p> Signup and view all the answers

    What is a common characteristic of chronic pancreatitis?

    <p>Progressive destruction of pancreatic tissue (C)</p> Signup and view all the answers

    What is the primary function of the gallbladder?

    <p>Storing bile (A)</p> Signup and view all the answers

    Which of the following is a potential risk factor for developing pancreatitis?

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

    What is the primary goal of treatment for acute pancreatitis?

    <p>Prevention of complications and relief of symptoms (A)</p> Signup and view all the answers

    Which of the following is a common symptom of pancreatitis?

    <p>Sudden onset of abdominal pain (A)</p> Signup and view all the answers

    What is a common cause of pancreatitis in women?

    <p>Gallstones (C)</p> Signup and view all the answers

    Which of the following is a potential complication of cholecystitis?

    <p>Gangrene of the gallbladder (B)</p> Signup and view all the answers

    What is a potential risk factor for developing pancreatitis?

    <p>Excessive alcohol consumption (D)</p> Signup and view all the answers

    What is a potential risk factor for developing cholelithiasis (gallstones)?

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

    Flashcards

    Hepatitis

    Inflammation of the liver caused by viruses, chemicals, or autoimmune diseases.

    Hepatitis Panel

    A series of blood tests that check for liver inflammation and infections.

    Cholecystectomy

    Surgical procedure to remove the gallbladder.

    Gallstones

    Solid particles that form in the gallbladder, often causing pain.

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    Symptoms of Pancreatitis

    Signs include severe abdominal pain, nausea, and vomiting.

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    Chronic Pancreatitis

    Long-term inflammation of the pancreas leading to changes in its structure.

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    Jaundice

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

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    Signs of Hepatitis

    May include fatigue, jaundice, and abdominal discomfort.

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    Liver Biopsy

    A procedure to remove a small piece of liver tissue for testing.

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    Risk factors for Gallstones

    Include obesity, diabetes, and family history.

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    Immunization for Hepatitis B

    Vaccination to prevent infection from the Hepatitis B virus.

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    Pain Management in Pancreatitis

    Focuses on reducing abdominal discomfort using medications.

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    Liver Enzymes

    Chemicals released into the blood when the liver is damaged.

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    Ascites

    Accumulation of fluid in the abdominal cavity, often due to liver disease.

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    Complications of Hepatitis

    May include liver cirrhosis, liver failure, or liver cancer.

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    Bilirubin

    A substance produced from the breakdown of red blood cells, high levels indicate liver issues.

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    Albumin

    A protein made by the liver, important for maintaining blood volume and pressure.

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    Cholecystectomy indications

    Surgical removal of the gallbladder due to gallstones or inflammation.

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    Pancreatitis

    Inflammation of the pancreas that can lead to severe abdominal pain.

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    Acute Pancreatitis

    A sudden inflammation of the pancreas requiring immediate medical attention.

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    Esophageal Varices

    Enlarged veins in the esophagus, often due to portal hypertension.

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    Hepatitis B transmission

    Spread through contact with infectious body fluids, notably blood.

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    Liver Cirrhosis

    Severe scarring of the liver often due to long-term liver damage.

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    Liver Function Tests (LFTs)

    Blood tests to assess the liver’s performance and detect liver injury.

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    Acamprosate

    A medication used to help maintain abstinence in people recovering from alcohol dependence.

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    Portal Hypertension

    Increased blood pressure in the portal venous system, can cause varices.

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    Study Notes

    Hepatic Diagnostic Tests

    • Comprehensive Metabolic Panel (CMP) includes: Albumin, globulin, total bilirubin, glucose, chloride, total protein, potassium, Alkaline Phosphatase, Calcium, creatinine/BUN, sodium, ALT/AST
    • Liver Function Tests (LFTs) include: Total bilirubin, total protein, AST, ALT, A/G Ratio, LDH, GGT
    • Hepatitis Panel: Hepatitis A, B, and C antibodies/antigens.

    Disorders of the Biliary System

    • Cholelithiasis: Gallstones, the most common biliary disorder. Stones may not always require removal.
    • Cholecystitis: Inflammation of the gallbladder, often associated with gallstones. Can be caused by medication or diet.
    • Cholecystectomy: Surgical removal of the gallbladder. Performed laparoscopically or by open surgery.
    • Pre-procedure care: Bowel prep (NPO, laxatives, enemas). Allergies/sensitivities (iodine). Informed consent. IV access.
    • Post-procedure care: No food or liquid until gag reflex returns. (or until bowel sounds return, up to 24 hours). Vital signs monitored frequently (Q15min x 1hr, Q30min x 1hr, Q1hr x 4h). Monitor for complications: bleeding, infection, respiratory depression.

    Cholelithiasis (Gallstones)

    • Pathophysiology: Pigment stones (10-25%) and cholesterol stones.
    • Risk Factors: Obesity, female gender, high-fat diet, genetics, age, diabetes ("Fat, forty, female").
    • Clinical Manifestations: Biliary colic (pain), jaundice (tea-colored urine, light/clay-colored stools), itching (pruritus), changes in urine/stool color, vitamin deficiencies, pain under rib cage/referred pain to scapula .
    • Diagnosis: Blood chemistry, ultrasound (rapid, accurate), increased WBCs, increased cholesterol (>200 mg/dL), x-ray of abdomen (rarely shows stones). Elevated bilirubin, AST, LDH, ALP. ERCP

    Pancreatitis

    • Acute Pancreatitis: Inflammation of the pancreas, often caused by alcohol abuse in men, or gallstones in women. Other causes include bacterial/viral infections, trauma, drug toxicities, and smoking.
    • Autodigestion: Self-digestion of the pancreas.
    • Diagnostic findings: Increased serum/urine amylase (diagnostic of acute pancreatitis), increased serum lipase, decreased serum calcium, elevated serum bilirubin, increased WBC, increased blood glucose (insulin production impaired).
    • Procedures: CT scan, ERCP, abdominal ultrasound.
    • Clinical manifestations: Abdominal pain (mid-epigastric/LUQ pain radiating to back), nausea/vomiting, fever, jaundice, hypotension/tachycardia, dyspnea, Turner's sign (blue discoloration on flanks), Cullen's sign (blue/gray periumbilical discoloration), potential dehydration, aggravated by food. Absent or decreased bowel sounds (paralytic ileus); monitor for hypocalcemia.
    • Management: Prevention/alleviation of shock, reduction of pancreatic secretions (e.g., NGT, low wall suction), correction of fluid electrolyte imbalance, removal of precipitating cause (e.g., NPO, IV fluids/antibiotics, no meds orally), incentive spirometer, clear liquids after 24-48 hours, bland easily digested foods, small frequent feedings (high carb, low fat, low protein).

    Chronic Pancreatitis

    • Definition: Progressive anatomic and functional destruction of the pancreas.
    • Causes: Alcohol abuse, gallstones, pseudocysts, acute pancreatitis.
    • Symptoms: Abdominal pain (dull, achey), steatorrhea (fatty stools), diarrhea, episodic nausea/vomiting, weight loss.

    Pancreatic Enzyme Products

    • Pancrelipase (e.g., Pancrease, Viokase): replacement therapy for pancreatic enzymes. Taken with all meals/snacks. Side effects include abdominal cramps, nausea, and diarrhea.

    Cirrhosis

    • Definition: Chronic, progressive liver disease characterized by extensive parenchymal cell degeneration and destruction of parenchymal cells. Late stage scarring/fibrosis.
    • Causes: Alcohol ingestion, nonalcoholic fatty liver disease (NAFLD), malnutrition, genetic factors, complications of hepatitis.
    • Pathophysiology: Liver unable to function optimally due to the extensive damage.
    • Diagnostic studies: Liver function tests, electrolytes, complete blood count (CBC), prothrombin time (INR), serum albumin, stool for occult blood, analysis of ascitic fluid, liver biopsy.
    • Early manifestations: Anorexia, dyspepsia, changes in bowel habits, flatulence, nausea/vomiting.
    • Clinical manifestations: Neurologic (hepatic encephalopathy, peripheral neuropathy, asterixis), integumentary (jaundice, spider angiomas, palmar erythema, purpura), hematologic (anemia, thrombocytopenia, leukopenia, coagulation disorders), metabolic (hypokalemia, hyponatremia, hypoalbuminemia), cardiovascular (fluid retention, peripheral edema, ascites), GI (anorexia, dyspepsia, nausea/vomiting, bowel habit changes, dull abdominal pain, esophageal/gastric varices), reproductive (amenorrhea, testicular atrophy, gynecomastia, impotence).
    • Nursing diagnoses: Imbalanced nutrition, impaired skin integrity, ineffective breathing pattern, excess fluid volume.
    • Complications: Portal hypertension, esophageal and gastric varices, peripheral edema, ascites, splenomegaly, hepatic encephalopathy, hepatorenal syndrome.
    • Collaborative care: B-complex vitamins (e.g., banana bag), avoidance of alcohol, aspirin, acetaminophen, and NSAIDs, management of ascites (diuretics, paracentesis), prevention/management of esophageal varices and encephalopathy, nutrition (high-calorie, high carbohydrate, low-fat, low-protein for those without complications; low-sodium for ascites/edema). Proper daily weights, girths, and extremity measurement.

    Lactulose

    • Action: Inhibits intestinal ammonia production, decreases serum ammonia, improves mentation.
    • Side effects: Diarrhea, increased bowel sounds (borborygmi), flatulence, bloating.

    Esophageal Varices

    • Abnormal dilation of veins in the lower esophagus.
    • Most life-threatening complication of cirrhosis.
    • Bleeding must be stabilized immediately, manage airway and provide intravenous therapy, 1:1 care is often required.
    • Balloon tamponade is a procedure to control hemorrhage.

    Ascites

    • Monitoring daily weights, girths, and extremity measurements.
    • High-carbohydrate, low-sodium diet.
    • Diuretics.
    • Paracentesis (temporary measure).
    • Peritoneovenous shunt (continuous reinfusion of ascitic fluid).

    Hepatic Encephalopathy

    • Neuropsychiatric manifestation from elevated serum ammonia levels ( >49).
    • Symptoms range from sleep disturbances to coma, based on ammonia levels.
    • Monitor for asterixis, fetor hepaticus.

    Hepatorenal Syndrome

    • Serious complication of cirrhosis; functional renal failure.
    • Assess I/O (including stool), level of responsiveness, sensory/motor abnormalities/ fluid/electrolyte imbalance and acid-base balance, and monitor for neuro assessment every 2 hours.
    • Promote proper nutrition: low sodium, low animal protein, rich in vegetable protein for patients who experience this condition

    Hepatitis

    • Liver inflammation, most commonly from viruses (e.g., Hepatitis A, B, C, D, E, G). Also, drugs, chemicals, autoimmune disorders, metabolic abnormalities.
    • Acute phase (maximal infectivity, 1-4 months): may be asymptomatic, but common symptoms include malaise, anorexia, fatigue, nausea, abdominal discomfort, headache, low-grade fever, arthralgias, skin rashes.
    • Convalescent phase (jaundice disappearing, weeks to months): Malaise and fatigability.
    • Chronic: often asymptomatic until severe liver disease is apparent. Physical exam may reveal hepatomegaly, lymphadenopathy, splenomegaly.

    Hepatitis C

    • Transmission: percutaneously (IV drug users, high-risk sexual behavior, occupational exposure).
    • Prevention: Avoid high-risk behaviors.
    • Treatment: Curative medications (interferon, ribavirin, protease inhibitors, polymerase inhibitors). Early detection is important due to often asymptomatic presentation.

    Hepatitis A

    • Transmission: fecal-oral route (rarely parenteral).
    • Prevention: Handwashing, Hep A vaccine, Immune globulin (IG).
    • Treatment: Supportive care, no specific medication.

    Hepatitis B

    • Transmission: Perinatal exposure, iv drug use, horizontal exposure to infected bodily fluids/products/STDs, kissing/sharing food.
    • Prevention: Hand washing, Vaccination (Recombivax HB, Engerix B). Hep B immune globulin (HBIG).
    • Treatment: Acute: no medication. Chronic: monitor for disease progression, antiviral drugs.

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    Description

    This quiz covers essential hepatic diagnostic tests including the Comprehensive Metabolic Panel and Liver Function Tests, as well as the various disorders of the biliary system such as cholelithiasis and cholecystitis. Test your understanding of diagnosis, pre-procedure, and post-procedure care.

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