Week 9 (Liver biopsy, hepatitis, pancreatitis) – Flashcards
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What 3 things are done in the "Pre-Procedure" stage of Liver Biopsy
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-baseline vitals -labs -Consent
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What do you do to lower a high PT, INR before a liver biopsy?
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>give Vitamin K or Fresh Frozen Plasma -won't fix the problem but will allow you to do the procedure
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Name 3 labs done before a liver biopsy
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1. Liver enzymes 2. CBC (H&H, platelets) 3. Coagulation (PT, INR)---may be elevated with liver disease
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Why is a liver biopsy obtained?
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to determine the cause of liver disease and extent of damage
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Where is liver?
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RU abdomen, under diaphram
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What protects the liver
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ribcage
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Name 6 functions of the liver
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-digestion and metabolism (metabolizes bilirubin) -produces bile for fat absorption -producing proteins from amino acids -package fat for storage or transportation in blood -regulate BS -process alcohol and drugs
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Name 3 reasons for why a liver biopsy is ordered
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-determine cause of abnormal LFTs -swelling/enlarged liver -jaundice
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What is elevated in jaundice?
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serum bilirubin
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Name 3 types of liver disease
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Cirrhosis, hepatitis, cancer
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What position should you been in during the biopsy?
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on back with right arm around head
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What is an important instruction for the patient undergoing liver biopsy?
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lay still, movement can hurt organs around liver like the gallbladder or lungs
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Is the patient awake during a liver biopsy?
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yes, only local anesthesia is given
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In the intra procedure step, what should the patient do?
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hold their breath as the needle is inserted and tissue sample is collected from the liver
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Post procedure, what position will the patient be in for 1 hour and then for 3 hours?
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-lay on right side for 1 hour after procedure -lay on back for 3 hours after laying on right
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What 2 vitals are monitored
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heart rate and blood pressure
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Where might patients feel pain after the biopsy?
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Right Side
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To prevent complications, what will be done at the site of the needle insertion?
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apply pressure and bandage will be placed
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How should the liver biopsy specimen be delivered to the lab?
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-don't use tube system *non-replaceable specimen*
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Why should you lay on your right side post procedure?
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to add pressure and prevent complications
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What is hepatitis?
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wide spread viral inflammation of liver cells
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How many different types of hepatitis are there and what are they?
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5! 1. Hep A 2. B 3. C 4. D 5. E
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How is Hep A spread?
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fecal-oral route by oral ingestion of fecal contaminants
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What is Hep A similar to?
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viral syndrome; often goes unrecognized
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Name 3 ways one can contract Hep A
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1. contaminated water 2. shellfish from contaminated water 3. food contaminated by handlers infected with Hep A
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Name 1 way that Hep A spreads
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oral to anal sexual activity
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What is the incubation period for Hep A
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15-50 days
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Is Hep A life threatening?
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no
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T/F People older than 40 may experience a more severe version of Hep A
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true
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Do most people who have Hep A, know they have it? What are symptoms similar to other than viral syndromes?
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No, similar to GI distress
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Name 6 ways Hep B is spread
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1. unprotected sex with an infected person 2. sharing needles 3. accidental needle stick 4. blood transfusions 5. hemodialysis 6. maternal-fetal route
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When do symptoms for Hep B occur?
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25-180 days after exposure *not immediate*
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What disease process has these symptoms: anorexia, N/V, fatigue, fever, RUQ pain, dark urine, light stool, joint pain, jaundice
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Hep B
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Can Hepatitis carriers infect others, even if they don't have symptoms?
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Yes
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What is the leading indication of liver transplantation in the US?
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Hep C
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Name 7 ways Hep C is spread
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1. sharing needles 2. blood 3. blood products 4. organ transplants (before 1992) 5. needle sticks 6. tattoos 7. intranasal cocaine
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What is the incubation period of Hep C?
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21-140 days
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Are Hep C patients symptomatic or asymptomatic?
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most are asymptomatic; damage is done over the decades
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How is Hep D transmitted?
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paraenteral routes
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What is the incubation period of Hep D
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14-56 days
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What 3 Hepatitis types can be transmitted via the paraenteral route?
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B,C,D
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What 2 Hepatitis types are transmitted the oral, GI route?
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A,E
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Where is Hep E present and who usually contracts it?
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endemic areas where waterborne epidemics occur and in travelers to those areas
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How is Hep E transmitted?
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fecal-oral route
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What other Hep type does Hep E resemble?
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Hep A
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What is the incubation period of Hep E
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15-64 days
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Name 10 clinical manifestations of Hepatitis
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1. Abdominal pain (liver under rib cage) 2. changes in skin or eye color (jaundice) 3. arthralgia (joint pain) 4. mylagia (muscle pain) 5. diarrhea/constipation 6. fever 7. lethargy 8. malaise 9. N/V 10. pruritis
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How is the skin turgor in Hepatitis patients?
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poor (dry skin)
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What lab value should be checked for a lethargic patient?
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patient can be dehydrated and BP can drop, things aren't metabolizing -> CHECK AMMONIA
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Name 4 nonsurgical managements
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1. Physical rest 2. Psychological rest 3. Diet therapy 4. Drug therapy
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What 3 things should be in drug therapy?
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1. antiemetics 2. antivirals 3. immunomodulators
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Name 4 characteristics of Liver nutrition
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-increase protein -maintain carbs -multivitamins: B,C,K -eliminate: coffee, cigarettes, alcohol
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What are vitamins B, C,K important?
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-Vitamin B: RBC production -Vitamin C: RBC production -Vitamin K: coagulation
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What is acute pancreatitis
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-serious and possibly life threatening inflammatory process of the pancreas -necrotizing hemorrhagic pancreatitis -necrosis of blood vessels -inflammation -theories of enzyme activation
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What does the pancreas do?
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regulates BS, produces hormones like insulin or glucagon
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Name 9 complications of acute pancreatitis
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1. hemorrhage 2. acute renal failure 3. paralytic ileus 4. hypovolemic shock 5. septic shock 6. pleural effusion, resp distress syndrome, pneumonia 7. multisystem organ failure 8. Disseminated intravascular coagulation 9. Diabetes Mellitus
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What is paralytic ileus?
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due to increased enzymes and pressure, bowel stops working and nothing passes through
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Why does an acute pancreatitis patient experience a complication of acute renal failure?
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increased enzymes
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How does one go into hypovolemic shock
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dehydration
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Name 3 characteristics of septic shock
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increased respirations low BP FEVER (septic people aren't normothermic)
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How do you treat DIC?
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Disseminated Intravascular Coagulation (DIC) - Treat with plasma, heparin
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What is DIC?
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-bleeding and misshapen platelets
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What is Cullen's sign?
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echymosis around umbilicus
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What is Turner's sign?
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echymosis on flank (ya gottta TURRRRNNN the patient to see this - aka turners)
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Name 7 manifestations of acute pancreatitis
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1. Cullen's Sign 2. Turner's Sign 3. Generalized Jaundice 4. No bowel sounds (due to ascites or paralytic ileus) 5. Abdominal tenderness, rigidity, guarding 6. pancreatic ascites 7. significant change in vital signs
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What does a healthy person's abdomen sound like when percussed vs. someone with ascites?
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-healthy person's abdomen when percussed: tympani -ascites abdomen when percussed: dullness
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Will these enzymes be elevated or low in liver disease? Lipase, Amylase, Trypsin, Alkaline Phophatase, alanine aminotransferase, WBC, glucose, Calcium
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elevated
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What is the priority for patient care in acute pain from acute pancreatitis?
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provide supportive care by relieving symptoms, decrease inflammation, anticipate and treat complications
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What are 2 comfort measures to reduce pain?
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-fasting -drug therapy
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What procedure should be done when patient experiences acute pain?
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ERCP
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Why should the patient fast and be on strict NPO?
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pancreatitis patients need GI rest for week or 2 weeks, worry about nutrition
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Since patients are fasting, what may doctors institute?
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>doctor may institute TPN early -check blood sugars (Q6)
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Breakdown the meaning of Endoscopic retrograde cholangiopancreatography (ERCP)
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-endoscopic: tube down mouth -retrograde: backwards (scope in opposite way) -cholangio: gallbladder -pancreato: pancreas -ography: graph
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Name 4 nonsurgical managements for acute pain from acute pancreatitis
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1. fasting and rest 2. drug therapy 3. comfort measures like oral care 4. ERCP
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What is a cytology?
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brushing of cells
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What is given to the patient before ERCP?
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numbing of the gag reflex
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What position should the patient undergoing ERCP be in?
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positioned on left side
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What does the dye from the ERCP show?
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obstruction
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T/F Doctor may ask you to change your position during the ERCP
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T
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How long will you be watched after the ERCP?
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15-30minutes
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What is inserted during preoperative care/surgical management of acute pancreatitis?
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NG tube
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What 3 surgical managements should be done post op
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1. monitor drainage tubes and record output from drain 2. provide meticulous skin care and dressing change 3. maintain skin integrity
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Due to strict NPO status, what is the patient at risk for?
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imbalanced nutrition: less than body requirements
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Name 5 interventions for acute pancreatitis care
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1. NPO in early stages 2. antiemetics for N/V 3. TPN 4. small, frequent, moderate to high carb, high protein, low fat meals 5. avoid foods that cause GI stimulation
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What is chronic pancreatitis ?
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progressive destructive disease of the pancreas
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What is chronic pancreatitis characterized by?
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remissions and exacerbations
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Name 5 nonsurgical managements for chronic pancreatitis
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1. drug therapy 2. analgesic administration 3. enzyme replacement 4. insulin therapy 5. nutrition therapy
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What is the most serious complication of pancreatitis; always fatal if untreated?
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pancreatic abscess
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Name 3 managements for pancreatic abscess
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1. blood cultures (before giving abx!!) 2. drainage via the percutaneous method or laparscopy 3. abx treatment alone cant resolve abscess (it's better to surgically remove abscess)
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T/F The patient with pancreatic abscess will have a low grade fever.
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F, patient will have a high fever
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What is insulinoma?
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-Most common type of neuroendocrine pancreatic tumor benign tumor of the islets of Langerhans that cause excessive insulin secretion and subsequent hypogylcemia
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How do you manage insulinoma?
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remove the tumor
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Name 3 nonsurgical managements for pancreatic carcinoma
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1. Drug therapy 2. Radiation therapy 3. Biliary Stent insertion
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Name 2 surgical managements for pancreatic carcinoma
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1. NG tube may be inserted 2. TPN typically begun
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Name 1 operative procedure for pancreatic carcinoma
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Whipple procedure
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T/F There is a high mortality rate for pancreatic carcinoma
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T
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What does a biliary stent do?
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-allows bile to flow to maintain digestive process, doesn't do anything for actual cancer
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What is the basic idea of the whipple procedure?
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whip out anything that is cancerous
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Name 5 postop care for surgical management of pancreatic carcinoma
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1. observe for complications 2. GI drainage monitoring 3. Positioning 4. Fluid and electrolyte assessment 5. glucose monitoring
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What position should the patient be in after surgery
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semi-fowlers to prevent lung expansion and avoid stretching of the stitches
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What does the whipple procedure remove?
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removal of the head of the pancreas, duodenum, parts of the jejunum and stomach, gallbladder, and possibly the spleen. The pancreatic duct is connected to the common bile duct, and the stomach is connected to the jejunum. *This procedure may be done laparoscopically*
