What is cirrhosis?
extensive, irreversible scarring of the liver, usually caused by chronic reaction to hepatic inflammation and necrosis
what are the most common causes of cirrhosis?
hepatitis C, alcoholism and biliary obstruction
the liver is scarred but can still perform essential functions without causing major symptoms
live function is impaired with obvious manifestations of liver failure
a persistent increase in pressure within the portal vein greater than 5 mm Hg, a major complication of cirrhosis
Hepatorenal syndrom (HRS)
A sudden decrease in urinary flow (oliguria), elevated BUN and creatinine levels, decreased sodium excretion
Increased urine osmolarity
Why is a beta blocker prescribed to treat cirrhosis?
A non-selective beta blocker propranolol (Inderal) prescribed to prevent bleeding. By decreasing heart rate and the hepatic venous pressure gradient, the chance of bleeding may be reduced
Patients with cirrhosis can easily bruise and bleed due to malabsorption of which vitamin?
How is neomycin sulfate (Mycifradin) used to treat patients with cirrhosis?
It destroys the normal flora of the bowel, diminishing protein breakdown and de- creasing the rate of ammonia production.
Which elevated laboratory test results indicate hepatic cell destruction?
Serum aspartate aminotransferase (AST), Serum alanine aminotransferase (ALT), Lactate dehydrogenase (LDH), Serum total bilirubin , Urine urobilinogen, International Normalized Ratio (INR)
inflammation of the gallbladder
What is the drug class of choice to treat acute biliary pain?
opioid analgesics such as Morphine or hydromorphone (Dilauded)
inflammatory process of the pancreas, caused by premature activation of excessive pancreatic enzymes that destroy ductal tissue and pancreatic cells, resulting in autodigestion and fibrosis of the pancreas
How would a patient describe pain of acute pancreatitis?
Described as intense, boring (feeling that it is going through the whole body) and continuous and is worsened by lying in the supine position
What are the major complications of acute pancreatitis?
acute kidney failure, paralytic ileus, ARDS and DIC
What is the primary risk factor for chronic calcifying pancreatitis?
Which diagnostic test is the most accurate in verifying a diagnosis of acute pancreatitis?
What could be the first sign of pancreatic cancer?
jaundice, which suggests late, advanced disease
What is a common complication of pancreatic cancer?
How do you prevent exacerbations of chronic pancreatitis?
Avoid caffeinated beverages, avoid alcohol, avoid nicotine, eat bland, low fat, high protein moderate carbohydrate diet, eat small meals, take prescribed pancreatic enzymes with meals, rest frequently
What can prealbumin indicate?
is a plaasma protein that provides a more sensitive indicator of a nutritional deficiency because of its short half life of 2 days
When caloric energy is inadequate, what does the body use for energy?
Which signs/symptoms in an older adult can be an indication of “failure to thrive?”
weakness, slow walking speed, low physical activity, unintentional weight loss, exhaustion
What is the most reliable indicator of fluid status?
What is one of the most common causes of being overweight?
high fat, high cholesterol diet
What are anorectic drugs?
suppress appetite, which reduces food intake, and over time may result in weight loss
What is the only prescription drug for the long term use of obesity?
Patients with what conditions should not take anoretic drugs?
Pts with HTN, heart disease, and hyperthyroidism, because these drugs may worsen their symptoms
Which drug therapies can lead to weight gain?
corticosteroids, estrogens and certain progestins, NSAIDS, antihypertensives, antidepressants, antiepileptic drugs and certain oral antidiabetic medications
What are the clinical symptoms of electrolyte imbalance?
shallow respirations, weakness, acute confusion, seizures, and increased bleeding tendency. These findings should be reported immediately.