NSG4330 Midterm 2 2026/2027 | Study Guide, Practice Questions & Answers, Exam Review

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NSG4330 - Midterm #2 Measurement of how well your body is clearing urea (which is end product of protein
metabolism)

Affected by fluid and diet
BUN
10-20 mg/dL



Product of muscle metabolism
Creatinine Not affected by fluid and diet


Macronutrient Metabolism
(protein b/d = ammonia, which converts to urea)
Drug Metabolism
Liver Function Vitamin Storage (glucose, iron, A, B, D)
Bile Production



Line liver capillaries
Kupffer Cells Macrophages b/d hgb and ingests old RBCs for iron

inflammation and necrosis of hepatic cells caused by cytotoxic cytokines + natural
killer cells (from viral invasion)
Viral Hepatitis
Basics Obstructs bile flow which causes backflow.


Serology to confirm antigen presence
(IgM- acute infx; IgG- past)
For Hep C, must test for active replication via PCR

Labs:
Liver enzymes show generalized inflammation
Viral Hepatitis LFTs (incr bili and PT/INR... decr albumin and platelets)
Diagnosis
Clinical Findings:
Rash, angioedema (lips and eyes), arthritis, fever, malaise, RUQ pain




Toxic: ingest/inhale toxic substances (glue, insecticides, work exposure)

Drug: acetaminophen, aspirin, statins

Symptoms: n/v, hepato/splenomegaly, GI sx, jaundice, RUQ pain
Toxic/Drug Induced Hepatitis
Tx: remove cause, gastric lavage, minimal meds, lactulose for ammonia excretion,
hydrate, low fat/mod protein/high CHO/calorie




Chronic degeneration disease of the liver, cells replaced with scar tissue.

Types:
1. Alcoholic
2. Post-necrotic (acute viral)
Cirrhosis 3. Biliary (chronic obstruction/infx)

Clinical Manifestations: dull abd pain in RUQ, n/v, dyspepsia)




Yellowing of the skin caused by an accumulation of bilirubin in the blood from decr
liver fxn.
Jaundice
Can also cause pruritus from bile salt accumulation on skin


Increase in venous pressure portal circulation due to obstructed blood flow through
the liver. Veins enlarge causing varices and ascites.
Portal Hypertension
Complication of cirrhosis




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NSG4330 - Midterm #2 Swollen veins in esophagus due to increased pressure. Can cause massive
hemorrhage/bleeding if ruptured.

Complication of portal hypertension

Found in 1/3 of cirrhosis pts, 45-50% mortality rate.

Treatment:
Close cardiovascular/BP monitoring
Bleeding control
Esophageal Varices TPN to bypass GI
N/V control
Balloon Tamponade (puts pressure on vessels to stop bleeding)
Meds (vasoconstrictors, b-blockers)




Fluid accumulation in the peritoneal cavity caused by decreased albumin (low
oncotic pressure).

Fluid from plasma leaks into interstitial space. Low plasma volume causes renin-
angiotensin system to kick in. Counter productive as this ends up retaining more
Ascites fluid, which continues to leak into the peritoneum.

Treatment: fluid restriction, diuretics/albumin therapy, paracentesis




Neuropsychiatric manifestation of liver damage. Caused by rising ammonia.

Hepatic Encephalopathy Treatment: prophylactic neomycin (abx) administration. Decreases gut bacteria that
produces ammonia.


Portal HTN + liver decompensation = vasodilation and decreased arterial blood flow.
This causes hidden effect on the kidneys (severe kidney damage with no diagnostic
Hepato-Renal Syndrome abnormalities detected)


Acute Liver Failure Extreme decompensated cirrhosis leading to liver failure. Survival rate up to 40%.

Symptoms:
Encephalopathy
Jaundice
Coagulation abnormalities + bleeding
Hypoglycemia, Met. Acidosis
Varices
Hypotension
Fluid build up
Acute Liver Failure
Symptoms and Diagnosis Diagnosis:
Imaging (x-ray, CT/MRI, ERCP)
Liver Biopsy




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