NURS 6560 Final Exam Study Guide.

NURS I6560 IFinal IStudy IGuide I

Liver IBiliary ITract, IPancreas, ISpleen I

• Evaluation, Idifferential Idiagnosis, I Idiagnostic Istudies, Iand Itreatment Ioptions I


1.Resection Iof Ithe Iliver I Iand Iregeneration Iand Ifollow Iup Ilabs Ipp I546-548
-commonly Iindicated Ifor Iprimary Iand Isecondary Imalignant Itumors Iand Isymptomatic Ibenign
Itumors



-May Ialso Ibut Iindicated Iin Itraumatic Iinjury, Iinfection/abscesses, Iand Iliving Idonor Itransplantation I
-after Iresection, Iliver Ifunction Iwill Ibe Iimpaired Ifor Iseveral Iwks
-Regeneration Istarts Iwithin I24hr Iwith Ihepatic Icell Ireplication Iand Ihas Iconsiderable Iregeneration
Iwithin I10 Idays Iand Icompleted Iregeneration Iby I4-5wks. I



-growth Iconsists Iof Iformation Iof Inew Ilobules Iand Iexpansion Iof Iresidual Ilobules
-Resection Iis Icontraindicated Iin Icirrhosis Idue Ito Ithe Iliver Inot Ibeing Iable Ito Imeet Imetabolic
Idemand Ifor Iregeneration Iof Itissue. I



-Child-Pugh Iclassification: Ibased Ion Iamount Iof Iascites, Idegree Iof Iencephalopathy, Ialbumin, Itotal
Ibilirubin Iand IPTT/PT Ilevels; Ithis Ipredicts Imortality Iin Ipts Iwith Icirrhosis Iafter Ihepatic Iresection I



-Child-Pugh IA Iand Iselective IB Ipts Iare Icandidates Ifor Iresection I


-up Ito I80% Iof Iliver Ican


-MELD Iscore: Iused Ito Iimprove Iallocation Iof Iliver Itransplant Ito Icirrhosis Ipts Iwith Ihighest Irisk Iof
Ideath; Ialso Iused Ito Iassess Iliver

Ifunction Iin Ipts Iundergoing

Iresection

,2 ITypes Iof IHepatic IResections: I Ianatomical I(based Ion Isegmental Iliver Ianatomy) Iand
Inonanatomical



-Anatomical Iresections Iare Iproffered Idue Ito Iless Iblood Iloss, Iand Ilower Iincidence Iof Ipositive
Iresection Imargins Iwith Imalignancy I



-major Iresections Iare Idone Iin Iaccordance Iwith Isegmental Ianatomy
-Two Istep Iresection Imay Ibenefit Ipts Iwith Imultiple Imetastases- Iallowing Itime Ifor Ithe Iliver Ito
Iregenerate Iand Icompensate Ifor Ithe Isecond Iresection. I



-operation Ientails Iremoval Iof Ilobe Ior Isegment Iand Iit’s Iafferent Iand Iefferent Ivessels Iwhile
Iavoiding Iremnant Itissue

,-most Ielective Iresections Idone Iwith Iabdominal Iincision I(open Iapproach) Iand Iis Istandard Iof Icare,
Imore Iare Ibeing Idone Ilaparoscopically. I



-If Ithe Ipt Ihas Ia Ivery Ilarge Iright Ilobe Itumor Ithen Iincision Ishould Ibe Ithroacoabdominal Iapproach. I
-Perioperative Igoal Iis Ito Iminimize Iblood Iflow Iby: Iachieving Ivascular Iinflow Iand Ioutflow Icontrol,
Icareful Idivision Iof Ithe Iliver Iwith Icontrol Iof Ivascular Istructures, Iinking Ilow Icentral Ivenous

Ipressure Ianesthesia I(which Ireduces Ihepatic Ivenous Iblood Iloss). I



-Pringle Imaneuver: I(temporary Iocclusion Iof Ithe Ihepatic Iartery Iand Iportal Ivein) Iclamping Iportal
Iinflow Ipedicle Ifor I10-15 Imin Ito Idecrease Iblood Iloss I




-preoperative Iportal Ivein Iembolization Imay Iimprove Isafety Iof Imajor Iresection I
-Close Imonitoring Iis Ineed Ifor Imajor Iresections Ifor Iseveral Idays. I
-Major Ipost-operative Iconcern Iis Ibleeding
-Pts Iwithout Icirrhosis Imay Ihave Isome Imetabolic Ichanges Ibut Inormalize Iand Ican Ibe Idischarged
Iwithin I7-8 Idays Ipost Iop. I



Follow IUp ILabs Iafter IResection: I
-T.Bili: Iincreases Iafter Isurgery Ibut Ireturns Ito Inormal Ias Iregeneration Iprogresses; Ipersistent Irise
Imay Iindicate Iliver Ifailure Iand Iperihepatic Ifluid Icollection(biloma)

, -Albumin: Idecreases
-PTT/PT: Iincreases I: Igive IFFP Iwhen IINR>2.0
-Ascites: Igive Idiuretics
-Hypoglycemia(due Ito Iglycogen Istores Iin Ithe Iliver): I5% IDextrose Isolutions; Iprofound
Ihypoglycemia Iconcern Ifor Iliver Ifailure



-Phos/Mg/K+: Idecreases Iand Imust Ibe Ireplaced
-AST/ALT: Iincreases Iin Ithe Ifirst Ifew Idays Ipos Iop Ithen Inormalizes
-ALK IPHOS: Iinitially Inormal Ithen Irises Iand Iremains Ihigh Ifor Idays Ito Iweeks


Complications Ipost Iop Iresection: Iinclude Iperihepatic Ifluid Icollectiaons Iwhich Imay Irequire
Idrainage, Ihepatic Iinsufficiency I(hyperbilirubinemia, Iascites, Icoagulopathy) Icommon Ibut

Iresolves, Ipleural Ieffusions, Iatelectasis, Iand Ipneumonia I(tx Iwith Iaggressive Ipulmonary Itoilet

Ipost Iop). I




Hepatic ITrauma: I
-Blunt Ior Ipenetrating Itrauma I
-Penetrating: Imore Ithan I1/2 Iof Icases Iand Iinclude Iprojectiles Isuch Ias Ibullets, Ishrapnel Ior Iknives. I
-In Icivilian Ipractice Imost Iof Ithese Itrends Itend Ito Ibe Iclean Iwounds Ithat Iare Idangerous Ibecause Iof I
Iincreased Iintra-abdominal Ibleeding. I



-Military Iweapons: Ihigh Ivelocity Iprojectiles Iand Ithat Ienergy Iis Itransferred Ito Ithe Iabdominal
Iviscera Iand Ican Ishatter Ithe Iparenchyma Ieven Iif Ithe Iprojectile Idoes Inot Ienter Ithe Iliver. I



-Blunt Itrauma: Idirect Iblow Ito Ithe Iupper Iabdomen Ior Ilower Iright Irib Icage I
-Causes Iof Iblunt Itrauma Iinclude: Ifar Ifrom Igreat Iheight, I(sudden Ideceleration), IMVC I(can Iproduce
Iexplosive Ibursting Iwounds Ior Ilinear Ilacerations Iof Ithe Ihepatic Isurface Iwith Iparenchymal

Idestruction), Ishearing Iforces I(tear Ithe Ihepatic Iveins Ileading Ito Iretrohepatic Iexsanguination Iinjury

Iwhich Iis Ihard Ito Iexpose Iand Irepair Iduring Isurgery). I



-Stellate Ibursting Itype Iinjury Iaffects Ithe Iposterior Iand Isuperior Iaspect Ipot Ithe Iright Iliver I(segment
IVI, IVII, Iand IVIII). I



-Damage Ito Ithe Ileft Iliver Iis Iless Icommon I
-Imaging Iincludes: ICT Iscan Iwhich Iallows Istaging Iof Iinjury I