LATEST 2025 NURS 6560 FINAL EXAM STUDY GUIDE
Liver Biliary Tract, Pancreas, Spleen
• Evaluation, differential diagnosis, diagnostic studies, and treatment options
1.Resection of the liver and regeneration and follow up labs pp 546-548
-commonly indicated for primary and secondary malignant tumors and symptomatic benign
tumors
-May also but indicated in traumatic injury, infection/abscesses, and living donor transplantation
-after resection, liver function will be impaired for several wks
-Regeneration starts within 24hr with hepatic cell replication and has considerable regeneration
within 10 days and completed regeneration by 4-5wks.
-growth consists of formation of new lobules and expansion of residual lobules
-Resection is contraindicated in cirrhosis due to the liver not being able to meet metabolic
demand for regeneration of tissue.
-Child-Pugh classification: based on amount of ascites, degree of encephalopathy, albumin, total
bilirubin and PTT/PT levels; this predicts mortality in pts with cirrhosis after hepatic resection
-Child-Pugh A and selective B pts are candidates for resection
-up to 80% of liver can
-MELD score: used to improve allocation of liver transplant to cirrhosis pts with highest risk of
death; also used to assess liver
function in pts undergoing
resection
,2 Types of Hepatic Resections: anatomical (based on segmental liver anatomy) and
nonanatomical
-Anatomical resections are proffered due to less blood loss, and lower incidence of positive
resection margins with malignancy
-major resections are done in accordance with segmental anatomy
-Two step resection may benefit pts with multiple metastases- allowing time for the liver to
regenerate and compensate for the second resection.
-operation entails removal of lobe or segment and it’s afferent and efferent vessels while
avoiding remnant tissue
,-most Belective Bresections Bdone Bwith Babdominal Bincision B(open Bapproach) Band Bis Bstandard Bof
Bcare, Bmore Bare Bbeing Bdone Blaparoscopically.
-If Bthe Bpt Bhas Ba Bvery Blarge Bright Blobe Btumor Bthen Bincision Bshould Bbe Bthroacoabdominal Bapproach.
-Perioperative Bgoal Bis Bto Bminimize Bblood Bflow Bby: Bachieving Bvascular Binflow Band Boutflow
Bcontrol, Bcareful Bdivision Bof Bthe Bliver Bwith Bcontrol Bof Bvascular Bstructures, Binking Blow Bcentral
Bvenous Bpressure Banesthesia B(which Breduces Bhepatic Bvenous Bblood Bloss).
-Pringle Bmaneuver: B(temporary Bocclusion Bof Bthe Bhepatic Bartery Band Bportal Bvein) Bclamping
Bportal Binflow Bpedicle Bfor B10-15 Bmin Bto Bdecrease Bblood Bloss
-preoperative Bportal Bvein Bembolization Bmay Bimprove Bsafety Bof Bmajor Bresection
-Close Bmonitoring Bis Bneed Bfor Bmajor Bresections Bfor Bseveral Bdays.
-Major Bpost-operative Bconcern Bis Bbleeding
-Pts Bwithout Bcirrhosis Bmay Bhave Bsome Bmetabolic Bchanges Bbut Bnormalize Band Bcan Bbe
Bdischarged Bwithin B7-8 Bdays Bpost Bop.
Follow BUp BLabs Bafter BResection:
-T.Bili: Bincreases Bafter Bsurgery Bbut Breturns Bto Bnormal Bas Bregeneration Bprogresses; Bpersistent
Brise Bmay Bindicate Bliver Bfailure Band Bperihepatic Bfluid Bcollection(biloma)
, -Albumin: Bdecreases
-PTT/PT: Bincreases B: Bgive BFFP Bwhen BINR>2.0
-Ascites: Bgive Bdiuretics
-Hypoglycemia(due Bto Bglycogen Bstores Bin Bthe Bliver): B5% BDextrose Bsolutions; Bprofound
Bhypoglycemia Bconcern Bfor Bliver Bfailure
-Phos/Mg/K+: Bdecreases Band Bmust Bbe Breplaced
-AST/ALT: Bincreases Bin Bthe Bfirst Bfew Bdays Bpos Bop Bthen Bnormalizes
-ALK BPHOS: Binitially Bnormal Bthen Brises Band Bremains Bhigh Bfor Bdays Bto Bweeks
Complications Bpost Bop Bresection: Binclude Bperihepatic Bfluid Bcollectiaons Bwhich Bmay
Brequire Bdrainage, Bhepatic Binsufficiency B(hyperbilirubinemia, Bascites, Bcoagulopathy)
Bcommon Bbut Bresolves, Bpleural Beffusions, Batelectasis, Band Bpneumonia B(tx Bwith Baggressive
Bpulmonary Btoilet Bpost Bop).
Hepatic BTrauma:
-Blunt Bor Bpenetrating Btrauma
-Penetrating: Bmore Bthan B1/2 Bof Bcases Band Binclude Bprojectiles Bsuch Bas Bbullets, Bshrapnel Bor Bknives.
-In Bcivilian Bpractice Bmost Bof Bthese Btrends Btend Bto Bbe Bclean Bwounds Bthat Bare Bdangerous Bbecause Bof
Bincreased Bintra-abdominal Bbleeding.
-Military Bweapons: Bhigh Bvelocity Bprojectiles Band Bthat Benergy Bis Btransferred Bto Bthe Babdominal
Bviscera Band Bcan Bshatter Bthe Bparenchyma Beven Bif Bthe Bprojectile Bdoes Bnot Benter Bthe Bliver.
-Blunt Btrauma: Bdirect Bblow Bto Bthe Bupper Babdomen Bor Blower Bright Brib Bcage
-Causes Bof Bblunt Btrauma Binclude: Bfar Bfrom Bgreat Bheight, B(sudden Bdeceleration), BMVC B(can
Bproduce Bexplosive Bbursting Bwounds Bor Blinear Blacerations Bof Bthe Bhepatic Bsurface Bwith
Bparenchymal Bdestruction), Bshearing Bforces B(tear Bthe Bhepatic Bveins Bleading Bto Bretrohepatic
Bexsanguination Binjury Bwhich Bis Bhard Bto Bexpose Band Brepair Bduring Bsurgery).
-Stellate Bbursting Btype Binjury Baffects Bthe Bposterior Band Bsuperior Baspect Bpot Bthe Bright Bliver
B(segment BVI, BVII, Band BVIII).
-Damage Bto Bthe Bleft Bliver Bis Bless Bcommon
-Imaging Bincludes: BCT Bscan Bwhich Ballows Bstaging Bof Binjury
Liver Biliary Tract, Pancreas, Spleen
• Evaluation, differential diagnosis, diagnostic studies, and treatment options
1.Resection of the liver and regeneration and follow up labs pp 546-548
-commonly indicated for primary and secondary malignant tumors and symptomatic benign
tumors
-May also but indicated in traumatic injury, infection/abscesses, and living donor transplantation
-after resection, liver function will be impaired for several wks
-Regeneration starts within 24hr with hepatic cell replication and has considerable regeneration
within 10 days and completed regeneration by 4-5wks.
-growth consists of formation of new lobules and expansion of residual lobules
-Resection is contraindicated in cirrhosis due to the liver not being able to meet metabolic
demand for regeneration of tissue.
-Child-Pugh classification: based on amount of ascites, degree of encephalopathy, albumin, total
bilirubin and PTT/PT levels; this predicts mortality in pts with cirrhosis after hepatic resection
-Child-Pugh A and selective B pts are candidates for resection
-up to 80% of liver can
-MELD score: used to improve allocation of liver transplant to cirrhosis pts with highest risk of
death; also used to assess liver
function in pts undergoing
resection
,2 Types of Hepatic Resections: anatomical (based on segmental liver anatomy) and
nonanatomical
-Anatomical resections are proffered due to less blood loss, and lower incidence of positive
resection margins with malignancy
-major resections are done in accordance with segmental anatomy
-Two step resection may benefit pts with multiple metastases- allowing time for the liver to
regenerate and compensate for the second resection.
-operation entails removal of lobe or segment and it’s afferent and efferent vessels while
avoiding remnant tissue
,-most Belective Bresections Bdone Bwith Babdominal Bincision B(open Bapproach) Band Bis Bstandard Bof
Bcare, Bmore Bare Bbeing Bdone Blaparoscopically.
-If Bthe Bpt Bhas Ba Bvery Blarge Bright Blobe Btumor Bthen Bincision Bshould Bbe Bthroacoabdominal Bapproach.
-Perioperative Bgoal Bis Bto Bminimize Bblood Bflow Bby: Bachieving Bvascular Binflow Band Boutflow
Bcontrol, Bcareful Bdivision Bof Bthe Bliver Bwith Bcontrol Bof Bvascular Bstructures, Binking Blow Bcentral
Bvenous Bpressure Banesthesia B(which Breduces Bhepatic Bvenous Bblood Bloss).
-Pringle Bmaneuver: B(temporary Bocclusion Bof Bthe Bhepatic Bartery Band Bportal Bvein) Bclamping
Bportal Binflow Bpedicle Bfor B10-15 Bmin Bto Bdecrease Bblood Bloss
-preoperative Bportal Bvein Bembolization Bmay Bimprove Bsafety Bof Bmajor Bresection
-Close Bmonitoring Bis Bneed Bfor Bmajor Bresections Bfor Bseveral Bdays.
-Major Bpost-operative Bconcern Bis Bbleeding
-Pts Bwithout Bcirrhosis Bmay Bhave Bsome Bmetabolic Bchanges Bbut Bnormalize Band Bcan Bbe
Bdischarged Bwithin B7-8 Bdays Bpost Bop.
Follow BUp BLabs Bafter BResection:
-T.Bili: Bincreases Bafter Bsurgery Bbut Breturns Bto Bnormal Bas Bregeneration Bprogresses; Bpersistent
Brise Bmay Bindicate Bliver Bfailure Band Bperihepatic Bfluid Bcollection(biloma)
, -Albumin: Bdecreases
-PTT/PT: Bincreases B: Bgive BFFP Bwhen BINR>2.0
-Ascites: Bgive Bdiuretics
-Hypoglycemia(due Bto Bglycogen Bstores Bin Bthe Bliver): B5% BDextrose Bsolutions; Bprofound
Bhypoglycemia Bconcern Bfor Bliver Bfailure
-Phos/Mg/K+: Bdecreases Band Bmust Bbe Breplaced
-AST/ALT: Bincreases Bin Bthe Bfirst Bfew Bdays Bpos Bop Bthen Bnormalizes
-ALK BPHOS: Binitially Bnormal Bthen Brises Band Bremains Bhigh Bfor Bdays Bto Bweeks
Complications Bpost Bop Bresection: Binclude Bperihepatic Bfluid Bcollectiaons Bwhich Bmay
Brequire Bdrainage, Bhepatic Binsufficiency B(hyperbilirubinemia, Bascites, Bcoagulopathy)
Bcommon Bbut Bresolves, Bpleural Beffusions, Batelectasis, Band Bpneumonia B(tx Bwith Baggressive
Bpulmonary Btoilet Bpost Bop).
Hepatic BTrauma:
-Blunt Bor Bpenetrating Btrauma
-Penetrating: Bmore Bthan B1/2 Bof Bcases Band Binclude Bprojectiles Bsuch Bas Bbullets, Bshrapnel Bor Bknives.
-In Bcivilian Bpractice Bmost Bof Bthese Btrends Btend Bto Bbe Bclean Bwounds Bthat Bare Bdangerous Bbecause Bof
Bincreased Bintra-abdominal Bbleeding.
-Military Bweapons: Bhigh Bvelocity Bprojectiles Band Bthat Benergy Bis Btransferred Bto Bthe Babdominal
Bviscera Band Bcan Bshatter Bthe Bparenchyma Beven Bif Bthe Bprojectile Bdoes Bnot Benter Bthe Bliver.
-Blunt Btrauma: Bdirect Bblow Bto Bthe Bupper Babdomen Bor Blower Bright Brib Bcage
-Causes Bof Bblunt Btrauma Binclude: Bfar Bfrom Bgreat Bheight, B(sudden Bdeceleration), BMVC B(can
Bproduce Bexplosive Bbursting Bwounds Bor Blinear Blacerations Bof Bthe Bhepatic Bsurface Bwith
Bparenchymal Bdestruction), Bshearing Bforces B(tear Bthe Bhepatic Bveins Bleading Bto Bretrohepatic
Bexsanguination Binjury Bwhich Bis Bhard Bto Bexpose Band Brepair Bduring Bsurgery).
-Stellate Bbursting Btype Binjury Baffects Bthe Bposterior Band Bsuperior Baspect Bpot Bthe Bright Bliver
B(segment BVI, BVII, Band BVIII).
-Damage Bto Bthe Bleft Bliver Bis Bless Bcommon
-Imaging Bincludes: BCT Bscan Bwhich Ballows Bstaging Bof Binjury
