NR574 FINAL EXAM, Week 1 content GI/GU emergencies ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
questions with precise detailed answers ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Terms in this set (81) ||\\//|| ||\\//|| ||\\//|| ||\\//||
Original
Hepatorenal syndrome (HRS) ||\\//|| ||\\//||
functional form of renal failure that occurs primarily in pt with cirrhosis and ascites.
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Type 1 hepatorenal syndrome is characterized by...
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
-rapidly progressive renal impairment ||\\//|| ||\\//|| ||\\//||
-doubling of initial serum Cr to greater than 2.5mg/dL over a period less than 2 weeks
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
-without liver transplant prognosis is very poor ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Type 2 hepatorenal syndrome is characterized by...
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
-moderate form of renal failure ||\\//|| ||\\//|| ||\\//|| ||\\//||
-serum Cr levels between 1.5 to 2.5 mg/dL ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
reduction in GFR with elevation in serum creatinine ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
-associated with a more indolent course and improved survival compared to type 1 ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Risk Factors of hepatorenal syndrome
||\\//|| ||\\//|| ||\\//|| ||\\//||
Dilutional hyponatremia ||\\//||
Previous episodes of ascites ||\\//|| ||\\//|| ||\\//||
Presence of esophageal varices ||\\//|| ||\\//|| ||\\//||
Poor nutritional status
||\\//|| ||\\//||
Infections such as spontaneous bacterial peritonitis ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Severe urinary sodium retention (urine sodium < 5 milliequivalents/liter [mEq/L])
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Large-volume paracentesis without albumin replacement ||\\//|| ||\\//|| ||\\//|| ||\\//||
Acute alcoholic hepatitis ||\\//|| ||\\//||
Low mean arterial blood pressure (map <80 mm Hg)
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
subjective clinical presentation of hepatorenal syndrome ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Most clients with HRS have a known diagnosis of acute or chronic liver disease and present
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
with nonspecific symptoms including:
||\\//|| ||\\//|| ||\\//||
-dysgeusia (altered taste perception) ||\\//|| ||\\//|| ||\\//||
, -malaise
-fatigue
-decreased urine output. ||\\//|| ||\\//||
objective clinical presentation of hepatorenal syndrome ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
HRS has no characteristic physical exam findings.
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
It is important to assess the client for stigmata of chronic liver disease including:
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
-spider nevi ||\\//||
-scleral icterus ||\\//||
-lower extremity edema ||\\//|| ||\\//||
-asterixis
-abdominal distention ||\\//||
-fluid wave ||\\//||
-paraumbilical hernia ||\\//||
-bruits.
Dx criteria in hepatorenal syndrome
||\\//|| ||\\//|| ||\\//|| ||\\//||
1. cirrhosis with ascites
||\\//|| ||\\//|| ||\\//||
2. increase in Cr >0.3 mg/dL within 48 hrs or >50% increase from baseline within a 7 day
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
period
3.no response to a 2 consecutive day diuretic withdrawal and volume expansion w/ albumin
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
1g/kg body wt ||\\//|| ||\\//||
4. absence of shock
||\\//|| ||\\//|| ||\\//||
5. no nephrotoxic drug use
||\\//|| ||\\//|| ||\\//|| ||\\//||
6. no macroscopic signs of structural kidney injury (proteinuria >500
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
milligrams/deciliter[(mg/dL], microhematuria with >50 red blood cells per high-power field, ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
and/or abnormal renal ultrasonography) ||\\//|| ||\\//|| ||\\//||
What is the Creatinine criteria when diagnosing hepatorenal syndrome
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
increase in serum creatinine of ||\\//|| ||\\//|| ||\\//|| ||\\//||
-greater than or equal to 0.3 mg/dL ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
or
-greater than or equal to 50% increase from baseline Cr ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
this is within a 7 day period.
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
What surgical intervention is used to treat hepatorenal syndrome?
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
TIPS Procedure ||\\//||
questions with precise detailed answers ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Terms in this set (81) ||\\//|| ||\\//|| ||\\//|| ||\\//||
Original
Hepatorenal syndrome (HRS) ||\\//|| ||\\//||
functional form of renal failure that occurs primarily in pt with cirrhosis and ascites.
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Type 1 hepatorenal syndrome is characterized by...
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
-rapidly progressive renal impairment ||\\//|| ||\\//|| ||\\//||
-doubling of initial serum Cr to greater than 2.5mg/dL over a period less than 2 weeks
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
-without liver transplant prognosis is very poor ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Type 2 hepatorenal syndrome is characterized by...
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
-moderate form of renal failure ||\\//|| ||\\//|| ||\\//|| ||\\//||
-serum Cr levels between 1.5 to 2.5 mg/dL ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
reduction in GFR with elevation in serum creatinine ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
-associated with a more indolent course and improved survival compared to type 1 ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Risk Factors of hepatorenal syndrome
||\\//|| ||\\//|| ||\\//|| ||\\//||
Dilutional hyponatremia ||\\//||
Previous episodes of ascites ||\\//|| ||\\//|| ||\\//||
Presence of esophageal varices ||\\//|| ||\\//|| ||\\//||
Poor nutritional status
||\\//|| ||\\//||
Infections such as spontaneous bacterial peritonitis ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Severe urinary sodium retention (urine sodium < 5 milliequivalents/liter [mEq/L])
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Large-volume paracentesis without albumin replacement ||\\//|| ||\\//|| ||\\//|| ||\\//||
Acute alcoholic hepatitis ||\\//|| ||\\//||
Low mean arterial blood pressure (map <80 mm Hg)
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
subjective clinical presentation of hepatorenal syndrome ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Most clients with HRS have a known diagnosis of acute or chronic liver disease and present
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
with nonspecific symptoms including:
||\\//|| ||\\//|| ||\\//||
-dysgeusia (altered taste perception) ||\\//|| ||\\//|| ||\\//||
, -malaise
-fatigue
-decreased urine output. ||\\//|| ||\\//||
objective clinical presentation of hepatorenal syndrome ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
HRS has no characteristic physical exam findings.
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
It is important to assess the client for stigmata of chronic liver disease including:
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
-spider nevi ||\\//||
-scleral icterus ||\\//||
-lower extremity edema ||\\//|| ||\\//||
-asterixis
-abdominal distention ||\\//||
-fluid wave ||\\//||
-paraumbilical hernia ||\\//||
-bruits.
Dx criteria in hepatorenal syndrome
||\\//|| ||\\//|| ||\\//|| ||\\//||
1. cirrhosis with ascites
||\\//|| ||\\//|| ||\\//||
2. increase in Cr >0.3 mg/dL within 48 hrs or >50% increase from baseline within a 7 day
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
period
3.no response to a 2 consecutive day diuretic withdrawal and volume expansion w/ albumin
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
1g/kg body wt ||\\//|| ||\\//||
4. absence of shock
||\\//|| ||\\//|| ||\\//||
5. no nephrotoxic drug use
||\\//|| ||\\//|| ||\\//|| ||\\//||
6. no macroscopic signs of structural kidney injury (proteinuria >500
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
milligrams/deciliter[(mg/dL], microhematuria with >50 red blood cells per high-power field, ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
and/or abnormal renal ultrasonography) ||\\//|| ||\\//|| ||\\//||
What is the Creatinine criteria when diagnosing hepatorenal syndrome
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
increase in serum creatinine of ||\\//|| ||\\//|| ||\\//|| ||\\//||
-greater than or equal to 0.3 mg/dL ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
or
-greater than or equal to 50% increase from baseline Cr ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
this is within a 7 day period.
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
What surgical intervention is used to treat hepatorenal syndrome?
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
TIPS Procedure ||\\//||
